Monday, October 5, 2009

Swinefeld and Thorny Medical Ethics Issues In H1N1 Pandemic

Every year I get a flu shot. As a professor, I work in a very public and populated organization - on campus, I come in contact with colleagues, staff and students. In my work in schools, I come in contact with hundreds of teachers and thousands of children of all ages. My husband and I are parents to two school age children who also play organized sports. So, my family is in regular contact with a great many people, from whom we could get a bug and to whom we could spread a bug. Each year, my whole family has gotten flu shots. This year, however, the decision to vaccinate, or not to vaccinate against seasonal flu is complicated by the onset of swineflu / H1N1 and the fear of a pandemic.

I have been doing a bit of reading and research about the current flu vaccination programs and policies. In Canada, while the seasonal flu vaccine will be administered to seniors and to people in long-term care facilities, most people are being advised to wait for the H1N1 flu vaccine, rather than getting two flu shots. The World Health Organization, the Public Health Agency of the Canadian Government, our Alberta Government, even my own campus has an emergency plan for Swine Flu. Government and Public institutions are warning their constituents about the swineflu / H1N1 season and how to try to protect themselves. So, why hesitate? As a good mother, as a responsible public professional, why would I even think about skipping the H1N1 flu shot?

What complicates my decision about automatically getting the swine flu vaccine for me and my family is what I have learned from one Canadian doctor, who suggests that the current panic about a swineflu pandemic is much ado about nothing and more about profits for pharmaceuticals and researchers, from another team of Canadian ethicists who ponder whether the government should mandate vaccinations, and a news source that identifies potential safety risks with the H1N1 flu vaccine - see the CTV News FAQ site on Swine Flu.

On Sept 19th "Swinefeld" episode of White Coat, Black Art on CBC, Dr. Brian Goldman talked about the thorny economic and ethical issues to do with the global pandemic of swine flu (also known as H1N1). Here is part of the tagline: "We've heard a LOT about the global pandemic of swine flu in recent months. Experts are predicting a deadly second wave of the illness this fall. Accordingly, Canadian health officials are scrambling to put plans in place to handle the expected health crisis. It's costing us millions and millions of dollars. But not everyone believes it's necessary. This week, we ask the question: could this be a pandemic about nothing?". Goldman suggests that there are a host of ethical and moral issues to do with pharmaceutical companies (who stand to benefit from widespread vaccination policies) pushing the pandemic panic button, and government (who has to be seen to be doing something) investment of millions of public dollars into a possible swineflu pandemic. Subsequently, on the WCBA blog: handwashing hogwash (Goldman suggested that getting people to cough into their sleeve to stop H1N1 transmission was a bit like asking school kids to "duck and cover" to save themselves from a nuclear blast).

After listening to Goldman's "Swinefeld" episode, and reviewing the CTV News site, I wondered if getting the H1N1 vaccine for my family was (1) worth the effort, or even (2) safe. Like any concerned parent, I want to do what is best for my children; as a professor, I have been vaccinated for seasonal flu each year. However, as an educated consumer, I wonder if I am being sucked into the fear flu factor by savvy pharmaceutical companies at the risk of safety - Canada / GlaxoSmithKline is using an adjuvant as part of its H1N1 vaccine regimen; adjuvants are chemical additives used in some vaccines to ramp up the response the immune system generates to a vaccine (GSK, Canada's pandemic vaccine manufacturer, has said its vaccine will contain its own proprietary adjuvant system, called AS03). So, serious questions arise about the "rush to approve" and the safety of the adjuvant-H1N1 vaccine for mid-November release.

A brand new Science Daily report, published Oct 4th, entitled "Medical Ethics Experts Identify, Address Key Issues In H1N1 Pandemic", summarizes key issues from nine papers published by the University of Toronto Joint Centre for Bioethics. Topics include duty of health care workers to work during a serious flu pandemic; government restrictions on individual freedoms and privacy and their responsibilities administering vaccination programs; how to allocate limited medical resources; and the obligation of rich countries to share such resources with those less fortunate. The report cites findings from the UofT Joint Centre for Bioethics telephone survey of the views of 500 Canadians and nearly 100 more via a series of town hall meetings, using seven topic headings: Duty to care, Priority setting, H1N1 vaccinations, Restrictive measures, Global issues, Risk communication and Vulnerability. One comment in particular caught my eye, "Coercion in vaccination policy could range from aggressive marketing campaigns, to introducing policies that exclude unvaccinated individuals, to introducing mandatory vaccination". Just wondering, would the aggressive marketing campaign to vaccinate be paid for by the pharmaceuticals (who stand to benefit financially) or government? Interesting "quick fact" from the GlaxoSmithKline website on fluvirals: "GlaxoSmithKline is the leading Canadian influenza vaccine manufacturer and will supply the majority of the Canadian government’s seasonal influenza vaccine purchases from 2005-2011."

Finally, there is ample descriptive media on what to do about Swine Flu / H1N1 (CTV for parents), and who should vaccinate: PBS here, CTV here and here, and CTV MedNews (for more, do a google search on swine flu latest news), and also a whole host of other media here, (GSK) here and here.

I will need to make an H1N1 vaccination decision for me and with my family in the next month - some estimates suggest the vaccine will become widely available in mid-November. From the CTV site: "There are still questions about whether everyone will want to be vaccinated. Keep in mind that H1N1 causes only mild flu in most people; in fact, some Canadians may have already been immunized through natural exposure to H1N1 during the spring's "first wave". Determining who has been exposed already is a scientific challenge at this time. Others might choose to wait until vaccine manufacturers gather more safety and effectiveness data".

Is the H1N1 flu vaccine safe? Is it even necessary? I am reading all that I can to make this important decision for me and with my family.

1 comment:

Hank said...

Skepticism here seems very appropriate. In fact, I have begun to characterize advisories coming from WHO as coming from the "World Hysterical Organization."

All too often these advisories lately seem like instances of the modern management craze, "let no crisis go to waste." And if there is no real crisis, let's create one, even a panic.

We need to be able to trust these people as authorities, not as crisis manufacturers. Some day there will, obviously, be another pandemic, but this past year doesn’t look to me that H1N1 qualifies. If the vaccine was truly free, and truly harmless, what's to lose, but it sure seems like crisis mongering, in which case: follow the money.

Skepticism is like paranoia, you aren't really a skeptic when they're really misleading you?