Securitising health: Australian newspaper coverage of pandemic influenza

This paper analyses contemporary Australian newspaper coverage of the threat of pandemic influenza in humans, specifically in the light of recent transformations in biomedical and public health understandings of infectious disease as continuously emerging. Our analysis suggests that the spectre of pandemic influenza is characterised, in newspaper accounts, as invoking a specific form of nation building. The Australian nation is depicted as successfully securing itself in the face of a threat from Asia (and in the absence of an effective international health body). What is described in newspaper accounts reflects a shift in the public health response to infectious disease. This response does not entail a direct focus on protecting either the population or national territory. Instead, it involves the continuous rehearsal of readiness to react to disasters through the networking of government and private agencies responsible for maintaining critical infrastructure. In this way, coverage of pandemic influenza positions health as central to national security, with little reporting of the reasons for or the potential implications of this alliance. Thus, the imperative to 'be prepared' is presented as self-evident.     

The swine flu episode and the fog of epidemics

The 1918 influenza pandemic has shaped research and public health for nearly a century. In 1976, the specter of 1918 loomed large when a pandemic threatened the country again. Public health officials initiated a mass vaccination campaign, but the anticipated pandemic failed to occur. An examination of the available data in 1976 and the decision to vaccinate, as well as lessons learned from the HIV/AIDS epidemic in the early 1980s, may help shape an appropriate public health response to future threats from avian influenza or other infectious diseases.     

Pandemic Influenza Planning,United States, 1978–2008

During the past century, 4 influenza pandemics occurred. After the emergence of a novel influenza virus of swine origin in 1976, national, state, and local US public health authorities began planning efforts to respond to future pandemics. Several events have since stimulated progress in public health emergency planning: the 1997 avian influenza A(H5N1) outbreak in Hong Kong, China; the 2001 anthrax attacks in the United States; the 2003 outbreak of severe acute respiratory syndrome; and the 2003 reemergence of influenza A(H5N1) virus infection in humans. We outline the evolution of US pandemic planning since the late 1970s, summarize planning accomplishments, and explain their ongoing importance. The public health community’s response to the 2009 influenza A(H1N1)pdm09 pandemic demonstrated the value of planning and provided insights into improving future plans and response efforts. Preparedness planning will enhance the collective, multilevel response to future public health crises.     

Major issues and challenges of influenza pandemic preparedness in developing countries

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 industrialized 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. Such an event will inevitably have a global effect. Therefore, improving pandemic preparedness in every country, particularly developing ones, is urgently needed.     

Pandemic influenza preparedness in Africa is a profound challenge for an already distressed region: analysis of national preparedness plans

A new highly pathogenic strain of influenza virus, H5N1, has emerged causing severe outbreaks in poultry and high mortality rates when humans are infected. The threat of a new influenza pandemic has prompted countries to draft national strategic preparedness plans to prevent, contain and mitigate the next human influenza pandemic. To evaluate preparedness for an influenza pandemic in the African region we analysed African national preparedness plans available in the public domain. A data extraction tool, based on a World Health Organization checklist for influenza epidemic preparedness, was designed in consultation with pandemic influenza planning experts and experts on the region's public health challenges. Thirty-five plans were identified and available from 53 African countries. Most plans are relatively robust in addressing detection and containment of influenza in animals but strategic preparedness to respond to pandemic human influenza is weak. In most plans communication strategies have been developed with the aim to raise awareness of transmission factors and promote hygiene measures. By contrast, the human health care sector is ill-prepared. Case management, triage procedures, identification of health care facilities for patient treatment (including home care and provisions for the distribution and administration of pharmaceuticals) are poorly addressed by most plans. The maintenance of essential services in the event of a pandemic is absent from most plans. Whilst many African countries have strategic pandemic influenza preparedness plans, most are developmental in nature and lack operational clarity, or focus principally on the containment of avian influenza rather than pandemic human influenza. Clear strategies, that are operational, need to be developed that reflect the realities of national context and resource constraints and that meet national objectives. These objectives need also to be coherent with international imperatives such that the global threat of pandemic influenza can be met effectively and efficiently.     

