In security circles we often discuss why some individuals and businesses find themselves in a perpetual state of high risk. While there can be complex factors, the bottom line is that many of us make poor risk management decisions in our business and personal lives.

Sometimes a high risk position results because we don’t correctly asses asset values, threats or vulnerabilities. Sometimes the cost of implementing a safeguard exceeds and expected loss, and the decision to accept risk is a logical one. And sometimes we simply make mistakes.

But there are other reasons that we Canadians are often too polite to point out: Laziness, denial, rationalization and risk decisions based upon emotion rather than logic.  The H1N1 ‘flu gives us plenty of examples.

We’re in the midst of an influenza pandemic.  Fortunately we know how to create ‘flu vaccines — we do it every year to combat the seasonal flu. So we have a vaccine, and every credible organization from the World Health Organization down to our local medical officers are recommending that we vaccinate ourselves and our families.

The risk is clear: pH1N1 is a nasty virus that, at best, will make you sick for a week or two.  At worst, it could kill you. The threat is real and much of resulting risk can be mitigated by a simple vaccination.  The Public Health Agency of Canada advises that, “without interventions like a vaccine and antivirals, close to 25 to 35 percent of the population could become ill over the period of a few months.”  Other health organizations have released similar estimates. The vaccine has been tested in Canada as well as other countries, and we know that approximately 1 in 100,000 people will have a serious reaction to it, as with any other vaccine.  (Source:

From a risk management perspective it doesn’t get much simpler than this. The benefits of the vaccine clearly outweigh the risks, and the cost (a few hours of our time at most) is minimal compared to the potential loss.  And that doesn’t take ethics and social responsibility into account.   Those who choose not to be vaccinated not only may become ill, but could also pass H1N1 on to more vulnerable family, friends and colleagues — including those who can’t be vaccinated due to alergies.

As a result, we continue to see people announce on the Internet that they’re not getting vaccinated. Some quote “facts” that are uninformed myths at best.  Some focus on the 1 in 100,000 serious reaction rate and completely loose perspective.  Others ignore a century or so of medical science and proclaim that they don’t need a vaccination because they are “healthy and take their herbs and vitamins.”

Chances are that you’ve already seen the writings of otherwise intelligent parents who are incapable or making good risk management decisions. Their blog posts usually start with how much they love their kids.  Then they latch on to the one quack that chargers people $50 each to attend a seminar to learn “the truth” and rationalize that “the medical community don’t all agree”.  They focus on the danger of mercury in vaccines, even though the exposure is less than you’d get from eating a can of tuna.  Or they repeat silly claims like suggesting that the vaccine is “untested”.

Some of these people obviously have other agendas.  It’s clear from their writing that they’re simply anti-vaccination shills. They write clever “balanced” articles pitting fact against laughable fiction and seek to “support” others who share their defective logic.

Some see themselves as rebells, not “giving in” to the experts who tell them they should be vaccinated.  The old phrase, “Rebells without a clue” comes to mind.

In others, the barrage of H1N1 information creates neurotic behaviour and they operate on a completely emotional level. They “agonize” (often at length and in writing) about how “difficult” the decision was.  They loose all perspective, and should you dare point out the flaws in their reasoning their feelings are hurt. How dare you suggest that they don’t know what’s best. They behave as if the act of conceiving a child instantly made them more knowledgeable on vaccines than the WHO, CDC, and the medical experts of countless countries, including their own. They have “the right” not to vaccinate themselves and their children, and as emotional people often do, they confuse having a right with it being the right thing to do.

4 Responses to H1N1: A case study in poor risk decisions

  1. Peter Whittaker
    Nov 29, 2009

    Unfortunately, Eric, there are insufficient data available to make an informed decision – and if I’m wrong, please do correct me and provide links to the data.

    There are at least seven data elements required, and I’ve only ever seen 3 (marked with asterisks):

    – probability of infection by H1N1

    * – probability of serious illness caused by H1N1

    * – probability of death caused by H1N1

    * – probability of serious reaction to H1N1 vaccine (serious enough to warrant hospitalization/care)

    – probability of death due to H1N1 vaccine

    – effectiveness of vaccine – expected reduction in H1N1 cases per unit population

    – all of the above broken down by age, overall health level, etc.

    The ones that I’ve marked with an asterisk weren’t actually found in any single useful place, I was able to piece them together from news articles, health care web sites, etc.

    Re the first statistic: I have never had the flu, I have never had a flu vaccine (in fact, the only time I ever tried to get one, I was told I shouldn’t, owing to a particular drug sensitivity – hmm, “told” is the wrong word, the form was ripped from my hands by a wide-eyed health worker. Comforting.

