A dangers posed by the H1N1 Swine flu, and whether it deserves the sobriquet of ‘Pandemic’, answers are being demanded because of the amount of money that has been spent on it globally and whether this expenditure was justified. We take a look at the many areas of public life where vast amounts were invested due to the swine flu scare:

Airports: The first cases of Swine flu entered India from abroad by channels such as air travel. So swiftly checking at international airports became the norm, with doctors and other health officials being placed at the site to monitor people coming in. Scanners and other detection devices such as thermal cameras were installed at very considerable cost at airports to try and screen and thereafter isolate those infected with Swine flu.

Healthcare costs: The government has incurred tremendous expenditure procuring and stockpiling Tamiflu tablets, equipping public hospitals with testing faculties to detect swine flu positive individuals and setting up isolation wards for swine flu positive patients. Further there has been a great deal of money spent on vaccine procurement. Since there is no indigenous vaccine currently available, in the country it was necessary to conduct clinical trials of imported vaccines to determine their safety and efficacy for Indian populations. There was increased pressure on already stretched public health care systems with vast crowds and long lines of people wanting to be tested and requiring medical attention for their swine flu infection.

Effect on the Educational System of the country: Countless numbers of schools have lost countless productive teaching days because of the swine flu scare firstly because of a government directive and then out of abundant caution or possibly due to parents pressuring school authorities to close schools. Whatever be the reason, one now wonders if there was sufficient reason for school closures.

Negative impact on Tourism: The swine flu scare has negatively impacted tourism in the country, with people choosing not to travel to Indian because of the H1N1 scare.

Negative Impact on the Movie industry: With the stress being placed on swine flu spreading in public places, particularly those where people tend to congregate in large numbers, people chose to stay at home rather than go to theatres to watch their favourite stars. A lot of money was lost due to this.

While the swine flu pandemic had this negative impact on several areas of public life, there have been those that have benefitted: certainly pharmaceutical companies have benefitted, with the government and people rushing to procure swine flu medication. Then manufacturers of surgical masks and hand wash liquids and hand sanitizer gels have also profited greatly from the pandemic.

Add to this there is now the emerging nexus between the board members of the WHO and several international pharma companies, which leads us to ask several questions about whether this was just a scare that was blown out of proportion of whether there was need to label Swine Flu a pandemic?

We are informed that around 3.7 million people in England alone have already been vaccinated against H1N1 flu at the urging of the WHO according to this NDTV report. 62 million Americans have received H1N1 shots and Chinese health experts told the WHO this week that a similar number had been vaccinated against the virus in China. And there is now real cause to wonder if people and governments were really required to undergo the expenses that they have? Has the world been taken for a ride in the interests of big pharma companies? These and several other pertinent questions are currently being asked.

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The minister, Dinesh Trivedi said it was important to find out whether there was ever a nexus between pharmaceutical companies and WHO which made the global health watchdog declare H1N1 flu a pandemic virus.  ”We definitely demand an inquiry. WHO is not god,” he was reported as having said.

Earlier WHO director general Margaret Chan herself had said that the H1N1 pandemic was not as serious as anticipated. She said that this was the first pandemic to occur since the revolution in communications and information technologies. For the first time in history, the international community could watch a pandemic unfold, and chart its evolution, in real time.

According to her the worst may be over but cautioned “But it would be unwise for anyone to reach firm conclusions before April, when the normal influenza season usually ends. There is still quite a lot of winter left.”

Health minister Ghulam Nabi Azad however gave a more toned down response, and implied that the swine flu scare had helped prepare for other pandemics in the future. “We have been telling people not to panic over the H1N1 virus. The only good thing is that the alarm has left us well prepared for a similar influenza pandemic in the future. In the last six months, virus testing laboratories have increased from the existing two at NICD, Delhi and NIV, Pune to 44 laboratories. Out of these, 26 are in the public sector and 18 in the private sector,” he said

The WHO has listed symptoms such as cough, fever, cold, body ache, running nose and sore throat as the common symptoms of swine flu however sometimes people do no display all these symptoms and there have been cases where patients have had only fever or only cold and still tested positive, according to the minster.

