(Weekly Organ of the Communist Party of India (Marxist)
January 17, 2010
Wither H1N1 Pandemic?
Amit Sen Gupta
THERE was a palpable sense of relief in the corridors of Nirman Bhawan � seat of the country�s ministry of health � as the new year was being ushered in. For much of 2009, the biggest �story� on health � going by column centimetres that newspapers used up and television bytes on news channels � was the swine flu epidemic. The jury is now almost set to pronounce its verdict � the worst of the H1N1 pandemic is over.
We would, in the coming weeks and months,
series of self adulatory reactions from the health ministry regarding
country managed to stave off the worst effects of the pandemic. We
shall not be
alone in this exercise � health agencies across the world, led by the
already started the self congratulatory exercise. By all accounts, in
all countries, the pandemic has peaked and is set to start declining.
data suggests that the pandemic has affected about 26,000 people in
picture is similar to what is unfolding in most countries across the
mid-2009, the department of health in UK had warned of 65,000 deaths,
set up a
special advice line and website, suspended normal rules so anti-flu
be given out without prescription and told health and local authorities
prepare for a major pandemic. Planners were told to get morgues ready
for the sheer
scale of deaths and there were warnings that the Army could be called
prevent riots as people fought to obtain drugs. But just 251 deaths
reported in the
So, did a Herculean effort in public health lead to such a dramatic turnabout? Unfortunately, the major reasons for the pandemic not creating the predicted bang lies somewhere else. It is now becoming clear that this is the least lethal modern pandemic of influenza. Present estimates indicate that the H1N1 virus is killing between 1 in 2,000 to 1 in 4,000 people. Contrast this with the Spanish Flu pandemic in 1918 that killed 1 in 40 people who contracted the infection. Even the �less virulent� pandemics of 1957 and 1968 killed about 1 out of every 500 people affected. In other words, the present pandemic is almost 100 times less lethal than the 1918 pandemic. Research now shows that the swine flu is not easily spread from person to person as first thought. Researchers followed more than 200 families and found that the flu only spread to 13 per cent of potential contacts.
Celebrations may still be premature as we are still not sure if the virus will mutate into a more virulent form, but the chances of that happening recede as the pandemic starts entering its second year.
PATHETIC CONDITIONS OF
PUBLIC HEALTH EXPOSED
Are there, then, any lessons to be drawn? The first lesson is of course that we still know very little about how new viruses will behave. The H1N1 virus has proved to be unusually co-operative � its infection rates are low, it rarely affects older populations, it is still susceptible to anti-viral medicines, and it has stubbornly refused to mutate and transform into a more lethal avatar. But precisely because we know so little about why this virus has proved to be so relatively benign, we know next to nothing about when the next truly lethal cousin will strike.
What if the pandemic had been of the
and virulence, or if the presence one suddenly starts living up to its
�promise�. Are the global and national efforts in the last nine months
cause for comfort? Unfortunately, the answer would have to be an
At the global level efforts have been singularly lacking in purpose and
At the national level, response by the government ranged from the comic to the tragic. Pronouncements ranged from sporadic show of bravado to pessimistic hand wringing in the face of an impending catastrophe (that mercifully did not unfold). Just one statistic should suffice to show how ill-prepared we really were. If Azad�s initial projection of 350,000,000 cases were to be taken at face value, and the initial estimates of 1 per cent of them requiring hospitalisation are factored in, we would have needed to hospitalise 3,500,000 swine flu cases over a period of six months. Calculating that each would have needed about a week�s stay in hospital, it would have meant that an excess of 1,00,000 people would have needed to be hospitalised at any given point of time. Not just hospitalised, they would have to have had access to modern facilities, including facilities to be put on a ventilator. Contrast this with a few hundred beds that have been kept aside to treat swine flu patients, and the gross mismatch between demand and supply would become clear.
The issue that we need to understand is that you cannot plan for a response to an epidemic, after it has been set in motion. Epidemics can be tackled only if public health facilities exist when a pandemic hits a population. The pandemic that almost never was, has shown up the utter lack of public facilities for health care in the country. If it had caused the destruction that was earlier predicted, we would perhaps had had no other option but to hide our heads, ostrich like in the sand, waiting for it to pass.
WAS THE PANDEMIC ALERT
As evidence about the �failed� pandemic starts mounting globally, there is now concern being expressed that the World Health Organisation was too hasty in announcing that the globe was actually in the midst of a new influenza pandemic. Pandemic, by definition, is a global epidemic that affects a significant number of people and the infection is sustained in local communities. Dr Margaret Chan, Director-General of the World Health Organisation (WHO), gave a statement on 11 June 2009 confirming that the H1N1 strain was indeed a pandemic. There are some who have started expressing the possibility that the false alarm and scare mongering about the pandemic was deliberately engineered.
major salvo, that recently captured headlines across the world, was
Wolfgang Wodarg, the chair of the health committee in the European
German parliamentarian is also an epidemiologist and former health
Wodarg has also held the �scare mongering� by the WHO responsible for huge contracts entered into by many European countries with vaccine manufacturers. He says: "The governments have sealed contracts with vaccine producers where they secure orders in advance and take upon themselves almost all the responsibility. In this way the producers of vaccines are sure of enormous gains without having any financial risks. So they just wait, until WHO says "pandemic� and activate the contracts."
Further, he makes the serious accusation that WHO deliberately changed its definition of �pandemic� so as to make it easier to declare the H1N1 infection as a pandemic. He claims that earlier, to be declared a pandemic, an infection had to be shown to be responsible for �high mortality and morbidity� i.e. cause severe illness and a large number of deaths in those affected. As the H1N1 did not qualify in this regard, Wodarg claims that the reference to mortality and morbidity was dropped in the definition of pandemic on WHO�s homepage.
This is not the first time that a senior epidemiologist has held the WHO responsible for keeping the definition of pandemic �too loose� and thereby open to the possibility of alarm bells being set to ring without sufficient cause. Last year, Peter Gross, infectious disease specialist with the Hackensack University Medical Center in New Jersey, in an editorial for the British Medical Journal suggested that the WHO's loose definition of a pandemic could lead to false alarms.
SET TO MAKE A KILLING
this controversy is the huge amounts of money that pharmaceutical
poised to make, riding the crest of the declared pandemic. It is
over two billion Euros have been spent, in
concerns that the drug for swine flu, Tamiflu, was aggressively pushed
adequate medical reasons for its widespread prescription.
Further, the nexus between the pharmaceutical industry, is not a matter of mere speculation. Last year, the Daily Mail carried reports about Sir Roy Anderson, a scientist who advises the government on swine flu, who also held a �116,000-a-year post on the board of GlaxoSmithKline. GSK makes anti-flu drugs and vaccines and is predicted to be one of the biggest beneficiaries of the pandemic.
The real story may take months to unravel, and the entire truth may still remain unknown. But the H1N1 pandemic has raised many issues regarding global preparedness in dealing with pandemics and the global dependence on pharmaceutical companies in situations of a potential crisis. It is hoped that proper lessons will be drawn by the global health community.