Anticipation and response: pandemic influenza in Malawi, 2009

Sambala, Evanson Z.; Manderson, Lenore

There were inevitable tensions between global policy and its local operationalisation. The adoption of decisions without consideration of Malawi-specific situations, needs, priorities and actions created confusion and communication difficulties. Insufficient epidemiological evidence at the national and local level raised questions about the science behind PRPI, echoing Schuchat's and colleagues' argument about decision-making with imperfect science, and the challenges of generalising patterns of transmission or risk factors in seasonal and pandemic influenza [19] . In this study, we found a weak scientific advisory committee unable to bridge the gap between the epidemiology of the disease and operational responses. This reflects in part the role of simulation exercises which could identify priorities and actions, and provide opportunities to test the level of preparedness. Simulation exercises may be integral to improving decision-making, procedures and skills by identifying gaps and weaknesses in the PRPI.