ECECDCWHO Uppsala

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EC/ECDC/WHOUppsala

• Presentation by David Nabarro
• UN System Influenza Coordinator
• May 15th 2006

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PREPARING FOR PANDEMICS

• Building a Movement of Actors
• Being Alert to Pandemic Potential
• Working for Pandemic Prevention
• Readying for Pandemic Response
• The H5N1 Wake-Up Call Urgency and Focus
• Our Common Cause
• An International effort for the Global Good

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1 BUILDING A MOVEMENT OF ACTORS WITH COMMON CAUSE

• Strategic Focus Science Base
• Acting Locally, Nationally, Regionally, Globally
• Involving Political Leaders, Government Services,
  Professional Bodies, Civil Society
• Engaging key figures, institutions, systems,
  technical networks for the long term
• Sustaining and institutionalizing focus on health
  security
• Mobilizing funds..

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2 BEING ALERT TO PANDEMIC POTENTIAL

• Local outbreaks Global Impact (SARS - lt1000
  dead, 50 billion economic loss).
• Significant loss of life High absenteeism
• IMF analysis significant temporary impact
• Disrupted supplies (markets closed, access
  reduced, unreliable utilities, shortages of cash,
  telecom outages
• Reduced demand (affecting travel and leisure,
  restaurant and food industry)
• Threats to Rule of law, Security, Continuity of
  Governance

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3 WORKING FOR PANDEMIC PREVENTION

• H5N1 in Birds

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H5N1 OUTBREAKS IN BIRDS CHRONOLOGY 1996 TO DATE
June 2005
1996 to 2003
June 2004
December 2004
December 2005
March 2006
Malaysia
Map compiled by WFP Emergency Preparedness and
Response Branch (ODAP) 06.03.06
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3 WORKING FOR PANDEMIC PREVENTION

• H5N1 in Birds
• An Epizootic moving rapidly across the world
  sporadic human cases and the potential to cause a
  pandemic
• More than 30 countries reporting H5N1 since
  January 2006
• 15 countries in the preceding 2.5 years
• 70 of new infections will come from the animal
  kingdom

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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
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4 BEING READY FOR PANDEMIC RESPONSE
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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AGREED STRATEGY (November 2005)

• Stop influenza in animals through stamping out
  the disease at the place where the infection
  starts
• Prevent emergence of pandemic by limiting human
  exposure
• if pandemic does start, contain it quickly
• if containment is not possible, mitigate pandemic
  consequences.

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IN PURSUIT OF THE STRATEGY

• Integrated National Influenza Plans
• Multiple Actors Engaged
• Financial Assistance Pledged (Jan 2006)
• Urgent Programmes Initiated
• National Plans Appraised
• External support for Implementation
• Emphasis on Coordination Harmony, Synergy, Unity

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INTEGRATED COUNTRY INFLUENZA PLANS

• Pandemic Prevention
• Reduce Animal Disease
• Bio-security and Disinfection
• Surveillance Early Warning
• Laboratory
• Response to infection
• Restriction on Movement
• Culling
• Compensation
• Strategic Vaccination
• Veterinary Capacity
• Protect Human Health
• Early Warning
• Laboratory
• Response
• Public Health
• Promote Safe Behaviour
• Risk Communication
• Target Groups

• Pandemic Management
• Contain Quickly
• Skilled Personnel
• Protective Equipment
• Consumables
• Ensure Services
• Health Care
• Basic Services for all
• Rights of vulnerable
• Enhance Continuity
• Governance
• Rule of Law
• Economic and Social Systems
• Coordinate and Communicate
• Inside Government
• Between States
• Initiate Recovery

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MULTIPLE ACTORS ENGAGED

• National execution with external technical
  assistance reflecting international standards and
  operational support with pandemic planning and
  response
• National civil society
• International NGOs and Red Cross
• Private entities (local, national, international)
• Networks (scientific, relief)
• Technical Assistance Coordination
• Animal Health (FAO, OiE)
• Human Health (WHO)
• Communications (UNICEF)
• Governance and Coordination (UNDP)
• Pandemic Preparedness (OCHA)
• Logistics and Vulnerability issues (WFP)
• Financial Assistance
• Intergovernmental Organization

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FINANCIAL ASSISTANCE AVAILABLE

• Extent of required international technical and
  financial assistance estimated during November
  and December 2005
• Multi-pathway Financing and coordination
  framework
• Countries
• direct bilateral support,
• multi-donor trust fund,
• UN system support
• Loans IDA, IBRD
• Regional
• Regional Institutions and Networks
• Global
• Intergovernmental bodies (OiE)
• Multilateral System (FAO, WHO, UNICEF
• International NGOs
• Support pledged in Beijing mid-January 2006
  overall value 1.9 billion implementation
  principles agreed
• Not sufficient for countries, not sufficient for
  UN

