Experts Examine H1N1 Response and Lessons for the Future

Approximately one year since the first cases of pandemic H1N1 influenza were confirmed in April 2009, experts gathered at Europe’s largest conference on infectious diseases – the European Congress on Clinical Microbiology and Infectious Diseases (ECCMID) – and also look back at the public health response and identify both lessons learned and future recommendations.

Speaking at the Congress, professor Javier Garau, president of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), organizers of ECCMID, stressed, “Predicting the exact nature and development of influenza viruses remain challenging as they are notoriously variable and you have to expect the unexpected with such pandemics.”

Worldwide at least 16,813 people are confirmed as having died from H1N1, although the true toll is probably many times higher and will take at least a year after the pandemic ends to establish. “In the main Europe has been fortunate so far, greatly helped by the quickness of reporting, the public health response, social distancing precautions, and vaccine production and roll out campaign,”  Garau added.

With cases now being reported in Southeast Asia and West Africa, the World Health Organization is stepping up its response to pandemic flu in the developing world with the distribution of millions of doses of the vaccine to countries in Africa, Eastern Europe, Asia and the Caribbean.

The response by the global health community has been attacked by some as creating a “false pandemic.” However, experts at ECCMID say there is never room for complacency when dealing with pandemic influenza. “It would have been irresponsible not to prepare as we did. Such pandemics don’t follow set patterns and each is different. What is crucial is to reflect on the response and adapt our future planning as appropriate,” said Garau.

A year ago at ECCMID a late breaking session on H1N1 was organized jointly by ESCMID and The Lancet. Speaking at ECCMID this year, the editor of The Lancet Infectious Diseases, John McConnell, said, “Although critics can point to an excessive response to the pandemic, the global health community needs to prepare for the worse with flu and if we don’t, we haven’t learned the lessons of history.”

Once the H1N1 vaccine was ready there were large variations within Europe in the proportion of populations who were offered and accepted -- ranging anywhere from over 60 percent to zero (Poland did not even offer the H1N1 vaccine). Professor Giuseppe Cornaglia, ESCMID past-president, explained, “A combination of factors appears to have affected people’s willingness to accept the jab. The usually mild nature of the illness may have discouraged many people and, for example, when health workers were being offered the vaccination, media reports were playing down the pandemic and people's perception of the virus were changing.” This may account for the lack of uptake with parts of the UK, for example, seeing vaccine rates for frontline health workers as low as 23 percent.

“People should consider the potentially serious consequences of declining flu vaccination, and physicians must make clear the vital protection role and safety of the vaccines, as well as ensuring that frontline health workers comply with recommendations themselves,” urged McConnell.

A key challenge and continuing worry for public health professionals has been the increasingly vocal anti-vaccination lobby in both Europe and the U.S., which also plays a role in people’s decisions to have the H1N1 jab. ESCMID continues to emphasize the central role vaccines have in protecting people against pandemic flu. “The risk-benefit balance is clearly in favor of the vaccine and no one can afford to be complacent or skeptical about its benefits,” said Cornaglia.

Speaking about future plans for response to the influenza season in autumn 2010/winter 2011, Garau explained, “It will be necessary to prepare for more than one scenario, and vigilance will be required.” Seasonal flu following the outbreak of a pandemic is usually worse than the years before because it has essentially become “invigorated” with new genetic material. It has now been agreed that the seasonal flu vaccine for 2010/2011 will contain the pandemic H1N1 strain and recommendations about risk and target groups in Europe are being reassessed.

“Other recommendations for the immediate future must include ongoing surveillance, in particular looking for changes in the H1N1 virus, studies on specific age group immunity, monitoring of the situation in Southern Hemisphere during its 2010 winter season (June through September) and countering anti-vaccine messages and campaigns,” Cornaglia added.