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“RECOMMENDED ACTIONS BEFORE, DURING AND AFTER A PANDEMICThe goal of planning and coordination efforts is to provide leadership and coordination across sectors.This section provides specific actions to be taken by national authorities and WHO. The new WHO pandemic phases and a summary of recommended actions for each phase are presented in Table 4. Recommendations are grouped by pandemic phases and the five components of preparedness and response which are the following:TABLE 4SUMMARY TABLE OF RECOMMENDED ACTIONS.planning and coordinationsituation monitoring and assessmentreducing the spread of diseasecontinuity of health care provisioncommunications.The goal of planning and coordination efforts is to provide leadership and coordination across sectors. One important aspect is to integrate pandemic preparedness into national emergency preparedness frameworks.The goal of situation monitoring and assessment is to collect, interpret, and disseminate information on the risk of a pandemic before it occurs and, once under way, to monitor pandemic activity and characteristics. To assess if the risk of a pandemic is increasing, it will be important to monitor the infectious agent, its capacity to cause disease in humans, and the patterns of disease spread in communities. It is important to collect data on influenza viruses, the genetic changes taking place and consequent changes in biological characteristics, and to rapidly investigate and evaluate outbreaks. Once a pandemic influenza virus begins to circulate, it will be vital to assess the effectiveness of the response measures.Reducing the spread of disease will depend significantly upon increasing the “social distance” between people. Measures such as individual/household level measures, societal-level measures and international travel measures, and the use of antivirals, other pharmaceuticals, and vaccines will be important.Individual/household level measures include risk communication, individual hygiene and personal protection, and home care of the ill and quarantine of contacts. Societal-level measures are applied to societies or communities rather than individuals or families. These measures require a behavioural change in the population, multiple sector involvement, mobilization of resources, strong communication, and media support.International travel measures aim to delay the entry of pandemic disease into not-yet-affected countries and will have an impact on international traffic and trade. Countries should balance reducing the risks to public health and avoiding unnecessary interference with international traffic and trade.The use of pharmaceutical interventions to prevent or treat influenza encompasses a range of approaches. Additionally, the successful prevention and treatment of secondary or pre-existing conditions will be a key factor in many settings for reducing the overall burden of illness and death.During a pandemic, health systems will need to provide health-care services while attending to the influx of patients with influenza illness. Planning for surge capacity in health-care facilities will help determine the extent to which the existing health system can expand to manage the additional patient load. Health-care facilities will need to maintain adequate triage and infection control measures to protect health-care workers, patients, and visitors.The goal of communications before and during a pandemic is to provide and exchange relevant information with the public, partners, and stakeholders to allow them to make well informed decisions and take appropriate actions to protect health and safety and response and is a fundamental part of effective risk management. Communications should be based on the five principles outlined in WHO's outbreak communications planning guide:25planning; trust; transparency; announcing early; and listening. Given the complex risks and perceptions associated with an influenza pandemic, communication strategies that simply disseminate outbreak information and recommendations will be insufficient. The scope and complexity of the task demands frequent, transparent, and proactive communication and information exchange with the public, partners, and other stakeholders about decision making, health recommendations, and related information. In addition to the suggested actions which follow below, countries are encouraged to develop core risk communication capacities such as those described in the WHO outbreak communication planning guide. By developing a solid foundation for pandemic influenza communications, Member States would also strengthen communication response systems for any public health emergency that may arise.Core elements of pandemic influenza communication are:to maintain and build public trust in public health authorities before, during and after an influenza pandemic;to support coordination and the efficient use of limited resources among