The answer depends on whom you believe. A debate is brewing between experts over the likelihood of a third wave. In previous pandemics, a more serious winter wave followed the autumn one. If that happens again, the H1N1 vaccine would still offer protection during the next round of infection.
But Schabas insists that the notion of a third wave is nonsense, a convenient theory to alleviate our surprise at how few people have actually died. He is so convinced we won’t see another round of pandemic H1N1 that he is considering telling healthy people in his area not to bother getting vaccinated. Fisman, who conducts mathematical modelling for MITACS, a Canadian research network, says his calculations also do not point to a third wave. But he is careful with his forecast because he says there may still be isolated pockets of H1N1 in the coming months.
Even if there is no third wave, experts argue that getting the pandemic shot is still important because there is a good chance H1N1 will become part of future seasonal flus, including what may come next fall. Dr. Monika Naus, an epidemiologist and director at the B.C. Centre for Disease Control, also predicts that H1N1 will become part of “the fabric of circulating strains for quite a while to come.” In fact, Naus says that there is “every expectation” that the World Health Organization will recommend that H1N1 be incorporated into the next seasonal vaccine.
Whatever comes next, everyone acknowledges this much: the H1N1 strain has provided a test run for public health authorities, an opportunity to learn a few hard lessons about what Canada can do better next time. Many health experts are calling for a complete rethink of how we deliver shots, even suggesting the creation of a national immunization program that would require all the provinces and local health units to roll out the pandemic flu vaccine in the same way. Crowcroft admits that it borders on blasphemy to propose that provincial and local authorities bow down to federal rules about their own well-being, but she’s not a fan of differentiation for its sake alone. “It doesn’t make a lot of sense to have different approaches. I know that goes against the Constitution of Canada, but it might have made some issues a lot easier.” Adds Scheifele: “It confuses the daylights out of the public when one province is saying one thing and the adjacent province is saying something else. There are lots of points where you wish there was just a czar who said: ‘We’re doing it this way.’ ”
For now, the experts are just happy that H1N1 hasn’t been the catastrophe that health authorities have been bracing for-—and had in mind when they wrote the frightening federal pandemic plan. “I’m grateful that it’s not the 1918 pandemic, that the mortality rates aren’t higher,” says Naus. “If we had that kind of situation in this type of vaccine supply we’d be in a much harder place.”
Much harder. What if a dozen Evan Frustaglios had died in the arms of their helpless parents? What if triple the number of fear-stricken people showed up at the country’s understaffed, under-supplied flu clinics? What if their frustration at being turned away led to violence? And what if—despite the best efforts of GSK—something else went wrong at the production plant and vaccines suddenly stopped flowing?
The answer, unfortunately, is that we would be pumping out the flu shot at much the same pace as we are right now. Of course, if this was a deadlier pandemic, many other measures would be implemented immediately. Schools, social centres and places of employment would close down, quarantines would be ordered at the first sign of infection, and the national stockpile of antivirals would be deployed en masse. And squabbling over who deserves the flu shot first would soon be trumped by unthinkable choices over who gets the last life-saving ventilator—the 65-year-old man with a bad heart, or the 21-year-old woman with a whole life to live?
Maybe the lineups aren’t so bad.
With Nicholas Köhler and John Geddes
