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A new report released today says that a majority of Americans have a positive impression of the U.S. government’s response to the H1N1 pandemic, but many citizens would not get a vaccine in the future either because they may believe that the illness does not pose a serious health threat or over concern about its safety.

The report, “The Public’s Response to the 2009 H1N1 Influenza Pandemic,” reviewed 20 national opinion polls, including eight by Harvard School of Public Health (HSPH) researchers, taken during the 2009 H1N1 pandemic. It was authored by HSPH’s Gillian K. SteelFisher, and Robert J. Blendon, Professor of Health Policy and Political Analysis. The analysis appears as an Online First Perspective in this week’s New England Journal of Medicine:

Throughout the H1N1 pandemic, more than half the U.S. population appeared to have a positive impression of the government’s response, although a sizable minority did not. For example, in the early days of the pandemic, 54% believed the response of the federal government was appropriate, whereas 39% believed the government had overreacted (CNN, May 2009). Nine months later, in January 2010, 59% believed that public health officials did an excellent or good job in their overall response to the pandemic, whereas 39% believed they did a fair or poor job (HSPH, January 2010)…

Our review of these data suggests that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine because they may believe that the illness does not pose a serious health threat, because they (especially parents) may be concerned about the safety of the available vaccine, or both. More work may need to be done to understand the basis of these beliefs and to address them in the case of a serious influenza outbreak.

Parental concern must be better addressed in any future pandemic vaccine rollout, according to the HSPH press release:

First, many people who did not get the vaccine were not convinced that the illness was a serious threat to them personally. In one January poll, 30% of people who would not or might not get the vaccine said a “major reason” was their belief that they were not at risk of serious illness and 37% said the H1N1 outbreak was not as serious as public health officials once thought. A second reason for not taking the vaccine was concerns about the safety of the vaccine. This was especially a concern for parents. In one poll, 56% of parents who were not going to or might not get the vaccine said a “major reason” for their decision was their concern about “safety risks from the vaccine,” compared to 35% of adults making the same decision for themselves about the H1N1 vaccine.

“These findings suggest that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine,” said SteelFisher. “Public health officials who want to encourage vaccination must better understand and address the beliefs and concerns of those who chose not to get the H1N1 vaccine.”

Polls during the 2009 H1N1 pandemic also suggest that public health communication efforts related to other personal influenza prevention behaviors, like hand-washing and staying clear of people with flu-like illness, were effective in reaching a large swath of the public. Even early in the outbreak, a large majority of people (59%-67%) said they had washed their hands more frequently due to H1N1, according to polls in April, May and June 2009.

“Building on these self-protection measures, as well as a vaccine strategy, may be useful for future response planning and throughout an outbreak,” said Blendon.

Michael Coston at Avian Flu Diary says that the survey results indicate a potential public complacency issue:

The concern here is that the impressions left by the experience of 2009 may mean that a lot of people may not be quick to accept a pandemic vaccine in the future. It is the same sort of reaction we see in Florida, and along the Gulf and Atlantic Coastline, after every hurricane season.

People who emerged unscathed, or who may have ridden out a weaker storm, come away believing that they’ve seen a hurricane . . . and they weren’t particularly impressed. People who evacuated upon the order (or advice) of local officials, only to return and find their house intact, are less likely to evacuate in the future. But of course, all hurricanes aren’t created equal. And basing your future expectations on the last storm can be a fatal error.

The same holds true for pandemics. As epidemiologists like to say, “If you’ve seen one pandemic . . . you’ve seen one pandemic.”

Although there were some missteps along the way (particularly in the overpromising of vaccine supplies in October and November) the HHS and the vaccine manufacturers pulled off a considerable coup by delivering a safe and effective vaccine a month sooner than originally anticipated. Despite the ominous warnings of the anti-vaccine contingent, we have not seen any spike in Guillain-Barre syndrome, or any other serious vaccine related side effects.

The pandemic shot has proven to have roughly the same safety profile as the seasonal flu shot, which is excellent. Unfortunately, the message that the `vaccine is deadlier than the virus’ continues to persist – particularly online – and that raises doubts in many people’s minds.

While everyone is happy that the pandemic of 2009 proved less deadly than first feared, the public complacency that this has engendered may prove to be a substantial obstacle the next time we face an emerging public health threat.