H1N1 pandemic ending with a whimper, not a bang

With H1N1 poised to enter history as the least deadly of four global flu pandemics, some experts are calling for an end to Canada’s mass vaccination program.

Nature is already achieving what we would hope to achieve by vaccinating, they say.

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The drop in cases suggests Canada has hit the critical fraction of the population that needs to be vaccinated to control the pandemic, says Dr. David Fisman, a University of Toronto expert in infectious disease dynamics.

Fisman can’t understand the rational for continuing mass vaccinations. He said that for a virus as contagious as H1N1, fewer than 30 per cent of the population needed vaccination to reach a critical level of immunity.

“I’m sure that the vaccine has prevented some deaths. I’m sure that there are people who are alive right now who would not have been alive if we hadn’t vaccinated,” he says. But the pandemic was already peaking, and then subsiding before the vaccination was rolling out in force.

Full Article: here.

From the most recent issue of Strategic Change’s newsletter, Michael Schiel on “What the H1N1 Panic Can Teach Us“:

“As the public panic begins to subside over the H1N1 vaccination response by Federal and Provincial governments, there is a good chance that calmer heads will prevail. If one takes a systemic point of view, some important organizational, policy or process lessons can be garnered.

When you filter through the hype, some of the important aspects include:

• Challenges with Estimating Demand – Although much of the reporting in the media has been hyperbolic, it is clear that the provinces have had some trouble in figuring out in advance how much supply was required.
• Challenges with Supply Side – The Federal Government was somewhat hamstrung as there was only one supplier of the vaccine, and they had issues meeting the changing needs of the government and the populace.
• Supply Logistics – There were many indicators that public health organizations had some trouble determining the best approach to supplying the vaccine, as evidenced by mixed messages, the allowance of queue jumping at many places, and the inability of some clinics to realistically handle the crowds.

What does all of this mean?

• Leadership is Complex - In a recent report, the Auditor General found that “defining a leadership role when each department responds to its own ministerial direction, and coordinating that direction with other departments can be a challenge”. I have seen this before on other large multi-ministry or inter-jurisdictional projects too. From a change management perspective, it is important to determine clear leadership links in advance, or at least to widely declare them if they need to be created on the fly.
• Roles and Responsibility – Thee Auditor General also found that “…while Public Safety Canada played a coordination role in some emergencies it has yet to establish the policies and programs that would help define its leadership and coordination role for emergency management in an all-hazards environment”. More thought and effort will need to go into planning for coordination across different jurisdictions.
• Communication is Key - One of the biggest challenges has been conflicting and changing messages from the government. It would be wise in future events for a calm, strategic approach to communication to be used. People resist change naturally, and one of the best ways to overcome that resistance is a more effective communication strategy.
• Forecasting – A key lesson here is that when planning for future external events like pandemics, public sector organizations will need to continue to find better ways to estimate what the public response will be.
• Need for Engaged and Experienced Staff – The area of Public Safety Canada that was responsible for planning and responding to the pandemic had an employee vacancy rate of 39 percent in the 2008-09 fiscal year, and a vacancy rate of 50 percent the previous year. Numerous studies exist on the difficulties that the Federal Government has faced in engaging staff during the 1990s and 2000s, and several reform efforts during that time have only partially eased some of the issues. Clearly it is hard to expect top level service delivery with low levels of staff, and one can imagine the existing staff are also overworked and somewhat stressed.
• Flexibility – It must be remembered though, that no amount of planning would be able to accurately foretell what the public reaction would be. The public changed its mind dramatically as the pandemic unfolded, and the various levels of government did their best to adjust their vaccination program rollout accordingly. Patience, openness and flexibility are key characteristics to achieve success during events like this.”

Toronto doctor says he regrets urging flu shot for hospital board

Board members at Mount Sinai Hospital were offered the vaccine last Monday, the first day it became available, despite public health officials advising only those who were most vulnerable to line up for the shots.

Donald Low, chief microbiologist at the hospital, said a clinic was set up on the first floor for staff and others. There was no word of a vaccine shortage at the time.

“It happened to be the same day that there was a board meeting at the hospital. And I encouraged board members to get the shot,” Dr. Low said today. “There was no indication that there would be any shortage.”

“What seemed like a good idea at the time was a bad idea. And you got to pay the price for it.”

