Memorandum submitted by the Royal College
of General Practitioners (SAGE 16)
This document offers the College's view on how
the Government used scientific advice and evidence during the
swine flu pandemic in 2009. The RCGP is not responding to any
of the other case studies.
The College has been involved in preparing for
an influenza pandemic for a number of years. Dr Maureen Baker,
RCGP Health Protection Lead, has worked closely with organisations
including the Department of Health's pandemic team and the BMA's
General Practitioners Committee to ensure that pandemic planning
is put in place.
During the H1N1 outbreak in 2009, the College
formed an excellent working relationship with the appointed Government
"flu tsar", Ian Dalton, who used RCGP Members' feedback
on the situation to inform his discussions with Strategic Health
Authority Leads in England. The College found that this feedback
mechanism helped inform policy and that most issues were addressed—at
least in part—by forwarding on Members' concerns and comments.
At the time, a joint RCGP-Health Protection
Agency panel was also formed to discuss how the situation was
operating on the ground and to examine what guidance was required
for GPs.
The following provides the College's views on
the questions outlined in the Commons Science and Technology Committee
Inquiry:
1. What are the potential hazards and risks
and how were they identified? How prepared is/was the Government
for the emergency?
(a) The potential hazards and risks relating
to the swine flu pandemic in 2009 include:
— Possible large numbers of excess deaths.
— Severe pressure on the NHS and social
care systems, affecting people with both flu-related and non-flu
related conditions.
— Supply chain difficulties for food and
essential services (eg power).
— Public panic and the potential for public
disorder.
— Accelerated spread of the virus due to
modern travel.
— Potential side effects of the pandemic
vaccine due to lack of thorough testing.
The College would like a good evidence base
for the potential hazards in future so that it can respond to
emergency situations appropriately.
(b) Government preparation for the emergency:
The Hine[5]
report notes that the UK's current central government crisis management
arrangements have been in place since 2002 and have been tested
in various crises and exercises and refined through those experiences.
It also states that the pre-pandemic planning, set out in Pandemic
Flu: a national framework for responding to an influenza pandemic,
ensured that many decisions had already been made in principle
prior to the pandemic and that key personnel had already had the
opportunity to work together.
Our view has been that the Government was extremely
well prepared for the challenge of pandemic flu. This was largely
because of well-documented evidence from previous flu pandemics
in the 20th century and recognition by the global public health/health
protection community that failure to plan for entirely foreseeable
crises—such as a severe flu pandemic—could result
in far greater numbers of deaths and adverse outcomes than would
be the case if effective preparations had been made.
The College is best placed to comment on preparations
within the health sector—although other work had gone on
in terms of dialogue with essential services, business and government
agencies. Within health, there was a national clinical director
for pandemic preparedness; professional advisory committees; managerial
flu leads at Strategic Health Authority level; advance purchase
of antivirals and advance contracts for pandemic vaccines.
2. How does/did the Government use scientific
advice and evidence to identify, prepare for and react to an emergency?
For flu, once identified as an issue for preparatory
work, the Government used those standing structures that it already
had in place—specifically the Scientific Advisory Group
for Emergencies (SAGE). Other groups were established, in particular
SPI (Scientific Pandemic Influenza group) and PICO (Pandemic Influenza
Clinical and Organisational group).
SAGE is a standing group that brings together
scientific and technical experts and draws on their expertise
to ensure co-ordinated and consistent scientific advice underpins
the Government's response to emergency situations. Membership
of the group depends upon the nature of the emergency. The other
structures were established as part of pandemic preparedness and
individuals had worked together on preparedness. This meant that
once the situation became active, there was already a pool of
people with knowledge and commitment on whom the Government could
draw.
3. What are the obstacles to obtaining reliable,
timely scientific advice and evidence to inform policy decisions
in emergencies? Has the Government sufficient powers and resources
to overcome the obstacles? Was there sufficient and timely scientific
evidence to inform policy decisions?
In the case of pandemic flu, the College believes
there were no particular obstacles—the experts had been
identified in advance and were willing to contribute to the Government's
response.
There was an issue regarding the amount of time
and input needed. Commenting on the situation at peak activity,
I feel that pandemic work took over most of my working life and
also consumed much of my leisure time. I suspect that was the
case for many and this probably means that many of the individuals
involved worked for institutions or organisations that were prepared
to release them for at least some portion of the working week.
The RCGP Research and Surveillance Centre (RCGP
RSC)—best known for its twice weekly reporting and surveillance
of influenza-like illness and other respiratory diseases—was
crucial during the pandemic. As we move forward this important
function should be reserved. The College relies on data from epidemiological
surveillance systems—such as the RCGP RSC—and this
is the type of information we need to respond appropriately to
emergency situations in future.
Interestingly, the Hine report states that during
the early stages of the pandemic definitive scientific evidence
was not always available but adds that once better data was to
hand, modelling became extremely accurate. It recommends that
in order to further enhance scientific advice in future pandemics,
ministers and key officials should be briefed on the strengths
and weaknesses of the likely available information; officials
should consider whether it would be possible to derive more robust
information earlier to support decision-making; and the balance
of contribution in SAGE should be reviewed to ensure that it benefits
from the expertise of key disciplines.
4. How effective is the strategic coordination
between Government departments, public bodies, private bodies,
sources of scientific advice and the research base in preparing
for and reacting to emergencies?
In the case of pandemic flu, I feel this was
extremely effective, although my view of this was as a representative
of a professional organisation that was in receipt of requests
for assistance. I am unable to comment on how easy or difficult
it was to co-ordinate from the Government's perspective.
Core to all of this was the effective communication
cascade and regardless of the reorganisation of the health service
under the new Government, we still need relevant communications
from Government channels in order to act appropriately in emergency
situations.
We also need effective electronic communication
systems and, if impaired through a technological breakdown or
reduced workforce through sickness, we would need a replacement
mechanism to ensure communication continues to be cascaded.
5. How important is international coordination
and how could it be strengthened?
The College believes it is extremely important
and appeared to work well in terms of exchange of information
and scientific developments (eg the virus genome; the development
of vaccine; and emerging information on clinical features of the
illness). The RCGP does not have any specific views on how international
coordination could be strengthened.
Dr Maureen Baker CBE DM
FRCGP
RCGP Health Protection Lead
Royal College of General Practitioners
9 September 2010
5 Dame Deidre Hine (2010). The 2009 Influenza Pandemic:
An independent review of the UK response to the 2009 influenza
pandemic. London: Cabinet Office. http://www.cabinetoffice.gov.uk/media/416533/the2009influenzapandemic-review.pdf Back
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