Facing the flu pandemic

By Jennifer Cole, Head of Emergency Management, RUSI

On Thursday 11 June, the World Health Organization upgraded its Global Influenza Preparedness Plan to Phase Six, confirming that a global pandemic is officially upon us for the first time in forty years. The numbers of recorded cases in Australia, Canada, Chile and Mexico has hit four figures, the number in the UK has doubled in the last week to over 800, and more than 13000 cases have now been recorded in the United States, but what does this really mean for our health? So far, the disease appears to cause only mild symptoms, so should we be concerned or are these worries melodramatic?

When the level was raised from Phase Four to Phase Five on 29 April, President Obama stated that the situation was 'a cause for concern, not alarm'. This is still very much the case: there is no need to panic but equally there is no place for complacency.

Putting plans into action

First, it is important to remember that the upgrading of the pandemic from Phase Five to Phase Six does not indicate failure on the part of the WHO, or the health authorities of individual countries, to deal with early cases. Once the new strain emerged, it was extremely unlikely that a pandemic could be contained. Rather than signalling a period in which this might be possible, Phase Five is defined by the WHO as the stage when 'the time to finalise the organisation, communication and implementation of the planned mitigation measures is short'.

Thankfully, the UK is very well prepared. According to the WHO, in fact, it is one of the two best prepared countries in the world, the other being France. Finalising these plans is therefore a relatively straightforward affair, though that does not mean it will be an easy one. Pandemic flu sits at the top of the Government's National Risk Register for very good reasons, amongst them the sheer numbers of the population who will be affected simultaneously.

The symptoms caused by the new strain of Influenza A (H1N1) responsible for swine flu appear to be much milder than they would have been had the pandemic evolved from avian flu’s H5N1. While swine flu will hit individuals no harder than other forms of seasonal flu, it will, however, hit many more of us and the strain on the healthcare sector to treat these additional cases will increase proportionately.

Swine flu in perspective

'Ordinary' seasonal flu hospitalises tens of thousands of people in the UK each year and kills between 4,000 and 12,000. This number is largely comprised of the very old, the very ill, and those with compromised immune systems such as cancer patients, diabetics and AIDS sufferers. People who fall into those groups are encouraged to have flu vaccines at the beginning of winter, and this keeps the mortality rates down. We are extremely fortunate in that the pandemic has hit in the summer, giving us time to develop a vaccine for the new strain before winter approaches - current estimates point to September - comfortably ahead of the worst of the winter weather.

While the worst case scenario predictions of an H5N1 mutation causing 750,000 UK dead are, thankfully, unlikely to be realised, this still does not mean that the reaction to the outbreak is a fuss about nothing. The outlook for the UK could have been much worse if the UK, and indeed the world, had not spent the last decade planning, exercising and preparing for this very eventuality. If the WHO had not noticed the outbreak so early; if plans for developing, distributing and administering vaccines were not so well advanced; if the pandemic had hit us in winter; or if it had been a more virulent strain, the situation would have been much more serious. The WHO has not been scaremongering by moving up through the phases. It has been giving health professionals the world over the time to ensure everything that can be done will be done.

Keep calm, but carry on

We should be proud that so many people are seeing swine flu as nothing for them to worry about. They are probably right - but only because the Department of Health, the Cabinet Office, the NHS, Local Resilience Forums and countless other organisations have done the worrying for them, and will continue to do so in the coming months. From national flu pandemic exercises such as 2007's Winter Willow, to countless smaller exercises that take place across the UK every month, to the pages of advice and information that can be found on NHS and Government websites, the UK is as well prepared as it can be to deal with the effects of the global flu pandemic we now face.

 The views expressed above are the author's own, and do not necessarily reflect those of RUSI.

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