The Catastrophe That Never Happened

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 2009?

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 over cautious 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.

Every year, thousands of people around the world die from seasonal flu. Governments in many advanced economies provide, or make available, vaccines designed to minimize the number of deaths.

When a new strain of flu comes along, a number of things need to be assessed quickly. First, how contagious is it- in other words, how likely are you to catch it from someone else in the normal course of going about your daily life. Second, how virulent is it - if you catch it, what are the odds it will kill you. Third, do existing vaccines provide a reasonable measure of protection or do we need to develop an entirely new one, and so on.

Having made these assessments, the relevant authorities can then decide the appropriate countermeasures.

The initial assessment of swine flu transmissability, both in Hong Kong and other places, was that the new form 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 the UK for example, the Department of Health announced the country could expect hundreds of thousands of cases and 65,000 deaths. The forecast was later lowered to 1,000 deaths. Moreover, by the start of this year, less than 5,000 cases had been recorded with just 360 deaths.

Hong Kong was caught up in the sense of foreboding, in large part affected by our experience of SARS in 2003, memories of which were still fresh. Just as with the earlier epidemic, 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 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 already, for example one elderly man had terminal cancer and another serious health problem. Was it correct to attribute his death to the new flu?

Quite soon it became evident to everyone that the new flu was extremely mild as these things go, less virulent even than normal seasonal flu. Yet that did not seem to slow the rhetoric or halt the steady stream of "emergency" measures. Every morning the WHO spokesman for the region could be heard on the radio warning that an even higher level of alert was imminent (We eventually made it all the way to Level Six, the highest.)

Many Governments spent heavily on vaccines. France for example spent over $6 billion to buy some 90 million doses. Hong Kong made global headlines by quarantining an entire hotel, and also splashed the cash on vaccine and a major PR campaign to push vaccinations. Our Chief Executive even wheeled in the TV cameras when he opted to be among the first in line ("I'll get the jab done.")

But to no avail. By now the great mass of local citizenry could see for themselves that 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. Similarly in France where less than ten percent got the injection.

What harm was done, you might ask? After all Hong Kong has plenty of money in the reserves. The real downside is two-fold. First, might the money have been better spent addressing other medical problems in areas with a higher mortality rate? Secondly, and more important, has the WHO -- and by extension individual governments -- lost credibility? If they have, then next time there could be a reluctance to follow official advice.

Hong Kong people are pretty pragmatic and are likely to shrug the matter off this time round. That is not the case in Europe. The governments there are pretty hard up for one thing. And there are some tough questions being asked 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.