On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.100 n.3 Cape Town Mar. 2010
FROM THE EDITOR
H1N1 hype a treasure trove for conspiracy theorists
In June 2009, the World Health Organization (WHO) declared the influenza H1N1 virus a pandemic, the first such pandemic to be declared in 41 years. At that time, the new strain had infected 28 000 people worldwide, with 141 fatalities. Since then the pandemic has turned out to be a bit of a damp squib for much of the global public. Americans believe that the flu threat was overblown and the pandemic is over, and therefore do not intend to get the swine flu vaccine being pushed by US public health authorities, according to a recent poll of the Harvard School of Public Health.1 To date, only one-fifth of the US population has been vaccinated. Vaccine uptake has been similarly unenthusiastic elsewhere in the world.
Americans could perhaps be excused for being sceptical about the vaccine. Back in the 1970s, with the anticipation of an imminent outbreak of an earlier variant of H1N1, US President Gerald Ford's administration rolled out a massive campaign to vaccinate every man, woman and child in the US against what was then also known as swine flu. The epidemic failed to materialise, but the vaccine was linked to an outbreak of Guillain-Barré syndrome that cost many lives, causing the campaign to be abandoned.
Did the WHO overstate the threat of an H1N1 pandemic? There are those who think so. Dr Wolfgang Wodarg, a member of the German parliament and chair of the Parliamentary Assembly of the Council of Europe's health committee, bluntly contends that 'WHO advised us falsely; they raised a false alarm.'2 Then there are those who believe that the timing of the WHO's declaration of a pandemic was contrived to benefit the big pharmaceutical companies that stood to make huge gains from such a declaration.
That big pharma did in fact benefit substantially from the declaration of a pandemic is beyond question. In response to the earlier emergence of SARS and the H5N1 avian flu and the panic they caused, most Western countries had taken steps to set up contingency plans to prepare for possible future outbreaks of other deadly pandemics. The plans included signing up to multi-billion dollar advance-purchase agreements with pharmaceutical companies for the supply of vaccines, that would automatically kick in if a deadly pandemic was declared by the WHO. These plans all envisaged a worst-case scenario. The UK's plan, for example, predicted between 50 000 and 750 000 deaths from such a flu pandemic. So far, however, there have been 400 British deaths from H1N1. In any event, when the WHO declared the H1N1 pandemic, these contracts were immediately activated and, as one conspiracy bloggist puts it, 'Once a "'pandemic"' is declared it is basically a license for pharma to print money. Great business model!' France alone spent $1.5 billion on procuring enough of the vaccine to inoculate its entire population of 60 million. However, with little demand for vaccination from the public, France and many other Western countries are now stuck with massive H1N1 vaccine surpluses and are scrambling to find ways to unload them.
But how did this come about? Did the WHO fiddle with its own definitions in declaring an H1N1 pandemic? There is some evidence that the WHO did in fact subtly change the terms under which such a pandemic may be declared. 'Before the arrival of novel A/H1N1 virus,' writes Doshi3 in the BMJ, 'pandemics were said to occur when a new subtype of influenza virus to which humans have no immunity enters the population, begins spreading widely, and causes severe illness. WHO, for example, for years defined pandemics as outbreaks causing "'enormous numbers of deaths and illness"', but in early May, removed this phrase from the definition.' WHO's Dr Keiji Fukuda, however, maintains that WHO's definition of influenza pandemics has always been based on transmissibility and has never had anything to do with the lethality of a virus.2 No matter; conspiracy theorists predictably pounced on the definitional change as the 'smoking gun' that proves WHO's complicity in the alleged machinations by the pharmaceutical industry.
The charge of a conspiracy does not ring true. And as Time Magazine puts it, 'it is not difficult to imagine an alternate scenario in which critics would now be accusing the agency of failing to warn countries properly of the H1N1 threat' if the worst had come to the worst. This may still come about; H1N1 has not been wiped off the face of the earth yet. More lethal waves of the flu may still lie ahead.
Daniel J Ncayiyana
1. McNeal DG Jr. Most Americans think swine flu pandemic is over, a Harvard poll finds. New York Times 2010; 6 February, p. A12. [ Links ]
2. Harrell E. Was the threat of H1N1 flu exaggerated? Time Magazine 2010; 26 January. www.time.com/time/health/article/0,8599,1956608,00.html (accessed 5 February 2010). [ Links ]
3. Doshi P. Calibrated response to emerging infections. BMJ 2009; 339: b3471. [ Links ]