The swine flu pandemic, which has cost the nation more than £1billion, was declared over yesterday.
With the number of new cases plummeting, health chiefs announced the 24-hour flu helpline will close down next Thursday.
Critics said the seven-month outbreak had been mishandled by ministers and health officials, who had made a flawed assessment of the threat.
Swine flu has killed 411 Britons, with 124 more still in hospital - yet the 5,000 cases a week are far below the average for seasonal flu.
Chief Medical Officer Sir Liam Donaldson had warned the pandemic might claim 65,000 lives and Health Secretary Andy Burnham said 100,000 could be struck down with the disease every day.
Total cases stand at 800,000 so far. Around the world, an estimated 14,000 deaths have been reported - a fraction of the number dying each year from ordinary flu.
The Government is thought to have ordered tens of millions of doses of vaccine.
So far only 4.25million have been administered to priority groups in England.
Sir Liam is still urging the vulnerable to have the jabs.
He insists the vast cost of tackling the pandemic has been justified, from the £1billion cost of vaccines and antivirals to the £10.4million spent on publicity.
The National Pandemic Flu Service, which cost a further £13.5million to run, allowed patients to bypass their GP and collect antiviral drugs after a telephone assessment.
Launched in July last year and employing 1,500 call centre staff, it led to 1.1million courses of antivirals being administered to patients - many of whom never had swine flu, according to research.
Anyone suspecting they have swine flu can still get antiviral drugs from their GP, while those in at-risk groups, including children under five, can receive a vaccination.
Sir Liam said: 'When the virus returns I would very much like to see young children already protected.
'From now on, most deaths from the pandemic flu virus should be regarded as potentially preventable.'
A spokesman for the Department of Health said: 'Our priority remains to vaccinate those most at risk from swine flu, as people are still in hospital from the virus.
'This is the first time we have had a vaccine to protect people while a pandemic virus has been circulating, so it has undoubtedly helped us save lives.'
However, the bumper revenues being reported by vaccine manufacturers - £4billion in windfall profits is predicted - have led to claims that the World Health Organisation fell under the influence of the industry when it declared a pandemic last June.
Matthew Elliott of the Taxpayers' Alliance said: 'The Government's reaction to swine flu has proved to be excessive and poorly managed.
'It beggars belief that they could have signed so many massive contracts with such a flawed assessment of the threat.'
But John Oxford, professor of virology at Bart's and The London Hospital, defended the flu strategy.
'Swine flu is behaving in a classic Darwinian fashion - the survival of the fittest - and has already displaced 98 per cent of the other flu viruses,' he said.
'My worry is that when it gets into the elderly next year, we could see many more deaths.
'We should be proud that Britain responded in a way that prevented many more cases and deaths.'
Over at last: The National Pandemic Flu Service will be stood down
1. High temperature, tiredness and lowered immunity
2. Headache, runny nose and sneezing
3. Sore throat
4. Shortness of breath
5. Loss of appetite, vomiting and diarrhoea
6. Aching muscles, limb and joint pain
Source: NHS
Dr Margaret Chan says avian flu is more of a problem than swine flu The head of the World Health Organisation (WHO) has warned the global swine flu pandemic is not yet over and the virus could still mutate.
Dr Margaret Chan said it was important to "guard against complacency" despite signs the disease had peaked in North America and parts of Europe.
She said the virus was still active in countries including India and Egypt.
More than 11,500 people are believed to have died in more than 200 countries and territories because of swine flu.
However Dr Chan said it would take at least two years before a true death toll could be established.
The WHO's director general said the US, Canada and the UK were among those countries where the worst of the swine flu outbreak had appeared to have passed.
Danger
But she added: "It is too premature and too early for us to say we have come to an end of the pandemic influenza worldwide."
She said experts needed to continue monitoring the pandemic for another six to 12 months as it could mutate into a more dangerous strain.
"We will watch this virus with eagle's eyes," she said.
Dr Chan said it was fortunate the pandemic had been milder than expected.
"The fact that the long overdue influenza pandemic is so moderate in its impact is probably the best health news in a decade," she said.
Millions of people are believed to have recovered after contracting the virus and displaying few symptoms.
