Avian Influenza and the potential for a human pandemic : International Response

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Avian Influenza and the potential for a human
pandemic International Response

• Presentation by David Nabarro
• UN System Influenza Coordinator
• September 2006

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1 The evolving Avian Influenza Situation
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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 (gt200)
• Potential (if there is mutation) to cause a
  pandemic
• The threat is not unique 70 of new human
  infections will come from the animal kingdom

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and FAO
Map courtesy of FAO using data from OIE
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Map prepared By US Government
MYANMAR
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Global Avian Influenza Situation What is
happening now?

• Continued H5N1 infections in Indonesia (enzootic)
• Re-emergence of H5N1 outbreaks in other East Asia
  countries
• New outbreaks in the last few months of H5N1 have
  been confirmed in Thailand and Laos
• Human cases reported from Thailand and suspected
  in Vietnam
• Continued outbreaks in birds and human cases in
  Indonesia
• Bird Migration Zones the cycle continues
• Unregulated Trade the secret source of spread
• The importance of encouraging safe poultry
  rearing and healthy human behaviour
• Intense pandemic preparedness work in Asia and
  the Pacific
• Uncertainty re situation in Russia, Eastern
  Europe and Africa

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Sporadic Human Cases of Avian Influenza

• Since 2003 H5N1 has infected 241 people
• 141 have died, mostly children and young adults.
  
• Human deaths have been confirmed from
  Azerbaijan, Cambodia, China, Egypt, Indonesia,
  Iraq, Thailand, Turkey and Vietnam.
• Vietnam (42) and Indonesia (46) account for more
  than 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

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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
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What is the current threat level?
UN System Influenza Coordination
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WHAT DO WE KNOW.

• 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 could be mild
• It could be severe
• It could be extremely severe
• It affects younger age groups more than seasonal
  influenza

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WHAT DO WE KNOW - TWO

• An effective pandemic influenza vaccine will take
  several months to develop
• There will probably be few anti-viral medicines
  available close to the affected location and the
  emergence of resistance is possible
• Need a global plan for rapid response to pandemic

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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
  Maintain distance, Stay at home
• If an infectious and damaging virus emerges,
  restriction on peoples movement may be justified
• Need for epidemiological information to guide
  action often hard to get such information quickly

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2 What Measures are being put in place to
increase capacity for surveillance, detection and
diagnosis internationally
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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

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Six Success Factors

• Six factors for national success in control of
  Avian Influenza
• Consistent high level political engagement and
  direction,
• Procedures, systems and finance for rapidly
  scaling up implementation of priority actions,
• Strong risk analysis, information dissemination
  and communication systems to encourage compliance
  with reporting and social mobilization,
• Mechanisms to sustain vulnerable livelihoods and
  relieve distress,
• Strategic alliances across all levels of
  government, that engage private and voluntary
  sectors, and
• Management systems that engage all stakeholders,
  encourage synergy, analyze progress review
  results and shift program emphasis when
  necessary.
• Plus coordination and synergy of external
  support
• (donors, World Bank, UN system)

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Seven Objectives
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Key International Bodies

• International Partnership on Avian and Pandemic
  Influenza (launched by US Government Sept 05)
• United Nations General Assembly
• 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

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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)

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3 What are the predicted economic impacts of a
global influenza pandemic
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ECONOMIC IMPACTS OF PANDEMIC

• The next pandemic will start with local outbreaks
  but will have global impact
• Compare with SARS - lt1000 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

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4 What action is being taken to help people
understand the risks they may face and prepare
for a possible pandemic
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PANDEMIC MODELS
MODEL 2 - Rapid Onset / Widespread impact Little
time for preparation, response is reactive and
defensive
MODEL 1 - Slow Onset / Moderate Localized
Impact Slowly acquires infectivity Containment
may be successful Limited pandemic
Impact
Current Situation - Extended Pandemic Phase 3 /
Continued Outbreaks of Avian Influenza Impact on
livelihoods due to culling of birds
Time
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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
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Promote 4 actions now!
Street-wise hygiene campaign
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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

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PANDEMIC INFLUENZA IMPLEMENTATION PLANS

• All of Government Involved
• Federal, State and Local Tiers
• Engage Private and Voluntary Sectors
• Action Items Indicated
• Responsible Bodies Identified
• Plan Tested
• Revised Regularly
• Sustain engagement

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Coordination is no Luxury

• Meeting together
• Sharing Information with each other
• Agreeing to work together with one strategy
• Achieving Harmony (No discord)
• Working in Synergy (Better than the sum of the
  parts)
• Establishing Trust and Unity (working as one)
• When coordination fails people suffer and die

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5 What steps can organizations take to limit the
risk of employee exposure to the avian influenza
virus
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BEST PANDEMIC PREPAREDNESS

• Life goes on even in adversity
• Analyze the business
• Work out the vital functions
• Focus on Funds, Travel, Supplies, Management
• Understand plans of the local authorities
• Link with Voluntary bodies
• Test procedures for Crisis Management
• Set up cross-country actions
• Simulate different outcomes
• Do not delay, challenge complacency

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PLANNING PROCESS
The Plan
Contingency Prioritization
Hazard/Risk Analysis
Scenario-Building
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?
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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 response of several
  months
• Now is the time to get ready
• Do not get complacent if disease incidence is low

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Much achieved much more to do

• It is up to all of us, together
• We will all be held to account

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Thank you nabarro_at_un.orgwww.influenza.undg.org