International Perspective on Influenza Pandemic Preparedness

1. La manifestation Coopération au niveau de la Confédération en cas de crise dans la domaine de la Santé Publique International Perspective on Influenza Pandemic Preparedness Presentation by David Nabarro UN System Influenza Coordinator 13.30 June 29th 2006

2. Different Kinds of Influenza: focus on Pandemics

3. Three Kinds of Influenza Seasonal Influenza “The Flu” Avian Influenza “Bird Flu” Pandemic Influenza “A Pandemic”

4. Past Influenza Pandemics 1847 42yrs 1889 29yrs 1918 39yrs 1957 11yrs 1968 1850 1900 30 – 40yearscycle 1950 No Pandemic for > 35 years 2000

5. Mortality during the pandemic of 1918-19 A/H1N1 – Spanish influenza • 3 epidemic waves in close succession • March 1918, Sept 1918, Feb 1919 • Estimate 40 million deaths world-wide

6. Geographic spread: 1918-19 06/18 ? 04/18 03/18 06/18 05/18 ? 01/19 06/18 C.W. Potter, Textbook of Influenza, 1998

7. Geographic spread: 1957-58 06/57 06/57 06/57 02/57 08/57 04/57 07/57 05/57 07/57 C.W. Potter, Textbook of Influenza, 1998

8. DETERMINANTS OF PANDEMIC INFLUENZA A new influenza virus emerges to which the general population has little/no immunity The new virus must be able to replicate in humans and cause disease NOT TO DATE The new virus must be efficiently transmitted from one human to another

9. ESTABLISHING PANDEMIC THREAT

10. What are the predicted health and economic impacts of a global influenza pandemic

11. Impact of pandemic on global health • Must distinguish between Seasonal Influenza, Avian Influenza and Pandemic Influenza • Pandemic influenza will happen (at some point) • It is more likely now than three years ago • It is most likely to be mild (2 – 3 million deaths) • Extreme case more than 100 million deaths • It affects younger age groups than "normal" influenza • Pandemic will come in waves

12. Impact of pandemic on global health • Need for RAPID detection of sustained human to human transmission • Must be contained within three weeks • Not all nations have mobile containment teams and stocks of anti-viral medicines • Virus may be resistant to antivirals • An effective pandemic influenza vaccine will take several months to develop • WHO has a global protocol for rapid containment of pandemic virus

13. Impact of pandemic on global health • Influenza is infectious – but not as highly infectious as measles • Not everyone will be infected • There are ways of reducing the numbers affected: Maintain distance, Stay at home • If an infectious and damaging virus emerges, restriction on people’s movement may be justified • Need for epidemiological information to guide action: often hard to get such information quickly

14. ECONOMIC IMPACT OF PANDEMIC • The next pandemic will start with local outbreaks but will have global impact • Compare with SARS - <1000 dead, $50 billion economic loss. • It could lead to significant loss of life and high absenteeism in all sectors • The IMF suggests a significant temporary impact • markets closed, unreliable utilities and telecoms, cash shortages • Reduced travel and leisure, impact on food industry • There may be threats to Rule of Law, Security, and Continuity of Governance

15. H5N1 Avian Influenza

16. AVIAN INFLUENZA • Birds frequently affected by influenza • H5N1 is a highly pathogenic influenza A virus • Moving across the world affecting domestic poultry; some asymptomatic carriage by wild birds; • More than 30 countries reporting H5N1 since January 2006; • 15 countries in the preceding 2.5 years • Sporadic human cases (>200) • Potential (if there is mutation) to cause a pandemic • Most human cases have had contact with infected birds • Virus attaches to receptors in lower respiratory tract • Clusters of Human Cases need careful investigation • The threat is not unique: 70% of new human infections will come from the animal kingdom

17. and FAO Map courtesy of FAO using data from OIE

18. Map prepared By US Government

19. Sporadic Human Cases of Avian Influenza • Since 2003 H5N1 has infected 227 people • 129 have died, mostly children and young adults. • Human deaths have been confirmed from: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. • Vietnam and Indonesia account for 80 of the total deaths. • Human infection with H5N1 is rare, and usually the result of virus transmission from birds to humans. • No evidence of mutation to sustained human to human transmissibility

