Anticipation and response: pandemic influenza in Malawi, 2009

Sambala, Evanson Z.; Manderson, Lenore

Assumptions in the pandemic plan for Malawi were that planned interventions would address the pandemic outbreak in a straightforward manner, yet there are considerable discrepancies at the level of pandemic preparedness and actual responses. Although discrepancies are expected in any pandemic planning nationally or internationally due to the uncertainty associated with pandemics, it is important to have a consistent basis for planning, especially if it is to be applied at both local and national levels. While Malawi developed communication strategies, strengthened influenza surveillance and updated overall goals in PRPI, most response actions addressing the 2009 pandemic failed to achieve the important public health goals that the plans set out. We found that the national pandemic plan was not updated regularly and experts in influenza emergency management were rarely consulted. A number of gaps in national action were also identified, including poor coordination between national policymakers with local stakeholders, weak leadership in the influenza working committee and lack of surveillance structures such as IACs and diagnostic laboratories. There is need for coordination between the private and public sectors in order to continue providing essential services such as water, energy and safe transport. Cooperation on influenza activities would reinforce the implementation of PRPI, but this would require that responsibilities and actions are defined phase by phase. Influenza research focusing on the national and local context is important to manage challenges and problems that might be experienced during the influenza outbreak. In addition, there is need for political interventions to improve pharmaceutical logistics which in turn would improve the availability of vaccines and other drugs, enabling people to be vaccinated on time during seasonal and pandemic periods. However, there is also a need to ensure that the public is aware that influenza is a reportable disease. Most importantly, there is a need to upgrade laboratory networks and diagnostic capacity, to include active sentinel surveillance through the Integrated Disease Surveillance and Response (IDSR) and other operational structures like FluNet. In general, PRPI operations can be strengthened through effective IEC activities such as communicating real time surveillance data or communicating the nature, spread, peak and decline of influenza (both seasonally and during pandemics) to the general public. This can be done by electronic means, phones and meetings. The regular dissemination of such information may change public attitudes and perceptions about influenza.