By the way, here's an example that I don't think fits your scenario: My great-grandmother is 95 years old and never leaves the house. She doesn't get flu shots because a) she'd have to leave the house to get one, and b) she shouldn't need to worry about becoming infected by the public because she doesn't go out into the public. But yesterday she fell and broke her hip and was taken, despite her protest, to the ER. So if she gets the flu from her ER doc is it just her own damn fault for trapsing about to the hospital without being vaccinated?
Yes, I would say that it is her fault for not leaving the house to get a vaccine. She is 95 years old and that is an age where it is common for broken hips to happen. She should know this, and knowing this she should take any of the necessary precautions regarding her health and if she feels there is a potentional to get the flu at the ER she should then take the steps necessary to prevent that. It isn't the ER's fault that she decided not to get vaccinated because she didn't have the forsight to realize that she just might eventually end up in the ER someday.
But she doesn't go out because she's trying to be careful to not break her hip. So, she could go out, get the flu shot, and increase her risk of breaking her hip and of getting the flu, or she could stay home, decrease her risk of breaking her hip and of getting the flu, and not get a flu shot. I think a risk/benefit analysis favors staying home.
By the way, here's an example that I don't think fits your scenario: My great-grandmother is 95 years old and never leaves the house. She doesn't get flu shots because a) she'd have to leave the house to get one, and b) she shouldn't need to worry about becoming infected by the public because she doesn't go out into the public. But yesterday she fell and broke her hip and was taken, despite her protest, to the ER. So if she gets the flu from her ER doc is it just her own damn fault for trapsing about to the hospital without being vaccinated?
Yes, I would say that it is her fault for not leaving the house to get a vaccine. She is 95 years old and that is an age where it is common for broken hips to happen. She should know this, and knowing this she should take any of the necessary precautions regarding her health and if she feels there is a potentional to get the flu at the ER she should then take the steps necessary to prevent that. It isn't the ER's fault that she decided not to get vaccinated because she didn't have the forsight to realize that she just might eventually end up in the ER someday.
But she doesn't go out because she's trying to be careful to not break her hip. So, she could go out, get the flu shot, and increase her risk of breaking her hip and of getting the flu, or she could stay home, decrease her risk of breaking her hip and of getting the flu, and not get a flu shot. I think a risk/benefit analysis favors staying home.
Clearly it didn't matter since she ended up breaking her hip anyway. I thought some states had laws against forcing people to go to an ER if they don't want to though? At least I'm sure it was that way in Minnesota because when my Grandma fell they wouldn't bring her until she said they could. Is it different where your great grandma lives?
Also, do doctor's not do housecalls anymore? Is it not possible to have one come visit your great grandma to administer a shot?
Clearly it didn't matter since she ended up breaking her hip anyway. I thought some states had laws against forcing people to go to an ER if they don't want to though? At least I'm sure it was that way in Minnesota because when my Grandma fell they wouldn't bring her until she said they could. Is it different where your great grandma lives?
Also, do doctor's not do housecalls anymore? Is it not possible to have one come visit your great grandma to administer a shot?
Well, she was "forced" by my uncle, who threatend to call an ambulance and she conceded because she didn't want there to be a scene.
I don't know of any docs in her area who do house calls. She would be really upset by a stranger coming to her house anyway, and it seems worse to get her all upset and force her to get a shot than to just let her live her remaining few days in the safety of her own house without being bothered.
I still don't think it would be right for a healthcare professional to give her the flu.
Clearly it didn't matter since she ended up breaking her hip anyway. I thought some states had laws against forcing people to go to an ER if they don't want to though? At least I'm sure it was that way in Minnesota because when my Grandma fell they wouldn't bring her until she said they could. Is it different where your great grandma lives?
Also, do doctor's not do housecalls anymore? Is it not possible to have one come visit your great grandma to administer a shot?
Well, she was "forced" by my uncle, who threatend to call an ambulance and she conceded because she didn't want there to be a scene.
I don't know of any docs in her area who do house calls. She would be really upset by a stranger coming to her house anyway, and it seems worse to get her all upset and force her to get a shot than to just let her live her remaining few days in the safety of her own house without being bothered.
I still don't think it would be right for a healthcare professional to give her the flu.
Well, I still don't think it would be right for someone to force another person to unwillingly inject a substance into their body regardless of what profession they work in. It seems apparent to me that your Great-Grandma is more worried about going outside/having strangers coming into her home than she is contracting the flu and that's her prerogative. It just doesn't seem to be an issue for her.
Well, I still don't think it would be right for someone to force another person to unwillingly inject a substance into their body regardless of what profession they work in.
You do realize that vaccinations are mandatory for entering school and in order to hold many jobs in the US, right?
Others are mandatory for travel to different parts of the world, and therefore, if your job requires you to travel to these destinations, and you refuse the vaccine, you would, most likely, be putting your job in jeapordy.
Im not arguing for or against H1N1 vaccinations
I'm just reading and learning... but your above stated point is pretty much moot. in the US vaccinations ARE mandatory in MANY situations
scb - just to show that not all docs are behind recommending the H1N1 vaccine...
Swine Flu Vaccine: What To Do?
posted by Dr. Frank Lipman Oct 11, 2009 5:00 pm
Summer is over and the question I am being asked most frequently in my practice is, “what do I do about Swine flu?” My patients are wondering whether or not they should get vaccinated and the simple answer I give most of the time is ..NO!
From what you may have read, you might think that the swine flu vaccine is the answer to swine flu. Unfortunately this is not true and until we know that the vaccine is safe, I cannot in good conscience recommend it to most of my patients.
From the outset, let me say, I am not anti all vaccinations, rather I am pro vaccine safety and freedom of choice.
This is why am I not recommending the swine flu vaccine:
1. At this stage, for the most part the swine flu seems benign.
Over a million people in the US have already come down with swine flu, many of them without even knowing that they had it. The vast majority of people who get the swine flu recover after a week or so of high fever, aches, and respiratory distress. It’s not pleasant, but except in rare circumstances, it is not fatal. Most people who’ve been infected by swine flu think so little of it, they believe they just had a really bad cold or a regular flu. So unless the swine flu evolves to a much more virulent form, there’s no need for mass vaccination.
2. We don’t know if the vaccine will be effective.
Vaccines are only useful against the specific viral strain that was available at the time of their manufacture. But influenza viruses mutate quickly, and as the WHO has already said, the real concern with H1N1 swine flu is that it will combine with seasonal flu in the Fall, creating a new strain that will of course be immune to all available vaccines.
I know that not every single doctor agrees, but what about the medical profession as a whole? What about those expert researchers you speak of? I don't even know who this guy is or where this article came from.
Listen, we'll have to agree to disagree here. I don't rely on gov't to tell me what's best for my health. I also have shown points how the H1N1 is not proven safe. You seem to want to believe that the medical community as a whole think it's wisest to get the vaccine and I disagree. But what do I care what doctors say? They make mistakes all the time. I'm done.
You don't rely on government, you don't rely on most doctors, but you'll rely on google?