local, national, regional and international public health partners;to provide relevant public health information to the public; to support vulnerable populations having the information they need to make well-informed decisions;to take appropriate actions to protect their health and safety; andto minimize social and economic disruption.Go to:A. PHASES 1-3Actions taken during pandemic Phases 1-3 are aimed at strengthening pandemic influenza preparedness and response capacities at global, regional, national and sub-national levels.PHASES 1-3PLANNING AND COORDINATIONWHO ACTIONSNATIONAL ACTIONSProvide technical support to Member States in the preparation of national pandemic preparedness plans.26Provide leadership in coordinating the prioritized activities for epidemic and pandemic preparedness.27Advocate new partnerships with organizations of the United Nations system, bilateral development agencies, nongovernmental organizations, and the private sector.28Facilitate and encourage the operability of national pandemic plans through preparedness activities, including exercises.Establish and activate a cross-governmental, multi-agency national pandemic preparedness committee that meets regularly.Assess capacities and identify priorities for pandemic preparedness planning and response at national and sub-national levels.Advise sub-national governments on best practices in pandemic planning; monitor and evaluate the operability and quality of their plans.Develop, exercise, and periodically revise national and sub-national influenza pandemic preparedness and response plans in close collaboration with human and animal health sectors and other relevant public and private partners with reference to current WHO guidance.Establish, as needed, full legal authority and legislation for all proposed interventions.Anticipate and address the resources required to implement proposed interventions at national and sub-national levels including working with humanitarian, community-based, and non-governmental organizations.Develop an ethical framework to govern pandemic policy development and implementation.29Integrate pandemic preparedness and response plans into existing national emergency preparedness and response programmes.Provide to public and private sectors the key assumptions, guidance and relevant information to facilitate their pandemic business continuity planning.Identify and address trans-border issues, including interoperability of plans across borders.Consider providing resources and technical assistance to resource-poor countries with foci of influenza activity.Participate, when possible, in regional and international pandemic preparedness planning initiatives and exercises.26Resolution WHA 56.19 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-sixth World Health Assembly, Geneva 19-28 May, 200327Resolution WHA 56.19 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-sixth World Health Assembly, Geneva 19-28 May, 2003.28Resolution WHA 56.19 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-sixth World Health Assembly, Geneva 19-28 May, 2003.29Ethical considerations in developing a public health response to pandemic influenza (WHO/CDS/EPR/GIP/2007.2), World Health Organization, 2007.PHASES 1-3SITUATION MONITORING AND ASSESSMENTWHO ACTIONSNATIONAL ACTIONSCollect, synthesize, and disseminate information on the global human influenza situation in collaboration with partners.Provide guidance and tools for detection, investigation, rapid risk assessment, reporting and ongoing evaluation of clusters of influenza-like illness.Provide support to countries with human cases of influenza caused by viruses with pandemic potential to assist in establishing facts and fully characterizing cases.Develop tools to estimate seasonal and pandemic influenza disease burden.30Establish joint initiatives for closer collaboration with national and international partners, including FAO and OIE in the early detection, reporting and investigation of influenza outbreaks of pandemic potential, and in coordinating research on the human-animal interface.31Establish global case definitions for reporting by countries of human cases of influenza caused by viruses with pandemic potential.Strengthen the Global Influenza Surveillance Network and other laboratories to increase capacity for influenza surveillance.32Provide diagnostic reagents to national influenza reference centres for identification of the new strain.Coordinate collection and testing of strains for possible vaccine production and antiviral susceptibility.Develop national surveillance systems to collect up-to-date clinical, virological, and epidemiological information on trends in human infection with seasonal influenza viruses, which will also help to estimate additional needs during a pandemic.Detect animal31,33 and human infections with animal influenza viruses, identify potential animal sources of human infection, assess the risk of transmission to