Letters A/H1N1 flu pandemic

History and economics lessons in asymmetrical flu threats

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3618 (Published 07 September 2009) Cite this as: BMJ 2009;339:b3618
  1. Niyi Awofeso, professor1
  1. 1School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
  1. niyi.awofeso{at}uwa.edu.au

    The process of combining predictive tools in epidemiology and biostatistics with those from history and economics to develop a sustainable framework for addressing the ongoing swine flu pandemic is a global multidisciplinary challenge. During the 1976 swine flu outbreak, a precipitate decision to produce and initiate mass vaccination led to more vaccine-related morbidity and mortality than swine flu infections, adversely affecting public health’s credibility. The current outbreak is so far mild compared with seasonal flu in the southern hemisphere. Therefore, whether vaccination should be the global first line of defence, as recently suggested by the World Health Organization, or whether current chemotherapeutic approaches are safer and more cost effective should be reconsidered.1 2

    The contingency plans of the current swine flu pandemic seem to parallel the international sanitary conferences for cholera control in the mid-19th century. Then, most of the planning focused on protecting wealthy European nations from cholera, while nations in cholera’s epicentre, particularly those adjacent to the Bay of Bengal, were under-represented.3 Now, Australia’s investment of over $480m (£294m; €336) in pandemic flu preparedness over the past three years exceeds the national flu control budgets of Mexico and all African countries.4 The United States spent $135m in procuring 48 million vaccine doses for swine flu in 1976. The current cost of antiviral chemotherapy for swine flu is at least $50 for each five day course. Healthcare workers are expected to take prophylactic antiviral drugs for up to six weeks while caring for patients with swine flu.5

    Any plans yet for how these laudable initiatives will be funded in poor countries?


    Cite this as: BMJ 2009;339:b3618


    • Competing interests: None declared.


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