Malta's health authorities are still targeting the beginning of next year to start administering swine flu jabs even as the World Health Organisation changes tack about the safety of earlier vaccines.

"We feel that we still need to see more evidence about the safety of the vaccines that will be available in October," director general of health Ray Busuttil told The Times.

WHO flu chief last week Keiji Fukuda has warned about the potential dangers of vaccines that have not undergone mass testing but last week the organisation defended the safety of fast-tracked jabs.

A press release published on the WHO website reassured the public that the regulatory procedures to license pandemic vaccines, including those to expedite regulatory approval, were "rigorous and do not compromise safety or quality controls".

But this jars with what Dr Fukuda had warned just a week before, when in an interview with the Associated Press he said there could be no question about whether the vaccine was safe or not as a number of European governments planned to fast-track the testing of vaccines against the virus causing a global pandemic.

"One of the things that cannot be compromised is the safety of vaccines," he had said.

Flu vaccines are normally tested on hundreds of people for several weeks or even months to ensure that the immune system provides enough antibodies to fight the infection and to identify any side effects.

But the European Medicines Agency is allowing companies to skip mass testing before giving its approval.

The fast-tracked vaccines are likely to be available in October, just months before jabs which have undergone more rigorous testing are in hand.

Earlier this month the local health authorities said they had decided not to compromise vaccine safety and preferred to wait for the fully-tested jabs, although they were keeping all their options open. The decision was endorsed by the Cabinet.

Despite the most recent WHO statement, the government is sticking with this decision, although the authorities will be keeping tabs on what other countries are doing.

"You don't change such a decision overnight," Dr Busuttil said when asked whether plans had changed following the WHO's statement.

Although the chances of complications from vaccines are minimal, the government wants to play safe, even because the pandemic virus is mild and the vast majority of people are recovering after a few days without complications.

Close to 200 people have been confirmed with influenza H1N1 in Malta. Although some were treated in hospital, mostly because of underlying health conditions, the majority recovered at home.

During a press conference earlier this month, the authorities explained that while pharmaceutical companies said they were taking an educated risk when skipping mass testing, governments which opted to go for the vaccines in question were being asked to assume responsibility for any side effects.

While the UK, Greece, France and Sweden are planning to go for early vaccination, the US is being more cautious following the 1976 health disaster when hundreds of people vaccinated for another form of swine flu developed the paralysing disorder Guillain-Barre syndrome, with more than 30 dying.

How it all started

When Charmaine Gauci and Tanya Melillo answered their mobile phones late on July 1, they were told to sit down.

It was only then that the two public health doctors were given the news - after weeks in the clear, Malta had its first cases of swine flu.

The patients were two 26-year-old rugby players who had just returned from Spain with their team. They had been swabbed the day before and the positive results were just in.

Although it was 10 p.m., Dr Gauci, the director of the Health Promotion and Disease Prevention Department, and Dr Melillo, who heads the department's Infectious Disease Prevention and Control Unit, started calling the other 20-odd members of the group.

"Since these were the first cases, the priority was to contain the virus and we wanted to identify who else could have contracted H1N1," Dr Melillo said.

One of the rugby players thought someone was cracking a joke on him. "Ha ha, this is candid radio," he laughed.

Only it was not. By the end of that day another two of the group had been confirmed to have swine flu. By the end of that week, the number of confirmed cases had gone up to 19.

As the news broke out just after 9 a.m. the next day, the floodgates opened on the pandemic helpline. "In just one hour, I had 55 missed calls," Dr Gauci said.

Many were enquiring what to do, whether they should still go abroad, and asking about the symptoms.

Even doctors were ringing to ask for advice on how to tackle patients showing flu-like symptoms. "I used to carry three phones - my own, one for the public helpline and another for the doctors' helpline," Dr Melillo laughs.

In the department's office in Msida the workload shot up suddenly. The team of five doctors had their hands full informing patients who were confirmed to be suffering from swine flu and giving the news to those who tested negative. "Those who tested negative would heave a great sigh of relief," Dr Melillo said.

The contacts of positive cases had to be tracked down and swabbed while patients were being followed to ensure there were no hitches in their recovery.

Then there was the paper work, inputting each case into a database and mapping their recovery.

"For the first week, we were working around the clock," the two doctors agree.

Then, a week after the first cases were confirmed, the authorities decided to stop their contact tracing and the policy was to only swab vulnerable people.

However, a sentinel surveillance was set up, with some 20 people who did not fall in the vulnerable categories swabbed each day to check who was most at risk. Children and young adults are mostly affected by swine flu, while few elderly people, who are at the highest risk of complications, have fallen ill.

"It has made a difference. We would have expected more hospitalisations had elderly people been affected, Dr Melillo said.

She believes that the flu will start spreading further once school starts in a few weeks' time, but the full extent of the spread might never be known since not everyone is being swabbed.