It's that time of year again, when people start asking themselves, and each other, whether to get a flu shot. I actually get asked this question a lot, presumably because I have a background in science, and I used to work in a plant that manufactured the flu vaccine. People also ask me if I think vaccines are safe, given my up-close experience with making them. The short answer is somewhat contradictory: yes they are safe, and no you probably don't need one (though many doctors will send me hate mail for the latter part of that statement). While I have fond memories of helping to make the flu vaccine (which was my first job out of college), I've also developed a sort-of working rationale against their utility.
It was not my fondest wish to work in a factory after college; most of my friends were heading off to graduate school or taking office jobs. I had hoped that my molecular biology degree would translate into a spot in some pristine lab at Merck or Johnson & Johnson, both of which have corporate headquarters in my hometown. Instead, I ended up in a vaccine manufacturing plant (I'm withholding the name due to a confidentiality agreement I signed before going to work there). Because I had some lab experience, they stuck me in the formulation facility. That's where all of a vaccine's given ingredients are pooled into one giant stainless-steel vat before being sent down the production line and packaged into the individual shots that most people get injected with at one point or another.
Despite the hint of manual labor in my official job title—manufacturing technician—it sounded exciting when I first signed on. It was early in the millennium, and a rash of quality-control problems had forced plants in Europe and the U.S. to suspend their influenza programs, leading to a colossal shortage of flu vaccines. When it came time to make that season's batch (after the Centers for Disease Control had selected the appropriate virus strains) ours was one of only two companies in the nation with the FDA approval needed to get the job done. Even though we mixed and stirred and blended hundreds of thousands of gallons of virus in a single season, we knew it would not be quite enough to inoculate the masses. As we went into overdrive (and overtime), expanding our campus and ramping up production to some 150 million doses (and that was just for influenza), public-health experts across the country were calling for more factories and more vaccines. Talk about a sense of urgency.
It was a fun place to work, though I probably wouldn't have said that at the time. We started at 6 a.m. sharp, which for me meant getting up at 4:30 to make the hourlong commute. The upside was that because we spent the whole day covered from head to toe in sterile gowns, there was no need to bother with hair, makeup or fancy clothes. After a quick breakfast in the cafeteria, we spent most of the morning just preparing to enter the dense cubicle bunkers where the actual formulating took place. That meant sterilizing everything, including ourselves.
Moving from the cafeteria through the locker rooms and hallways to the inner sanctum of the formulating rooms involved a series of clothing changes we called "gowning up." First we changed from street clothes to scrubs. This included putting on special work shoes that never left the building. Passing from the locker rooms into the lab area meant covering those shoes with paper booties and donning a hairnet, safety goggles and at least one layer of latex gloves. Except for our own skin, which we couldn't do anything about except cover, nothing that had seen the outside world, not even jewelry, was allowed beyond that point.
Scrubs were OK for wiping down equipment—which we did obsessively, throughout the day, with 95 percent bleach—or standing in the hallways. But going into the formulating rooms required a whole extra layer of clothing, a layer that had been autoclaved (cooked in a steel vessel under pressures and temperatures high enough to kill any and all microbes) and packaged just so.
Getting into that clothing actually took practice: no portion of the outside of the jumpsuit could touch you, the walls or the floor. The formulating rooms were completely sterile. If you gowned up the wrong way and if even a single bacterium had managed to sneak past all those other security checkpoints, you might introduce contamination. So you had to open the package and remove the jumpsuit and hood without touching the outfit's outside. Then, you would carefully unroll the legs of the suit while stepping into them so that they did not touch the floor, even for a second.
The suits themselves were stark white and the hoods looked like pure science fiction. Between them, the goggles, the facemask and, by that point, two pairs of latex gloves, absolutely no portion of your body was exposed to the air. Heaven help you if you had forgotten to go to the bathroom or felt an itch anywhere at all. (Every once in a while, some exhausted manager or overworked technician would forget to change into his or her street clothes and would stagger into the cafeteria for lunch in a lab suit and safety goggles. You probably had to be there to appreciate how funny this was).
Unlike the high-containment labs that provide such good fodder for science fiction writers, none of the measures we took were meant to protect us from the virus. By the time it reached our lab, all of that stuff had long since been attenuated (modified in a way that made it incapable of causing disease without diminishing its ability to trigger an immune response). No, the idea behind all the gowning and gloving and alcohol spraying—the goal of pretty much every technique we employed, actually—was to protect the viruses and bacteria from us. Humans, even the most fastidious among us, are a notoriously filthy lot. And damned if we were going to let a stray hair or an aberrant sneeze lay waste to so much medicine. All in all, I think we did a pretty good job of it. Most of the same people that I worked with are still there now; they're smart and experienced and they take their work very seriously.
The labs themselves had windows that looked out onto the halls and sometimes, like when the protocol called for 45 minutes of automated stirring, the people inside the lab would play charades with the people standing in the hallway. Occasionally, the FDA inspectors would come to watch us, and we would act very serious and use extra bleach on everything.
