National Influenza Pandemic Preparedness and Response Plan (NIPPRP)

Objectives

The National Influenza Pandemic Preparedness and Response Plan provides a flexible, risk-based, whole-of-government and whole-of-society framework to prepare for, respond to and recover from influenza pandemics and other emerging respiratory threats in Bhutan, reducing health, social and economic impacts while strengthening national resilience.[1][2][3]It is aligned with the Health Emergency and Disaster Contingency Plan 2024, World Health Organization guidance, the International Health Regulations (2005), regional pandemic frameworks and the Preparedness and Resilience for Emerging Threats framework.[3][4][5]

• Strengthen prevention, preparedness, response, recovery and restoration of routine health services through phased actions and defined triggers.[5][6]
• Improve real-time collaborative surveillance, risk assessment, laboratory diagnosis, genomic monitoring and early detection of influenza, severe acute respiratory infection and other respiratory pathogens.[3][7][8]
• Protect vulnerable groups through equitable access to vaccines, antivirals, treatments, clinical care, public health measures and social support.[3][9][10]
• Strengthen One Health collaboration across human, animal, wildlife and environmental health to address zoonotic and transboundary influenza threats.[11][4][12]
• Maintain flexible and equitable clinical care, healthcare surge capacity, infection prevention and control, and continuity of essential services during pandemic periods.[6][13][14]
• Protect communities through risk communication, community engagement, vaccination, isolation, quarantine and proportionate public health and social measures.[15][16][17]
• Embed equity, inclusiveness, evidence-informed decision-making, transparency, sustainability, non-discrimination, informed consent, privacy and protection of human rights as guiding principles.[18][19]
• Support recovery by restoring maternal and child health services, routine immunisation and other non-pandemic health services, while providing mental health and psychosocial support to health workers, patients and affected communities.[5]

Implementation

Implementation uses an Incident Command System and phased emergency-management model, combining national leadership, multisectoral coordination, district-level delivery, community participation and international cooperation.[20][21][22]The Ministry of Health leads health-sector action, while the National Task Force for Health Emergencies, chaired by the Prime Minister, makes high-level decisions and allocates resources; the Health Emergency Management Committee directs preparedness, response and recovery through the Health Emergency Operations Centre.[21][22]

• Activate the Health Emergency Operations Centre following specified national outbreak thresholds or a World Health Organization declaration of a Public Health Emergency of International Concern or pandemic.[22][9][23]
• Coordinate national action through the Ministry of Health, Royal Centre for Disease Control, Department of Public Health, Department of Clinical Services, Department of Livestock, Bhutan Food and Drug Authority, Ministry of Finance, local government, hospitals, Primary Health Centres and authorities at points of entry.[3][14]
• Deploy National and District Health Rapid Response Teams for case finding, contact tracing, outbreak investigation, risk assessment, field operations, reporting and control measures.[22][24]
• Establish technical, clinical, quarantine, mental health, risk communication, medical logistics, finance and operational logistics teams to provide specialist support to the Health Emergency Management Committee.[24][25][26]
• Use the tiered health-service network for outbreak response, referral and surge care, with national and regional referral hospitals supporting district hospitals and Primary Health Centres monitoring local respiratory illness trends.[27]
• Maintain strategic stockpiles and procurement arrangements for medicines, vaccines, antivirals, Personal Protective Equipment, diagnostics, ventilation support and other essential supplies, including emergency medical stores in Paro, Thimphu, Phuentsholing, Samdrup Jongkhar and Gelephu.[16][28][17]
• Deliver vaccination through the Expanded Programme on Immunization, prioritising vulnerable populations and supported by regulatory authorisation of medical countermeasures by the Bhutan Food and Drug Authority.[16]
• Implement surveillance through the National Early Warning Alert and Response Surveillance system, sentinel influenza-like illness and severe acute respiratory infection surveillance, points-of-entry monitoring, laboratory networks and One Health data sharing.[7][8][29]
• Submit severe acute respiratory infection data daily and influenza-like illness data weekly, publish epidemiological reports monthly and bulletins quarterly, and share relevant influenza data through FluNet, FluID and the Global Influenza Surveillance and Response System.[8]
• Conduct regular risk assessments, simulations, drills, preparedness assessments and plan reviews, using lessons from exercises, COVID-19 and emerging evidence to update actions.[20][2][6]
• Engage communities, civil society, businesses, educational institutions, religious leaders, media and international partners in awareness, misinformation management, social protection and continuity of essential services.[2][29][30]
• Mobilise financing through domestic disaster-financing arrangements, Ministry of Finance reimbursement mechanisms, annual budgeting, the General Reserve for Disaster Relief, international partners and potential rapid access to the South-East Asia Regional Health Emergency Fund and World Health Organization Contingency Fund for Emergencies.[31][32]
• Establish a dedicated contingency fund for influenza epidemics and outbreaks, with Ministry of Health guidance defining its establishment and eligible expenditure; no monetary target or quantified funding gap is specified.[32]

Monitoring & Evaluation

Monitoring and evaluation combine real-time, integrated human and animal health surveillance with risk assessment, laboratory confirmation, operational reporting, simulations and periodic plan revision. A five-year monitoring and evaluation framework under the Health Emergency and Disease Control Plan 2024 assigns responsibilities, collaborating agencies and timelines for reviewing pandemic and other health-emergency responses.[31]

