Much of the American public has unofficially declared the influenza A(H1N1) pandemic of 2009-2010 over, even though health officials continue to urge Americans to get vaccinated.
The U.S. population spoke with its unrolled sleeves and averted nostrils. That's to say that during January, the period when the H1N1 vaccine was available to all U.S. residents and not officially limited to just those in high-risk groups, the pace of vaccination fell to the relatively low rate of about 9 million people immunized during the month. This was a significant drop compared with an average rate of about 20 million vaccinations per month from October through December, according to survey results and extrapolations made by the Centers for Disease Control and Prevention (CDC).
Interest in the H1N1 vaccine in January ran parallel with the low level of H1N1 infection that month. During the final week of January, the CDC's sentinel system found that 1.9% of physician visits involved influenza, with virtually all identified strains H1N1, compared with a national baseline level “during the off-season” of 2.3%, indicating infection rates were far from epidemic.
The prospects for much more H1N1 vaccine uptake by Americans seem dim, given results from a poll conducted Jan. 20-24 by the Harvard Opinion Research Program of Harvard University's School of Public Health, Boston. A telephone interview survey of more than 1,400 American adults found that 44% said the H1N1 outbreak was “over,” and only 32% had concern that they or someone in their immediate family might get sick from H1N1 during the next several months.
The poll also found that 61% of respondents had not received the H1N1 vaccine and did not intend to get it in the future, with 37% of those polled saying their major reason for shunning the vaccine was that they did not think the H1N1 outbreak to be as serious now as public health officials once thought.
“The skepticism of this group indicates that, going forward, it may be difficult to get more movement in the percentage of adults vaccinated for H1N1,” Robert J. Blendon, Sc.D., professor of health policy and political analysis at Harvard and director of the Opinion Research Program, said in a statement.
“The public aren't dummies. They figured out that despite the exhortations of the CDC to still get vaccinated [against H1N1] because the virus is still out there, at the moment it's a much quieter flu season than usual and so they are not lining up for vaccine,” said Dr. William Schaffner, professor and chairman of the department of preventive medicine at Vanderbilt University in Nashville. “In Tennessee, we have ample supplies of vaccine and few customers right now. The stock is not moving.”
CDC officials maintained their commitment to widespread vaccination of the American public against H1N1. At a media briefing in February, Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, warned that “many people believe the outbreak is over, and I think it's too soon for us to have that type of complacency. … My sense is that we are not at all out of the woods, because the [H1N1] virus continues to circulate. The chances of a very large, additional wave are very hard to predict.”
But indications are that the CDC will not meet a receptive public unless a third wave of widespread H1N1 infection does indeed occur before the end of the flu season this spring.
Statistics show the H1N1 vaccine never caught on in the United States. The approximately 70 million Americans who got the vaccine through the end of January—23% of the population according to CDC numbers—contrasts with the 32% of Americans who received the seasonal 2009-2010 flu vaccine through mid-November 2009, according to a survey by the RAND Corp. For the 2008-2009 season, 38% of American adults had received the seasonal flu vaccine as of March 2009, according to RAND.
Experts cite poor timing in the H1N1 vaccine's availability last fall, confusion about who was to get the vaccine based on its limited early supply, and concerns about the vaccine's safety.
“The vaccine was too little, too late in the public's mind,” said Dr. Gregory A. Poland, professor of medicine and director of the vaccine research group at the Mayo Clinic, Rochester, Minn.
“Vaccine availability peaked just as the second wave of the pandemic diminished.” The public “waited and waited for [the vaccine], and when it become available they stopped hearing reports of cases.” Another important factor was the “underlying distrust and suspicion about vaccines, with many Americans believing the vaccine was too rushed, untested, and not safe.”