The United States' swine flu vaccines will leave millions worldwide unprotected.

Health and medicine explained.
Sept. 17 2009 3:36 PM

To Boost or Not To Boost

The United States' swine flu vaccines will leave millions worldwide unprotected.

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The painful part is that the adjuvant being used to boost these swine flu vaccines, known as MF59, has been used to boost seasonal flu vaccines in Europe for 12 years now—and those vaccines have caused no more adverse effects than our unboosted U.S. vaccines have. * It appears to be quite safe. Vincent Racaniello, a prominent virologist at Columbia University who also keeps the Virology Blog, told me his European colleagues are aghast that the United States doesn't use the adjuvanted seasonal flu vaccines. "They think we're nuts," Racaniello told me. "They simply don't understand it."

But, as Racaniello noted, what his European colleagues really don't understand—and what the CDC and other U.S. health officials understand all too well—is that this country's anti-vaccine sentiment is so strong, and its distrust of scientists so great, that the sensible, even obvious public-health decision about adjuvanted flu vaccines is an untenable political decision.

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"There's simply no way," as Racaniello put it, "that you want to buck that sentiment."

And so we have ordered, with only rare discussion of the consequences, some 195 million doses of an unboosted vaccine that consume enough antigen to make 390 million doses of boosted vaccine. * Even worse, of those 195 million doses, we'll probably use, given our vaccination anxiety, perhaps 60 million to 100 million.   If that is the case, we'll probably throw away about 100 million or more doses.

Our vaccine anxiety runs high—and it, along with a growing distrust of science and medicine and our relentless focus on individual rather than community health, has led us to short the rest of the world some 200 million to 250 million doses. Even if the virus retains its present, relatively "mild" course—killing about as many as the seasonal flu but more heavily concentrated on adults under 60, especially the sick and the pregnant—this could mean some 20,000 to 50,000 deaths.

It is natural to look after your own. It's understandable to seek maximum safety. But from masthead height, this looks mighty ugly. Our insistence on the safest vaccine possible means halving the supply, even as our own domestic drug factories are devoted to more-profitable drugs. Effectively, we're taking two doses from others to give us one. We come off looking rather like the proverbial first-class passengers who, having scoffed at the need for lifeboats because they take up deck, now scramble into the few rafts while steerage looks on.

We could, of course, make some amends by giving away half of the 195 million doses we have lined up, since they're going to go twice as far as anticipated. But with health care and vaccines so laden politically, that, too, seems unlikely.

Correction, Sept. 21, 2009: This piece originally suggested that we will have double or quintuple the expected supply of swine flu vaccine. We will have double or quadruple the vaccine. (Return  to the corrected sentence.) Also, the available supply of antigen could create 390 million doses of boosted vaccine, not 380 million. (Return  to the corrected sentence.)

Correction, Sept. 21, 2009: This piece originally and incorrectly stated that MF59 adjuvant has been used in both Canada and Europe for the last 12 years. Europe has used the adjuvant for that long; Canada has not. (Return  to the corrected sentence.)

David Dobbs is writing The Orchid and the Dandelion (Crown), a book exploring ideas about how genes and experience shape temperament, behavior, and fate.