Poor pandemic advice overwhelmed GPs, report finds

GPs received 'overwhelming' and 'insufficiently co-ordinated' information about the unfolding 2009 swine flu pandemic, a report by MPs has found.

A House of Commons committee report criticised the provision of advice and updates during the pandemic. It called for a single, government-led information source to inform health professionals during future outbreaks.

MPs also warned over the independence of key advisory panels during the outbreak, and highlighted the lack of a government flu vaccination awareness campaign in autumn 2010.

The report from the Science and Technology Committee examined the UK’s response to national emergencies, and used the 2009 swine flu pandemic as a key case study.

Giving evidence to the panel, the BMA said frustrated doctors had reported that key advice had been lost within the large volume of emails received. The BMA stated: ‘Doctors felt overwhelmed by the volume of information about the HINI pandemic issued by various bodies.’

GPC negotiator Dr Peter Holden told the panel that the RCGP, BMA, Health Protection Agency (HPA) and DoH faced difficulties providing advice online when data quickly became out of date. ‘We came unstuck because we were so keen to be up-to-date and offer timely advice,’ he said.

The committee recommended the government create a single online source of information to be used by the public and emergency responders in times of emergency.

Responding to the report, BMA head of science and ethics, Dr Vivienne Nathanson, said:  'We must learn from what happened and move to having one single portal of information during a health emergency.

She added that it would be important this information is linked to an academic journal so that doctors can be certain of its evidence-base. 'It also needs to be regularly updated in real time,' she said.

The DoH said it supported the single portal idea.

During the pandemic, a Scientific Advisory Groups in Emergencies (SAGE) committee, which drew heavily on a separate Scientific Pandemic Influenza Advisory Committee (SPI), was set up to provide the government with scientific advice.

However, the report raised concerns over the lack of a statistician on the SAGE panel.

Furthermore, the DoH’s joint committee on vaccination and immunisation (JCVI) gave advice on vaccines to SAGE rather than directly to ministers, the report found.

MPs recommended that a future committee should include JCVI members to ‘speed up the process by which ministers receive advice on vaccination strategies’.

The report also looked at the media attention surrounding the notorious ‘worst case scenario’ estimate of swine flu deaths.

The then CMO Sir Liam Donaldson had held a press conference on 16 July 2009, during which he suggested 65,000 people could die from swine flu in the UK.

But Sir Liam said that despite being given both the best and worst figures, the press chose to report the latter. ‘Apart from one correspondent, they didn’t contextualise the figure at all,’ he said.  

Professor Neil Ferguson, director of the Medical Research Council, said that a ‘reasonable’ worst caste scenario of 2% fatality was based on the mortality seen during the 1918 Spanish flu pandemic.

Sir Liam added that although such a high number was scientifically sound at the time, it may not have been an appropriate number to release to the public. ‘I think a great deal of care needs to be taken about the use of figures,’ he said.

‘Even a back of the envelope calculation that I did suggested to me that we would get no more that a thousands deaths, but that was the scientifically agreed figure.’

The committee recommended that the government should make the concept of ‘most probable scenarios’ clearer to the public. ‘It should use the experience of the 2009 pandemic to emphasise the range and likelihood of various possibilities,’ the report said.

The report also singled out the lack of a seasonal flu awareness campaign in the autumn 2010, especially considering swine flu was circulating that winter.

‘The government should carefully consider the public’s assumptions about swine flu – or any new flu strain – when communicating the risks of that strain in the context of seasonal, rather than pandemic, outbreak,’ said MPs.

The report also questioned evidence for vaccinating under-fives and called for a further review into the JCVI’s advice not to vaccinate this age group.

A DoH spokesman said: 'The JCVI reviewed its long standing advice on this in December 2010 and at that time did not recommend the vaccination of children who do not have risk factors.

'The JCVI will be reviewing all seasonal flu vaccination recommendations in 2011.'

The spokesman added that the department was updating its preparedness strategy and will study the committee's report before responding in detail.

Meanwhile, the Cabinet Office has created a tool to help Local Resilience Forums (LRFs), which work to prepare for local incidents and emergencies, calculate effects of a future pandemic. The tool models the effect of a pandemic through the additional strain placed on GP surgeries and hospitals.

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