Thursday, August 08, 2019

WHO: Survey Of Pandemic Preparedness In Member States


Five months ago the World Health Organization released a new global influenza strategy for the decade ahead (2019-2030), with the the stated goals of preventing seasonal influenza, controlling the zoonotic spread of influenza to humans, and preparing for the next influenza pandemic.

And over the past couple of years we've seen a renewed push for global pandemic preparedness, including:
CDC: 2018 Interim Guidance On Allocating & Targeting Pandemic Influenza Vaccine
WHO: Global EOC Pandemic Flu Exercise (GEOCX)
CDC/HHS Community Pandemic Mitigation Plan - 2017
ECDC: Guide To Revising The Influenza Pandemic Preparedness Plan

But the reality is, the world is far from ready to deal with a severe pandemic, as many countries have put pandemic planning on the back burner; gambling that the next pandemic will not occur anytime soon (or at least not on their watch)
In an attempt to gauge the world's pandemic readiness, in 2018 the World Health Organization sent out a 2 part questionnaire to 194 member states, and the results were published in June 2019.
Sadly, only just over half (n=104, or 54%) of member states responded. And of those, just 92 stated they had a national pandemic plan. Nearly half (48%) of those plans were created prior to the 2009 pandemic, and have not been updated since. 
It gets worse, as only 40% of the responding countries have tested their pandemic preparedness plans - through simulated exercises - in the past 5 years. 
As we've discussed before, having a plan is a good start, but it is far from making a nation prepared. Plans make assumptions, both about the severity or impact of a pandemic, and their country's ability to respond. If the assumptions are off, the plan will surely fail under the pressure of a real event. 
More than half of the countries reporting that they have a plan have not made them publicly available. 
You can (and should) read the full 54-page report at this link, but you'll find the executive summary below.  When you return, I'll have a postscript. 
Executive Summary
Influenza pandemics are unpredictable but reoccurring events that can have serious consequences for human health and socio-economic well-being worldwide. Advanced planning and preparedness are critical to mitigate the risk and impact of an influenza pandemic.

It has been 10 years since the most recent influenza pandemic which occurred in 2009. Many lessons were learned and good practices in pandemic preparedness were identified from the response to the pandemic. Although progress has been made among Member States in pandemic preparedness since then, many countries still lack important preparedness capacities or have not updated their pandemic influenza preparedness plans.
In late 2018, the WHO Global Influenza Programme consulted its Member States through a survey to better understand the current level of pandemic preparedness among Member States and to identify the capacity areas in which WHO and its partners should focus their technical assistance in the coming years.

The survey was conducted through a username and password protected secure online WHO platform, where Member States were asked to complete a questionnaire. The questionnaire included 55 questions and structured in two parts with Part 2 divided into five sub-sections each representing a key capacity area in pandemic preparedness and response outlined in WHO pandemic preparedness checklist:       

  1. Status of national pandemic influenza preparedness plans
  2. Key capacities in pandemic preparedness and response
  • Preparing for an emergency (planning, coordination and resources)
  • Surveillance (laboratory, epidemiology or event), investigation and assessment (risk and severity)
  • Health services and clinical management
  • Preventing illness in the community (pharmaceutical and nonpharmaceutical interventions)
  • Maintaining essential services and recovery
A scoring system was adapted to produce quantifiable points for each capacity area. The outcomes were analysed by WHO region and income status.
Completed survey questionnaires were received from 104 of 194 (54%) WHO Member States of all WHO regions and income status (table 1 and 2). While globally 92 of 104 (88%) countries indicate they have a national pandemic influenza preparedness plan, 44 of those (48%) were developed before the 2009 influenza pandemic and have not been updated since then.
More than half of national pandemic influenza preparedness plans (50, 54%) are not publicly available. However, countries are very conscious of the need for updating their plans. Globally, 91 of 104 (88%) countries intend to develop or update an existing pandemic influenza preparedness plan within the next one to two years.
Only 42 of 104 (40%) countries tested their national pandemic influenza preparedness plans through simulation exercises in the past five years. More than half of the countries were either not aware or aware but not yet consulted the WHO pandemic influenza preparedness guidance and tools outlining planning strategies, essential capacities, and steps. 1, 2, 3

