Research just published on reports that about half of healthcare workers surveyed in Hong Kong say they would not be vaccinated against swine flu because of fears of side effects and doubts about effectiveness.

Still, the authors underline that vaccination is one of the most effective ways to reduce illness and death linked with pandemic flu. They believe that the benefits highly compensate for any possible risks.

The results of the research are unexpected, according to the authors, given SARS had such a huge impact in Hong Kong. Also, the study was underway at the same time as the World Health Organization (WHO) escalated its alert for swine flu to phase 5.

The results are comparable to a recent UK poll of almost 1,500 Nursing Times readers. It revealed that 30 percent of nurses said they would not have the swine flu vaccine.

The study documents that practically all countries with a pandemic flu plan intend to vaccinate healthcare workers as a priority group in order to protect the essential health infrastructure of their countries. However, this policy will only be successful if there is a high uptake of the vaccine.

Given the results of this study, lead author Professor Paul Chan from the Chinese University of Hong Kong mentions that a campaign to promote vaccination among healthcare workers is required.

Over 8,500 doctors, nurses, and related health professionals were surveyed. All were working at 31 hospital departments of internal medicine, pediatrics, and emergency medicine in Hong Kong.

Participants were initially surveyed from January to March 2009. This was when the WHO influenza pandemic alert was at phase 3. Then they were surveyed again in May 2009. At that point, the WHO raised its pandemic alert to phase 5 and it was the first time participants were specifically asked if they were willing to be vaccinated against swine flu. There was a response rate of 46.6 percent for the first survey and 48 percent for the second.

About 28 percent of respondents in the initial survey said they would be willing to be vaccinated against avian flu (H5N1).Interestingly, the authors explain, “no significant changes in the level of intention to accept pre-pandemic H5N1 vaccine were observed, despite the escalation to phase 5 because of the wide spread of H1N1 virus (swine flu).”

When the WHO alert level was at phase 5, 47.9 percent of respondents said they would be willing to be vaccinated against swine flu (H1N1).

The most frequent reasons for an intention to accept were:
• “wish to be protected”
• “following health authority’s advice”

The most common reasons for refusal were:
• “worry about side effects”
• “query on the efficacy of the vaccine”
• “simply did not want the vaccine”
People who said they would accept the swine flu vaccination tended to be younger. They usually had received the seasonal flu vaccine in 2008-9 and feared they were more likely to get swine flu.

The authors write in conclusion: “To our knowledge, this is the largest study conducted to assess the willingness of healthcare workers to accept pre-pandemic influenza vaccination, and it provides important information on barriers to vaccination. Campaigns to promote vaccination should consider addressing the knowledge gap of staff and the specific target groups for intervention.”

In an associated editorial, Rachel Jordan from the University of Birmingham and Andrew Hayward from the UCL Centre for Infectious Disease Epidemiology, emphasize that vaccination for healthcare workers is vital for their own protection and the safety of their patients. It could be of assistance to keep the NHS functioning at full capacity during the swine flu pandemic.

They claim that education and promotional campaigns alone have not been sufficient to convince healthcare workers to get vaccinated, “but the additional use of convenient mobile systems, monitoring and feedback systems, and the use of “opt-out” systems (where healthcare workers need to indicate their reasons for not accepting the vaccine) show promise.”

30% of nurses ‘don’t want’ flu jab

“Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys”
Josette S Y Chor, assistant professor, Karry LK Ngai, postdoctoral fellow,William B Goggins, assistant professor, Martin C S Wong, associate professor, Samuel Y S Wong, associate professor, Nelson Lee, associate professor, Ting-fan Leung, professor, Timothy H Rainer, professor,Sian Griffiths, professor,Paul K S Chan, professor
BMJ 2009; 339:b3391

“Should healthcare workers have the swine flu vaccine?”
Rachel Jordan,lecturer and NIHR research fellow, Andrew Hayward, senior lecturer

Written by Stephanie Brunner (B.A.)