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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

CCIH Conference

on the ground field level realities of life
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…
background avian influenza ai human influenza hi


  • 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)
background avian influenza human influenza


  • 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
background avian influenza human influenza1


  • 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?
latest ai hi situation in asia

“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
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
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
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
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
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
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
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
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
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