Servicemembers have to get flu shots. Civilians? It’s a harder sell.

A girl watches her mother get a flu shot Dec. 11, 2018 at the Vicenza Army Health Clinic. Active duty troops are required to get the shots, as are children who attend base schools and child care centers, as well as workers there.


By NANCY MONTGOMERY | STARS AND STRIPES Published: December 13, 2018

VICENZA, Italy — Despite decades of studies showing its safety and effectiveness in preventing flu or reducing severity of the disease that killed more than 80,000 Americans last year, the influenza vaccine can be a tough sell among U.S. Army Europe civilians.

One bolted from the Vicenza Army Health Center recently when she saw the word “formaldehyde” on the paperwork, clinic workers said. Several more disappeared without explanation from the waiting room. Some have said they don’t need the vaccine because they never get the flu or they wash their hands a lot.

Some change their minds at the very last minute.

“I’m not feeling well,” one woman on Tuesday said before hustling out of the treatment room with her two toddlers, who’d just gotten their flu shots.

USAREUR schools and child care centers require flu shots for attendance.

Another woman, asked if she, too, would be getting a shot after her daughter was vaccinated, said no. “I don’t do that,” she said.

“I don’t like to put anything like this into my body,” said a third, who got a flu shot only because her job required it. “If I live to be 80, load me up, but not now.”

Officials at Public Health Command-Europe said that they don’t have data on how many family members, civilians and retirees decline to get flu shots, which are urged by public health officials for almost everyone over age 6 months.

A University of Chicago study released this month showed that by mid-November, only 43 percent of adults received flu shots, and that the majority of those who hadn’t weren’t planning to. Almost half of people aged 30 to 59 said they wouldn’t get vaccinated and half of those 18 to 29 said the same.

For active duty troops, it’s a different story. Some 94 percent of U.S. Army Europe soldiers have gotten flu shots since the beginning of flu season in October, said Col. Kerry LeFrancis at Regional Health Command-Europe.

Seven bases this year participated in pandemic drills inoculating thousands of soldiers within days or hours. Over four days in October, for example, more than 3,000 Vicenza soldiers were vaccinated, LeFrancis said.


An order rooted in WWI

The Army has required soldiers to get annual flu shots for decades, ever since a vaccine became available. That was partly because of conditions particular to the military, such as close-quarters living and foreign deployments that can easily and rapidly spread the virus through a formation. “We’ve always had to be more aware and in the vanguard,” said Col. Rodney Coldren, chief of preventive medicine services at the Public Health Command-Europe.

There was also the historical lesson of the 1918 flu pandemic, he said.

The so-called Spanish flu got its start, according to one widely supported theory, at a U.S. Army camp in Kansas training troops to fight in World War I. It then spread with American troops across the Atlantic into the trenches and into civilian communities all over the globe.

The Spanish flu was the deadliest disease outbreak in human history. It killed at least 50 million people worldwide, dwarfing battle casualties of both world wars. It caused the average life expectancy in the United States to drop by about 12 years for both men and women.

It sickened at least 26 percent of the Army — more than 1 million men — and killed almost 30,000 before they even got to France, according to a military report.

In June 1918, nearly 50,000 British troops were hospitalized in a single week. “Entire offensive operations ... had to be postponed due to the lack of sufficient numbers of functional soldiers,” according to an Australian military health journal.

“The Spanish flu demonstrated to us the significant impact that influenza can have on our ability to accomplish our mission,” Coldren said.


The best option

The flu vaccine isn’t perfect. Vaccine composition is determined months in advance based on which virus strains are circulating and how they might mutate.

“It’s a scientifically informed — I don’t want to say bet — best informed idea of what will be circulating the following year,” Coldren said. “There will always be the potential for mismatch or that strains won’t be covered.”

Most years, the vaccines are between 40 and 60 percent effective. “That said, the best way to prevent influenza is still to get the shot,” Coldren said.

The public health command is currently doing a study to determine why people don’t get the shot, so that they can better target that population. A higher percentage of vaccinations provides better protection throughout the community, he said.

“The best thing we can do is keep trying to educate people,” Coldren said. “There are some people who will never be convinced, and that’s unfortunate.”

Surveys in the U.S. have shown that many people who avoid the vaccine believe a variety of myths. It’s scientifically impossible to get the flu from the shot, for example. It does not cause autism, a claim first attributed to a flawed and ultimately retracted 1998 study of the measles, mumps and rubella vaccine. It has since drawn repeated studies finding no support for the retracted study’s conclusions.

As for the formaldehyde, used to kill viruses and bacteria that could contaminate the vaccine during production, then removed before packaging, the amount is so small compared to how much formaldehyde occurs naturally in the human body that it does not pose a safety concern, according to the Food and Drug Administration.

The idea that vaccines introduce harmful agents into the body has it backward, Coldren said.

“Nature does that all the time,” he said. “And one of those things is the influenza virus.”

Twitter: @montgomerynance


Soldiers suffering from influenza at the hospital in Camp Funston, Kansas in 1918. Camp Funston was where the influenza epidemic which would kill more than 50 million people world-wide, including 675,000 Americans, first made a major appearance. Troops from the camp carried the virus to other Army bases during World War I.

Christian Torres, 10 months old, reacts to getting his first flu shot Dec. 11, 2018 at the Vicenza Army Health Clinic. Public health officials recommend the shots for everyone except infants under 6 months old. Christian cried for less than a minute.

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