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Environ Health Prev Med. 2011 Sep;16(5):320-6. doi: 10.1007/s12199-010-0202-x. Epub 2010 Dec 25.

Physicians' recommendations to their patients concerning a novel pandemic vaccine: a cross-sectional survey of the 2009 influenza A/H1N1 pandemic in Japan.

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Department of Public Policy, Institute of Medical Science, The University of Tokyo, Shirokanedai, Minato-ku, Japan.



Striking a balance between the rapid availability of a novel vaccine while ensuring its safety, quality, and efficacy is a major challenge during a pandemic. We aimed to elucidate physicians' attitudes regarding the novel vaccine during the influenza A/H1N1 pandemic of 2009, and to determine factors that affected their vaccination recommendations to patients.


Of a random sample of 1,000 general practitioners (GPs) in Japan, 515 participated in the cross-sectional anonymous survey conducted just before the novel vaccine was available (between 28 September and 18 October 2009).


A total of 453 GPs (88.3%) replied that they intended to receive the new vaccine themselves; however, only 177 GPs (34.6%) intended to proactively recommend it to their patients. The anticipated cost of the vaccine negatively influenced the intention to vaccinate themselves and their recommendations to patients (P < 0.001, χ (2) test). Results of multivariate logistic regression analysis showed that physicians with experience in influenza A/H1N1 patient contacts [1-20 contacts, odds ratio (OR) = 7.49 (95% confidence interval [CI]: 1.73-32.36), P = 0.007; >20 contacts, OR = 8.03 (95% CI: 1.77-36.50), P = 0.007, compared with no contacts] were more likely to recommend the vaccine to patients, whereas those with knowledge of the fear on the causal association between Guillain-Barré syndrome (GBS) cases and the 1976 swine flu vaccination in the USA were less likely to recommend the vaccine [OR = 0.66 (95% CI: 0.45-0.97), P = 0.036].


Results of our survey indicate that physicians experience a moral conflict regarding recommending the novel vaccine to patients, which may be the result of their own experience with the disease, knowledge of vaccine side-effects, and cost.

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