I woke up yesterday morning with a sore throat and mentioned this fact to a friend. "Swine flu?" he asked, oinking a few times for emphasis. No, as far as I can tell, I do not have swine flu, the virus more formally known as H1N1. But even if I did, I'm not entirely sure that anyone around me would take it very seriously.
How did we get to this point? That is, how did we get to a point where outbreaks treated with the utmost seriousness by the World Health Organization—swine flu has been officially declared a pandemic—receive vastly different levels of respect in different countries, different cities, and even among different social groups within them? Some seem convinced that the current flu epidemic is a modern version of the Black Death. Others—including a number of elected politicians and health bureaucrats—suspect a hoax perpetrated by Swiss drug companies. Although the wide variety of reactions has been present since the disease first appeared in the spring, the subsequent failure to come to any global consensus about how swine flu should be treated is producing as many medical reactions as there are national governments.
Look at Ukraine, for example, where public awareness went from "zero" this summer to "panic" this autumn. Late last month, politicians began to speak of mass illness and mass death. The government quarantined several provinces, shut down parliament, and banned mass gatherings. When the dust began to clear last week, it appeared that there had been a small outbreak of swine flu, but most of the people who got sick didn't have the H1N1 virus. So far, swine flu death rates in Ukraine are no higher than those for flu or pneumonia in other years.
None of which has stopped the flu panic from spreading westward faster than the virus itself—though, again, all Ukraine's neighbors have behaved differently. Slovakia closed most of its border crossings with Ukraine. Hungary did not close its borders but launched a mass vaccination campaign. Poland did neither and has so far bought no vaccine at all on the grounds that swine flu is actually more benign than ordinary flu and that the vaccine might therefore do more harm than good.
Each one of these countries has produced different medical explanations for its actions, and each medical explanation is widely perceived to be a cover for political machinations, at least by the relevant government's opponents. In Ukraine, a second wave of rumors now holds that the flu panic was spread by one or more presidential candidates (elections are due in January) in order to gain an advantage; the current president has accused the prime minister, who is seeking the presidency, of spending more on her election campaign than on flu-response measures. In Hungary, widespread distrust of a very unpopular government has led to mass refusal to use the expensively purchased vaccine. In Poland, some accuse the health ministry of plain stinginess.
The politicization of disease response is not unique to Eastern Europe; nor are arguments about who gets which treatment. In the United States, an outcry followed the news that employees of Goldman Sachs and Citigroup got their vaccines before others; a similar scandal erupted in Germany when it emerged that two kinds of vaccine are available—and that the one perceived to be "safer" is going to government officials and the military. Few of the world's democracies will avoid a partisan debate over disease response this flu season, while few of the world's autocracies will avoid wild rumors.
I've written before that a touch of media panic never hurts—at least it teaches people what the disease in question might be—but what we're seeing now is something different—not media panic, but official panic, inconsistent information, and rapid policy changes that seem inspired by political demands, not medical need. As it turns out, hardly anyone, anywhere, has thought through the logistics or the morality of rapid vaccine distribution. As it turns out, hardly anyone knows what to make of the World Health Organization and its Web site. Is the word pandemic just medical bureaucratese for a cough and a sore throat? Or does it mean that everyone who isn't vaccinated will die?
Presumably, the answer lies somewhere in between, but WHO hasn't yet figured out how to explain that. Neither have most national governments. You can train all the doctors you want, but if they can't explain to the public concepts like "high-risk groups" and "probability" and "some people really need this vaccine, but most don't," then every epidemic, severe or mild, will become a public-relations disaster. So far, swine flu is not a medical emergency, though no one says that very clearly. And if it becomes one, how will we know?