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Last Updated: Sunday, 16 October 2005, 10:50 GMT 11:50 UK
Flu pandemic?
On Sunday 16 October 2005 Andrew Marr interviewed Professor Sir Liam Donaldson, Chief Medical Officer

Please note "BBC Sunday AM" must be credited if any part of this transcript is used.

Professor Sir Liam Donaldson
Professor Sir Liam Donaldson, Chief Medical Officer

ANDREW MARR: Now, bird flu has been, obviously, a matter of great concern in the Far East for more than a year but it is now on our doorstep and we're getting seriously worried.

As we've been hearing, the government is putting in place a comprehensive, indeed quite a startling emergency plan to deal with the health issues.

Now the government's Chief Medical Officer, Sir Liam Donaldson, is here. Sir Liam, can I start by just looking at the science of it, as we understand it.

I'm right in saying that the crucial breakthrough, if you like, that the virus hasn't yet made, is direct human to human infection? LIAM DONALDSON: That's right. This virus has been around in the bird population for about five or six years at least and - mainly in the Far East - and we've seen a lot of chickens and ducks and geese slaughtered or dying from it.

We've seen a small number of cases from either poultry workers or people living in close proximity but we've no firm evidence yet of person to person spread. So bird flu is actually quite difficult for someone to catch but where, what it's significance -

ANDREW MARR: Sorry - I was going to say, I mean given that, a lot of people will say so what's all this stuff in the papers about the pandemic?

LIAM DONALDSON: Well the significance of it is isn't that there will be a pandemic of bird flu itself. The significance of it is that at some point, and we go by the lessons of history, the bird flu virus will combine with a human flu virus and then it will become easily transmissible. Why is that inevitable?

Well because it's happened before. It happened in 1918, it happened in 1958 and it happened in 1968/9. So these things come in natural cycles, once in a while, every ten to 40 years, the flu virus mutates into a strain which we haven't got natural immunity to.

ANDREW MARR: So it really is when not if.

LIAM DONALDSON: It is when, yes, but there's a lot we can do to prepare. If we look back to the last pandemic in 1968/9, we didn't have some of the measures that we now have, like anti-viral drugs.

ANDREW MARR: Well let's turn to those, anti-viral drugs first of all. We've got something which may work and you're trying to accumulate, I think, 14 million doses of it. LIAM DONALDSON: Yes.

ANDREW MARR: How many have we got so far?

LIAM DONALDSON: We've got two and a half million so far and they're coming in at the rate of about 800,000 a month.

ANDREW MARR: So not nearly enough.

LIAM DONALDSON: Well, not yet - but we're one of the few countries to have embarked on this stockpiling at a very early stage so we feel that -

ANDREW MARR: I thought the French and others were way ahead of us on this.

LIAM DONALDSON: The French have a stockpile, the US at the moment have about 1/25th of what we've got and some other countries have a stockpile but up until now we've been one of the countries which has been in the lead on this and it's part of a comprehensive plan - we can't make this pandemic go away, because it is a natural phenomenon, it will come, but what we can do is to limit its impact, and that's the whole basis of the contingency plan that we're releasing on Thursday.

ANDREW MARR: But the earlier it comes for us, if it came this winter for instance, the worse, because we haven't got the stockpiles we might need.

LIAM DONALDSON: Well no we've got some drugs so far and those would obviously be deployed but give us a little bit more time and we'll be even better prepared.

ANDREW MARR: Well yes, of course, that's what a virus can't do necessarily.


ANDREW MARR: How many people are going to die?

LIAM DONALDSON: Well in a normal winter flu year, people might be surprised, flu we tend to think of as a, as a friendly companion that's around all the time, but it actually kills in excess of 12,000 people every winter with the normal winter flu. But if we had a pandemic, the problem would be that our existing vaccines don't work against it, we would have to develop a new vaccine and people don't have natural immunity because it hasn't been around before.

So the estimate we're working to in the number of deaths is around 50,000 excess deaths from flu, but it could be a lot higher than that it very much depends whether this mutated strain is a mild one or a more serious one.

ANDREW MARR: The top end, we read in the papers, about 750,000 people dying, which would be a national catastrophe obviously.

LIAM DONALDSON: Yes it would and if that happened it would be an international catastrophe and I think we have to, we have to say that if we're making comparisons with the Spanish flu in 1918/19, where 40 million people worldwide died, 250 million in the UK, we are living

ANDREW MARR: Two hundred and 50 thousand -

LIAM DONALDSON: Yes - 250,000 in the UK - we are living in very different times - those were in the days before proper hospital facilities, before intensive care, before antibiotics, so we're not planned - we obviously have to be flexible in our plans and prepare for everything - but at the moment our estimate is that we expect around 50 - 55,000 but it could be higher -

ANDREW MARR: Three - three quarters of a million is not unrealistic.

LIAM DONALDSON: It's not impossible but I think it's more realistic that the figure will be a lot lower than that.

