title: Assessing Argentina's response to H1N1 in austral winter 2009: from presidential lethargy to local ingenuity.
abstract: Argentina experienced a heavy burden of novel H1N1 influenza in austral winter 2009. In early July 2009, Argentina reported more than 1,500 cases and was confronting the highest per capita H1N1 mortality rate in the world. By September 2009, more than 500 people had died of H1N1 in Argentina. Unlike sister countries Chile and Mexico, Argentina's national authorities did not respond by implementing mitigation measures such as public gathering bans and school closures or by issuing broad-based messages about personal hygiene and disease prevention. Around the globe, many observers expressed dismay at this inaction. For example, The Economist scolded the country's leadership for its halting response and seeming apathy to an escalating health crisis. Why did Argentina, a middle-income country with a developed and, in many respects, sophisticated system of health and education, fall short in enacting a national pandemic plan during the 2009 H1N1 outbreak? What can we learn from Argentina's experiences about obstacles and opportunities during a pandemic crisis? This article, based on extensive qualitative research, including document capture, media analysis, and oral history interviews, assesses Argentina's mixed response to H1N1 during austral winter 2009, and adds to a growing body of studies focused on how governments and health systems in the Americas performed during the 2009-2010 H1N1 pandemic. When the first cases of novel H1N1 influenza were identified by the U.S. Centers for Disease Control and Prevention (CDC) in mid-April 2009, Argentina's national health ministry appeared to be prepared. Starting in 2002, primarily in response to the prospect of avian influenza, the health ministry had formulated a preparedness plan and, beginning in 2005, had conducted at least five pandemic simulation exercises. In April 2009, Argentina's health ministry activated its pandemic response plan, triggering the establishment of an executive-level situation room equipped with rapid communications and computer surveillance to track events as they unfolded. In addition, several expert committees were assembled to assess the situation and solicit input from health practitioners, academics, hospital staff, and allied professionals.
authors.affiliation: Center for the History of Medicine, University of Michigan, 100 Simpson Memorial Institute, 102 Observatory, Ann Arbor, MI 48109-0725, USA. amstern@umich.edu
authors.forename: Alexandra Minna
authors.initials: AM
authors.lastname: Stern
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Koreck
authors.forename: Howard
authors.initials: H
authors.lastname: Markel
mesh_terms: D001118:Argentina; D001294:Attitude to Health; D004189:Disaster Planning / Q000458:organization & administration; D035082:Federal Government; D006285:Health Planning / Q000458:organization & administration*; D015277:Hotlines; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D007857:Leadership; D009111:Local Government; D008402:Mass Media; D009313:National Health Programs / Q000458:organization & administration; D058873:Pandemics / Q000517:prevention & control / Q000706:statistics & numerical data; D011057:Politics; D011159:Population Surveillance; D015397:Program Evaluation; D015980:Public Health Practice; D036301:Qualitative Research; D012621:Seasons; D011795:Surveys and Questionnaires