I am at a loss reading your comments.
I almost lost my husband TWICE due to medical errors. As you said, doctors are human, but your argument about a corporate conspiracy is really, really weak.
... and the will to show I will always be better than before.
Well, I still don't think it would be right for someone to force another person to unwillingly inject a substance into their body regardless of what profession they work in.
You do realize that vaccinations are mandatory for entering school and in order to hold many jobs in the US, right?
Others are mandatory for travel to different parts of the world, and therefore, if your job requires you to travel to these destinations, and you refuse the vaccine, you would, most likely, be putting your job in jeapordy.
Im not arguing for or against n1h1 vaccinations
I'm just reading and learning... but your above stated point is pretty much moot. in the US vaccinations ARE mandatory in MANY situations
Plus, "force" is relative. They have an option to not get vaccinated - there are just consequences to that decision. Just sayin'...
Well, I still don't think it would be right for someone to force another person to unwillingly inject a substance into their body regardless of what profession they work in.
You do realize that vaccinations are mandatory for entering school and in order to hold many jobs in the US, right?
Others are mandatory for travel to different parts of the world, and therefore, if your job requires you to travel to these destinations, and you refuse the vaccine, you would, most likely, be putting your job in jeapordy.
Im not arguing for or against H1N1 vaccinations
I'm just reading and learning... but your above stated point is pretty much moot. in the US vaccinations ARE mandatory in MANY situations
And you do realize that there are exemptions that can be made for children who have not received vaccinations to enter school? And you do realize that just because something is mandatory that doesn't make it correct, right?
Please inform me on what occupations there are that require vaccinations. All I can think of right now is the military.
Traveling to other parts of the world is irrelevant to this discussion because we weren't talking about the policies of other countries, we were talking about the policies of the United States where we are supposed to be free of the government mandating and forcing its citizens to purchase a product or enter foreign substances into their body.
To say that my point is moot is pretty ignorant. You have only outlined one case where vaccinations are actually mandatory and that is foreign travel.
Well, I still don't think it would be right for someone to force another person to unwillingly inject a substance into their body regardless of what profession they work in.
You do realize that vaccinations are mandatory for entering school and in order to hold many jobs in the US, right?
Others are mandatory for travel to different parts of the world, and therefore, if your job requires you to travel to these destinations, and you refuse the vaccine, you would, most likely, be putting your job in jeapordy.
Im not arguing for or against n1h1 vaccinations
I'm just reading and learning... but your above stated point is pretty much moot. in the US vaccinations ARE mandatory in MANY situations
Plus, "force" is relative. They have an option to not get vaccinated - there are just consequences to that decision. Just sayin'...
Losing ones job is not much of an option. Have you ever heard of duress?
Losing ones job is not much of an option. Have you ever heard of duress?
All I'm saying is that "force" is a relative term.... everything in life has consequences.
Since we're repeating ourselves:
All I'm saying is losing ones job is not much of an option. Have you ever heard of duress?
Welcome to the grown-up world. People have to make difficult choices.
You know what else is a shitty option? Getting the flu (and possibly dying) from your HEALTHcare provider. Being "forced" to enter a contaminated place to receive your flu shot or care for your medical emergency.
I understand the right to decide what goes into one's body. But you've got to acknowledge that the public also has the right to expect their healthcare facilities to take precautions to not infect them. They're already expected to take all kinds of other precautions that no one argues about - like washing hands, sterilizing instruments, using clean needles, banning smoking, etc. - so the precedent is there.
Your notion of "fault" and "protection" doesn't seem to take these things into consideration. If I stepped on a rusty nail and needed a shot, and got HIV from a dirty needle at the hospital, would you still say it was my fault because I should have taken more responsibility to protect myself and the hospital & its employees should not be forced to "protect" me at their own expense (needles aren't cheap).
There's probably a way to get an exemption anyway, like the one you spoke of for school.
Welcome to the grown-up world. People have to make difficult choices.
You know what else is a shitty option? Getting the flu (and possibly dying) from your HEALTHcare provider. Being "forced" to enter a contaminated place to receive your flu shot or care for your medical emergency.
I understand the right to decide what goes into one's body. But you've got to acknowledge that the public also has the right to expect their healthcare facilities to take precautions to not infect them. They're already expected to take all kinds of other precautions that no one argues about - like washing hands, sterilizing instruments, using clean needles, banning smoking, etc. - so the precedent is there.
Your notion of "fault" and "protection" doesn't seem to take these things into consideration. If I stepped on a rusty nail and needed a shot, and got HIV from a dirty needle at the hospital, would you still say it was my fault because I should have taken more responsibility to protect myself and the hospital & its employees should not be forced to "protect" me at their own expense (needles aren't cheap).
There's probably a way to get an exemption anyway, like the one you spoke of for school.
Except people aren't "forced" to enter healthcare facilities like you are alluding to. You said it yourself...twice
All I'm saying is that "force" is a relative term.... everything in life has consequences.
In fact, many people don't even have to go to medical facilities to receive their flu shot. The office I work in had a wellness day where the health care providers came to us to administer the shots. Along with this, I see them offered everywhere now and I see people going to these alternate places to get them in the name of convenience. Are we to now require that these other sites make sure anyone who enters them be vaccinated? (i.e. the restaurant/pharmacy/drug store that offers them in my area)
Your example with the dirty needle falls short. Requiring clean needles to be used is not requiring the person who is tasked with this duty to unwillingly enter a foreign substance into their body that may or may not be harmful to their health in order to use the clean needles.
As for their "probably being an exemption", that's not the way it sounds in NYS. In fact there is a news article in this very thread that talks about how the health care workers there are now engaging in litigation because they aren't given any exemptions.
Thank you so much for your patronizing words and inducting me into what you consider the grown-up world.
In fact, many people don't even have to go to medical facilities to receive their flu shot. The office I work in had a wellness day where the health care providers came to us to administer the shots. Along with this, I see them offered everywhere now and I see people going to these alternate places to get them in the name of convenience.
But we're not just talking about preventative care here. We're talking about people who need life-saving medical care, people who need prenatal care, people who are in labor, people who may not even be conscious to object to being taken to the hospital, etc....
Your example with the dirty needle falls short. Requiring clean needles to be used is not requiring the person who is tasked with this duty to unwillingly enter a foreign substance into their body that may or may not be harmful to their health in order to use the clean needles.
Maybe not, but there is still a burden placed on the hospital and its employees. Here's another one: What if I was a nurse and refused to give anyone a shot for fear of harming my own health via a needle stick? What if I was an EMT who refused to give someone mouth-to-mouth for fear of getting sick? What if I was a doctor who refused to care in any way for a person with HIV for fear of catching HIV? What if I was a morphology technician who refused to do an autopsy on someone with hantavirus for fear of catching it? Healthcare jobs require that people put their own health at a certain level of risk every day. If they refused to accept this risk, their employer would be justified in firing them.
