The public demand for the new swine flu vaccine may be underwhelming. The government has ordered 20 million doses, enough to vaccinate the entire population or half if two doses are required. The roll-out of the program will begin in the next few weeks, starting with pregnant women, health-care workers and those with chronic medical problems. Depending on the results of current trials, children may then be vaccinated either once or twice, followed by the rest of the population.

Even before the program starts, those promoting the vaccine are grappling with an image problem. There remains uncertainty about the magnitude and severity of swine flu and levels of existing immunity in the population. Against this, any potential risks from the vaccine must be weighed. It may be a safe vaccine but that is not yet clear. Serious reactions are likely to be rare but for this very reason they will only become apparent after many thousands have had the vaccine. Into this mix, the Australasian Society of Infectious Diseases, a doctor group, are expressing concern about multi-dose vials, which carry a very small risk of contamination. On Monday, the AMA was reported as asking the Government to delay the program until medical indemnity issues could be fully resolved.

These are important issues that require time to address. However, there is clearly an impetus from the Government to get the vaccine out as soon as possible. The issue of timing is key; does the Government wait to address the uncertainties and engage in more consultation with key groups or start quickly, as has long been promised? People are still dying from swine flu. The trade-off is not an easy one.

If the vaccine does prove safe and worthwhile, it will be in the interests of the target groups to take it up. However, there may be an up-hill battle in getting them to accept it. The general question marks over the vaccine will stay in people’s minds. Doctors will also need to be won over as they have the power to persuade reluctant people to vaccinate.

For people to want a vaccine they must not only believe it is safe. They must also think it is necessary. Protection from infectious diseases is a powerful motivator, particularly so if you have identifiable disease victims. Meningococcal disease, with its pictures of mutilated victims, usually young people in the prime of their lives, stirred dread in the community. The vaccine was welcomed and people queued up.

Swine flu has been portrayed as generally mild. This is true for the vast majority. However, there have already been 150 deaths and the toll will continue to rise. Many more have been put into hospitals and it has disproportionately affected younger adults, not all of them with underlying conditions. However, most reports of deaths have come with the qualifier that the person had an underlying medical condition, presumably with the intention of allaying fears among the healthy wider community. Very few of these reported have included the personal testimony from families of the loved ones so often seen with the higher outrage diseases. Against this background, the perceptions of a media and government beat-up prevail.

Part of the lack of outrage about swine flu is that influenza has always been seen as a banal disease. People wrongly confuse it with the common cold leading to a tendency to think influenza isn’t much to worry about. Yet 1000-3000 Australians die each year from seasonal strains and thousands more end up in hospitals. Despite this, getting target groups, particularly health professionals, to accept the seasonal flu vaccine has been a major challenge.

In the face of low outrage about swine flu, many will feel that actual or perceived issues of vaccine safety weigh too heavily against the benefits of the vaccine. If the swine flu vaccine does prove safe and effective and people have it, there’s the chance of saving lives and preventing illness.

Vaccine trials are happening and the public need full transparency from the authorities. This will include the data it is using to assess the vaccine presented in comparison with data comparing the risks of swine flu in Australia. Systems for reporting adverse events following immunisation will need to be in place along with a well-communicated plan for responding to them. This is important if doctors and the public are to overcome any doubts and proceed with confidence.