National Pandemic Influenza Plan

Objectives

Ireland’s pandemic influenza plan seeks to reduce mortality and morbidity, minimise disruption to society, and protect essential health services and wider social functioning during a severe and unpredictable pandemic.[1][2]It follows the World Health Organization’s pandemic preparedness framework and alert phases, supplemented by national subdivisions and Irish alert levels, and is intended to be updated as scientific knowledge and the international situation develop.[2][3][4]

• Strengthen preparedness across planning and coordination, situation monitoring, prevention and containment, health-system response, communications, legal preparedness and business continuity.[2][5]
• Prepare households, health services and employers for high illness rates, staff absence, service disruption and sustained pressure on healthcare capacity.[6][5]
• Support home-based management for most people with influenza, while preserving hospital and specialist capacity for patients with serious illness or higher clinical vulnerability.[7][6][8]
• Reduce transmission through early case detection, contact tracing in the initial stages, voluntary isolation, infection-control measures and public advice on hygiene and avoiding unnecessary contact when ill.[9][10]
• Provide antiviral treatment during the first pandemic wave, when influenza-specific vaccine may not yet be available, and procure sufficient pandemic vaccine for the whole population once production permits.[4][9]
• Prioritise early vaccine supplies for healthcare workers, personnel maintaining essential services and people at high risk of serious illness.[4][6]
• Maintain essential services during pandemic waves, recover progressively between waves, restore suspended activities according to priority, and prepare for possible subsequent waves.[10][11]
• Protect the population from international disease spread while seeking to minimise unnecessary disruption to international travel and trade, in line with the International Health Regulations and European Union commitments.[5]

Implementation

The Department of Health and Children leads governmental preparedness jointly with the Health Service Executive, the lead response agency for public health emergencies.[11]The model combines phased national action, international surveillance, cross-government coordination, health-service reorganisation, public communications, stockpiling and organisational continuity planning.[3][12][5]

• Coordinate policy and operations through the Cabinet Committee, Government Task Force on Emergency Planning, Inter-Departmental Committee on Public Health Emergency Planning, National Public Health Emergency Team, Health Service Executive planning and crisis-management teams, and the Pandemic Influenza Expert Group.[12]The expert group provides clinical, public-health and specialist advice.[12]
• Align national measures with World Health Organization phase decisions and information from the World Health Organization, European Centre for Disease Prevention and Control and Health Protection Surveillance Centre.[13][14]Planning activity is intended to increase substantially during World Health Organization Phases 4 and 5.[15]
• Detect unusual or unexplained acute respiratory illness through hospitals, general practitioner surgeries and other healthcare facilities, and trigger public-health and laboratory investigations.[9]At Irish Alert Level 3, obtain and immediately test specimens from people presenting with influenza symptoms; at Alert Level 4, undertake sample-based surveillance.[10]
• Apply early containment through treatment and isolation of index cases, antiviral prophylaxis or treatment for close contacts, and contact tracing, recognising that intensive contact measures are limited to the early stages of pandemic activity in Ireland.[9]
• Deliver communications through household leaflets, health-service publications, a phase-specific website, media briefings, advertising, television, radio and professional updates.[6][15]Operate a 24-hour telephone hotline from Phase 5 to advise the public, assess suspected cases, identify high-risk callers and direct them to appropriate services while reducing avoidable attendance at general practitioner and emergency departments.[6][15][8]
• Organise primary care workers, including general practitioners, public health nurses and home carers, to support education, infection control, surveillance, case reporting and care in the home.[16]Postpone non-essential activity, avoid non-essential new hospital appointments, establish influenza treatment locations, redeploy staff and resources, and coordinate with private, voluntary and contracted providers to meet increased demand.[9][10]
• Maintain and distribute national stocks of antivirals, vaccines and personal protective supplies, including masks, gloves and gowns, and replenish them according to need and pandemic severity.[15]As at January 2007, stockpiles included one million adult Tamiflu packs, 63,000 paediatric Tamiflu treatment courses, 70,000 adult Relenza packs and 184,200 H5N1 vaccine doses for essential workers.[15]
• Plan vaccine supply in stages because pandemic vaccine is unlikely to arrive in one consignment and significant supplies may not be available until at least six months after a pandemic declaration.[4][9]Contracts covered a further 636,000 Relenza packs during 2007 and 215,800 additional H5N1 vaccine doses in early 2007.[15]
• Require public, private and other organisations to identify essential functions, protect employee health and safety, assess dependencies, curtail non-essential services where necessary and maintain core activities during prolonged absenteeism.[5]Workforce planning uses assumptions that ill people may isolate for at least seven days and that peak absence can be higher in small organisations or units.[17]
• Test health-service arrangements through regular exercises, use surveillance-informed modelling to revise estimates of pandemic severity and duration, review the plan as knowledge develops, and communicate developments through daily updates and bulletins where required.[4][15][16][11]
• Provide government funding of 9.3 million euro in 2005 and 19.3 million euro across 2006 and 2007 for pandemic contingency planning, principally directed towards the national medicines and supplies stockpile.[6]The material does not specify a comprehensive budget, financing sources, funding gaps or a formal indicator and accountability framework.[6][18]

