The surveys conducted at WHO pandemic alert phases 3 and 5 found a consistently low level of willingness to accept pre-pandemic influenza vaccination among hospital based healthcare workers, especially in those working in the allied health professions. This is particularly surprising in a city where the SARS outbreak had such a huge impact. The intention to accept vaccination against H1N1 influenza (swine flu) in our study was less than 50% even at WHO alert phase 5. On 21 May 2009, the WHO stated that 41 countries had officially reported 11034 cases of swine flu, including 85 deaths. 17 This was the time when our survey was conducted. It was surprising that neither this information nor the escalated WHO alert phase affected the intention to accept pre-pandemic vaccination. Vaccination is one of the potentially effective measures that can reduce mortality and morbidity from pandemic influenza. On 13 July 2009, the WHO also recommended that all countries should immunise their healthcare workers as a first priority to protect the essential health infrastructure. 18 However, the effectiveness of this measure depends heavily on the uptake rate in those groups assigned high priority. Therefore, the low potential acceptance of this vaccine warrants our attention, with a view to improving acceptance.