London School of Hygiene & Tropical Medicine

A report to be published in an upcoming issue of the World Health Organisation (WHO) Bulletin will call for urgent attention to the politically sensitive issue of border control, and the need for coherent and robust national plans in the face of a catastrophic flu pandemic . The report comes after the recent confirmation of person-to-person transmission of a strain of avian influenza A (HN51) in Northern Sumatra: although the outbreak was contained by voluntary quarantine and rapid administration of antiviral medication, scientists admitted that the world had 'dodged a bullet' and 'may not be so lucky next time.

"Governments need to work with their neighbours, sharing best practices and strategic thinking openly. The European Centre for Disease Prevention and Control (ECDC) might have successfully established pan-European surveillance procedures but the current significant differences in countries' pandemic plans are likely to test any notion of global solidarity or security," said study author, Dr Richard Coker, Reader in Public Health at the London School of Hygiene and Tropical Medicine, in the United Kingdom.

The report surveyed EU and bordering countries and found that:

• Europe is broadly better prepared than a year ago, with most countries having drafted a preparedness plan
• Fewer than half provide defined plans for distribution of antivirals or specific guidance on where vaccines would be stored, how they would be distributed, and who would administer them
• Two thirds of national plans depart from WHO guidelines on the crucial step of limiting people's movement from affected to unaffected areas

Concerns about the lack of restrictions on imported goods, and potential chaos caused by uncertainty about how to deal with travellers on board plane or ships from affected areas were also highlighted. Only eight countries of the thirty surveyed recommend separating sick travellers from others, and just four aim to provide masks to either passengers or crew¹.

"A year on from the previous review, many nations remain ill prepared for the on-the-ground realities of an imminent flu pandemic" commented Dr Richard Coker. "Critically, the who, what, when and where is not defined for antiviral medications which are the first line of defence before vaccine supplies can be manufactured and distributed."

The report notes the recent increase in stockpiles of antivirals by many countries. However, the issue of how to deliver antivirals to individual patients is not addressed with the majority of plans: basic medical supplies that would be required (syringes, antibiotics and protective clothing) have not necessarily been taken into account, and would inevitably be affected by disruptions to transportation.

"In the event of pandemic, initial demand for antivirals may outstrip the medical community's ability to administer them. Although many countries in Europe have stockpiles, rigorously thought through plans for storage, distribution and administration are now an urgent requirement, as panic and ultimately chaos will result unless the operational procedures are defined and tested in advance of a pandemic," commented Dr Coker. He added: "The absence of international cooperation on border control is alarming, and raises the ugly spectre of people detained without warning, and possibly against their will, when they are travelling from one country to another."