National Influenza Pandemic Preparedness Plan

Objectives

Sri Lanka’s National Influenza Pandemic Preparedness Plan provides a continuously updated, whole-of-society framework to prepare all sectors and administrative levels for influenza pandemics, minimise health, social and economic disruption, and support recovery. It incorporates lessons from highly pathogenic avian influenza A(H5N1) preparedness and the 2009 and 2010 influenza A(H1N1) waves, aligns with World Health Organization pandemic phases and the International Health Regulations (2005), and is intended to guide both pandemic response and preparedness for other major communicable-disease outbreaks.[1][2][3][4]

• Reduce opportunities for human infection from infected animals and pandemic emergence through integrated human and animal influenza surveillance, animal-disease control, poultry biosecurity, movement controls and safer industry practices.[5][6][7]
• Strengthen early warning, situation assessment, laboratory diagnosis, epidemiological investigation and the detection of unusual respiratory illness, deaths, clusters and animal or human infections with zoonotic potential.[8][9][10]
• Contain or delay transmission at source and reduce spread through hygiene, isolation, quarantine, infection prevention and control, social distancing, reduced overcrowding, measures for mass gatherings and preparedness at points of entry.[6][10][11]
• Reduce morbidity, mortality and social disruption by maintaining continuity of health-care provision, preparing referral facilities and surge capacity, and planning access to antivirals, vaccines, clinical supplies and patient care.[6][9][11]
• Communicate timely, transparent and coordinated risk information, address rumours and public concerns, and enable informed decisions by communities, health workers, agencies and the media.[12][13]
• Monitor and evaluate the evolving response, revise plans and guidelines using evidence and lessons learnt, replenish preparedness stocks, and prepare for post-peak recovery or further pandemic waves.[14][15][4]

Implementation

Implementation uses a phased, multisectoral national preparedness and response model. The Ministry of Health leads the health response in collaboration with the Ministry responsible for livestock development, the Department of Animal Production and Health, other ministries, provincial and local authorities, public and private providers, civil society, international partners and relevant emergency services. Preparedness is integrated into wider emergency and disaster-management arrangements, with actions adapted to World Health Organization phases, national epidemiology and the status of human and animal outbreaks.[3][6][13][15]

• Coordinate policy, phase decisions and technical advice through national steering, technical and expert committees, including the National Technical Committee on Avian/Pandemic Influenza Preparedness and Response. The committees bring together public health, epidemiology, quarantine, laboratory, clinical, veterinary, animal-health, health-education, medical-supply and provincial expertise.[1][6][16]
• Assign operational planning and implementation to a programme secretariat and designated ministry focal points, while engaging intersectoral committees at administrative levels and using national command, control and coordination arrangements during an emergency.[4][13]
• Deliver services through Sri Lanka’s public and private health system, linking national authorities with Provincial Directors of Health Services, Regional Directors of Health Services, Medical Officers of Health, hospitals, ambulance services and primary-care facilities. Provincial services provide support to district services and hospitals, including private-sector facilities where needed.[17][18][15]
• Operate integrated surveillance through routine notification, event-based early warning and human and animal influenza monitoring. Human surveillance includes influenza-like illness surveillance in 20 sentinel hospitals and severe acute respiratory infection surveillance in three hospitals, with specimens examined by the Medical Research Institute, the National Influenza Centre. Animal surveillance covers poultry, wild birds, unusual flock events and influenza viruses with zoonotic or pandemic potential.[19][20][6]
• Investigate, record and report suspected notifiable diseases through the health-service hierarchy. Medical practitioners notify the relevant Medical Officer of Health, Public Health Inspectors investigate and return reports, and Medical Officers of Health submit weekly returns to the Epidemiologist. Under the International Health Regulations (2005), human influenza caused by a new subtype is notified to the World Health Organization within 24 hours of assessment, followed by continuing risk and response information.[19][16]
• Prepare health-system delivery by training personnel, establishing rapid-response capacity, strengthening laboratories, providing triage and isolation arrangements, identifying surge and resource-management priorities, and designating the Infectious Disease Hospital in Colombo as the national focal point for case management. Sentinel hospitals serve as provincial referral points, while other General and Base Hospitals are prepared for pandemic care.[21][22]
• Maintain and distribute essential supplies through national plans, including antivirals held centrally, in district regional medical stores and at sentinel hospitals; prepare vaccine deployment, personal protective equipment, diagnostics, oxygen, antibiotics, antipyretics and hydration support.[20][11]
• Implement communications through a national strategy, communication sub-committee, trained spokespersons, standard operating procedures, multiple media channels and public feedback mechanisms.[12][22][13]
• Review inputs, processes, outputs and outcomes through indicators, scenario and tabletop exercises, outbreak feedback, surveillance and laboratory data, hospital-readiness assessments, and evaluation of pharmaceutical and non-pharmaceutical measures. The supplied material does not provide consolidated indicator definitions, quantitative targets, a full reporting timetable or a quantified budget.[11][15][4][23]