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NATIONAL PROGRAMMES STARTED

• Urgent action to contain animal disease
• Medium term action to improve performance of
  animal and human health sectors
• Substantial commitment to investment by
  Government
• A strong evidence base
• Institutional development and capacity building
• Long-term technical assistance
• Readiness for Rapid Containment Prepare for
  Pandemic
• Country by Country

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NATIONAL PLANS APPRAISED

• A realistic reflection of ongoing processes?
• Purposeful direction from highest political
  level?
• Risk and capacity analyses, evidence base
• Sound Technical Strategy with Priority Actions
  (Behaviour Change, Animal Health, Human Health,
  Pandemic Preparedness, )
• Plans for Community Engagement?
• Implementing Capacity Addressed?
• Triggers for crisis mode, standard procedures,
  pandemic readiness tested?
• Inputs national, regional and international

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EXTERNAL HELP TO IMPLEMENT

• National level task force Government, Bilateral
  Donors, Development Banks, NGOs, Private
  Entities, Specialized International Agencies,
  Wider UN system (harmony, synergy)
• Single Integrated Programme and Plan Evolving
  from crisis to longer term cash and technical
  support (like a SWAP)
• Joint finalization, appraisal, prioritization
• Negotiation Financing conference, support for
  elements of plan
• Challenge Managing the appraisals, financing
  short-term action (culling, compensation)

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HARMONY, SYNERGY, UNITY
THE ONLY WAY TO RESPOND IS TO WORK TOGETHER

• Inclusive National Leadership
• Join up government departments, civil society and
  partners, as one
• Implement and monitor together

In Country

• Share information
• Agree global standards
• Support national efforts
• Monitor achievements jointly

Inter Agency

• Align national strategy for global good
• Assess progress together
• Fill gaps and surmount blocks
• Face up to the difficult issues first

Inter-country
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BEST PRACTICE 05 - 06

• Sound, evidence-based national strategy and plan
• Focus on immediate (under one year) and medium
  term (up to 5 years)
• Primary focus to animal health (including
  veterinary services and livestock sectors),
• Emphasise effective systems for public health
• Inter-sectoral approaches to pandemic
  preparedness.
• Fully-costed operational plan
• Implementation and management arrangements
• Regular reviews of relevance and utility
• Transparent analyses of achievements

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• MAKING BEST PRACTICE HAPPEN
• POLITICAL LEADERSHIP FOCUSING ON TOUGH ISSUES
• THE WHOLE OF GOVERNMENT INVOLVED, MORE THAN
  HEALTH AND AGRICULTURE PRIVATE AND VOLUNTARY
  SECTORS TOO
• MASS MEDIA CAMPAIGNS TO PROMOTE HEALTHY ACTIONS
  AND PANDEMIC READINESS
• MANAGEMENT SYSTEMS FUNDS AND STANDARD
  PROCEDURES DISTRIBUTED, KEY PEOPLE MADE
  RESPONSIBLE AND ACCOUNTABLE AT NATIONAL AND
  LOCAL LEVELS
• INCENTIVES AND COMPENSATION SCHEMES TO REDUCE
  VULNERABILITY AND SUSTAIN LIVELIHOODS
• REGULAR REVIEWS OF PROGRESS BY ALL STAKEHOLDERS,
  ANALYZING PROGRESS, TRACKING FUNDS, AND MODIFYING
  PROGRAMME DIRECTION
• EXTERNAL COMMUNITY WORKING TOGETHER IN SUPPORT OF
  NATIONAL ACTION

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6 INTERNATIONAL ACTION

• Risks posed by avian Influenza and potential
  pandemic
• Sharing information on threats to livelihoods, to
  continuity of services, to health joint response
  to uncertainty
• Information and Support for Behaviour Change
• Encouraging an international movement for
  reduction of pandemic risks a joint approach
  reflecting best practice
• Technical support for better Animal Health
• Inter-country support for surveillance,
  incentives, prompt reporting, responsiveness,
  bio-security, strategic vaccination and recovery
• Technical support for Pandemic Containment
• Inter-country support for public health systems
  surveillance, information, containment access to
  vital supplies
• Continuity and well-being during Pandemic
• Intergovernmental mechanisms to sustain health
  outcomes, equity, continuity, and recovery
• Applying science to animal and human influenza
• International epidemiological initiatives
  Development of Vaccines and Diagnostics

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ASKING QUESTIONS OF OURSELVES.

• Are we working together, as a team
• making the weak links strong, wherever they may
  be?
• Being ready to raise our game - at a moments
  notice?
• Moving as one, holding our shape, keeping fluid,
  whatever the challenges we face?
• At ease with uncertainty about what will happen
  but determined to get the right result?