pH1N1 - a comparative analysis of public health responses in Ontario to the influenza outbreak, public health and primary care: lessons learned and policy suggestions

Abstract

BackgroundOntario’s 36 Public Health Units (PHUs) were responsible for implementing the H1N1 Pandemic Influenza Plans (PIPs) to address the first pandemic influenza virus in over 40 years. It was the first under conditions which permitted mass immunization. This is therefore the first opportunity to learn and document what worked well, and did not work well, in Ontario’s response to pH1N1, and to make recommendations based on experience.MethodsOur objectives were to: describe the PIP models, obtain perceptions on outcomes, lessons learned and to solicit policy suggestions for improvement. We conducted a 3-phase comparative analysis study comprised of semi-structured key informant interviews with local Medical Officers of Health (n = 29 of 36), and Primary Care Physicians (n = 20) and in Phase 3 with provincial Chief-Medical Officers of Health (n = 6) and a provincial Medical Organization. Phase 2 data came from a Pan-Ontario symposium (n = 44) comprised leaders representing: Public Health, Primary Care, Provincial and Federal Government.ResultsPIPs varied resulting in diverse experiences and lessons learned. This was in part due to different PHU characteristics that included: degree of planning, PHU and Primary Care capacity, population, geographic and relationships with Primary Care. Main lessons learned were: 1) Planning should be more comprehensive and operationalized at all levels. 2) Improve national and provincial communication strategies and eliminate contradictory messages from different sources. 3) An integrated community-wide response may be the best approach to decrease the impact of a pandemic. 4) The best Mass Immunization models can be quickly implemented and have high immunization rates. They should be flexible and allow for incremental responses that are based upon: i) pandemic severity, ii) local health system, population and geographic characteristics, iii) immunization objectives, and iv) vaccine supply.Conclusion“We were very lucky that pH1N1 was not more severe.” Consensus existed for more detailed planning and the inclusion of multiple health system and community stakeholders. PIPs should be flexible, allow for incremental responses and have important decisions (E.g., under which conditions Public Health, Primary Care, Pharmacists or others act as vaccine delivery agents.) made prior to a crisis.

Enhancing Reporting of After Action Reviews of Public Health Emergencies to Strengthen Preparedness: A Literature Review and Methodology Appraisal

“…The reviews covered national and international responses to the 2009 A(H1N1) influenza pandemic (n = 8), [21][22][23][24][25][26][27][28] terrorist bombing incidents (n = 5), [29][30][31][32][33] industrial explosions (n = 6), [34][35][36][37][38][39] hurricanes (n = 2), 40 , 41 chemical contamination of drinking water (n = 1), 42 a heat wave (n = 1), 43 and largescale flooding (n = 1) (see Table 1). 44…”

“…Validity boosting measures most frequently reported in the 24 reviews included spending adequate time to observe the setting, people, and incident documentation; sampling a diverse range of views; using multiple sources of data collection; and utilizing multiple perspectives during the analysis 21 44 However, these techniques were generally reported in brief, with few reviews fully meeting all 4 basic validity dimensions.…”

European Civil Security Governance

“…Here, the 'openness and inclusiveness in institutional processes and constructive interactions' (Schmidt, 2013, p. 8) are particularly important. A survey conducted in Canada in the aftermath of the H1N1 pandemic revealed that -although there was not any single best model of how to handle the crisis -the comprehensive planning, the involvement of multiple stakeholders and communication (both among the official bodies as well as with the general public) were crucial to address the crisis successfully (Masotti et al, 2013). Similarly, the literature on disaster management stresses also the inclusion of various stakeholders and both internal and external distribution of information as factors crucial for success (Harrald, 2006;Moe and Pathranarakul, 2006;Fitzgerald et al, 2012;Schemann et al, 2012).…”

Organization of Primary Health Care in pandemics: a rapid systematic review of the literature in times of COVID-19

“…At the beginning of the epidemic, it was common for health professionals and the population to face deficiency or an excess of information about the problem, coming from the most varied institutions and through the most diverse channels. In general, these studies show that such plans must be as operational as possible, focusing on what is especially necessary to be done in the health service that directly impacts the quality of care offered, with the greatest possible safety for users and professionals [14][15][16]19 .…”

“…Some studies, especially those from fragmented systems in developed countries [14][15][16] , show that healthcare workers can receive contradictory or redundant messages from different sources: their own institutions, local and national health authorities, media and scientific literature.…”