Washing our hands: The Non-Science-Based Response to H1N1

March 10, 2010

Public Policy

Science may not provide the answers to all questions, but when we ignore science to pursue other policy objectives we undermine our ability to convince the public. Consider how the approach to social marketing in relation to H1N1 used science.

The Public Health Agency of Canada (PHAC) issued two television ads during the flu season. One ad, not surprisingly, focused on getting vaccinated. The second, “Protect Yourself Against the Flu“, was about the ways to protect oneself and began with the image of a person washing their hands.

“No evidence has been found that hand hygiene or other interventions that might prevent contact transmission (e.g., glove use in healthcare facilities) prevent the transmission of influenza.” page 4

This was the 2007 conclusion of the Council of Canadian Academies, a science-based organization, in a study entitled Influenza Transmission and the Role of Personal Protective Respiratory Equipment: An Assessment of the Evidence. Vaccination was the best science-based method of preventing the transmission of influenza.

Throughout the lead up to the flu season the challenge was clearly to convince people to get vaccinated and to manage that process effectively. Would it be easy to convince people to get vaccinated? That was a difficult question to answer.  In 2008, 32 per cent of Canadians received an influenza vaccine according to a Statistics Canada report.

In a 2007 survey for PHAC, 34% claimed to have gotten a flu shot while 32% washed their hands frequently as steps they took to reduce their chance of getting the flu in the previous year. More importantly, washing your hands is widely viewed by the public as the most effective precautionary method (95% rate it as effective (5-7 on 7 point scale).

There are three potential reasons for recommending a hand washing course of action:

  1. There is a belief  that it is effective;
  2. Health officials want to empower people to do other things in addition to getting a vaccine (since people had to wait to get the vaccine)
  3. Since hand washing likely has other health benefits, the influenza was being used as a “teaching opportunity”.

Since the science told us that hand washing is not effective in preventing the transmission of influenza, the reality is that this recommendation was unnecessary (financially and conceptually).

Throughout the vaccination period, health officials had to battle erroneous claims that the vaccine itself was unsafe. Their response focused on the science and in trying to explain the different types of risk. Once wonders if the unintended consequence of selectively using science — to argue for the safety and effectiveness of vaccines versus ignoring it when it comes to hand washing — is that people might at some point wonder who can be trusted.

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About Richard Jenkins

Market research professional and small business owner

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2 Comments on “Washing our hands: The Non-Science-Based Response to H1N1”

  1. Patrick Fafard Says:


    Interesting post. A couple of questions/comments:
    – as much as I respect the Council of Canadian Academies, is it unambiguously clear that their conclusion re hand washing is the best available evidence on the question? (See BMJ 2009;339:b3675)
    – I think you correctly allude to the fact that the choice of an intervention should be based on a combination of its effectiveness, its cost, the likelihood of compliance, etc. Thus, while hand washing may not be as effective as some hope, the fact that it is relatively easy to implement and compliance can be high means that it may be more effective, overall, than other measures that may be more effective when measured in a controlled setting but in the wild, implementation costs of low compliance means the effectiveness drops.
    – to what extent is the recommendation of an intervention in fact based on models of risk assessment and risk communication?

    – your core argument, that if public officials fudge the science, they may be deemed less credible in other situations is, to my mind, the most critical issue. What is not clear to me is whether we can ever get categorical statements to the effect there is or was selective use of science. It seems to be that science does not work that way. All scientific results are, to some extent, probabilistic and subject to review. Decisions nevertheless have to be made in real time. They can be disputed but I am less sure that it is very often possible to say that a certain decision was “wrong” or based on a misuse of the scientific evidence.

    Given the recent debate over the science of climate change this is a critical issue.


    • richardjenkins Says:

      Thanks for the comments Patrick. Thought provoking.

      I agree that science is rarely unambiguous in an academic sense of the word. What is the history of science but the process of previous “truths” being shown to be wrong. And, no I don’t have actual insight into the process by which decisions were made about what course of action to take. Whether people “fudged” the science or were unaware of it or simply believed they had science on their side, would be great to know.

      Certainly my argument is that the risk of the selective use (or appearance of the selective use) might damage public trust. I agree that the debate over the science of climate change is an important parallel

      On the issue of compliance and awareness, one thing is certain from the POR surveys — even before the advertising campaign everyone already believed that washing their hands was the best way to prevent the transmission. So, I wonder how effective the advertising could have been. Maybe we need to be told things we already believe but my sense is that we don’t. I think more money spent on advertising the vaccine might have been more efficient.


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