Anticipation and response: pandemic influenza in Malawi, 2009

Sambala, Evanson Z.; Manderson, Lenore

Despite weak infrastructure in the health system and limited management capacity, the command structures of the PRPI, including the advisory committee, were in place to lead coordination and leadership for the early detection and rapid containment of influenza. However, respondents reported that the advisory committee was unable to provide streamlined operational and expert advice; it remained focused predominantly on probable threats of avian influenza rather than the antigenic shifts of both avian (H5) and human influenza subtypes. Preparedness prior to 2009 H1N1 had failed to account for other influenza viruses subtypes, such as H1, H2, H3, H7 or H9, although most policymakers believed these subtypes posed pandemic risks too. In addition, many respondents viewed the advisory committee as non-representative, and considered it neither 'transparent' [P2] nor 'inclusive' [P17]; they felt that the government could have better engaged its partners in establishing a working advisory committee to meet the different needs of the people represented by different organisations. Participants also expressed concern that the experts appointed to advise on influenza preparedness were not specialists in infectious disease control and not qualified to perform their duties. As one participant argued, 'I think the [advisory] committee was hastily instituted without bringing on board experts who know more about the topic [influenza, preparedness and response]. . . not a good beginning for an efficient and effective planning system' [P13].