UK pandemic review cites lessons learned for future planning

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

The independent review committee was appointed in March and was headed by Dame Deirdre Hine, a physician with training in public health who was chief medical officer of Wales. The 183-page report covers the central government’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 her team reviewed 700 documents and that she conducted 100 interviews during their assessment. She called the UK's response "proportionate and effective." Though the pandemic was milder than a more lethal event that could occur from an H5N1 avian influenza pandemic, she said the few deaths that occurred, which included children and pregnant women, were particularly tragic and poignant.

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

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

The flu crisis tested the government's top response managers, and the committee suggested more backup arrangements for those who play key roles in crisis response. Though the outbreak did not test many parts of the UK's pandemic framework, the group wrote that managing additional deaths needs 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, the group wrote. Early in the outbreak, health ministers and officials had unrealistic expectations of modeling, which wasn't yet reliable, because it lacked adequate data, they found. However, modeling became more accurate as better information became available.

The review group suggested that top government officials be prepped on the strengths and limitations of scientific advice early on and that the UK health ministers commission work to help better gauge pandemic severity in early stages.

In the containment phase part of the review, the group suggested that government officials explore more flexible, evidence-based triggers for response activities, rather than relying on current World Health Organization (WHO) and UK alert levels.

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

Regarding the vaccine, the reviewers said the UK's department of health followed good practices when setting up advance-purchase agreements with pharmaceutical companies, but said though there was much flexibility in the amount the UK could purchase, policies were more rigid once vaccine contracts were signed. They pointed out that Baxter agreed to a break clause, but GlaxoSmithKline did not.

"Now that it has been shown that for certain pandemics a one-dose strategy will suffice, it is important to build as much flexibility as possible into such agreements," the committee wrote.

The government's pandemic communication strategy was effective, but the reviewers suggested that some terms confused the public. For example, they said the word "containment" was often construed to mean completely containing the disease, though health officials use the word to describe slowing disease spread.

See also:

Jun 30 independent review of UK pandemic H1N1 response

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