She said the demand for swine flu vaccinations in some European countries had been lower than expected and WHO was investigating whether superfluous vaccines could be sent to developing countries.
Dr Chan said drug makers and countries promised to donate nearly 190 million vaccine doses to WHO, with the first doses of the donated vaccines to be distributed in Azerbaijan, Mongolia and Afghanistan next month.
However she admitted she had not yet had a vaccine but said she would have it soon.
She said that although countries are now better prepared to cope with a global disease outbreak, people still had to be aware of the dangers of bird flu (H5N1).
She said this was more toxic and deadly than swine flu and that many countries remained ill-prepared for mass outbreaks of this virus.
"The world is not ready for a pandemic to be caused by H5N1," she said.
The head of the World Health Organization (WHO) warned on Tuesday that the A/H1N1 pandemic influenza is not over yet and the world needs to continue monitoring the evolution of the disease in 2010.
"It's too premature, too early for us to say we have come to an end of the pandemic influenza worldwide," Dr Margaret Chan told a news conference at the WHO headquarters in Geneva.
It's true that many countries in the northern hemisphere have passed the peak of the pandemic, notably in the United States, Canada and parts of Europe, but on the other hand there are still intensive influenza activities in countries like Egypt and India, Chan said.
The current pandemic caused by the H1N1 flu virus has been described as "moderate", but scientists cannot rule out the possibility that the virus could mutate and become more dangerous given the fact that flu virus are highly unpredictable.
So "it would be prudent and appropriate for the WHO together with our members’ states to continue to monitor the evolution of this pandemic for the next six to 12 months," Chan said.
So far nearly 12,000 people worldwide have been killed by the A/H1N1 influenza since the disease first emerged in April, according to an update released by the WHO last week.
But Chan noted that was a laboratory confirmed number, and it actually underestimates the real number of deaths caused by the pandemic.
"Many countries don't have the capacity for surveillance, for diagnosis and for confirmation. So there would be some deaths in some countries that are not reported," Chan said.
According to the WHO chief, the handling of the A/H1N1 pandemic has shown that the world is much better prepared now than five years ago to deal with such diseases. But there are still many gaps in the health systems in many countries.
She warned that the world is not yet ready for dealing with a pandemic caused by the H5N1 bird flu virus, which is "much more toxic and deadly" than the H1N1 virus.
"I just wish that the world does not have to deal with a pandemic ignited by a much more toxic and deadly virus, the avian flu virus H5N1," Chan said.
Vaccine are made from old technology as lack of funding earlier hamper development.Vaccines are sold cheap but produced in millions. Current tecnology are old depends on injecting virus into egg. Latest technology range from using kidney cells of dogs,monkey , e coli cells and even the virus dna .Read more below.
After a lethal bird flu virus emerged in Asia, U.S. officials launched an intense effort to build new defenses against a pandemic, including replacing an antiquated vaccine system, which depends on millions of chicken eggs.
But six years later, as Americans from Washington to California line up to get inoculated against the swine flu, the slow progress toward developing better ways to make a vaccine has become glaringly obvious.
This lag and the shortage of H1N1 vaccine have focused attention on the status of government efforts to develop state-of-the-art techniques to make flu and other vaccines, including those needed to protect against bioterrorism, and the nation's dependence on a process that is notoriously slow and unreliable.
Several new technologies are showing promise. Spurred by $487 million in federal funding, a sprawling new vaccine factory is opening in North Carolina Tuesday that will produce shots using dog cells instead of chicken eggs. A Connecticut biotech company has also applied to sell a vaccine employing a radically different approach involving a genetically engineered virus infecting insect cells -- a strategy a Rockville firm is testing to inoculate people against the swine flu in Mexico. Dozens of other high-tech approaches are also moving through the pipeline.
While several companies are trying to ready their new techniques in case the H1N1 pandemic worsens, most of these remain years away from contributing significantly to the world's capacity to respond to a deadly new pathogen.
"If this pandemic had come next year, we might have had some of these vaccines licensed and we would have been able to use them -- our investments might have borne fruit," said Robin Robinson, of the Health and Human Services Department. "But unfortunately they didn't help us this year. Others still have a ways to go."
