1.1 Pandemic Planning

1.1.1 Plans and legislation

Over the past decade, international concern over the potential for an influenza pandemic has encouraged countries, including Australia, to raise their level of preparedness for a significant emergency response. Detailed planning has been undertaken in all sectors of government to prepare Australia to respond to an influenza pandemic. Australia has a series of connected pandemic action plans – health and whole-of-government; national and jurisdictional – to guide a coordinated response to an influenza pandemic. These plans are intended to provide a ‘menu’ of options rather than strictly defined actions to be exactly followed. This allows a degree of flexibility in adapting plans as understanding of the behaviour of the disease develops, and re-targeting of efforts and resources as better information becomes available about the epidemiology and pathology of the disease.

1.1.1.1 Health sector

Since 2005, Australia has had in place a national health pandemic influenza plan – the Australian Health Management Plan for Pandemic Influenza (AHMPPI) – that has been regularly reviewed and revised to incorporate the latest scientific and policy developments. The AHMPPI 2008 provided the health sector with a nationally agreed strategic framework to guide preparedness and response activities for an influenza pandemic, outlining the health sector’s responsibilities as part of a broader whole-of-government response. It is based on planning to have the capacity, capability and flexibility to respond to a severe pandemic.

Each state and territory has a pandemic health response plan that integrates with the national plan.

1.1.1.2 Whole of government

The AHMPPI is supported by the National Action Plan for Human Influenza Pandemic (NAP), a Council of Australian Governments (COAG) document that is managed by the Department of the Prime Minister and Cabinet and has been in place since 2006. The NAP outlines the roles and responsibilities of each level of government in Australia, with a focus on addressing the broader socioeconomic effects of a pandemic, including establishment of a National Pandemic Emergency Committee (NPEC) during a pandemic to provide strategic policy advice to leaders on issues that require a nationally consistent approach, such as communications. This plan was revised in 2010 to reflect experience in response to pandemic (H1N1) 2009.

All states and territories have their own whole-of-government pandemic action plans that complement the NAP.

1.1.1.3 Legislation

Australia is a signatory of the International Health Regulations 2005 (IHR). Under the IHR, Australia has agreed to report incidents and maintain good surveillance and response capacity to prevent the international spread of disease, while avoiding unnecessary interference with international traffic and trade. Australia has designated the Australian Government Department of Health and Ageing’s National Incident Room (NIR) as Australia’s National Focal Point (NFP). The NFP is responsible for notifying and reporting public health events of international significance to the World Health Organization (WHO) within 24 hours of assessment of the event, and for responding to national public health risks and national public health emergencies. In the event of a pandemic, the NFP would receive and distribute information critical to decision makers in Australia and internationally.

The Quarantine Act 1908 provides very broad powers including the examination, exclusion, detention, observation, segregation, isolation, protection, treatment and regulation of vessels, installations, humans, animals, plants and other goods or things; and the prevention or control of the introduction, establishment or spread of disease that could cause significant damage to humans, animals, plants, other aspects of the environment or economic activities.

The National Health Security Agreement⁴ under the National Health Security Act 2007 establishes a national coordination framework for rapid decision making and health sector response to public health emergencies. This includes the sharing of information between the Australian Government and the states and territories in relation to communicable diseases, in order to enhance understanding of epidemiology threats and the ability within Australia to respond to those diseases.

The states and territories also have a broad range of public health and emergency response powers which provide the legislative framework to support actions that may be required at jurisdictional level to respond to a pandemic.

1.1.2 Decision making

The AHMPPI details the health sector decision-making structures for pandemic planning and response purposes. Coordination of national health sector preparedness and response is managed through a series of committees that fall into three broad functional categories: strategic decision-making committees, expert advisory committees and operational committees.

