Major motives in non-acceptance of A/H1N1 flu vaccination: The weight of rational assessment
Introduction
The A/H1N1 influenza of 2009 (H1N1 hereafter) is considered one of the most widespread pandemics in recent history. In March 2009, the outburst of a novel strain of influenza, linked to swine influenza was detected in Mexico [1], [2] and as of January 2010 it had caused nearly 15,000 deaths in 209 countries [3]. H1N1 was declared a pandemic by the World Health Organization on the 11th of June 2009, as soon as infection had shown sustained human-to-human transmission in different geographic regions [4], [5]. The WHO declaration boosted the implementation of various countermeasure programs by national organizations worldwide, and prompted the development and production of vaccines against H1N1 [4], [5].
The first H1N1 vaccines were licensed in mid-September, and by October 2009 most industrialized countries had rolled out national vaccination programs. In parallel, the public's attitude towards H1N1 vaccination was examined by several public opinion polls [6], [7], [8], [9], [10], [11]. At this stage, the reported willingness to accept vaccination was relatively high (55% in Australia, 45% in Hong Kong, and 60% France).
The positive attitude of the public towards vaccination has quickly changed. On the one hand concerns about the safety of the vaccine were expressed by various lay and expert agents worldwide. On the other hand the severity of the disease turned out to be lower than expected [12], [13]; most people experienced mild symptoms and severe illness was uncommon, mainly occurring in individuals with underlying chronic health conditions. Eventually the discrepancy between what was expected and what happened resulted in vast rejection of the vaccination by the general public. When the wave of H1N1 began to recede in the first quarter of 2010, many countries were left with large stockpiles of unused vaccines. Health authorities were then blamed for mismanaging the preparedness efforts and for wasting public funds [14].
In many aspects, the sequence of the H1N1 events in Israel resembled those observed in other industrialized countries. The first case of H1N1 was identified in Israel on the 24th of April, and by the end of July, 1500 confirmed cases were reported. The Israeli government placed an order for 7.7 M doses on the earlier stages of the pandemic, and the vaccination program was launched at the beginning of November 2009. Vaccination was offered to everyone, free of charge, supplying the vaccine progressively, according to the level of risk. Controversies related to vaccination, focusing mainly on the safety of the adjuvant-containing inactivated vaccine preparations purchased by Israel started early on. The government's efforts to promote the H1N1 vaccine were met with skepticism, resulting in a low compliance rates among Israelis.
In this study, the attitudes of the Israeli public towards H1N1 vaccination were analyzed. The extent of non-compliance among various socio-demographic groups was examined, and the reasons for the rejection of the H1N1 vaccination during the 2009 pandemic were evaluated.
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Study population
This cross-sectional study was based on a randomly selected representative sample of the Israeli adult population (aged 18 and over). A probabilistic stratified sampling of households was built based on the official statistical areas characterized by socio-demographic characteristics. Areas were then matched with the computerized list of subscribers to the national telephone company and households were randomly chosen. Only one adult in each household was interviewed. The proportion of Israeli
Declared acceptance of H1N1 vaccination by the adult population
The survey sample (Table 1) included 501 adult participants. Representation of the main socio-demographic variables in the sample was not significantly different from their representation in the adult Israeli population in terms of gender, income, and ethnicity [15]. The older age group (>60) is over represented in our survey (30% vs. 22% in the general population), on the expanse of the younger age group. In addition, over-representation of individuals with lower level of education was noted
Discussion
Healthcare professionals worldwide can be credited for a number of outstanding achievements in the control of the recent H1N1 influenza pandemic. These include: immediate identification of the new outbreak, effective mapping of disease propagation, effective coordination of international endeavors, as well as rapid development and production of safe licensed vaccines [16]. However, the H1N1 control efforts are marked by the failure to convey to the public the need to be vaccinated against the
Acknowledgements
We thank Prof. Boleslav Goldman for stimulating discussions, Janice Wasser for assistance in analysis of responses, and Saralee Glaser for the helpful revision of the manuscript. We also thank Dr. Anat Oren for supervising the survey and helping in some of the interpretations.
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