Nurses protest H1N1 safety as vaccines are delayed

Some 16,000 registered nurses in 39 Nevada and California hospitals may strike on Oct. 30 to protest safety procedures, and staffing levels in the wake of the H1N1 swine flu pandemic.

The nurses argue that hospitals have failed to provide enough protections against swine flu for its members, this is nothing new. Neither hospitals nor governments have paid enough attention to biological events. And the current flu pandemic has obviously failed to ignite significant protective measures if nurses are now moved to strike.

As expected, vaccine supplies will be even more scarce than government projections. This means 28 million to 30 million doses, at most, will be divided around the country by the end of the month, not the 40 million-plus that states had been expecting. So far, Nevada has only received 71,600 vaccine doses, enough to vaccinate less than three percent of the population. This has caused health districts to increase rationing.

Further, the governments failure to accelerate the use of experimental drugs, like Peramivir, to rescue patients on the brink of death, has frustrated both doctors and nurses. Peramivir is an antiviral drug like Tamiflu and Relenza. But unlike those drugs, it's being studied as an intravenous treatment for critically ill patients. Human clinical trials in the U.S. and Japan have called Peramivir safe and effective. But the FDA has not approved it.

However, the FDA has made at least 20 Peramivir exceptions, for compassionate use upon request. In addition, the FDA is considering an Emergency Use Authorization, for the drug. This would allow the government to stockpile the drug and reduce most paperwork. The FDA says the changes are coming "fairly soon" - but doctors say they're needed now.

There is no excuse for either the vaccination or emergency use delays. Flu is not a new event, and the medical community has been aware of H1N1 since April. Further, while American medical care may be the most expensive in the world, its quality is among the lowest. Research suggests that the United States spends more than twice as much on each person for health care as most other industrialized countries. But it has fallen to last place among those countries in preventing deaths through use of timely and effective medical care.

In addition, access to care in the United States has worsened with reports suggesting that between 40 and 75 million people lack adequate health insurance or are uninsured altogether. And within the nation, the cost and quality of care vary drastically.

In some cases, the nation’s progress has been overshadowed by improvements in other industrialized countries, which typically have more centralized health systems, which makes it easier to put changes in place.

The United States, for example, has reduced the number of preventable deaths for people under the age of 75 to 110 deaths for every 100,000 people, compared with 115 deaths five years earlier, but other countries have made greater strides. As a result, the United States now ranks last in preventable mortality, just below Ireland and Portugal, according to the Commonwealth Fund’s analysis of World Health Organization data. The leader by that measure is France, followed by Japan and Australia.

The swine flu pandemic is another lesson in the pathology of governance. And unless this pathology is immediately corrected the nation can expect an ever increasing death count. And should the nation experience a bio-terrorist attack by 2013, as projected by the Commission on the Prevention of Weapons of Mass Destruction the death count will be measured in millions.

For further information see: Allcountries.org healthu care_008. H1N1 a case study in governance Major restructuring necessary to deal with bio-terrorism Total Health Expenditures as % of GDP,  World at Risk: The Report of the Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism.

Michael Manford McGreer, PhD is author of No Harm, No Foul; Bio-terrorism in the 21st Century. A Study in the pathology of governance.