Swine flu, it seems, is back. Yesterday a mostly compliant media dutifully reported the latest efforts by the Commonwealth’s Chief Medical Officer Professor Jim Bishop to scare Australians into getting a swine flu vaccination to ward off a threatening “second wave” of the influenza strain. A host of medical authorities fell into line to tell the media the second wave could be far more deadly than the first.
Only Sydney’s Sunday Telegraph, to its credit (and, as we will see below, not before time) showed some scepticism, although the journalists failed to note that mass vaccination critic Professor Nikolai Petrovsky isn’t just any old “medical researcher” but research director for Vaxine, which has criticised the Government for not buying its vaccine rather than CSL’s.
In total, the Government has handed $120 million to CSL for more than 20 million doses of H1N1 vaccine. Two-thirds of the vaccines are sitting in warehouses going off, despite GPs virtually throwing them at patients presenting for anything from a cough to a sprained ankle. The latest efforts to convince Australians of the mortal threat posed by swine flu bear a very close resemblance to an effort to spare the Government embarrassment.
It’s not politicians who should be embarrassed, though it’s their health bureaucrats and advisers and the elements within the health industry who encouraged them. Let’s revisit their original warnings about swine flu. In July, Nicola Roxon, on the advice of her department, said that the worse case scenario was 6000 deaths from swine flu (a figure that has since vanished from the Health Department’s “Health Emergency” page). She made the comment in response to hysterical reporting, for example from the Telegraph’s Joe Hildebrand, that the death toll could reach 10,000 “in NSW alone” (the “in NSW alone” bit is the killer, ain’t it?)
The context for the 6000 figure is that more than 3000 Australians die each year from influenza.
As of the most recent update, 191 Australians have died from swine flu. ANU’s Professor Peter Collignon, a consistent proponent of taking a more realistic look at swine flu and mass vaccination, has said that the 2009 flu season was about on par with, or slightly less severe than, other years in the last decade or so, although certain groups such as pregnant women were over-represented (eight pregnant women have died of swine flu in Australia).
The Department of Health’s estimate — eminently conservative as it was compared to the garbage coming from the tabloids — was about as useful as those thermal imaging machines the department sent to airports to detect swine flu cases. Too bad the bulk of swine flu victims don’t develop a fever and would pass unnoticed through a thermal scanner.
Professor Bishop and the Department of Health have offered no acknowledgement that their estimates of the impact of swine flu were so badly wrong. Instead, we continue to get horror scenarios and meaningless factoids (“37,584 confirmed cases of H1N1”). In a recent interview with Croakey’s Melissa Sweet, Bishop insisted there had been no overreaction. In fact, Bishop went further and suggested they had always known swine flu wouldn’t be severe: “people at the start of this were genuinely unclear about what the virus looked like. We were very fortunate that we had about seven weeks at the start where we watched what was happening overseas before there were any cases here. That allowed us to understand it wasn’t causing a high death rate in a modern society.”
That didn’t stop predictions of thousands of deaths, curiously.
Putting aside Bishop’s claim that the Government always knew swine flu would be mild, the severity — or lack thereof — of swine flu was known well before a vaccine was developed and tested and the Government embarked on a mass vaccination campaign, which started at the end of September. Indeed, Collignon had identified in Crikey in May why swine flu wouldn’t be severe and followed that up on 20 August showing that the strain had clearly been far less severe than expected and indeed little different to normal flu seasons.
The public have shown almost a complete lack of interest in immunisation September, which Bishop puts down to “people have felt it is over and it’s last year’s problem”. It wouldn’t have anything to do with the Government and the media being so demonstrably wrong about swine flu, presumably.
The big winner from the mass vaccination campaign, regardless of whether anyone gets vaccinated or not, is CSL, which a long time ago was publicly owned but flogged off by the Keating Government. CSL has a contract with the Commonwealth Government to produce flu vaccines, having won the contract after a tender process in 2004. Another vaccine, Gardasil, helped turn CSL into one of the world’s leading biotherapy companies.
The contract is not CSL’s only link with the Government. On the CSL board is former Big Carbon player John Akehurst, who is a Reserve Bank board member. Chair Elizabeth Alexander was until last year a member of the Takeovers Panel. The CEO is Brian McNamee, who chaired Kim Carr’s review of the pharmaceutical industry in 2008. Chief Scientific Officer Andrew Cuthbertson was appointed to the National Health and Medical Research Council last year.
In October, the NHMRC endorsed the Government’s flu vaccination strategy. Cuthbertson declared a conflict of interest and didn’t participate in the discussion.
Later in that meeting, Cuthbertson commented “on the need to engage with the community and especially about increasing public understanding of the risks and benefits of the use of effective medical interventions, for example, vaccination.”
Risks and benefits are indeed an issue with swine flu vaccine. CSL has been indemnified for adverse reactions to the vaccine, despite, as Collignon has noted, a well-established history of (very rare) serious side effects. The benefits in terms of reduced mortality or actual impact (e.g. working days lost) have not been clearly demonstrated. Given the mildness of swine flu, the case for mass swine flu immunisation — as opposed to the case for high-risk group immunization, which is very strong — remains unmade by Bishop.
Sweet asked Bishop about the issue of conflict of interest, less at high corporate level than at expert consultant level. Bishop replied “we have a number of expert groups all required to declare their conflicts of interests, such as advising a drug company. The Federal Government has a lot of conflict of interest arrangements.”
Conflict of interest is a clear and easily-remedied problem, at least for objective observers. Crikey is not suggesting anyone involved in the Government’s response to swine flu did not address conflict of interest issues, if and where they arose, appropriately.
Rather, the problem is one of groupthink across an entire sector, encompassing industry, regulators, advisers and academics: groupthink occasioned by disproportionate capacity to influence government decisions and to gain access to taxpayer funding. Nicola Roxon could never have rejected the advice of Bishop and the departmental advisers on mass immunisation, for fear of the political fallout merely from being seen to place Australians’ health at risk. In no other portfolio except possibly Defence, and even there nowhere close to the degree that it applies in Health, are stakeholders so powerful and the capacity for genuine political oversight so limited.
The health industry – or more correctly the health complex, made up of industry, academics and health bureaucrats, and facilitated by a compliant media – never met a problem that couldn’t be solved with tens and hundreds of millions of dollars of extra funding, and rare are the politicians who can say no. That’s why there’s such a learned helplessness at the political level toward increased health costs associated with an ageing population. Moreover, health programs can be extended almost infinitely into new areas of activity that requires funding. Talk of an “obesi-genic society” allows education, transport, urban planning, housing and broadcasting to be brought within the health remit for regulation and new spending, and opens up exciting prospects for expensive social engineering on a vast scale.
Those who point out the alarmist and false estimates of the impact of swine flu are scolded for missing the point about what might have been; such measures were necessary from a risk management point of view (see, for example, this response to Guardian and Telegraph commentary in the UK).
To which the appropriate answer: risk management for whom? The allocation of every dollar in health is an exercise in risk management, a process of identifying where it can be spent most effectively in terms of a range of outcomes, but most particularly illness minimised, quality of life maintained, deaths prevented. There is as yet no evidence $120m hasn’t been wasted on a stockpile of useless vaccine and better returns for CSL when a much smaller, targeted rollout of vaccines to high-risk groups would have sufficed.
What would $120m have achieved for health areas of greater priority but without extensive and well-organised support from Big Pharma, the health industry and academics – areas like rural and regional health services, or indigenous health? Australians in those communities are living out the “what might have been” scenario every day of the week.