|Implemented in this survey?|
On the 24th of April 2009, the World Health Organization (WHO) notified the Federal Health authorities in Australia of outbreaks in Mexico, Canada, the United States and Europe of a novel influenza A virus (H1N1 influenza 2009, previously called human swine influenza). Since then the virus has spread to other countries around the world including Australia. As a result, the Australian Health Management Plan for Pandemic Influenza (2008) was implemented.
The Australian Health Management Plan for Pandemic Influenza (2008) AHMPPI describes a range of strategies aimed at eliminating the outbreak and reducing the transmission of pandemic influenza. It aims to guide planning and assist in prioritising the types of interventions that would be implemented during an influenza pandemic. The plan describes six different phases of the pandemic (alert, delay, contain, sustain, control, recover) as well as the key actions that should follow these. Besides the implementation of the plan, the Government also established the Health Emergency website (1) which provides up-to-date information about the influenza outbreak in Australia, including updated bulletins, Australian influenza surveillance reports, latest news, daily updates and information for health professional, individuals, business.
The specific objectives of the AHMPPI are to:
The AHMPPI provides an overarching framework for preparedness and response activities within the health sector. (2)
Government, Health Care providers, Consumers
|Medienpräsenz||sehr gering||sehr hoch|
The pandemic policy was based on modelling studies synthesising the best available evidence (at that time). However it was produced based on the assumptions that the pandemic would be severe and would have high mortality. Even though it is evidence-based, the policy has been described rigid by those in the "front line" (3,4).
Dr Eizenber, Chair of a Division of General Practice, in one of the most affected areas in Victoria summarise the situation as "it became evident that the rhetoric contained in the AHMPPI did not
match the reality on the ground". For example the plan failed to consider basic issues such as stockpiling of personal protective gear (especially by general practitioners) or means of rapidly
distributing antivirals and equipment. Some providers reported not receiving the necessary equipment until almost a month after the alert notice of the pandemic was received (3,4).
The AHMPPI is somehow system dependent as as the Australian pandemic phases were designed to describe the situation in Australia and to guide its response. Therfore these may not always be the same as those descrided by the World Health Organisation. According to the Goverment - having an Australian system means that actions can be taken in Australia before a change of phase is declared by the WHO" (2).
Detailed planning and preparation went into the Australian Health Management Plan for Pandemic Influenza. In 2008, the AHMPPI was updated and released by the Minister of Health who stated that this demonstrated "the Rudd's Government [current Labor Government] commitment to keeping Australia secure against potential threats. Its development has also embodied the Government's commitment of working closely with the states and territories". (2)
|Implemented in this survey?|
The AHMPPI was initially developed and released in 2006 and updated in 2008. It was based on the assumption that the pandemic would be as severe as the 1918 - Spanish flu pandemic. The plan was therefore designed to deal with a serious new strain of influenza with 40% of the population showing signs of infection and 2.4% of those affected dying (i.e. high mortality rates). Experts in virology, epidemiology and health policy came together to produce this plan. Assumptions about the disease transmission rates, severity, and the likely effectiveness of an antiviral drug (oseltamir) were modelled. The overall pandemic planning aims to protect Australians and to reduce the impact of a pandemic on social function and the economy as well as minimise the impact of an influenza pandemic on health and the health sector. (2)
However, on the 17th of June 2009, the AHMPPI was revised and amended to include the "protect" phase. This phase provides greater focus on those most likely to have poor outcomes from a case of influenza and recognises the disease patterns which were emerging across Australia. For example, it was recognised that, for most people, infection with H1N1 Influenza 09 is not as severe as originally foreseen and that the new disease is mild in most cases, severe in some and moderate overall. (5)
On the 18th of September the Therapeutics Goods Administration (the agency that provides marketing/licensing approval for drugs and devices) approved the Panvax® H1N1 vaccine. On the 30th of September 2009 the Department of Health and Ageing launched the national immunisation program for the H1N1 vaccine. The vaccine is now provided free through general practitioners. However, to date, the uptake of the vaccine has been slow.
