UK Bird Flu News - UK News

The international response to the influenza pandemic: WHO responds to the critics

Report condemns swine flu experts' ties to big pharma

Trio of scientists who urged stockpiling had previously been paid, says report

Scientists who drew up the key World Health Organisation guidelines advising governments to stockpile drugs in the event of a flu pandemic had previously been paid by drug companies which stood to profit, according to a report out today.

An investigation by the British Medical Journal and the Bureau of Investigative Journalism, the not-for-profit reporting unit, shows that WHO guidance issued in 2004 was authored by three scientists who had previously received payment for other work from Roche, which makes Tamiflu, and GlaxoSmithKline (GSK), manufacturer of Relenza.

City analysts say that pharmaceutical companies banked more than $7bn (£4.8bn) as governments stockpiled drugs. The issue of transparency has risen to the forefront of public health debate after dramatic predictions last year about a swine flu pandemic did not come true.

Some countries, notably Poland, declined to join the panic-buying of vaccines and antivirals triggered when the WHO declared the swine flu outbreak a pandemic a year ago this week. The UK, which warned that 65,000 could die as a result of the virus, spent an estimated £1bn stockpiling drugs and vaccines; officials are now attempting to unpick expensive drug contracts.

The cabinet office has launched an inquiry into the cost to the taxpayer of the panic-buying of drugs.

Today, the Council of Europe, produces a damning report into how a lack of openness around "decision making" has bedevilled planning for pandemics.

"The tentacles of drug company influence are in all levels in the decision-making process," said Paul Flynn, the Labour MP who sits on the council's health committee. "It must be right that the WHO is transparent because there has been distortion of priorities of public health services all over Europe, waste of huge sums of public money and provocation of unjustified fear."

Although the experts consulted made no secret of industry ties in other settings, declaring them in research papers and at universities, the WHO itself did not publicly disclose any of these in its seminal 2004 guidance. In its note, the WHO advised: "Countries that are considering the use of antivirals as part of their pandemic response will need to stockpile in advance."

Many nations would adopt this guidance, including Britain. In 2005, the government said it had begun bulk-buying the drug Tamiflu, initially ordering 14.6m doses after bird flu killed 40 in Asia.

The specific guidance on antivirals was written by Professor Fred Hayden. He has confirmed in an email that he was being paid by Roche for lectures and consultancy work at the time the guidance was produced and published. He received payments from GSK for consultancy and lecturing until 2002. He said "[declaration of interest] forms were filled out for the 2002 consultation".

The previous year Hayden was also one of the main authors of a Roche-sponsored study that asserted what was to become a main Tamiflu selling point – its claim of a 60% reduction in flu hospitalisations.

Dr Arnold Monto was the author of the WHO annex dealing with vaccine usage in pandemics. Between 2000 and 2004, and at the time of writing the annex, Monto had openly declared consultancy fees and research support from Roche and GSK. No conflict of interest statement was included in the annex published by the WHO.

When asked if he had signed a declaration of interest form for WHO, Dr Monto said "conflict of interest forms are requested before participation in any WHO meeting".

The third scientist, Professor Karl Nicholson, is credited with the WHO's influential work Pandemic Influenza. According to declarations he made in the BMJ and Lancet in 2003, he had received sponsorship from GSK and Roche.

Even though the previous year these declarations had been openly made, no conflict of interest statement was included in the annex. Nicholson said he last had "financial relations" with Roche in 2001.

When asked if he had signed a declaration of interest form for WHO, he replied: "The WHO does require attendees of meetings, such as those held in 2002 and 2004, to complete declarations of interest."

A WHO official told the BMJ it had to balance an individual's privacy with the robustness of guidelines, which were subject to a wide external review process.

Did the authrotities overreact to swine flu?

Swine flu cost in Wales revealed

The great flu conspiracy | Zoe Williams

The idea of Big Pharma duping the WHO over swine flu is thrilling. The reality is more prosaic

It emerged this week that the Department of Health over-bought swine flu jabs by 30 million doses or, to interject coarsely with mention of money, £150m. That money went somewhere: Big Pharma, the target of nineties-noughties conspiracists. In this case, it was GlaxoSmithKline, though there was originally a side order with Smaller Pharma, Baxter.

While the Tories try to make mileage out of an alleged mishandling, Labour MP Paul Flynn questions the advice from the World Health Organisation that spurred the huge purchase in the first place. He points to all the recent scares that have failed to live up to their deadly billing: Sars, CJD, avian flu. Flynn is involved in a Council of Europe inquiry into the influence of drug companies on government policy, so is likely to be trenchant. Still, I was surprised by his boldness when he said, on the Today programme yesterday: "Did they make these terrifying claims because of epidemiology or did they do it under pressure from pharmaceutical companies?"

