Policies regarding the control of H1N1 influenza

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The new flu H1N1 caused redefinition of the main health policy and public health policy priorities in many countries. The danger of a pandemic that would strike a relevant share of the population, causing important health consequences and immense economic damages brought preventative measures to the forefront. Following the initial developments and the rise in the number of cases over summer, Slovenia joined preparations for a broad application of vaccine and strengthened pandemic preparedness.

Purpose of health policy or idea

The idea about how to manage the problem of the new flu has quickly become a major (health) policy and political issue. Following the initial concerns, there was a brief uneventful period, after which the first cases started appearing, most of them people returning from holidays in other countries. The first bigger group of infected were high school graduates who spent their baccalaureate trip in the island of Kos in Greece. After the summer holiday period came to an end, also the number of new cases start to decline. Until 5 October 2009 a total of 256 new cases were officially registered with only 37 new cases in September.

In spite of these reassuring numbers, there have been different actions ranging from health promoting activities to raise awareness about the disease to revisions of the national pandemic preparedness plan. In view of that the MoH decided to focus on the following activities:

1. Health promotion activities to inform about the disease, help in developing preventative and containing measures to control its spread
2. Preparedness according to the Pandemic preparedness plan for Slovenia
3. Stockpiling of antivirals for national needs
4. Ordering two doses of vaccine for 650,000 persons (around one third of the total population)

Main points

Main objectives

The main objectives were:

1. To ensure adequate and timely preparedness of all services for the flu epi/pandemic
2. To secure sufficient quantities of antivirals and of the new flu vaccine for containment of the disease
3. To secure the basic functioning of the state and all its services during the peak epidemic period

The approach followed international recomendations and considerations, but also national reflections on the activities needed to control the spread of the disease in Slovenia. As an exceptional measure, the state budget provided for 14 million Euro financial resources in order to purchase the above mentioned vaccine and the antivirals.

Type of incentives

1. Health promoting incentives
2. Budgetary finance for the purchase of vaccine
3. Securing enough antivirals to cover the estimated number of patients in the initial waves of the disease

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Political and economic background

Complies with

EU regulations

Following the dominant choices in the EU regarding stockpiling of antivirals and ordering vaccine for a substantial part of the population.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The idea was generated by the Ministry of Health and a part of the public health professionals. This is evidenced also in the fact that the vaccine was bought by the national budget (responsibility of the Government) and that the full cost of the vaccine will be borne by the State. The responsibility for control of communicable diseases lies with the State, which is responsible for financing all those activities that lead to prevention, control and treatment of this group of diseases. In this sense and avoiding the main potential risks, such as unavailable vaccine, the MoH stepped in to secure the vaccine.

The costs of the treatment (the application of the vaccine) are most likely to be borne by individuals, but they are expected to be below 10 EUR per dose. This will be unavoidable given the anticipated losses at the Health Insurance Institute of Slovenia (the sole insurer for compulsory health insurance) of approximately 150 million Euros.

Slovenia followed the stream of similar decisions in other countries but remained reasonable about the population share to be covered.

Initiators of idea/main actors

• Government

• Patients, Consumers

• Scientific Community

Stakeholder positions

The fact that the outbreak happened before summer holidays and the fact that there were deaths reported caused a sufficient level of interest; the key decisions of the government were not questioned.

Increasing international demand triggered the decision that Slovenia would also make a reservation for a quantity of vaccine sufficient to vaccinate about one third of the entire population. The Government took this decision on its own, securing funding for the purchase of the vaccines from the national budget instead of referring the decision to the Health Council, which decides about expenditures from the compulsory health insurance. Therefore, the procedure strayed from standard routes, but there was no clear opposition in the general public nor in the professional community.

The biggest concern before the outbreak in autumn was that the uptake of vaccination among the population might be slow. This proved to be true until the first fatality occurred (2 November 2009), after which there has been enough interest for vaccination that incoming vaccines are consumed as they arrive.

Actors and positions

Government
Government	very supportive		strongly opposed
Patients, Consumers
General public	very supportive		strongly opposed
Scientific Community
Professional community	very supportive		strongly opposed

Actors and influence

Government
Government	very strong		none
Patients, Consumers
General public	very strong		none
Scientific Community
Professional community	very strong		none

Positions and Influences at a glance

Adoption and implementation

This policy was adopted outside of the standard procedures, which had been defined by the Health Council (the main advisory body of the MoH and also the consultative HTA advisors). It is interesting that this was the case as such a decision was in clear contrast with the lengthy public and professional discussion surrounding the introduction of the HPV vaccination (also see HPM 13/2009 and HPM 12 /2008). In the latter case, around 3 million Euro will be spent on vaccinating 12-year old girls over the next 3 years, while in the new flu, the state expense (not counting the costs of the vaccinations!) will be of 14 million Euro. There were realistically no obstacles to this decision; on the contrary, this decision was expected to take place in view of the quickly spreading flu across the summer months.

Vaccination will be voluntary and the cost of the application of the new flu vaccine will be borne by individual persons. The rest of the implementation will be simple as vaccination will be performed by the selected personal physicians (GPs and paediatricians), who are registered as vaccinating physicians.

Expected outcome

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

It is difficult to estimate economic parameters of this policy as of this moment in time. A lot will depend on the dynamics of the epidemic, which will then determine the extent and the consequences, which will be reflected in all adverse outcomes, including the related direct and indirect costs. As the incidence rates are still low, the 'investment' into vaccine seems of rather low cost-efficiency. 

References

Sources of Information

1. Decisions of the MoH and the Government of Slovenia on the new flu spreading
2. A revised version of the 2009 National Immunisation Programme, including the new flu

Author/s and/or contributors to this survey

Tit Albreht

Suggested citation for this online article

Albreht, Tit. "Policies regarding the control of H1N1 influenza". Health Policy Monitor, October 2009. Available at http://hpm.org/survey/si/a14/1