Current pandemic influenza plans of the Organisation for Economic Co-operation and Development (OECD) countries were reviewed, with particular attention to countries with similar pandemic response capabilities. Several search strategies were used, including a review of World Health Organization (WHO) and European Centre for Disease Prevention and Control (ECDC) webpages on pandemic planning, and a Google search using ‘influenza pandemic plan’ and ‘country’. Only the most recently published English version of any national plan was included. Each was evaluated according to the following criteria [10] (see Table 1 ):

Does the country have a list of pandemic vaccine priority groups?

Are pandemic vaccine priority groups ranked and if so, how?

What is the rationale for the prioritisation concept?

Were ethical committees involved in establishing this concept?

Which types of institutions were involved in development of vaccine priority groups?

Summary of pandemic plans reviewed and updated since 2009.

To identify gaps between pre-existing plans and implementation of vaccine strategies during the 2009 pandemic response, a literature search was undertaken in OVID Medline using the Medical Subject Headings (MeSH) terms ‘Pandemics’, ‘Influenza A Virus, H1N1 Subtype’, ‘Disaster Planning’, ‘Health Planning’, ‘Health Policy’, ‘Public Health Administration’, ‘Communicable Disease Control’, ‘Evaluation Studies’, ‘Program Evaluation’, ‘Immunization’ and ‘Immunization Programs’. A text word search was conducted on evaluation or reviews of influenza pandemic plans. Search results were de-duplicated, limited to ‘Humans’, English language and publication years 2009–2018. In addition, a grey literature search for reports on pandemic vaccine program evaluation commenced with Google Scholar keywords ‘pandemic’, ‘plan’, ‘influenza’, ‘lessons’, ‘review’, ‘response’, ‘evaluation’, and combinations of these terms with country names. Government health websites from Australia, the US, Canada, NZ and the UK were searched, along with key agencies such as the US Centers for Disease Control and Prevention (CDC) and Public Health England (PHE).

Papers were initially selected via a Google Scholar search and from the authors’ reference collection. A snowball technique followed up citations in key publications. A systematic literature search was not conducted, as terms in ethics are not uniformly used or indexed in databases, leading to poor sensitivity and specificity [11].

Semi-structured interviews were conducted with representatives of communicable disease and pandemic preparedness programs from each Australian state and territory, Canada, Japan, Singapore, NZ, the UK, the US, the WHO and ECDC (see Supplementary Material). Findings were transcribed and synthesised for recurrent themes and salient recommendations.

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