Except people aren't "forced" to enter healthcare facilities like you are alluding to. You said it yourself...twice
All I'm saying is dying from lack of emergency medical care is not much of an option. Have you ever heard of duress?
Ah, I see you are catching on here...sort of...except duress doesn't apply to your attempt at twisting my words at all. Dying from a lack of emergency medical care does not fall under the definition of duress; there isnt anyone coercing the person into death.
But we're not just talking about preventative care here. We're talking about people who need life-saving medical care, people who need prenatal care, people who are in labor, people who may not even be conscious to object to being taken to the hospital, etc....
and thus we go back to an earlier post of mine that I don't think you agreed with where I said that those people before arriving in those situations could have taken the action necessary to immunize themselves. Except for the unconscious people who didn't get immunized in your example, not much I can think of that could be done there other than if they weren't immunized beforehand, chances are they didn't want to be and it wasn't something they thought necessary. If that is the case it wouldn't matter either way if they were conscious or not, because if they were afraid of contracting something by not being immunized, don't you think they would have already obtained a shot? If it's that much of a concern for some people, couldn't they get one of those wrist bracelets that diabetics wear to let people know they are diabetic if circumstances require medical attention? Only instead of being a diabetic bracelet it would be something stating they refuse ER care no matter what.
Look, I'll be the first to admit that I don't have all the answers, but that doesn't mean that I think what you are advocating is the correct way to go about this.
Maybe not, but there is still a burden placed on the hospital and its employees. Here's another one: What if I was a nurse and refused to give anyone a shot for fear of harming my own health via a needle stick? What if I was an EMT who refused to give someone mouth-to-mouth for fear of getting sick? What if I was a doctor who refused to care in any way for a person with HIV for fear of catching HIV? What if I was a morphology technician who refused to do an autopsy on someone with hantavirus for fear of catching it? Healthcare jobs require that people put their own health at a certain level of risk every day. If they refused to accept this risk, their employer would be justified in firing them.
I thought you were worried about the patients and not the employees?
The judge blocked enforcement of a requirement that all state healthcare workers be vaccinated for the seasonal and the swine influenza.
Friday, October 16, 2009
NEW YORK (Reuters) - A New York state judge on Friday blocked enforcement of a requirement that all state healthcare workers be vaccinated for the seasonal and the swine influenza, according to a New York Times web site.
The temporary restraining order by Justice Thomas McNamara, an acting judge on the State Supreme Court in Albany, New York, came in response to a lawsuit filed by three nurses who argued the mandatory directive violated their civil rights, the Times said.
The directive, issued August 13 by state Health Commissioner Richard Daines, said healthcare workers must be vaccinated by November 30 or face fines.
New York Department of Health officials said they would fight the judge's restraining order, the Times said.
The judge scheduled a hearing for October 30 on the lawsuit and two other cases challenging the mandatory vaccinations, one filed by the New York State Public Employees Federation and the other by the New York State United Teachers Union.
Calls to the judge's chambers in Albany were unanswered.
The state Health Commissioner has argued the mandatory regulation is the only way to get full participation of all healthcare workers and protect the public health. Opponents have argued workers should not be required to be vaccinated.
The new vaccine has raised questions as to how well it has been tested, whether it can cause the flu and whether it has any side effects.
Only about 40 percent of U.S. healthcare workers get vaccinated against seasonal influenza.
The judge blocked enforcement of a requirement that all state healthcare workers be vaccinated for the seasonal and the swine influenza.
Friday, October 16, 2009
NEW YORK (Reuters) - A New York state judge on Friday blocked enforcement of a requirement that all state healthcare workers be vaccinated for the seasonal and the swine influenza, according to a New York Times web site.
The temporary restraining order by Justice Thomas McNamara, an acting judge on the State Supreme Court in Albany, New York, came in response to a lawsuit filed by three nurses who argued the mandatory directive violated their civil rights, the Times said.
The directive, issued August 13 by state Health Commissioner Richard Daines, said healthcare workers must be vaccinated by November 30 or face fines.
New York Department of Health officials said they would fight the judge's restraining order, the Times said.
The judge scheduled a hearing for October 30 on the lawsuit and two other cases challenging the mandatory vaccinations, one filed by the New York State Public Employees Federation and the other by the New York State United Teachers Union.
Calls to the judge's chambers in Albany were unanswered.
The state Health Commissioner has argued the mandatory regulation is the only way to get full participation of all healthcare workers and protect the public health. Opponents have argued workers should not be required to be vaccinated.
The new vaccine has raised questions as to how well it has been tested, whether it can cause the flu and whether it has any side effects.
Only about 40 percent of U.S. healthcare workers get vaccinated against seasonal influenza.
Fewer than half of Americans say that they are planning to receive the new H1N1 swine flu vaccine, according to recent polls — a trend that is leaving many health professionals at a loss.
"I'm genuinely baffled," says Arthur Kellermann, an emergency medicine physician at the Emory University School of Medicine who has treated swine flu cases. "The public has developed this odd sense of complacency. The only thing that comes to my mind is photos of people standing on the seawall of Galveston hours before the hurricane hit."
The public's skepticism over the vaccine has persisted despite health experts' warning that the unpredictable H1N1 virus, which can cause very severe complications even in healthy young adults and children, has reached pandemic proportions.
The Centers for Disease Control and Prevention says an unusually high number of children have died since it first arose last spring. "There are now a total of 86 children under 18 who have died from the 2009 H1N1 influenza virus," the CDC's Dr. Anne Schuchat told reporters in a briefing Friday. Eleven of those deaths were reported in the past week, the CDC says.
Public health officials and the medical community are scrambling to figure out how to convince more Americans to get vaccinated when supplies of the vaccine become more widely available, but it won't be easy.
Creating Awareness, Avoiding Panic
For one thing, there are many different reasons why people say they are unlikely to get vaccinated. Nearly a third are worried about side effects, according to a Harvard School of Public Health survey in September. Twenty-eight percent said they don't believe they are at risk for a serious case of the flu, while another quarter say they can get medication to treat the flu if they do get sick.
That last statistic is the one that really worries Kellermann, who is also an associate dean for health policy at Emory's medical school. He says that even a mild flu outbreak could overwhelm the nation's emergency rooms, which already have a limited supply of the high-tech equipment that is needed to fight the most virulent cases of the H1N1 virus.
"This flu, seemingly by random, occasionally picks out the healthy child or young adult and puts them in the intensive care unit, hanging on by a thread," he says. "We don't have thousands and thousands of ICU beds and high-frequency jet ventilators standing by to care for those people."
For now, government officials are trying to walk a fine line with their message: They're touting the safety of the vaccine and warning about the risks of swine flu, but stopping well short of creating a panic.
"They really can lose public credibility for decades if what they do is threaten that thousands are going to die and be hospitalized, and it doesn't occur," says Robert Blendon, a professor of health policy and political analysis at the Harvard University School of Health. "They feel confident there's going to an outbreak, but they don't know how many severe cases there will be."
