Table 5.

Facilitators and inhibitors in pandemic management identified: Influenza A (H1N1)

Political (P)	Economic (Econ)	Sociological (S)	Technological (T)	Ecological (E)	Legislative (L)	Industry (I)
Influenza A (H1N1):
Facilitators
Arrangement and strength in governance and stewardship (Asia) [30]	External funds through the Partnership Contribution (PC) of Pandemic Influenza Preparedness (PIP) (Eastern Mediterranean) [28]	Public knowledge (eg, knowledge in transmission mechanism, infection control measures; efficacy and effectiveness of control measures); optimal perception of severity and vulnerability of the infection (Global) [29]	Technologies available for surveillance, case detection, and infection control (Asia) [30]	Vaccination coverage; early initiation of antivirals (Eastern Mediterranean) [28]		External resources available for LMICS (eg, Laos, Cambodia) (Asia) (31)
		Optimal knowledge in the influenza pandemic; having a health-related personal network (eg, having family or friends who can provide health-related information or support) (US) [31]		Existing epidemiological profile of high life expectancy and low mortality (Asia) [30]
		Adherence with antiviral medication (either as prophylaxis or treatment) associated with previous compliance with other precautionary advice about pandemic flu, beliefs that the recommended preventive measures were necessary; having discussed the option of taking antiviral medication with someone who had not experienced side effects (Global) [32]
		Perception of benefits of vaccination (eg, protecting themselves and loved ones, protecting patients); adequate perception of susceptibility (eg, risk of infection, immunity via previous exposure) and severity; responsive action to information from mass media, public health authorities, and coworkers/supervisor (Global) [34]
Inhibitors
Inadequate preparedness plans lacking detailed strategic review and assessment (Eastern Mediterranean) [28]	Insufficient budget for pandemic preparedness; reliance on external funding (Asia) [30]	The annual Islamic pilgrimage (Hajj) driving transmission; population displacement and migration due to ongoing wars and conflicts (Eastern Mediterranean) [28]	Lack of complete surveillance systems across national, sub-national and regional level; absence of integration between animal and human surveillance networks (Eastern Mediterranean) [28]	Global migratory bird flight increasing transmission of Avian influenza through wild birds, poultry and humans (Eastern Mediterranean) [28]	Absence of legal framework (for declaring emergency and taking actions) in pandemic planning (Eastern Mediterranean) [28]	Shortage in trained staff and laboratory equipment for surveillance; lack of planning for procurement, storage and distribution of vaccines; low utilisation of research and evaluation to revise preparedness plans and improve prevention and containment measures (Eastern Mediterranean) [28]
		Anxiety and fear (Global) [29]				Shortage of qualified human resources restricting surveillance and response capacity (Asia) [30]
		Lack of public health education specifically for Influenza A (instead focusing on Avian influenza) (Asia) [30]
		Low education; unemployment and low socio-economic position associated with inadequate access to health information (US) [31]
		Non-adherence with antiviral medication due to experienced or perceived adverse effects, not wanting to take medication, forgetting, losing, or running out of tablets (Global) [32]
		Social stigma and discrimination against one or more particular social sub-group (s); lack of trust in government’s capacity and fairness when handling the emergence; inequalities in exposure to public health communication messages which led to negative outcomes including low vaccine uptake; inadequate knowledge, attitude, and beliefs about the pandemic; suboptimal care seeking behaviour; low ability and willingness to seek and process information; poor emotional responses (Global) [33]
		Vaccine hesitancy among HCWs due to concerns in vaccine safety, adverse effects, effectiveness/efficacy) (Global) [34]