Destroyed Surpluses and Million Dollar Losses: The Flu A Vaccine Fiasco Reverberates in 2021

It was July 2009 and the world was amidst the AH1N1 pandemic, also known at first as swine flu, then the Government of Spain decided to buy 13 million vaccines to immunize around 30-40% of its population.

Almost half left, about 6 million expired doses to destroy for an amount of 42 million euros.

This is how the Spanish historians María and Laura Lara explain the fiasco of the vaccination campaign of the last great pandemic before the coronavirus in their book “The Yellow Horses: Diseases No One Saw Coming”.

Spain was not the only country that was forced to destroy the vaccines acquired due to the lack of adherence to the vaccination campaign. France got rid of the last H1N1 vaccines in November of the following year: 19 million of doses, with a total purchase and destruction cost of approximately 400 million euros.

Forever France is cited as an example of the resounding failure of that vaccination campaign because it was the country that lost the most vaccines, according to Euronews researcher Daniel Jesús Catalán Matamoros from the Department of Journalism and Audiovisual Communication Carlos III University of Madrid. But the same phenomenon occurred in countries around the world.

United States eliminated 40 million expired doses, a loss valued at about 260 million dollars (about 211 million euros). The UK stayed with ua reserve of 39 million doses after vaccinating only about five million people. Italy distributed 10 million doses purchased for 184 million euros, but injected only 865,000.

Europe was one of the regions that used fewer vaccines of those initially acquired, according to a WHO report, 57%.

In a European Union report to evaluate the vaccination campaign it was revealed that skepticism and lack of interest from the population they were among the first reasons for failure. Also the moderate nature of the disease, which did not encourage vaccination.

More than a decade later, the world has begun an ambitious and unprecedented vaccination campaign to end a pandemic of a virus more communicable and dangerous than influenza A, which has disrupted the lives of more than half the planet in ways hard to imagine in 2009 outside of science fiction stories.

Spain has authorized the purchase of at least 73.6 million doses of COVID-19 vaccines. France, one of the countries most skeptical of the vaccine against the new virus, 200 million. Both Governments face criticized for its slowness, that dot even the Executive of Germany, the country that has vaccinated the most people so far in the European Union.

Is the shadow of the failed vaccination campaign of the previous pandemic looming over the current one? Do the most cautious governments fear a repeat of failure? Will the surpluses end up being destroyed, at multimillion-dollar costs?

What was influenza A?

H1N1 was a subtype of the flu family, like the so-called Spanish flu that caused the 1918 pandemic, explain the historians Laura and María Lara. “The World Health Organization (WHO) declared influenza A as a pandemic in June of that same year, lasting a total of 14 months, until September 18, 2010, when it was terminated ”.

Historians recall that the origin of the H1N1 infection was a variant of the H1N1 strain with genetic material from one human strain, two pigs and one avian. “The point is that a mutation allowed heterocontagion or jump between species, from pigs to humans and then between humans,” they add.

During the 14 months that the pandemic lasted 14% of the population was infected and 500,000 people died, “In the most dramatic of accounts,” say María and Laura Lara. To put it in perspective, about 10 months after the WHO declared the coronavirus pandemic, the number of deaths from the new virus is already close to 2 million. The number of confirmed infections (86 million) does not reach 1.5% of the world population, but according to WHO estimates 10% of the world’s population may have contracted the disease.

The pandemic that was not

As has happened with COVID-19, shortly after the important spread of the virus was known, research began on the vaccine for influenza A. If in 2020, the American pharmaceutical company Pfizer has marked the milestone, in 2009 it was the Swiss pharmaceutical group Novartis.

“On June 12, 2009, the Swiss pharmaceutical group Novartis found the vaccine, which led the antiviral solution in the crisis situation caused by influenza A together with the British pharmaceutical company GlaxoSmithKline (GSK)”, explain the historians Lara.

Clinical trials began in July, and testing in humans began in August. “Since the virus strain was known in April and the vaccine was found to work, it quickly began to be mass-produced in order to fight the virus.”

