Calling the shots

The report of Hong Kong's first case of H7N9 avian flu has sent health department staff scurrying to cover off border entry points, while authorities step up their campaign to persuade local residents to heed the warnings to get their seasonal flu shots.儲存倉 Hazel Knowles writes. In the YouTube video, a smiling Dr Alvin Chan Yee-shing, vice-president of the Hong Kong Medical Association (HKMA), appears not in the traditional white coat of a doctor but a yellow jacket and bow-tie, singing into a microphone in the unlikely setting of a recording studio. The cute voice of a child joins in and together they urge family members and doctors and nurses to "take shots with no tears". The shot, the lyrics say, will make you stronger and protect you. It's a happy song which, despite its upbeat tune, carries a serious message about the importance of the seasonal influenza vaccine, says Chan. It's a message Chan has repeated in more traditional formats on numerous occasions — although it appears to have gone largely unheeded by the Hong Kong public. A survey earlier this year by the HKMA found more than 85 per cent of 1,013 interviewees had not been vaccinated in the previous 12 months. The survey also found few people understood the potential seriousness of seasonal influenza, even though it results in around 300 intensive care cases and deaths every year. More than 80 percent did not understand herd immunity — the concept that a virus has difficulty surviving when around 40 percent of the population is immune, either through previous infection or through immunization. Herd immunity aim Chan believes Hong Kong should be aiming for herd immunity by ensuring half its population receives the season flu vaccination every year. However, uptake of the vaccine has remained steadfastly low in recent years at only 10 percent — well below the rate required for herd immunity. This means that seasonal flu virus can easily spread and potentially become an epidemic, says Chan. An epidemic would be especially dangerous among the young, the old, pregnant women and those with chronic illness. According to Chan, one of the main reasons for the low rate of vaccination is the government's failure to widely subsidized vaccines. Only limited groups are eligible for free or subsidized vaccines. "In America last year, almost 200 million seasonal influenza vaccines were issued in a population of 300 million. That means more than 50 percent of the population was vaccinated," said Chan. "The policy there is to encourage every individual to be immunized, whereas here in Hong Kong the government subsidizes only certain groups, for example, those below six years of age and those over 65. "Although the government recommends vaccination for healthcare workers, pregnant women and those with obesity, chronic illnesses, diabetes and lung diseases, many people in these high risk groups are not subsidized. "Even if the government subsidized all high risk groups, we are not talking about a big sum of money — but it probably could prevent an epidemic." Chan said more alarming was the fact that healthcare workers in the private sector were not subsidized. Among those working in the public sector only 30 percent of doctors and 20 percent of nurses are being vaccinated. "In America, vaccination is almost mandatory for health workers. In fact, the vaccination rate for healthcare workers in America is over 90 percent," he said. "Either the Hong Kong government is not effective in promoting vaccination or staff are too busy to go to a clinic to be vaccinated. "But if the healthcare workers themselves are not getting vaccinated, then they might be less eager to encourage the public to get vaccinated. And what happens in the event of a pandemic? If healthcare workers are coming down wi迷你倉最平h flu when you need them most, it would be a joke." Chan urged the government to be more proactive, saying he would like to see special teams providing free vaccines for healthcare workers in their workplaces. Vaccination push Likewise, Chan would also like to see all school children and pregnant women vaccinated. A Hospital Authority report said that more than 12,300 of its 60,000 healthcare workers had received the vaccine under the Government Vaccination Programme (GVP) in its institutions in 2012-13 . It said eight staff clinics at various hospitals had been assigned to administer staff vaccination and from last year, its cluster hospitals had set up mobile teams to facilitate staff taking up the vaccine which it had promoted in various publicity campaigns. According to the Department of Health, 243,000 seasonal influenza vaccines were administered under the GVP last winter. These free shots target those most at risk of serious infection, including elderly people in residential care, along with public sector health workers, people working with poultry and pigs, plus at-risk groups receiving welfare such as pregnant women, people with chronic illnesses, and those over 50. In addition, its two vaccination subsidy schemes helped pay for 223,000 shots for the elderly and children aged under six last winter. As of 24 November this year, a total of 259,000 shots had been administered under the three schemes – representing around 3.5 per cent of the city's population. In a statement, the Department of Health said it encouraged all eligible persons to receive vaccination and that eligibility was decided on the recommendations of the Scientific Committee on Vaccine Preventable Diseases and various assessments. It pointed out that a Centre for Health Protection survey revealed the main reason for many people not being vaccinated last winter was misunderstanding - and not lack of subsidy. As a result, it had enhanced publicity and education materials aimed at improving the public's understanding of the virus and that serious influenza infection could occur even in healthy individuals, it said. Chan said more needed to be done to address the public's "irrational fears" of the vaccine and it was this reason he wrote the song "Take Shots With No Tears" in 2009. At the time, fear about the safety of a new vaccine created to combat the global outbreak of human swine flu resulted in many people shunning it. As a result the government had to discard more than 2.8 million of three million stockpiled vaccine doses at a cost of HK$220 million. This year's influenza vaccine offers protection from two strains of influenza A, including human swine flu, and one strain of B which experts predict could be circulating this year. If correctly targeted, it offers up to 80 per cent protection, said Dr Chan. "It is well proven vaccines today are safe without any side effects. I would urge everyone to think about seasonal flu vaccination in the winter seasons together with pneumococcal conjugate 13 vaccine," he said. "It is not too late for this flu season especially when we see that 2012 had a very prolonged season which lasted from January to late June, or even July. "Each year, after the influenza vaccination subsidy scheme has been launched, only 10 per cent of the population is vaccinated. That really is too low." One of the biggest fears with H7N9 is that it could adapt and spread from human to human. Every time it infects a human there is the chance the virus will mutate and acquire that ability." benjamin cowling scientist researching on H7N9 And what happens in the event of a pandemic? If healthcare workers are coming down with flu when you need them most, it would be a joke." alvin chan yee-shingvice-president, hong kong medical association 迷你倉