GHF2010 – PS35 – Pandemic Preparedness and Response: Lessons Learned from H1N1

Session Outline

Parallel session PS35, Monday, April 19 2010, 11:00-12:30, Room 2
Chair: Tessa Richards, Assistant Editor, British Medical Journal (BMJ), United Kingdom
H1N1 Preparedness and Response: Early Lessons Learned
Sandra Jack-Mounier, Lecturer, Department of Public Health and Policy, Communicable Diseases Policy Group, London School of Hygiene and Tropical Medicine, United Kingdom
Global Response to Pandemics: Navigating amidst Great Uncertainty
Dominique Legros, Medical Officer, World Health Organization, Switzerland
H1N1 Vaccine Production: The Industry Perspective
Norbert W. Hehme, Chair, IFPMA Influenza Vaccine Supply (IVS) International Task Force, Germany
The Ethics of Pandemic Preparedness for Migrants and Host Communities
Montira Inkochasan, Migration Health, International Organization for Migration, Laos

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Session Report

Submitted by: Mary Picard (ICVolunteers); Contributors: Jane Marriott (ICVolunteers)

Healthcare practitioner administering the H1N1 live attenuated intranasal vaccine (LAIV), photo Public Health Image Library (PHIL) of CDC, James Gathany

Major lessons learned from the recent H1N1 flu pandemic were presented by representatives of the WHO, the International Organisation for Migration (IOM) and the pharmaceutical industry. Topics discussed were the importance of the revised International Health Regulation (IHR) in the sharing of information between governments, the necessity of communicating directly with the public and crisis management during the acute phase of the health crisis, and improved risk management models. Topics of ethics in pandemic preparedness among migrant communities and consequences for host governments were also examined.

Dominique Legros, Medical Officer for the World Health Organization (WHO), presented a talk entitled Global Response to Pandemics: Navigating Amongst Great Uncertainty. He discussed similarities and differences between the H1N1 pandemic and previous pandemics encountered in recent public health history such as Ebola, Marburg, SARS and Avian Flu.

The H1N1 pandemic varied from previous recent strains of influenza in that populations had very little immunity, the virus spread very quickly internationally and the concentration of deaths and complications were found in younger segments of the population. At the level of global coordination, it was the first time many countries were well prepared with stockpiles of vaccines and with coordinated and shared information and communication, due, in large part, to IHR which came into effect in 2007. Additionally, public access to information was not limited to government channels. Improved models of risk assessment by WHO and outside agencies allowed for improved tracking and coordination during the acute phase of the crisis. These models were used both in material (vaccine preparation) coordination and the tracking of health risks. For the first time, direct communication with the public became a critical factor. The speaker acknowledged that the handling of the pandemic by WHO was being reviewed by an external body, as outlined by the IHR, with preliminary findings being released in May of 2010.

Montira Inkoshasan, of Migration Health for the IOM Laos, spoke of the absolute necessity for the world and for individual governments to address the needs of migrant Groups and refugees in their planning. Ms Inkoshasan mentioned the fact that this vulnerable group is still largely neglected when it comes to host-nation planning, though this often occurs due to oversight rather than conscious neglect.

In a survey recently carried out by the IOM, it was found that only two global plans referred to the need for the clinical treatment of migrant workers and only one national plan recognised the risk of stigma and discrimination for these vulnerable groups. Language and addressing cultural differences is the key to creating viable planning options for migrant populations. It is the lack of fluency in the host-county’s language which has meant migrants and other vulnerable groups have been excluded in most of the National, Regional and Global Pandemic Plans.

The IOM will continue to promote awareness of migrant needs and their inclusion in pandemic preparation plans in all communities worldwide.

Ms Bernat of IFPMA Influenza Supply was standing in for Norbet Hehme of the same organization. She discussed the pharmaceutical industry’s review of the H1N1 pandemic, specifically the need for increasing global collaboration. The industry and WHO worked together to ensure that there was a plentiful supply of H1N1 vaccines before the start of the influenza season in November 2009 through constant communication and consultation.

However, Ms Bernat commented that for manufacturers to continue to strengthen their state of preparation, it is important to maintain and enhance both drugs and systems, particularly in regard to the support of developing countries. The industry is currently concerned with strengthening future preparedness and understands that information dissemination and communication are essential.

There is a need, underlined Ms Bernat, for WHO to work towards improving and standardising its communication systems to make future decision making more streamlined and therefore quicker and more effective.

Ms Bernat stated that the industry continues to learn from last year’s pandemic and is committed to improving its communication and vaccine production systems in conjunction with WHO.

The moderator, Mr R. Waldgate, a freelance journalist specializing in medicine and world health, most notably with the Lancet, stood in for Tessa Richards, assistant editor of the British Medical Journal. He began the discussion segment with the question of whether WHO was ready for a pandemic in South America. The answer was that it would depend, as always, on the level of demand for medication and that this was of course the unknown which makes a response so uncertain.

Mr Waldgate went on to ask whether public trust had been eroded by the controversy surrounding the response to last year’s H1N1 pandemic, which displayed communication failings and a rush to increase vaccine production which, in hindsight, may have been unnecessary.

Interestingly, Ms Bernat, speaking on behalf of the pharmaceutical industry, declined to respond but directed the audience to statements on this subject already issued by the industry’s official press.

A spokesman for Médicins sans Frontières (MSF) asked for some clarification of global capacity for vaccine production. Ms Bernat responded that total world-wide capacity is 4.49 million, which has to cover pandemic requirements as well as normal demand for doses of seasonal influenza vaccines.

There was a general consensus that more needs to be done to reach the world’s poorest populations and that this is largely the responsibility of individual countries. Intellectual Property Watch, here in Geneva, raised the point of unfair distribution of vaccines. During last year’s H1N1 pandemic, there was a shortfall in supply of vaccines in developing countries at the same time as there was a surplus elsewhere. The participants agreed that a fairer distribution needs to be made a priority in future.

An interesting question was raised by a manager from the University Hospital in Geneva (HUG) as to what can be done in the future about the significant number of the public who were reluctant to be vaccinated against H1N1, particularly here in Western Europe. The consensus was that this is a matter of better communication between health officials and the public. A new web-site is being planned by the Institut Pasteur in order to address the need for better dissemination of accurate information on health issues.

Interestingly, the public response differed around the world. In particular, there was a contrast between the public response in North America and that in Europe. The delegates believed the media had played a big role in this contrasting response and that communication between WHO and Governments needed to be looked at. Someone from the floor asked about how much the pharmaceutical industry had profited from the creation and distribution of the H1N1 vaccine. The panel referred to information published by individual pharmaceutical companies.

In an interview conducted after the meeting, Dominique Legros highlighted the role of a ‘no risk’ policy, which many governments around the world apply to public safety, in guiding them to err on the side of caution when judging possible vaccine requirements. Manufacturers plan production based on these government estimates. The current grounding of all commercial aircrafts in Europe is an example of this ‘no risk’ attitude at work.

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