01.11.2010 Swiss pandemic control evaluated
Evaluations. Two expert evaluations of Switzerland’s efforts to control the H1N1 influenza (swine flu) pandemic acknowledge the great commitment of those responsible while also identifying potential for improvement.
The two evaluations conducted by external experts focused on the Swiss H1N1 vaccination strategy and on the work of the Federal Office of Public Health’s internal crisis management organisation in connection with the H1N1 crisis that lasted from March 2009 to February 2010. The purpose of the evaluations was to draw up proposals for improvements to future vaccination strategies in the event of a crisis and to crisis management within the FOPH, and also to draw up recommendations for the revised Law on Epidemics that is currently in the consultation phase.
Evaluation of vaccination strategy: pandemics require strong, centralised management
The main goals of the evaluation of Swiss vaccination strategy were to assess vaccination planning and the procurement, authorisation, delivery, local distribution, use and subsequent deployment or disposal of the vaccine. According to the experts, the Swiss authorities generally handled the situation well. Many of the difficulties that Switzerland had to contend with also cropped up in other European countries.
The evaluators identified lack of coordination and of standardisation of the national and cantonal pandemic plans as the main problem facing management of the H1N1 pandemic. They recommend transferring the responsibility for standardisation and Swiss-wide implementation of essential elements of the pandemic plans to the Federal Government. In particular, this includes control of a standardised process for distributing the vaccines from a central warehouse to the cantons. In addition, scenarios for different degrees of pandemic severity should be integrated into the pandemic plans. In the pre-pandemic phase, the most important processes should be exercised at regular intervals. With regard to procurement of the vaccine, the experts propose that greater consideration should be given to the possibility of a simplified regulatory procedure for future vaccine selection. Moreover, a data exchange agreement between the Swiss drugs regulator Swissmedic and other key regulatory authorities (e.g. the European Medicines Agency) would significantly simplify the approval procedure and speed up any action, which is essential in an emergency.
To improve communication in a crisis situation, the authors recommend integrating a communication strategy into the pandemic plan, including the nomination of a figurehead who will assume responsibility for Swiss-wide communication and coordinate information exchange with all stakeholders.
The revision of the Federal Law on Epidemics is designed to strengthen the role of the Federal Government overall and thereby create a framework for an efficient and cost-effective vaccination strategy. Under the law as it currently stands, the Federal Government has no legal basis for preparing and monitoring a coordinated and coherent response to pandemic influenza before it reaches a critical phase. In most cases it is then too late.
Evaluation of the crisis management organisation within the FOPH: develop a «shadow» organisation in normal times
The evaluation of the crisis management organisation within the FOPH concludes on balance that FOPH staff managed the crisis with a great deal of dedication and flexibility and were able to draw on their experience of earlier crises. The experts identify shortcomings particularly in systematic, coherent planning and implementation of the FOPH crisis management organisation. This body should be developed as a «shadow» organisation during periods of normality so that it can be rapidly activated in times of crisis. This means drawing up requirement profiles for the different crisis-related functions and recruiting and training suitable staff. Those involved should also draw a clearer distinction between responsibility for processes and specialist responsibility. Crisis management of the H1N1 virus was initially perceived as much more of a medical-science problem than as an organisational challenge, which meant that staff had to be changed in mid-crisis.
Though the crisis manuals of the FOPH and the Public Health Directorate provided important approaches and tools for crisis management, they were not sufficiently established in the organisation and therefore little use was made of them. The production of a crisis manual in the form of an organisation development process involving all players would considerably improve its acceptance and use.
For the FOPH, the conclusion to be drawn from the two evaluations is as follows: the Federal Law on Epidemics needs to be revised so that it strengthens the powers of the Federal Government in the event of a (possible) epidemic. Also in need of revision is the Swiss Pandemic Plan. Additionally, the crisis organisation and the FOPH’s crisis manuals need to be rethought along the lines of an organisation development process. A start has already been made to much of this. In addition, essential features of crisis management need to be exercised in advance of any crisis and on a regular basis.
Eva Bruhin, Evaluation and Research, email@example.com