Improving Pandemic Response: A Sensemaking Perspective on the Spring 2009 H1N1 Pandemic

Abstract

Pandemic response takes place in distributed, uncertain, and high-tempo environments. These conditions require public health agencies to rapidly generate and roll out publicly accountable responses in the face of incomplete and ambiguous evidence. To perform under these conditions, public health organizations have devised several tools to support decision making and response. This article examines two such tools that debuted during the 2009 H1N1 outbreak-the 2005 International Health Regulations and influenza pandemic planning. Relying on an international network of researchers who gained access to lead public health agencies in advance of the 2009 pandemic, this study draws on several forms of data-primary documentation, interviews, and an extended workshop with key officials-that were collected as the pandemic unfolded. With this unique dataset, we analyze the performance of the International Health Regulations and pandemic influenza plans from a "sensemaking" perspective. We find that insufficient attention to both the complexities and time horizons involved with adequate sensemaking limited the ability of both tools to fully meet their goals. To improve organizational performance during global pandemics, the sensemaking perspective calls attention to the importance of informal venues of informationsharing and to the need for decisionmakers to continually update planning assumptions.

Freezing deliberation through public expert advice

“…An emerging literature documents that certified experts -virologists, epidemiologists and infectious disease specialists who were policy advisorswere pivotal to countries' 2009 H1N1 responses (Baekkeskov 2016;Keller et al 2012;MacPhail 2014). One author's interviews with 2009 H1N1 policy-makers in Sweden and Denmark indicate that government experts' advice was generally turned directly into response policy (Linde 2014;Nielsen 2014;Pedersen 2013;Smith 2013;Tegnell 2014).…”

Same Threat, Different Responses: Experts Steering Politicians and Stakeholders in 2009 H1n1 Vaccination Policy‐making

“…The EU also sought to coordinate (EC and HPA 2010; Baekkeskov ). Finally, biomedical specialists and other members of transnational epistemic communities played important roles in the responses (Keller et al ; Baekkeskov , ). National pandemic response decisions thus overrode international isomorphic pressures, including the threat itself and efforts to streamline policies.…”

“…An H5N1 ‘avian’ influenza emerged in 1997 and proved fatal to 60 per cent of known cases (WHO ). Public health agencies feared that mutations of H5N1 would generate pandemics (Keller et al ; MacPhail ; Lakoff ). In contrast, pandemic influenzas in 1957 and 1968 killed relatively few people.…”

“…Analyses of the 2009 H1N1 vaccination policies show how sharp response divergences can arise. Recent work on 2009 H1N1 argues that responses prepared for H5N1‐type flu were implemented by some expert health authorities because ‘retooling’ in the midst of the crisis was too costly (Keller et al ; MacPhail , p. 124). This article analyses four explanations from political studies of crisis management, drug policy and epidemic response (Baldwin ; Boin et al ; Colgrove ; Vallgårda ; Boin et al ; Healy and Malhorta ; Reeves ; Meijer et al ).…”

Interactive use of simulation models for collaborative knowledge construction

“…It emphasizes the ongoing learning process of participants in at times disturbed, uncertain and high-tempo environments (Keller, Ansell et al 2012). Collaborative knowledge construction is to a large extent measurable through real-time observation, which helps us to assess the influence of interactive models on decision-making.…”