While most US survey respondents had heard of H5N1 highly pathogenic avian flu, only about a quarter knew it can spread to people, and over half were unaware that pasteurized milk is safer than raw milk, finds a study published yesterday in the American Journal of Public Health.
The survey, fielded by a CUNY Graduate School of Public Health–led team, also found that less than one fifth of respondents understood that H5N1 has been detected in cattle, and nearly a third each were unwilling to change their diet to reduce their risk of exposure to the virus or take a vaccine if it were available—even if recommended by the US Centers for Disease Control and Prevention (CDC).
The researchers surveyed 10,000 US residents (half from rural areas) from August 5 to 15, 2024.
"Since spring 2024, highly pathogenic avian influenza (HPAI) has reemerged as a significant threat to public health in the United States," the study authors wrote. "Despite the growing risks posed by HPAI, a concerning disconnect exists between public health experts' warnings and the public's awareness and response."
Only one fourth knew that people are at risk
Only 26.1% of participants knew that people can contract H5N1, and while 62.3% agreed that the virus is a threat to human health, only 27.4% thought they were at risk for infection. Although nearly 71.3% understood that cooking meat at high temperatures can kill harmful bacteria and viruses like H5N1, 53.7% didn't know that pasteurized milk—which undergoes heating to kill pathogens—is safer than raw milk.
Without broad public support, vaccine uptake will likely remain insufficient to stem the tide of the virus.
"This was of particular concern given that evidence from California suggests H5N1 can be found in raw milk," the researchers wrote. "The state issued a recent recall of contaminated raw milk."
Overall, 27% of respondents said they wouldn't change their diet to lower the risk of exposure to the virus, and 28.7% said they would be reluctant to get vaccinated against H5N1, even if it were recommended by the CDC. Another 32.7% were unsure whether they would get a vaccine.
"The H5N1 virus is a real and present danger, and a vaccine could be one of the most effective tools for preventing further spread," the authors wrote. "However, without broad public support, vaccine uptake will likely remain insufficient to stem the tide of the virus."
Relative to Democrats, Republicans and Independents were significantly less likely to support vaccination and dietary changes (Republican adjusted odds ratio [aOR], 3.51 for vaccination and 1.56 for dietary modifications; independent aOR, 2.69 and 1.43, respectively).
Rural residents, who are more likely to work or live near livestock operations, were less likely to accept public health measures than their urban peers, including vaccination (33.3% vs 39.8%, respectively) and dietary changes (38.9% vs 45.8%).
"This hesitation reflects broader societal trends in which people are often unwilling to alter their behaviors in response to health risks," the researchers noted.
Low trust in government
Respondents reported low levels of trust in government agencies such as the CDC, Food and Drug Administration, and the US Department of Agriculture, at nearly 40%. And 38.0% of respondents said they were mentally and emotionally exhausted by the constant COVID-19 pandemic–related cycle of health warnings and changes to daily life.
"These attitudes could pose a serious obstacle to containing the virus and preventing a major public health crisis," lead author Rachael Piltch-Loeb, PhD, MSPH, said in a CUNY news release. "The fact that responses vary significantly by political party and geography emphasizes the need for a carefully segmented health communications strategy to address the issue."
