Professor Peter Collignon has examined the swine flu outbreak and discovered a litany of problems with the response to the health emergency.

''Intensive-care units in Australia managed to cope with the large numbers of generally younger influenza patients but had major problems and were worryingly very stretched,'' Professor Collignon said in the Medical Journal of Australia, out today.

''This demonstrated the lack of spare capacity in our hospitals and ICUs a problem most apparent every winter.

''Australia's population mortality rate from swine flu was 0.9 per 100,000. If a more virulent virus with a 1 per cent case-fatality rate infected 30 per cent of the population, our hospitals and ICUs could not cope.''

In Australia, work and school absenteeism during the outbreak was similar to levels reported in winter three years ago.

''The 191 associated deaths were substantially fewer than the 3000 estimated yearly deaths from seasonal influenza in Australia,'' he said.

''Although, there may have been additional influenza-associated deaths that were not diagnosed by laboratory testing.''

Australia was one of the first countries to produce and distribute a vaccine but it was only available at the end of September after the epidemic had ended. ''In the future, it could be worthwhile to consider another approach to vaccination,'' he said.

''Currently, effective vaccines are only available after the horse has bolted. Because of poor matching, seasonal influenza vaccine efficacy varies from 50 per cent to 80 per cent.''