Public Health Policy and Experience of the 2009 H1N1 Influenza Pandemic in Pune, India

Document Type : Original Article

Authors

1 The Maharashtra Association of Anthropological Sciences, Centre for Health Research and Development, Pune, India

2 Savitribai Phule Pune University, Pune, India

3 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland

4 University of Basel, Basel, Switzerland

5 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

Abstract

Background
Prior experience and the persisting threat of influenza pandemic indicate the need for global and local preparedness and public health response capacity. The pandemic of 2009 highlighted the importance of such planning and the value of prior efforts at all levels. Our review of the public health response to this pandemic in Pune, India, considers the challenges of integrating global and national strategies in local programmes and lessons learned for influenza pandemic preparedness.
 
Methods
Global, national and local pandemic preparedness and response plans have been reviewed. In-depth interviews were undertaken with district health policy-makers and administrators who coordinated the pandemic response in Pune.
 
Results
In the absence of a comprehensive district-level pandemic preparedness plan, the response had to be improvised. Media reporting of the influenza pandemic and inaccurate information that was reported at times contributed to anxiety in the general public and to widespread fear and panic. Additional challenges included inadequate public health services and reluctance of private healthcare providers to treat people with flu-like symptoms. Policy-makers developed a response strategy that they referred to as the Pune plan, which relied on powers sanctioned by the Epidemic Act of 1897 and resources made available by the union health ministry, state health department and a government diagnostic laboratory in Pune.
 
Conclusion
The World Health Organization’s (WHO’s) global strategy for pandemic control focuses on national planning, but state-level and local experience in a large nation like India shows how national planning may be adapted and implemented. The priority of local experience and requirements does not negate the need for higher level planning. It does, however, indicate the importance of local adaptability as an essential feature of the planning process. Experience and the implicit Pune plan that emerged are relevant for pandemic preparedness and other public health emergencies.

