BBC on Gov Prep Plans

[JJackson]

http://news.bbc.co.uk/2/hi/health/6054810.stm

Warning over global bird flu plan

Almost half of the countries prioritised antiviral treatments
A third of countries which have drawn up flu pandemic plans have failed to set out how they would distribute medical treatment, a report has found.
Researchers at the John Hopkins Bloomberg School of Public Health and Ben Gurion University Israel studied 45 national pandemic plans.

They warned resources would be scarce, so decisions on who should get drugs or vaccines should be made in advance.

They said prioritising treatment could help reduce death and disease.

The World Health Organisation (WHO) has urged every country to develop and maintain a national plan on bird-flu.

It also recommends nations prioritise the allocation of pharmaceutical resources among the population.

Rationing

Researchers looked at 19 plans from developed nations and 26 from developing countries. In total, these represented around two-thirds of the world's population - 3.8bn people.

The countries included the US, Norway, Australia, India, China, Serbia, Bahrain, Israel, South Africa, UK, Mexico, Venezuela, Hong Kong, Thailand and Singapore.

The report, Priority Setting for Pandemic Influenza: An Analysis of National Preparedness Plans, found almost half of the plans they examined favoured antiviral medications, such as Tamiflu, while 62% prioritised giving citizens a flu vaccine.

Individual countries have not consistently prioritised population groups for vaccines and antivirals.

Lori Uscher-Pines

This was an unexpected finding, researchers said, as antiviral treatment may be the only pharmaceutical intervention available in some countries.

"We cannot expect to vaccinate more than 14% of the world's population within a year of pandemic."

Lead author of the study, Lori Uscher-Pines, said resources would need rationing if there was a flu pandemic.

"We learned that individual countries have not consistently prioritised population groups for vaccines and antivirals.

"No countries prioritised population groups to receive ventilators, face masks and other critical resources," she said.

The study also found allocation decisions for different groups varied widely from country to country.

Most countries - including the UK - prioritised health care workers for the vaccine and antiviral treatment, but policies varied on other groups such as the elderly, essential service workers and children.

Key interventions

It also found almost half of the countries studied had prioritised children, despite a WHO recommendation against it.

Only once the disease is moving will we know who it's targeting

Professor John Oxford

The report said it was also unclear why vaccine and antiviral medications had been singled out for treatment when there is likely to be a shortage of many resources.

It said further guidance was needed to address whether schemes for ventilator masks and hospital beds are necessary.

It is the first study to look at prioritisation decisions in developed and developing countries.

Professor John Oxford, a virologist at Queen Mary School of Medicine, London, said he was not surprised at the variations in plans betweens countries.

"Only once the disease is moving will we know who it's targeting. There's going to be an element of 'wait and see'."

He said antivirals, vaccines and hygiene levels were all key to intervening in a pandemic.

He added the study could potentially be a "huge contribution" towards helping countries further develop their plans.

The Department of Health said it has taken steps to prepare.

It has purchased 14.6m courses of Tamflu and 2.5m doses of H5N1 vaccine. PCTs have also been asked to draw up local contingency plans to respond to a pandemic, which the department will audit.

"The World Health Organisation has said that the UK is at the forefront of preparations internationally for a pandemic influenza," a spokesperson said.

"Preparing for a pandemic is ongoing and we are constantly reviewing and developing our plans as new information emerges."

[GaudiaRay]

Re: BBC on Gov Prep Plans

The BBC article is lagging information, way behind the reality of the thinking on this topic. The news groups, especially this and its predeceasor and sister sites, have explored these topics at great depth. But the BBC is just waking up to notice this.

As to the good Professor, it has been my experience in reading the myriad of statements from this man that he has never or almost never volunteered one proactive thought. His observations are current and in hindsight. As there is nobody else, save Nabarro, from the UK, to be quoted, I'd say that as there seems to be only one virologist in the UK who's associated with H5N1, I can expect nothing more or less than reading this professor's musings.

The UK Pandemic Plan is one of the earliest and is a role model for the world. But the public face of the state of its preparation, the good professor, is not reflective of the thought that's included in that Plan. Possibly, were the professor to spend some time reviewing the Plan once again, there would less "surprise" and "dry" observation, and more suggestions for proactive thinking to his fellow UK'ians.

[JJackson]

Re: BBC on Gov Prep Plans

GR

I would agree about Oxford. However, I am concerned about the UK pandemic plan. The Department of Health plan is good ,however it is strategic, and and devolves responsibility for the planning and implementation of antiviral distribution and patient care to the Primary Care Trusts. This is where the system fails. I you or others have information showing that the PCTs have fulfilled these responsibilities I would love to see it. I have been trying to get information from my local PCT for a year with no concrete results. There was a report a few months ago saying PCTs were leaning towards a phone consultation with personal collection of antivirals from schools or similar temporary distribution centers but I am not convinced having sick (or family members of the sick) queuing up for Tamiflu together is the best course of action.

[Vibrant62]

Re: BBC on Gov Prep Plans

JJackson - I agree with all you have said. Additionally you have to factor in the following facts when considering NHS ground level preparedness.

1. Many hospital Trusts are presently overspent. No additional funds for pandemic planning and provisioning have been made available: there has been considerable amounts of additional money allocated to the NHS , and at present there is no more budget being made available from national resources. Labour is being hammered in the press by NHS failures, and with leadership challenges and elections not so VERY far away, they are not likely to seek to attract attention to the NHS at present. Many hospitals are overspent and over budget already. Therefore all pandemic plans are being made assuming that only existing resources are available, on all fronts. Add to this the fact that individual departments are competing for resources, and all are under pressure to ensure that their waiting list targets are being met. This means that there will be very little in the way of practical resources immediately available for pandmeic preparation and provisioning.

