Influenza Pandemic Strategic Plan

Objectives

Taiwan’s Third Edition Influenza Pandemic Strategic Plan provides an all-hazards, whole-of-society framework for preparedness, response, control and recovery, informed by World Health Organization pandemic phases, national experience of the 2009–2010 H1N1 pandemic, and ethical and human-rights principles.[1][2][3]Its overarching goals are to sustain surveillance, prevent or contain imported novel influenza, reduce health harm through treatment and public-health interventions, preserve essential social and medical functions, and support social, economic and psychological recovery.[4][2][3]

• Organise action through five lines of defence: containment abroad, border control, community epidemic control, maintenance of medical-system functions, and individual and family protection.[5][2]
• Maintain surveillance across preparedness and response stages to identify international and domestic threats, unusual clusters, clinical changes, viral evolution and epidemic trends, and to support warnings and assessment of control measures.[4][5][6]
• Interrupt transmission through hygiene promotion, respiratory etiquette, staying home when ill, patient isolation, contact quarantine, social distancing, limits on gatherings, school measures, public-place closures and transport infection-control measures where justified by epidemiological conditions.[7][8][9]
• Contain early clusters through defined containment and buffer zones, intensified surveillance, antiviral treatment and prophylaxis, vaccination where appropriate, movement controls and social-distancing interventions.[10][11][12][13]
• Protect travellers and communities through international cooperation, epidemic information sharing, travel health advice and alerts, arrival screening, symptom declarations, contact management, and evidence-based restrictions or border measures when necessary.[2][14][15][16]
• Maintain access to antivirals, vaccines and personal protective equipment, prioritising treatment, prophylaxis and vaccination according to epidemic conditions, exposure risk, disease burden, vaccine availability and the need to sustain essential functions.[17][11][12][13]
• Preserve health-care capacity through infection prevention and control, triage, isolation, designated treatment arrangements, expanded local facilities, home self-care for mild illness, and support for offshore islands and remote areas.[18][19][20]
• Communicate clear and timely risk information to the public, health professionals, media, businesses and communities, while using volunteers and civic organisations to support prevention, feedback, supplies and households affected by control measures.[21][20][22][23]
• Apply measures lawfully, proportionately, equitably and without discrimination, treating compulsory restrictions as a last resort and considering ethical issues in the allocation of vaccines, antivirals, treatment and other scarce resources.[2][3][8][10]

Implementation

Implementation is phase-based rather than reliant on a separate domestic pandemic-phase system, allowing measures to be adapted to changing epidemic conditions.[1][23]Preparedness is treated as a national-security and cross-sectoral responsibility: the Executive Yuan provides overarching coordination, the Department of Health develops strategy and central preparedness arrangements, and local governments implement plans, mobilise local resources and lead local response operations.[4][5]

• Convene Executive Yuan cross-sectoral mechanisms to mobilise ministries and resolve critical issues, and establish the Central Epidemics Command Center when escalating risk requires central coordination of resources, equipment and personnel.[4][5]
• Require local governments to prepare response plans and budgets, manage medical and logistics resources, conduct surveillance, supervise hospital infection control, mobilise agencies and volunteers, and establish local command centres during a pandemic.[5][21]
• Operate surveillance through institutional, school, emergency-department, mortality, notifiable-disease and symptom reporting, supported by contracted laboratories, case investigation and virus sequencing or reference-laboratory procedures.[6][7]Relevant institutions report within 24 hours, participating schools report weekly, and sentinel systems provide influenza samples for virus characterisation and antiviral-resistance assessment.[6]
• Use the Central Epidemic Command Center to determine major interventions, including nationwide contact restrictions, rapid containment, public-place closures, travel restrictions and exceptional cordon sanitaire measures.[8][9][10][14]Review compulsory travel restrictions or border closures within three months against their necessity and feasibility.[14]
• Coordinate border operations among health, foreign affairs, consular, immigration, carrier and local-government actors, including fever screening, passenger assessment, reporting by international carriers, diagnostic testing, isolation, and contact follow-up.[14][15][16]
• Maintain diversified antiviral stocks, including neuraminidase inhibitors, pre-position supplies with hospitals and local health authorities, distribute medicines through the national health insurance system during a pandemic, and manage stock, dispatch and dispensing through an information subsystem.[17][11]
• Prepare pandemic vaccines through advance purchasing, pre-pandemic stockpiling, expedited approval or importation, inspection, vaccination exercises and revision of priority groups as epidemiological evidence and supply change.[11][12]
• Maintain a three-tier personal protective equipment stockpile across central authorities, local authorities and medical facilities, supported by inventory monitoring, stock rotation, unified procurement, emergency release, domestic production and foreign procurement during shortages.[13][24]
• Expand clinical capacity progressively from negative-pressure isolation and response hospitals to cohorting, designated isolation sites, home self-care and patient transfer through medical networks, including aeromedical transport where required.[18][19][20]
• Deliver risk communication through dedicated websites, professional networks, media engagement, social media, text messages, hotlines, polling and workplace continuity planning, with training for communication personnel and health professionals.[20][22][23]
• Monitor epidemic conditions, intervention effectiveness, medical access, triage, infection control, stockpile adequacy and antiviral resistance, and share lessons after the pandemic.[23][25]The available material does not specify a consolidated quantitative indicator framework, routine reporting timetable, numerical preparedness targets or a pandemic-response budget.[4][5][23][25]

