Universities are not immune to natural or manmade disasters, and past experience with these have illustrated the importance of continuity during and after these events [5, 9]. In an influenza pandemic, such institutions must maintain a balance between academic continuity, with infection control and minimising morbidity [5].

In contrast to pre-pandemic and early pandemic findings in Australian communities [10, 11], most of the University population surveyed were not anxious about the Australian pandemic situation nor did they think it was serious. Younger respondents (aged 20-34) were most likely to believe they were not susceptible to pandemic H1N1 2009, despite being the most affected group in previous influenza pandemics. Following the resurgence of media coverage of "swine flu" in Australia, we did measure a significant rise in anxiety, perceived susceptibility and seriousness. This however declined with the approach of spring and the decline of laboratory confirmed cases of influenza A (H1N1) in NSW [12]. This illustrates that public perception of a pandemic is unstable, especially when the severity and natural progression cannot be accurately predicted.

If requested by authorities, most respondents in our cohort were willing to undergo isolation if suffering from influenza-like-illness (ILI). Of concern was the high proportion of students who indicated that they would still attend University with symptoms. In the event of an exam or assessment deadline, their proportion tripled. Such behaviour is detrimental for both students and the community, for in addition to spreading the pandemic virus, students with ILI are also likely have reduced academic performance by up 30-60% [3]. Absenteeism from University was higher in respondents who had indicated making a lifestyle change, implying the practicality of encouraging general positive health behaviour in this population. Along with encouraging students to self-isolate in the case of illness, there must be ongoing education about the importance of infection control, especially when anxiety rates and risk perceptions are low. Health messages need to educate students about the impact of the illness on their studies, and Universities should emphasise their illness/misadventure assessment policies during disease outbreaks.

Online resources such as lecture recordings and forum tutorials allow for off-campus education, and can provide continuity of learning for students undergoing isolation. However in our study, few respondents had adopted the use of online teaching or learning resources as a result of pandemic influenza (H1N1). This may be due to a number of factors including: (1) the apparent mildness of the pandemic; and/or (2) the lack of promotion by the University to use these resources. It was encouraging to see that students were very willing to continue University schooling via online resources, indicating the potential for expanding the existing UNSW online teaching resources. While it was encouraging that students would undertake online courses, we found very little support for an online teaching method among the academic staff members. Reluctance to use online resources was associated with increased age, and may be due to unfamiliarity with or resistance to technology. In preparation for an outbreak, Universities should focus on creating additional support for technologies that allow faculty and students to continue their teaching and learning activities which minimise disruption. Online recordings, virtual learning environment, blogs, web conferencing and discussion forums should all be utilised to assist in the delivery of lessons. Having a contingency and communication plan for teaching key sections may provide the needed continuity for students and faculty. Training must be provided in the pre-pandemic periods to minimise disruption.

We found that most respondents had not made any lifestyle changes or undertaken any specific behaviour change despite receiving information from the University. This may be attributed to the mildness of pandemic (H1N1) 2009. This finding supports both the pre-pandemic and post-SARS findings on the dose-response relationship between outbreak severity and the responses to it [13, 14]. Of the respondents who did indicate behaviour change, increased hand hygiene was the most common. It would therefore be beneficial and at minimal cost for institutions such as Universities to provide extra hand-washing facilities and posters encouraging compliance in communal areas and computer labs. Universities could also boost hygienic practices by openly distributing small bottles of hand gels or tissue packets to staff and students on campus.

Close to 60% of our respondents stated that they were 'very willing' to receive a hypothetical pandemic vaccine. As the survey period ended before the vaccine became available, we were unable to follow up participants to ascertain if they did receive the vaccine. In Australia, the H1N1 vaccine was not released until September 2009, by which time, virus activity was very low. A recent national survey [15], found that although 96% of the Australian cohort was aware of an available pandemic vaccine, less than 20% had received the vaccine. We can therefore expect similarly low vaccination rates in our cohort. The survey also identified that uptake of the H1N1 vaccine was three times as high in those aged 65 years and over (42%) than in those aged 18-64 years (14%), with no statistically significant difference between males and females [15]. We found that respondents who had received seasonal influenza vaccinations in the past were significantly more likely to accept the pandemic vaccine then their non-vaccinated counterparts. These findings are consistent with several recent studies on pandemic vaccine uptake [16, 17]. Providing the vaccine through clinics or university health facilities should help bolster vaccine uptake, especially for international students, who may not have access to free healthcare.

Of the participants surveyed, Asian-born respondents were the most likely to be anxious about the Australian pandemic situation, rate the situation as serious, undertake specific behavioural changes and comply with public health measures. It could be hypothesised that these respondents, their families, friends or members of their communities may have been exposed to previous infectious disease situations such as SARS and avian influenza [18, 19]. If not exposed, at the least these respondents have lived in countries where their governments have had to deal with these situations, leading to stricter infection control standards and higher levels of media exposure. Interestingly, Asian born respondents who have been settled in Australia for longer periods were less likely to have made any lifestyle changes compared to their counterparts who have been in the country for only short amount of time. It would appear that living in Australia dilutes the tendency to adopt behavioural changes, and it would be beneficial for future studies to identify aspects of Australian culture which influence health behaviours.

We acknowledge that this study has several limitations. These include: (1) the survey was restricted to the UNSW student, general and faculty staff, mostly highly educated Sydney residents; (2) the electronic format of the survey may have excluded persons without internet access; (3) we did not defin what "requested by the authorities meant" so it was open to the respondents interpretation and (4) the survey was not translated into other languages. However, English is the dominant language used in both teaching and communication and UNSW relies heavily on electronic communication with its campus population to disseminate other unrelated information in English. There was no established measure of influenza protective behaviour, as most of the survey items were developed prior to the publication of the CDC Guidance for Responses to Influenza for Institutions of Higher Education [5]. The declining number of participants who accessed the online survey towards the end of the survey period likely restricted analysis of how responses to the pandemic change over time.