Thinking locally about pandemic influenza.

The February 2004 release of the Canadian Pandemic Influenza Plan 1 is a wake-up call to those who provide local health, public health, and emergency services. The possibility of a novel highly pathogenic influenza virus affecting 15-35% of our population has profound implications. This calls for planning at not only international, national and provincial levels of government, but also “on the ground” where health care providers will need to take care of unprecedented numbers of sick people. The Canadian Pandemic Influenza Plan was developed to assist in the “planning, preparedness and response to pandemic influenza.” The goal of this plan is “first, to minimize serious illness and overall deaths, and second to minimize societal disruption among Canadians as a result of an influenza pandemic.” It assigns roles and responsibilities according to the World Health Organization classification of phases of a pandemic, level of government, and by major activities: surveillance, vaccine programs, anti-virals, health services, emergency services, public health measures and communications. The Canadian Pandemic Influenza Plan is a wake-up call for two reasons. First, by adopting the World Health Organization (WHO) phases of pandemic, it quickly becomes apparent that we are already on the slope that may lead to a pandemic. “Phase 0” is the interpandemic phase that has three levels. Level 1 is the identification of a novel virus. Since December 2003, eight Asian countries have confirmed outbreaks of a highly pathogenic avian influenza, H5N1. WHO recently noted that over 100 million birds either have died or been culled in Asia – a figure greater than the total number of poultry affected in the world’s five largest outbreaks combined. We are currently in the Interpandemic Phase 0, Level 2, which means that a novel virus has infected two or more persons. As of the end of February 2004, avian influenza H5N1 had infected 32 people worldwide and caused 22 deaths. The second wake-up call is that there is already a large “to-do list” for local health, public health and emergency planners at Interpandemic Phase 0, Levels 1 and 2. Local responsibilities at Level 1 include updating emergency contact lists and educational materials and estimating the number of health care workers by type and work setting. Local responsibilities at Level 2 include reviewing results of any previously conducted simulation exercises, assessing supplies, equipment and locations for mass vaccine clinics, and identifying gaps in response capacity that will require additional resources. Confirmed human-to-human transmission of avian influenza anywhere in the world would bring us to Interpandemic Phase 0, Level 3. The local responsibilities for this level include increasing surveillance activities, reviewing estimates of high priority populations for vaccine or anti-virals, mobilization of human and financial resources, and training staff for mass immunizations (that is, if vaccine is available). Table I identifies the local responsibilities for surveillance, vaccine programs and other public health measures at each of the three levels of the interpandemic phase.