A(H1N1): the state facing the risks of a pandemic

Through close examination of the Pandemrix vaccine purchase contract from a legal and political point of view, researchers analysed the position and role of the Belgian state within nowadays society. An issue that conceals many others relating to the mechanisms of pressure, the power of states, pharmaceutical groups and the WHO, and the relative neutrality of the experts.

Cover-CRISP-AH1N1001The mention of A(H1N1) flu today causes a snigger. In the end, this virus will have cost the taxpayer a great deal of money without ever have posed any real danger. Significantly less in any case than its cousin responsible for the “Spanish fluepidemic just after the First World War. The announced epidemic finally turned out to be less serious than seasonal flu and the subject has now fallen into oblivion. However, three years ago, when the risk of an epidemic was a frightening possibility, we were faced with a world crisis. And governments had to position themselves and urgently assume what they took as their responsibilities within a context they didn’t understand and that exceeded them.

On 24th April 2009, a few cases of flu caused by a mutant strain, which seemed particularly virulent at first sight, were recorded in Mexico and the United States. Barely a week later, 13 countries were affected in five regions of the world. On 8th May, 25 countries reported people to have contracted the disease. On 12th May, the virus crossed the border into Belgium. Seven thousand five hundred people in 34 countries were affected, 65 of whom died.

In less than 20 days, the virus spread to the four corners of the earth and caused international panic. The possibility of a pandemic, seen from every angle, rapidly became an established risk for the public authorities. “Besides this risk”, adds François Thoreau, an FRS – FNRS research fellow at Spiral, University of Liège, “at least four other factors forced governments to take a quick decision to prevent the spread of the virus in a complicated situation. The alleged urgency, both from the scientists and politicians point of view; the almost monopolistic, alarming and patchy information from the WHO; the limited number of vaccine suppliers and the threat of shortages in the available stocks; and finally, the extraordinary press coverage, which left no-one indifferent.”

A rapidly marketed vaccine

On 22nd July 2009, upon the combined initiative of the ministries of the interior and health, together with the department of health, and following numerous expert reports, the Belgian government signed a contract with the pharmaceutical group GlaxoSmithKlein (GSK). This contract initially provided for the delivery of more than 12 million doses of the Pandemrix vaccine at a cost of EUR 110 million. “Owing to the perceived urgency”, François Thoreau explains, “this vaccine benefited from an accelerated marketing authorisation procedure by the European Commission. Therefore, its efficacy wasn’t entirely guaranteed but at the time, it was a matter of the best perceived solution to prevent an epidemic.”

Following the example of the majority of European governments, Laurette Onkelinx, the then health minister, revised the contract downwards, finally signing it for the sum of EUR 85 million for the delivery of 8 million doses. Highly controversial and supposedly confidential, the contents of this contract were nonetheless revealed in a Belgian daily on 5th May 2010. In a paper that has just been published by CRISP, ULg (François Thoreau and Nicolas Rossignol) and UCL (Cédric Cheneviere) (1) researchers have gone over the contract with a fine-toothed comb to provide a legal and political analysis of the role of the state and its governmental responsibility in the management of this crisis.

(1) François Thoreau, Cédric Cheneviere, Nicolas Rossignol, Action publique et responsabilité gouvernementale: la gestion de la grippe A(H1N1) en 2009, in Courrier Hebdomadaire du CRISP, no. 2138-2139, 2012

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