Why do countries fail to implement disaster plan recommendations?
ToggleStates spend a lot of cash and time preparing for emergencies, but fail to act on these plans when pandemics or disasters occur, writes Dr Gail Sheppard, School of Business
In Germany, disaster planning exercises were carried out and risks identified, but weren’t followed up before Covid. By contrast, there was only basic general emergency planning in place in Ireland, but the outcomes from Covid were largely the same as for Germany. Can any lessons be learned for future pandemics or disasters?
In 2007, Germany carried out its largest ever disaster preparedness exercise. LÜKEX 2007 was based on a global influenza pandemic scenario and was developed over 14 months with the Robert Koch Institute. It involved seven federal states, 11 federal ministries, key personnel from the interior and health ministries, government agencies, companies, relief organisations and around 300 participants.
The fallout from a medium-severe pandemic was examined over two days. Day one was a field exercise for the first wave of the pandemic, focusing on personnel and supply requirements, while day two focused on the second wave of the pandemic and examined the distribution of scarce vaccines, general supplies, medical care, and transport infrastructure. The exercise recommended improvements in IT systems availability, expert personnel allocation, and public information systems.
In 2012, Germany carried out a SARS study, again involving the Robert Koch Institute and government departments and the defence forces. This simulated a SARS outbreak originating in Asia and spreading to Germany before official WHO warnings were received. It predicted the rapid spread of the disease due to high levels of transmissibility. The study recommended measures such as school closures and behavioural changes and drew attention to increased demand for and potential shortages of medicines, medical equipment, personal protective equipment and disinfectants.
But despite these elaborate pandemic planning exercises, many of the recommendations and warnings seem to have been ignored when Covid-19 struck in 2020. For example, the recommendation to acquire and store PPE and disinfectants in hospitals was ignored, so Germany had warehouses full of materials in case of war but not for treating viral infections. Shortages of important equipment had significant knock-on effects in the second and more serious wave of Covid, with both a high level of sickness absence among healthcare personnel and a shortage of medications.
Ireland also engaged in disaster preparation, but to a much lesser extent than Germany. A National Pandemic Influenza Expert Group (1999) published a National Pandemic Influenza Plan in 2007 with reference to a communications strategy, responsibilities of the public, surveillance planning, antiviral drugs, pandemic vaccine strategy, reorganisation of the health services and availability of essential supplies. This plan was updated in 2008 and 2009. Ireland's Framework for Major Emergency Management (2016) only mentioned pandemics twice, and the subsequent National Risk Assessment (2019) only had a short section on pandemics.
While it did not undertake disaster planning exercises, Ireland nonetheless had national frameworks to deal with major disasters, although these were general rather than specific to a pandemic, for example. While Ireland had not anticipated the severity of the pandemic, it was able to refer to the 2016 document as a blueprint for what to do in a general emergency.
Like Germany, Ireland experienced shortages of PPE, essential medicines and medical equipment. Unlike Germany, however, Ireland had not engaged in carrying out pandemic preparedness exercises, yet its outcomes from the pandemic were largely similar. Why was this so?
Much of the failure to implement pandemic preparedness exercise recommendations in Germany was because the exercises were carried out at a national level, but the implementation of their recommendations was left to the federal states. The implementation suffered from a lack of coordination and-or a deprioritisation at state level. States failed to release budgetary allocations or even to allocate budgets to prepare for a pandemic that might happen but wasn’t guaranteed.
Concurrently, states had to deal with more immediate disasters such as severe flooding. Distracted by these and in the absence of a national effort to convince states to buy in to pandemic preparedness, the pandemic exercise recommendations withered on the vine. In essence, Germany experienced final-stage failure or the running of red lights.
Ireland activated its generalised national emergency plan when Covid struck, which was coordinated nationally but operationalised locally. The generalised nature of the plan allowed it to be adapted to suit the pandemic circumstances. However, the absence of a specific pandemic preparedness plan meant Ireland experienced shortages of key supplies and some decisions arguably being taken without the direction of a specific pandemic plan. Nonetheless, for both Ireland and Germany, the outcomes from the pandemic were largely similar: in Ireland, more by default than design, and in Germany, more by design than default.
Lessons can be drawn in both directions. Ireland could usefully learn from Germany by engaging in more specific pandemic preparedness planning, while Germany could follow Ireland’s lead with a blueprint for an agreed national plan, coordinated at national level but operationalised at state level. Both would result in more optimal outcomes and avoid running that red light. When a red light looms, governments need to act quickly and decisively with appropriate budgets.
Prof Matthias Beck, University College Cork, co-wrote this article.
This article originally appeared on RTÉ Brainstorm