It's an enormous charge against the WHO. If it were to stand up, the consequences would be vast. The idea of a central, co-ordinated advisory body on health would probably be ended.

The organisation itself, not surprisingly, rebuts this in the strongest terms. Gregory Hartl, a WHO spokesman, said: "Unequivocally, there is no influence on the WHO by big pharmaceutical companies. We of course have contact with them. It would be irresponsible of us not to work to develop the best tools possible. At the same time, we do have in place internal safeguards to ensure that vaccine manufacturers or individuals associated with them do not exert influence on WHO." Well, sure, you have to imagine this said with feeling – it does seem a little underpowered.

The British Medical Association is in complete accord. Its pandemic flu chief, Peter Holden, is adamant there were no vested interests anywhere near this – and furthermore puts it in context: the world was due a flu pandemic; the NHS had anticipated the crisis, putting out new guidance for GPs in January 2009; that guidance had to take into account not just the flu itself but the change in national circumstances since the last pandemic, in 1968. We only have two-thirds as many hospital beds as we did in 1997. "There are social changes, both parents in a household probably work, we live in a just-in-time economy, there are only four days' food on the shelves, seven days' supply in pharmacies. We had to keep the hospitals liquid; keep the intensive care system running as long as we could; keep as many people at work as we could. What you want to avoid at all costs is civil disorder." Holden is convinced of, and pretty convincing on, the sagacity of the measures taken. One of his simplest points is that the vaccine was ordered on the understanding that people would need two doses; it turned out one would do, but there was no way of knowing that until it had passed into use.

There's a slight faultline here, which is that H1N1 still turned out to be a disease non-event, and the actions taken by individual countries are only as sensible as the threat level issued by the WHO. Hartl points out that, if you measure it in life years, rather than lives, it has had the largest impact of any flu in recent years – most of its victims being young people, children and pregnant women. "I would use the analogy of a seatbelt; if you wear a seatbelt and don't crash, you don't think that's a waste of time." But there's no cost involved in a seatbelt: we're not yet so grand a species that any cost, however large, is preferable to any risk, however small. "I'm not an economist, I can't get into those kinds of questions."

I don't think the WHO is in the grip of pharmaceutical paymasters: It's enough just being the WHO for most of your threats to be overstated. It is in the nature of epidemiology that it's a blunt tool – all you can do is move with the middle of the graph. So even within the borders of one nation, guidelines won't be right for everybody. You'd expect your own government to be stringent. But there is almost no advice that would work equally well across nearly 200 countries at levels of development that vary from Gabon to Germany.

Very few aspects of health don't rely on factors like population density, sanitation, underlying wellness and access to drugs. So either we have to accept that a centralised body will frequently be pessimistic to the point of purposelessness or we have to let go of the idea of a centralised body altogether. If only there were a conspiracy, this would be a lot easier.

• This article was amended on 10 April 2010. The original said that the WHO "refutes" the accusation against it. This usage has been corrected.

Record number of patients in hospital with flu last year: official data

Government cancels swine flu vaccine order

Department of health has struck a deal with drug giant GlaxoSmithKline to cancel part of its massive order for swine flu vaccine, it emerged today

The government has struck a deal with the British drug giant GlaxoSmithKline to cancel part of its massive order for swine flu vaccine, it emerged today.

The government ordered 90 million doses of swine flu vaccine - enough to vaccinate the entire population and more per head than any other country in Europe. With flu cases down to below 5,000 a week - as they have been for the last three months - it has become very clear that the UK has substantially more vaccine than it needs.

The agreement will save a third of the value of the contract the government entered into with GSK to buy its vaccine Pandemrix, the department of health said. But the NHS will still be left with many more doses than it needs - it will now pay for 38.4 million doses from GSK instead of 60 million (a further 30 million were ordered from Baxter Healthcare but the contract had a get-out clause and was terminated at the end of February). But less than 5 million people have been vaccinated in England.

GSK will not suffer from the cancellation - the deal involves a commitment by the department of health to buy some of its other products instead.

The department of health, which issued a joint statement with GSK, refused to reveal how much money the contract was worth or how much it will still have to pay - but the figures will be substantial. Last September, the government said that it would spend £155.4 million over four years on swine flu vaccine.

The government says the surplus vaccine will be kept as a stockpile in case a "third wave" of swine flu emerges. The 38.4 million doses include those already received by the NHS and those specifically manufactured and stockpiled by GSK for the UK, which, says the statement, could not reasonably be retracted.

