Health of a nation

28 Oct 05
VICTORIA MACDONALD | As Professor Sir Liam Donaldson launched his book on the history of chief medical officers this week, he must have been reflecting on how difficult the job has become.

As Professor Sir Liam Donaldson launched his book on the history of chief medical officers this week, he must have been reflecting on how difficult the job has become.

Donaldson indeed tells a good story of the CMO who, after the Second World War, made the first public health service broadcast to the nation — having taken a leaf out of Winston Churchill’s book — warning of the perils of sexually transmitted diseases and tuberculosis.

Compare that with Donaldson’s round of the radio and television studios over the past couple of weeks warning of a flu pandemic. A pandemic caused by a virus that might or might not mutate from avian flu, that might or might not kill 50,000 people in the UK, that might or might not hit this year.

All this against a background of a general public suspicion over the government’s handling of ‘mad cow disease’, foot and mouth and even of the MMR (mumps, measles and rubella) vaccination. How easy a mere chat with the public about STDs must seem.

Donaldson, as the current CMO, is passionate about public health and is determined to see the country as prepared as possible for what he truly believes is the inevitability of a pandemic. But it is a classic situation of damned if he does, damned if he doesn’t. If he did not do anything and the pandemic hit the UK, he would be sent to the CMO’s equivalent of Siberia. If he does warn of a pandemic, as he has done — and it doesn’t happen — he faces accusations of scaremongering.

Also, having taken the decision to start the preparations, he now faces criticisms that he has not gone far enough, that there are too many questions unanswered.

In fact, it is not true that the UK is unprepared. According to Health Secretary Patricia Hewitt, Britain is one of the top three most prepared countries.

But when you look at the other two countries, they are far ahead of where we stand now. France has stockpiled 40 million doses of the anti-viral vaccine Tamiflu, while the Australian government started organising itself in 2003 and has already ordered face masks, gloves and surgical equipment to be delivered this December.

Here, there is a contingency plan, launched last week, and some primary care trusts and health authorities have taken part in exercises, as has Cobra, the Cabinet Office’s civil contingency group. In the east Midlands they role-played what could happen, looking at issues like where to put the bodies so as not to offend various faith groups.

But the planned stockpiling of 14 million doses of Tamiflu will not happen until next September.

After that, the government says it will buy 120 million doses of the vaccine, which will be enough to immunise 60 million people. But that cannot happen until the virus has been identified and then there is a six- month lag while it is developed, although Donaldson has said it will issue contracts early so the manufacturers are ready to start when the order is given.

What are not in the contingency plan, though, are what seem to be utterly vital points: who would get the first doses? Who constitutes a key worker — a GP, a nurse or a petrol tanker driver? If the government wants people to avoid going into their doctor’s surgeries how are they going to get Tamiflu? Supermarkets? Door-to-door deliveries? And who will be given priority in the family?

How, too, will the NHS cope? The last time there was a larger than normal number of flu cases (the government said it was an epidemic although it never reached those numbers), hospitals were stretched to breaking point and bodies were put in freezer trucks because mortuaries were overflowing.

The projection is 32,000 visits to GPs by week six of a pandemic and almost 18,000 hospital admissions. This would involve a tripling of demand for intensive care unit beds. They simply do not exist.

Having made the decision to make public the threat of the pandemic and the contingency plan, the government is now duty bound to fill in the gaping holes, not least because this will only work if people trust what they are being told and when — or if — the time comes, do what they are told.

Already chinks have appeared with the death of two parrots from avian flu in quarantine. It appears they were caged with birds from Taiwan and the government has now had to say it will tighten up its procedures.

The government should also heed the warning of Mr Flu himself, the virologist Professor John Oxford, who recently wrote that should the H5N1 virus arrive in the UK this year, ‘via an overflying goose on the western flight path over the Netherlands and East Anglia towards Ireland, we would be caught napping’.

Oxford added that if we are not prepared: ‘I fear we will be planning the memorial service for the victims of the 2005/06 pandemic.’

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