H1N1 preparedness varies throughout the world

Friday, October 9, 2009 | 12:17 p.m. CDT; updated 8:35 a.m. CDT, Thursday, October 15, 2009

Stuart Loory, Lee Hills Chair in Free-Press Studies, Missouri School of Journalism: How well is mid-Missouri, the nation and the world prepared to avoid a pandemic of swine flu? As the flu season develops in the Northern Hemisphere, there is some fear that supplies of the H1N1 vaccine will not be adequate to immunize enough people. There is also concern that vaccines to prevent seasonal flu may not be adequate. Much of the concern arises from the large number of swine flu cases last spring. First, give us an assessment of the coming flu season in mid-Missouri.

William Salzer, professor of clinical medicine, infectious disease director, University of Missouri School of Medicine: Compared to other years, it is probably going to come earlier because this novel H1N1 is currently circulating. Usually, the flu doesn’t start here until December. I thought it would have kicked off already when the kids got back in school, but it is really not extensive. We’re turning up 10 or 15 people a week with positive tests.

Loory: Is it a problem that the H1N1 vaccine won’t be available until the end of the month or perhaps in November?

Salzer: It has been shipped and is in Columbia. The first shipments were the live vaccine, which is OK for healthy kids but cannot be used on most high-risk groups. The injectables will be shipped in a couple of weeks.

Loory: What about the seasonal flu and vaccine this year?

Salzer: Before the H1N1 hit, they were planning on making more doses of the seasonable than last year, then the priority changed to the H1N1. The same factories make both types, so there may be a reduced supply of the seasonal. I expect that H1N1 is going to dominate the early part of the year and the usual seasonal strain will circulate later, but we don’t know.

Loory: How about the rest of the country?

Rob Stein, national health reporter, The Washington Post, Washington, D.C.: The Federal Center for Disease Control and Prevention is reporting that the flu activity is fairly widespread throughout the country. This much activity is very unusual; pretty much every part of the country is reporting widespread viruses circulating.

Loory: The New York Times reported that the situation is not as bad as expected in New York; apparently because so many people became immunized from the spread of the virus last spring. Is that also the case for the rest of the country?

Stein: It is an interesting hypothesis; there are some early indications that may be the case in some parts of the country. Everybody is taking a wait and see attitude because the flu is very unpredictable.

Loory: This may not be the case in mid-Missouri?

Salzer: If a lot of people got sick in an area with last spring’s wave, they will probably see less of it in the winter than places that did not have many early cases. We saw some but not a lot of cases. What makes this new strain so successful is that it comes into a population that doesn’t have immunity to it. Everything we’ve seen so far is unlike the usual seasonal strains that affect older people; this one affects younger people. This strain resembles those circulated before 1957, so those alive before then have some partial immunity. Flu circulates better in the winter months because of the lack of humidity in the air. If it hits in the winter, it is likely to spread more than in June.

Loory: A lot of vaccine is manufactured in Canada and shipped to the U.S. Is there an adequate amount being prepared this year?

Caroline Alphonso, national reporter, Globe and Mail, Toronto, Canada: A facility in Quebec is making vaccine. Canada has ordered enough to vaccinate its entire population, about 50 million doses. Public health authorities say it should be rolling in early November, a few million doses every week. The flu is not as widespread in Canada, a few clusters in British Columbia. We had enough doses to vaccinate most of the population with two doses. Now it appears that most people will only need one dose, and we may have more than we need. Our vaccine is different from yours because our vaccine contains an adjuvant. The Canadian government hasn’t decided whether we will be donating our excess vaccine to the developing world, unlike the U.S. and some other countries that have already made that decision.

Loory: Explain what an adjuvant is.

Salzer: It boosts the immune response to a given dose of an antigen. They discussed while the vaccine was developed, and still with bird flu, if they had enough antigen. By using an adjuvant, they can often use a smaller dose of antigen and vaccinate more people with the same amount of raw materials.

Loory: Does this mean there will be plenty of vaccine for use throughout the world?

Salzer: The World Health Organization wants enough to vaccinate the entire population of the earth, but there is not that capacity. If a child under the age of 10 or 11 has never received a flu vaccine before, they need two doses a month apart. The presumption is that will be the case with the H1N1 vaccine.

Loory: Austria and Switzerland manufacture vaccine; will the output be enough this year?

Peter Schoeber, deputy manager, Austrian Broadcasting Corporation, Vienna, Austria: The situation is quite good in Austria. Authorities have ordered over 500,000 doses. Every household in Austria, Switzerland and Germany probably has enough Tamiflu to battle H1N1 for the next 300 years. The authorities have cranked down on the hysteria and are making every effort to keep this in proper relation compared to the threat.

Loory: What is the situation in India? Is there enough vaccine and how does that many people get immunized?

Lalita Panicker, senior associate editor, The Hindustan Times, New Delhi, India: There are not enough vaccines, and we are not prepared for it because the government reacted very late to the problem. Reported deaths have decreased from H1N1. The government seems to suggest this is not a problem. But, we have poor registration of births and deaths. People may be dying from this, but we don’t have recorded evidence. It seems to have moved out of the media totally.

Loory: India is manufacturing its own vaccine?

Panicker: Correct, but because the public health system is so poor and badly connected, the vaccines are not reaching the places it should, like the rural areas, which is 80 percent of India.

Loory: The cost of a dose of flu vaccine has gone up considerably, why?

Stein: Costs have gone up, but so has production capacity, something they focused on extensively in the U.S. over the last few years. They were concerned the capacity would not be enough to supply the entire world, a huge problem facing developing countries.

Alphonso: It is troubling that some countries may have an excess of vaccine but have not stepped up to contribute to the developing world. Some countries like Canada may have way too much vaccine and could help.

Loory: What is being done in European Union countries?

Schoeber: First, they are trying not to have any hysteria within the population, which is also critical for the role the media plays with this pandemic. Second, huge numbers of vaccines are being bought by public officials and put in stock. People who have a high risk of getting infected, like nurses and doctors, are getting the vaccine right now.

Loory: The advent of the flu season is always a matter of great concern and of course it remains to be seen what this season is going to be like.

Producers of Global Journalist are Missouri School of Journalism graduate students Jared Gassen, Brian Jarvis, Sananda Sahoo, Melissa Ulbricht and Megan Wiegand. The transcriber is Pat Kelley.



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