Britons least likely to adopt protective behaviours against flu

A new international survey published in The Lancet Infectious Diseases has revealed that during the H1N1 influenza pandemic in 2009, people in Britain lagged far behind other countries in adopting protective behaviours, such as increasing their practice of covering their mouth with a tissue when sneezing or coughing.

Researchers questioned nearly 5000 people in Argentina, Japan, Mexico, UK, and USA about the protective habits they adopted during the 2009 H1N1 ‘swine flu’ pandemic, asking about non-pharmaceutical protective behaviours such as increased hand washing; social distancing behaviours such as avoiding hugging or kissing; and vaccination. 

Nearly three quarters (73%) of British people surveyed admitted that they did not cover their mouth or nose with a tissue more frequently when coughing or sneezing during the pandemic, and just under half (47%) of British people did not wash their hands or use hand sanitiser more frequently.

By contrast, almost four fifths (77%) of Mexicans made increased efforts to cover their mouth with a tissue when coughing and sneezing, and in all other countries surveyed, at least two thirds of people said that they washed their hands more frequently during the pandemic, with the highest proportion of respondents (89%) claiming this in Argentina.

The researchers found that uptake of non-pharmaceutical behaviours such as increasing hand washing and avoiding large gatherings did not appear to affect the uptake of vaccination, although they noted that vaccination uptake was low in all of the countries surveyed.  Mexico had the highest vaccination uptake, with a third (33%) of survey participants claiming that they had been vaccinated – in Britain, 21% of survey respondents said they had been vaccinated.

The researchers also examined whether respondents supported government recommendations to distance themselves from others in various ways or adopt additional personal protective measures during the flu pandemic.  In most countries, approval of these recommendations was fairly high, although again, Britons responded less enthusiastically, with around half of respondents saying that they would not have approved of government policies to avoid public places or wear a mask in public.

According to one of the study’s authors, Dr Gillian SteelFisher of the Harvard School of Public Health in Boston, USA, “The wide variations between countries in our study shows that in the event of another serious outbreak of infectious disease, public perceptions have to be taken into account to best tailor and communicate policy approaches that need public support in each country.” 

“Our findings suggest that promoting non-pharmaceutical interventions – such as handwashing and avoiding large public gatherings of people – do not jeopardise the adoption of vaccination, though the uptake of vaccines was low compared to other behaviours in all countries we surveyed.  To maximise the effect of pandemic policies, future efforts might need to combine vaccination programmes with support for the most effective non-pharmaceutical interventions.”

Writing in a linked Comment, Alison Holmes of Imperial College London, UK, adds that, “Providing an effective response to emerging infectious disease remains a pressing global health challenge.  Governments and international organisations have to promptly implement feasible and proportionate health protection measures, while accepting the limitations of the scientific evidence used to underpin those measures.  Establishing which protective behaviours are effective is not sufficient – we need to understand how populations make sense of recommendations and adopt them.”