The nation is in the midst of the largest mass vaccination campaign against flu in history, but about half the population is saying they are not interested.
Many have a sense that the vaccine was rushed to production, compromising safety. Some are convinced that it contains harmful chemicals.
Neither is right, federal officials say. But they are clearly worried about vaccine naysayers and skeptics.
A new panel of independent experts met Monday to review data on more than 10,000 people who have received swine flu vaccine. It is part of an effort to reassure those worried about side effects. So far, officials say, no danger signals have emerged.
Dr. Howard Markel at the University of Michigan says vaccine opposition comes in many flavors.
"The reasons are really all over the place," he says. "But there are enough people who are concerned about getting vaccinated that we as doctors and public health professionals have to at least listen to those people and try to convince them otherwise."
Markel, who has studied flu pandemics, says this one comes at a time when trust of authority has been eroding for decades. It is also a time when anybody with an ax to grind can get an instant Internet audience.
Conflicting Views On Government Response
Markel says he thinks government officials have been doing a pretty good job selling the new flu vaccine.
Peter Sandman, a consultant to the Centers for Disease Control and Prevention, disagrees. He specializes in communicating about risk.
"They've done an OK job talking to people about the virus," Sandman says. "They've done a terrible job, in my judgment — or at least a pretty poor job, I'll give them a C-minus — in talking to people about the vaccine."
Sandman says the CDC has failed to engage vaccine critics and doubters, and address their concerns in a way they can accept. For instance, he says, the CDC should set up an objective test to prove the vaccine does not contain an immune-boosting chemical called squalene, as some critics insist.
"Deep in their hearts, public health people think of themselves as the good guys. They wear the white hats," Sandman says. "That's really getting in the way of talking to a skeptical public."
Public health officials also believe so strongly in vaccines, he says, that it is hard for them to acknowledge many people's uneasiness.
"There's something deeply embedded in human psychology — something hard-wired — that makes us anxious about vaccination," Sandman says. "There's something intuitively weird about vaccination."
It seems unnatural to many people to inject something that causes a disease in order to prevent it.
An Alternate Message
"When you get the sort of generic mistrust of government combined with the intuitive distrust of vaccination, that's a potent combination," Sandman says.
Sandman advises the CDC to send a different message to skeptics. Something like this: "We'd rather see you get vaccinated now, or as soon as you can. But if you're skeptical, OK, we don't want to coerce you into rolling up your sleeves."
Sandman says it is better to let people make up their own minds after they've seen the evidence on whether the vaccine causes serious side effects, and whether the pandemic continues to worsen. There will still be vaccine around later for those who decide to get it.
Countering Misinformation
For now, the CDC is plowing ahead with its insistence that the vaccine is safe. It is also monitoring social media to keep track of the opposition.
"It's a really challenging communications environment we all work in these days," says Kristine Sheedy, who is in charge of marketing the new H1N1 vaccine.
"There's a lot of information out there that isn't all correct," Sheedy says. "And it can be frightening, and does call into question the information that we at CDC and other public health officials put out about vaccines. And that's having influence."
The CDC is trying to counter misinformation, but a shortage of the new vaccine has stalled the agency's planned $2 million media campaign until mid-December.
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