If you think that everything is going just swell with the efforts to immunize the American population against swine flu, that's because you've been reading the New York Times, the Washington Post, USA Today, or the Los Angeles Times. Today, these papers are trumpeting the great news that a single dose of the vaccine probably will protect adults from the virus. But they bury the real lede: The vaccine may arrive too late in the United States to help all but the lucky few.
The stories report new findings, from Australia, that one dose of the H1N1 vaccine should provide immunity in adults, which means that there ought to be enough of it to go around. (The U.S. government, with great fanfare, today heralded similar results in trials here.) The bad news, underplayed or left out of today's reports, is that it may be impossible to deliver enough of the vaccine to protect the vast majority of people who most need protection—and that widespread disease may be inevitable: The first shipments of the vaccine aren't expected to arrive until mid-October—just as the first peak of H1N1 infections is predicted.
Those are the findings of Science magazine reporter Jon Cohen, who has been covering the story since the virus was first identified. Writing in Science's blog today and in this week's issue of the magazine (paid), Cohen cites the August report by the President's Council of Advisers on Science and Technology as well as University of Washington biostatistician Ira Longini to make his case.
(Disclosure: Cohen has contributed to Slate, is a close friend of mine, and worked for me long, long ago.)
Longini seconds (paid) the White House report's prediction that a "mismatch in timing could significantly diminish the usefulness of vaccination." His paper argues that at least 70 percent of the population—children first—must be vaccinated to effectively curb the spread of influenza. In the rosiest scenario, the H1N1 vaccine will start arriving in mid-October, conferring immunity on the vaccinated in about two weeks. But those early vaccinations will be of limited value if the epidemic is peaking at the same time they're given. As Longini and others note, that's what happened during a deadly influenza pandemic in the fall of 1957, killing an estimated 80,000 Americans.
If, by luck, the epidemic peaks in mid-November or mid-December, the nation is still in for trouble. In August, Longini presented a model for the coming epidemic for a Lancet conference (PDF) that predicted a massive shortfall in vaccine coverage (see Slide 21). His model assumed that two doses of the vaccine would be required per person—which still might be true for children—before news that one dose is sufficient in adults surfaced. But that hasn't changed Longini's prediction of a huge shortfall in vaccine coverage. If the current influenza pandemic mirrors the 1957 U.S. pandemic, Longini tells Cohen, the H1N1 vaccine may arrive "too late to have any effect on the pandemic."
The Washington Post waits until 885 words into its 1,000-word story to note that "the first Americans would not be protected until after the outbreak might have peaked." Then it drops the subject.
The New York Times' upbeat 900-word story reports the likelihood that the nation's 159 million high-risk people could be vaccinated "well before the flu's expected midwinter peak." This discussion of a "midwinter peak" is curious, because it's the autumn peaks that epidemiologists are most worried about. The Times reports two-thirds of the way through its piece that the vaccine won't start arriving until mid-October and then drops the subject without mentioning that the outbreak might have already peaked by then. Likewise, brief articles in the Los Angeles Times and USA Today neglect the supply and timing crisis.
It's not as if the press corps is oblivious to the supply and time problems spelled out in the White House report. The Aug. 25 Washington Post highlighted the report's findings about the "potential mismatch in timing" of the vaccine, as did USA Today, which warned in its Aug. 25 edition that "the first doses may not become available until after the swine flu season peaks." As long as we're handing out passing grades, let's give one to the Aug. 25 Wall Street Journal, which drew attention to White House findings that the inoculation campaign would start just as the infections peaked. The New York Times and Los Angeles Times don't soft-pedal the dangers of the flu but they fail to address the peaking-in-October topic.
How to explain the inadequate coverage? Have reporters fallen for the Obama administration's official message that everything is going swimmingly even though the White House's big August report pointed to gut wagons filled with the dead? I'm totally befuddled. I grew up believing that reporters love to accentuate the negative. I can't be the last Gloomy Gus in the newsroom, can I?