Study: Most Americans Skeptical Of H1N1 Vaccine

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, in our international briefing today, we'll talk about the status of gay rights in Africa. Homosexuality is illegal in most African countries with one notable exception. Now, a new bill in Uganda proposes the death sentence for gays who are HIV positive and sexually active. We'll talk with a gay rights activist in Uganda to ask how the LGBT community is responding.

But first, here at home, flu season is here and it's hard not to be bombarded by news about the H1N1 virus, especially the push by health officials to vaccinate pregnant women and young children.

But apparently, most Americans are not yet persuaded of the need. In fact, in a new nationwide survey by the University of Michigan says only 40 percent of parents are planning to have their children get the H1N1 flu vaccine, far fewer than those who plan to get their children the seasonal flu vaccine.

We wanted to know more, so we called Dr. Matthew Davis who directed the poll. Dr. Davis is an associate professor of pediatrics, internal medicine and public policy at the University of Michigan. Also joining us is Dr. Howard Markel. He's a professor of pediatrics and medical history at the University of Michigan and an advisor to the Centers for Disease Control. Welcome to you both or welcome back in Dr. Markel's case, I should say.

Dr. MATTHEW DAVIS (Pediatrics, University of Michigan): Well, thank you for having us.

Dr. HOWARD MARKEL (Pediatrics, University of Michigan): And good to be with you.

MARTIN: So Dr. Davis, the findings, as we said, only 40 percent of the parents you surveyed plan to have their children get the H1N1 vaccine. That's compared to 54 percent who plan to get the seasonal flu vaccine. What reasons do the parents cite for not wanting to get the H1N1 flu vaccine?

Dr. DAVIS: Well, Michel, we asked that question exactly to the parents and found out that about one half were worried about side effects of the H1N1 vaccine and about another half were not worried about children getting the H1N1 flu itself. About 20 percent felt that H1N1 just simply is not a serious disease and therefore they don't need to protect their kids with a vaccine.

MARTIN: And what about the - were you able to identify why they're worried about side effects?

Dr. DAVIS: Well, you know, the level of parental concern about side effects for vaccines has apparently been rising over the last few years. And I think parents are wisely asking their physicians and other health care providers about the safety record for vaccines. The interesting thing here in this case is that the H1N1 vaccine is manufactured with the very same processes and manufacturing platform that the seasonal flu vaccine has. And the seasonal flu vaccine for children has had a really great safety record over the last several years for which it has been regularly recommended for young kids.

MARTIN: Well, may be parents don't know that, though.

Dr. DAVIS: That's certainly possible. And the movement out there that is certainly galvanizing concern about vaccines is a very effective one and well spoken one. In contrast, the public health community seems to be having some challenges in trying to reach out to parents and convince them that these newer vaccines are safe.

MARTIN: I was going to ask Dr. Markel about that because he studied the history of medicine. Dr. Markel, historically, are Americans distrustful of new vaccines or is this a relatively new phenomenon?

Dr. MARKEL: Oh no, it has a very long history. It goes back all the way to small pox vaccines in the late 18th century. One of my favorite stories is about John Adams and a friend getting their small pox inoculation and watching each other throw up as they got sick from the side effects. And so, there are lots of ingrained perceptions of the dangers of these vaccines and some vaccines in the past frankly were dangerous.

But as Dr. Davis just pointed out with the influenza vaccine whether it's H1N1 or seasonal, we have an incredible track record with millions and millions of children and adults who have underwent this vaccine with no untoward effects and in fact was great benefit.

MARTIN: It's interesting you raised the John Adams story because my favorite story is Abigail Adams who made the decision to get her children vaccinated on her own because he was away. So, she had to figure it out on her own.

Dr. MARKEL: Absolutely.

MARTIN: So, that's the part of the story that I like. So�

Dr. MARKEL: It was very dangerous - it was very dangerous back then too, you were inoculating, literally putting in small pox virus into people's arms. Very different process than what we use today.

MARTIN: Dr. Davis, your poll says - on a separate issue, your poll says that African-Americans were the least likely to say they plan to vaccinate their children. But unlike a number of other areas, black parents and white parents weren't that far apart on this issue. Thirty percent of black parents said they would definitely or probably get their kids vaccinated, 38 percent of white parents said the same, but Hispanic parents were the most likely to say, they were going to get their children the H1N1 virus if they could. Fifty two percent of Hispanic parents said they probably or definitely would get their kids vaccinated. What do you make of that?

Dr. DAVIS: Yes, Michel, this is one of the most remarkable findings from our study. Usually what we've seen is that Hispanic parents have the same level of enthusiasm as non-Hispanic white parents, and for other vaccines sometimes African-American parents are not as interested in getting their kids vaccinated. But here we have very similar levels for non-Hispanic white and black parents and much higher rates of interest among Hispanic parents. What we think is responsible for that is the fact that the H1N1 outbreak began and was very severe in Mexico.

And because about two-thirds of Hispanics in the U.S. are of Mexican origin, they may have either contact with people who have had personal experience with H1N1 or knew somebody who was severely affected by it or they may have a greater sense of vulnerability to this particular illness.

MARTIN: More of a sense of awareness, that sort of a high awareness of it, that's interesting. It's interesting. So Dr. Davis, though in general, is ethnicity a big factor in determining whether kids get basic vaccinations or does the divide tend to happen on things that are optional like seasonal flu vaccine which is not required, as I understand it?

