Health care providers play a critical role in H1N1 vaccinations

Patients and parents expect health care providers to have information about new vaccines. So, when a new H1N1 vaccine became available in October 2009, the question was: Would health care providers recommend it?

Results from the latest C.S. Mott Children's Hospital National Poll on Children's Health indicate health care providers play a critical role in influencing parents and patients to vaccinate their children and themselves against H1N1 flu.

The poll found that 29 percent of children and 16 percent of adults have received H1N1 vaccine, as of January 2010. Vaccination levels were more than two to three times as high when parents thought their children's providers strongly recommended the vaccine (66 percent) and when adults perceived strong recommendations from their own providers (57 percent).

"For H1N1 vaccination among kids and adults, it looks like the advice of health care providers is tremendously important," says Matthew Davis, M.D., director of the poll and associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the U-M Medical School. "Our study indicates that the impact of provider recommendations on H1N1 vaccination goes in both directions," says Davis.

For patients and parents whose health care providers strongly favored H1N1 vaccination, immunization rates were much higher than average. But if providers were less positive about the vaccine or even neutral—neither for nor against it—then H1N1 vaccination was much less likely, Davis says.

Among parents who had communicated with providers about H1N1 vaccine, only 38 percent reported that providers strongly recommended H1N1 vaccine for their children; 35 percent of parents perceived that the providers were neutral.

Among adults who had spoken with providers about H1N1 vaccine, 22 percent reported that providers strongly recommended the vaccine, while 55 percent perceived that their providers were neutral.

"Information on safety and effectiveness of H1N1 vaccine was not available until shortly before the vaccine became available in October," says Davis, who is a primary care pediatrician and internist and also associate professor of public policy at the U-M Gerald R. Ford School of Public Policy. "But patients were asking me what I thought about this vaccine as early as July. Many health care providers may have had less information than usual about this vaccine, just because of the timing of the pandemic and vaccine production. As a result, many providers may not have felt comfortable making strong recommendations in favor of the H1N1 vaccine, even if they typically recommend seasonal flu vaccine and other approved immunizations."

The poll also found that public health efforts to expand the availability of H1N1 vaccine in different community settings have been successful. While a doctor's office was still the most common vaccine site for both children (53 percent) and adults (44 percent), about one-quarter of children were vaccinated at school clinics and one-third of adults received the H1N1 vaccine at a city, county or state health department. Pharmacies, grocery stores, retail clinics and workplace clinics accounted for 21 percent of adult H1N1 vaccinations.

"To achieve vaccination of about 30 percent of children and almost 20 percent of adults in just 3 months with a new vaccine is a major accomplishment," says Davis. "With newly approved vaccines for kids and adults, we usually see uptake rates in the first year at around 10 percent. But with H1N1 vaccine the levels are considerably higher. It looks as if the coordinated national, state, and local efforts to protect the population against H1N1 have helped increase public acceptance of the vaccine in this early period. When patients heard those messages in combination with strong recommendations from their health care providers, most decided to get vaccinated or vaccinate their children."

Among those who have not yet received the H1N1 vaccine, 11 percent plan to get vaccinated in the upcoming weeks, while 25 percent plan to get vaccinated if the H1N1 outbreak worsens.

The overall H1N1 vaccination rates in this poll (29 percent among children; 16 percent among adults) are very similar to national statistics reported by the Centers for Disease Control and Prevention using a telephone survey (29 percent among children; 17 percent among adults) during the period December 27, 2009-January 2, 2010.