The most immediate solution to the vaccine shortage would be adjuvants -- compounds that boost the immune response, allowing limited stock to be stretched into more doses. H1N1 vaccine with adjuvants is available in Europe, Asia, the Middle East, Canada and Mexico. The United States has decided against using adjuvants because the Food and Drug Administration has not fully reviewed them. Officials worried that a new product would make people even more nervous about the inoculation.
'Old fragile unpredictable technology'
For decades, flu vaccine has been produced by identifying which strains of flu virus were most likely to be circulating, tinkering with microbes in the laboratory to create "seed" virus, injecting that virus through the fragile shells of newly fertilized chicken eggs and waiting several days for the microbes to grow.
The process takes six to nine months and is highly unpredictable. The H1N1 seed virus initially grew inside the eggs at only about a third to a quarter of the expected rate, accounting for most of the lag in production.
"It's a time-honored but nonetheless fragile technology," said Anthony S. Fauci of the National Institute of Allergy and Infectious Diseases.
In addition, the process relies on having access to millions of eggs -- each egg typically produces one to three doses of vaccine. If the next pandemic is caused by a virus that kills birds, like the H5N1 avian flu virus that emerged in 1997 in Hong Kong and reemerged in 2003, any process dependent on chickens would be vulnerable.
Pharmaceutical companies, however, have had little incentive to invest in new technologies. Flu vaccine is relatively cheap and the market is capricious -- millions of doses often end up being discarded because of tepid demand. The long, expensive process of getting new vaccines approved creates another disincentive.
"We're behind the curve in embracing new technology because we're exceedingly cautious," said Scott Gottlieb, a former deputy FDA commissioner now at the American Enterprise Institute.
But in 2006 the federal government awarded $1.3 billion to six companies to develop flu vaccines using cells to grow the virus instead of eggs, although three recipients have dropped out or stalled.
"You just take the cells out of the freezer right away and ramp up production," said Andrin Oswald of Novartis. The Swiss company already makes flu vaccine using dog kidney cells for Europe and Japan at a factory in Germany; on Tuesday, it will cut the ribbon on a massive new facility in Holly Springs, N.C., that will eventually be able to produce 150 million doses of vaccine in six months for the United States. But the factory will not be ready to start making vaccine until 2011 at the earliest.
Baxter International won approval last month to sell an H1N1 vaccine in Europe that uses a decades-old line of African green monkey kidney cells, and it is working on a vaccine for the United States.
But the Deerfield, Ill., company has not said yet whether it will build a U.S. factory, which the federal government required in the contracts. Britain's GlaxoSmithKline spent $300 million on a facility in Marietta, Pa., but it remains in the earliest stages of development.
Sanofi Pasteur shelved its efforts after studies indicated the cell-based vaccine it was developing was not superior to the traditional vaccine it makes at its new $200 million facility in Swiftwater, Pa. Solvay dropped out after deciding to expand its production capacity in The Netherlands instead of building a U.S. factory. MedImmune of Gaithersburg put its program on hold after the FDA demanded additional studies that the company argued were unnecessary.
Even if cell-based vaccines eventually make it to the U.S. market, no one sees them as a long-term solution. They may shave weeks off the production time, which this year would have made a significant difference. But they still require lengthy production schedules for purification and testing.
Latest Modern approaches
More promising is a new generation of vaccines that do not depend on growing the virus. Instead, they exploit the latest in genetic technologies to use the viral DNA to quickly churn out key proteins to elicit a protective immune response.
Protein Sciences of Meriden, Conn., has applied to the FDA for approval to sell a vaccine made by genetically engineering flu genes into a worm virus, which then infects cells from caterpillar ovaries to produce the necessary proteins to make vaccine.
"The other approaches are evolutionary. Ours is revolutionary," said Daniel D. Adams, the company's chief executive.
After being turned down for government funding for years, the company last spring won a five-year, $147 million contract from HHS to develop the vaccine. An FDA advisory panel Thursday voted that the vaccine appeared to be effective in adults but more studies were needed, including to make sure it worked in children and was safe.
