Government officials are working urgently to put arrangements in place that could see all 60 million citizens rolling up a sleeve to receive the H1N1 vaccine when it becomes generally available – the first campaign on such a scale since 1964, when every Briton was vaccinated against smallpox.
Although the media focus on the pandemic has diminished as the first wave of infection has begun to recede, officials at the Department of Health (DH) have been planning to try to ensure both that the inoculation campaign goes smoothly and that the NHS can cope if the second wave of infection expected in the autumn proves more serious than the first.
"This is an enormous operation. It's a huge logistical challenge," said one of those involved in the planning.
Several questions need to be answered once the vaccine is available. Who gets it first? Which are the priority groups – healthcare workers, under-fives, pregnant women, or people with a long-term health condition? And, crucially, how does everyone get the necessary jabs?
The numbers involved are daunting. In England alone 1.2 million people work for the health service, although not all in frontline care. Among the other probable priority groups there are 9.7 million schoolchildren, 3.8 million under-fives, around 700,000 mothers-to-be and millions of people with long-term illnesses such as asthma or heart disease. "You are dealing with many millions of people in these priority categories and the key is how you prioritise," added the source.
A DH spokeswoman, when asked if it was necessary to vaccinate the whole population, said: "The risk profile of the virus has not been fully characterised. Whilst it has generally been mild, previously healthy people have died. It is impossible to predict whether the virus will become more severe in the winter but being first in the queue for enough vaccine … puts us in the strongest position to respond."
There are also several practical problems to overcome. How will the vaccine be transported? Are there sufficient "cold chain" refrigerators in the NHS to store it? Which medical professionals will administer the swine flu jab? The strong likelihood that pupils will be immunised at school distills many of the complex practicalities involved.
DH planners have not yet finalised how many nurses or doctors would go into each school. The need to be able to resuscitate any pupil who goes into anaphylactic shock – a severe allergic reaction to a vaccine – may mean that some nurses and health visitors need to undergo fresh training, said the DH source.
Planners speak calmly, though. Measures taken after the bird flu outbreak in 2003 means that all parts of the NHS and public bodies such as local councils, police forces and fire brigades already have detailed plans in place. Andy Burnham, the health secretary, has pledged to produce two key strategies by the end of the month, one covering vaccination and the other detailing how the NHS will create more intensive care capacity.
Timing is not the only issue with the vaccine. Drugs companies around the world have been scrambling to produce a vaccine since H1N1 was first identified in the spring, and clinical testing by manufacturers is under way. Results are not expected until the first two weeks of September. Only then will scientists know whether one or two doses will be needed, or even whether it works at all.
