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Vaccine Is On Its Way, But Public Still Wary
Swine Flu Campaign Faces Key Barriers: Unease, Ambivalence

By Rob Stein
Washington Post Staff Writer
Sunday, October 4, 2009

Billions of tax dollars have been paid to giant pharmaceutical companies. Millions of doses of vaccine are on their way to huge warehouses across the country. Thousands of health workers are poised to start injecting into arms and squirting up noses.

The question is: When the swine flu vaccine finally arrives this week, will Americans line up to get it?

As the federal government launches the most ambitious inoculation campaign in U.S. history, several surveys indicate the public is decidedly ambivalent. A nationally representative poll of 1,042 adults released Friday by the Harvard School of Public Health found that only 40 percent were sure they would receive the vaccine and that about half were certain their children would. Recent research by the University of Michigan and by Consumer Reports yielded similar results.

Although the proportion of Americans who are immunized against the flu in a typical year tends to be even lower than those numbers, health authorities expected and hoped demand would surge for this vaccine, especially for those most at risk.

"We're talking about a campaign where ultimately nearly the whole population is supposed to be vaccinated," said Harvard's Robert J. Blendon, a professor at the School of Public Health, which has been studying attitudes about the swine flu pandemic for the federal Centers for Disease Control and Prevention. "This sends a signal that where we are now, that's not likely to happen."

Part of the reason for the tepid enthusiasm may be that the vaccine campaign is being buffeted by political and social currents: wariness of mainstream medicine combined with suspicion of big government and a general unease and complacency about vaccines. Together, these trends have sparked a flood of misconceptions about the vaccine's safety and effectiveness, as well as about supposed plans to make the vaccine mandatory.

"There's a lot of misinformation out there," said Gregory Poland, a flu vaccine expert at the Mayo Clinic. "Then you mix into that people's concerns about conspiracy theories and government misbehavior and conflicts of interest and all of that, and the average layperson has a difficult time discerning what to do."

Experts stressed that the vaccine was made the same way it is every year and that there is no reason to think it will pose any greater risk. Serious side effects involving the seasonal vaccines are extremely rare.

"Safety is our top priority," said Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. "What I want people to know is that no corners were cut at all."

Although the new H1N1 virus generally causes mild illness, most people have no immunity against it, meaning far more people will probably become infected, sick, end up in the hospital and possibly die than during a usual flu season. Most disturbingly, children, young adults and pregnant women appear to be especially vulnerable.

"It's surprising numbers are as low as they are, given that public health authorities have tried to emphasize that H1N1 tends to be at much greater risk to children," said Matthew Davis of the University of Michigan, who led that poll analysis.

The primary reasons people give for their reticence is concern about the vaccine's safety and doubts about the seriousness of the threat.

"From what I've read and what I've heard, all it causes is just a mild case of the flu," said Laura Reavis of Buford, Ga., who has no plans to go for shots herself and no inclination to inoculate her 2-year-old daughter, Rebecca, and 6-month-old son, Woodrow. Her husband, Daniel, plans to pass, too. "You get sick for a few days or maybe a week, get over it, and life goes on."

About half of the parents in the University of Michigan survey who said they were not planning to inoculate their children cited fears about side effects. About a third of those in the Harvard survey said they were worried about side effects and only 18 percent thought the vaccine was very safe for children ages 6 months to 2 years.

"We are concerned that the H1N1 vaccine is too new and too untested to be given to such a young child," said Jenn Lewis, an attorney who lives in the District and has a 9-month-old daughter. "We would prefer that our child not be a 'guinea pig' for the vaccine."

Doctors are especially concerned about pregnant women, who appear to be particularly at risk. At least 100 pregnant women have required intensive care and 28 have died from the virus. Although many pregnant women say they are eager to get vaccinated, the warnings have not swayed others. Only 13 percent of those surveyed in the Harvard poll thought the vaccine was very safe for pregnant women.

In addition to studies conducted by the vaccine manufacturers, the National Institutes of Health sponsored several clinical trials of the vaccine involving more than 4,600 people, including children and pregnant women. Although the tests were designed primarily to determine the vaccine's effectiveness and the right dose, no side effects were detected other than soreness and redness where the shot was given, a common side effect of the seasonal flu vaccines.

The CDC is launching a multimillion-dollar campaign to promote vaccination and quell concerns, including on a Web site dedicated to such questions. The agency is also partnering with state and local health departments and other researchers across the country to monitor closely for any serious side effects as quickly as possible.

"This is a serious virus," said Schuchat of the CDC. "And vaccine is the best way to protect yourself and those you love."

The Department of Health and Human Services has spent more than $2 billion to buy at least 250 million doses of vaccine from five manufacturers -- more than enough to immunize everyone who is considered high-priority. The government has pledged to buy enough to vaccinate the entire population for free if there is sufficient demand.

Officials expect interest in the vaccine will vary from city to city and town to town depending on how sick people are getting and whether there are any high-profile deaths, especially among children and young people. About 6 out of 10 in the Harvard survey who said they did not think they would get the vaccine said they would change their minds if people in the community were taking ill and dying from the virus.

"Things could shift very quickly," Blendon said.

Everyone ages 6 months to 24 years, those who care for babies younger than 6 months, pregnant women, health-care workers, and adults with health conditions such as asthma, diabetes and obesity are being given priority for the vaccine.

States began ordering vaccine last week. The first 600,000 doses are expected to start becoming available as soon as Tuesday, with about 7 million arriving by week's end. About 40 million doses should begin showing up in doctors' offices, clinics, hospitals, schools, pharmacies and other locations by midmonth, with as many as 20 million doses every week after that.

"People seem to be wired two ways," Poland, of Mayo Clinic, said. "One group is wired this way: 'If there was something I could have done and didn't do and something happened, I would never forgive myself.' The other group is: 'If I do this and something happens, I'd never forgive myself.' These are often emotional rather than data-driven decisions. So it's very hard to try to educate people because you can't use data to change someone's mind who has made an emotional decision."

Some pointed out that initial reticence may give health officials more time to gear up their efforts.

"There won't be enough for everybody on Day One," said William Schaffner, a leading vaccine proponent at Vanderbilt University. "If the early acceptors show up, and they have a good experience, as more vaccine comes in some of the skeptics may be persuaded to come in and take advantage themselves."

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