Public health doctor defends swine flu response

By DR. GEORGES C. BENJAMIN

Updated 5:39 PM EDT, Sat, Nov 14, 2009

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Who would really know if you had contracted swine flu or not?

The U.S. response to the H1N1 flu pandemic has come under fire recently, however, much of the criticism fails to capture the extraordinary achievements we’ve seen thus far.

Since March when H1N1, also known as swine flu, first emerged, U.S. health officials have acted quickly and effectively to keep the public informed, learn about the virus, and minimize its spread and negative outcomes. This transparency and coordination between agencies has been a hallmark of the flu response since the beginning of the outbreak and has led to an honest conversation with the American people about the risks of and preparation for H1N1.

During this same time, we witnessed the rapid identification of this novel organism and its genetic sequencing, and the creation of a safe, effective vaccine to protect against its infection.

Only a year or two ago, the federal government had to cajole and incentivize vaccine manufacturers to produce the seasonal flu vaccine. You see, creating the flu vaccine is not as profitable as other ventures for manufacturers. At a time when our production capacity was in question, we ramped up our ability to produce not only the seasonal flu vaccine, but to develop and produce a new vaccine for the H1N1 virus. This dual production far exceeded expectations of just a year ago despite unanticipated problems with growth of the H1N1 strain in the production lab.

Thanks to effective planning, public education and communication, demand for the flu vaccine has never been higher. People understand the risks and have responded in kind. The public health system — a system that suffers from long neglect and a resource-starved infrastructure — has accomplished this not just for one, but for two diseases at the same time: seasonal and pandemic flu. It’s an especially extraordinary achievement given the current economic environment.

Don’t get me wrong. There is always opportunity for improvement. When our nation moves to using more robust 21st century health information technology, we’ll be able to rapidly identify those populations at highest risk and more effectively link them to available vaccines and antiviral therapeutics.

And while we can improve our system to ensure that vaccine is equitably distributed and first reaches those at highest risk during vaccine shortages, distribution could have been worse. Our experience with prior seasonal flu vaccine shortfalls reveals even greater disparity between those who should have been vaccinated first and those in lower-risk categories. Historically, when we’ve had shortages of seasonal influenza vaccine, the distributors would often get the vaccine to big, commercial organizations that buy in bulk before distributing adequate doses to state and local public health departments that often serve the most vulnerable populations. This should not happen. In contrast, the system used for H1N1 was designed to minimize this occurrence, and with the exception of some high-profile cases, it appears to have been successful. Nevertheless, we need to improve our logistics to eliminate this problem permanently.

Perhaps the biggest disappointment is the delay in providing an adequate supply of vaccine to meet demand. This is not a failure of planning or implementation, but one based on our reliance on 40-year-old technology that requires the growth of the basic vaccine component in eggs. Researchers are working on improved methods and are getting close, but were not close enough for this round of flu vaccine production.

When this pandemic is over, we will need to look back and find ways to improve on our response. In fact, high quality systems always do that. This nation has responded admirably during this crisis to date and as they say “it isn’t over ‘til it’s over.” But based on the effort to date, it could have been far worse.

Dr. Georges C. Benjamin is the executive director of the American Public Health Association.