Influenza pandemics are a natural phenomenon that have occurred from time to time for centuries – including 3 times during the 20th century. They present a real and daunting challenge to the economic and social wellbeing of any country, as well as a serious risk to the health of its population.
There are important differ4 ences between ‘ordinary’ seasonal flu and pandemic flu. These differences explain why we regard pandemic flu as such a serious threat.
Pandemic influenza is one of the most severe natural challenges likely to affect the UK, but sensible and proportionate preparation and collective action by the government, essential services, businesses, the media, other public, private and voluntary organisations and communities can help to mitigate its effects.
Inter-pandemic years provide a very important opportunity to develop and strengthen our preparations for the potentially devastating impact of an influenza pandemic, and the government will continue to take every practical step to prepare for and mitigate its health and wider socio-economic effects.
The Department of Health (DH) is the lead department for planning for a human influenza pandemic. However, given the wide impacts of a pandemic all government departments are involved in planning to mitigate its impacts.
This guide brings together available information on a possible influenza pandemic in order to support planning at all levels of society.
However well developed, plans are unlikely to be successful without the active support of individuals and communities. Therefore, a key part of the response will be to encourage the public to follow government advice and adopt basic hygiene measures to manage or reduce their own risk of catching or spreading the virus. Ensuring that all of us are fully aware of the necessary precautionary and response measures, are prepared to cooperate actively with them and accept responsibility for helping themselves and others must therefore be an integral part of our overall preparedness strategy.
Pandemic flu: description of the risk
Cause of pandemics
Pandemic influenza emerges as a result of a new flu virus which is markedly different from recently circulating strains. Few - if any - people will have any immunity to this new virus thus allowing it to spread easily and to cause more serious illness. The conditions that allow a new virus to develop and spread continue to exist, and some features of modern society, such as air travel, could accelerate the rate of spread. Experts therefore agree that there is a high probability of a pandemic occurring, although the timing and impact are impossible to predict. The H1N1(2009) pandemic does not lessen the probability of a further pandemic in the near future, and should not be seen as representative of future pandemics.
Impacts of a pandemic
Past pandemics have varied in scale, severity and consequence, although in general their impact has been much greater than that of even the most severe winter ‘epidemic’.
Each pandemic is different and, until the virus starts circulating, it is impossible to predict its full effects. As such, it is impossible to forecast the precise characteristics, spread and impact of a new influenza virus strain, however, based on historical information and scientific evidence we are able to predict the possible impacts:
Many millions of people around the world will become infected, up to around 50% become ill with symptoms and a variable proportion die from the disease itself or from complications such as pneumonia.
In the UK, up to one half of the population may become infected and between 20,000 and 750,000 additional deaths (that is deaths that would not have happened over the same period of time had a pandemic not taken place) may have occurred by the end of a pandemic in the UK.
In the absence of early or effective interventions, society is also likely to face social and economic disruption, significant threats to the continuity of essential services, lower production levels, shortages and distribution difficulties. Individual organisations may also suffer from the pandemic’s impact on business and services.
Large numbers of staff are likely to be absent from work at any one time.
More information on the challenges posed by an influenza pandemic, and the planning assumptions for pandemic preparedness can be found at: UK influenza pandemic preparedness strategy and analysis of the scientific evidence base.
The World Health Organization (WHO) Global Influenza Surveillance Network, comprising 105 countries, acts as a global alert mechanism, monitoring circulating influenza viruses in order to detect the emergence of those with pandemic potential.
UK influenza pandemic preparedness strategy 2011
The UK influenza pandemic preparedness strategy is aimed at guiding and supporting integrated contingency planning and preparations for pandemic influenza in health and social care organisations and more widely across government and public and private sector organisations. It provides information on the likely impact of an influenza pandemic and sets out some of the key assumptions for use in response planning.
Additionally, it describes the government’s strategic approach to responding to a pandemic and the arrangements within which organisations responsible for planning, delivering or supporting local responses should develop and maintain integrated operational arrangements.
The UK influenza pandemic preparedness strategy builds upon but supersedes the approach set out in the 2007 national framework for responding to an influenza pandemic (and the Scottish equivalent), taking account of the experience and lessons learned in the H1N1(2009) influenza pandemic and the latest scientific evidence.
