Pandemic response lessons from influenza H1N1 2009 in Asia


  • The Authors: Associate Professor Dale Fisher is head of Infectious Diseases at the National University Hospital and is a regular clinician consultant for GOARN. Professor David S. Hui is the Head of Division of Respiratory Medicine, Chinese University of Hong Kong, with interest in the clinical management of influenza and other emerging respiratory infections. Professor Zhancheng Gao is the Chief of Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, with interest in the clinical management of severe acute emerging respiratory infections. Dr Christopher Lee is an infectious Diseases physician and advisor to the Malaysian Ministry of Health and GOARN. Professor MD Oh is an infectious disease physician and regular consultant to Korea Centers for Disease Control and Prevention. Associate Professor Cao Bin is an infectious disease physician interested in influenza and pneumonia. Professor Tran Tinh Hien is an Infectious Disease specialist and Director of Clinical Research Oxford University Clinical Research Unit Viet Nam. Krista Patlovich has a Master of Public Health degree from the University of Texas and interested in infection control and overall healthcare quality improvement. Jeremy Farrar is Professor in Tropical Medicine, Oxford University, Global Scholar, Princeton University and Director of Oxford University Clinical Research Unit Viet Nam.

Dale Fisher, Division of Infectious Diseases, National University Health System, 5 Lower Kent Ridge Road, Main Building 1, Level 3, Singapore 119074. Email:


During April 2009, a novel H1N1 influenza A virus strain was identified in Mexico and the USA. Within weeks the virus had spread globally and the first pandemic of the 21st Century had been declared. It is unlikely to be the last and it is crucial that real lessons are learned from the experience. Asia is considered a hot spot for the emergence of new pathogens including past influenza pandemics. On this occasion while preparing for an avian, highly virulent influenza virus (H5N1 like) originating in Asia in fact the pandemic originated from swine, and was less virulent. This discrepancy between what was planned for and what emerged created its own challenges. The H1N1 pandemic has tested national health-care infrastructures and exposed shortcomings in our preparedness as a region. Key health challenges include communication throughout the region, surge capacity, access to reliable information and access to quality care, health-care worker skills, quality, density and distribution, access to essential medicines and lack of organizational infrastructure for emergency response. Despite years of preparation the public health and clinical research community were not ready to respond and opportunities for an immediate research response were missed. Despite warm words and pledges efforts to engage the international community to ensure equitable sharing of limited resources such as antivirals and vaccines fell short and stockpiles in the main remained in the rich world. This manuscript with authors from across the region describes some of the major challenges faced by Asia in response to the pandemic and draws lessons for the future.