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About half of Hong Kong's health workers would refuse the swine flu vaccine, new research says, a trend that experts say would likely apply worldwide. In a study that polled 2,255 Hong Kong health workers this year, researchers found even during the height of global H1N1 panic in May, less than half were willing to get vaccinated.

Most said they would pass on the H1N1 shot, which is not yet available, because they were afraid of side effects and doubted how safe and effective it would be.

Doctors and nurses are on the swine flu front lines — and if they become infected, they may not only spread the disease to patients, but their absence from work could cripple health systems.

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The World Health Organization recommends countries vaccinate their health workers. Many Western countries including Britain, Spain, and the U.S. have said doctors and nurses will be among the first to get H1N1 shots.

The study results, published online in BMJ, formerly known as the British Medical Journal on Wednesday, suggest that carrying out those plans may be tricky.

"A good argument can be made that health workers have an ethical obligation to be vaccinated, not to protect themselves, but to protect their patients," said George Annas, a bioethics expert at Boston University. "But if they don't believe that vaccine to be safe and effective, it will be a hard sell."

Several drug makers are testing their H1N1 flu vaccines. So far, officials say that among the few thousand people who got the injections no one has reported anything more serious than a sore or swollen arm.

It is unlikely any rare side effects will pop up until the vaccine is given to millions. That might include things like Guillain-Barre syndrome, a temporary paralyzing disorder, which was seen after the 1976 swine flu vaccination campaign, and happens fewer than once every 1 million vaccinations.

Researchers at the University of Hong Kong surveyed doctors and nurses in public hospitals this year from January to May, asking them if they would get a pandemic vaccine based either on bird flu or H1N1 virus. About 35 percent of health workers were willing to get a bird flu vaccine, versus 48 percent for H1N1.

Experts were surprised so few of Hong Kong's health workers were willing to be vaccinated, since the city was hit hard during the 2003 outbreak of SARS, or Severe Acute Respiratory Syndrome.

Paul Chan of the Chinese University of Hong Kong, one of the study authors, thought the results would be similar elsewhere. Fewer than 60 percent of health workers in most countries get vaccinated against regular flu, thought to be a reliable indicator of whether they might get a H1N1 flu shot. In the U.S., about 35 percent of health workers get a regular flu shot, while in Britain, only about 17 percent do.

Annas said health workers were ultimately like everyone else when it comes to getting vaccines. "Like the lay population, they assume they won't need the shot because they don't think they will get the flu."

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On the Net:

http://www.bmj.com