The World Health Organization, the health arm of the United Nations, declared a Phase 6 Pandemic Global Alert on 11 June 2010 for the H1N1 Influenza A or Swine Flu virus. Director-General Dr Margaret Chan repeatedly warned that while the H1N1 virus had been mild, the emergency declaration was necessary because of the unpredictability of the influenza virus and the poor facilities in countries with fewer resources.
WHO Director of the Initiative for Vaccine Research, Dr Marie-Paule Kieny reiterated that statement in a press conference on September 24 in Geneva. She stated that "we are lucky that the pandemic is moderate in severity that most people experience a mild illness and recover spontaneously."
This means a large number of people recover from the flu with no vaccination, no Tamiflu or any other antiviral drugs.
WHO Director-General Margaret Chan had claimed combating the pandemic would only be possible if we ensured that enough vaccines are distributed to the poorer countries in the southern hemisphere. This is in direct contradiction to the WHO Strategic Advisory Group of Experts (SAGE) that stated on the official WHO website that the H1N1 virus does not pose a threat in the southern hemisphere.
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The WHO raised over a billion dollars for vaccines in poorer countries. The United States and several other countries even pledged 10% of their vaccine supply to countries in need. Large stockpiles of vaccine were the norm as countries feared supply shortage. These vaccines were only useful for this particular strain of H1N1 and would be useless if the virus mutates.
The questions we should ask ourselves are: Was the panic induced by the H1N1 virus justified? Should we vaccinate ourselves against an influenza virus that is relatively mild in symptoms? How widely should we vaccinate the population when we can't predict the exact extent of the pandemic?
Culture of Fear
The culture of fear refers to our society being in the grip of an ever-expanding preoccupation with risk. Our human perception of danger has very little to do with the actual probability of us suffering a misfortune from that source. For example, many people in the world suffer from a debilitating fear of travelling by airplanes but will be more than happy to drive a car to work. Yet, the probability of us suffering a fatal car crash is infinitely higher than that of a plane crash.
There are two main schools of thought on this phenomenon: that it is consciously constructed by those who wish to create fear to induce certain behaviors, such as voting for an appropriate presidential candidate, or that it is the natural result of historical events. The point of this paper is not to make a definite stand on either of these views but to show how the H1N1 pandemic runs along the lines of large scale "fear" events like 9/11 to better understand whether we should take the vaccine or not.
Some distinctive traits of these events include careful selection and omission of news, distortion of statistics and numbers and causal inversion; turning a cause into an effect and vice-versa. As we cover the facts surrounding the H1N1 panic, we can see some of these factors present H1N1 pandemic.
There was nary a day where a swine flu case did not make the headlines in the summer of 2009. The fear permeating the streets was palpable as many of us feared another SARS episode. Yet, if anyone had perused the news carefully, the actual death toll was surprisingly low. By the time an SMU student had brought the virus to Singapore, the WHO was reporting a total death toll of 7.
The WHO raised the H1N1 virus threat level from 4 to 5 in April 2009, and moved it to level 6 barely 2 months later. Level 6 is the very highest threat level, meaning a pandemic was almost a certainty. The fine print states these phases deal with the probability of a pandemic and not a virus's severity. These events coupled with articles containing inflammatory headlines like "An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All" from Wired and speeches from WHO Dr Chan about how "All of humanity is under threat" contributed to the growing fear in the public.
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Experts were trotted out in the media, telling us there was a high likelihood the pandemic would mutate into a much more virulent form and many safety measures from the SARs period were introduced. Temperature takings, face masks and antiseptic hand wash became popular products again. Everyone feared a large scale spread of a disease like SARs and the specter of the 1918 Spanish flu hung like a cloud over businesses.
Experts, particularly scientific experts, play a unique role in today's culture of fear. Although experts often contradict one another, we find it difficult to ignore what they have to say. This is because they are underpinned by the most influential form of twenty-first century authority: science. We view experts as having insights that we ordinary people do not possess. Thus, their views are far more important and profound than the uninformed public.
A large number of our anxieties are the direct result an expert's statements and predictions. How many times do we hear the phase "experts warn"? Their dire forecasts range from the devastating threat of global warming and impending food and energy shortages to a flu epidemic and 'super bugs' put our imagination into overdrive. They warn us of dangers in the future that cannot be seen by ordinary human beings.
The numbers that have been published differ depending on the source that you refer to. The infection and death rate of the virus have been published but there are indications that the numbers might be inaccurate. The statistics are questionable due to the method of confirming H1N1 infection. The method used in the process changed throughout the course of the pandemic. In the beginning, the WHO was only reporting confirmed cases. A swab had to be taken from the patient and a test was performed on the culture to show a H1N1 virus match. Of course, this method is time and resource consuming, add to the fact that that only a limited number of labs can perform this test.
Later on, patients were tested using the rapid influenza antigen tests. These tests can miss up to 30% of influenza cases, may only detect 10-70% of 2009 H1N1 influenza infections, and will occasionally be positive when someone does not actually have the flu. Besides that, these tests only differentiate between type A and type B. The patient is presumed to have contracted swine flu if he or she tests positive for type A influenza. But type A influenza also comprises the different strains of seasonal flu and there is no exact way of discerning that.
The medical services in Third World countries are less sophisticated. This means that they usually do not have access to the lab or rapid antigen test. In these countries, cases were counted based on symptoms. The H1N1 symptoms are similar to those of the common flu and this makes the reported numbers even more suspect.
Recently released statistics place the number of deaths around 25,000. While every death is tragic and we should not discount these numbers, the U.S. Center for Disease Control (CDC) estimates the regular seasonal flu is responsible for 36,000 deaths in America annually. The WHO reports a total between 250,000 and 500,000 deaths worldwide from seasonal flu, depending on the severity.
