Public Health Policy and Experience of the 2009 H1N1 Influenza Pandemic in Pune, India

Abstract

Background: Prior experience and the persisting threat of influenza pandemic indicate the need for global and local preparedness and public health response capacity. The pandemic of 2009 highlighted the importance of such planning and the value of prior efforts at all levels. Our review of the public health response to this pandemic in Pune, India, considers the challenges of integrating global and national strategies in local programmes and lessons learned for influenza pandemic preparedness. Methods: Global, national and local pandemic preparedness and response plans have been reviewed. In-depth interviews were undertaken with district health policy-makers and administrators who coordinated the pandemic response in Pune. Results: In the absence of a comprehensive district-level pandemic preparedness plan, the response had to be improvised. Media reporting of the influenza pandemic and inaccurate information that was reported at times contributed to anxiety in the general public and to widespread fear and panic. Additional challenges included inadequate public health services and reluctance of private healthcare providers to treat people with flu-like symptoms. Policy-makers developed a response strategy that they referred to as the Pune plan, which relied on powers sanctioned by the Epidemic Act of 1897 and resources made available by the union health ministry, state health department and a government diagnostic laboratory in Pune. Conclusion: The World Health Organization’s (WHO’s) global strategy for pandemic control focuses on national planning, but state-level and local experience in a large nation like India shows how national planning may be adapted and implemented. The priority of local experience and requirements does not negate the need for higher level planning. It does, however, indicate the importance of local adaptability as an essential feature of the planning process. Experience and the implicit Pune plan that emerged are relevant for pandemic preparedness and other public health emergencies.

Health system preparedness for emerging infectious diseases: A synthesis of the literature

“…WHO reporting requirements clear and applied (Garcia Serpa Osorio-de- Castro et al, 2017;Qiu et al, 2018;Wilson et al, 2010) . Risk-communication strategy available and implemented (Espinal et al, 2016;Garcia Serpa Osorio-de-Castro et al, 2017;Jacobsen et al, 2016;Lapao et al, 2015;Li et al, 2016;McPake et al, 2015;Purohit et al, 2018;Qiu et al, 2018;Siekmans et al, 2017;Stoto et al, 2013) (Continued ) (Bhatnagar et al, 2016;Boozary et al, 2014;Cancedda et al, 2016;Mulinge & Soyemi, 2016;Regmi et al, 2015;Siekmans et al, 2017) . Security protocols at reference hospitals (Cancedda et al, 2016;Lapao et al, 2015) .…”

“…Directory of reference laboratories and laboratory contact information (Balajee et al, 2016) . Media supportive of prevention and control efforts (Kaufman, 2008;Lapao et al, 2015;Li et al, 2016;McPake et al, 2015;Nyarko et al, 2015;Ozawa et al, 2016;Purohit et al, 2018;Qiu et al, 2018) . Community-led communications (especially women, leaders) (Buseh et al, 2015;Cancedda et al, 2016;Jacobsen et al, 2016;McPake et al, 2015;Nyarko et al, 2015;Ozawa et al, 2016;Regmi et al, 2015;Siekmans et al, 2017) .…”

“…(Gostin & Friedman, 2015) . National/subnational leadership (Cancedda et al, 2016;Kruk et al, 2015;McPake et al, 2015;Nyenswah et al, 2016;Purohit et al, 2018;Scott et al, 2016) . Regional/transnational cooperation (Cancedda et al, 2016;Gostin & Friedman, 2015;Scott et al, 2016) .…”

“…National-level coordination (Kaufman, 2008;Lapao et al, 2015;McPake et al, 2015;Thiam et al, 2015); subnational coordination (Kruk et al, 2015;Lapao et al, 2015;McPake et al, 2015;Stoto et al, 2013;Thiam et al, 2015) . Inter/multi-sectoral action for health (Kaufman, 2008;Purohit et al, 2018;Scott et al, 2016) . Coordination between Ministry of Health, migration services, and Ministry of Agriculture (Kaufman, 2008;Lapao et al, 2015) .…”

“…Coordination between Ministry of Health, migration services, and Ministry of Agriculture (Kaufman, 2008;Lapao et al, 2015) . Partnership and coordination between government and non-government organisations (Buseh et al, 2015;Cancedda et al, 2016;Espinal et al, 2016;Gostin & Friedman, 2015;Kaufman, 2008;Martineau, 2016;McPake et al, 2015;Nyarko et al, 2015;Nyenswah et al, 2016;Purohit et al, 2018;Regmi et al, 2015;Siedner et al, 2015;Stoto et al, 2013) . Engagement & partnerships with civil society (Buseh et al, 2015;Cancedda et al, 2016;Gostin & Friedman, 2015;Martineau, 2016;Regmi et al, 2015;Siedner et al, 2015;Thiam et al, 2015) .…”