Friday will mark the one-year anniversary of influenza A/H1N1 being declared a pandemic. The pesky little virus, despite some early hype, didn't turn out to be much of a killer, but it continues to make headlines.
Let's take a look behind one of those headlines, as it appeared in The Globe and Mail: The Flu Reality: Ottawa's Mass Immunization Program Failed was a story about the dramatically different vaccination rates during the mass immunization campaign.
There is no doubt that vaccination rates were abysmal, particularly given the investment in a "universal" campaign. Public-health officials said repeatedly that they were hoping to get at least 70 per cent of citizens immunized, a level at which there would be herd immunity so even the unvaccinated would be largely protected.
More than $2-billion was spent buying vaccine, setting up clinics and on a massive advertising campaign, and it was supplemented by blanket media coverage.
Yet, in three provinces - Ontario, Alberta and Manitoba - barely one-third of citizens received the vaccine. In Canada's biggest city, Toronto, only one in four people got a pandemic flu shot.
Only one province, Newfoundland, reached the 70-per-cent target.
But does that mean the vaccination campaign was a failure?
What matters ultimately is the health of the public and the bottom line was that 2009-10 will be remembered as one of the mildest, least deadly flu seasons on record.
Sure, Mother Nature played a role: The feared pandemic strain H1N1 turned out to be pretty lame, though it did kill a troubling number of young healthy people. And let's not forget that, along with the flu, rates of other viral diseases plummeted, a result of heightened awareness and the new-found fondness for hand washing.
Canada's pandemic preparedness plan also got its first real-life test and there should be some valuable lessons learned.
Two lessons stand out above all others: 1) good communication is paramount and 2) mass campaigns don't really work in the 21st century.
Put another way, the notion that we could vaccinate 70 per cent or more of the population in a short time period is unrealistic. And the idea that we could convince them to do so by essentially yelling at them through a bullhorn is fantastical.
The hallmark of modern society is individualism, with communities fragmented into subpopulations.
We also live in skeptical times, cynical times even. Anything that the government says is good or necessary will trigger a backlash.
Finally, in our fast-paced world, we live in the present. Nothing is a threat unless it is in our face - and then we expect instant help.
We saw all these factors come into play with H1N1. Conspiracy theories abounded. Many people decided they would only get the vaccine if there was an imminent threat to their own health. In fact, vaccination rates were highest in small communities, where people had personal knowledge of those sick with H1N1.
Despite these modern realities - all of them well known - public-health and government officials opted for a big, centralized, vaccine campaign with dour messaging from wooden public officials.
A distinctly 20th-century approach that was costly and not particularly effective.
We have to be careful here not to judge the performance of public health too harshly, or in hindsight. There was an honest scientific belief that a pandemic strain of influenza would necessarily be more virulent and deadly. The reality too is it takes months to produce vaccines, essentially forcing governments to take all-or-nothing gambles.
Still, the implementation of the vaccine campaign could have been much better - particularly on the communications side.
So what big lessons need to be retained and acted upon in updating pandemic planning and public-health messaging more generally?
First and foremost, public-health officials have to stop behaving like vaccination is an opiate for the masses.
Preachy sloganeering is not enough. You need to engage the public, sell the benefits, talk openly about the risks, and roll up your sleeves and take on the critics. There is much skepticism and it has only grown because of H1N1.
In a fragmented media market, six-page newspaper ads don't cut it. Public-health messaging has to be more pointed and targeted at specific communities.
In the era of the 24-hour news cycle, the traditional once-a-day press conference featuring talking heads with a bunch of fancy titles has to be revamped and supplemented with Twitter posts, YouTube videos and the like.
The public needs to be engaged in conversations and debate about issues of public health, they don't need to be lectured to.
While there needs to be a variety of methods, the message needs to be clear. During H1N1, there was much "conflusion," much of it stemming from a desire to act on a large scale and reluctance on the part of public officials to utter the words: "We don't know."
Knowledge evolves, sometimes day-to-day. The public understands this, so give them some credit.
In times of (potential) crisis such as a feared pandemic, existing networks have to be put to good use. One of the big mistakes of the H1N1 vaccination campaign was not providing vaccine to individual physicians and clinics. The large clinics, which were costly and took a lot of time to set up, should have supplemented not supplanted normal operations.
Finally, public health has to be a lot more pro-active, and less reactive.
It is telling that the story comparing vaccination rates between provinces was based on the research of a reporter. The Public Health Agency of Canada refused to release the information, contenting itself with blandishments such as: "More than half the population was vaccinated."
Public health needs to be more open about its successes and its failures. It can be bruising, but that's how you earn the public trust.