"The two deaths are our fault," announced István Jankovics, a leading Hungarian virologist at a conference last Wednesday, upon official publication of the news that the new flu had taken the lives of two people in Hungary. These are the only deaths in Central Europe so far, there have been about a hundred times as many verified cases in Germany but nobody has died.

Germans survive

This also means that predictions claiming that one person out of three hundred to one thousand infected could die have not been proven right, since there would have to have been at least 20-60 victims in Germany already. Although there have been 82 fatal cases registered in the UK and 36 in Spain, neither of the two countries has seen its economy collapse. Therefore, there is no reason to panic. Still, the tragedy of the two Hungarians who died of primary viral pneumonia is a warning sign: denying there is an epidemic might be damaging, too.

Despite the summer heat, there were about ten thousand people - three times the number so far - visiting their doctor last week with flu-like symptoms. This also shows that preparations need to be made for an epidemic much more widespread than those in recent years. Nevertheless, it is far from the devastation caused by Spanish Flu. In 1918, 3% of the world's population died of the disease, foam came out of the lungs of patients and they suffocated within a day. However, such a widespread epidemic cannot occur again, for at least three reasons. At the end of the First World War, antibiotics had not yet been discovered, there were no vaccinations and no drugs against viruses. Military censors removed any information about the disease from the papers, therefore no measures could be taken against the epidemic.

The current virus is not as virulent as that of Spanish Flu, therefore there certainly will not be tens of thousands of fatalities. Something that is unusual in the case of an influenza is that it causes deaths even during the summer. Businesses are right to prepare for an unexpected additional peak of simultaneous holidays taken by employees during the autumn or winter, when many stay away for one to two weeks. For businesses that cannot afford sending their staff on holiday, it is probably worth ordering vaccines with the help of the company doctor.

Another argument for vaccination is that although the virus brings about symptoms of a normal influenza, it can cause primary viral pneumonia in certain cases, the course of which is so short that there is no time to even ask for help before death occurs. Within a couple of weeks, families should be making their minds up whether to vaccinate themselves or not.  However, they are also confronted with rumours about the vaccine being more dangerous than the virus itself. "Are you more intelligent than a ten-year old?" This is the title of an email spread via the Internet that contains seemingly scientific statements. We asked László Bujdosó, president of the National Pandemic Commission and István Jankovics, head of the Pandemics Department of the National Medical Officer's Service to comment on the letter's content.

Scaremongering on the Internet

"Vaccinate two hundred thousand people with an untested vaccine just to save one single life, while many more will die as a result of the vaccination - this makes you think, doesn't it?" There is a hitch already in the first half of the sentence, but let's analyse the second part first. As an example, the letter presents a case from 1976, when a 19-year-old private died of swine flu in the United States and there were hundreds infected. The President, Gerald Ford, announced a widespread vaccination campaign, 40 million people were vaccinated by December, even though thirty people had died by April as a result of the vaccination and eventually, there was no epidemic. Ford could make good use of the crisis situation before the elections since he could play the role of a strong, determined politician. (In the end, Jimmy Carter was elected as the next president.)

Thirty years have passed since then and the question is, can a vaccine cause such a serious illness today? Certainly not in large numbers, since requirements have been made much stricter since the case of 1976. In 2004, for example, 48 million vaccines were destroyed in the United States. On the other hand, it would not be true to say vaccines do not have any side effects. The flu vaccine could cause one in one million vaccinated to develop a certain serious illness of the nervous system. In Hungary, there have been four cases verified out of the twenty million seasonal vaccinations where patients became ill after vaccination. The product of a foreign company was used in all of them.

Vaccination can carry a risk, but that is much smaller than that of even the seasonal virus, which causes several hundreds of deaths each year. Logical arguments, however, are not enough: public health authorities have not been able to decide how much money general practitioners are entitled to for vaccinating a patient. As a result, many GPs are against vaccination and their unwillingness to act could result in the failure of the vaccination programme. The Ethics Committee of the Hungarian Medical Chamber passed a resolution condemning practitioners who only vaccinate patients if they renounce their right for compensation in writing, even though responsibility lies with the manufacturer.

