Sunday, November 15, 2009

H1N1 watch

Some stock taking items on the H1N1 issue for consideration today.

First, Dr. Richard Schabas, who is the former chief medical officer in Ontario, continues to be quite critical of the H1N1 federal effort and is calling the whole thing into question going forward now. Significantly, he's saying it's too late for the H1N1 vaccine program to work, in contrast to federal officials. It's a real phenomenon to have leading medical officials disputing the very way forward now, it speaks for itself. Here's Schabas with his (latest) broadside:
The Public Health Agency of Canada has made a "mess" of the H1N1 vaccination campaign and proceeding with it should be up for debate because its benefits are quickly evaporating, according to one of the country's most vocal chief medical officers.

Dr. Richard Schabas, Ontario's former chief medical officer and a top health officer in the province, said Friday it might simply be too late for a mass vaccination program to work. In an interview with Canwest News Service and Global National, he said that for immunization to be truly effective in preventing a disease, it has to be done before the disease hits.

"As it happened in Canada this year with H1N1 the vaccine didn't come until the outbreak had already started and even now is only coming in relatively small quantities. So an opportunity to really have an impact on the disease, to immunize before the outbreak, is gone," he said.

"In eastern Ontario where I live and work the outbreak is effectively over. If we're immunizing people now essentially you're barring the barn door after the horse is well out the farm gate."

Schabas said outbreaks of the swine flu in populous parts of the country, including southwestern Ontario and British Columbia, are on the wane.

"I seriously question the continued focus on mass immunization, at least in those areas," he said.
As the report notes, this is contrary to what Dr. David Butler-Jones, Canada's Chief Public Health Officer is saying:
Butler-Jones has heard the criticisms from Schabas and others who feel the risk of the pandemic is overblown. In a news briefing Friday, he countered by saying "complacency is not warranted."

"Even when we reach the peak, whenever that might come, we still have the other side of the hill to come down, which means millions more potentially infected," said Butler-Jones.

What is a non-medical lay person to think of this conflict of experts that's playing out? The views are pretty far apart. Part of the problem is that federal decisions have led to a state of affairs where criticisms from prominent medical authorities like Schabas find an audience.

For example, as noted at the HarperBizarro blog yesterday, the unadjuvanted versus adjuvanted back and forth decision machinations executed by federal health officials have sown delay and confusion:
Health Minister Aglukkaq ordered 1.8 million doses of unadjuvanted vaccine in September. That order had to be placed to cover off the expected needs of pregnant women, which was forgotten, apparently, when the same Minister got around to placing her original order in August. The August "order" was among the last placed worldwide.
The 1.8 million dose order for non-adjuvanted vaccine then disrupted and delayed GSK's "bottling" of adjuvanted vaccine, which was intended for use in the broader population. This delay caused line ups and general mayhem along the vaccination distribution system as there was a shortage of vaccine, which exists to this day.
At the same time, GSK wasn't able to get the non-adjuvanted product ready quick enough anyway and the government had to order 200,000 doses from another supplier in Australia.
All the while, mass confusion amongst the health providers and pregnant women as to what really was the advice of the government. (emphasis added)
It's a big question mark as to when non-high risk persons will be able to get the vaccination in most communities. It's quite possible that the above delay has contributed to a situation where the Schabas scenario is playing out, i.e., it's too late for the vaccination program to work. And again, we have one expert saying that would be OK (for certain parts of the country where it is in his view subsiding) and another warning us it wouldn't. It's confusing.

And now we read that the unadjuvanted vaccine is being approved for wider use beyond pregnant women. Is this an improvisation due to the production delays described above? If they originally intended for the adjuvanted version to be given to the general non-high risk population, why is unadjuvanted now OK?
A version of the H1N1 vaccine intended for pregnant women is now also being offered to healthy adolescents, teens and adults in yet another fundamental shift to Canada’s vaccination strategy.

Federal health officials said yesterday that an adjuvant-free vaccine is not only safe for pregnant women, but also induces a strong immune response in healthy people between the ages of 10 and 64.
Which seems to raise questions about the wisdom of pursuing the adjuvanted versus unadjuvanted route in the first place, doesn't it? Some of that delay noted above might have been avoided.

Finding it difficult to see how any of this is particularly confidence inspiring.