The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.     

Department of Defense influenza and other respiratory disease surveillance during the 2009 pandemic

The Armed Forces Health Surveillance Center's Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system's surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system's worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS's support of a global network contributes to DoD's force health protection, while supporting global public health.     

中国流感监测网络的发展与展望

流感引起的每年季节性流行在全球造成严重的疾病负担,而且流感还会不定期引起世界性流感大流行,造成严重社会恐慌、经济损失。由于流感病毒的高度可变性和不可确定性,流感防控面临诸多挑战。监测是预防和控制流感的关键策略,流感也是第一个实行全球监测的传染病。中国流感监测60余年,为我国和全球流感防控做出了巨大贡献。特别是近10余年来,流感监测网络得以飞跃发展,规模显著扩大,监测内容和范围不断完善,监测质量迅速提升。中国流感监测网络是我国和全球新发传染病病原的早期发现体系之一,为新发突发传染病应对准备了技术和人才队伍,有助于全面提升公共卫生系统对新发传染病的防控和预测预警能力。     

Trust in medical organizations predicts pandemic (H1N1) 2009 vaccination behavior and perceived efficacy of protection measures in the Swiss public

Following the recent avian influenza and pandemic (H1N1) 2009 outbreaks, public trust in medical and political authorities is emerging as a new predictor of compliance with officially recommended protection measures. In a two-wave longitudinal survey of adults in French-speaking Switzerland, trust in medical organizations longitudinally predicted actual vaccination status 6 months later, during the pandemic (H1N1) 2009 vaccination campaign. No other variables explained significant amounts of variance. Trust in medical organizations also predicted perceived efficacy of officially recommended protection measures (getting vaccinated, washing hands, wearing a mask, sneezing into the elbow), as did beliefs about health issues (perceived vulnerability to disease, threat perceptions). These findings show that in the case of emerging infectious diseases, actual behavior and perceived efficacy of protection measures may have different antecedents. Moreover, they suggest that public trust is a crucial determinant of vaccination behavior and underscore the practical importance of managing trust in disease prevention campaigns.     

Australia’s pandemic influenza ‘Protect’ phase: emerging out of the fog of pandemic

Recent sociological analyses of contemporary emergency planning foreground a potential break between preparedness plans animated by the spectre of an imaginary future catastrophe and classical public health efforts that are anchored in close knowledge of populations and efforts to prevent the transmission of disease. Whilst scholarly analysis to date suggests that the distinct rationales of public health governance underpinning these different approaches are likely to be entwined and to work in productive tension with each other, less attention has been paid to how this tension plays out in practice. Using 27 semi-structured interviews with public health experts involved in the development or implementation of Australia’s pandemic influenza plan, this paper examines how preparedness efforts established in anticipation of a catastrophic threat were reconfigured during the Australian 2009 (H1N1) pandemic influenza. Specifically, one Australian state broke with the national plan and rapidly inserted an entirely new pandemic phase – which became known as ‘Protect’ – into their response, thereby providing a critical reorientation in the ‘fog of pandemic’. Our analysis indicates that classical population health efforts interrupted not only the vision of catastrophe embedded within the plans, but the actual plans and their implementation, forcing the public health response in a new direction.     

Evaluation of Border Entry Screening for Infectious Diseases in Humans

In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.     

Preparing for the next influenza pandemic: a New South Wales perspective

Pandemic influenza is one of a small number of infectious diseases that pose a significant global threat. Pandemic preparedness has accelerated around the world in recent years in response to the perceived increased risk of a pandemic developing following the emergence of H5N1 avian influenza in domestic poultry flocks in Asia, Africa and Europe. There is a hierarchy of pandemic plans - international, national, state, and local - and harmonisation of all of these is imperative for a coordinated and effective response. At the national and state levels, plans have been developed for a whole-of-government response to a pandemic, in addition to plans specifically for the health sector. It is inevitable that influenza pandemics will occur and careful planning is crucial to mitigate their potentially devastating effects.     

