Table 1.

A selection of the more important lessons to be learnt in Europe from the 2009 Pandemic [9]

Topics	Learning point	Notes
Planning scenarios	Countries and plans to be flexible—preparing for a range of scenarios [2]
	Undertake more operational planning and preparation at the delivery end [2, 3, 8, 9]	This means determining how for example how vaccines will be delivered, intensive care capacity increased quickly using tools like WHO’s checklist and ECDC’s Acid Tests as a starting point [7]
Early analyses	Early assessments should be more structured and rehearsed annually for seasonal influenza [2]	This was done for the 2010-11 seasonal influenza epidemics in Europe by ECDC and its advisors through a structured risk assessment
	There need to be more sophisticated descriptions of pandemics, the severity reflecting the inherent complexity of the pandemics and their countermeasures [2]	ECDC is taking a lead in developing this for Europe working with Member States and WHO using seasonal influenza as a model
	The results of important analyses need to be shared in a more timely manner between countries [2]	Problems arose from the need for independent peer-review and authorities producing analyses but not necessarily thinking who else needed to know the results
Surveillance	Surveillance needs to be better targeted to answer certain essential questions and particular weaknesses (surveillance in hospitals, mortality surveillance and seroepidemiology) need to be addressed using seasonal influenza as a model [25]	A general finding was the near impossibility of establishing new surveillance and other systems during a crisis like a pandemic (e.g. surveillance in hospitals). In contrast pre-existing systems, primary care and virological surveillance worked well
Decision making in the pandemic	There should be more formal if rapid independent reviews of earlier decisions at national and international levels [2, 26]	This did happen in a number of circumstances learning from earlier recommendations [24]
	Opinion giving should be transparent with those advising being identified and with public declarations of interest [2]	An adviser having a conflict of interest does not mean that their advice is incorrect or should be discounted. There are certain areas (e.g. pharmaceutical development) where conflicts of interest are inevitable among those giving advice
Communications	Prepare the population and professionals for a range of possibilities [2, 9]	A particular problem was that the public and decision makers thought they had been promised a severe pandemic [27]
	The opinions, concerns and views of the public and professionals should be monitored at national levels during a pandemic and responded to rapidly	This was done in a few countries notably the United States. Professionals are especially important for pandemics as it is they who need to deliver the countermeasures like early medical treatments, antivirals and vaccines to the public
	A disconnect between technical epidemicological and virological risk assessments and the politically-driven risk management process was evident and partially fuelled by the media coverage in early days of the 2009 pandemic [28]
	Many public health authorities are poorly equipped to deal with the multi-source two-way communication platforms that the internet and social media allows today	This was one of the reasons leading to a variable public health response in some countries, especially when it came to vaccinations [28, 29]
Essential research and development	It should be more possible to rapidly commission essential research in a pandemic	Some countries were able to do this but current European Union rules and procedures make it almost impossible to use EU monies for this