A perspective piece by Danielle Ofri of the NYU School of Medicine, in last week's New England Journal of Medicine (subscription required) nails the H1N1 vaccine hysteria:

After repeated delays, H1N1 vaccine finally arrived in our clinic earlier this month to the uniform relief of the medical staff. But my formerly desperate patients were now leery. "It's not tested," they said. "Everyone knows there are problems with the vaccine." "I'm not putting that in my body."

I was unprepared for this response, but maybe I shouldn't have been. For weeks now, in the schoolyard of my children's elementary school, other parents had been sidling up to me, seemingly in need of validation. "You're not giving your kids that swine flu shot, are you?" they'd say, their tone nervous, if a bit derisive.

How to explain this dramatic shift in 6 short months? It certainly isn't related to logic or facts, since few new medical data became available during this period. It seems to reflect a sort of psychological contagion of myth and suspicion.

Ofri lays out an 'emotional epidemiology' for H1N1. Back in the spring, when it was this mysterious freak illness, frightened people demanded the vaccine in her clinic. Now that H1N1 is old news, not so unknown, not so mysterious, her patients have flipped and become suspicious about the vaccine itself - even though the case for the vaccine is just as strong now as it was back in April.

She concludes:

We cannot combat H1N1 influenza merely by ensuring adequate supplies of vaccine and oseltamivir. Unless the medical profession confronts the emotional epidemiology of H1N1 with a full-court press, we run the risk of an uncontrollable epidemic.

There is no doubt that we are far behind the curve in terms of public relations. Our science has not been dithering at all, but our articulation of that science has often seemed that way, from the unfortunate initial appellation of swine flu to our inability to clarify distinctions between vaccine-production issues and clinical-risk issues. Suspicion has its own contagion, and we have not been aggressive enough in countering it.

Well, sure, but how to counter suspicion is not obvious. 

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