No right for Poles to vaccines

Patients on the outskirts of Europe
 
The majority of European countries, including all developed countries, have ordered vaccines against the A/H1N1 swine flu for their citizens. So far, the flu has turned out to be relatively merciful, which, in turn has prompted loud criticism of the government, and widespread condemnation of the authorities for excessive spending on too great a number of vaccines. So, are these allegations justified?

In the heat of questions relating to the cost and the number of unused vaccines, the situation in Poland has escaped the notice of the general public. Poland did not order a single A/H1N1 vaccine, including vaccines for those in high-risk groups. The Polish government has hailed this as a great success and publicises it in the national media.  Its Department of Health is held up as an example - it refused to yield before a vision of a possible pandemic and has saved millions of euros in the process. Is the Polish government’s attitude towards the flu pandemic really viewed positively across the world and can it exemplify the way forward?

The right to choose

The vaccination programme in the EU – despite the opinions of a small group of politicians – turned out to be correct in principle; 32 million people have been vaccinated against the A/H1N1 influenza. Patients in developed countries had a choice – to have the vaccine or risk getting swine flu.

The A/H1N1 virus has dominated the flu season across the entire northern hemisphere. Therefore, the A/H1N1 vaccination programme turned out to be completely justified. The fact that in many countries only a few to a dozen or so percent of the population took up the preventive vaccination is due to several factors. One of them is the pattern of mild illness recorded in the majority of those infected, however, it can be very serious, and in some cases fatal, including young, otherwise healthy people. Between November 2009 and 17 February, 2010, 4,444 people with laboratory-confirmed A/H1N1 flu died in Europe, including children, young and middle-aged adults, whilst the typical seasonal flu is fatal mainly in people over 65 years of age.

Insurance policy

On the scale of a given country, from its authorities’ point of view, the availability of A/H1N1 vaccines is a kind of insurance against the effects of flu, which are difficult to predict. The virus may mutate in various ways, pose a deadlier threat and cause a previously unknown mortality rate in the future. For this reason, prudent governments give their citizens the option to have the vaccine.

A situation, where a few percent of the population gets vaccinated and the majority is vaccinated is a state of shaky balance, where a dynamic change with regards to the development of flu and social behaviour is possible. It should be stressed, that the public awareness of too small a number of vaccines in the face of a rising threat may cause a sudden u-turn and panic-stricken attempts to obtain the scarce flu antidote. A moment of reflection shows, that it is not possible to order the “right” number of vaccines. There can only be far too many of them, or far too little. There is a third option – a total lack of vaccines and a belief that the pattern of flu will prove to be benign.

Darwinian principles

As in the case of the majority of diseases, A/H1N1 has a defined high-risk group. In the case of flu, it includes the chronically ill, children, older people, those with reduced immunity, hospital in-patients and others with many other specific medical indications. In Poland, A/H1N1 vaccines are currently still unavailable, even for those people.

For some patients, an additional disease status in the shape of a viral flu infection means risking death. It is exceptional for those people not to receive basic medication. As numerous bulletins announce, Poland has seen many people die as a result of becoming infected with the A/H1N1 in combination with another, often chronic illness. Regardless of the intentions of the Polish Department of Health, this outcome is concurrent with Darwin’s theory of evolution, which states, that in the long-term, the death of the weakest specimens lies in the interest of the general population.

Aside from any factors strictly relating to the evolution of the species, the death of the chronically ill severely reduces the cost of running the health service, which means that more valuable resources remain to be shared amongst the living (and not necessarily sick). This attitude surely does not reflect the viewpoint of civilised societies; therefore it comes as no surprise, that the majority of European countries, including all developed states, purchased a large number of A/H1N1 vaccines and have encouraged preventative vaccinations.

An untested vaccine or no vaccine at all

In the debate over A/H1N1 vaccines, it is often pointed out that clinical tests have not been completed, and the pharmaceutical firms do not bear the risks of side effects of the vaccine. However, a flu epidemic, and especially, the threat of a pandemic, requires fast decision-making and epidemiological action, which means no possibility for completing long-term procedures on medication usage.

Reaction time and experience in the manufacture of vaccines is very important, which guarantees adequate certainty that further routines tests will not show up any currently unknown threats. We cannot be surprised by pharmaceutical companies, ambiguous in legal terms, due to a lack of a complete drug testing procedure being carried out, that in this situation they do not want to bear additional risks. Their role is to take due care to manufacture the product according to their best practice and knowledge. The A/H1N1 vaccine is produced according to methods used to manufacture the seasonal flu vaccine, therefore, possible side effects are known to both the pharmaceutical firms and medical personnel.

Belief in the safety of the new vaccines was achieved on reasonable and common-sense grounds. Following the vaccination of over 32 million people in the EU (including over 300,000 pregnant women) no concerns were identified regarding the A/H1N1 preventive vaccines. As virology experts claim, the safety of swine flu vaccines is no different from that of other seasonal flu drugs, which have been in use for many years.

