ANALYSIS
Uncertainty over H1N1 warranted, experts say
October 9, 2009
Judy Gerstel
SPECIAL TO THE STAR
What I'm thankful for this weekend is the way health policy people in the provincial and federal government are handling the H1N1 pandemic. Surprised?
It's true that many have been critical of the seeming confusion regarding who gets which vaccines when – and whether the new flu is more dangerous than a regular flu or whether it's a scourge that will overwhelm hospitals, close schools and spread panic.
"There's a meme in the media that experts are confused and that the public is concerned," says risk communication expert Peter Sandman, speaking from his New Jersey office. "It's very important to make a distinction between confusion and uncertainty."
The flu, he says, "is very tricky."
Especially tricky is this pandemic flu, the first pandemic since 1968. "If you've seen one pandemic, you've seen one pandemic," says Sandman.
I'm thankful that decision-makers in this province and this country who are mandated to deal with the looming pandemic have been transparent and upfront about just how tricky it is. Instead of the platitudes and false, patronizing reassurances that they might have bestowed, we've been exposed to the uncertainties as they occur.
"It would be even better if officials flat out said this pandemic flu has them flummoxed," Sandman says. "But they're not papering over their pandemic uncertainties. The public mostly gets it that the experts have more questions than answers at this point – and that's good."
For example, will one dose or two separate doses of H1N1 vaccine be required? Will this be mostly a mild flu or a killer?
Other questions are whether seasonal flu vaccinations may be a contributing factor to cases of pandemic H1N1, as unpublished Canadian research has shown, and whether those vaccinations may result in less severe cases of pandemic H1N1 as other preliminary research has shown.
Most reassuring, impressive and even brave was how Ontario, led by Chief Medical Officer of Health Dr. Arlene King, altered the sequence of vaccinations in the province based on that research.
Ontario was the first province to postpone the seasonal flu vaccination until after the mass inoculations for H1N1, except for people over 65 and others who are high risk of seasonal flu but at low risk for H1N1. They'll be able to get their seasonal flu vaccinations this month. The rest, prioritized according to risk and exposure, will be offered pandemic H1N1 vaccinations in November.
It's actually rather amazing to see a traditionally cautious government agency, responsible for medical decisions, being able and willing to turn on a dime.
"The good thing is that the government considered the most recent research in their decision making, even if the changing situation has given a degree of confusion to the public," says Chingiz Amirov, director of infection prevention and control at Baycrest, where most residents are over 65.
He praises the Ontario government for taking "advantage of having this knowledge available from a local study and putting it to use right away."
That's also the opinion of Dr. Donald Low, chief of microbiology at the University Health Network and Mount Sinai Hospital.
"Decision-making bodies are having to take new information, digest it and try to respond to it," he says. "It's difficult for them and people react as if they don't know what they're doing but really, they're just trying to be responsive.
Sandman also has praise for the decision-makers' responsiveness .
"Some scientists and public health officials think new, tentative studies should be kept quiet," Sandman says. "It takes courage to let the public in on the messiness and uncertainty of cutting-edge research. And it takes courage to base real-world decisions partly on that research, knowing the research is controversial and could turn out wrong."
Low observes, "You do run into this double-edged sword in being too transparent."
Transparency, responsiveness, agility and acknowledgement of uncertainty don't deserve our swipes or criticism.
Read more on our swine flu page.
Judy Gerstel can be reached at: judygerstel@gmail.com
Toronto Star