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Excerpted From:  Nita Madhav, Ben Oppenheim, Mark Gallivan, Prime Mulembakani, Edward Rubin, and Nathan Wolfe, Chapter 17 Pandemics: Risks, Impacts, and Mitigation, Jamison DT, Gelband H, Horton S, et al., editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27. doi: 10.1596/978-1-4648-0527-1/pt5.ch17 (References Omitted) (Full Document)



Pandemic preparedness and response interventions can be classified by their timing with respect to pandemic occurrence: the pre-pandemic period, the spark period, and the spread period, as shown in box 17.1.

Whereas some interventions clearly fall under the purview of a single authority, responsibility for implementing and scaling up many critical aspects of preparedness and response is spread across multiple authorities, which play complementary, interlocking, and, in some cases, overlapping roles. The governance of pandemic preparedness and response is complex, with authority fragmented across international, national, and subnational institutions, as well as among multiple organizations with functional responsibility for specific tasks. Pandemic preparedness requires close coordination across public and private sector actors: vaccine development requires close coordination between government and vaccine producers; whereas critical response measures—such as managing quarantines—requires engagement between nonprofit organizations (hospitals, clinics, and nongovernmental organizations), public health authorities, affected communities and civil society groups, and the security sector.

Historical pandemics offer only a partial view to guide preparedness and response activities. Many countries and organizations have used the historical influenza pandemics in 1918, 1957, and 1968 to estimate the potential morbidity and mortality burden during a future pandemic. However, using these moderate-to-severe events to plan for a mild pandemic (for example, the 2009 influenza pandemic) can lead to an overzealous response—such as widespread mandatory school closures—that may create unintended negative economic consequences. And although the 1918 influenza pandemic is sometimes considered a “worst-case scenario” for planning purposes, possible scenarios today could be far more damaging—such as if a highly transmissible, highly virulent influenza virus were to emerge. Especially in LMICs, intensive care unit (ICU) beds and therapies for acute respiratory distress syndrome are in short supply, which could lead to many casualties.


Box 17.1  Examples of Pandemic Preparedness and Response Activities, by Time Period

Pre-pandemic period (before a pandemic starts)

  • Stockpile building
  • Continuity planning
  • Public health workforce training
  • Simulation exercises
  • Risk transfer mechanism set-up
  • Situational awareness

Spark period (as a pandemic starts)

  • Initial outbreak detection
  • Pathogen characterization or laboratory confirmation
  • Risk communication and community engagement
  • Animal disease control
  • Contact tracing, quarantine, and isolation
  • Situational awareness

Spread period (after a pandemic starts)

  • Global pandemic declaration
  • Risk communications
  • Contact tracing, quarantine, and isolation
  • Social distancing
  • Stockpile deployment
  • Vaccine or antiviral administration
  • Care and treatment
  • Situational awareness

Situational awareness includes passive and active animal and human disease surveillance and monitoring of public health facilities and resources. 


Vernellia R. Randall
Founder and Editor
Professor Emerita of Law
The University of Dayton School of Law