Socioeconomic factors affecting the scenario of the first influenza (swine flu) pandemic of 21st century

by Yadav Sharma Bajagai

During March-April 2009, a new episode of highly contagious respiratory infection (influenza) was emerged from Mexico which was found to be caused by a novel strain of the influenza virus H₁N₁ believed to be originated from swine and thus widely called as swine flu. The disease soon spread widely across many countries through human to human transmission and World Health Organization (WHO) declared that as first influenza pandemic of 21^st century with pandemic alert phase 6 on 11 June 2009. The disease has been declared to move into post-pandemic phase on 10 August 2010. It was estimated that more than 200 million people were affected worldwide from this pandemic influenza causing death of more than 17000 people . Children, young adults and pregnant women were particularly susceptible to the disease.

After its first appearance in Mexico and California during March and early April 2009, the influenza was reported by 208 countries till the end of 2009. The number of countries increased to 214 till April 2010. Although the spread of disease was more gradual in Northern hemisphere spreading from USA to Spain, England, Japan and Germany, the disease spread quickly in Southern hemisphere affecting most of the countries. The countries affected by the disease and death of people due to the pandemic are depicted in figure 1.

 

Figure 1: Countries affected by 2009 pandemic influenza and cumulative death of the people. Source: WHO.

The incidence of disease was found to be clustered among the children and young adult while older aged people were found relatively immune for the disease (figure 2)   

Figure 2: Pattern of age distribution of disease (Tuite et al., 2010). It is evident that age group 10-20 were most affected.

There were many social, economic, political and geographical factors which affected the overall pandemic scenario and disease transmission. Marginal and disadvantaged people with low socioeconomic status are generally more vulnerable during pandemic outbreak of a disease. Limited access to the media (radio, television, internet), lack of adequate resources for precautionary activities, lower literacy rate, inadequate access to health services, crowded accommodation etc. made these people more prone to be affected by the pandemic. In addition, lower socioeconomic status makes the people emigrate from one country to another and these immigrants are particularly vulnerable due to low access to facilities and language barrier. 

Economic Globalization is probably one of the most important factors for faster transmission of the pandemic disease across the continents (figure 3). Cross border movement of the people due to integrated nature of current world economy make the disease transfer from one country/continent to another. Inventions like aeroplane and ship have made this easier. Higher frequency of disease incidence among children and young adults than that in older population is mainly attributable to low level of immunity in these age groups due to lower past exposure to the virus. Therefore, prevention of exposure of non-infected person to the infected person by movement control, hygienic behaviour, isolation of sick people, and immunization to increase immunity against the disease are some important strategies to fight against the pandemic influenza.  

Figure 3: Relationship among different factors affecting pandemic

Beliefs and attitude of general public towards the disease is highly crucial for the prevention strategies to be successful during this type of pandemic situation. Spread of the disease largely depends upon the way people perceive the threat and their behaviour accordingly. People’s behaviour and attitude regarding the influenza pandemic was changing over the time. People were more concerned and terrified during initial period of declaration of pandemic. When there was no vaccine available against that particular strain of influenza virus, people were more cautious about personal hygiene like washing hands, wearing of face mask, use of sanitizers etc. They were more reluctant to meet other people infected with influenza and were avoiding public exposures as far as possible. Even, some people were blaming authorities for exaggerating the risk and effect of the pandemic.

When vaccine was made available, then one group of the people readily accepted to be vaccinated and became more dependent on vaccination rather than the personal hygiene and other precautionary behaviour. But significant proportion of the people did not agree to be vaccinated as they were not convinced about safety of the vaccine and some were also thinking that they were not in need of vaccine. Later, people who initially rejected to be vaccinated also accepted the vaccine when they saw more and more people vaccinated without showing any harmful effects. Not only general public but also large proportion of health care professionals didn’t show any willingness to be vaccinated in some countries due to fear of side effects in spite of strong recommendation of WHO to immunize health professional as the first priority. We can imagine how those professionals could convince general public about the importance of the vaccine. In one hand the willingness of general public and health care professionals to be vaccinated was low but on the other hand vaccination was the main strategy adopted by WHO and other concerned authorities. Policy makers and healthcare professionals rely on the assumption that general public would widely accept the vaccine offered by the authority. Thus, there seems lack of holistic view to tackle the situation. These types of public behaviour had significant effect on disease course and spread. 

Anxiety and fear among the people which might have had socioeconomic effect was another issue which didn’t get due attention in particular. Activities of some people might have affected due to hyped media response about the incidence. In some countries, government announced immediate closure of schools and child care centres which in some way helped to prevent the spread of the disease but made the public more panicked. Therefore, delivering message to the public in balanced way so that they become adequately conscious to take the precautions to prevent disease spread but not over-panicked resulting other harms in health and economy is very crucial issue to be addressed by the responsible authority during such pandemic.