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Brian Edwards, CBE
University of Sheffield, UK
HOPE (European Hospital and Healthcare Federation)
The European Parliament has been strongly critical of the European response to the swine flu outbreak in 2009–10.1 Michèle Rivasi, a Green Party representative from France, reported that there had been a disproportionate response across Europe that was potentially influenced by the pharmaceutical industry. H1N1, the official name for swine flu, caused 2,900 deaths in Europe by April 2010, comparing with 40,000 deaths due to seasonal flu in a moderate year.
The response of member states ranged from wholesale vaccination programmes to none at all, as in the case of Poland. The cost ran into billions of euros – €3 billion in the UK and €700m in France.
The World Health Organization has been asked to review its definition of a pandemic to take into account the severity of the illness as well as the spread of the virus. The European Centre for Disease Prevention and Control should be equipped to assess risks independently, according to MEPs, although Marina Yannakoudakis, a European Conservative and Reformist from the UK, thought that this was beyond its competence and could create a false sense of security. Communication about flu outbreaks must be more independent with safeguards to prevent conflicts of interest including declarations of interest by those experts advising European health authorities.
This tough language hides a real dilemma for public health. Do governments act promptly to safeguard the public health or wait until the problem has got well underway? What if the virus had developed beyond a moderate threat into something much more serious? Who decides what risk is proportionate and should this be a national or a European decision? Anne Delvaux, a Christian Democrat representative from Belgium, thought the experience had put at risk the trust of the citizen in public health messages. All vaccines have some side effects and Finland had suspended the use of the vaccines pending the outcome of further trials.
It must remain, for the present at least, a national decision given that the cost has to be set against other national health priorities. Some procurement coordination would be useful but it is doubtful whether this would influence cost.
Some of the H1N1 vaccines could of course have been falsified and the European Parliament has now approved new rules that should prevent falsified medicines from entering the legal supply chains. Marisa Matias, a member of the European United Left/Nordic Green Left and a representative for Portugal, said that falsified medicines are “silent killers, either because they are devoid of effect or because they contain toxic substances that may harm, or even kill, those who take them”. The scale of the problem in Europe is limited to perhaps 1% of the supply chain but in other parts of the world it could be as high as 30% including lifesaving drugs. One per cent still represents a lot of patients at risk of harm.
In an important new step, the rules will apply to Internet sites that act as a key route through which fake drugs enter the EU supply chain. In those EU countries where Internet pharmacies are allowed to operate they will need to be authorised to supply drugs to the public and will be required to display a common logo recognisable throughout the EU to help the public ascertain linkage to an authorised pharmacy.
Response to the next virus may be more considered and action better coordinated. We had better hope that this process does not slow down appropriate action.