Tohoku University Graduate School of Medicine, Sendai, Japan

According to this 14-page article (published in the Centers for Disease Control and Prevention (CDC)'s Emerging Infectious Diseases publication), based on the premise that better preparedness for an influenza pandemic mitigates its impact, many countries have started developing and implementing national influenza pandemic preparedness plans. However, the level of preparedness varies among countries. Developing countries encounter unique and difficult issues and challenges in preparing for a pandemic. Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialised countries. Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries. The public health and clinical infrastructure of developing countries are often inadequate to deal with a widespread health crisis such as an influenza pandemic. Given that an influenza pandemic will inevitably have a global effect, improving pandemic preparedness in every country, particularly developing ones, is necessary.

This article identifies several requirements related to improving preparedness for future consideration:

Improving Planning Processes
"To minimise the impact of an influenza pandemic, good preparedness plans need to be developed. With the increasing risk for a pandemic caused by the spread of avian influenza A virus (H5N1), most countries have started such planning. ...[T]he approaches used by industrialised countries may not be feasible or appropriate for developing countries. Feasible, user-friendly tools are needed to assist these countries. [The World Health Organization] WHO has developed several such tools, including a checklist for national preparedness. However, these tools describe the general approaches to pandemic preparedness and are not specifically designed for countries with limited resources. For developing countries more practical tools are needed, among them models to estimate the impact of a pandemic in developing countries, a list of feasible interventions to mitigate the impact of pandemic without available pharmaceutical interventions, and planning guidelines for hospitals with limited resources."

Increasing Availability of Antiviral Agents and Vaccines
"If the next pandemic occurs in a few years, vaccines and antiviral agents, particularly neuraminidase inhibitors, may not be available as a main intervention in developing countries. Availability needs to be increased to fill the gaps between developed and industrialized countries."

Providing Better Medical Care
"Several issues need to be addressed to provide adequate medical care during a pandemic. First, essential medical supplies such as masks, gloves, and antimicrobial agents should be available in hospitals and clinics. Second, healthcare personnel should be trained for infection control measures. Third, healthcare and public health systems need to be maintained to minimize the impact of a pandemic."

Developing Feasible Mitigation Strategies
"More feasible and effective strategies should be developed as soon as possible to mitigate the negative impact of an influenza pandemic in developing countries. Since the availability of pharmaceutical interventions in developing countries is less likely, nonpharmaceutical interventions such as social distancing and personal hygiene may be the only available interventions."

Strengthening Core Capacities
"Improving pandemic preparedness without establishing a proper national program for seasonal influenza is unrealistic. For example, increasing the availability of pandemic vaccines without increasing the use of vaccines for seasonal influenza is difficult. It is also difficult to implement infection control measures in hospitals and personal hygiene during a pandemic if they are not routinely implemented for seasonal influenza and other infections."

Strengthening International Collaboration
"Timely sharing of the virus strains and relevant information is essential for such containment to be successful."

This article concludes with the observation that preparing for a pandemic by strengthening preparedness within a single country is not sufficient. According to the authors, a pandemic should be considered from a global perspective.