Influenza Pandemic Exercise Report Available

A 72 page report on the 2006 Australian National Pandemic Influenza Exercise is available online from the federal government. Anyone interested in how to deal with a pandemic, or with how to conduct an exercise for a major disaster should read it.

"Exercise Cumpston 06: National Pandemic Influenza Exercise Report", Department of Health and Ageing, Office of Health Protection, , Australian Government, 2007 is available as a 493 kbyte PDF document. A HTML version is promised on the web site.

Below I have picked out some of the report's findings and recommendations related to ICT, Internet and the Web. In 2005 and I talked at a conference in 2006 using the wireless web and podcasting in a pandemic. Some of those techniques might be used to address problems found in the exercise.

Use open source systems for pandemic?

It appears that Australian agencies have built their own web based systems:

• Health Alert Network (HAN)
• NetEpi web based outbreak reporting and management system, and
• An unnamed exercise management system.

Problems were experienced with all of these during the excise. Such systems will rarely be used by most of their intended users and will only rarely be exercised. There development and operation are expensive and problematic. In addition these systems will be of little value if other countries have no such systems and thus have unmanaged outbreaks of influenza.

It may make better use of resources if DoHA was to release these systems as open source software and make them available for global use, particularly by developing nations. The Sahana Disaster Management System provides an award winning example of this approach. An Australian Government example of open source development is the National Archives of Australia's Xena electronic archiving software.

As well as pooling expertise and making a system available for third world nations, building an open source system would have advantages for design. This would place a discipline on developers that the system would have to be very simple to use, efficient, easy to understand and very compliant with widely used standards.

Excepts from 2006 Australian National Pandemic Influenza Exercise Report

Recommendation 3: Health electronic communications systems, including the Health Alert Network and the Department of Health and Ageing website, need to be further developed and exercised.

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5.2.4 Information and communications technology

A number of information and communications technology (ICT) systems were utilised for information collection and dissemination, including a new secure information sharing network currently under development by DoHA, the Health Alert Network (HAN). This system encountered 'bedding-down' problems, and was new to many users. Lack of familiarity caused a degree of distrust in the system, and to compensate, duplicate systems were used (for example, the same message sent out on normal e-mail and HAN). As a result there was considerable overlap and information overload.

While many users were comfortable with HAN, others complained that the system was not intuitive, that it was cumbersome to use, and that response times were slow. It was apparent that user expectations were not being met, and that training and familiarisation was inadequate. Specific problems encountered with HAN included:

• unacceptable delays incurred in the distribution of alerts;
• alerts not indicating the priority of the content; and
• the system not allowing multiple addressing.

A secure system is always going to be more difficult to access and use than an unclassified one. It may be necessary to consider a more limited range of uses for HAN or improve its functionality so that it can complement other systems, particularly e-mail.

Rationalisation of information systems and methods is necessary, as is appropriate training to ensure familiarity with their use. HAN is part of the Biosecurity Surveillance System being developed by DoHA, which is further discussed in Section 5.4.3.

The main activity also identified ICT issues relating to the DoHA exercise website that hindered rapid communication among participants. The password-protected website designed for exercise play performed poorly. There were delays, caused by technical problems, of up to several hours in posting materials onto the website, which led to information vacuums at critical points of the response. This caused confusion among participants and pseudo media throughout the main activity.

The main activity reinforced DoHA's need to re-examine the robustness of its IT systems in handling the large volumes of visitors to its website that could be expected during a pandemic. DoHA also needs to examine its website capacity for the downloading of vision and sound files that would be critical in ensuring the media is well served.

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Information was available for the public and health care workers online, but its existence and how to access it were not well promoted to the public via the pseudo media. Rural and remote communities may have limited access to the Internet and this medium should not be relied upon as the sole means of disseminating public information. There was no information available targeted to Indigenous and culturally and linguistically diverse (CALD) populations.

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5.4.3 ICT infrastructure for surveillance

State and territory health departments collected information on cases and their contacts using nationally agreed definitions developed by the CDNA. This information was entered into a single point: a web based outbreak reporting and management system called NetEpi.

While the version of NetEpi maintained by DoHA is an interim system only (with recognised limitations), there were nevertheless criticisms and a lack of national consistency in its use, particularly in relation to data entry and the format of data fields. It should be noted that the version of NetEpi used was not the most current version and subsequent versions have addressed a number of the ICT limitations identified in the main activity. It is essential that there is national agreement in regard to data collection for any web based ICT system to be used effectively for national data collection.

In addition to the use of NetEpi, jurisdictions were encouraged to update the NIR via telephone in regard to critical events, for example, confirmation of cases or deaths. While NetEpi was generally updated within several hours, at some stages there were inevitable discrepancies between current jurisdictional reports at teleconferences, and the NIR reports, which were also delayed at times by clearance processes. In a rapidly changing environment these discrepancies are unavoidable. Criticism of this could be tempered by agreed regular reporting timeframe, so that national data are current up to a determined point, with acknowledgement that individual jurisdictions may hold more up-to-date information.

DoHA is currently improving the infrastructure of national communicable disease surveillance systems. The Biosecurity Surveillance System (BSS) is being developed to provide a more effective and comprehensive surveillance system. Components include enhancement of both HAN (Section 5.2.4 refers) and NetEpi. The lessons learned during Cumpston 06 should be applied in the BSS development.

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Recommendation 10: General practitioners, community pharmacies and other primary care providers need to be better integrated into detailed plans at national and jurisdictional level. To achieve this: (a) the role of general practitioners, pharmacists and other primary care providers needs to be clarified in preparedness plans following consultation with providers; and (b) the primary care annex of the Australian Health Management Plan for Pandemic Influenza should be published on the Department of Health and Ageing web as a priority.

The "Australian Health Management Plan for Pandemic Influenza" is at: