Physician survey shows mixed views on pandemic risk

Jun 6, 2007 (CIDRAP News) – Fewer than half of physicians who responded to a survey at a recent conference in Europe said they thought an influenza pandemic was very likely in the next few years, according to a report in the journal Archives of Disease in Childhood.

The survey was an anonymous electronic poll conducted at a pediatric infectious disease course at Oxford University in England. The group included 161 physicians, mostly from Europe, with half from the United Kingdom. The poll was conducted by Nigel Curtis of the University of Melbourne (Australia) and Andrew Pollard of Oxford.

The findings, published early online, revealed that only 72 (44.7%) of respondents took the view that an avian influenza pandemic is "almost inevitable" or "very likely" within "the next few years."

Seventy-three physicians, or 45.4%, thought a pandemic was "possible" in that time span, while 16 (9.9%) viewed such an event as unlikely or very unlikely.

The researchers also asked if attendees had gathered a supply of the antiviral drug oseltamivir for personal or family use. Only 11 (7.9%) of 139 respondents said they had. By training level, only 1 of 27 infectious disease specialists reported having acquired the antiviral, but among those in infectious disease training, 5 of 24 (17.2%) had their own supply.

The authors concluded that the survey contains some mixed messages about physicians' perceptions of pandemic risk. Despite widely publicized evidence that the world faces a serious threat of a pandemic, more than half of the respondents "did not believe the risk of an imminent influenza pandemic was more than a possibility," the report says. However, a "significant minority" of the doctors believed the risk was high enough to warrant gathering their own antiviral supply, despite recommendations against personal stockpiling.

"If the perceived risk of an influenza pandemic observed in our survey is reflected in the wider medical community then it is perhaps not surprising that doctors are largely silent about this issue," the authors write. They add that the reasons for physicians' attitudes warrant further investigation if they are to help alert the world to the threat of a pandemic.

Sarah Long, MD, chief of infectious diseases at St Christopher's Hospital for Children in Philadelphia, said she has spoken at the same Oxford conference before and knows the audience. "It's a very educated group, with a lot of doctors in training," she told CIDRAP News.

Long wasn't surprised by the survey results, but she said they may give a false impression that physicians don't take the pandemic threat seriously, because qualifiers such as "possible" may not accurately gauge what people think. "Some might think 'probably' is associated with inevitable in the next 2 or 3 years," she said. "Some of us are lumpers, and some of us are splitters."

Concerning antiviral stockpiling, Long said, "I'm pleased that such a small number [of survey respondents] have their own stockpile." Antiviral supplies should be reserved for early responders and patients who need them, but other countries may have different views on physicians' keeping their own supply, Long added.

Peter M. Sandman, PhD, a risk communication expert from Princeton, N.J., and a columnist for the CIDRAP Business Source Weekly Briefing, questioned the authors' interpretation of their survey findings, saying they equated pandemic inevitability with pandemic imminence. "We are on solid ground when we say another flu pandemic is nearly inevitable. We are on extremely weak ground when we say that it's probably imminent, and we are doing terrible science and terrible risk communication when we conflate the two claims," he told CIDRAP News.

Sandman said that in the face of a dramatic decline in media coverage of H5N1 avian flu, the finding that 45% of physicians thought a pandemic was inevitable or very likely represents a sustained concern, rather than complacency. "The data suggest, if anything, that European physicians share the hunch that H5N1 makes a pandemic likelier than usual," he added.

"It is good news that many of Curtis and Pollard's respondents still think a pandemic may well be imminent," Sandman said. "But it would be better news if they realized that nobody has a clue whether a pandemic is imminent or not, and if they understood that preparedness doesn't depend on whether a pandemic is imminent or not."

Curtis N, Pollard PJ. Physicians' perception of pandemic influenza. Arch Dis Child 2007 May 10 (early online publication) [Abstract]

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