Pandemic influenza response capacities in Thailand: modelling health service resource gaps

Background: Countries with limited health service capacities, like many developing countries, rely on data to optimize allocation of resources to improve pandemic influenza outbreak response effectively. Identifying resource shortcomings and its impacts on the disease burden would give vital information to guide and prioritise response planning practically. Method: Data about available health service resources in all Thai provinces was collected. A deterministic SEIR model was programmed to describe pandemic influenza (H1N1v) outbreak progression in these provinces to calculate actual resource gaps and the corresponding effects on the expected number of cases and deaths. Results: In model simulations, the number of hospital beds was sufficient throughout the country. However, there was a gap in ventilators and antiviral (AV) stockpile for 35 and 40 provinces, respectively, with an associated excess death-toll of 579 and 583 deaths resulting from these respectively. Fifty one provinces (67.1%) experienced resource gaps in at least one resource and 24 provinces (31.6%) experienced resource gaps in both medical ventilators as well as AVs. The total number of lacking ventilators was 318 ventilators (mean across provinces=9, range=1 to 27) and 10,744 AV treatment courses were lacking with an average gap of 269 courses (min 13, max 808). Discussion: Our study highlights the grave effect of shortages in ventilators during the outbreak peaks on the expected number of excess deaths, which could be tackled by resource improvement, treatment triage, or resource mobilisation. However, due to the simplified model assumptions as well as the inherent uncertainty surrounding the underlying disease parameter values, the estimated number of cases and deaths and the extrapolated resource needs should be interpreted with caution. Yet, even this simple model highlights the potentially huge impact of resource gaps on health outcomes and provides a means to indicate where efforts should be concentrated to improve pandemic response.