Influenza pandemics are unpredictable but recurring events that can have severe
consequences on human health and economic well being worldwide. Advance planning
and preparedness are critical to help mitigate the impact of a global pandemic. This
WHO guidance document Pandemic influenza preparedness and response significantly
updates and replaces WHO global influenza preparedness plan: The role of WHO and
recommendations for national measures before and during pandemics which was
published in 2005.
Why update the 2005 Guidance?
The global response to the spread of avian influenza A (H5N1) that began in 2003 has
helped shape a number of significant public health advances. First, avian and pandemic
influenza initiatives have led to substantial gains in strengthening national and global
capacities and building partnerships between animal and human health sectors.
Extensive practical experience in dealing with outbreaks of avian influenza (H5N1) virus
in poultry and humans in addition to pandemic preparedness and response exercises
carried out in various countries, has led to a greater understanding of the issues that
need to be addressed in pandemic preparedness. Second, there is increased
understanding of past pandemics, strengthened outbreak communications, greater
insight into disease spread and approaches to control, and development of increasingly
sophisticated statistical modeling techniques. Third, there has been growing attention to
global health security following the adoption of revised International Health Regulations
(IHR) in 2005 which provide a framework to address international public health concerns.
Finally, stockpiles of antiviral drugs and other essential supplies are now a reality, new
approaches to influenza vaccine development are under way and a Global Vaccine
Action Plan2 has been devised to increase the supply of pandemic vaccine.
Overview of the major changes
The revised Guidance:
1. Retains the six-phase structure but regroups and redefines the phases to more
accurately reflect pandemic risk and the epidemiological situation based upon
2. Highlights key principles when undertaking pandemic planning including:
a) application of ethical principles to assist policymakers in balancing a
range of interests and protecting human rights;
b) integration of pandemic preparedness and response into national
emergency frameworks to encourage sustainable preparedness;
c) incorporation of a “whole-of-society” approach that emphasizes not only
the central role played by the health sector, but also the significant roles
of other sectors such as businesses, families, communities and
3. Harmonizes the recommended measures with the IHR 2005 and the concurrent
development/revision of WHO guidance in related areas such as pandemic
influenza surveillance, disease control measures, rapid containment and
4. Includes suggested planning assumptions, their implications and a selected
evidence base to aide planning efforts on a national level.
How to use this Guidance
This document should be used as a guide to inform and harmonize national and
international preparedness and response before, during and after an influenza pandemic.
Countries should develop or update national influenza preparedness and response plans
that address the recommendations in this Guidance. This document is not intended to
replace national plans which should be developed by each country.
This Guidance serves as the core strategic document in a suite of materials. It is
supported by a complement of pandemic preparedness materials and tools (Figure 1).
These documents and tools provide detailed information on a broad range of specific
recommendations and activities, as well as clear guidance on their implementation. The
individual elements of the guidance package will be made available as they are finalized.
FIGURE 1: The WHO guidance package for pandemic influenza preparedness and
Roles and responsibilities in preparedness and response
A “whole-of-society” approach to pandemic influenza preparedness emphasizes the
significant roles played by all sectors of society.
The national government is the natural leader for communication and overall
coordination efforts. Central governments should work to put in place that the
necessary legislation, policies and resources are in place for pandemic
preparedness, capacity development and anticipated response efforts across all
The health sector (including public health and health care services) provides
critical epidemiological, clinical and virological information which, in turn, informs
measures to reduce spread of the pandemic virus and its attendant morbidity and
The diverse array of non-health sectors must provide essential operations and
services during a pandemic to mitigate health, economic and social impacts.
Civil society organizations are often well placed to raise awareness,
communicate accurate information, counter rumours, provide needed services,
and liaise with the government during an emergency.
Families and individuals can help reduce the spread of pandemic influenza
through adoption of measures such as covering coughs and sneezes, hand
washing, and the voluntary isolation of persons with respiratory illness.
WHO will work with Member States across a range of activities, including:
Coordination of the international public health response under the IHR 2005.
Designation of the current global pandemic phase.
Selection of the pandemic vaccine strain and recommendation of timing to start
pandemic vaccine production.
Assistance to national pandemic rapid containment efforts.
Assessment of pandemic severity
Global aggregation of key epidemiologic, virologic, and clinical information about
the pandemic virus to help national authorities in deciding the optimal response.
Provision of guidance and technical assistance.
The WHO pandemic phases
The phases are applicable globally and provide a framework to aid countries in
pandemic preparedness and response planning. The use of a six-phased approach has
been retained to facilitate incorporation of new recommendations into existing national
plans. However, the pandemic phases have been re-defined (Table 1). To facilitate
planning at national and global levels, Phases 1-3 and 5-6 have been grouped to include
common action points. In addition, the time after the first pandemic wave has been
elaborated into post peak and post pandemic periods. When making a change to the
global phase, WHO will carefully consider all available information to assess if the
criteria for a new phase have been met.
Recommended actions before, during and after a pandemic
Recommended actions to be taken by WHO and national authorities are presented for
Phases 1-3, Phase 4, Phases 5-6, a post-peak period and a post-pandemic period.
These actions are organized into the five basic components of preparedness and
1. planning and coordination
2. situation monitoring and assessment
3. reducing the spread of disease
4. continuity of health care provision
Actions taken during Phases1-3 are aimed at strengthening pandemic preparedness and
response capacities at global, regional, national and sub-national levels. The
overarching goal of actions taken during Phase 4 is containment of the new virus within
a limited area or delay of its spread. If successful, valuable time could be gained to
implement interventions including the use of vaccines. During Phases 5-6, actions shift
from preparedness to response at a global level to reduce the impact of the pandemic.
Actions during the post-peak period focus on addressing the health and social impact of
the pandemic as well as preparation for a possible future pandemic wave(s). The focus
of the post-pandemic period is restoration of normal health and social functions while
addressing the long-term health and social impact of the pandemic.