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Britain closes swine flu hotline

Swine flu drop sees service close

Vietnam slaughters poultry over bird flu fears (AFP)

AFP - Thousands of ducks and chickens have been slaughtered in Vietnam as the government tries to contain an outbreak of bird flu ahead of the Lunar New Year, the government said Wednesday.

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Avian influenza - situation in Egypt - update 28

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Swine flu could have been a disaster | Mark Honigsbaum

We were right to prepare for a swine flu pandemic – and it must not stop us anticipating future global health risks

Swine flu is no longer sickening very many people but that does not mean it is no longer newsworthy. On the contrary, in recent weeks a succession of critics have rounded on "happy-go-lucky" virologists, "headline-hungry" journalists and the World Health Organisation, accusing them of being variously dupes of the pharmaceutical industry or willing accomplices to pointless hysteria. Their crime? Hyping the pandemic that never was and thereby helping Big Pharma to a billion-dollar vaccine bonanza.

Leading the told-you-so's is Dr Wolfgang Wodarg, the former head of the Council of Europe's health committee, who this week tabled a motion in Strasbourg accusing the WHO of having "faked" the pandemic. Another is the Guardian's Simon Jenkins. In characteristically acerbic prose he rails against government scientists for peddling "drivel" about the tens of thousands of Britons who might have died this winter. That they didn't and that you and I are still alive shows that H1N1 is not the "Andromeda strain" long- predicted by scientists. "It was pure, systematic, government-induced panic," he writes. "Swine flu was a textbook case of a scare," concurs Christopher Booker in the Daily Telegraph.

Jenkins is a sharp and entertaining writer and when he accuses the media of playing "its joyful part" in propagating panic I have to admit the dart hits home: as a medical historian and expert on the 1918 "Spanish" influenza pandemic I was continually asked to comment on the parallels with swine flu last summer and no doubt added to the hype. But as all good schoolboys know, post hoc doesn't make propter hoc. Just because 65,000 Britons didn't die this winter does not mean that the computer models were wrong or that the Department of Health shouldn't have ordered 50m doses of Tamiflu, only that prognostications about pandemics, like prognostications about earthquakes, are not an exact science.

Writing in this paper last week, Tom Sheldon eloquently makes the point that predicting pandemics is a species of risk analysis and thus, by definition, subject to error. With better virological and epidemiological data perhaps the government wouldn't have stockpiled so much Tamiflu or ordered 90m doses of vaccine. But if it hadn't and armageddon had occurred, Jenkins would have been the first to call for the guillotining of the Chief Medical Officer.

I do not wish to labour the point but it seems to me that the backlash against swine flu is a species of conspiracy-thinking, one that wilfully misconstrues the role of science in the regulation of technologies of health which have brought so many benefits to society. In the same way that 9/11 denialists point to the collapse of World Trade Centre 7 to support their wacko theories about "controlled demolitions", swine flu denialists point to Donald Rumsfeld's position on the board of Gilead, the company that developed Tamiflu, to argue that the "panic" was got up by similar shadowy neo-conservative corporate interests. It is then a short step to seeing all such panics as conspiracies. Thus, according to the Nation of Islam leader Louis Farrakhan, the vaccine is really a tool for culling inner-city black populations because of military leaders' concerns about pressures on the global food supply.

Similar conspiracy-thinking infects health advice websites that advise mothers not to give their children the swine flu jab because of the risk of rare side-effects, such as Guillain-Barré syndrome. In fact, according to the Institute of Medicine, the chances of contracting GBS from influenza vaccination is one or two per million. By comparison, a recent French study found that the risk of contracting GBS from naturally occurring influenza is four to seven out of every 100,000 cases. But that hasn't stopped NHS staff, who should know better, from shunning the swine flu vaccine. Nor, I am sorry to say, are such peer-reviewed studies likely to persuade the sort of people who continue to refuse to give their children the MMR vaccine because they once read somewhere that it might be linked to autism.

Twenty years ago, writing in the context of a very different epidemic, one that to date has claimed two million lives worldwide, Susan Sontag warned that the modern ability to anticipate and estimate the scale of future disasters had resulted in two very different visions of apocalypse: "There is what is happening now. And there is what it portends: the imminent, but not yet actual, and not really graspable, disaster." The result was what Sontag called a "permanent modern scenario: apocalypse looms… and it doesn't occur."

Sontag, of course, was writing in the context of Aids and Jenkins is quite right to point out that in the response to swine flu there has been a similar inflation of apocalyptic rhetoric. But just because swine flu turned out to be a non-event, that doesn't mean that we should conclude that our technology is at fault and that it is a mistake to try to anticipate future disasters. As Margaret Chan, the director of the World Health Organisation, acknowledged in June when she issued a "phase six" alert, triggering the drawdown on the government's stockpile of Tamiflu, "the virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time".

