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Pandemic ethics: Party to the flu (or vigilante vaccination)

A public health expert has warned yesterday against the idea of swine-flu parties, arguing that it may undermine the fight against the emerging pandemic. But others, including James Delingpole in the Telegraph have embraced the idea, hoping that mild influenza now will protect against more serious illness later. Exposure parties might be thought of as a form of vigilante vaccination against influenza.

The idea of swine flu parties draws on the experience of chicken-pox parties or rubella parties. Since both of these infections are, or have been (prior to widespread immunisation), almost ubiquitous in childhood, some parents have sought to deliberately expose their children to the virus by attending the house of a friend currently infected. The idea would be to control the timing of infection (potentially avoiding parents having to take time off work) and to prevent the child form developing the infection in adult life when it can be more serious. For example adult women who contract rubella while pregnant have a serious risk of developing major congenital abnormalities in the fetus.

At present H1N1 appears relatively mild, though there were reports yesterday of the first child to die related to swine flu in the UK. But many infectious diseases experts have warned that H1N1 could become more severe. Previous pandemics, including the infamous 1918 swine flu pandemic, have started out being relatively mild, but increasing in virulence with time. It is possible that contracting mild swine flu now would protect against later severe influenza. And, Delingpole argues, if we are all going to catch later in the year when the flu season hits, individuals might as well get it out of the way now.
There are two main arguments against deliberate self-infection with influenza. The first is prudential. Although contracting H1N1 influenza might lead to mild illness there would also be a small but significant risk of serious illness and death. Many of those who died in Mexico from swine flu were young and previously healthy.  It is also unclear how much benefit infection now would provide to an individual. Although mild infection now might prevent later more serious infection, it is not clear yet whether this pandemic will become more severe. If it takes some time to become more virulent there would hopefully be enough time for a vaccine to be manufactured and made available, a strategy that would involve much less personal risk.
The second argument against swine flu parties is the potential harm to others. Although an individual might themselves have a mild illness it would be easy to inadvertently pass the virus on to an elderly relative, friend or passer-by who could develop much more serious complications. In addition such parties would potentially accelerate the spread of the virus within the community leading to a higher number of infections overall, a greater demand on medical resources, and an increase in the number of deaths. While the virus continues to spread despite intensive efforts to contain it, that does not mean that we should be complacent about the spread of this infection, nor risk worsening the problem in the community.
Like other forms of vigilantism swine flu parties are driven by fear. But our response to the pandemic both on an individual and a community level should be guided by reason, evidence and caution – not by fear of the unknown.

Swine flu parties a bad idea BBC 29/6/09

Is now a good time to get swine flu? BBC magazine 14/5/09

Coming to my swine flu party? Telegraph 30/6/09

Debating the wisdom of swine flu parties New York Times 6/5/09

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