2. Because many hospitals in the South east especially are overspent, they are needing to press more costs (and patients) onto primary care quickly to minimise thier spend. Therefore PCT budgets are also under pressure, whereby if a surgery overspends in any area then cuts must be made in surgery level spending on either staff, equipment, hospital referrals etc. There is no point PCTs directing surgeries to carry out certain actions without provision of additional funds (that are not there) which for surgeries where GPs are working under contract, they (The PCT) must fund. All adds up to no action at ground boots level: they cannot add more pressure onto the primary care system, so I think they are looking for the easy option which leans on the fewest number of people in terms of medicine delivery and distribution. I think that this needs further consideration, and a better solution found.

However, one of the earlier draft plans somewhere for the UK spoke of armed guards at surgeries and pahrmacies - except that this is impractical as there are some 20,000 or more such locations in the UK. Therefore they have to centralise this activity - but that its bad for Flu transmission.

All in all, I would concur with the report that says this aspect needs greater work and consideration as a matter of urgency, at least in the UK. There will be another option - such as doorstep delivery. One team working an area, perhaps with an emergency collection point if someone was missed.

I am also very concerned that many of the continuity plans appear to be founded on assumptions that estimate an absence period from work of 5 days with illness for seven (in some cases), but they do have variable scenarios for attack rate (25 - 50%) and other parameters. I think that this assumption is hopelessly optimistic and hope that it is being re-evaluated so that pandemic impacts and simulations can be re-evaluted with a worst case parameter of 18 days. This is based on 1918 advice, whereby bed rest was ordered for two weeks after the resolution of fever, otherwise there was a severe risk of a secondary pneumonia. Additionally, existing human cases appear to be hospitalised for far longer than a week at a time. If we assume that there will be some 'mild' cases then a combination of such factors suggests that even an average figure of 18 days may be optimistic. The knock on effect of this single shift in assumptions will be enormous.

The UK plans have been described as exemplary - and indeed they were at the early stages of planning, when the consensus appeared to be that a pandemic probably would not happen for a decade or more, and that a 1968 level of pandemic was the most 'likely' scenario. Based on present experience and virual evolution, thee opinions have been changed, and indeed some aspects of plans are being continually updated and renewed - but the plans do not appear to have had all assumptions updated. Additionally, 'on the ground' awareness of what is contained in the plans seems to be very low amongst those persons who would have to enact them.

I hope that in writing this, it may be noticed by those who may be able to, and may wish to re-assess plans - so that actions can be taken to address these issues.

[JJackson]

Re: BBC on Gov Prep Plans

The central goverment plan is fine, given there is little they can do, but they should be more honest in that - like Levitt in the US - they should make it plain that in anything but the mildest scenario health service will only be able to help a few of those in need and personal preparation is required by all.
Each PCT is free to make their own arrangments for local distribution of the Tamiflu stocks and these plans (if they exist) have not been publisied. I personally thing Tamiflu distribution should be by the postal delivery service to peoples homes after telephone consultation with a call centre. The call centre should be a virtual call centre operated from the homes of the HCW or by self diagnosis from a flow chart. If the clinical symptoms are anything like as sever as those suffered by current H5N1 casualties it is unlikely there will be a great deal of miss diagnosis in the UK, fortunatly we do not suffer from many 'tropical' disease that cause high fever, breathing difficulties etc.

[Vibrant62]

Re: BBC on Gov Prep Plans

J Jackson: Good points all of them, and agreed. I feel that the reason that PCT / local plans are not being published or publicised at present is that it will commit spend and money that isn't there at the moment. I also dont know how much planning they have actually done - although there is a designated Pandmeic Planner at both hospital trust and PCT level. They have often not had specific direction to go as far as to allocate resources, and there is no requirement to feed such plans back to the centre for overall co-ordination.

Therefore, there is no way to know if these local level plans are robust or not. This is indeed a big problem.

[GaudiaRay]

Re: BBC on Gov Prep Plans

Not a soul would challenge the competence of thought by attentive, focused, UK leadership and functionaries.

It's just nice to see that the UK Plan shows the 16-17 weeks of a typical, and EXPECTED pandemic, as well as the dramatic, rapid increase and decrease of the numbers infected.

...we all recognize that (if we assume as does everyone watching that H5N1 portends the worst pandemic in the past 500 years).

I suggest that you turn to the NZ Plan and the HK Plan and quote extensively from those.

And, fascinatingly, in the UK, the well-proven approach of preventative sequestration (cite Defoe's, Journal of the Plague Year) has been unraised, unidentified, unsupported for the current generation of human flu-fodder.

......so this time it will be your House of Commons (and maybe one or two from the Lorders) which and who will offer even the thinnest shred of advance preparatory funding.

Maybe what would be best is a plan betwixt the two of you to issue prepared commenataires on topics, using FluWiki for quick facts and quotes, to complement Oxford.

[Shannon Bennett]

Re: BBC on Gov Prep Plans

I have recently come across plans for states but, it is very difficult to acquire permission to publish these where Joe Q Public may review them. That nasty fear of panic among the public again. Local hospitals here in the Oregon are just now sending out information about the possibility of bf. I was talking to a local physician the other day and she told me they had only received a memo on the subject the week before. Nothing has been done though other than notifying the doctors of the possibility for pandemic. I suspect the hospital itself has a master plan but they have yet to coordinate or even discuss the specifics with the staff. I wish I had a cave to hide in sometimes.