H1N1 R.I.P.: Reflections on a Life of Controversy

According to the World Health Organization, we are now in the post-pandemic phase of H1N1. Good riddance. While the virus remains, the threat of another widespread outbreak has passed, says WHO Director-General Margaret Chan. (Here's the WSJ's review.)

WHO had been criticized by some authorities for fabricating the pandemic and pandering to drug companies who stood to gain from developing and marketing vaccines (see "The Great Swine Flu Conspiracy: The Plots Thicken", my column from a few months past). But Chan defends her organization's actions as necessary precaution, and points out that with H1N1 we all just dodged a bullet: "This time around, we have been aided by pure good luck. The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile."

Now comes the time for assessment, and reflections upon the life of H1N1:

The Center for Infections Disease Research and Policy (CIDRAP) says that we may never know where the virus originated: "The virus's real birthplace may never be pinpointed, because its ancestors are missing from the surveillance records for at least 10 years . . . The parents haven't been detected for a long time. . . . The moment may have passed."

Among its Top 5 lessons learned, Time notes that vaccine manufacturing is still woefully inadequate, no surprise to many of us: "But the major hindrance is the way vaccines are currently manufactured — grown in individual doses in batches of chicken eggs. While flu vaccines take months to produce, flu viruses spread around the planet in a matter of days. So unless the U.S. and other wealthy nations upgrade their vaccine-production strategies (experimental cell-based techniques may be able to churn out new vaccines much more quickly) and add more capacity, we're guaranteed to struggle to defend against the next pandemic. Vaccines may represent the best line of defense against a new flu virus, but not if they're too slow to do any good."

The Bioethics Forum outlines the many manufacturing problems that exist with vaccines, but notes that better methods of manufacturing and distribution are within reach: "It will require government funding, and government control over vaccine production. Yet this is not a man-on-the-moon effort. The technology to achieve meaningful results is well within our grasp right now. Developing a more responsive and flexible vaccine manufacturing system should be a public health priority for countries in the developed world capable of initiating such a program. It is not something we can afford to put off; it is a necessity that cannot be delayed without endangering many lives."

--Paul Thomas