• Operate the National Early Warning Alert and Response Surveillance system as a web-based and mobile short message service platform, combining indicator-based weekly and immediate reporting with event-based reporting of unusual events, clusters and outbreaks.[8]
• Maintain sentinel surveillance for influenza-like illness, severe acute respiratory infection, SARS-CoV-2, respiratory syncytial virus and other respiratory viruses, with daily severe acute respiratory infection reporting and weekly influenza-like illness reporting.[8]
• Publish disease epidemiology reports monthly and surveillance bulletins quarterly, share weekly sentinel reports with sites, the Ministry of Health, the World Health Organization country office and relevant sectors, and submit influenza surveillance data weekly to FluNet and FluID.[8]
• Expand surveillance during a pandemic to health centres and points of entry, including airports and land crossings, and use linked point-of-entry, laboratory, community and national surveillance data to detect cases, monitor variants, guide containment and inform resource allocation.[7][29]
• Strengthen diagnostic reliability through quality assurance, calibration, method validation, proficiency testing, laboratory supervision and staff training, led nationally by the Royal Centre for Disease Control as the National Influenza Reference Laboratory and World Health Organization-designated National Influenza Centre.[7][8]
• Monitor acute respiratory illness through weekly reporting from Primary Health Centres to district authorities, investigate unusual increases, and refer clinical samples through regional laboratories or the Public Health Laboratory for influenza and emerging pathogens.[27]
• Monitor animal-health risks through veterinary and livestock surveillance, biosecurity, food-safety regulation and commercial-farm monitoring, supported by One Health information sharing across human, animal, wildlife and environmental sectors.[11][12]
• Use ongoing risk assessments to track transmission, severity, healthcare capacity, vulnerable-population risks and emerging threats; apply the Pandemic Influenza Severity Assessment and Influenza Risk Assessment Tool to inform and adjust interventions.[15][33][13]
• Require outbreak teams to conduct case finding, contact tracing, field investigation, database management, rapid needs assessments, risk communication and regular reporting to the Health Emergency Management Committee or higher authorities.[24]
• Require clinical teams to maintain updates on cases, hospitalisations, recoveries and deaths, and report contingency-plan readiness and surge-capacity needs.[24]
• Maintain regular situation reports for the National Emergency Operations Centre, senior authorities and the National Task Force, alongside records of Health Emergency Management Committee meetings and daily media monitoring, rumour verification and official public-information updates.[26][15][10]
• Assess preparedness through checklists, simulations, mock drills and annual exercises, produce exercise reports, and use findings, lessons learnt and evolving evidence to update the National Influenza Pandemic Preparedness and Response Plan.[9][6][31]
• Monitor vaccination coverage and adverse events, continue pharmacovigilance, and use appropriate genomic and seroprevalence studies to strengthen response learning.[10][14]

Key performance indicators have been established, but the supplied material does not define a consolidated indicator set, targets, thresholds, reporting calendar, standard reporting templates, independent review process or comprehensive accountability matrix.[4][14][31]

Costing & Financing

Financing arrangements emphasise rapid emergency resource mobilisation, domestic disaster-financing mechanisms, international emergency funds, stockpiling and sustainable multi-year preparedness financing. No overall pandemic budget, costed action plan, quantified funding gap, allocation target or economic modelling assumption is provided.[10][31][32]

• Mobilise resources through the Ministry of Health from local health facilities, international partners and non-governmental organisations, supported by periodically updated inventories of supplies, equipment and personnel and pre-agreements with suppliers for quality-assured emergency procurement.[32][34]
• Use national disaster-financing arrangements under the Disaster Management Act 2013 and the Operational Guidelines for Disaster Financing 2017 to support response, relief, infrastructure restoration, capacity building and recovery.[31]
• Access the South-East Asia Regional Health Emergency Fund within 24 hours when a state of emergency is declared, external assistance is requested formally and a humanitarian coordinator is appointed; seek additional rapid and flexible support from the World Health Organization Contingency Fund for Emergencies.[31]
• Require the National Disaster Management Authority and Ministry of Finance to ensure resources, with the Ministry of Finance reimbursing actual eligible response and relief expenditure under applicable arrangements.[31]
• Incorporate recovery and reconstruction needs into normal planning and annual budgets after comprehensive damage assessment, with the Department of Planning, Budget, and Performance able to allocate General Reserve for Disaster Relief resources to requesting agencies.[32]
• Establish a dedicated contingency fund for influenza epidemics and outbreaks, with Ministry of Health guidance to define its establishment and eligible expenditure.[32]
• Develop sustainable financing mechanisms and multi-year budgets, together with arrangements for rapid disbursement during pandemics that enable flexible resource use while reducing the risk of misuse.[10]
• Map available resources and supply systems, and assess requirements for facilities, trained personnel, equipment, personal protective equipment, laboratory reagents, medicines, vaccines, antivirals, diagnostics, transport and surge capacity.[10][12]
• Maintain strategic stocks of medicines, vaccines, personal protective equipment and other medical supplies at emergency medical stores in Paro, Thimphu, Phuentsholing, Samdrup Jongkhar and Gelephu.[28]

Resource needs also include healthcare infrastructure, staffing, field hospitals, logistics, social support for affected people and businesses, and restoration of essential services; however, their costs, financing sources and funding gaps are not quantified.[23][30][32]