Take an enigmatic, pandemic disease, add overwhelmed doctors, wary patients, rampant misinformation and a limited supply of vaccine and you’ve got a recipe for confusion, fear and, ultimately, panic.
As H1N1 (still better known as swine flu despite a concerted name-change campaign) makes its predicted autumn comeback, we’ve vaulted past confusion and seem to be teetering somewhere between fear and full-blown panic. The effort to vaccinate as many people as possible—especially those in identified high-risk groups—has kicked into gear, but questions persist about the safety of the vaccine and possible side effects. Meanwhile, local health care providers are wrestling with limited supplies and spotty communication from federal agencies.
First, to the question of safety. On its Web site, the national Centers for Disease Control and Prevention (CDC) says the H1N1 vaccine is “expected to have similar safety profiles as seasonal flu vaccines, which have very good safety track records.” Dr. Lorrin Pang, Maui’s district officer from the state Department of Health, says that explanation “doesn’t quite hack it.”
Simply because two vaccines are made under the same conditions doesn’t make them identical, says Pang. As an example, he compares two hypothetical batches of brownies, one made with chocolate and the other made with dirt. In both cases you’d cook the brownies to eliminate contaminants from raw eggs, but the result would still be two very different desserts. “In the end,” he says, “dirt is dirt and chocolate is chocolate. When you change the target protein, that requires safety testing.”
Studies—initiated after the new version of the disease appeared—have been done to determine the safety of the H1N1 vaccine. Pang says so far the results are encouraging. “We have a person in Honolulu who is in touch almost every day with CDC and asking, ‘Any side effects? Any side effects?’ And the answer is ‘no,’” he says.
That doesn’t mean, Pang adds, no side effects will pop up. In 1976, when fear of a swine flu outbreak led to a large-scale vaccination campaign, cases of Guillain-Barre Syndrome (GBS), a paralysis-inducing nerve disorder, were linked to the vaccine. Pang says that in ’76, cases of GBS appeared within weeks after the vaccine was administered and were relatively rare—about 500 above the “background,” or what would be expected without the vaccine. In the end, Pang and most other health care professionals agree, the risks of contracting swine flu outweigh the potential for vaccine-related problems.
Pang says he’s been frustrated by the government’s reluctance to release the results of studies as they become available. “I’ve been on a mission,” he says with a wry laugh. “And I got yelled at: ‘The data is preliminary, the data’s not final.’” He says he “feels comfortable now,” but that it took “a lot of headache, a lot of name-calling: ‘Who are you?’ Why do you want to know?’ I think the public wants to know, too, and if they don’t come out with [information], the public has a legitimate reason for asking.”
Another concern associated with the vaccine is the use of themerosal, a mercury-containing compound that’s been linked—controversially and inconclusively—with autism. Mercury is used to kill bacteria and preserve the vaccine, meaning it’s found in vials holding multiple doses. Single, themerosal-free doses tend to run out faster since people request them, Pang says. He says Hawaii recently received another batch of mercury-free doses, but that, again, federal communication has been lacking. “They’re not telling us,” he says. “It’s supposed to come in weekly and then they say, ‘None this week.’ So [we’re] kind of living from day to day. It depends on the manufacturers, too. They had a manufacturing error and had to throw out a whole batch, which set us back.”
Pang likens the situation to the aftermath of Hurricane Katrina, when FEMA issued checks to hurricane victims but didn’t tell them if more assistance was on the way. “They gave us a bunch [of vaccines] and told us the next bunch would come, but they didn’t know when or how much. So everyone’s sitting around looking at this bunch,” he says. “But it’s wrong not to give it.”
Pang says even some people in the most high-risk groups—including health care workers—haven’t gotten the vaccine. “There’s so little to go around, we’re fighting amongst ourselves,” he says.
The good news is that H1N1 is still not a major killer. Though deaths have spiked this season, compared to the 1918 swine flu outbreak that killed tens of millions of people worldwide, the 2009 incarnation is downright tame. But, Pang says, it’s too early to heave a sigh of relief (even if you carefully cover your mouth). “If you look at the deaths [in the 1918 outbreak], in that first July, 5 percent occurred. Then it was very quiet until late October, and between late October and about the second week of January, 60 percent of the deaths occurred. So there was a little blip, then quiet, then tons of deaths. Now I don’t know if it mutated to a more virulent strain or if it was just more contagious, but something happened. It’s only a study of one [outbreak], but you’d be a fool not to pay attention.”
Not exactly reassuring. But probably the best we’re going to get in these uncertain times.
Swine flu FAQ
Who is most at risk?
Health care workers (because of the risk of spreading the disease) and pregnant women and people with chronic or underlying health conditions (because of a higher incidence of hospitalization and death)
What are some key warning signs?
Shortness of breath, inability to keep down food and liquids, sudden drowsiness, irritability or disorientation or a “rebound fever” (a fever that goes away and comes back)
Is a vaccine available?
Yes, though supplies are limited and high-risk groups are being prioritized
Is it safe?
Tests have shown no significant side effects so far. Some of the doses do contain mercury, which has been inconclusively linked with autism
Where can I get more information?
The Hawaii Department of Health www.hawaii.gov/health and national Centers for Disease Control and Prevention www.cdc.gov are good places to start