Influenza pandemic planning and performance in Canada, 2009.

This commentary evaluates Canadian actions following identification of pH1N1 influenza virus in 2009. We also report on some international issues affecting vaccine manufacture, and compare pH1N1 influenza vaccination programs in several industrialized countries. WHO's pandemic declaration was the trigger for Canada to take the following steps: (1) implement its sole source pandemic vaccine supply contract, (2) use an alternate, internationally-developed approach to authorize emergency use of adjuvant-containing vaccine not yet fully approved in Canada, (3) release stocks of antiviral, and (4) develop many health-related policies, through committees other than those normally used outside a pandemic. We note key successes and challenges in these steps, and suggest responses to two priority issues: first, improve planning for surges in demand for the clinical services that represent the main way in which severe disease impact was reduced, and second, establish from the outset of Public Health planning that immunization programs will phase use of vaccine in different target groups, as done elsewhere, reflecting realistic vaccine delivery rates and the likely early occurrence of the main epidemic wave.