National Influenza Pandemic Preparedness Plan

Objectives

Provide Sri Lanka with an integrated, regularly updated National Influenza Pandemic Preparedness and Response Plan that enables all levels and sectors to recognise, prepare for, manage and recover from an influenza pandemic, minimising morbidity, mortality, social disruption and economic harm.[1][2][3]The framework incorporates lessons from the 2009 and 2010 H1N1 pandemic waves, World Health Organization guidance and a five-year work-planning process.[4][1][5]

• Strengthen planning and coordination by integrating pandemic preparedness into national emergency arrangements and defining stakeholder roles across human health, animal health, public services, private providers and communities.[6][3][7]
• Enhance surveillance and risk assessment through routine, sentinel, event-based, laboratory and animal-health surveillance to identify pandemic threats, detect unusual clusters, assess zoonotic transmission and declare national pandemic onset.[8][9][10]
• Reduce transmission and human infection from animals through poultry biosecurity, movement control, surveillance of poultry and wild birds, outbreak investigation, hygiene, infection prevention and control, isolation, quarantine, social distancing and other proportionate public-health measures.[3][11][12][13]
• Contain or delay spread at source and reduce illness, deaths and societal disruption through pharmaceutical and non-pharmaceutical interventions, including managed antiviral and vaccine stockpiles, contact management and targeted community measures.[3][11][14]
• Maintain continuity of healthcare and essential services by preparing triage, isolation, referral, surge-capacity, clinical-management, workforce and supply arrangements across public and private health systems.[10][15][14]
• Deliver timely, transparent and responsive risk communication that informs the public, partners and stakeholders, addresses concerns and enables households, institutions and communities to act before, during and after a pandemic.[11][10][15]
• Monitor and evaluate the evolving response, including surveillance performance, health-system impacts, interventions, antiviral effectiveness and resistance, vaccine coverage, effectiveness and safety, and communication effectiveness.[3][9][16][17]
• Prepare for post-peak recovery and future waves by rebuilding essential services, supporting affected health workers, replenishing supplies and stockpiles, evaluating measures and revising plans, guidelines and protocols using lessons learnt.[16][17]

Implementation

Implement the plan through a phased, multisectoral and decentralised delivery model led by the Ministry of Health in collaboration with the Ministry responsible for livestock development, the Department of Animal Production and Health, other ministries, provincial and district services, laboratories, healthcare providers, civil society, the private sector and international partners.[4][18][12]The national pandemic phase and changes between phases are determined by the National Technical Committee on Avian/Pandemic Influenza Preparedness and Response, informed by the global World Health Organization phase and Sri Lanka’s epidemiological situation.[2][3]

• Govern through a National Steering Committee, National Technical Committee, expert and technical sub-committees, designated focal points and a Programme Secretariat responsible for planning and implementation.[4][19][13][5]
• Coordinate delivery through national, provincial, regional, district, municipal and local structures, including Provincial Directors of Health Services, Regional Directors of Health Services and Medical Officers of Health, while mobilising public and private healthcare providers.[20][21][12]
• Operate communicable-disease notification under the Quarantine and Prevention of Diseases Ordinance, requiring notification to Medical Officers of Health, investigation by Public Health Inspectors and weekly reporting to the Epidemiologist and Regional Epidemiologists.[19]
• Maintain influenza-like illness surveillance in 20 sentinel hospitals and severe acute respiratory infection surveillance in three hospitals, with specimens sent to the Medical Research Institute, the national influenza centre.[8]
• Coordinate human and animal surveillance, including Department of Animal Production and Health activities and event-based surveillance under the Sri Lankan Exotic Disease Emergency Plan, with animal-health feedback reviewed through Technical Committee meetings.[22][9]
• Develop rapid-response capability by training multisectoral teams, health workers and community-level personnel; conducting tabletop exercises; and adapting activities to pandemic phase, evidence and identified weaknesses.[10][15][23]
• Prepare health services through designated referral arrangements, including Infectious Disease Hospital, Colombo as the national case-management focal point, sentinel hospitals as provincial referral points, and wider hospital preparedness for pandemic care.[22]
• Manage essential commodities by stockpiling antivirals and supplies, planning procurement and distribution, maintaining minimum stock levels and quality assurance, and auditing utilisation in hospital settings.[22][14]
• Activate national emergency, disaster-management and command-and-control mechanisms during pandemic escalation, mobilise additional human and material resources, and coordinate operational and logistics teams.[24][25]
• Meet International Health Regulations (2005) obligations by reporting human influenza caused by a new subtype to the World Health Organization within 24 hours of assessment, maintaining event communication and responding to verification requests.[26][27]
• Use monitoring arrangements that track inputs, processes, outputs and outcomes against key indicators, supported by a Ministry of Health Operation Room and work plans assigning agencies, responsible persons, timelines, benchmarks and indicators.[12][13][5][23]
• Mobilise resources by identifying available government funding and gaps, seeking donor and technical assistance where needed, and preparing activity-level work plans and budgets; however, no quantified national budget, allocation or funding gap is specified.[5][23]

