Dr. Kumanan Wilson, Canada Research Chair in Public Health Policy and an associate professor of medicine at the University of Ottawa.
Globe and Mail writer Caroline Alphonso hosted a live discussion on Friday, Sept. 11 at 11 a.m. ET with Dr. Kumanan Wilson, Canada Research Chair in Public Health Policy at the University of Ottawa and Ottawa Hospital Research Institute. What follows is a transcript.
10:58 Globe and Mail: Hi everyone -- Dr. Wilson will be here soon to take your questions. Feel free to post them and he will get to them as soon as he can.
11:00 Caroline Alphonso: Good morning everyone. I'm Caroline Alphonso, a reporter with The Globe and Mail, and I'm pleased to have Dr. Kumanan Wilson on-line with us today. Dr. Wilson is the Canada Research Chair in Public Health Policy at the University of Ottawa and the Ottawa Hospital Research Institute. Welcome Dr. Wilson.
11:01 Kumanan: Hi and thank you for inviting me.
11:01 Caroline Alphonso: To start off with, there's been some reluctance on the part of Canadians to get vaccinated. Why do you think that is so, and what should public health authorities do?
11:04 Kumanan: I think the publics attitude to getting the flu vaccine is somewhat of a moving target and I suspect will be largely influenced by their perception of how serious the outbreak is going to be. With the standard influenza vaccine one of the challenges in getting young healthy people to get the vaccine is that they don't feel its neccessary. With this virus, though, this population may be at particular risk.
I think public health officials need to communicate the need for the vaccine - bu thtey have to be careful to do so in a way that doesn't look like they are forcing it on people. They also need to communicate all of the mechanisms they are instituting to ensure that the vaccine is both safe and effective.
11:05 Caroline Alphonso: Thanks, Dr. Wilson. We had quite a few reader comments overnight. So why don't we start with a couple of those questions.
Here's one:
Hello, my 17-year-old daughter has a history of asthma and pneumonia. She takes an inhaled steroid daily to control her symptoms. She also has severe egg allergy, so she will be unable to receive any type of flu vaccine available in Canada. I understand from following the media that Novartis, the U.S. supplier, has a limited quantity of vaccine not incubated in eggs. Is any of this vaccine going to be available in Canada to egg-allergic individuals and, if not, what strategy should we follow to deal with the H1N1 virus? I am worried and feeling rather helpless.
11:07 Kumanan: My understanding is that at present all of Canada's vaccine is to be egg based. Canadian researchers are beginning to look it the question of whether our assumption that people with egg allergies should not receive the flu vaccine is correct. I am not sure whether the results of these studies will be available prior to the vaccine campaign. Unfortunately, there are segments of the population that will either not be able to receive the vaccine or will not develop sufficient immunity to the vaccine. This is why it is particularly important that we have a high rate of vaccine coverage so that these individuals can be protected by herd immunity (when enough of the population is effectively vaccinated, the transmission of the virus from person to person may be stopped).
11:09 Caroline Alphonso: Here's another question from a reader:
Thanks for taking questions. Have there been any clinical trials done on pregnant women? What outcomes, beyond efficacy, were measured? Have any been through a peer-reviewed process to assess their methods? And even if they have, can we possibly have any longterm, reliable data on the effects on a fetus of this vaccine? Given what I perceive as a paucity of testing, I may be more given to take my chance with Tamiflu.
11:09 Kumanan: The first clinical trial of the H1N1 vaccine in pregnant women has just been launched by the US National Institutes of Health. This trial will examine the effect of the vaccine on women in their 2nd and third trimester. It will examine safety data and the response of the women's immune systems to the vaccine. It will also examine whether the vaccine may provide some protection to the fetus. While this trial will use a different vaccine than Canada's we should have some results from this study prior to the release of the vaccine here. Canada has recently decided to purchase non-adjuvanted vaccines for pregnant women and the vaccine that is being used in this trial is also does not have an adjuvant. There is good data on the safety of non-adjuvanted standard flu vaccines in pregnant women. We do know that pregnant women are a priority population to receive the vaccine because they appear to be having a higher complication rate from this particular virus.
11:11 [Comment From Guest ]Those that are against the vaccine site overwhelmingly site their fear and anger at the 'Big Pharma'. How can health officials overcome this argument in order to achieve 'herd immunity'?
11:12 Globe and Mail: Just a note for all the participants who have posted questions: Caroline will be feeding them into the discussion from time to time, so don't be concerned if your question hasn't shown up yet
11:15 [Comment From Jean ]When is this vaccine available and how to get it?