As part of the deal, the NHS will also take some stocks of "bird flu" vaccine from GSK and supplies of Relenza, its inhaled antiviral drug, to replace those that have already been used.

"This deal means the UK will save approximately one third of the original value of the orders with GSK," said Health Secretary Andy Burnham. "I am pleased we have reached an agreement that is good value for the taxpayer and means that the department has retained a strategic stockpile to protect the UK population without incurring a cancellation fee. This both protects the public purse and ensures the UK remains at the forefront of pandemic preparedness worldwide.

"The probability of a 'bird flu' pandemic, which is likely to be more severe than swine flu, has not diminished. This agreement means we are ready if a 'bird flu' pandemic occurred, and allows us to maintain our status as one of the most prepared countries in the world."

Labour MP Paul Flynn, who is involved in an investigation by the Council of Europe into the flu pandemic and allegations of drug company influence on World Health Organisation and government policies, said he was glad a limit had been set on vaccine purchase but called for more transparency.

The UK bought "vastly more than any other country we know of", he said, but would not reveal the price it paid per dose. He pointed out that the Polish health minister told the Council of Europe's investigation last week that her country refused to buy any vaccine at all - and yet the outcome had been little different from that in the UK. The drug companies selling flu vaccines and medicines, he said, "have made millions and their profits have shot up".

Swine flu vaccine uptake figures

Is there anyone out there still interested in swine flu?

Clearly the H1N1 virus has had its day in terms of being a big news story. Barring a sudden resurgence next autumn or some unusual mutation, we can be thankful that the first pandemic of the 21st Century was as mild as could be hoped.

But in the interest of dotting a few i's and crossing some t's, I offer the following:

The Department of Health has released swine flu vaccine uptake figures for England. 37% of those in at-risk groups (asthma, heart disease, pregnant women etc) were immunised while 20% of healthy children under 5 received the swine flu jab. 40% of front line healthcare workers have also been immunised.

The Department of Health has said anyone travelling to the Southern Hemisphere, including the World Cup in South Africa, should be vaccinated to prevent them from catching the virus and bringing it back. The flu season will be in full swing in South Africa during the tournament.

Despite it still being flu season here, there is very little swine flu about. Latest figures for England suggest the number of new cases in the last week is below 5,000 where it has been for the last 12 weeks. There are 65 patients in hospital, 14 of them in critical care.

The death toll from the H1N1 virus now stands at 457 in the UK since the outbreak began almost a year ago. Probably several million Britons have had swine flu and most will have had either no symptoms or a mild illness.

Useful resources:

• Detailed UK weekly epidemiology update
• Swine flu figures for Northern Ireland
• Swine flu figures for Scotland
• Swine flu figures for Wales

Britain closes swine flu hotline

Swine flu drugs service shut down

Swine flu drop sees service close

Protect kids against swine flu, doctors urge

NHS flu line being switched off in sign outbreak is over

BC Centre for Disease Control launches influenza genome sequencing project

Report on response to swine flu

Child swine flu jab scheme starts

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.

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.

Children offered swine flu jabs

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.

Welsh swine flu cases declining

Young people more likely to catch swine flu from an infected person in their household

Swine flu dominates health year

Swine flu cases continue to fall

I doubt the latest fall in H1N1 swine flu cases will warrant more than the briefest of mentions in the media, but this blog is there to report the good as well as the bad. And perhaps I should say the ugly, as I am typing this with a large amount of purple silicone goo in each ear. Before you wonder whether this is some strange BBC festive ritual, I am in fact having ear-pieces made for each ear - the clear plastic things which allow the editor or the director in the gallery to shout, cajole or bark instructions to me during live broadcasts.

Back to swine flu and there is more reassuring news today from across the UK. Cases of swine flu appear to be falling throughout the country. It means the second wave of the pandemic is on its way out, though there is still a chance of an upsurge in seasonal flu after Christmas.

Generally then, there is less flu about and most people who get it either are not aware they are infected or have a very mild disease. There were an estimated 9,000 new cases of swine flu in the past week in England, compared with 11,000 the week before. In Scotland there were around 8,000 cases, down from nearly 9,000 the week before. Cases are continuing to fall in Wales and Northern Ireland.

But there is another side to swine flu. In England there are more than 500 people in hospital with swine-flu-related conditions, more than 100 of them in intensive care. And there've been almost 300 deaths since the outbreak began in April. In the past week another 16 people have died across the UK. That's a tiny number compared to what was feared. But Sir Liam Donaldson, the Chief Medical Officer said:

"You can take a cold statistical view and look at the 300 deaths and throw your hat in the air. Or you can look at the families who may not have a child or a father or mother around the table this Christmas. If we can prevent those deaths then that is a reason to throw your hat in the air."

