The Canadian government’s response to the H1N1 virus has been widely criticized for its perceived lack of foresight regarding its ability to inform and inoculate an increasingly frightened public.

Although the actual logistics of providing the vaccine are largely being seen to by individual provincial health services, Steven Harper’s Conservative government has borne the brunt of attacks about their level of preparedness in managing what the World Health Organization has been calling a global pandemic of so called ‘Swine Flu’ since August 29, 2009.

On October 21, 2009, Health Minister Leona Aglukkaq and Canada’s chief public health officer Dr. David Butler-Jones hosted a joint press conference in Ottawa to urge all Canadians to ward against this new, highly virulent and potentially deadly strain of influenza.

“I’m happy to say that today Health Canada has authorized the H1N1 flu virus vaccine,” said a reassuring Aglukkaq, “This is a milestone in our efforts to fight H1N1 flu virus.”

However this did little to allay fears by skeptics that the drug was not being subjected to the same degree of safeguards expected of other vaccines. The reality is that the H1N1 vaccine has been developed in exactly the same manner that all seasonal vaccines have been for the past 60 years; the virus is grown in chicken eggs, purified, and then treated with a chemical agent which inactivates the strain.

During questioning, Aglukkaq later admitted that although the vaccine had passed Health Canada’s preliminary testing, the drug had not yet completed clinical trials in Canada, which according to the WHO’s website, “Previous influenza vaccines for the southern and northern hemispheres, including that for the 2009/2010 flu season, are ineffective against the new strain. It could take several months to develop, manufacture, and distribute a new vaccine.”

It’s worth noting that this is well within normal vaccine production and distribution timeframes, particularly for a viral strain whose first cases were only diagnosed in September 2008. In the following year, the swine flu threat has been closely monitored worldwide, prompting the WHO to raise its pandemic warning to their second highest level of 5 in April/09. This meant that the WHO considered the threat of a pandemic to be “imminent, and that human-to-human transmission cases have been recorded in multiple countries.”

Both Aglukkaq and Butler-Jones emphasized that the vaccines should be prioritized to initially inoculate those Canadians deemed most at risk of contracting the virus, which included children under 5 (with those under 2 years of age especially vulnerable), people 65 or older, pregnant women, health care workers, people living in remote areas and Canadians with underlying medical issues, particularly respiratory ailments.

This brought about fresh concerns about the contents of the vaccine. The current form available in Canada is one which contains an ‘adjuvant.’ Adjutants are chemical compounds added to vaccines to stimulate or boost the immune system, most commonly used when there is a limited supply of the antigen (the agent which when introduced into the body, stimulates the production of an antibody), or when the vaccine itself does not produce an effective or sufficient antibody response.

GlaxoSmithKline, the pharmaceutical company that produces the vaccine, has a contract with the Canadian government to manufacture 50 million doses from its facility in Quebec City.

Canada has ordered nearly 2 million doses of the H1N1 vaccine to be manufactured without the adjuvant specifically for pregnant women and young children, because of the lack of testing data on reactions to the drug among those high risk groups.

This fuelled a public outcry as to why the Harper government was authorizing the use of the adjuvant containing vaccine for high risk groups such as young children and pregnant women, without adequate information regarding the safety of the drug on those most vulnerable groups.

The government later amended its guideline to suggest that the adjuvant form of the vaccine was in fact safe for pregnant women past the 20 week period of their first term.

Many in the medical profession have also expressed concern about the level of information they have received in advance of the roll out of the vaccination program. Doctors and nurses across the country have complained that they have not been provided with adequate information to relay to their patients about when and where to receive the shots, and have been forced to rely on the Health Canada website for what news they can confirm for the benefit of their patients. Hospitals and health clinics have been disappointed in the lack of access to up to date information regarding what is being called the largest mass inoculation program in Canada’s history.

Harper himself only added to the frustration and confusion when asked directly at an October 14 press conference if and when he would himself be immunized; “My plan, if it’s generally recommended for people to get the vaccine, my plan is to get the vaccine. But as yet, of course, we haven’t actually made a final decision or set a date. We’re, as you know, right now, waiting [for] final approval of the vaccine, but we expect that imminently.” Harper’s aides later clarified that what the P.M. meant was that he would get the vaccine when it was approved by Health Canada, not if or when it was recommended. That approval subsequently followed a week later.

Despite Health Canada’s assurances that adequate volumes of the drug would be available for the first week in November, the dire warnings about the effects of the virus, as well as the growing numbers of casualties (a total of 101 as of November 3, 2009), has prompted larger than expected crowds of Canadians anxious to receive it, with people waiting from between 2 to 6 hours in some cases due to the huge lineups at clinics and health centers across the country.

Add to that the recent admission by Dr. Butler-Jones that GlaxoSmithKline has shipped excess quantities of the antigen, the main ingredient of the vaccine, to nations overseas that require it. This comes on the heels of the embarrassing news that many flu clinics across Canada have thus far received so few quantities of the vaccine, that they have to shut their doors until additional supplies become available. Butler-Jones was adamant that the antigens being shipped out of Canada would in no way impact on Health Canada’s ability to provide the vaccine to everyone in the country who wants or needs it.

“There has been bulk vaccine that we’re not able to actually fill here so that has been exported,” he said. “But all of the vaccine that we can fill in Canada has stayed and will stay in Canada until our immunization is complete.”

Compounding many Canadian’s frustration is the controversial revelation that professional sports teams from the NHL, the Calgary Flames and the Toronto Maple Leafs, as well as Toronto’s NBA franchise Raptors, have this week jumped the queues and received the vaccine, while thousands of high priority Canadians continue to wait for hours in mass lineups to receive theirs.

All in all it would be difficult to ignore the growing sense of doubt in the minds of many Canadians as to how well their government is being seen to have dealt with the issue of H1N1 at the start of the seasonal flu season.

The next month should be the last grace period Mr. Harper may enjoy if he and his government cannot convince Canadians that they have met the challenges of swine flu in a timely and effective manner.

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Tags: h1n1, health, healthcare, leona aglukkaq, stephen harper, swine flu

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