Reflections on the UK's approach to the 2009 swine flu pandemic: conflicts between national government and the local management of the public health response.

The first cases of swine flu in the UK were detected on 27th April 2009. Two weeks later Birmingham became a "hotspot" for the HIN1 pandemic in England. This paper describes the experiences of local public health agencies during the pandemic and the problems encountered when trying to work within a hierarchical and hermetic system of national policy making. We argue that over reliance on the speculative logic of modellers, together with a failure to adapt swiftly the nation's preparedness plans and public health apparatus created in readiness for a serious and fatal disease, led to an institutional void of policy making during the pandemic, where new rules and concepts emerged about what constituted scientifically acceptable and politically legitimate interventions. The imposition of a single national approach to managing the pandemic and a disregard for the role of local authorities seriously impaired the ability of local agencies to respond in a flexible, timely and pragmatic way to the rapidly emerging situation. Future planning for pandemics must recognise that global epidemics are curbed at the local level, and ensure that any response is proportionate, flexible and effective.