Novavax of Rockville is testing a similar vaccine on 4,000 people in Mexico in the hopes of getting an H1N1 vaccine approved by Mexican regulators.
VaxInnate of Cranbury, N.J., for example, produced an experimental H1N1 vaccine using genetically engineered E.coli bacteria, and Vical of San Diego just won a $1.25 million contract from the Navy to develop an H1N1 vaccine that involves injecting DNA sequences from the virus directly into people.
But these remain probably years away from producing a marketable vaccine, and given the skittishness of many Americans about the traditional shots and even the newer nasal spray, it remains unclear how many would feel comfortable with vaccines produced using insect cells, bacteria, animal kidney cells or other new approaches.
"It will be a uphill road in convincing people that it's safe and effective and represents an advance," said Gregory Poland, a flu vaccine expert at the Mayo Clinic.
Many experts say that while these approaches potentially offer a much quicker and easier way to produce large amounts of vaccine, they do not represent the ultimate solution.
That goal, they say, would be to produce a "universal vaccine," which would not have to be altered each year to match whatever strain of the virus is circulating.
"That would be the home run of flu vaccines," said John Treanor, a University of Rochester flu vaccine expert.
Other experts said the federal government should also take steps to guarantee vaccine makers that it would buy any excess vaccine and subsidize excess vaccine production capacity.
"Imagine if this was 1918-like influenza and lots more people were dying and we had no vaccine. We would see the world coming to a screeching halt," said Michael T. Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. "This should be a wake-up call that we need to have an intervention that allows us to stay in control. Right now the virus is in charge."
Health and Human Services Secretary Kathleen Sebelius promised that, despite delays, there would eventually be enough swine flu vaccine for all Americans. “The vaccine is coming out the door as fast as it comes off the production line,” she said. The secretary appeared on three morning television news programs to deliver the assurance. Slow growth of the vaccine in eggs and different production problems at the five companies making the vaccine mean the country will have only about 30 million doses by the end of this month.
Ontario has become the first province to delay seasonal influenza vaccines to most residents because of the threat posed by swine flu.
The decision, announced Thursday, comes as public health officials across the country are reconsidering their immunization plans in light of unpublished Canadian studies that suggest earlier seasonal flu shots raise the risk of contracting the pandemic H1N1 flu virus.
“Is it typical that we adjust our programs?” said Arlene King, Ontario's chief medical officer of health. “No, it isn't typical, but we are not dealing with a typical flu season this year.”
Ontario's program is based on a calculation that swine flu will sicken more people than seasonal influenza this fall and winter. Despite hopes for a pan-Canadian vaccination strategy, the province's approach is different than those in other provinces.
Parents panicked over whether their sick children might have swine flu are unnecessarily clogging Houston's emergency rooms, and supplies of the most popular flu symptom-fighting drug aren't meeting the region's demand, health officials said Thursday.
Waiting rooms at both children's hospitals in the Texas Medical Center are packed at levels typically seen in January, the peak of traditional flu season, officials said. Texas Children's Hospital opened an outdoor assessment center under a tent Wednesday afternoon to handle a 40 percent increase in patients. Children's Memorial Hermann Hospital has had an equivalent increase in flu patients, spokeswoman Jennifer Hart said, and there's been a significant uptick at Memorial Hermann's community hospitals.
Clinicians say the scene is similar to what happened in the spring, when the H1N1, also known as swine flu, broke out in Mexico and was transmitted across the globe. Children and young adults are especially at risk, having the highest rates of hospitalization and deaths.
Meanwhile, federal health officials on Thursday said the first swine flu vaccinations should be available in the coming weeks, though there won't initially be enough for everyone to be treated.
“We are likely to have some initial doses available the first full week in October,” said U.S. Health and Human Services Secretary Kathleen Sebelius.
Sebelius said 6 million to 7 million doses will be available in that initial batch. Priority will be given to those considered most vulnerable, including children, pregnant women and health workers.
By mid-October, roughly 40 million doses will be distributed, officials said. And every week thereafter, 10 million to 20 million doses will roll out across America.
The federal government has purchased 250 million vaccines, “enough for everyone in America who wants a vaccine,” Sebelius said.