humans, and communicate this information to WHO and relevant partners.Detect and investigate unusual clusters of influenza-like respiratory illness or deaths and assess for human-to-human transmission.Characterize and share both animal and human influenza virus isolates and associated information with relevant international agencies, such as WHO, FAO and OIE, to develop diagnostic reagents, candidate vaccine viruses, and monitor antiviral resistance.Strengthen the national laboratories in influenza diagnostic capabilities.30Resolution WHA 56.19 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-sixth World Health Assembly, Geneva 19-28 May, 2003.31Resolution WHA 58.5 Strengthening pandemic influenza preparedness and response. In: Fifty-eighth World Health Assembly, Geneva 16-25 May, 2005 (WHA58/2005/REC/1).32Resolution WHA 58.5 Strengthening pandemic influenza preparedness and response. In: Fifty-eighth World Health Assembly, Geneva 16-25 May, 2005. (WHA58/2005/REC/1).33Using current FAO and OIE guidelines: Avian influenza and the virus that causes it(ftp://ftp​.fao.org/docrep​/fao/010/a0632e/a0632e02.pdf accessed 8 October 2008), Terrestrial Animal Health Code 2008, Article 10.4.29, Surveillance strategies (http://www​.oie.int/eng​/normes/mcode/en_index.htm accessed 8 October 2008).PHASES 1-3REDUCING THE SPREAD OF DISEASEWHO ACTIONSNATIONAL ACTIONSPromote agreements for international technical assistance and resource mobilization to resource-poor countries with foci of influenza activity.Preventing human influenza infection from animalsActivate joint mechanisms for actions with other organizations (e.g. FAO, OIE) to control disease in animals and to implement prevention measures.Encourage dissemination of information on spread in animals and interspecies transfers.Individual/societal level measuresProvide guidance on measures to reduce the spread of influenza disease (social distancing and use of pharmaceuticals) and develop tools to estimate their public health value.34Periodically reassess and modify recommended interventions in consultation with appropriate partners, including those not in the health-care sector, regarding acceptability, effectiveness and feasibility.AntiviralsDevelop principles to guide national recommendations for use of antivirals (for prophylaxis and treatment).Manage WHO strategic global stockpile of antivirals and develop standard operating procedures for rapid deployment.Increase global antiviral availability by using UN/WHO mechanisms such as the prequalification programme35 and the Essential Medicines List.36VaccinesDevelop principles to guide national recommendations for use of seasonal and pandemic vaccines.Support strain characterization and development and distribution of vaccine prototype strains for possible vaccine production.Review and update WHO recommendations for pandemic vaccine use.Provide technical support, capacity building and technology transfer for influenza vaccines and diagnostics to developing countries.37Formulate mechanisms and guidelines to promote fair and equitable distribution of pandemic influenza vaccines.38Manage an international stockpile of H5N1 vaccine for use in countries in need.Identify, regularly brief, and train key personnel to be mobilized as part of a multisectoral expert response team for animal or human influenza outbreaks of pandemic potential.Preventing human influenza infection from animals39Reduce infection risk in those involved in responding to animal outbreaks (education and training regarding the potential risk of transmission; correct use of personal protective equipment; making antivirals available if indicated by the risk assessment).Recommend measures to reduce human contact with potentially infected animals.Control potentially contaminated environments such as wet markets and ponds with free grazing ducks.In conjunction with animal health authorities, establish national guidance on food safety, safe agricultural practices, and public health issues related to influenza infection among animals.<brIndividual / household level measuresPromote hand and respiratory hygiene.40Develop infection control guidance for household settings.41Develop plans to provide necessary support for ill persons isolated at home and their household contacts.Societal level measuresEstablish protocols to suspend classes, especially in the event of a severe pandemic or if there is disproportionate or severePromote development of mitigation strategies for public and private sector workplaces (such as adjusting working patterns and practices).Promote reduction of unnecessary travel and overcrowding of mass transport systems.Develop a framework to facilitate decision-making for cancellation/restriction of mass gatherings at the time of the pandemic.42International travel measuresDevelop capacities for emergency public health actions at designated points of entry in accordance with IHR (2005) Annex 1 B.2.Antivirals and other pharmaceuticalsEstimate