Via the New England Journal of Medicine, a brilliant essay by Dr. Danielle Ofri: The Emotional Epidemiology of H1N1 Influenza Vaccination. Excerpt:
Just as there are patterns of infection, there seem to be patterns of emotional reaction (”emotional epidemiology”) associated with new illnesses.
When 2009 H1N1 influenza was first detected, it fit a classic pattern that Priscilla Wald recently outlined in her book Contagious1: It was novel and mysterious; it emerged from a teeming third-world city, and it was now making its insidious — and seemingly unstoppable — way toward the “civilized” world.
This is the story line for most headline-grabbing illnesses — HIV, Ebola virus, SARS, typhoid. These diseases capture our imagination and ignite our fears in ways that more prosaic illnesses do not. These dramatic stakes lend themselves quite naturally to thriller books and movies; Dustin Hoffman hasn’t starred in any blockbusters about emphysema or dysentery.
When the inoculum of dramatic illness is first introduced into society, the public psyche rapidly becomes infected. Almost like an IgE-mediated histamine release, there is an immediate flooding of fear, even if the illness — like Ebola — is infinitely less likely to cause death than, say, a run-in with the Second Avenue bus.
This immediate fear of the unknown was what had all my patients demanding the as-yet-unproduced H1N1 vaccine last spring.
As the novel disease establishes itself within society, a certain amount of emotional tolerance is created. H1N1 infection waxed and waned over the summer, and my patients grew less anxious.
There was, of course, no medical basis for this decreased vigilance. Unusual risk groups and atypical seasonality should, in fact, have raised concern. By late summer, the perceived mysteriousness of H1N1 had receded, and the number of messages on my clinic phone followed suit.
But emotional epidemiology does not remain static. As autumn rolled around, I sensed a peeved expectation from my patients that this swine flu problem should have been solved already. The fact that it wasn’t “solved,” that the medical profession seemed somehow to be dithering, created an uneasy void. Not knowing whether to succumb to panic or to indifference, patients instead grew suspicious.
No amount of rational explanation — about the natural variety of influenza strains, about the simple issue of outbreak timing that necessitated a separate H1N1 vaccine — could allay this wariness.
Similarly, reassuring fellow parents that I was indeed vaccinating my own children did little to ease their apprehension. When the New York City public school system offered free vaccinations for both students and families, there was an abysmally poor turnout. Less than one quarter of the consent forms sent home in kids’ backpacks were returned.
The dramatic shift in public sentiment over the course of this H1N1 epidemic is both fascinating and frustrating. It is clear that there is a distinct emotional epidemiology and that it bears only a faint connection to the actual disease epidemiology of the virus.
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.
Staff Writer
