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<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD>Fact vs. fiction 
Why it was difficult to separate good information from bad during the H1N1 pandemic
ASHLEY FITZPATRICK
The Telegram
</TD></TR></TBODY></TABLE>
Quick, off the top of your head. True or false:
1. There is more than one type of H1N1 flu vaccine in Canada.
2. Health Canada is responsible for conducting the clinical trials of the H1N1 flu vaccine.
3. The H1N1 flu vaccine prevents you from contracting the H1N1 flu.
4. When the H1N1 flu vaccine shots are taken too closely together by children, it can lead to the child developing autism.
The correct answers: 1) True. 2) False. 3) False. 4) False.
If you didn't get all the answers right, you are likely not alone. Learning about H1N1 and the vaccine has been a challenge for many Canadians.
H1N1 facts were limited at the start of the outbreak, changed continually during the spread of the pandemic and, on occasion, simply got lost in panic, rumour or summary.
Now that more is known about the 2009 H1N1 flu, the vaccines used to help fight it and how they were rolled out, what lessons can be learned about the collection and delivery of that information?
As H1N1 flu spread across the globe last year, Canada was introduced to the first flu pandemic of the 21st century.
Canadians quickly sought information on the illness and the vaccines being offered by the government to help protect against the worst of it (it is still possible to contract the illness after vaccination, although symptoms should be less severe).
In the beginning, not much information was available.
H1N1 flu was something different than the bird flu (H5N1) that had become well known in the media and researched by scientists.
H1N1 flu didn?t kill as many of the people it infected compared with bird flu, but it was spreading quickly. That much we knew.
As government, media, researchers, individuals and private companies scrambled to fill the information gap, it was easy to stumble across misleading statements and even flat-out incorrect information on the Internet, in conversation and, yes, in the media.
The scare was out there.
On April 27, 2009, a Canadian Press story headlined ?Mild swine flu cases shouldn?t lull people into dismissing threat: experts? ran in The Telegram, noting the beginnings of H1N1 flu cases in Canada.
?International authorities, as well, suggested people should prepare themselves for continued spread of the virus, the possibility of school closures as the virus hits new communities and that deaths are likely to occur,? the news report stated.
Talk began of a possible mass vaccination program.
In time, vaccine development was kicked into high gear.
Cue the rumour mill.
Fast-forward to the fall.
It was an Interim Order issued on Oct. 13 by federal Health Minister Leona Aglukkaq to the Public Health Agency of Canada that allowed the sale of the vaccine from private manufacturer Glaxo Smith Klein.
Such an order is issued ?in rare situations where the minister believes that immediate action is required to deal with a significant risk, direct or indirect, to human health, public safety, or the environment,? stated the Health Canada notice.
H1N1 vaccine was distributed to the provinces despite what Health Canada described at the time as ?limited clinical testing in humans.?
In light of the Health Canada order, timeline and limited information available on the vaccine, more rumours began.
Understanding with time
Of course, as the pandemic developed, the factual information needed to fully explain public health concerns was not always available, or was static.
The federal health minister demonstrated how much the information on H1N1 was changing when she appeared before the House of Commons Standing Committee on Health and the H1N1 flu virus on Aug. 12.
Aglukkaq said she?d provided more than 20 briefings for opposition MPs on H1N1 since February.
In contrast, the public was being presented with simplified H1N1 information ads and flyers.
?These ads reminded Canadians about appropriate infection-prevention behaviours. They were supplemented by information on the Public Health Agency of Canada website, posters at Canadian airports and transit ads in major Canadian cities,? stated Aglukkaq.
?It?s why more and more Canadians are getting the message ? cough into your sleeve, wash your hands regularly, clean common surfaces and stay home if you feel sick.?
It was limited information at a time when people wanted more than a message track.
Question and answer
From the media?s perspective, in-depth information was not always available when requested, which, in turn, affected what got out to the public.
For example, Health Canada released a statement on Nov. 13 announcing the approval of non-adjuvanted H1N1 flu vaccine to be supplied by Glaxo Smith Klein.
?Health Canada?s authorization was arrived at independently and on the basis of sound health science,? Dr. Elwyn Griffiths, director general of the biologics and genetics therapies directorate of Health Canada, stated in the announcement.
?Canadians can be confident that this vaccine is both safe and effective.?
Many news reports from that time repeat the exact phrase ? ?sound health science.? Yet few stated exactly what that health science was, where it was from and who was providing it.
Anyone who phoned the Public Health Agency of Canada to ask for further details on the vaccines was directed to call Health Canada, as ?they are the source for any information on clinical trials.?
But when contacted by The Telegram, a Health Canada representative said: ?the information on clinical trials is proprietary information that belongs to GlaxoSmithKlein.?
Private company GlaxoSmithKlein responded to submitted questions. The company said it planned to conduct 25 clinical trials for H1N1 flu vaccines involving 10,000 people (The clinical trial details are available at: www.clinicaltrials.gov. Updates from the trials are being made available at: www.gsk.com/ media.).
The first trial started in August and the last trial will continue until November 2010.
