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.

Too many doses

Yesterday the ANSA press agency, by l'Unità newspaper, covered a story about the mistrust of the flu vaccine. According to the poll conducted by Key-Stone, the 97% of Italians refuse to get the vaccine against the swine flu. The 25% refuse all kinds of vaccines, the 24 only the swine flu vaccine, while the 21% were advised by their doctors to not get the shot. More then half of the interviewed (59%) said that they have changed their hygienic habits, usually (in 80% of the cases) buying a disinfectant for the hands.
The vaccination campaign is now very slow. The Ministry of Health said that 821,000 people have been vaccinated, including the 15% of all the health care workers (159,093 people). The available vaccine doses are 10,047,421. The Ministry has also announced that it won't sell the vaccine stock to other countries.

Second peak, maybe

Today Il Giornale di Sicilia, a newspaper of Palermo, wrote that the swine flu epidemic might hit again Italy, and that a further peak might occur in the next months. Apparently, the newspaper was quoting CDC Director Thomas Frieden. Meanwhile, the Bmj, a scientific journal, published an article on December 7th, with the title “Fall in swine flu cases may not signal an end of the epidemic, warns Professor Donaldson”, in which it was explained why experts are cautious about the end of the pandemic in Europe. It said also that UK health authorities are uneasy because “the continuing deaths from swine flu and the high rate of hospitalisations despite low levels of the disease in the community”. The death toll has reached 270 in the United Kingdom and there are still 1000 people in hospital. According to the last report of the Italian Ministry of Health, updated on December 24th , in Italy the deaths are 188. Campania accounts for 25% of the fatal cases (47 deaths). But Campania accounts for only 10% of the Italian population.

Swine flu, no coverage

Many Italian news media don't cover the swine flu any more. Yesterday the Ansa press agency reported about the 10th death in Veneto, a man 56 years old, already ill by cancer, who died near Verona after 20 days in a hospital. And this is the only bit of news about the swine flu.

Situation Update: Week 51

Yesterday the Italian Institute of Health updated its weekly report about the swine flu in the country. The swine flu incidence (as the number of new cases in a week out 1,000 people) is abating and now it has dropped to an incidence of 1.79‰ (or 0.179%). The incidence is moderately high only in the island of Sardinia, where it is still 7.68‰.

All the regions are past the peak. Meanwhile, there have been some differences in the regional peaks of the swine flu. In Basilicata, Campania, Emilia-Romagna, Lazio, Marche, Abruzzo, Molise, Sardinia the maximum incidence has been more than 1.5%, everywhere else less than that. In Abruzzo e Marche the peak has been 3-4%, but maybe the data is wrong.

Swine flu update: Week 50

Yesterday the Ministry of Health said that the swine flu has killed 163 people. In Campania the regional authority has recorded 45 deaths, in Puglia 25, in Lombardia e Calabria 12 each. In the South of Italy the fatal cases are 90, more than half of the national cases. Maybe there's a different kind of recording or updating the data, but it's really strange such a large number.
Until now the Ministry has recorded 811 hospitalized cases, which required respiratory aids in 439 cases. All the cases are 3,794,000. All over Italy the pandemic has already peaked, the total incidence is 0,22%. Only in Sardinia, where the incidence is above 1%, there's still some flu activity. The update has received almost no  coverage by the newspapers.

WHO: 'Too early' to say pandemic over

Today the only piece of news about the swine flu is the WHO press conference in Geneva. Italian news media have covereved the talk of Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza. "Now we are about 8 months into the pandemic and one of the common questions coming to us is, that is the pandemic over, is it time to call it, and really the answer is, that it is still too early to make such a call." said Fukuda. In Italy the flu outbreak has already peaked, thus people expect the WHO to say that pandemic has ended.
Newspapers covered also the reason, according to Dr. Fukuda,to not call the pandemic over. The WHO expert said that the flu activity is still high in parts of Europe such as France and Switzerland, in the Czech Republic, and in parts of central Asia such as Kazakhstan and Kyrgyzstan, and in Russia. So it's to early.
Instead there was nothing about the second reason given by Dr Fukuda. "It is clear in some parts of the world, such as North America and in some parts of Europe, we have seen that the pandemic activity for now, has clearly peaked and is on the way down." said Fukuda "But the peaking has occurred extraordinarily early for influenza and we still have several months for winter to go and one of the big questions which is still before us is whether we expect to see yet another wave of activity occur or perhaps at late winter or in the early spring months".

