Newsmaker of the Year '09: Patient zero

Newsmaker of the year, N1H1

It started with Edgar “Patient Zero” Hernandez, the five-year-old boy in rural Mexico who caught the first confirmed case of H1N1 last March. He came home from school with a fever and headache. After a few days, and lots of consolatory ice cream, Hernandez recovered. But for thousands of others worldwide, H1N1 has been lethal, including here in Canada, where casualties have included: 13-year-old Evan Frustaglio, the hockey player who died in his father’s arms after a bath; 10-year-old Vanetia Warner, who loved figure skating and Miley Cyrus; 38-year-old Keith Fagnou, a popular chemistry prof with a growing family. “Burying your own kid is the most horrific thing for any human being,” said Paul Frustaglio, Evan’s dad. “There is no plan, no instinct, nothing to guide you.”

In a matter of months, H1N1 has become the defining public health event of the decade, arguably causing more confusion, fear and heartache than anything the world has seen since the 1918 Spanish flu. With one crucial difference. Where our ancestors could only wish for a medical intervention to spare 50 million people from death, most countries today are, fortunately, armed with a preventative weapon: the pandemic flu shot. “The vaccine,” says Gregory Hartl of the World Health Organization, “is the single most important tool we have against influenza.”

Having the tool and knowing how to best use it are separate matters, though. As big an achievement as the H1N1 vaccine is, the big dilemma this pandemic has been whether or not to actually get the shot. And, if so, when and how. Preparedness—or lack thereof—has been a running theme.

Health authorities, initially uncertain of this flu’s virulence, braced for a deadly crisis. Scientists scrambled to decode the strain, and then struggled to grow it in the lab so they could create a vaccine. There was debate about whether to administer one dose or two, and who should get immunized first. In Canada, federal and provincial governments invoked their pandemic plans, only to realize that even these detailed documents couldn’t account for the logistical challenges of inoculating 33 million people almost at once.

This flu also brought to the fore intense anxieties about the safety and efficacy of immunization. As of late October, 33 per cent of Canadians didn’t believe the H1N1 vaccine was safe for adults; 41 per cent said it wasn’t safe for kids, according to a poll by the Strategic Counsel. People worry the shot will lead to autism or cause paralysis, or that the government is attempting population control or being swindled by money-hungry drug companies. This subculture of “vaccine denialism” has many champions. Nation of Islam leader Louis Farrakhan has said: “The earth can’t take 6.5 billion people. We just can’t feed that many. So what are you going to do? . . . We have to develop a science that kills them and makes it look as though they died from some disease.” Tame by comparison, talk show host Bill Maher has tweeted, “If u get a swine flu shot ur an idiot.”

Comments like these have rallied vaccine supporters. The commissioner of the U.S. Food and Drug Administration penned a 1,278-word letter to physicians coaching them on how to explain the H1N1 shot to patients. In a new book called Denialism, author Michael Specter argues that the anti-vaccine movement is based on political gaming and fear rather than science. He says we are increasingly fixated on the rare worst-case scenarios that may result from getting the shot rather than the reality of how far we’ve come in treating diseases, including the flu. Discover magazine blogger Chris Mooney refers to vaccine denialism as “a late-modern decadence” that people can indulge in because, ironically, they haven’t been killed off by measles, mumps or polio—which have been seemingly obliterated in most places by mass inoculation.

Even Canada’s chief public officer of health, Dr. David Butler-Jones, has subtly squared off with vaccine deniers, announcing that the odds of bad reactions to the H1N1 shot are less than 0.001 per cent, and that the benefits of getting it “far outweigh any theoretical risk.” Of the 6.6 million doses that had been administered across the country by mid-November, there were 36 serious adverse effects—making the pandemic shot safer than the seasonal flu version. One elderly person died after getting immunized, but it’s unclear still if that was due to an underlying condition or the vaccine.

As of late November, H1N1 has killed 309 Canadians, and 6,500 others worldwide, though the WHO says that estimate is low because many places have stopped testing and reporting cases. More than half a billion people across 206 countries or territories have been sick, and the flu has attacked an unlikely group: the young and healthy, as happened in 1918. Now experts suggest that a “third wave” of H1N1 may hit this winter (the first wave was last spring, the second this fall), and that it’ll probably form future seasonal flus—all of which means this virus won’t be out of the news soon.

Before Hernandez was confirmed as having H1N1, many in his village were sick. His father said to his mother, “We can’t be afraid of what might or might not happen.” But it’s not surprising if you are.

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