Polio Outbreak Simulation Exercise: How to Test National Preparedness Plans Using the POSE Model

"This simulation exercise is primarily designed for health organizations to run as a discussion-based simulation exercise over one day. The exercise is intended to be facilitated by emergency planners with specialist assistance as required. Multiagency participation is beneficial and is enabled through the scenario and discussion points."

This publication provides practical instructions for facilitators seeking to carry out a one-day exercise, including guidance notes and explanatory documents for participants. The goal is to help Member States of the World Health Organization (WHO) European Region critically review and update their national plans for responding to the detection of imported wild poliovirus (WPV) or vaccine-derived polioviruses (VDPV), which are rare strains of poliovirus that have genetically mutated from the strain contained in the oral polio vaccine (OPV).

The exercise addresses communication, coordination, and collaboration at an international and national level, as well as weaknesses in polio preparedness and response arrangements. Each exercise proposes a specific scenario, starting with detection of a suspected polio case and progressing into cross-border transmission. The scenario of the exercise was developed primarily for countries utilising inactivated polio vaccine (IPV). Participants are asked to simulate implementation of country preparedness plans aimed at containing the outbreak. The exercise concludes with a post-event scenario some 25 weeks after the last case was reported.

A number of concrete suggestions are offered, such as how to conduct feedback sessions, a final debrief, and report. "The encouragement of open and candid feedback is critical to capturing any lessons from the exercise. The sticky note system of giving feedback is a useful way for each group to bring forward the key points from their discussions in each of the three feedback sessions. A poster describing potential areas for comment is included in this simulation exercise pack as a visual prompt to stimulate feedback. A master response sheet for each organization/group to complete during discussions is also included and these should be collected after each session to assist with report writing. Facilitators may of course wish to use their own method of gathering feedback to suit the needs of the groups involved and/or additional facilitators to assist in the process."

By facilitating hands-on practice, POSE exercises: emphasise the importance of communications as the key element of any response; point to the need for crisis communications plans; provide an opportunity to review national plans from a new perspective and using a novel methodology; and highlight the importance of liaising across borders/countries and building partnership as part of outbreak response preparedness.

Since the need for heightened preparedness was demonstrated by an outbreak of imported polio in Tajikistan in 2010, regional exercises have been conducted in: Bosnia and Herzegovina (2011) for representatives of Bosnia and Herzegovina, Montenegro, and Serbia; Ukraine (2013) for representatives of Armenia, Azerbaijan, Georgia, and Ukraine, as well as an observer from the Russian Federation and experts from European polio reference laboratories; and Romania (2015) for representatives of Czech Republic, Hungary, Republic of Moldova, Romania, and Slovakia. A national exercise was also conducted in the United Kingdom in February 2013. The exercises are attended by observers from the World Health Organization (WHO) headquarters, country offices, and partner agencies.

Any national organisation or health agency interested in implementing the exercise may send an email - vaccine@euro.who.int - to receive the materials in editable formats for adaptation to the local context.