Human Swine Flu A(H1N1) - Swine Flu Vaccines and Anti-Virals

Poland swine flu threat remains

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From headline news to has-been

Swine flu began as a global health emergency, but thankfully never lived up to the initial fears. Cast your mind back to July 2009 and Britain was in the grip of swine flu fever. There were more than 100,000 cases a week and it dominated the headlines. When the National Pandemic Flu Service was launched it initially went into meltdown. Little wonder as at one point the website was getting 2,600 hits per second.

The chief medical officer for England, Sir Liam Donaldson described the media interest as unprecedented, reaching "Michael Jackson proportions" (the pop legend died the previous month).

Today there is so little demand for the online and telephone service (where you can get Tamiflu simply by answering a series of tick-box questions) that it will be shut down at 1am on Thursday 11 February. The service only ever operated in England.

So does this mean we can forget about swine flu? And was it all a huge over-reaction? Millions of Tamiflu tablets remain in warehouses unused, and unless we get a fresh pandemic in the next couple of years, they are likely to pass their sell-by date. You could argue that was a waste of money, but it is easy to be wise after the event.

Professor Wendy Barclay, a virologist from Imperial College London says that the pandemic could have been a lot worse:

By my reckoning (and this is an estimate only) around 5.25 million people have been vaccinated in Britain. That means there is an awful lot of vaccine - tens of millions of doses - going spare. I'm told an announcement is likely in around 10 days regarding what will be done with the remaining stocks. As yet we don't have figures for how much the vaccine cost - due to commercial confidentiality.

A huge over-reaction or prudent planning? Sir Liam Donaldson says that he would rather be accused of doing too much to protect the population than too little:

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So has swine flu gone for good? Absolutely not. There may be very few cases now, but it's likely to be back next autumn and for years to come, replacing other flu strains to become the dominant seasonal flu virus.

That's why the government is recommending vaccination for everyone at risk of flu complications, plus all healthy children aged six months to under-five. Swine flu has been a very mild illness for the vast majority, but 60 children in England have died since last April. Given that this is now a vaccine-preventable illness, immunisation now should prevent the chance of them getting the virus in the future.

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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".

Swine fluHealthWorld Health Organisation

Children given adult flu jab dose

Number of cases remains low

If you catch swine flu at the moment, you really are among a tiny minority. There is such little H1N1 around that health officials are able only to give a very general estimate. For the third week in succession, they believe the number of cases in England is below 5,000. The rate of GP consultations for flu-like illness was a tiny 12.1 per 100,000 for the week ending 17 January.

Anything below 30 per 100,000 is regarded as "background" levels, and the rate is tiny for this time of year. Rates of swine flu are falling in Scotland, Wales and Northern Ireland. The vast majority who get infected have a mild illness or no symptoms at all.

Having said, that there are 211 patients in hospital with swine flu in England, 62 of whom are in critical care. The total number of deaths stands at 390 (279 in England, 66 in Scotland, 28 in Wales and 17 in Northern Ireland).

Vaccination

3.7 million people in priority groups in England have received the H1N1 vaccine (out of around 12 million eligible).

Of those, 132,000 pregnant women and 214,000 children aged six months and under five have been immunised.

Rates of swine flu are so low that the Chief Medical Officer Sir Liam Donaldson no longer gives journalists a weekly briefing. This has been replaced with a fortnightly statistical bulletin from the Department of Health. Despite the low levels of swine flu, Sir Liam urged those in priority groups to have the jab:

Global picture

The World Health Organization says the death toll from the swine flu pandemic has risen to at least 14,142 - up 588 from a week ago. It says North Africa, South Asia and parts of Eastern Europe are now seeing the most intense transmission of the H1N1 virus.

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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.

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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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