An overview of the science underpinning the proposals in the strategy has also been published.
The UK strategy with regards to international preparedness is covered in the UK influenza pandemic preparedness strategy 2011. This supersedes the UK international preparedness strategy.
WHO global influenza preparedness plan
WHO has developed a global influenza preparedness plan (pdf), which defines the responsibilities of WHO and national authorities in case of an influenza pandemic. This plan incorporates new scientific data and experience obtained during recent outbreaks that had pandemic potential. WHO also offers guidance tools and training to assist in the development of national pandemic preparedness plans.
Further information on the work of WHO with regard to pandemic influenza, including detail of the pandemic influenza preparedness plan, is also available.
Fact sheet for British nationals overseas
The Foreign and Commonwealth Office (FCO) has produced a travel advice fact sheet for British nationals overseas. It describes sensible precautions for travellers and residents in affected areas, both in respect of avian influenza, and a possible future human flu pandemic. It also sets out the measures taken by FCO and its diplomatic posts abroad (embassies, consulates and high commissions) in response to these concerns.
Guidance for local planners
The Cabinet Office Civil Contingencies Secretariat has produced a guidance document for local planners in England and Wales, as part of its role in providing leadership and guidance to the resilience community and in supporting the Department of Health, as lead department, in preparing and planning for a possible influenza pandemic. The guidance supersedes the earlier Cabinet Office documents ‘Preparing for Pandemic Influenza – Guidance to Local Planners’, and ‘Preparing for Pandemic Influenza – supplementary guidance for Local Resilience Forum Planners’ (and Welsh equivalent).
The primary aim of the updated document is to support the UK Influenza Pandemic Preparedness Strategy 2011 published by the Department for Health, to provide local planners with additional guidance and information to support the development of local level, multi-agency plans.
Local planners may also wish to refer to sector specific guidance in the development of their plans, including guidance aimed at the health and social care sectors, education, or guidance aimed at those responsible for the management of excess deaths. Further information on sector specific guidance can be found at in the sector-specific guidance section.
Generic guidance for businesses can also be found at the workplace/business guidance section. In addition, the following resources may be of assistance:
National planning assumptions assessments tool
To assist local planners in their planning and preparations for an influenza pandemic, central government has developed the National Planning Assumptions Assessments Tool to facilitate the application of national planning assumptions to the local setting.
Faith communities and pandemic flu
If an influenza pandemic happens in the UK, everyone will need to play a part in managing how it affects our society. This booklet explains how faith communities can play a part in protecting themselves and others, and how they can help face the challenge should an influenza pandemic occur in the UK.
Health and social care
UK health and social care services will be at the forefront of the response to an influenza pandemic coming under, at times, extraordinary strain. The Department of Health produces a number of guidance documents for the health and social care sectors. This includes Health and Social Care Influenza Pandemic Preparedness and Response. This guidance for health and social care workers is intended to support local preparedness and response planning in England.
Further guidance documents for the health and social care sector include:
- Pandemic flu: managing demand and capacity in health care organisations
- Pandemic influenza: guidance on preparing mental health services in England
Management of deaths
Scientific modelling estimates that the UK could experience up to 750,000 additional deaths over the course of a pandemic. These figures might be expected to be reduced by the impact of countermeasures, but the effectiveness of such mitigation is not certain. The combination of particularly high attack rates and severe disease, resulting in this deaths figure, is also relatively (but unquantifiably) improbable.
Taking account of this, and the practicality of different levels of response, when planning for excess deaths, local planners have been set the target of preparing to extend capacity on a precautionary but reasonably practicable basis, and aim to cope with a population mortality rate of up to 210,000 to 315,000 additional deaths, possibly over as little as a 15 week period and perhaps half of these over 3 weeks at the height of the outbreak.
These increases to the numbers of natural deaths in a potentially short period of time will place considerable pressure on local service providers. It is therefore essential that local authorities, Local Resilience Forums and other service providers (any private or public organisations involved in the management of deaths) develop plans for this eventuality. More extreme circumstances would require the local response being combined with facilitation or other support at a national level. The existing guidance consists of:
A framework for planners preparing to manage deaths
The guidance Planning for a possible influenza pandemic – a framework for planners preparing to manage deaths offers advice to local authorities and service providers who are responsible for producing and maintaining emergency and business continuity plans associated in the management of excess deaths.