Monitoring & Evaluation

The plan establishes a comprehensive monitoring and evaluation approach centred on integrated human and animal influenza surveillance, early warning, laboratory confirmation, outbreak investigation, situation assessment and phased response review. It requires monitoring of pandemic risk before emergence, declaration and tracking of national pandemic activity, and assessment of interventions and health-system performance as the event evolves.[6][9][15]

• Maintain routine, event-based and sentinel surveillance for human and animal influenza, including influenza-like illness surveillance in 20 sentinel hospitals, severe acute respiratory infection surveillance in three hospitals, and routine poultry and wild-bird surveillance.[20][11]
• Submit at least 30 influenza-like illness samples monthly from each sentinel hospital to the Medical Research Institute, while severe acute respiratory infection sites submit samples from all admitted patients meeting surveillance criteria.[20]
• Detect and investigate unusual respiratory illness, deaths, cases and clusters; collect specimens for testing and virological characterisation; and assess human-to-human transmission and potential animal sources.[10][13]
• Monitor viral characteristics, including pathogenicity, genetic and antigenic changes, antiviral sensitivity, complications, mortality, community spread and outbreak patterns.[6][24]
• Review animal influenza prevention and control through monthly Technical Committee feedback, and coordinate human surveillance with animal-health surveillance under the Sri Lankan Exotic Disease Emergency Plan.[20][9]
• Track health-system readiness, laboratory performance, availability of medicines and vaccines, health-worker capacity, hospital and alternative-facility capacity, absenteeism, essential-worker availability and mitigation-measure uptake.[11][24][14]
• Use indicators covering surveillance, laboratory performance and health-care delivery, and monitor inputs, processes, outputs and outcomes across pandemic phases.[11][4]
• Assess the safety, effectiveness and resistance implications of antivirals, and evaluate vaccine coverage, effectiveness and safety.[15]
• Provide feedback through formal outbreak review at central, provincial or district level, weekly surveillance returns through the health-service hierarchy, and epidemiological publications issued by the Epidemiology Unit.[19][20]
• Share regular situation updates and relevant information with the World Health Organization under the International Health Regulations (2005), including notification within 24 hours of assessing human influenza caused by a new subtype.[13][16]
• Communicate continuing information on case definitions, laboratory findings, risk source and type, cases, deaths, transmission factors and interventions, and respond to World Health Organization verification requests with available information.[16][25]
• Evaluate response measures, communication effectiveness and lessons learnt; update surveillance tools, guidelines, protocols and preparedness plans; and activate surveillance for subsequent pandemic waves.[12][14][15]
• Assign the National Technical Committee on Avian/Pandemic Influenza Preparedness and Response responsibility for assessing the national situation and determining phase transitions, while the Ministry of Health operation room and laboratory reporting arrangements monitor response operations.[6][15][7]
• Specify responsible persons, timelines, benchmarks and indicators for activities, and use tabletop and scenario exercises to identify gaps and improve preparedness.[4][23]

The supplied material identifies surveillance reporting, committee review and operational monitoring mechanisms, but does not provide a consolidated indicator dictionary, universal reporting timetable, formal audit process, detailed evaluation methodology or fully defined accountability framework.[1][8][4][23]

Costing & Financing

The plan identifies substantial resource needs for pandemic preparedness and response, including surveillance and laboratory capacity, workforce training, hospital readiness, essential medical supplies, antivirals, vaccines, diagnostics, personal protective equipment and logistics. However, the supplied material provides no quantified budget, expenditure estimate, funding allocation, cost methodology or economic assumption.[8][11][23]

• Plan for procurement, stockpiling, distribution and replenishment of antivirals, vaccines, diagnostics, personal protective equipment, antibiotics, antipyretics, hydration supplies, oxygen, ventilation support and other clinical materials.[11][14]
• Maintain antiviral stocks at the central Medical Supply Division, district regional medical stores and 20 sentinel hospitals.[20]
• Invest in hospital infrastructure, laboratory capacity, personnel training, referral facilities, triage, isolation, infection prevention and control, points-of-entry arrangements, and surge-capacity planning.[8][22][11]
• Mobilise additional human and material resources through emergency, disaster-management and command, control and coordination mechanisms during a response.[13]
• Assess available government resources and remaining gaps to support resource mobilisation, including possible donor engagement and collaboration with non-governmental organisations.[10][4][23]
• Address identified constraints, including limited capacity to procure pandemic vaccine and insufficient laboratory equipment and hospital materials; the extract reports adequate quantities of required antiviral medicines.[23]
• Require a work plan and budget for each activity, although no activity-level monetary values are included in the supplied sections.[23]

Financial and technical constraints are recognised as major barriers, and the programme is described as unable to be fully financed by the Government of Sri Lanka.[23]Pandemic impacts on social infrastructure, essential services and the wider economy are acknowledged, but no monetary impact assessment or funding gap is quantified.[2][8][24]