As governments gear up to launch national vaccination programmes against swine flu, questions are beginning to emerge about how many people will be prepared to take up the offer of the vaccine.

A survey published online this week in the BMJ found that just over half of 8500 healthcare workers in Hong Kong said they would not be vaccinated against swine flu because of fears of side effects and doubts about the vaccine’s effectiveness (BMJ 2009;339:b3391, doi:10.1136/bmj.b3391).

Evidence from 11 focus groups conducted in Canada before the current pandemic also indicates that parents and healthcare workers may refuse to be vaccinated or to vaccinate their children if they believe that the risks outweigh the benefits (Emerging Health Threats Journal 2009;2:e8, www.eht-forum.org/ehtj/journal/v2/pdf/ehtj09008a.pdf). And a survey by Israel’s ministry of health similarly found that at least 25% of the population is not willing to be vaccinated against swine flu.

Last week England’s chief medical officer, Liam Donaldson, shrugged off suggestions that NHS staff might turn down the vaccine …