COVID-19疫情给其它传染病防治带来的挑战与机遇

COVID-19大流行对人类健康造成巨大威胁的同时也给全世界公共卫生系统带来前所未有的挑战和机遇。为迅速控制疫情,世界各国采取保持社交距离、重新分配医疗资源、调整医疗策略等应急措施,原有医疗服务秩序遭到破坏,有限医疗资源受到再挤压,其它传染病防治最佳时机被错过,导致结核病、肝炎、麻疹、艾滋病等多种传染病发病率和死亡率快速上升,给人类健康和社会经济都造成严重损害。但是也有一些意外收获,如改变了人们对旅行安全常态的定义、完善了中低收入国家被忽视的传染病防控关键内容、暴露出医疗体系中传染病医生匮乏问题、降低严重复杂性流感和侵袭性肺炎球菌等疾病发病率等。年初,COVID-19大流行给全世界敲响了警钟,让各国看清自身公共卫生系统在应对传染病暴发上的不足。年末,COVID-19和其它传染病或将同时暴发,各国公共卫生系统将面临更为严峻的大考,亟待各国政府高度重视并做好充分准备。     

Shaping meeting to explore the value of a coordinated work plan for epidemic and pandemic influenza vaccine preparedness

In March 2019, a group of global health leaders with expertise in influenza, vaccinology and pandemic preparedness was convened for a meeting titled “Shaping Meeting to explore the value of a coordinated work plan for epidemic and pandemic influenza vaccine preparedness.” Influenza epidemics occur annually in every country in the world, resulting in significant global burden of illness and deaths. While every country is effected, most deaths and severe disease occur in low- and lower middle-income countries (LIC and LMIC). Influenza immunization programs that limit the burden of disease, deaths, and reduce economic impact are a fundamental public health intervention for seasonal epidemics. In addition, they provide the experience, systems and infrastructure for the timely and efficient use of vaccines and other medical countermeasures critical for effective pandemic responses. Pandemic influenza response activities, including vaccination efforts, will be most effective if used and practiced regularly. Consequently, countries with seasonal influenza prevention and control programs should be better prepared for, and have more effective pandemic responses than countries without such programs. A decade after the 2009 pandemic, despite ongoing prevention efforts, most LICs and LMICs still lack access to robust seasonal influenza immunization programs. Given this current state, meeting participants concluded that there is critical need to advance the expansion and strengthening of seasonal influenza immunization programs in LICs and LMICs not only to reduce the economic and public health effects of annual influenza epidemics, but also to increase preparedness to mitigate the threat of future pandemics and improve global heath security. Many government and private sectors, in a whole of government approach, need to be working together to support and advance countries' epidemic and pandemic influenza capacities preparedness objectives. Accomplishment of these objectives can be achieved with a coordinated work plan developed and guided by an alliance of international stakeholders, to include, among others, government, and nongovernment organization representation, civil society representatives, vaccine manufacturers, international organizations, and health security and influenza experts.     

mRNA vaccines manufacturing: Challenges and bottlenecks

Vaccines are one of the most important tools in public health and play an important role in infectious diseases control. Owing to its precision, safe profile and flexible manufacturing, mRNA vaccines are reaching the stoplight as a new alternative to conventional vaccines. In fact, mRNA vaccines were the technology of choice for many companies to combat the Covid-19 pandemic, and it was the first technology to be approved in both United States and in Europe Union as a prophylactic treatment. Additionally, mRNA vaccines are being studied in the clinic to treat a number of diseases including cancer, HIV, influenza and even genetic disorders.The increased demand for mRNA vaccines requires a technology platform and cost-effective manufacturing process with a well-defined product characterisation. Large scale production of mRNA vaccines consists in a 1 or 2-step in vitro reaction followed by a purification platform with multiple steps that can include Dnase digestion, precipitation, chromatography or tangential flow filtration. In this review we describe the current state-of-art of mRNA vaccines, focusing on the challenges and bottlenecks of manufacturing that need to be addressed to turn this new vaccination technology into an effective, fast and cost-effective response to emerging health crises.     

