The Hungarian government recently announced that the country was officially in the midst of a flu epidemic. Hungary is well into this year's flu season and, despite all efforts, concern over the H1N1 virus still hasn't affected most people. Several schools have already been closed because of the virus, and although people have been inundated with news related to the disease (another infection here, another death there) only a little over 10% of the population has been vaccinated against the virus, with another 30% or so considering it. According to experts, however, about 60% of the population needs to be vaccinated against the virus in order for the population to be adequately protected.
The seeming lack of concern in Hungary over swine flu isn't to say that people aren't aware of it or the dangers it poses. Yet, judging by the demand for the vaccine it's quite clear that the vast majority of Hungarians feel that the hype is more prevalent than the risk.
Since going on the market, there has been little interest in the vaccine. There are several reasons for this. First and foremost, there is deep mistrust toward the influence of big business in the government vaccine program. Most are convinced that there is collusion between the government and multinational corporations to force upon them something that they don't want and most probably don't really need.
As in most other areas of the world, Hungarians feel that the H1N1 virus is nothing more than a scare campaign in order to help generate profits for multinational pharmaceutical corporations. Sadly, this view is often reinforced by some sobering facts. For example, according to a market research report entitled "Global H1N1 2009 Influenza Vaccine" published by Markets and Markets, it is estimated that the global H1N1 influenza vaccine market will be worth over $7,000 billion by 2011, growing at a rate of 222.4 %. Some of the key players in this market are GlaxoSmithKline, Novartis, CSL, MedImmune, Sanofi-Pasteur, Solvay, Sinovac Biotech and Hualun Biologicals.
Already, pharmaceutical companies have felt the effects of the virus on their share price: GlaxoSmithKline has seen its share price rise by about 35% as a result of the swine flu virus, while in China the company Sinovac Biotech Ltd. has seen a resounding 650% increase. Meanwhile, those who aren't already involved in the manufacture or distribution of vaccines have been eager to get on the bandwagon. The company Johnson and Johnson, for instance, although not directly involved in the swine flu cash cow, has nevertheless already bought itself into a company which is.
Aside from the production and distribution of vaccines, an operation that is exclusively controlled by a few giant multinationals (also known as Big Pharma), there are other ways capitalism seeks to exploit this disease in order to make money -- even for small time investors. For example, the investment newsletter Free Retirement Planning Tips offering advice on "H1N1 Vaccine Investments" noted that "companies that are able to respond quickly and effectively in providing influenza vaccines could be excellent investments."
In some cases, this capitalist fervor has gone to the extreme. In mid September Sun Worldwide Asset Management initiated a telemarketing campaign in Hungary and other countries within the region offering the deal of a lifetime. Their campaign tried to entice potential investors by offering futures in the purchase of vaccines produced by Sinovac which would be then later sold at an enormous profit. According to Sun Worldwide telemarketers, the demand for Sinovac vaccines was growing by leaps and bounds and profits which were to be made were more or less "guaranteed". The deal sounded too good to be true and no doubt many were swayed by the logic of the telemarketers. As one outsider remarked on September 19th in the Investor Village blog "is there somebody who knows what is going on with Synovac [sic!], the shares are going up and up, but why?"
What the telemarketers at Sun Worldwide failed to mention was that their campaign was nothing more than an elaborate scam to keep the demand for Sinovac vaccines at an elevated level. In mid September the share price for Sinovac peaked as the demand for the company's vaccines began to decrease. This is because on September 15th the company had fulfilled its initial order from the Chinese government for its stockpiling plan. During this peak period the share price for Sinovac Biotech Ltd was over 10 dollars a share; at present it's below eight and has been stuck there for some time. While those who invested in the company during the peak period may not be too happy at the moment, those taken in by the futures scam are even worse off as they don't even own shares in the company; instead, their investment is in millions of vials of vaccine that no-one really wants. Although the company has received further orders for the vaccine from the Chinese government and local authorities, its share price has stubbornly remained off their September highs, thus it's quite unlikely that small time investors will realize the enormous profits that were promised them any time soon.
