Retrospect and mitigation: public health discourse on 2009’s H1N1 pandemic Mark Davis (Monash University) & Paul Flowers (Glasgow Caledonian University) 4S/EAAST Joint Conference Copenhagen, 19 October 2012

The precautionary principle The main ethos of public health is one of prevention: to prevent disease and avert avoidable deaths. The response of WHO and many countries to the pandemic was a reflection of this mindset. This was affirmed in the sentiments expressed by many Member States to the Review Committee: in the face of uncertainty and potentially serious harm, it is better to err on the side of safety. Public- health officials believe and act on this conviction. It is incumbent upon political leaders and policy-makers to understand this core value of public health and how it pervades thinking in the field. (page 10, WHO (2011) Implementation of the International Health Regulations, 2005)

Luhmann and Rabinow Luhmann: “knowing that we do not know” (1998, Observations on modernity. Stanford University Press; 100) Rabinow: “saturated by partially volatile and partially frozen sets of power relations” (Marking time: On the anthropology of the contemporary. Princeton University Press; 61)

Interviews 10 PHE in 2 UK cities Involved with health protection activity during the pandemic

The unprecedented H1N1 pandemic “I’ve worked in public health for over twenty years and never had such a situation as we had” (Interviewees 03 & 04, joint interview). “We’ve been waiting for the pandemic flu to happen for quite a while now. But it just didn’t fit the text books when it did come.” (Interviewees 03 & 04)

Containment? So how can you contain something that you already know you haven’t?... It [government] tried to contain the swine sniffle for far too long. We got to over a thousand cases that we were meant to do contacting for. We were meant to find everybody who had been within one metre for one hour for over a thousand people... and give them Tamiflu. It was just crazy to be able to, to expect that you can contain it for that long. (Interviewee 09)

‘We had to do what we thought was right at the time’ So I think in retrospect people thought well we had to do what we thought was right at the time because nobody knew how the virus was going to behave and it could have been catastrophic, and it’s easy enough to look back and say when you’ve got all the information, actually yeah we really didn’t need to do that for quite as long or maybe we should have done it that way but you know (Interviewee 01)

Precautionary principle it was being presented to us it was low but in numbers terms it was still significant. If you say there is still a chance that it could go pear shaped... there is any chance at all, we need to keep going. (Interviewee 07)

Political imperatives I think they were almost agreeing with us but I think some of the problem was the politicians, not that I dislike politicians, but politics gets in the way of science... Now I can understand that from a political point of view that you want to be seen to be doing everything to make sure that they didn’t have deaths on their hands etc so they were more reluctant to stop the swabbing and the containment stage in light of the evidence. (Interviewee 10)

Conclusion Flaws in plans not simply procedural Plans refuse the present by making it difficult to respond to an emerging pandemic How then can we plan for a radically uncertain future?