In October 2006, several people thought to be infected with avian influenza flew into Brisbane, triggering an emergency response that revealed important gaps in the country’s preparedness for a pandemic.
The “patients” were in fact participants in a massive exercise, involving 1500 participants, testing whether the $610 million invested in pandemic planning over the previous three years had been well spent.
A subsequent report on Exercise Cumpston made many recommendations, including that decision-making processes be streamlined, there should be greater flexibility in planning, that messages across and between governments should be consistent, and that general practice, primary care and community pharmacies should be better integrated into planning.
The report also questioned the health system’s capacity for distributing antivirals in the event of a pandemic, and identified a lack of information for Indigenous and other specific groups.
It has become clear that these lessons from Exercise Cumpston remain extremely relevant when considering our recent history with swine flu. They were among the concerns raised when I recently interviewed more than a dozen experts from universities, bureaucracies, health services and relevant organisations for a British Medical Journal article examining the lessons from the Australian pandemic.
Many of these experts also highlighted the difficulties that governments have had in adjusting to cope with an infection that has not been as dangerous as the “worst case scenario” expectations that underpinned planning.
It is telling that the 2006 exercise was named for Dr John Howard Lidgett Cumpston, the ﬁrst Director-General of the Commonwealth Department of Health, who was largely responsible for containing the spread of Spanish Inﬂuenza in Australia in 1919 while he was the Commonwealth Director of Quarantine.
It is telling because so much of our planning has been based on fears of a repeat of this pandemic, although as experts like the University of Melbourne’s Professor John Mathews argued early in the outbreak, there are some grounds for questioning such assumptions.
There are of course many legitimate reasons why governments and public health officials might want to plan for the worst case scenario.
But one contributing factor may be the marketing campaigns that vaccine manufacturers have run over many years, warning of the perils of another pandemic. I know about these, because I was involved in one during a stint working in PR in the early 1990s.
Our clients were two vaccine manufacturers although the campaign was run under the auspices of medical organisations. One of the campaign’s spokespersons was Alan Hampson, who was then employed by CSL although this was not mentioned in our press releases, which instead played up his position with a WHO influenza laboratory.
We compiled thick books of the media coverage, mostly regurgitating our press releases, and rarely, if ever, mentioning who was behind the campaign.
Hampson still crops up in the news as chair of the Influenza Specialist Group which runs a public awareness campaign “aimed at educating the community about the potential severity and consequences of influenza and the importance of preventing infection and appropriate treatment”.
The SIG is funded by several companies with an interest in influenza, including Roche, which makes Tamiflu, and CSL, although typically these industry links are not mentioned in media reports. The SIG and its members are about to become the latest additions to the Crikey Register of Influence.
This is not to denigrate Hampson, who is well thought of by his scientific colleagues, and has received an honorary doctorate and other awards in recognition of his longstanding work in influenza and vaccine development.
But as we gallop towards a massive roll-out of CSL’s vaccine, it might just be worth taking time to reflect broadly on our experiences with H1N1 to date, and the role of the various professional and commercial interests in driving policy.
It’s particularly important given that the vaccine is going to be distributed in multi-dose vials in the interests of speedier delivery, although as one senior GP told me, “we have spent the last decade trying to get multi-dose vials out of general practice” because of the risk of spreading infections.
While there are differing views on many matters related to the swine flu pandemic and Australia’s response, my interviews found widespread agreement about at least one thing: that there should be a rigorous, transparent and independent evaluation of our response, to help guide future efforts both locally and globally.
There was also widespread agreement that this matter was too important to be conducted by those with a vested interest in the outcomes — i.e. the Federal Department of Health and Ageing, or indeed any government agencies involved in pandemic planning and responses.
Even if we gain a genuinely frank and fearless review, I somehow doubt we will get to read about it in nearly as much detail as we can about the lessons from Exercise Cumpston. It would be nice to be proven wrong though.