South East Asia could be the epicentre of the next human influenza pandemic

The Asia-Pacific region faces a number of challenges in preparing for an influenza pandemic, yet gaps and inconsistencies in plans across the continent could hinder an effective response to a pandemic, according to a new report presented at the Lancet Asia Medical Forum 2006, Singapore.

Over 80% of human deaths from avian influenza (H5N1) recorded to date have occurred in South East Asia, which suggests that countries in the region could be the epicentre of the next human influenza pandemic.

The report reveals two distinct groupings in Asia-Pacific. Hong Kong, Australia and New Zealand were found to have comprehensive operational guidance manuals that facilitate national responses to pandemic influenza. Plans prepared by China, Thailand and Vietnam were less operational but strategically plan for investment to develop future capacity. The regional as a whole drew from its previous experience of SARS. This report follows a previous analysis of European pandemic plans, a summary of which was published in the Lancet.

Dr Richard Coker, the report's lead author, said: 'The strategic approach towards pandemic preparedness taken by Australia, Hong Kong, and New Zealand is similar to the best of the European plans - the remaining Asia-Pacific countries surveyed are likely to be less prepared for an imminent pandemic and might consider developing operational plans that recognise current capacity limitations'.

London School of Hygiene & Tropical Medicine - LSHTM researchers examined the preparedness plans of five countries in the Asia Pacific region - China (and the Special Administrative Region of Hong Kong), Vietnam, Thailand, Australia and New Zealand. Pandemic plans for Cambodia, Laos and Indonesia were not available.

The WHO's Global Influenza Preparedness Plan5 provides guidelines for governments on preparing for and managing an influenza pandemic, and is the benchmark against which all national preparedness planning should be implemented. The completeness and quality of these national preparedness plans were assessed based on the World Health Organization's (WHO) preparedness checklist,6 addressing levels of:

• Planning and coordination
• Surveillance
• Public health interventions (public health control measures, vaccines and antivirals)
• Health system response
• Maintenance of essential services
• Communication
• Putting plans into action

Potential gaps and weaknesses were identified in the Asia Pacific Region. For example some countries organise their responses by pandemic phases differently from the WHO pandemic phases which could cause confusion during the management of a regional or global crisis. A further gap is that the maintenance of essential services is not addressed fully in several plans.

Dr Richard Coker said: 'Many of the gaps common in this region, such as identifying priority groups for antivirals and vaccines, planning for essential services and understanding how healthcare systems might respond during a pandemic are also common to the European region. Opportunities exist for co-operative relations between countries to be developed and built upon in influenza preparedness'.

The LSHTM researchers acknowledge that only those plans available for analysis at the time of research (February 2006) were included. The analysis does not include plans under review, amendment or pending finalisation.