I very much welcome the opportunity to meet the joint committee to outline the details of our response to pandemic (H1N1) 2009 and to address questions members may have. I am joined by the following: Dr. John Devlin, deputy chief medical officer; Mr. Brian Mullen, principal officer, public health division, Department of Health and Children; Dr. Pat Doorley, director of population health, HSE; Dr. Kevin Kelleher, assistant director of population health with responsibility for health protection, HSE; and Mr. Gavin Maguire, assistant national director of population health with responsibility for emergency planning, HSE.
I will outline an overall summary of the position since April. On Friday, 24 April we received from the World Health Organization, WHO, through the international health regulation system, an alert indicating that human cases of influenza type A, H1N1 virus infection, had been identified in both the United States and Mexico. On 26 April the WHO upgraded the pandemic alert level from phase 3 to phase 4 and on 28 April it was upgraded again to phase 5 of a six-phase level. On Thursday, 11 June, following consideration by its emergency committee, the WHO raised the influenza alert level to pandemic level 6. Pandemic means an influenza virus new to the population has appeared, is spreading and causing disease in many parts of the world. Phase 6 means there is increased and sustained transmission in human populations in at least two regions of the WHO which is divided into half a dozen regions on a global basis.
The WHO's decision reflected the geographic spread as opposed to any statement of its severity. When it made the declaration, the organisation categorised the severity of the pandemic as moderate. We had anticipated the changes in categorisation from level 3 to level 6 and the categorisation of the pandemic as moderate, as did the international scientific community. With regard to our plans and preparations, at each of these stages, we were ready for the step-ups as and when they occurred. The Department and the HSE have been preparing for years for an influenza pandemic. These preparations reflected international developments, the learning from the SARS outbreak in 2003 and the possibility in more recent years of a global pandemic emerging as a result of the H5N1 virus, the so-called avian flu.
On receipt of the initial WHO alert in April, the Department activated our national plan for pandemic influenza, which was originally launched in January 2007 and in keeping with which we launched our response. The plan has been accompanied by a guidance report developed by a standing influenza pandemic expert group, chaired by Professor Bill Hall of the national virus reference laboratory in UCD. That group further updated its guidance in April based on experience with the new pandemic and it has continued, as required, to update the guidance. We are following that guidance in our response at every level in the health system.
In line with the national plan, the so-called national public health emergency team which manages the health system response to a public health emergency was convened and it has met regularly throughout the incident. It is chaired by the Secretary General of the Department of Health and Children, Mr. Michael Scanlan. The chief executive officer of the HSE is also a member. The expert group chaired by Professor Hall continues to provide public health and scientific advice on preparedness and control measures for the national public health emergency team. An interdepartmental committee drawn from every other Department and other public agencies on pandemic planning, which co-ordinates the intersectoral response to a potential pandemic, has met since the declaration of this incident on an approximately fortnightly basis. Within the HSE, national and regional crisis management teams have been meeting regularly to co-ordinate the HSE preparedness and response measures they have had to put in place.
The Department and HSE regularly participate in teleconferences and meetings with the European Centre for Disease Control, the agency of the Commission at European level which co-ordinates responses among member states. We have also been linking with our colleagues in Northern Ireland and with public health officials in other European member states and the WHO.
As members may be aware, we have been holding regular press briefings to provide information and to convey important public health messages and have been doing so regularly since the outset of the crisis. We are now doing so on a weekly basis by arrangement, namely, we hold a press briefing every Thursday afternoon. Information is also regularly updated on the Department's website and the HSE website. More recently, we launched the pandemic H1N1 2009 website at www.swineflu.ie. which provides advice on travel, schools, care in the home, hospitals and other health care settings and general measures the public can take to limit their own risk of acquiring or transmitting the infection should they become infected.
The Minister for Health and Children has also provided regular briefings for the Cabinet, and Oireachtas health spokespersons have been briefed on a couple of occasions on preparations in regard to the incident. Arrangements were also put in place in advance of the declaration of this pandemic to secure access, should we need it in a pandemic situation, to supplies of a vaccine. This led to us being able to put in place an arrangement whereby 7.7 million doses have been acquired for use in the Irish population. Initial doses are currently arriving into the country. Administration of this vaccines will not commence until after they are licensed, which is not expected to be until October. Advance arrangements were also put in place which had insured that at the outset of this incident Ireland had anti-viral drugs in place for 47% of the population. Additional supplies have been procured since the beginning of the incident.
