UK response to H1N1 pandemic was highly satisfactory, independent review says

BMJ 2010; 341 doi: (Published 05 July 2010) Cite this as: BMJ 2010;341:c3569
  1. Jacqui Wise
  1. 1London

    The United Kingdom’s response to the 2009 H1N1 flu pandemic, which cost £1.2bn (€1.5bn; $1.8bn), was highly satisfactory and good value for money, concludes an independent review. But any purchasing for future pandemics should allow greater flexibility, it adds.

    The review, by Deirdrie Hine, a former chief medical officer for Wales, says that preparations, including stockpiling drugs and plans to buy up to 132 million doses of vaccine, were “soundly based in terms of value for money, reflecting the inherently low cost of vaccination in relation to the value of lives saved.”

    Around £1bn was spent on pharmaceuticals, including antivirals, antibiotics, and vaccines. More than 30 million doses of vaccine are believed to be left over, as the swine flu pandemic virus proved far milder in its effects than expected.

    Dame Deirdrie said that lessons needed to be learnt for future pandemics. She said that UK health departments should negotiate advance purchase agreements that include “break clauses” allowing less vaccine to be bought. This is particularly important now that it has been shown that one dose of vaccine was enough to provide protection against pandemic flu, rather than the two doses originally thought. One vaccine supplier, Baxter Healthcare, agreed to a break clause in its contract, but the second supplier, GlaxoSmithKline, did not.

    The review, which looked at more than 700 documents and interviewed almost 100 individuals, makes a total of 28 recommendations.

    Summing up the findings Dame Deirdrie said, “The planning for the pandemic was well developed, the personnel involved were fully prepared, the scientific advice provided was expert, communication was excellent, the NHS and public health services right across the UK and their suppliers responded splendidly, and the public response was calm and collaborative.”

    But she added: “It is important that the experience of 2009 does not lead to complacency. It’s a bit like childbirth: when it’s over we tend to forget how painful it was. There will be another pandemic, and that one may be more severe.”

    Worst case scenario figures for England estimated that there could be 65 000 deaths. But the latest figures show that 457 people died as a result of the pandemic.

    Dame Deirdrie dismissed as “fallacious” criticisms that the response to the pandemic was a fuss over nothing. “The costs may seem enormous, but it is clear that lives were saved by the action taken.” She added that health ministers told her they would rather be criticised for doing too much than too little.

    The swine flu pandemic was the first major health emergency since devolution, and the review concluded that the four devolved administrations had worked well together. But it says that even more flexibility is needed—at national, regional, and local level—in planning and response, particularly as the virus turned out to be much milder than expected.

    The report also calls for the four UK health departments to review their use of language during pandemics to ensure that it accurately conveys the levels of risk. Terms such as “containment” and “reasonable worst case” are easily misunderstood, it says.

    Dame Deirdrie said that some elements of the national response framework to pandemic flu had not been fully tested. For example, paediatric critical care units came under pressure even though the pandemic was mild. She said that changes need to be made to ensure that critical care services can cope with a more severe pandemic should it occur.

    She congratulated health professionals on their excellent work in vaccinating priority groups but said that negotiations over fees were time consuming and complex. She recommended that a “sleeping contract” with GPs and community pharmacists be negotiated so that such discussions do not slow down the implementation of a vaccination programme.

    In response to the review the health secretary for England, Andrew Lansley, said, “The UK response was the result of careful preparation, but it is vital that we learn lessons. The government will take these recommendations into consideration in planning for the future to ensure that we remain one of the best prepared countries in the world for any future pandemics.”


    Cite this as: BMJ 2010;340:c3569