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By Joel A. Harrison, PhD, MPH


August 15, 2011 (San Diego)--According to an article in Friday’s Union-Tribune (Aug 12), “State to reduce supply of free flu vaccines,” San Diego County will receive 30,000 “fewer free flu vaccines available for low-income adults than in previous years.”


During an average flu season between 5 and 20% of the population gets the flu. According to one study, if none of these 30,000 low-income adults manage to get vaccinated, on average 10 – 15 will be hospitalized for pneumonia and 27- 30 for respiratory and circulatory conditions. Those above 60 will have higher rates of hospitalization.


In addition, one can expect numerous emergency room visits and, for those working, loss of income from sick days. One study from 2000 found “the mean cost of flu treatment for patients discharged directly from the emergency department was $141.89; the mean cost of treatment for hospitalized patients was $3251.04. . . . Compared with younger patients, elderly patients were more likely to be hospitalized and incur higher costs.”


Given medical cost inflation during the past 10 years, I conservatively estimate current emergency department costs at $300 and hospitalizations at $7,000. Both are probably underestimated. The free vaccines probably cost $10 or less per dose. So using extremely conservative estimates the vaccines would have cost ca. $300,000 or less, whereas hospitalizations alone will cost at least $300,000 and probably more, emergency department visits will cost probably another $30,000 and probably more, and even one weeks loss of income could possibly total at least $10 - $20,000.


The numbers above are just guestimates from a quick search on the Internet. I believe the numbers are extremely conservative and, thus, the costs of not providing the free vaccines will be considerably higher. These costs do not include the possibility of some deaths and/or long term disabilities. As many people understand, preventive medicine is cost-effective and, thus, the savings from reducing the availability of free vaccines is penny wise and pound foolish.


But for those not convinced by pure economics, then self-interest comes into the picture. In the past 20 years one third of all emergency departments have closed around the U.S. People without insurance delay seeking medical care until their problems become too serious to ignore and crowd our emergency rooms. By law they have to be treated; but since they can’t pay, the emergency departments lose money. As emergency rooms close, the remaining ones become evermore crowded leading to emergency room (ER) diversions—when ambulances are redirected from one hospital emergency room to another—becoming common in communities across the country, raising concern that critically ill patients are increasingly confronting obstacles to timely medical care. These diversions are especially high during the winter flu season.


Obviously if we had some form of non-profit national health insurance like that of most other nations, fewer people would end up in emergency rooms from serious conditions which could have been prevented; but during the flu season, getting shots to as many people as possible will reduce the emergency room crowding, a rather inexpensive approach to ensuring that when we need emergency care, it will be there.


And something most people don’t realize is that low income members of our society actually subsidize the health care that the rest of us receive (see an article I wrote in Dollars and Sense Magazine, “Paying More, Getting Less,” May/June 2008, I show the amounts and percentages of income that low income people contribute to our health care system through sales taxes, Medicare taxes, excise taxes, etc., even if they don’t pay income tax.


To summarize, the cost of providing free shots to low income adults is far less than the costs that would be incurred from actual cases of the flu. In addition, it would lead to fewer emergency department visits and, thus, less chance of delays in getting treated when needed.


And finally, for some of us, it is more than just economics and personal safety, it is a moral issue. Health care is not an economic commodity, it is a basic human right. Flu shots prevent needless suffering. Given the current political and economic system we have, the least we can do is provide free flu shots to those who need them.



F. M. Cox et all, “Cost of treating influenza in emergency department and hospital settings, American Journal of Managed Care, 2000, Vol. 6, No. 2, Feb 2000, pp. 205 – 14.

Mary Brophy Marcus, “Third of hospital ERs have closed over past 20 years,” USA TODAY , May 18, 2011.

William W. Thompson et al, “Influenza-Associated Hospitalizations in the United States, Journal of the American Medical Association, Vol 292, no. 11, Sept 15, 2004, pp. 1333 – 1340.


Joel A. Harrison, PhD, MPH, a native San Diegan, is a semi-retired epidemiologist. He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. Dr. Harrison, a longtime advocate for a single-payer health care system, has lived in Canada and Sweden.The opinions in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. To submit an editorial for consideration, contact

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