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Developments in the response to swine flu

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(15) 2010
Author(s): 
Adam Oliver
Health Policy Issues: 
Public Health
Reform formerly reported in: 
The response to swine flu
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes yes no

Abstract

The UK's response to the swine flu pandemic has been a salient feature of government health policy over the past year. The initial response was summarised in a previous report; the current report reviews the developments over the past six months. Many (largely repititious) press releases on swine flu have been issued by the Department of Health over the above stated time period, which reflects the importance that the DH has attached to their response to the pandemic.

Recent developments

The biggest development in the response to the pandemic was announced on November 19th 2009, when it was stated that the swine flu vaccination programme would be extended to all healthy children aged between six months and five years (high risk children in this age group were already eligible for vaccination). The principal reason for extending vaccination to this age group (comprising of approximately three million children, although vaccination is voluntary and would for children therefore ultimately depend on the actions/wishes of parents/guardians) was probably because young children are more likely to be hospitalised than other groups if they become infected with the virus, and may also be more susceptible to picking up viruses.

Initially, the Chairman of the Royal College of General Practioners encouraged parents to talk to GPs in order to make an informed choice on whether to vaccinate their children, which was surprising (to me at least), as one can surmise that GPs would be concerned about the inevitable increases in pressure on their time. Indeed, by December 2009, the DH announced that it had failed to reach an agreement with the British Medical Association's GPs' Committee on vaccinating the newly eligible group through GP practices, which implies that the GPs were indeed protective of their time and were not, as part of a national policy, willing to assume the added workload, at least not within the limits of the incenitves that the DH were presumably prepared to offer.  Nonetheless, the DH has sought to develop the vaccination programme via 'willing' GPs, health visitors, district nurses, and alternative providers such as hospital paediatric services and pharmacies. 

  

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Characteristics of this policy

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

My views have just slightly changed since the previous report.

Purpose and process analysis

Current Process Stages

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

Initiators of idea/main actors

  • Government
  • Providers

Stakeholder positions

The opinion of the stakeholders, as far as I can tell, has remained the same as in the previous report on the swine flu. Although the incidence of swine flu is low and stable (as will be detailed below), the Chief Medical Officer (CMO) remains committed to vaccinating all target groups, as he views this as essential to prevent complications, hospital admissions and deaths in possible future outbreaks of the illness. It is after all likely that swine flu will be the predominant strain of the flu virus in the next flu season in late 2010, and the CMO believes that vaccinating children under five now (in addition to the at risk groups - e.g. the unhealthy elderly; 'front line" health care professionals - who have been eligible for vaccination for some time) will help limit the incidence and spread of the virus at that time.

Similarly, the Joint Committee on Vaccination and Immunisation (JCVI, which advises the government on vaccination policy), recommended in February 2010 that the swine flu vaccination programme should be continued so as to protect against a future outbreak, and, despite the current low incidence, the Emergency Committee of the WHO, also in February 2010, concluded that "it was premature to conclude that all parts of the world have experienced peak transmission of the H1N1 pandemic influenza." 

Perhaps interestingly, in relation to the possible imminent increase in the incidence of the swine flu virus in other countries, in March 2010 the DH announced that people travelling to the Southern Hemisphere, including those attending the football World Cup in South Africa in June and July, should get themselves vaccinated against swine flu. This is because the flu season in the Southern Hemisphere is expected to begin very soon, and thus vaccination should help to protect travellers (and those who they come into contact with on their return).  

 

Actors and positions

Description of actors and their positions
Government
Central governmentvery supportivevery supportive strongly opposed
Chief Medical Officervery supportivevery supportive strongly opposed
Providers
GPsvery supportiveneutral strongly opposed
current current   previous previous

Influences in policy making and legislation

Not applicable.

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
Central governmentvery strongvery strong none
Chief Medical Officervery strongstrong none
Providers
GPsvery strongstrong none
current current   previous previous
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

There is nothing more to say in this section, over and above what I have written above. An agreement was not reached between the government and the GPs on a national policy to deliver the vaccination to the new target age group through GP practices, and so the vaccination has been made available via other 'avenues', discussed above.

Monitoring and evaluation

As of March 2010, new cases of swine flu are near their lowest levels since the outbreak of the disease. Indeed, figures are so low that the National Flu Pandemic Service, which was established to help cope with the swine flu pandemic (and which was discussed in the previous report), was closed in mid February 2010, although it can if needed be restored to full operation within seven days.

As of early March 2010, there was an estimated number of new cases of swine flu of less than 5,000 per week, a figure that had remained stable for the previous twelve weeks, and the number of hospitalisations, although slightly increased, remained low at 65 patients in hospital and 14 patients in critical care. As of March 18th, 2010, 405,000 front line health care workers had been vaccinated, and the total number of people in the priority groups who had been vaccinated was 4.74 million, including 649,000 in the new target group of healthy children aged six months to five years. By March 25th, there had been a total number of 457 confirmed swine flu-related deaths in the UK since the outbreak of the diseaase, although most of these patients had underlying health care problems.  

Expected outcome

I have nothing to add in this section over and above the previous report. The Chief Medical Officer was clearly a big player in the swine flu vaccination policy and somewhat embedded himself to the policy, and I think both he and the DH operated under something of a precautionary principle, wanting to be seen to be doing something in case the worst case scenario was realised. My fear is that this approach carried very serious opportunity costs that were not fully considered, by taking resources and effort away from other important areas of government health policy on the basis of a risk that was probably very small.

On March 25th, the DH announced that they are establishing an independent review of the UK's response to the swine flu pandemic, to be Chaired by Dame Deirdre Hine, a former Welsh Chief Medical Officer. The review team will report later in the summer of 2010, and it is intended that they will provide lessons for the future planning of pandemics on the basis of the government's recent response.

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 neutral very high
current current   previous previous

Again, my conclusions have just slightly changed since the previous report.

References

Reform formerly reported in

The response to swine flu
Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Oliver, Adam. "Developments in the response to swine flu". Health Policy Monitor, April 2010. Available at http://www.hpm.org/survey/uk/a15/3