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Canada is facing the H1N1 pandemic in an atmosphere of confusion and doubt, as a result of an unpublished study that no one else in the world has found persuasive. Yet the Canadian authors of the study and the unnamed journal they have written it for are citing the usual academic protocols as a reason for keeping the study from the public. Momentous decisions are being made, but the public is being denied access to the basis for those decisions.

Public-health authorities in this country have not only read the study but responded to it, and the paper has not even been peer-reviewed yet. So it is safe to say the usual protocols are out the window, as they should be when the public's health may be at risk. The public should then be given access to the study, too.

The public is of critical importance in any vaccination plan, but is being treated as if it should accept on trust, or faith, whatever public-health officials in each province decide for them. That is a recipe for failure.

The study found that the seasonal flu vaccine may double the risk of catching H1N1. Most provinces have responded by altering their vaccination plans. They will not offer seasonal vaccine shots, or at least, not until January, when the first wave of swine flu is expected to have passed. New Brunswick, on the other hand, says it will give out seasonal flu shots as it always does.

The decision of the provinces is certainly quick and bold. Whether it is the right decision is open to question. The paper has been shared around the world. It has gone to the World Health Organization, the European Centre for Disease Prevention and Control, the U.S. Centers for Disease Control and Prevention in Atlanta, and British and Australian authorities. None of them has chosen to act on it. (Some scientists abroad have dubbed it "the Canada problem.") So who is right? At the moment it is impossible for Canadians to judge.

The authors, who include Danuta Skowronski of the British Columbia Centre for Disease Control and Gaston De Serres of Laval University, should explain without constraint the methods and findings. Dr. Skowronski insisted in an interview yesterday that peer review was needed before putting the paper before the public. "The broader public should be informed of results that have withstood scientific scrutiny," which she expects within four weeks. But why? There seems little chance of hysteria or alarm. The bigger danger is confusion and doubt, which may affect public willingness to show up for the H1N1 vaccine, about which some doubts are developing.

Maybe the "Canada problem" is not the seasonal flu making people more susceptible to H1N1. It's the attitude that major public-health debates should be held in-house, among public-health officials. This country has not had a national town-hall meeting on swine flu, as the United States did, bringing together governors, health and school officials and, notably, the President himself. The public has simply been told Canada has the problem well in hand. Leave public-health policy to the experts, show up on the appointed day and roll up your sleeves.

But what if, having been excluded from the discussion, the public says no?

 

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