The swine flu vaccine is now being distributed in some places and is being targeted to those considered at high risk, including health care workers. Pregnant women and children are likely to be next. But the CDC says some deliveries of vaccine will be delayed because production is lower than expected. And officials do not want to create a panic.
"There's too much at risk to try to use scare tactics to try to get people to vaccinate," says Kristine Sheedy, the communications director for the CDC's National Center for Immunization and Respiratory Diseases. "While we don't want to scare people into getting vaccinated, we also want to make the disease real."
High-Profile Skeptics
It is still very early in the fall flu season. As skeptics see more and more people getting vaccinated, experts expect others to change their minds. Reports of swine flu deaths, particularly in people's own communities and schools, could end up being the most powerful motivator.
But this year, officials are also fighting some high-profile counterweights to their message. First, an unusual set of high-profile personalities — including conservative media commentators like Rush Limbaugh and Glenn Beck, and more liberal ones like Bill Maher — is publicly opposing the vaccination effort.
Their opposition appears to be part of the larger anti-government movement that has been vocal during the debate over the Obama administration's efforts to overhaul the nation's health care system. Beck told his viewers on Fox News that he would do "the exact opposite" of whatever the government recommends. Maher echoed that on his HBO talk show, saying, "I don't trust the government, especially with my health."
It's not yet clear how persuasive their opinions will be. "There's no question that the anti-government feeling and fears are playing a role," says Blendon. "We just don't know the magnitude of the impact."
Public opinion surveys show that doctors and nurses are seen as the most credible sources of information on these kinds of medical decisions, but there has also been a flurry of media reports about some health professionals resisting mandatory vaccination campaigns at certain hospitals.
"It is shocking to me when I hear a news story about nurses or doctors not getting vaccinated," says Kellermann, who says that he and his entire family will be vaccinated. "It is an issue of professional ethics. It's not just that I'm making decisions about my own health, but about my vulnerable patients. It's no different than washing your hands. It's part of my job."
But the CDC's Sheedy says that doctors and nurses have always been tough sells when it comes to the flu. Vaccination rates for the seasonal flu have never topped 50 percent for health professionals — and usually hover barely above 40 percent.
"We hear the same misperceptions among some providers as we do among the general public," she says. "It is quite a challenge for us to ask the public to go out and take this step and get vaccinated to protect themselves, when we have so many health care workers out there who aren't doing the same."
Pushing A Safety Message
Most professional medical organizations do recommend that their members be vaccinated. Some are planning information campaigns to encourage wider participation.
The U.S. government is also starting to roll out its informational campaign. Part of the message will center on the safety of the H1N1 swine flu vaccine.
"There is not an understanding that those of us in this business make influenza vaccines every year with different strains," says Sheedy. "It takes us about six months, and this one took us about six months. It is just another flu vaccine."
Sheedy says that along with public service ads and flyers, the CDC is reaching out over social media sites such as Twitter to spread the message.
Beyond the warnings about the seriousness of swine flu and reassurances about the vaccine's safety, there is one other simple point, made by Leigh Vinocur, an emergency physician at the University of Maryland School of Medicine:
"Does it feel good to have the flu?" she asks. "Do you like staying home in bed for two days feeling like you've been hit by a truck?"
I typically have high regard for NPR. So I was perplexed by this article as it was EXTREMELY biased for getting the vaccine. I mean, I go to NPR for objective and independent news once in a while, but any proponent for objective journalism would know that this article is obviously a bias piece. So I went to the npr.com home page. There are 11 articles that are pro-vaccine and not one being objective on the subject. The credibility of NPR has just flown right out the window. How TRULY disappointing.
I typically have high regard for NPR. So I was perplexed by this article as it was EXTREMELY biased for getting the vaccine. I mean, I go to NPR for objective and independent news once in a while, but any proponent for objective journalism would know that this article is obviously a bias piece. So I went to the npr.com home page. There are 11 articles that are pro-vaccine and not one being objective on the subject. The credibility of NPR has just flown right out the window. How TRULY disappointing.
OR maybe NPR is still credible and it's just a good idea to get the vaccine.
Legal Immunity Set for Swine Flu Vaccine Makers
8/20/09
Department of Health and Human Services Secretary Kathleen Sibelius has not only given immunity to the makers of Tamiflu and Relenza for injuries stemming from their use against swine flu, she has granted immunity to future swine flu vaccines and “any associated adjuvants”.
The last time the government embarked on a major vaccine campaign against a new swine flu, thousands filed claims contending they suffered side effects from the shots. This time around, they will have no recourse.
The 2006 Public Readiness and Emergency Preparedness Act (the PREP Act) allows the DHHS Secretary to invoke almost complete immunity from liability for manufacturers of vaccines and drugs used to combat a declared public health emergency.
The PREP Act removes the right to a trial jury unless a plaintiff can provide clear evidence of willful misconduct that resulted in death or serious physical injury -- and gets permission to sue from the DHHS Secretary.
But once the PREP Act is invoked to shield manufacturers from liability, the pharmaceutical firms have no financial incentive to make the safest product, and have a negative incentive to test it for safety. As long as they do not deliberately harm consumers of the product, they will not be liable for damages.
The Worst Emerging Disease of All
Henry I. Miller, 05.07.09, 02:13 PM EDT
Obstructive bureaucrats at the World Health Organization
The emergence of new viral diseases serves as a reminder of the high stakes and huge ripple effect of public health decision-making. The 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) should have been a wake-up call. Over a few months, the illness, caused by a previously unknown coronavirus, spread from the Guangdong province of China to more than three-dozen countries in North America, South America, Europe and Asia before the outbreak was contained. It sickened about 8,000 people worldwide, of whom 774 died.
The impacts were widespread and dramatic. International travel was curtailed, world-class athletic events scheduled to be held in Asia were canceled or moved elsewhere and the disruption of commerce caused economic losses in the billions of dollars. Although only eight people in the U.S. showed laboratory evidence of SARS infection, and most of them had contracted the virus abroad, many Americans assiduously avoided Asian businesses.
Although we are still at the stage of observing developments and accumulating data concerning the ongoing H1N1 flu outbreak, we've already learned a few important lessons. First, the electronic media, in particular, has been neglecting necessary context in their reports to the public. Applying the ethic, "If it bleeds, it leads," they have been hyping the story endlessly and breathlessly.
Second, the essence of public health decision-making involves complex tradeoffs and cost-benefit calculations. Overly conservative, risk-averse actions can have dire consequences.
Third, the decisions and pronouncements from the World Health Organization, an agency of the highly politicized and invariably self-serving United Nations, have not been reassuring. Most flu and public health experts consider them to have been overly alarmist, and that their decision during the week of April 27 to raise the pandemic flu threat to the penultimate Level 5, "Pandemic Imminent," far outpaces the data that have accumulated and is therefore unwarranted.
But this is what we have come to expect from an organization that is scientifically challenged, self-important and unaccountable. WHO may be well equipped to perform and report worldwide surveillance, but its policy role should be drastically limited.