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Response: Swine flu wasn't overhyped – research meant we had to play it safe

There was no conspiracy or panic. Scientists were right to prepare us for a major crisis

Simon Jenkins's distaste for scientists leads him to declare that they deliberately overstate risks, and make panic predictions (Swine flu was as elusive as WMD. The real threat is mad scientist syndrome, 15 January). In reality, scientists worked calmly – not "frantically" as Jenkins asserts – to predict the progress of the disease and to understand risk.

Jenkins says of the initial predictions about the spread of swine flu: "The chief medical officer, Sir Liam Donaldson, bandied about any figure that came into his head, settling on '65,000 could die', peaking at 350 corpses a day."

Worst-case predictions are not figures plucked out the air "to convey plausibility", but result from well-researched computer simulations. Margins of error are high; no one pretends otherwise. Yet Jenkins is delighted when a worst-case scenario isn't met, as though he were right and everyone else wrong.

There is a genuine debate which we must not overlook. What should the government response be? Does the risk justify the expense of stockpiling vaccine? Is it right to divert funds away from other health matters? But Jenkins doesn't ask such questions – instead he dismisses it all as "hysteria". Reasonable advice – alerting morgues, identifying vital key workers – is denounced as "drivel".

You could argue that media coverage of H1N1 was excessive and that editors think the biggest numbers make the best headlines. But the scientific process has been evidence-based and transparent throughout. At the Science Media Centre we have tried to ensure that responsible journalists have had access to the best scientists. We've seen lots of co-operation and very little hysteria.

Science moves by small steps, and as we learn more the picture becomes clearer. This is how official advice on Tamiflu for children was revised. Each time a risk comes along we are better prepared to characterise the next one. But decisions still need to be made early. Picture a beleaguered Simon Jenkins in the middle of a deadly pandemic, decrying the government's woefully inadequate response and failure to order enough vaccine.

It's embarrassingly straightforward. Viruses usually don't mutate into major killers; that's why there are still people left on the planet. But it has happened before and will happen again. We can't predict when – that's what risk is – but we can perform the analyses, educate ourselves and be prepared, all underpinned by evidence drawn from virology and epidemiology. Or we could shrug and say it's all hype, and most of the time we'd be right. Similarly, most of the times I put on a seatbelt I don't crash my car.

Jenkins's logic goes as follows. Once there was a boy who cried wolf, but there wasn't a wolf. Therefore not only do wolves not exist, but there must be a conspiracy between wolf experts, the lupine risk assessment board and the manufacturers of bite-proof trousers to convince the rest of us that they do.

With swine flu there wasn't conspiracy and hype; just scientists, patiently performing the analyses, and explaining the possibilities.

Swine flu was a textbook case of a scare

UPDATED: CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April - December 12, 2009

Swine flu was as elusive as WMD. The real threat is mad scientist syndrome | Simon Jenkins

Remember the warnings of 65,000 dead? Health chiefs should admit they were wrong – yet again – about a global pandemic

Let me recap. Six months ago I reviewed the latest bit of terrorism to emerge from the government's Cobra bunker, courtesy of Alan Johnson, home secretary. Swine flu was allegedly ravaging the nation. The BBC was intoning nightly statistics on what "could" happen as "the deadly virus" took hold. The chief medical officer, Sir Liam Donaldson, bandied about any figure that came into his head, settling on "65,000 could die", peaking at 350 corpses a day.

Donaldson knew exactly what would happen. The media went berserk. The World Health Organisation declared a "six-level alert" so as to "prepare the world for an imminent attack". The happy-go-lucky virologist, John Oxford, said half the population could be infected, and that his lowest estimate was 6,000 dead.

The "Andromeda strain" was stalking the earth, and its first victims were clearly scientists. Drugs were frantically stockpiled and key workers identified as vital to be saved for humanity's future. Cobra alerted the army. Morgues were told to stand ready. The Green party blamed intensive pig farming. The Guardian listed "the top 10 plague books".

If anyone dared question this drivel, they were dismissed by Donaldson as "extremists". When people started reporting swine flu to be even milder than ordinary flu, he accused them of complacency and told them to "wait for next winter". He was already buying 32m masks and spending more than £1bn on Tamiflu and vaccines. Surgeries refused entry to those with flu symptoms, referring them to a government "hotline" where prescription drugs were ordered to be made available without examination or doctor's note. Who knows how many died of undiagnosed illness as a result? Lines were instantly jammed. It was pure, systematic government-induced panic – in which I accept that the media played its joyful part.

This week the authorities admitted that, far from a winter upturn in swine flu, there has been a slump. From 100,000 a week at the peak, there were just 12,000 last week. After the coldest winter for decades, when deaths might be expected to rise, the rate is below that of seasonal flu. In the UK, 360 people have died under its influence, most with prior "non-flu" conditions. Swine flu is not nice – I have had it – but bears no ­relation to the government hysteria.

