Assessing and Responding in Real Time to Online Anti-vaccine Sentiment during a Flu Pandemic

The perceived safety of vaccination is an important explanatory factor for vaccine uptake and, consequently, for rates of illness and death.The objectives of this study were (1) to evaluate Canadian attitudes around the safety of the H1N1 vaccine during the fall 2009 influenza pandemic and (2) to consider how public health communications can leverage the Internet to counteract, in real time, anti-vaccine sentiment.We surveyed a random sample of 175,257 Canadian web users from October 27 to November 19, 2009, about their perceptions of the safety of the HINI vaccine.In an independent analysis, we also assessed the popularity of online flu vaccine-related information using a tool developed for this purpose.A total of 27,382 unique online participants answered the survey (15.6% response rate).Of the respondents, 23.4% considered the vaccine safe, 41.4% thought it was unsafe and 35.2% reported ambivalence over its safety.Websites and blog posts with anti-vaccine sentiment remained popular during the course of the pandemic.Current public health communication and education strategies about the flu vaccine can be complemented by web analytics that identify, track and neutralize anti-vaccine sentiment on the Internet, thus increasing perceived vaccine safety.Counter-marketing strategies can be transparent and collaborative, engaging online "influencers" who spread misinformation.P rior to the 2009 influenza A (H1N1) pandemic, public health experts recognized that communities throughout the globe were deficient in pandemic planning (Mareinniss et al. 2009) and could benefit from strategies to increase vaccination rates.In any epidemic, high vaccination uptake is essential in order to limit transmission, protect groups at high risk, reduce the number of severe outcomes and prevent an overload of health services use.Inadequate information about the protective effects of a demonstrably safe flu vaccine reduces immunization rates, contributing to a more rapid spread and wider distribution of an epidemic.Healthcare workers are at particular risk, and, accordingly, in some jurisdictions such as Ontario, it is a hospital board-level responsibility to ensure rapid-response emergency preparedness plans are in place to protect the safety of hospital workers in the event of an infectious outbreak (Seeman et al. 2008).Systematic reviews show that vaccines prevent infection, complication and death, especially when provided to groups at high risk (Jefferson et al. 2008).Why, then, do many people choose not to be vaccinated?Reasons include a lack of familiarity with the epidemiological facts, a lack of support or notification from the healthcare system and unfounded fears about vaccine safety (Baeyens 2010;Maurer et al. 2010).Common fears are that a new vaccine has been rushed to production with insufficient prior research, that it has not been adequately tested and that long-term studies are needed (Seale et al. 2010).

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