Skepticism on Swine Flu’s Danger Limits European Vaccine Demand

From Bloomberg

By Andrea Gerlin

Dec. 8 (Bloomberg) — Fewer Europeans are getting pandemic flu vaccine than typically get seasonal flu shots, as safety concerns and lower-than-expected death rates have damped demand.

The U.K., Ireland, Italy, Germany and France have vaccinated less than 10 percent of their populations, compared with 20 percent in Europe in a typical flu season. As a result, a fraction of the European Union’s 500 million people will be protected against the pandemic virus by early next year.

Public concerns that the vaccines made by GlaxoSmithKline Plc, Novartis AG and Baxter International Inc. may cause serious side effects have kept some Europeans on the sidelines since governments began vaccinating residents for free in October. That means Europe may donate more doses to poorer countries or experience a surge in hospital admissions if the virus mutates.

“If it’s not in the news anymore and if people don’t experience a lot of severe cases, to them it’s just a flu and not a pandemic flu in a way,” said Christian Ruef, professor of infectious disease and director of infection control at University Hospital Zurich. “The term pandemic to them is probably associated with more serious disease.”

The number of deaths is lower than what was predicted in worst-case scenarios after the virus first struck, Ruef said. Perceptions that the virus is mild may be hampering vaccination, he said.

The European Society of Clinical Microbiology and Infectious Diseases said on Nov. 23 that it was concerned about “mixed levels of uptake” and opposition from anti-vaccine activists challenging the safety of and need for the shot. The vaccines made by London-based Glaxo, Basel, Switzerland-based Novartis and Deerfield, Illinois-based Baxter were approved for use by the European Medicines Agency.

Unpredictable Virus

“No one should reject a safe and effective vaccine when we are dealing with an unpredictable virus capable of killing children and young adults in their prime,” said Javier Garau, president of the Basel-based European Society of Clinical Microbiology and Infectious Diseases.

More than 8,768 people worldwide have died from swine flu since it was first identified in Mexico and the U.S. in April, the Geneva-based World Health Organization said on Dec. 4. More than 850 deaths have been reported in Europe since April, according to the Stockholm-based European Centre for Disease Prevention and Control. As many as 500,000 people globally die of seasonal flu each year, according to the WHO.

Officials expect the virus to be prevalent again in 2010. The WHO in September decided to include swine flu in the vaccine for seasonal influenza in the next Southern Hemisphere flu season, meaning the agency believes it’s the most likely H1N1 strain to be circulating.

Polish Negotiations

Poland hasn’t used any vaccine so far, the country’s health ministry said.

We’ve been negotiating with producers for at least a month now because we want them to guarantee the vaccine’s safe and take responsibility for any unwanted side effects, and that’s something they don’t want to do,” said Piotr Olechno, a Polish Health Ministry spokesman. The government is in talks with five companies, Olechno said. He declined to name them.

The U.K. has shipped 10 million doses of swine flu vaccine to family doctors, who have inoculated about 1.6 million of the 9.3 million people in risk groups, England’s Chief Medical Officer Liam Donaldson said Dec. 3. That’s less than 2 percent of the country’s entire population of about 60 million.

Washing Hands

To reduce the risk of catching swine flu, Emma Murphy is washing her and her toddler’s hands more often, avoiding people with colds and stocking up on honey and lemon. She and her 17- month-old son won’t get immunized.

They put the vaccine out so quickly that I wouldn’t feel secure in giving it to him,” said Murphy, 29, a human resources assistant and student in Manchester, England, in an interview. “We’re being scared into making the decision by people saying children are dying.”

Italy had immunized 494,915 people out of about 60 million who live there as of Nov. 22, according to a Dec. 2 Health Ministry press release. France, where two patients died from a mutated version of the H1N1 virus that causes swine flu, has given pandemic shots to about 1.3 million people since Oct. 20, Health Minister Roselyne Bachelot-Narquin said on Dec. 3. The French government has ordered 94 million doses of vaccine for the country’s 63 million people.

Hard Decision

Parisian Simone Cartier said she “agonized” over whether to have her daughters, ages 2 and 5, immunized against swine flu. She doesn’t know anyone who has had the illness. After reading about the vaccine, she became concerned that it was produced too quickly and contains an adjuvant, an ingredient that boosts the immune system’s response. She then spoke to her doctor and changed her mind. Two weeks ago, she waited three hours in a school gym to get Glaxo’s Pandemrix shot for herself and her daughters.

“The night before going I thought: Am I going to inject my children with this poison or in 20 years am I going to be in front of a judge with kids who are sick?” said Cartier, 35, who works in book production. “Five minutes before leaving, I wanted to turn around. I try not to think about it.”

In Ireland, more than 150,000 people in risk groups — pregnant women and people with underlying illnesses — had been vaccinated as of Nov. 25, Gerry Mulligan of the Health Service Executive said. The country has had lower-than-expected uptake among children under 5 since it began vaccinating them in mid- November, Mulligan said. Ireland started vaccinating schoolchildren on Nov. 30, he said.

In the German federal state of Thuringia, 150,000 of 2.3 million residents have been immunized since Nov. 9, according to Thuringia’s health department.

Bright Spot

Declining swine flu rates in some countries also may deter people from getting the vaccine. England reported the fourth consecutive weekly drop in new swine flu cases on Dec. 3. Visits to U.S. doctors for influenza-like illness fell to the lowest level in three months, the government said on Dec. 4.

One bright spot in Europe’s pandemic immunization effort is Scandinavia. A third of Sweden’s 9.2 million people are estimated to have gotten the swine flu shot as of Nov. 20, according to the Swedish Association of Local Authorities and Regions. About 3.3 million doses of vaccine had been delivered to Sweden as of Nov. 20 and demand has outpaced supply.

“Everybody in my family got the shot,” said Jenny Mattisson, 36, a mother of three who lives in a suburb of Stockholm and usually doesn’t get a seasonal flu shot. “Our daughter is in a risk group so we wanted to try to minimize the chance of her getting sick, but I would have taken it anyway. I think it’s a good idea to get the vaccine; it helps slow it from spreading.”

Norway, U.S. Demand

Norway, where mutations in the H1N1 virus have been detected among two patients who died of the flu and one who was severely ill, had vaccinated all 1.2 million people in its risk groups as of Nov. 24, almost 25 percent of its total population, said Bjoerne-Inge Larsen, director general of Norway’s Directorate of Health. Finland has immunized about 1 million people, or 19 percent of its population, the government said on Nov. 26.

In the U.S., demand for the vaccine has been strong, with quick uptake of doses as they become available and waiting times at many providers, said Joseph Quimby, a spokesman for the U.S. Centers for Disease Control and Prevention, in an interview on Dec. 4. Doctors had administered about 20 million shots by mid- November. Health officials plan to release updated estimates of inoculations in the next few weeks, Quimby said.

There were 73 million vaccine doses available for distribution by the end of last week and an additional 10 million doses arriving this week, CDC director Thomas Frieden said in a press conference Dec. 4. Some states are beginning to offer the shots to a wider audience, after initial supplies were focused on protecting pregnant women, children and adults with chronic health conditions.

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