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The response to swine flu

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(14) 2009
Author(s): 
Adam Oliver
Health Policy Issues: 
Public Health
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

As in most countries, swine flu (H1N1) has been a public health preoccupation in the UK this year. The government's response to this problem has been swift (some might even say that it has been excessive), and during the course of the year the governemnt has issue a range of initiatives that it hopes will help to contain the virus. This report will detail those efforts, in chronological order.

Purpose of health policy or idea

The first cases of swine flu in the UK were detected in April 2009. Since then, the government's efforts have focussed on containing the virus and preventing the virus in high risk groups. The government has been very responsive to this problem, but critics, such as me, might argue that their efforts have been inordinate, and have come at a cost of attention and resources that could have been directed towards other health policy issues. Indeed, the government seems to be operating according to some form of 'precautionary principle', and may consequently be overlooking somewhat the (opportunity) costs of focussing too much attention to one particular issue. That said, if swine flu did take hold, then the government would no doubt face the wrath of the electorate if they hadn't done all that they possibly could have, which is a point that I suspect the government has in mind.

Main points

Main objectives

As noted above, the government's efforts have focussed on containing the virus. Some of the first people to catch the virus were schoolchildren, and 'affected' schools issued all children with antivirals such as tamiflu and relenza and, in several instances, closed for a week. We now know that most people who contract the virus experience symptoms no worse than normal flu (thus far), but I suspect the uncertainty and panic at the time that the virus was first detected induced substantial risk aversion among the authorities. In April, the government announced plans to stockpile antivirals to treat 50 million people (it had already built up a stock to treat 33 million people, apparently), even though it is known that these drugs tend to shorten flu symptoms for only about one day. Still, this was probably good news for certain pharmaceutical companies, at least.

The governement, in April, also launched a mass public health media campaign, reminding people via advertisments and leaflets that they should cover their mouths and noses with tissues when sneezing, should throw the tissue away and should wash their hands. This stunningly enlightening information was captured under the catchy slogan of, "Catch it. Bin it. Kill it". 

By May, the government announced that they have Advance Purchase Agreements with pharmaceutical manufacturers to provide a flu vaccine for the entire UK population, to come into effect when the virus was given pandemic status. From that point, it was stated that it would take over a year for all of the necessary vaccine to be provided (90 million doses, apparently). By December 2009, there would be sufficient vaccine for half of the population. 

In July 2009, the government established the National Flu Pandemic Service (NFPS), which consists of a website and call centres designed to inform people whether they have swine flu. If it is thought that a person has swine flu, then that person can designate a friend to pick up their antivirals for them. Those who have the flu themselves are being discouraged from visiting their GP or emergency services, firstly to relieve the pressure on these services (to enable GPs, for example, to deal with patients with other illnesses), but also to minimise the spread of the virus. However, those in a number of high risk groups, including those with a serious underlying illness, pregnant women, those with a sick child under one year old, those whose flu is getting progressively much worse, and those whose condition is still deteriorating after seven days, are advised to visit their GP rather than use the NFPS.

Type of incentives

The main incentives in relation to this policy are centred on rewarding GPs to provide the flu vaccination. Following negotiations between the Department of Health, the General Practitioners Committee (GPC) of the British Medical Association (BMA) and NHS employers, it was agreed that vaccination, to begin in Autumn 2009, would initially target the 9 million people most at risk from complications. It was felt that this would reduce flu-related hospitalisations, and would thus save the NHS money in the long run. The at-risk groups are:

1. People aged between 6 months and 65 years who are already in at-risk groups for seasonal flu - e.g. those with low immunities, certain chronic illnesses etc. (about 5 million people).

2. Pregant women (about 500,000 people).

3. Those who regularly come into contact with people with low immunities (500,000 people).

4. The non-healthy over 65s (3.5 million people).

As of October 2009, the above specified people and two millon frontlline health care staff began receiving the vaccination. GP surgeries receive £5.25 for each administered vaccine dose, which is expected to help towards the costs of contacting at-risk patients, giving the vaccine, and possibly employing any additional required staff. The Secretary of State for Health has stated explicitly that the best line of defence against the virus is the vaccine.

Groups affected

Potentially everyone in society, but initially, in terms of receiving the vaccine, about 11 million at-risk people, GP surgeries, who have to administer the vaccine

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low high very high
Transferability strongly system-dependent rather system-neutral system-neutral

I have already made my own views clear.