Assessing Argentina's response to H1N1 in austral winter 2009: from presidential lethargy to local ingenuity

Argentina experienced a heavy burden of novel H1N1 influenza in austral winter 2009. In early July 2009, Argentina reported more than 1,500 cases and was confronting the highest per capita H1N1 mortality rate in the world. By September 2009, more than 500 people had died of H1N1 in Argentina. Unlike sister countries Chile and Mexico, Argentina's national authorities did not respond by implementing mitigation measures such as public gathering bans and school closures or by issuing broad-based messages about personal hygiene and disease prevention. Around the globe, many observers expressed dismay at this inaction. For example, The Economist scolded the country's leadership for its halting response and seeming apathy to an escalating health crisis. Why did Argentina, a middle-income country with a developed and, in many respects, sophisticated system of health and education, fall short in enacting a national pandemic plan during the 2009 H1N1 outbreak? What can we learn from Argentina's experiences about obstacles and opportunities during a pandemic crisis? This article, based on extensive qualitative research, including document capture, media analysis, and oral history interviews, assesses Argentina's mixed response to H1N1 during austral winter 2009, and adds to a growing body of studies focused on how governments and health systems in the Americas performed during the 2009-2010 H1N1 pandemic. When the first cases of novel H1N1 influenza were identified by the U.S. Centers for Disease Control and Prevention (CDC) in mid-April 2009, Argentina's national health ministry appeared to be prepared. Starting in 2002, primarily in response to the prospect of avian influenza, the health ministry had formulated a preparedness plan and, beginning in 2005, had conducted at least five pandemic simulation exercises. In April 2009, Argentina's health ministry activated its pandemic response plan, triggering the establishment of an executive-level situation room equipped with rapid communications and computer surveillance to track events as they unfolded. In addition, several expert committees were assembled to assess the situation and solicit input from health practitioners, academics, hospital staff, and allied professionals.     

Public health implications of emerging zoonoses

Many new, emerging and re-emerging diseases of humans are caused by pathogens which originate from animals or products of animal origin. A wide variety of animal species, both domestic and wild, act as reservoirs for these pathogens, which may be viruses, bacteria or parasites. Given the extensive distribution of the animal species affected, the effective surveillance, prevention and control of zoonotic diseases pose a significant challenge. The authors describe the direct and indirect implications for public health of emerging zoonoses. Direct implications are defined as the consequences for human health in terms of morbidity and mortality. Indirect implications are defined as the effect of the influence of emerging zoonotic disease on two groups of people, namely: health professionals and the general public. Professional assessment of the importance of these diseases influences public health practices and structures, the identification of themes for research and allocation of resources at both national and international levels. The perception of the general public regarding the risks involved considerably influences policy-making in the health field. Extensive outbreaks of zoonotic disease are not uncommon, especially as the disease is often not recognised as zoonotic at the outset and may spread undetected for some time. However, in many instances, the direct impact on health of these new, emerging or re-emerging zoonoses has been small compared to that of other infectious diseases affecting humans. To illustrate the tremendous indirect impact of emerging zoonotic diseases on public health policy and structures and on public perception of health risks, the authors provide a number of examples, including that of the Ebola virus, avian influenza, monkeypox and bovine spongiform encephalopathy. Recent epidemics of these diseases have served as a reminder of the existence of infectious diseases and of the capacity of these diseases to occur unexpectedly in new locations and animal species. The need for greater international co-operation, better local, regional and global networks for communicable disease surveillance and pandemic planning is also illustrated by these examples. These diseases have contributed to the definition of new paradigms, especially relating to food safety policies and more generally to the protection of public health. Finally, the examples described emphasise the importance of intersectorial collaboration for disease containment, and of independence of sectorial interests and transparency when managing certain health risks.     