and prioritize antiviral requirements for treatment and prophylaxis during a pandemic.Develop mechanisms and procedures to select, procure, stockpile, distribute, and deliver antivirals based on national goals and resources.Plan for the increased need for antibiotics, antipyretics, hydration, oxygen, and ventilation support within the context of national clinical management strategies.Assess effectiveness and safety of antiviral therapy using standardized protocols when possible.VaccinesFor countries not using seasonal influenza vaccine, document the disease burden and economic impact of seasonal influenza and develop a national vaccine, policy if indicated.43For countries using seasonal influenza vaccine, work to increase seasonal influenza vaccine coverage levels of all high risk people. 44Establish goals and priorities for the use of pandemic influenza vaccines.45Develop a deployment plan to deliver pandemic influenza vaccines to national distribution points within seven days from when the vaccine is available to the national government.46Consider the feasibility of using pneumococcal vaccines as part of the routine immunization program in accordance with WHO guidelines.4734Resolution WHA 58.5 Strengthening pandemic influenza preparedness and response. In: Fifty-eighth World Health Assembly, Geneva 16-25 May, 2005 (WHA58/2005/REC/1).35Prequalification. World Health Organization (http://www​.who.int/hiv​/amds/prequalification/en/ accessed 11 February, 2009).36Essential medicines list and WHO model formulary. World Health Organization (http://www​.who.int/selection_medicines​/list/en/ accessed 11 February 2009).37Resolution WHA 58.5 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-eighth World Health Assembly, Geneva 16-25 May, 2005 (WHA58/2005/REC/1).38Resolution WHA 60.28 Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits In: Sixtieth World Health Assembly, Geneva 14-23 May, 2007 (WHASS1/2006-WHA60/2007/REC/1)39Avian influenza: guidelines, recommendations, descriptions. World Health Organiztion (http://www​.who.int/csr​/disease/avian_influenza​/guidelinestopics/en/index.html accessed 11 February, 2009).40Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, WHO Interim Guidelines. Geneva, World Health Organization 2007. (WHO/CDS/EPR/2007.6).41Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, WHO Interim Guidelines. Geneva, World Health Organization 2007. (WHO/CDS/EPR/2007.6).42Communicable disease alert and response for mass gatherings. Geneva, World Health Organization, 2008 (WHO/HSE/EPR/2008.8).43Resolution WHA 56.19 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-sixth World Health Assembly, Geneva 19-28 May, 2003.44Resolution WHA 56.19 Prevention and control of influenza pandemics and annual epidemics. In: Fifty-sixth World Health Assembly, Geneva 19-28 May, 2003.45Currently there are no WHO recommendations either supporting or opposing the stockpiling of new influenza vaccines for use either prior to a pandemic or during its early stages.46Guidelines for the deployment of a pandemic influenza vaccine (to be published in 2009). World Health Organization 2009.47Pneumococcal conjugate vaccine for childhood immunization - WHO position paper. Weekly Epidemiological Record, No. 12, 2007, 82:93-104.PHASES 1-3CONTINIUITY OF HEALTH CARE PROVISIONWHO ACTIONSNATIONAL ACTIONSProvide guidance for appropriate infection control, laboratory biosafety and clinical management in health care and social settings, and in care facilities.Establish regional clinical advisory network for timely distribution and collection of important clinical information, identify knowledge gaps, and develop standardized clinical protocols.Assist national health care delivery authorities in identifying priority needs and response strategies, and assessing preparedness (e.g. through developing checklists, model pandemic preparedness plans, training and table-top exercises).Develop guidance for remote, resource-poor communities on home-based care of patients during an influenza pandemic.Identify priorities and response strategies for public and private health care systems for triage, surge capacity, and human and material resource management.Review and update continuity of health care provision strategies at national and sub national levels.Develop strategies, plans, and training to enable all health care workers, including community level workers, to respond during animal outbreaks and a pandemic.Develop case-finding, treatment, and management protocols, and algorithms.Develop national infection control guidance.48Estimate and plan for procurement and distribution of personal protective equipment for protection of workers.49Develop and implement routine laboratory biosafety and safe specimen-handling and shipping policies and procedures.50Explore ways to provide drugs and medical care free of charge (or cover by insurance) to encourage prompt reporting and treatment of human cases caused