When Pig Flu Flew

Once again, critics are claiming public health experts last year hyped the potential threat of a uniquely piggish version of the influenza virus – the H1N1 virus, or so-called swine flu. This time, however, some of the critics add that the hype was done to benefit the drug industry.

The World Health Organization and other leading health authorities strongly reject the criticism, saying they acted prudently given the risk of a deadly pandemic such as the world experienced in 1918.

The truth is likely somewhere in between.

The WHO did over-react to the threat, but hardly because it would help the drug industry sell vaccines and drugs. Part of the problem here is how we react to uncertainty and potentially deadly risks.

If the goal is simply to do whatever it takes to reduce risk, why aren’t we also setting up nuclear-tipped rockets to blast killer asteroids, given that scientists say it is a near-certainty that the planet will again be struck by one of these things? Because, on balance, the cost and trouble of doing so seems unjustified given the level of uncertainty about when and where.

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An especially dangerous flu pandemic like 1918 is more likely than a killer asteroid, but when and where it will strike is similarly uncertain. When the H1N1 virus was first discovered in a flu outbreak in Mexico, authorities sounded the alarm because young people had died and the virus contained a unique combination of pig, bird and human flu genes. The experts said a repeat of 1918 was a distinct possibility.

Pandemic. That was the word that got everyone excited. In the excitement, the pharmaceutical industry was exhorted by WHO and other leading health authorities to step up production of anti-viral drugs and vaccines to respond to the looming threat.

But, technically, flu is always pandemic since it spreads worldwide and kills a large number of people – every year.

As this “swine flu” spread worldwide, it became pretty clear early on that the mortality rate in Mexico was unique and due to some factor other than the virus (perhaps poor health care). The death rates were not out of the norm for regular flu. But given the genetic nature of this virus, WHO and others continued to warn that this flu could still turn exceptionally nasty.

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When the threat did not materialize, WHO changed its working definition of “pandemic” to remove its own requirement that to label an outbreak as pandemic must involve excessive mortality. People were still warned that this was something special. Individuals were urged to get vaccinated and agencies stockpiled drugs.

The recent criticism implies that the WHO was unduly influenced to keep fanning the flames by experts with ties to the drug industry. WHO director Dr. Margaret Chan says they were not.

Who knows? But one big lesson here is that you can’t un-ring a bell.

(Originally published at my personal blog.)

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.