The federal panel that recommends what immunizations Americans should get has determined that all adult smokers should be immunized against a bacteria that causes pneumonia and meningitis (the pneumococcal vaccine).

I have two, somewhat contradictory, reactions to this news.

First, vaccinating smokers makes a lot of sense. Pneumococcal pneumonia is a big killer. It’s the most common serious complication of the flu, causing tens of thousands of deaths each year in the U.S. And being a smoker makes you much more susceptible. About a third of invasive pneumococcal disease in adults under 65 years old is attributable to smoking. No great surprise, when you consider the damage that cigarette smoke does to the lining of the lungs.

But second, I see this as an example of how our medical-industrial complex can be both brilliant and stupid at the same time.  There are 31 million smokers who will be eligible for this vaccine. At a cost of around $30-$40 a shot, that would represent a cost of over a billion dollars to implement!!!  According to an earlier report this year to the same panel, most adults who developed invasive pneumococcal disease had some other condition like chronic obstructive pulmonary disease, which would have made them candidates for vaccination. The vaccine is only partially protective, and tends to wear off after five to ten years. So the net benefit to smokers is likely to be small from this new recommendation.

The synthesis of brilliant and stupid is that the panel also recommended that smokers should quit smoking! This is a far superior strategic approach to lowering your risk of death and disease from smoking. However, the panel offered no practical ways to actually ensure that giving 31 million smokers a vaccination would result in them quitting. In fact, I worry that these types of interventions that aim to make smokers healthier while they continue to smoke can send a perverse, and largely untrue, message: “it’s ok if you keep smoking, because now you are IMMUNIZED!”  There are similar efforts afoot in other areas of medicine, such as the lobbying for routine spiral CT scanning of smokers to detect lung cancer early.  Again, the cost would be high (in this case tens of billions of dollars), and the benefit largely unknown.

At the same time all this traditional medical activity is going on, we have simple, proven medication and counseling treatments that can actually help smokers quit.  Quitting is still the only 100% guaranteed approach to dramatically improving your chances of living a longer and healthier life.  A 30 year old adds 10 YEARS to their life expectancy when they quit. My guess is they probably add about ten DAYS to their life expectancy by getting a pneumococcal vaccination. It’s a real benefit, but it’s just a drop in the bucket compared to quitting. An inter-agency federal task estimated that for a billion dollars a year, we could help two million people quit smoking! But our brilliant and stupid medical-industrial complex is a lot better at delivering up vaccines, x-rays, and other traditional medical approaches than it is at providing simple upstream help quitting that eliminates the underlying cause of the diseases that result from smoking.

Kudos to our far-sighted institutional clients who are breaking ground by helping their employees, health plan members, and state residents attack the root of their health problems by supporting them in their efforts to quit smoking!

And for you smokers out there reading this, my advice is simple:  Go ahead and get a pneumococcal vaccination. It won’t hurt, and it may help some. But if you really want to live long and prosper, take on the 800-pound gorilla:  quit smoking. That is your best vaccination for health.