Full Article: here

More Toronto hospital execs given H1N1 shot

The lineup of people in Toronto who have jumped the queue for their H1N1 vaccination is longer than first thought.

Already it has been revealed that members of the board of directors at Toronto’s Mount Sinai Hospital were offered the shot last week, before it was available to people in the province’s high-risk groups.

Now CBC News has learned the board members of the University Health Network — which represents Princess Margaret, Toronto Western and Toronto General — and St. Michael’s Hospital have also had their shots.

Full Article: here

Vaccinating NHL Hockey Teams – Let’s Find a Scapegoat

As the slow, cumbersome and often incompetent roll out of the hiney (H1N1) vaccine continues, Canadians are looking for someone to get mad at.

Right on cue, the Calgary Flames have stepped into the breach. Earlier this week, the public learned that the Calgary Flames and their families had a special vaccine clinic of their own – ahead of pregnant women, young kids and people with underlying medical problems. An Alberta health official identified as “the most senior staff member involved” in the decision to allow the vaccination of members of the Flames and their families was fired.

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But please don’t blame the Flames, the Leafs or the Raptors. They didn’t jump the queue. To conclude they did so is to assume there was an orderly queue to begin with. We now know that the roll out of the vaccine—contrary to assertions by David Butler Jones, head of the Public Health Agency of Canada – has been anything but praiseworthy. It has been marked by confusion and lack of co-ordination.

Full Article: here

H1N1 Preparedness Guides are now available from the Public Health Agency of Canada (PHAC), and print copies have begun to arrive in the mail at residences across Canada. PHAC is also making the guide available online here.

H1N1 Flu Virus information is also being made available by province or territory via a clickable map.

Infection Watch Live is hard at work in southeastern Ontario, now that we’re in the third week of this second wave of Novel H1N1 Influenza A (human swine flu).

Infonaut’s online, publicly-accessible Infection Watch Live solution, implemented for KFL&A Public Health, clearly shows widespread respiratory and gastrointestinal symptom presentation in the area.

Click the image below to see live infection data for southeastern Ontario:

Google Flu Trends tool comes to Canada

Google Flu Trends, an internet search tool that tracks the spread of influenza as an early warning of outbreaks, expanded to Canada and 15 other countries on Thursday.

The company said it launched the tool in the U.S. last November after finding a close relationship between how many people searched for flu-related topics and how many people actually have flu symptoms.

Full article: here.

Scotland funds nurses returning in swine flu pandemic

Nurses and midwives returning to work in Scotland to help in any worsening of the H1N1 outbreak will have their re-registration costs paid for by the Scottish government.

The Nursing and Midwifery Council has written to former members whose registration has lapsed in the previous four years to encourage them to re-register. This would make them available to employers in the event of a surge in the pandemic.

Full article: here.

Singapore launches program to ensure business continuity during flu pandemic

Singapore launched on Tuesday a program to help businesses remain undisrupted in times of a possible flu pandemic.

The Flu Pandemic Business Continuity Program targets to help at least 1,000 companies become flu pandemic prepared by the end of 2010.

It is part of a 30 million Singapore dollars (20.98 million U.S. dollars) National Business Continuity Management Program announced last year.

Full article: here.

MDs, nurses pressing for more specific pandemic plan

Canada’s doctors and nurses pressed MPs to help fill the gaps in the national pandemic plan Monday, urging them to ask the government for more consistent communication. They also warned they do not yet feel prepared for a second wave of the H1N1 pandemic.

Representatives from three doctors’ and nurses’ professional organizations, along with the Canadian Medical Association, appeared before the House of Commons health committee and did not hold back in expressing their concerns.

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“We urge you to protect health-care workers and make SARS lessons national lessons. If the Public Health Agency of Canada (PHAC) won’t do it, nurses will.”

Full Article: here.

School nurse shortage hampers swine flu response

As schools grapple with a resurgence of swine flu, many districts have few or no nurses to prevent or respond to outbreaks, leaving students more vulnerable to a virus that spreads easily in classrooms and takes a heavier toll on children and young adults.

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When the swine flu emerged last spring, it was a school nurse in New York City — Mary Pappas at St. Francis Preparatory School — who helped identify and curtail the country’s first major outbreak after she noticed large numbers of students complaining of high fevers and sore throats.

Full article: here.