The swine flu virus – Influenza A (H1N1) 2009 – is behaving as expected: it’s back as the dominant seasonal flu. Maybe a little early, but so is the winter. It’s also behaving like all previous influenza-A strains in that some infections have been fatal; usually, but not exclusively, in people with pre-existing health problems.
We’re much better at handling flu than we used to be. Severe infections can be treated in intensive care units; the last pandemic before swine flu was in 1968-69 when ICUs hardly existed, and the development of extracorporeal membrane oxygenation (ECMO) machines was a long way off. Essentially, ECMO does the work of patients’ lungs for them; most of the 14 machines in England are currently being used to treat flu cases. We have effective anti-virals. And vaccine development and delivery is now very quick: six million doses were given in response to swine flu without significant safety issues.
But vaccine uptake in those who need it most has been disappointing. The traditional target, pensioners, have been much keener than younger people who are at risk. But the elderly have less need of vaccination, thanks to pre-existing immunity, probably conferred by exposure to a virus similar to swine flu many decades ago. On 14 December, the director of immunisation at the Department of Health wrote to immunisation officers at the Special Health Authorities about the poor uptake:
In view of the recent rise in the incidence of influenza, and the proximity of Christmas – when people may be away and surgeries closed – it is suggested that GP practices should actively invite (for example by telephone) those in the high risk groups who are unimmunised to visit surgeries to be vaccinated.
He followed up with a letter on 16 December to the Royal Colleges of Midwives and of Obstetrics and Gynaecology, urging their members to encourage all pregnant women to get the vaccine ‘as soon as possible’. According to the Health Protection Agency, ‘the incidence of severe illness due to influenza infection requiring access to critical care services has increased.’
The interim chief medical officer for England, Sally Davies, has said that she would have preferred ministers not to axe the annual flu jab publicity campaign as part of the spending cuts. Beyond reasonable doubt, immunisation saves lives. It also prevents the infections that drive people into expensive intensive care and onto even more expensive ECMO, so it’s fair to say that cutting the publicity is likely to be bad economics.
Davies’s predecessor as CMO, Liam Donaldson, played a key role in pandemic planning and the vigorous response to the first wave of swine flu. He resigned on 15 December 2009 and left office the following May. He has not yet been permanently replaced. Could his post be disappearing, like the Special Health Authorities (soon to be abolished) and the Health Protection Agency, another victim of the bonfire of the quangos? Influenza, rejoice!