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Swine flu policy

In spring 2009, an influenza (flu) strain commonly known as ‘swine flu’, emerged in Mexico. The strain is thought to have incubated and originated in pigs (hence the name) and is composed of genes from avian, human and pre-existing swine flu viruses. It spread worldwide and, in June, the World Health Organisation (WHO) declared swine flu a pandemic.

As the virus outbreak got underway, the UK government began preparations for the pandemic were it to reach Britain. So, how did they come up with the policy?

The planning

In 1997 the Department of Health (DH) released the UK Health Departments' Multiphase Contingency Plan for Pandemic Influenza, which was “widely seen as a model to follow”. In July 2003, a report titled Fighting Infection was produced by The House of Lords Science and Technology Committee, whose remit is to investigate science and technology matters and provide recommendations for government action. This report was produced in response to the Severe Acute Respiratory Syndrome (SARS) outbreak but also touched on the possibility of pandemic flu.

In October 2005, the DH (England) released a revised policy, UK Health Departments' Influenza Pandemic Contingency Plan, based on the WHO’s recommended framework for pandemic flu.

In December 2005, the Committee published Pandemic Influenza in response to the bird flu outbreaks in Asia. This report included calls for clarification of the Government’s policy on anti-viral drugs and their stock levels. It also pointed out the need to specify the practical aspects of their contingency plan.

It was the 2005 report that influenced the present pandemic flu strategy. Changes that came into effect included the appointment of a National Director of Pandemic Influenza Preparedness and contingency plans for public transport and other vital services. The current strategy, Pandemic flu: a national framework for responding to an influenza pandemic, was published jointly by the DH and the Cabinet Office in 2007. In July 2009, the Committee released Pandemic Influenza: Follow-up Report which was intended to merely update the 2005 report but the outbreak of swine flu changed its focus.

While the DH led the English response, Scotland, Wales and Northern Ireland all had their own policies. Information on the Welsh and Northern Ireland polices can be found on the government’s website*.

The Scottish Government published their policy, Pandemic Flu: A Scottish framework for responding to an influenza pandemic in November 2007. It was based on and updated the 2005 UK contingency plan taking into account changes in scientific advice and lessons learned from UK and Scottish pandemic flu exercises, including “Winter Willow”, a major prevention exercise in February 2007. Interestingly, a four week Scottish pandemic flu exercise was scheduled for 2009 but was cancelled as the threat of a real flu pandemic became apparent.

The response

Even before swine flu was declared a pandemic, the Government began to act. We are all familiar with the public service adverts and literature, confirmatory testing of suspected cases, use of anti-virals such as Oseltamivir (‘Tamiflu’) and the swine flu vaccination programme, to name just a few. In addition, other activities directed at the health services, employers and other entities have also been taking place.

As this was written, cases had fallen below 5,000 per week in England and Scotland.

The aftermath

As the number of new cases continues to fall, people are now starting to ask - did the government get it right?

One of the biggest criticisms has been that the Government’s response was disproportionate to the actual severity of the virus. Seasonal flu routinely kills about 6,000 people in the UK each year; the swine flu death toll is currently about 360, with most people suffering only mild illness.

The widespread use of anti-viral drugs has also been criticised with some saying these did little to stop the spread of flu, and may, in fact, had little clinical effect. Swine flu vaccines have also been targeted for criticism as a large surplus has been left, resulting in the Government looking at either selling them to other countries or donating them to the developing world.

Supporters of the policies point out that the UK’s flu strategy was based on the ‘worst-case scenario’ – a virus that mutated quickly causing severe illness and a high death rate, similar to the 1918 flu. Their feeling is that the Government policy was correct, given the scientific advice available and WHO recommendations.

As the threat of a severe pandemic dissipates, the Government must look at the lessons learned and incorporate them into a new strategy for the future.

Kirsten Shuler examines the government’s response to swine flu

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