Last updated 11/04/2014
Australian Health Management Plan for Pandemic Influenza
April 2014
Acknowledgements
European Centre for Disease Prevention and Control (ECDC). European Centre for Disease Prevention and Control Technical Report: Guide to public health measures to reduce the impact of Influenza pandemics in Europe: 'The ECDC Menu'.2009
The World Health Organization (WHO). Outbreak Communication, Best practices for communicating with the public during an outbreak. Report of the WHO Expert Consultation on Outbreak Communications held in Singapore, 21-23 September 2004. World Health Organization, Outbreak Communication 2004
National collaboration with state and territories and the health sector in development of the plan.
Contents
Australian Health Management Plan for Pandemic Influenza
Contents
i.How to use this document
PART 1
Overview of the National Approach
1Executive Summary
2Introduction
2.1Aims of a national pandemic response
2.2Key aspects of this plan
2.3Comprehensive approach
2.4Context of pandemic planning
2.5Legal framework
2.6Ethical framework
2.7Proportionate response
2.8Planning assumptions
2.9Participating parties
2.10Review and amendment
3Escalation
3.1Seasonal influenza arrangements
3.2Escalation from existing arrangements
3.3Escalation across stages
3.4Activation of other plans
3.5Enhanced arrangements
4Governance
4.1Roles and responsibilities
4.2Decision making and consultation
5Implementation
5.1Prevention activities
5.2Preparedness activities
5.3Response activities
5.4Recovery activities
5.5Resilience
5.6Emergence of the novel virus first in Australia
5.7Application to seasonal influenza
6Communications
6.1Key principles:
6.2Information gathering
6.3Sharing information between those involved in managing the response
6.4Public communications
PART 2
Operational Plan
Preparedness activities
Standby stage
Initial action stage
Targeted action stage
Standdown stage
PART 3
SUPPORT DOCUMENTS
Attachment A.Glossary
Attachment B.Decision Making Committees
Whole of Government decision making
Health sector decision making
Health advisory groups
Attachment C.Communication materials
Attachment D.Decision Support Map
Major decision making points
Attachment E.Introduction to the Menu of Actions
Menu of actions: infection control
Menu of actions: border measures
Menu of actions: social distancing measures
Menu of actions: pharmaceutical measures
References
Attachment F.Guide to Implementation
Attachment G.Surveillance Plan
1.INTRODUCTION
1.0Surveillance data
1.1Surveillance systems
1.2Surveillance activities by pandemic stage
1.3Roles and responsibilities
1.4Surveillance reporting
1.5Flexibility of the Plan to adapt to a different disease threat
1.6Additional studies
2.PREPAREDNESS
2a. Monitor:
2b. Investigate:
3.STANDBY
4.ACTION
4a. Initial action
4b. Targeted action
5.STANDDOWN
Attachment H.Evidence Compendium
Attachment I.Governance Table
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i.How to use this document
This plan is presented in three parts. Part one comprises the chapters of the Australian Health Management Plan for Pandemic Influenza (AHMPPI). Part two is the Operational Plan. Part three contains documents that provide additional detail to support decision making or operations.
The chaptersof the AHMPPI provide a high level overview of the national approach to the management of an influenza pandemic inkey areas. They are divided into:
Escalation:
An explanation of when arrangements under the AHMPPI will be used and how escalation through the stages will occur.
Governance:
An outline of the roles and responsibilities of key stakeholders and committees, and description of decision making and consultation processes.
Implementation:
An outline of the recommended overall approach to management of an influenza pandemic and discussion of the measures which could be implemented in each of the AHMPPI stages.
Communications:
A strategy for communicating with the public, the media and those involved in implementing the pandemic response.
The Operational Plan provides an operational checklist for planners (for use prior to or during a pandemic) of activities that could be considered for implementation in each of the AHMPPI stages. The Operational Plan is closely linked with the Implementation chapter.
