Reconstruction of a Mass Hysteria: The Swine Flu Panic of 2009

Swine flu kept the world in suspense for almost a year. A massive vaccination campaign was mounted to put a stop to the anticipated pandemic. But, as it turned out, it was a relatively harmless strain of the flu virus. How, and why, did the world overreact? A reconstruction. By SPIEGEL staff.

Photo Gallery: Overreacting to H1N1 Photos
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At first things did not look good for Edgar. The five-year-old boy had a high fever. He'd lost his appetite, his throat was burning and his entire body ached.

The people in the Mexican village of La Gloria were quick to blame the pigs. They had long been convinced that the animals were a curse. In the nearby town of Perote, half a million hogs were being fattened for slaughter. The wind carried the stench through the narrow streets of the surrounding villages. No one was very surprised when Edgar Hernandez fell ill.

But then, after only four days, the boy recovered. His illness disappeared as quickly as it had started. It turned out to be nothing more than the flu, and the people of La Gloria soon forgot about it.

'Boy Zero'

It wasn't until several weeks later that a laboratory in Canada tested a mucosal smear taken from the boy. The results made him famous. Edgar didn't have an ordinary flu, but had been infected with a new kind of pathogen, the swine flu virus. Edgar went down in history as niño cero, "boy zero," the first person to fall ill with the new plague.

The Mexican boy's infection was mild, like an overwhelming majority of the millions of cases that would occur worldwide in the coming months. The new virus would probably have attracted far less attention if it hadn't been for modern molecular medicine, with its genetic analyses, antibody tests and reference laboratories. The swine flu would have conquered the world, and no doctor would have noticed.

But the world did notice, largely because of high-tech medicine and the vaccine industry. From Ebola to SARS to the avian flu, epidemiologists, the media, doctors and the pharmaceutical lobby have systematically attuned the world to grim catastrophic scenarios and the dangers of new, menacing infectious diseases.

None of these diseases receives more attention than influenza. Researchers in more than 130 laboratories in 102 countries are constantly on the lookout for new flu pathogens. Entire careers and institutions, and a lot of money, depend on the outcomes of their work. "Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur," says flu expert Tom Jefferson, from an international health nonprofit called the Cochrane Collaboration. "And all it took was one of these influenza viruses to mutate to start the machine grinding."

Now turned up, the machinery was set into motion. Researchers got to work examining the molecular structure of the virus. The pharmaceutical industry started to develop vaccines. Government agencies laid out disaster plans. There was only one thing that everyone was ignoring: The new pathogen was, in fact, relatively harmless.

How did all this happen?

April 24, 2009 : WHO Headquarters in Geneva

Shortly after midnight Keiji Fukuda, an influenza specialist with the World Health Organization (WHO), received a phone call from Nancy Cox, the chief of the influenza division at the United States Centers for Disease Control (CDC) in Atlanta.

Fukuda and Cox had once worked together to fight the Asian bird flu. Both scientists remembered all too well how the aggressive killer surfaced in Hong Kong. A third of those infected with the virus died. To this day, Fukuda retains the fear that a similar pathogen could permanently make the jump to humans.

So the potential significance of the call was clear to Fukuda: the start of a devastating pandemic, in which, according to WHO estimates, between 2.0 and 7.4 million could die -- assuming the pandemic was relatively mild. But if the new virus proved to be as aggressive as the one that triggered the Spanish Flu in 1918, the death toll could run to the tens of millions.

"The first thing I thought was: We have to act quickly," says Fukuda. He immediately called WHO Director-General Margaret Chan, another veteran of the fight against avian flu. As Hong Kong's director of health at the time, she was the one who ordered the slaughter of all chickens in the city.

IT specialist Jered Markoff, in charge of the WHO's Strategic Health Operations Center -- also known as the SHOC room -- received a call at 3:15 a.m. Markoff activated the SHOC room from home: Using his personal computer, he issued the necessary commands to pull out the 15 monitors hidden in tables, start up the computers and switch on the large projection screens attached to the walls. Then he drove to WHO headquarters.

For the next few months, the SHOC room would serve as the center of the worldwide battle against H1N1, the swine flu virus. It was staffed 24 hours a day with three rotating shifts of WHO employees, who used videoconferencing equipment to communicate with doctors, scientists, politicians and industry representatives around the world. News, charts, maps and statistics were constantly popping up on the projection screens.

The situation was still confusing. At first, there was talk of several dozen dead in Mexico, but soon the authorities adjusted that number downward to seven. The epidemic experts were moving in a scientific gray area, filled with contradictory information and many unanswered questions. How fast does the virus spread? Which people are at the greatest risk? Does the normal influenza vaccine provide protection? Most of all: Just how dangerous is the new virus?