Monitoring & Evaluation

Monitoring and evaluation rely principally on international and national surveillance, pandemic-alert phases, laboratory investigation, modelling, exercises and public reporting. The framework does not set out a consolidated quantitative indicator set, formal evaluation methodology, reporting timetable or independent accountability system.[2][3][4][9][15][8][10][18]

• Monitor global developments through the World Health Organization (WHO), European developments through the European Centre for Disease Prevention and Control, and national communicable-disease intelligence through Ireland’s Health Protection Surveillance Centre.[19][14][9]
• Apply the WHO six-phase alert framework, supplemented by national subdivisions from Phase 2 and European Union and Irish alert levels during Phase 6; WHO’s Director-General determines phase designations and transitions.[13][3]
• Use surveillance in hospitals, general practitioner surgeries and other healthcare facilities to detect unusual or unexplained acute respiratory illness and initiate public-health and laboratory investigations.[9]
• Increase clinical vigilance as alert levels rise, including observation for pandemic symptoms by hospitals, general practitioners and healthcare workers.[20][16][10]
• Conduct immediate laboratory testing of swabs from symptomatic people presenting to hospitals or general practitioners at Irish Alert Level 3, then conduct sample-based surveillance at Irish Alert Level 4.[10]
• Undertake contact tracing and contact management during the early stages of pandemic activity in Ireland, with staff rosters supporting tracing activity where required.[9][10]
• Use modelling based on emerging surveillance information to estimate weekly clinical cases, hospitalisations and deaths, recognising that model outputs are planning estimates rather than predictions.[4]
• Monitor pandemic activity worldwide daily and adapt national plans as evidence develops on likely Irish impacts, including infection rates, duration, mortality and morbidity.[16]
• Review planning assumptions and update health-service plans as international understanding, treatments and the assessed threat evolve.[1][4][15][18]
• Test health-service plans through regular exercises and assess the adequacy of the national stockpile continuously as WHO alert levels rise.[15][20]
• Report developments through daily website updates, bulletins and media communications, including information on expected subsequent waves, public measures, available services and access arrangements.[11]
• Support accountability through defined governance roles: the National Public Health Emergency Team assesses and recommends policy measures, while the Cabinet Committee provides policy direction where necessary.[12]
• Use workforce-absence assumptions as business-continuity planning inputs, including at least seven days’ isolation for people ill with influenza and differentiated peak absence estimates for large and small organisations.[17]
• Return surveillance progressively to pre-pandemic levels after the pandemic ends, while maintaining national and international surveillance between waves to identify renewed activity.[11]

Costing & Financing

Financing information is limited, but the plan records Government pandemic-contingency funding and substantial procurement and stockpiling requirements. Most identified resources concern antivirals, vaccines, personal protective equipment, communications, workforce redeployment and essential supplies; no comprehensive budget, funding-gap analysis or resource-mobilisation framework is specified.[6][15][20][16][8][10]

• Allocate €9.3 million in 2005 and €19.3 million across 2006 and 2007 for development of pandemic contingency plans, with most investment directed to the national stockpile of medicines and supplies.[6]
• Maintain and review a national stockpile of antivirals, vaccines, masks, gloves and gowns because supplies may be difficult to obtain during a pandemic.[15]
• Supplement stockpiles through contracts for additional Relenza and H5N1 vaccine supplies, with further review and supplementation dependent on pandemic timing and severity.[15]
• Plan to procure sufficient pandemic vaccine for the entire population when available, while prioritising initial supplies for healthcare workers, essential-service personnel and people at high risk of serious illness.[4][6]
• Recognise that pandemic-vaccine supply may be delayed for at least six months after a pandemic declaration and may arrive in staged deliveries rather than one consignment.[4][9]
• Identify expenditure-related operational needs for antiviral distribution, vaccine development and administration, supply delivery and replenishment, communications, healthcare reorganisation and staff redeployment, but provide no individual monetary values for these activities.[20][16][10][11]
• Frame preparedness as an investment intended to reduce the direct medical and economic effects of a pandemic and strengthen infrastructure for other epidemics and infectious-disease threats.[1]
• Record that Ireland had put considerable resources in place for implementation of the International Health Regulations, without specifying an amount, funding source or expenditure breakdown.[5]