The H1N1 Flu Pandemic: What Went Right and Wrong?

The H1N1 pandemic of 2009-10 may be fading from memory for most. But for the public health community, swine flu provided a critical case study in how well-prepared we are for a widespread outbreak of novel communicable disease. The pandemic also offers important lessons on the persistence of health disparities and on the importance of public trust in public health emergencies.

So with flu season upon us, it seems a fitting time to review a June 2011 report by the U.S. Government Accountability Office summarizing what worked and what didn’t with the federal government’s $4.1 billion H1N1 response effort.

Key findings:

  • While the pandemic didn’t unfold as planners had imagined, advance efforts paid off because they established relationships between different sectors of government;

  • Government credibility was compromised when vaccine availability didn’t live up to what was promised;

  • Information about H1N1 risk was communicated effectively to most people, but not to those who spoke little or no English;

  • The Strategic National Stockpile—the government’s stash of medicine and medical supplies for a national emergency—operated as planned, but gaps in distribution and long-term storage plans were identified.

According to the Philadelphia Department of Public Health, 276 residents were hospitalized with H1N1 during the initial phase of the pandemic—10% of whom were admitted to an ICU and 3% of whom died.

Two additional challenges worth noting here lay beyond the scope of the GAO Report and require further attention.

First, the 2009-10 flu season underscores the relationship between vaccination and health disparities by self-identified race and ethnicity. Vaccine disparities have been associated with several factors, including socioeconomic status, access to health providers, religion, culture, language, and political values. Trust in government and medical institutions, as well as the attitudes of healthcare providers, and family member opinions on vaccination, are also believed to play a role in fostering disparities.

In 2009-10, there were measurable disparities among racial and ethnic groups. For the seasonal flu vaccine, for example, non-Hispanic whites, Asians, and Native Americans had higher vaccination rates, while African-Americans and Hispanics had lower overall rates. For that year's separate H1N1 vaccine, Native Americans and Asians had the highest rates, non-Hispanic whites and Hispanics moderate rates, and African-Americans, the lowest. Rates for the H1N1 vaccine were lower than for seasonal flu across the board, primarily because of the shorter window to receive the vaccination (it wasn’t widely available until November), and because of a popular perception, as the pandemic wore on, that it wasn’t as serious as expected and didn’t merit getting the vaccine.

Second, and finally, we are not going to delve into the belief in some circles that governments around the world overreacted to the virus, setting off an unnecessary international response at great expense. You can read about that here or here. However, an important lesson remains: When it comes to vaccination, the public’s trust is increasingly fragile, and governments, particularly in the United States, must articulate clear risk messages about the virus, and about the vaccine itself.

If you have thoughts about the GAO report, about vaccine-related disparities, or about issues of trust concerning vaccination programs, please post a comment. We invite all perspectives to join in this dialog.

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