A new study suggests those arms are more likely to belong to Canadians of a variety of ethnic backgrounds — Filipino, Japanese, Chinese and southeast Asian among them — than to Canadians who describe themselves as white or black.
In fact, of 12 ethnic groups, all were more likely to get a flu shot than white or black Canadians. Those two groups were essentially equally likely — or unlikely — to agree to get a flu shot, the study found.
Lead study author Susan Quach admits the results came as a surprise.
She and her co-authors are not entirely clear what's behind the finding. One idea is that some ethnic communities may be "shielded" to a degree from anti-vaccination messages.
"One of the things we thought it could be related to was just exposure to the anti-vaccination media," says Quach, a research associate at Public Health Ontario who specializes in influenza studies.
"They might have less exposure to this due to language issues, or where they seek health information. They might be influenced by family and health professionals differently on decisions about vaccinations versus other groups."
The findings may help officials who devise health policy and people who craft public health messaging to figure out how to reach more people when provinces and territories announce they are offering flu shots.
Those announcements are coming soon. Flu shot programs will start within the three to six weeks, depending on the jurisdiction. For instance, British Columbia hopes to start delivering vaccine in mid-October, says Dr. Perry Kendall, the province's chief medical officer of health.
Manitoba's program is aiming to start in early to mid-October, when Ontario plans to kick off its effort. Saskatchewan expects to start vaccinating in late October. Precise timing and delivery location information can be obtained from each provincial or territorial ministry of health.
Most jurisdictions in Canada offer shots for free to all. The four that don't — British Columbia, Quebec, New Brunswick and Newfoundland and Labrador — still provide free vaccines to a range of people, including the elderly, people with chronic conditions, young children and household contacts of those people.
And this year in a Canadian first, B.C. is requiring health-care workers to be vaccinated, or to wear masks during flu season.
The flu shot study, published in this week's Canadian Medical Association Journal, used data collected through Statistics Canada's Canadian Community Health Survey.
The survey asks respondents — chosen to represent a cross-section of Canadian society — a variety of questions about their health. It also asks people to identify their ethnic background.
The researchers amalgamated data from the surveys conducted in 2003, 2004, 2007, 2008 and 2009, in the process accumulating a pool of nearly 440,000 respondents. Then they looked at the answer to the question "Did you receive a flu shot last year?" and correlated it by ethnic background.
One year's data wouldn't have given them enough people in the individual ethnic groups to draw solid conclusions. But with such a large number of respondents, patterns of behaviour started to become clear.
People who identified themselves as Filipino Canadians were twice as likely to get a flu shot as people who described themselves as white or black. Canadians of southeast Asian origin were 1.66 times more likely. Korean Canadians were 1.48 times more likely to get vaccinated against influenza than white Canadians.
Why would that be? That's the key question, but this study can't answer it. It does, however, serve as a starting point for more research to get to the bottom of the issue.
Dr. Kumanan Wilson, a researcher who explores vaccine acceptance issues, says the answer isn't about being from a particular ethnic group. It is something about the values or lifestyles or behaviour patterns of people within those groups that explains the acceptance of or resistance to flu shots.
"It's not like being white makes you less likely to get vaccinated," says Wilson, a Canada Research Chair in health policy at the Ottawa Hospital Research Institute.
"The factors going along with that are what contributed to these people not being vaccinated. ... What are those other factors that cluster along with ethnicity that contribute to the behaviour and are they modifiable?"
Wilson says finding these answers will help in targeting groups to persuade them to get flu shots.
"I think perhaps one of the problems we've had with vaccine communications issues is to treat the entire population as one group and present a common message to them," he says, suggesting the poor uptake of flu shots is proof that approach isn't working.
Quach says she'd like to see more work done on figuring out who is "vaccine hesitant" as opposed to vaccine resistant.
"We really have no idea of what percentage of Canadians are vaccine hesitant and who these people are," she says.
"It's hard to convince the die-hards to get vaccinated, but there's a pool of people who are sitting on the fence and we need to do more work to understand this population better and how best to address their concerns."
Public health funding for flu vaccination by province/territory: