Swine Flu – A Lose-Lose Situation for Public Health Authorities

After the great SARS terror of 2002 which was predicted to cause more devastation than AIDS, and the bird flu panic of 2006 when we were warned that a quarter of Britons might die, we now have the great swine flu crisis of 2009. But just as SARS and bird flu failed to deliver on their predicted devastation (together, they were responsible for an estimated 1031 deaths globally), so will the great swine flu disaster also fade away into the annals of health scares that never were?

The truth is, it is simply too early to tell. While the number of swine flu cases greatly exceeded initial predictions and early attempts at containing the virus were soon abandoned, the summer outbreak has already peaked in the US and Mexico and is predicted to peak very soon in the UK. Furthermore, although there have been a number of tragic deaths, the severity of swine flu in most cases has been relatively mild, even milder than ‘normal’ seasonal flu for many people. On the face of it, it looks as though our worst fears have not been realized. The great flu epidemic of 2009 failed to materialize. Once again, a health scare has failed to live up to its hype.

However, this is not over this yet. Flu viruses are notoriously unstable. The H1N1 virus could still mutate at any time and without warning. The antiviral treatments that seem to be having some effect at the moment could be rendered useless against an evolved version of the virus. And, although the summer outbreak in the Northern hemisphere looks to have peaked, the cooler weather of the autumn and winter may bring the virus back with a vengeance; perhaps just as we let down our guard. Furthermore, the shadow of bird flu still threatens; just because we have had swine flu, does not mean we will not have bird flu. This is not an ‘either, or’ situation.

So, real threat or phantom menace? Who knows? Only one thing is certain; nobody responsible for public health is likely to come out of this well. If governments and health authorities underplay the threat, they stand accused of negligent complacency, and if they talk-up the threat, they are accused of scaremongering. They simply cannot win.

Ultimately, if we emerge through this scare relatively unscathed, there will be the predictable backlash against the authorities for causing unnecessary panic and squandering public resources. What we will never know, however, is how much all the preemptive action was responsible for mitigating the effects of the disease. As with the millennium bug scare (and, who knows, with SARS?), those in authority may be condemned by the very success of their actions.

In practice, global health authorities have no option but to plan for the worst case scenario, and advise the public accordingly. However, as they consider ongoing and future precautions, policy-makers must know they are in that familiar territory — damned if they do and damned if they don’t.


Editorial (2009). Between a virus and a hard place Nature, 459 (7243), 9-9 DOI: 10.1038/459009a

  • Nice outline of the dilemmas! I was reading the whole article, hoping you would say, “damned if they do and damned if they don’t,” so I was very pleased when I got you your last line.

    Because in reality, it goes like this:

    DARNED if they do, and DAMNED if they don’t.

    The post-mortem critique of disaster management is never symmetrical.

    If you over-reacted, and warned people loud and clear about what might be imminent, and then nothing really awful happens, you get accused of being a fear-monger. A media hog (different word often used, but “hog” will do). You get accused of mis-directing resources that could better have been targeted at X, the next disaster that actually happens out of all the ones that MIGHT happen. You don’t usually get fired; you don’t usually lie awake at night thinking about all the people who died because you didn’t warn them. You just get, well, scoffed at.

    You are darned if you do.

    If you under-reacted, and under-warned, and under-prepared, you are brought before post-even Parliamentary or Congressional Commissions and Inquiries. You get fired. You are vilified in the media. The families of victims who died all find out your email address, and send you pictures of the children who died because you didn’t warn them. You wonder if you will ever get their pictures out of your head. You think you never should.

    You are damned if you don’t.

  • Linda

    Furthermore, the shadow of bird flu still threatens; just because we have had swine flu, does not mean we will not have bird flu. This is not an ‘either, or’ situation.

    Are you not aware that the H1N1 virus contains swine, bird and 2 human types of dna?

    I was with you until I read the part of your article I quoted above.

  • Linda

    Thank you for your comment.

    As you know, both swine flu and bird flu are examples of a influenza A viruses, which are classified according to which type of the proteins hemagglutinin and neuraminidase are present.

    The bird flu virus subtype which is causing most concern is classified as H5N1 (meaning it has a type 5 hemagglutinin and a type 3 neuraminidase), while virus subtype responsible for the current outbreak of swine flu is H1N1. This was the distinction that I was making in my article.

