A bird flu pandemic is inevitable but unlikely to strike Britain this winter, the chief medical officer, Sir Liam Donaldson, said yesterday in an attempt to talk up the government's preparedness for the infection, but talk down its imminence.
He said contingency planning was based on an estimate that a new strain of flu mutating from infection in the bird population could kill about 50,000 people in the UK, compared with about 12,000 flu-related deaths in a normal winter.
"But it could be a lot higher than that. It very much depends whether this mutated strain is a mild one or a more serious one," Sir Liam told BBC television's Sunday AM programme.
After criticism from the Tories that ministers had been slow to prepare the UK's medical defences, he said Britain was one of the few countries to have begun stockpiling the most effective antiviral drugs at "a very early stage". He conceded that France started earlier, but said Britain was well ahead of the US.
The Department of Health had ordered 14m doses of the Tamiflu drug to tackle bird flu, with 2.5m doses acquired so far and the rest coming at 800,000 a month. "We can't make this pandemic go away, because it is a natural phenomenon. But we can limit its impact," he said.
Sir Liam was speaking after an announcement that biological samples linked to the current outbreak of bird flu in Romania were tested this weekend in a British laboratory and found to contain the H5N1 virus. The environment department yesterday confirmed that the samples were from the same lethal subgroup of H5N1 which has been seen in south-east Asia.
There is no evidence, however, that the virus has mutated anywhere in the world into a form that would allow infection to pass from human to human.
Sir Liam said that history suggested the bird flu virus would combine with a human virus, becoming easily transmissible. It had happened in 1918, 1958 and 1968/69, following "natural cycles" of mutation that produced new strains for which people did not have natural immunity. "There is a lot we can do to prepare. If we look back to the last pandemic, in 1968/69, we didn't have some of the measures that we now have, like antiviral drugs," he said.
These were "very different times" to the Spanish flu pandemic of 1918-19 in which 40 million people died worldwide, including 250,000 in the UK. That was "before proper hospital facilities, before intensive care, before antibiotics".
Higher estimates of deaths up to 750,000 from a future pandemic were "not impossible", but more realistic estimates were a lot lower.
If a pandemic did break out anywhere in the world, the priority would be to get samples back to laboratories in Britain to identify the virus's characteristics and develop an effective vaccine. The government would also deploy antiviral drugs, which would reduce severity in the first 24 to 48 hours of the disease and stop some people dying.
Essential workers would be the first to get protection, including "frontline" NHS staff, those caring for the patients. There would then have to be a decision about which groups of people were most vulnerable to the infection; they would probably include the elderly and those with chronic diseases. However, the 1918 pandemic struck mainly younger adults, in the 20-40 age group, and priorities would have to be set once the characteristics of the new strain were known. It would probably not be necessary to close airports to restrict access to Britain, but the government would be likely to urge citizens to avoid unnecessary travel, keep children off school and cancel public meetings.
Asked about whether the problem would hit in the coming months Sir Liam said: "I think it is less likely that it will come this winter."
Officials said farmers were given expanded bio-security and risk assessment advice over the weekend, on the threat of the bird flu, while GPs got advice on what to do in the event of a pandemic.
The Tamiflu drug being stockpiled by the government will be enough to treat 25% of the population, the proportion the Department of Health believes would be affected by the virus.
Martin Wiselka, a consultant in infectious diseases at Leicester royal infirmary, commented: "The worry is that the stockpile of drugs being amassed is being accumulated over a year. If [the disease does arrive] this winter then we would not have sufficient drugs. We are basing it on the assumption that it is coming next year rather than this year."
Andrew Lansley, the shadow health secretary, said yesterday: "We now have around 2m out of 14m doses of antiviral drugs and may well need more than 14m if they are used as preventative rather than treatment measures. It's all very well to say it [a pandemic] won't happen this year, but we won't have a stockpile fully in place until next September, so to that extent we are exposed. There are medical personnel who don't feel they know enough about this still."
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