Push needed for pandemic planning

Abstract

Three years after the H1N1 influenza pandemic, there is a reluctance to talk about it--even among health officials--as, despite widespread alarm, it was far less devastating than the 1918 Spanish flu. Pandemic fatigue has set in and is difficult to overcome in the current economic crisis. It's vital for the global health community to take in what happened during the 2009 outbreak and learn from says Dr Nahoko Shindo from the World Health Organization's (WHO) Global Influenza Programme. She warns that if this is not done soon, countries will lose momentum and the memory of what happened will fade. We need to fix the things that didn't work so that we can tackle similar threats better in future. Top on her list is the fact that, during the early phase of the 2009 pandemic, some countries were following their national guidance based on an older version of WHO pandemic preparedness guidance while WHO was following the updated version. In addition, she cites the fact that vaccines arrived in many countries after their first waves of the pandemic were over. Health authorities were criticized for calling for large sums to be spent on vaccines and antivirals at the time yet, in retrospect, available data show that antivirals helped to save lives and that vaccines were effective in immunizing populations, Shindo says. [ILLUSTRATION OMITTED] In mobilizing against H1N1 in 2009, WHO dispatched three million oseltamivir treatments to 72 countries in two weeks. Diagnostic kits were sent to 140 countries. Over the course of a year more than 78 million doses of a new vaccine went to 77 countries. The process of revising WHO pandemic preparedness guidance in line with lessons from the 2009 H1N1 pandemic started this year and involves consultation with WHO's 194 Member States. Initially the Organization will report progress on this to countries at the Executive Board meeting in January next year and then at the World Health Assembly in May. Shindo says that the revised guidance is likely to retain the whole-of-society approach involving all sectors, but that two components could be treated differently: the severity of the pandemic and the phases of the pandemic, a system used to determine all aspects of the response. Still, she adds, given the confusion over these elements, the revision process is far from over. These and other elements could change. Yet such guidance on pandemic influenza preparedness is important. Low- and middle-income countries, in particular, rely on it, while many high-income countries tend to make their own plans. An influenza pandemic is a global event and, therefore, when revising WHO guidance it is important to have countries' agreement on the concept of 'phases', 'severity' and other terminology, Shindo says. The challenges for health authorities preparing for the next pandemic are numerous so solid guidance is essential. Why plan for flu outbreaks and spend money to stockpile resources that may never be used? How should health authorities respond to an evolving health threat when national budgets are tight? And, in future, how should they communicate uncertainty in a fast-moving situation that is emotionally and politically charged? People are scared in outbreaks because the source of the fear is invisible, Shindo explains. They get angry too because outbreaks expose the weaknesses of their health systems, putting these systems under immense strain and then people suffer as a result. A WHO study released in 2011, Comparative analysis of national pandemic influenza preparedness plans, shows that more than 100 countries had such plans in 2009. Some plans have since been revised in light of the 2009 experience, but others are left as they were in 2009. And even where countries have plans, many are just on paper, they have never been tested in a desktop exercise, simulation or drill, Shindo says. …