    Scientists at the Centre for Biochemical Engineering, University College London, have described a disturbing (if unlikely) scenario in which swine flu spreads to countries such as Indonesia where it infects animals or humans who are already affected by bird flu. Bird flu is currently not easily transmitted, but is highly virulent if caught; while swine flu is more readily transmitted, but causes relatively mild symptoms. If a person becomes infected by both strains, it is possible that there will be an exchange of genetic material resulting in the creation of an easily transmissible but highly virulent virus

    On a lighter note, some people say that the real difference between bird flu and swine flu is that with bird flu you may need tweetment whereas with swine flu you may need oinkment…


  • “The antiviral treatments that seem to be having some effect..” Are you sure the antivirals indeed treated the patients.
    1. Oseltamivir (Tamiflu) causes suicidal tendencies.
    Already over a dozen kids have committed suicide due to that & hence it’s banned in Japan for children.
    2. It only reduces the duration of symptoms by 2 days, as per clinical records.
    3. It’s side effects are the same as the symptoms of swine flu.
    4. The only good thing inside it is “star anise”. Why not have it directly. Rest all is chemical poison.
    Do google for “swine flu meta cure” for something more useful…

  • Taarak

    My article was not intended to be a defence of antivirals. Every drug must be assessed on the basis of its risk/benefit ratio. Some would say that the jury is still out on Tamiflu.

    As suggested, I googled ‘swine flu meta cure’, and was particularly interested to learn that:

    “…all flu started with the mass-killer 1918-19 spanish flu […]. As per nature’s law, thousands of dead bodies lying unattended during the 1914-18, attracted destructive agents from outside the earth to do what they did best – decompose those bodies as ‘the dead must decay’. They were the subtler microvita – the fundamental units of all life – but of the bad type.

    They travel uninterrupted unstopped across all the worlds – for example in the form of bio-photons. Since then they have adopted our earth as their home as they really fell deeply in love with some of the herd-minded earthlings here : pig-minded pigs, bird-headed birds & both pig-minded + bird-headed of all humans as their well-deserved hosts.”

    I encourage any readers to do the same google search and draw their own conclusions.


  • erika

    linda is correct — what they are calling swine flu has avian flu dna as well

  • Below is how and why the Swine flu was Genetically Engineered.
    For full version 83 pages search the US patent Application 20090010962

    United States Patent Application 20090010962
    Kind Code A1
    Palese; Peter ; et al. January 8, 2009
    Genetically Engineered Swine Influenza Virus and Uses Thereof
    The present invention relates, in general, to attenuated swine influenza viruses having an impaired
    ability to antagonize the cellular interferon (IFN) response, and the use of such attenuated viruses in
    vaccine and pharmaceutical formulations. In particular, the invention relates to attenuated swine
    influenza viruses having modifications to a swine NS1 gene that diminish or eliminate the ability of
    the NS1 gene product to antagonize the cellular IFN response. These viruses replicate in vivo, but
    demonstrate decreased replication, virulence and increased attenuation, and therefore are well suited
    for use in live virus vaccines, and pharmaceutical formulations.
    Inventors: Palese; Peter; (Leonia, NJ) ; Garcia-Sastre; Adolfo; (New York, NY) ; Webby;
    Richard J.; (Memphis, TN) ; Richt; Juergen A.; (Ames, IA) ; Webster; Robert G.;
    (Memphis, TN) ; Lager; Kelly M.; (Colo, IA)
    Name and
    222 EAST 41ST ST
    Assignee Name
    and Adress:
    New York
    1 of 82 1/2/10 2:14 PM
    Serial No.: 628292
    Series Code: 11
    Filed: June 1, 2005
    PCT Filed: June 1, 2005
    PCT NO: PCT/US2005/019382
    371 Date: February 6, 2008
    U.S. Current Class: 424/199.1; 424/209.1; 435/236; 435/325
    U.S. Class at Publication: 424/199.1; 435/236; 424/209.1; 435/325
    Intern’l Class: C12N 7/00 20060101 C12N007/00; C12N 5/10 20060101
    C12N005/10; A61K 39/145 20060101 A61K039/145; A61P
    31/12 20060101 A61P031/12; C12N 7/04 20060101
    1. An attenuated swine influenza virus comprising a mutation in a swine influenza NS1 gene that
    diminishes the ability of the NS1 gene product to antagonize the cellular interferon response, and
    permits the attenuated virus, at a multiplicity of infection of 0.001, to grow to titers between
    approximately 3 fold to approximately 7 fold lower than wild-type swine influenza in pig cells, as
    determined approximately 5 days post-infection when propagated under the same conditions.
    2. The attenuated swine influenza virus of claim 1, wherein the attenuated virus is genetically
    3. The attenuated swine influenza virus of claim 1, wherein the attenuated virus is a mutagenized virus
    or reassortant.
    United States Patent Application: 0090010962 .

Rachel Danks, PhD

Rachel Danks, PhD, is a freelance medical writer and editor with over 12 years of experience in the field. She has written and edited numerous academic papers, and is experienced in preparing marketing materials, educational resources and regulatory documents. Her clients include medical education groups, advertising agencies, pharmaceutical companies and academic institutions.

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