An outbreak of swine flu scare has hit Georgia. Things like this happen from time to time everywhere, and very much affects the West too. The flu pandemic in 2009 was real, but the health scare was somehow even more real. In 2009, Georgia had other problems (the previous year’s war), and it wasn’t so affected by the outbreak anyway. In some sense, Georgia is having it all ten years late.
The big issue in Georgia, however, unlike what was much the case in the West, is not just the overreliance on a single drug of choice. That’s a social medicine problem which is very much real in the developed world; and arguably related to that is the anti-vaccine hysteria cropping up not only in the U.S. but even in the Netherlands. Of course reliance on a quick-fix scheme of less-than-certain effect is very much also one of the issues in Georgia. In the West in 2009, this quick fix was for the most part in the form of the vaccine (which by the way was delivered when the threat was already over, and it turned out to have additional side-effects); in Georgia, it is Tamiflu which is the designated miracle cure, a switch which makes sense in a way seeing as the outbreak is already underway.
It’s pretty obvious it’s impossible for the Georgian authorities to launch a mass vaccination program Western-style (which was doubtful efficacy anyhow), and anyway it’s too late now. There is some routine pre-season vaccination of at-risk individuals. A more sinister problem seems to be a confusion over what is actually meant by ‘vaccine’, with media reporting on Tamiflu in the context of vaccination. The effectiveness of Tamiflu as a medicine turned out to be overrated; a vaccine it never was in the first place. But ‘vaccine’ of course is a nice buzzword.
By the way, let’s make something clear: the most likely way to be hospitalized in Tbilisi is doubtless traffic. This probably goes for any major city, but let’s just say in Tbilisi it is very much so. The same day the flu scare came on in earnest, an ambulance drove into a construction site on Chavchavadze Avenue, killing one and injuring a dozen. The ambulance driver was arrested for drunk driving. No, this is not someone’s twisted sense of humour — it actually happened. And I know I’m being mean and cynical right now, but somehow it’s hard to be surprised even. (Another huge traffic-related but more long-term health problem in Tbilisi is the smog. Some study even put Georgia as world lead in relative number of smog deaths, though that figure would be skewed by almost half the country’s population living in one really polluted city.)
The big problem in Georgia is informational: people have little idea what disease is. Most, including doctors and other intelligentsia, still think (and are adamantly convinced) infectious diseases are in fact generated by exposure to cold: going outside with wet hair, sitting close to an open window. That is the abyss of post-Soviet medicine.
This of course makes people less likely to think about washing their hands, not sneezing on others, and generally not going about in public with symptoms (granted, sick-leave must be pretty underdeveloped). And it’s the reason why a number of people did believe the rumour that drinking ammonia would prevent flu infection. This classic-style urban legend must have started as a macabre practical joke, for ammonia is probably the most intensely foul-smelling substance ever known. How one could get oneself to drink it, even in small doses, is beyond belief. It must require some serious conviction. It is poisonous too, of course.
And that’s also the reason why people are wearing those silly facemasks outdoors (sometimes taking them off when they go inside!) but would never stop kissing icons. The latter may well be the single biggest preventable source of influenza spread. Not that any government official would dare to suggest such a thing: the backlash would be riotous.
There is one other major problem of course: the health care is hardly able to handle anything, much less an outbreak of something. I should probably try avoiding the suggestion that the ambulance incident above is somehow reflecting the state of medical care, but still.
So, anyway, the Georgian government and media are totally sold on Tamiflu. The discussion seems to revolve around only how to pay for it. Now the health minister managed to get the pharma company to donate medication for PR. Oh well. As it happens, the Tamiflu patents are now expired, so the medication itself is no longer a big deal anyway for big pharma, and the disinformation PR success is surely worth more (“look some country still believes what we tell them!”). It seems the Georgian mainstream media is hopelessly lost at asking the right questions, at having their own information channels other than that of the government.
The statistically proven effect of Tamiflu is that it reduces the average duration of symptoms from 6 to 5 days. That’s rather lame. And more importantly the side effects mean it should not be recommended without some serious weighing of risks.
Please, policy makers everywhere, stop putting all your money in one boat putting up a show of action-taking and hoping it will turn out alright anyway; when it fails to, this will only favour anti-vaccine sentiment and general distrust of established medicine. Not only is medication resistance growing alarmingly, but so is information resistance. People are so muddled up on what ‘science’ supposedly tells them, get frustrated and fall for anti-intellectualism.
Of course, simply abiding by one way of doing things and hoping for the best is all that politicians think they can do. Politicians feel in some way accountable, and have to act on that. But the end result is populism.
Countries like Georgia are looking to Western governments for how they did things. But Western countries with a working health care, social security, multiple other stable institutions to carry the burden, and a budget with a room for unforeseen consequences can afford to make one or two underdeveloped moves because there are so many buffers. One must allow for these mistakes, they are inevitable. But Western countries should be aware other countries are watching, not the nuances of the debate or the committee analyses afterwards, but for the big picture, the actions that were taken in real-time as it happened. In a way it is good that Western countries try out strategies on themselves: in an otherwise working system, what went right and what went wrong, so that other countries might learn from their mistakes and make it better themselves the second time around. This does not seem to happen however.
Why medication pricing is the executive responsibility of the prime minister is more than a bit puzzling. And well, why the hell should every citizen get free Tamiflu? Medically, it’s unwarranted for sure. It is, of course, symbolic politics. Where the Western politicians at least tend to have some grasp of the value of a principled response and a sense of long-term rather than just short-term accountability, Georgian democracy works more on a feudal principle: the government has to show it does something tangible to protect people. The same tendency does crop up in the West as well in stressful situations, but there it is usually mortified by criticism, even if sometimes too late. Here this is more than just a panicky response by weak-minded politicians to an acute threat, which is what it is that occasionally happens in the West. In Georgia, it seems to be more in line with the generally accepted way society is to be governed.
Update: The media report that there would be ‘disinfection work’ carried out in all educational facilities was so meaningless I didn’t even know where to start. Maybe with the fact that flu virus has a 48 hour life outside of host under optimal conditions, so how could you call it disinfection if the facility is to be closed for a week anyway. I thought it was just some miscommunication. Then I saw it happen. Two cleaning ladies dressed up in white coats (!) going round, guarded by a janitor, with spraybottles (ethanol? chlorine?) doing some token dousing on the floor carpet. I did not see them clean any door handles or surfaces, or do anything remotely useful.
Oh, just for the record, flu virus survives something like four times as long on a hard surface (tables, handles) as compared to a porous one (carpet). Not that there is any way for transmission from the floor to occur anyway, apart from scrubbing your hands on it. If they even believed themselves they were ‘disinfecting’ the air rather than the floor surely at least they would have pointed the spraybottles upwards? All the while the librarian on duty and others in the hall were obviously displaying flu symptoms and sure used the door handle to get in and out.
On another note, the separatist territories took the outbreak as an excuse to completely close off the borders, apparently indefinitely. Maybe this will be the most lasting result.
Update 2: The separatists’ borders did ‘open’ again, but the event did allow them to flex their muscles. The lasting result instead seems to be the fuelling among the Georgian ultra-right backed by Russia (makes sense, no?) of a conspiracy theory holding the really quite measly outbreak to have been orchestrated by the CIA. Budget cuts must’ve hurt bad, either the CIA or the Kremlin conspiracy theorists.
Tbilisi Flipsides 