The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.
Public health measures to combat the COVID-19 outbreak follows the Icelandic Pandemic and Influenza Preparedness Plan (IPIPP). IPIPP was activated in mid-January 2020 few days before the declaration of state of uncertainty. The plan was updated for the current pandemic on March 5th 2020, a day before the declaration of the state of alert. The plan adheres to the revised International Health Regulation (IHR). It states the aim of a responses and preparedness plan in times of pandemic, the main actors in the plan, both public and private, division of tasks and responsibilities, the governing structure, the three phases of response and what they involve.
The Government of Iceland is at the top of a hierarchical structure constituting the chain of delegation and accountability of a network of participating governing and operating bodies at all levels of government both public or private. All Departments of government play a role, while in times of pandemic influenza, the main responsibility rests within the Ministry of Health and the Ministry of Justice. A brief layout of the pandemic influenza response plan as stated on the National Commissioner of Icelandic Police (NCIP) website is:
- The Minister of Health is the authority for measures against communicable diseases, including pandemic influenza.
- The Chief Epidemiologist is responsible for measures to mitigate communicable disease, including global influenza preparedness under the authority of the Minister of Health.
- The National Committee on Communicable Diseases is an advisory body for the health authorities concerning measures to prevent the spread of communicable disease.
- The Medical Director of Health is responsible for the professional inspection of the operations and working facilities of health professionals, health institutions and measures against communicable disease.
- The Minister of Justice is the authority for Civil Protection.
- The National Commissioner of the Icelandic Police governs civil protection activities under the authority of the Minister of Justice.
- The Civil Protection Department of the National Commissioner of the Icelandic Police is responsible for the implementation of civil protection, including the management of general measures to keep social infrastructures operable, and support for official measures against communicable diseases.
- The Chief Epidemiologist and the Civil Protection Department of the National Commissioner of the Icelandic Police shall be responsible for the organisation of education, training and dissemination of information for the purpose of clarifying the situation at any time to the public.
The chain of command goes from the Minister of Health and the Minister of Justice to a platform, the National Crisis Coordination Centre which is the strategic apex of the Civil Protection Department within NCIP and the Chief Epidemiologist within the Medical Director of Health in their joint responses to pandemics. The chain of command goes on to all health care institutions, companies and firms at national level. While coordinated nationwide, the responses are decentralised to the regional police and health authorities around the country which activate the Local Crisis Coordination Centre to coordinate and manage responses at local levels (IPIPP, p20).
The pandemic response plan is activated and implemented nationwide jointly by the Civil Protection Department and the Chief Epidemiologist. The Chief Epidemiologist operating within the Directorate of Health mandated by the Minister of Health and stipulated in the Act no. 97/1997 on Health Security and Communicable Diseases, is responsible for health security and public measures against communicable diseases. The Act on Health Security and Communicable Diseases grants the Chief Epidemiologist with and extraordinary decision-making authority. For instance, in case of an urgency the Chief Epidemiologist can, without consulting the Minister, decide to close the country entirely or parts of the country without consulting the Minister, but must inform the Minister as soon as possible about that decision.
The Civil Protection Department operating within the National Commissioner of Icelandic Police as stipulated in the Civil Protection Act no. 82 from 2008 is responsible for responding to the consequences of a pandemic together with the Chief Epidemiologist. This includes the management of general measures to keep social infrastructures operable and support for official measures against communicable diseases. The objectives of pandemic preparedness are:
• To prevent the pandemic reaching the country if possible.
• To reduce its domestic spread to the extent possible.
• To administer medical treatment and care to patients.
• To protect the people involved in the diagnosis, treatment, and care of patients.
• To protect social infrastructures and people responsible for indispensable services in the country.
Data to support exit planning
Icelandic authorities are in close relationship with international organizations such as WHO and agencies such as European Centre for Disease Prevention and Control (ECDC) in order to learn from experiences of other countries and plan the next steps as the COVID-19 crisis evolves. In addition, Iceland is a member of the Nordic Council which has for decades been an organized platform for an extensive co-operation between the Nordic countries in a variety of policy areas such as health, education, social security and welfare and more . Although the Nordic countries have taken somewhat different approaches to the COVID-19 pandemic, this organized co-operation has still been an important source of exchange of ideas and learning from experiences.
Directorate of Health, March 5th 2020. the Icelandic Pandemic and Influenza Preparedness Plan, 3rd edition 2020. https://www.landlaeknir.is/utgefid-efni/skjal/item29596/
WHO International Health Regulations (2005), Third edition. https://www.who.int/ihr/publications/9789241580496/en/
National Commissioner of Icelandic Police, Civil Protection Department. https://www.almannavarnir.is/english/pandemic-influenza/pandemic-response-plan/
Directorate of Health, March 5th 2020. the Icelandic Pandemic and Influenza Preparedness Plan, 3rd edition 2020. https://www.landlaeknir.is/utgefid-efni/skjal/item29596/National Commissioner of Icelandic Police, Civil Protection Department. https://www.almannavarnir.is/english/pandemic-influenza/