From the Editor: H1N1, Shamanism and Shame

Thirty-three years after the last “Swine flu” scare, we still cannot seem to make flu vaccine and antiviral manufacturing any more predictable. Are today’s solutions like amulets whose power cannot last?

By Agnes Shanley, Editor in Chief

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The threat of danger always brings out the worst in people. Consider the hysteria wrought by the H1N1 flu outbreak this Spring. China detained and evicted over 80 healthy Mexican citizens, neighbors of recovered flu patients welcomed them home by shunning them, and counterfeiters sprang into action with ffake Tamiflu capsules and Relenza inhalers, at five times the market price.

This was a time for conspiracy theories—H1N1 was cooked up to kill Mexican tourism and awaken overzealous border patrolling, said one theorist. Reporters ran with a casual statement by an Australian researcher, Adrian Gibbs, who speculated that the virus might have been accidentally leaked from a government lab. (“Accidentally or intentionally?” asked the lunatic fringe.) As the media fanned the flames, its coverage of the flu outbreak also triggered the “nocebo” effect in many otherwise rational people, who began to feel as if they were coming down with something. While greatly saddened by news of the deaths from the flu, I wondered why the media felt compelled to focus on each and every fatality.

Then came an unexpected jolt with reality, as I found myself bundling my son into a taxi at 4 a.m. to go to the E.R. He had developed a fever and flu-like symptoms for the second time last month, only now his fever was raging and had seriously weakened him.

A surreal scene awaited us: 2,000 miles from Mexico City, the lobby of this huge hospital had been transformed into a flu triage center. Have a fever? Grab a mask from the stack and prepare to wait (that part hadn’t changed).

Fortunately, my son’s is now well and has taken his prophylactic Tamiflu dose. But, for me, our brush with H1N1 raised many questions about how mankind is approaching the flu in the twenty-first century: it’s still two parts science, three parts shamanism.

First, there’s the inaccuracy of flu tests. Then, there is the tenuous supply of antivirals. We haven’t heard too much about GSK’s Relenza so far, as the media seems focused on
Tamifl u. At least Tamiflu’s supplier, Roche, and inventor, Gilead, have patched up licensing diff erences. But is there any wonder that the drug has been in short supply?

It’s derived from Chinese star anise, relies on potentially hazardous azide chemistry and, according to some sources, can take up to a year to synthesize. Roche and Michigan State University researchers have reportedly developed routes based on different chemistries.

Will these be up and running once the dominant flu strain actively resists the drug? I clutched our $100 box from the pharmacists’ gratefully, as we couldn’t even get it two weeks before. But, aren’t today’s antivirals like amulets whose power cannot last? Last year, the CDC had already discovered a Tamiflu-resistant flu strain.

H1N1 awakened long-buried memories of the last “swine flu” outbreak, and a dreary school volunteer service project manning a Red Cross hotline. Spurring people’s calls was
a $137-million public outreach program, which funded advertisements urging vaccination, even though the vaccines’ health risks were not fully known.

Of the 200 people who developed swine flu that year, one person died, while over 500 people developed neurological problems that may have been connected to vaccines
released before their time. Twenty-five people died from these problems, and the director of what would later become the CDC was forced to resign.

Did the government act too soon? Maybe, yet officials took exactly the kind of decisive approach that would be needed in the case of a pandemic. Thirty-three years later, at a time when we stress science and risk management, we still cannot seem to make vaccine or antiviral development and manufacturing any more predictable.

What is needed are “universal” flu vaccines. Fortunately, these are inching closer, but, clearly, they won’t be available for a while. We have every reason to fear a flu pandemic. But as concerns over H1N1 mount, let us hope that we control the only thing we can: our reactions to that fear.

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