Lara historians conclude that “the pandemic had a low mortality, in contrast to its wide distribution.”

Many people thought that influenza A was not really a problem, and that therefore, it was not necessary to be vaccinated ”, says Adolfo García Sastre, professor of Microbiology at the Icahn School of Medicine at the Monte Sinaí Hospital.

“Influenza A was actually a problem, and if more people had been vaccinated, more lives would have been saved ”.

The echoes of the failure of 2009

France is a clear example of how what happened in 2009 still resonates a decade later. All analysts agree that the “trauma” of swine flu has been very present in the caution with which they have planned vaccinations.

The French government has been caught up in its own strategy that was intended to “build trust,” says a Franceinfo article.

Paris did not want to open “vaccination centers” to carry out large-scale punctures for fear of seeing them empty. Instead, the Government wanted to involve family doctors – their absence was another of the most repeated criticisms in 2009 – and to “give security” to patients, a complex protocol has been established with a first medical visit and four days of reflection to retract.

The result is that on January 5, the country of 60 million people had only reported 512 vaccinations. In the face of growing criticism for the poor progress of the campaign, Paris is trying to reverse this intricate strategy.

The Catalan Matamoros researcher points to three factors in the fiasco of the influenza A vaccination campaign in 2009: the communication of adverse effects, poor coordination and misinformation that even caused many health workers to decide not to get vaccinated and did not recommend it to your patients.

“Therefore, in the end there were millions of doses left over all over the world”, sentence.

Among the side effects that made the most headlines at the time, one of them was the narcolepsy.

“I vividly remember that we were all lined up in the hallway and they told us we had to. It was not a choice“This is how a British nurse explained to Buzzfeed her traumatic experience receiving the H1N1 vaccine in 2009. Since then she says she has suffered from this chronic central nervous system disorder characterized by extreme fatigue during the day and sudden attacks of sleep.

The Centers for Disease Control and Prevention (CDC) say it was found an increased risk of narcolepsy after vaccination with Pandemrix, a monovalent vaccine against 2009 H1N1 flu, which was used in several European countries during the pandemic.

A team of scientists, in which the CDC participated, analyzed the safety data of the H1N1 vaccines (arenaprix-AS03, Focetria-MF59, and Pandemrix-AS03) in 10 global case studies in 2018 and concluded that did not detect any association between vaccines and narcolepsy. However, the European Medicines Agency decided to withdraw the authorization of the Pandemrix vaccine, which, in any case, “did not have enough demand”. the report concluded.

In any case, over-mediating the adverse effects of the vaccine can be counterproductive when it comes to achieving the herd immunity needed to end the coronavirus pandemic, which is estimated between 70% and 80%, indicates researcher Daniel Jesús Catalán Matamoros.

“The media is already beginning to publish the ‘few’ adverse effects that the COVID-19 vaccine is having. This type of media coverage produces increased fear and fear on the part of the public”, Emphasizes the researcher, author of several studies on the influence of the media on public health. “The media are very important when it comes to increasing vaccination rates.”

Get vaccinated or “new normal” forever?

“With COVID-19, the problem is much greater than the problem that caused influenza A”, Professor García Sastre hopes that this fact will encourage a higher percentage of the world population to be vaccinated. “There is a higher incidence of severe illness with COVID-19 than there was with influenza A.”

However, he notes that there are two groups that will remain reticent: the anti-vaccines – “This group is small and impossible to convince, since they do not follow any pro-vaccine reasoning” – and those outside the risk group and “that as with vaccination with influenza A, think that it is not necessary for them to get vaccinated.”

This second group can still be made to change their opinion, predicts García Sastre, and agrees with the researcher Catalán Matamoros on the importance of the media for this:

“The message that must be transmitted is that vaccines are safe and that the more people get vaccinated, not only will fewer people have severe disease, but before we can return to a normal life, from which we all benefit ”.