On June 11, 2009, the World Health Organization issued a statement declaring that the A/H1N1 influenza virus (henceforth, the swine flu) had reached pandemic proportions [1
]. Around 30,000 people worldwide have died because of this virus, including 17,000 in the USA and around 90 in Israel [3
Governments geared up to launch national programs to vaccinate the population against the swine flu. Most governments planned to vaccinate groups of people at risk and healthcare personnel in the first stage and the entire population in the second stage [5
]. Yet, while compliance rates were quite high in some countries, such as Australia (67%) and France (60%) [1
], in others the rates remained quite low. For example, according to a representative survey carried out by the CDC in 2010, by February 2010 only 23.4% of Americans had been vaccinated against the swine flu, while in Israel by February 2010 less than 10% had taken the new vaccine [7
The purpose of the current study was to examine the factors affecting the intention among students in Israel to be vaccinated against the swine influenza. We chose to focus on this group of young people because the swine flu affected not only at-risk groups but also young people in the labor force. In fact, a major difference between seasonal influenza A and the 2009 outbreak of H1N1 influenza was the age distribution of life-threatening cases and deaths [8
]. According to media reports, most deaths from H1N1 2009 influenza were among young and middle-aged adults. In contrast, most deaths from seasonal influenza A occur in the older population, while deaths of young people due to seasonal influenza are rare [9
]. Indeed, the true public health burden of H1N1 2009 influenza may be better measured by the number of deaths rather than by the number of life-years lost [8
Several recent studies have examined willingness to be vaccinated against the swine flu in developed countries. For example, the results of Blendon et al. [10
] showed that among a representative sample of the US population just 40% of adults were “absolutely certain” they would get the H1N1 vaccine for themselves. In addition, those who were not “absolutely certain” they would get the H1N1 vaccine cited the following as the “major” reasons for their thinking: (1) concerned about side effects of the vaccine, (2) they are not at risk of getting a serious case of the illness, and (3) there are alternative medications to treat H1N1.
Similar results were found for the general population in France [11
]. Raude et al. [11
] indicate the following reasons for vaccine acceptance among French adults: (1) beliefs associated with severity and personal vulnerability to the illness, (2) perception of vaccine efficacy and safety, and (3) trust/distrust of those advocating the vaccine. In addition, the results of Setbon and Raude [12
] indicated that level of worry, risk perception, and previous experience with vaccine against seasonal flu in France consistently predicted swine flu vaccination. Similar results were also cited as predictors for swine flu vaccination acceptance in Australia [6
]. Yet, 67% of the population in Australia was willing to be vaccinated against the swine flu [6
]. Finally, in Israel, a telephone survey conducted several months after the peak of the outbreak indicated low compliance for the A/H1N1 vaccine (17%) [13
]. The results showed that apathy, fear, and distrust were motives leading to noncompliance.
Willingness to get vaccinated against a given infectious illness is recognized as a major issue affecting the success of vaccination programs. For example, according to the Theory of Reasoned Action [14
], which has explained and predicted a variety of human behaviors, the most important determinant of behavior
is a person's behavior intention
]. In addition, several studies have shown that the intention-behavior correlation is quite strong. For example, the meta-analysis study by Armitage and Conner [16
] showed this correlation as r
= .47, Randall and Wolf [17
] reported a corresponding relationship of
.45 (98 studies), and Sheeran and Orbell [18
] reported a mean correlation of
.44 (28 studies of condom use).
Our study examines the factors affecting the intention to get vaccinated against the swine influenza using the Health Belief Model (HBM) [19
] as a conceptual framework. The HBM, which has largely been tested empirically, explains and predicts preventive health behavior in terms of belief patterns, focusing on the relationship between health behaviors and utilization of health services. According to the HBM, getting vaccinated against influenza depends on the following predictors: perceived susceptibility to influenza, beliefs about severity of influenza, perceived benefits of the vaccine in preventing influenza, and perceived barriers to getting vaccinated [20
]. Based on these findings with respect to seasonal influenza, we expect to find similar predictors for the intention to get vaccinated against swine flu.
The current study was conducted in December 2009 in Israel, after several people in the country died of the swine flu and after the topic had received extensive media coverage. In addition, the timing of the survey was one month after the Israeli government launched a vaccination program offering the vaccine to people at risk and to healthcare personnel and before the vaccine was offered to everyone free of charge. Nevertheless, the government announced that in the second stage the vaccine would be offered to everyone free of charge.
The study contributes to the existing literature by
- examining the factors affecting the intention to get vaccinated against the swine influenza among students in Israel;
- examining the conditional intentions to get vaccinated;
- comparing sociodemographic characteristics of the intention to get vaccinated against the swine flu to characteristics marking the intention to get vaccinated against the seasonal flu.