Doctors prepare for mass swine flu jabs

Published Date: 23 July 2009
By LYNDSAY MOSS
DETAILS of the first Scots likely to receive a swine flu vaccine have emerged, amid growing concerns over how GPs will cope with the extra workload. A nationwide vaccination programme could start as early as next month, as the first vaccine supplies arrive from manufacturers.
New guidance to GP practices, seen by The Scotsman, reveals doctors are being asked to draw up plans to vaccinate certain at-risk groups first – these include pregnant women, young children and those with existing health problems.

But there are worries over whether surgeries have the right storage facilities to handle the vaccines, and how they will manage the huge numbers of patients coming in to be immunised.

After Tuesday's death of a 15-year-old girl in Glasgow, another swine flu fatality was confirmed yesterday in the West Midlands, taking the number of UK deaths linked to the virus to 31.

The news emerged as the first human trials of a swine flu jab began in Australia, while companies supplying the UK said they were making rapid progress towards delivering vaccines.

The UK government has ordered up to 132 million doses of vaccine from pharmaceutical firms GSK and Baxter.


About 60 million doses – enough to cover half the population at two jabs per person – are expected to arrive before the end of the year. The Scottish and UK governments have yet to finalise who the priority groups will be, but guidance sent to GP surgeries in the Lothian area says these groups are likely to include patients aged six months to 65 who have "risk factors as per seasonal flu programme".

This includes patients with conditions such as heart and respiratory diseases, diabetes and weakened immune systems.

The guidance also says children aged three to five who don't have any risk factors are likely to be targeted by practices, along with pregnant women.

The guidance continues: "Vaccination of school-age children will be planned and delivered by the school nursing service with enhanced additional staff. This information takes into account best current forecasts. Indubitably, there will be changes."

The document, which was issued by Marion Storrie on behalf of the Primary Care Pandemic Group, also suggests that GP practices should make sure staff have the appropriate training to be able to deliver the vaccines.

Doctors warned yesterday that the vaccination programme would affect their ability to do other work, such as carrying out check-ups on patients with chronic conditions.

Dr Peter Shishodia, secretary of Lothian Local Medical Committee, said there were still "huge issues" to be resolved over how staff would be trained, where the vaccine would be delivered and how it would be stored.

Dr Shishodia, a GP in Muirhouse, Edinburgh, said: "In a practice like mine, you are possibly talking about 2,600 inoculations being given. That is with the at-risk groups getting two vaccines each for swine flu. To try to squeeze that in above your ordinary work is going to be quite difficult.

"The big issue for us is, if you have to take on 2,600 consultations in a short period of time, we may need to compromise our ordinary surgeries to be able to deliver that programme.

"That is an issue we will need to wrestle with soon. It may be that we need to compromise our ordinary consultations… possibly delay the review of people with chronic diseases and chronic illnesses."

The guidance to Lothian GPs asks practices to review their current cold-storage capacity for vaccinations.

Vaccines have to be kept at the same temperature to keep them as effective as possible. In the past, problems with storage in some Scottish surgeries have led to patients having to be revaccinated to make sure that they are protected.

Dr Shishodia said the issue of the "cold chain" still needed to be discussed and resolved. "Not only will we have the swine flu, but we will have the ordinary flu vaccine, and the child vaccines as well," he said.

"I have just looked at our fridges and they are all full at the moment, and we don't have the swine flu vaccine."

Dean Marshall, chairman of the British Medical Association's Scottish GPs committee, said planning was under way to decide how doctors would manage the extra workload.

"The problem we are going to have is how do we actually fit in the vaccinations alongside our general work," Dr Marshall said.

"The other thing is, if we do have an upsurge in people with swine flu, it's expected to be around the same time as we are trying to vaccinate, so that's the logistical problems we are trying to deal with just now.

"How we manage that is going to be extremely difficult and will be potentially a huge workload for practices."

Dr Marshall said patients would have to continue to receive the normal healthcare they would expect from their GP.

But he said that some of the bureaucratic work doctors had to do could have to be stopped or scaled back during the pandemic period.

Another option might be for health staff to work outside normal hours to deliver vaccines.

Dr Marshall said he hoped GPs could vaccinate the at-risk groups within a couple of months, before starting on the rest of the population.

Yesterday, the pharmaceutical giant GSK, which is supplying vaccine to the UK along with another company, Baxter, said first batches of its vaccine would be available in September.

A spokeswoman for Baxter said it expected to ship the first batches of its swine flu vaccine at the end of this month or early in August.

