Open Access Research article

Canadian national surveys on pandemic influenza preparations: pre-pandemic and peri-pandemic findings

Paul Ritvo123*, Daniel F Perez1, Kumanan Wilson4, Jennifer L Gibson38, Crissa L Guglietti1, C Shawn Tracy35, Cecile M Bensimon3, Ross EG Upshur3567 and University of Toronto Joint Centre for Bioethics – Pandemic Ethics Working Group

Author affiliations

1 School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, M3J 1P3, Canada

2 Research, Prevention and Cancer Control, Cancer Care Ontario, 505 University Avenue, Toronto, M5G2L7, Canada

3 University of Toronto Joint Centre for Bioethics, 55 College, Street, Suite 754, Toronto, M5T 1P8, Canada

4 Department of Medicine, Ottawa Health Research Institute, University of Ottawa, 725 Parkdale Ave, Ottawa, K1Y 4E9, Canada

5 Primary Care Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada

6 Dalla Lana School of Public Health, 155 College St., Toronto, On, M5T 3M7

7 Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, Toronto, M5T 1W7, Canada

8 Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 1P8, Canada

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Citation and License

BMC Public Health 2013, 13:271  doi:10.1186/1471-2458-13-271

Published: 25 March 2013



Prior to the 2009 H1N1 Influenza pandemic, public health authorities in Canada and elsewhere prepared for the future outbreak, partly guided by an ethical framework developed within the Canadian Program of Research on Ethics in a Pandemic (CanPREP). We developed a telephone-based survey based on that framework, which was delivered across Canada in late 2008. In June, 2009, the WHO declared pandemic Phase 6 status and from the subsequent October (2009) until May 2010, the CanPREP team fielded a second (revised) survey, collecting another 1,000 opinions from Canadians during a period of pre-pandemic anticipation and peri-pandemic experience.


Surveys were administered by telephone with random sampling achieved via random digit dialing. Eligible participants were adults, 18 years or older, with per province stratification approximating provincial percentages of national population. Descriptive results were tabulated and logistic regression analyses used to assess whether demographic factors were significantly associated with outcomes, and to identify divergences (between the pre-pandemic and intra-pandemic surveys).


N = 1,029 interviews were completed from 1,986 households, yielding a gross response rate of 52% (AAPOR Standard Definition 3). Over 90% of subjects indicated the most important goal of pandemic influenza preparations was saving lives, with 41% indicating that saving lives solely in Canada was the highest priority and 50% indicating saving lives globally was the highest priority. About 90% of respondents supported the obligation of health care workers to report to work and face influenza pandemic risks excepting those with serious health conditions which that increased risks. Strong majorities favoured stocking adequate protective antiviral dosages for all Canadians (92%) and, if effective, influenza vaccinations (95%). Over 70% agreed Canada should provide international assistance to poorer countries for pandemic preparation, even if resources for Canadians were reduced.


Results suggest Canadians trust public health officials to make difficult decisions, providing emphasis is maintained on reciprocity and respect for individual rights. Canadians also support international obligations to help poorer countries and associated efforts to save lives outside the country, even if intra-national efforts are reduced.

Pandemic influenza; Canada; Survey research; Public health ethics; Bioethics; H1N1