by an animal influenza virus or virus with pandemic potential.Develop the capacity for the rapid deployment of diagnostic tests once available.Assess health system capacity to detect and contain outbreaks of human influenza disease in hospital settings.50Collecting, preserving and shipping specimens for the diagnosis of avian influenza A(H5N1) virus infection, Guide for field operations. World Health Organization 2006 (WHO/CDS/EPR/ARO/2006.1).PHASES 1-3COMMUNICATIONSWHO ACTIONSNATIONAL ACTIONSUpdate national and international authorities, other partners/stakeholders, and the public, with current information on risks, sources, personal safety, and ways of mitigation of influenza pandemics.Maintain formal communication channels among Member States, other international organizations, key stakeholders, and technical/professional associations to facilitate information sharing and coordination.Increase the familiarity of news media with WHO activities, operations, and decision-making related to influenza and other epidemic-prone diseases.Develop feedback mechanisms to identify emerging public concerns, address rumours, and correct misinformation.Support Member States' communication efforts during a pandemic by providing material and technical guidance.51Establish an emergency communications committee with all necessary standard operating procedures to ensure a streamlined, expedited dissemination of communications products.Update leadership and other relevant sectors regarding global and national pandemic influenza risk status.Build effective relations with key journalists and other communications channels to familiarize them with influenza and pandemic related issues.Develop effective dialogue and listening mechanisms with the general public.Develop effective communication strategies and messages to inform, educate, and communicate with individuals and families so they are better able to take appropriate actions before, during, and after a pandemic.Initiate public health education campaigns in coordination with other relevant authorities on individual-level infection control measures.Increase public awareness of measures that may be available to reduce the spread of pandemic influenza.Create messages and feedback mechanisms targeted towards hard-to-reach, disadvantaged, or minority groups.Test communications procedures through exercises.Update communications strategies as feedback from the general public and stakeholder organizations is collected and analysed.51Advise household contacts to minimize their level of interaction outside the home and to isolate themselves at the first sign of any symptoms of influenza.Provide infection control guidance for household caregivers61 taking into account the WHO guidance.62Societal level measuresImplement social distancing measures as indicated in national plans, such as class suspensions and adjusting working patterns.Encourage reduction in travel and crowding of the mass transport system.63Assess and determine if cancellation, restriction, or modification of mass gatherings is indicated.64International travel measuresConsider implementing exit screening as part of the early global response (i.e. first few affected countries).65Provide advice to travellers.Pharmaceutical measuresDistribute antivirals, and other medical supplies in accordance with national plans.Implement vaccine procurement plans.Plan for vaccine distribution and accelerate preparations for mass vaccination campaigns.Modify/adapt antiviral and vaccine strategies based on monitoring and surveillance information.Implement medical prophylaxis campaigns for antivirals and/or vaccines according to priority status and availability in accordance with national plans.Monitor safety and efficacy of pharmaceutical interventions to the extent possible and monitor supply.COUNTRIES NOT YET AFFECTEDBe prepared to implement planned interventions to reduce the spread of pandemic disease.Update recommendations on the use of planned interventions based on experience and information from affected countries.Implement distribution and deployment plans for pharmaceuticals, and other resources as required.Consider implementing entry screening at international borders.6659Assuming a PHEIC has been determined to be occurring as defined by IHR (2005)60Especially if non-pandemic strains are still circulating.61If medical masks are available and the training on their correct use is feasible, they may be considered for symptomatic persons and susceptible caregivers in household settings when close contact can not be avoided.62Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, WHO Interim Guidelines. Geneva, World Health Organization 2007. (WHO/CDS/EPR/2007.6)63Symptomatic people should self-isolate and avoid using public transport. There is, however, insufficient evidence to date to either support or oppose the closure or restriction of mass transport systems as a measure to reduce disease transmission in the