Pasirengimo Gripo Pandemijai 2019–2023 Metų Programos Patvirtinimo

Objectives

Lithuania’s 2019–2023 Influenza Pandemic Preparedness Programme provides a cross-sectoral framework to reduce the scale and severity of an influenza pandemic, protect health and essential services, and sustain public administration, economic activity and social support through all pandemic phases.[1][2][3]It applies principles of equality, impartiality, proportionality, non-discrimination, solidarity, benefit and efficiency.[3]

• Strengthen preparedness, prevention, containment, health-system response, public communication and information exchange across the interpandemic, alert, pandemic and transition periods.[4][5]
• Protect people at elevated risk through seasonal vaccination, with a 75% coverage recommendation for risk groups from the World Health Organization and the Council of the European Union.[6]
• Ensure access to vaccines and antiviral medicines, recognising that development of pandemic vaccines may take six to eight months and initial production capacity may be insufficient.[7]
• Maintain continuity of essential institutional functions, healthcare delivery and public services while protecting staff and managing high patient volumes.[8]
• Strengthen human and animal influenza surveillance, laboratory readiness, antiviral-resistance monitoring, outbreak investigation and adaptation of case definitions and preparedness arrangements.[9][10]
• Improve clinical management, diagnosis, treatment, infection prevention and control, patient isolation, hospital surge capacity, workforce readiness and alternative care arrangements.[11][12]
• Anticipate pandemic waves, monitor epidemiological, virological and clinical developments, maintain essential health and social support, and use post-pandemic learning to improve future preparedness.[13][14][15][16][17][18]

The Programme includes measurable preparedness ambitions for 2023, including maintaining sentinel clinical and virological surveillance participation by 1–5% of family, internal medicine and paediatric doctors; maintaining full functioning of the World Health Organization reference laboratory; increasing exercise participation from 45 to 80 people; and increasing the proportion of health-system institutions prepared for emergencies from 60% to 75%.[19][20]

Implementation

Implementation uses a phased, multi-agency emergency-management model led by the Ministry of Health and delivered through state institutions, municipalities, public-health bodies, laboratories, healthcare providers, veterinary and border authorities, universities and other designated organisations.[8][21][22][23]Pandemic measures are adjusted to the national epidemiological situation and reviewed when the World Health Organization pandemic phase changes.[4][5]

• Coordinate national preparedness through the Ministry of Health, which monitors Programme implementation, while a deputy minister has execution oversight and the Influenza Pandemic Preparedness Consultants’ Group provides scientific advice and reviews institutional readiness.[1][5][8]
• Apply civil-protection arrangements through the Government Emergency Commission, the State-level Emergency Operations Centre or Ministry of Health Emergency Operations Centre, with municipal administration directors responsible for declaring and revoking municipal emergencies.[24][8]
• Require authorities, municipalities, businesses and healthcare organisations to prepare and update pandemic measures, risk assessments and preparedness plans, supported by national recommendations updated during the Programme period.[8][25]
• Conduct preparedness exercises, establish reserves of antiviral medicines and personal protective equipment, review capacities and resource gaps, and plan remedial action.[21][26]
• Operate municipal epidemic declarations when weekly influenza and acute upper respiratory tract infection incidence reaches at least 100 cases per 10,000 inhabitants and clinical influenza represents around 30% of registered cases.[27]
• Use the National Influenza Centre within the National Public Health Surveillance Laboratory to identify, preserve, multiply and share influenza strains with the regional World Health Organization laboratory.[27]
• Participate in European Union joint procurement of medical countermeasures, including pandemic vaccines, under the agreement Lithuania signed in 2014.[7]
• Prepare targeted, science-based communication for the public, risk groups, healthcare professionals and media, and maintain national and international information exchange.[24][28]
• Assess health-system readiness using the World Health Organization’s 2018 influenza pandemic risk and impact management checklist, identify deficiencies, test patient-flow and isolation arrangements, and use alternative premises such as schools and hotels if hospital demand exceeds capacity.[11][12]

During heightened alert and pandemic stages, responsible bodies coordinate cross-border action, investigate human and animal outbreaks, assess surveillance and laboratory capacity, monitor vaccine and antiviral availability, distribute antivirals, vaccinate priority groups where feasible, reallocate staff and resources, and maintain essential energy, fuel, healthcare and social-support services.[29][30][31][23][32][15][16]