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References

  1. Mounier-Jack S, Coker R. Pandemic influenza preparedness in the Asia-Pacific Region: An Analysis of Selected National Plans. London School of Hygiene & Tropical Medicine; 2006.
  2. De Francisco N, Donadel M, Jit M, Hutubessy R. A systematic review of the social and economic burden of influenza in low-and middle-income countries. Vaccine. 2015;33(48):6537-6544. doi:10.1016/j.vaccine.2015.10.066
  3. Influenza (Seasonal). WHO website. http://www.who.int/mediacentre/factsheets/fs211/en/.  Accessed February 7, 2016.
  4. Gasparini R, Amicizia D, Lai PL, Panatto D. Clinical and socioeconomic impact of seasonal and pandemic influenza in adults and the elderly. Hum Vaccines Immunother. 2012;8(1):21-28. doi:10.4161/hv.8.1.17622.
  5. Social and Economic Impact of Influenza - Article in Motion. http://www.rapidreferenceinfluenza.com/chapter/B978-0-7234-3433-7.50013-X/aim/impact-of-pandemic-influenza.  Accessed February 19, 2017.
  6. Osterholm MT. Preparing for the next pandemic. N Engl J Med. 2005;352(18):1839-1842.
  7. Rao BL. Epidemiology and control of influenza. Natl Med J India. 2002;16(3):143-149.
  8. Azziz-Baumgartner E, Smith N, González-Alvarez R, et al. National pandemic influenza preparedness planning. Influenza Other Respir Viruses. 2009;3(4):189-196. doi:10.1111/j.1750-2659.2009.00091.x
  9. Jog S, Kadam D. H1N1 influenza pandemic: what we did and what we learnt? Indian J Crit Care Med. 2013;17(5):271-272. doi:10.4103/0972-5229.120316
  10. Tandale BV, Pawar SD, Gurav YK, et al. Seroepidemiology of pandemic influenza A (H1N1) 2009 virus infections in Pune, India. BMC Infect Dis. 2010;10:255. doi:10.1186/1471-2334-10-255
  11. Mishra AC, Chadha MS, Choudhary ML, Potdar VA. Pandemic Influenza (H1N1) 2009 Is Associated with Severe Disease in India. PLoS One. 2010;5(5):e10540. doi:10.1371/journal.pone.0010540
  12. Chunsuttiwat S. Response to avian influenza and preparedness for pandemic influenza: Thailand’s experience. Respirology. 2008;13(s1):S36-S40. doi:10.1111/j.1440-1843.2008.01256.x
  13. IDSA. IDSA Seasonal and Pandemic Influenza Principles for US Action 2012. http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Influenza_and_Bio-Threats/Seasonal_and_Pandemic_Influenza/IDSA%20Seasonal%20and%20Pandemic%20Influenza%20Principles%20for%20US%20Action%202012.pdf.  Accessed April 20, 2015. Published September 2012.
  14. Uscher-Pines L, Omer SB, Barnett DJ, Burke TA, Balicer RD. Priority setting for pandemic influenza: an analysis of national preparedness plans. PLoS Med. 2006;3(10):e436.
  15. Dumiak M. Push needed for pandemic planning. Bull World Health Organ. 2012;90(11):800-801. doi:10.2471/BLT.12.021112
  16. Charles R Penn. Future perfect? Improving preparedness through the experiences of the influenza A (H1N1) 2009 pandemic. Bull World Health Organ. 2011;89(7):470-470.
  17. World Health Organization. Influenza Pandemic Plan. The Role of WHO and Guidelines for National and Regional Planning. Geneva: WHO; 1999.
  18. World Health Organization. Global influenza preparedness plan: the role of WHO and recommendations for national measures before and during pandemics. Geneva: WHO; 2005.
  19. WHO. WHO checklist for influenza pandemic preparedness planning. Geneva: WHO; 2005.
  20. Fineberg HV. Pandemic Preparedness and Response — Lessons from the H1N1 Influenza of 2009. N Engl J Med. 2014;370(14):1335-1342. doi:10.1056/NEJMra1208802
  21. World Health Organization. Comparative Analysis of National Pandemic Influenza  Preparedness Plans. Geneva: WHO; 2011.
  22. Mounier-Jack S, Coker RJ. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet. 2006;367(9520):1405-1411. doi:10.1016/S0140-6736(06)68511-5
  23. Kamigaki T, Oshitani H. Influenza pandemic preparedness and severity assessment of pandemic (H1N1) 2009 in South-east Asia. Public Health. 2010;124(1):5-9. doi:10.1016/j.puhe.2009.11.003
  24. WHO. Strengthening Response to Pandemics and Other Public-Health Emergencies. http://www.srmuniv.ac.in/downloads/ihr_global_public_health_emergency.pdf.  Accessed January 1, 2016. Published 2011.
  25. USAID. Towards a safer world. http://towardsasaferworld.org/sites/default/files/tasw_booklet_final_11.28.11.pdf.   Accessed September 19, 2015.
  26. Rao BL, Kadam SS, Pavri KM, Kothavale VS. Epidemiological, clinical, and virological features of influenza outbreaks in Pune, India, 1980. Bull World Health Organ. 1982;60(4):639.
  27. Fukuda K, World Health Organization, Global Influenza Programme. Pandemic Influenza Preparedness and Response: A WHO Guidance Document. Geneva: World Health Organization; 2009.
  28. Directorate General of Health Services, Ministry of Health and Family welfare, Government of India. Action Plan Pandemic Preparedness and Response for Managing Novel Influenza A H1N1. http://delhi.gov.in/wps/wcm/connect/ffa04980406954a5b451bc34262e20fd/Pandeimc+Preparedness+plan-5-6.doc?MOD=AJPERES.  Accessed July 14, 2014.
