Influenza Pandemic Strategic Plan

Objectives

The Third Edition of the Influenza Pandemic Strategic Plan provides Taiwan’s national framework for influenza pandemic preparedness and response, aligning national arrangements with World Health Organization pandemic phases and guidance while adapting measures to domestic conditions. It treats pandemic influenza as a national security issue and seeks flexible, all-hazards, whole-of-society action that is legally grounded, ethical, proportionate and respectful of human rights.[1][2][3][4]

• Strengthen surveillance and assessment to detect international and domestic threats, characterise viruses, identify unusual clusters, assess interventions and monitor epidemic impacts.[3][5][6][7]
• Prevent imported infections and interrupt transmission through border measures, hygiene promotion, isolation, quarantine, social distancing, community controls and, where necessary, travel restrictions or cordon sanitaire.[3][8][9][10]
• Reduce health, social and economic harm through timely treatment, antivirals, vaccination, personal protective equipment, resilient health-care services and public risk communication.[3][11][12][13][14]
• Support social, economic and psychological recovery after a pandemic, including post-pandemic evaluation, continued surveillance for subsequent waves and sharing of lessons learned.[3][15][16]

The plan is organised around nine operational strategies: surveillance, transmission interruption, border control, manpower mobilisation, antivirals, vaccines, personal protective equipment, health-care preparedness and risk communication.[17][15]Its principal response framework also identifies surveillance and assessment, interruption of transmission, antivirals and influenza vaccination as four major strategies, delivered through five lines of defence: containment abroad, border control, community epidemic control, maintenance of medical-system functions, and individual and family protection.[5][8]

Preparedness and response are phased across preparedness phases 1 to 3, phase 4, phases 5 to 6, post-peak and post-pandemic periods, enabling measures to intensify as epidemiological risks and service pressures change.[16]The plan aims to sustain core capacities between pandemics, including annual seasonal influenza vaccination, stockpiles, medical-network readiness, training, exercises, communication infrastructure and community preparedness.[4][18][16]

Implementation

Implementation uses centrally coordinated, locally delivered pandemic management. The Executive Yuan coordinates cross-sectoral action; the Department of Health leads strategy planning, preparedness supervision, stockpiling, training and exercises; and local governments develop context-specific plans and implement response measures.[5]When risks escalate, the Department of Health may seek approval to establish the Central Epidemics Command Center, which coordinates decisions and allocates personnel, equipment and other resources.[5]

• Operate integrated surveillance covering international outbreaks, incoming passengers, institutions, schools, emergency departments, outpatient influenza-like illness, deaths, notifiable diseases, symptoms, virus activity and laboratory findings.[6][7]
• Use contracted laboratories and more than 200 sampling sentinels to collect, isolate and type influenza viruses weekly, including monitoring antiviral resistance and sharing relevant virus information domestically and internationally.[7]
• Manage borders through travel advice and alerts, passenger health declarations, fever screening, quarantine, diagnostic assessment, case reporting, contact tracing and restrictions proportionate to the epidemic situation.[19][20][21]
• Apply transmission-control measures progressively, from personal hygiene, staying home when ill, masking and patient isolation to contact quarantine, gathering controls, school closures, sheltering, rapid containment and movement restrictions when necessary and feasible.[9][22][10]
• Mobilise medical staff through inter-hospital assistance, local rosters, retired personnel, volunteers and primary health-care resources, while using community volunteers to disseminate information, identify needs, support isolated households and maintain social order.[21][23]
• Maintain and distribute diverse antiviral stockpiles, including arrangements for urgent importation, hospital and local-authority supply, prophylaxis, treatment, rapid containment and expiry monitoring.[23][11]
• Secure pandemic vaccine access through stockpiling, urgent procurement, advance purchase agreements, expedited authorisation and vaccination priorities adjusted to epidemiological information, supply and disease burden.[18][12]
• Maintain three-tier personal protective equipment stockpiles across central and local health authorities and medical facilities, supported by inventory systems, stock rotation, emergency release, production expansion and anti-hoarding enforcement.[24][25]
• Scale health-care delivery from negative-pressure isolation and designated hospitals to cohorting, additional isolation sites, home self-care for mild illness, triage clinics, patient transfer and emergency medical-network support.[26][13][27]
• Deliver risk communication through media briefings, websites, hotlines, social networks, workplace channels, professional associations and two-way public feedback mechanisms.[27][14][17]

Local authorities are expected to allocate budgets, establish inter-agency mobilisation arrangements, manage medical resources, stockpile essential logistics, supervise hospital infection control and assess community organisations for mobilisation.[5]The source does not specify consolidated budget totals, costed allocations, a comprehensive indicator set, reporting timetable or independent accountability framework.[3][5]

Monitoring is nonetheless embedded in operational systems: surveillance data inform warnings and intervention assessment; selected reporting frequency increases after domestic cases emerge; personal protective equipment and antiviral distribution are tracked through management information systems; and forcible travel restrictions or border closures are reviewed within three months.[6][7][19][18][24]The plan is updated every one or two years, subject to Executive Yuan review and ratification, with response guidelines issued when required.[3]

