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A patient gets a shot during a flu vaccine program in Calgary on Oct. 26, 2009.JEFF McINTOSH/The Canadian Press

It's one of the great conundrums of Canadian public health: Despite widespread awareness of the dangers of the flu, influenza vaccination rates remain stubbornly low. This flu season, as many as 2,500 people will die of the various strains that are floating across the country, yet the vast majority of Canadians will find reasons not to get vaccinated. Fewer than one in three typically get a flu shot; in some provinces, as few as one in five bother.

The flu is in the news at the moment because of a large number of cases of H1N1, a.k.a. swine flu. But this seasonal spike isn't unusual, and no one is yet worried about a pandemic like the one that killed 280,000 people worldwide in 2009. Still, people are lining up to get belated flu shots in Alberta, where the first cases were reported. Typically, it has taken a scare to prompt Canadians to get the jab they should have had in November.

Why do Canadians ignore a common-sense measure that can protect them and their children? Dr. Allison McGeer, an expert in infectious diseases at Mount Sinai Hospital in Toronto, says there are a number of reasons. For one, it takes time to get the public to understand the risks. Two generations of public health campaigns on the dangers of cigarettes lowered the incidence of smoking, but haven't eliminated it. Health officials need to continue to drum home the message that the flu can turn deadly, and not just in the elderly.

As well, unfounded doubts about the safety of vaccinations continue to be spread by alarmist websites and celebrities. Almost all medical interventions have side effects and few are 100-per-cent effective, but a campaign of ignorance has singled out vaccinations as particularly dangerous.

The other, even more galling reason many Canadians say they don't bother to get a flu shot is that, thanks to union lobbying, health-care workers in many provinces don't have to get the shot. If a nurse doesn't need it, why would a patient, goes the logic. Dr. McGeer has a simple answer for that: "Health-care workers don't get vaccinated, patients die." Provincial governments should require health-care workers in direct contact with patients to get an annual flu shot. It could prevent deaths, and demonstrate the importance of vaccination. Doctors who have seen the peer-reviewed studies on the risks and communicability of influenza understand how critical it is: At Mount Sinai, 96 per cent of physicians got the shot this year.