Préparation d'un vaccin

Prophylactic holiday in Mexico?

Jean-Hervé Bradol

Medical doctor, specialized in tropical medicine, emergency medicine and epidemiology. In 1989 he went on mission with Médecins sans Frontières for the first time, and undertook long-term missions in Uganda, Somalia and Thailand. He returned to the Paris headquarters in 1994 as a programs director. Between 1996 and 1998, he served as the director of communications, and later as director of operations until May 2000 when he was elected president of the French section of Médecins sans Frontières. He was re-elected in May 2003 and in May 2006. From 2000 to 2008, he was a member of the International Council of MSF and a member of the Board of MSF USA. He is the co-editor of "Medical innovations in humanitarian situations" (MSF, 2009) and Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontiéres, The Rwandan Experience, 1982–97 (Manchester University Press, 2017).

Influenza A H1N1 is turning into a pandemic. What will the number of cases be, what groups will be the most affected, how virulent will the virus be, and how long will it last? Despite extensive modelling, no one really knows. The term "pandemic" implies the global spread of a new virus against which no one has any defence. Individual and collective protective measures (vaccination, treatment, wearing a mask, restrictions on public gatherings and movement and other measures) have never been tested with this prevalent new virus. Because unexpectedness is one of its defining characteristics, though that is not totally true, no one knows what strategies might be suitable. With the catastrophic nature of earlier outbreaks still vivid in people's memories, especially the 1918/19 Spanish flu, there is no room for complacency: a response to the threat must be planned.

 Currently the main idea is to slow the geographic spread of the virus to have enough time to produce a vaccine. If this is successful, will the use of the vaccine limit the number of cases and the mortality? Wouldn't it be better for the virus to spread before it is not very virulent, or, on the other hand, wouldn't this very spread guarantee that it could become even more virulent? Doesn't this hope of slowing its geographic spread smack of a vain attempt to put up a dyke at the last minute in the face of a tidal wave? Uncertainty reigns where action is dependent on mathematical modelling based, obviously, on knowledge gained in previous outbreaks, but still with too many unknowns remaining to allow for a clear prognosis.

 Nonetheless, because of such a strategy, the risk is great enough for governments to take a raft of measures which limit civil liberties (free movement and contact between individuals), bringing in discriminatory measures directed at individuals and whole populations, in a  context in which the only certainty that prevails is the disparity between the available resources and the potential demand (who will have the privilege of getting vaccinated in time, or of accessing appropriate care?). In addition, the measures being considered constitute in themselves a massive economic gamble. To sum up, it must be understood who will be sacrificed (or saved) and who will grow rich (or go to the wall) in this extremely ambitious, unprecedented undertaking, where the results are all hypothetical.

 The situation requires less strident information (citizens, get ready to follow the advice of your committee of public safety) which would explain the human and economic sacrifices demanded by political leaders in line with the ruling strategic mindset. As far as this goes, wouldn't it be better to outline the alternatives instead of suggesting as a stock response that the very mention of them is some sort of reckless indiscipline? Given the current state of knowledge, there's a strong temptation to recommend that people take a preventive holiday in Mexico. The H1N1 virus currently circulating there would cause a run-of-the-mill cold, thereby conferring immunity at a low cost (the price of holidays in the country having plummeted) which would afford protection once the epidemic reaches Europe in the autumn with a heightened virulence. On their return to France, to comply with public health requirements, people would have to give up the selfless temptation to pass the infection on to their nearest and dearest so that they might develop an immunity without going to the trouble of moving to Mexico. All they need do is just extend their stay in this fascinating country by a few days so that they're no longer contagious when they get home.

To cite this content :
Jean-Hervé Bradol, “Prophylactic holiday in Mexico?”, 15 juin 2009, URL :

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