Sunday, 14 March 2010

Pandemic Panic

Remember Swine Flu? Der Spiegel has a report on how and why a relatively mild flu virus mutated into a medical and media epidemic. It's long and detailed, but here are two vital paragraphs:

Researchers in more than 130 laboratories in 102 countries are constantly on the lookout for new flu pathogens. Entire careers and institutions, and a lot of money, depend on the outcomes of their work. "Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur," says flu expert Tom Jefferson, from an international health nonprofit called the Cochrane Collaboration. "And all it took was one of these influenza viruses to mutate to start the machine grinding."

Now turned up, the machinery was set into motion. Researchers got to work examining the molecular structure of the virus. The pharmaceutical industry started to develop vaccines. Government agencies laid out disaster plans. There was only one thing that everyone was ignoring: The new pathogen was, in fact, relatively harmless.

Spiegel contends that the World Health Organisation deserves a large measure of the blame for declaring a pandemic where none existed. They did so after a mere 141 deaths worldwide had been reported. "Efforts to downplay the risks were unwelcome, and the WHO made it clear that it preferred to base its decisions on a worst-case scenario." WHO was also working to a ridiculous definition of "pandemic" based solely on the number of cases and not on the seriousness of the infection.

What's shocking, though, is the closeness between some national and international health officials and major pharmaceutical companies who stand to gain from over-provision of drugs and vaccines during a "pandemic". It isn't simply a case of governments ordering medicines in response to a perceived risk: the contracts are set up in advance, and a WHO declaration triggers them automatically:

Phase 6 acted as a switch that would allow bells on the industry's cash registers to ring, risk-free. That's because many pandemic vaccine contracts had already been signed. Germany, for example, signed an agreement with the British firm GlaxoSmithKline (GSK) in 2007 to buy its pandemic vaccine -- as soon as phase 6 was declared. This agreement could explain why Professor Roy Anderson, one key scientific advisor to the British government, declared the swine flu a pandemic on May 1. What he neglected to say was that GSK was paying him an annual salary of more than £100,000.

No country, of course, got the swine-flu-virus virus worse than Britain. Just as the recession was beginning to bite, the government spent at least £1 billion on vaccines, enough to inoculate the entire population twice over. Millions of pointless leaflets were printed. Call centres were set up in which teenagers were empowered to prescribe tamiflu to anyone who complained of a runny nose. The chief medical officer - a man more used to scaremongering about obesity - predicted that there would be 20 million sufferers and many thousands of deaths. Instead of preparing for the most likely scenario - a mild but inconvenient epidemic, slightly worse than an average outbreak - the government assumed the worst and planned accordingly. They justified this as being precautionary, whereas in fact it was merely wasteful.

Most countries overreacted in some way to the outbreak. But only in Egypt, where the phrase "swine-flu" empowered the country's Islamists to demand a cull of every single pig, was the reaction more bizarrely disproportionate to the actual threat than it was in the UK. It's worth asking why. I think there are several factors, all of which have a significance going beyond the particular issue of flu epidemics and the proper response to them.

One is that we have a government and civil service wedded to the precautionary principle, which gives to much weight to worst-case scenarios and not enough to the likelihood of calamitous events transpiring. This doesn't just mean that money is wasted on the principle that it's "better to be safe than sorry" - the downside of overcaution also tends to be overlooked.

In this instance, by the time the pandemic was declared there was more than sufficient evidence that the H1N1 virus was not deadly. Of course, it "might" have mutated at a later date - but those who used that as an argument for stockpiling vaccines and drugs ignore the fact that if it had mutated many of those vaccines would have been useless. The safest course, as well as the least profligate one, would have been to keep a careful watch on the progress of the epidemic and be ready to move if the virus did turn into a killer.

Still, the £1-2 billion squandered on swine flu represents a fairly small example of precautionary folly. Too much government policy is based around averting huge but unlikely disasters and too little on coping with the inevitable but humdrum problems. Even in a good year, flu kills many more people than have been killed by terrorists in the whole of recorded history - yet the government spends billions every year on the counter-terrorism industry. Tony Blair, as he told the Chilcot Inquiry, took Britain to war in Iraq largely because he, the intelligence services - and the American administration - told themselves scary stories about what might happen and ignored a more common-sense assessment of what probably would (i.e. little or nothing). The government scares itself (and us) witless worrying about obesity time-bombs and catastrophic climate change and imagines that it's simply being cautious by getting ready for the worst. The worst almost never happens. And when it does, the precautions invariably turn out to have been inadequate.

Other factors played their part. As so often, the government took refuge in supposedly impartial scientific advice (which sometimes isn't quite as impartial as it seems) and was happy to give the likes of Liam Donaldson free rein to predict 60,000 deaths. It showed its usual over-deference to international bodes (in this case the WHO). The panic engaged the centralised, producer-friendly bureaucracy of the NHS. The government, as usual, relished the opportunity of spending public money.

Then, of course, there is New Labour's addiction to headline-chasing, unabated after thirteen years in power. Swine flu was hyped absurdly by all sections of the media (not least, all you Mail-bashers out there take note, by the BBC). There were calmer voices, such as Simon Jenkins who predicted both the hysterical overreaction and the non-materialisation of mass death before either occurred. But most commentators and reporters were keen to talk up the danger.

I don't really blame them. It was big news: new, unquantifiable, potentially devastating. That sort of thing sells. The press was just doing its lurid, fear-spreading, catastrophe-mongering job. But that doesn't mean the government had to follow. Rather than making a careful assessment of the actual threat, and the balance of costs and risks, the government's PR machine jumped into action. The need to be seen doing something trumped anything else.

It's important to note that this wasn't just fear on the government's part that if swine flu did develop into a major epidemic they would be savagely criticised for their complacency. The danger, as they saw it, was much more immediate than that. They needed to be seen to be doing everything in their power to be prepared for the Aporkalypse then and there. The headline they feared most wasn't "Millions dead because the government did nothing": that was always most improbable, and they knew it. What they feared were the headlines that ran "millions MIGHT die because the government is doing nothing."

Paradoxically, hyperactive government action didn't forestall such negative headlines. Rather, it served actually to increase the panic by taking measures that seemed to suggest the problem was genuinely a serious one. So they were still faced with headlines demanding more be done - until it became obvious that swine flu wasn't after all a mass killer. Then the headlines were all about the unused stockpiles of vaccine. Headline-chasing never works in the end.