Standing in the hallway was actually a job. The people who did this—I called them runners—were responsible for watching through the window in case anything went wrong, or an extra piece of equipment was needed. Almost nothing ever went wrong (at least not in the year I spent there), but it wasn't inconceivable. A hose could blow, or a 14-gallon bottle of reagent could have some particles floating in it. Anything like that had to be fixed immediately (hence the running) because the manufacturing protocols called for each step to be completed in a very finite period of time, and if too much time was lost, 500 gallons of vaccine, worth millions of dollars, would be wasted.
The low men on the totem pole were always runners. In the beginning, I was a runner. To earn a spot in the lab, you had to win the respect of the senior techs. That meant showing up on time, working hard and proving that you were not a complete idiot. A good sense of humor went a long way, but nothing topped a strong work ethic.
Formulating the flu vaccine was a matter of mixing the three different Centers for Disease Control-selected strains of the virus and adding the mercury-based preservative (the source of much anxiety for so many parents of late), along with several other ingredients (the details of which are proprietary). Sounds simple, I know. But the devil is in the details, and the details were all about pacing, documenting and being sure to read the labels. Except for the flu strains, which were somewhere between the color of honey and syrup, all the other ingredients looked exactly the same—clear liquid in a giant, clear glass bottle with a giant black rubber stopper at the mouth. Each liquid flowed from its own container into the main vat, usually a 500-gallon tank—shiny, silver and doused in bleach—from which all sorts of rubber hoses and metal clamps protruded. Everything was very heavy, and after gowning, the worst part of the job was hoisting the containers from the cart to the countertop and back again.
The formulating rooms were small, and, for the most part, we worked in teams of three that almost never changed. Each group developed its own routines and rhythms. The heavy masks and the roar of sterile air blasting down through the ceiling made conversations nearly impossible, and the teams that had been together longest could get through a three-hour procedure without so much as a whisper.
Many of the techs had been there a few decades, long enough to see the old factory through a string of corporate mergers and buyouts, which instilled in them a stoic humor and stubborn pride. Come what may, the vaccines would be made. Through two world wars, the Great Depression and countless changings of the guard, theirs was the proud site that had churned out the bulk of America's vaccines, including most of the shots that helped eradicate smallpox in the late '70s.
It was a real family place, too, the kind where co-workers were also spouses, siblings and childhood friends. Some of that closeness was inspired by the urgency of our work, though no one there would admit that to you. But a lot of it was a consequence of simple geography: the factory sat on the edge of a sparsely populated mountain town with only a handful of places to socialize and practically no other places to work. So we ate together and drank together and learned to love and hate the same things about our shared experience.
Despite my faith in the good people of the vaccine plant and despite my deep faith in science, I have never actually been injected with the flu vaccine myself. In fact, every time someone asks me whether they should get a flu shot, I almost always tell them no, even if they are elderly. Especially if they are elderly. It's actually a misconception that older people stand to gain the most from the influenza vaccine. Yes, like the very young, people over the age of 65 tend to have weaker immune systems. And yes, that means that they face a greater risk of contracting whatever devious bugs happen to be flying around. But studies have shown that, unlike infants and toddlers, the immune systems of elderly people are less adept at converting the influenza vaccine—meaning the shot does not trigger in them an immune response strong enough to protect against subsequent infection. In fact, a 2005 analysis by the National Institutes of Health suggested that giving the flu shots to elderly people has not saved any lives over the past three decades. (The CDC still includes people over the age of 65—along with infants and toddlers, pregnant women and health-care workers—among those who should most definitely get a flu shot. That policy will not change until more studies are done).
Kids, on the other hand, have no trouble with conversion, and their penchant for playgrounds and general disdain for washing hands make them the ideal beneficiaries of the vaccine formulators' efforts. If my 10-year-old niece were to ask my opinion, I'd tell her to get a shot straight away. I am not alone here. Many experts have begun to suggest that school-age children would make a much better target for protecting the population at large. Again, more studies are needed before the CDC will change its policy.
In the meantime, I am a firm believer in the theory of herd immunity. As long as a certain portion of the population has been inoculated against a given infectious disease, the rest of the population will be largely protected. The portion that needs to be vaccinated for this to work (called the herd-immunity threshold) depends on several factors, including what pathogen we're talking about. For influenza, it's around 70 percent. That means as long as somewhere near 70 percent of the people around me have gotten their shots, I don't really need to get mine, because most people I interact with will not be capable of catching the virus or passing it on to me. Their vaccinations basically act as a firewall that protects me and anyone else too busy with holiday shopping to make it to the doctor. I admit it's a bit of a gamble; the percentage of New Yorkers who get vaccinated may be well below 70 percent, and there's no accounting for tourists. But it's just not the biggest gamble I take. After all, I still smoke.