UK pandemic review cites lessons learned for future planning

Lisa Schnirring  Staff Writer

Jul 1, 2010 (CIDRAP News) – An independent review of theUnited Kingdom's response to the H1N1 pandemic gave the government good marksfor the way it handled the outbreak, but said the experience yielded usefullessons for the next such health emergency, such as including break clauses inall future vaccine contracts.

The independent review committee was appointed in March andwas headed by Dame Deirdre Hine, a physician with training in public health whowas chief medical officer of Wales. The 183-page report covers the centralgovernment's response, plus that of the four United Kingdom countries: England,Northern Ireland, Scotland, and Wales.

In her forward letter to health ministers, Hine said herteam reviewed 700 documents and that she conducted 100 interviews during theirassessment. She called the UK's response "proportionate andeffective." Though the pandemic was milder than a more lethal event thatcould occur from an H5N1 avian influenza pandemic, she said the few deaths thatoccurred, which included children and pregnant women, were particularly tragicand poignant.

The independent review's praise of the UK's pandemicresponse stands in contrast to criticisms from some European politicians, suchas members of the Council of Europe, who have criticized governments foroverreacting and wasting resources on pandemic vaccine purchases.

The independent commission's report contains 28 suggestedimprovements for future pandemic planning. The suggestions fall into six majorcategories: central government response, scientific advice, containment,treatment, vaccine, and communications.

The flu crisis tested the government's top responsemanagers, and the committee suggested more backup arrangements for those whoplay key roles in crisis response. Though the outbreak did not test many partsof the UK's pandemic framework, the group wrote that managing additional deathsneeds more work to ensure that the region is prepared for a severe pandemic.

Scientific advice was an important element of the response,especially given high levels of uncertainty about the nature of the virus, thegroup wrote. Early in the outbreak, health ministers and officials hadunrealistic expectations of modeling, which wasn't yet reliable, because itlacked adequate data, they found. However, modeling became more accurate asbetter information became available.

The reviewgroup suggested that top government officials be prepped on the strengths andlimitations of scientific advice early on and that the UK health ministerscommission work to help better gauge pandemic severity in early stages.

In the containment phase part of the review, the groupsuggested that government officials explore more flexible, evidence-based triggersfor response activities, rather than relying on current World HealthOrganization (WHO) and UK alert levels.

"In particular, this work should ensure that clearguidance is set out to enable the rapid adjustment of the prophylaxis policy asmore is learned about the nature of the virus," they wrote.

Regarding the vaccine, the reviewers said the UK'sdepartment of health followed good practices when setting up advance-purchaseagreements with pharmaceutical companies, but said though there was muchflexibility in the amount the UK could purchase, policies were more rigid oncevaccine contracts were signed. They pointed out that Baxter agreed to a breakclause, but GlaxoSmithKline did not.

"Nowthat it has been shown that for certain pandemics a one-dose strategy willsuffice, it is important to build as much flexibility as possible into suchagreements," the committee wrote.

The government's pandemic communication strategy waseffective, but the reviewers suggested that some terms confused the public. Forexample, they said the word "containment" was often construed to meancompletely containing the disease, though health officials use the word todescribe slowing disease spread.

See also:

Jun 30 independent review of UK pandemic H1N1 response