‘H1N1: now entering the recrimination phase,’ a recent ‘Editor’s Choice’ in the British Medical Journal was headlined. The piece began: ‘If influenza was a rock band how would it rate its latest release, H1N1? Not too well, I suspect, despite the greatest prepublicity since – well, its previous release.’ A nice summary. People have died – but in far fewer numbers than even the most optimistic official estimates predicted. Absenteeism has not stopped the trains or planes or threatened food supplies. The second wave came, but the virus had not mutated. We have been lucky, so far. The virus has been no nastier than seasonal flu, and the usual target for lethal infections, the elderly, have been largely spared, probably because of immunity conferred by H1N1 infections suffered by them 60 and more years ago.
It is too soon to rank the impact of medical and social interventions, but my guess is that intensive care in hospitals will emerge as the most important life-saver. ICUs were invented around the time of the 1968 pandemic, and since then their ability to manage people with bad lungs and sinking blood pressures has improved almost miraculously. In 2009 many went into ICUs with H1N1. Most were discharged, and recovered.
But the absence of catastrophe in the face of the doom-laden predictions of the pandemic planners has stimulated the conspiracy theorists. The most prominent of these is Dr Wolfgang Wodarg, a former public health doctor in Schleswig-Holstein, SPD member of the Bundestag until he lost his seat last year, and outgoing chair of the Council of Europe Parliamentary Assembly Health Subcommittee. He says that we are suffering from a ‘fake’ pandemic, and that the World Health Organisation changed its definition in May 2009 to ‘transform a run-of-the-mill influenza into a worldwide pandemic – and made it possible for the pharmaceutical industry to transform this opportunity into cash’. He claims that millions of healthy people have been exposed ‘to the risk of an unknown amount of side-effects of insufficiently tested vaccines’.
Evidence is absent from Dr Wodarg’s polemic. The pandemic is not a ‘fake’. It may be benign, but the unequivocal evidence that an out-of-season virus was spreading in North America, Europe and Asia was the signal that obliged the WHO to declare it. And whether pandemic or seasonal, influenza is never ‘run-of the-mill’. More than a third of the 388 killed by H1N1 in the UK since last May had no significant risk factors. All the evidence accumulated since flu vaccines were developed in the 1940s says that they are safe, and that they work.
The expectation is that H1N1 will stay. Vaccines against it will still be needed. Still very influential for me is a post-mortem I attended in February 1976 on a previously healthy, 20-year-old Glasgow shop assistant who died after a 12-hour illness caused by the H3N2 virus that had become seasonal after causing the 1968 pandemic.