North American pandemic plan takes shape

Aug 23, 2007 (CIDRAP News) – Leaders of Canada, Mexico, and the United States who met at a security summit in Montebello, Quebec, on Aug 21 unveiled a North American pandemic influenza plan designed to share expertise, coordinate public health messages, and overcome anticipated obstacles at national borders.

The plan evolved from the Security and Prosperity Partnership of North America, a trilateral effort launched in 2006 to enhance collaboration on security and economic issues. At the 2006 summit, leaders vowed to develop a pandemic plan and establish a senior-level coordinating body to work on preparedness issues, according to a US State Department fact sheet.

Though the plan covers traditional areas such as information sharing, surveillance, and medical resources, it emphasizes preserving the three countries' economies in the event of an influenza pandemic.

"Although influenza will not physically damage critical infrastructure, systems may be weakened by the absence of essential personnel in the workplace or the diversion of resources," the 44-page report states. "The Plan, therefore, extends beyond health and medical sectors to include provisions in relation to critical infrastructure and the movement of goods and services across our borders."

Kim Elliott, deputy director of Trust for America's Health (TFAH), a nonprofit public health advocacy group based in Washington, DC, said TFAH welcomes the release of the pandemic flu plan. "The flu virus doesn't respect borders, so it's incumbent upon every country to plan for coordination," she told CIDRAP News.

A pandemic plan is meaningless unless it stipulates that participants hold exercises to test it, Elliott said. The North American plan includes provisions for bilateral and trilateral pandemic response exercises, with a target date of December 2008.

Among the challenges North American pandemic planners will face, Elliott said, is vastly different healthcare systems—particularly Canada with its more centralized approach, and the United States with a more privatized healthcare model. "So it's good to test operations and different strategies," she said.

The plan spells out the triggers that would prompt one of the three countries to request assistance from its neighbors: when human or material resources are scarce, when a pandemic event in one country threatens the others, and when an outbreak requires robust coordination of responses by all three countries.

In several areas, the plan calls on the countries to address obstacles that could hamper outbreak containment. For example, authorities should ensure rapid cross-border movement of diagnostic materials and reagents, as well as specimens, isolates, and vaccines. Also, the document specifies that countries should ease the way for veterinary and medical personnel to respond to emergencies in other countries.

Sharing information and best practices is another theme of the plan. For example, it says countries should share information about how they plan to use nonpharmaceutical interventions and communicate public health messages to their citizens.

Regarding stockpiling of vaccines and drugs, planners acknowledge that though the countries have different goals, it is useful for them to share their strategies for shelf-life extension, vaccine and antiviral allocation, and mass distribution.

Though border restrictions are not a centerpiece of the plan, the document does address international arrivals. The three countries will share and coordinate triggers, criteria, and protocols for screening international travelers, the report says. "These . . . should be balanced against the necessity to maintain the flow of persons, cargo, and trade across North American borders," it states.

The plan advises countries to adopt a layered passenger-screening approach consisting of predeparture, en route, and arrival checks.

Because the infrastructures of the three countries are highly interrelated, the plan suggests that infrastructure sectors in each country, such as agriculture, transportation, and utilities, join with their counterparts in the other countries to assess their risks and share their resiliency strategies. The United States has already identified how it would protect critical infrastructure and key resource sectors, and Canada and Mexico are both finalizing similar plans, the report says.

Greg Dworkin, MD, one of the editors of the FluWiki, an interactive pandemic planning Web site, told CIDRAP News that one element that seems missing from the North American plan is a strategy to inform citizens of the countries about, and involve them in, for example, community mitigation plans.

Dworkin, who is chief of pediatric pulmonology at Danbury Hospital in Danbury, Conn., said a recent study from the Irish Council for Bioethics suggests that global pandemic planners need to do more to teach citizens about their pandemic risks. The study found that 7 in 10 Irish people were unaware of the flu pandemic risk and that three-fourths weren't fully aware of avian flu risks.

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