Monitoring & Evaluation

The plan establishes a comprehensive monitoring, evaluation and accountability approach centred on surveillance, phase-based assessment, reporting, review of response measures and transparent communication. It aims to monitor pandemic risk before emergence, declare and track pandemic activity, assess the characteristics and impact of outbreaks, and evaluate the evolving response.[3][9]

• Maintain integrated human and animal influenza surveillance, linking the Epidemiology Unit, Medical Research Institute, Health Education Bureau and Department of Animal Production and Health, including routine, sentinel, laboratory, event-based and avian influenza surveillance.[18][8][9]
• Operate influenza-like illness surveillance through 20 sentinel hospitals, each expected to submit at least 30 samples monthly to the Medical Research Institute, and severe acute respiratory infection surveillance in three hospitals.[8]
• Use defined clinical case criteria for influenza-like illness and severe acute respiratory infection, supported by specimen transport, laboratory confirmation, epidemiological investigation and contact management.[8][9]
• Monitor viral characteristics, severity, mortality, community transmission, antiviral sensitivity, genetic and biological changes, outbreak patterns and zoonotic risks from animal influenza strains.[9][28][29]
• Detect and investigate unusual clusters of respiratory illness or deaths, assess possible human-to-human transmission, characterise and share virus isolates, and monitor antiviral resistance.[10][15]
• Investigate notified communicable diseases through Public Health Inspectors, record cases in disease registers, and submit weekly returns from Medical Officers of Health to the Epidemiologist, with copies to Regional Epidemiologists.[19]
• Provide epidemiological feedback through the Weekly Epidemiological Report and Quarterly Epidemiological Bulletin, and review animal-health surveillance and control activities at monthly Technical Committee meetings.[8][22]
• Use the National Technical Committee on Avian/Pandemic Influenza Preparedness and Response to assess the national phase, review surveillance and direct preparedness and response through regular and extraordinary sessions.[3][9]
• Develop indicator-based review systems for epidemiological and laboratory surveillance, healthcare delivery, and sentinel and referral hospitals; conduct hospital consumable-utilisation audits and maintain quality assurance for stockpiled materials.[7][14]
• Monitor supplies, vaccines, antivirals, healthcare-worker availability, hospital occupancy, alternative facilities, laboratory stocks, mortuary capacity, absenteeism, essential-worker availability and the uptake and effects of mitigation measures.[29][30]
• Evaluate outbreak-control, pharmaceutical and non-pharmaceutical interventions, including antiviral effectiveness, safety and resistance, and vaccine coverage, effectiveness and safety; activate surveillance for subsequent waves and incorporate the pandemic subtype into resumed seasonal surveillance.[16][17]
• Appraise communication effectiveness, monitor public and media concerns and barriers to compliance, revise messages and strategies accordingly, and provide regular public updates.[11][7][25]
• Apply a systems approach to monitor inputs, processes, outputs and outcomes against key indicators as the pandemic progresses, with work plans assigning responsible persons, timelines, benchmarks and progress measures.[13][5][23]
• Notify the World Health Organization within 24 hours of assessing human influenza caused by a new subtype, maintain ongoing event communication and provide information required for verification under the International Health Regulations (2005).[26][27]

Specific quantitative targets, a consolidated national indicator framework, standardised evaluation schedules and detailed accountability procedures are not consistently specified beyond the surveillance, reporting, committee-review and International Health Regulations mechanisms described.[3][10][24][26]

Costing & Financing

The plan identifies substantial resource requirements for preparedness, response, recovery and health-system continuity, but provides no quantified budget, cost estimates, funding allocations or economic assumptions.[6][9][7][16]

• Mobilise resources for surveillance, laboratories, rapid-response capacity, referral hospitals, equipment, personnel, communication, infection prevention and control, and pharmaceutical and societal interventions.[9][11]
• Maintain preparedness capacities through stockpiles of essential supplies and antivirals, hospital infrastructure, laboratory capacity, staff training and health-service surge arrangements.[6][22][14]
• Develop mechanisms to procure, stockpile, distribute and audit antivirals and other materials, including minimum stock levels, quality assurance and rapid distribution plans.[14]
• Plan for increased requirements for antibiotics, antipyretics, hydration, oxygen, ventilation, vaccines, personal protective equipment, laboratory materials and humanitarian assistance.[14][28][29]
• Mobilise additional human and material resources during containment and pandemic response through national emergency, disaster-management and logistics mechanisms.[24][25]
• Determine resource and capacity needs for possible subsequent waves, replenish national and regional stockpiles, renew essential equipment and rebuild essential services during recovery.[16][17]
• Require activity-specific work plans and budgets, identify available government resources and remaining gaps, and pursue resource mobilisation and donor engagement where appropriate.[5][23]

The Government of Sri Lanka is not expected to be able to fully finance the programme because of financial and technical constraints; the plan identifies gaps in laboratory equipment and hospital materials, and notes that pandemic vaccine procurement would be difficult despite adequate antiviral availability.[5]Developing countries may also face shortages of vaccines, antivirals, antibiotics and other medical supplies, with potentially limited international assistance during a global emergency.[31]

Economic considerations include minimising pandemic effects on the economy and society, forecasting economic disruption during a pandemic, and recognising potentially severe consequences from poultry outbreaks; however, no monetary valuation or quantified economic scenario is provided.[3][29][30][31]