Guidance on the management of death certification and cremation certification
The Department of Health has published proposed changes to the procedures for death and cremation certification that could be used in a severe influenza pandemic, in order to enable doctors to spend as much time as possible on the care of the living, and to ensure that processes for death and cremation certification can be managed as effectively as possible during a pandemic.
Guidance for coroners and planners in the event of a flu pandemic in England and Wales
Guidance on the operation of the coroner system in England and Wales has been published by the Ministry of Justice to assist coroners, local authorities and Local Resilience Forums to prepare for and mitigate the effects of an influenza pandemic.
The Department for Education has produced a range of guidance documents in consultation with other government departments and various external bodies as part of the government’s co-ordinated efforts to encourage prudent planning across all sectors, supporting the Department of Health, as lead department, in preparing and planning for a possible pandemic. This guidance is currently under review and a link to revised guidance will be provided in the near future.
The Justice system plays a key role in the maintenance of law and order and public confidence in and respect for democratic institutions, rights and responsibilities, the safety of individuals and the protection of property. It depends on the effective participation of numerous agencies and other participants, so planning is vital to ensure services can be maintained during periods of disruption. The establishment of contingency plans for responding to a flu pandemic in the justice system is part of the government’s wider pandemic planning.
The aim of the guidelines is to bring together assumptions and response strategies of the various agencies involved in the justice system in England & Wales. This will enable planners at different levels within agencies to check consistency of their pandemic flu plans with their agency’s national position, and also check that their plans take account of the positions being taken by other agencies and the needs of other stakeholders.
The Cabinet Office has published a Pandemic flu checklist for businesses to assist in developing and reviewing plans. It identifies important and specific activities which organisations can do to prepare for a pandemic.
Other relevant guidance includes:
Pandemic flu workplace guidance, Health and Safety Executive (HSE)
Pandemic flu plans
An effective response to a pandemic will require the cooperation of a wide range of organisations and the active support of the public. As there may be very little time to develop or finalise preparations, effective pre-planning is essential. Many important features of a pandemic will not become apparent until after it has started (ie when person-to-person transmission has become sustained), so plans must be:
- constructed to deal with a wide range of possibilities
- based on an integrated, multi-sector approach
- built on effective service and business continuity arrangements
- responsive to local challenges (eg rural issues) and needs
- supported by strong local and national leadership
With this in mind pandemic preparedness plans from across the resilience sector can be viewed under the headings below:
- Local plans
- Critical sectors
Aims and objectives
The overall objectives of the UK’s approach to planning and preparing for an influenza pandemic are to:
- minimise the potential health impacts of a future influenza pandemic by:
- supporting international efforts to detect its emergence, and early assessment of the virus by sharing scientific information
- promoting individual responsibility and action to reduce the spread of infection through good hygiene practices and uptake of seasonal influenza vaccination in high-risk groups
- ensuring the health and social care systems are ready to provide treatment and support for the large numbers likely to suffer from influenza or its complications whilst maintaining other essential care
- minimise the potential impact of a pandemic on society and the economy by:
- supporting the continuity of essential services, including the supply of medicines, and protect critical national infrastructure as far as possible
- supporting the continuation of everyday activities as far as practicable
- upholding the rule of law and the democratic process
- preparing to cope with the possibility of significant numbers of additional deaths
- promoting a return to normality and the restoration of disrupted services at the earliest opportunity
- instil and maintain trust and confidence by ensuring that health and other professionals, the public and the media are engaged and well informed in advance of and throughout the pandemic period and that health and other professionals receive information and guidance in a timely way so they can respond to the public appropriately
Given the uncertainty about the scale, severity and pattern of development of any future pandemic, 3 key principles should underpin all pandemic preparedness and response activity:
- Precautionary: the response to any new virus should take into account the risk that it could be severe in nature. Plans must therefore be in place for an influenza pandemic with the potential to cause severe symptoms in individuals and widespread disruption to society.
- Proportionality: the response to a pandemic should be no more and no less than that necessary in relation to the known risks. Plans therefore need to be in place not only for high impact pandemics, but also for milder scenarios, with the ability to adapt them as new evidence emerges.