If you compare these numbers, even accounting for statistical inaccuracies, the death toll of H1N1 seem to pale in comparison to the seasonal flu death toll. Now in 2010, reports from doctors who had treated the disease and patients who had survived H1N1 around the world all indicate that H1N1 was a relatively mild disease.
WHO released a report indicating H1N1 was affecting a disproportionately large number of children and young adults. This is slightly out of the norm as it's usually the elderly that are more affected by flu. This may be due to a variety of reasons, a new strain of disease usually means the immune systems has low defenses and the higher probability of young adults congregating in crowded areas.
We can see that the numbers published by the WHO have a high probability of being exaggerated due to the data collection method. Manipulation of data is at the root of most media discourses these days and it serves to perpetuate the culture of fear. The media needs to latch on to sensationalistic headlines to sell better. Why else is there a need to emphasize a rather negligible difference in the H1N1 infections among the young?
Costs to the public
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Kalorama Information, an independent market research publishing firm that is one of the leaders in their field, revealed that the H1N1 vaccines that were developed to combat "Swine Flu" are the main reasons for the 3.3 billion increase in revenue of pharmaceutical companies. Companies who benefitted include Novartis, GlaxoSmithKline, Astra Zeneca and Australian pharmaceutical company CSL.
How much has this pandemic cost? The director of the Initiative for Vaccine Research, Dr Marie-Paule Kieny stated that the H1N1 flu vaccine cost between $2.50 and $20 per dose, based on the countries' ability to pay. The large scale panic caused governments to stockpile large amounts of the vaccine. GlaxoSmithKline reports that various governments had placed orders up to 440 million doses of Pandemrix, its flagship H1N1 vaccine.
I am not trying to say that corporations shouldn't turn a profit from products they have painstakingly developed. After all, these companies probably took significant risks by diverting a significant portion of their resources to research and development during the pandemic period. But the culture of fear that is so pervasive in our society created a climate where governments were using taxpayer's money to stockpile vaccines for a flu virus that poses little threat to their citizens.
Some governments even went as far as to use it as a political tool. In Ukraine, elections were being held around November 2010 and H1N1 vaccination became a way for the country's politicians to score points with the voters. Prime Minister Yulia Tymoscheko, clothed in a surgical mask, made a public spectacle of receiving Tamiflu deliveries at the Kiev and Lviv airports. The Ukrainian authorities were simply tapping on to the hysteria caused by the flu outbreak to distract their citizen's from the massive social and economic problems plaguing the country.
Safety of the vaccine
One of the key factors for deciding whether to take the vaccine depends on the safety of the vaccine in question. Vaccination is not always the magic pill that solves our problems. In 1976, some Americans who were vaccinated against the Swine Flu threat suffered adverse effect such as Guillain-Barre Syndrome (GBS). GBS is a neurological disorder that causes nerve damage. It can result in loss of muscle control and lead to paralysis, potentially causing death.
We have come a long way in the last 34 years. The H1N1 vaccine released to public is said to be akin to the seasonal influenza vaccine. These vaccines are distributed every year in the United States. Both the FDA and CDC claim the risk profiles are the same and these vaccines have demonstrated very high safety records.
Critics cautioned that the new vaccine has not been thoroughly tested. The vaccine was released very quickly and was approved without testing in some countries like Canada. But safety debates of any new medication are like an endless circle. You can't ensure the safety of the vaccine without a large sample size but you can't obtain large enough sample size without releasing it to the public.
The CDC has also given us the profiles of people that are highly recommended to get the vaccination. They include
Pregnant women and caregivers
Healthcare and medical personnel
People with health conditions arising from medical complications related to influenza.
We have shown that there was high panic level surrounding the swine flu pandemic, but the actual number of lethal H1N1 cases was relatively low. I am not a conspiracy theorist and I certainly will not be drawn into concluding that the hysteria caused by H1N1 was some sinister plot by "Big Pharma" to profit from the fears of the people. But it would not be far-fetched to say that the threat has been overhyped to a certain degree.
The most mathematical translation of risk is probability of event and impact if event occurs. I consider the probability of contracting H1N1 to be rather low as Singapore has a 251.48 per million infection and the death rate is 3.93 per million according to flucount.org which tracks H1N1 flu statistics. And there is ample evidence that a young healthy adult like me will recover from H1N1 even without Tamiflu.
As such, I would most likely not be getting a H1N1 vaccination. I would like to point out that there are repercussions to hyping the extent of the virus and cultivating fear in the media. Exaggeration comes at a price. Not only do people panic and engage in behaviours that increase the risk, like waiting in a crowded clinic to get a flu shot and thereby increasing the likelihood of being in an enclosed space with someone who has contracted the virus. People may also grow cynical and ignore future health messages that really matter.
Benefits have come about as a direct result of the H1N1 pandemic. We have thoroughly tested our pandemic response system and found it to be satisfactory. Vaccines and medication were made available quickly. I'm sure that the people responsible have gathered vast amounts of data to improve the system and we can be fairly confident in our response time to future pandemics.
There were also some promising advancements in pandemic detection. Most of the crisis responses in pandemics are reactionary measures, but early detection is the key to controlling the spread of diseases if we are to prevent pandemics from occurring in the first place. Google Flu Trends have given us some tantalizing progress in that aspect. It can detect regional outbreaks of influenza 7-10 days before conventional CDCs and prevention surveillance systems.
This is done by tracking large spikes in web queries for flu related symptoms. Google will be working with public health care practitioners to develop specialized tools, using Google Flu Trends as a blueprint, to track infectious diseases. This promises to be the first step in true real-time outbreak surveillance.