PAHO Strategic and Operational Plan for Responding to Pandemic Influenza

1
PAHO Strategic and Operational Plan for
Responding to Pandemic Influenza
San José, Costa Rica Central America. December
14-16, 2005
2

• I had a little bird
• Its name was Enza
• I opened the window
• And in-flew-enza

from a lullaby popular in USA during the early XX
Century
3
Influenza global Implications

• The newly adopted International Health Regulation
  (IHR-2005) lists human influenza caused by a
  new subtype among the 4 diseases that need to be
  notified to WHO
• The emergence and widespread circulation of a new
  highly pathogenic avian influenza A (H5N1) strain
  in Asia
• This virus has the capacity to infect humans
  creating an opportunity to the occurrence of a
  new pandemic

4
Task Force on Epidemic Alert Response

• PAHO Director established an inter-programmatic
  and multidisciplinary Task Force on Epidemic
  Alert and Response
• Advise, Enable, Coordinate, and Monitor
• PAHO activities for to influenza pandemic
  preparedness and response
• Implementation of the International Health
  Regulations in the Region
• Responsible for drafting the PAHO Strategic and
  Operational Plan for responding to pandemic
  influenza

5
Strategic Operational Plan for Responding to
Pandemic Influenza

• Objectives
• To direct PAHO Technical Cooperation activities
  to prepare the Region for an influenza pandemic
• To assist countries in their Development of
  National influenza pandemic preparedness plans
• To assist countries in the implementation of
  supporting actions which are needed for the
  effective response to a pandemic

6
Considerations for Development Strategic and
Operational Plan

• Directives given by PAHO and WHOs Governing
  Bodies
• The phase-specific approach set forth by the WHO
  strategic plan
• WHO Global influenza Preparedness plan
• WHO checklist for influenza pandemic preparedness
  plan
• Other WHO documents
• Countries existing NIPPPs
• The newly adopted International Health
  Regulations (IHR-2005)
• Ongoing Technical Cooperation

7
Impact of an Influenza Pandemic

• Unparalleled tolls of illness and death expected.
• Air travel could hasten viral spread and decrease
  available time for preparing interventions.
• Health care systems could be rapidly
  overburdened, economies strained, and social
  order disrupted.
• But it should be possible minimize the
  consequences by having prepared for the challenge
  in advance.
• Essential to preparedness planning is to estimate
  likely impact of the next pandemic, including
  associated morbidity and mortality burden health
  services surge capacity, and social economic
  impact.

8
Economic Impact of Selected Infectious Diseases
9
Pandemic Preparedness

• Development of National Influenza Pandemic
  Preparedness Plans are urgently needed.
• Mandated by the 56th World Health Assembly and
  the 44th Pan American Health Organization
  Directing Council Resolutions
• Guidelines
• WHO Global Influenza Preparedness Plan
• WHO Checklist for influenza Pandemic Preparedness
  Planning
• WHO Strategic Action Plan for Pandemic Influenza
  2006-2007
• Consider worst-case scenarios
• No vaccines and antivirals drugs

10
Pandemic Preparedness Planning

• Complicated by the unpredictability of the time
  of inception and severity a pandemic influenza
  strain
• Public health authorities recognize risk and
  impact of pandemic
• Development of plan not always a priority
• Competes with other public health issues
• Many countries lack the human resources to
  dedicate time and effort to something that is not
  yet real
• WHO has revised guidelines to assist countries in
  the development of pandemic preparedness plans
  PAHO has translated and disseminated them in the
  Region

11
Development of National Influenza Pandemic
Preparedness Plans (NIPPPS)

• New International Health Regulations (IHR-2005)
  recommends that countries develop their necessary
  core capacities to detect and respond to diseases
  like influenza
• Pandemic preparedness should be built on existing
  processes and programs and cannot be disconnected
  from routine and current activities
• Plan should seek to integrate National and local
  activities involved in the response to a pandemic