Swine flu lesson

"And if the virus were only a cold?" wrote La Repubblica some days ago. The article by Angelo Aquaro explains that the mortality of the swine flu has been by far inferior to the expected (0.018%, less than the seasonal flu), there's been a decrease of the hospitalized cases in the United States and Europe (except France) in the days of the expected peak, many controversies on the vaccines (in Italy only the 14% of the health care workers have been immunized), and on the role of the Big Pharma and on WHO. Italy has bought 24 millions of doses of Novartis vaccine for 184,8 million of euros.
"If until now the things have gone better than what was expected, the merit is not surely of the vaccination campaign that has involved a low number of people" is reported to have said in the article Mauro Moroni, Director of Infectious Disease Department of Sacco Hospital, in Milan. "The culprits of the flop, says De Martino, "are also who refused to get the shot themselves, and I speak about my medical colleagues, and the citizens".
And at the end there's the conclution of Giovanni Rezza, Director of Infectious Disease Department of Istituto superiore di sanità in Rome. "The truth is that from this crisis we have learned two lessons. First, that the opposite extremisms, alarmism and denyingser, are counter-productive. The second one is that we must learn to produce the vaccine more quickly in order to prevent situations more serious."

Newly appointed minister

Today Professor Ferrucio Fazio has been appointed to the newly created role of Minister of Health. He has received strong  support by his party's MPs, but also by  medical associations and business unions. In the last months he managed to prepare for the pandemic of swine flu, and many people owe that to him.
Things are going quite well,  especially in North Italy. In the southern regions, in Campania, Puglia and Calabria there's the highest death toll.
Total deaths 149
Abruzzo 3
Basilicata 1
Calabria 16
Campania 32
Emilia Romagna 10
Lazio 14
Liguria 4
Lombardia 9
Marche 1
Molise 3
Piemonte 8
Puglia 19
Sicilia 11
Toscana 4
Umbria 5
Veneto 8
P.A. Bolzano 1

An Italian vaccine

Italy have done well against the swine flu, and the country is ready to research a new universal vaccine against all the flu viruses. Yesterday the Deputy Minister of Health Ferruccio Fazio talked about the pandemic in Italy. Fazio said also that one of the goals of the Istituto Superiore della Sanità is the universal vaccine, active against all the influenza viruses. The target of the research will be the hemagglutinin, "the primary protein responsible for binding to receptor sites on the cell membrane, allowing the virion to enter the cell" (some weeks ago New Scientist published an article about this issue). Professor Fazio said also that Italy has spent for the vaccine campaign less money than other European countries, obtaining better results. However, it's too soon to draw conclusions: the number of cases is decreasing, and so the number of deaths, but the pandemic hasn't stopped yet, said Professor Fazio. In order to end  it it's important to continue the vaccination plan, he said. In Italy there's an high incidence only in Sardinia right now.

The Imaginary pandemic

"The Imaginary Virus. Swine flu milder than the seasonal one and almost nobody got the vaccine shot": this was the headline of Il Foglio newspaper on December 3. "As expected, the 'A' is a second class flu" wrote il Giornale after a week. In these days there are a few of editorials about the swine flu. The outbreak has already peaked, the emergency rooms are no longer crowded by scared people, there are fewer new flu cases. With "only" 146 deaths in total, the swine flu is judged a false alarm by some newspapers. So, the news media have started blaming WHO, flu experts, and a large part of journalists for what happened. Il Corriere della Sera shows a different point of view. It wrote on December 13: "Health care, a communication crisis", blaming  on health authorities and on the lack of good communication for the false alarm.