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?