    Generally speaking, the seasonal flu vaccine is a gamble: Take a best guess as to which particular virii will be virulent, take a best guess as to which protein coats to emphasize in a vaccine, hope to get them out in time.

    Not a comforting approach when attempting to evaluate actual risk levels.

    H1N1 may be a different, in that researchers have a better idea of the specific virii and protein coats. But where are the effectiveness numbers?

    Point of fact, there are none, because flu vaccines are essentially guess work.

    Boil it down for: My % risk of getting the flu (healthy mid-40s male in good physical condition), % risk of adverse reaction, % likely effectiveness, % likely impact of the flu itself.

    Until I have those numbers, all the blog posts in the world are just words.

    ps I invite you to research what health care organizations in other countries, e.g., one of the major nursing unions in France, are saying about the vaccine and the flu and how they are recommending that their members not get vaccinated.

    Re your tweet: I am responsible parent. I do not experiment with my children.

  2. Evolving Squid
    Dec 01, 2009

    >> – probability of infection by H1N1

    That has very little to do with why you should or should not get any vaccine. At best, if the rate of death from the virus in the population is significantly higher than the death rate from the vaccine, it’s probably a very good idea to get the vaccine. Influenza vaccines have a MUCH lower injury and death rate than influenza disease.

    Vaccines work on populations, not individuals. Each person who sees only the selfish view undermines the program and puts the whole population at risk.

    >> – probability of death due to H1N1 vaccine

    If you google around, I believe you will find it is less than 1 in 1 million.

    >> – effectiveness of vaccine – expected reduction in H1N1 cases per unit population

    Theoretically, 100% of people vaccinated should be safe from the disease. With the “herd” vaccinated at a rate of over about 90%, cases should drop to near zero. That’s the way vaccines work…

    … except when they’re undermined by people who say “well, I probably won’t get the disease, so I won’t bother”. That lowers the “herd” number, thereby increasing infections per unit population. Worse still, by doing that it endangers people for whom the vaccination is contraindicated (allergic to vaccine components, for example).

    >> I was told I shouldn’t, owing to a particular drug sensitivity – hmm, “told” is the wrong word, the form was ripped from my hands by a wide-eyed health worker.

    It is also contraindicated for me. Thus, to some degree, your health (and mine) depend on people understanding how vaccinations work and getting them when they’re supposed to, rather than mining trivia, or following the advice of washed-up porn stars like Jenny McCarthy, to rationalize an excuse not to get it.

    That you have not had the flu is more a turn of good fortune than it is any magical immunity.

    >> Not a comforting approach when attempting to evaluate actual risk levels.

    It’s easy to evaluate the risk levels. You just have to want to, and you have to pick the relevant numbers. The H1N1 vaccine is not guess work, although the regular annual flu vaccines are, and sometimes it turns out wrong… not often, but it has been documented.

    However, from the globe and mail:

    There have been, in Canada, just under 210 H1N1 hospitalizations per million population, of which 1/6 went to ICU, and 1/24 died (8.4 per million). Obviously, there have been less serious cases as well, but for your calculation, you want the serious stuff, I assume. So this doesn’t take into consideration lost days of work etc. by people who don’t quite get sick enough to go to the hospital.

    From this site:–few-adverse-reactions-to-h1n1-vaccine

    The serious adverse reaction rate seems to be 5.4 per million – a little over half the death rate.

    The highest death rate from H1N1 by age group seems to be men between the ages of 40 and 49 ( )

  3. Evolving Squid
    Dec 01, 2009

    Oh, and I can’t get the MMR shot either, so if your kids aren’t vaccinated for MMR, please keep them away from me.

    Anti-vaccination woo regarding the MMR shot is killing children in the UK, US and Canada right now because irresponsible parents are listening to lies from Oprah and Jenny McCarthy rather than truth medical professionals.

  4. kingthorin
    Dec 07, 2009

    @ Peter

    As Mr. Squid has tried to point out it doesn’t seem like people have a firm grasp on how vaccines are meant to work. This seems evident base one your required data elements:

    – probability of infection by H1N1
    * – probability of serious illness caused by H1N1
    * – probability of death caused by H1N1
    * – probability of serious reaction to H1N1 vaccine (serious enough to warrant hospitalization/care)

    Not matter how sick you get if you carry then you chance spreading it to others. So really these 4 elements are one, it shouldn’t be relevant how sick one might get if you’re infected then it should be a problem not only for you but those around you.

    The more people get vaccinated the less people there are the spread the disease, the safer it is for people for which the vaccine is contraindicated.

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