During a pandemic, the Government will issue specific advice on the full range of potential response policies, based on its understanding of the nature of the virus and its likely impact.

During an influenza pandemic, the Government's overall aim will be to encourage people to carry on as normal, as far as possible, if they are well, while taking additional precautions to protect themselves from infection and to lessen the risk of spread to others.

The main objectives of the Government's response to an influenza pandemic

will be to:

•   Limit illness and death arising from infection.
•   Provide treatment and care for those who become ill.
•   Minimise disruption to health and other essential services.
•   Maintain business continuity as far as possible.
•   Reduce as far as possible disruption to society.

One of the main challenges faced by those planning against an influenza pandemic is that the nature and impact of the pandemic virus cannot be known until it emerges. During a pandemic, the Government will issue firm advice on the full range of response policies that should be adopted to achieve the objectives set out above, based on its understanding (including through the use of scientific modelling) of the nature of the pandemic virus and its likely impacts.

Until then, planning should be based on the assumptions 3 set out in the UK Health Departments' Influenza Pandemic Contingency Plan (July 2006) – “The UK Flu Plan” - and on the additional advice contained in this Note, which builds on and develops in some areas Annex J to that Plan. Both documents draw on the best information currently available (again, especially through scientific modelling) on the potential impact of a pandemic virus and on the feasibility and merits of specific response options. Uncertainty about the nature and impact of the pandemic virus means that planning across all sectors needs, for prudence, to be sufficiently flexible to cope with a range of possible impacts, including those arising from a pandemic virus with a clinical attack rate and case fatality rate in the upper ranges of the planning assumptions set out in the UK Flu Plan and this Note.

Further information:

• Department of Health
• World Health Organization (WHO)
• Directgov
• NHS Choices

Evolving Policies for Managing a Pandemic

This section sets out, on the basis of advice from UK Health Departments, information on:

• Access to medical countermeasures (antiviral drugs and vaccines).
• Reducing the risk of infection.
• Current thinking on social measures and travel restrictions.
• School closures.

Medical countermeasures

The Department of Health has ordered sufficient antiviral drugs to treat 25% of population, in line with the planning assumption that 25% of the population will become ill. The stockpile will be complete by September 2006. These drugs will be the only major medical countermeasure available in the absence of a specific vaccine. Used for treatment only, they need to be taken as early as possible after symptoms first start, preferably within 48 hours of onset. Their effectiveness will not, however, be known until the pandemic virus is circulating. Based on evidence from seasonal flu, treatment with antiviral drugs is expected to shorten the duration of illness by one day, and to reduce complications and hospitalisations. They do not provide a cure. Those taking them may still be ill for around one week or more, and consequently absent from work.

If a pandemic were to emerge before the antiviral stockpile was complete, available supplies would be prioritised to treat health workers and the vulnerable (i.e. priority medical groups) first. As further drugs became available, they would be offered to treat those who became ill. There is unlikely to be any further prioritisation of the stockpile by sector, not least because treatment only shortens the duration of illness by one day.

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The action point for planners

That plans should be able to cope with rates of staff absence calculated on the basis of the advice above.

Vaccines against the pandemic virus would not be available until at least 4-6 months after a pandemic had struck, which could be well after the first wave of illness in the UK . The Department of Health is intending to order sufficient vaccines for the whole population. But, even after vaccines start to become available, the total order is unlikely to be completed for several months. Final advice on prioritisation of vaccines will be issued during a pandemic when the characteristics and impacts of the pandemic virus are known. Whether to prioritise essential workers as the vaccines become available is under consideration. But decisions on prioritisation would need to take into account the practicalities of such a policy and the relative benefits provided. We will provide further advice on policy in this area as it develops.

In the meantime, the action point for business continuity planning is that all sectors will need to plan to cope without vaccines in at least the first wave of the pandemic. When vaccines start to become available, essential and emergency services (other than the health service) and other sectors should not assume priority access to pandemic vaccine.

Reducing the risk of infection

Transmission of the pandemic virus from person-to-person will be through close contact. The balance of evidence suggests that the most important transmission routes will be through large droplets (e.g. from coughing and sneezing) and through direct and indirect contact with infected people. Airborne or fine droplet transmission may also occur.

