Here is copy of a recent article from the Edmonton Sun by Christina Spencer
WHAT WENT RIGHT
Advance planning (1)
Canada has had a pandemic plan of some kind since the late 1980s. After SARS killed 44 Canadians in 2003, more action followed: A federal chief public health officer was appointed, the Public Health Agency of Canada was created, and federal and provincial governments agreed on an up-to-date pandemic influenza plan. A prototype vaccine was tested on the H5N1 bird flu, and a stockpile of antiviral medications (for treating influenza) was set up.
Canadian science
The public health agency's National Microbiology Laboratory in Winnipeg was first to map the genetic code of the H1N1 Mexican flu virus back in April. Canadian scientists have continued to produce significant research on H1N1 ever since, says Dr. Paul Hebert, a critical care physician and editor-in-chief of the Canadian Medical Association Journal. Doctors and other experts nationwide have worked closely to share information.
Communications (1)
As Health Minister Leona Aglukkaq is fond of pointing out, the federal government has held more than 42 press briefings since last spring. She has also ensured briefings for opposition politicians. Until recently, most of the federal government's messaging to the public was measured in tone, reflecting the nature of the illness itself for most people, says Dr. Richard Schabas, Ontario's chief medical officer from 1987 to 1997. Most important, Canadians know about the virus and are actively discussing their options.
A good vaccine
Canada signed an agreement in 2001 for a domestic supply of vaccine in case of a pandemic. Yes, there's controversy about whether we should have arranged more than one supplier, but as Aglukkaq keeps repeating, we're doing well compared to much of the world: almost 6.5 million doses were in the field by the end of this past week. Furthermore, the vaccine itself is highly effective, particularly its adjuvanted version, according to chief public health officer Dr. David Butler-Jones. And it's also very safe. The World Health Organization said Thursday that among the millions of shots given out so far this fall, no unusual side-effects have been found.
Priority groups
The federal, provincial and territorial governments all agreed generally on who should go to the head of the line for the vaccine. "There's a lot of judgment that goes into how one interprets the data to put people on those lists," Hebert says. "They made the right choices." After initial confusion, most Canadians, at least those who aren't professional hockey players, have tried to respect their place in the pecking order.
Dr. David Butler-Jones
Hebert thinks Canada's first chief public health officer "has done a great job" and praises the Public Health Agency of Canada for good advice to provincial health authorities and Canadians in general. Even politicians who are critical of the government's overall approach respect Butler-Jones, and many wish he had more power.
A weak virus
The best development, however, is that H1N1, although a pandemic, has been mild. This isn't smallpox, diphtheria or polio. Most healthy people will get over it at home.
"It's a bit like being bomb-proof," says Schabas, "I'm bomb-proof if the bomb's a dud."
WHAT WENT WRONG
Timing
"There were lots of reasons, even in July, to think we would see an early flu season," says Schabas. Yet Canada slowed vaccine production by placing an order for unadjuvanted product, which is harder to make than adjuvanted. "If you wanted unadjuvanted vaccine, that's fine, but because production is so much smaller, it should only have come after we had a large number of adjuvanted vaccine," he says.
Federal officials did rush some vaccine out to the public ahead of the original launch date of early November, but have ended up having to assure people that inoculation will still be fine even if we have to wait until Christmas. Meanwhile, in parts of the country, experts think the flu season has already peaked.
The World Health Organization
Though Canada has followed the evolving advice of the international body, some people, such as Liberal health critic Dr. Carolyn Bennett, say we should make our judgments independently. The WHO, for instance, advised countries to finish production of regular seasonal flu vaccine before manufacturing H1N1 vaccine, which delayed H1N1 shots. It also advised making unadjuvanted vaccine available for pregnant women, which delayed the general vaccine rollout. The WHO came under fire from the British Medical Association Journal for what is perceived as a too-liberal definition of the term "pandemic."
Communications (2)
Health authorities over-promised and under-delivered on vaccine availability, notes University of Ottawa health economist Doug Angus. "Telling people that the whole Canadian population is going to be vaccinated -- the reality is that's not true. They don't have enough doses to accommodate even half the population," he says. "Putting out those kinds of false assurances I think has created some anxiety."
In late summer and early fall, Butler-Jones was peddling a gentle line about the flu's severity, says Schabas. But when health officials began to worry people wouldn't get the vaccine, they cranked up the rhetoric. Then, a few weeks after that, "they realized they had created demand they couldn't meet. So now they're scrambling in the opposite direction." Communication has also been muddy around which vaccine is best for pregnant women.
And there have been unfortunate PR tangents such as the controversy that erupted when 100 body bags were ordered for remote aboriginal communities in Manitoba.
Only one supplier
Bennett and other opposition politicians say Canada should have, and could have, had agreements with more than just GlaxoSmithKline to manufacture vaccine. The feds made their initial arrangement for vaccine back in 2001, to ensure a made-in-Canada source in case a serious pandemic led countries to close their borders. But Rob Van Exan, director of immunization policy for Sanofi Pasteur, says Canada should consider a second supplier. In the wake of bottlenecks in production and rollout, many critics now agree with him.
Advance planning (2)
Part of Canada's plan should have included vaccine programs in schools and through physicians' offices, Angus says. He feels there has been a lack of oversight, a gap that led to instances such as H1N1 vaccine being offered to private, for-profit medical companies. But, a bigger problem, Schabas argues, is that public health officials didn't know when to diverge from their plan.
Canada's pandemic planning assumed a more severe illness, in which up to 50,000 people might die. But H1N1 hasn't been such a plague. "For healthy people . . . the risks from H1N1 are very tiny," he says. "Does it really make sense to put a huge amount of public resources and do all this stirring up of public anxieties for the purposes of people being immunized against a disease which really isn't going to be a big problem for them anyway?"
christina.spencer@sunmedia.ca
Presented by Larry Guzda
Information on this page is provided for informational purposes only. It is not meant to be a substitute for medical advise. Contact your physician for diagnoses of all health related problems as soon as possible.Dietary supplements HAVE NOT be evaluated by The Food And Drug Administration and are not intended to diagnose,treat,cure or prevent any disease.
This article may be copied but not changed in any way.
No comments:
Post a Comment