Preparedness, Coordination, Monitoring

1. Preparedness, Coordination, Monitoring \ Prepared with the support of Peacepath Consulting

2. Three Kinds of Influenza • Seasonal Influenza • An annual pattern • Usually mild, but can be serious – even fatal – in elderly • Routine vaccination available • Avian Influenza (“Bird Flu”) • Current epidemic of Highly Pathogenic Avian Influenza in Asia and entering Europe • Pandemic Influenza • Intermittent, Major morbidity and mortality, Economic and social consequences 040317-GMH-FAO-Coordv05

3. Past Influenza Pandemics 1847 42yrs 1889 29yrs 1918 39yrs 1957 11yrs 1968 1850 1900 30 – 40yearscycle 1950 No Pandemic for > 35 years 2000 040317-GMH-FAO-Coordv05

4. Mortality during the pandemic of 1918-19 A/H1N1 – Spanish influenza • 3 epidemic waves in close succession • March 1918, Sept 1918, Feb 1919 • Est 40 million deaths world-wide, 040317-GMH-FAO-Coordv05

5. Pandemic 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 040317-GMH-FAO-Coordv05

6. Pandemic 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 040317-GMH-FAO-Coordv05

7. H5N1 is a new strain of influenza virus present in birds • The human population has demonstrated low immunity to the H5N1 strain with high mortality 2. Outbreaks have occurred in poultry, migratory birds and other fowl across SE Asia, Europe and Russia 3. This “Bird Flu” has caused millions of poultry deaths, affected household economies & infected humans Overview What is the “Bird Flu”? Why is it a threat to humans? 2. Influenza viruses can be highly transmittable (e.g. airborne) 3. The H5N1 virus could change and become transmissible between humans 040317-GMH-FAO-Coordv05

8. ? Threat of H5N1 Human Influenza Prerequisites for a pandemic: • A novel influenza virus must emerge to which the general population has little or no immunity and for which there is no effective vaccine • The new virus must be able to replicate in humans and cause disease • The new virus must be efficiently transmitted from one human to another 040317-GMH-FAO-Coordv05

9. What do we know…. • Pandemic influenza will happen (at some point) • It is more likely now than three years ago • It could be mild • It could be severe • It could be extremely severe • It affects younger age groups than "normal" influenza 040317-GMH-FAO-Coordv05

10. What do we know - Two • It could come once or in waves • It will probably come quickly • Work forces will be badly affected • Economies will be disrupted • Maybe infectious before symptoms appear • There are infections with no symptoms • Modelling suggests that containment will not be easy • The time between detection and effective response is very short 040317-GMH-FAO-Coordv05

11. What do we know - Three • Influenza is infectious – but not as highly infectious as measles • Not everyone will be infected • There are ways of reducing the numbers affected • If an infectious and damaging virus emerges, containment of people may be justified • An effective vaccine will take several months to develop • There will probably be many less anti-viral medicines available that will be requested by governments; the emergence of resistance is possible 040317-GMH-FAO-Coordv05

12. Strategy • take action to contain the avian influenza epidemic through upgrading veterinary infrastructure, improving bio-security and changing patterns of bird trade, • prepare for the next pandemic with vastly improved surveillance, stockpiled anti-virals and other medicines, protective clothing, containment plans, and • be ready to respond to the pandemic in ways that keep vital services and societies going and minimise suffering. When the pandemic starts it will be too late to get prepared 040317-GMH-FAO-Coordv05

13. WHO has a classification for threat level … 040317-GMH-FAO-Coordv05

14. Humanitarian Engagement • Critical roles of statutory and voluntary bodies, at global, regional, national and local levels (National Governments, WHO, FAO…. • Information Sharing: Risks, Threats, Preparedness and Response • Agreed working relationships and protocols: International volunteer bodies, civil society at country level, National authorities, International organizations • Preparedness planning among IASC membership through existing processes • Preparedness planning, including scenarios and simulations, through dedicated new process 040317-GMH-FAO-Coordv05

15. The Coordination Challenge Several factors influence the complexity of the AI/HI coordination challenge: Uncertainties • Nature of the AI / HI threat (severity, reach) • When and where escalation will occur • Duration of AI / HI presence Certainties • Local threat with global implications • Countries have variable capacity to prevent, prepare and respond • Short window of opportunity for initial assessment and robust response • Indirect behaviours (e.g. public reaction, media response, government actions) will influence the operating environment as much as the direct behaviours of the AI or HI virus 040317-GMH-FAO-Coordv05

16. Implications for Approach To succeed, Avian and Human Influenza coordination mechanisms must: • Ensure accurate, timely, relevant and transparent exchange of information • Generate clear, consistent and timely messages on the status of the situation • Facilitate unprecedented levels of trust and joint action across agencies, actors and levels • Enable the international community to optimally deploy global resources (technical, human, financial) to minimize the global impact on lives and livelihoods • Build on existing processes where possible 040317-GMH-FAO-Coordv05

