Chan: Lack of H1N1 vaccine demand surprising

Robert Roos

Jan 19, 2010 (CIDRAP News) – The H1N1 influenza pandemic brought no "devastating surprises," but what has surprised public health agencies is the public's lack of interest in getting vaccinated, Margaret Chan, director-general of the World Health Organization (WHO), said yesterday.

Chan, speaking at the opening of the WHO Executive Board's meeting in Geneva, made the comment in the wake of moves by a number of European countries to reduce their vaccine orders in response to falling public demand for the vaccine.

"Although the virus has not delivered any devastating surprises, we have seen some surprises on other fronts," Chan said in her prepared remarks. "We anticipated problems in producing enough vaccine fast enough, and this did indeed happen. But we did not anticipate that people would decide not be vaccinated."

The US Centers for Disease Control and Prevention reported last week that about 20% of Americans had received an H1N1 vaccine by the end of December. With the pandemic waning at least for now, some reports from Europe have indicated uptake well below that level, prompting governments to trim vaccine orders.

Recently some members of the Council of Europe, a 47-nation group that works for European integration, charged that H1N1 has been a "false pandemic"—a threat exaggerated by the WHO and governments under improper influence from vaccine manufacturers. WHO and national public health officials, as well as industry groups, have emphatically denied the accusations.

Chan did not refer explicitly to those allegations in her speech. But, given the vast range of health information now available to the public, she said, public health leaders may not have the authority and credibility they once did.

"People make their own decisions about what information to trust, and base their actions on those decisions," she said. "The days when health officials could issue advice, based on the very best medical and scientific data, and expect populations to comply, may be fading. It may no longer be sufficient to say that a vaccine is safe, or testing complied with all regulatory standards, or a risk is real."

Chan said part of the problem is the sharp contrast between expectations based on the H5N1 avian flu threat and the pandemic that so far has occurred: "An event similar to the 1918 pandemic was feared, when what actually happened is probably closer to the 1957 or 1958 pandemics." But she also warned that another wave of cases may be on the way.

She observed that public health officials, faced with making far-reaching decisions amid scientific uncertainty, nearly always err on the side of caution. "I believe we would all rather see a moderate pandemic with ample supplies of vaccine than a severe pandemic with inadequate supplies of vaccine," she said.

The pandemic's relative nonseverity has been a huge blessing, Chan said. "For me, the best health news of the previous decade is the fact that the long overdue influenza pandemic has been so moderate in its impact."

She cited a litany of lucky breaks and appropriate responses that have helped blunt the sting of the pandemic: The virus initially spread in countries with good surveillance systems; early reporting was honest and speedy; the virus did not mutate to become more virulent; resistance to oseltamivir did not become widespread; the vaccine proved safe and closely matched the circulating virus.

Further, with recent advances in information technology, the world "could watch a pandemic unfold, and chart its evolution, in real time." Rapid collection of data permitted the WHO to issue treatment guidelines, monitor transmission, and keep a close watch for mutations, Chan said.

She called the sharing of information, diagnostic support, test kits, and viruses "commendably generous," adding, "To date, well over 23,000 viruses and other specimens have been submitted to the WHO network laboratories for analysis."

"When the history of this pandemic is written, I believe that the speed of actions taken by governments to protect their populations will earn the highest marks," she said. Despite heavy burdens on emergency rooms and intensive care units, "nearly all health systems have coped well. Let me pay tribute to all the health care workers who have worked tirelessly to care for patients."

The close observation of the pandemic will yield "a wealth of new knowledge," Chan said.

In an indirect response to the WHO's critics, Chan added, "It is natural that every decision or action that shaped the response will likewise be closely and carefully scrutinized. WHO can withstand this scrutiny."

As for where the pandemic will go from here, Chan said the critical question is whether there are "enough susceptible people left to sustain further waves of community-wide transmission. At present, we simply do not have enough data to answer this question with certainty. Studies are, however, under way."

The CDC has said it is doing serologic studies to assess what share of the population has antibodies to the virus as a result of either vaccination or infection, with or without symptoms. But no results have been reported so far.