National Influenza Pandemic Preparedeness Plan

Objectives

The National Influenza Pandemic Preparedness Plan is an all-government framework to build core prevention, preparedness and response capacities, mobilise expertise and services, and minimise morbidity, mortality and social disruption from highly pathogenic avian influenza and pandemic influenza. It also seeks to strengthen capacities relevant to other infectious-disease epidemics and public-health emergencies under the International Health Regulations (2005).[1][2]

• Reduce opportunities for human infection from avian influenza and prevent the introduction and spread of highly pathogenic avian influenza through biosecurity, border controls, import regulation, surveillance and movement restrictions.[1][3][4]
• Strengthen human and animal surveillance, laboratory diagnosis, early warning, epidemiological investigation and rapid response to detect unusual clusters, outbreaks and novel influenza viruses promptly.[1][5][6][7]
• Contain or delay transmission at source through rapid containment, defined containment and buffer zones, case isolation, contact management, quarantine, antiviral measures, social distancing and infection prevention.[1][8][9][10]
• Minimise health-system pressure and maintain essential services by preparing health-care surge capacity, secondary care sites, staff mobilisation, supply stockpiles and continuity plans across critical public and private sectors.[11][12][13][14]
• Protect workers, communities and vulnerable groups through personal protective equipment, risk communication, hygiene promotion, safe clinical care, community support and public-health measures proportionate to pandemic severity.[11][15][16][17]
• Restore disease-free status after animal outbreaks through stamping out, safe disposal, decontamination, post-outbreak surveillance, controlled restocking and, in exceptional circumstances, strategic vaccination.[18][19][20][21]
• Monitor and evaluate national and sectoral response capacity as an explicit objective, although the supplied material does not provide a consolidated national indicator framework or quantified targets.[1][22]

Implementation

Implementation uses a phased, multisectoral incident-management model aligned with World Health Organization pandemic phases. It combines national policy direction, technical coordination, district and field operations, integrated human and animal health action, and continuity arrangements for essential societal functions.[11][23][24][5]

• Govern through a National Steering Committee chaired by the Prime Minister, which provides high-level decisions, approves plan updates and lead agencies, declares pandemic phases on technical advice, promotes intersectoral collaboration and mobilises implementation resources.[25]
• Direct implementation through the National Executive Committee, which provides overall guidance, monitors implementation and supporting projects, reviews and updates the plan, develops guidance and protocols, and identifies intersectoral lead agencies.[23]
• Provide technical advice through a Technical Committee during pre-pandemic phases and deploy its members to the National Incident Command Centre or Incident Operation Centres during pandemic response.[22][26]
• Activate the National Incident Command Centre as the highest technical decision-making body following investigation and expert recommendation, with authority to direct response policy, notification, resource mobilisation, risk communication and liaison.[27]
• Establish district-level Incident Operation Centres within six hours of a national executive order to coordinate field operations, rapid response teams, logistics, daily meetings and daily situation updates to the national level.[28]
• Deploy multidisciplinary Rapid Response Teams at national, regional and district levels for disease investigation and surveillance, medical and quarantine action, logistics, communication, and law-and-order functions.[29][12][28]
• Coordinate animal-health action through the Department of Livestock, Bhutan Agriculture and Food Regulatory Authority, National Centre for Animal Health, veterinary laboratories, regional and district veterinary services, livestock extension centres and quarantine stations.[30][6][31]
• Use the Ministry of Health to lead human disease pandemic response and the Ministry of Agriculture and Forests to lead animal disease response, while coordinating zoonotic risks, laboratory services, border measures and recovery actions.[14][32]
• Integrate pandemic arrangements with national disaster management through the Department of Disaster Management, National Emergency Operation Centre, Dzongkhag Emergency Operation Centres and local administrations led by the Dzongda.[24][32]
• Coordinate continuity planning across healthcare, food and fuel, finance and insurance, law and order, energy, transport, telecommunications, education, water and sanitation, and the private sector.[24][33][34]

Operational delivery combines routine and enhanced surveillance with laboratory referral, risk assessment, public communication, outbreak investigation and proportionate control measures. Human health facilities submit weekly acute respiratory infection reports, while animal-health services use immediate notification for suspected highly pathogenic avian influenza and regular surveillance reporting through veterinary networks.[35][36][37]

• Maintain laboratory-based surveillance in humans and animals, including sentinel Influenza-Like Illness and Severe Acute Respiratory Infection surveillance, poultry surveillance, wild-bird monitoring and referral of samples to national, regional or international reference laboratories where needed.[29][6][7][38]
• Test district and national preparedness through tabletop and field simulations at least twice yearly, conduct annual hospital simulation exercises, and train rapid response personnel annually.[26][29][13][28]
• Stockpile and redistribute antivirals, personal protective equipment, diagnostic supplies and other essential commodities through national, regional and district systems, with additional procurement managed through the Drug, Vaccine and Equipment Division where approved.[39][40]
• Fund district pandemic-plan implementation through annual district budget proposals and maintain yearly earmarked district resources for outbreak containment, while recognising that most budget amounts, allocations and funding gaps are not specified.[26][12]
• Seek international technical, laboratory, commodity and financial support from organisations including the World Health Organization, Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, World Bank, United Nations Children’s Fund and other partners.[5][22]