- Flexibility: there will need to be local flexibility and agility in the timing of transition from one phase of response to another to take account of local patterns of spread of infection, within a consistent UK-wide approach to the response to a new pandemic, and accounting for the different healthcare systems in the 4 countries.
- implemented in a phased, sustainable and proportionate way which can be adapted to the characteristics of a pandemic
- are based on the best available scientific evidence
- build on the existing services, systems and processes of local responders, augmenting, adapting and complementing them as necessary to meet the unique challenges of a pandemic
- can be understood by and acceptable to service providers and the general public
- can be implemented in advance of a pandemic if this action has significant potential to mitigate the effects of a pandemic and, where possible, other threats or hazards
- designed to promote the earliest possible return to normality
You can also find more detailed information about civil protection arrangements in Scotland, Wales and Northern Ireland in the Devolved administrations section.
A number of Local Resilience Forum flu plans are hosted on local websites, or alternatively, are available on the National Resilience Extranet in a number of cases.
Critical sector plans
Private sector organisations are increasingly responsible for the provision of many essential services, including the manufacture, supply and distribution of items critical to the response to an influenza pandemic and to minimising its social and economic effects. Planning to ensure the maintenance of supplies and services for as long and as far as that is possible is an essential part of developing effective response arrangements. Sector-specific emergency arrangements to build resilience and develop effective response frameworks are already required, and plans are in place in most key sectors. Those frameworks should recognise the unique nature of the disruptive challenges that an influenza pandemic is likely to present. A wider community of industrial and commercial organisations also plays a direct role in maintaining social normality and will want to minimise potential losses from disruption to business and promote a return to normality as soon as possible.
Recognising the impact on the service provision that a pandemic would bring (perhaps from increased rates of absenteeism) the telecommunications industry would respond to a crisis by seeking to limit the impact on services by prioritising fault repairs at the expense of routine maintenance and the provisioning of new services. New services provided during such a crisis would generally be restricted to urgent requests from emergency responders recognised as Category 1 and Category 2 responders under the Civil Contingencies Act 2004.
Organisations planning to increase home working in a pandemic must talk to their telecommunications providers well in advance and will also need to ensure that they have the necessary hardware and software in place and appropriate arrangements to ensure support, oversight and audit of home workers.
Although there may at some point be some degradation of postal services due to a high level of staff absence at the peak of a pandemic, a wide range of postal operators will ensure that the sector maintains priority delivery services and essential postal communications.Any reduction to Royal Mail services would be managed in accordance with a list of corporate priorities reviewed by Postcomm, the industry regulator, which focus on maintaining those services involving high social responsibility (for example, access to cash/benefits). Normal deliveries and collections would be maintained as far as possible with any necessary managed degradation (for example, the number of collections during the course of the day may be reduced but final collections would be carried out to ensure optimum workflow). Continued access to the Post Office network (for example, for cash and benefits) will be maintained, with any local disruptions managed through contingency arrangements.
The provision of energy (gas and electricity) depends, at a high level, on a number of elements:
- the primary ‘production’ of the energy, such as by the power station or the gas field/terminal
- the transmission of that energy nationally
- the distribution of that energy locally
- the supply of that energy to consumers
It’s possible, for an individual customer, that different companies may be responsible for each of these 4 elements in order to provide energy to that customers’ site. Therefore it requires a cross industry effort to ensure that planning for an emergency (such as a possible flu pandemic) is effective in terms of providing energy to customers. The energy sector, along with government, the regulator and the devolved administrations, has been working for sometime to ensure this cross-industry preparation (for a possible flu pandemic) is undertaken and kept under review.
The energy sector is planning to maintain supplies of gas and electricity at near-normal service levels during a pandemic. Whilst routine maintenance is likely to be afforded lower priority if there are staffing shortfalls, essential repairs will continue to be carried out. Similarly, planning by fuel suppliers is aimed at maintaining near-normal levels. In both cases there may be some service disruption if peak staff absences coincide with technical or weather-related supply difficulties, leading to potentially longer periods of service loss than would normally be expected, and imports from main overseas suppliers may also be disrupted.
Pandemic planning in this sector is being led and coordinated by the tripartite authorities (HM Treasury, the Financial Services Authority and the Bank of England), which share responsibility for maintaining financial stability in the UK. Planning – involving financial firms, infrastructure providers and overseas financial regulators – is advanced and has primarily focused on business continuity (ie maintaining core business activities whilst experiencing above-normal staff absence levels) and provision of basic services, such as cash circulation, banking and payment systems.