Monitoring combines epidemiological surveillance, laboratory data, institutional preparedness reviews, vaccination coverage, exercise participation and post-response evaluation.[5][27][6][17][33]Financing is drawn from approved state and municipal budget appropriations, European Union and other structural funds, international programmes, the Compulsory Health Insurance Fund and other lawful sources; the covered text does not specify a total budget or detailed allocations.[34]

Monitoring & Evaluation

The programme combines phase-based surveillance, implementation monitoring and post-pandemic review, with the Ministry of Health responsible for monitoring implementation and Annex 2 setting baseline and 2023 target values for eight criteria.[8][19][20]

• Monitor pandemic conditions through national epidemiological surveillance, reassess measures whenever the World Health Organization pandemic phase changes, and apply actions according to Lithuania’s epidemiological situation.[4][5]
• Maintain continuous surveillance of human and animal influenza, acute upper respiratory tract infections, antiviral resistance and unexplained viral pneumonias; investigate outbreaks and share virus information with European and World Health Organization reference networks.[9][10][31][35]
• Use municipal incidence thresholds and the proportion of clinical influenza cases to identify local epidemics, and monitor virus types through the National Influenza Centre operated by the National Public Health Surveillance Laboratory.[27]
• Track preparedness through Annex 2 indicators, including participation of 1–5% of family, internal medicine and paediatric doctors in sentinel clinical virological surveillance, 100% functioning of the World Health Organization reference laboratory, influenza vaccination coverage among people over 65, and participation in preparedness exercises rising from 45 people in 2018 to 80 in 2023.[19]
• Increase the proportion of national health-system personal and public healthcare institutions prepared for emergencies from 60% in 2018 to 75% in 2023, while maintaining 100% performance for notification of animal influenza cases, the national early-warning and response system, and national coordination-centre functions under the 2005 International Health Regulations.[20]
• Assess the readiness of surveillance systems, laboratories, healthcare institutions and municipalities; review isolation, treatment, surge, infection-control, staffing and resource capacity; and identify deficiencies requiring corrective measures.[11][23][36][37][32]
• Monitor vaccine availability, procurement and distribution prospects, seasonal vaccination among healthcare workers and animal-exposed groups, antiviral stock readiness, antiviral distribution and supply, and essential medical resources during pandemic stages.[23][38][36][13][15]
• Evaluate institutional preparedness and response through the Influenza Pandemic Preparedness Consultants’ Group, which reviews institutional information and surveillance data and assesses state and municipal preparedness.[5]
• Evaluate pandemic impact, vaccination coverage, effectiveness and safety, antiviral effectiveness and resistance, information dissemination, and implementation of preparedness and emergency-management plans during the transition period; use findings to revise plans, methods, legislation and future preparedness measures.[17][18][33]

Implementation assessment of the 2016–2018 action plan found that all planned criterion values were achieved except accumulation of antiviral medicines.[5]The supplied extracts do not specify a unified reporting timetable, a complete methodology for all indicators, audit arrangements, or an independent accountability mechanism beyond responsible institutions, monitoring reviews and information exchange.[8][23][37][17]

Costing & Financing

Financing is intended to draw on approved general appropriations in annual state and municipal budgets, European Union and other structural-fund resources, international programmes, the Compulsory Health Insurance Fund budget and other lawfully obtained funds.[34]The extracts provide no total programme budget, itemised costings, allocations, quantified funding gap or economic assumptions.[34]

• Finance publicly funded influenza vaccination for people in risk groups and procure medical countermeasures through the European Union joint procurement mechanism, which Lithuania joined in 2014.[6][7]
• Purchase antiviral medicines from the state budget for priority population groups during an influenza pandemic, and establish reserves of antivirals and personal protective equipment.[22][21][26]
• Plan financial resources for pandemic preparedness and response, review resource and capacity shortfalls, and ensure essential energy and fuel supplies during a pandemic.[31][21]
• Provide patients and healthcare institutions with medicines and healthcare services purchased from state-budget funds, while monitoring and reallocating personnel, services and alternative-care capacity where required.[15][16]
• Identify additional resources for subsequent pandemic waves and future pandemics, replenish medical supplies after the response, and continue vaccination subject to available stocks.[32][17][18][33]
• Recognise vaccination as economically effective because evidence associates it with fewer medical visits, lost working days and antibiotic use, and among older people in closed communities with reduced hospitalisation and mortality.[6]

A resource shortfall was identified under the 2016–2018 action plan because the planned antiviral-medicine stock was not accumulated, although its quantity and cost are not specified.[5]A marked implementation measure is conditional on additional targeted funds, but the amount, source, currency and timing are not specified.[39]