News analysis: Influenza chaos

What happened to all the flu jabs? How can they have disappeared, leaving some elderly people and others with asthma or diabetes unprotected from a disease that could kill them this winter?

Even the Department of Health (DoH) is confused. "We don't know where the vaccines have gone," admitted a senior source. "It's a total shambles." Downing Street is privately fuming at the national shortfall and the way it has been handled by the department. Senior officials have been hauled in to No 10 to explain themselves.

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Now the DoH says a flu co-ordinator will be appointed to serve every health trust and make sure that nobody who is at risk goes unprotected. But it is unclear where the shots will come from. Another 200,000 have been ordered, but they will not be ready until January. Experts agree that the flu season is usually all but over by then.

That may be too late to save some of the vulnerable, who can be killed by a bout of flu that healthier or younger people would shake off. And it is already too late to save the Prime Minister from the nausea he must have felt after the leader of the opposition gave him a thorough examination on Wednesday.

"Is it any wonder that GPs and others are in despair at the inefficiency and incompetence of the DoH and the Secretary of State?" crowed Michael Howard. "If the department can so comprehensively bungle the routine administration of the seasonal flu vaccine, what confidence can we have in their ability to cope with a pandemic of bird flu?"

Tony Blair insisted that enough doses had been ordered, and on the face of it he was right. There are 13.2 million people considered at risk from the flu (although for a couple of days last week the DoH gave the impression it was 11 million). There has never been a year when every single one of those people came forward for a jab. The manufacturers were told to make 14 million shots. That should have been enough.

Yet GPs received a letter from the DoH last Tuesday telling them there were only enough vaccines left to last a couple of days. Doctors already knew there was a shortage; they had been demanding more supplies - but there was uproar at the letter's suggestion that some of them had been persuaded to give doses to "the worried well". The same phrase was used by the Health Secretary, Patricia Hewitt, who imperiously reminded GPs that they should inject only "those who will really benefit".

Doctors are still outraged by this attack, pointing out that it would cost them large amounts of their own money to give jabs to the "worried well" on the NHS. "The idea is absurd," says Laurence Buckman, a family practitioner in Finchley, north London, and deputy chair of the British Medical Association's GP committee. Doctors order their vaccines directly from the manufacturers, he explains. They pay for the drugs themselves and are reimbursed by the DoH for every person at risk who is protected. They get nothing back for vaccinating a fit person.

"It would not take very many acts of kindness before you started losing large amounts," says Dr Buckman. "Whatever else GPs may be, they are not stupid with their money."

He believes the vaccines may actually have gone to the "appropriately deserving, people who fit the criteria". Last year, 70 per cent of pensioners came forward for a jab, and 42 per cent of people in the other risk groups, which include those with poor immunity and diseases of the liver, kidney or heart. "I don't think anybody realises how much the bird flu scare has encouraged people to have a jab who are eligible but would not have bothered in the past," says Dr Buckman. So the right people have been scared into action? "Exactly. That's right."

Let's be clear: a vaccination against ordinary flu will not offer any protection whatsoever against avian flu, when (or if) it learns to spread from person to person. But that message did not get through very clearly when Britain was gripped by bird flu fever a few weeks ago. Infected finches were found here just at the time GPs were putting up flu posters. Usually reluctant patients came forward in droves. People were frightened. And if the frightened fit could not get a jab from the doctor, where could they go?

Bupa was one answer, with shots costing £14.50. Boots and other private companies offered similar deals. But not now. "We've run out, too," says the receptionist at my local Bupa clinic. "We won't get any until mid-December. This bird flu has terrified the nation."

Indeed. But surely the shots for all those private patients did not have to come out of the same 14 million batch? Er, yes, confirms a spokeswoman for the DoH. The total supply for the country must meet all demands, NHS or private. And that's not all. Here comes a group of late arriving patients: the carers.

All doctors have to place their orders with vaccine manufacturers in the spring. But in July, after they had done that, they each received a letter from Sir Liam Donaldson, the Chief Medical Officer, saying that the main carer for someone at risk should also qualify for a jab.

"There is a huge number of carers and there was no stock for them," says Jim Johnson, chairman of the BMA, who accused the Government of "moving the goalposts".

The Conservatives estimate there are five million carers, which would blow a big hole in all the calculations. The DoH disputes that figure. "The vaccine is intended for those caring for someone who is completely dependent on them and is at the GP's discretion," says a spokeswoman. "We don't anticipate that that will be a huge number, and certainly not five million."

Even if that is true, considerable numbers of carers, and the worried well with the means to go private, have suddenly been competing this year with the 13.2 million deserving sick, more of whom than before were keen to have jabs. Suddenly 14 million doses doesn't seem so many.

Why does it matter? Well, it matters to me because I am asthmatic, can't get a jab and don't want to die. And any incompetence should matter to all of us because the World Health Organisation says we are "closer to another influenza pandemic than at any time since 1968".

Hong Kong flu led to 30,000 deaths in Britain that winter, and up to four million worldwide. Asian flu in 1957 killed a million globally and 33,000 here. In the winter of 1918 Spanish flu killed 250,000 people in Britain and 40 million worldwide. Flu haunted the British winter like a ghost at the Christmas feast, for generations.

But we became complacent. Since 1968 the most dangerous viruses have usually been variations - or drifts, as the scientists say - of Hong Kong flu, H3N2. The boffins could beat those, by growing the new strains on fertilised hens' eggs and using them to seed vaccines. Then along came the birds, to scare us all to death again.

A pandemic could occur if the flu virus mutates into a completely new strain that defies all the vaccines. Bird flu is not the only possible cause of this, but the most likely. Just as the Prime Minister was suffering hot flushes at Question Time last week, it was confirmed that a second person had died in China from bird flu: a 35-year-old farmer called Xu. Bird flu, H5N1, has killed 100 million birds and at least 67 people since 2003. The fear is that the body of someone like Xu will act as a crucible in which the virus evolves into a strain that passes easily from human to human.

If that happens, millions of people across the world could die. But that is another story - an entirely different kettle of finch, you might say - from what is happening in Britain. For that, given the "shambles" inside the DoH, maybe we should all be very grateful.

Inside the virus

This artist's impression of the influenza virus shows one of the eight segments that contain strands of the genetic material RNA. These carry the blueprint for making new copies of the virus. Two main types of spike stick up from the surface. The green ones represent the protein hemagglutinin, which enables the virus to stick to a cell in the host body. The other, neuraminidase, allows newly formed viruses to move on and spread infection

13.2m people in Britain are considered to be more at risk from a flu virus because of their age or a health condition such as asthma or diabetes

14m Vaccines were ordered from the manufacturers by the Department of Health earlier this year. Yet there are still shortages

23% of Britons caught flu during the pandemic of 1918-19, the biggest outbreak of the last century. It killed 250,000 people in this country

How the vaccine works. And how the flu can beat it

1. Flu virus carried on the air by droplets or particles from a sneeze or cough enters the body through nose or throat

2. Each year's vaccine contains the three strains most in circulation at the time - two of type A flu strain and one of type B

3. After vaccination, the system produces antibodies that fight the flu strains. They latch on to the surface of a virus, which stops it attaching to healthy cells and infecting them

4. The flu virus can mutate, because it is made of RNA. This has chemical strands that are much more likely to change than those of DNA

5. The strands determine the shapes of the spikes on the surface of the virus. If a strand mutates, then the shape of its spike will also change. If the shape of the spike changes, then the antibodies will no longer latch on. The new-look virus is now free to attach to healthy cells and infect the body. A new vaccine is needed

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