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2006 Releases

While Concerned, Most Americans Do Not Expect Widespread Human Cases of Avian Flu in U.S. in the Next Year

For immediate release: February 23, 2006  

Boston, MA -- The latest national poll conducted by the Harvard School of Public Health (HSPH) Project on the Public and Biological Security finds that at the moment, the majority of the American public is concerned about the threat of avian flu, but only a small proportion is very concerned. However, should cases of avian flu emerge in poultry or humans in this country, the public reaction could lead to significant disruption of the economy and the health care system.

To see the figures related to this poll, visit
To see the topline, visit

Concern about Avian Flu
More than half of Americans (57%) report that they are concerned about the potential spread of bird flu in the United States (Figure 1). However, only 15% are very concerned at the moment. A higher proportion of African Americans report that they are concerned about this than whites (70% versus 54%). Similarly, the majority of Americans are not currently concerned that they or a family member will get avian flu within the next twelve months; only one in five (21%) people are worried about this possibility (Figure 2). Six in ten people are concerned about a pandemic outbreak of avian flu, that is, an outbreak in many countries (62%), but only 20% are very concerned. In addition, the American public does not believe avian flu will ultimately spread widely among wild birds (only 28% think so), poultry (24%), or humans in the United States (14%) in the next 12 months. (Figure 3)

If the U.S. were to experience human cases of the avian flu virus currently circulating in Asia, there would be significant public reaction. If such cases were to occur in their state, most people said that they would reduce or avoid travel (75%), avoid public events (71%), try to get a prescription for Tamiflu or other antiviral drugs (68%), and stay at home and keep their children at home while the outbreak lasted (68%). (Figure 4)

"If the public were to respond this way to human cases in their state, it would likely slow the spread of the disease, but it would also have major impact on the state's economy and health care system," said Robert Blendon, Professor of Health Policy and Political Analysis at HSPH. "Because of this, it is important to prepare for a prompt and effective public health response."

As a result of growing reports of avian flu outbreaks in Asia and Europe, the survey asked Americans what they would do if avian flu were to spread to poultry in the U.S. The survey found that an outbreak of avian flu in poultry in the U.S. would have strong effects on the public's willingness to eat poultry. Nearly half (46%) of respondents who eat chicken or other poultry said that they would stop eating it if such cases were reported. (Figure 5)

"Should there be cases of flu in chickens here, it could lead to a substantial reduction in the consumption of chicken, which would adversely affect the U.S. poultry industry," said Blendon. "Public education regarding the safety of cooked chicken could help prevent this problem."

Antiviral Treatments
Just under half of the American population has heard of Tamiflu or other antiviral drugs that can be used as possible treatments for avian flu (45%). Of this group, only one-quarter believe that these drugs are effective treatments once someone has gotten the symptoms of avian flu (25%). Despite media coverage of Tamiflu and other antiviral medications, only 2% of Americans have talked to their doctor about the use of Tamiflu or other antiviral drugs for the treatment of avian flu, and even fewer have gotten a prescription for the drug for this purpose (<.5%).

Possibly reflecting uncertainty about the seriousness of the threat posed by avian flu in the United States and the effectiveness of Tamiflu, two-thirds of the American population (66%) think that in the case of an outbreak in other countries, the United States should share some of its supply of antiviral drugs in order to keep the disease from spreading to the U.S.

Furthermore, respondents were asked whether, in the event of an outbreak of avian flu in humans in the U.S. in which there were a shortage of antiviral medication, they would be willing to let flu patients and first responders receive doses first. A significant majority of respondents said that they would be willing to wait to get an antiviral drug until after people such as those hospitalized with the flu (81%), doctors and nurses (80%), and police and firefighters (74%) had received the drug.

Most Americans are supportive of quarantine measures. Ninety-six percent of respondents said that they would agree to be quarantined for two to three weeks if they had avian flu. Over four out of five people said that they would also agree to be quarantined even if they might have the disease (83%). However, six in ten respondents who were employed admitted that they were "very" or "somewhat" concerned that, in the event of an outbreak in their state, they would not get paid if they had to be away from work (59%). In addition, four in ten employed respondents were "very" or "somewhat" concerned that their employer would make them go to work even if they were sick (39%).

Awareness of Avian Flu
Over half of Americans report following the news media's coverage of avian flu closely (54%). Most Americans were aware that there had been cases of avian flu in humans in Asia (69%). Furthermore, most people were aware that there had not been cases in the United States. However, one in seven people believed that human cases had occurred in the United States (15%). (Figure 6)

Additionally, most Americans know that a regular or seasonal vaccine will not prevent a person from getting avian flu (77%). Perhaps reflecting greater media attention in recent months to the possibility of an outbreak of avian flu, the amount of people who are worried that they or a family member may get sick from avian flu in the next twelve months has risen from 12% to 21% since 2003.
************************************************************ According to CDC reports, from December 2003 to February 13, 2006, there were 169 confirmed cases of H5N1 avian flu in humans and 91 deaths. They occurred in the following nations: Vietnam, 93 cases and 42 deaths; Thailand, 22 cases and 14 deaths; Indonesia, 25 cases and 18 deaths; China, 12 cases and 8 deaths; Cambodia, 4 cases and 4 deaths; Turkey, 12 cases and 4 deaths; and Iraq, 1 case and 1 death. To date, no cases have been reported in the U.S.

In addition, the following nations had confirmed H5N1 in poultry/birds since 2003: Austria, Azerbaijan, Bulgaria, Cambodia, China, Croatia, Egypt, Germany, Greece, Hong Kong (SARPRC), Italy, Indonesia, Iran, Japan, Kazakhstan, Laos, Liechtenstein, Malaysia, Mongolia, Nigeria, Romania, Russia, Slovenia, South Korea, Thailand, Turkey, Ukraine, and Vietnam. To date, there have been no cases reported in the U.S.

This is the 23rd in a series of studies by the Harvard School of Public Health Project on the Public and Biological Security. The study was designed and analyzed by researchers at the Harvard School of Public Health. The project director is Robert J. Blendon of the Harvard School of Public Health. The research team also includes John M. Benson, Channtal Fleischfresser, and Kathleen J. Weldon of the Harvard School of Public Health, and Melissa J. Herrmann of ICR/International Communications Research. Fieldwork was conducted via telephone for the Project by ICR/International Communications Research of Media (PA) between January 17 and 25, 2006. The survey was conducted with a nationally representative sample of 1,043 non-institutionalized adults age 18 and over. The margin of error for the total sample is plus or minus 3.3 percentage points.

Possible sources of nonsampling error include nonresponse bias, as well as question wording and ordering effects. Nonresponse in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, education, as well as number of adults and number of telephone lines in the household. Other techniques, including random-digit dialing, replicate subsamples, callbacks staggered over times of day and days of the week, and systematic respondent selection within households, are used to ensure that the sample is representative.

The Harvard School of Public Health Project on the Public and Biological Security is funded by the Centers for Disease Control and Prevention to provide public health agencies with technical assistance for public health communication by monitoring the response of the general public to public health threats.

Christina Roache
HSPH Office of Communications


Centers for Disease Control and Prevention Media Relations 404-639-3286