11:15 Kumanan: I agree that in some segments of the populations this can be a challenge. I think its important to emphasize that we have excellent public health professionals and vaccinologists in Canada and are fortunate in this respect. These people need to communicate openly and transparently their committment to protecting Canadians from the virus and the how the vaccine program is going to be both adminsitered and monitored. I understand that we will soon be implementing an adverse event monitoring system for the vaccine - this should be communicated to the public. Standardized information on the vaccine needs to be provided and this information should be all on their website. Public health officials should also look at more innovative ways to communicate with the public including using social media sites.
11:16 Caroline Alphonso: Hello Jean. Thanks for your question. Dr. David Butler-Jones, Canada's chief public health officer, said the vaccine could be ready as early as October if the virus turns more severe. The latest it will be rolled out is mid-November. It's up to provinces to decide how they will deliver the vaccine, and that's being worked out at the moment.
11:17 [Comment From Guest ]Thanks Dr. Wilson,
11:17 Caroline Alphonso: Dr. Wilson, Here's a question posted by a reader:
I applaud the Globe for allowing this discussion. I am very concerned about the calls for mass vacinations of all school age children. Concidering the studies linking vacinations to an increased incidence of autism in children and the hosts of possible side effects linked to the ingrediants of the adjuvants, would not increased use of propholatic measures such as hand sanitizers be safer in reducing the spread of infections?
11:19 Kumanan: There have been numerous studies examining vaccines and autism and an association has not been supported. The US no-fault compensation court, with a low threshold for determining if a link exists also recently stated that no association exists. The US Institutes of Medicine also reviewed all of the evidence and said that there was no association.
School aged children need to be vaccinated for 2 reasons - first to protect themselves. In August the US CDC reported that 42 of the 556 H1N1 deaths were in children under 18. Second to protect others by preventing the ongoing spread of the virus. An interesting study in Japan found that when they immunized school children with the flu vaccine, influenza related death in the eldelry was reduced. When they stopped immunizing these children death increased again.
Prophylactic measures such as good hygiene should always be encouraged.
11:20 [Comment From Jenny ]Is it true that the longer a virus spreads, uncontrolled by vaccine, the more likely it is to mutate and be able to become resistant to vaccine?
11:21 Will you get the H1N1 vaccine?
Yes ( 41% )
No ( 29% )
I'm not sure ( 30% )
11:22 Kumanan: yes, typically a new virus can rapidly mutate. However, preliminary studies have shown that this virus is relatively stable in this respect. This is good news as we develop the vaccine.
11:22 Caroline Alphonso: Another question posted by a reader:
Dr. Wilson, I am impressed that a physician of your high calibre, during such a busy season, is able to make time to help educate the public. Thank you for your contribution.
Reading some of the previous comments it is clear that most people are indeed in need of more information, especially with all the misinformation about the dangers of vaccination being circulated in the media. Next we'll be hearing that SweetTarts cure the flu!
What advice can you give to health care professionals who still have doubts about vaccination, both for H1N1 and the "regular" strains?
11:26 Kumanan: Thank you for the question. Healthcare professionals are a key group to be vaccinated. First they will be in contact with H1N1 patients and are at increased risk of contracting the virus and should be protected as our responsibility to them. Second, studies with the seasonal influenza vaccine suggest that vaccinating healthcare workers can reduce influenza illness and death in their patients. I think we need to adress health care workers fears about any vaccine side effects respectfully. Again, the safety monitoring of the vaccine needs to be conveyed to them. Many are worried about the risk of Guillain-Barre syndrome. This risk with the standard flu vaccine is no more than 1 in a million individuals vaccinated.
11:27 [Comment From Guest RN ]Is the planned vaccine one or two doses? Will high-risk populations receive 2 doses?
11:29 Caroline Alphonso: Thanks for your question, Guest RN. Health officials are planning on two doses, but with an adjuvant being used in Canada's vaccine, one dose could be sufficient. Clincial trials will tell us more over the next few weeks. And there's evidence today, published in the New England Journal of Medicine, that one dose may be enough.
11:29 [Comment From Peter ]Is there truly a need for the adjuvant as some preliminary studies have shown none is needed?
11:32 Kumanan: There are a few reasons why an adjuvant is being considered or viewed as needed. The first is that it allows us to use less of the active part of the vaccine so we can make more vaccines available. This is important in Canada. Its very important if we want to help developing countries by providing them with vaccine. The second reason, is that there is evidence to suggest that the adjuvant can be helpful in maintaining an immune response if the virus were to change.
11:33 Caroline Alphonso: Dr. Wilson, here's another question from a reader. There's been quite a few posted on the fact that front-line workers are reluctant to get the vaccine, so maybe you can address that through this question: As a health professional, I am not taking the vaccine. There was not enough studies. what are the long term effects? Quo bono?
