ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats

 

#18,402

Eighteen years ago - after H5N1 managed to spread rapidly out of Southeast Asia into Europe, Africa, and the Middle East for the first time - pandemic planning suddenly became a global priority. Nearly every nation (and every U.S. state and Federal Agency) crafted a pandemic plan, and table top exercises and drills were held regularly.

Some of these plans, and drills, were better conceived than others, of course. Far too many envisioned a `mild' pandemic, or focused on delivering unlikely-to-be-available vaccines (see No Such Thing As A `Planacea').

A few (out of hundreds of) examples include:

• Hong Kong : Exercise Redwood - 2009
• UK Exercise: PPE Usage In A Pandemic –2008
• Singapore: Public Involvement In Financial Sector Pandemic Drill –2008
• Florida's Pandemic Simulation – 2008
• Idaho BlogEx : July 28th –2008
• UK: Lessons Learned From Winter Willow – 2007

 When an influenza pandemic finally did emerge in 2009, it came from a swine H1N1 virus, and was relatively mild (except for those who died from it). 

Critics of pandemic planning (which was, admittedly expensive and time consuming) insisted the age of severe pandemics was over (pointing to 3 successively weaker pandemics since 1918), and that modern medicine could more than cope with anything that might emerge. 

Having dodged a bullet, interest in pandemic planning, and drills, gradually declined and most existing pandemic plans gathered dust on the shelf.  While there were constant concerns raised that the `world was ill prepared' for a pandemic, little actual progress in preparing for the next pandemic occurred. 

Although once again from an unexpected source, COVID in 2020 reaffirmed that severe pandemics still happened, and that 10 years after the last pandemic, we were still woefully unprepared to deal with one (see The Most Predicted Global Crisis of the 21st Century).

A few, of many challenges included:

NIOSH Update: More Fake/Counterfeit N95 Masks Entering Market

JAMA: A Framework for Rationing Ventilators & ICU Beds During the COVID-19 Pandemic

Contemplating A Different `Standard of Care'

HHS ASPR-TRACIE: COVID-19 Crisis Standards of Care Resources

Rather than learn from these mistakes, five years after the start of the COVID pandemic we've dismantled much of our surveillance and reporting systems, in order to declare the emergency ended (see No News Is . . . Now Commonplace).

Worse, the international sharing of emerging disease information is - as near as I can tell - the most dysfunctional its been since I began this blog nearly 20 years ago (see The Wrong Pandemic Lessons Learned).  

While the world appears to be sleepwalking towards the next global health crisis, we've seen some movement.  Last summer both South Korea and Japan issued revised pandemic plans, and last November Hong Kong held a Coordinated Avian Flu Drill `Amazonite'.

A number of countries and regions have purchased (or arranged to purchase) limited quantities of H5N1 vaccine.

• In 2023 Japan announced plans to stockpile about 10 million doses.
• The United States ordered about 4.8 million doses last summer, enough for about 2.4 million people.
• The EU announced plans to acquire 650,000 doses  
• Last December the UK announced plans to purchase 5 million doses, 
• Six weeks ago Canada PHAC Announces Plans To Purchase 500,000 doses Of H5N1 Vaccine.

Over the past year the ECDC has been busy issuing guidance documents to its member nations.  Like with our own CDC - these are not mandates, only recommendations - and it is up to each individual public health entity to decide what to incorporate in their planning. 

While most of this recent surge in preparedness is likely inspired by the continued spread of H5N1, the reality is we could easily be blindsided (again) by something other than avian flu with the next pandemic. 

Just over a year ago (March 20th, 2024) we looked at the first part of this 2-part plan (see  ECDC Guidance: Public Health and Social Measures for Health Emergencies and Pandemics in the EU/EEA), which was published less than a week before the announcement of H5N1 in American livestock. 

I've only included the link and executive summary of this 49-page installment.  Follow the link to read it in its entirety.  I'll have a bit more after you return.

Recommendations for preparedness planning for public health threats

Public health guidance
2 Apr 2025

This document aims to provide public health authorities in European Union and European Economic Area (EU/EEA) countries with guidance for improved preparedness planning taking the lessons that have been identified through various activities in the context of recent public health crises (e.g. COVID-19 pandemic, mpox multi-country outbreak 2022–23) and translating them to concrete advice.

Executive summary


This document, together with the ECDC recommendations on the implementation of public health and social measures (PHSMs) for health emergencies and pandemics published in 2024, form a package of concrete recommendations for preparedness planning for the EU/EEA countries.

Lessons learned primarily from the response to the COVID-19 pandemic, but also from the response to the multicountry mpox outbreak in 2022–23, were collected through various activities from Member States, the European Commission, the World Health Organization (WHO) and the WHO Regional Office from Europe. We have then presented these in the form of specific recommendations for planners within each phase of the continuous cycle of preparedness (Anticipation, Response and Recovery), following a prototype structure of a preparedness and response plan. In each section, we have presented a relevant example from a Member State or international organisation to illustrate their practice or attempt to implement lessons after COVID-19 or the mpox outbreak. These examples were identified either through literature review or communication with representatives of the countries within ECDC’s network for Preparedness and Response.

Annex 1 includes an overview of the main lessons for the public health sector and Annex 2 includes a compiled catalogue of documents, tools and other resources for public health preparedness planning.

Download

Recommendations for preparedness planning for public health threats - EN -

[PDF-2.82 MB

Over the past year, PAHO (Pan American Health Organization) has repeatedly urged its member nations to proactively prepare to deal with a potential influenza pandemic. While H5N1 is assumed, it could certainly be from another coronavirus (or something entirely unexpected).

Just over 4 months ago, in A Personal Pre-Pandemic Plan, I wrote about the practical things you and your family can do now to prepare for a possible pandemic in the months or years ahead.

While I still hope we can avoid (or at least delay) that eventuality, the simple truth is, preparedness is always easier before the next emergency starts. 

And the clock is always ticking.