Pandemic report warns against 'flu fatigue,' complacency

Nov 10, 2010 (CIDRAP News) – A review of several after-action pandemic assessments released today shows that earlier investments in emergency preparedness were helpful, but serious gaps such as low flu vaccination rates in minority groups and continued erosion of public health infrastructure could undermine response to the next national health emergency.

The big-picture view of the nation's pandemic response was provided by the Trust for America's Health (TFAH), a nonprofit health advocacy group based in Washington, DC. Jeffrey Levi, PhD, executive director of TFAH, said today at a press conference that reviewing the pandemic lessons raises important public policy issues. "The nation is at a crossroads," he said. "We can go back to complacency or build on the momentum of our pandemic efforts."

The report, titled "Fighting Flu Fatigue," comes as seasonal flu vaccination campaigns ramp up across the nation during the first year of the federal government's universal flu immunization recommendation. However, the TFAH report notes that the recommendation faces a stiff headwind: one public opinion poll showed that only 37% of respondents planned to get this season's flu vaccine.

During last year's seasonal and pandemic flu vaccine campaigns, public health officials saw immunization rates rise for children, especially in areas where school-based vaccination clinics were held. Years of flu vaccination messages targeted to seniors have pushed levels in that group to high levels, but rates have foundered in adults, minority groups, and even healthcare providers, the TFAH report points out.

To increase vaccination rates, TFAH said a major campaign is needed to educate people about the need for an annual flu shot and to increase access to the vaccine, even in those who are uninsured or don't receive regular medical care.

Litjen (L.J.) Tan, PhD, the American Medical Association's director of medicine and public health, told reporters that elevating seasonal flu vaccination for all groups will require a culture change and an underlying message that flu is unpredictable and can be serious. "Flu vaccination needs to be a routine part of fall and winter activities," he said, adding that getting a flu shot this time of year should be as common as other seasonal icons, such as turkey, Christmas presents, and New Year's parties.

One strategy to increase uptake is to target high-priority groups, especially minorities. TFAH, citing figures from the US Centers for Disease Control and Prevention (CDC), said 2009 H1N1 vaccination levels were lower for African-Americans and Hispanics and that pandemic flu hospitalization rates for those two groups, plus Native Americans, were nearly twice as high as rates for whites.

Flu vaccine campaigns aimed at minority groups need to address negative beliefs and misinformation and should be delivered through a variety of channels, including trusted religious and community leaders, the report says. Levi said long-term relationships between public health and minority groups that address health issues that the communities deem important on an ongoing basis, such as chronic health conditions, can help pave the way for better acceptance of flu vaccination messages.

TFAH said a major flu vaccination campaign would also include increased access to flu shots, with a focus on more affordability and convenience, and incentives for healthcare workers to be immunized.

When the new H1N1 virus emerged in the spring of 2009, the federal government quickly responded with emergency supplemental and contingency funding. "However, the emergency funding could not backfill long-existing gaps in the nation's public health infrastructure," the report says.

The nation's response to the pandemic seemed to validate the importance of planning, but plans are effective only if the public health infrastructure, which includes surveillance, lab capacity, and the workforce, is strong enough to carry them out, TFAH points out. Other key response areas that are vulnerable to the pressures of limited resources include surge capacity and updated pharmaceuticals, vaccines, and medical equipment.

The Robert Wood Johnson Foundation supported the TFAH report, which is available on the group's Web site.

See also:

Nov 10 TFAH "Fighting Flu Fatigue" report

Nov 10 TFAH press release

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