Giving local authorities responsibility for implementing pandemic flu plans may not be the best policy, says a senior public health doctor in this week's BMJ.
He warns that, in the event of a pandemic, much of the planning could be redundant.
In the worse case scenario, a pandemic of influenza in the United Kingdom would cause 750,000 excess deaths and cost around £170bn in the longer term, writes Dr Richard Coker of the London School of Hygiene and Tropical Medicine.
In March, a new draft plan for pandemic flu was published, setting out the government's strategic approach to limit the domestic spread of a pandemic and minimise harms to health, the economy, and society.
It deals with several previously neglected areas, such as transport and international policy, education and social mixing, drug interventions, and communications. It also makes clear the primary responsibility for planning and responding to any major emergency rests with local organisations.
But the author questions whether timely and effective implementation in a time of crisis can be achieved under a devolved system and whether the documents offer enough guidance for local planners on issues such as how to allocate scarce resources.
Severe acute respiratory syndrome (SARS) taught us that "there should be clarity established beforehand, as to what decisions are taken at what level and by whom during an epidemic," he writes. Government guidance also states that "all organisations and individuals that might have a role to play in emergency response and recovery should be properly prepared and be clear about their roles and responsibilities."
Yet concern persists at local level that current plans for pandemic flu in the UK do not take account of what we have learnt from the experience with SARs.
Ultimately, it will be a remarkable achievement if devolved-operational authority is successful, he says. History suggests that the political imperative in a national (indeed global) crisis will be to centralise strategic and operational authority. If this happens then much of the planning could be redundant and an alternative approach might be needed.