The H1N1 epidemic in Mexico

By Ioana Botea

The epidemic of influenza A (H1N1) receded in Mexico after having perturbed the daily lives of 106 million people for over two weeks. Like all crises, it tested the solidarity of the people and the ability of authorities, and revealed the flaws of the system. It also left a fundamental question unanswered: why has the same infectious agent, now affecting twenty-six countries, caused more hospitalizations and deaths in Mexico than anywhere else? So far, the H1N1 caused 56 deaths in Mexico, as opposed to 3 in the United States (including a Mexican child treated in Texas), 1 in Canada, and none in Europe.

A thorough investigation is necessary to determine whether the high incidence of deaths was caused by biological reasons, as suggested by the scientist Antonio Lazcano, an evolution of life specialist. According to Lazcano, the new virus is more inclined than others to rapid changes, and it is very aggressive in its initial outbreak before weakening as its genetic message is transmitted.

Another explanation, perhaps equally important, is social. Mexico has undoubtedly reached a first world status. In terms of purchasing power parity it has overtaken Spain, and according to IMF’s 2008 chart, it is now the 11th largest economy in the world. Nevertheless, it retains in many respects the features of a third world country, where the poor have little access to information and health care.

Additional interpretations varied from divine warnings to conspiracy theories. When the Mexican government declared the health emergency on April 23, fervent followers of the Catholic Church formed a procession to the cathedral of Mexico City for the first time since the last plague. According to conservatives, the new disease is a sign of divine wrath two years after the law legalizing abortion was passed.

Conversely, the extreme left propagated rumors that influenza A (H1N1) was the product of manipulation of pharmaceutical companies, or even an accident in their laboratories, revealing plans for a “bacteriologic war” plotted, of course, by the United States.

Scientists, including the National Autonomous University of Mexico (UNAM), a bastion of the Left, have defended the "medical rationality," and cooperated with President Felipe Calderon. Mr. Calderon has consulted with several former ministers of health, including Juan Ramon de la Fuente, chief of the UNAM until 2007, and Julio Frenk, director of the Harvard Medical School, who believes that the plan of epidemiological alert has worked rather well.

The current incumbent, Jose Angel Cordova, however, has difficulties verifying the information collected from states in the country, which explains the confusion between the deaths due to influenza A and those caused by other types of 'respiratory infections. The viruses have caused 14 575 deaths in Mexico in 2007 – too many, even if reduced to half from 1985.

For the scientific community, the new flu episode has highlighted the dependence on foreign assistance in both study for the virus and analysis of samples in the manufacture of vaccines. Mexico will take years to recover production capacity, due the agreement signed in March with Sanofi. It also pays the price of constant erosion over the past decade, since the budget allocated for research is 0.33% of GDP, by comparison to 4% in the United States.

Although the vast majority of the population has good hygiene practices despite the lack of water, sanitary precautions imposed on the reopening of schools became puzzling for more than 26 000 primary and secondary schools that do not have running water. But the crisis has particularly revealed the two-tier health care – even three-tier, if you consider that indigenous people are still using herbs and Temazcal, a sort of sauna, to treat themselves. It is in the big cities that access to health services is most unequal. While the wealthy are entitled to five-star clinics under their private health insurances, the average Mexican spends long hours in hospital waiting rooms or must resort to expeditious consultations offered by some pharmacy chains. Self-medication is also widespread, especially among women who do not have time to go see a doctor. This may explain why two thirds of patients who succumbed to influenza A are women, mostly young and previously healthy.