The global average score of all capacity areas in the survey was 29.4 out of 46 total possible points (63.9%). The average scores for High Income Countries, Upper-middle Income Countries, Lower-middle Income Countries, and Low Income Countries are 34.5 (75.0%), 30.6 (66.6%), 27.2 (59.0%), and 17.7 (38.5%), respectively.
The ranking order of global average scores from high to low for the capacity areas are Preparing for an Emergency (5.3 out of 7 points, 75.5%), Surveillance, Investigation and Assessment (7.1 out of 10 points, 71.0%), Health Services and Clinical Management (8.0 out of 12 points, 66.7%), Maintaining Essential Services and Recovery (1.8 out of 3 points, 61.2%),
Preventing Illness in the Community (pharmaceutical and nonpharmaceutical interventions) (4.1 out of 8 points, 51.5%), and the Status of National Pandemic Influenza Preparedness Plans (3.1 out of 6 points, 51.0%).
The survey revealed major gaps in pandemic influenza preparedness among Member States.
The priorities for strengthening include:
• Updating pandemic influenza preparedness plans and making them publicly available;
• Conducting simulation exercises to test and validate pandemic preparedness plans;

• Establishing mechanisms to secure access to pandemic influenza vaccine during a pandemic and defining regulatory pathways for the emergency use of pandemic influenza vaccine;

• Including and specifying nonpharmaceutical public health measures for pandemic response in preparedness plans;

• Preparing mechanisms to conduct risk communications and community engagement during a pandemic;

• Developing plans to manage excess mortality during a pandemic;
• Establishing standard operational procedures for conducting systematic influenza risk and severity assessments using surveillance data.
Majority of countries participated in the survey intended to develop or update their pandemic influenza preparedness plans in the next one to two years. WHO clearly has an important role to play in supporting its Member States in this endeavour and can use the results of this survey to inform strategies or approaches to focus its technical support. WHO also need to make efforts to improve awareness and uptake of its guidance and tools on pandemic influenza preparedness and may need to consider developing a better outreach strategy for knowledge disseminations. 
Member States at all income levels have rooms for improvement in pandemic influenza preparedness. The levels of preparedness are far from optimal even in high income and upper-middle income countries.
However, low income countries clearly require additional and targeted support to prepare for an influenza pandemic. This is most evident in the African Region – a result that can be linked to the lower overall income status of countries from the Region. WHO and its partners may need to adapt a sustainable and resilient strategy to better address the resources challenges and competing health priorities of many countries in the region. 

The global perspective of this survey has been extremely valuable to understand the current levels of pandemic influenza preparedness among WHO Member States, and to identify and validate priorities for future efforts and investments in pandemic preparedness from WHO and partners. Conducting such survey periodically could be beneficial in stimulating and demonstrating progresses of pandemic influenza preparedness over time among Member 

(Continue . . . )

Even among high and upper-middle income nations, pandemic planning is described as `far from optimal' - which becomes even more sobering when you realize these grades are based on self-reporting. 
We could get lucky, and the next pandemic could be mild - like we saw in 2009 - or moderate, like 1957. And while millions could still die, we'd muddle through, even without a cohesive global pandemic response.
But if the next pandemic is like 1918 - or worse, like the scenario envisioned in last year's Clade X exercise (see CLADE X: Archived Video & Recap) - our lack of preparedness could be devastating. 
If you don't have the time to watch the entire 8 hour exercise, I would urge you to at least view the 5 minute wrap up video. It will give you some idea of the possible impact of a severe - but not necessarily `worst case' - pandemic.
Recap Video

While over the past two years we've enjoyed a drop in novel flu news, we need to be using this time wisely.  Although the following quote is more than a dozen years old, it is just as true today as it was in 2006:
“Everything you say in advance of a pandemic seems alarmist.  Anything you’ve done after it starts is inadequate."- Michael Leavitt,  Former Secretary of HHS
All reasons why, we - along with the rest of the world - need to find the foresight, fortitude, and political will to do something substantial to prepare before the next crisis strips us of that opportunity completely.

For more on pandemic planning and preparedness, you may wish to revisit:

#NatlPrep : Because Pandemics Happen

Pandemic Planning For Business

The Pandemic Preparedness Messaging Dilemma