Summary and simplicity
News reports summarized but did not reprint straight medical information on the H1N1 vaccine. At times, the medical data was not always at hand.
At other times, the medical information and complete descriptions would have been detrimental to include.
For example, would you have wanted to read through this complete description of the vaccine every day in your paper?
?Each 0.5 mL dose of the Arepanrix H1N1 vaccine contains 3.75 ug haemegglutinin (HA) derived from A/California/07/2009 (H1N1)v. The AS03-adjuvant component is composed of an oil phase containing the natural, biodegradable oil, squalene (10.69 mg per dose) and DL-a- tocopherol (Vitamin E oil; 11.86 mg per dose), mixed with an aqueous phase composed of an isotonic phosphate buffered saline solution. Polysorbate 80 (Tween 80; 4.86 mg per dose) is used as an emulsifier to stabilize the oil/water interfaces. Each dose also contains 5ug of the preservative thimerosal. Prior to administration, the contents of the adjuvant vial are withdrawn and mixed in a one-to-one ratio with the contents of the antigen vial.?
A summary of that information ? ?adjuvanted H1N1 flu vaccine? ? is infinitely more mentally digestible.
The best we can do: vaccine information
Chris Kaposy, an assistant professor of health ethics at Memorial University and a member of the Canadian Centre for Vaccinology told The Telegram that, considering the unknowns in any vaccine roll-out, communication problems can arise.
However, ?given circumstances changing as much as they did, I think people at public health did as good a job as they could,? he said.
Even so, Kaposy said more easily accessible, in-depth information on the vaccine and the vaccine roll-out might have dissipated some of the fear.
?I?m an ethicist. I like situations where there?s as much info available as possible,? said Kaposy.
?The information is out there,? he said. ?If you were a pregnant woman, you could do some research and find out, but I?m not sure it was as readily available as it could have been.?
Even so, more than two-thirds of the people in this province have now received the H1N1 flu vaccine.
Ultimately, there are lessons in communication to be absorbed on all sides following our first run-in with H1N1.
By considering past errors and changing communications strategies, perhaps next time around we can all ace the post-pandemic true/false quiz.
afitzpatrick@thetelegram.com
Why it was difficult to separate good information from bad during the H1N1 pandemic
ASHLEY FITZPATRICK
The Telegram
</TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD vAlign=top align=middle>
</TD></TR><TR><TD class=photoCaption vAlign=top width="100%" height="100%"><TABLE height="100%" cellSpacing=0 cellPadding=5 width="100%" border=0><TBODY><TR><TD class=photoCaption>Within minutes of the Nov. 20 announcement that members of the general public could obtain the H1N1 vaccine, lines began to form at the clinics offering the shot such as this one at the Mount Pearl Square centre. ? Photo by Keith Gosse/The Telegram</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>
</TD></TR><TR><TD class=photoCaption vAlign=top width="100%" height="100%"><TABLE height="100%" cellSpacing=0 cellPadding=5 width="100%" border=0><TBODY><TR><TD class=photoCaption>Within minutes of the Nov. 20 announcement that members of the general public could obtain the H1N1 vaccine, lines began to form at the clinics offering the shot such as this one at the Mount Pearl Square centre. ? Photo by Keith Gosse/The Telegram</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>Quick, off the top of your head. True or false:
1. There is more than one type of H1N1 flu vaccine in Canada.
2. Health Canada is responsible for conducting the clinical trials of the H1N1 flu vaccine.
3. The H1N1 flu vaccine prevents you from contracting the H1N1 flu.
4. When the H1N1 flu vaccine shots are taken too closely together by children, it can lead to the child developing autism.
The correct answers: 1) True. 2) False. 3) False. 4) False.
If you didn't get all the answers right, you are likely not alone. Learning about H1N1 and the vaccine has been a challenge for many Canadians.
H1N1 facts were limited at the start of the outbreak, changed continually during the spread of the pandemic and, on occasion, simply got lost in panic, rumour or summary.
Now that more is known about the 2009 H1N1 flu, the vaccines used to help fight it and how they were rolled out, what lessons can be learned about the collection and delivery of that information?
As H1N1 flu spread across the globe last year, Canada was introduced to the first flu pandemic of the 21st century.
Canadians quickly sought information on the illness and the vaccines being offered by the government to help protect against the worst of it (it is still possible to contract the illness after vaccination, although symptoms should be less severe).
In the beginning, not much information was available.
H1N1 flu was something different than the bird flu (H5N1) that had become well known in the media and researched by scientists.
H1N1 flu didn?t kill as many of the people it infected compared with bird flu, but it was spreading quickly. That much we knew.
As government, media, researchers, individuals and private companies scrambled to fill the information gap, it was easy to stumble across misleading statements and even flat-out incorrect information on the Internet, in conversation and, yes, in the media.
The scare was out there.
On April 27, 2009, a Canadian Press story headlined ?Mild swine flu cases shouldn?t lull people into dismissing threat: experts? ran in The Telegram, noting the beginnings of H1N1 flu cases in Canada.
?International authorities, as well, suggested people should prepare themselves for continued spread of the virus, the possibility of school closures as the virus hits new communities and that deaths are likely to occur,? the news report stated.
