Response to pandemic (H1N1) 2009 influenza in Australia - lessons from a State health department perspective.

This article reviews the lessons that can be learned by the health sector, in particular, and the public sector, more generally, from the governmental response to pandemic (H1N1) 2009 influenza A (pH1N1) in Australia during 2009. It covers the period from the emergence of the epidemic to the release of the vaccine, and describes a range of impacts on the Western Australian health system, the government sector and the community. There are three main themes considered from a State government agency perspective: how decisions were influenced by prior planning; how the decision making and communication processes were intimately linked; and the interdependent roles of States and the Commonwealth Government in national programs. We conclude that: (a) communications were generally effective, but need to be improved and better coordinated between the Australian Government, States and general practice; (b) decision making was appropriately flexible, but there needs to be better alignment with expert advice, and consideration of the need for a national disease control agency in Australia; and (c) national funding arrangements need to fit with the model of state-based service delivery and to support critical workforce needs for surge capacity, as well as stockpile and infrastructure requirements. What is known about the topic? There have been a number of articles on pandemic (H1N1) 2009 influenza in Australia that have provided an overview of the response from a Commonwealth Government perspective, as well as specific aspects of the State response (e.g. virology, impact on intensive care units across Australia, infection control). Victoria, Queensland and NSW have published papers more focussed on epidemiology and an overview of public health actions. What does this paper add? This would be the first in-depth account of the response that both details a broader range of impacts and costs across health and other State government agencies, and also provides a critical reflection on governance, communication and decision making arrangements from the beginning of the pandemic to the start of the vaccination program. What are the implications for practitioners? Practitioners (clinical, public health, and laboratory) would recognise the importance of the workforce and surge capacity issues highlighted in the paper, and the extent to which they were stretched. Addressing these issues is vital to meeting practitioner needs in future pandemic seasons. Policy makers would see the relevance of the observations and analysis to governance arrangements within a Federal system, where the majority of funding is provided from the Commonwealth level, whereas service delivery responsibilities remain with the States and Territories. In particular, the argument to consider a national disease control agency along the lines of the US and UK will be of interest to public health and communicable disease practitioners in all States and Territories, as it would affect how and where policy and expert advice is created and used.