“Consider testing of non-symptomatic patients also for H1N1 and administer Tamiflu. At least, there is no shortage of Tamiflu,” Azad has therefore suggested according to this Indian Express report.

As the trials for the Swine flu vaccine are proceeding apace in the country, there are glad tidings that the first imported consignment of swine flu will be arriving in the country next month from a French pharma company, Sanofi Aventis according to this DNA report.

It is to be remembered however that even when the vaccine finally made available in the country, it will be made available for the use of the higher risk groups first, before being made available for use by the common man. Doses will be first provided to the high risk groups like doctors, health care workers, etc, who are most vulnerable to contract the H1N1 infection, the Health minister was quoted as having said.

It was also clarified that once the indigenous vaccine is out again priority will be given to individuals from the high risk groups like pregnant women, senior citizens and children.

Meanwhile the swine flu death toll in the country has now gone up to 1,082 and the total number of people infected with the virus now stands at 27,901. ‘Till date, samples from 117,943 people have been tested for Influenza A (H1N1) in government laboratories and a few private laboratories across the country and 27,901 of them have been found positive,’ according to an official statement.

Swine flu cases in the national capital of Delhi reached the 9,570 and children continue to be the worst sufferers there according to this PTI report, some 5,330 children being affected by H1N1 virus, causing the disease.

According to the WHO, India continues to report maximum number of cases of swine flu in the south east Asian region.

The national death toll from the swine flu virus is now up to 831 with more than 24,000 people in all being infected with the highly contagious flu virus.

Maharashtra continues to have the highest number of fatalities, with 251 deaths. The national capital is another area from where there is a steady stream of news of swine flu infections. Out of the 137 new cases reported recently, as many as 59 are children and the total number of persons affected by swine flu in Delhi now stands at 8,888.

Meanwhile Australian researchers have confirmed the recommendation previously made by the World Health Organization, that for children, a one shot dose of the swine flu vaccine is likely to be enough. Although it is school aged children that have been targeted most by the swine flu virus owing to lower immune response to the infection, the Australian researchers have opined that one shot will be enough for children to build up immunity according to this DNA report.

According to experts, it is advisable to provide one dose to as many children as possible over the age of 6 months and under 10 years as possible. The vaccines have been seen to be safe for children as well as pregnant women; and the benefits from the vaccine are seen to far outweigh any risks. The researchers found that most of the adverse reactions to the vaccine were mild to moderate, but the immune responses were strong.

Though the WHO recommends that one shot is enough for children to build up an immune response to the Swine flu virus, a note of caution has been injected by the American National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDCP), Atlanta. “The immunogenicity data suggest that at least some children will be protected after a single 15-microgram dose, but the findings cannot be generalized to all children, which is why it is prudent to give two doses,” CDCP experts were reported as having said.

The swine flu vaccine is only likely to be available to Indians by about March 2010; they are not likely to reach Indian markets before that time according to the report.

India is currently undergoing the second wave of Swine flu, with the setting in of winter due to a number of reasons; such as the fact that the virus is not able to thrive in very high temperatures and due to the fact that in winter people tend to congregate indoors together much more, making it an ideal situation for the virus to pass from person to person.

Additionally the virus is able to infect a person more easily during winter because of lower blood circulation in the body, as per Dr Sapatnekar. “Low temperatures favor the spread of the flu externally. As during winters the blood circulation is low in the human body as blood capillaries close down to conserve heat and that is why most viruses become severe during winters,” the doctor was quoted as having said.

Meanwhile according to this PTI report, the Swine flu death toll has now climbed to 591 in India, with the total number infected being 18,543.

Also according to an article published in the Hindustan Times, as many as 225 doctors and 172 paramedics are still engaged in screening passengers as they arrive into India. Each day about 50,000 passengers at 22 international airports all over the country are subject to such testing.

