In April 2009, the influenza H1N1 virus emerged in the United States and had the key characteristics of a pandemic virus. After a few weeks, it had spread to almost every region in the country. The number of H1N1 cases, hospitalizations, and deaths were substantial. This raised a few questions about the response level and its success. Response can be defined as the capabilities necessary to save lives, protect property and the environment, and to meet the basic human needs after an incident has taken place. One of the critical aspects of response is the availability of resources. The response problem that was encountered during the HINI virus was that there was a lack of adequate resources to confront the incident that lasted for years. This paper discusses the resource problem of inadequate resources, analyzes its impacts, how it was solved, and recommendations from the report drafters on how it was solved.
The response problem
One of the leading bodies that participated in the responses of the H1N1 influenza was the WHO. However, the WHO experienced an internal response capacity limitation of resources. This was because the WHO health emergencies were geared towards short-term geographical focal events that could be experienced several times a year. However, the pandemic required a consistent worldwide response that could last between one to two years. Before the emergence of the pandemic, the Severe Acute Respiratory Syndrome (SARS) was the only global emergency unit which provided WHO with a sample of demands which could only last for a few months and affected very few countries.
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The response problem is that the WHO capacity to respond in a sustained way to any public health emergency is limited by chronic funding shortfalls. Even though different countries are aware of the needs to prepare adequately for a proper response, they still face limited availability of resources. The funding shortfalls by the WHO and member states thus limits its capacity to respond to public health emergencies that occur in the long-term. For instance, the WHO spent more than $75 million on the immediate response without including the cost of vaccines and drugs.
Impacts resulting from the problem
The limit in the capacity to respond to public-health emergencies which occur in the long-term led to several problems. One problem that emerged was that strains were put on health care systems, surveillance systems, and laboratory systems. The strains could have been even more severe had the pandemic lasted longer. The H1N1 pandemic tested the health-care infrastructure and thus exposed one of the shortcomings in the preparedness as a region (Fisher et al., 2011). In case the gap between the global need and global capacity had not been addressed, then the result could have been that tens of millions of people were at risk of dying.
Another impact of the problem was that the disease became easily transmitted. Even though the 2009 H1N1 pandemic was a less severe disease, the limit in the resources caused the prevention, containment, and impact-reduction measures to become severely affected. While most countries had been prepared, the preparation had been aimed to respond with greater severity in a short period of time. The pandemic went on for a long time and it was difficult to contain it and limit its spread.
The length of the pandemic also caused a significant amount of strain on WHO staff. Managers were used to releasing their staff for short periods to manage emergencies or for long-term programs. The pandemic was different because it involved a prolonged situation which required intense activity for several months. Some member states supplied staff but these created difficulties due to the extended period of the pandemic.
Addressing the challenges during the response
One of the ways that the WHO tried to respond to the pandemic was by declaring it a Public Health Emergency of International Concern (PHEIC). The declaration was made under the International Health Regulations (IHR). This resulted in an awareness and addition of resources by the Member States. The declaration also led to a coordinated international response to combat the spread of the pandemic and its longevity.
While there was a limit in resources, the WHO made a decision to strengthen the readiness and response capacities of communities and countries in the world’s most vulnerable regions. An emphasis on vulnerable regions was put in place to ensure that the severity of the pandemic could be reduced. Some of the activities carried out in the region included accelerated access to vaccines, monitoring and tracking disease progression, and generation and support of the countries.
Recommendation from the report drafters
One recommendation from the report was to establish a more extensive global and public-health reserve workforce. The workforce should be equipped to deal with a pandemic that could last for some time like the H1N1 which lasted for approximately 2 years. Member States can play a huge role in creating an extensive global reserve workforce of experts and public-health professionals that can be part of a sustained response (World Health Organization, 2011). Additionally, a high number of experts with particular skills ought to be deployed depending on the characteristics of the emergency that the workforce is responding to. The workforce should be used to strengthen the global capacity, composition, and resources with a view of better support for sustained responses towards public-health emergencies.
The drafters recommended the creation of a contingency fund for public-health emergencies. Member States can establish a public-health emergency fund that is about $100 million. The fund should be held in trust in a location and form that is easily accessible to WHO. The fund can be used to support the surge capacity and longevity of a pandemic and could be released after the declaration of the Public Health Emergency of International Concern. The additional fund may not be used for the purchase of materials and should be negotiated among the Member States for the best ways to use it.
Another recommendation was to have a faster response of access to vaccines. One of the reasons why the pandemic proceeded for a long period of time was that there was limited access to the virus. As such the response became more of trying to achieve to a solution instead of prevention. The report drafters noted that the WHO should include negotiations under the Open-ended Working Group of Member States on Pandemic Influenza Preparedness. The negotiations could lead to wider availability of the vaccines and other benefits such as timely sharing of the influenza virus.
Personal recommendations
One recommendation is that there should be proper planning and preparedness as they observe the worst case scenario. The previous planning by the WHO focused on fighting diseases that were less severe and could be treated easily. However, they should start planning by observing worst case scenarios. Worst case scenario planning would ensure that the resources which can be used to fight the pandemic are adequate. Additionally, it would ensure that the situation would be handled effectively in case it occurs over a long period of time.
Low and McGeer (2010) assessed the response and pandemic preparedness in Canada. Their study found that the limit in resources could best be addressed by having the entire situation become a local responsibility for every region. They note that knowledge translation and communication ought to be handled locally and not according to the general clinical and public perception of handling it on a national level. This will ensure that the existing local public health infrastructure is put into use when fighting the pandemic.
The polluter pay’s principle can also be applied to fight future pandemics and their occurrences. According to the polluter pays’ principle, the cost of pollution should be handled by those that cause it (Ambec and Ehlers, 2014). This calls for vigilance in combating the pandemic in the country that could have caused it. Additionally, it would be the responsibility of countries that have the disease prevalent in their nations to limit its spread to other nations. The principle would ensure that each country takes full responsibility of the pandemic and limits its spread to other nations. This would ensure that the disease can be contained easily with few or limited resources.
In conclusion, the response problem as a result of the H1N1 virus of 2009 was the lack of adequate resources to confront the incident which lasted for several years. The WHO had a limit in the capacity to respond to public-health emergencies which occur in the long-term. This led to several problems such increased spread, strains on healthcare resources, and strains on healthcare staff. The WHO tried to combat this problem by raising the status of the disease to a national health concern level to mobilize the resources of member states. The report had recommendations such as having a contingency fund, establishing a robust global workforce, and faster response to accessing vaccines. Recommendations from research noted the need to plan through worse case scenarios, addressing the pandemic locally, and following the polluter’s pay principle.
References
Ambec, S., & Ehlers, L. (2014). Regulation via the Polluter ‐ pays Principle. The Economic Journal , 126 (593), 884-906.
Fisher, D., Hui, D. S., Gao, Z., Lee, C., OH, M. D., Cao, B., ... & Farrar, J. (2011). Pandemic response lessons from influenza H1N1 2009 in Asia. Respirology , 16 (6), 876-882.
Low, D. E., & McGeer, A. (2010). Pandemic (H1N1) 2009: assessing the response. Canadian Medical Association Journal , 182 (17), 1874-1878.
World Health Organization. (2011). Strengthening response to pandemics and other public health emergencies: report of the review committee on the functioning of the International Health Regulations (2005) and on pandemic influenza (H1N1) 2009.
