Was swine flu threat exaggerated?

The Irish Times - Tuesday, January 19, 2010

The World Health Organisation stands accused of being unduly influenced by pharmaceutical companies, writes RONAN McGREEVY

WHEN IS A pandemic not a pandemic? That critical question will be debated next week by the Council of Europe in an investigation that is likely to have worldwide implications.

To date, the swine flu pandemic has killed more than 13,500 people worldwide. It is a significant number, but nowhere near some of the more ghastly estimates which surfaced when the H1N1 virus began in Mexico last June.

The figure contrasts with the 35,000 people who die in the US alone from common influenza every year.

There is now a growing feeling that the threat from swine flu was grossly exaggerated and billions were spent worldwide by governments stockpiling vaccines. There was talk of hundreds of thousands of deaths this winter, but, as the threat has receded, so has demand for the vaccine. To date in Ireland, almost 700,000 (one in six) of the population has been vaccinated even though the Government bought enough vaccines last summer to immunise 3.85 million people.

The Parliamentary Assembly of the Council of Europe (Pace) represents 47 countries throughout Europe.

Unlike the European Parliament, it has no decision-making powers, but, as was demonstrated by its report into extraordinary rendition, it does have the power to make life uncomfortable for the powers that be.

The impetus for a public inquiry has come from the president of the Health Committee of the Council of Europe Dr Wolfgang Wodarg, a German doctor and epidemiologist. Dr Wodarg’s charges against the WHO could hardly be more serious. He has accused it of changing the definition of a pandemic from one that breaks out in several continents at once and has above-average morbidity to one where the spread of the disease is constant.

Dr Wodarg says that the WHO is unduly influenced by pharmaceutical companies and that the declaration of a pandemic hugely enriched the industry at the expense of taxpayers and governments.

He also said it was strange that two vaccines were initially needed, not one, and that the swine flu epidemic could have been tackled using modifications of existing viruses. “There are systematic questions to be put so that we don’t get cheated by those who make us panic,” he said.

The WHO said it will vigorously defend itself and is conducting its own inquiry. Keiji Fukuda, special adviser to the WHO director-general on pandemic influenza, has said that “the world is going through a real pandemic” and “the description of it as a fake is both wrong and irresponsible”.

The pharmaceutical industry has also issued statements defending its position, but the public appears to believe that the threat was exaggerated given the huge stockpiles of unused vaccines – even allowing for the fact that only one vaccine is needed instead of two.

The Government ordered 7.7 million vaccines last summer, enough for two doses for each of the population. This was compromised of equal batches of Pandemrix, a vaccine made by GlaxoSmithKline, and Celvapan, made by Baxter.

It has now emerged that a shot of Pandemrix is sufficient for both children and adults, except those with weakened immune systems. As a result the Government has renegotiated its contract with Baxter and will not be taking up 3.7 million doses of the Celvapan vaccine as had been originally ordered, resulting in a saving of between €25 million and €35 million from an original vaccine budget of €88 million.

The pattern is being repeated across Europe as countries scale back their vaccination plans. France wants to cancel 50 million of the 94 million doses it ordered. Switzerland is giving away more than half its store of vaccines to the WHO for distribution in other countries, as is the Netherlands. Germany and Spain are renegotiating their contracts with the pharmaceutical companies.

In the UK, Labour MP Paul Flynn, a member of the Council of Europe, is trying to find out how much money Britain spent on vaccines. “What we want to find out is whether this was decided on proper scientific basis or the pressure from pharmaceutical companies to make bigger profits. How powerful are the pharmaceutical companies in influencing the World Health Organisation?” he said.

Prof Patrick Wall, associate professor of public health at UCD, said the WHO had been “damned if it does and damned if it doesn’t” in declaring a pandemic and the fact that the swine flu outbreak was never as bad as predicted may be testament to the success of the vaccine programme that it encouraged states to implement.

Prof Wall recounted that the chief medical officer, Dr Tony Holohan, had advised, even at the height of the swine flu scare, that the flu itself was relatively mild though there was no grounds for complacency. “I thought it was a good mantra,” Prof Wall added.

He also says that the H1N1 virus is no ordinary flu virus and it was necessary to develop a new vaccine.

“When this first happened, I said this virus would be the same as the other flu viruses, but I was wrong about that. It did not behave the same as a conventional flu virus. We needed to get the vaccine to vaccinate the vulnerable subset. There was no vaccine at the time, so we had to negotiate with the vaccine makers to make it. That was a legitimate approach.”

Prof Wall said the allegations against the WHO were serious and needed to be addressed if only to allay concerns in people’s minds about the objectivity of the organisation, which is the most important health body in the world. “His (Dr Wodarg’s) worries need to be banged on the head and sorted out, and an inquiry might help us learn lessons from this,” he said.

To date, GPs have administered 250,000 H1N1 jabs. A further 356,000 people were vaccinated in HSE clinics, 46,000 through schools and 45,000 health care workers were vaccinated.

Chairman of the Irish College of General Practitioners Dr Mark Walsh said the vaccination campaign was successful in targeting vulnerable groups. He said it was important to bear in mind that 22 people have died from the disease here and there have been nearly 1,800 confirmed cases. He believes things have not been as bad as feared because people took precautions in washing their hands regularly and there was also an element of good fortune, but the main reason was the vaccination programme.

“As the level of vaccination increased, the incidence of the disease decreased and there may be a relation between the two. We as GPs just have to take advice from public health experts. I’ve heard the arguments about whether that it is really a pandemic, but in pandemics, mutations can occur, so it might be too early to say it is an over-reaction.”