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Boy died after swine flu mistake

Swine flu: One year on

This time last year, swine flu was on the brink of becoming a major global health story. With hindsight we can be thankful that the pandemic was mild for most while serious for a small minority.

In retrospect was it all a huge, global over-reaction? Not according to a team of experts assembled by the Science Media Centre. Professor Robert Dingwall from the University of Nottingham wondered what journalists would have said had the pandemic turned out to have been as serious as that in 1918.

Professor Peter Openshaw from Imperial College London said the public-health response had been proportionate and that politicians had listened to the experts. The general tone of those assembled was that it's always better to prepare for the worst rather than simply hope for the best. Mike Grannatt, formerly of the Cabinet Office and now an expert in risk communication, said the government must not be afraid of crying wolf in the future, because "one day the wolf will come" in the form of a more serious pandemic.

There are lessons to be learned. Professor Neil Ferguson, a leading disease modeller, felt that although his team was able to quickly determine that the H1N1 virus was mild for most, it took much longer to assess what the effect would be on the health service.

Professor Ferguson, an epidemiologist at Imperial College London, said ball-park projections for the transmissibility and severity of the virus were calculated within weeks of the first cases being highlighted in Mexico. This meant when the virus began circulation in the UK, people were aware that it was worth taking note of, but there was no reason to panic. But transforming ball-park projections into more accurate ones was more problematic.

Professor Dingwall pointed out the pandemic is not over. We are at the beginning of the flu season in the southern hemisphere. "We can't relax our vigilance, especially since the historic evidence is that a more virulent second wave is possible," he said.

I should stress that most experts, including Professor Dingwall think it unlikely that the H1N1 virus will mutate into something much more serious. Unlikely, but not impossible. Neil Ferguson said there had recently been a resurgence of flu in some southern American states, notably Alabama.

So the H1N1 virus is still out there. Dr Stephen Gardner, influenza policy director at GlaxoSmithKline, said the H1N1 pandemic strain is now being incorporated into seasonal flu vaccines. Seasonal flu jabs are trivalent; in other words, they are effective against three different strains of influenza. That should greatly simplify the vaccination process, for patients and GPs, when the flu season begins this autumn.

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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.

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