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André Picard's Second Opinion

Flu-shot impatience: Let's try a dose of reality Add to ...

Could we please stop all the bleating and whining about the waits for the H1N1 flu vaccine?

Honestly, how long do people think it takes to develop, test, manufacture and package 50.4 million doses of vaccine?

How long do people think it takes to distribute those doses across a country as massive as Canada?

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And how long do they think it takes to administer vaccine to the 34 million people who could potentially get it?

Wading through the letters to the editor, the posts, the political rhetoric and the often self-serving recommendations from interest groups on how to resolve the "crisis" in H1N1 immunization, one cannot but despair at the unrealistic expectations placed on public health, and on science.

Sorry, folks, but real life is not a CSI episode, where scientific Gordian knots are unloosed in one hour flat, with time to spare for romance and a half-dozen commercial breaks.

Swine flu (H1N1) first came to light in March of this year. The new virus was isolated and genetically decoded in record time.

Then, with very little firm information on how the pandemic might evolve, key decisions needed to be made: Was this a real threat? Should a vaccine be developed? If so, how much should we buy?

In the real world, it takes about six months to produce industrial quantities of vaccine. You harvest some seed stock and then you grow the virus in eggs. It takes time.

Canada decided early to err on the side of caution and invoke its pandemic preparedness plan. That includes ordering enough vaccine to immunize 75 per cent of the population with two doses each.

That was a $400-million decision and it was the right decision. To second-guess it now because the H1N1 is not as lethal as it might have been is disingenuous.

Fast forward to the fall. Production of the actual vaccine actually begins. There have been no delays. The vaccine started rolling off the production line at GlaxoSmithKline in Ste-Foy, Que., in October. It had to be tested and then held for a certain time to ensure there is no contamination.

Sensibly, the vaccine went first to the farthest reaches of the country and last to areas closest to the plant. Naturally, all 50.4 million doses were not available at once. Rather, there will be an average of three million doses a week through December.

Then came the hard part: Getting the vaccine into people - the right people. Because stock is limited, there was a need to set priorities. The process for this is laid out in the Canadian Pandemic Influenza Plan whose goals are 1) to minimize serious illness and deaths and 2) to minimize social disruption.

Admittedly, there have been some glitches. But, examined dispassionately, the mass immunization has hardly been a disaster. In fact, at least three million people have already received the vaccine and we're still in the early days of the rollout.

The main difficulty has been the impatience of the public. Underlying the stampede to flu shot clinics has been the illogical notion that everyone can be first in line.

Public-health officials have perhaps not been clear enough in their messaging. From the get-go, they have said there will be vaccine for everyone. They have perhaps not emphasized that this availability would be spread out over a period of 12 weeks, and there would be waits.

The greatest frustration has been the long lines. The question is: Were they avoidable?

In the ideal world, absolutely; everybody and their dog has offered up suggestions on how the immunization clinics could have been better run. Many of these suggestions imply that there is no other health care to deliver in this country but flu shots to healthy people.

In Canada, we have built ourselves a tremendous sickness care system. But, despite the lessons of SARS, we have a pretty clunky, under-funded public-health system. It can do the basics like routine immunization but has no ability to carry out massive short-term projects like a universal pandemic immunization program.

There is no surge capacity, no easy way of shifting resources so there can be well-staffed, around-the-clock flu vaccine clinics. The suggestion that priority patients get bracelets is a good one, but where is the information going to come from in a system without electronic health records? Sending the vaccine to family doctors is great in theory too; but are they going to drop everything to give shots?

There is no ability - meaning time and money - in our current system to plan ahead. If the clinics look like they are being run by the seat of the pants it's because they are.

The Public Health Agency of Canada and provincial health agencies have little or no power, and a laughable amount of resources. Clinic locations and staff were begged and borrowed. Nurses are doing yeoman's work but they can't vaccinate a million people a day.

We have a wonderful pandemic plan but good intentions are not enough.

Today, we are reaping the harvest of decades of under-funding of public health.

As the Scottish poet Robert Burns wrote:

In proving foresight may be vain:

The best laid schemes of mice and men

Go often askew,

And leave us nothing but grief and pain,

For promised joy!

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