UK plans for pandemic flu don't go far enough

Avian influenza: Preparing for the pandemic; BMJ Volume 332 pp 783-92

The UK's contingency plans for pandemic flu don't go far enough, argues a director of public health in this week's BMJ.

Plans for pandemic flu in the United Kingdom are said to be among the best in the developed world, but important lessons from the past have been missed, writes Hilary Pickles. These include the need to prepare for high death rates, being open with the public, and understanding population behaviour. Clear and appropriate accountability and communications are also needed, she concludes.

In response, David Salisbury, Director of Immunisation at the Department of Health, argues that preparedness has been strengthened through cross government working, enhanced communications, and international cooperation.

In a second article, public health experts in Belgium discuss the risks of a pandemic and ask whether stockpiling antiviral drugs is the best response. They argue that, in a climate of fear, the perception of risk is easily distorted from the actual risk, making us over-react to hypothetical dangers. This has led to stockpiling of antiviral drugs of no clear use, and following mindlessly the advice of disease experts with undeniable interests.

They believe that the energy unleashed by the fear of a pandemic should be directed at tackling real health problems.

"Intensive care resources are unlikely to be able to meet the extra demand of an influenza pandemic, warns critical care specialist, Richard Marsh. Based on data from influenza patients admitted to hospital in Asia, he predicts that between four and five times the number of intensive care beds available in most general hospitals in the UK would be required to meet demand at the peak of the epidemic.

Decisions will be difficult and will require an unprecedented degree of cooperation between everyone caring for these patients, he concludes.

In terms of primary care, preparation is key, says Anthony Harnden. It is not sufficient for practices to rely on government or primary care trust plans. Current guidance is voluminous and general practitioners are in danger of not being able to see the wood for the trees. He believes that practices should develop straightforward plans that are applicable to local circumstances.

Whether H5N1 becomes pandemic, no one can say. The only certainty is that there will be a flu pandemic, some time, warns leading microbiologist Hugh Pennington. "The lesson from history is that making predictions about the virus is a fool's game. It will go on evolving whatever we do." He suggests that the best way forward is to focus on vaccines: to improve their immunogenicity, their breadth of protection, and the speed of manufacture.

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