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Flu troubles a symptom of what ails U.S.

How refreshing to hear the word "vaccine" uttered, again and again, in an election campaign. U.S. President George W. Bush and Senator John Kerry have been sparring in recent days about the flu-vaccine shortage that has sent a wave of panic across the United States.

Unfortunately, the shots the two presidential contenders exchanged have had little to do with the sorry state of the U.S. public-health system, and plenty to do with jingoistic, partisan politics.

What political leaders south of the border should be asking themselves is how the country that spends $1.7-trillion annually on health care --$5,805 (U.S.) per capita -- cannot deliver on something so basic and simple as an annual flu vaccine.

The simple answer is that bacterial contamination at a plant in Liverpool, owned by the American company Chiron, led to a shortfall.

But the fact that a bad batch of vaccine -- which is not an unusual occurrence in the vaccine-making world -- could bring a major public-health program to a virtual standstill points to a fundamental structural problem.

One shudders to think what would happen during an influenza pandemic, when a new strain of influenza emerges to which humans have no immunity. In the United States, upward of 100 million people would be infected in a matter of weeks, and as many as 500,000 would die. The economic impact would be in excess of $200-billion -- more than the U.S. has spent on the Iraq war, a conflict that has also killed 1,000 soldiers.

While such a pandemic is inevitable and perhaps imminent, judging from the troubling evolution of avian flu in parts of Asia, preparation has been minimal.

Of course, an elaborate pandemic-preparedness plan exists. But the infrastructure and reflexes required to deal with a pandemic are not there. As the country next door, that should worry us.

The U.S. has only two suppliers of flu vaccine, and a single flu-vaccine manufacturing plant exists in the entire United States -- the Aventis Pasteur plant in Swiftwater, Pa. Canada, with one-tenth of the population, has just as many suppliers and our principal flu-vaccine manufacturer, ID Biomedical Corp., is expanding to satisfy U.S. demand.

It is quite pathetic to see the daily scenes of Americans lining up and paying exorbitant prices for flu vaccine. Truth is, the U.S. has among the worst vaccination rates in the industrialized world. While good numbers are hard to come by, likely fewer than one in five Americans gets the flu vaccine.

In Canada, about one-third of citizens now get a flu vaccine and the rate is much higher in high-risk populations; in Ontario, where the flu vaccine is free for everyone, the rate is close to 50 per cent, one of the highest in the world.

The sad reality is that U.S. politicians and policy-makers, Republican and Democrat alike, lack a firm commitment to effective public-health measures like vaccination. That, not bacterial contamination of a single batch of flu vaccine, is at the root of the current crisis.

Right now, in the U.S., there is no incentive for manufacturers to produce vaccine. It's not profitable to do so. A dose of flu vaccine, which goes for less than $3 (U.S.) when purchased in large quantities, generates much less profit than a single Viagra pill.

Vaccines are also much riskier and more difficult to make, and generate a lot more lawsuits than other drugs.

During the presidential campaign, there has also been talk of legislation to protect pharmaceutical manufacturers from frivolous lawsuits -- and no one needs this protection more than vaccine makers.

But that is not the only solution. A number of countries, like Canada, buy vaccines in large quantities, making production worthwhile for companies; others have buy-back plans, guaranteeing the purchase of leftover stocks at year's end so companies won't make too little. (The makeup of the vaccine changes annually, so it can't be stockpiled.)

Some countries, as well as the province of Quebec and some U.S. states, have also created no-fault insurance plans to compensate the vaccine-damaged. These programs are necessary because, while the benefits of vaccines, particularly childhood vaccines, are undeniable, a few recipients suffer serious side effects -- although it should be noted that flu vaccine is among the safest.

Many U.S. public-health officials look upon Canada with envy. In this country, there is a clear recommendation that everyone over the age of six months should receive the flu vaccine annually. Getting the vaccine is easy, and cheap. And, in the case of a pandemic, there is a guaranteed supply of 32 million doses of vaccine, one for every single resident.

The U.S. could have a similar program for around $1-billion (U.S.) a year -- a fraction of the $150-billion it has spent on the Iraq campaign.

Terror comes in many forms. Influenza, seemingly mundane, is a terrifying disease. It kills upward of 40,000 people in North America in an "ordinary" year. During a pandemic, it would easily kill 15 times that number.

It is a public-health issue that should concern everyone, from presidential aspirants on down.

apicard@globeandmail.ca

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