A critical evaluation of H1N1 2009 planning and response efforts from the perspective of child and family well-being

The 2009 H1N1 pandemic was relatively mild but afforded Public Health the opportunity to implement and subsequently evaluate preparedness plans. This mixed methods study reports findings from analysis of public health response efforts throughout the United States, Mexico and Canada during H1N1 and SARS. Specifically, 2,608 respondents including parents and children, health care providers, public health professionals, behavioral health providers, ethicists and legal experts provided data through interviews, focus groups and surveys. In addition, content analyses of state pandemic plans and professional organization disaster guidelines were completed. Results showed that little a priori attention was given to the effects of disease mitigation efforts on children despite their high rate of infection. Moreover, these mitigation efforts produced unintended consequences of traumatic stress, confusion, noncompliance and resistance to medical advice. Children and their caregivers who were quarantined or isolated suffered rates of post-traumatic stress disorder similar to those after natural disaster. Inconsistent implementation of social distancing actions such as school closures led to parental confusion and noncompliance. Lack of behavioral health professional inclusion in the planning and response efforts hampered efforts to relieve stress. Legal and ethical questions such as those concerning mandatory vaccination of health care workers were hastily addressed. However, there were also numerous examples in which the public health response was creative and effective. Lessons learned and suggested best practices pertaining to the protection of the well-being of children and their families during a pandemic, are presented.