Did pandemic preparedness help Europe deal with H1N1?

Before the 2009 H1N1 pandemic health authorities in Europe had many discussions on preparing for a pandemic, and documents relating to flu surveillance and dealing with a flu pandemic were shared.

I have involved in a project looking at the experience of health officials and health workers in applying these to a real-world pandemic. This work was performed in collaboration with the WHO Regional Office for Europe, Influenza and Other Respiratory Pathogens Program, led by Dr Caroline Brown.

We wanted to know what elements of this guidance were helpful, what parts were unhelpful, and how the priorities set out in the official guidance could be optimised.

To do this, we have visited seven countries and conducted 49 interviews. Note that we have not assessed how European countries responded to H1N1; we are interested in how the advance planning performed in practice.

A number of themes emerged through the course of this work, including a sense that the process of producing a plan ultimately proved more useful than the plan itself. It was, in itself, useful to establish networks of experts and officials across Europe and for each Member State to have access to other countries’ pandemic plans.

A strong consensus also that emerged about the importance of robust political support for pandemic preparedness as a key factor for success.

One of the more negative findings was that there was insufficient involvement of primary care doctors (GPs) in pandemic preparedness. Many stakeholders also highlighted inadequate communication between national level health authorities and frontline health care workers during the pandemic.

Several interviewees stressed insufficient flexibility in national planning and international guidance, noting that there was too much emphasis on worst-case scenarios and insufficient planning for proportionate responses to milder pandemics.

In terms of immunisation, many countries felt they did not plan adequately for the detailed logistics of mass delivery.

Furthermore, the mildness of the pandemic caused many countries to alter their vaccination policies (compared with what they had planned) but authorities found that there was often insufficient flexibility in the plans themselves as laid down before the pandemic.

The overall goal of this exercise is to incorporate our findings into a revised WHO and ECDC pandemic planning guidance.

To read more detail on this research, please click here

Dr Jonathan Van Tam is Professor of Health Protection at the University of Nottingham

This article is adapted from Dr Van Tam’s presentation at this week’s ESWI Influenza Conference