Page #33
Q: I have read a lot over the winter and would like to ask a few questions about H1N1 and HIV, would you mind?
MA: I hoped that you would.
Q: Wolfgang Wodarg, head of health at the Council of Europe, has charged that the pandemic of H1N1 was overstated in order to allow the pharmaceutical companies to cash in. He has also called for an inquiry into the pandemic - claiming it is "one of the great medicine scandals of the century"
India has asked the World Health Organization to explain reports that the pandemic status given to swine flu was a "false" one.
Poland, the only country to reject the H1N1 vaccine, stated that "We will not take part because it's not honest and it's not safe for the patient." This was from Prime Minister Donald Tusk who now stands by his decision.
What is your opinion of the validity of these claims? Do you think that the situation was overstated on purpose, or that financial motive was a factor in the elevation of this new virus to such an emergency level?
MA: I am not sure if you remember, but in June Dr. Chan was under withering criticisim to quicken the pace of the authorities in responding to this crisis.
On June 11th, 2009 she raised the alert level to "6" - our highest level. At that time many people were saying that we were dragging our feet and loosing all credibility.
In particular, I remember Dr. Michael Osterholm, who is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, saying that we had abandoned science and were failing to declare a level "6" because of political motives.
It was a mixed bag. But looking back at the first months of the outbreak I am forced to ask what were our choices? If we failed to respond in a robust and unified manor then not only our moral credibility but our future decisions were in grave peril. The phrase "better safe than sorry" comes to mind.
I would rather have a huge stockpile of vaccine that we did not use than to have a true medical emergency without sufficient supplies to treat the public.
We are not Gods - there are no hard and fast rules about predicting the outcome of new pathogens. We try to be as proactive as possible (when given time) but much of medicine is reactive - and in truth we often are wrong in our decisions.
But to impute the motives of these fine people is scurrilous. I have spent a long lifetime in the company of people who are forced to make decisions about health on a very large scale - and our public health professionals are, by and large, ethical and caring individuals
Q: But MA from the start you stated that this was probably a moderate outbreak.
MA: Yes, and so did many others. But we are not carrying the heavy responsibility for the vast complexities that must be mobilized to meet a pending pandemic.
When the buck stops on your desk, you do not have the luxury of taking the middle ground. When there is even a potential for disaster, the CDC and WHO must always prepare for the "worst case" scenario. It is their duty.
Page #34
Q: What about your reservations on mass vaccination and the use of neuraminidase inhibitors?
MA: That is a different issue. I am strongly opposed to the use of neuraminidase inhibitors on any individual who has a disorder of the immune system (HIV, Rheumatoid arthritis etc.) We do not have enough information on the contraindications of this reaction to safely prescribe this regimen.
As to mass vaccination - when you have new vaccines it is wise to be cautious. The more controlled and disciplined we can be in their administration, the more confident we can be in their safety and efficacy.
-------------------------------------------------------------------------------------
(This was the only time I was to visit MA prior to her developing pneumonia and getting very sick.
Winter came and went, MA got well and although she did not open the Tahoe “cabin” this summer, her health is good and I am anxious to complete this work.)