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Preventing iatrogenic pandemics of panic. Do it in a NICE way

BMJ 2010; 340 doi: (Published 09 June 2010) Cite this as: BMJ 2010;340:c3065
  1. Luc Bonneux, epidemiologist, Netherlands Interdisciplinary Demographic Institute (NIDI), The Hague, Netherlands,
  2. Wim Van Damme, professor, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  1. Correspondence to: L Bonneux bonneux{at}

    The decisions to stockpile antivirals and influenza vaccines to control avian flu (2005-6) and swine flu (2009) cost large amounts of money.1 2 Both epidemic threats were mostly iatrogenic pandemics of panic, which caused little human suffering, but the global plans to control them were largely a waste of money.1 Was this the consequence of rational risk management in conditions of uncertainty, of fear accompanying any epidemic threat,3 or of close working relationships between disease experts and the drugs industry?

    Severe acute respiratory syndrome (SARS) in 2003 was an epidemic by an unknown and therefore scary new virus, but we know much more about influenza viruses.2 4 5 The new A/H1N1 swine flu was a far cry from the lethal A/H1N1 pandemic of 1918. There has never been evidence that the recent A/H1N1 virus was anything but mild,6 and it was not reasonable to consider it the first wave of a much more serious second wave. The theory that the 1918 influenza pandemic was caused by a second …

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