London School of Hygiene & Tropical Medicine

The decision by the Government to make local authorities responsible for implementing pandemic flu plans is being questioned by a leading expert writing in today's British Medical Journal.

The government published a draft plan in March, which detailed its strategic approach to limit the spread of pandemic flu in the event of a UK outbreak, and to minimise its impact on health, the economy and society. The document makes clear that primary responsibility for planning and responding to an outbreak lies with local authorities and organisations.

Dr Richard Coker of the London School of Hygiene & Tropical Medicine warns that, historically, there has been a tendency by governments to centralise strategic and operational authority in the event of national and global crises, which would make much of the planning to devolve responsibility redundant. He also raises questions as to whether the plan provides enough guidance for local planners on issues such as how to allocate scarce resources.

Dr Coker warns against adding to the confusion that will inevitably arise if pandemic flu strikes the UK by having strategies in place which cannot, in reality, be acted upon. He cautions that we need to learn lessons from the outbreak of severe acute respiratory syndrome (SARS), the impact of which could have been lessoned if there had been greater clarity beforehand as to who was responsible for making decisions and implementing strategies.

'Severe acute respiratory syndrome (SARS) taught us that there should be clarity established beforehand, as to what decisions are taken at what level and by whom during an epidemic', writes Dr Coker. 'Government guidance also states that all emergency response and recovery should be properly prepared and be clear about their roles and responsibilities. Yet concern persists at local level that current plans for pandemic flu in the UK do not take account of what we have learnt from the experience with SARS'.