Why Didn't We All Get Flu Vaccines Before?

This is Nathan Alden Robinson, golden son of my oldest friend. He was born sunny and spread light and humor. He was brilliant at math and music. Always healthy, he died suddenly of flu complicated by pneumonia at age 15.

I know there's no point in might-have-beens. But as I watch the ads for flu vaccines these days, emphasizing that everyone — everyone — should get them, I cannot help but think: Nathan's parents are the best parents I know. If flu vaccines had been recommended for children his age in the winter of 2007-8, he would have gotten one. But they weren't. Back then, flu vaccines were recommended mainly for children under 5 and people at high risk because of advanced age or suppressed immunity. Most people said, "Eh. It's only flu."

I used to say that too. Then Nathan died, and in that same epidemic winter, the 3-year-old son of an acquaintance suddenly succumbed after a high fever. My own son was then 3. I fell into terror. I knew it was a statistical fluke. But I started fervently pushing for vaccines. I helped run a flu vaccine clinic in our school. I wrote a column in The Boston Globe that began, "I love vaccines." I wished everyone I knew would get vaccinated, creating enough "herd immunity" to help protect my children.

And strangely, circumstances have conspired to grant me my wish, or close to it. Nathan died in early 2008, and later that very year, federal health authorities recommended for the first time that virtually all children get the flu vaccine. 2009 saw the H1N1 pandemic, and suddenly people were lining up for hours to get flu vaccines. And this year, the CDC is calling for everyone to get one — a combo designed to fight both H1N1 and two other strains. Producers are making about 160 million doses to fill expected demand. The vaccines are already widely available in Massachusetts.

I should be happy.

And I am. More children and teens will be protected, including mine. But I also feel confused. I understand why flu vaccines are widely recommended now, especially with H1N1 still afoot. But I don't understand why they weren't widely recommended before. After all, estimates that flu kills well over 30,000 Americans a year, including dozens of children, are not new. Neither is the knowledge that the vaccine is the best way to prevent flu.

So I'm trying to report it out. I've begun by talking with an infectious disease specialist at Children's Hospital Boston, the CDC's flu spokesman, and an academic expert. Please stay tuned to hear what they told me, but here's the headline: I still feel confused.