Before the June amendment there was some debate amongst academics and infectious disease experts about whether a downgraded response to the outbreak would be appropriate considering the relatively low virulence and mild nature of the disease. A lower level of response would consume fewer resources.
Even though supportive of the AHMPPI, the Australasian Society for Infectious Diseases and the Transplantation Society of Australia and New Zealand considered the AHMPPI infection control advice not entirely workable and as a response developed their own infection control guidelines for patients with influenza-like illness, including pandemic (H1N1) influenza 2009, in Australian health care facilities. Their main concern was the recommendation on the adoption of "Droplet Additional Precautions is required within 1 meter of an infections patient". According to the ASID (HICSIG) this approach does not provide an appropriate level of safety.
General public: a general public survey conducted by Seale et al in early May in Sydney showed low levels of anxiety amongst respondents, as most believed they were not at high risk of contracting the pandemic influenza. Respondents also believed the Government was prepared to respond effectively and quickly to the pandemic. (6)
|General public||sehr unterstützend||stark dagegen|
|Australasian Society for Infectious Diseases and the Transplantation Society of Australia and New Zealand||sehr unterstützend||stark dagegen|
|Media||sehr unterstützend||stark dagegen|
|General public||sehr groß||kein|
|Australasian Society for Infectious Diseases and the Transplantation Society of Australia and New Zealand||sehr groß||kein|
The policy was implemented in April 2009 as a response to the H1N1 Influenza 09 pandemic. However, some commentators suggest that the translation of the information in the AHMPPI report (e.g. evidence from epidemiological trials into pandemic policy) was challenging, given the complexity or real world factors that influence the effectiveness of the intervention. (3,7)
As previously described, the policy was conceived on the basis that the pandemic would be severe, which turned out not to be the case for the H1N1 pandemic.
An evaluation of the impact of the pandemic policy implementation is yet to be conducted. The outbreak has provided an excellent opportunity to review the AHMPPI and assess its performance in practice.
The latest pandemic H1N1 2009 figures report that as of 6th October 2009, Australia had 36,927 confirmed cases of H1N1 influenza and183 deaths due to the virus. The total number of hospitalisations since April is 4,806. It is important to note that since the 17th of June 2009, laboratory testing has been directed only towards people with moderate and severe illness and those in institutional settings. This means that the number of confirmed cases does not reflect how many people in the community have acquired the virus. The Government is also expected to evaluate the pandemic policy in light of the latest developments. In the current AHMPPI foreword the Minister of Health states that "A process for continual review of these planning assumptions has been established to ensure that pandemic planning in Australia is evidence-based and in line with the latest advances". (2)
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
1. Australian Government Department of Health and Ageing. Health emergency http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/home-1 (accessed 06 Oct 2009).
2. Australian Government Department of Health and Ageing. Australian health management plan for pandemic influenza (2008). Canberra; 2008.
3. Grayson ML, Johnson PD. Australia's influenza containment plan and the swine flu epidemic in Victoria. The Medical Journal of Australia 2009; 191: 150.
4. Eizenberg P. The general practice experience of the swine flu epidemic in Victoria--lessons from the front line. The Medical Journal of Australia 2009; 191: 151-153.
5. Australian Government Department of Health and Ageing. Protect phase annex to the Australian health management plan for pandemic influenza. Canberra 2009.
6. Seale H, McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D, et al. The community's attitude towards swine flu and pandemic influenza. The Medical Journal of Australia 2009; 191: 267-269.
7. McCaw JM, Wood JG, McBryde ES, Nolan TM, Wu JT, Lipsitch M, et al. Understanding Australia's influenza pandemic policy on the strategic use of the antiviral drug stockpile. The Medical Journal of Australia 2009; 191: 136-137.