Saturday, August 29, 2009

H1N1 Flu Spreads, But Vaccine a Mistake

There have been multiple reports of H1N1 flu spreading rapidly in the last week, particularly in Japan and on U.S. college campuses. This is happening even before the summer in the northern hemisphere gives way to fall. Usually, the North American flu season gets going around November, so if flu is hitting three months early, it suggests that far more people than usual may be infected between now and May.

Despite this risk, the rush to release an H1N1 flu vaccine is a big mistake. Some medical groups have gone on record urging their members not to take the new vaccines. It is unrealistic to expect to learn much about the safety or effectiveness of a new drug in just a few weeks, and the tests that are being conducted are very small in size, so any conclusions that come from them are really no more than educated guesses. We won’t know for months how many people will be harmed by the vaccine, nor how many people will be protected.

You might imagine that there is a standard way of creating a flu vaccine, which can simply be adapted to the new shape of the new flu virus. Yet many of the H1N1 vaccines being tested contain ingredients that have never been deployed on such a large scale in any drug. With that high-risk approach, it is quite possible for the vaccine to do more harm than the disease. That is exactly what happened with a rush flu vaccine in the 1970s, and the new flu vaccines are being slapped together faster than that one was.

An untested vaccine that may stop an epidemic provides a situation where the interests of the state are at odds with those of the individual. From the point of view of the United States government, it is rational to put the lives of millions of citizens at risk in order to stop the spread of a disease that could possibly infect half the people in the country. But from the point of view of the individual, taking an untested vaccine to protect against a hypothetical epidemic is not so rational.

You maximize your own chance of survival by waiting to get a vaccination until the new virus proves the risk it poses is greater than the risks posed by the vaccine. If you are basically healthy, that might mean waiting until a fourth of the people in your community have been infected before you seek out the vaccine. But the government authorities have a better chance of reducing the spread of the disease by vaccinating as many people as possible as early as possible. The vaccine may be just as damaging as the disease it protects against, but its effects are not so easily spread from person to person.

Not wanting to wait until even the most minimal tests are complete, the U.S. government is ordering huge batches of untested vaccines to be released about a month from now. These early vaccines carry the additional risk that they could be mostly or completely ineffective — they might create negative health consequences and not provide any protection against the flu virus. This rush to mass-produce an untested vaccine is unprecedented in medical history and cannot be justified by the moderate severity of the new H1N1 flu strain. There are a few people for whom the thought of a flu infection is so frightening that they might choose to take a chance on a vaccine that just might work, and might be safe. For the rest of us, a more rational approach is to wait to find out how dangerous the new flu is and how safe the new vaccine is. That means, don’t get the new H1N1 flu vaccine this year. It is safer to wait until next year.