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pH1N1 - a comparative analysis of public health responses in Ontario to the influenza outbreak, public health and primary care: lessons learned and policy suggestions

Paul Masotti1*, Michael E Green2*, Richard Birtwhistle3, Ian Gemmill4, Kieran Moore4, Kathleen O’Connor4, Adrienne Hansen-Taugher4 and Ralph Shaw5

Author Affiliations

1 Department of Community Health Sciences, John Buhler Research Centre, University of Manitoba, Room 564, 715 McDermot Ave, Winnipeg, MB R3E 3P4, Canada

2 Departments of Family Medicine and Public Health Sciences, Queen’s University, Abramsky Hall 3rd Floor, 21 Arch Street, Kingston, Ontario, Canada K7L 2N6

3 Departments of Family Medicine and Public Health Sciences, Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, Canada K7L 5E9

4 Kingston, Frontenac and Lennox & Addington Public Health, 221 Portsmouth Ave, Kingston, Ontario, Canada K7M 1V5

5 Centre for Health Services and Policy Research, Queen’s University, Abramsky Hall 3rd Floor, 21 Arch Street, Kingston, Ontario, Canada K7L 2N6

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BMC Public Health 2013, 13:687  doi:10.1186/1471-2458-13-687

Published: 27 July 2013



Ontario’s 36 Public Health Units (PHUs) were responsible for implementing the H1N1 Pandemic Influenza Plans (PIPs) to address the first pandemic influenza virus in over 40 years. It was the first under conditions which permitted mass immunization. This is therefore the first opportunity to learn and document what worked well, and did not work well, in Ontario’s response to pH1N1, and to make recommendations based on experience.


Our objectives were to: describe the PIP models, obtain perceptions on outcomes, lessons learned and to solicit policy suggestions for improvement. We conducted a 3-phase comparative analysis study comprised of semi-structured key informant interviews with local Medical Officers of Health (n = 29 of 36), and Primary Care Physicians (n = 20) and in Phase 3 with provincial Chief-Medical Officers of Health (n = 6) and a provincial Medical Organization. Phase 2 data came from a Pan-Ontario symposium (n = 44) comprised leaders representing: Public Health, Primary Care, Provincial and Federal Government.


PIPs varied resulting in diverse experiences and lessons learned. This was in part due to different PHU characteristics that included: degree of planning, PHU and Primary Care capacity, population, geographic and relationships with Primary Care. Main lessons learned were: 1) Planning should be more comprehensive and operationalized at all levels. 2) Improve national and provincial communication strategies and eliminate contradictory messages from different sources. 3) An integrated community-wide response may be the best approach to decrease the impact of a pandemic. 4) The best Mass Immunization models can be quickly implemented and have high immunization rates. They should be flexible and allow for incremental responses that are based upon: i) pandemic severity, ii) local health system, population and geographic characteristics, iii) immunization objectives, and iv) vaccine supply.


We were very lucky that pH1N1 was not more severe.” Consensus existed for more detailed planning and the inclusion of multiple health system and community stakeholders. PIPs should be flexible, allow for incremental responses and have important decisions (E.g., under which conditions Public Health, Primary Care, Pharmacists or others act as vaccine delivery agents.) made prior to a crisis.

pH1N1; Pandemic influenza plans; Influenza responses; Public health; Primary care; Mass immunization; Public health policy