Notes on a non-crisis

091104_N1H1_2A summary of what we know now:

- The federal government put in an order for 50 million doses of swine flu vaccine — enough to vaccinate everyone in the country 1.5 times — with GlaxoSmithKline in early August. As of this week, GSK has delivered to the feds, and the feds have shipped to the provinces, 6.7 million doses. But at last count only 2 million had been administered. The feds have delivered nearly twice as many doses, per capita, as the Obama administration (deliveries in the US have lately crested 30 million), and claim to have the highest per capita delivery rate in the world, but even if they had delivered twice as many again, they’d only ensure that 10 million doses were backed up waiting to be administered.

- Perhaps the vaccinations should have been ready sooner. But two decisions, both medically defensible, contributed to this. One, they held off producing the H1N1 vaccine, on the advice of the public health officer, to produce the seasonal flu variant — understandably, since it’s far more deadly, at least in the short run. And two, they slowed production of the adjuvanted (more potent) vaccine this week, in favour of the unadjuvanted variety, which the World Health Organization had recommended as safer for pregnant women. The WHO has since changed its mind.

- Even at that, we might have got by without the lineups of the past week. Not two weeks ago, the public gave every indication of giving the whole thing a pass. Polls showed only a small minority intended to get vaccinated. So the authorities were likely planning on the basis of a leisurely take-up rate. Then 13-year-old hockey player died suddenly of the disease, and everyone flipped — from apathy to mass panic, in the space of a couple of days. Couple that with large numbers of queue-jumpers, healthy adults who are not among the high-priority, and you have a recipe for incipient chaos.

- There is no emergency. The current flu outbreak kills at a fraction of the rate of regular, seasonal flu, which hardly anyone worries about. The child who died of the disease was freakishly unlucky. Obviously the sooner the better, but it’s debatable whether anyone will die because the vaccinations are administered in November rather than October, since you have to take the already tiny proportion of people who would have been susceptible to dying from it, divide that by the proportion of those who would have caught it in the absence of a vaccine, and divide that by the proportion of those who would have had the foresight to get themselves vaccinated.

- Should the government have relied on a single supplier? Maybe, maybe not. But the Liberals are ill placed to make this point, since the contract to supply the flu vaccine was signed with Ste. Foy, Quebec-based Shire BioChem (later bought by GSK) in 2001, by the Chretien government: a 10-year contract worth $323.5-million. CTV reports the Liberals received a $56,000-plus donation from Shire BioChem that same year.

- The Auditor General makes some good points about emergency planning — in general. But she was auditing the Public Safety department, not Public Health, and she did not look specifically at the H1N1 issue. Doubtless there has been some bungling, but this was a) mostly by the provinces, who are responsible for administering the vaccine, b) no worse than garden variety government bungling, c) probably made worse by the confusion of overlapping roles between three levels of government. Some provinces have done a better job than others, and within each province some regions have done better than others.

- Bottom line: This was an inherently difficult undertaking: the largest vaccination program in the country’s history. The task now should not be to point fingers, but to learn so we can all do a better job the next time, when the stakes may be very much higher.

Print Story PrintComment Comment
ShareDelicious

This website uses IntenseDebate comments, but they are not currently loaded because either your browser doesn't support JavaScript, or they didn't load fast enough.

421 Responses to “Notes on a non-crisis”

  1. RasAlhague says:

    It is amazing how the media can simply drop in a little politics to preoccupy every sheep’s mind. So obsessed with liberal this, conservative that… no one questions the safety of the vaccine anymore. How can anyone think this stuff is safe to use?

    http://health.gsk.com/hcp/H1N1Vaccine/safety.htm

  2. Kim says:

    More people get killed in car crashes every year than will die from the flu. In the grand scheme of things a few dying every year is normal. Our society is far too hung up on every one living forever and their fear of death. It will happen to all of us, some just sooner than others.

  3. Mulletaur says:

    ""I believe that if they had made the bold and courageous decision to follow the evidence, and abandon the seasonal flu vaccine, that we could have had our H1N1 vaccine about six weeks earlier," says Dr. Richard Schabas, Ontario's former chief medical officer of health.

    "The consequence of that is that we've got lots of seasonal flu vaccine, but no seasonal flu, and not enough H1N1 vaccine, and lots of H1N1," Schabas said. "It's backwards."."

    From a story in the Edmonton Journal today entitled "Canada should have abandoned seasonal flu shot to focus on H1N1: critics".

    Puts the lie to all the ConBots who are trying to defend the (non)-response of Stephen Harper's Conservative government to this health crisis, which is costing people their lives.

  4. KatieMate says:

    Further to others' comments about Australia's handling of the swine flu earlier this year:

    I am a Canadian living in Australia where we haven't heard a single word about H1N1 since our flu season back in May/ June. I know that the vaccine is available to me – only because I have been seeking out information from the NSW Immunization Department. I do plan on getting it because my family is returning home to Canada for Christmas. Where it gets confusing for me, is that the vaccine has not been approved for children under ten years old here. I am bringing two young children with me; but I'm told here not to worry as they are not considered to be within the 'high risk categories'.
    They maintain that those at highest risk are people with underlying conditions such as asthma, diabetes etc. in addition to young adults (otherwise healthy).
    It seems to me that governments and health authorities need to get their acts together and present consistant information to the public. I'm confused and wondering if I should be exposing my children or if I'm just being paranoid (after watching a few too many Youtube clips looking for information!).

  5. KRB says:

    Carolyn Bennett is an idiot, pure and simple, Hedy Fry is even worse ("why aren't we being vaccinated!!"), and Kristy Duncan has that "wild eyes" look that give me the creeps.

    They're perfectly following Wells rule of politics (forget which one): Whomever auditions for the role of opposition, will get it.

From Macleans