Swine flu vaccine mired in bureaucracy

Vaccinations against swine flu began in Prague as it emerged that insurance companies and the Health Ministry are dictating who is eligible for the vaccine.

"It is a complete mess, really, with the vaccination," one general practitioner, who requested anonymity, told The Prague Post.

Patients are recommended to visit their doctors to get a referral to a vaccination center.  

"Health insurance companies are sending us lists of patients to be vaccinated. They pick those considered 'at risk' patients, for example, those with lung disease. The lists, however, were wrong: They included patients who were too ill to be vaccinated, which is obviously very dangerous," the doctor said.

One insurance company confirmed that the Health Ministry had given it a list of patients.

"The ruling came from the Health Ministry," said Jiří Rod, spokesman for the General Health Insurance Company (VZP).

"It concerns patients with underlying health problems, such as chronic heart disease, lung problems, asthma patients and patients on chronic dialysis and transplantation patients."

Concerns are also growing that swine flu infections in the Czech Republic will outpace the vaccination program.

There have been 11 reported deaths due to swine flu with close to 800 infections in the country so far. There are six vaccination centers in Prague carrying out, on average, 30 vaccinations daily, Monday to Friday. That is just under 1,000 vaccinations per week, given mostly to frontline health workers and patients deemed most at risk who suffer from underlying health problems.

The vaccine can take up two weeks to kick in, according to World Health Organization (WHO) guidelines, which means that those vaccinated this week will not see the full benefit of the vaccine until mid-December, the time when the Health Ministry has said a possible epidemic could occur.

In November, Chief Public Health Officer Michael Vít said swine flu might reach an epidemic level by mid-December.  

The first phase of the initial 100,000 vaccinations is being given free of charge to targeted patients and frontline healthcare workers, but, with a possible surge this month, the program may be lagging behind the infection rate.

An epidemic is defined as 2 percent of the population showing signs of infection. In the Czech Republic, that would mean 200,000 people becoming infected.

It also emerged that children under 10 years of age, one of the high-risk groups according to WHO, will not be vaccinated in the Czech Republic due to concerns over potential side effects.

"We are not giving vaccinations to children under 10," said Dr. David Macharáček who works in a vaccination center on Spálená street in Prague.

"There could be side effects, and we will wait and see before deciding to vaccinate children in this age group."

But the head of the Czech Immunology Society dismissed fears over vaccine safety.

"The fear of vaccines is caused by negative media campaigns and is unsubstantiated," Roman Prymula said. "The danger is that patients will not want to get vaccinated because they fear the side effects."

The vaccinations in Prague commenced as deaths in Europe from swine flu increased by more than 1,000 in the past week, according to the WHO.

At least 7,826 people are known to have died following infection with the A/H1N1 virus since it first emerged in Mexico in April.

Europe saw an 85 percent increase in the week of Nov. 21 to 27, with the total number of deaths rising from at least 350 to at least 650, WHO said.

On the morning of Nov. 30, the Spálená street clinic waiting room had seven people waiting for shots. Most were doctors, but one mother with a young child waiting to get the shot had been told her child, a boy aged 2, could not get one.

Tests on the vaccine available in the Czech Republic have been encouraging, WHO said. The vaccine, Pandemrix, was tested on thousands of people, including children as young as 6 months old and the elderly. The tests showed the vaccine produced an immune response to swine flu in almost all those who received it and there were no health complications reported, according to WHO, but the organization insisted that further monitoring is necessary.

However, Keiji Fukuda, WHO's special adviser on pandemic influenza, did raise the possibility the virus could mutate into something more dangerous as mutations are common in all influenza viruses.

"The question is whether these mutations suggest there is a fundamental change going on in viruses out there, whether there's a turn for the worse in terms of severity," he said. "The answer right now is that we are not sure."

The virus is almost certain to mutate, but what form this may take and its potential severity are questions that can not yet be answered, he said.  

- Klára Jiřičná contributed to this report.

Tom Clifford can be reached at
tclifford@praguepost.com