Monitoring & Evaluation

The plan establishes a multi-level surveillance, reporting and incident-management system for human and animal influenza, with monitoring intended to support early warning, outbreak investigation, containment, response-capacity review and restoration of disease-free status.[1][5][36]Human surveillance combines routine and enhanced reporting, laboratory diagnosis, sentinel surveillance, rapid response and event-based investigation.[41][29][35]Animal surveillance combines clinical, virological and serological methods, targeted risk-based sampling, laboratory confirmation, border monitoring and international notification.[4][42][43]

• Require health facilities to submit weekly Acute Respiratory Infection reports through District Health Officers to the Department of Public Health, which reviews trends monthly and may deploy outbreak investigation teams following sudden increases.[35]
• Compile, analyse and report influenza surveillance data weekly, while maintaining Influenza-Like Illness surveillance at 11 sentinel facilities and Severe Acute Respiratory Infection surveillance at all sentinel sites.[11][29]
• Investigate unusual respiratory clusters, deaths and suspected cases through national, regional and district Rapid Response Teams, using updated case definitions, contact tracing, laboratory testing and daily recording during incident operations.[12][8][44]
• Require the Incident Operation Centre to hold daily meetings and debriefings and submit daily information on disease status, response progress and control measures to the National Incident Command Centre.[28]
• Require suspected highly pathogenic avian influenza cases to be notified within 24 hours, with weekly surveillance reports to the Department of Livestock and National Centre for Animal Health and weekly national reporting through the Ministry of Agriculture and Forests website.[45][46]
• Use animal-health trigger indicators including poultry mortality, reduced feed and water consumption, respiratory signs and egg-production declines; investigate mortality exceeding 2% for two consecutive days in organised farms or 5% in village-based settings.[4][37]
• Conduct purposive laboratory testing at least every six months during routine avian-influenza surveillance, increasing targeted testing to monthly in high-risk districts when neighbouring countries report outbreaks.[37]
• Apply sampling designs intended to achieve 95% probability of detecting infection at specified prevalence assumptions, including 1% prevalence in targeted bird populations or premises.[47][48][49]
• Report human outbreaks to the World Health Organization under the International Health Regulations and report notifiable animal disease outbreaks to the World Organisation for Animal Health.[5]
• Monitor and evaluate district and national plans through tabletop and field simulation exercises at least twice yearly, while each district hospital conducts at least one annual simulation exercise to assess detection and containment capacity.[26][13]

Accountability is principally embedded in assigned committee, incident-command, laboratory, surveillance and sector-lead responsibilities. The National Executive Committee monitors plan implementation and supporting projects, while lead agencies monitor incidents, coordinate support and report to the National Steering Committee and National Executive Committee.[23][24]The plan does not provide a consolidated indicator framework, standard reporting templates, independent audit mechanism or comprehensive performance-accountability timetable.[23][22]

Costing & Financing

The plan identifies substantial resource requirements for preparedness, surveillance, laboratory capacity, surge care, containment, logistics, communication, personal protective equipment, antivirals, vaccination, culling, decontamination and compensation, but it does not set out a consolidated national budget or costed implementation plan.[50][1][51][52]Financing responsibilities are distributed across national, district, emergency-response and external-support arrangements.[26][12][27]

• Incorporate implementation of district pandemic plans into district annual budget proposals.[26]
• Maintain yearly earmarked district budgets for disease-outbreak containment and finance secondary-care-site logistics through district health-sector outbreak budgets or district emergency contingency funds.[12]
• Mobilise funds and logistics through the National Incident Command Centre, which supports Rapid Response Teams, while Incident Operation Centres and district disaster-management structures manage operational supplies, transport and finances.[27][28]
• Mobilise resources through the National Steering Committee for implementation of the National Influenza Pandemic Preparedness Plan.[25]
• Seek technical and financial assistance from international agencies and donors, including World Health Organization support for medical equipment, rapid tests, antivirals, vaccines and personal protective equipment, and World Bank support for preparedness capacity, laboratory upgrades and communications during 2008–2010.[5]
• Maintain national, regional and district stocks of antivirals and personal protective equipment, with additional procurement managed by the Drug, Vaccine and Equipment Division subject to ministry approval.[39][40]
• Provide compensation for authorised poultry, egg, feed and feed-material losses from culling, supported by a small World Bank-funded project compensation fund, although no fund amount or payment rates are specified.[20]
• Provide nearly all animal-health services, medicines and drugs free of charge through government services, while the National Veterinary Referral Hospital applies medicines cost recovery and a minimal service charge.[30]

Economic evidence cited in the plan is contextual rather than a Bhutan-specific financing model: H5N1 outbreaks were estimated to have caused direct costs of US$8–12 billion in affected countries, while a modest one-year pandemic was estimated to cause losses of up to 3% of Asian gross domestic product and 0.5% of world gross domestic product, equivalent to approximately US$150–200 billion.[53]The source does not specify domestic financing allocations, funding gaps, unit costs, economic assumptions or a total cost for implementation.[1][25][5]