The decisions that need to be made are difficult, encompassing virology, medicine and even economics and ethics. Should nations close borders and restrict domestic and international travel and trade? And given the relatively indolent spread of the H1N1 virus, should we rush to prepare vast amounts of vaccine?
The closing of borders would deny access to many items made abroad that are needed during a pandemic, including masks and gloves, electrical circuits for ventilators and communications gear and certain pharmaceuticals and their precursors. And it would severely disrupt commerce and the creation of wealth, both of which ultimately impair the health of individuals and societies.
Even if we did begin to formulate and manufacture a vaccine immediately, it would arrive far too late to significantly attenuate the first wave of infections, but a crash program to manufacture a vaccine could possibly blunt the second wave, if there is one. (Historically, flu pandemics have come in two or three waves, lasting a total of 13-23 months, in the case of the devastating 1918-1919 panish flu, which killed 20 million to 50 million worldwide, the vast majority of deaths occurred during the second wave, which began several months after the first--possibly following a genetic change in the virus during its sojourn in the Southern hemisphere during their winter.)
A complicating factor is that the production of a swine flu vaccine would need to occur at the expense of the vaccine against next winter's seasonal flu, which still kills 30,000-40,000 a year on average in the U.S., and 10 times that number worldwide--even when a significant fraction of the population is immunized with an effective vaccine.
Although often the pandemic strains are both qualitatively and quantitatively worse than the seasonal ones, this does not seem to be the case for the new H1N1. If it were, a high proportion of those infected would require hospitalization for pneumonia and would be dying. However, except for Mexico (for reasons that remain unclear), illnesses have generally been mild, hospitalizations few and mortality minimal.
The WHO's leaders, who have informed vaccine manufacturers that within a few weeks they can expect a request to divert some proportion of vaccine production be diverted to an H1N1 vaccine, appear to lack a basic understanding of how flu vaccines are developed and produced and the timeline for it; some of the obstacles involved are described here and here.
For now, any requests by the WHO to shift production to a vaccine against H1N1 at the expense of the seasonal vaccine should be categorically rejected. And in the longer term, we need to re-think the mandates, management and accountability of the WHO. The health of the world's population is too important to be entrusted to this bunch.
The UN's involvement in international public health policy is just one manifestation of its grand design; the organization has become the regulator-wannabe for all manner of products and human activities, from chemicals to new genetic varieties of plants. The UN's regulatory policies, requirements and standards regularly defy scientific consensus and common sense: UN agencies' virtual ban on DDT for mosquito control and their stultifying regulation of agricultural biotechnology are lamentable examples. The result is a more precarious, more dangerous and less resilient world.
Why is there such relentless incompetence within the sprawling organization?
First, the UN is essentially a monopoly. Inefficiency and incompetence are not punished by "consumers" of their products or services spurning the UN and patronizing a competitor. On the contrary, it is not uncommon in these kinds of bureaucracies for failure to be rewarded with additional resources. In other words, it's not working so let's make it bigger.
Second, we need to recall economist Milton Friedman's observations that if you want to understand the motivation of an individual or organization, follow the self-interest. Sadly, the self-interest of UN bureaucrats seems seldom to coincide with the public interest. UN officials are rewarded for making the bureaucratic machinery run--regardless of the value of the decisions and policies.
Third, there's no accountability--no House of Lords Select Committee, U.S. Government Accountability Office or parliamentary oversight (recall the Iraq oil-for-food debacle and its cover-up at the UN), and no electorate to kick the UN reprobates out when they act contrary to the public interest. It's hardly surprising, therefore, that we see egregious examples of ineptness, arrogance and corruption, let alone day-to-day featherbedding and laziness in individual UN programs and projects.
Fourth, in the absence of accountability, UN officials feel little need for transparency in policymaking; and the PR offices simply spin, spin, spin. Several years ago I attended a major WHO event in Geneva at which the NGO I represented was denied accreditation because it was known to be an advocate of free markets and a critic of some of the UN's policies. You get to participate in the UN's marketplace of ideas only if there is official approval of what you're selling.
Fifth, there's the issue of the quality of the pool from which senior UN officials are selected. The country or region of origin of a candidate is more important than the nominee's credentials and qualifications: no meritocracy there. Finally, ponder this factor related to the competence of the potential candidates: If you were a nation's president or its environmental or health minister, would you send your best and brightest people to work for the UN?
After about two weeks of accumulated knowledge and widespread publicity about the H1N1 outbreak, policymakers worldwide are left with vexing cost-benefit decisions. The bureaucrats at the WHO and other UN agencies will be little help. They are worse than any germs.
Henry I. Miller, a physician, molecular biologist and former flu researcher, is a fellow at Stanford University's Hoover Institution. He headed the FDA's Office of Biotechnology from 1989 to 1993.
I typically have high regard for NPR. So I was perplexed by this article as it was EXTREMELY biased for getting the vaccine. I mean, I go to NPR for objective and independent news once in a while, but any proponent for objective journalism would know that this article is obviously a bias piece. So I went to the npr.com home page. There are 11 articles that are pro-vaccine and not one being objective on the subject. The credibility of NPR has just flown right out the window. How TRULY disappointing.
OR maybe NPR is still credible and it's just a good idea to get the vaccine.
DId you not read the article? It was blatant biasness. It REEKED of agenda.
Comments
But she doesn't go out because she's trying to be careful to not break her hip. So, she could go out, get the flu shot, and increase her risk of breaking her hip and of getting the flu, or she could stay home, decrease her risk of breaking her hip and of getting the flu, and not get a flu shot. I think a risk/benefit analysis favors staying home.
Clearly it didn't matter since she ended up breaking her hip anyway. I thought some states had laws against forcing people to go to an ER if they don't want to though? At least I'm sure it was that way in Minnesota because when my Grandma fell they wouldn't bring her until she said they could. Is it different where your great grandma lives?
Also, do doctor's not do housecalls anymore? Is it not possible to have one come visit your great grandma to administer a shot?
In my 27 years on this earth, I've never heard of a doctor doing a house call.
I don't know...looks to me like it does happen:
http://www.businessweek.com/bwdaily/dnf ... _db037.htm
http://www.ohio.com/lifestyle/health/46583302.html
http://doctorsmakinghousecalls.com/
Well, she was "forced" by my uncle, who threatend to call an ambulance and she conceded because she didn't want there to be a scene.
I don't know of any docs in her area who do house calls. She would be really upset by a stranger coming to her house anyway, and it seems worse to get her all upset and force her to get a shot than to just let her live her remaining few days in the safety of her own house without being bothered.
I still don't think it would be right for a healthcare professional to give her the flu.
Well, I still don't think it would be right for someone to force another person to unwillingly inject a substance into their body regardless of what profession they work in. It seems apparent to me that your Great-Grandma is more worried about going outside/having strangers coming into her home than she is contracting the flu and that's her prerogative. It just doesn't seem to be an issue for her.
You do realize that vaccinations are mandatory for entering school and in order to hold many jobs in the US, right?
