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Thursday, July 16

H1N1/swine flu: British health officials give textbook illustration of how not to manage an infectious disease outbreak

First Andy Burnham, the health minister, newly installed in his job on June 5, reportedly assured Britons on June 12 that swine flu was nothing to worry about, and on June 30 remarked, "The risk to the general public remains low and we can all play our part in slowing the spread of the virus by following simple hygiene procedures – like washing your hands and using tissues when coughing or sneezing."

Two days later Burnham set off a panic in Britain and made himself a laughing stock among mathematicians by announcing that according to projections 100,000 Britons a day could be infected with swine flu and 40 could be dying every day by the end of August.

Not satisfied with the health ministry's handiwork, Dr Peter Holden, who played a key role in drawing up the government's contingency planning for a pandemic, announced on July 11 that routine surgical operations and preventive treatment would have to take second place to swine flu treatment.

By that evening, I suppose, the government had noticed that the masses were worried about dying at the rate of 40 a day from swine flu and being deprived of medical treatment for ailments other than flu. And with two leaked government memos in mind -- one that explained Scots wouldn't see a swine flu vaccine for another 16 months, another that complained the National Health Service was in a muddle about emergency swine flu planning -- they made an executive decision.

Thus, on June 12, the (London) Sunday Times chirped that swine flu vaccine was due to arrive in Britain in a few weeks and that regulators said it could be approved for use in just five days.

I don't think the assurance had quite the intended effect because the Times didn't know when to shut up. Instead, they got way too technical and explained that the vaccine would be fast-tracked through clinical trials.

One damn thing leads to another. So then the Times article had to dig a deeper hole by acknowledging that while some might worry about hasty trials of a new vaccine, "regulators said fast-tracking would not be at the expense of patient safety. 'The vaccines are authorised with a detailed risk management plan.' ”

However, the Times, and the British government, tended to overlook that they were not talking inside a sealed room in the year 1902. In other words WHO officials in Switzerland immediately heard about the announcement.

This meant that after some hesitation WHO Director-General Margaret Chan decided she had no choice but to risk the ire of the British government and correct the rosy prediction:
Chan told the [U.K.] Guardian newspaper that a vaccine would not be available for several months, despite statements from health officials in Britain that the first stocks would start arriving in August.

"There's no vaccine. One should be available soon, in August. But having a vaccine available is not the same as having a vaccine that has proven safe," Chan said.

"Clinical trial data will not be available for another two to three months," she added.
So then the British government had to dig a deeper ditch for themselves. Dateline today:
Chief Medical Officer Sir Liam Donaldson, seeking to calm fears of more deaths from the H1N1 virus, hit back at claims by Dr Margaret Chan of the World Health Organisation that the drug could be delayed.

[...] Sir Liam said: "She may be commenting from a global perspective, but as far as the UK is concerned, we are still expecting 60 million doses by the end of the calendar year.

"There is some uncertainty because vaccine manufacture involves a complex process of testing biological products, so it can sometimes go wrong and cause delays.

"We then have to license it properly and it may take a little time, but we still will be one of the first countries to get it."

The Government also said the 60 million vaccines would be enough to cover half the population - with each person needing two doses - with the rest of the delivery following next year.


Delays could result between manufacturers Baxter and GlaxoSmithKline delivering the supplies and people receiving vaccinations because the drug has to be approved by two agencies beforehand.

This process can take months but the Government insisted last week the drug could be fast-tracked for use in Britain within five days.

The Department of Health said yesterday: "The manufacturers have told us they will be delivering the first supplies of the vaccine at the end of August. This is not the Department of Health's schedule - it's the manufacturers. These contracts were set up some time ago to ensure we are first in the queue."

Around 40,000 people a week are now contacting their GP over fears they have swine flu. The figures, from the Royal College of GPs, show a 50% leap in the past seven days.

"It may take a little time but we will still be one of the first to get a vaccine," [said] Sir Liam Donaldson.
If you ask, 'Isn't he actually saying the same thing that Margaret Chan said?' -- if you go over both statements with a fine tooth comb, then, if he'd just stuck to replying to Chan, yes, he said essentially the same thing.

But he didn't stop there. So imagine you're sitting at a computer terminal in Nairobi or Dhaka, both of which will be lucky to see any swine flu vaccine by 2012, and reading that once again the British are doing everything to be first in a queue.

Meanwhile, Margaret Chan is going around hat in hand, as it were, trying to wheedle a few million free doses out of vaccine manufacturers for countries that couldn't buy their way to the front of the swine flu vaccine distribution line.

In their rush to assure voters that the United Kingdom would get all the vaccine its citizens needed, Gordon Brown's administration forgot that Donaldson's words would be posted on the internet within seconds of their publication.

The British government doesn't need lessons in propaganda basics -- Say as little as possible, Say it as vaguely as possible, Don't nail yourself down to a date -- but politics has overtaken common sense.

I understand the Labor party is on shaky ground right now, but what bothers me about all this, aside from the fact that I and my readers have more important things to do than watch a three-ring circus, is that Brown will most probably act to true to form.

This means he might try to pressure President Obama to get Congress to authorize a huge donation of vaccine to WHO and other international organizations for distribution in the poorer countries.

I hope my imagination has not run away with me. But being the nervous imaginative type, I have a few words for Britain's government: First you did too little. Then you talked too much. Don't try to use swine flu as a bludgeon against the United States in order to cover up your mistakes. My government has enough of its own mistakes to deal with on the swine flu front.

And the United States has already agreed to donate 420,000 treatment courses of Tamiflu to help treat severe cases of influenza in Latin America and the Caribbean.

There is a bigger issue with rushing the vaccine. The fast track is based on a vaccine designed for H5N1, not H1N1. The viruses are unlikely to be interchangeable. Who would want to be the guinea pig for that?


Thanks for your exceptional work on this issue.
Anonymous, Thank you for the information on the fast-tracked vaccine -- and for the pat on the back. I suspect several of my colleagues on the blogosphere are wondering whether I've lost my mind for giving so much attention to swine flu.
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