community.64If a country decides to cancel, restrict or modify all or certain mass gatherings, this decision should be based on the nature of the gathering and on local disease levels, and should only be implemented once the disease is present in the community.65If exit screening is implemented, it should be considered as a time-limited intervention and the isolation and treatment of cases and quarantine of contacts resulting from screening must be carried out in accordance with IHR (2005).66If entry screening is implemented, it should be considered as a time-limited intervention and the isolation and treatment of cases and quarantine of contacts resulting from screening must be carried out in accordance with IHR (2005).WHO recognizes individual country considerations will affect national decisions, but, in general, does not encourage:pandemic-related international border closures for people and/or cargo;general disinfection of the environment during a pandemic;the use of masks in the community by well persons;the restriction of travel within national borders during a pandemic, with the exception of a globally led rapid response and containment operation, or in rare instances where clear geographical and other barriers exist;PHASES 5-6CONTINUITY OF HEALTH CARE PROVISIONWHO ACTIONSNATIONAL ACTIONSCoordinate response with other international organizations.Provide guidance to national authorities in assisting clinicians in recognition, diagnosis, and reporting of cases and other critical issues as needed.Implement pandemic contingency plans for full mobilization of health systems, facilities, and workers at national and sub-national levels.Implement and adjust the triage system as necessary.Enhance infection control practices in healthcare and laboratory settings and distribute personal protective equipment in accordance with national plans.Provide medical and non-medical support for patients and their contacts in households and alternative facilities if needed.Provide social and psychological support for health-care workers, patients, and communities.Implement corpse management procedures as necessary.FOR COUNTRIES NOT YET AFFECTEDPrepare to switch to pandemic working arrangements.PHASES 5-6COMMUNICATIONSWHO ACTIONSNATIONAL ACTIONSUpdate national authorities, other partners and stakeholders, and the public on global situation, trends, epidemiological characteristics, and recommended measures.Continue to work with partners to promote consistent messages.Regularly update the public on what is known and unknown about the pandemic disease, including transmission patterns, clinical severity, treatment, and prophylaxis options.Provide regular communications to address societal concerns, such as the disruption to travel, border closures, schools, or the economy or society in general.Regularly update the public on sources of emergency medical care, resources for dealing with urgent non-pandemic health care needs, and resources for self-care of medical conditions.Go to:D. THE POST-PEAK PERIODThe overall goal of actions during the post-peak period is to address the health and social impact of the pandemic, as well as to prepare for possible future pandemic waves.THE POST-PEAK PERIODPLANNING AND COORDINATIONWHO ACTIONSNATIONAL ACTIONSIdentify lessons learned for immediate application, as well as for future needs.Determine the need for additional resources and capacities during possible future pandemic waves.Begin rebuilding of essential services.Address the psychological impacts of the pandemic, especially on the health workforce.Consider offering assistance to countries with ongoing pandemic activity.Review the status of and replenish national, local, and household stockpiles and supplies.Review and revise national plans.THE POST-PEAK PERIODSITUATION MONITORING AND ASSESSMENTWHO ACTIONSNATIONAL ACTIONSAssist countries in estimating national impact.Continue global situation monitoring for global spread and national trends.Review lessons learned and make adjustments in surveillance guidelines and tools for countries.Assess and monitor the type and pathogenicity of circulating influenza viruses.Activate the surveillance activities required to detect subsequent pandemic waves.Evaluate the resources needed to monitor subsequent waves.THE POST-PEAK PERIODREDUCING THE SPREAD OF DISEASEWHO ACTIONSNATIONAL ACTIONSFacilitate evaluation of interventions.Evaluate the effectiveness of the measures used and update guidelines, protocols, and algorithms accordingly.Continue with vaccination programmes in accordance with national plans, priorities, and vaccine availability.THE POST-PEAK PERIODCONTINUITY OF HEALTH CARE PROVISIONWHO ACTIONSNATIONAL ACTIONSUpdate guidance to national authorities to optimize use of scarce facilities.Ensure that health-care personnel have the opportunity for rest and recuperation.Restock medications and supplies and service and renew essential equipment.Review and, if necessary, revise pandemic