12
Implementation of NIPPS

• Activities in pandemic preparedness plan should
  be subject to constant revision
• Simulation exercises need to happen at different
  levels
• including facility and local jurisdictions
• enable the testing of contingency plans for
  patient care to deal with surges and delivery of
  services where there are problems of access
• Importance of organizing national debriefings on
  response
• when outbreak with pandemic potential occurs
• conduct periodic reviews of the plan to include
  new evidence and technical developments

13
WHO Pandemic Phases

• Pandemic Alert Period
• Phase 3. Human infection with the new subtype but
  no human-to-human transmission
• Phase 4. Small clusters with limited human-to-
  human transmission.
• Phase 5. Larger clusters but human to human
  transmission still localized 

• Interpandemic Period
• Phase 1. No new human influenza subtype. Low risk
  of infection of circulating animal influenza
  virus
• Phase 2. No new human influenza subtype.
  Circulating new animal influenza virus poses risk
  to humans

• Pandemic Period
• - Phase 6. Pandemic increased and sustained
  transmission in general population 

14
Phase-specific Approach and Objectives

• Phase pre-pandemic
• Promote the development of National Influenza
  Pandemic Preparedness Plans
• Strengthen the early warning system
• Support countries in making available pandemic
  vaccine antivirals
• Plan for health-care services and infection
  control
• Reduce opportunities for human infection
• Implement a communication strategy and raise
  awareness to encourage pandemic planning
• Estimate potential impact of an influenza
  pandemic and assess additional information gaps
  to guide policy-making
• Build partnerships and strategic alliances

• Phase emergence of pandemic virus
• Contain or delay early spread of the virus

• Phase pandemic declared spreading
  internationally
• Reduce morbidity, mortality, and social
  disruption through a coordinated response
• Quantify and monitor pandemic impact and
  epidemiology

15
ER 7.1 Potential health impact of pandemic
estimated, including economic impact to guide
policy-making

• Indicator
• Studies estimating Regional morbidity, mortality,
  and economic impact due to pandemic influenza
  conducted.
• Framework for country level estimation of health
  and economic impact of influenza pandemic
  developed, validated and disseminated to the 21
  countries of Latin America and CAREC.
• Key activities
• Develop and validate tools for country level
  estimation of health and economic impact of
  influenza pandemic.
• Conduct modelling studies of pandemic virus
  emergence considering possible pathways for viral
  emergence.
• Conduct modeling studies to estimate burden of an
  influenza pandemic.
• Conduct modeling studies to assess economic
  impact of an influenza pandemic.
• Translate, adapt, and distribute the following
  WHO publications, pending publication
• Generic protocol for population-based
  surveillance to estimate the disease burden of
  influenza and other ARI from vaccine preventable
  or potentially preventable agents

16
Next Steps

• Development of a budget timeline for
  implementation of activities detailed in Plan
• Widen consultation on the Plan
• Resource mobilization started
• Capacity building of country-level resources,
  early 2006
• Development of National Influenza Pandemic
  Preparedness Plans with PAHO support early 2006
• Consultation meeting on the implementation of Non
  Pharmaceutical Public Health Measures during a
  pandemic period. April 2006

17
Final Remarks CE137/5

• We urge all Ministries of Health of the Region
  not only to support but also take the lead in the
  development implementation of National
  Influenza Pandemic Preparedness Plans.
• The Development of the Plan should include other
  partners beyond the Health Sector, including the
  private sector.
• PAHO will cooperate and support Member States in
  the mobilization of necessary technical
  financial resources for the achievement of this
  goal.
• PAHO will coordinate with partners to support
  countries in the development and implementation
  of the National Pandemic Plans

18

• The role of public health is, whenever possible,
  to prevent epidemics, not to primarily describe
  them
• Thomas R Frieden

No vale ver después. Lo importante es ver antes
?y estar preparados José Martí