Introduction

In April 2009, an outbreak of the H1N1 swine flu virus captured the attention of the world. The UK government quickly claimed that the country was well prepared to respond to this potential global pandemic. Indeed, ever since (and even before) the 2002 H5N1 avian flu outbreak, the government had been laying the foundations for action. The Chief Medical Officer (CMO) for England, Sir Liam Donaldson, was deeply involved in the response, having himself published a 2002 policy document entitled Getting Ahead of the Curve: A Strategy for Combating Infectious Diseases (Department of Health, 2002), and in 2007 the government published A National Framework for Responding to an Influenza Pandemic (Cabinet Office/Department of Health, 2007). The Framework was geared towards a worst case scenario, and planned for between 55,500 and 750,000 fatalities. It said that there should be a stockpile of antiviral medications sufficient to treat 50 per cent of the population, and in the event of a pandemic, stated that the government should purchase sufficient vaccine to immunize everyone in the country and should establish a national pandemic flu service so that people can have antivirals authorized over the phone. The government’s response to the 2009 outbreak was directly informed by the Framework.

The initial response focused on containing the virus, principally so as to try to buy some time to better understand the virus before a treatment stage was initiated. Among the first people infected were schoolchildren, and the schools affected issued antiviral medications in many cases to all those in the same year as the infected pupil, and in some cases to the whole school. In several instances, schools closed for a week. On 29 April, two days after the first cases of swine flu were detected in the UK, the government announced plans to increase its stockpile of antivirals from levels sufficient to treat 50 per cent of the population to levels sufficient to treat 80 per cent, and people were advised to take these medications if they had come into contact with an infected person. Moreover, a mass public health media campaign was launched, and leaflets were sent to every household in the country advising on what swine flu is, and how to respond to it (e.g. to cover noses and mouths when sneezing and to undertake regular hand-washing, captured under the slogan, ‘Catch it. Bin it. Kill it’).