Analysis And Comment

Using lessons from the past to plan for pandemic flu

BMJ 2006; 332 doi: (Published 30 March 2006) Cite this as: BMJ 2006;332:783
  1. Hilary Pickles, director of public health (
  1. 1 Hillingdon Primary Care Trust, West Drayton, Middlesex UB7 7HJ
  • Accepted 3 February 2006

Plans for pandemic flu in the United Kingdom are said to be among the best in the developed world.1 2 Could they be even better if we learnt all the important lessons from the past? The Canadians have said of their handling of SARS (severe acute respiratory syndrome), “There was much to learn—in part because too many earlier lessons were ignored.”3 The responses to AIDS, bovine spongiform encephalopathy (BSE), foot and mouth disease, and SARS provide examples of mistakes to be avoided and good practice to follow. This paper outlines some lessons that are yet to be incorporated into current UK planning for pandemic flu, as judged by what has been made public to date, but many more examples exist.

Pandemic flu

The influenza pandemic in 1918-9 killed about 40-50 million people worldwide.4 Disruption was widespread, and civilised society broke down in some communities. The world population is now much bigger, and domestic and international travel is more extensive. Although modern medicine may prepare us better for the medical consequences of pandemic flu, the socioeconomic consequences could be even more devastating this time. Pandemic flu could be the biggest disruptive challenge that society will face. This makes it more important that we learn all we can from the past.

Government departmental lead

One of the key lessons from foot and mouth disease was that the wider implications of an epidemic must be considered early and appropriately.5 Foot and mouth disease proved too big for the Ministry of Agriculture, Fisheries, and Food to manage, and pandemic flu might be too big for the health departments. The UK national plan focuses on the health response, with the Department of Health as lead department.1 The government submission to the recent House of Lords committee, written by the Department of Health, pays little attention …

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