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of which were developed in 2005 and 2006, but have not been
subjected to thorough revision since. These regional plans tend to
focus on the response to avian influenza outbreaks rather than a full-
blown pandemic. Despite this, avian influenza contingency planning
is an essential part of pandemic planning, as it provides a good basis
for developing national capacity and pandemic preparedness.
One of the main obstacles to improving pandemic preparedness is
a general lack of resources dedicated to pandemic preparedness plan-
ning. With other public health issues taking priority over planning for
a pandemic, there is a lack of human as well as financial resources
available to develop and implement pandemic preparedness plans,
thus having a significant impact on the progress made. Furthermore,
there is a need for better government understanding of the concept
of pandemic preparedness (versus avian influenza preparedness) and
awareness of the importance of pandemic preparedness planning. It
was also observed in most countries that government endorsement is
necessary from the highest level down to each municipality and hospi-
tal, to emphasize the need to start planning for a pandemic now.
With one or two exceptions, there are not yet operational
pandemic preparedness plans in the SEE countries. Current plans
are strategic documents containing broad statements of intent, not
operational documents ready for implementation. Most countries
express the intention to update their pandemic plan with the publi-
cation of the new WHO guidance document in 2009. Revising the
pandemic plan according to the new WHO guidance will include a
shift in focus from plans focused exclusively on the health sector to
an inclusion of other essential sectors in society, the so-called ‘whole-
of-society’ approach. Some countries in the region have already
started to consider how to expand pandemic preparedness to include
non-health sectors, but at the moment there are no written plans for
non-health sector preparedness in the SEE countries.
Communication
– up until now, communication strategies in SEE
countries have generally focused on seasonal and avian influenza. For
avian influenza, training sessions have been held by the United Nations
Childrens Fund in at least four countries. As well as this, many coun-
tries have distributed information material to the popula-
tion, including specially developed material for children,
the Roma population and occupationally exposed groups,
on avian influenza and how to deal with issues such as
dead poultry. Nearly all countries have developed sensi-
ble means of communicating with the general public on
seasonal or avian influenza, which includes advertising at
bus stands, distributing leaflets in public places or attach-
ing them to newspapers. At least one country reported
that since not all inhabitants have Internet access, it had
to think of other means of communicating with the public.
An actual pandemic communication strategy was not seen
in any country. Some countries had mixed seasonal, avian
and pandemic communication strategies, but a closer look
at these strategies made it clear that work still needs to be
done on a specific strategy for pandemic influenza. In two
countries, communication material from other countries
had been used and translated into the local language and,
to some extent, adapted to the national culture. In at least
three countries it was reported that the seasonal influenza
strategy needed updating to address the need for increas-
ing the uptake of seasonal influenza vaccinations,
particularly in risk groups.
Monitoring and health system preparedness
– all countries
visited had outbreak investigation teams in place for
outbreaks of avian influenza. At least five national influenza
laboratories in the region have the capacity to detect H5 in
clinical specimens and other laboratories are in the process
of establishing the necessary capacity to do so.
SEE countries have invested in educating and inform-
ing healthcare workers about human cases of avian
influenza, including training of healthcare workers, distri-
bution of information leaflets and case management
guidance. Most countries, however, have not yet addressed
the education of healthcare workers and development of
hospital preparedness plans for pandemic influenza, and
in general the hospital staff/management that were visited
were not aware of the need to develop such plans. In
several countries, the reason for this was that it was unclear
who should initiate the process. Hospital staff/manage-
ment, for example, expected the initiative to come from
regional level administration, while regional level admin-
istration expected hospital staff/management to be aware
that they needed to develop a pandemic plan.
Additionally, lack of resources among hospital staff to
develop and test hospital plans and to educate and train
staff contributes to the low priority given to hospital
preparedness so far in some countries. Until now,
funding has mostly been made available for improving
preparedness against outbreaks of avian influenza in
humans and animals. A general trend in the SEE region
is that preparedness in the primary healthcare services
has not yet been addressed. As primary healthcare facil-
ities may be the first point of contact with the healthcare
system for patients during a pandemic, it is essential to
address the handling of an excessive number of patients.
Pharmaceutical and non-pharmaceutical interventions
–
all countries in SEE have procured antivirals for outbreaks
of human cases of avian influenza, but for the moment
Pandemic preparedness is discussed during the visit to Bosnia and Herzegovina
Image: André Jacobi