Anticipation and response: pandemic influenza in Malawi, 2009

Sambala, Evanson Z.; Manderson, Lenore

Where influenza cases are detected in the human population, implementation efforts should be directed towards NPIs such as quarantine, closing schools and hygiene promotion, although it is important to be cautious of overestimating the benefits of these strategies [30] . NPIs are only helpful in delaying infection and reducing the burden of the disease; they do not necessarily halt the disease once it is circulating. There are also concerns about how much they intrude on personal liberties. During the 2009 H1N1 pandemic in Malawi, people were forcibly vaccinated [31] , despite evidence that voluntary vaccination, quarantine and isolation is possible and effective. A study in Canada found these measures were effective in Toronto during the SARS outbreak when over 27,000 affected persons were asked by public health officers to accept quarantine measures and the populace cooperated [32] . Gostin and Berkman argue that effective communication is critical for gaining public trust and participation in community containment measures [33] , as would be needed for volunteer vaccination. According to Peny, authoritarian approaches not only raise ethical concerns but damage the public trust in police and health services [34] .