Friday, November 17, 2017

ECDC: Guide To Revising The Influenza Pandemic Preparedness Plan


A decade ago - when H5N1 was looming as a global threat, and before the emergence of the 2009 H1N1 virus - pandemic planning was all the rage.  Every state had, or was working on a plan, and many countries around the world had produced plans, and were actually holding serious preparedness drills.
The military considered pandemic flu a national security issue, and many (mostly large) players in the private sector viewed it as an existential threat, and were developing serious business continuity plans.
While not all of these plans were created equal - some were overly optimistic on pandemic severity, and the local/state/federal government's ability to respond - at least everyone was thinking about how to deal with a severe pandemic.

Two events served to thwart this momentum.  
  • The first being the global economic crisis and downturn in 2008.  While pandemic planning and business continuity are important, it is hard to worry about the creek potentially rising when your building is already on fire. 
  • And the second was the 2009 H1N1 pandemic, which - while far from benign - was considerably less virulent than the three pandemics of the previous century.  The media, which over-hyped the virus in the beginning, then began to dismiss the pandemic as a `non-event' and heavily criticized governments and agencies for over-reacting.
After the 2009 H1N1 pandemic ended, there was a general feeling that `we'd had our pandemic, it wasn't terrible, and it would be decades before the next one hit . . . '.
The problem with that logic being that viruses don't use calendars.  The gap between the 1957 and 1968 pandemics was 11 years, while the inter-pandemic period between the 1775 and 1781-82 outbreaks was only 6 years (cite).
With the rapid growth in novel viruses with pandemic potential over the past 5 years (see Updating the CDC's IRAT Rankings) - including some (H7N9, H5N1, H5N6, MERS) with potential virulence that could exceed the 1918 Spanish Flu - over the past year we've seen  renewed interest in updating pandemic plans around the globe. 

Today it is the ECDC's turn, with their release of a 26-page technical document designed to assist EU member nations as they update and revise their pandemic plans.  Some excerpts follow, but you'll want to download the entire PDF file.
ECDC: Guide To Revising The Influenza Pandemic Preparedness Plan
During the past decade, the 53 Member States of the WHO European Region, 31 of which are part of the European Union/European Economic Area, invested considerably in pandemic preparedness. This came in the wake of global threats posed by (re-)emerging diseases such as avian influenza A(H5N1) and A(H7N9), the SARS outbreak of 2003, and the outbreak of MERS (Middle East respiratory syndrome) which began in 2012. Adequate preparedness is also a national obligation under the International Health Regulations (2005) and the EU Decision on serious cross-border threats to health (No 1082/2013/EU).

The first pandemic since 1968 occurred in 2009, caused by a new strain of influenza A(H1N1) of swine origin. The virus spread rapidly around the globe and caused only mild disease in the majority of cases. However, severe disease and deaths occurred in a significant number of people, mostly in the same groups that are at risk of complications due to seasonal influenza infection, but also in other risk groups and even in previously healthy individuals. It has been estimated that in the first year of the pandemic between 151 000  and 475 000 deaths worldwide were attributable to influenza. Healthcare services, particularly critical care units, were often stretched to their limits, and early recognition and treatment of severe disease could be life-saving.

The 2009 pandemic tested national plans, and in the aftermath many countries and international organisations evaluated their preparedness and response activities. European countries, particularly in the western part of the Region, were generally better prepared for the 2009 pandemic than most countries. But when confronted with a milder pandemic than was expected, even the better prepared countries experienced gaps in their surveillance  and healthcare systems. Their planning assumptions were not flexible enough, they faced difficult communications and logistics issues with respect to pandemic vaccines, and often failed to establish effective communication lines with front-line healthcare responders.

An evaluation performed by the WHO Regional Office for Europe in collaboration with the WHO Collaborating Centre for Pandemic Influenza and Research, University of Nottingham, United Kingdom, showed that pandemic preparedness activities undertaken prior to the 2009 pandemic were useful in the response to the pandemic, and guidance from WHO and ECDC was critical in the preparedness phase. However, a global review of the functioningof the International Health Regulations and the response to the pandemic by both countries and WHO came to the conclusion that the ‘world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency.’ 

The recommendations of this review have been only partially implemented, and the world has since been confronted with the failure to respond rapidly – and on the scale needed – to prevent the largest outbreak of Ebola ever recorded. As a result, the 69th World Health Assembly agreed to reform the WHO emergency response arrangements. It also agreed that the full implementation of the IHR core capacities by all Member States must be accelerated. In 2016, the new WHO Health Emergencies Programme was established (

A future influenza pandemic is inevitable, although it cannot be predicted when it will happen nor how severe it will be. Since the stress on the non-healthcare sectors was limited during the 2009 pandemic, only limited experience has been gained in multisectoral coordination. Business continuity which will be crucial in a more severe pandemic.

Earlier findings from European assessments and exercises show that there are still weaknesses in those areas. Since 2009, only thirteen countries in the WHO European Region have published revised pandemic preparedness plans (as of July 2017). This document therefore takes into account:

  • the need for all countries to review and revise as necessary their pandemic plans based on the lessons learned from the 2009 pandemic and WHO guidance on pandemic influenza risk management
  • (see: influenza_risk_management_update2017/en/);
  • the need for continuous integration of pandemic preparedness with preparedness for other public health emergencies, in line with the International Health Regulations, Decision No. 1082/2013/EU, and in light ofshrinking resources;
  • the need to develop plans for different scenarios of severity with more emphasis on national risk assessment to inform pandemic response; and
  • the need to revise the ‘WHO/Europe and ECDC Joint European Pandemic Preparedness Self-Assessment Indicators’ and develop a planning document that is useful to all Member States.
Description of the guide
Pandemic planning can be divided into 12 key areas. For each key area, the rationale and a list of good practice requirements for effective pandemic preparedness are provided.

For each key area, or requirement under a key area, countries may:

  • add requirements, indicators or outcomes for determining if a key area or requirement has been covered or implemented, or if progress has been made;
  • indicate changes that have been made to their pandemic plans after the 2009 pandemic;
  • provide to the WHO Regional Office for Europe and ECDC examples of good practice which may be shared with other countries; and
  • include questions to be addressed for each key area.
         (Continue . . . .)

Six months ago, in World Bank: World Ill-Prepared For A Pandemic, we saw the latest in a long line of assessments stating that a severe pandemic would test our modern medical system, society, and economy in ways that few can truly comprehend.  
While no amount of planning can fully prepare us for a severe pandemic, every little bit - undertaken by governments, the private sector, and even individuals - can help lessen the impact.
For more on pandemic preparedness, you may wish to revisit a few of these recent blogs.
WHO: Candidate Vaccines For Pandemic Preparedness - Sept 2017
#NatlPrep : Pandemic Planning Considerations

Upcoming Webinar: The Strategic National Stockpile
Are We Prepared to Help Low-Resource Populations Mitigate a Severe Pandemic?