These characteristics mean that the pandemic virus is expected to spread quickly through the population after if first arrives in the UK . Scientific modelling suggests that it may only take 2-3 weeks from the virus first entering the UK to its being widespread.

Early management of the pandemic will rely mainly on two elements. First, antiviral drugs for treating those ill with the pandemic. Second, robust public health messages encouraging sensible precautionary self-help measures to reduce the risk of an individual becoming infected. Alongside the key message to people to continue their everyday (essential) activities as normal will be messages encouraging personal responsibility for self-protection and social responsibility to lessen spread and thus protect others. The key public health messages will be:

If you do catch flu:

• Stay at home and rest
• Take medicines such as aspirin, ibuprofen or paracetamol to relieve the symptoms (following the instructions with the medicines). Children under 16 must not be given aspirin or ready made flu remedies containing aspirin.
• Drink plenty of fluids
• You can reduce, but not eliminate the risk of catching or spreading influenza during a pandemic by:
• Covering your nose and mouth when coughing or sneezing, using a tissue when possible
• Disposing of dirty tissues promptly and carefully – bag and bin them
• Avoiding non-essential travel and large crowds wherever possible
• Maintaining good basic hygiene, for example washing your hands frequently with soap and water to reduce the spread of the virus from your hands to your face, or to other people.
• Cleaning hard surfaces (eg, kitchen worktops, door handles) frequently, using a normal cleaning product
• Making sure your children follow this advice.

These measures are for your own health and to avoid spreading the illness to others.

Social measures and travel restrictions

A third possible element of the response is the use of additional measures which would reduce social mixing and thereby aim to reduce exposure to the virus. The UK Flu Plan sets out a range of possible additional measure that would fall to be considered. These could include:

• Probable school closures.
• Postponing large-scale public gatherings and events, particularly those with participants travelling from overseas. Even were events organisers to decide to proceed with events, they would need to consider the following factors which may increase the risk of further spread of infection:
• Droplet spread in seated venues (usually three feet or less through the air).
• The availability and adequacy of handwashing facilities.
• The adequacy of, and standards set for, cleaning the venue before and after use.
• The most appropriate management of areas of close human-to-human contact on entering or leaving the ground or venue.
• Their own duty of care to their staff.
• Issuing advice to travel only if essential, encouraging remote working or the staggering of journeys to work using public transport.
• The introduction of additional port health measures or entry screening of passengers returning from those countries first affected by the pandemic virus. Even if implemented, such measures are likely to be discontinued once the virus has taken hold in the UK .
• The introduction of exit screening at ports to protect other countries were the UK to be one of the first countries affected by the pandemic virus. As further countries became affected, the WHO would be likely to advise that this measure be discontinued.
• The management of, or provision of advice on, the isolation of confirmed cases in closed communities such as care homes, boarding schools and prisons.

Scientific modelling has been used as far as possible to develop the evidence base to support Ministers' decisions on the feasibility and merits of such measures. Overall, the evidence so far suggests that there are significant uncertainties about whether public health benefits would in practice be achieved by the introduction of such measures.

Once the nature of the pandemic virus is known, further modelling will be undertaken as the basis for advice to Ministers on the pros and cons of introducing each measure. If it is assessed that the pandemic virus is likely to result in higher rates of sickness and death than suggested by modelling based on current planning assumptions, public health benefits may be more readily achieved.

In the event that Ministers decide that the merits of introducing any of these measures are likely to outweigh the disbenefits, local planners and other bodies will need to be ready to implement them.

It is unlikely that Ministers would make implementation of such measures compulsory under available powers or under additional powers that could be secured under the Civil Contingencies Act, not least because of the difficulties of enforcement. But if the virus turned out to be more virulent than current planning assumptions, so that the balance of advantage changed, there might well be a case for requiring, rather than advising, such measures to be implemented. As well as decisions on which measures would on balance be helpful, Ministers would consider in the early stages of a pandemic the most appropriate implementation route (advisory or compulsory through regulation). At this stage, however, planning should proceed on the basis that emergency powers will not be used. As a result, local responders will need to plan how best to promulgate the recommendations to their communities and to achieve compliance on a voluntary basis.