20. THREE PANDEMIC SCENARIOS MODEL 3 - Rapid Onset / Widespread impact Little time for preparation, response is reactive and defensive MODEL 2 - Slow Onset / Moderate & Localized Impact Slowly acquires infectivity Containment may be successful Limited pandemic Impact MODEL 1 - Extended Pandemic Phase 3 / Continued Outbreaks of Avian Influenza Impact on livelihoods due to culling of birds Time

21. RESPONSE BEYOND HEALTH… Human Survival and Health • High illness & potentially higher death rates • Overstretched health facilities • Impact on persons with chronic disease • Absenteeism affecting manufacture and services Interruption of Electricity and Water Supplies • Telecommunications overload Basic Services and Utilities • Increased demand for governance & security • Higher public anxiety, reduced capacity • Potential exploitation Rule of Law and Governance • Diminished coping & support mechanisms • Shortage of basic necessities • Vulnerabilities – & needs - of Contained Groups Vulnerable Livelihoods • Trade & commerce disruptions • Reduced availability of cash • Interruption of logistics Financial Systems And Trade

22. Global Preparedness: Current Situation

23. LESSONS FROM SARS • Give priority to well-being of front line personnel • Do not withhold information • Engage communities • Encourage responsible, science-based and effective responses • Involve media • Global action is critical • Harness energies of multiple actors • Supportive Leadership – building effective coalitions

24. Pandemic Implementation Plans • Most countries have plans • Most plans focus on health sector • Plans should focus on continuity of Government, Utilities, Humanitarian relief, financial services, • Importance of Cross-border Planning • Ideal plans: • All of Government Involved • Federal, State and Local Tiers • Link to plans of Private Entities and Voluntary Sector • Engage Military • Involve Civil Defence • Priority to Public Information • Plan Must be Tested • Action Items Indicated • Responsible Bodies Identified • Emphasis on Communicating Information to Public • Plan Must Be Revised Regularly

25. Wash hands thoroughly with soap frequently Cover coughs and sneezes Wear a mask if symptomatic Don’t spit! The UNICEF “CREATE” InitiativePromote 4 actions now! ‘Street-wise’ hygiene campaign

26. BEST PRACTICE PANDEMIC PREP…. • Make sure that there is Health Care cover • Look at the business. • Establish core functions vital for business continuity • Focus on Economic, Travel, Logistics, Governance, and Social issues • Check out the plans of the local authorities • Liaise with Community-Based Organizations • Test procedures for Crisis Management • Establish protocols for critical cross-country actions • Use simulations to plan for different outcomes • Do not delay

27. PLANNING PROCESS Hazard/Risk Analysis Contingency Prioritization Scenario-Building The Plan PreparednessActions & PlanMaintenance What are risks to staff, operational continuity and operating environment? Which risks should be planned and prepared for? How might selected contingencies affect staff, operational continuity and operating environment? Prepare and share plan Plan rehearsal, updating as necessary, new factors?

28. Global Strategy Agreed Nov 2005 • 1 Stop influenza in animals through stamping out the disease at the place where the infection starts • 2 Prevent emergence of pandemic by limiting human exposure; • if pandemic does start, contain it quickly; • if containment is not possible, mitigate pandemic consequences. • Financing arrangements agreed Jan 2006

29. Key International Bodies • Food and Agriculture Organization • Crisis Management Centre • Regional Centres (Bangkok. New Delhi, Bamako, Gaborone, Nairobi, Budapest, Buenos Aries) • Monitoring and Risk Assessment • World Organization for Animal Health (oiE) • Standards for animal health • Reporting systems • Response strategies

30. Key International Bodies • World Health Organization • Revised International Health Regulations • (agreed May 2006) • Epidemic and Pandemic Alert and Response Team • Global Outbreak Alert and Response Network • Other United Nations Bodies (UNICEF, UNDP, WFP, OCHA, UNHCR) • Inter-agency Humanitarian Committee (IASC) • United Nations General Assembly • International Partnership on Avian and Pandemic Influenza (launched by US Government Sept 05)

31. WHAT SHOULD I DO? • Work through the issue with colleagues • Participate in Pandemic Simulations • Make sure that front line personnel get adequate support and protection • Emphasise the importance of keeping essential services going • Prepare to “hunker down” – supplies, stocks: six weeks? • Sustain the capacity for a respond of several months • Now is the time to get ready • Do not get complacent if disease incidence is low

32. Much achieved: much more to do It is up to all of us, together We are all held to account

33. Thank you david.nabarro@undp.orgwww.influenza.undg.org