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• Preparedness for outbreaks of avian influenza in humans is in
place and information material has been distributed to health care
facilities in many countries
• Initial preparations have been established on whole-of-society
preparedness
• Unicef outbreak communication training has been undertaken in
many of the SEE countries
• Avian influenza exercises have been undertaken in several coun-
tries and an inter-country exercise was undertaken in 2008.
Experience from these exercises is useful for future pandemic
preparedness exercises in and between countries
• All countries have been provided access to the EISS platform
) to report seasonal influenza and currently five
countries are reporting to the weekly bulletin.
Next steps
Although progress has been made on pandemic preparedness in SEE,
there are still several areas of pandemic preparedness that have not yet
been addressed and areas that need to be revised and strengthened.
Based on assessment visits to countries, the recent SEE workshop
on pandemic preparedness and the new WHO guidance document,
countries are encouraged to revise and update their plans and make
sure that they are operational. By implementing country-specific
recommendations and following the new WHO guidance, pandemic
preparedness in SEE will grow stronger in the coming years. Stronger
pandemic preparedness will have an impact on the countries’ general
emergency preparedness and defence against communicable diseases
other than influenza, as well as contributing to the implementation
of the International Health Regulations.
In addition to the overall recommendation to revise pandemic
plans following country-specific recommendations and the new
WHO guidance, the main areas of pandemic preparedness which
countries are encouraged to address in the coming year are:
Preparedness beyond the health sector – countries are encouraged
to initiate pandemic preparedness planning in sectors other than the
health sector in order to ensure the continuity of essential functions
in society during a pandemic. To initiate this process, it is vital that
one ministry (typically the health ministry) takes the lead in inform-
ing other ministries about the importance and relevance of their
involvement in pandemic preparedness planning. This topic will be
addressed in the new WHO guidance on pandemic preparedness.
Planning at regional and local level – planning is not simply a matter
of having a good national preparedness plan. It is essential to build capac-
ity at lower administrative levels and to involve all levels in the planning
process. Municipalities will need to develop pandemic plans and hospi-
tals, power plants and water and food suppliers will need to develop
business continuity plans to ensure that they can continue their essen-
tial functions throughout a pandemic. It is also important to coordinate
pandemic preparedness with general emergency plans within a country.
Strengthening interoperability in SEE – countries are encouraged to
collaborate on pandemic preparedness planning and through joint
planning efforts, create a strong regional preparedness. Countries are
also recommended to review pandemic plans of neighbouring coun-
tries and to learn from each other. Interoperability was addressed
during the assessment visits as well as during the recent SEE work-
shop and, as a result, a SEE working group on regional interoperability
in pandemic preparedness will be created.
Exercises – pandemic plans need to be tested in exercises, to ascertain
that they are sufficient and realistic. This is an important component of
preparedness planning and needs to be done at a national
as well as a local level. Testing plans is a useful way to iden-
tify gaps and to harmonize plans with existing outbreak
response or emergency preparedness plans. Plans should
be updated according to lessons learned during the exer-
cise. In addition to in-country exercises, international
exercises are also considered beneficial, and could be consid-
ered for SEE when all countries have well established
national pandemic plans.
Conclusion
To date, countries as well as external partners have
focused their efforts on strengthening avian influenza
contingency plans, which is a crucial step in enabling
detection and, if possible, containing the spread of a new
human influenza virus. Significant achievements have
been made in this field and countries have developed
their capacity to respond to outbreaks of avian influenza
in animals as well as humans. It is now time for involved
stakeholders, national as well as external, to focus more
on strengthening preparedness against a pandemic.3
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The SEE HN
The SEE countries have experienced drastic changes in the past
20 years. War, and economic and political tumult led to periods
of civil unrest, political crises and in many areas a cessation of
community services. This has led to a number of difficulties
including adverse impacts on health care, which threatened their
populations in many ways.
In 2001 the SEE HN was established and a commitment was
made by the signatories of the Dubrovnik Pledge to improve
health in the region. SEE ministers of health agreed to work
together and implement nine regional public health projects
(mental health, communicable disease surveillance, food safety
and nutrition, blood and blood components safety, tobacco
control, maternal and neonatal health, health information
systems, medical emergency services, and public health
services). The governments of Belgium, France, Greece,
Slovenia, Sweden, Switzerland and the United Kingdom support
the projects both technically and financially.
The SEE HN has become a political forum of regional
cooperation in public health of the highest level. SEE countries
will assume full ownership of this cooperation in 2009 by
establishing a new SEE HN Secretariat and regional health
development centres on the specific technical areas of
cooperation as outlined by the Dubrovnik and Scopje pledges.
In 2002 the project of strengthening surveillance and control of
communicable diseases was started and all countries are
committed to collaborate and establish a network of experts. A
number activities within the project such as training on applied
epidemiology and surveillance, establishing and assessment of
surveillance systems, seasonal influenza and the International
Health Regulations took place throughout 2002-2008 and
others are scheduled in 2009 and beyond.
Most of the activities related to pandemic preparedness are
supported by the Belgian Government. The project management
office is in Tirana, Albania. For further information please contact
the SEE HN Secretariat. Contact information can be found on the
WHO Regional Office for Europe website:
www.euro.who.int/stabilitypact as well as