Swine Flu- A Panic Or Pandemic?

In the past few months, we have been inundated with news about an influenza virus that originated in a faecal swamp of an industrial pigsty in Mexico, which today has transformed into a threat that looms large on the lives of millions of people across the globe.  A glance at the volumes of affected people since it was first reported in April 2009 reveals an infection that is travelling at lightening speed; a speed faster than any other reported pandemic of the past.

Given the fact that common type A influenza virus (that most of us are immune to) causes deaths in 1 million people yearly, even a modest increase of virulence of this porcine virus or H1N1 or Swine flu as it is commonly referred to, would lead to major human catastrophe.

As one would expect with a virus having the potential to cause such a debacle, news and internet are flooded with numerous debates, reports and statements by government agencies. The availability of such surfeit of information understandably leaves behind one big question in the thoroughly confused minds of readers- ‘What is the real story?’

Swine Flu: The Origin

Influenza A, Novel H1N1 or 2009 Swine Flu virus originated in pigs and only spread from one hog to another. However, the present burgeoning of livestock production, greatly due to corporatisation, has transformed a once happy farm into over crowded pigpens, with animals bathing in volumes of their own excretory wastes, causing them to have weakened immune systems and allowing an exchange of pathogens at a maddening pace. These conditions also create a very conducive environment for the viral strains to mutate, making them capable of infecting humans as well. In addition, cross contamination between birds and pigs causes more mutations to give rise to a ‘avian-swine’ flu strain, to which humans have low natural resistance.

Public Health Response

In April 2009, the World Health Organisation raised swine flu threat awareness level to 5 out of 6, indicating that the world is on the brink of a pandemic. Following this announcement, the European Union health commissioner advised Europeans to postpone nonessential travel to the United States or Mexico.

Countries were put on high alert to track unusual outbreaks of influenza-like illness and severe pneumonia. Dr Margaret Chan, the WHO director-general, raised the current level of influenza pandemic alert from phase 4 to phase 5. “This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions now should be undertaken with increased urgency and at an accelerated pace”, she said in a conference in Geneva.

Other countries took different measures, with United Kingdom setting up the ‘National Pandemic Flu Service’ that provides phone and Internet diagnoses. Canada on the other hand announced that their National Microbiology Laboratory (NML) had mapped the genetic code of the swine flu virus. A pre-existing contract obligating pharmaceutical giant GlaxoSmithKline to prioritise Canada’s needs in the event of a pandemic further ensures at least one dose of the vaccine to individuals before Christmas.

The United States has recorded the most cases of the swine flu, with the number being more than 13,000. The Centres for Disease Control (CDC) and other American governmental agencies, used the period before the official ‘flu season’ to take stock of the situation in the country and planned for a second influenza vaccination drive in addition to the one for seasonal influenza, by improving synchronization between federal, state, and local governments and private health providers. This was followed by Obama declaring swine flu a national emergency in November 2009, giving Secretary of Health and Human Services the authority to grant waivers to requesting hospitals from usual federal requirements and providing nearly $2bn of emergency funds to purchase vaccine components as well as helping plan for immunisation campaigns.

In the Middle East, around 21 countries reported swine flu. Following this, countries like Saudi Arabia have taken measures like postponing flights from other countries coming into theirs. UAE and Saudi have installed thermal imaging cameras in their airports to screen passengers. About 1500 cases of swine flu were reported in the Middle East, about 4% of cases reported worldwide.

Although this region is weathering the pandemic fairly well, concerns were raised with millions of pilgrims coming into the region for Hajj. There have been a few fatalities reported with Hajj pilgrims, but this was with individuals who were not vaccinated. Communication is being sent out to all pilgrims to receive vaccine shots before they entered Saudi. The Saudi Arabia government has deployed 20,000 health workers in Mecca, Medina and Jeddah, and hundreds of extra beds were made available in hospitals. The also have in key locations equipment which can positively identify the virus in a person suspected of infection within a few hours.

Stringent hygiene measures have been advocated in all countries, with a few countries like Thailand, one of the worst hit in Asia-Pacific, setting up thermal scanners in airports to detect body temperatures before people enter their country.

The Race To Turn A Virus Into A Vaccine

A strategy adopted by the WHO in response to this outrage is to provide a focussed and quick response to severe outbreaks to minimise impact, rather than on attempting to halt growth of the virus. It has recommended that each country tailor its own response rather than adhering to a global plan that might not suit all geographies.