The Australian Health Protection Committee (AHPC), the primary strategic decision-making committee for health-related emergencies, is pivotal to the inter-governmental coordination of the health sector response to a pandemic. The AHPC is convened and chaired at deputy secretary level within the Australian Government Department of Health and Ageing (DoHA). The Australian Government Chief Medical Officer (CMO) and the Chief Health Officers (CHOs) of each state and territory constitute the core membership of the AHPC. This high-level representation enables rapid communication of health response issues and the formulation of national response strategies. The AHPC reports to the Australian Health Ministers’ Advisory Council (AHMAC) and through it to the Australian Health Ministers’ Conference (AHMC).⁵

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The AHPC meets as often as necessary. During an influenza pandemic its role is to oversee the public health response, disseminate information, undertake national coordination of resource transfers between jurisdictions, and assure consistency of health messages to the public across Australia. These arrangements mean that all states and territories can benefit from the capacity of the national health system.

The AHPC is supported by a number of sub-committees and working groups, incorporating experts who perform both advisory and operational functions. These committees include the Communicable Diseases Network Australia (CDNA) and the Public Health Laboratory Network (PHLN). Each committee meets regularly during a pandemic to review the public health implications of the unfolding event and report to the AHPC when appropriate.

According to the AHMPPI 2008, the Pandemic Control Network (PCN) was to convene during a pandemic response to provide streamlined operational and expert advice to the AHPC, in order to assist with its strategic decision making. It was anticipated that the PCN may be required to coordinate specific operational elements of the national response and constitute selected members from the CDNA, PHLN, Chief Health Quarantine Officers (CHQO), Inter-jurisdictional Pandemic Planners Working Group (IPPWG) of the AHPC, and AHPC National Immunisation Committee Pandemic Vaccine Working Group (AHPCNIC), in the interests of efficiency.

Expert advisory committees provide technical and scientific advice to the CMO on a range of areas including influenza virology, epidemiology, public health, clinical management and influenza research. The Scientific Influenza Advisory Group (SIAG) provides medical, scientific and evidence-based advice to the CMO regarding pandemic planning. The Vaccine Advisory Group (VAG) provides advice to the CMO on aspects of vaccines that could be used to control a pandemic. These committees operated during the pre-pandemic planning (preparedness) stage. It was planned that they would combine during a pandemic response, as the Scientific Pandemic Advisory Group (SPAG), to act as the primary expert technical committee and to streamline decision making. In addition, the Expert Advisory Group on Pandemic Influenza (EAG) would convene during a pandemic to provide advice to the CMO on determining the Australian pandemic phase in accordance with the AHMPPI and other advice as requested. In practice, however, the roles and responsibilities of these groups differed from what was planned (see section 1.2).

The AHMPPI outlines that decisions to implement control measures that are outside the health sector and could have a major impact on the economy or society would be made at a whole-of-government level. Such measures may include: international aid to avert a pandemic; border interventions; the repatriation of Australians from overseas; and support for actions within Australia to slow a pandemic, such as social distancing measures or school and childcare centre closures. In these situations the health sector would contribute advice on the most effective strategies from a health perspective and the most effective timing for implementation.

1.1.3 Pandemic phases

Australia’s pandemic planning has been based on the assumption of a severe influenza pandemic (like the 1918 pandemic) and that an emerging pandemic would move sequentially through a number of phases as the virus becomes more adept at infecting humans, spreads around the globe and throughout Australia. Australia’s phasing system in the AHMPPI describes whether the emerging virus is in countries overseas or in Australia. Having an Australian phasing system allows actions to be taken in Australia independent of the global pandemic phases as declared by WHO. Response strategies for each phase outline a different set of actions designed to guide decision making with respect to the most appropriate actions to be taken, enabling succinct communications to the Australian health sector and the public. While the AHMPPI acknowledges that during any phase different response strategies may be used simultaneously in different parts of Australia due to variations in the local stage of a pandemic, how this would be implemented is not described.

The AHMPPI also outlines the steps for determining and implementing pandemic phase changes in Australia.

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4. Available from www.health.gov.au/internet/main/publishing.nsf/Content/ohp-nhs-agreement.htm
5. Current when this report was drafted.