2 The case studies |
9. Influenza, or flu, is caused by a virus that affects
the respiratory tract. "Ordinary" influenza circulates
constantly in humans and tends to peak in the winter months. Pandemic
influenza, on the other hand, results from a new strain of virus
that spreads globally due to lack of human immunity to the new
virus. Influenza pandemics have occurred several times over the
last century, although they are difficult to predict and the virulence
and mortality rate can vary greatly.
10. The most severe infections are caused by influenza
A viruses, such as H5N1 or A/H1N1 (the "H" and "N"
numbers refer to the protein structure of the virus). The "swine
flu" virus (A/H1N1, frequently referred to as H1N1) was a
new strain of H1N1 flu virus. The A/H1N1 virus is far less virulent
than the less-transmissible, but more deadly, H5N1 virus.
11. Fears around the impact of a new influenza pandemic
have focused on the threat of an H5N1 pandemic. H5N1 is an avian
(bird) influenza virus that emerged in 1997 in Hong Kong and re-emerged
in 2003 in a number of countries of South East Asia to become
endemic in a number
of them. As of 13 January 2011, there have been 306 confirmed
deaths due to H5N1, approximately half of them in Indonesia.
It is impossible to predict when the virus might reach a sufficient
level to allow for widespread human-to-human transmission. The
World Health Organisation (WHO) estimates that in the case of
a pandemic caused by H5N1, millions of people could die of the
disease. Since 2005, there have been significant investments by
national governments and the international community to prepare
for an H5N1 pandemic. In the UK, preparedness has involved comprehensive
emergency planning in the NHS, antiviral and H5N1 vaccine stockpiling,
and the provision of sleeping contracts for pandemic strain vaccines
(meaning that manufacturers reserve a certain number of doses
of vaccines they develop).
12. The swine flu story began on 23 April 2009 when
cases of H1N1 virus were confirmed in Mexico and the USA. A few
days later, cases in the UK were confirmed. A timeline of key
events is summarised in Box 1.
Box 1: Swine flu pandemic timeline
|23 April||Cases of H1N1 virus are confirmed in Mexico and the USA
|27 April||The first two UK cases of H1N1 are confirmed in a couple from Scotland
|29 April||Government announces that the stockpile of antivirals will be increased from 33.5 million to 50 million
|1 May||First case of human-to-human transmission in the UK is confirmed
|15 May||Agreements made to secure up to 90 million doses of pre-pandemic vaccine
|11 June||World Health Organisation raises its pandemic alert level to 6, the highest level
|16 July||Chief Medical Officer announces that up to 65,000 people could die from swine flu in a worst case scenario
|13 August||Secretary of State for Health announces the identification of priority groups: pregnant women, front-line health and social care workers, and everyone in at-risk groups aged over six months
|10 September||The four UK health departments release critical care strategies to cope with the expected increases in demand during the second wave of the pandemic
|21 October||Vaccination programme begins: front-line healthcare workers and their patients who fall into at-risk categories
|19 November||Phase two of vaccination programme begins: children over six months and under five years
|18 March||Total UK deaths: 457; 342 in England, 69 in Scotland, 28 in Wales and 18 in Northern Ireland
|1 April ||Antiviral medicines no longer available from national stockpiles
Antiviral collection points in England are closed
The Swine Flu Information Line is terminated
Treatment of people with flu-like symptoms returns to business as usual
13. The virus remained in circulation even though
the pandemic was no longer treated as an emergency. October normally
marks the start of flu season, and in October 2010 the consultation
rate for influenza-like illnesses in England and Walesa
proxy for the level of influenzabegan to rise, peaking
at 124.2 consultations per 100,000 population in early December
2010. By 12 January 2011, 112 fatal cases from across the UK had
been reported to the Health Protection Agency and confirmed to
be associated with influenza infection, out of which 95 were caused
by H1N1. The swine flu
(H1N1) virus was being treated as one of the group of seasonal
flu viruses circulating around the world rather than as a pandemic
(that is, an emergency situation).
(We were interested in the differences in vaccination strategy
and, in January 2011, wrote to the Government to ask why the seasonal
vaccination programme differed from the pandemic. The Government's
response can be found in the written evidence accompanying this
Report and we examine
this matter briefly at paragraph 129.)
14. The swine flu pandemic was the first emergency
where a Scientific Advisory Group for Emergencies (SAGE) was convened
to advise Government. SAGE was a key focus of our inquiry and
is explained in detail in chapter 6. During the swine flu emergency,
a SAGE committee met 22 times between 5 May 2009 and 11 January
15. Iceland is situated on the Mid-Atlantic Ridge,
the boundary between two tectonic plates. The island itself was
formed by volcanic activity and has several active volcanoes.
