It’s that time again—time to get lots of rest, drink lots of water, and obsessively wash your hands. It’s time to avoid the flu.

For many, a big part of the flu evasion ritual includes getting vaccinated. And with the season ramping up to be one of the worst in more than a decade, that might seem like a good idea. However, some would disagree, and that has led to an ongoing debate about the social responsibility of vaccination.

“Protecting oneself is an altruistic act,” Dr. Elizabeth Baorto told the Mother Nature Network. “By getting vaccinated, you not only protect yourself, but you protect those around you as well. We are fortunate that we have a cheap and effective way of protecting ourselves with the flu vaccine.”

Even when price isn’t a sticking point, there are many reasons people choose not to get the flu vaccine—allergies, religious beliefs, disappointment in effectiveness rates. Does that make them reckless misanthropes or should we all have a right to unvaccinated exposure?

For most people, the answer is simple. But for years now healthcare workers have faced sanctions or even termination if they opt out of the shot.

“Where does it say that I am no longer a patient if I'm a nurse,” Carrie Calhoun, a longtime Chicago critical care nurse asked in an NPR interview. Calhoun was fired for refusing to take a flu shot, according to NPR.

Although many would balk at the idea of an employer making health care choices for them, it’s different when your choice not to be treated can lead to someone becoming seriously ill or dying, say supporters of the stipulation.

“If you don't want to do it, you shouldn't work in that environment,” Art Caplan, medical ethics chief at New York University's Langone Medical Center, told NPR. “Patients should demand that their health care provider gets flu shots—and they should ask them.”

Caplan’s take-it-or-leave-it stance may apply in the healthcare world, but there are other callings that might also demand flu shots—such as motherhood. Research released last week indicated that while the flu shot is safe for pregnant women, actually contracting the flu could nearly double the chances of stillbirth or miscarriage.

“One misconception women have is that it’s no big deal—it’s just the flu,” researcher Camilla Stoltenberg of the Norwegian Institute of Public Health told Science News. “But it can be a big deal.”

Sometimes it’s the vaccine and not the flu that ruins your life. That’s the experience of about 800 European children who developed narcolepsy linked to a 2009 swine flu vaccination, according to Reuters. Scientists are investigating how the drug—which was given to 30 million people in 47 countries, although not in the United States—might be related to the debilitating condition.

“The big question is was it worth it? And retrospectively I have to say it was not,” Swedish public health official Goran Stiernstedt told Reuters. “This is a medical tragedy,” he said. "Hundreds of young people have had their lives almost destroyed."

It’s easy to wring our hands in retrospect, but anyone who remembers the push for vaccines during the swine flu outbreak will recall there was intense demand for protection against the anticipated pandemic.

“In the event of a severe pandemic, the risk of death is far higher than the risk of narcolepsy,” David Salisbury, the British government's director of immunization, told Reuters. “If we spent longer developing and testing the vaccine on very large numbers of people and waited to see whether any of them developed narcolepsy, much of the population might be dead.” Given the unsure results of flu vaccine—both in effectiveness and long-term effects—it’s likely the to-vaccinate or not-to-vaccinate debate will continue until a better vaccine comes along. Until then, the flu will remain nothing to sneeze at.