U.S. public health officials haven’t given up on the influenza H1N1 pandemic, but it seems like the American public has.
The irony is that just as the H1N1 vaccine became widely available in December, rates of pandemic flu infection dropped to vanishingly low levels and concurrently concern about H1N1 largely dropped off the national radar.
The recent downturn in H1N1 infections helped further blunt any fear. Slow-to-build vaccine supplies undercut the vaccination push. The bottleneck made widespread vaccination impossible during the hyped-up early days of the pandemic’s current wave. The result: the momentum to get much of the American public vaccinated fizzled out. The only thing that could reinvigorate the vaccination campaign now would be a third wave of infection later this winter or in the spring – certainly a possibility, but hardly a given.
The U.S. H1N1 vaccine supply stream remained at a disappointingly moderate level in December. During the 5 weeks from late November through the last day of 2009, an additional 48 million doses shipped, bringing the total since the vaccine began appearing in early October to a hair under 100 million doses through the end of last year, half the total ordered and paid for by the Department of Health and Human Services.
What this meant was that until mid-December, access to the vaccine was officially limited to high risk groups. According to a report last Friday in the New York Times by Douglas G. McNeil Jr., 60 million Americans had received the H1N1 vaccine through the end of 2009. Just when vaccine availability began to open up, the pandemic wave ebbed away. During the week ending Dec 26, the Centers for Disease Control and Prevention reported that its surveillance labs identified 83 isolates as H1N1 (with another 76 isolates influenza type A, with subtyping not done). That compared with more than 9,500 H1N1 isolates identified (with another 2,100 type A isolates not subtyped) during the current wave’s peak, the week of Oct. 18-24. Four states were reporting widespread flu at the end of December, down from a peak of about 40 states in late October.
Here’s a personal story that typifies the missed opportunities and misinformation that have hampered the H1N1 public health campaign. I’m not a member of a high-risk group, and so waited till mid-December to call my physician’s office about getting the vaccine, only to hear that they would not carry the vaccine at all, not now or at any time in the future. I was amazed, as this practice routinely administers flu vaccine each fall. I asked why, and the practice’s nurse told me: Their patients are almost entirely middle-aged or elderly, and hence faced little or no risk from H1N1. That was their conclusion, despite the fact that so far this flu season essentially the only virus in U.S. circulation has been H1N1, and despite the fact that infection by H1N1 is still a nasty experience even for older adults. During the current U.S. flu season starting last September, U.S. surveillance labs identified about 60,000 H1N1 isolates compared with fewer than 300 isolates of other flu A types or B type.
Unless the H1N1 pandemic resurges, the U.S. legacy will be a vaccine that wasn’t available for most people until the infection threat died down, and a triaging of initially-limited vaccine supplies to high-risk groups that got mistaken by even well-informed people to mean that high-risk people were the only ones at risk.
–Mitchel Zoler (on Twitter @mitchelzoler)