In a few weeks, every adult in Canada will decide if they (and their children) will get the ﬂu vaccine to protect against H1N1. At the best of times, it seems the decision of whether or not to get the seasonal ﬂu shot is tough to make. Only about one-third of Canadians do each year. Now, with the pandemic vaccine arriving in doctor’s ofﬁces in November, Canadians are being asked to get a second shot this fall.
But will they? Probably not. A recent poll shows that, as of the ﬁrst week of October, only one in three Canadians plan on getting the H1N1 vaccine, according to Harris/Decima. That’s down from 45 per cent in late August. Experts say this reﬂects the public’s growing apathy toward the pandemic in light of seemingly contradictory information about H1N1 (which is commonly referred to as swine ﬂu, even though it’s a combination of ﬂu viruses from pigs, birds and humans). People are being bombarded by “on the one hand” and “on the other hand” studies and recommendations. “There is confusion,” says Dr. Sarah Kredentser, president of the College of Family Physicians of Canada. “And I think it’s warranted confusion, because the messages keep changing.”
Only last spring, the world was expecting the worst: thousands of cases of H1N1 in Mexico caused its capital city to shut down. Many countries, including Canada, issued travel advisories urging people to cancel their trips. There were calls to have international borders closed. News footage emerged of citizens wearing aseptic white masks, with only their fear-ﬁlled eyes visible. Terrifying stories cast back to the Spanish ﬂu outbreak of 1918. And daily—sometimes twice a day—the World Health Organization issued updates, and elevated its phase of alert until ﬁnally, in June, came the most ominous declaration yet: H1N1 was a full-blown pandemic.
That sparked one of the most dramatic public health responses of our time. Health Canada began preparing our stockpile of top-notch antiviral drugs for distribution in case Canadians started getting severely sick. Companies installed hand sanitizer stations at every door. Minor hockey leagues directed coaches to make sure all players had their own water bottle. And then the biggie: the federal government ordered enough H1N1 ﬂu vaccines for every man, woman and child across the country who would want or need one—more than $400 million worth—and notiﬁed the provinces that the shots would be ready for the fall and winter onslaught.
And yet, the majority of Canadians say they won’t bother being vaccinated—even though Health Canada is resolute, as are other medical bodies, that everyone should get the pandemic shot. Experts believe that “trust issues” are developing between Canadians and public health authorities. “People are feeling like there’s mixed messages coming out,” says Natalie Henrich, a bio-cultural anthropology researcher at the B.C. Centre for Disease Control, and that’s contributing to “a possible erosion of conﬁdence in what health ofﬁcials are saying.” Some Canadians are checking out of the debate altogether because they’ve had enough of trying to keep up. “People throw their hands up in the air and say, ‘I don’t know how to decide what I should do or not, so I’m not going to do any of it,’ ” says Henrich.
There are good reasons for the confusion. For starters, despite the pandemic alert, the H1N1 virus has been mostly mild. While any number of fatalities is a tragedy, in Canada, death has been the least common outcome of the H1N1 ﬂu—79 people have died across the country as of the ﬁrst week of October. In most cases, the pandemic ﬂu causes minor symptoms such as coughing and fever, and the majority of infected people fully recover in a few days. “Right now,” says Henrich, “people don’t see the virus as particularly threatening.”
When the H1N1 ﬂu does prove severe or lethal, it’s often a surprising group of Canadians who are the victims—young adults, especially women. Usually, the elderly and children with other medical problems are the most susceptible to the seasonal ﬂu and its killer potential. The fact is, each ﬂu attacks different groups. H1N1 also hits people who have underlying health problems such as diabetes, asthma and heart disease particularly hard. That’s bad news in a country where these conditions are common: “The growth of people living with chronic disease in most of the developed world has been tremendous over the past decade,” says Sandra Crouse Quinn, professor of behavioural and community health sciences at the University of Pittsburgh, adding, “They’re going to be at a higher risk” for H1N1 complications.
And there’s confusion about some rather serious logistical matters. An unpublished study has revealed that among a group of Canadians who had the seasonal ﬂu vaccine ﬁrst, their risk of contracting the H1N1 pandemic virus was 1 to two times higher. A vociferous debate erupted over when people should get each ﬂu shot. That’s led some provinces and territories to change the order of the vaccines—giving the pandemic shot to most people before the seasonal one. Those different decisions, say experts, don’t alleviate public concerns. “You’ve got this variation in policy between the provinces,” says Dr. Donald Low, microbiologist-in-chief at Mount Sinai Hospital in Toronto, which “just adds fuel to the ﬁre.”
The H1N1 vaccine schedule has also been complicated by an editorial in the Canadian Medical Association Journal, which warned that the federal government’s plan to deliver 50.4 million pandemic shots in November is too late for at-risk people. The editorial also raised the issue of using a pharmacological agent called an adjuvant in the H1N1 vaccine to boost people’s response to the vaccine. Until now, adjuvants have never been used in Canadian ﬂu shots. “So when people hear you not only have a new vaccine,” says Low, “but you have a vaccine that has an adjuvant, that’s just a little bit more reason for concern.”