The NEJM just published an interesting account of the public respond to the H1N1 pandemic…in a nutshell?  Public health officials, take note: the old fable of “If we build it, they will come” approach to a pandemic flu vaccine isn’t going to work. You’re also going to have to convince people that the illness is a serious health threat, and that the vaccine is safe.

That’s the essence of a Harvard School of Public Health review of 20 national opinion polls taken at various points during last year’s H1N1 pandemic. The theme of the research: people who didn’t get vaccinated didn’t believe H1N1 was dangerous and were also concerned about the vaccine’s safety.  Here are some highlights:

  • We were pretty good about washing our hands more – or at least telling pollsters we were washing our hands more. At the beginning of the pandemic, about two-thirds of us reported our families were soaping up or using sanitizer.
  • Before the vaccine became available on a limited basis in October, about half of those surveyed said they planned to get the vaccine, and between 59% and 70% of parents said they’d get it for their kids.
  • Almost 90% of adults said they thought the H1N1 vaccine was “safe” or “very safe,” but only 33% of those were in the “very safe” camp, compared with 57% who expressed that sentiment about the seasonal flu vaccine.
  • Of the parents who said they wouldn’t or might not have their kids vaccinated, 33% said they were concerned about “exposure to another serious illness.” And 31% of that same group said they didn’t trust public health officials to give them accurate safety info.
  • As vaccine became more widely available in December, public worries about actually getting sick waned
  • When the vaccine was in short supply, 54% of respondents in one poll said the feds were doing a poor or very poor job of providing enough of the stuff.
  • Still, in early November, adults were split on whether the H1N1 vaccine had been rushed through the production process too quickly to guarantee its safety.
Early in the pandemic, when no vaccine was available, a majority of Americans were quick to adopt two central public health recommendations: Almost two thirds of Americans (59 to 67%) said that they or someone in their family had begun to wash their hands or clean them with sanitizer more frequently, and a majority (55%) had made preparations to stay at home if they or a family member got sick.

The authors conclude that “in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine because they may believe that the illness does not pose a serious health threat, because they (especially parents) may be concerned about the safety of the available vaccine, or both.”

There were two major reasons why people said they would not or might not get the H1N1 vaccine, one of which was concern about its safety. Among adults overall, this concern was present but not dominant: most (87%) believed the H1N1 influenza vaccine was "very safe" or "somewhat safe." The other major reason for avoiding the H1N1 vaccine was the belief that it was not needed.

Given the crucial role that the public plays in containing or spreading illness and in seeking related medical care, the government should take note of these findings and revise plans going forward for a more effective response.