Managing pandemic influenza in general practice

A guide for preparation, response and recovery

1. Introduction

☰ Table of contents

Pandemics are unpredictable but recurring events that can have consequences on human health and economic wellbeing worldwide. Advanced planning and preparedness are critical to help mitigate the impact of a pandemic.1

All pandemics differ – not only from each other but in impact across countries and communities. This makes them difficult to predict and therefore to prepare for. One of the most important lessons learned from the 2009 pandemic (H1N1) was that planning must be flexible to accommodate the biological variations in the clinical picture and potential uniqueness of each pandemic scenario – enabling resources to be effectively directed to achieve optimal outcomes.2

The influenza A (H1N1) 2009 pandemic provided a wealth of information on the influenza virus at the human–animal ecosystem interface. Although the 2009 influenza pandemic was of low severity compared with those of the 20th century, it was the first opportunity to implement pandemic plans in response to a real threat.3 It also showed that many countries had prepared for a pandemic of high severity, following the emergence of a new avian influenza virus (H5N1) in 2003, and appeared unable to adapt their national and regional responses adequately to a more moderate event. In some instances, plans were considered overly rigid and the recommended responses were not appropriate for a more moderate event.1 Since 2009, capability to respond to pandemic influenza has improved in many countries.4

The 2009 pandemic also revealed that, as with influenza epidemics, the main burden of managing patients fell on the primary care sector.5,6 National and state planning is necessary; however, practices need their own flexible pandemic plans as no one size fits all.

The lessons learned by general practice from that experience are now used to strengthen preparedness to future pandemics. Six consistent major themes are considered to be essential for successful pandemic preparedness – communication, coordination, capacity, adaptability/flexibility, leadership and mutual support, which are collectively represented by the acronym CALM.3

The RACGP’s pandemic resources provides practices with information across these themes for use in developing integrated but practice-specific pandemic preparedness and response plans.

  1. World Health Organization. Pandemic influenza risk management: WHO interim guidance. Geneva: WHO, 2013.
  2. Department of Health and Ageing. Review of Australia’s health sector response to pandemic (H1N1) 2009: lessons identified. Canberra: Australian Government, 2011.
  3. Jean-Gilles L, Hegermann-Lindencrone M, Brown C. Recommendations for good practice in pandemic preparedness: identified through evaluation of the response to pandemic (H1N1) 2009. Copenhagen: WHO Regional Office for Europe, 2010.
  4. Moen A, Kennedy PJ, Cheng PY, MacDonald G. National inventory of core capabilities for pandemic influenza preparedness and response: results from 36 countries with reviews in 2008 and 2010. Influenza Other Respir Viruses 2014;8:201–8.
  5. Kunin M, Engelhard D, Thomas S, Ashworth M, Piterman L. Influenza pandemic 2009/A/H1N1 management policies in primary care: a comparative analysis of three countries. Aust Health Rev 2013;37:291–99.
  6. Simonsen KA, Hunskaar S, Sandvik H, Rortveit G. Capacity and adaptations of general practice during an influenza pandemic. PLoS One 2013;8:e69408.