Monitoring & Evaluation

Monitoring and evaluation combine multi-channel surveillance, operational information systems, periodic review and post-pandemic learning. Surveillance is intended to detect domestic and international epidemic trends early, assess viral characteristics and transmission, guide warnings and control measures, and evaluate the effects of interventions.[4][5][6][23]

• Maintain surveillance across international epidemic conditions, incoming-passenger health, domestic trends, notified disease, symptoms, mortality, clusters, mild and severe cases, laboratory-confirmed virus activity, and antiviral resistance.[4][3][6]
• Use reporting systems that include populous institutions, participating schools, more than 100 hospital emergency departments, notifiable-disease reporting, symptom surveillance and contracted virus laboratories.[6]
• Require relevant institutions to report within 24 hours, participating schools to report weekly, emergency departments to report daily, and more than 200 sentinel sites to submit influenza samples weekly for virus isolation, typing and resistance assessment.[6]
• Conduct case investigations through local health authorities and the Centers for Disease Control communicable epidemic investigation system, linked with symptom, notifiable-disease, voluntary-quarantine and home self-care systems.[7]
• Use virus examination, strain data and resistance findings to support clinical treatment, vaccination policy, vaccine development and assessment of epidemic development.[6]
• Publish periodic surveillance information through Taiwan Influenza Express, update virus information and interpretations weekly on the Centers for Disease Control website, and share representative viral sequences with international genetic databases and the National Center for Biotechnology Information GenBank.[6][7]
• Monitor antiviral stability near expiry and use test results and pharmaceutical regulations to decide whether supplies can be extended, used during shortages, released before expiry or destroyed.[17]
• Track personal protective equipment procurement, delivery, storage, release and replenishment through the Management Information System of Materials for Communicable Disease Control, adjusting stock levels to usage, safety needs and epidemic development.[13][24]
• Assess vaccine priorities using epidemiological information, vaccine availability and disease burden, while inspecting antigens, adjuvants and repackaged vaccines and maintaining safety during expedited approval.[11][12]
• Monitor quarantine health status, clinical symptoms, virus characteristics and communicability to determine isolation duration and related control decisions.[8]
• Review compulsory travel restrictions or border closures within three months of implementation, reassessing necessity and feasibility against the epidemic situation.[14]
• Assess passenger symptoms and temperature screening results to determine reporting, diagnosis, follow-up, treatment or quarantine measures.[14]
• Collect public feedback through hotlines, correspondence, media disclosures and opinion polls, using findings on knowledge, attitudes and practices to amend procedures and inform policy assessment.[20][22]
• Require businesses to test and amend pandemic business-continuity plans through exercises.[22]
• Review preparedness through Executive Yuan cross-sectoral meetings, Department of Health supervision of local governments, advisory consultation, training and drills where necessary.[4]
• Evaluate health-care access, triage, infection control, stockpile effectiveness, antiviral resistance, pandemic characteristics and health-system performance, and share lessons after the pandemic.[23][25]

Accountability is principally exercised through the Executive Yuan, the Department of Health, the Central Epidemic Command Center and local governments. Local authorities implement central policy, undertake surveillance and contact follow-up, oversee hospital infection control, manage local command arrangements, and inspect isolation-site resources.[4][5][16][19]The supplied material does not provide a consolidated quantitative indicator framework, routine public reporting timetable, audit process, performance targets or comprehensive evaluation methodology.[4][5][18][19]

Costing & Financing

Financing detail is limited. The plan identifies substantial resource requirements for preparedness and response, including stockpiles, healthcare capacity, personnel, logistics, communications, surveillance and emergency procurement, but does not provide a pandemic budget, expenditure total, financing plan, funding gap, costing methodology or quantified economic assumptions.[4][5][23][25]

• Allocate local government budgets for preparedness and response, alongside responsibilities for logistics stockpiling, medical-resource management, surveillance, workforce mobilisation and local response arrangements.[5]
• Maintain government stockpiles of vaccines, antivirals, personal protective equipment and essential logistics, and mobilise resources, equipment and staff through central and local command structures.[4][5]
• Procure and maintain diversified antiviral stocks, distribute medicines through the national health insurance system during a pandemic, and release government-subsidised supplies if manufacturers cannot meet demand.[17]
• Use advance vaccine purchase agreements, pre-pandemic stockpiles and expedited procurement when available vaccine strains do not match the pandemic virus or contracted supplies are insufficient.[11][12]
• Use bulk procurement of pre-pandemic vaccine to save cost and storage space, and consider separate antigen and adjuvant stockpiles because longer-lived adjuvants may reduce the total budget.[11][12]
• Maintain central, local, medical-facility and household personal protective equipment supplies, replace expired inventory, and expand domestic production, foreign procurement and customs clearance during serious shortages.[13][24]
• Temporarily reduce import tariffs for personal protective equipment during serious supply shortages and investigate hoarding or price-gouging to stabilise supply and prices.[24]
• Consider staffing, material, hardware and software resources before establishing airport or seaport facility quarantine, and mobilise reserve medical staff through hospitals, local-government rosters, retired personnel, volunteers and primary-care settings.[16]
• Provide additional medical personnel, equipment and logistical support to offshore islands and remote localities through the Communicable Disease Control Medical Network.[20]
• Recognise that pandemic preparedness can consolidate disaster planning and potentially save time, money and manpower, although no quantified assessment is supplied.[3]

Economic effects are recognised through the potential for disruption to society, the economy and health services.[26][4]Compensation is referenced for designated or expropriated facilities, but no compensation amount is specified.[18][19]The publication price is listed as 900 New Taiwan dollars; this is a publication charge rather than a pandemic-response budget.[25][27]