All this has, naturally, led people around the world to be increasingly skeptical about the motives behind the campaign of governments to stockpile vaccines. For some, it appears that Big Pharma wanted to avoid the problems that occurred during the panic over bird flu. Then, a drug against the virus called Tamiflu was produced in large quantities. When the scare over bird flu quickly subsided, large amounts of Tamiflu were left unused. Ironically, when swine flu made its appearance, these surplus stockpiles of Tamiflu were quickly thrown back on to the market and used up, much to the relief of the authorities and Big Pharma, even though it was obvious that Tamiflu is virtually ineffective against the present swine flu virus.
Aside from the view that the H1N1 virus is being used by government authorities to help generate profits for Big Pharma, some feel that the H1N1 vaccines ordered by governments are actually dangerous. To this extent, there is a feeling that both the government and Big Pharma are involved in a conspiracy of sorts. According to an article by F. William Engdahl entitled "Swine Flu Vaccine Linked to Paralysis" the purpose behind this collusion between governments and Big Pharma is not to safeguard public health, but to push forward "a long-term agenda of political control of populations through deliberate means of making them ill, weak, partly paralyzed or otherwise too weak to focus on the increasingly obvious social crisis facing us all, the global breakdown of the dollar system." Along these lines, some also regard government vaccine programs as nothing more than an elaborate form of corporate welfare. Hence, stockpiling vaccines are a way to help cushion the effects of the overall financial crisis by lifting the sector, much in the same way that scrapping bonuses have been used to help buoy the automobile sector.
Others, meanwhile, note that we have been down this road before. In 1976 fears over a similar swine flu epidemic led to a mass vaccination program in the US through an equally massive propaganda promoting a vaccine which, as it soon turned out, ended up severely hurting thousands of people and even led to some two dozen deaths. Many regard this as a typical example of government attempts to "cure the disease but kill the patient".
In Hungary questions pertaining to the safety of the H1N1 vaccine is one of the main reasons for skepticism over the government vaccine program. Thus, along with selling out to big business, many Hungarians feel that the whole process has been rushed and, as a result, the vaccine (produced by the company Omninvest) isn't safe.
Without a doubt, mistakes attributed to the rush to get the vaccine to market had severely shaken people's confidence. For example, the expiration date was missing on initial batches of the vaccine; therefore it can't be clearly determined how old a certain vial of the vaccine really is. Likewise, information leaflets included with the vaccine claimed that the drug had been approved for use on children when in reality it had not yet been officially approved by the government (the vaccine has since received official approval). These and other such mistakes have been put down to simple administrative errors; even so, this has not allayed public fears or concerns over the safety of the vaccine.
In conjunction with this, there have been several rumors circulating that the vaccine is actually based on a decades old strain and therefore is useless against the present virus. The fact that many doctors are also skeptical over the reliability of the vaccine has added to public mistrust. Furthermore, a recent death in where a person died two days after being vaccinated reinforced the feeling among some that the vaccine itself is not safe.
Given these and other mistakes and mishaps, it's not surprising that the government vaccination program has not been going very well. In the beginning only a few percent of the overall population had themselves vaccinated, despite a massive propaganda campaign through state media and other outlets. The numbers of those who have been willing to get vaccinated has increased in recent days, however, but the number is still well off target.
Because of the popular resistance against the vaccine, the government has done all it can to promote it -- including the use of force through the threat of legal action. Unfortunately, old habits die hard in Hungary, and in such circumstances the government often resorts to methods it was fond of using during the communist era, albeit in a slightly modified form. Thus, the Health Minister threatened legal action against anyone propagating negative information against the vaccine. Indeed, the government even attempted to bring a case against a few doctors. The case was duly thrown out of court and subsequently the government was forced to retreat from its position, in effect acknowledging that people had the right to express their views whether the authorities liked it or not.
Apart from brute force, the government has tried other ways to cajole people into getting the vaccine. This includes the use of tax incentives for enterprises that have their employees vaccinated. Additionally, with the announcement that Hungary is now officially in the grips of an epidemic, the government has set up vaccination points where people can get the vaccine immediately without having to go through the process of first visiting their doctor and then purchasing it at the pharmacy.
