Notes on a non-crisis -

Notes on a non-crisis

A child died, and everyone flipped—couple that with large numbers of queue-jumpers and you have a recipe for chaos


091104_N1H1_2A summary of what we know now:

– The federal government put in an order for 50 million doses of swine flu vaccine — enough to vaccinate everyone in the country 1.5 times — with GlaxoSmithKline in early August. As of this week, GSK has delivered to the feds, and the feds have shipped to the provinces, 6.7 million doses. But at last count only 2 million had been administered. The feds have delivered nearly twice as many doses, per capita, as the Obama administration (deliveries in the US have lately crested 30 million), and claim to have the highest per capita delivery rate in the world, but even if they had delivered twice as many again, they’d only ensure that 10 million doses were backed up waiting to be administered.

– Perhaps the vaccinations should have been ready sooner. But two decisions, both medically defensible, contributed to this. One, they held off producing the H1N1 vaccine, on the advice of the public health officer, to produce the seasonal flu variant — understandably, since it’s far more deadly, at least in the short run. And two, they slowed production of the adjuvanted (more potent) vaccine this week, in favour of the unadjuvanted variety, which the World Health Organization had recommended as safer for pregnant women. The WHO has since changed its mind.

– Even at that, we might have got by without the lineups of the past week. Not two weeks ago, the public gave every indication of giving the whole thing a pass. Polls showed only a small minority intended to get vaccinated. So the authorities were likely planning on the basis of a leisurely take-up rate. Then 13-year-old hockey player died suddenly of the disease, and everyone flipped — from apathy to mass panic, in the space of a couple of days. Couple that with large numbers of queue-jumpers, healthy adults who are not among the high-priority, and you have a recipe for incipient chaos.

– There is no emergency. The current flu outbreak kills at a fraction of the rate of regular, seasonal flu, which hardly anyone worries about. The child who died of the disease was freakishly unlucky. Obviously the sooner the better, but it’s debatable whether anyone will die because the vaccinations are administered in November rather than October, since you have to take the already tiny proportion of people who would have been susceptible to dying from it, divide that by the proportion of those who would have caught it in the absence of a vaccine, and divide that by the proportion of those who would have had the foresight to get themselves vaccinated.

– Should the government have relied on a single supplier? Maybe, maybe not. But the Liberals are ill placed to make this point, since the contract to supply the flu vaccine was signed with Ste. Foy, Quebec-based Shire BioChem (later bought by GSK) in 2001, by the Chretien government: a 10-year contract worth $323.5-million. CTV reports the Liberals received a $56,000-plus donation from Shire BioChem that same year.

– The Auditor General makes some good points about emergency planning — in general. But she was auditing the Public Safety department, not Public Health, and she did not look specifically at the H1N1 issue. Doubtless there has been some bungling, but this was a) mostly by the provinces, who are responsible for administering the vaccine, b) no worse than garden variety government bungling, c) probably made worse by the confusion of overlapping roles between three levels of government. Some provinces have done a better job than others, and within each province some regions have done better than others.

– Bottom line: This was an inherently difficult undertaking: the largest vaccination program in the country’s history. The task now should not be to point fingers, but to learn so we can all do a better job the next time, when the stakes may be very much higher.