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When it comes to H1N1 vaccine, some doctors are just saying no

Nurse Terri Jackson administers the swine flu vaccine to Jimmie Jackson at the Utah County Health Department in Provo. A small group of health-care providers are choosing not to provide the vaccination.
Nurse Terri Jackson administers the swine flu vaccine to Jimmie Jackson at the Utah County Health Department in Provo. A small group of health-care providers are choosing not to provide the vaccination. (George Frey/bloomberg)

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By Rob Stein and Michael Laris
Washington Post Staff Writer
Sunday, November 8, 2009

The biggest frustration facing many doctors is the dearth of swine flu vaccine for their patients. But not Paula Soghomonian's pediatrician at Pediatric Village in the District. She is not recommending the shots -- or the nasal spray.

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"The senior doctor there doesn't believe in it and doesn't want it for her patients," Soghomonian said. "I think the feeling was it's just too new."

Soghomonian's doctor is one of a small cadre of outliers who remain skeptical about the government's unprecedented immunization campaign, citing doubts about the risks presented by the H1N1 virus or the safety of the vaccine, despite the fact that no worrisome reactions have been reported.

"My feeling is that this is all being over-hyped," said Laurence J. Murphy, a pediatrician in Burke who also will not inoculate his patients. "Most people who get this virus do beautifully. I believe the vaccine hasn't been tested enough. I just think the benefit of it at this point is not outweighed by the possible risk."

Such contrarian voices, through the megaphone of cable news or in the quiet of exam rooms, have forced federal health officials to play defense as well as offense in their campaign to encourage immunization.

Public health leaders are at a loss to explain the skeptical minority, except to say that it mirrors the chronically low percentage of health-care workers who get the seasonal flu vaccine every year. Officials worry that these doubters could have a disproportionate influence in an already frustrating and confusing situation, and stress that the studies conducted so far and the intensive monitoring underway indicate that the vaccine is as safe as any flu vaccine.

"I am very disappointed, deeply puzzled and very disturbed by this," said William Schaffner, president-elect of the National Foundation for Infectious Diseases. "The people for whom these doctors are not recommending this vaccine are clearly high-priority patients who could have very adverse outcomes if they get infected with the virus."

'Not enough data'

Although no one has surveyed doctors' views on the vaccine, polls show that people look to their physicians when deciding whether to get the shots or nasal spray. A nationally representative survey of 1,042 adults in September found that 68 percent said they trusted the advice of their doctor or their child's pediatrician on this issue, far more than those who said they trusted top federal health officials and medical groups.

"People rely very heavily on their physician's judgments about whether or not they should take a vaccine," said Robert J. Blendon, a professor of health policy at the Harvard School of Public Health who conducted the survey. "They are at the top of the charts."

As a result, the naysayers have left patients torn between a doctor's long-respected advice, their own judgment and official recommendations.

"It's like total confusion for me to try to figure out what to do," Soghomonian said as she lined up with her 3-year-old daughter, Ally, on a recent morning at a District flu clinic.

"It's really been very frustrating and very scary," said Soghomonian, who eventually left after deciding to give her daughter only the seasonal flu vaccine. "I just want someone to tell me what to do, you know?"


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