Talk began of a possible mass vaccination program.
In time, vaccine development was kicked into high gear.
Cue the rumour mill.
Fast-forward to the fall.
It was an Interim Order issued on Oct. 13 by federal Health Minister Leona Aglukkaq to the Public Health Agency of Canada that allowed the sale of the vaccine from private manufacturer Glaxo Smith Klein.
Such an order is issued ?in rare situations where the minister believes that immediate action is required to deal with a significant risk, direct or indirect, to human health, public safety, or the environment,? stated the Health Canada notice.
H1N1 vaccine was distributed to the provinces despite what Health Canada described at the time as ?limited clinical testing in humans.?
In light of the Health Canada order, timeline and limited information available on the vaccine, more rumours began.
Understanding with time
Of course, as the pandemic developed, the factual information needed to fully explain public health concerns was not always available, or was static.
The federal health minister demonstrated how much the information on H1N1 was changing when she appeared before the House of Commons Standing Committee on Health and the H1N1 flu virus on Aug. 12.
Aglukkaq said she?d provided more than 20 briefings for opposition MPs on H1N1 since February.
In contrast, the public was being presented with simplified H1N1 information ads and flyers.
?These ads reminded Canadians about appropriate infection-prevention behaviours. They were supplemented by information on the Public Health Agency of Canada website, posters at Canadian airports and transit ads in major Canadian cities,? stated Aglukkaq.
?It?s why more and more Canadians are getting the message ? cough into your sleeve, wash your hands regularly, clean common surfaces and stay home if you feel sick.?
It was limited information at a time when people wanted more than a message track.
Question and answer
From the media?s perspective, in-depth information was not always available when requested, which, in turn, affected what got out to the public.
For example, Health Canada released a statement on Nov. 13 announcing the approval of non-adjuvanted H1N1 flu vaccine to be supplied by Glaxo Smith Klein.
?Health Canada?s authorization was arrived at independently and on the basis of sound health science,? Dr. Elwyn Griffiths, director general of the biologics and genetics therapies directorate of Health Canada, stated in the announcement.
?Canadians can be confident that this vaccine is both safe and effective.?
Many news reports from that time repeat the exact phrase ? ?sound health science.? Yet few stated exactly what that health science was, where it was from and who was providing it.
Anyone who phoned the Public Health Agency of Canada to ask for further details on the vaccines was directed to call Health Canada, as ?they are the source for any information on clinical trials.?
But when contacted by The Telegram, a Health Canada representative said: ?the information on clinical trials is proprietary information that belongs to GlaxoSmithKlein.?
Private company GlaxoSmithKlein responded to submitted questions. The company said it planned to conduct 25 clinical trials for H1N1 flu vaccines involving 10,000 people (The clinical trial details are available at: www.clinicaltrials.gov. Updates from the trials are being made available at: www.gsk.com/ media.).
The first trial started in August and the last trial will continue until November 2010.
Summary and simplicity
News reports summarized but did not reprint straight medical information on the H1N1 vaccine. At times, the medical data was not always at hand.
At other times, the medical information and complete descriptions would have been detrimental to include.
For example, would you have wanted to read through this complete description of the vaccine every day in your paper?
?Each 0.5 mL dose of the Arepanrix H1N1 vaccine contains 3.75 ug haemegglutinin (HA) derived from A/California/07/2009 (H1N1)v. The AS03-adjuvant component is composed of an oil phase containing the natural, biodegradable oil, squalene (10.69 mg per dose) and DL-a- tocopherol (Vitamin E oil; 11.86 mg per dose), mixed with an aqueous phase composed of an isotonic phosphate buffered saline solution. Polysorbate 80 (Tween 80; 4.86 mg per dose) is used as an emulsifier to stabilize the oil/water interfaces. Each dose also contains 5ug of the preservative thimerosal. Prior to administration, the contents of the adjuvant vial are withdrawn and mixed in a one-to-one ratio with the contents of the antigen vial.?
A summary of that information ? ?adjuvanted H1N1 flu vaccine? ? is infinitely more mentally digestible.
The best we can do: vaccine information
Chris Kaposy, an assistant professor of health ethics at Memorial University and a member of the Canadian Centre for Vaccinology told The Telegram that, considering the unknowns in any vaccine roll-out, communication problems can arise.
However, ?given circumstances changing as much as they did, I think people at public health did as good a job as they could,? he said.
Even so, Kaposy said more easily accessible, in-depth information on the vaccine and the vaccine roll-out might have dissipated some of the fear.
?I?m an ethicist. I like situations where there?s as much info available as possible,? said Kaposy.
?The information is out there,? he said. ?If you were a pregnant woman, you could do some research and find out, but I?m not sure it was as readily available as it could have been.?
Even so, more than two-thirds of the people in this province have now received the H1N1 flu vaccine.
Ultimately, there are lessons in communication to be absorbed on all sides following our first run-in with H1N1.
By considering past errors and changing communications strategies, perhaps next time around we can all ace the post-pandemic true/false quiz.
afitzpatrick@thetelegram.com
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