The latest issue of the Canadian Medical Association Journal contains two papers on H1N1, which tell of the mistakes and problems with Canada’s response to the flu pandemic. Among other conclusions, the reports conclude that our health-care system did not fully recognize the risks posed by the H1N1 pandemic on vulnerable populations such as pregnant women and aboriginal people. “However reasonable the initial precautionary decision to order 60 million doses of adjuvant vaccine was, subsequent decisions and problems resulted in the wheels falling off the immunization cart,” wrote Dr. Don Low of the microbiology department at Toronto’s Mount Sinai Hospital and Dr. Allison McGeer, also of Mount Sinai and the University of Toronto. “The vaccine could not be made quickly enough to protect Canadians from the second wave, the complexity of delivering vaccine was badly underestimated and attempts to deliver rapid public education about vaccination with an adjuvant vaccine failed.” While the death rate was lower than initially projected, the years of life lost and hospitalizations were notable because the 2009 pandemic skewed toward younger populations compared to the deaths from the seasonal flu. Certain groups, such as indigenous populations of North America, had rates of severe infection with swine flu increased by a factor of five to seven. A second paper in the CMAJ concludes that a third wave of H1N1 probably won’t occur in 2010.