Deirdre Hine’s ‘independent review of the UK response to the 2009 influenza pandemic’ was published yesterday. Her team was based in the Cabinet Office, which played a central role in the implementation of the pandemic plan. That’s one reason the word independent had to be in the title of her review. But there’s no doubting Hine’s independence. As the chief medical officer for Wales, she got into trouble during the BSE crisis for criticising the work of officials above her pay grade at the Department of Health in London. She was right then, and she has got it just about right this time too.
She concludes that the UK pandemic plan was good, but points out that
No plan, however, survives intact its first contact with the enemy – and the only predictable characteristic of the flu virus is its unpredictability.
The enemy did not, of course, behave as expected. It wasn’t a hot virus moving slowly to us from the east, as the plan predicted, but one that travelled quickly from Mexico with an early bad reputation that soon turned out to be unjustified. Hine is particularly critical of the way, early in the pandemic, that the Scientific Advisory Group for Emergencies (SAGE) relied on mathematical modelling. The elegance and abstruseness of the algorithms counted for little because the data being fed into the computers was so poor; but ministers and officials advised by SAGE lacked the technical skills to challenge its conclusions. Better ways of predicting the behaviour of a new flu virus need to be found, one of the most important recommendations of the review but probably the most difficult to implement. Flu virologists have been researching it for more than fifty years.
The plan rolled on. In the early days ‘the response was being tailored to fit what was in the plan, rather than the nature of the virus itself,’ Hine says. But things turned out all right. Even if communication should have been better within government, between it and scientists and heath care workers, and with the public, and worst-case planning assumptions reached the public labelled as predictions, there was no panic. Tougher contracts should have been negotiated with the vaccine manufacturers, but for the first time a vaccine was developed, delivered and used while the pandemic was still evolving.
Hine’s recommendation that the next pandemic plan should be more flexible and not restricted to coping with a doomsday virus is obvious. She also reminds us, however, that the threat of the latter is just a real as it ever was.