Understanding the school community’s response to school closures during the H1N1 2009 influenza pandemic
BMC Public Health
Understanding the school community's response to school closures during the H1N1 2009 influenza pandemic
Annette Braunack-Mayer 0
Rebecca Tooher 0
Joanne E Collins 0 2
Jackie M Street 0
Helen Marshall 0 1 2
0 School of Population Health, The University of Adelaide , Adelaide, South Australia 5005 , Australia
1 School of Paediatrics and Reproductive Health, The University of Adelaide , Adelaide, South Australia 5005 , Australia
2 Vaccinology and Immunology Research Trials Unit, University Department of Paediatrics, Women's and Children's Hospital , Adelaide, South Australia 5005 , Australia
Background: During the 2009 H1N1 influenza pandemic, Australian public health officials closed schools as a strategy to mitigate the spread of the infection. This article examines school communities' understanding of, and participation in, school closures and the beliefs and values which underpinned school responses to the closures. Methods: We interviewed four school principals, 25 staff, 14 parents and 13 students in five schools in one Australian city which were either fully or partially closed during the 2009 H1N1 pandemic. Results: Drawing on Thompson et al's ethical framework for pandemic planning, we show that considerable variation existed between and within schools in their attention to ethical processes and values. In all schools, health officials and school leaders were strongly committed to providing high quality care for members of the school community. There was variation in the extent to which information was shared openly and transparently, the degree to which school community members considered themselves participants in decision-making, and the responsiveness of decision-makers to the changing situation. Reservations were expressed about the need for closures and quarantine and there was a lack of understanding of the rationale for the closures. All schools displayed a strong duty of care toward those in need, although school communities had a broader view of care than that of the public health officials. Similarly, there was a clear understanding of and commitment to protect the public from harm and to demonstrate responsible stewardship. Conclusions: We conclude that school closures during an influenza pandemic represent both a challenge for public health officials and a litmus test for the level of trust in public officials, government and the school as institution. In our study, trust was the foundation upon which effective responses to the school closure were built. Trust relations within the school were the basis on which different values and beliefs were used to develop and justify the practices and strategies in response to the pandemic.
Australia; Pandemic; H1N1; Community values; Public health response; Ethical framework
-
Background
The 2009 outbreak of influenza A (H1N1) highlighted the
substantial risk to health and security posed by pandemic
influenza. Public health measures such as social
distancing, school closures, home isolation, use of stock-piled
anti-viral drugs and provision of H1N1 vaccine were
important components of local, national and international
responses to the pandemic. Pre-2009, pandemic planning
had acknowledged the need to understand community
values, beliefs and expectations if these measures were to
be successfully implemented [1-3]. Yet, surprisingly little
research has been conducted post-2009, to understand the
experience and perspectives of those affected by
implementation of such measures [4,5]. Research into the beliefs
and values which underpinned community responses
during the pandemic is crucial to enhance planning for future
pandemics and other public health emergencies.
One domain in which community beliefs and values
might be expected to be particularly important is school
closures. School closures were a key non-pharmacological
public health measure used to limit pandemic influenza
transmission during the 2009 H1N1 Pandemic [6]. School
closures are expected to slow viral transmission by
limiting contact between school children, as children are
thought to be particularly susceptible to influenza and
highly infectious [7]. The success of the strategy relies on
adherence to recommendations for home isolation and
other behavioural change.
School closures pose practical and policy challenges.
They transmit powerful messages to those affected, and
the wider community, about the severity of the
pandemic and the likely risk it poses [8]. Modelling studies
[9,10] and natural experiments [11,12] suggest that
school closures are only effective if invoked early, before
sustained community transmission occurs. Therefore, a
decision to close a school must be made under
considerable uncertainty and, because information about
virulence of a viral strain only becomes available during the
course of the pandemic, recommendations about the
need for school closures are likely to change as the
pandemic progresses.
In our study we focused on school clo (...truncated)