Giuseppe
Emeritus
[Source: World Health Organization, full PDF document: (LINK). Extract.]
Pandemic Influenza Risk Management - WHO Interim Guidance
Executive summary
Influenza pandemics are unpredictable but recurring events that can have consequences on human health and economic well-being worldwide.
Advance planning and preparedness are critical to help mitigate the impact of a pandemic. This WHO guidance document, Pandemic Influenza Risk Management, updates and replaces Pandemic influenza preparedness and response: a WHO guidance document, which was published in 2009.
This revision of the guidance takes account of lessons learnt from the influenza A(H1N1) 2009 pandemic and of other relevant developments.
The influenza A(H1N1) 2009 pandemic was both the first of the 21st century and the first since WHO had produced pandemic preparedness guidance. The experience of Member States during the pandemic varied, yet several common factors emerged. Member States had prepared for a pandemic of high severity and appeared unable to adapt their national and subnational responses adequately to a more moderate event.
Communications were also demonstrated to be of immense importance: the need to provide clear risk assessments to decision-makers placed significant strain on ministries of health; and effective communication with the public was challenging. These, and other areas with improvement potential, were identified by the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009.
The influenza A(H1N1) 2009 pandemic provided a wealth of additional information to the established and growing body of knowledge on influenza viruses at the human?animal ecosystem interface. Other notable developments since the publication of the 2009 guidance include the adoption by the Sixty-fourth World Health Assembly of the Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits. In addition, risk management of acute public health events that have the potential to cross borders and threaten people worldwide continues to improve as a result of the International Health Regulations (2005) and States Parties? obligations on capacity strengthening.
This guidance can be used to inform and harmonize national and international pandemic preparedness and response. Countries should consider reviewing and/or updating national influenza preparedness and response plans to reflect the approach taken in this guidance.
The roles and responsibilities of WHO relevant to pandemic preparedness, in terms of global leadership and support to Member States, are also articulated. This document is not intended to replace national plans, which should be developed by each country.
New in the 2013 guidance
Emergency Risk Management for Health
The approach taken in this 2013 guidance applies the principles of all-hazards emergency risk management for health (ERMH) to pandemic influenza risk management. The objectives of emergency risk management for health are to: strengthen capacities to manage the health risks from all hazards; embed comprehensive emergency risk management in the health sector; and enable and promote multisectoral linkage and integration across the whole-ofgovernment and the whole-of-society. This guidance therefore aligns more closely with the disaster risk management structures already in place in many countries and underscores the need for appropriate and timely risk assessment for evidence-based decision-making at national, subnational and local levels.
Risk-based approach
This guidance introduces a risk-based approach to pandemic influenza risk management and encourages Member States to develop flexible plans, based on national risk assessment, taking account of the global risk assessment conducted by WHO. To support implementation, content on the application of assessments of risk and severity have been strengthened.
Approach to global phases and uncoupling global phases from national actions
In response to lessons learnt from the influenza A(H1N1) 2009 pandemic, a revised approach to global phases is introduced in this guidance. The phases, which are based on virological, epidemiological and clinical data, are to be used for describing the spread of a new influenza subtype, taking account of the disease it causes, around the world. The global phases have been clearly uncoupled from risk management decisions and actions at the country level. Thus, Member States are encouraged as far as possible to use national risk assessments to inform management decisions for the benefit of their country?s specific situation and needs.
PIP Framework
The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits, commonly known as the PIP Framework, brings together Member States, industry, other stakeholders and WHO to implement a global approach to pandemic influenza preparedness and response. Its key goals include:
1. Introduction
The influenza A(H1N1) 2009 pandemic was the first to occur since WHO had produced preparedness guidance. Guidance had been published in 1999, revised in 2005 and again in 2009 following advances in the development of antivirals and experiences with influenza A(H5N1) infections in poultry and humans. The emergence of the influenza A(H1N1)pdm09 virus provided further understanding of influenza pandemics and requirements for pandemic preparedness and response. The report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009 concluded: ?The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency? (1).
