"Nevermind what we said": the UK's best laid plans go astray

First we heard plans about what governments were going to do in the event of a flu pandemic. Now that we are looking the pandemic in the eye, we are getting the Truth: lots of those things aren't really going to happen. Consider the plans to give essential workers in the UK the antiviral oseltamivir (Tamiflu). There are about 3 million key workers like health care workers, police and fire but currently only about 100,000 courses of the drug. So the alleged 12 million dose stockpile announced earlier was just "on order" and the manufacturer, Roche Pharmaceuticals, is overwhelmed with global demand. Thus the UK health authorities have decided they will only use it to treat those seriously ill with the disease, since using it prophylactially or as "post exposure prophylaxis" (giving it to the key workers and to associates and close family members exposed to infected cases) would quickly exhaust the supply.

At a conference in London last week, Dr Jane Leese the senior government medical officer in charge of pandemic plans, said they were working on the basis that the drug could not be given prophylactically - in other words as a preventative measure.

She said: 'Although it can be taken over time to prevent you getting flu, that would consume a huge amount of the drug, for a very inefficient use for the savings, so this is a strategy for treating ill patients.'

This decision was backed by a Department of Health spokesman. 'Under our current plans, we would be unlikely to use the drug for post-exposure prophylaxis for healthcare workers or for close family members of cases. As the drug takes seven to 10 days to develop an immune response [sic], we don't believe it would be the most effective use of the stockpile.' (The Observer)

Disregarding the incorrect notion that Tamiflu produces "an immune response," the big problem with this is that the drug is ineffective for those seriously ill with the disease. For some already sick it may work to improve their prognosis if treated within the first 48 ours of symptom onset (and preferably within the first 30 hours), but most people will not be treated within that narrow time window, and of those that are, the drug will only be partially effective. Moreover, recent studies suggest the currently stipulated dose may be too low for the H5N1 serotype (bird flu) and higher doses needed.

We are not the only ones surprised by this new policy:

The government's decision to ignore this latter use has surprised health professionals. Professor John Oxford, head of virology at Barts and the London Hospital, said : 'If you gave this to everyone as soon as the virus arrived on our shores it would obviously go very quickly, but if you give it to people once they have been exposed, that would be a sensible halfway house measure. Personally, that's what I would want for myself, knowing that you get 90 per cent protection from the virus if you use it prophylactically.'

Here's something else that allegedly won't happen (but in reality probably will):

It has also emerged that the government will not automatically start to ban flights from Asia once the disease becomes a fully human form of flu.

Studies show that banning international travel would not prevent it from entering the UK as there are so many potential points of entry and it would only have the effect of delaying the disease.

It's true that travel restrictions probably are fruitless to stop this disease, but you can be fairly sure that if there is an explosive outbreak in Vietnam or Indonesia there will be immediate restrictions, whatever the authorities say.

The UK has more advanced planning than the US, but this illustrates how far behind the curve even the UK is. It will all come down to timing. If we have a year, we will be in better shape (if we use the extra time wisely). If it is 6 months, the failure to prepare for what was foreseeable will have deadly consequences.

And I am betting that no one will be held accountable.