National Influenza Pandemic Preparedness and Response Plan (NIPPRP)

Objectives

Bhutan’s National Influenza Pandemic Preparedness and Response Plan provides an adaptable national framework to prevent, prepare for, respond to and recover from influenza pandemics and other respiratory or zoonotic health threats. It aims to reduce mortality, illness, health-service disruption and wider social and economic harm, while sustaining essential services and supporting recovery.[1][2][3]The framework aligns with the World Health Organization Pandemic Influenza Preparedness Framework, the Preparedness and Resilience for Emerging Threats framework, International Health Regulations (2005), and Bhutan’s Health Emergency and Disaster Contingency Plan 2024.[4][5][6][7]

• Strengthen early detection, risk assessment, integrated surveillance, laboratory diagnosis and rapid outbreak response for influenza, severe acute respiratory infections and emerging respiratory pathogens.[7][8][9]
• Protect communities through equitable access to vaccines, antivirals, diagnostics, treatment, public-health information and social support, with particular attention to vulnerable and difficult-to-reach populations.[7][10][11]
• Build resilient health services through scalable clinical care, surge capacity, workforce development, infection prevention and control, medical countermeasures and continuity of routine health services.[7][12][13]
• Apply a One Health approach that integrates human, animal, wildlife and environmental health to address zoonotic threats, including highly pathogenic avian influenza.[14][6][8]
• Uphold equity, inclusion, non-discrimination, transparency, accountability, informed consent, privacy, human rights, evidence-informed decision-making and continuous learning throughout pandemic management.[15][16]
• Adapt measures to pathogen transmission, severity, affected populations, health-system capacity and societal impact, rather than relying solely on fixed pandemic phases.[5][17][18]

Implementation

Implementation follows a whole-of-government and whole-of-society model led by the Ministry of Health, combining national command arrangements, decentralised delivery, community participation, cross-border cooperation and international technical collaboration.[1][2][19]The plan uses an Incident Command System and Health Emergency Operations Centre arrangements to coordinate preparedness, response and recovery at national, regional, district, Dzongkhag and Thromde levels.[20][18][3]

• Coordinate high-level decisions through the National Task Force, chaired by the Prime Minister, while the Health Emergency Management Committee leads health-sector command, control and coordination through the Health Emergency Operation Centre.[18][21]
• Deploy Technical Advisory Groups, national and district Rapid Response Teams, outbreak investigation teams and clinical management teams to provide specialist advice, conduct risk assessments, investigate outbreaks, manage cases and support overwhelmed districts.[21][22]
• Deliver services through referral hospitals, district hospitals, Primary Health Centres, sub-posts, Thromde Health Centres, regional laboratories and the Royal Centre for Disease Control, which serves as the National Influenza Reference Laboratory and World Health Organization-designated National Influenza Centre.[23][24][25]
• Strengthen collaborative surveillance through the National Early Warning Alert and Response Surveillance system, influenza-like illness and severe acute respiratory infection sentinel surveillance, laboratory confirmation, genomic sequencing, points-of-entry data and One Health information-sharing.[9][26]
• Maintain regular surveillance reporting, including weekly influenza-like illness data, daily severe acute respiratory infection data, monthly epidemiological reports and quarterly bulletins, to identify trends, assess severity and trigger action.[9]
• Prepare health facilities for surges by assessing beds, intensive-care units, ventilators, oxygen, staffing, supplies and alternative care sites; reallocate personnel and resources; and use referral pathways to redistribute patients.[12][27][11]
• Maintain strategic stocks and procurement arrangements for vaccines, antivirals, essential medicines, personal protective equipment, diagnostics, consumables and ventilation support, including pre-agreements with suppliers and mapped supply systems.[28][29][30]
• Implement public-health and social measures proportionately, including testing, isolation, contact tracing, quarantine, hygiene, mask use, physical distancing, risk communication and measures at points of entry.[18][31][32]
• Engage local authorities, communities, civil-society organisations, media, religious figures, businesses, volunteers and community health workers in trusted communication, misinformation management, vaccination uptake, home-based support and continuity of essential services.[19][11]
• Test readiness through annual simulations, drills, preparedness checklists and operational reviews, and use lessons from exercises, influenza outbreaks and COVID-19 to revise the plan and response procedures.[10][13][33]
• Coordinate preparedness with animal-health, agriculture, environment, wildlife, border-security, education, finance, transport, water and sanitation sectors, alongside the World Health Organization, neighbouring countries and other international partners.[14][19][26]
• Mobilise emergency resources through national disaster-financing arrangements, district annual budgets, international emergency mechanisms and a proposed dedicated contingency fund; the source does not specify a quantified pandemic budget or funding gap.[33][30]

