Populist decisions vs. public health

Populist decisions vs. p

December 12, 2009 21:51
3 minute read.

Opening the Treasury's purse strings to expand healthcare is a notoriously difficult, usually fruitless campaign of blood, sweat and tears. The Treasury claims there is no money for building new hospitals and rebuilding outdated infrastructure in the rest, for annually enlarging the health basket by a set rate, for cutting deaths by tackling smoking, obesity and lack of exercise, for producing more doctors and funding biomedical research. But a few months ago, Prime Minister (and nominal Health Minister) Binyamin Netanyahu opened the purse to spend as much as NIS 1 billion to purchase one dose of H1N1 flu vaccine and the anti-viral drug Tamiflu for everyone. If unused, remaining doses will likely be thrown out in a year, as the virus tends to mutate. The World Health Organization, which had not been fully alert to the now-forgotten "pandemics" of SARS and avian flu, called the the new "swine flu" strain from Mexico an emergency with the highest pandemic designation. This triggered fears that the 1918-1920 Spanish flu (a cousin of today's strain) - which killed 50 million to 100 million people - had come back to haunt us. The local media thought flu deaths would mean "ratings" and sensationalized them. Netanyahu was forced to decide quickly whether to purchase options for an as-yet-undeveloped vaccine from foreign pharmaceutical companies; a delayed decision would mean no vaccine. Netanyahu's office says the decision was based on professionals' recommendations, but senior Health Ministry officials and experts anonymously insist they advised Netanyahu to purchase enough only for high-risk groups, estimated to be about 1.5 million people. It was a difficult decision and a gamble - but the health system makes life-and-death decisions every day. Israel, with its universal health insurance system, has highly accessible, quality healthcare and a mild climate, unlike many countries that purchased doses for all. So far, 127,000 Israelis - only a minority of the high-risk group - have been voluntarily vaccinated - and even most medical personnel have declined, despite employers' urging due to their constant exposure to patients who may have H1N1. Some top-level physicians maintain they were "misled" by officials who exaggerated the threat and endorsed the policy based on incorrect data. Neither Netanyahu nor Deputy Health Minister Ya'acov Litzman rolled up sleeves for the shot at their press conference calling on the public to get vaccinated as a "civic duty" - unlike ministry director-general Dr. Eitan Hai-Am, who tried to boost citizens' confidence in its so-far-proven safety. Israelis are a stiff-necked people who don't like to be told what to do. Only 1.12 million (or 15% of the whole population) have gone for the familiar seasonal flu shot since the 2010 formula arrived in September. And it is that "ordinary" strain, while less infectious than H1N1, that causes fatal complications in up to 1,000 Israelis each winter, most of them elderly or sickly. Very few of the Tamiflu doses have been used, and the British Medical Journal insists there is no proof it protects against serious complications but only shortens the flu by a day or two. Back in early summer, the health funds could have sent opt-out/in postcards to all members, with the government ordering vaccine only for the opt-ins and with those who asked for shots but didn't go getting fined. Perhaps Netanyahu really believed vaccine and Tamiflu for all would save Israel, but his decision to invest such a huge sum - enough to build a much-needed hospital or two, or fund other projects that would save many more lives - looks populistic. It is not even clear how many have really died of H1N1: As no autopsies were carried out, the official casualty list includes anyone infected who later died - even if the cause was chronic illness or age. One on the list of almost 70, for instance, is a young construction worker who, the Health Ministry said, had a fever from H1N1 and fell off the scaffolding. Plainly, the decision on what vaccines and how many doses to purchase should in future rest with a high-level interdisciplinary committee, whose opinions cannot be tilted by politics and concerns about popularity. And, in future, when the Treasury pleads poverty to reject urgent health spending, we will be certain that there is plenty of money around; the only problem is the state's priorities.

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