Obligatory Topical Swine Flu Post

The appearance of Swine Flu over the past couple of days is the sort of thing that provides ample food for thought among ethicists, particularly public health ethicists.  One perennial question, for example, concerns exactly what governments ought to do to protect their populations from infection – is spending on flu vaccines a good way to neutralise the risk?  Is it efficient?  Could the money still be better spent on university lecturers’ pay, bailing out the banks, and schools?  (For what it’s worth: Yes, no, possibly, in that order.)  At the same time, we might want to know what liberty-limiting measures might be in order, and what the threshold conditions are for them to become morally acceptable.

Of course, there are lessons we can learn here.  We know, with reasonable certainty, that there will be a public health emergency of some sort at some point in the future that will present a severe threat to a great many people: James Lovelock has predicted that, by the end of the century, the human population will undergo a 90% cull – and there’s no reason to suppose that disease (as opposed to famine or war, as if the three were separable anyway) won’t be a part of that.  Lovelock is, perhaps, at the extreme end (I don’t think he’s a pessimist: a cull like that wouldn’t necessarily be bad for humanity or the planet – it could be good – though it would be bad for many particular humans).  What we don’t know is the form that the cull will take.

A couple of years ago, there was a lot of fuss about H5N1.  The current problem is to do with H1N1 – a different strain of virus.  So we got that wrong.  In principle, we could be making greater mistakes elsewhere – we got the flu bit right, but, of course, flu of any strain might turn out to be as nothing compared to, say, Ebola or (worse yet) something that is as-yet unknown – remember that, not so long ago, noone knew of HIV, either.

The point of this isn’t to be gloomy for gloomy’s sake – it’s to point out that predicting and forestalling pandemics is a tricky business, and the correct response will have to take that into account.

A further problem is that governments have to respond to public pressure, and that isn’t always all that well-informed – the death-toll from the current outbreak in Mexico, apparently, has been calculated from deaths in hospital (go to about 3:20 on the clip behind the link) – where, of course, we’d only ever see the most seriously ill people to begin with.  Looking more widely, H1N1 is not (by some measures at least) nearly as virulent as H5N1.  Nevertheless, that’s not likely to make exciting headlines – and, therefore, the public’s demands, which are politically important to governments, are susceptible to being based on a misapprehension.  Implicitly, the worry is that policy responses may not be the best by scientific standards.

Not, of course, that governments are immune from their own brands of foolishness.  Take, for example, Yakov Litzman, the Israeli deputy health minister, who has, according to Haaretz, decided that

Israel would call the new potentially deadly disease that has already struck two continents ‘Mexico Flu,’ rather than ‘Swine Flu, as pigs are not kosher.

I can’t help thinking that, perhaps, he has missed the important point in this case, and that his response could have been directed at more pressing concerns.  (I’m also intrigued by the implication that Mexican flu would be kosher.  Can you have a kosher disease?)

Not that Litzman is alone in his, um, idiosyncratic approach to the problem.  Siti Fadilah Supari, the Indonesian health minister, has reportedly suggested that the virus is man-made and designed as a ploy to help Western pharmaceutical companies maximise profits.  Meanwhile, Martin Robbins is building up a nice compendium of other flu-conspiracy ravings with wry amusement.

And, of course, xkcd is on the case


UPDATE: Naturally, Ben Goldacre has something interesting to say

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