There is only one truth

The governments of some EU states have ordered enough vaccines for the whole of Europe, whilst Ewa Kopacz, the Polish health minister, did not provide the patent drug for even the most needy, for whom becoming infected with the flu virus poses a real threat of death. Some have “squandered” their money, whilst the Polish government can be held liable for exposing patients – in the case of the very sick, those with low immunity, hospital in-patients etc.

Neither side has reached the ideal. Instead of saying that both sides made a mistake, one may say that both were partially right – it sounds better that way. But that would be a misinterpretation. So, who was right? Those, who risked the lives of others or those who risked excessive spending? The governments of developed European countries chose the vaccine and the financial costs they bore, in order to guarantee everyone’s safety, are a measure of how much they value their citizens.

On the whole, public spending will always be born by society and it is society, who will decide in subsequent elections whether the government acted correctly by buying life insurance for its people, or whether it would be better if it took a risk, hoping the virus would “pass unnoticed”.

I hear cries; vaccine YES, number of vaccines NO. Are they right? In my opinion, they are totally wrong, for it is not possible to be spot-on. For those, who keep insisting that the numbers could have been more accurate, if not spot-on, then at least near enough, the answer remains the same. Neither pandemic patterns nor social reactions are easy to predict by any means. A group of Italian politicians from the opposition party, who wishes to win voters, believes their government wasted money by purchasing vaccines for 40% of the population, when only a million doses have been used to date. However, in Sweden, over 60% of the population was vaccinated and if the Italians behaved in a similar fashion, then they would fall short of around 12 million vaccines, and the government of the Eternal City would be cursed for endangering the life, and health of its inhabitants.

Therefore there is only one truth – there is a decided majority of prudent health ministers in Europe.

Jaroslaw Suplacz
 

A cautionary tale

Towards common sense

The commotion surrounding vaccinations used for waging political battles will eventually turn against communities.

The 1918-1919 flu pandemic, nicknamed “the Spanish flu”, was also caused by the A/H1N1 swine flu virus. Its first wave had a similar course to the current incidence of disease. In spring 1918, the first wave of the pandemic hit. Although highly contagious, it did not bring with it a significant death rate. The second outbreak, which commenced in September 1918, was marked by an incredibly high number of fatalities, whilst the third took place in 1919.

The course of the current A/H1N1 pandemic without a great number of fatalities (if one can describe the death of 20,000 people in such a way) is not conducive to a rational assessment of the preventive vaccination programme. For many politicians, populism and the desire to win over voters are the only determinants of their actions. Such politicians prey on the low awareness on the part of society, which notices only events, and imagining what could potentially happen is outside their visible realm. Also, a lack of knowledge about the course of the “Spanish flu” pandemic of 1918-1919 and its death toll, estimated at between 50 million and 100 million people, is not conducive to preventive vaccinations.

If an anti-vaccination attitude is reinforced in social beliefs, then the future may see the deaths of millions of people as a result of abandoning general preventive vaccinations. The message to inform people of the risk carried by an influenza pandemic is an important one. Let us hope that the situation will be different from the regularity, which often accompanies capital markets, where world crunches occur within cycles every few decades or so, and awareness of the threat dies with the generation.

We find ourselves in a place and time where the future of mankind’s existence in the conflict with mortal viruses is clinched. Let us stop the feverish bus ride, fed with political populism and short-sighted electoral perspective. Let us look at the warning signs, which mankind encountered in his path in the years 1918-1919.

If you believe that it is worthwhile doing something for the common good, then forward this appeal to others, so that the information has a chance to spread. We are the ones who can influence whether common sense prevails.

Sense is sometimes in the minority and loses out to populism,

but let us not give up just yet!

 

The Polish health minister is

… a fan of smoking in public places

Ewa Kopacz, the Polish health minister, recorded a video clip a dozen or so months ago, in which she opposes the proposed smoking ban in public places. In her film, she tries to convince people that she enjoys smoking and she can currently smoke in the cafeteria, in the car, outside buildings and when the anti-smoking bill is introduced, she will lose the right to light up her favourite cigarette in those places.

The Polish prime minister appointed a fan of smoking in public places as health minister, moreover, an individual, who actively promotes smoking in such places as restaurants, cafeterias and outside buildings etc. In every normal country the minister of health encourages an anti-smoking culture and does not appoint herself as a public smoking activist!

With such a disrespectful attitude towards her own health and the health of the general public, it is no wonder that the Polish health minister has taken the right to vaccines away from her patients. She refuses this right even to chronically ill patients on hospital wards, where the infection of debilitated bodies with the flu virus poses a serious threat of death or serious complications.

If the Polish health minister follows any European models at all, then they most likely belong in the 19th century. However, Polish patients demand a more civilised approach to safeguarding their health and it turns out that this path is only effective when it leads via European institutions, and European opinion polls.