Preparedness for a pandemic of influenza (PI) is a policy issue currently attracting increased attention from international organizations, governments, and private sector businesses. This is due in large part to the absenteeism rates that could be caused by a virulent strain of influenza affecting all demographics in our population, and the impact that would have on society as a whole. It is also an issue whose effects are cross cutting through both the private and public sectors equally making it a critical issue for society as a whole. Either prospectively agreeing when to implement certain strategies or having a process in place for decision making during the event, is an essential element of PI preparedness. One of the most effective and efficient methodologies to ensure readiness and evaluate preparedness is through exercises where different stakeholders are brought together to dialogue on how they will react to a given set of circumstances.Objective: To create awareness among senior policy makers as to the critical role of exercises in societal pandemic influenza (PI) preparedness and the critical process steps.Methods: Taking the collective objective experience from designing and implementing over 100 exercises for senior policy makers, 20 of which were pan flu related, the authors have advanced the science in the field, observed phenomena and drawn conclusions regarding appropriate exercise design, similarities to other forms of research and best practices for PI exercises/all-hazards preparedness.Results: Employing a decision matrix using the following factors: policy, plan, procedure, tactics and skills, an entity can determine the appropriate exercise typology and associated resource requirements. It was important to consistently raise specific issues in order to comprehensively address various preparedness and response issues.Conclusion: Despite a lack of common framework and methodology for the conduct of table top exercises (TTX), discussion based TTX have demonstrated to be an efficacious, effective, and efficient means for identifying policy gaps and fostering pandemic influenza response readiness.
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