  29. Directorate General of Health Services. Contingency plan for human cases of Avian influenza India 2005. http://www.fao.org/docs/eims/upload/221470/national_plan_ai_ind_en.pdf.  Accessed May 19, 2016. Published December 2005.
  30. Pune’s first case of swine flu, a techie. Indian Express. June 23, 2009. http://archive.indianexpress.com/news/pune-s-first-case-of-swine-flu-a-techie/479906/.  Accessed September 12, 2016.
  31. Day after, rush at Naidu Hospital; no need to panic, says NIV director. Indian Express. August 5, 2009. http://archive.indianexpress.com/news/day-after-rush-at-naidu-hospital--no-need-t/498107/.  Accessed September 12, 2016.
  32. Medical stores run short of supplies as citizens scramble for sanitisers, eucalyptus oil. Indian Express. August 13, 2009. http://archive.indianexpress.com/news/medical-stores-run-short-of-supplies-as-citi/501465/.  Accessed September 12, 2016.
  33. In epidemic zone, schools shut, so are private hospital doors. Indian Express. August 2009. http://indianexpress.com/article/news-archive/web/in-epidemic-zone-schools-shut-so-are-private-hospital-doors/.  Accessed September 12, 2016.
  34. Kishore J. National health programmes of India: National policies and legislations related to health. New Delhi : Century Publications, 2001.
  35. Córdova-Villalobos JA, Sarti E, Arzoz-Padrés J, Manuell-Lee G, Méndez J, Kuri-Morales P. The influenza A(H1N1) epidemic in Mexico. Lessons learned. Health Res Policy Syst. 2009;7(1):21. doi:10.1186/1478-4505-7-21.
  36. Dhere R, Yeolekar L, Kulkarni P, et al. A pandemic influenza vaccine in India: from strain to sale within 12 months. Vaccine. 2011;29 Suppl 1:A16-A21. doi:10.1016/j.vaccine.2011.04.119
  37. Goel MK, Goel M, Khanna P, Mittal K, others. Pandemic influenza A (H1N1) 2009 vaccine: An update. Indian J Med Microbiol. 2011;29(1):13.
  38. Byramjee Jeejeebhoy Medical College and Sassoon General Hospital. http://www.bjmcpune.org/history.htm.  Accessed August 23, 2016.
  39. The World Health Organization. Implementation of the International Health Regulations (2005) Report of the Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009. http://www.srmuniv.ac.in/downloads/ihr_global_public_health_emergency.pdf.  Accessed December 29, 2014. Published 2011.
  40. John TJ, Muliyil J. Pandemic influenza exposes gaps in India’s health system. http://imsear.hellis.org/handle/123456789/135869.   Accessed March 15, 2014. Published 2009.
  41. Chadha MS, Hirve S, Dawood FS, et al. Burden of Seasonal and Pandemic Influenza-Associated Hospitalization during and after 2009 A(H1N1)pdm09 Pandemic in a Rural Community in India. PLoS One. 2013;8(5):e55918. doi:10.1371/journal.pone.0055918.
  42. Sundaram N, Purohit V, Schaetti C, Kudale A, Joseph S, Weiss MG. Community awareness, use and preference for pandemic influenza vaccines in Pune, India. Hum Vaccines Immunother. 2015;11(10):2376-2388. doi:10.1080/21645515.2015.1062956
  43. Fedson DS. Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries. Emerg Infect Dis. 2009;15(3):365-371. doi:10.3201/eid1503.080857
  44. Phadke A. Response to an epidemic of novel H1N1 flu in Pune: need for introspection. Indian J Med Ethics. 2009;6(4):176-178.
  45. Gautham M, Binnendijk E, Koren R, Dror DM. “First we go to the small doctor”: First contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India. Indian J Med Res. 2011;134(5):627-638. doi:10.4103/0971-5916.90987
  46. Sundaram N, Schaetti C, Purohit V, Kudale A, Weiss MG. Cultural epidemiology of pandemic influenza in urban and rural Pune, India: a cross-sectional, mixed-methods study. BMJ Open. 2014;4(12):e006350. doi:10.1136/bmjopen-2014-006350
  47. Kakkar M, Hazarika S, Zodpey S, Reddy KS. Influenza pandemic preparedness and response: A review of legal frameworks in India. http://imsear.li.mahidol.ac.th/handle/123456789/139267.  Accessed January 28, 2016. Published 2010.
  48. Patro B, Tripathy J, Kashyap R. Epidemic diseases act 1897, India: Whether sufficient to address the current challenges? J Mahatma Gandhi Inst Med Sci. 2013;18(2):109. doi:10.4103/0971-9903.117796
  49. Jacob JT. Human Rights and Public Health During Pandemic Influenza. Indian J Med Ethics. 2006;3(1):2-3.
  50. Burkle FM. Do pandemic preparedness planning systems ignore critical community and local-level operational challenges? Disaster Med Public Health Prep. 2010;4(1):24-29.
  51. Jacob JT. Swine Flu Surprises. Econ Polit Wkly. 2015;50(22):24-26.
  52. Harrington J, Kroeger A, Runge-Ranzinger S, O’Dempsey T. Detecting and responding to a dengue outbreak: evaluation of existing strategies in country outbreak response planning. J Trop Med. 2013;2013:756832.

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History

  • Receive Date: 13 September 2016
  • Revise Date: 25 April 2017
  • Accept Date: 26 April 2017
  • First Publish Date: 01 February 2018

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