A background paper, containing additional methodological details and results, is available electronically at the following URL:


Glen Nowak, PhD

Office of Health Communications

National Immunization Program

Centers for Disease Control and Prevention

Although much of this section focuses on the communication challenges presented by the need to increase public awareness of and uptake of seasonal influenza immunization, pandemic influenza will require similar efforts to enlist public support and cooperation. In both cases—as in most such circumstances—it is important to recognize that good communication is necessary, but not entirely sufficient, to achieving desired behavioral outcomes. Policies and incentives are also usually necessary to motivate many people to get annual flu shots (e.g., those people who believe influenza vaccination is helpful, but who are not willing to experience much inconvenience to get vaccinated).

It is crucial to note that good communication requires more than simply releasing facts, figures, and statistics to the public (Working Group on Governance Dilemmas in Bioterrorism Response, 2004). Many times, campaigns or efforts designed to achieve adoption of health promotion behaviors or recommendations rely primarily on the provision of numbers and statistics. The assumption is that people will conclude that the disease or adverse health outcome is more likely than they may have assumed. A 2004 campaign designed to increase attention and concern about deep vein thrombosis (DVT), for example, featured print ads pointing out that “DVT strikes 2 million Americans each year and that complications from this disorder cause up to 200,000 deaths per year—more than breast cancer, car crashes and AIDS combined.” Although the campaign likely caused a modest increase in awareness of DVT and ways to prevent it, many (and perhaps most) people who may be affected by DVT probably remain unaware or unconvinced of this health threat. Providing numbers and statistics is helpful, but motivating people to take health-protective action requires doing more than simply listing morbidity and mortality statistics. The challenge of changing and influencing human behavior is difficult, and often far more difficult than it seems.

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