The Review Committee recommended that WHO should revise its pandemic preparedness guidance to support further efforts at the national and subnational level. Revisions recommended included: simplification of the pandemic phases structure; emphasis on a risk-based approach to enable a more flexible response to different scenarios; reliance on multisectoral participation; utilization of lessons learnt at the country, regional and global level; and further guidance on risk assessment. The Review Committee?s report reflected the broad experiences of Member States during the influenza A(H1N1) 2009 pandemic ? and the key point that previous pandemic planning guidance was overly rigid. Member States had prepared for a pandemic of high severity and appeared unable to adapt their responses adequately to a more moderate event. Communications also proved to be of immense importance during the influenza A(H1N1) 2009 pandemic, within the health and non-health sectors and to the public.
Provision of clear risk assessments to decision-makers placed significant strain on ministries of health, and effective communication with the public was challenging.
This 2013 guidance is based on the principles of all-hazards emergency risk management for health (ERMH), thereby aligning pandemic risk management with the strategic approach adopted by WHO, in accordance with World Health Assembly resolution 64.10.1
Commensurate with this approach, this guidance promotes building on existing capacities ? in particular those under the International Health Regulations (2005) (2) (IHR [2005]) core capacities, in order to manage risks from pandemic influenza. Certain aspects of implementation of ERMH for national pandemic preparedness may therefore be linked with the core capacity strengthening activities required by the IHR (2005). This guidance can therefore be used as a model to illustrate how the mechanisms required for response to and recovery from pandemic influenza can be applied, as appropriate, to the management of all relevant health emergencies.
A risk-based approach to pandemic influenza management is emphasized and Member States are encouraged to develop flexible plans, based on national risk assessments. This guidance also places pandemic planning in the whole-of-society context.
This 2013 revision therefore (1) reflects the approach taken at national level where pandemic influenza planning often rests with national disaster management authorities and (2) introduces or promotes all-hazards ERMH at Ministry of Health level, including mechanisms for wider national engagement.
This guidance also summarizes the roles and responsibilities of WHO relevant to pandemic preparedness, in terms of global leadership and support to Member States.
________
(1) WHA Resolution 64.10 in 2011, urges Member States to (1) integrate all-hazards health emergency and disaster risk management programmes (including disaster risk reduction) into national or subnational health plans; and (2) institutionalize capacities for coordinated health and multisectoral action to assess risks, proactively reduce risks, and prepare for, respond to, and recover from, emergencies, disasters and other crises.
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Pandemic Influenza Risk Management - WHO Interim Guidance
Executive summary
Influenza pandemics are unpredictable but recurring events that can have consequences on human health and economic well-being worldwide.
Advance planning and preparedness are critical to help mitigate the impact of a pandemic. This WHO guidance document, Pandemic Influenza Risk Management, updates and replaces Pandemic influenza preparedness and response: a WHO guidance document, which was published in 2009.
This revision of the guidance takes account of lessons learnt from the influenza A(H1N1) 2009 pandemic and of other relevant developments.
The influenza A(H1N1) 2009 pandemic was both the first of the 21st century and the first since WHO had produced pandemic preparedness guidance. The experience of Member States during the pandemic varied, yet several common factors emerged. Member States had prepared for a pandemic of high severity and appeared unable to adapt their national and subnational responses adequately to a more moderate event.
Communications were also demonstrated to be of immense importance: the need to provide clear risk assessments to decision-makers placed significant strain on ministries of health; and effective communication with the public was challenging. These, and other areas with improvement potential, were identified by the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009.
The influenza A(H1N1) 2009 pandemic provided a wealth of additional information to the established and growing body of knowledge on influenza viruses at the human?animal ecosystem interface. Other notable developments since the publication of the 2009 guidance include the adoption by the Sixty-fourth World Health Assembly of the Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits. In addition, risk management of acute public health events that have the potential to cross borders and threaten people worldwide continues to improve as a result of the International Health Regulations (2005) and States Parties? obligations on capacity strengthening.
This guidance can be used to inform and harmonize national and international pandemic preparedness and response. Countries should consider reviewing and/or updating national influenza preparedness and response plans to reflect the approach taken in this guidance.
The roles and responsibilities of WHO relevant to pandemic preparedness, in terms of global leadership and support to Member States, are also articulated. This document is not intended to replace national plans, which should be developed by each country.
New in the 2013 guidance
Emergency Risk Management for Health
The approach taken in this 2013 guidance applies the principles of all-hazards emergency risk management for health (ERMH) to pandemic influenza risk management. The objectives of emergency risk management for health are to: strengthen capacities to manage the health risks from all hazards; embed comprehensive emergency risk management in the health sector; and enable and promote multisectoral linkage and integration across the whole-ofgovernment and the whole-of-society. This guidance therefore aligns more closely with the disaster risk management structures already in place in many countries and underscores the need for appropriate and timely risk assessment for evidence-based decision-making at national, subnational and local levels.
