Pandemic flu: turning a drama into a crisis

Like every GP in Britain, I have received this week, from the Department of Health, free of charge, a bulky ‘information pack’ about ‘Pandemic Flu’ (1).

It contains a 50-page guide from the chief medical officer, entitled ‘Explaining Pandemic Flu’, aimed at ‘professionals or interested members of the public’; a leaflet, headlined ‘Pandemic Flu’, offering ‘important information for you and your family’ aimed at the general public’; a ‘fact sheet’ providing ‘key facts’ about ‘Pandemic Flu’ for members of the public requiring larger writing; and a ‘Pandemic Flu’ poster, to brighten up our waiting rooms. The strange thing about this extraordinary deployment of public funds is that there is at present no flu pandemic, nor any imminent prospect of one.

Numerous reports in the press and on television have featured accounts of the 1918-19 pandemic of ‘Spanish flu’ that killed between 20 and 40 million people (2). The recent outbreak of flu among poultry in South East Asia has been widely heralded as the harbinger of viral Armageddon. The chief medical officer has suggested that pandemic flu in Britain could cause 50,000 deaths, while cautioning that the death toll could be much higher. It is scarcely surprising that the public has formed the impression that we are in the midst of a flu pandemic, or at least that such a pandemic is about to strike. Nor is it surprising that many have sought out what appears to be the only form of protection – vaccination against flu (even though this is only effective against the ‘ordinary flu’ that circulates every year and is currently reserved for the elderly and those deemed at high risk).

According to Zsuzsanna Jakab, director of the European Centre for Disease Prevention and Control (ECDC) in Sweden, the impression that the bird flu virus (A/H5N1) is about to start a pandemic of human influenza is mistaken (3). The ECDC has undertaken an assessment of the current threat that this virus poses to human health and has concluded that ‘the human health risks associated with the virus, in its present form, are low and focused on people directly exposed to infected birds’ (though even for these groups, risks are low).

The A/H5N1 virus has two crucial weaknesses in terms of its potential to become a serious threat to humans. Firstly, it is ‘a bird flu virus poorly adapted to humans for whom it is not very infectious’. Secondly, though it may cause serious illness in those few humans it infects, ‘it only rarely transmits on to others’. If this virus is not easily acquired by humans and, if acquired, not easily passed on, then it is highly unlikely to cause a human pandemic.

It is of course possible that A/H5N1 could mutate to become a more infectious and more transmissible virus. But this is true of every flu virus that has emerged from the close conjunction of large domestic animal and human populations in East and South East Asia over the past century. This particular viral strain first threatened to become more dangerous when it infected 18 people and killed six in Hong Kong in 1997. But a cull of 1.5million chickens appeared to stop further spread and there has been no subsequent evidence that this strain has adapted to become more virulent. Over the past two years, there have been further outbreaks of bird flu caused by this virus in Vietnam, Cambodia, Thailand and China, and more than 120 people have been infected, with around 70 deaths. Yet the very fact that this has not yet spread further west is reassuring: in the most recent global pandemics (1957-58, 1968-69) flu reached Europe and North America from South East Asia within three months.

The ECDC conclusion is clear: ‘A/H5N1 avian influenza is not, for the moment, a pandemic strain of human influenza and it is far from clear that it will become one.’ So why have British health authorities decided to launch a pandemic flu panic in Britain?

A key quotation recurs throughout the Department of Health’s pandemic flu propaganda (it features on the cover of the ‘Explaining Pandemic Flu’ guide from the chief medical officer): ‘most experts believe that it is not a question of whether there will be another severe influenza pandemic, but when.’ It is interesting to note that the origin of this statement is another report by the chief medical officer, on government strategy for combating infectious diseases, a report published with negligible publicity some three years ago (4). Indeed, the government’s pandemic flu strategy was first produced in 1997, at the time of the Hong Kong outbreak, when it was not felt necessary to promote mass public awareness of the possibility of a flu pandemic. It is true to say that most experts have for decades believed that another flu pandemic will occur at some time in the future. It is also true that the same experts have no very strong grounds for believing that this is more likely this year than in any year since 1918. Yet this year, it has suddenly become necessary to alert the public to the danger of a flu pandemic.

The origins of the flu panic are not to be found in any antigenic shift in the flu virus, but in the increasingly irrational drift of health policy under New Labour, particularly in Tony Blair’s third term. In its desperate desire to restore respect and authority, to appear relevant and engaged, the government has relentlessly politicised all aspects of healthcare, and it has sought both to provoke and to respond to popular anxieties about health (see The absurdity of a patient-led NHS, by Dr Michael Fitzpatrick).

In response to the SARS epidemic of 2003 and the 9/11 and 7/7 events in the USA and London, the government has sought to avoid blame for any lack of preparedness in face of biological or terrorist threats (or any combination of these) by conducting contingency planning in the full glare of publicity. As in many areas of government policy, public relations take priority over both principle and practicality. The need to popularise the conception of a ‘pandemic’ reflects public exhaustion with mere epidemics: now that these have become so commonplace (obesity, bullying, binge drinking, etc) a new term is required to achieve the level of anxiety that the government is seeking to foster around flu. It is important to note that the ‘pandemic flu’ promotion provides no information of any preventive value, and its answers to the question ‘What can I do?’ during a pandemic are the familiar banalities from any self-help guide on dealing with coughs and colds.

In a revealing aside in a recent circular on ‘avian influenza and pandemic influenza’ to all doctors and health authorities, the chief medical officer comments earnestly that, ‘as you can imagine, with the high level of public interest in this subject, things are very hectic in the Department of Health at the moment’ (5). When a non-existent pandemic can create such a febrile climate, it is no surprise that the National Health Service is heading into increasing chaos. The immediate casualty of the pandemic flu scare is the annual routine of vaccination against ‘normal flu’ for the elderly and vulnerable. It is ironic that the drama of pandemic flu has produced a crisis in vaccine supply: though pandemic flu is unlikely to kill anybody in Britain this winter, some vulnerable people may yet die from ‘normal flu’ because supplies of vaccine have run out.

As New Labour transforms the NHS into a vehicle of government propaganda it is not only the well who should be worried, but even more those who have the misfortune to fall ill.

Dr Michael Fitzpatrick is a GP and author of The Tyranny of Health: Doctors and the Regulation of Lifestyle (buy this book from Amazon UK or Amazon USA), and MMR and Autism: What Parents Need to Know (buy this book from Amazon (UK) or Amazon (USA)).

(1) Pandemic Flu: information pack, Department of Health, October 2005

(2) We can’t afford to be caught napping again, John Oxford, The Times(London), 20 October 2005

(3) Putting the risk to human health from bird flu (type A/H5N1) in perspective, Zsuzsanna Jakab, European Center for Disease Prevention and Control

(4) Sir Liam Donaldson. Getting ahead of the curve – a strategy for combating infectious diseases. A report by the Chief Medical Officer. Department of Health, 2002

(5) Sir Liam Donaldson, Avian influenza and Pandemic Influenza, Department of Health, 19 October 2005