Although pandemics have occurred at irregular intervals throughout history, pandemic preparedness plans only appeared in Europe in the 1990s. (1,2) Following preliminary guidance from the World Health Organization (WHO) in pandemic planning (1999), the 2003 World Health Assembly adopted a resolution that called for the development of national and global pandemic preparedness plans and that set the first targets for seasonal influenza immunization coverage. (2,3) The global disruption caused by severe acute respiratory syndrome (SARS) in 2003 fuelled the adoption in 2005 of the first comprehensive International Health Regulations. That same year WHO published its first global guidance and checklist for pandemic planning. (2,4)
In 2001, the European Union (EU) and its Member States held the first European pandemic planning workshop drawing on European legislation for health security} The European Centre for Disease Prevention and Control (ECDC) commenced operations in May 2005 and made pandemic preparedness its first disease-specific priority. The ECDC worked with WHO's Regional Office for Europe in supporting Member States of the EU and the European Commission (EC) in strengthening pandemic preparedness in EU and European Economic Area (EU/EEA) countries, while the WHO's Regional Office also worked with other countries in WHO's European region.
This paper reports on the work of the ECDC, the EC and WHO's Regional Office in supporting the assessment, development and strengthening of pandemic planning and preparedness in WHO's European Region in 2005-2009. It explains the initial problems encountered, the changes made to the assessment procedure with experience, the lessons learnt from the 2009 pandemic, and those aspects of pandemic preparedness that should be improved. In a short paper the detail is limited, but more information is available through a timeline and in pandemic preparedness web pages. (2,5-7)
During 2005-2009, national pandemic preparedness was assessed in 43 European countries, including all countries belonging to the EU. Central to this was a standardized procedure to assist countries in assessing and improving their national and local pandemic preparedness plans based on WHO's 2005 checklist, whose indicators of preparedness were used. (4) These activities intensified when human cases of influenza A(H5N1) "bird flu" appeared in Azerbaijan and Turkey along with sporadic infection in wild and domestic birds in most other European countries. (2)
The assessments, which began in the summer of 2005, were conducted by external teams of pandemic preparedness experts from the ECDC, the EC and WHO's Regional Office for Europe. During brief visits to each country, these teams worked with health ministry officials and technical agencies in completing a standard questionnaire based on WHO's checklist of preparedness indicators. They subsequently sent a written report to each country. (2)
Procedural improvements and problems
As country visits took place, the limitations of the external assessment model became clear. Over time a self-assessment tool and procedure (2,6,8) based on improved indicators were developed. The indicators were specifically designed for the pandemic planning process and reflected the increasing complexity of national and local pandemic preparedness. This revised assessment procedure covered new issues, such as local preparedness; intersectoral work (i.e. work beyond the health sector); the consistency of policies across neighbouring countries (interoperability); vaccination against seasonal influenza; laboratory preparedness; antiviral treatment and vaccination strategies; pandemic simulation exercises; and communication between agencies and with the public, professionals and neighbouring countries. Some national authorities had stopped preparations after producing written plans and had not developed the operational aspects or determined if they would work in practice. …