title: Low acceptability of A/H1N1 pandemic vaccination in French adult population: did public health policy fuel public dissonance?
abstract: BACKGROUND
  In July 2009, French public health authorities embarked in a mass vaccination campaign against A/H1N1 2009 pandemic-influenza. We explored the attitudes and behaviors of the general population toward pandemic vaccination.
  
  
  RESULTS
  We conducted a cross-sectional online survey among 2,253 French representative adults aged 18 to 64 from November 17 to 25, 2009 (completion rate: 93.8%). The main outcome was the acceptability of A/H1N1 vaccination as defined by previous receipt or intention to get vaccinated ("Yes, certainly", "Yes, probably"). Overall 17.0% (CI 95%, 15.5% to 18.7%) of respondents accepted A/H1N1 vaccination. Independent factors associated with acceptability included: male sex (p = .0001); older age (p = .002); highest or lowest level of education (p = .016); non-clerical occupation (p = .011); having only one child (p = .008); and having received seasonal flu vaccination in prior 3 years (p<.0001). Acceptability was also significantly higher among pregnant women (37.9%) and other at risk groups with chronic diseases (34.8%) (p = .002). Only 35.5% of respondents perceived A/H1N1 influenza illness as a severe disease and 12.7% had experienced A/H1N1 cases in their close relationships with higher acceptability (p<.0001 and p = .006, respectively). In comparison to 26.0% respondents who did not consult their primary care physician, acceptability was significantly higher among 8.0% respondents who were formally advised to get vaccinated, and lower among 63.7% respondents who were not advised to get vaccinated (respectively: 15.8%, 59.5% and 11.7%- p<.0001). Among respondents who refused vaccination, 71.2% expressed concerns about vaccine safety.
  
  
  CONCLUSIONS
  Our survey occurred one week before the peak of the pandemic in France. We found that alarming public health messages aiming at increasing the perception of risk severity were counteracted by daily personal experience which did not confirm the threat, while vaccine safety was a major issue. This dissonance may have been amplified by having not involved primary care physicians in the mass vaccination campaign.
authors.affiliation: INSERM, U912: Economic and Social Sciences, Health Systems and Societies, Marseille, France. michael.schwarzinger@inserm.fr
authors.forename: Michaël
authors.initials: M
authors.lastname: Schwarzinger
authors.forename: Rémi
authors.initials: R
authors.lastname: Flicoteaux
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cortarenoda
authors.forename: Yolande
authors.initials: Y
authors.lastname: Obadia
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D053118:Influenza A Virus, H1N1 Subtype; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data; D058873:Pandemics / Q000517:prevention & control; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011640:Public Policy