Health System Resource Gaps and Associated Mortality from Pandemic Influenza across Six Asian Territories

Abstract

BackgroundSoutheast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia.Methods and FindingsWe collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a “mild-to-moderate” pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as “avoidable” mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored.ConclusionsThe findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths.

Cost–effectiveness analysis of pandemic influenza preparedness: what’s missing?

“…Recent work by Rudge et al highlights health system resource gaps for pandemic influenza scenarios in six countries in south-eastern Asia and, not surprisingly, the greatest gaps between service demand and health system capacity were frequently found in the poorest areas. 6 Ignoring health system capacity implicitly assumes that capacity is unlimited, an assumption that is even less justifiable in a low-or lower-middle-income context than in that of a high-income. The question of whether health system strengthening in poor countries is the most effective investment in pandemic preparedness is still to be answered.…”

Predictive accuracy of particle filtering in dynamic models supporting outbreak projections

“…Vaccination and intervention strategies such as school closures for early mitigation of pandemic influenza spread may reduce severe complications and deaths [1]. Key concerns during an outbreak include staffing requirements for implementation of a pandemic response, clinical resource constraints [2], managing individuals’ expectations and behaviors, which often relate their risk perception [3], and mobilization of health resources [4]. Rapid or ideally real-time reporting of surveillance data provide a clear picture of what has happened, but fail to provide clarity on how the epidemic will evolve.…”

Human H5N1 influenza infections in Cambodia 2005–2011: case series and cost-of-illness

“…Cambodia, like many other developing countries, has a limited and likely insufficient level of pandemic preparedness to deal with an outbreak of a highly pathogenic and transmissible strain of influenza [3,9-12]. Based on data collected regarding key health system resources, Cambodia has been identified as having some of the largest resource gaps and potentially the highest rate of avoidable deaths when compared to other countries in Southeast Asia, including Indonesia, Lao PDR, Taiwan, Thailand and Vietnam [12].…”

“…Cambodia, like many other developing countries, has a limited and likely insufficient level of pandemic preparedness to deal with an outbreak of a highly pathogenic and transmissible strain of influenza [3,9-12]. Based on data collected regarding key health system resources, Cambodia has been identified as having some of the largest resource gaps and potentially the highest rate of avoidable deaths when compared to other countries in Southeast Asia, including Indonesia, Lao PDR, Taiwan, Thailand and Vietnam [12]. Cambodia has the lowest density of health professionals per capita in the region; insufficient healthcare facilities with no surge capacity; equipment shortages including mechanical ventilators; and only 0.025% of the WHO recommended national stock of anti-viral tablets [3,9-12]; Sok Touch, Ministry of Health Cambodia, personal communication].…”

“…Based on data collected regarding key health system resources, Cambodia has been identified as having some of the largest resource gaps and potentially the highest rate of avoidable deaths when compared to other countries in Southeast Asia, including Indonesia, Lao PDR, Taiwan, Thailand and Vietnam [12]. Cambodia has the lowest density of health professionals per capita in the region; insufficient healthcare facilities with no surge capacity; equipment shortages including mechanical ventilators; and only 0.025% of the WHO recommended national stock of anti-viral tablets [3,9-12]; Sok Touch, Ministry of Health Cambodia, personal communication]. Additionally Cambodia does not have any discretionary budget for local level administration for influenza or pandemic preparation [10].…”