Raphael Vassallo
Karl Stagno-Navarro
The medical profession has thrown its weight behind the Health Division’s ongoing immunisation campaign against the A-H1N1 virus, with all practising GPs who spoke to MaltaToday readily affirming that they themselves would recommend vaccination to their own patients.
Dr Julian Mamo, epidemiologist and public health doctor, explained that public concerns about the safety of the new vaccine have to be viewed within a much wider context than the local scenario alone.
“It s fair to say that, on a global level, the health benefits of vaccination may not be as high as many claim them to be,” he conceded. “But then again, the reported health risks associated with the same vaccine are nowhere near as serious as some would have us believe.”
Contrary to various reports, especially on the Internet, Dr Mamo explained that the vaccine has in fact been tested well within the usual parameters for approval by the World Health Organisation.
“Having said that, it is impossible to safeguard against the odd, one-in-a-million unforeseen side-effect,” he said. “This is however true of other drugs also.”
Barring the possibility of complications affecting an infinitesimal fraction of the population – which would in any case be impossible to prevent without undertaking millions of tests – the numbers of tests carried out to date is adequately comparable with those of other approved medicines.
But what makes the situation with A-H1N1 slightly different is that, unlike many other medications upon first release to the public, it is being recommended specifically for (among others) pregnant women and children under five – normally deemed to be at higher risk than other categories.
“In the balance of benefits, persons falling within ‘vulnerable’ categories such as these will benefit far more than a non-vulnerable individual,” Mamo said. “The converse is also true: a healthy person will not stand to gain as much by immunisation as someone with any of the recognised high-risk conditions.”
Nonetheless, the Health Department is apparently unsatisfied with the public response so far, and is now set to boost its public awareness campaign on the importance of vaccination against the A-H1NI virus that so far has been responsible for the death of four people in the country.
Speaking to MaltaToday, the Director-General for Public Health Ray Busuttil stressed that the 18,232 figure of persons who so far have taken the vaccine, is still a far cry from the targeted 100,000 who fall under the category of the most vulnerable, which includes people with chronic diseases, pregnant women, the elderly, and health professionals.
“In four days since we initiated the vaccination programme we have just exceeded 18 per cent of those who should be first to take it,” Busuttil said, while adding that it is high priority to encourage more people to take the vaccination.
Ray Busuttil - who is a doctor by profession – stressed the importance that one takes the vaccine as a measure to be “better prepared to face a normal disease but that could develop complications that may lead to death.”
He criticised the sceptics who have been talking to the media and ‘scaremongering’ against the inoculation programme amongst the general population.
“The rumours that are being spread about the vaccines are senseless and are definitely not based on any scientific or medical evidence,” he said, while adding that the vaccines have been certified by the World Health Organisation (WHO).
The Director General for Public Health also stressed the fact that the WHO and the European Medicines Agency (EMA) have worked in the best interest of the populations.
“None was subjected to any influence or pressure, either governmental or public. WHO and the EMA acted solely in the best interest of the health and safety of all citizens,” he said.
Apart from the health concerns of individual patients, another benefit of widespread immunisation (from the point of view of the medical profession) is that it reduces the risk of ‘cross-mutation’ between the swine flu virus with existing seasonal influenza.
“There is a possibility of yet another mutation of A-H1N1, which is what we are all worried about,” one doctor, who preferred not to be named, told MaltaToday. “As you are aware A-H1N1 is a mutation of ordinary swine flu (affecting pigs) which unlike the original virus can be passed on from human to human. But what is not often reported is that the rate of fatality of this new strain is actually less than ordinary seasonal influenza.”
The latter stands at approximately 0.7 per 100,000 patients. Swine flu so far has registered a fatality rate of around 0.4 per 100,000 patients... making it theoretically ‘safer’ than ordinary flu.
“The difference is in the categories most affected. If an 80-year-old dies of the flu, it is not normally reported in the media. But if the victim is 20, it’s a different story...”
Hence the fear of an additional cross-mutation, which could have entirely unpredictable effects: “A new virus mutation at this stage would be a far worse scenario than the present one, because where the A-H1N1 has proved less fatal than ordinary flu, it is impossible to say what sort of disease a new mutation would result in.”
Ensuring widespread inoculation is therefore more than just a way of preventing infection of an individual patient with an existing disease: it is also an important part of public health strategy towards preventing new diseases from forming in the first place.
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