Was our response to swine flu alarmist?
Seema Singh -
Sunday, September 06, 2009 11:20 AM
Now that the media have somewhat stopped counting the A/H1N1 deaths, and there seems to be a sense of relief in the society, it's time to see how the public health measures taken in response to the swine flu spread actually measure up.
A research paper in the latest issue of British Medical Journal by Peter Doshi from the Massachusetts Institute of Technology says the public health response to the swine flu outbreak can be seen as "alarmist, overly restrictive, or even unjustified". Doshi's argument is based on the thesis that the response largely took into account the worst case scenario (as has been happening in the last four years), considering H1N1 as an unfolding disaster.
Some countries erected port of entry quarantines. Others advised against non-essential travel to affected areas and some closed schools and businesses.
Pandemic A/H1N1 is significantly different than the pandemic that was predicted, says Doshi. Pandemic A/H1N1 virus is not a new subtype but the same subtype as seasonal H1N1 that has been circulating since 1977. Moreover, a substantial portion of the population may have immunity.
The high public attention, low scientific certainty and the emphasis on lab testing for the virus in the first few weeks itself of the outbreak made the perceived risk look gigantic, he says.
Since the emergence of H1N1, the WHO has even revised its definition of pandemic flu.
If the 2009 influenza pandemic turns severe, early and enhanced surveillance may prove to have bought critical time to prepare a vaccine that could reduce morbidity and mortality, says Doshi. But if this pandemic does not increase in severity, it may signal the need to reassess both the risk assessment and risk management strategies towards emerging infectious diseases.
He suggests that future responses to infectious diseases may benefit from a risk assessment that broadly conceives of four types of threat based on the disease's distribution and clinical severity.
For example, the 1918 pandemic was a type 1 epidemic (severe disease affecting many people), while SARS was a type 2 epidemic (infecting few, mostly severe disease), and the H1N1 pandemic may prove to be type 3 (affecting many, mostly mild).
"Public health responses not calibrated to the threat may be perceived as alarmist, eroding the public trust and resulting in the public ignoring important warnings when serious epidemics do occur," he warns.
In the Indian context, what the public health agencies can surely learn from this outbreak is that investment in scientific and technical expertise shouldn't be a knee-jerk response but a sustained effort, with long-term planning at building capacity and data.
Hopefully the wisdom of some of the govt's responses will be debated in near future and the officials will realise that successful public health strategies are as dependent on technical expertise as on media relations and communications.