The painful side effects of a shot in the dark
As governments around the world prepare to throw away billions of dollars worth of date-expired vaccine, the question must be asked: did some world health authorities, including those in Hong Kong, overreact to the great swine flu scare of last year?
The easy answer is to say: 'No. It's always better to be safe than sorry.' But the easy answer is not always the right answer. And being overcautious can sow the seeds of future problems. A new report being prepared for the Council of Europe attempts to address the nuances of this complex issue.
When a new strain of flu comes along, a number of things need to be assessed quickly. First, how contagious is it? Second, how virulent is it - what are the odds it will kill those it infects? Third, do existing vaccines provide a reasonable measure of protection or do we need to develop an entirely new one? Having made these assessments, authorities can decide on appropriate countermeasures.
In this case, the initial assessment, both in Hong Kong and other places, was that the new form of flu spread easily. This was essentially correct. But before there was a firm, evidence-based assessment of virulence, some really scary scenarios were launched into the public arena and helped to shape policy choices.
In Britain, the Department of Health announced that the country could expect hundreds of thousands of cases and 65,000 deaths. But, by the start of this year, it recorded fewer than 5,000 cases and only 360 deaths.
Hong Kong was caught up in the sense of foreboding largely because of our experience of severe acute respiratory syndrome in 2003. Just like then, the main news item each day was a report on the latest number of suspected and confirmed cases of H1N1. Each death was taken as a confirmation of the most gloomy assessment of the likely outcome, with a very real sense being created that the numbers were about to rocket.
Yet a closer reading of the news items gave an altogether different impression. Many of the victims were elderly and/or had chronic diseases. Was it correct to attribute their deaths to the new flu?
Quite soon, it became evident that the new flu was extremely mild as these things go, less virulent even than seasonal flu. Yet that did not seem to slow the rhetoric or halt the steady stream of 'emergency' measures. Every morning, the region's World Health Organisation spokesman could be heard on the radio warning that an even higher alert level was imminent.
Many governments spent heavily on vaccines. France, for example, spent over US$6 billion to buy some 90 million doses. Hong Kong made global headlines by quarantining an entire hotel, then splashed the cash on vaccine and a major publicity campaign to push vaccinations.
But, by then, most Hongkongers could see there was no real crisis, and news was beginning to emerge of some pretty ugly side-effects. Most people decided to save their arms for next time.
What harm was done, you might ask? After all, Hong Kong has plenty of money in its reserves. The real downside is two-fold. First, might the money have been better spent addressing other medical problems with higher mortality rates? Second, and more important, have the WHO and individual governments lost credibility? If they have, then next time there could be a reluctance to follow official advice.
While pragmatic Hongkongers may shrug it off this time, that seems less likely in Europe, where governments are pretty hard up. They are asking tough questions about representation on WHO internal committees by the big drug companies who benefited from the high alert level. The last chapter of this story has yet to be written.
Mike Rowse is a retired civil servant and an adjunct professor at Chinese University of Hong Kong
