title: Did pandemic preparedness aid the response to pandemic (H1N1) 2009? A qualitative analysis in seven countries within the WHO European Region.
abstract: BACKGROUND
  Although the 2009-2010 influenza A (H1N1) pandemic was of low severity compared with other pandemics of the 20th century, this pandemic was the first opportunity for countries to implement a real-life pandemic response. The aim of the project was to review the extent to which these plans and planning activities proved useful and to identify areas of pandemic planning that require further strengthening.
  
  
  METHODS
  We randomly selected seven countries within the WHO European Region to participate in a comprehensive, qualitative study to evaluate the pandemic preparedness activities undertaken prior to March 2009 compared with the subsequent pandemic responses mounted from May 2009 onwards. Research teams visited each country and interviewed stakeholders from health and civil response ministries, national public health authorities, regional authorities and family and hospital doctors.
  
  
  RESULTS
  The following six consistent themes were identified as essential elements of successful pandemic preparedness activities: communication, coordination, capacity building, adaptability/flexibility, leadership and mutual support. Regarding future pandemic preparedness activities, an emphasis on these areas should be retained and planning for the following activities should be improved: communication (i.e., with the public and health professionals); coordination of vaccine procurement and logistics; flexibility of response and hospital surveillance.
  
  
  CONCLUSIONS
  Pandemic preparedness activities were successfully undertaken in the WHO European Region prior to the 2009 pandemic. These activities proved to be effective and were generally appropriate for the response provided in 2009. Nevertheless, consistent themes also emerged regarding specific areas of under planning that were common to most of the surveyed countries.
authors.affiliation: Health Protection Research Group, Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham, City Hospital, Nottingham, United Kingdom. ahmed.hashim@nottingham.ac.uk
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hashim
authors.forename: Lucie
authors.initials: L
authors.lastname: Jean-Gilles
authors.forename: Michala
authors.initials: M
authors.lastname: Hegermann-Lindencrone
authors.forename: Ian
authors.initials: I
authors.lastname: Shaw
authors.forename: Caroline
authors.initials: C
authors.lastname: Brown
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nguyen-Van-Tam
mesh_terms: D002959:Civil Defense / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology*; D058873:Pandemics