Wednesday, 20 November 2019

Vaccine downers

In his 1916 Proclamation, St Padraig of Pearse promised “The Republic guarantees religious and civil liberty, equal rights and equal opportunities to all its citizens and declares its resolve to pursue the happiness and prosperity of the whole nation and all its parts, cherishing all the children of the nation equally.

That sounded just fine, despite being seen as quite difficult to achieve in practice. But it doesn't take a moral philosopher to expose the uselessness of the statement; it just takes someone who has seen a version [as L] of the equality vs equity meme which has been widely circulated recently. The trouble with memes is that they get tired and debased long before their value is diminished. Here's an interesting re-look at some of the issues. Anatole France, who was born 35 years earlier than Pearse, articulated the key issue: La loi, dans un grand souci d'égalité, interdit aux riches comme aux pauvres de coucher sous les ponts, de mendier dans les rues et de voler du pain. From Le Lys Rouge, The Red Lily tr: The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.

I'm thinking about these issues because Aoife Bennett has been awarded a chunk of money because she is now suffering from narcolepsy and she definitely didn't before she took a shot of Pandemrix against the swine 'flu while at school in 2009. I wrote about the connexion between 'flu vaccines and this peculiar and rare condition in 2013. There was a bit of a flap about swine flu in 2009, in England the data looked like:
There were several weeks that Summer (with a second peak in Oct/Nov) when 50,000+ new cases were being diagnosed and 10 people were dying from the flu [source: BMJ].  In England 140 people died of flu and more from more than 500,000 cases that year. For parochial interest, the population of Ireland is about a tenth of England's and the flu cases and mortality rates were about the same. The flu is nothing like the sniffles or a cold: if you can think about getting out of bed you haven't got the flu. Anyone would want to avoid that, if they could do so easily, perhaps especially if The Gumment was picking up the tab. The tab, in this case, being the price of a couple of doses of Pandemrix manufactured by GSK aka GlaxoSmithKline one of the world's largest MegaPharm companies. The HSE forked over €80,000,000 for 8 million shots of Pandemrix in 2009 and  sweetened the deal by offering GSK indemnity for any adverse reactions to their vaccine. In 2011, they uttered some of left-over doses in the face of an anticipated flu sweep and at least one now narcoleptic girl got Pandemrix both years.

Aoife Bennett's case is that the HSE should have known about the narcolepsy connexion. A spike in narcolepsy, probably associated with Pandemrix, was reported in Finland a month after the HSE started to reissue the drug in 2011. The population of Finland and the rate of flu vaccination is about the same as Ireland; and if the HSE and the Irish disease surveillance system hadn't been asleep at the wheel, they too have spotted the association early enough to toilet the surplus vaccines that were issued in early 2011. I don't think anyone is claiming that GSK and the regulators were culpably negligent in 2009 before Pandemrix was widely enough prescribed to trigger a countable number of narcolepsy cases.

Padraig Pearse's poorly articulated 1916 'cherish equally' aspiration in a free and independent Ireland was that if some person, especially a child, gets all buggered up then the state will take care of them, even if they will now require more care and attention and money than their more fortunate neighbours. Pearse knew nothing about medical or regulatory negligence; his assertion was that the state had the back of all its citizens even the unlucky ones. The Ireland we have now is not a socialist paradise: successive centre-right governments have been elected on a wave of lower taxes, so there is no spare money to handle the difficult cases: the Down's, the haemophiliacs,  the anti-D women, team cystic fibrosis. Actually, these cohorts do have their cost of treatment picked up by the Minister of Health but thousands of other less articulate people with less dramatic conditions are quietly shuffled to the back of the class if they are quiet and undemanding, or to a no-see-um institution if they start to frighten the horses.

This is why Aoife Bennett has to sue the state for some help and take a 10 Year journey through the courts to vindicate her right to be treated with equity. It's your fault, and mine, because we don't pay enough tax to cherish anyone else: our mortgage, our car, our lattes, our holiday, our children's education takes precedence.

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