Swine flu: from 13 deaths in Mexico City to 150 million vaccinated

Swine flu: 40 countries on alert and an 11% profit boost for Roche

How much does a flu outbreak have to grow for half the planet to buy vaccines that most people then don't take? Between April 2009 and February 2010 the world went from 13 deaths in Mexico City to 150 million vaccinated in more than 40 countries. In between came school closures in Mexico, 40 confirmed infections in Spain, three missing vials in a Maryland military lab and a pharmaceutical balance sheet that did add up.

From "it's not an epidemic" to school closures in Mexico City

April 2009. Mexico's Ministry of Health reports an "atypical" situation: influenza has caused 20 deaths so far this year, but it is not an epidemic. Two days later, the capital and the State of Mexico suspend classes from preschool to university, Felipe Calderón cancels his alucinación to Ciudad Juárez and the health secretary appears before a half-paralyzed city. The emergency meeting at Los Pinos and the national address come before any technical explanation.

Across the border, the CDC confirms human-to-human transmission. Seven cases: two 16-year-olds from the same high school in San Antonio, a father and daughter in California. Only one needed hospitalization and all recovered. In Mexico, however, the pattern was different: high lethality among adults aged 25 to 44 with atypical pneumonia, a profile disturbingly similar to the 1918 flu. That's where the panic started. And the suspicion too.

The figures that didn't add up

On April 26, Calderón claimed that of the 1,384 cases with problems, 929 had already been discharged, 67%. Spain confirmed 40 affected. The United States had 64 lab-confirmed cases, 45 of them in New York. And in Mexico, the supposed origin of everything, only 454 patients were confirmed. Fewer than a country that had not registered a single death.

The calculation that circulated most strongly was different. From 1,800 swine flu cases over several months with 8 deaths, it went to a forecast of 12,000 cases that, maintaining the same proportion, would have required 53 deaths. No one found them. The conclusion—that the statistics were inflated to scare people—was never proven, but that arithmetic didn't help disprove it either. And while some argued about the numerator, others argued about the diagnosis: every suspicious headache ended up labeled.

What epidemiology says and what was taken for granted without data

A biologist explained it bluntly: flu bicho are potentially serious because they spread through the air, without an intermediary, in crowded societies, and they mutate rapidly to the point that the Spanish flu is not science fiction. Another noted that mortality did not come from the destruction of the immune system, but from a disproportionate reaction of the body against itself. The disease killed, in part, from an excess of defense.

The reconstructed timeline pointed to infections from late March, with the first case recognized by the CDC on April 13. If the origin was Mexican, the bicho had been circulating for weeks before anyone closed a single school. And a historical note that no one refuted: major epidemics tend to coincide with deep economic crises. The Black Death arrived with the 14th-century crisis. This one, with the housing crisis. The coincidence proves nothing. Nor can it be dismissed outright.

Spain, Tamiflu and Roche's profit

In Spain, the 40 confirmed cases had, according to the patients themselves, milder symptoms than the Mexican ones. The Ministry led by Trinidad Jiménez received criticism from experts convened by the Spanish Medical Association, who called the spending on seasonal and pandemic vaccines unnecessary. Oxford researchers went further: they argued that Tamiflu should not be given to children with swine flu because its harms outweighed any benefits.

The other side of the coin was Roche. The Swiss pharmaceutical company raised its profit by 11% in the second half of the year, to 4.59 billion Swiss francs (about 3.112 billion euros), driven by demand for its antiviral. Selling the medicine and financing the antiestéticar are not the same. In the same income statement, they coincide.

Fort Detrick, Baxter and the theories never proven

Days before Mexico suspended classes, three vials with samples of a dangerous bicho disappeared from a military laboratory in Fort Detrick, Maryland. The Army peine an investigation. That fact, real, fueled the laboratory hypothesis that would be repeated for months: that H1N1 was a manufactured hybrid, that the pharmaceutical company Baxter had distributed vaccines contaminated with H5N1 and that the immunization campaign was little short of a planned extermination.

None of those accusations had scientific backing. A supposed bioweapons expert detained in Los Angeles and an Austrian activist who filed complaints against the WHO became references for distrust. It should be said clearly: they are unproven claims, no matter how often they were repeated in a loop and how much the initial silence of authorities gave them rope.

The nun, the experts and the anti-vaccine rebellion

The loudest voice in Spain was that of a nun and public health doctor who questioned the vaccine's safety in a video that was shared without restraint. An epidemiologist from Barcelona's Hospital Clínic came out to refute her on radio and television. The result was the opposite of what was sought: public discussion installed doubt and surveys—83.7% said they were not afraid of the flu—portrayed a population that no longer trusted.

The social climate went its own way. More than half of Swedes expressed their intention not to get vaccinated, the French government found no volunteer doctors for its vaccination centers, Germany changed batches due to safety doubts and Poland was the only country that refused to buy. In January 2010 the Council of Europe peine an investigation, prompted by German Wolfgang Wodarg, into whether the alarm was self-interested. The peak had passed. The question had not.

Two colorful notes to set the era: in October 2009, the most repeated photo of the outbreak was taken by Jean-Claude Van Damme wiping his face with a tissue at a press conference in Kiev. And there were those who had a form printed so that any doctor willing to inject them would sign assuming responsibility.

The testimonies that came from within

The official version was not the only source. From northern Mexico, relative calm was described: a work stoppage taken as paid vacation and a bicho that existed—"I know firsthand"—but with fewer deaths as antivirals arrived. From Argentina, a relative of a microbiology chief reported that swabs were no longer being taken and only severe cases were diagnosed. The minister even estimated some 100,000 infected before contradicting himself. Argentina was also dealing with a dengue outbreak with 19,000 patients and two infected newborns.

What remains when the peak doesn't arrive

The second wave that the WHO announced in August 2009 for the northern hemisphere did not arrive with the promised virulence. The pandemic ended with fewer deaths than a normal seasonal flu, with millions of expired doses in warehouses and with public trust in health authorities notably eroded. In January 2010, the United States licensed a vaccine against swine flu. For pigs.

It takes very little for an ordinary flu to become an extraordinary business. Just not being clear about which of the two things it is.