Risk-based approach
This guidance introduces a risk-based approach to pandemic influenza risk management and encourages Member States to develop flexible plans, based on national risk assessment, taking account of the global risk assessment conducted by WHO. To support implementation, content on the application of assessments of risk and severity have been strengthened.
Approach to global phases and uncoupling global phases from national actions
In response to lessons learnt from the influenza A(H1N1) 2009 pandemic, a revised approach to global phases is introduced in this guidance. The phases, which are based on virological, epidemiological and clinical data, are to be used for describing the spread of a new influenza subtype, taking account of the disease it causes, around the world. The global phases have been clearly uncoupled from risk management decisions and actions at the country level. Thus, Member States are encouraged as far as possible to use national risk assessments to inform management decisions for the benefit of their country?s specific situation and needs.
PIP Framework
The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits, commonly known as the PIP Framework, brings together Member States, industry, other stakeholders and WHO to implement a global approach to pandemic influenza preparedness and response. Its key goals include:
- to improve and strengthen the sharing of influenza viruses with human pandemic potential; and
- to achieve, inter alia, more predictable, efficient and equitable access for countries in need of life-saving vaccines and medicines during future pandemics.
1. Introduction
The influenza A(H1N1) 2009 pandemic was the first to occur since WHO had produced preparedness guidance. Guidance had been published in 1999, revised in 2005 and again in 2009 following advances in the development of antivirals and experiences with influenza A(H5N1) infections in poultry and humans. The emergence of the influenza A(H1N1)pdm09 virus provided further understanding of influenza pandemics and requirements for pandemic preparedness and response. The report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009 concluded: ?The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency? (1).
The Review Committee recommended that WHO should revise its pandemic preparedness guidance to support further efforts at the national and subnational level. Revisions recommended included: simplification of the pandemic phases structure; emphasis on a risk-based approach to enable a more flexible response to different scenarios; reliance on multisectoral participation; utilization of lessons learnt at the country, regional and global level; and further guidance on risk assessment. The Review Committee?s report reflected the broad experiences of Member States during the influenza A(H1N1) 2009 pandemic ? and the key point that previous pandemic planning guidance was overly rigid. Member States had prepared for a pandemic of high severity and appeared unable to adapt their responses adequately to a more moderate event. Communications also proved to be of immense importance during the influenza A(H1N1) 2009 pandemic, within the health and non-health sectors and to the public.
Provision of clear risk assessments to decision-makers placed significant strain on ministries of health, and effective communication with the public was challenging.
This 2013 guidance is based on the principles of all-hazards emergency risk management for health (ERMH), thereby aligning pandemic risk management with the strategic approach adopted by WHO, in accordance with World Health Assembly resolution 64.10.1
Commensurate with this approach, this guidance promotes building on existing capacities ? in particular those under the International Health Regulations (2005) (2) (IHR [2005]) core capacities, in order to manage risks from pandemic influenza. Certain aspects of implementation of ERMH for national pandemic preparedness may therefore be linked with the core capacity strengthening activities required by the IHR (2005). This guidance can therefore be used as a model to illustrate how the mechanisms required for response to and recovery from pandemic influenza can be applied, as appropriate, to the management of all relevant health emergencies.
A risk-based approach to pandemic influenza management is emphasized and Member States are encouraged to develop flexible plans, based on national risk assessments. This guidance also places pandemic planning in the whole-of-society context.
This 2013 revision therefore (1) reflects the approach taken at national level where pandemic influenza planning often rests with national disaster management authorities and (2) introduces or promotes all-hazards ERMH at Ministry of Health level, including mechanisms for wider national engagement.
This guidance also summarizes the roles and responsibilities of WHO relevant to pandemic preparedness, in terms of global leadership and support to Member States.
________
(1) WHA Resolution 64.10 in 2011, urges Member States to (1) integrate all-hazards health emergency and disaster risk management programmes (including disaster risk reduction) into national or subnational health plans; and (2) institutionalize capacities for coordinated health and multisectoral action to assess risks, proactively reduce risks, and prepare for, respond to, and recover from, emergencies, disasters and other crises.
(?)
-
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