Patient knowledge and attitudes about avian influenza in an internal medicine clinic

BACKGROUND: Avian influenza is an emerging threat to public health, but little is known about how the public perceives this threat. The objective of this study was to describe beliefs, attitudes and knowledge regarding avian influenza among patients in an internal medicine clinic. STUDY DESIGN: Cross-sectional survey. METHODS: Four hundred adult patients in an internal medicine clinic received the survey between April and June 2006. RESULTS: The most common sources of information about avian influenza were local and national television news (74%), cable news (51%) and newspapers (50%). The mean percentage of correct answers to seven questions regarding knowledge of avian influenza was 49%. Multivariable linear regression using the percentage of correct answers to these questions as the primary outcome showed that: (1) college education, Internet and cable news as sources; (2) income greater than $75,000; and (3) receiving an influenza vaccine in the last influenza season were positively associated with knowledge. Having a viral upper respiratory infection on the day of the survey was negatively associated with knowledge. However, greater knowledge was not associated with more positive attitudes regarding possible public health interventions in a pandemic setting. Although 42% of patients were worried about avian influenza, only 22% trusted the Government to contain its spread. Most patients were willing to wear a mask (82%), be quarantined (78%) or undergo mandatory vaccination (55%). CONCLUSION: Knowledge about avian influenza was poor in this mainly college-educated sample, but most patients had positive attitudes towards public health control measures that would be used in a pandemic scenario. Further studies are needed to inform education strategies and pandemic influenza planning.     

Epidemic Intelligence Service Officers and Field Epidemiology Training Program in Korea

Korea has adopted Epidemic Intelligence Service (EIS) officers through the Field Epidemiology Training Program (FETP) since 1999 for systematic control of emerging and re-emerging infectious diseases. Graduates of medical schools in Korea are selected and serve as public health doctors (PHDs) for their mandatory military service. The duration of service is 3 years and PHDs comprise general practitioners and specialists. Some PHDs are selected as EIS officers with 3 weeks basic FETP training and work for central and provincial public health authorities to conduct epidemiological investigations. The total number of EIS officers is 31 as of 2012. The Korea Centers for Disease Control and Prevention (KCDC) has 12 specialists, whereas specialists and each province has one or two EIS officers to administer local epidemiological investigations in 253 public health centers. The Korean EIS officers have successfully responded and prevented infectious diseases, but there is a unique limitation: the number of PHDs in Korea is decreasing and PHDs are not allowed to stay outside Korea, which makes it difficult to cope with overseas infectious diseases. Furthermore, after 3 years service, they quit and their experiences are not accumulated. KCDC has hired full-time EIS officers since 2012 to overcome this limitation.     

Lessons from pandemic influenza A(H1N1): the research-based vaccine industry's perspective

As A(H1N1) influenza enters the post-pandemic phase, health authorities around the world are reviewing the response to the pandemic. To ensure this process enhances future preparations, it is essential that perspectives are included from all relevant stakeholders, including vaccine manufacturers. This paper outlines the contribution of R&D-based influenza vaccine producers to the pandemic response, and explores lessons that can be learned to improve future preparedness.The emergence of 2009 A(H1N1) influenza led to unprecedented collaboration between global health authorities, scientists and manufacturers, resulting in the most comprehensive pandemic response ever undertaken, with a number of vaccines approved for use three months after the pandemic declaration. This response was only possible because of the extensive preparations undertaken during the last decade.During this period, manufacturers greatly increased influenza vaccine production capacity, and estimates suggest a further doubling of capacity by 2014. Producers also introduced cell-culture technology, while adjuvant and whole virion technologies significantly reduced pandemic vaccine antigen content. This substantially increased pandemic vaccine production capacity, which in July 2009 WHO estimated reached 4.9 billion doses per annum. Manufacturers also worked with health authorities to establish risk management plans for robust vaccine surveillance during the pandemic. Individual producers pledged significant donations of vaccine doses and tiered-pricing approaches for developing country supply.Based on the pandemic experience, a number of improvements would strengthen future preparedness. Technical improvements to rapidly select optimal vaccine viruses, and processes to speed up vaccine standardization, could accelerate and extend vaccine availability. Establishing vaccine supply agreements beforehand would avoid the need for complex discussions during a period of intense time pressure.Enhancing international regulatory co-operation and mutual recognition of approvals could accelerate vaccine supply, while maintaining safety standards. Strengthening communications with the public and healthcare workers using new approaches and new channels could help improve vaccine uptake. Finally, increasing seasonal vaccine coverage will be particularly important to extend and sustain pandemic vaccine production capacity.