Wednesday, January 06, 2010

NEJM Article on Emotional Epidemiology of H1N1 Vaccine

The latest issue of the New England Journal of Medicine has this apt perspective piece on the public's reaction to the H1N1 vaccine.

Here is a sample:

Last spring, when 2009 H1N1 influenza first came to our attention, my patients were in a panic. Our clinic was flooded with calls and walk-in patients, all with the same question: "When will there be a vaccine?"

It was all so new then, and we didn't have an answer. That lack of answer seemed to fuel anxiety to a fever pitch. A substantial cohort of my patients continued calling, almost on a weekly basis, to ask about the vaccine.

These, of course, were the same patients who routinely refused the seasonal flu vaccine. Each year we'd go through the same drill: I'd offer them the flu shot. I'd explain the clinical reasoning behind this recommendation. I'd strongly encourage vaccination.

"No, thanks," they'd say. "The vaccine makes me sick." Or "My brother had a bad reaction." Or, simply, "I don't do flu shots."

The irony was painful. No matter how often I trotted out the statistics of 30,000 to 40,000 annual deaths from influenza, the patients would not be moved. So when they demanded the H1N1 vaccine last spring, I reminded them of their reluctance over the seasonal flu shot. "Oh, that's different," they said.

Six months have passed. Flu season is now here. After repeated delays, H1N1 vaccine finally arrived in our clinic earlier this month to the uniform relief of the medical staff. But my formerly desperate patients were now leery. "It's not tested," they said. "Everyone knows there are problems with the vaccine." "I'm not putting that in my body."

I was unprepared for this response, but maybe I shouldn't have been. For weeks now, in the schoolyard of my children's elementary school, other parents had been sidling up to me, seemingly in need of validation. "You're not giving your kids that swine flu shot, are you?" they'd say, their tone nervous, if a bit derisive.

How to explain this dramatic shift in 6 short months? It certainly isn't related to logic or facts, since few new medical data became available during this period. It seems to reflect a sort of psychological contagion of myth and suspicion.