Another remark often used to argue against vaccination is that it is not effective enough. The letter spread via the Internet claims that only 1% of fatalities can be prevented by vaccination, therefore "saving one life from the H1N1 virus costs HUF 200 to 800 million." In reality, vaccination proves efficient in 70 to 80 % of cases. (This is known because antibodies appear in the blood of 70 to 80 percent of persons vaccinated.) If the situation becomes more serious in a humid autumn and the disease does result in a 0.1-0.3 % death rate, the number of fatalities for 2 million infected could be between 2 to 6 thousand. Calculating with 4 million free vaccines, saving one life could cost HUF 0.8-2.2 million of public money and not 200 to 800 million, as stated in the letter.

Secretive proprietor

"The vaccine that is used on our children was prepared in great haste. There were decrees issued so that the usual tests conducted before manufacturing could be avoided," says the letter. This is a misunderstanding: the technology had been authorised earlier and the vaccines were tested in clinical trials. The reason why the vaccine became available so fast is that manufacturing started before the marketing licence was received. Therefore, there are no serious arguments against vaccination, if not the idea that there have been so many false alarms we might have every reason to believe the problem will not be as serious as many claim.

Judging by the contradictory measures taken by public health authorities, it is worth being cautious. How can they cut the budget of hospitals by twenty percent if we are facing an epidemic that can only be contained by 4 million free vaccines? The National Medical Officer recommends vaccination for pregnant women, this is also disputed. Pregnant women are more at risk from the virus. However, as there was no time to examine what impacts the vaccine has on the foetus, some professionals say expectant mothers should be protected using antiviral medication instead.

The biggest problem is that the proprietorship of the offshore company manufacturing the vaccine is unclear. The fact that nobody knows who the majority stakeholder of the company benefiting from a state order to the magnitude of HUF 4.4 billion actually is, is reason enough for suspicion. The Hungarian state had already paid HUF 2 billion to Omninvest Ltd in 2006 to develop the vaccine against bird flu, which has not resulted in one single fatality in the whole world and out of which vaccine not one single ampoule has been sold to anyone. Similarly, there have been no incoming foreign orders for the Hungarian vaccine developed against the new flu, although 15 % of such revenues would go to the state budget.

The story of the virus that escaped from the laboratory

In recent years, there was another H1N1 virus infecting people, but this was "created" by former socialist countries and not multinational manufacturers as conspiracy theories suggested. The "great-great grandchild" of the H1N1 virus responsible for Spanish Flu disappeared in the 1950s, but surfaced again in 1977 - in China. According to a study written by virologist Béla Lomniczi, it could have escaped from a laboratory. The "genetic clock" of the virus stopped, that is, it was exactly the same in 1977 as decades earlier, although influenza viruses continually change in structure. István Jankovics believes that the only way this could have happened was for the virus to have been stored in a "fridge" for twenty years, from where it once escaped.

In 1978 the new H1N1 spread all over the world, infecting many millions of people, but it was not very dangerous. There were no fatalities in Hungary, for example. The epidemic, however, alarmed the Soviet Union and China, where tens of millions of vaccines containing attenuated (live, not killed, but less virulent) virus micro-organisms were used. "This is what should never have been done! The live virus gradually regained its virulence and its virulent mutants spread again. That is why in 2007-2008, apart from the B-virus, it was the A/H1N1 subtype of influenza that caused an epidemic." This quote comes from a study published this February by officials working at the Division of Virology at the National Centre of Epidemics. Even the vaccine used last year contained the "runaway" H1N1 virus, but there are only genetic similarities between this one and the new H1N1 (roughly to the extent that man resembles a chimpanzee), colloquially called swine flu. From an immunological point of view, the two are different. This is why elderly people who recovered from the disease caused by the late descendant of Spanish Flu are better protected against the new flu than those who contracted it last year, István Jankovics told us.

Questions about the new flu

Are the symptoms milder than those of the seasonal flu? No.
In most cases, the symptoms experienced are the same: fever, sore throat, cough, possibly vomiting. The real problem comes if the virus attacks together with pneumonia.

Is the world facing a catastrophe? No.
This virus is less dangerous than the one that caused the Spanish Flu, for example, but it spreads much faster and is less predictable than normal influenza.

Was the vaccine authorised without testing? No.
It was tested on animals and human adults, the tests are still in progress on children.

Is the vaccine more dangerous than the one used for normal influenza? No.
This vaccine contains killed micro-organisms, just like the seasonal vaccine.

If we opt for vaccination this year, will it protect us from the virus next year? No.
However, its course will probably be much less severe.