I accept that anyone can make a mistake, and authority has some duty to err on the side of caution. As Alastair Campbell implied on Tuesday, Iraq might have had weapons of mass destruction, so Blair was right to go to war just in case. But it is reasonable to ask, as the Chilcot inquiry is doing, why precaution on such a colossal and potentially ­destructive scale was justified when those who questioned the need for it have since been proved right. Is anyone asking about flu?

Swine flu is not the first time we have suffered this nonsense. I have a stack of predictions by senior scientists on BSE/CJD in 1995. It would "lead to 136,000 deaths" – a spurious exactitude used to convey plausibility – and "could infect up to 10 million Britons". This led to an obscene £5bn campaign of cattle destruction and compensation. When the prediction proved wildly wrong, the government excused itself with a classic Rumsfeld-ism: "The absence of evidence is not the evidence of absence."

This was followed by Sars 2003, a "panic gripping the world". The World Health Organisation declared that "One in four Britons could die". The medical doom-monger, Dr Patrick Dixon, said that Sars had "a 25% chance of killing tens of millions", whatever that meant. The madcap Tory health spokesman, Liam Fox, demanded the arrest and quarantining of all recent travellers from Asia, including 30,000 Asian students.

In the event, some 800 people died with Sars worldwide, against 21,000 who died in Britain in the seasonal flu epidemic of 1999/2000.

Undaunted, within a year the same alarmists were at work on avian flu. With now habitual hyperbole, Donaldson predicted 50,000 deaths, with "an upper limit", graciously conceded, of 750,000. When one dead swan slumped on a beach in Scotland, BBC reporters went crazy as inspectors stumbled through the seaweed, clad in anti-nuclear armour. Within a year the horror had passed. The global mortality was put at 262, with not one death in Britain. Another fiasco was brushed under the carpet.

The Blair government, and now Brown's, have proved adept at using scare politics to divert attention from other troubles. During foot-and-mouth Blair was quick to don a yellow jumpsuit for photographers and intone as if he alone stood between an illness (that is in fact harmless to humans) and armageddon. This time the swine flu coincided with two other "mystery diseases", MRSA and C-difficile, which killed 10,000 Britons in 2007 alone. But those deaths lay squarely at the doors of unclean NHS hospitals. Hence there were no scary stories or predictions about them from Donaldson.

Donaldson and his eager virologists will doubtless stick loyally to their predictions since it is "too early to be complacent". His allies at the BBC did their bit on Wednesday with a Horizon programme that turned a serious study of virology into grotesque scaremongering, with solemn music and voices crying, "there's no escape", "this could take a devilish turn", and "we don't even know how many viruses there are!" Children writhed in agony from smallpox.

Mad scientist syndrome is rampant. Had these scares been disseminated by a private firm, a local authority or a newspaper (as was anti-MMR), they would be damned from on high with demands that heads roll. As it is, the government's Scientific Advisory Group for Emergencies sails gaily on, still graced by the presence of Sir Roy Anderson, who ­happens also to draw a six-figure salary as a non-executive director of GlaxoSmithKline, which made hundreds of millions from the government's panic. Anderson, and GSK, vigorously deny any conflict of interest.

The Council of Europe's head of health, Wolfgang Wodarg, is one of the few who have dared blow the whistle on the links between "Big Pharma" and national and ­supranational agencies. He this week persuaded the council to stage a debate on the "enormous gains" made by GSK and others from the swine flu pandemic. He seeks details of relations between the companies and the WHO, given that stockpile contracts kick in the moment that ­organisation uses the word "pandemic". It did so for the first time last year, with reckless alacrity.

I am not aware of the WHO or the General Medical Council or any of the medical colleges investigating these matters, or any check on conflicts of interest of government doctors who work for drugs companies. I am not aware of any Whitehall or Commons committee, any National Audit Office or competition inquiry into the supply of these drugs. All I know is that a huge amount of health money, time and effort was last year diverted from possibly critical therapies into what looked from the start to be yet more terror virology.

This is why people are ever more sceptical of scientists. Why should they believe what "experts" say when they can be so wrong and with such impunity? Weapons of mass destruction, lethal viruses, nuclear radiation, global warming … why should we believe a word of it? And it is a short step from don't believe to don't care.

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MMWR: Outbreak of 2009 Pandemic Influenza A (H1N1) at a School --- Hawaii, May 2009

Millions of doses of swine flu vaccine to be off-loaded

What do you do with vaccine that no-one needs?

That is the question currently puzzling the Department of Health. Back in May the government signed contracts with two suppliers - GSK and Baxter - to supply 90 million doses of H1N1 pandemic vaccine.

That was on the basis that two doses would be needed to provide protection. Swine flu has turned out to be far milder than was initially feared and so the government is going to be left with a huge amount of unused vaccine.

