Storm in a teacup?

The aftermath of the swine flu pandemic

Did the world, and the UK, overreact to the 2009 swine flu pandemic?

As it turned out, the 2009 swine flu pandemic was relatively mild – certainly nothing like the 1918 Spanish flu pandemic. Was there an overreaction to the threat of this new virus?

Back in 1918 there was no defence against the pandemic virus, but the 21st century has both drugs and vaccines to fight with. Antiviral drugs are given to patients who have already caught the virus and are getting ill, while vaccines are given to people before they are even exposed to the virus. (For more, see our articles on Drugs for influenza and Vaccines for influenza.)

Some have suggested that the UK overreacted to the 2009 pandemic, particularly by spending too much money on antiviral drugs and vaccines – some 132 million doses of vaccine were acquired, enough to vaccinate the whole country with two shots each. In the event many were not used, in part because vaccine take-up was low.

An initial ‘worst-case scenario’ figure of 65,000 deaths, later revised down, was widely quoted in the media early in the pandemic, and may have given the impression of an ‘overhyping’ of the pandemic.

One of the most vocal critics of the response to the pandemic has been the MP Paul Flynn, who accused the World Health Organization (WHO) of ‘crying wolf’. He led a Council of Europe enquiry into the response to the pandemic, which criticised WHO, national governments and the EU for their lack of transparency and wasteful use of public money. “This was a pandemic that never really was,” he is quoted as saying.

Yet there was considerable uncertainty at the beginning of the pandemic. A formal review of the response was undertaken by Dame Deirdre Hine – the so-called Hine Review. This concluded that £1.2 billion had been spent responding to the pandemic, and that on the whole money had been spent wisely. She did, however, highlight the lack of flexibility in planning, one consequence of which was the commitment to purchase large quantities of vaccine that were in the end not needed.

Do antiviral drugs work against influenza?

The antiviral drugs given to influenza-infected patients target a specific and unique enzyme of the virus, the neuraminidase. The effectiveness of neuraminidase inhibitors, and their value during pandemics, has stirred heated debate. Many scientists have long felt that the effectiveness of medicines is sometimes hard to judge, because drug companies do not always release all the results of their clinical trials. One example is the neuraminidase inhibitor Tamiflu (oseltamivir).

Following a long and at times acrimonious campaign by doctors, scientists, the ‘British Medical Journal’ and others, Tamiflu’s maker, Roche, agreed to release all its data for independent analysis. The well-respected Cochrane Collaboration analysed data from all random controlled clinical trials with Tamiflu or its related drug Relenza (manufactured by GlaxoSmithKline) and concluded that it only reduced the time for which people had flu symptoms by one day.

The authors suggested that, although drugs had been stockpiled for use in a pandemic at great cost, they had little value in such circumstances. One author commented: “I think the whole £500 million has not benefited human health in any way and we may have harmed people.”

Not everyone agreed. Roche called the analysis flawed. And some scientists spoke up in support of Tamiflu and Relenza, suggesting that the experience from the 2009 swine flu pandemic showed that they were beneficial. One senior medical scientist commented: “We now know that antivirals saved lives during the pandemic and we risk losing one of the few weapons we have because of overly negative publicity.”

One particular issue was that the Cochrane analysis was mostly of data from seasonal flu rather than pandemic flu. A retrospective analysis of data from hospitalised patients during the pandemic suggested that antiviral treatment did reduce mortality, particularly when drugs were given early in infection.

How serious was the pandemic?

The 2009 H1N1 swine flu pandemic was considered mild, with WHO having reported ‘only’ 18,500 deaths by the end of August 2010. But this figure significantly underestimates the actual death toll. Many other people died from complications associated with swine flu, particularly other respiratory infections.

Two modelling studies have provided better estimates of the impact of swine flu. A 2012 study came up with a figure of 280,000 deaths, while a 2014 study with additional data from 2009 estimated between 123,000 and 203,000 deaths. So swine flu was less deadly than 20th-century pandemics – there were 1 million deaths in 1968 and 50 million in 1918 – but it was certainly not negligible.

In addition, the later modelling study suggested that the severity of swine flu varied across the globe, with South America, for example, experiencing more severe disease than Europe.

And while the death toll is likened to that of ‘normal’ seasonal flu, this does not take into account the fact that the pandemic typically affected younger people – so in terms of the total number of life years lost, the swine flu pandemic was considerably more serious.

Lead image:

Ben Terrett/Flickr CC BY NC


About this resource

This resource was first published in ‘Influenza special issue’ in October 2009 and reviewed and updated in January 2015.

Health, infection and disease, Medicine, History
Influenza special issue
Education levels:
16–19, Continuing professional development