Others are mandatory for travel to different parts of the world, and therefore, if your job requires you to travel to these destinations, and you refuse the vaccine, you would, most likely, be putting your job in jeapordy.
Im not arguing for or against H1N1 vaccinations
I'm just reading and learning... but your above stated point is pretty much moot. in the US vaccinations ARE mandatory in MANY situations
You don't rely on government, you don't rely on most doctors, but you'll rely on google?
I am at a loss reading your comments.
I almost lost my husband TWICE due to medical errors. As you said, doctors are human, but your argument about a corporate conspiracy is really, really weak.
Plus, "force" is relative. They have an option to not get vaccinated - there are just consequences to that decision. Just sayin'...
And you do realize that there are exemptions that can be made for children who have not received vaccinations to enter school? And you do realize that just because something is mandatory that doesn't make it correct, right?
Please inform me on what occupations there are that require vaccinations. All I can think of right now is the military.
Traveling to other parts of the world is irrelevant to this discussion because we weren't talking about the policies of other countries, we were talking about the policies of the United States where we are supposed to be free of the government mandating and forcing its citizens to purchase a product or enter foreign substances into their body.
To say that my point is moot is pretty ignorant. You have only outlined one case where vaccinations are actually mandatory and that is foreign travel.
Losing ones job is not much of an option. Have you ever heard of duress?
All I'm saying is that "force" is a relative term.... everything in life has consequences.
Since we're repeating ourselves:
All I'm saying is losing ones job is not much of an option. Have you ever heard of duress?
Welcome to the grown-up world. People have to make difficult choices.
You know what else is a shitty option? Getting the flu (and possibly dying) from your HEALTHcare provider. Being "forced" to enter a contaminated place to receive your flu shot or care for your medical emergency.
I understand the right to decide what goes into one's body. But you've got to acknowledge that the public also has the right to expect their healthcare facilities to take precautions to not infect them. They're already expected to take all kinds of other precautions that no one argues about - like washing hands, sterilizing instruments, using clean needles, banning smoking, etc. - so the precedent is there.
Your notion of "fault" and "protection" doesn't seem to take these things into consideration. If I stepped on a rusty nail and needed a shot, and got HIV from a dirty needle at the hospital, would you still say it was my fault because I should have taken more responsibility to protect myself and the hospital & its employees should not be forced to "protect" me at their own expense (needles aren't cheap).
There's probably a way to get an exemption anyway, like the one you spoke of for school.
Except people aren't "forced" to enter healthcare facilities like you are alluding to. You said it yourself...twice
In fact, many people don't even have to go to medical facilities to receive their flu shot. The office I work in had a wellness day where the health care providers came to us to administer the shots. Along with this, I see them offered everywhere now and I see people going to these alternate places to get them in the name of convenience. Are we to now require that these other sites make sure anyone who enters them be vaccinated? (i.e. the restaurant/pharmacy/drug store that offers them in my area)
Your example with the dirty needle falls short. Requiring clean needles to be used is not requiring the person who is tasked with this duty to unwillingly enter a foreign substance into their body that may or may not be harmful to their health in order to use the clean needles.
As for their "probably being an exemption", that's not the way it sounds in NYS. In fact there is a news article in this very thread that talks about how the health care workers there are now engaging in litigation because they aren't given any exemptions.
Thank you so much for your patronizing words and inducting me into what you consider the grown-up world.
All I'm saying is dying from lack of emergency medical care is not much of an option. Have you ever heard of duress?
But we're not just talking about preventative care here. We're talking about people who need life-saving medical care, people who need prenatal care, people who are in labor, people who may not even be conscious to object to being taken to the hospital, etc....
Maybe not, but there is still a burden placed on the hospital and its employees. Here's another one: What if I was a nurse and refused to give anyone a shot for fear of harming my own health via a needle stick? What if I was an EMT who refused to give someone mouth-to-mouth for fear of getting sick? What if I was a doctor who refused to care in any way for a person with HIV for fear of catching HIV? What if I was a morphology technician who refused to do an autopsy on someone with hantavirus for fear of catching it? Healthcare jobs require that people put their own health at a certain level of risk every day. If they refused to accept this risk, their employer would be justified in firing them.
Hey, no problem - any time!
P.S. I'm sorry if I was patronizing; it wasn't my intention.
http://www.sciencebasedmedicine.org/?p=2116
Wash me in the blood of Rock & Roll
Ah, I see you are catching on here...sort of...except duress doesn't apply to your attempt at twisting my words at all. Dying from a lack of emergency medical care does not fall under the definition of duress; there isnt anyone coercing the person into death.
and thus we go back to an earlier post of mine that I don't think you agreed with where I said that those people before arriving in those situations could have taken the action necessary to immunize themselves. Except for the unconscious people who didn't get immunized in your example, not much I can think of that could be done there other than if they weren't immunized beforehand, chances are they didn't want to be and it wasn't something they thought necessary. If that is the case it wouldn't matter either way if they were conscious or not, because if they were afraid of contracting something by not being immunized, don't you think they would have already obtained a shot? If it's that much of a concern for some people, couldn't they get one of those wrist bracelets that diabetics wear to let people know they are diabetic if circumstances require medical attention? Only instead of being a diabetic bracelet it would be something stating they refuse ER care no matter what.
Look, I'll be the first to admit that I don't have all the answers, but that doesn't mean that I think what you are advocating is the correct way to go about this.
I thought you were worried about the patients and not the employees?
it appears to me as though scb is concerned about the general welfare of people... as in... from a public health perspective
:shock:
New York judge blocks mandated swine flu shots
The judge blocked enforcement of a requirement that all state healthcare workers be vaccinated for the seasonal and the swine influenza.
Friday, October 16, 2009
NEW YORK (Reuters) - A New York state judge on Friday blocked enforcement of a requirement that all state healthcare workers be vaccinated for the seasonal and the swine influenza, according to a New York Times web site.
The temporary restraining order by Justice Thomas McNamara, an acting judge on the State Supreme Court in Albany, New York, came in response to a lawsuit filed by three nurses who argued the mandatory directive violated their civil rights, the Times said.
The directive, issued August 13 by state Health Commissioner Richard Daines, said healthcare workers must be vaccinated by November 30 or face fines.
New York Department of Health officials said they would fight the judge's restraining order, the Times said.
The judge scheduled a hearing for October 30 on the lawsuit and two other cases challenging the mandatory vaccinations, one filed by the New York State Public Employees Federation and the other by the New York State United Teachers Union.
Calls to the judge's chambers in Albany were unanswered.
The state Health Commissioner has argued the mandatory regulation is the only way to get full participation of all healthcare workers and protect the public health. Opponents have argued workers should not be required to be vaccinated.
The new vaccine has raised questions as to how well it has been tested, whether it can cause the flu and whether it has any side effects.
Only about 40 percent of U.S. healthcare workers get vaccinated against seasonal influenza.
Okay, I think we pretty much said our pieces anyway.
Edit: I see I forgot about that other discussion too, most likely before you did since you were posting questions and I wasn't responding.
Good. This needed to happen.
