A Birmingham health chief has hit out at the Health Protection Agency (HPA) for its “inconsistent and confused” policy of treating people in the swine flu outbreak, which is now the virus hotspot of the UK.

Jacky Chambers, public health director at Heart of Birmingham Primary Care Trust, also criticised the way that the HPA decided to treat children at the centre of the first major outbreak, at Welford School, in Handsworth.

The doctor said decisions over giving children antiviral drugs for preventative means had “varied between the whole school, no school and single classes”.

She wrote in an open letter to the British Medical Journal that in some cases, Tamiflu had been given to “pupils sitting within one metre” of someone with the virus and in others to pupils “listed on the school register as having medical conditions (which include those who wear glasses).”

Dr Chambers also described a ruling to give the medication to patients who did not have the H1N1 virus as “indefensible”, adding that the HPA policy was “ineffective”, not based on any credible evidence and seemed to be politically driven.

She said mass treatment of healthy people with antiviral drugs was an irrational, indefensible and ineffective response and that such policies may promote “bad hygiene practices” because children treated with Tamiflu appeared to have later developed swine flu symptoms and returned to school still unwell.

The public health boss called for early and rapid treatment of high-risk patients and more focus on educating people about how to prevent the virus’s spread.

Dr Chambers said: “The time has come for the public health community to return to some basic principles for managing this pandemic and minimising potential harm.”

Around 200 pupils, teachers and families connected to Welford Primary were diagnosed with swine flu in May, but since then, other schools have been shut down by the virus and the number of people affected in the West Midlands has soared to 2,582, the highest amount in any region of the UK.

HPA officials ruled last week that the outbreak was too large to be contained and that there would be mass provision of Tamiflu to people showing symptoms without any swab tests.

Four people in the UK have died after contracting swine flu and all had underlying health problems.

In June, six-year-old Birmingham schoolgirl Sameerah Ahmad became the youngest UK victim to date.

Sameerah, from Edgbaston, who was born with a rare life-threatening disease, died at Birmingham’s Children’s Hospital on June 25 after contracting swine flu, although it is unclear if it contributed to her death.