Study cites gaps in Europe's flu pandemic plans

Apr 24, 2006 (CIDRAP News) – European countries' plans for coping with an influenza pandemic are generally good but have a number of gaps, including a lack of detail on distribution of drugs and supplies, according to an analysis published last week by The Lancet.

The analysis of plans prepared by 21 countries gave them average scores of 54% for completeness and 58% for quality. The report was prepared by Sandra Mounier-Jack, MSc, and Richard J. Coker, MD, of the Department of Public Health and Policy at the London School of Hygiene and Tropical Medicine.

"Governmental commitment in most European countries is strong, and levels of preparedness are broadly good," the authors wrote. "However, gaps in preparedness planning remain, and substantial variations exist between countries, with important implications for the region and nation states. Improved cooperation between countries may be needed to share experience, and to ensure coherence of approaches."

The researchers checked the plans of 25 European Union (EU) members, plus those of nonmembers Norway and Switzerland and those of Bulgaria and Romania, which are preparing to join the EU. Only the 21 plans published between January 2002 and Nov 30, 2005, were included in the analysis.

In their analysis, the authors used 47 essential criteria and looked at seven thematic areas: planning and coordination, surveillance, public health interventions, health system response, maintenance of essential services, communication, and "putting plans into action."

They found the plans generally good in the areas of surveillance, planning and coordination, and communication. But the plans were "probably inadequate" when it came to maintenance of services, putting plans into action, and public health interventions.

Some specific problems the analysts found were as follows:

  • Details on the distribution of antiviral drugs, vaccines, masks, and other medical supplies were missing from the plans, and none included estimates of quantities needed.
  • Except in Eastern Europe, most plans didn't mention the need for collaboration with neighboring countries.
  • Few countries specified which institutions would handle triage.
  • Seven plans didn't address the need to prepare for maintaining essential services during a pandemic.
  • Most countries did not discuss the potential role of the media.
  • Aside from an EU-wide exercise in 2005, only three countries have tested their plans in national simulation exercises.
  • Eighteen plans recommend that people exposed to the pandemic virus receive preventive antiviral treatment, and 13 plans offered guidance on who should have priority for that. But none of the plans spell out how members of priority groups will be identified.
  • While most of the plans discussed public health interventions such as closing schools and restricting public gatherings, many of them were unclear about when, in terms of the World Health Organization's (WHO's) pandemic phases, such interventions would be used.

All but one plan (Portugal's) had a strategy for use of a vaccine, and 14 of the 21 plans call for immunizing the entire population if vaccine is available. Most plans called for vaccinating healthcare workers first, essential service workers second, and people at risk for serious flu complications third. (Although several countries are developing H5N1 avian flu vaccines, a specific pandemic vaccine cannot be developed until the pandemic virus emerges.)

The article says the WHO has suggested that travel restrictions are unlikely to help much and are mostly impracticable, yet 15 of the 21 plans included some kind of travel restriction.

The scores for completeness ranged from 24% to 80%, while quality scores ranged from 27% to 86%. Countries with the most complete plans, the report says, were France, Germany, Ireland, the Netherlands, Sweden, Switzerland, and Britain. In the middle range were Austria, Denmark, Estonia, Greece, Norway, Slovakia, and Spain. Those with the least complete plans were Czech Republic, Italy, Latvia, Lithuania, Romania, Poland, and Portugal.

The authors caution that written plans are just one element of preparedness. "The completeness of plans could show simply the attention paid to drafting rather than preparedness. Countries may be prepared in areas that are not mentioned in their plans," they write.

Mounier-Jack S, Coker RJ. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet 2006 (early online publication Apr 20) [Abstract]

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