There are a number of groups that are especially vulnerable in terms of susceptibility to influenza and barriers to accessing vaccinations. This may lead to larger problems in case of a pandemic; for example, in the H1N1 2009 outbreak in Australia, indigenous Australians, a hard to reach group, were overrepresented in rates of hospitalisation (Seale et al 2010). Hard to reach groups may have adverse health outcomes, and the complex interplay of gender and social and economic marginalisation makes this a particular issue for women (Davidson et al 2011).
Some countries are slowly moving toward the implementation of a two-way PH communication strategy. For example, in May 2010, shortly after the H1N1 pandemic, the public health authorities of New Zealand designed a rapid response initiative to have feedback from population on the communication campaign and on their risk perception. The project consisted in a study, which aimed to retrieve evidence-based information which health authorities could use to design tailored health communication campaigns during/after periods of pandemics.
For a country, being ready to face an infectious disease outbreak requires, among other things, the capability to reach and involve all the components of the society. Especially those that are more exposed to health threats due to low quality housing, poor nutrition, lack of parental education and weak links to health services, as it happened in the 2010 measles epidemic in Bulgaria, where 90% of recorded cases occurred within the so-called Roma community.