Thank you for posting the link.
Flu, Me? Public Remains Wary Of H1N1 Vaccine
by Kevin Whitelaw
October 17, 2009
Fewer than half of Americans say that they are planning to receive the new H1N1 swine flu vaccine, according to recent polls — a trend that is leaving many health professionals at a loss.
"I'm genuinely baffled," says Arthur Kellermann, an emergency medicine physician at the Emory University School of Medicine who has treated swine flu cases. "The public has developed this odd sense of complacency. The only thing that comes to my mind is photos of people standing on the seawall of Galveston hours before the hurricane hit."
The public's skepticism over the vaccine has persisted despite health experts' warning that the unpredictable H1N1 virus, which can cause very severe complications even in healthy young adults and children, has reached pandemic proportions.
The Centers for Disease Control and Prevention says an unusually high number of children have died since it first arose last spring. "There are now a total of 86 children under 18 who have died from the 2009 H1N1 influenza virus," the CDC's Dr. Anne Schuchat told reporters in a briefing Friday. Eleven of those deaths were reported in the past week, the CDC says.
Public health officials and the medical community are scrambling to figure out how to convince more Americans to get vaccinated when supplies of the vaccine become more widely available, but it won't be easy.
Creating Awareness, Avoiding Panic
For one thing, there are many different reasons why people say they are unlikely to get vaccinated. Nearly a third are worried about side effects, according to a Harvard School of Public Health survey in September. Twenty-eight percent said they don't believe they are at risk for a serious case of the flu, while another quarter say they can get medication to treat the flu if they do get sick.
That last statistic is the one that really worries Kellermann, who is also an associate dean for health policy at Emory's medical school. He says that even a mild flu outbreak could overwhelm the nation's emergency rooms, which already have a limited supply of the high-tech equipment that is needed to fight the most virulent cases of the H1N1 virus.
"This flu, seemingly by random, occasionally picks out the healthy child or young adult and puts them in the intensive care unit, hanging on by a thread," he says. "We don't have thousands and thousands of ICU beds and high-frequency jet ventilators standing by to care for those people."
For now, government officials are trying to walk a fine line with their message: They're touting the safety of the vaccine and warning about the risks of swine flu, but stopping well short of creating a panic.
"They really can lose public credibility for decades if what they do is threaten that thousands are going to die and be hospitalized, and it doesn't occur," says Robert Blendon, a professor of health policy and political analysis at the Harvard University School of Health. "They feel confident there's going to an outbreak, but they don't know how many severe cases there will be."
The swine flu vaccine is now being distributed in some places and is being targeted to those considered at high risk, including health care workers. Pregnant women and children are likely to be next. But the CDC says some deliveries of vaccine will be delayed because production is lower than expected. And officials do not want to create a panic.
"There's too much at risk to try to use scare tactics to try to get people to vaccinate," says Kristine Sheedy, the communications director for the CDC's National Center for Immunization and Respiratory Diseases. "While we don't want to scare people into getting vaccinated, we also want to make the disease real."
High-Profile Skeptics
It is still very early in the fall flu season. As skeptics see more and more people getting vaccinated, experts expect others to change their minds. Reports of swine flu deaths, particularly in people's own communities and schools, could end up being the most powerful motivator.
But this year, officials are also fighting some high-profile counterweights to their message. First, an unusual set of high-profile personalities — including conservative media commentators like Rush Limbaugh and Glenn Beck, and more liberal ones like Bill Maher — is publicly opposing the vaccination effort.
Their opposition appears to be part of the larger anti-government movement that has been vocal during the debate over the Obama administration's efforts to overhaul the nation's health care system. Beck told his viewers on Fox News that he would do "the exact opposite" of whatever the government recommends. Maher echoed that on his HBO talk show, saying, "I don't trust the government, especially with my health."
It's not yet clear how persuasive their opinions will be. "There's no question that the anti-government feeling and fears are playing a role," says Blendon. "We just don't know the magnitude of the impact."
Public opinion surveys show that doctors and nurses are seen as the most credible sources of information on these kinds of medical decisions, but there has also been a flurry of media reports about some health professionals resisting mandatory vaccination campaigns at certain hospitals.
"It is shocking to me when I hear a news story about nurses or doctors not getting vaccinated," says Kellermann, who says that he and his entire family will be vaccinated. "It is an issue of professional ethics. It's not just that I'm making decisions about my own health, but about my vulnerable patients. It's no different than washing your hands. It's part of my job."
But the CDC's Sheedy says that doctors and nurses have always been tough sells when it comes to the flu. Vaccination rates for the seasonal flu have never topped 50 percent for health professionals — and usually hover barely above 40 percent.
"We hear the same misperceptions among some providers as we do among the general public," she says. "It is quite a challenge for us to ask the public to go out and take this step and get vaccinated to protect themselves, when we have so many health care workers out there who aren't doing the same."
Pushing A Safety Message
Most professional medical organizations do recommend that their members be vaccinated. Some are planning information campaigns to encourage wider participation.
The U.S. government is also starting to roll out its informational campaign. Part of the message will center on the safety of the H1N1 swine flu vaccine.
"There is not an understanding that those of us in this business make influenza vaccines every year with different strains," says Sheedy. "It takes us about six months, and this one took us about six months. It is just another flu vaccine."
Sheedy says that along with public service ads and flyers, the CDC is reaching out over social media sites such as Twitter to spread the message.
Beyond the warnings about the seriousness of swine flu and reassurances about the vaccine's safety, there is one other simple point, made by Leigh Vinocur, an emergency physician at the University of Maryland School of Medicine:
"Does it feel good to have the flu?" she asks. "Do you like staying home in bed for two days feeling like you've been hit by a truck?"
I typically have high regard for NPR. So I was perplexed by this article as it was EXTREMELY biased for getting the vaccine. I mean, I go to NPR for objective and independent news once in a while, but any proponent for objective journalism would know that this article is obviously a bias piece. So I went to the npr.com home page. There are 11 articles that are pro-vaccine and not one being objective on the subject. The credibility of NPR has just flown right out the window. How TRULY disappointing.
OR maybe NPR is still credible and it's just a good idea to get the vaccine.
8/20/09
Department of Health and Human Services Secretary Kathleen Sibelius has not only given immunity to the makers of Tamiflu and Relenza for injuries stemming from their use against swine flu, she has granted immunity to future swine flu vaccines and “any associated adjuvants”.
The last time the government embarked on a major vaccine campaign against a new swine flu, thousands filed claims contending they suffered side effects from the shots. This time around, they will have no recourse.
The 2006 Public Readiness and Emergency Preparedness Act (the PREP Act) allows the DHHS Secretary to invoke almost complete immunity from liability for manufacturers of vaccines and drugs used to combat a declared public health emergency.
The PREP Act removes the right to a trial jury unless a plaintiff can provide clear evidence of willful misconduct that resulted in death or serious physical injury -- and gets permission to sue from the DHHS Secretary.
