A randomized placebo-controlled trial shouldn’t be unethical.
They did it to test polio vaccine.
http://www.sph.umich.edu/about/polioannouncement.html
“In placebo control areas, where vaccine was interchanged with an inert substance, 428 out of 749,236 children contracted the disease.”

They’re doing it to test malaria vaccine on children.
http://online.wsj.com/article/SB124364038701367907.html
“The latest study will include two age groups: infants and children five to 17 months old. Half of each group will get the vaccine and half a placebo… Then they will be followed over two years for signs of clinical malaria.”

Suppose the vaccine is 60% effective, but there’s a 50% chance of getting the placebo. That’s equivalent to getting a vaccine that’s 30% effective, which is better than nothing.

While a vaccine does theoretically protect an individual, one of the major reasons behind vaccination campaigns is to prevent or slow *an epidemic* — or the spread of a disease through a group, instead of preventing one person from getting sick. This is a little like voting, because part of the point of democracy is to keep crazy despots from coming into power and wrecking the country, instead of specifically protecting one person’s interests.

The economists will tell you that, in a country of hundreds of millions of people, voting isn’t worth the time or expense on an individual level, but if not enough people vote (or vote the “correct” way, whichever way you think that is), we could end up with someone running the country who can destroy it.

Similarly, when enough people get vaccinated against the flu, it should slow down the spread of disease enough that, yes, perhaps fewer people get the disease, or it just spreads more slowly. When the flu spreads more slowly, that should decrease 1)the number of opportunities the flu has to mutate into a more deadly flu at any one time, or 2)the chances that so many people will be sick at one time that healthcare facilities are overwhelmed or basic services (like police) cannot be fully staffed because too many people are sick.

We are very lucky today to not understand a deadly epidemic. The flu epidemic in 1918 didn’t just kill thousands of Americans–it brought normal life to a standstill, including much economic activity. Other, far deadlier epidemics, such as yellow fever and bubonic plague, resulted not only in unprecedented numbers of individual deaths, but also in panic and disorder that brought down cities. I do not say this to scare people (don’t be scared!) but to try to articulate that a true epidemic is not just about sickness but about preventing chaos that can lead to economic and physical safety problems. It is far easier to prevent people from getting a disease through vaccination than it is to prevent people from panicking when a disease hits.

While we haven’t had a true flu epidemic in many decades, I don’t think we’ve ever gotten enough people (or the right people–that would be children, food service workers, healthcare providers, etc) vaccinated to actually prevent a flu season, and that has translated to what (I believe) the CDC has estimated as 30,000 annual flu-related deaths a year, mostly among elderly people.

But these costs and benefits are difficult to measure. Since we haven’t had an epidemic in years, we don’t see the possibilities that vaccination could be preventing–it’s like how we don’t appreciate how much we need clean water, because we are not routinely sick from not having it. Because we don’t have two identical Earths hanging out, we can’t tell if our vaccination campaigns slowed down the development of a new flu pandemic, by preventing many chances for different strains to mutate or come in contact with one another. (This is important, not just in delaying a bad event, but in allowing people to develop better Flu treatments. Anti-viral medications have come a long way in the past twenty years.) Finally, those thirty thousand estimated flu deaths may not show up on death certificates, where cause of death will often be the complications of flu, like pneumonia or dehydration.

I completely support people’s rights to refuse vaccination, and I hope that I’ve provided a coherent explanation of the public health reasons for flu vaccination, whether you agree with me or not

True, but I’m not convinced there is a key issue in the flu vaccine question: there are a suite of issues, which are unfairly jumbled together in the Atlantic article.

http://scienceblogs.com/effectmeasure/2009/10/the_atlantic_article_sur_rebut.php#more

BTW, in the benefits column, I think you forgot to account for:

eliminating “pain and suffering” caused by the flu
not transmitting the flu to your family and others
decreased probability of contracting other diseases, such as pneumonia
decreased probability of death

Also, note that Vitamin D was not part of this meta-analysis, is not an antioxidant, and low blood levels of it are associated with an increased risk of death.

“Studies show that young, healthy people mount a glorious immune response to seasonal flu vaccine, and their response reduces their chances of getting the flu and may lessen the severity of symptoms if they do get it.”

I HATE having the flu; if the cost is 1.5 hours or my time but the benefit is a 1% chance of avoiding five days of being miserable in bed, then that’s worth it to me. I’d give it about a three-to-one ratio– I’d rather spend three hours waiting in the doctor’s office than one hour being miserable and feverish in bed.

Also, I have two school-aged children, so I bet my chances of getting the flu are higher than the overall 1% incidence figure.

Using these aggregate numbers it’s just too hard to figure out what is causing the correlations.