There is too much hyper. Are you getting it yourself and your family and friends. I would like to see it before I consider to get any of it. I asked my doctor if he was going to get it and he was silent. I said: Good answer.
11:39 Kumanan: It is my personal belief that it is the responsibility of health care workers to get immunized to protect their patients so I do get the vaccine. I do realize there is a lot of concern amongst health care workers and getting good immunization rates with the seasonal flu vaccine has been a challenge. I am not sure how much more we can do to encourage vaccination rates because education programs have not had enough of an effect. In addition to monitoring for adverse events, health care workers and all Canadians should be told who to contact if they beleive they have developed an adverse event. I think all Canadians should also be provided with financial compensation if they develop an adverse event. While these last 2 points, in my opinion make for a fair system, I am not sure how much impact they would have on encouraging health care workers to get vaccinated.
11:41 [Comment From worried mom ]the virus is here now with one private school in Vancouver sending boarding students home...once a child has had the virus or been exposed, does it still make sense to be vaccinated?
11:42 Caroline Alphonso: Worried mom: Canada has purchased enough vaccine for all who want and need it, and in my conversations with health authorities, they recommend getting the vaccine even if you have been exposed. You should also consult your doctor.
11:42 Kumanan: If you have definately had the virus and this has been laboratorily confirmed - you likely don't need the vaccine. But I think this would not apply to many cases.
11:43 [Comment From Sandra ]Why do most people have an issue with the flu shot in general. I arrange for flu sho at my place of employment and 60% refuse and thing that the flu shot is a bad thing to do to your body? Is there any reason for the flu shut to have such a reputation?
11:45 [Comment From Michael ]Health authorities recommend getting the vaccine after you have been exposed? I like Kumanan's response better. If that were true, then I would definately question the rationale.
11:46 Kumanan: Again, I think the primary issue is that most people - in particular, young, health people - don't believe the vaccine is neccessary. This creates suspicion as to why they are being told they need to get the vaccine. With this virus, though, young health people may be more effected.
11:48 [Comment From Peter ]Does the addition of an adjuvant present an increased risk of GBS?
11:51 Kumanan: The issue of GBS is an interesting one. The risk of GBS with the 1976 vaccine was about 1 in 120 000 vaccinated. Some studies showed no association with susbequent seasonal vaccines. An Ontario study showed a risk of about 1 in a million individuals vaccinated.
Nobody is quite sure why the risk exists. There is no evidence linking adjuvants to GBS. If GBS is related to the part of the virus included in the vaccine then by reducing this amount through an adjuvant this risk may be reduced even further. However, I am speculating here.
11:52 [Comment From worried mom ]I appreciate the answers regarding vaccination after exposure or having had the flu. As I understand tho', health officials are no longer testing to confirm cases as H1N1...so how exactly is one to know if you have had it or been exposed?
11:53 [Comment From RG ]I may not be in Canada during the flu shot season, but will be in the USA. How different are the 2 flu vaccines (CDN vs USA). Which one is better to receive? If I can't manage to get one in Canada, should I get it while I am in the USA?
11:53 Kumanan: I dont think you can really know for sure. In a Nova Scotia cohort 40% of affected individuals didnt even have a fever. So its therefore safer to get the vaccine.
11:54 Does the use of an adjuvant in the H1N1 vaccine scare you?
Yes ( 77% )
No ( 23% )
11:56 Kumanan: Helllo RG,
The primary difference if that the US vaccine does not have an adjuvant and the Canadian vaccine does. The two studies in the New England Journal of Medicine today seem to suggest both approches can be effective. If you can't get the vaccine in Canada you should consider getting it in the US.
11:58 Caroline Alphonso: Thanks Dr. Wilson for joining us today. We're almost out of time, so do you have any final thoughts on the H1N1 vaccine?
12:02 Kumanan: Yes and thanks everybody for your questions.
First, I would again like to say we are fortunate in this country to have excellent people in our public health system. If their committment to Canadians can be effectively conveyed, I think this would reassure many people.
Second, I think the comments by some who feel they may not be able to get the vaccine and are worried demonstrate how we are all in this together. That by getting vaccinated we are not only providing protection to ourselves but to others.
And finally, I do believe the relationship goes both ways - that if we expect people to get vaccinated we need to reassure them that we are doing everything possible to monitor the safety and effectiveness of the vaccine. I am hoping we here more from our public health officials in this regard as I understand these systems are being developed.
12:03 Caroline Alphonso: Very good points, Dr. Wilson. Thanks again for joining us.
On-line guests, we're sorry we couldn't get to all your questions today. I'm sure we'll be hosting another one of these soon. If you have any other H1N1 questions, we welcome them. They can be posted anytime at this link.