But once the PREP Act is invoked to shield manufacturers from liability, the pharmaceutical firms have no financial incentive to make the safest product, and have a negative incentive to test it for safety. As long as they do not deliberately harm consumers of the product, they will not be liable for damages.
Well this is nice and comforting to the consumer.
http://www.foodconsumer.org/newsite/Non ... akers.html
Henry I. Miller, 05.07.09, 02:13 PM EDT
Obstructive bureaucrats at the World Health Organization
The emergence of new viral diseases serves as a reminder of the high stakes and huge ripple effect of public health decision-making. The 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) should have been a wake-up call. Over a few months, the illness, caused by a previously unknown coronavirus, spread from the Guangdong province of China to more than three-dozen countries in North America, South America, Europe and Asia before the outbreak was contained. It sickened about 8,000 people worldwide, of whom 774 died.
The impacts were widespread and dramatic. International travel was curtailed, world-class athletic events scheduled to be held in Asia were canceled or moved elsewhere and the disruption of commerce caused economic losses in the billions of dollars. Although only eight people in the U.S. showed laboratory evidence of SARS infection, and most of them had contracted the virus abroad, many Americans assiduously avoided Asian businesses.
Although we are still at the stage of observing developments and accumulating data concerning the ongoing H1N1 flu outbreak, we've already learned a few important lessons. First, the electronic media, in particular, has been neglecting necessary context in their reports to the public. Applying the ethic, "If it bleeds, it leads," they have been hyping the story endlessly and breathlessly.
Second, the essence of public health decision-making involves complex tradeoffs and cost-benefit calculations. Overly conservative, risk-averse actions can have dire consequences.
Third, the decisions and pronouncements from the World Health Organization, an agency of the highly politicized and invariably self-serving United Nations, have not been reassuring. Most flu and public health experts consider them to have been overly alarmist, and that their decision during the week of April 27 to raise the pandemic flu threat to the penultimate Level 5, "Pandemic Imminent," far outpaces the data that have accumulated and is therefore unwarranted.
But this is what we have come to expect from an organization that is scientifically challenged, self-important and unaccountable. WHO may be well equipped to perform and report worldwide surveillance, but its policy role should be drastically limited.
The decisions that need to be made are difficult, encompassing virology, medicine and even economics and ethics. Should nations close borders and restrict domestic and international travel and trade? And given the relatively indolent spread of the H1N1 virus, should we rush to prepare vast amounts of vaccine?
The closing of borders would deny access to many items made abroad that are needed during a pandemic, including masks and gloves, electrical circuits for ventilators and communications gear and certain pharmaceuticals and their precursors. And it would severely disrupt commerce and the creation of wealth, both of which ultimately impair the health of individuals and societies.
Even if we did begin to formulate and manufacture a vaccine immediately, it would arrive far too late to significantly attenuate the first wave of infections, but a crash program to manufacture a vaccine could possibly blunt the second wave, if there is one. (Historically, flu pandemics have come in two or three waves, lasting a total of 13-23 months, in the case of the devastating 1918-1919 panish flu, which killed 20 million to 50 million worldwide, the vast majority of deaths occurred during the second wave, which began several months after the first--possibly following a genetic change in the virus during its sojourn in the Southern hemisphere during their winter.)
A complicating factor is that the production of a swine flu vaccine would need to occur at the expense of the vaccine against next winter's seasonal flu, which still kills 30,000-40,000 a year on average in the U.S., and 10 times that number worldwide--even when a significant fraction of the population is immunized with an effective vaccine.
Although often the pandemic strains are both qualitatively and quantitatively worse than the seasonal ones, this does not seem to be the case for the new H1N1. If it were, a high proportion of those infected would require hospitalization for pneumonia and would be dying. However, except for Mexico (for reasons that remain unclear), illnesses have generally been mild, hospitalizations few and mortality minimal.
The WHO's leaders, who have informed vaccine manufacturers that within a few weeks they can expect a request to divert some proportion of vaccine production be diverted to an H1N1 vaccine, appear to lack a basic understanding of how flu vaccines are developed and produced and the timeline for it; some of the obstacles involved are described here and here.
For now, any requests by the WHO to shift production to a vaccine against H1N1 at the expense of the seasonal vaccine should be categorically rejected. And in the longer term, we need to re-think the mandates, management and accountability of the WHO. The health of the world's population is too important to be entrusted to this bunch.
The UN's involvement in international public health policy is just one manifestation of its grand design; the organization has become the regulator-wannabe for all manner of products and human activities, from chemicals to new genetic varieties of plants. The UN's regulatory policies, requirements and standards regularly defy scientific consensus and common sense: UN agencies' virtual ban on DDT for mosquito control and their stultifying regulation of agricultural biotechnology are lamentable examples. The result is a more precarious, more dangerous and less resilient world.
Why is there such relentless incompetence within the sprawling organization?
First, the UN is essentially a monopoly. Inefficiency and incompetence are not punished by "consumers" of their products or services spurning the UN and patronizing a competitor. On the contrary, it is not uncommon in these kinds of bureaucracies for failure to be rewarded with additional resources. In other words, it's not working so let's make it bigger.
Second, we need to recall economist Milton Friedman's observations that if you want to understand the motivation of an individual or organization, follow the self-interest. Sadly, the self-interest of UN bureaucrats seems seldom to coincide with the public interest. UN officials are rewarded for making the bureaucratic machinery run--regardless of the value of the decisions and policies.
Third, there's no accountability--no House of Lords Select Committee, U.S. Government Accountability Office or parliamentary oversight (recall the Iraq oil-for-food debacle and its cover-up at the UN), and no electorate to kick the UN reprobates out when they act contrary to the public interest. It's hardly surprising, therefore, that we see egregious examples of ineptness, arrogance and corruption, let alone day-to-day featherbedding and laziness in individual UN programs and projects.
Fourth, in the absence of accountability, UN officials feel little need for transparency in policymaking; and the PR offices simply spin, spin, spin. Several years ago I attended a major WHO event in Geneva at which the NGO I represented was denied accreditation because it was known to be an advocate of free markets and a critic of some of the UN's policies. You get to participate in the UN's marketplace of ideas only if there is official approval of what you're selling.
Fifth, there's the issue of the quality of the pool from which senior UN officials are selected. The country or region of origin of a candidate is more important than the nominee's credentials and qualifications: no meritocracy there. Finally, ponder this factor related to the competence of the potential candidates: If you were a nation's president or its environmental or health minister, would you send your best and brightest people to work for the UN?
After about two weeks of accumulated knowledge and widespread publicity about the H1N1 outbreak, policymakers worldwide are left with vexing cost-benefit decisions. The bureaucrats at the WHO and other UN agencies will be little help. They are worse than any germs.
Henry I. Miller, a physician, molecular biologist and former flu researcher, is a fellow at Stanford University's Hoover Institution. He headed the FDA's Office of Biotechnology from 1989 to 1993.
http://www.forbes.com/2009/05/07/world- ... e-flu.html
DId you not read the article? It was blatant biasness. It REEKED of agenda.