Flu Pandemic Preparedness Planning Paying Off
Last week, experts from 24 countries and territories in the WHO European Region met to discuss the key issues for responding to pandemic (H1N1) 2009 during the coming months. Building on existing national plans, countries are working to mitigate the pandemic's impact by reducing morbidity and mortality, as well as the burden on health care systems and society.
Preparedness activities in recent years helped to ensure that measures were quickly put in place during the first stages of the pandemic. At present, it is classified as of moderate severity. Countries are revising their strategies in accordance with this risk assessment and in preparation for the autumn, when further spread of the virus and an increase in the number of cases is expected.
Mitigation, not containment
One of the main planning challenges identified by the experts is how countries can make best use of the limited resources available, such as intensive care units in hospitals, antiviral medicines, antibiotics and pandemic vaccines. In light of this, they highlighted the importance of focusing on mitigation – reducing the pandemic's impact – rather than attempting to contain or slow its spread. Current experience suggests that passenger screening and border controls, for example, are labour intensive and do not prevent introduction of the virus in a country.
In addition, the meeting participants recognized the benefits of combining several mitigation strategies: providing medical interventions, training health care workers and encouraging simple public health measures, such as washing hands and avoiding close contact with sick people.
Treating severe disease
Most people with pandemic (H1N1) 2009 influenza are expected to experience mild symptoms. Nevertheless, as case numbers are expected to increase in the coming months, a corresponding increase in the small percentage of severe cases is likely. This will place additional strain on intensive care units in hospitals. The experts at the meeting said that it was essential to train health care workers to recognize people with severe disease, and those at risk of it, and to manage these cases appropriately. Similarly, they emphasized that any increase in capacity for intensive care units must include not only equipment but also trained staff and maintenance services.
Maintaining surveillance capacity
The participants thanked WHO for its work in collating and sharing surveillance findings in countries, and requested that surveillance capacity be maintained. Continuous surveillance is essential to monitor further spread of the pandemic (H1N1) 2009 virus and monitor the burden of disease.
The discussion of surveillance included the core data that are needed as a basis to report on the monitoring indicators outlined in "Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance". In particular, the participants focused on the value of sentinel surveillance to monitor changes in the virus and the severity of disease, and the progression of the pandemic. Laboratories should continue to share viruses with WHO to inform vaccine strain selection and detect any emergence of antiviral resistance.
For the countries that have agreements with manufacturers to purchase pandemic vaccine, production limitations mean that delivery will take place over many months. It is crucial to start planning now for vaccine procurement and deployment, including pharmacovigiliance. Appropriate communication to the public is important to ensure that people understand the priorities set for the distribution of the limited doses of vaccine, which will be the reality in all countries.
WHO will assist countries that have not purchased pandemic vaccine by providing information on manufacturers and identifying potential mechanisms to secure vaccine availability.
Need for flexible plans
Finally, as the situation is constantly evolving and more is learned about the virus and the disease, the participants agreed that pandemic plans must remain flexible.