The withdrawal of the vaccines

The Minister of Health, Professor Ferruccio Fazio, said yesterday that the Ministry has began to count the number of the unused vaccines in the Regions. This is the first step for the withdrawal of the vaccines. He said also that if the WHO doesn't declare  the phase 5 of the pandemic (we are in phase 6), the pandemic alarm can't be ended. He concluded that the final assessment of the pandemic in Italy is good if there won't be a new swine flu outbreak. Actually, there are some flu virus circulating in the country, but they are the flu type B viruses.

Update: Week 4

The influenza virus is spreading again in Italy. There have been 111,000 cases in the last week, a bit more than in the previous week (97,000). It looks like it's not the A(H1N1) virus but a different one. A newspaper of Genoa, the local edition of La Repubblica, has said that in Liguria region the cases increased by 30% in the last week (Osservatorio Epidemiologico Regionale data).

Vaccine, the popular one

The swine flu vaccine is really unpopular in Italy. According to the Ministry of Health, at the end of January just 851,549 people were vaccinated. Most of them had one single dose, while 47,013 people got two doses. The Ministry has an huge surplus of vaccine, that nobody knows how to use. As a matter of fact, only a small amount of the 1,047,421 available doses has been given. The data of the previous vaccinatation campaign, against a 'common' flu virus, is much higher. In the 2008-2009 campaign the 19.1% of the population got the shot, almost 11,5 millions of people. Anyway, in that case the elderly were also offered, after many years of targeted public communication. In the swine flu campaign instead only old people with other medical conditions were included, and only in the last phase of the campaign. Moreover, this has been the first time that healthy young people, aged 18-27, have been offered the flu vaccine.

Update: Week 3

Last Friday the '1500' swine flu telephone number has been discontinued. The Ministry of Health has said that in the last weeks it received very few calls, as the pandemic eased off. On the third week there have been recorded 96,000 new cases of flu, a bit more than on the previous week (82,000). The strain of the virus is unknown, it could be the A(H1N1) or another one. Meanwhile, the swine flu deaths have risen to 228. Almost half of them occured in South Italy, where live only a quarter of the Italians. The 82% of the people who died were in the at-risk group.

What about the vaccine safety?

Maybe MF59 adjuvated vaccine, like the Focetria vaccine by Novartis, used in Italy against the swine flu, could protect people from more types of virus. In a paper published by Science Translational Medicine, researchers from FDA, Novartis and Vanderbilt University Medical Center in Nashville, said that the MF59 adjuvant can make the trick. They said that they can boost the efficacy of the vaccine against the avian virus adding the adjuvant. "MF59 adjuvant improves the immune response to a H5N1 vaccine by inducing qualitative and quantitative expansion of the antibody repertoires with protective potential" they write. So, the MF59 vaccine generates an immune response non only against the selected strain, but also against others. According to the journal, this can be really useful in large scale vaccination.

Ironically, the safety of the MF59 got questioned by Italians, that preferred to skip the vaccine against the swine flu. Right now the Minister of Health don't know what to do with all the stocked doses.

On persuading Novartis

Sergio Dompè, the president of the association of pharmaceutical industry (Farmindustria), hopes that Novartis and the Italian government will reach a new agreement to change their contract and to convert the swine flu vaccine supply in something else. Instead of buying other doses, the government will buy other products. Dompè said that, considering the actual need, it's understandable to find a way to make more efficient the expenditure (184 million euros). He also added that he will try to persuade Novartis to change the contract. Only 865,000 people in Italy got the swine flu shot, while some 10 millions of doses are stocked. Other 14 millions of doses have been ordered but not yet delivered.

The secret agreement

Altreconomia, an Italian magazine, has published on-line the “secret agreement” between the Italian government and the pharmaceutical company Novartis to buy 24 million doses of the swine flu vaccine. The article said that the agreement was too partial to Novartis, because the company was liable only for damages caused by defects of production, it was made no responsible for any delay in the production, and also because the vaccines were too expensive (168 million euro + VAT). These were the objections made by the article, that were reported by many other media. There's a feeling in Italy that the vaccination campaign has been a big business for the pharmaceuthical companies, not accetable given the mildness of the pandemic. The objections were first risen by a decision of Corte dei Conti, the court of law that checks that the financial government's acts are in accordance with the rules. The Corte dei Conti concluded that the government had to accept such unfavourable provisions because of the urgency of the matter. Actually, the timing of the production and delivery of the vaccines has been one of the troubles, but on this issue there's no debating.

Situation Update: Week 1

Yesterday the website of La Repubblica said that the “second wave” of the swine flu epidemic could be looming, because in the last week the flu cases increased from 75,00 to 78,000 (data of the Ministry of Health). The national incidence has slightly increased from 1.23‰ to 1.30‰. But it isn't clear if the involved virus is still the H1N1 virus or the seasonal one. There are also some people in the hospitals and the death toll has risen to 210. According to the Ministry, the 73% of the deaths are people below 65 years of age. This is one of the unusual, quite disturbing, character of the swine flu, even though it has gone unnoticed by the news media (in the table the deaths in terms of age and region). In the 2006 only the 7% of the flu victims were under 65 years old (Istat data, an unorthodox comparison).

Too late, too much

Today the Minister of Health, Professor Ferruccio Fazio, was asked in Parliament what to do with the unused doses of the swine flu vaccine. He was also questioned about the safety and efficacy of the vaccine itself, and about the costs of the campaign. Professor Fazio admitted that “the vaccine was available only when the first wave of the epidemic has begun”, and that the flu was, “thankfully”, really mild. These two facts have kept people away from the vaccine. Some 850,000 people got vaccinated, using a small fraction of the 10-million available doses. But there is this lesson of the swine flu, the vaccine supply was too late.

The Government expect to pay 184 million euros for 24 millions of doses, but the final figure could be less than that. According to the Minister, “the Government is evaluating some possibilities that could guarantee an appropriate use of the commitments decided by the Government against the swine flu.” The pronouncement isn't very clear, but it could mean the Government is going to sell the vaccine stock.

Bad surprise

Today, for the first time after many weeks, some on-line news media have published the story of another swine flu victim, a 32-years-old woman who died in Pisa (Tuscany). She was admitted in the local hospital on December 23, after been hit by the H1N1 virus. The Ansa press agency report also the deaths of other 3 people since the start of the year: a 59-years-old man in Perugia (Umbria), a 56-years-old woman in Brindisi (Puglia) and a 76 years-old man in Ancona (Marche). The death toll has been updated to 204 deaths. The Corriere della Sera looks a bit surprised by the piece of news, writing “The A flu starts to kill again.” In the media the swine flu has been first promoted to the role of the century's pandemic, and then it has been relegated to the role of a common cold, so now the situation is confused, even though the deaths have trickled quite continuously.