Monday, November 02, 2009

Key decisions in Harper Government H1N1 preparedness

As we've watched the rollout of the H1N1 vaccine this past week and the overall carriage of the issue by the Harper Government over the past few months, it's become apparent that there have been a number of decisions the government has made that warrant scrutiny. Many of those are listed at HarperBizarro's blog today. In addition, the questions about the timing of the government's vaccine order, showing us lagging other nations, have also been chronicled today.

Here are a few more of the decisions, offered to supplement those lists above and with additional links to make some of the points:

1. Gutting the federal public health budget for pandemic planning/response. As noted in an earlier post, federal moneys have been cut back on this issue. The Conservatives have tended to operate financially with no buffers, there is rarely a "rainy day" mentality at work. That was evident with the high government spending combined with the GST cuts that led to a deficit situation prior to the global recession. In health care matters, that mentality also prevails. Letting the provinces shoulder expenses where the federal government has failed is a recurring theme for the Harper government, e.g., the Chalk River shutdown which continues and which has put provincial health budgets into deficit, with no alleviation from the federal government. Now, as the provinces are clearly struggling with this massive vaccination rollout, will they move off their reluctance to provide funding? Perhaps that emergency debate tonight in the House of Commons at the initiative of opposition parties might help with some pressure.

2. The initial decision-making to go with an adjuvant vaccine, in contrast to the U.S., for e.g.. Having two vaccines has sown confusion in the public and has caused disruption of the production line (harried recent revert to non-adjuvant production for pregnant women), a matter compounded where we have a single supplier of vaccine in Canada. In addition, the use of an adjuvant vaccine may have lengthened waiting times. Canada bought the vaccine and the adjuvant unmixed: "“It is more difficult and slower than with usual vaccines,” she said. “Many family docs simply do not have the capacity to use this vaccine.”"

3. Back to the issue of timing, the lateness of the vaccine is a central consideration, coming six weeks too late according to some experts. Combine that fact with the decisions that were made across the country, in the absence of federal leadership, to not administer both H1N1 and seasonal flu vaccine at once. The National Advisory Committee on Immunization is now recommending it.

4. The ineffective public health campaign. No clarity on high risk groups meant to go first. Lateness in sending material to homes identifying symptoms and when it did arrive (end of last week), there was no mention of a prioritization of the high risk groups for the vaccine. Provincial resources have been strained as a result: e.g., Telehealth Ontario hotline experiencing surge in calls from 3,000/day to 13,000/day, 8-plus hour wait times.

Lots of decisions, lots of questions to be asked.