ONCE upon a time, a village asked its nerds to warn it when wolves threatened the chickens. One day the nerds saw wolf tracks 鈥� but how many wolves were there, and how hungry? The forest was big and there was not enough time to find out before sunset, so the nerds advised the panicked villagers to buy rifles.
But before the rifles were even loaded, one small and skinny wolf slunk out of the woods, killed two chickens and ran away. The nerds tried to explain that there were probably more wolves out there, but the angry villagers took the rifles back to the store and lynched the nerds.
This is the parable of swine flu. Governments had asked the World 午夜福利1000集合 Organization to coordinate their response to flu pandemics, and when one broke in April 2009 the WHO did exactly that, triggering expensive government health measures and vaccine purchases. Critics now allege the flu was less deadly than normal flu, meaning vast sums of public money were wasted on nothing more than a . Some even claim that it was a conspiracy to boost vaccine company profits.
Advertisement
So were the WHO and governments right to respond as they did? Or was it all an expensive overreaction, or a hoax? This week an delivers its preliminary answers to these questions. Similar inquiries are under way in the UK, the US and elsewhere.
Here鈥檚 the answer I hear from scientists: declaring a pandemic and making vaccine were overwhelmingly the right things to do given the science and technology at our disposal.
First and foremost, the notion that swine flu is not so deadly is an illusion caused by incomplete statistics: it certainly rivals normal flu, and its impact so far exceeds some previous flu pandemics.
Even if that were not true, the reaction was still correct. To understand why decisions were made, you have to look at how events unfolded.
Governments have pandemic vaccine orders in place largely because they are worried about bird flu. Nobody disputes that this is the correct strategy. If this highly lethal virus starts spreading readily in people, it could be worse than the 1918 flu pandemic, which killed millions. But other flu viruses are potential pandemic threats too.
Most new strains of flu do not cause pandemics because they are related to strains already in circulation, so most people are partially protected by antibodies. Occasionally, though, a flu virus appears that is so different no one has antibodies to it, whereupon it spreads like wildfire. That is a pandemic virus.
By March 2009, it was clear that H1N1 swine flu was in this category: it didn鈥檛 react with antibodies to any recent flu. So we knew then it would go pandemic.
What about lethality? Even though early reports from Mexico suggested a high mortality rate, when the virus hit the US in April it did seem fairly benign. Should the vaccine plans have been shelved at that point?
No. The virus鈥檚 lethality in April is not what mattered. The crucial point is that it takes six months to make useful quantities of vaccine. That means you have to predict the virus鈥檚 next move, which is currently impossible. Flu evolves, especially when it is blasting through millions of new hosts.
鈥淭he virus did seem fairly benign in April 2009, but its lethality in April is not what mattered鈥�
We know the 1918 virus got worse as it spread. Nobody knew in April last year what swine flu would be like six months down the line, at the start of the winter flu season in the northern hemisphere. It could have turned very nasty 鈥� and to have vaccine ready for that eventuality meant making it immediately.
Given these constraints, what health agencies did was no overreaction. What if the virus had become highly lethal and they had decided not to make vaccine? British officials are being castigated for citing epidemic models that predicted up to 65,000 deaths 鈥� which did not materialise. Imagine if 65,000 people had died because they decided not to prepare.
The real scandal is the antiquated and slow vaccine-making technology used by all the major vaccine companies. In the US, that delayed deliveries until cases were already subsiding and some 12,000 Americans had died. Meanwhile, poor countries got no vaccine at all. Just as well the virus was a wimp.
We could do better next time round 鈥� but that requires more investment in research and development. Will we get it after all these ugly accusations? That may be what is now at stake. For example, we knew this kind of swine flu posed a pandemic threat many years ago, yet H1N1 spread undetected in Mexico for months. We need better surveillance.
There are also ways to estimate the lethality of a flu virus, by looking at immune reactions other than antibodies. They weren鈥檛 used last April because there are no standard tests yet. It would be good to develop some.
Most importantly, we need the capacity to make much more vaccine much faster, so we don鈥檛 have to make near-impossible decisions months in advance and end up squabbling over limited supplies. Prototype technologies exist, but investment has been limited because making flu vaccine will never bring in massive profits. How ironic, when companies are now being accused of fabricating a pandemic for money.
Industry enthusiasm for novel flu vaccines is unlikely to grow as the belief spreads that the pandemic was a rip-off. Indeed, we may lose what we have. With several countries asking for their money back on unused vaccine, my industry sources say future pandemic contracts are unlikely to allow returns, meaning fewer countries will place orders.
If that happens, we will be even less prepared for the next pandemic. Those making ill-informed accusations ought to keep that in mind.