17. Objective To facilitate a collaborative process among key actors to transform: A collection of organizationsworking independently toward individual objectives A community of organizations and active networks working together to achieve common objectives The inefficient use of collective experience, expertise and resources An optimal use of collective experience, expertise and resources 040317-GMH-FAO-Coordv05

18. Levels of Coordination Coordination will be active at three broad levels: 1 Country LevelCoordination • Provide local leadership • Integrate and inform global teams • Implement preparedness & response 2 Working LevelCoordination • Facilitate information exchange • Set global standards • Prioritize activities against objectives 3 • Align strategy • Track progress • Identify gaps and blocks • Drive Resolution Global Level Coordination 040317-GMH-FAO-Coordv05

19. Working Level Coordination Financing Partners: MDBs, Bilaterals, etc Private Initiatives Regional Organizations: APEC, ASEAN , etc FAO OIE WHO IASC membership Proposed Framework To provide coordinated operational and technical support: National Coordination Mechanism (Country Led) Integrated Country Plan Alignment and Harmonization International Consortium on Avian & Pandemic Influenza(Countries, Agencies, Financiers, Civil Society) 040317-GMH-FAO-Coordv05

20. In Practice – Country Level • National Government central actor in coordination • Propose the use of existing coordination arrangements that bring in UN system agencies, Development Banks, OIE, Key Financiers, Other stakeholders (such as Red Cross, Private Sector, Civil Society) • Strengthening capacities of regional networks and organizations, particularly so they can effectively support coordination on cross-border issues. • Encourage cooperation on research and development • Quick and flexible mechanism to draw down funding to finance control in event of a major outbreak. • Ensuring specialized institutions (FAO, OIE, WHO and others) are equipped to provide standards, policy and technical guidance and to support capacity building, in response to country needs Sector Stakeholders Beneficiaries 040317-GMH-FAO-Coordv05

21. In Practice – Global Level Consortium composed of high-level representatives of countries affected or at risk, international technical agencies, financiers, regional bodies, civil society. Functions include: • To ensure collective responsibility for response to AI and pandemic threat (from new and emerging infections) from a global perspective within a set of agreed principles • To take on High Level coordination functions (a) aligning strategy, (b) tracking progress, (c) identifying gaps and blocks, (d) driving progress to results • Establish global goals, promote international standards, monitor regularly, and adjust the overall effort as needed • Take on and address challenging policy, financing, and access issues, provide guidance on ways in which they can best be addressed • Support could be provided jointly by UN System Influenza Coordinator, and World Bank with other relevant bodies 040317-GMH-FAO-Coordv05

22. UN System Coordinator Contributions The UN Coordinator will aim to provide the following inputs to the consortium: 1 Strategy framework to guide integration and alignment of strategies generated by the working level teams 2 Tool for tracking progress against critical activities and objectives (e.g. dashboard) 3 Information on where and why resources required, upon which financiers can base investment decisions 4 Targeted analysis to identify possible scenarios and risks as the situation evolves and implications for prevention, preparedness and response 040317-GMH-FAO-Coordv05

23. Coordinator for Avian and Human Influenza Engagement in Policy Initiatives: Constructive interactions between the UN system/World Bank/IASC and partnerships of decision makers) Instruments, information and systems for effective coordination within UN system and synergized UN system links with other involved parties Regional level: coordination support • Countries: Coordinated support (through RCs and UN/Bank Country Teams) • (i) track • influenza situation, , • implementation of integrated national plan, • coordination of support • overall effectiveness of programmes • (ii) stimulate effective actions, fill gaps, reduce duplication undo blocks • UNDGO • BCPR • Whole UN Country Teams • Working-level inter-agency coordination & synergy of UN system -external linkages • Interagency strategy; • Engagement by humanitarian agencies; • Engagement with private entities, NGOs, militaries, academics, foundations, prof assocs; • information network • financial tracking services • Harmonized communications on influenza issues; • consistent messages to communicate risk and stimulate specified behaviours • strategic dissemination of chosen messages • ensuring strategies are fully implemented through multiple networks • coordinated communication through UN system Preparedness and Contingency Planning: UN system R/Cs and IASC country teams, and regional offices, support cross-sectoral pandemic response and containment planning (a) both within and between countries; (from region to global), (b) between UN system and each country’s authorities (c) throughout the UN system at each level (and link efforts to keep staff safe): Seeking resolution on difficult policy decisions: (i) availability of stocks of antiviral medicines, their distribution in the event of need: (ii) means for triggering changes in alert levels (iii) vaccine development, (iv) response and containment, access to PPM (v) rapid improvement in animal health services (vi) marshalling of science and technology 040317-GMH-FAO-Coordv05

24. Potential Dashboard Tool 040317-GMH-FAO-Coordv05

25. Pandemic Preparedness • Pandemic will have extraordinary impact on economic Avoids duplication of efforts • Optimizes use of global assets and resources • Facilitates knowledge transfer and active learning as the situation evolves • Provides a forum for building strong, effective working relationships before a full scale crisis hits Strengthened capacity to successfully combat the AI / HI threat 040317-GMH-FAO-Coordv05

26. Thank you 040317-GMH-FAO-Coordv05