Statistics from Altmetric.com
EARLIER this year, Exercise Hawthorn, a simulation exercise planned for April 5 to 6 to test defra's contingency plans for an outbreak of avian influenza, had to be stopped after the first day when it turned out that the plans would be tested for real. Preliminary tests had found highly pathogenic avian influenza virus in a sample from a swan found dead in the harbour at Cellardyke on the Scottish coast, and the uk's Chief Veterinary Officer, Dr Debby Reynolds, decided that the simulation should be brought to an end so that all available resources could be brought to bear on the real situation (VR, April 15, 2006, vol 158, p 494). The Cellardyke incident in itself provided a test of defra's contingency plans, as did a subsequent disease outbreak involving low pathogenic avian influenza in Norfolk. Despite being stopped prematurely, Exercise Hawthorn also provided useful information. An analysis of what was learned* has just been published on defra's website. Like an earlier report into last year's outbreak of Newcastle disease, it is admirably frank in its analysis and, as a result, makes fascinating reading.
defra has devoted considerable effort to contingency planning since the foot-and-mouth disease (fmd) outbreak of 2001, and the fact that such a large-scale simulation exercise was conducted at all is a measure of how much things have improved. The two-day exercise planned for April represented the culmination of various earlier exercises and was designed to test the then current contingency plans for an outbreak of avian influenza and to explore how well they might work in practice.
The exercise was based around a hypothetical outbreak involving h5n1 virus in a high-density outdoor, free-range production unit in Norfolk during March, in the middle of the annual human flu cycle, with spread to locations in south Wales and North Yorkshire on days 3 and 4 of the outbreak. It had been agreed beforehand that there would be no direct Scottish involvement in the exercise scenario so it was, perhaps, a little ironic that, halfway through, all eyes should suddenly turn north. However, the important thing about contingency plans is that they need to be flexible — and one of defra's conclusions from the way things worked out was that the plans proved robust and effective when presented with a real emergency situation. ‘The overriding conclusion that can be drawn from this exercise is that defra and the State Veterinary Service would have coped well had there been a real-life avian influenza outbreak. This was demonstrated by the rapid and effective transition from an exercise environment to dealing with the real avian influenza incident in Cellardyke and reaffirmed by the subsequent outbreak of low pathogenic avian influenza in Norfolk later that same month.’
This is not to say that problems were not encountered during the exercise, and, indeed, the report identifies several areas where things could be improved. Some of these may sound familiar to those who were involved in, or read the reports on, the 2001 fmd outbreak, who might be forgiven for suffering a sense of déjà vu. They also emerged as issues during Exercise Hornbeam — a simulation exercise conducted in 2004 to test contingency planning for fmd — and during last year's outbreak of Newcastle disease. defra continues to develop, test and refine its contingency plans, and this is to be applauded. However, it seems that, for all the effort that is being devoted to this area, some fundamental issues have still to be resolved.
A particular aim of the exercise was to examine liaison between the many operational partners that would be involved in dealing with an avian influenza outbreak, including defra, the State Veterinary Service, the Department of Health, the Health Protection Agency, the Health and Safety Executive, the Civil Contingencies Secretariat, the Department for Communities and Local Government Regional Resilience Team, and the devolved administrations of Scotland and Wales, as well as various stakeholders. Pulling all this together is no mean task and, not surprisingly, communication, both internally and externally, was identified as a key area of concern. Roles and responsibilities were not always clear, and concern was also expressed about the resources and facilities at Local Disease Control Centres. Cross-border issues arose during the exercise, as did issues concerning finance and procurement. The report gives specific examples and notes that, in broad terms, the exercise ‘highlighted some key areas for improvement, including, amongst others, more effective communications, both internally and with operational partners, as well as a strengthening of instructions to facilitate the operational response’.
It is in the nature of such analyses to focus on what went wrong rather than what went right, and the point is made in the report that some of the problems have since been resolved. It also notes that, ‘In many respects, Hawthorn and real-life events have confirmed that the disease control policies, procedures and plans we have in place are robust enough to effectively control an outbreak of avian flu.’ There is no doubt that defra has worked hard to improve its readiness for disease outbreaks over the past five years; a recent example of this is the targeted surveillance strategy for avian influenza, details of which were posted on its website last week (see p 400 of this issue). It is also right that it should constantly re-examine its procedures. However, it remains worrying that in exercises and disease outbreaks, the same kinds of problems recur.