Soon after WHO declared an impending pandemic in the early summer of 2009, pharmaceutical companies world over began investing efforts to develop a vaccine that would help combat the spread of infection. Amidst fears that the vaccine demand vs. supply might prove to be tense, governments are prioritising patient groups depending on their risk factor, to ensure that those at highest risk get the first doses of the jab.

Currently in the United Kingdom, Glaxo Smithkline’s Pandemrix and Baxter’s Celvapan are available, with the latter being reserved for patients with egg allergies.

In the United States, AstraZeneca’s MedImmune vaccine technology unit has an initial $90 million order from the U.S. government, with a potential for more orders. In an attempt to meet the increasing demand in the US, the government has also tied up with other companies like GlaxoSmithKline Plc, Novartis, Sanofi-Aventis, and CSL Limited. The federal government is purchasing all of the swine flu shots and is then distributing them via a centralized distribution program.

The Swiss pharma giant Novartis’ first batch of the vaccine arrived weeks ahead of expectations. The company is therefore being summoned by at least 30 governments to supply them with a swine flu vaccine.

Mass production of the seasonal flu vaccines is already underway, raising concerns over the capacity of companies to manufacture any new vaccine simultaneously. Says John Wood, principal scientist at Health Protection Agency; “This is the difficulty with all flu manufacturers at the moment. They are two months into production, and if they have to stop now, there could be shortages of the seasonal vaccine in the winter.” However, GSK seems to have devised a strategy to make enough of both vaccines with their spokesperson saying, “We have a lot of product capacity around the world and we have a flexible approach to moving things around.”

The new H1N1 virus is likely to be around for many years and there is every chance that it could mutate to become more dangerous. Therefore some experts opine that in the future, the H1N1 strain might be incorporated into the annual flu jabs.

Should I, Should I Not? Answering The Vaccine Dilemma

The frenzy over swine flu has led to questions being raised on whether the vaccine, once available, is safe enough to be taken.  In an attempt to clear the air, governments are emphasising on the absolutely minimal side effects of the vaccine. Bodies like the CDC and a few other research institutes are running intense vaccine monitoring programs to keep track of any complaints that may require a doctor’s visit. In the United States, this vaccine is available as a jab and nasal spray, both of which develop reactions similar to when an influenza vaccine is administered to patients. The common symptoms include a very sore arm (with a shot) along with mild headache, fatigue, fever, nasal congestion and muscle aches. Nasal sprays are not recommended in pregnant women.

The last mass inoculation during the 1976 swine flu pandemic was linked to a rare paralyzing condition, Guillain-Barre syndrome. However, studies done ever since have not established a conclusive link between the vaccine and this condition.

“We don’t have any reason to expect any unusual problems with this vaccine,” said Dr. Neal Halsey, director of Hopkins’ Institute for Vaccine Safety, who is directing the e-mail surveillance. Think about this- more than 3000 people die everyday of heart attack. But if one were to indeed have an attack the day after a flu shot, they would likely blame the vaccine rather than the burgers and fries they have been eating all their lives. This is an inherent aspect of human psyche.

Are We Just Crying Wolf?

Six years ago, Science dedicated a major story to evidence that “the North American swine flu virus has jumped onto an evolutionary fast track”. And this brings us to ponder upon the swine flu paradox- highly unexpected, yet accurately predicted! While swine flu was predicted early on, has it indeed reached the threat level that is being professed by government agencies? Or is it just an overblown reaction to an epidemic or a test of ‘emergency preparedness’ by agencies? Is this just a panic pandemic?

According to a report published on Centres for Disease Control and Prevention Web site, total deaths since August from ‘Influenza and Pneumonia-Associated’ illness are 1,397, with only 192 of those being laboratory-confirmed as flu of any type. Today neither the CDC nor the WHO publish lists of laboratory-confirmed cases of swine flu, but a peek into numbers show only a few hundred cases reported worldwide.  The irony is that CDC reports about 36,000 deaths annually in the United States alone due to the annual seasonal flu.

There have been about 4,100 swine flu deaths worldwide in the last six months, fewer than those who die every six days from seasonal flu. A keener observation shows that media too reports people with ‘flu-like symptoms’, rather than those with confirmed flu cases. Recent reports from across the globe have indicated that numbers of swine flu infections have indeed dropped, indicating that the pandemic is not as severe as feared.

Despite all the facts and figures, the truth is- this pandemic media coverage has created enough hysteria in the minds of a common man, causing him to swamp emergency rooms for treatment. However, to conclude, this report does not mean to suggest any lackadaisical approach to the safety and hygiene measures recommended by governments, but just to strike a balance between watchfulness and hysteria.

Article By Snigdha Taduri For Biomed-ME