Companies across the food sector will work together through their representative organisations and the Department for Environment, Food and Rural Affairs to maintain supplies as far as possible. However, at the peak of the pandemic, there may be a reduction in choice and accessibility if some local outlets close due to non-availability of staff.
Public transport operators aim to run as near to normal services for as long and as far as that is possible during a pandemic and their plans provide for emergency timetables, redeploying staff and operating revised working (shift) patterns, if required. Although the government is not planning to impose closure of transport hubs/facilities in the UK, all sectors may experience operational difficulties when the pandemic virus is circulating and staff absence levels are significantly higher than normal. The aviation sector may also experience difficulties if non-UK airports or airlines have operational problems or stop operating.
All water and sewerage companies have identified the minimum staffing levels required to maintain essential supply and sewerage operations, and have factored in potential staff absences in a pandemic scenario. As many key operations are automated, companies are confident that they will have sufficient staff to sustain these essential operations during a pandemic. Water companies have generic contingency plans for continuity of essential supplies. They have worked with suppliers and contractors to check preparedness arrangements, particularly in critical areas such as chemical supplies for water treatment.
Essential repairs to maintain water and sewage pipe work will continue, but staff shortages may reduce or halt non-essential work.
The Security and Emergency Measures Direction 1998 (SEMD) provides the legal framework within which water companies in England and Wales undertake planning for water and sewerage incidents and improve resilience of their infrastructure. In essence, it places a duty on such companies to have in place emergency plans, and in the eventuality of a incident, to make provisions for alternative water supplies, prioritising the vulnerable.
The devolved administrations are responsible for the major areas of pandemic influenza planning and response in their respective countries.
This section provides information on pandemic flu preparedness arrangements in the devolved administrations.
Northern Ireland has an integrated system for the delivery of health and social services. The Department of Health, Social Services and Public Safety (DHSSPS) sets the strategic direction and allocates the annual budget for health and social care services. Responsibility for commissioning services, resource management, performance management and service improvement lies with the Health and Social Care Board. Responsibility for delivery of services lies with 5 Health and Social Care Trusts, which currently provide hospital-based services and community services, and a single ambulance trust for the region.
The Public Health Agency has responsibility for health protection, screening, health improvement and development to improve overall public health and address existing health inequalities. DHSSPS takes the lead in regional contingency planning for pandemic influenza and is represented in national UK pandemic planning structures by its senior medical officer. Pandemic planning work is progressed through a Regional Pandemic Flu Steering Group. Each Health and Social Care Trust has identified ‘flu leads’, who oversee planning for their respective organisation.
The Northern Ireland Contingency Plan for Health Response for an Influenza Pandemic outlines the strategic approach to and preparations for an influenza pandemic. It provides general information on the likely impact and sets out some of the key assumptions for use in response planning. This plan is currently being updated to reflect the UK Influenza Pandemic Preparedness Strategy 2011. Information on pandemic influenza planning including the Northern Ireland Contingency Plan for Health Response for an Influenza Pandemic can be found on the NI Direct website.
The Office of the First Minister and deputy First Minister (OFMDFM), through its Civil Contingencies Policy Branch (CCPB), is responsible for co-ordinating the non-health preparedness of the NI departments and their associated sectors for an Influenza Pandemic. The focus of these preparations is to ensure that all public service organisations and utilities have business continuity arrangements in place to help enable them to maintain essential services during an Influenza Pandemic and to provide for the effective management of supply lines and the operations of government. This work is overseen by the Civil Contingencies Group (NI), which is chaired by OFMDFM.
Managing the impact of a pandemic presents us with unique and difficult challenges if we are to save lives and keep our society running. The Scottish government has been working very hard to meet these challenges both across Scotland and as part of the wider UK planning.
The majority of emergency preparedness work in Scotland is conducted at a local level, and carried forward by strategic co-ordinating groups which comprise key local responders in each of Scotland’s 8 police force areas. This is backed by a range of work underway at a national level to support these local planning arrangements.
The UK Influenza Preparedness Strategy 2011 sets out the strategic approach for responding to an influenza pandemic in Scotland.
