Canada's Risky Swine Flu Plan

Story from the Victoria Times Colonist

Among the many concerns about swine flu, one grows larger by the day. Canada's public health managers are running considerable risks with their strategies.

When it became clear that the new H1N1 flu virus threatened a pandemic, many countries decided on an accelerated response. They chose a vaccine type that is quick and easy to develop.

But Canadian officials preferred a double-barrelled serum that both repels the virus and boosts the patient's immune system.

That was a controversial decision, because the more complex vaccine takes longer to develop. Countries that opted for the simpler approach are now ready to begin distribution. Some have already started.

But it will be at least mid-November before the Canadian vaccine is available and it could be January before everyone is treated.

That would be slow even for the regular flu cycle, which peaks in the early new year. But recent evidence suggests the H1N1 flu epidemic is accelerating faster than expected. There's a good chance that a million or more Canadians will contract the disease before the medication reaches them. Although the H1N1 virus has proved less dangerous than feared, some will die.

Swine Flu Cases - As Of May 2009

It's possible the double-barrelled vaccine will eventually save more lives than are lost. But in going this route health officials are taking a calculated chance.

Then there is the uncertainty about whether to offer regular flu shots before the swine flu vaccine is available. It's an important question. Every year around 20,000 Canadians are hospitalized with regular flu and up to 8,000 die.

On the one hand, Canada's chief public health officer insists swine flu poses no additional risk to patients who have already received regular flu shots.

Yet his colleagues in several provinces, including B.C., have concluded there could be a risk. They cite unpublished research that suggests patients who have received a regular flu shot might be more vulnerable to H1N1.

On that basis, most regular flu shots will be delayed until early next year in B.C. (People over 65 and residents of nursing homes can receive them right away.)

This is a momentous conclusion to base on limited information. Experts in other countries have been unable to confirm the research.

There's also considerable uncertainty about how priorities will be implemented when the H1N1 flu vaccine does arrive. The B.C. government has said first choice must go to pregnant women, people under 65 with chronic ailments, residents of isolated communities, pre-school children and front-line health workers.

But how is this to be done? Will people who do not meet these criteria be turned away in the early stages of the campaign? Physicians and clinics haven't received those kinds of instructions.

The question is moot if enough supplies arrive for everybody. That is what health officials are counting on.

They might be right. When the vaccination program was in the planning stages, the federal government ordered 50 million doses. At that time, it was thought each patient might need two shots. It now appears most adults will require only one dose.

But what happens if the serum comes late, or the epidemic comes sooner?

There is always a degree of trial and error in developing new vaccines. But in this instance, there is more than the usual level of confusion and uncertainty. Canadian officials have chosen a different approach than many western countries. Let's hope it turns out to be the right one.