The first case of swine flu was confirmed in Ireland on 2 May 2009. We have since had two deaths and more than 800 laboratory confirmed cases in Ireland. In line with the national plan and arrangements in other countries, we initially operated what is termed a containment strategy. The rationale for this was to delay the development of the disease to ensure we could put in place and optimise our preparations for a response to the pandemic by identifying each individual case that occurred here and then actively identifying and tracing each contact of that case. Members may recall we were offering Tamiflu to each one of those contacts. We said from the outset that this would be a time limited strategy and as a result — this is pretty much in line with other countries — in mid-July, we changed our response to one of mitigation. This means our response is now focused on minimising the impact of the disease on the population and on the functioning of society generally. As a result patients are now diagnosed and managed clinically by their general practitioner. Swab tests for the virus are no longer routinely taken from patients and sent for viral testing. The number of laboratory cases has therefore ceased to be a reliable indicator of the burden of infection. While we would at the beginning have been reporting the exact number on a daily basis, for the reasons just outlined we no longer have an accurate representation of the burden of infection on the population.
Since the end of July, an estimated number of cases is now provided each week based on information derived from the so-called national influenza sentinel GP surveillance network. This gives a good estimate of the number of cases of influenza-like illness being treated by GPs. That system shows that influenza-like illness rates have been stable in the past number of weeks, ranging somewhere between 30 and 40 per 100,000 of population. To put this in context, the peak reported influenza-like illness rate during last winter, which was a high peak, was approximately 120,000 per week.
While we cannot predict with any certainty how the disease will progress from here, we are planning on the basis of certain assumptions which are broadly consistent with those either recommended by or used in other countries. These assume that approximately 25% of the population could become infected in a first wave and that up to 10% of the workforce may be absent from work during that time and that, perhaps, somewhere between 1% and 2% of cases may require treatment in hospital. In that scenario we would be looking at an equivalent influenza-like illness rate of in the region of 1,000 to 1,500 per 100,000.
It is indeed reassuring that in the great majority of cases the infection will be mild and self limiting and people will be able to care for themselves at home without having to visit a GP or hospital. Small numbers, especially those with underlying risks, will develop significant complications and some more people will, in that scenario of increased infection, inevitably and unfortunately, die. Therefore, an infection rate of 25% in a wave that could last up to 15 weeks would still have a significant impact on our health services. It is this that has been the focus of our continued planning and preparations over the past number of weeks and months. Even as a mild disease, it should be understood that people — we expect them to follow our advice — will be absent from workplaces and schools.
This means that the functioning of society as a whole would be impacted during such a wave of infection. It is for this reason we have been working with other sectors, through the interdepartmental committee I mentioned earlier. We have been saying for some time that businesses and organisations should develop business continuity plans, based on the excellent guidance produced by Forfás on behalf of the Department of Enterprise, Trade and Employment on business continuity planning for an influenza pandemic. This is available through the Department's website and through that of the Department of Health and Children.
A key issue being addressed is the finalisation of our arrangements to provide pandemic vaccine to the whole population. This is an enormous and logistically complex undertaking for the health system. We will, shortly, launch this plan and announce the precise arrangements that will be put in place. I take this opportunity to call on health professionals to come forward for vaccine once it is offered for them and to accept the responsibility they have to protect themselves in the first instance so that they will continue to be available for work and to ensure the patients they care for are not put at risk of picking up infection from an unvaccinated health care worker.
Again, I thank the Chairman for the opportunity to make this presentation. Ireland is well prepared for what we face with regard to pandemic influenza. The plans have worked well up to now and we have had excellent co-operation and support from our health professionals at the front line, from teachers, unions, Departments, the media and public representatives. I am confident that if we continue to pull together in this way as a society, we will minimise the impact of this pandemic on the population and the functioning of society.
