Informal Consultation on Influenza Pandemic Preparedness in Countries with Limited Resources

(Kuala Lumpur, Malaysia, 23–25 June 2004)

Full Text (PDF, 27 pp, 97 Kb)
Introduction
Background
- A new influenza virus: how it could cause a pandemic
- Consequences of an influenza pandemic
- Why prepare?
- Why develop a pandemic preparedness checklist?
Objectives of the consultation
Summary of the discussions

I. How to develop a national influenza pandemic preparedness plan
- Political commitment
- Intersectoral and multilevel collaboration
- Generic versus specific planning

II. Gaps in preparedness
- Impact of pandemic and inter-pandemic influenza
- Plan versus reality

III. Legal and ethical issues
- Legal basis for public health measures
- Ethics and social support

IV. Surveillance
- Pandemic phases
- Interaction with animal influenza networks
- Priorities for human influenza surveillance

V. Public health interventions (non-pharmaceutical interventions)

VI. Vaccines and antivirals
- Vaccines
- Antivirals

VII. Maintaining essential services

VIII. Risk communication

IX. Pandemic preparedness checklist
- Recommended actions for national governments
- Recommended actions for WHO
- Agenda
- List of participants

- PAHO Influenza Page
- WHO Influenza Page

Objectives | Recommendations to National Governments, WHO

Introduction

The recent avian influenza outbreaks in Asia have provided a stark reminder that the threat of an influenza pandemic is ever present. Epidemiological models indicate that such a pandemic would be responsible for a major burden of disease and for potentially enormous economic costs worldwide, with the greatest impact occurring in the poorest countries, as a result of limited surveillance and health care resources as well as the poor health and nutritional status of the population.

To minimize the impact of a pandemic, planning and implementation of preparatory activities must start well in advance. The World Health Organization (WHO) published its first guidelines for influenza pandemic preparedness plans in 1999 and recommended that each Member State develop its own pandemic preparedness plan. So far, only a small number of countries, mostly developed ones, have influenza pandemic plans. It is important that the most vulnerable countries (those with limited resources) have a pandemic plan.

To assist such countries in developing their plans, WHO has drafted a pandemic preparedness checklist and guide to pandemic preparedness planning. An informal consultation was conducted in Kuala Lumpur, Malaysia, from 23 to 25 June 2004, at which representatives of more than 10 Asian countries participated. This report contains a summary of the discussions held on key elements of the checklist and recommendations for countries with limited resources.

Objectives

The main objective of this informal WHO consultation was to get feedback on key elements of a draft influenza pandemic preparedness checklist prepared by WHO. The specific objectives were as follows:

• raise awareness of the need and potential benefits of pandemic preparedness;
• understand the processes involved in planning influenza pandemic preparedness;
• reach some consensus on the priority components of a pandemic plan;
• develop specific recommendations relevant to the high-priority areas of pandemic planning;
• identify the way forward for Member States as they develop their pandemic plans;
• identify whether WHO assistance is needed and, if so, what form it should take.

Recommended Actions for National Governments

1. A national influenza pandemic preparedness plan should be an integral part of the national disease surveillance and response for outbreak-prone diseases. Plans should include arrangements for regular testing and evaluation of the early warning and response systems.
2. Governments should include multiple sectors in the development of a national pandemic preparedness plan, as well as local administrative levels and the wider community, in order to ensure broad commitment.
3. International coordination is necessary to implement some measures (e.g. border control). In addition, seeking international collaboration may create opportunities to divide tasks and increase efficiency in planning. It can also be used to increase peer pressure on neighbouring countries with limited progress.
4. As surveillance is a cornerstone for response and policy decisions, it is a priority to ensure a communicable disease surveillance system for humans and animals is in place.
5. Governments should develop or review laws and legislation, especially those addressing the legal basis for the imposition of quarantine and isolation. During the development or review, the new IHR should be taken into account.
6. Although it will take at least several months before vaccines become available during a pandemic or potential pandemic, governments should identify priority groups for immunization in advance. The same also applies for allocation of antivirals, although their availability is even more uncertain in the absence of stockpiles.
7. In addition, governments should explore possible national (governmental) funding opportunities and mechanisms for the procurement and licensing of pandemic vaccines.
8. Governments need to identify essential services and encourage the development of contingency plans within these services to maintain basic activities.
9. Open and transparent risk communication is an essential part of the response during a pandemic. It is crucial that governments designate an official spokesperson(s).
10. Every country should try to estimate the impact on their country of a pandemic.
11. Governments should ensure there is a strategy to monitor adverse events related to antivirals or vaccines.
12. Governments should make provisions for psychosocial support to professionals (especially health-care workers) and affected citizens during a pandemic or potential pandemic.

Recommended Actions for WHO

1. WHO should advocate the importance of pandemic preparedness with Member States that have not started pandemic preparedness activities. This may involve reference to the World Health Assembly resolution on pandemic planning.^*
2. WHO should revise its current pandemic preparedness plan, especially to:
   review pandemic phases based on discussions at this meeting;
   2. issue guidance on surveillance needs during the different phases;
   3. harmonize advice about preparedness planning with the IHR and further clarify reporting requirements.
3. WHO should provide support to countries with limited resources in responding to outbreaks in pre-pandemic phase, including laboratory services.
4. WHO should be responsible for:
   1. issuing guidance on public health measures, including travel advisories;
   2. providing early alerts and updates on continuing outbreaks.
5. WHO should work with other international organizations and associations (e.g. the International Air Transport Association) to develop and implement standard measures for travellers on international conveyances.

^* Resolution WHA56.19, Prevention and control of influenza pandemics and annual epidemics. Fifty-Sixth World Health Assembly, Geneva, 19–28 May 2003.