Vaccine manufacturing is big business. Intended to protect people against the strain of influenza known as swine flu, the H1N1 vaccine is raking in hundreds of millions of dollars for international pharmaceutical companies. More than 30 governments are buying H1N1 ingredients from Novartis, a Switzerland-based company, including the USA, whose order just misses the $290 million mark. Other large companies such as Sinovac in China, ADImmune Corporation in Taiwan, and the Government Pharmaceutical Organization in Thailand are also hard at work manufacturing the vaccine or its ingredients and supplying governments worldwide.

Despite the massive quantities of H1N1 being produced and marketed, a shortage was initially predicted. According to The New England Journal, twenty-five states , counties and cities in the USA received their first shipments of the H1N1 vaccine in the first week of October, but those shipments were earmarked for high-risk people. NECN.com stated, “The initial shipments are so small, that most states are reserving them for health workers and in some cases, children.” However, by mid-October, 40 million H1N1 doses will become available, and the supply is expected to increase gradually going forward.

With so much effort and money being poured into the manufacture of H1N1, you’d expect that Americans would be flocking to be vaccinated—especially health care workers, who are at higher risk. However, this doesn’t seem to be the case. Despite the World Health Organization’s public statements of confidence regarding the H1N1 vaccine and reiterated calls for mass vaccination, a Consumer Reports poll implied that only about 30% of Americans have a definite intention to get the H1N1 vaccine. Nearly 50% of Americans are still undecided.

As for health care workers, the Las Vegas Review-Journal published an article by Paul Harisim that indicates a marked reluctance from local medical providers and first responders to receive the H1N1 vaccine. According to the October 13 article, only around a dozen of the Las Vegas Fire Department’s 550 emergency first responders chose to get the vaccine, which was offered at a clinic at the Southern Nevada Health District.

Department spokesman Tim Szymanski is quoted as saying, “I know I’m leery about a live virus going into me….My wife is a nurse and she feels the same way.”

The form of the vaccine offered at the Southern Nevada Health District was FluMist, which is sprayed into the nostrils rather than being injected. The official FluMist website claims, “FluMist helps your body develop…antibodies that help protect you from the flu….Like the chicken pox vaccine, FluMist is a weakened live virus vaccine. That means it is made from a live virus that has been designed not to cause the flu.” The website also cites a 2004-5 study that showed that children who received FluMist had fewer cases of flu than those who received a traditional shot.

If FluMist is being marketed as totally safe, why are health care providers wary about receiving it? Paul Harisim quotes the head of the emergency department at University Medical Center in Nevada as saying, “A significant number of health care workers, paramedics and firefighters are concerned about the FluMist.”

However, it’s not just FluMist—health care workers are refusing all forms of H1N1 all across the world, from New York city to Hong Kong. According to the employee health coordinator for Springfield-based Memorial Health System, only 40 percent of health-care workers nationwide get flu shots each year. A Canadian study published in Emerging Health Threats Journal indicated that health care workers don’t want to get the vaccine because they perceive flu as a mild condition.

Some proponents of the H1N1 vaccine put the reluctance of health care workers down to “misinformation” or “lack of education.” But is lack of education really the root of the issue? Bulgaria, China, and Portugal reported their first H1N1 deaths recently, and over 100 people have died in the USA. Nobody is saying that these deaths are exaggerated or fabricated. Health care workers, including first responders and nurses, have the benefit of specialized training and are encouraged to keep up with current research as part of their jobs, and information about the ingredients and side-effects of H1N1 is widely available. It seems unlikely that the bulk of the health care field is making a knee-jerk decision against the H1N1 vaccination.

Perhaps the reluctance of health care providers has more to do with their perception that they are being coerced into making a decision. One health care provider posted an anonymous comment on the ACPInternist blog, saying, “Once a year I am forced to receive a tuberculosis skin test. Usually after this test I get a bad cold or flu. Now I am expected to serve as a guinea pig for the new H1N1 vaccine.”

Nobody likes to be told what to do, especially when it comes to health. Whatever the reasons for health care workers’ refusal of the H1N1 vaccine, name-calling and condescending comments will likely not change their minds. And where health care workers are reluctant, how can the American public be expected to boldly go?

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