The efficacy and requirement of such testing is certainly questionable at this point of time and at this stage of the Swine flu pandemic in the country. There are many reasons for this:

• Statistics now show that less than 2% of the people diagnosed with Swine flu in India have a history of foreign travel. This is to say that people in India are contracting Swine flu domestically not from abroad so there is really no point in checking if individuals coming into India are swine flu positive or not.
• The Swine flu virus is now said to be established in India and the major source of infection is domestic.
• Health care and medical resources in India are precious and inadequate and they could be put to better use than having hundreds of doctors and paramedics involved in the pointless activity of screening passengers at airports. These resources could be far better utilized elsewhere.
• The WHO has said that containment measures at this stage of the pandemic, (Stage 7) are of limited value since the infection is disseminated and spreading at the community levels as is the case now in India.

The criticism leveled at the airport screening process is that the government is continuing with this exercise which is essentially one of futility, because they want to be seen as doing something.

Meanwhile the death toll in the country from this disease is 530 and the total number of people infected with the swine flu virus is 15,726.  The number of positive cases in Maharashtra is 3,828 and in Delhi the number of infections is 3,837 with 62 new cases being reported yesterday.

Meanwhile in India the Swine flu death toll has reached 524 according to health officials as reported here.  The total number of people affected with the virus is now at 15,424.

Maharashtra, which continues to have the highest number of deaths from the H1N1 swine flu pandemic, has a death toll that has gone up to 213 – the highest in the country.

Of the 161 new cases reported, 96 were from Rajasthan and 26 from Delhi. Till date, Delhi has recorded a total of 3,761 cases of swine flu, which is only behind 3,796 cases in Maharashtra. As many as 18 people have died in the national capital so far due to swine flu.

‘Of the 161 cases, only three have foreign travel history and the rest are indigenous cases,’ said an official statement.

“We have launched Oseltamivir brand, called Antiflu, which is the only flu medicine from India to be prequalified by World Health Organisation (WHO),” Cipla’s Chairman and Managing Director, Y K Hamied said according to this NDTV report.

Antiflu will be available both in capsule as well as liquid form and will cost Rs. 475 for 10 capsules as well as the liquid. Cipla has the capacity to produce up to 2 million Antiflu (oseltamivir) pills in one month. The timing of the launch of the drug may be crucial as India is expecting the second wave of swine flu to commence along with the winter.

According to another report, Cipla has also offered export Antiflu to the US where there is currently shortage of the anti swine flu medication.

“Now the US is facing a shortage of oseltamivir and we have informed our readiness to supply the drug if needed,” said Hamied.

Central America and Latin America still account for the highest number of fatalities with 4,399 deaths according to this AFP report.  According to the WHO, there is “increasing and active transmission” of pandemic influenza virus across Northern and Eastern Europe, including Ukraine and Belarus, as well as in eastern Russia and the pandemic is also gaining intensity in Mongolia, Oman, Afghanistan and Japan, especially on the northern island.

However, it is heartening to note that in tropical areas of Central and South America, as well as parts of south and southeast Asia, this pandemic appears to be on the wane somewhat.

Meanwhile in India, there were three more deaths reported yesterday that resulted from Swine flu, and the national death toll is now up to 489 in the country. The total number of people affected with the contagious virus is at 14,340.  Till date, samples from 75,516 people have been tested for Influenza A (H1N1) in government laboratories and a few private laboratories across the country and 14,340 of them have been found positive, according to a statement quoted in this report.

On the other hand according to this report here, one shot was found to be enough for pregnant women, 92% of whom showed sufficient immune response even after receiving only one shot of the Swine flu vaccine. The same study found that one shot of the vaccine appeared to have a weaker response in children aged between 3 and 9 years, only 55% of whom showed sufficient immune response. It was only after the second dose that they showed adequate immune response.

This is contrary to the WHO directive issued some days back. The WHO directive had indicated that it was more important to vaccinate a bigger number of children rather than to give each child two shots. So if the children were given only one shot, then with the same number of vaccines, double the number of children could be vaccinated.