Table1: Support documents to the AHMPPI
Attachment / Type / DescriptionA / Glossary / An explanation of terms and acronyms; acknowledgements and details of key committees.
B / Decision Making Committees / A description of the key government, health sector, health advisory and consultative committees involved in influenza pandemic decision making.
C / Communication Materials / A template to support high level decision makers (such as AHPPC) in the development of consistent, comprehensive messages, and atable exploring methods of sharing information with the public, the media and those involved in implementing the pandemic response. Supports the Communications chapter.
D / Decision Support Map / A map, for high level decision makers (such as AHPPC) and planners, of the key decisions to be made in each stage of the AHMPPI. Includes general background and triggers for each decision.
E / Menu of Actions / A list of the public health measures that could be implemented during a pandemic and the key factors relevant to determining suitability for implementation.
F / Guide to Implementation / A quick reference tool for decision makers, showing which measures from the Menu of Actions are relevant to each stage of the AHMPPI.
G / Surveillance Plan / A guide to national surveillance activities for pandemic influenza.
H / Evidence Compendium / A collection of literature reviews and modelling undertaken to provide evidence of the effectiveness of public health measures that might be applied to an influenza pandemic.
I / Governance Table / A detailed breakdown of roles and responsibilities across the AHMPPI stages and who will undertake them. Supports the Governance chapter.
PART 1
Overview of the National Approach
1Executive Summary
TheAustralian Health Management Plan for Pandemic Influenza(AHMPPI), the national government health sector pandemic influenza plan, outlines the agreed arrangements between the Australian Government and State and Territory Governments for the management of an influenza pandemic. To support an integrated and coordinated response, it also gives a broad indication of the roles and responsibilities of the other key health sector stakeholders that would be involved in this process.It is written for government decision makers and will be used to inform operational planning in state and territory governments and the broader Australian Government.
In 2009 the AHMPPI 2008 was used to guide Australia’s response to the H1N1 pandemic. Drawing on the lessons learned in 2009 and developments in the approach to pandemics within the international community, a new version of the AHMPPI has been developed, which takes a substantially different approach.
The key factors in this plan’s approach include:
- the use ofexisting systems and governance mechanisms as the basis of the response, particularly those for seasonal influenza;
- stronger linkages with emergency response arrangements, to capitalize on existing systems and avoid duplication;
- recognition of the potential to apply this plan to seasonal influenza when it threatens to overwhelm our health systems;
- the adoption ofa flexible approach that can be scaled and varied to be proportionate to the needs experienced at the time;
- incorporation ofan analysis of risks and benefits of the main public health measures which could be applied during a pandemic, to support evidence-based decision making;
- clear and detailed guidance on the collection of national surveillance data; and
- an emphasis on communicationactivities as a key tool in management of the response, including an exploration of the key principles and mechanisms to facilitate this.
Pandemic stages
An influenza pandemic represents a significant risk to Australia. It has the potential to cause high levels of morbidity and mortality and to disrupt our community socially and economically. Like any other hazard, Australia will approach this risk by undertaking activities to:
- prevent, where possible, the development of a pandemic overseas or in Australia;
- ensure we are prepared to meet the health needs of our community should a pandemic occur;
- respond promptly and effectively to minimise the pandemic’s impact; and
- contribute to the rapid and confident recovery of individuals, communities and services.
The activities required to support our community during a pandemic will involve state and territory governments, the Australian Government and many other health sector parties.Coordination and communication at national level will be particularly important during the active response, when a pandemic is currently circulating in our community. The AHMPPI therefore focuses primarily on response activities and the activities required to be prepared to respond.
To clearly show how the approach will change over the course of responding to a pandemic the AHMPPI is divided into several stages.
The following table outlines the key activities in each of the AHMPPI stages.
Table 2: Key activities in each of the AHMPPI stages.
