H1N1/09 Preparedness Cost vs Benefits?

[Kevin R Brown]

I'm clueless when it comes to virology; for the most part, if the WHO recommends people take a given precaution and/or vaccine, I just go and do it.

An acquaintance of mine has recently been making the argument that the cautionary voice of the WHO during the recent H1N1/09 pandemic has been the equivalent of fear mongering and that, given what information we know about the virus's lack of resistance to oseltamivir and it's low mortality rate, there's hardly any point in imposing any recommendations for avoiding contact with the disease, spending the money to produce large quantities of the vaccine or expending the resources to track the pandemic.

Like I said, I'm clueless, so I don't really know if his stance is in error or just politically incorrect (...the WHO's numbers on mortality in North America do seem to suggest that the virus isn't particularly dangerous, so there's that). I went and got my flu shots anyway and would hardly regret it in any case (one tiny step closer to another pathogen being eradicated, or that's my thinking anyway), but do you think it was worth it in hindsight for us to spend all of the resources we have to go on the alert for something that doesn't seem to even be as threatening as the seasonal H1N1 strain? I know that the 1918 outbreak killed a lot of people, but that was before the advent of oseltamivir, so it seems like we're in much better shape even if something more dangerous like A/H5N1 had a real outbreak?

Could someone with perhaps a little more insight into virology and/or microbiology give me a break down here of what the expert view on the pandemic and the overall reaction to it by bodies like the WHO has been?

[bradenatchley]

I agree that the media has taken this, and many other "pandemics", out of proportion for that sake of sale; that is not to say that we should not be prepared. No one asks the cost-benefit ratio of a seasonal virus vaccine. This should be no different, and the same precautions should be taken for anything that could be potentially harmful, at least for temporary states of wellness.

Many people I know have had H1N1, and there were no chronic effects of the virus. No one died. The people who do, however, are mostly infants and the elderly who are normally at risk for bugs such as this. I received a vaccine, did not get "swine flu", and, in turn, did not give it to anyone else.

[jayh]

There is an element of 'lying for Jesus' in this, and a 'need' to make it a very scary story to get people to respond. This is not the first,or the last time.

[Eligbak]

Could someone with perhaps a little more insight into virology and/or microbiology give me a break down here of what the expert view on the pandemic and the overall reaction to it by bodies like the WHO has been?
Sorry, but isn't the WHO entitled to an expert view? ;)

The European Centre for Disease Control (ECDC) has an informative page on H1N1 (truckloads of PDF files):
h**p://ecdc.europa.eu/en/healthtopics/H1N1/Pages/general_info.aspx
It seems highly likely that even when WHO judges the post-peak and post-pandemic phases to have been reached, Europe will continue to experience low-level transmission and small outbreaks of the pandemic 2009 A(H1N1) influenza. This is the most likely scenario throughout the whole of 2010. However, larger outbreaks cannot be excluded given the lack of information from seroepidemiology.
Epidemic transmission of the pandemic virus is highly likely in the next (2010/2011) winter season, at least in very young children and other susceptible individuals. It is also most likely that pandemic influenza A(H1N1) will become the dominant virus in the coming winter season along with influenza B viruses, though the presence of influenza A(H3N2) viruses as well cannot presently be excluded. By then Europe will probably be referring to this combination as the ‘new seasonal influenza’.
There is currently no evidence of a changed pathogenicity of the circulating pandemic influenza virus. No significant genetic or antigenic changes to the pandemic influenza virus have so far been reported and so patterns in morbidity and mortality similar to those seen during the pandemic should initially be expected from this virus next winter though numbers of cases will be considerably smaller because of the previous transmission and vaccination.
From: ECDC Forward look risk assessment (Update 08 March 2010) (1003_RA_forward_look_influenza.pdf)

I don't pretend to see through the medical jargon (it probably helps a great deal of you just look it up), but I suppose the swine flu virus is about as dangerous as the normal annual flu, given that "normal" flu also mutates/changes over time. We'll sooner or later all get it and develop antibodies to it, one way or the other.

The "hype" about H1N1 was due to, as I understand it:
* It was a new virus that was initially over-rated in its lethal potential, due to higher-than-usual reported numbers of deaths from Mexico
* Pandemic potential (world-wide)
* Likelihood and harmful potential of mutations not sufficiently known