With official deaths remaining relatively low, the backlash against the H1N1 pandemic response is in full swing. Claims range from a massive overreaction by health authorities to a conspiracy cooked up by Big Pharma. But while swine flu may have boosted profits for vaccine manufacturers, the reality of the pandemic is more complicated.

First, the pandemic isn't over. While cases in Western Europe and North America have trailed off, the virus is still spreading in eastern Europe, Africa and Asia. Meanwhile, Europe and North America could see cases rise again, if the flu pandemic of 1957-8 is anything to go by.

By January 1958, following an initially low death rate, officials assumed the pandemic was over, and vaccine went unused. But then there was a wave of deaths in the United States in February, which might otherwise have been avoided.

"They had vaccine but they didn't encourage its use," says Anne Schuchat of the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia. To prevent a similar scenario, the CDC recommends continued vaccination. Yet several countries and U.S. states have vaccine gluts, and many European countries are cutting orders and selling or giving vaccine away.

Even if we don't see a 1958-style comeback, classifying the pandemic as a damp squib at this point would be premature. Although the World Health Organization's official death toll stands at 13,000 worldwide, this is likely to be an underestimate.

"We anticipate that these figures will be much larger," Keiji Fukuda, head of flu at the WHO, told the press in January. Many cases are not seen by doctors, or are misdiagnosed: the CDC estimates that flu directly causes 2.7 times as many deaths as are officially counted in the US.

What's more, straight death counts mask what was particularly scary about 2009 H1N1: that it doesn't just strike the old and infirm. About 90 percent of seasonal flu victims are over 65. In contrast, 88 percent of H1N1's victims have been under 65.

The perception that H1N1 is harmless may stem from ordinary people rarely seeing the severe cases, says D.A. Henderson of the University of Pittsburgh in Pennsylvania, who ran the CDC's flu surveillance in 1957 and famously led the eradication of smallpox. Of a similar misperception in 1957, he says: "A quarter of Americans had flu, and there were excess deaths. But for one watching from close range, it did little more than disrupt school football schedules."

What about the millions paid to vaccine companies? All the scientists contacted by New Scientist say launching vaccine production at the start of the pandemic was appropriate.

"When a virus emerges from the animal reservoir you don't know how it will behave," says Ilaria Capua of the World Organization for Animal Health's flu reference lab in Legnaro, Italy. "We were quite lucky with this virus. Would you prefer to have no vaccine? This was the only thing we could do."

Vive la Resistance to Flu
Debora MacKenzie

Vaccinating people against swine flu may be a lot easier than anyone dared hope, as it turns out that people have an unexpected degree of immunity to the pandemic now sweeping the world.

Air Kisses, Hugs, and Other Ways to Avoid Getting Swine Flu
Deborah Kotz

In an effort to contain swine flu, the French Health Ministry this week called for citizens to avoid "all direct contacts between people and particularly with sick people," which means no kissing or shaking hands.

4 Flu Vaccine Doses for Kids This Fall -- but Where and When
Nancy Shute

This may go down in history as the most confusing flu season ever, given that a vaccine for the new H1N1 swine flu isn't yet available, but the plain old seasonal flu vaccine is. Talk about a recipe for pandemonium at the pediatrician's office!

Seasonal Cold or Swine Flu? Moms Face Tough Calls
Deborah Kotz

I sent my 11-year-old son to school today with a stuffy nose and mild cough, as I've done countless times in the past. Now, though, I'm wondering whether I should have kept him home. How do I know it's really a garden-variety cold and not the swine flu?

Still Confused About Swine Flu Shots? Kids Under 10 Will Need 2
Nancy Shute

The National Institute for Allergy and Infectious Diseases made it easy to think that all children will need just one swine flu immunization, but that's not true. The younger a child is, the less well his or her immune system responded to the swine flu vaccine in clinical trials. So children under age 10 will need two doses of swine flu vaccine, one month apart, according to the NIAID itself.

Better Ways Medicine Can Beat Back Swine Flu
Bernadine Healy M.D.

Yes, today's swine flu outbreak could change quickly. But it's time to give up the ghosts of 1918 that so haunt our medical thinking. Our challenges today are not what they were when we had nothing to offer but are more about knowing just what to offer, when, and to whom. This swine flu pandemic promises to teach numerous lessons that will inform future crises. Some are already evident

(c) 2010 Debora MacKenzie, New Scientist Magazine