The Swine Flu Business Should Germany Gamble Millions on More Vaccine?

Swine flu hasn't caused nearly as many problems as some had predicted. Still, some worry that the next wave of the epidemic is going to be much, much worse. A debate is raging in Germany over whether to steer millions more to pharmaceutical companies for additional vaccine for the entire population.

By SPIEGEL Staff


Matthias Orth is fighting on the frontlines against the epidemic. He works as a medical manager at the Marienhospital in the southwestern German city of Stuttgart. This is where the city's emergency health facilities are, and this is where the ill gather at night and on the weekends.

Last month, there was a remarkable number of German tourists who came back from Spain coughing. They made a bee line from the airport to the hospital. "Suddenly, we had half of the busloads of tourists from Lloret de Mar standing here," Orth says, referring to a popular tourist destination on the Spanish coast just north of Barcelona.

Photo Gallery

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Photo Gallery: The Fight against Swine Flu

Still, the battle being fought at Marienhospital isn't really a matter of life or death. "The course of the disease is milder than that of a normal flu," Orth says, "so we've sent people home and told them to go to bed." He adds: "There's been such a fuss about this virus, but the fact is that it's really pretty run-of-the-mill. I'm going to get vaccinated against the normal flu, but not against swine flu!"

Given his daily experience as a practicing physician, Orth is rather annoyed at the commotion over swine flu stirred up by state health officials. Germany has already ordered €500 million ($725 million) in swine flu vaccine, but now these officials are calling for another million doses -- for another €500 million.

"Nobody expected this pandemic to progress so mildly," says Stefan Becker, head of the University of Marburg's respected Institute of Virology.

Global preparations for the next influenza pandemic had actually been modeled on those for the aggressive bird flu virus H5N1, which began causing numerous deaths in 2004. If it had been more easily communicable, that virus would have undoubtedly caused many more deaths. But, in the case of swine flu, a highly contagious pathogen has emerged, but one that is far less life-threatening.

"We probably just didn't notice before that there was an ongoing pandemic," Becker admits. "That's certainly happened on several occasions in the past."

It's only been in the last few years that the Geneva-based World Health Organization (WHO) has supervised the establishment of a sophisticated monitoring system. From Afghanistan to Papua New Guinea, 128 reference labs are trying to make sure that any new flu strain will be rapidly detected.

Worth the Expense?

Still, the massive amount of funds devoted to this defensive network has made some wonder whether it has taken on a life of its own rather than remaining part of an overall health-care strategy.

"If something happens, nobody wants to be accused of having done nothing," says Matthias Gruhl, who oversees health policy in Bremen. "But this concern for safety is expensive," Gruhl adds. "It costs more than €1 billion, which could be spent elsewhere in the health-care system."

Gruhl has criticized the Robert Koch Institute (RKI), Germany's federal institution for disease control and prevention, as well as the Paul Ehrlich Institute (PEI), which is responsible for approving vaccines, for putting too much pressure on politicians to buy "more and more vaccines and drugs."

And Gruhl isn't alone in his criticisms. Dietrich Wersich, for example, Hamburg's top health official, has also called for a halt in vaccine purchasing. "We believe that the already-ordered doses are enough for 30 percent of the population," he says. "But, when the PEI and the RKI recommend buying vaccine for 80 percent of Germans, they make the recommendation without knowing how much of the population is really willing to let itself be vaccinated."

Such misgivings ultimately led to a secret meeting last Friday, at which the finance ministers of Germany's 16 federal states decided not to allocate any more money to the vaccine. They reasoned that, since Federal Health Minister Ulla Schmidt had not asked them to do so, then the federal government could foot the bill itself.

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