Monitoring & Evaluation

Monitoring and evaluation centre on integrated surveillance, operational reporting, periodic review and use of findings to adjust pandemic-control measures; however, no consolidated national indicator framework, quantified targets, standard reporting timetable or independent accountability mechanism is specified.[3][5][17][15]

• Monitor international epidemic developments, domestic virological findings, mild and severe cases, clusters, incoming passengers and epidemic trends to enable early detection and limit spread.[1][3][6]
• Operate domestic surveillance across populous institutions, schools, emergency departments, outpatient influenza-like illness services, deaths, notifiable diseases, symptoms and virus activity.[6]
• Require immediate reports from populous institutions within 24 hours when criteria are met, collect weekly reports from participating schools, and obtain daily influenza-like illness data from more than 100 hospital emergency departments and the National Health Insurance outpatient system.[6]
• Monitor pneumonia and influenza mortality through the death-reporting network and periodically publish surveillance findings through Taiwan Influenza Express.[6]
• Increase selected surveillance-reporting frequencies after domestic cases emerge to track epidemic trends and assess interventions.[6]
• Use contracted virus laboratories and more than 200 sampling sentinels to collect, isolate and type influenza viruses weekly, including surveillance of antiviral resistance.[7]
• Use virological evidence to guide clinical treatment, vaccination policy, vaccine development and assessment of epidemic progression.[7]
• Investigate unusual clusters, abnormal clinical symptoms, infection routes, sources, contacts, virus characteristics and mutation trends, using findings to revise reporting criteria and control measures where appropriate.[5][8][7]
• Register case-investigation information through the Centres for Disease Control communicable epidemic investigation system and link it with symptom, notifiable-disease, voluntary-quarantine and home-self-care systems.[7]
• Update influenza virus information and interpretation weekly on the Centres for Disease Control website, update international influenza sequence databases regularly, and submit representative sequences to the National Center for Biotechnology Information GenBank.[7]
• Stop individual case sampling and investigation when the Central Epidemic Command Center judges that case volumes make individual investigations unhelpful for surveillance.[7]
• Monitor and report arriving passengers, conduct health screening and diagnostic assessment, and use local-government follow-up, specimen collection and health monitoring for contacts.[8][20]
• Review forcible travel restrictions and border closures within three months of implementation against epidemic conditions, necessity and feasibility before further announcement.[19]
• Supervise local preparedness, organise training and drills when necessary, and update the plan every one or two years subject to Executive Yuan review and ratification.[3][5]
• Manage antiviral delivery, returns, dosages, safety stockpiles, dispatch and dispensing through the influenza antivirals subsystem of the Management Information System.[18]
• Monitor expired antiviral stock continuously and use testing and pharmaceutical-administration requirements to determine whether supplies can be extended, substituted during shortages or destroyed.[11]
• Track personal protective equipment procurement, delivery, storage, release and replenishment through the Management Information System of Materials for Communicable Disease Control, supported by regular inspections and first-in, first-out stock rotation.[24][25]
• Use public feedback, opinion polls, hotline service-quality verification, website updates and workplace exercises to identify communication gaps, amend procedures and verify business-continuity arrangements.[27][14]
• Evaluate pandemic characteristics, monitoring tools and interventions after the pandemic, assess the health-system response and share lessons learned.[15][16]

Costing & Financing

Financing arrangements are largely unquantified: the plan identifies preparedness funding, local budget responsibilities, government procurement and stockpiling mechanisms, but does not specify programme budgets, unit costs, funding gaps, total allocations or broader economic assumptions.[3][5][23][11]

• Use the National Influenza Pandemic Preparedness Plan as the basis for requisitioning preparedness funding, while requiring local governments to allocate budgets within their preparedness and response plans.[3][5]
• Maintain national stockpiles of vaccines, antivirals and personal protective equipment, alongside local stockpiles of essential logistics and medical supplies.[5][24][25]
• Support antiviral preparedness through government procurement and stockpile maintenance, government-subsidised medicines, private-sector donations and National Health Insurance distribution.[23][11]
• Use advance purchase agreements with vaccine manufacturers to secure future supply, reduce reliance on pandemic-period purchasing and reduce the quantity of pre-pandemic vaccine requiring stockpiling.[12]
• Procure vaccine bulk to save costs and storage space, while allowing for repackaging, examination and inspection before use.[18]
• Consider separate stockpiling of vaccine adjuvants and antigens as a potential budget-saving measure, subject to compatibility and inspection requirements.[18][12]
• Mobilise medical personnel, community volunteers, emergency supplies, hospital capacity, equipment, medicines and logistics support, but without quantified resource-mobilisation targets or monetary allocations.[2][21][26][13]
• Expand supply during serious personal protective equipment shortages through domestic production, foreign sourcing, accelerated customs clearance, temporary tariff reductions and Ministry of National Defense production facilities.[25]
• Recognise qualitative efficiency gains from consolidating preparedness planning for disasters with shared characteristics, without providing a quantified economic assessment.[6]
• Identify regular travel-health information dissemination as potentially cost-effective, without providing a quantified analysis.[19]
• Require additional resources and personnel when pandemic-related public enquiries increase, without a monetary estimate.[27]
• Record the publication price of the Third Edition, published in July 2012, as 900 New Taiwan dollars; this is a publication charge rather than a pandemic-response budget.[16]