Given the government's past record on the use of statistics and creative bookkeeping (especially in the financial field), there is some doubt over the government's claim that Hungary is officially in the grips of an epidemic. Firstly, the government announcement of the epidemic refers to a flu epidemic in general. In other words, the number of people with the H1N1 virus was mixed together with the number of people with a seasonal flu virus. In addition to this, some note that these numbers also include those people who simply visited their doctor because of flu-like symptoms; this doesn't mean that they actually have the flu, whether it is the H1N1 strain or any other kind.
Ironically, while much attention and resources have been focused on the H1N1 virus, the seasonal flu virus has been largely ignored. As a result, although the country is still not through the peak period of the flu season, seasonal flu vaccines have already run out. To make matters worse, there won't be more of this type of vaccine available since all production had been geared toward the production of the H1N1 vaccine.
What this means is that Hungary may find itself in a peculiar position in where more people will be sick and even die of the seasonal flu because it has been neglected to the deference of swine flu. So far the number of those who have died as a result of the H1N1 virus is not much higher than the number usually killed by a seasonal flu virus.
To make matters worse, neighboring countries throughout the region -- especially Romania and the Ukraine -- have seen a dramatic increase in the number of flu victims. With the number of infections in neighboring countries spreading rapidly, the pressure of the flu crossing over into Hungary is immense as these countries are generally short of medication, let alone vaccines against the H1N1 virus or the seasonal flu.
Indeed, in some cases people from Slovakia and Romania have been crossing over into Hungary in order to purchase medication. This includes the H1N1 vaccine. Subsequently, the Hungarian government has been criticized for turning a blind eye to this in order to sell the surplus vaccines that Hungarians apparently don't seem to want. This only reinforces the view of those who feel that the government vaccine program is about money, as officially the vaccines have been stockpiled for domestic use only.
There is no doubt that the authorities in Hungary and various other countries are deeply concerned about the effects of the H1N1 virus. Yet often it's the way in which these governments conduct themselves that raises suspicion. Take, for instance, the scandal in Germany where government officials were given a different vaccine than the one on offer for the rest of the population.
Not only this, although there has been much talk about swine flu or H1N1, not many people, including government ministers and so-called experts, really know what they are talking about. Indeed, if they really knew what they were talking about then there wouldn't be so much of an emphasis on stockpiling vaccines; rather, the focus would be more on stockpiling anti-biotic medications instead.
This is because the H1N1 virus is actually nothing new. We have been down this road before and based on past experience we know what would happen if a global epidemic did occur. Hence, the actions which should be taken need to be based on a review of past mistakes (which were mostly due to our limited knowledge and access to technology at the time) rather than a knee-jerk reaction to a problem.
First and foremost, the present outbreak of H1N1 is part of a group of diseases which, sadly, have been gradually becoming all too familiar. Other such diseases include AIDS (which stemmed from an adaptation of simian immunodeficiency virus to humans), SARS, bird flu and BSE, better known as mad cow disease. Although mad cow disease is not actually caused by a virus, what all these diseases have in common is that they appear to have crossed what is commonly known as the "species barrier" and have shaken our faith in the infallibility of this natural form of protection. Thus, even though swine fever, which kills pigs very rapidly, never infects their human contacts, swine influenza is perfectly capable of crossing the species barrier. Not only this, one of the mechanisms thought to be responsible for the new variants of human influenza is a recombination of bird viruses that infect pigs and are then passed from pigs to humans.
From a molecular standpoint, whether or not someone contracts influenza depends on the haemagglutinin (H) number used to classify the different influenza A viruses. Numerous antigenic subtypes exist that are defined on the basis of two membrane glycoproteins of Type A influenza viruses (haemagglutinin, 'H', and neuraminidase, 'N'). These two groups determine the virulence of the infection: either the mortality rate is close to 100% (mainly from subtypes H5 and H7) or the infection is mild and of a respiratory nature. Since early 2003, there have been a number of epizootics involving humans: H5N1, H7N7 and H7N3.
At present, we are aware of 16 virus variants, only three of which are fully adapted to humans and infect us with our familiar seasonal influenzas. Haemagglutinin is the so-called "key" which the virus uses to enter its host's cells. According to our present knowledge, only the H1, H2 and H3 viruses have caused pandemics in the entire history of humankind.