To obtain the best possible assessment, WHO Director-General Chan convened the "Emergency Committee," a group of 15 carefully selected experts from around the world, for a first teleconference. "In that early phase, we still had too little information," says Australian John Mackenzie, the chairman of the committee. "But everything we knew at the time sounded alarming."

Worst-Case Scenarios

Does this mean that a very mild course of the pandemic was not even considered from the start? At any rate, efforts to downplay the risks were unwelcome, and the WHO made it clear that it preferred to base its decisions on a worst-case scenario. "We wanted to overestimate rather than underestimate the situation," says Fukuda.

Mackenzie, another veteran in fighting epidemics, is accustomed to smelling trouble around every corner. He worked for the Australian Biosecurity Cooperative Research Centre for several years, where he was responsible for protecting Australia from new infectious diseases. When he left the Centre in 2008, he issued an emphatic warning about the next influenza pandemic.

Most of all, however, it was probably the horrific images of the avian flu that distorted the experts' view of the idiosyncrasies of the new pathogen. The vision of a highly aggressive virus had become lodged in their minds, a virus that, once it began to spread, would lead to catastrophe.

The media also did its part in stoking fears. SPIEGEL, for example, had reported at length on the avian flu. Now it devoted a cover story to the new "global virus," a story filled with concerns that the swine flu pathogen could mutate into a horrific virus.

The pharmaceutical industry was particularly adept at keeping this vision alive. Manufacturers of flu remedies and vaccines even funded a group of scientists devoted solely to this issue: the European Scientific Working Group on Influenza, which regularly held conferences and meetings of experts. The lobbying group was headed by Albert Osterhaus of the Erasmus Medical Center in Rotterdam, who also happened to be one of the WHO's most influential advisors on influenza vaccines.

Together with Osterhaus, Johannes Löwer was asked to provide Director-General Chan with recommendations on the subject of swine flu vaccination. The then president of the Paul Ehrlich Institute (PEI), which specializes in vaccines, is now convinced that he and his fellow experts were probably too strongly influenced by the horror scenarios swirling around the avian flu. "We expected a real pandemic, and we thought that it had to happen. There was no one who suggested re-thinking our approach."

April 27, 2009: The WHO raises its pandemic warning to phase 4, meaning it has discovered human-to-human transmission of the virus in at least one country.

April 28, 2009 : The first seven suspected cases of swine flu are reported in Germany.

April 29, 2009: The WHO raises its warning to phase 5, the last stage before a pandemic. Influenza researchers are elated. "A pandemic -- for virologists like us, it's like a solar eclipse in one's own country for astronomers," says Markus Eickmann, director of the BSL-4 high-security laboratory in the central German city of Marburg .

April 30, 2009 : Egypt begins killing all domestic pigs in the country. French actress and animal rights activist Brigitte Bardot begs President Hosni Mubarak to stop the mass slaughter, but her appeals are unsuccessful.

May 4, 2009 : In Mexico , football matches in the country's four highest-ranking leagues take place without spectators. The legislature in Germany 's western state of Saarland imposes a ban on kissing as a form of greeting.

June 10, 2009 : The WHO has received reports of 141 swine flu deaths. The majority of the victims have serious pre-existing conditions. In most cases, however, the course of the infection is mild. A recovered patient tells a German daily newspaper, the Süddeutsche Zeitung, "My main problem was finding someone to go shopping for me."

June 11, 2009 , WHO Headquarters

The Emergency Committee convened for another teleconference. This time the discussion focused on critical questions: Should the WHO raise its warning to phase 6? Was the swine flu a pandemic?

The 15 experts scattered around the world debated for hours. After the meeting, Chan told the press that the virus was unpredictable and unstoppable. It was official: An influenza pandemic had broken out for the first time in 41 years.

"I think we did everything right," committee chairman Mackenzie says, looking back. Strictly speaking, his statement is correct.

According to the regulations, phase 6 becomes effective when a new virus is spreading uncontrollably in several regions of the world. The regulations say nothing about the severity of the disease.

In fact, the vast majority of experts on epidemics automatically associate the term "pandemic" with truly aggressive viruses. On the WHO Web site, the answer to the question "What is a pandemic?" included mention of "an enormous number of deaths and cases of the disease" -- until May 4, 2009. That was when a CNN reporter pointed out the discrepancy between this description and the generally mild course of the swine flu. The language was promptly removed.

Apparently German infectious disease experts also misunderstood the official WHO definition of phase 6. An influenza epidemic, according to Germany's national pandemic plan -- updated in 2007 -- is "a long-lasting, international situation involving substantial loss…and causing such lasting damage as to jeopardize or destroy the livelihood of large numbers of people."

The situation on June 11, 2009 did not correspond with these descriptions. Critics were already asking derisively whether the WHO had any plans to declare the latest outbreak of the common cold a pandemic. "Sometimes some of us think that WHO stands for World Hysteria Organization," says Richard Schabas, the former chief medical officer for Canada's Ontario Province.

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