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Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Health Advisor May 27, 2006 PowerPoint PPT Presentation

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Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Health Advisor May 27, 2006 CCIH Conference. On-the-ground, Field-level realities of life. Can't see beyond today…let alone seeing into the future…

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Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Health Advisor May 27, 2006

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Avian Influenza/Human Influenza

Pandemic Preparedness Plans

World Vision Asia-Pacific Region

Sri Chander, Regional Health Advisor

May 27, 2006

CCIH Conference

On-the-ground, Field-level realities of life

  • Can't see beyond today…let alone seeing into the future…

  • Can't feed their children…

  • Don't have access to basic housing…

  • Don't have access to clean water…soap hard to find

  • Don't have access to basic sanitation...

  • Land tenure is insecure…

  • Can barely pay for school...

  • Poultry is their savings account…it's their future livelihood…backlash to investigations: Sumatra

  • Need realistic, practical solutions…

  • The challenge is to raise awareness when it is difficult to see beyond today…



  • Nature of AI/HI threat (severity/extent)

  • When and where escalation will be seen

  • Duration of AI/HI pandemic (most probably last 1-2 years and will come in series of 2 to 4 month waves as the virus further mutates)



  • Local threat with global implications

    (US$268 billion loss & drop of 6.5% in GDP in Asia alone: ADB)

  • 2-3 Weeks’ Window (on reaching Level 4) to prevent global pandemic

  • AI must be fought at source (small-scale/backyard poultry farms & wild birds (30 million HH out of 80 M HH in Indonesia, 8 M HH out of 11 M HH in Vietnam) with Asia as the ground zero

  • Migratory flyways: Eurasia, North and East Africa

  • Children are vulnerable

  • High expectations of NGOs like WV to deliver

  • Tamiflu/anti-virals: not silver bullets--worldwide shortage

  • No safe, effective vaccine available to prevent a global HI pandemic



  • HI Virus adheres to URT mucosa

    —more efficient human transmission

  • H5NI virus:

    --less replication capacity in URT

    --adheres to LRT (bronchioles/alveoli)

    severe hemorrahigic pneumonia

    —>less efficient human transmission

    --multiple organ involvement—GIT/CNS

  • Illegal bird trade>migratory birds?


“Avian Flu Wanes in Asian Nations It First Hit Hard” –NYT/FT

  • Vietnam vaccinated 220M chickens and

    culled 50 m chickens in last 1 year;

    CFR dropped: 60% (2004)13% (2005)

    No AI/HI case in 2006

  • Thailand culled and compensated well &

    trained 100,000 VHVs to report cases

  • Tamiflu issued small Thai/VN hospitals to treat

    all flu cases even before confirmation

  • China: 10 cases in 06: caution/encouraging

Other countries—not good news

  • Indonesia: “Bird Flu future lies here”

    --30 M HHs with 200 M backyard chickens

    --H5NI found in 2/3 of 33 provinces

    --Can’t compensate—little culling

    --2nd highest # (33) of bird flu deaths

    --2006: largest # (22) bird flu deaths

    --Largest cluster (7 deaths) in N

    Sumatra with no poultry contact—

    Ist time passed from 1 person

    another person 3rd person

    --Ist time---increasingly contagious?

    --WHO--raise to Level 4 Pandemic Alert?

Others: Not good news (2)

  • Myanmnar: > 100 outbreaks in

    different parts of the country

    --”Epidemiological black hole”

  • Cambodia and Laos—vague, few

    reported cases; silence not

    neccesarily good news

  • Risk of virus returning to Vietnam and Thailand ever present

  • “Tomorrow, the whole thing could change again”---David Nabarro

Global Pandemic Priorities

  • Contain avian flu epidemic

    • Culling (50M birds in Vietnam: Dec 03-Dec 05)

    • Upgraded veterinary infrastructure/vaccination

    • Improved bio-security

    • Compensation (ADB offer of USD 500M for Asia)

  • Prepare for pandemic

    • Improved surveillance

    • Stockpiled antivirals and other medications

    • Personal Protective Equipment (PPE)

    • Containment plans (quarantine, zoning, etc)

  • Prepare for pandemic response

    --Business Continuity Plans (BCPs) to keep vital

    services and societies going, minimize suffering

WV Pre-Pandemic Preparations

  • Well-defined structure with global leadership for global/ regional CAT 3 response

  • WV Global/Regional AI/HI working group and AI/HI Rapid Response Team established

