Life

Learning from H1N1

• Publication Date：03/12/2010
• Source： Taiwan Today
• By  Dr. Michael M.C. Lai

The influenza A (H1N1) pandemic has held the world’s attention over the past six months and caused havoc in many ways. Now that the brunt of the outbreak is largely over, it is time to take stock of what has transpired and learn from the experience.

First of all, is the World Health Organization guilty of overreacting to pandemic threats? Ever since the Hong Kong Flu in 1968, experts have warned about the next pandemic. The WHO has a proven track record of reacting forcibly to such developments, including Swine Flu of the 1970s and Avian Flu in 1997 and in 2004.

When H1N1 first broke out in Mexico in the spring of 2009, the WHO immediately issued a worldwide warning. But, it was soon realized that the virus was not as severe as the previous pandemics and its mortality rate was even lower than that of regular seasonal flus. Still, when the geographical pattern of cases reached the definition of pandemic, the WHO wasted no time in declaring the dawn of the H1N1 pandemic, despite the relatively mild nature of the disease.

Soon after, a chorus of local experts announced that Taiwan would soon be hit with tens of thousands of cases per week, with many people expected to die. These warnings created a panic among the public, a scramble for antiviral drugs and hysterical responses in the media. The prevailing feeling then was that we would soon face a calamity of the magnitude of the severe acute respiratory syndrome all over again. In retrospect, the WHO should have taken into consideration the fact that H1N1 is no more serious than the regular seasonal flu and avoided the doomsday prediction.

Secondly, did the ROC government respond appropriately? Borrowing from the SARS experience, the government managed H1N1 by imposing many stringent measures, such as body temperature screening, class suspension policies, public health education campaigns, importing antiviral drugs and starting a domestic vaccine manufacturing program.

By and large, these measures were appropriate. But some of them, in particular, the class suspension policy, were overly stringent. The severity of H1N1 symptoms did not justify the suspension of classes when two students are stricken within the same period of time. Although these measures are effective in controlling the spread of the disease, the social cost is far too high. This policy probably stemmed from Taiwan’s SARS experience.

On the other hand, the use of antivirals to treat influenza outbreaks is controversial, to say the least. It appears that discussions by local experts on the shortage of this medicine actually created public anxiety and caused some sectors of society to hoard the drug.

Thirdly, why did the government’s vaccination campaign collapse? The push to import H1N1 vaccine and have a local pharmaceutical company manufacture Taiwan’s first-ever self-made medicine is a praiseworthy accomplishment. And yet, after the success of the initial vaccination campaign, the public turned suspicious and became distrustful of Taiwan’s vaccine, and later, imported H1N1 vaccine as well.

This apprehension began after initial unconfirmed reports of vaccine-induced death. Although most of the untoward side effects were later found to be unrelated to the vaccine, the unfavorable reports took a lot of time to blow over and public trust nose-dived.

The government’s subsequent PR efforts did not succeed in undoing the damage. Taiwan is not alone in mistrusting the H1N1 vaccine. This has happened elsewhere, including the EU and U.S. Apparently, the overblown severity of the disease created doubt in the public’s mind about the necessity and benefits of vaccination. The lessons learned from this experience should be remembered for the next epidemic.

Finally, have resources been squandered in acquiring so many antivirals and vaccines but not using them? The answer, simply, is no. Public health measures and vaccines are just like military weapons. Taiwan has bought and manufactured so many combat aircraft, warships and other costly weapons, and yet, has not used any of them in the past 40 years. The nation is safe because of these weapons. The same can be said for stockpiled antivirals and vaccines.

H1N1 offered many good lessons for managing future outbreaks of infectious diseases. The WHO should be more judicious in declaring the impact of an impending epidemic; the government more forthright in dealing with unfavorable events; scientists and policymakers more open with their communication; and the media more responsible in presenting its coverage.

Taiwan deserves international recognition for successfully containing the influenza A (H1N1) pandemic and, in the process, joining the exclusive list of countries that are able to manufacture vaccines. It is safe to say that the nation has learned its H1N1 lessons well.

—Dr. Michael M.C. Lai is the president of Tainan-based National Cheng Kung University. These views are the author’s and not necessarily those of “Taiwan Today.” Copyright © 2010 by Dr. Michael M.C. Lai

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