The numbers immunised against H1N1 swine flu continue to rise. I can't give you UK-wide figures at present, because the four nations don't collect their data in the same way, but I do have the statistics for England: three million people in the first priority groups have received the jab, including 101,000 pregnant women. 343,000 front line health workers have been vaccinated, about three times the number given the seasonal flu jab last year.

Two-thirds of primary care trusts in England have now reached agreement for GPs to immunise the under-fives and the others are said to be "very close" to signing up. The rise in immunisation may well help curb any third wave of swine flu.



As usual, have a look at the bold red line, which is good for showing trends and you'll see that flu-like illness rates with GPs have fallen below the baseline threshold of 30.0 per 100,000. This simply confirms that there is not that much flu about.

This is useful because it shows, contrary to what some might have imagined, that the second wave of flu this autumn has been bigger than the first in early summer. The peak in July was higher but it fell more quickly, whereas the second wave is craggier and longer-lasting.



This shows that, as well as having more cases, the second wave has seen many more hospitalisations.



The picture in the United States where consultations due to flu-like illness continue to fall - reassuring as in the previous two waves our peaks followed a few weeks after theirs.

Useful resources:

• Detailed UK weekly epidemiology update
• Swine flu figures for Northern Ireland
• Swine flu figures for Scotland
• Swine flu figures for Wales

The goo is out of my ears and my blog is done. I wish you all a peaceful and swine-flu free festive period. I will try to blog over the festive period as and when there is news to report.

Swine flu 'less lethal than was feared'

New research has estimated that there have been 26 deaths out of every 100,000 cases of swine flu in England.

The authors say this makes the first pandemic of the 21st Century "considerably less lethal than was feared in advance". No surprises there, but it is the first time we've had a figure for death rates in this country.

The study, published online in the British Medical Journal was carried out by a research team at the Department of Health.

It concludes that swine flu has a fatality rate of 0.026% or put another away, about one death in every 3,800 people infected.

That would make it 10 times less lethal than flu pandemics in the 50s and 60s and 100 times less dangerous than the pandemic of 1918-19. So-called Spanish flu is thought to have killed at least 50 million people, more than died in the World War I.

It's worth pointing out that all estimates of deaths from flu pandemics are subject to very wide variation. Increases in fatality are usually worked out more than a year later by analysing trends in death rates and calculating the likely proportion due to flu.

This is the first time that individual deaths from a pandemic flu virus have been counted. The Centers for Disease Control and Prevention estimate for deaths in the United States is similar at 0.018%.

The Chief Medical Officer, Sir Liam Donaldson said improvements in nutrition, housing and health care might explain some of the apparent decrease in fatality from one pandemic to the next.

But even the comparatively low death rate of 0.026% may itself be a huge overestimate. That's because huge numbers of those infected have probably had swine flu without knowing it.

Recently the Health Protection Agency estimated that up to one in five schoolchildren have had the virus, half of them without showing symptoms.

Two thirds of those who died from swine flu would have been eligible for vaccination and the authors say this demonstrates the importance of immunising those at high risk of complications.

Swine flu: "considerably less lethal" than feared

Swine flu: second vaccine jab can give children fever, say experts

Government seeks advice on smaller doses after European Medicines Agency warns of temperatures topping 38C

Children who have been given a second injection of the vaccine against swine flu could develop a fever, European medical officials warned today.

The European Medicines Agency (EMEA) says parents and doctors should monitor the temperature of children who have received their second dose.

The warning could lead to the Department of Health shifting position and recommending that only a single dose of the vaccine is necessary for young children.

The update has been circulated as GPs in the UK prepare to deliver the vaccine to all healthy children under the age of five. Unlike adults, children are being given two half-dose shots, three weeks apart.

The EMEA says that the "increased reactogenicity" with the second dose of the influenza vaccine Pandemrix was "unexpected as [it had not been] seen with the mock-up vaccine". It was revealed following the release of fresh data from the manufacturer, GlaxoSmithKline.

The notice says: "Parents and carers of young children (below six years of age) vaccinated with Pandemrix should be aware that fever may occur, and that this fever can be high (above 38C) [over 100.4F]. They should monitor the child's temperature after each vaccination, and give a medicine such as paracetamol to control the fever as necessary."

Adverse reactions among young children aged between six months and three years, and reported by the manufacturers, included "soreness at the site of injection, drowsiness, irritability and loss of appetite after the second dose".

The European agency did, however, conclude that a "single dose of vaccine triggered a good immune response in young children" while a second dose did bring about further protection against catching swine flu.