The UK's vaccine contracts with Baxter and GSK are worth £155.4 million over four years.

NHS Lothian refused to comment on specific aspects of its guidance to GPs.

Dr Dermot Gorman, swine flu vaccine programme director, said: "It is a complex and constantly evolving situation and, like all health boards, NHS Lothian is working closely with the Scottish Government and Health Protection Scotland to ensure the effective delivery of the national vaccination programme."

The Scottish Government said plans for the vaccination programmes were still being finalised.

A spokeswoman said: "Scotland and the UK are preparing very well for an H1N1 vaccine.

"We have always said that the first vaccine deliveries may come in August, and, for that reason, we need to plan on the basis of being able to deliver a vaccine from August. This is consistent with advice from the World Health Organisation.

"We are preparing rigorously to ensure that the NHS is ready whenever the H1N1 vaccine arrives – but this does not necessarily mean that vaccination will commence immediately.

"The start point for the programme will need to take account of the licensing position and scientific advice about safety. No vaccine will be used without scientific and medical advice indicating that it is safe to do so."

Meanwhile, swine flu sufferers could sue their employers for up to tens of thousands of pounds if they can prove they contracted the virus at work, lawyers claimed yesterday.

Employees under pressure not to take time off and supermarket check-out staff dealing with hundreds of potentially infected customers per day are said to be the most likely to have a case. James Wilders, an employment law partner at the legal firm Dickinson Dees, said check-out staff would be "acting completely reasonably" if they refused to serve a customer who was sneezing and spluttering, and could complain if they were forced to do so.

He added that employers would be leaving themselves open to legal action if they failed to provide soap in office bathrooms, or if staff were infected by sick colleagues who were not "sent home promptly" when they developed flu symptoms, or who were asked to return before they had fully recovered.

Mr Wilders said: "In the most tragic instance, if someone died from swine flu and their relatives could show they probably contracted the disease at work because of lax health-and-safety procedures, it could be potentially very costly for the employer."

The claim emerged as it was revealed the number of people taking time off work with swine flu had trebled in a week, to some 130,000 absences across the UK.


Britain well placed to cope, Brown tells public

PRIME Minister Gordon Brown sought to reassure the public yesterday, saying "robust plans" were in place to deal with the swine flu pandemic.

He said the government was making an "enormous effort" to ensure the UK was prepared

and insisted measures were being taken in a "calm and organised and ordered way".

More than 700 people worldwide are known to have died after getting the virus, which the World Health Organisation says is spreading faster than any previous flu pandemic.

Speaking at his monthly news conference in Downing Street, Mr Brown said: "Cases of swine flu in the UK have so far proved to be generally mild in most people, but they have been severe amongst a small minority, mostly where patients have had underlying health problems.

"I want the public to be reassured that we have been preparing for the possibility of a pandemic for a number of years."

He went on: "Robust plans are in place, the NHS is continuing to cope well thanks to the sterling efforts of its staff, but as swine flu cases have started to increase, we need to be able to give greater numbers of antivirals to greater numbers of people quickly."

The National Pandemic Flu Service in England is to start work from the end of the week to diagnose people with swine flu and allow them to get antivirals from local centres.

Health secretary Nicola Sturgeon said there were no such plans in Scotland because demands on GPs and NHS 24 from people with symptoms were not that high. But she said Scotland could opt in to the service in future if necessary.


Conditions at high risk of infection are revealed

HEALTH conditions which put patients at "high risk" if they go on to contract swine flu have been identified. They are:

• Chronic lung conditions

A spokeswoman for Asthma UK said: "People with asthma are no more likely to catch swine flu than anyone else, but it could add to breathing difficulties."

• Chronic heart disease

Patients should take extra care with using pain killers to combat swine flu.

• Diabetes

"Having flu can upset diabetes control," said Caroline Butler at Diabetes UK. "This can leave people open to pneumonia and bronchitis."

• Chronic kidney disease

It is "very important" renal patients seek advice before taking vaccines, the National Kidney Federation said.

• Chronic liver disease

The British Liver Trust said: "The advice given to the population as a whole applies equally to people with liver disease."

• Chronic neurological disease, including motor neurone disease, multiple sclerosis and Parkinson's

The MS society said: "If you are on certain modifying drugs or taking immunosuppressants, you may be more at risk of picking up infections."

• Pregnancy

Complications are pneumonia, difficulty breathing and dehydration, said the NHS.