Political and economic background

As everyone knows, swine flu has solicited a serious response from many countries around the world over this past year, but the UK's responsiveness has generally be hailed as among the highest. This may in part be due to the committed interest of the Chief Medical Officer, Sir Liam Donaldson, in this issue. Indeed, Sir Liam also took a keen interest in the avian flu outbreak of a few years ago. The government has stated that it has been preparing for the current outbreak for five years, and the avian flu scare may well have served as the catalyst for this preparation.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

All of this is discussed above. The policy appears to have been in preparation for several years in the expectation that a flu pandemic would occur at some point. That this has now occured served as the stimulus for the policy initiatives to be actioned.

Initiators of idea/main actors

  • Government
  • Providers
  • Opinion Leaders

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The policy has been in preparation seemingly for a long time, and, as stated above, the Central government (and the Chief Medical Officer) are clearly in support. The GPs, who were at risk of being swamped by flu patients (and of course by patients who incorrectly think they have swine flu), have clearly had to be placated - hence the financial incentive for administering vaccinations and the introduction of the NFPS to discourage low-risk people from visiting their GPs for flu diagnosis. The BMA has explicitly stated that it is in favour of the programme, as has the lead negotiator for NHS employers. I don't sense any resistance to the programme among the general public at large, nor from the opposition political parties, all of whom appear to place great emphasis on 'doing something' to combat the flu pandemic, irrespective of the opportunity costs.   

Actors and positions

Description of actors and their positions
Government
Central governmentvery supportivevery supportive strongly opposed
Providers
GPsvery supportivesupportive strongly opposed
Opinion Leaders
Chief medical officervery supportivevery supportive strongly opposed

Influences in policy making and legislation

n/a

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
Central governmentvery strongvery strong none
Providers
GPsvery strongstrong none
Opinion Leaders
Chief medical officervery strongstrong none
Chief medical officerCentral governmentGPs

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

All of what has been stated above has been implemented. The vaccination programme itself began in October 2009.

Monitoring and evaluation

Nobody really knows what is going to happen regarding swine flu. At the moment, it appears to be no worse than seasonal flu, but whether this state of affairs continues depends upon whether or not the virus mutates. The Government plans to closely monitor the flu and vaccination rates, and will release a swine flu factsheet update every Thursday afternoon on the Health Protection Agency website. The latest figures shows that there has been a recent increase in the flu rate in England to around 40 per 100,000 people per week, with the main burden falling on the 1-14 years old age groups. However, there is considerable uncertainty around these figures. The use of antivirals is also increasing.  

Review mechanisms

n/a

Dimensions of evaluation

Process

Results of evaluation

This section is not really applicable to the flu pandemic policy initiatives, at least not until after the scare is over, when we will know how widespread the incidence of the flu and how serious its consequences was/were. We will only really know if the flu programmes in the UK were worthwhile if the populations of similar countries without such an extensive programme suffer far worse consequences than the UK. Let's hope that it does not come to this.

Expected outcome

This is impossible to say right now, although the government clearly expects that its flu programmes will be able to thwart a flu-related catastrophe in the UK. Given the unlikeliness of this catastrophe happening (with or without the programme), and given the fact that antivirals, for example, are not in themselves without side effects, I would personally like to see at least some of the Department of Health's flu-related efforts and resources directed to other areas of health policy.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low low very high

The flu programme is arguably of good quality, although given its expense and given the impending era of public sector cost containment, the quality of non-flu services may suffer as a consequence. The programme appears to be directed towards the whole UK population, and thus I don't perceive it to be inequitable. Given its cost, and given that swine flu is unlikely to prove catastophic with or without the programme (I hope), one could argue that these flu initiatives do not really represent the most worthwhile use of public funds (and hence, one can question whether they are cost efficient).

References

Sources of Information

www.dh.gov.uk/en/News/Recentstories/DH_098647

www.dh.gov.uk/en/News/Recentstories/DH_099966

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_107340

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_103203

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_10512

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_107436

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_102909

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_099248

www.dh.gov.uk/en/Publichealth/Flu/Swineflu/News/DH_103008

 

 

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Oliver, Adam. "The response to swine flu". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/uk/a14/2