It also recommended that doctors continued their vaccination programme "according to the recommendations given by the health authorities in each member state".

England's chief medical officer, Sir Liam Donaldson, has warned that the under-fives are suffering particularly badly with swine flu. The flu can cause trouble with breathing.

A Department of Health spokesman said: "It's good news that such a strong response is shown after just a half-dose of the Pandemrix swine flu vaccine is given to children. Our current guidance is for children under 10 to be given two half-doses, at least three weeks apart. However, we are now asking the Joint Committee on Vaccination and Immunisation, (an independent advisory committee), for advice on whether one half-dose of the Pandemrix vaccine is sufficient. New guidance will be developed as necessary.

"The vaccine is our best defence against swine flu. More than 10 million doses of the Pandemrix vaccine have been given across the EU, including to children, and no unexpected safety concerns have emerged."

Swine flu cases 'on the way down'

Swine flu deaths in Scotland

Swine flu vaccine is vital | Robert Read

The anti-immunisation movement has been peddling fear since the 1800s, but we must ignore its misinformation on H1N1

Many people are facing the question of whether to vaccinate themselves and their children against pandemic influenza H1N1 (so-called swine flu) – a vaccine that will provide safe and effective protection against a debilitating and potentially fatal illness. But the question comes at a time when some experts are concerned that a vociferous anti-vaccine lobby will undermine the mass vaccination campaigns being rolled out across Europe, putting the public and individuals' health at risk.

Vaccination – priming the body's immune system to resist attack – is the best defence an individual can have against infectious diseases. It can provide effective protection from infection, and means not having to face the uncertainty of whether treatment with anti-microbial drugs will be successful. Besides protecting us individually, vaccination also has a vital public health role because once the number of people immunised against an infection reaches a critical mass, that infection can no longer spread in the community.

Alongside improvements in sanitation, nutrition, and housing, vaccination has practically eliminated infectious diseases as a cause of childhood deaths in industrialised countries. Our children no longer die or are crippled by diphtheria, tetanus, whooping cough, or polio, to name a few examples. Even in the world's poorer countries that have yet to benefit from infrastructure improvements, vaccination has eradicated smallpox, is on the verge of doing the same for polio, and has cut deaths from measles by three quarters in the past decade alone. The countless millions of lives saved by vaccination are arguably science's greatest triumph.

The anti-vaccination movement took off in the 19th century as immunisation against smallpox was encouraged and, for example in the UK was then made compulsory by parliament in the 1840s and 1850s. As a 2002 article in the BMJ showed, arguments against the use of vaccines have barely changed in 150 years – opponents cite that they cause illness, they are ineffective, vaccination campaigns are an alliance for profit between government and industry, they are a poisonous chemical cocktail, immunity after vaccination is temporary, and a healthy lifestyle is an effective alternative. Yet in the past century and a half, anti-vaccines campaigners have produced no credible scientific evidence to support their arguments.

Concerns about the Pandemrix vaccine against H1N1, which is being widely distributed across Europe and in the UK, relate to whether it might itself cause flu, whether is has been adequately tested, and the safety of its component parts. The viral components in Pandemrix, which are necessary to stimulate immunity, are dead and cannot therefore cause an infection. The vaccine has been subjected to the same rigorous testing for safety and immunogenicity as seasonal flu vaccines, which have over the past 30 years had an unimpeachable safety record.

Clinical trials of Pandemrix among thousands of volunteers, including children as young as six months and the elderly, showed the vaccine produced a protective immune response in almost all those who received it, and raised no concerns about safety. The vaccine contains an adjuvant (designed to stimulate the immune response) based upon squalene; adjuvants of this type have been used in seasonal flu vaccines in Europe for more than 10 years without safety concerns. It also contains a preservative, thiomersal, which has had a controversial history, but whose safety is now backed by a mass of scientific data.

Although a milder illness than once feared, pandemic influenza is not a negligible disease. There have been an estimated 715,000 cases of H1N1 in the UK and 245 deaths. Children under five are particularly at risk of infection and serious illness, which is the reason why the vaccine is now being made available to this age group. About 80% of under-fives hospitalised for pandemic flu in the UK have no underlying health issues.

Reports from Wales of transmission from person to person of H1N1 virus resistant to the antiviral drug oseltamivir (Tamiflu) also raise concerns that treatment of pandemic flu may become difficult, and further emphasise the point that prevention is better than cure. Given that an effective vaccine without any known adverse event profile is available to prevent a disease with known potential for serious or even fatal illness, the decision to vaccinate seems an easy one to make.