Monitoring & Evaluation

Monitoring and evaluation combine integrated respiratory and One Health surveillance, routine reporting, risk assessment, simulation exercises and post-event learning to guide adaptive pandemic action.[9][13][33]

• Maintain real-time surveillance through the National Early Warning Alert and Response Surveillance system, influenza-like illness and severe acute respiratory infection sentinel sites, laboratory testing, genomic sequencing, points-of-entry information and event-based reporting.[25][9][26]
• Report weekly influenza-like illness data and daily severe acute respiratory infection data from sentinel sites, publish National Early Warning Alert and Response Surveillance epidemiological reports monthly and quarterly bulletins, and share weekly surveillance reports with the Ministry of Health, World Health Organization and relevant sectors.[9]
• Submit daily or weekly situation reports to the National Task Force during response periods, including information on cases, hospitalisations, recoveries, deaths, quarantine capacity and compliance, supply inventories and emergency expenditure.[34][35][29]
• Conduct outbreak investigation, case-finding, contact tracing, laboratory referral, field risk assessment and follow-up reporting through rapid response, surveillance and district health teams.[24][22]
• Use surveillance and risk-assessment findings to monitor transmission, severity, healthcare capacity, vulnerable populations, emerging variants and intervention effectiveness, and to adjust public-health and social measures, resource allocation and clinical response.[31][36][32]
• Apply the World Health Organization Influenza Pandemic Risk Assessment tool and Pandemic Influenza Severity Assessment framework, alongside national modelling and locally relevant epidemiological parameters, to inform operational decisions.[37][12][36]
• Monitor vaccination coverage and adverse events, supported by past coverage reporting for children and pregnant women, and continue pharmacovigilance during post-peak recovery.[5][29][38]
• Test readiness through at least annual simulation exercises, drills, operational reviews, preparedness checklists and seasonal outbreak analysis; use resulting reports and lessons from outbreaks to revise plans and procedures.[8][10][13]
• Use the Health Emergency and Disaster Contingency Plan 2024 monitoring and evaluation plan as a five-year framework assigning responsibilities, collaborating agencies and timelines for evaluating emergency and influenza-pandemic responses.[33]
• Support accountability through Health Emergency Management Committee oversight, technical advice, regular updates to senior authorities, transparent risk communication and legal provisions addressing non-compliance with health measures.[6][21][22]

Although the framework calls for key performance indicators and identifies substantial surveillance and reporting arrangements, the supplied material does not provide a consolidated indicator set, target values, comprehensive evaluation methodology, independent audit mechanism or a single reporting timetable across all plan components.[6][9][13]

Costing & Financing

Financing arrangements emphasise sustainable preparedness, rapid emergency disbursement, resource mapping, stockpiling and coordinated mobilisation, but the supplied material gives no overall pandemic-plan budget or quantified funding gap.[29][33]

• Mobilise resources through the Ministry of Health in coordination with health facilities, government agencies, international partners, non-governmental organisations and other sectors, while using national and international health-agency partnerships to support funding.[15][30][39]
• Develop sustainable multi-year budgets and rapid fund-disbursement mechanisms to enable flexible emergency spending, reduce reliance on supplementary budget processes and limit misuse risks.[29]
• Use national disaster-financing frameworks, including the Disaster Management Act 2013 and Operational Guidelines for Disaster Financing 2017, to support emergency response, relief, restoration, capacity building and recovery.[33]
• Access the South-East Asia Regional Health Emergency Fund within 24 hours where emergency declaration, formal external-assistance request and humanitarian-coordinator appointment conditions are met, and use the World Health Organization Contingency Fund for Emergencies as an additional rapid financing source.[33]
• Use annual budgets for immediate district response and relief, with reimbursement of actual expenditure by the Ministry of Finance; eligible support includes food, shelter, medical care and other essential resources subject to specified standards.[33]
• Support restoration and recovery through post-disaster assessment, normal planning and annual budgeting, with possible General Reserve for Disaster Relief allocations by the Department of Planning, Budget, and Performance.[33][30]
• Establish a dedicated contingency fund for influenza pandemics, epidemics and outbreaks to permit rapid action without diverting resources from other critical sectors.[30]
• Plan procurement, stockpiling, distribution and delivery of vaccines, antivirals, medicines, personal protective equipment, diagnostics, consumables, oxygen and ventilation support using inventories, estimated needs, supplier pre-agreements and mapped supply systems.[12][40][32][39]
• Record emergency expenditure, consolidate budget requirements and delegate emergency financial and administrative authority under simplified procedures and designated oversight.[35]

The health system is government-financed and provides free basic public health services, while health technology assessment considers the cost-efficiency of essential drugs, equipment and hospital supplies.[5][23]No monetary allocations, programme costs, cost-effectiveness results, financing commitments, expenditure ceilings, funding gaps or economic assumptions are specified in the supplied material.[36][32]