AHMPPI STAGES / AHMPPI STAGES / ACTIVITIESPreparedness / Preparedness /
- Establish pre-agreed arrangements by developing and maintaining plans;
- research pandemic specific influenza management strategies;
- ensure resources are available and ready for rapid response;
- monitor the emergence of diseases with pandemic potential, and investigate outbreaks if they occur.
Response / Standby /
- Prepare to commence enhanced arrangements;
- identify and characterise the nature of the disease (commenced in Preparedness); and
- communicate to raise awareness and confirm governance arrangements.
Response / Action / Action is divided into two groups of activities:
Initial (when information about the disease is scarce)
- prepare and support health system needs;
- manage initial cases;
- identify and characterise the nature of the disease within the Australian context;
- provide information to support best practice health care and to empower the community and responders to manage their own risk of exposure; and
- support effective governance.
- support and maintain quality care;
- ensure a proportionate response;
- communicate to engage, empower and build confidence in the community; and
- provide a coordinated and consistent approach.
Response / Standdown /
- Support and maintain quality care;
- cease activities that are no longer needed, and transition activities to seasonal or interim arrangements;
- monitor for a second wave of the outbreak;
- monitor for the development of antiviral resistance;
- communicate to support the return from pandemic to normal business services; and
- evaluate systems and reviseplans and procedures.
When no pandemic is occurring (the inter-pandemic period) preparedness activities will be undertaken on an ongoing basis to ensure our readiness to respond promptly, should a pandemic emerge. As part of preparedness activities monitoring for the emergence of new viruses with pandemic potential and liaison with international colleagues will be routinely carried out. The activities undertaken during preparedness will be based on existing arrangements for seasonal influenza and the monitoring of communicable diseases.
Should a virus of concern emerge, surveillance systems will monitor the situation and advise on the need to enhance our existing arrangements for managing influenza by escalating to the response stages in the AHMPPI. The decision to formally escalate the AHMPPI through each of its stages will be made by the Chair of the Australian Health Protection Principal Committee (AHPPC), in consultation with AHPPC members and with advice from advisory bodies.
Once response activities are completed arrangements will return to the Preparedness stage, to monitor for any future pandemics.
Objectives and activities
The objectivesin all stages will be to:
- Minimise transmissibility, morbidity and mortality;
- Minimise the burden on/ support health systems; and
- Inform, engage and empower the public.
The activities which should be implemented will be selected by AHPPC, in consultation with relevant parties and on advice from advisory bodies. A comprehensive evidence compendium and an analysis of the key public health measures is available to support this plan to inform these decisions. As our understanding of the management of communicable diseases, immunisation and technology is constantly evolving, these support documents will be periodically revised to ensure they are providing decision makers with up-to-date and comprehensive information.
Reflecting a flexible approach, choices on implementation of public health measures may vary across states and territories to reflect the jurisdictional context, particularly in relation to timing of implementation and stand down, however negotiation within AHPPC will ensure a coordinated and consistent approach.
Proportionate response
In the past all pandemic planning was aimed at responding to a worst case scenario, similar to the influenza pandemic of 1918-19. The 2009 pandemic showed clearly the need for the flexibility to scale the response to be proportionate to the risk associated with the current disease.Although it will only be possible to quantify the overall impact of the pandemic once it has run its course, to assist planners, an estimate of the anticipated level of impact will be developed early in the response,and updated as new data becomes available. This estimate will be used to:
- guide the allocation of resources (including anticipation of when they are needed, as this will change over time);
- put in place strategies to supplement likely shortfalls (e.g. innovative options);
- reduce the risk to vulnerable people.
The level of impact that the pandemic has on the Australian community will depend on a number of factors. The most influential will be the clinical severity and transmissibility of the disease, and the capacity of the health system to cope with the demand and the need for specialist services.Three scenarios have been developed and used in this plan to assist planners interpret the influence of these factors. The scenarios look at three different pandemics: one where clinical severity is low, one medium and one high, and in each explore changes in transmissibility and health system capacity, and how this will affect the community, and therefore require different approaches and levels of resources.
