Australia's pandemic 'Protect' strategy: the tension between prevention and patient management.

Recent experience during Australia's initial public health response to the swine influenza pandemic provides valuable lessons for the future. An intense containment effort lasting 7 weeks was unable to prevent local community transmission in some areas of Australia; however, despite the mobility of many people living in rural and remote parts of the country, much of the outback was unaffected. By the end of the Containment Phase, most parts of rural New South Wales only recorded low rates of confirmed H1N109 infection. As Australians living in rural areas often have poorer access to health services than their urban counterparts, they are likely to be more affected by an extended emergency, even one as moderate as the present H1N109 swine influenza pandemic. There may have been benefits in extending containment measures in these less affected areas and in communities where large numbers of vulnerable people such as Indigenous Australians reside. Containment is worthwhile in limiting the spread of disease in specific situations but is unlikely to change the course of a pandemic unless it can be sustained until a large proportion of the population is vaccinated. Strenuous containment efforts should certainly be applied in outbreaks of severe disease, particularly those caused by novel infectious agents with a low reproductive rate (R0). Should advances in vaccine manufacture reduce the time taken to produce a new vaccine, then increased effort to extend containment will be even more worthwhile.