The Department of Health has revealed that it has a break clause in its contract with Baxter which had been asked to supply 30 million doses, but it appears there is no get-out clause in the deal with GSK, set to provide 60 million doses. GSK has so far delivered 23.9 million doses to the government and Baxter five million.

That is more than enough to vaccinate all the at-risk groups and the government made clear there are no plans to extend immunisation.

The Head of Immunisation at the Department of Health, Professor David Salisbury said: "The Baxter contract has a break clause. We are in discussion with GSK about future supplies of vaccine." When asked how much the government might be able to re-coup from the deal with GSK he said "That is what we are discussing now."

For commercial reasons no figure has been given for the cost of the vaccine contracts, but it's likely to run into several hundred million pounds. Professor Salisbury said there were a number of options which included selling excess doses or giving them away to developing countries.

But he added that it was essential that the UK kept a stockpile of H1N1 vaccine in case there was a resurgence of the virus over the coming year.

One option being discussed with GSK, which was described as "innovative" by the Chief Medical Officer Sir Liam Donaldson, would involve keeping a stockpile of adjuvant, the booster chemical which is produced separately from the vaccine and mixed later.

Professor Salisbury said this would be a good idea as it could be used in conjunction with another flu vaccine in the event of a new pandemic. He said the adjuvant had a shelf life of five years.

When asked whether the NHS would be left substantially out of pocket by purchasing so much H1N1 vaccine, Sir Liam said that the contracts were signed earlier this year amid the early and very alarming information about deaths from the virus in Mexico. The death rates in Mexico were later reduced.

Vaccine uptake

There are no accurate figures for the UK. But in England:

• At least one in three people in the initial priority groups has had the vaccine.
• 3.2 million doses have been administered.
• 113,000 pregnant women have had the jab out of around 600,000 - about one in five.
• 373,000 front-line health workers have had the jab out of around a million (there are no figures for uptake among front-line social care workers).
• 86,000 doses have been given to healthy children aged six months to under five out of more than three million, but this process only got underway before Christmas.

Professor Salisbury urged all those in the at-risk groups to get immunised, especially children under five because it was not clear what would happen with swine flu over the year ahead.

Swine flu figures

There is very little swine flu about. Latest figures show that there were fewer than 5,000 new cases in England over the past week. And disease "modellers" have advised the Department that a third wave of swine flu is unlikely this winter.

Sir Liam pointed out that there were the same experts who predicted that up to 65,000 people might die from swine flu this winter - a figure which was later downgraded to 1,000.

This lack of swine flu in the community will make it more difficult to persuade those at risk of flu complications to come forward to be immunised.

But the Chief Medical Officer Sir Liam Donaldson pointed out that 20 children under five and 12 pregnant women had died in the UK from swine flu related conditions since April.

To date there have been 360 deaths from swine flu in the UK (251 in England, 64 in Scotland, 28 in Wales and 17 in Northern Ireland). But the vast majority of those infected have had either a mild disease or no symptoms at all.

In England there were 393 people in hospital with swine flu on 6 January, 103 of them in critical care.

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What will happen to swine flu in 2010?

We can all be grateful that the NHS did not have the Christmas or New Year it was expecting. Looking back to June last year, there was huge expectation that H1N1 swine flu would cause immense pressure on the health service with predictions that intensive care could face its toughest challenge in forty years.

Swine flu has not entirely gone away, and there are still patients critically ill in hospital with the complications of the virus. But it is nothing like as bad as had been feared. The latest figures from the Health Protection Agency show that cases continue to decline across the UK with the majority of infections being mild.

So what should we expect in 2010? Has swine flu had its day? Time for some New Year predictions, which will no doubt return to haunt me in months ahead.

Anyone who has studied the influenza virus will tell you that it is an unpredictable so-and-so, which makes forecasting rather difficult. But surely it is safe to say now that we are well over the worst of the first pandemic of the 21st Century?

We might get a bit of an upsurge in the coming weeks, but it should not be anything that the NHS couldn't handle.

The biggest concern would be virus mutation. But there are no tangible signs of a mutated H1N1 pandemic virus spreading in the community. So far, so reassuring - but let's wait and see what the year holds. So many people have been infected with swine flu that there is now quite a bit of herd immunity in Britain, which might itself force the virus to change its genetic make-up in order to keep circulating.

The H1N1 pandemic strain is being incorporated into the seasonal flu vaccine for the southern hemisphere, which will be distributed in a couple of months. The same will happen later this year for the northern hemisphere.

This means that by the time the next flu season comes round, in late autumn 2010, millions of us will either have had swine flu or have been immunised against it. So the second winter of swine flu should, hopefully, be as mild as the first.

PS: Many thanks for your comments in 2009, and a very Happy New Year to you all.

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Avian influenza - situation in Egypt - update 26