Dr. DAVIS: Well, it's important to say that no vaccines are required by the government. Vaccines are recommended by the government. States, depending upon the vaccine, require vaccines for school and daycare entry. So, the question is about race and ethnicity and whether that's as important as other factors in terms of who gets vaccines among kids. And over the last several years, Michel, what was actually been seen is that the gaps between kids of different racial or ethnic background have been narrowing. But what we've been seeing is a persistent effect of income on vaccination rates. And so, kids living in poverty are less likely to be vaccinated than kids not living in poverty and that unfortunately speaks to the persistent disparities in the U.S. related to income and health care access.

MARTIN: If you're just joining us, this is TELL ME MORE from NPR News and we're talking about a recent poll that suggests that most American parents are not convinced of the need to or are not planning to get their children vaccinated against the H1N1 virus. We're talking about this with doctors Matthew Davis and Howard Markel. Just one more thing, Dr. Davis, this poll was taken in August and I do wonder - I mean the survey was taken in August and I do wonder if now the flu season is actually here and that more parents will have experience with flu clinics, for example, that are now up and running so they can get the natural experience, real world experience or feedback from their friends and neighbors about how these things are actually going whether the results might be different if you were taking the poll today?

Dr. DAVIS: Well, Michel, I think that's a great point and this is such a fast moving picture and a difficult to manage picture that it's almost certain that what we would find today is different than what we heard from parents in August. But these are the latest data about what parental intentions are and we want to bring these differences by race to your audience because we think it represents a different way that parents are thinking about the risks of flu out there.

MARTIN: And, Dr. Markel, as again you studied this, so the history of these things as well as teaching, you know, pediatrics and so forth, how - I don't know if you feel you have recommendations about how health officials should go about addressing the concerns that parents have, certainly a concern about costs. I noticed in the survey that some parents were worried that 23 percent of those who said they were not planning to get their children vaccinated were worried about the cost. I think that officials have been addressing that by offering free clinics. But how else should the government go about addressing these concerns and how has this been handled in the past? What's worked and what hasn't worked?

Dr. MARKEL: Well, cost is important. And as Matt brings up, you know, health disparities in this country keep a lot of people from getting all sorts of medical interventions or preventive measures. But I think the best way that the Public Health Administration can handle this is very similar to the way we doctors handle it - one on one. You know, doctors are teachers and they have to teach people about various vaccines or medications or health interventions all the time.

And the best way is to simply ask the patient or the parent what are your concerns and to address them honestly and openly. What has really changed over time - and I think much to organized medicine's credit - is that 50 or 100 years ago, we would dismiss such complaints or queries out of hand. We tend to listen to those very carefully now. And I think that's why things are moving so quickly. That those people who are afraid of vaccinations, whether it's flu or some other infectious disease, whether it's for themselves or for their children, is not a monolithic community.

And there's many different reasons as there are groups or individuals who may have concerns about them. Some are divided by ethnicity or race. Some are divided by economic status. Some are divided just based on the intellectual information that they have available to them. So we have to do a better job of communicating, communicating and communicating. And, you know, the best way to avoid terrible influenza is to roll up your sleeve and get an injection.

MARTIN: And it makes me wonder, and forgive me if I'm asking you to be speculate, but the White House issued a statement saying that the Obama girls were vaccinated with H1N1 virus at the same time it became available to all school children in the District of Columbia where they live and where they go to school. But there was no picture released, and I wonder if it might have been helpful if they had made a bigger deal out of it. Obviously, as parents, they have the right and responsibility to make these decisions for their children. And they've done a very - they've made a very determined decision, as most parents do, in that situation to not expose their children to a lot of press attention. But I do wonder, in this case, if you think it might be helpful. Very briefly, Dr. Markel.

Dr. MARKEL: I think it would. I think it was a great move. I think it was a very good thing to have the two Obama girls vaccinated. There may be a historical reason for no photographs. You may recall in 1976 when the swine flu vaccines were going around that time, which was not a successful story.

Gerald Ford rolled up his sleeve and had his injection in the Oval Office and that was on the front page of newspapers all around the world. And so I wonder if some staffer may have recalled that and said, well, maybe we don't want to advertise this too much. But, I think, it's a very good idea. I mean, people ask me too, I mean, doc are you going to get it?

MARTIN: Are you?

Dr. MARKEL: Absolutely.

MARTIN: Okay.

Dr. MARKEL: Because I'm ready. I already had my seasonal. I'm waiting for my H1N1. Absolutely.

MARTIN: Okay.

Dr. MARKEL: So will my children.

MARTIN: All right, Dr. Howard Markel is a professor of pediatrics and medical history at the University of Michigan. He's an advisor to the Centers for Disease Control and he joined us from WUOM in Michigan. Dr. Matthew Davis is an associate professor of pediatrics, internal medicine and public policy at the University of Michigan. He is also the director of the C.S. Mott Children's Hospital National Poll on children's health. He was kind enough to join us by phone from San Diego, California.

And if you want to read the poll we're talking about in its entirety, we'll have a link on our Web site. Just go to npr.org, click on programs and TELL ME MORE. Thank you doctors both for speaking to us.

Dr. MARKEL: Thank you.

Dr. DAVIS: My pleasure.

(Soundbite of music)

MARTIN: Coming up, a plot to topple an African government goes awry and one of the perpetrators walks away. Plus, what does it mean to be gay in Africa.

Mr. DAVID KATO (Advocacy Investigation Officer, Sexual Minorities Uganda): The moment the state gets interested in your sexual practices, I think people are quite right to be wary.

MARTIN: That's coming up on TELL ME MORE from NPR News. I'm Michel Martin.

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