preparedness and response plans in anticipation of possible future pandemic wave(s).Revise case definitions, treatment protocols, and algorithms as required.THE POST-PEAK PERIODCOMMUNICATIONSWHO ACTIONSNATIONAL ACTIONSRegularly update the public and other stakeholders on any changes to the status of the pandemic.Urge Member States, partners, and other stakeholders to make adjustments to their communications plans and systems.Regularly update the public and other stakeholders on any changes to the status of the pandemic.Communicate to the public the ongoing need for vigilance and disease-prevention efforts to prevent any upswing in disease levels.Continue to update the health sector on new information or other changes that affect disease status, signs and symptoms, or case definitions, protocols and algorithms.Go to:E. THE POST-PANDEMIC PERIODThe goal of activities during the post-pandemic period is to address the long-term health and social impact of the pandemic, as well as to restore normal health and social functions.THE POST-PANDEMIC PERIODPLANNING AND COORDINATIONWHO ACTIONSNATIONAL ACTIONSFacilitate implementation of lessons learned for immediate application, as well as for future needs.Evaluate the effectiveness of specific responses and interventions and share findings with the international community.Review the lessons learned and apply to national emergency preparedness and response programmes.Revise national and sub-national pandemic preparedness and response plans.THE POST-PANDEMIC PERIODSITUATION MONITORING AND ASSESSMENTWHO ACTIONSNATIONAL ACTIONSReport on the global situation.Review lessons learned and make adjustments in surveillance guidelines and tools for countries.Collect and analyse available data to evaluate the epidemiological, clinical, and virological characteristics of the pandemic.Review and revise situation monitoring and assessment tools for the next pandemic and other public health emergencies.Resume seasonal influenza surveillance incorporating the pandemic virus subtype as part of routine surveillance.THE POST-PANDEMIC PERIODREDUCING THE SPREAD OF DISEASEWHO ACTIONSNATIONAL ACTIONSProvide technical support to Member States, as requested, to evaluate the impact of the pandemic on the country and the effectiveness and impact of interventions utilized during the pandemic.Conduct a thorough evaluation of individual, household, and societal interventions implemented.Conduct a thorough evaluation of all the pharmaceutical interventions used, including:antiviral effectiveness, safety, and resistance; andvaccine coverage, effectiveness, and safety.Review and update relevant guidelines as necessary.Continue with vaccination programmes in accordance with national plans, priorities, and vaccine availability.THE POST-PANDEMIC PERIODCONTINUITY OF HEALTH CARE PROVISIONWHO ACTIONSNATIONAL ACTIONSUtilize existing clinical networks to review clinical information and effectiveness and safety of clinical interventions; advise on knowledge gaps and research needs.Review and revise relevant guidance.Collect and analyse available data to evaluate the response of the health system to the pandemic.Review the lessons learned and share experiences with the international community.Amend plans and procedures to include lessons learned.As needed, provide psychosocial services to facilitate individual and community-level recovery.THE POST-PANDEMIC PERIODCOMMUNICATIONSWHO ACTIONSNATIONAL ACTIONSEvaluate communications response during previous phases; review lessons learned.Ensure that lessons learned are incorporated into revised and improved communications plans of all stakeholders, ready for use in the next pandemic/major public health event.Continue to work with Member States to increase the effectiveness of national communications activities.Publicly acknowledge the contributions of all communities and sectors.Communicate to the public and other stakeholders the lessons learned about the effectiveness of responses during the pandemic and how the gaps that were discovered will be addressed.Encourage stakeholders across all sectors, public and private, to revise their pandemic and emergency plans based upon the lessons learned.Extend communications planning and activities to cover other epidemic diseases and use the principles of risk communications to build the capacity to dialogue with the public on all health matters of potential concern to them.Improve and adjust communications plan in readiness for the next major public health event.Go to:Footnotes25World Health Organization Outbreak Communication Planning Guide. World Health Organization 2008. ISBN 978 92 4 159744 9.Copyright © 2009, World Health Organization.All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications - whether for sale or for noncommercial distribution - should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e- mail: tni.ohw@snoissimrep).”Source:RECOMMENDED ACTIONS BEFORE, DURING AND AFTER A PANDEMIC