The comprehensive, coordinated, whole-of-society approach to pandemic preparedness is necessary and crucial to the success of influenza control program . The communities of international organizations have paid increasing attention to bringing member countries, industry and some other stakeholders together to implement the global approach to pandemic influenza preparedness. In this context, the present bibliometric analysis may serve as a starting point for further improvement of international guidance regarding pandemic influenza preparedness. We focused on the official documents of international organizations related to the topic of pandemic influenza control from the quantitative, qualitative and content’s points of view and clearly shows the variations of these documents.
The consequences of the pandemic influenza for society and economy will not be more serious, if the governments, businesses, civil society, individuals and families have planned preparedness to how they can maintain their essential services and communicate disease information validly. It has been emphasized by the ‘whole-of-society’ approach to pandemic influenza preparedness that all sectors of society played significant roles . The differences of the sector responsibilities and measures description that mentioned in the existing guidelines across the pandemic period provided some hints of guidelines modification. Compared to 2009, the roles and responsibilities in 2017 were described more comprehensively in ministries of education, ministries of energy, ministries of agriculture and animal health, ministries of communication and the business sector. Lessons learned from the 2009 H1N1 pandemic influenza action, the roles and responsibilities of the different departments were refined more clearly.
As shown in Table 1, the training items were added for the central government and business sectors in the version of 2013 and 2017. The nation-level financial planning and emergency funding mechanisms for pandemic influenza was added for ministries of finance in the version of 2013 and 2017. Because of the urgency and complexity of the pandemic H1N1 situation, a flexible financing framework embracing a variety of funding mechanisms was proposed as the best means of providing financial support to least resourced countries [13, 14]. Participating countries were seeking support to enable them to strengthen their readiness and response to H1N1 pandemic influenza. Capacity development is central to ensure that the workforce is well equipped to implement influenza response planning. Thus, funding and training are crucial to a national pandemic preparedness plan .
It has been proved in the global polio eradication action that the effectiveness of technology depends on national political commitment, security assurance, social support, religious support, local public support, project management and community participation [15, 16]. Influenza pandemic preparedness strategies and polio eradication plan share many common aspects, including extensive surveillance and laboratory networks, preparedness and response to epidemics, extensive communication, social mobilization networks and etc. As expected, the results of the present study provide some hints or experience of the prevention and control of pandemic influenza.
There have been some studies focusing on the intervention of pandemic influenza, such as communication, vaccination coverage, gas mask distribution, public health surveillance, knowledge and practices of intervention [17,18,19,20,21,22,23,24,25,26], while the correlations among these interventions were not discussed sufficiently. As the influenza control measures were different across pandemic influenza and the internal links between the measures are vague, the research adopted a word frequency analysis to explore the linkage of various influenza control measures. Information communication and disease surveillance provide essential disease information for better planning and decision making, which has been clearly indicated by the Ochiai coefficients. The higher correlations between the word frequencies after the pandemic influenza suggested that the relationships among the various measures were emphasized.
Assessment is an important part of pandemic influenza preparedness, which cannot be ignored. Early and comprehensive information on the severity of an influenza pandemic and risk assessment can help support decision-making at global and country levels. The five aspects of assessment of national planning have been identified as planning and coordination, situation monitoring and assessment, prevention and containment, health system response and communication . A good planning requires simulation exercises to ensuring the feasibility of the plan . WHO has provided 5 kinds of simulation exercises, each of them having strengths and weakness. Of the five types of exercises, an orientation is the simplest and costs the least, while the table-top exercise (TTX) is the workhorse, ranging in scope and complexity. The full-scale exercise is the most comprehensive also the most cost one . Decision makers can choose the most suitable one according to their situation. Referring to effectiveness of public health measures, it is also difficult to evaluate the effectiveness of individual measures because it was difficult to determine what to measure and it often combined with other interventions .
There are several limitations in the present study which may encourage further research efforts. Firstly, although the correlations between the word frequencies of influenza control-related vocabularies in the included documents were analyzed, the interaction of different preventive measures could not be identified. Better understanding the role of each preventive measures in the influenza control network will be considered in our future work. Secondly, the included influenza control-related measures were summarized from the documents released by international organizations, however, the implementation of these measures in the real world is unknown. There will be no response if funds are not set aside for rapid and proper action, moreover, personnel who are properly trained are needed. The governments should plan this and set aside special pandemic influenza preparedness budget when they prepare their yearly budget. Cost-benefit analysis may help to provide some evidence in the future. Thirdly, different experts were invited by each international organization according to its own interest to provide their opinions about pandemic influenza preparedness. WHO is concerned with human health, FAO and OIE are concerned with animal health, while the World Bank is more concerned with the economic losses caused by the disease. Different main focus of these international organizations affected the content and article length of the documents regarding pandemic influenza preparedness. Fourth, the present bibliometric analysis focused on the official documents released by international organizations, and the documents released by WHO were treated as the gold standard. However, the choice of WHO text was also a kind of limitation, because pandemic influenza preparedness varied in different situations. For example, the US government has its own national implementation plan for pandemic influenza . In terms of evaluation, a literature review by Arin Dutta provided a comprehensive description on determinants of a pandemic influenza outbreak, the effectiveness of different policies, cost and cost-effectiveness of policies and ethical dimensions of pandemic control policies . Fifth, the phase during 2009 influenza pandemic was shorter than the other two phases before and after pandemic, which might cause the amount of those documents during the pandemic period was relatively smaller than those released in the other two periods, thus, the result of the word frequency analysis might be affected. Finally, the actual work was done 1–2 years earlier than the publication date of the included documents, which might mislead the assessment of the changes over time in the documents.