title: Response to the 2009-H1N1 influenza pandemic in the Mekong Basin: surveys of country health leaders.
abstract: BACKGROUND
  Soon after the 2009-H1N1 virus emerged as the first influenza pandemic in 41 years, countries had an early opportunity to test their preparedness plans, protocols and procedures, including their cooperation with other countries in responding to the global pandemic threat. The Mekong Basin Disease Surveillance cooperation (MBDS) comprises six countries - Cambodia, China (Yunnan and Guangxi Provinces), Lao People's Democratic Republic, Myanmar, Thailand and Vietnam - that formally organized themselves in 2001 to cooperate in disease surveillance and control. The pandemic presented an opportunity to assess their responses in light of their individual and joint planning. We conducted two surveys of the MBDS leadership from each country, early during the pandemic and shortly after it ended.
  
  
  RESULTS
  On average, participants rated their country's pandemic response performance as good in both 2009 and 2010. Post-pandemic (2010), perceived performance quality was best for facility-based interventions (overall mean of 4.2 on a scale from 1 = poor to 5 = excellent), followed by surveillance and information sharing (4.1), risk communications (3.9) and disease prevention and control in communities (3.7). Performance was consistently rated as good or excellent for use of hotlines for case reporting (2010 mean of 4.4) and of selected facility-based interventions (each with a 2010 mean of 4.4): using hospital admission criteria, preparing or using isolation areas, using PPE for healthcare workers and using antiviral drugs for treatment. In at least half the countries, the post-pandemic ratings were lower than initial 2009 assessments for performance related to surveillance, facility-based interventions and risk communications.
  
  
  CONCLUSIONS
  MBDS health leaders perceived their pandemic responses effective in areas previously considered problematic. Most felt that MBDS cooperation helped drive and thus added value to their efforts. Surveillance capacity within countries and surveillance information sharing across countries, longstanding MBDS focus areas, were cited as particular strengths. Several areas needing further improvement are already core strategies in the 2011-2016 MBDS Action Plan. Self-organized sub-regional cooperation in disease surveillance is increasingly recognized as an important new element in global disease prevention and control. Our findings suggest that more research is needed to understand the characteristics of networking that will result in the best shared outcomes.
authors.affiliation: Health Unit, RAND Corporation, Arlington VA, USA. mmoore@rand.org.
authors.forename: Melinda
authors.initials: M
authors.lastname: Moore
authors.forename: David J
authors.initials: DJ
authors.lastname: Dausey