The arrangements for responding to an influenza pandemic in Wales are currently under review in the light of the lessons learnt from the response to Swine Flu in 2009 and the publication of the UK Influenza Pandemic Preparedness Strategy 2011. A multi-agency Pandemic Influenza Task and Finish Group has been established to develop arrangements which take account of the structures and processes established under the UK Strategy and the consolidation of the response arrangements contained in the Wales Pandemic Influenza Response Arrangements, the Wales Framework for Managing Major Infectious Disease Emergencies and the structures used under the Pan-Wales Response Plan.
The work being taken forward focuses on 5 key areas:
- developing a Wales storage and distribution solution to deal with the deployment and use of the range of health countermeasures
- ensuring Wales has access to levels of health countermeasures needed for a pandemic with a higher attack rate and produce more severe symptoms than swine flu
- ensuring there is a robust plan for dealing with excess deaths that would result from a higher attack rate more severe virus than swine flu
- revising Wales pandemic plans at all levels to ensure they are precautionary, proportionate and flexible
- strengthening planning for communication of pandemic information to local responders, professional bodies and the public in Wales
The Welsh government website contains information explaining pandemic flu, why we are planning for it, and what we are doing now to minimise any future impact.
The Local Resilience Forums (LRFs), based on the police force areas of South Wales, North Wales, Dyfed-Powys and Gwent, provide the statutory basis for multi-agency planning for an influenza pandemic in Wales. Guidance has been issued to support this work through the Wales Framework for Managing Major Infectious Disease Emergencies. This document focuses on the need for organisations to have robust business continuity arrangements in place and to engage in co-ordinated multi-agency planning to implement any social measures that may be recommended, provide for integrated working with health services on areas such as the use of medical countermeasures, plan for handling excess deaths and prepare for any wider impacts. Through the LRF structure there is also a mechanism for establishing the progress being made with local planning and for testing plans. The Wales Resilience Forum, chaired by the First Minister for Wales, provides the mechanism for a national multi-agency overview of pandemic preparedness in Wales.
Pandemic flu: underpinning evidence and studies/research
Scientific evidence papers
We understand that public confidence in the government’s pandemic strategy depends on it being based on a credible and wide-ranging evidence base, which has been objectively analysed. This enables informed decisions and ensures that all options are explored to their full potential. With this in mind, the Department of Health has produced an evidence base paper which informed and underpinned the policy content of the UK Influenza Pandemic Preparedness Strategy 2011.
Scientific Pandemic Influenza Advisory Committee (SPI)
We are fortunate in having some of the best scientific and medical experts in the world leading our work on pandemic preparations, and the World Health organization (WHO) has identified the UK as one of the best prepared countries in the world.
In 2005, as part of the UK’s pandemic influenza preparation, the Department of Health established a Scientific Advisory Group (SAG) on Pandemic Influenza, to advise on the scientific evidence base for health-related pandemic influenza policies. The Scientific Pandemic Influenza Advisory Committee (SPI) is an enhanced group which replaces the SAG. Besides providing advice on specific questions, the group will act as an information network for the government to ensure that it is informed of important developments in pandemic influenza related sciences, which could affect government policy.
Pandemic flu: communication and public engagement
Preparing for, responding to and recovering from an influenza pandemic will depend significantly on cooperation between the government, public authorities, business, non-governmental organisations, the voluntary sector and individuals. An effective 2-way communication strategy that positively engages each of these key groups prior to and during a pandemic is therefore a major strand of the government’s preparations. Any emergency on this scale also needs strong national direction of public information from the outset. Timely advice and information will help prepare the population for the potential impact of a pandemic and will be critical to its subsequent management.
Please see Section 5 of the UK Influenza Pandemic Preparedness Strategy 2011 for detailed information on the UK’s communications and public engagements strategy, and the separate UK Pandemic Influenza Communications Strategy 2012.
Public health campaign
During the inter-pandemic period, the main objectives are to provide accurate advice and information, encourage the adoption of high standards of personal hygiene and prepare the population for the emergence of an influenza pandemic and its potential impacts.
During any period of increased alert and throughout the response phase, the objectives are to promote and reinforce individual and collective actions that reduce the spread of influenza and minimise its health and wider impact on the UK.
For more information on the Department of Health’s hygiene information please follow the links below.