In April 2010, the Eyjafallajökull volcano erupted, ejecting
significant quantities of ash into the atmosphere. The ash eruption
coincided with meteorological conditions that meant the ash covered
much of Europe. Historically, Icelandic volcanic eruptions producing
ash which is deposited in the UK is nothing unusual.
However, there has not been an eruption affecting the UK for decades,
coinciding with the time period over which aviation became part
of everyday life. The most significant impact of the eruption
in April 2010 was that airspace was closed for a week, causing
huge disruption to aviation, stranding passengers around the world
and costing the UK economy hundreds of millions of pounds. The
key scientific issue was determining the tolerances of aircraft
and their engines to the particular ash particulates present in
16. A timeline of key events is summarised in Box
Box 2: Volcanic ash emergency timeline
|December||Seismic activity detected at Eyjafjallajökull volcano in Iceland
|20 March||Eyjafjallajökull volcano in Iceland first erupts through a side fissure Impacts are largely confined to Iceland
|14 April||A more intense and sustained eruption occurs in the central crater, resulting in ejection of solid matter up to11 km into the atmosphere
|15 April||Many European aviation authorities (including UK) close airspace.
Government Chief Scientific Adviser meets with Cabinet Office
British Geological Survey start advising civil contingencies secretariat
Met Office uses NERC plane for four-hour test flight
|18 April||Government Chief Scientific Adviser meets Prime Minister|
British Airways conducts three-hour test flight in Cardiff
|19 April||British Airways CEO declares blanket restrictions on airspace are unnecessary after engines were found to be unaffected
|20 April||Scottish airspace reopens
|21 April||All UK airports reopen
First SAGE meeting takes place
|3 May||Ash cloud returns; some airports in Scotland and Northern Ireland close
|6 May ||All UK airports (re)open
|16 May||Several airports in northwest England close as ash cloud returns
|17 May||Heathrow and Gatwick close|
Several airports in northwest reopen
|23 May ||Volcanic Ash Advisory Centre at Met Office declares eruption over
17. This was the second time a SAGE was convened.
The SAGE formed to provide scientific advice in this emergency
met four times between 21 April and 24 June 2010.
18. "Space weather" refers to changes in
the space environment near Earth, caused by varying conditions
in the Sun's atmosphere. Table 1 summarises the different types
of space weather and indicates examples of impact.
Table 1: Categories of space weather
||Cause||Examples of potential impacts
|Coronal Mass Ejections (CMEs)
||Plasma ejected violently from outer atmosphere of Sun
||Fluctuations in Earth's magnetic field (geomagnetic storms), driving additional current into power grids, disrupting satellites, GPS and radars
|Solar Energetic Particle (SEP) events
||High energy particles expelled from Sun during solar events like CMEs
||Damage to electronics, computer chips and power systems in spacecraft (possibly at ground level too), raised ground radiation levels
|Solar radio bursts
||Intense bursts of radio noise produced by solar events like CMEs
||Interference with low power wireless radio technologies such as mobile phones, wireless internet and GPS receivers
||Outburst of radiation and energetic particles
||Modest effects at Earth
19. Space weather is an everyday occurrence and resilience is
routinely built into some components of infrastructure such as
satellites. However, more severe events do occur. The Carrington
event in 1859, named after the British astronomer who first witnessed
the solar activity, was (and remains) the most severe space weather
event recorded. The Carrington event was a CME that caused global
disruption to telegraph systems around the world. Even when telegraphers
disconnected the batteries powering the lines, induced electric
currents in the wires still allowed messages to be transmitted.
So wide-ranging was the impact that aurorae (visual effects caused
by geomagnetic disturbances in the atmosphere, normally seen towards
polar regions) were seen in near equatorial regions such as Hawaii.
20. It is widely believed that an event of the same
magnitude today would have a much greater impact due to our increased
reliance on electricity-based technology.
There have been less severe events since 1859. For example,
in 1989, a geomagnetic storm caused by a CME caused Quebec's power
grid to collapse within 90 seconds, affecting several million
people for nine hours.
In 2003, space weather caused an hour-long power outage in Sweden.
The effects of severe space weather are not limited to particular
latitudes; the 2003 event also affected South Africa.
21. Solar activity changes according to a cycle lasting
approximately 11 years. In this period, solar activity increases
during a solar maximum, making space weather events more likely.
