Many healthcare workers are reluctant to accept pre-pandemic influenza vaccinations, according to research¹ published this week in the BMJ. The findings echo those of similar studies conducted in other parts of the world.

 

“The most common reason for refusal was ‘worry about side effects’, and other reasons included ‘query on the efficacy of the vaccine’, ‘not yet the right time to be vaccinated’, and ‘simply did not want the vaccine’”, write Josette Chor, of the Prince of Wales Hospital and the Chinese University of Hong Kong, and colleagues.

 

The researchers conducted a survey with two different sets of questionnaires in public hospitals all over Hong Kong. The first, to which 1866 people responded, was done when the World Health Organization (WHO) pandemic alert level was at phase 3, from January to March 2009; another one, with 389 respondents, was done during May 2009 when the alert level was at phase 5. They found that only 28.4% of these healthcare workers were willing to accept a new H1N1 vaccine at phase 3, and 47.9% at phase 5.

 

In the current pandemic, the WHO alert level moved up to phase 6 last June, when it became clear that the ‘swine flu’ virus had spread widely. A pandemic vaccination programme is expected to begin in many countries of the northern hemisphere in autumn, with healthcare workers, pregnant women and people with underlying health problems being offered the jab first. But experts are concerned about the recent survey results which suggest that most healthcare professionals are reluctant to get vaccinated.

“In a pandemic there are many uncertainties, but without vaccination many healthcare workers will become infected,” say Rachel Jordan and Andrew Hayward in an associated editorial². “Although this will be a mild illness for most, deaths in previously healthy young adults have occurred.”

 

Chor and colleagues point to past studies indicating that less than 60% of healthcare workers are willing to be vaccinated against other types of seasonal influenza. In their current survey, the key barriers to pre-pandemic vaccination were identified as fear of side effects, and doubts about efficacy.

 

Other recent surveys conducted with healthcare professionals in other countries have elicited similar responses. A questionnaire administered online by the Nursing Times found that 30% of 1500 frontline nurses in the UK who responded would not consent to vaccination for swine flu when the jab became available. Nearly two thirds of these nurses cited concerns about the safety of the vaccine, and a further 31% stated that they did not consider the risks to their health to be great enough to receive the vaccination.

 

“In line with surveys of seasonal flu vaccine uptake, intended acceptance of pre-pandemic or pandemic flu vaccines was associated with receipt of previous seasonal flu vaccines, perceived likelihood of being infected, and belief in the efficacy of flu vaccines,” say Jordan and Hayward.

 

In another study published online in Emerging Health Threats Journal, Natalie Henrich and Bev Holmes assessed public attitudes towards a novel pandemic vaccine in Vancouver, Canada during 2006 and 2007 — before swine flu emerged and while the bird flu virus posed a more distant but also more serious threat. The researchers conducted 11 focus groups with university students, parents, people from various ethnic groups and healthcare workers. They found that most people were hesitant to receive a novel vaccine due to a perceived low risk of infection, and “concern that unsafe pharmaceuticals may be rushed to market during the health crisis”.

 

Plans by US and EU health authorities to fast-track a swine flu vaccine could be fuelling current concerns over safety.

 

“This [health workers’ concerns about influenza vaccines] suggests that public and hospital health agencies need to provide more information to the staff, especially to those with higher levels of anxiety and doubt,” suggest Chor et al.