title: Analysis of public responses to preparedness policies: the cases of H1N1 influenza vaccination and gas mask distribution.
abstract: BACKGROUND
  During several months in 2009-2010, the Israeli population was asked to take part in two preparedness programs: Acquisition of gas masks against a potential chemical-warfare attack, and vaccination against the A/H1N1 influenza pandemics. Compliance with the first request was moderate and did not attract much attention, whereas compliance with the second request was very low and was accompanied by significant controversy. The aims of this study are to compare the public's attitudes towards these two preparedness campaigns, and to explore the roles of trust, reasoned assessment, and reflexive reactions in the public's response to governmental preparedness policies.
  
  
  METHODS
  The comparative analysis was based on a telephone survey of 2,018 respondents representing a cross-section of the adult Israeli population. Univariate analysis to describe associations of public response and attitude was performed by Chi-square tests.
  
  
  RESULTS
  A set of queries related to actual compliance, trust in credibility of authorities, personal opinions, reasons for non-compliance, and attitudes towards uncertainties was used to characterize the response to mask-acquisition and vaccination. In the case of mask-acquisition, the dominant response profile was of trusting compliance based on non-conditional belief in the need to adhere to the recommendation (35.6% of respondents). In the case of vaccination, the dominant response profile was of trusting non-compliance based on a reflective belief in the need for adherence (34.8% of respondents). Among the variables examined in the study, passivity was found to be the major reason for non-compliance with mask-acquisition, whereas reasoned assessment of risk played a major role in non-compliance with vaccination. Realization of the complexity in dealing with uncertainty related to developing epidemics and to newly-developed vaccines was identified in the public's response to the H1N1 vaccination campaign.
  
  
  CONCLUSIONS
  The newly identified profile of "trusting-reflective-non-complier" individuals should be of concern to policy makers. The public is not accepting governmental recommendations in an unconditional manner. This is not driven by lack of trust in authorities, but rather by the perception of the responsibility of individuals in confronting forthcoming risks. Nevertheless, under certain conditions the public may respond in a non-reflective way and delegate this responsibly to authorities in an uncontested manner. This leaves the policy makers with the complex challenge of interacting with a passive non-involved public or alternatively with an opinionated, reflexive public.
authors.affiliation: Genetic Policy and Bioethics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer 52621, Israel. baruchv@gertner.health.gov.il.
authors.forename: Baruch
authors.initials: B
authors.lastname: Velan
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.forename: Gilead
authors.initials: G
authors.lastname: Shenhar
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: Giora
authors.initials: G
authors.lastname: Kaplan
references.citation: Health Psychol. 2007 Mar;26(2):136-45
references.pmid: 17385964
references.citation: JAMA. 2009 Aug 19;302(7):795-6
references.pmid: 19690315
references.citation: Pediatrics. 2006 May;117(5):1532-41
references.pmid: 16651306
references.citation: Vaccine. 2010 Jul 12;28(31):4895-902
references.pmid: 20553769
references.citation: Vaccine. 2012 Feb 8;30(7):1255-64
references.pmid: 22214889
references.citation: Br J Gen Pract. 1990 Mar;40(332):114-6
references.pmid: 2112014
references.citation: J Urban Health. 2001 Jun;78(2):382-91
references.pmid: 11419589
references.citation: Ann Emerg Med. 1998 Aug;32(2):224-33
references.pmid: 9701306
references.citation: Eur J Immunol. 2009 Nov;39(11):2946-54
references.pmid: 19790188
references.citation: Infection. 2009 Oct;37(5):381-9
references.pmid: 19768379
references.citation: Vaccine. 2011 Feb 1;29(6):1173-9
references.pmid: 21167862
references.citation: Hum Vaccin Immunother. 2012 Sep;8(9):1272-82
references.pmid: 22894959
references.citation: Mayo Clin Proc. 2010 Mar;85(3):257-73
references.pmid: 20118381
references.citation: Adv Prev Med. 2011;2011:353207
references.pmid: 22229099
references.citation: BMC Infect Dis. 2011 Apr 14;11:92
references.pmid: 21492430
references.citation: Behav Res Ther. 1985;23(4):437-51
references.pmid: 3896228
references.citation: Hum Vaccin. 2011 Oct;7(10):1077-82
references.pmid: 21941096
references.citation: Hum Vaccin. 2011 Dec;7(12):1261-70
references.pmid: 22108039
references.citation: Vaccine. 2006 Jan 12;24(2):177-84
references.pmid: 16157422