Even though events formerly thought to be impossible have in fact become possible today, scientists argue that the species barrier against influenza viruses is still extremely robust. These viruses have been circulating for a very long time and, despite the close proximity in which birds, poultry and humans live in some countries of the world, there is no record of an epidemic outbreak of H5N1 in humans occurring in the 20th century, although there were several episodes of avian influenza.
Yet influenza is more organ-dependent than species-dependent, as the virus can cross the species barrier between warm-blooded animals with similar organs. The H5N1 virus, which is optimal at 39°C, has still not adapted to humans, who have a body temperature 2 to 3 degrees lower than that of birds. Even so, scientists have warned that it would take only one element in the H5 structure to change to remove the avian specificity of H5N1 viruses. Humanization of the virus, which could occur by the recombination of H5N1 with other strains, would then open the door to a pandemic. For some, the likelihood of this happening is only a matter of time.
The problem at present, however, is that leading experts and government officials are either intentionally or unintentionally confusing the situation. There appears to be a fear that the world is on the verge of being struck by another pandemic on the scale of the one in 1918 (the "Spanish Flu"), which claimed between 20 and 40 million lives. Then, the 1918 virus was a new strain (which we now know to be H1N1) with which humans may never have previously come into contact. Herein lays the main difference between seasonal and pandemic influenza: in the case of the former, only a fraction of the population is susceptible because of acquired immunity; in the case of the latter, the entire population is susceptible to a strain that is new to the human race.
While the 1918 pandemic appears to be used as the basis for the present concern over H1N1 (in essence history appears to be repeating itself) lessons from the 1918 pandemic apparently have not been learned. As doctor and bio statistician Antoine Flahault, who helped the WHO develop its Global Influenza Surveillance Network (FluNet), noted earlier this year in an article entitled "Should we be afraid?", "in 1918, between 80 and 85% of deaths arose from bacterial complications. Infected people died en masse from pneumonia, whereas nowadays they would be given antibiotics." This means that to guard against an influenza pandemic of this kind it would be necessary to stockpile not vaccines but antibiotics.
Along these lines, it appears that governments are actually taking the wrong approach in dealing with the present outbreak of H1N1. For some, the reason for this is quite obvious: since vaccines have a shorter shelf-life than antibiotics, it makes better business sense to stockpile vaccines and not antibiotics since the former has a higher rate of redundancy. This, in turn, helps to ensure that the cash cow is not killed off too early.
As many seem to be either fully or partially aware of all this, it should come as no surprise that there is much public skepticism about government attempts to vaccinate entire populations against the H1N1 virus. This skepticism has much deeper roots, however. In effect, it's part of a more general trend of growing public opposition toward the use of immunizations and vaccinations as a means to safeguard our health.
This trend is clearly evident in North America where some people are refusing to have their children immunized against common diseases. In many ways, the western world has become a victim of its own success as some are now beginning to feel that immunizations and vaccinations are useless. This, in turn, has led to a fear among scientists that those diseases in the western world which were once thought to have been forever eradicated, such as smallpox (which was eradicated in 1979) could soon reappear. Similarly, although Europe only became polio-free in 2002, many experts feel that if present conditions continue then it is highly likely that it will soon make its reappearance.
Yet the problem isn't simply that a few people have made a foolhardy decision based on a lack of understanding. Rather, the problem is that state health care has become too closely aligned with private interests, nurturing a feeling of suspicion and mistrust within the general public. Simply put, governments such as in Hungary suffer from a creditability gap. This is why most governments around the world are having a hard time in convincing people to get vaccinated against the H1N1 virus.
This creditability gap looks set to widen further as people become increasingly skeptical about government programs aimed at protecting their health. Ultimately, this will lead to a tragedy of enormous consequences when a disease -- one which really does threaten society as a whole -- is able to spread unabated because of this creditability gap. The only way to narrow and eventually eliminate this creditability gap is to decouple public health care from the private sector. Unless this is not done soon, it will only be a matter of time when a simple epidemic mushrooms into a global pandemic of catastrophic proportions.
Flickr photo from Sarihuella