What if they threw a mass vaccination . . . and nobody came?
Sure, the H1N1 vaccination centers are crowded, but for every man, woman or child lining up for a dose of the vaccine, there may be more at home with doubts about whether they should.
A nationwide CNN poll taken last month found that only 49 percent of those asked consider the H1N1 vaccine safe. And according to an L.A. Times/USC poll released on Friday, a majority of registered voters in California are planning to skip the H1N1 shot altogether.
"There's a substantial minority that may become majority of people who are saying, 'I think I'll wait. I don't think I'll line up right now and get swine flu vaccine for myself or my child,'" said Barbara Loe Fisher.
Barbara loe Fisher, co-founder of the private, vaccine-critical organization, National Vaccine Information Center, says we just don't know enough about the H1N1 vaccine to make an informed decision.
"What's the true nature of this outbreak?" she asked. "What are the true risks of the vaccine for different people? I don't think we have all those answers."
"I think it's perfectly legitimate for people to question whether or not they should get vaccinated, and whether or not for some it's better to have the influenza, get antibodies and be protected in future years."
Dr. Paul Offit, chief of the infectious diseases division at Children's Hospital of Philadelphia - and a champion of vaccines - admits vaccination is controversial but sees things differently.
"We know a lot about this vaccine," Dr. Offit said. "We've been making a vaccine very similar to this for the last 60 years. We know that this vaccine induces an adequate immune response. We know that it can protect your child. Why would you ever choose not to get it, given everything that you know about the disease and everything you know about the vaccine?"
"What about, even if I get my children vaccinated, if you don't get your children vaccinated, are you threatening me?" Smith asked.
"Of course. Because no vaccine is 100 percent effective. There's, actually, a wonderful study that was done in the Netherlands between 1999 and 2000 where they looked at an outbreak of about 4,000 people that got measles. And what they found may surprise you, which is that you were actually much more likely to get measles if you were fully-vaccinated, highly-vaccinated, living in a relatively unvaccinated community, than if you were unvaccinated living in a highly-vaccinated community, because you were protected by that population."
It's called "herd immunity" - infectious diseases just can't spread when large numbers of a population are immune - but to achieve herd immunity with H1N1, Dr. Offit says more than 90 percent of the herd needs to take the vaccine . . . and therein lies the problem:
"If you choose not to get the H1N1 vaccine then you're choosing to subject your child to getting a virus which has already caused tens of thousands of people to be hospitalized, and more than 100 children to be killed," he said. "We have every reason to know that that vaccine is going to be safe and effective. It's a terrible choice not to get H1N1 vaccine. It's the wrong choice."
The debate over vaccines began in the twenties . . . the 1720s, with a crude smallpox inoculation.
"This is actually the earliest form of vaccination, that even came before Edward Jenner, and this involved taking live smallpox from a smallpox sore and rubbing into a person's arm or leg," said journalist Arthur Allen.
Benjamin Franklin was an early skeptic, but changed his mind after he lost a 4-year old son to smallpox, writing in his autobiography that "I long regretted bitterly, and still regret that I had not given it to him by inoculation."
By 1796, Englishman Edward Jenner proved that scratching the relatively mild cowpox into a person's skin would stave off smallpox. And after that, millions eventually lined up, arms bared.
"The idea of it really spread around the world with remarkable speed, considering there was no Internet or anything like that," said Allen. "And, you know, Jenner became an international sort of hero, you know, one of the first sort of medical heroes in history."
"He went viral?" Smith asked.
"He went viral! He did, as it were, so to speak."
Talk about medical heroes: Jonas Salk was a superstar when he rolled out a polio vaccine in 1955. Yes, there were adverse reactions, even deaths, from the Salk vaccine. But to many, it was an acceptable risk, given the prospect of life in a wheelchair . . . or worse.
The public's faith in vaccines took a few hits through the years, like in 1976 for example, when a vaccine for the swine flu was associated with a paralyzing nerve disease.
So when the H1N1 vaccine program was announced, not everyone cheered.
"I think fear is the most infectious thing on the planet at the moment," said journalist Michael Specter. "I'm hoping it's not the most dangerous. But I could be wrong about that."
In his new book, "Denialism" (Penguin), Specter says that fear and mistrust are driving people into denial about scientific progress.
"Pharmaceutical companies have lied to the American public in the past," said Smith. "So, shouldn't we be skeptical?"
"Yeah, if we're not skeptical about everything, we're nuts," said Specter. "We should be skeptical about vaccines. We should be skeptical about the food we eat. We should be skeptical about everything doctors and government officials say to us.
"Denialism is when you get thousands of studies saying one thing, and you just say, 'I don't care. I don't care, because I'm not going to have the measles shot. Because it doesn't matter how many studies say This is going to work, the risk is relatively low. I'm still gonna hide.'
"People don't think in terms of risks," Specter said. "Every decision we make is a risk. But they don't think, What is the risk of not getting this vaccine? They only hear about stories about the one in 1,000 people who do have reactions, and that happens.
"It's like plane crashes. We all know a story about a plane crash. No one reports the 19 million air miles flown every year where no one gets hurt."
But for some, the H1N1 vaccine is not an acceptable risk . . . at least not yet.
"It was not the kind of lethal pandemic that they thought it was going to be," said Fisher. "So, you know, we have to all pray that this is going to remain a moderate outbreak. And there certainly is no indication at this time that it's going to be any worse than it is right now."
"But we could do more than pray - we could get vaccinated," said Smith.
"And certainly you can get vaccinated. And that absolutely is your choice. Absolutely."
For more info:
"Vaccine: The Controversial Story of Medicine's Greatest Lifesaver" by Arthur Allen (Norton)
National Vaccine Information Center (private, vaccine-critical organization)
Infectious Diseases Division, Children's Hospital of Philadelphia
"Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives" by Michael Specter (Penguin)