  • WV Global Guidelines for Pandemic Preparedness issued

  • AI/HI point person/working group for each NO—in process to develop Business Continuity Plans

  • Pre-positioning of 1,500 Tx courses of Tamiflu—plan to double that to cover 35% of 9,000+ staff in 17 countries

  • Develop risk communication guidelines to quickly disseminate timely, clear, consistent messages

  • Develop a 2-yr comprehensive operational plan

  • Develop quick/flexible mechanisms to draw down $


  • Resistance: Vietnam & Japan

  • Study: gave Tamiflu to 90% of ill & PEP to HH contacts within 24 hrs— attack rate reduced 1/3: 27%->17%

  • New WHO Anti-V recommendations

  • Stockpile for >50% of population

    --Treat ill cases & PEP for >90% of

    HH contacts within 24-48 hrs

    --Prepare for 30-35% attack rate in popn

  • Roche/licensees:400m Rx courses by ’07

  • Pediatric concerns: Cx (<1yr); SE (2-12 yr)

Protect WV Staff & Prepare for Business Continuity

  • Issue risk communications guidelines to all WV staff

  • Seasonal (twice yearly) HI vaccine for staff in avian flu-affected areas

  • Stockpile/preposition Personal Protective Equipment (PPE) (gloves, masks, soap, alcohol hand swabs, etc.) at country level

  • Stockpile/preposition medical supplies at country level

    (i) Tamiflu to cover at least 30% of WV staff

    (ii) Other supplies, such as intravenous (i.v.) antibiotics, i.v. fluids and

    i.v. drip sets, disposable syringes & needles, disinfectants, etc

  • Develop clear triggers for decision making, clear decision making, and clear authority for decision making

  • Now in WHO’s Phase 3 of global pandemic warning. Issue WV advisory if/when Phase 4 occurs--borders will be closed in Phases 5 and 6

  • Develop business continuity plans at APRO/NO and project levels

  • Explore pre-positioning > 90-day supply of food at NO/local level

Build AI/HI-Resilient Communities

  • Participate in AI/HI risk assessments with partners

  • Jointly conduct a Knowledge-Attitudes-Practices (KAP) survey of communities, especially families with small-scale/backyard poultry farms

  • Develop behavior change messages & materials for communities:

    --change harmful farm/market place practices of mixing chickens

    with ducks and mixing chickens with pigs

    --promote personal hygiene practices

  • Facilitate community assets-building exercises to plan for community-based AI/HI Response

  • Promote vaccination of birds in small-scale/backyard poultry farms

  • Jointly draw up contingency plans for mitigation of economic impact (especially alternative livelihoods and compensatory mechanisms for culling of birds)

Promote Animal Health as Primary Prevention of AI

  • Jointly conduct assessment of veterinary services

  • Increase number of veterinary vaccination centers

  • Promote expansion of coverage of poultry vaccination in line with national policies

  • Consider providing transport, vaccination equipment, cold chain equipment for poultry vaccination

  • Provide bio-safety and clinical equipment, PPE biohazard equipment

  • Build capacity of public sector veterinary staff in vaccine transport, cold chain maintenance, vaccination & humane culling in line with World Organization for Animal Health (OIE) standards

Jointly Develop Early Warning/Rapid Response Networks at Local Level:

  • Develop active, community-based surveillance networks for AI/HI in partnership with local and national health authorities:

    -Provide TA in setting up community-based surveillance of AI/HI

    -Train WV staff/partners as first-line surveillance agents & mobilize

    them for same-day, transparent notification of AI/HI cases

  • Strengthen Rapid Response Capacity of national, local & village-level health and veterinary staff in:

    -pandemic preparations and planning

    -surveillance and real-time management information systems

    -early detection and rapid diagnostic confirmation of suspects

    -stamp out outbreaks: humane culling & quarantine/zoning of infected areas

    -treatment and post-exposure prophylaxis with antivirals

    -clinical management of AI/HI

    -communications lines

Engage in Risk Communications, Advocacy, Partnerships & Resource Acquisition

  • Insist on World Vision being at the table for planning with the UN, FAO, WHO, OIE; USG response: USAID, Inter-agency group

  • Form partnerships with governmental/NGO community AI/HI efforts

  • Develop a risk communications plan for WV Partnership, communities, sponsors, public sector, private sector, local NGOs and donors

  • Engage with local media in aggressive evidence-based advocacy

  • Work with Inter-agency Working Group to secure govt funding

  • Alert WV SOs of immense needs/quick resource commitments

  • Document and share lessons learned with strategic networks

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