ANDREW MARR: If this pandemic arrives, what else does the government do? Do you close schools, airports; do you close public buildings; do you encourage people to stay at home?

LIAM DONALDSON: Well I think the two most important measures, apart from obviously having good surveillance so that we're aware when it's coming, is to immediately get that virus from wherever it occurs - and the most likely is it will still be in the Far East - into the laboratories in Britain and start characterising it and then manufacturing a vaccine.

ANDREW MARR: As quickly as possible.

LIAM DONALDSON: As quickly as possible. And we have some of the top scientists in the world in Britain, we're very proud of the work that they do and we're in very close contact with them. Secondly, deploy the anti-virals - the anti-virals won't cure flu but they will reduce the severity of an attack if given in the first 24, 48 hours, and they will stop some people from dying from it.

I think measures such as controlling movement of populations are not as important because flu transmits extremely quickly, it's not like Sars, so that might slow its impact and it might be necessary, if we're at the absolute peak of a pandemic in this country, but it's not the prime intervention that we need to use.

ANDREW MARR: But to be clear, you have a plan, you have an emergency strategy, if it gets that bad, and presumably places like airports, where people are moving internationally, would be closed.

LIAM DONALDSON: It would not, I think, come to that. What would be more sensible and more realistic is that we would look to reducing the amount of movement of people.

We'd be saying well unless your travel is absolutely essential do you need to go up to the north east this weekend or do you need to go to that particular social gathering. It would be things like that. But all of those things would slow the pandemic and that of course gives us time to catch up with the vaccine, which would take a few months to prepare.

ANDREW MARR: Schools, public buildings, public places?

LIAM DONALDSON: There might be the need to do that but initially I think the main measures would be the deployment of the anti-virals and then getting that vaccine into the - getting that virus in the laboratories and getting the vaccine production started.

ANDREW MARR: Now inevitably there's not going to be enough vaccine for everybody when you get going. How do you decide who gets it first?

LIAM DONALDSON: Well we would decide firstly to give it to essential workers. So front-line NHS staff, that we want to keep our hospitals running obviously, we want to care for the patients that would become ill. The next group would be people who are known to be in the higher risk groups.

Now with the normal winter flu that's elderly people and people with chronic diseases, but we would have to watch the pattern of this flu very carefully - this new flu whenever it came out - and it may be that different groups would be affected. For example in the Spanish flu, it was mainly adults, 20 to 40 years old, who were the high risk group. So if we saw a new pattern emerging then we would reprioritise the risk groups.

ANDREW MARR: Right. In your - this may be an impossible question to answer so I apologise in advance - but what is your best guess about this, is it going to come this winter?

LIAM DONALDSON: I think it's less likely that it will come this winter. The attention at the moment is focused in Europe because of these outbreaks, that doesn't mean that the pandemic flu is creeping closer to the UK, it simply means that the bird flu is occurring in other parts of the world, as it has over the last five to six years.

I think the likelihood is still that we will see the epicentre of this pandemic and flu, this mutation, in the Far East. For example in China, one and a half billion chickens live in close proximity to people in China and that's where we've so far -

ANDREW MARR: That's where ...

LIAM DONALDSON: - think the greatest, it could happen in Europe, but most likely in the Far East.

ANDREW MARR: Now despite all the things you've been talking about, the opposition parties, in particular, have accused the government of being very slow off the mark so there isn't enough vaccine being stockpiled, there aren't enough arrangements being made in case things turn very difficult indeed this winter.

LIAM DONALDSON: Well we have been quick off the mark, we have started stockpiling the anti-virals - many other countries haven't - we've also ordered two and a half million doses of the H5N1 vaccine just as a contingency.

It may not the be right vaccine because we don't know what the strain is going to be, but we've done that as a contingency. So I think we are, we are in a strong position - the World Health Organisation has commended our plan - but funnily enough, you may be surprised that people like me actually quite like criticism because once in a while -

ANDREW MARR: Because it raises the subject -

LIAM DONALDSON: Well it raises the awareness but once in a while people come up with an idea that we haven't thought of, so we're always willing to listen to criticism and comment.

ANDREW MARR: And what about the birds themselves? Should people be worried about chickens roaming free range, should they be worried about wild fowl, is there anything that people can do to help stop this spreading in the avian form, the bird form?

LIAM DONALDSON: Well at this stage we haven't got bird flu in this country and I know that the Department for Environment, Food & Rural Affairs is increasing bio-security around farms, but until we get it in this country I don't think there are any special precautions that people need to take - and in any case -

ANDREW MARR: There's not much we can do, frankly, individually.

LIAM DONALDSON: No. If it happened, it would mainly be a threat for people working in the poultry industry and those in close contact with birds. It's this mutation which would occur between the bird strain and the human strain we really need to be worried about.

ANDREW MARR: Sir Liam Donaldson, thank you very much indeed for that.


NB: this transcript was typed from a recording and not copied from an original script.

Because of the possibility of mis-hearing and the difficulty, in some cases, of identifying individual speakers, the BBC cannot vouch for its accuracy

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