Swine flu strikes back

Hugh Pennington

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!


  • 21 December 2010 at 4:38pm
    cigar says:
    Why should we put our trust on this scare monger, who joined the corrupt WHO and an easily deceived, ignorant media in hyping the swine flu manufactured epidemic last year? Does he expect people to have such short memories as to forget that in the end not only did the epidemic turned out to be monumentally exaggerated, but resulted in a formal investigation by the EU into the WHO's possible collusion with the pharmaceutical industry? Before you battle snow and ice to get one of the mostly useless vaccines pushed by this guy's crowd, probably risking a fatal slip, you should take a look at this:,1518,682613,00.html

  • 21 December 2010 at 4:46pm
    cigar says:
    For those discouraged by the sight of more than a dozen words, here's a graph that sums it all up:

    • 21 December 2010 at 9:00pm
      It seems you haven't bothered reading the article or even checking out the graph. We live in a world of scarce resources. A vaccine is not a helmet. It requires expensive storage, does not last a lifetime, can be used only once, and even then won't protect for more than a few months. Stockpiling vaccines costs millions, while a helmet can easily be sold through a supermarket. Money used for flu vaccines is money that won't be available to deal with other threats (for example, tuberculosis, VD's, or even salt for wintry roads). According to your logic, a classic example of the precautionary principle at work, it is all ok to ignore other risks, or even cost benefit analysis to find out whether a particular threat deserves more resources than another. To the true believers like you, what matters is near absolute prevention against a monolithic treat that might as well be regarded with the same awe as Satan was in the Middle Ages. But the graph above shows that swine flu has been exaggerated, and the article, that there are interests groups that willingly did so to benefit themselves.

      But since it seems you can't think outside of a childish frame of mind prone to pepper your propaganda with scary, out of context factoids (are hygienic conditions as bad today as those of 1918, when people were still fighting in the muddy, rat infested trenches of WWI?), I will lay out a warning in a way you will surely understand.

      How many times will people take little Thomas seriously when he cries "The Swine Flu is Coming!"? And if it *does* come after they have grown weary and bored of his apocalyptic sermons, who will be to blame?

  • 22 December 2010 at 1:05am
    outofdate says:
    It used to be the orthodoxy that when you're in a hole it's a good idea stop digging. This was disproved when the WHO didn't even wait a year after the bird flu debacle before it whipped up another panic and against all the odds that caught on as well. So now whenever they're found out they'll just top their last claim with an even more outlandish one until we all die of human-to-human transmitted idiocy.

    It also used to be the orthodoxy that coulda-woulda-shoulda is, to use the scientific term, neither here nor there. That's also beyond reasonable doubt gone down the drain.

  • 24 December 2010 at 10:51am
    echothx says:
    It's the unsolvable conflict between treating an individual or a population. I'm sympathetic to the arguments there are far more cost-effective population-based public health measures which are ignored. I'm particularly suspicious of public health measures that involve the wholesale medicalisation of populations by situating preventative interventions at the level of the individual rather than society.
    But I'm also sensitive to the woman who I've just seen, requesting vaccination who came from her antenatal appointment at UCL where she was told that 5 pregnant women have died from flu in the last week.

  • 24 December 2010 at 4:39pm
    echothx says:
    Serious students of the phenomenon of disease mongery (like myself) will enjoy Ray Moynihan's work:

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