Communication and consultation
The management of an influenza pandemic will require governments, health sector industry and the community to work together. Communication will be a priority under this plan, to ensure responders are provided with timely, accurate and comprehensive clinical information and advice in order to effectively manage patients; implement pandemic control measures and minimise their own risk of exposure.Consultation with responders and with the public will be essential to inform decision making.
Public communication will be used to provide an opportunity both to address any public concern caused by the pandemic and to engage the public in strategies to manage the impact of the disease. By giving the public up to date, consistent and accurate information about the status of the disease overseas and in Australia they can participate in managing the pandemic by taking stepsto reduce the risk to themselves and their families. They can also make more informed decisions about work and travel, taking up health recommendations and planning for people in at risk groups. Information about the implementation of activities and arrangements will be used to build public confidence in the capacity of health services to manage the response.
Structure of the AHMPPI
The four chapters that comprise the body of this plan (Part I) set out the broad policy approach to the management of a pandemic. Acknowledging the importance of exploring and agreeing how this policy could be implemented, the AHMPPI also includes considerable operational detail. The Operational Plan at Part II provides an operational checklist for planners, for use prior to or during a pandemic. The support documents at Part III examine activities at an individual task level and provide information to support decision making processes.
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2Introduction
This section outlines the aims of this plan, key factors in the approach taken, the context within whichit has been developed and methods of achieving a response proportionate to the risk posed by the current pandemic
Pandemics are unpredictable. When the next pandemic will occur, how rapidly it will emerge and how severe the illness will be are all unknown. What we do know is that even when the clinical severity of the disease is low, such as experienced in 2009, a pandemic can cause significant morbidity and mortality. It can overwhelm our health systems and in more severe scenarios, cause significant disruption to our economy and to society.
2.1Aims of a national pandemic response
Australia’s whole-of-government pandemic frameworks, at Australian, state and territory government levels, aim to protect Australia’s social function and economy.
During an influenza pandemic, the health sector will aim to minimise the pandemic’s impact on the health of Australians and our health systems. This, theAustralian Health Management Plan for Pandemic Influenza(AHMPPI), is the Australian national health sector pandemic influenza plan, and contributes to these aims by:
- clarifying the roles and responsibilities within the health sector of the Australian Government and state and territory governments;
- identifying areas where national guidance and coordination will be provided, and how this will be achieved; and
- supporting decision makers to respond in a manner thatis flexible, informed and proportionate to the circumstances at the time.
Across all activities the Strategic Objectivesof this plan will be to:
- Minimise transmissibility, morbidity and mortality;
- Minimise the burden on/ support health systems; and
- Inform, engage and empower the public.
2.2Key aspects of this plan
Since 1999 state and territory governments and the Australian Government have developed and refined a series of pandemic plans to guide how we might respond to an influenza pandemic.
Through these preparations we aim to increase the speed and efficiency of our response and to make our systems more robust in the face of increased demand. The H1N1 pandemic in 2009 gave us the opportunity to test these arrangements. This plan builds on the lessons identified and learnt in the 2009 response.
The key factors in this plan’s approach include:
- the use of existing systems and governance mechanisms, particularly those for seasonal influenza;
- a flexible approach thatcan be scaled and varied to meet the needs experienced at the time;
- evidence-based decision making;
- strong linkages with emergency responsearrangements
- the potential to apply this plan to seasonal influenza, when it threatens to overwhelm our health systems;
- clear guidance on the collection of national surveillance data; and
- an emphasis on communicationactivities as a key tool in management of the response.
2.3Comprehensive approach
This plan takes an emergency response approachas its framework. This approach will allow it to be readily integrated into broader emergency arrangements. It will also assist those who are implementing activities during a health emergency to communicate more easily with others outside the health sector.