However, space weather events do not necessarily obey the solar
cycle; the Carrington event
occurred in the middle of an unexceptional solar cycle.
The next solar maximum (a period of likely increased activity)
is predicted to occur around 2012-13. Given the impending solar
maximum, we were interested in how the Government was assessing
the risks posed by space weather and preparing for a potential
22. The Government publication Cyber Security
Strategy of the United Kingdom, published in June 2009, defines
cyber space as encompassing "all forms of networked, digital
activities; this includes the content of and actions conducted
through digital networks".
Cyber security is usually taken to mean the resilience of these
complex interconnected networks.
23. There are different types of cyber attack, many
of which occur on a daily basis in the UK. Table 2 provides a
Table 2: Types of cyber attack
|Denial of Service (DoS/DDoS)||DoS attacks overload systems with so much traffic that they cannot cope. Distributed denial of service (DDoS) attacks come from many sources simultaneously. The machines creating the attack traffic are usually running "malware" (malicious software) which has been delivered by email or picked up by visiting a website. Users are generally completely unaware that their machines have been compromised.
|Phishing||Forging e-mails to entice users to visit a fake version of a bank website, so that their login details can be stolen
|Spear phishing||E-mails addressed to a single person within an organisation, perhaps forged to appear to come from colleagues. The malware within these e-mails will infect that person's computer with the aim of perpetrating a major financial crime, or stealing commercial secrets.
|Subversion of supply chain||Altering technology supplied to an individual or organisation (for example implanting malicious programs) in order to make network attacks easier or to deliberately leak financial data
|Complex attacks on infrastructure||Much of the "critical national infrastructure" relies upon computers and communications networks. Cyber attackers might interfere with these, perhaps over the Internet from a remote location, and thereby cause widespread disruption.
24. The cyber attacks case study, in contrast to the other three,
described a man-made threat rather than a natural risk. As well
as the different types of attack, the motivations of attackerscriminal,
political or state-sponsoredmust also be considered. As
we began our inquiry, the "Stuxnet" worm had just been
identified to be circulating. It is understood to be the first-known
worm designed to target physical infrastructure such as power
stations, water plants and industrial units, and, in this case,
for the sole purpose of disrupting Iran's uranium enrichment programme.
Subsequent analysis has shown it to be a highly sophisticated
program that can not only spread over the Internet but can also
be carried from machine to machine on portable flash drives, giving
it the ability to infect isolated systems. We were told that it
would have taken six people to create the worm over five months,
with funding to the order of £1 million.
25. The Stuxnet worm provided an actual example of
how organised and structured cyber attacks on critical infrastructure
systems could succeed
and how they could be used in the future to cause emergency situations.
We wanted to find out more about how the Government is assessing
the risks of cyber attacks and preparing for a potential national
5 Endemic means that the infection is sustained in
the population without external inputs. Back
"Cumulative Number of Confirmed Human Cases of Avian Influenza
A/(H5N1) Reported to WHO", World Health Organisation,13
January 2011, www.who.int Back
Cabinet Office, The 2009 Influenza Pandemic: An independent
review of the UK response to the 2009 influenza pandemic,
July 2010, pp 2-5 Back
"Swine flu could kill 65,000 in UK, warns chief medical officer",
The Guardian, 16 July 2009, www.guardian.co.uk Back
Health Protection Agency, HPA Weekly National Influenza Report,
12 January 2011 Back
"October - flu season and HPA flu surveillance begins",
Health Protection Agency press release 2010, 6 October 2010 Back
Ev 164 Back
"Iceland and the British Isles: the volcanic connections",
British Geological Survey, www.bgs.ac.uk Back
Ev 100 [Government Office for Science and Cabinet Office] Back
Ev 124 [Research Councils UK], para 33 Back
Natural Environment Research Council Back
Ev 100 [Government Office for Science and Cabinet Office] Back
"A Super Solar Flare", NASA Science News, 6 May
2008, nasa.science.gov Back
Ev 120 [Royal Aeronautical Society], para 37 Back
Ev 119 [Royal Aeronautical Society], para 36 Back
Ev w37 [UCL Institute for Risk] Back
Cabinet Office, Cyber Security Strategy of the United Kingdom:
Safety, security and resilience in cyber space, June 2009,
p 7 Back
"Israeli Test on Worm Called Crucial in Iran Nuclear Delay",
The New York Times, 15 January 2011, www.nytimes.com Back
Qq 257-58 Back
Q 258 Back