Adaptation of the National Plan for the Prevention and Fight Against Pandemic Influenza to the 2020 COVID-19 Epidemic in France.

On Tuesday, March 17, 2020, at noon, France became the third European country to impose a nationwide containment policy in the fight against epidemic coronavirus disease 2019 (COVID-19) viral infection. Announcing that the country was at "war," President Macron called upon all to play a role in mitigating against further development of contagion. This extreme measure never seen before during peace time was the result of adapting not only the French Pandemic Influenza Plan (PIP) being applied to the national context but also real-time clinical, epidemiological, and scientific information about the evolution of COVID-19 infection in the country. The situation was further complicated by local municipal elections and political agendas by populist opinions. Despite mass communication about the importance of individual behavioral attitudes to counter disease propagation, few heeded government advice. Consequently, the situation rapidly deteriorated with increasing number of cases that started to overwhelm health services. As a result, decisive and immediate action was taken by the State for the national public health interest. This report from the field details the timely events that contributed to this extreme policy decision taken by France. A policy decision that other Western democracies have since applied as the pandemic disseminated across the globe.

Challenges and changes: immunization program managers share perspectives in a 2012 national survey about the US immunization system since the H1N1 pandemic response.

In mid-2012 we conducted survey of immunization program managers (IPMs) for the purpose of describing relationships between immunization programs and emergency preparedness programs, IPM's perceptions of challenges encountered and changes made or planned in programmatic budgeting, vaccine allocation and pandemic plans as a result of the H1N1 vaccination campaign. Over 95% of IPMs responded (61/64) to the survey. IPMs reported that a primary budget-related challenge faced during H1N1 included staff-related restrictions that limited the ability to hire extra help or pay regular staff overtime resulting in overworked regular staff. Other budget-related challenges related to operational budget shortfalls and vaccine procurement delays. IPMs described overcoming these challenges by increasing staff where possible, using executive order or other high-level support by officials to access emergency funds and make policy changes, as well as expedite hiring and spending processes according to their pandemic influenza plan or by direction from leadership. Changes planned for response to future pandemic vaccine allocation strategies were to "tailor the strategy to the event" taking into account disease virulence, vaccine production rates and public demand, having flexible vaccine allocation strategies, clarifying priority groups for vaccine receipt to providers and the public, and having targeted clinics such as through pharmacies or schools. Changes already made to pandemic plans were improving strategies for internal and external communication, improving vaccine allocation efficiency, and planning for specific scenarios. To prepare for future pandemics, programs should ensure well-defined roles, collaborating during non-emergency situations, sustaining continuity in preparedness funding, and improved technologies.