The Global Threat of Avian Flu

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The Global Threat of Avian Flu

• David Nabarro
• United Nations System Influenza Coordinator
• December 18 2005

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Our focus People (especially children) and
their birds
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Starting Points

• 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

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Starting points

• Distinguish three different kinds of influenza
  seasonal, avian and human pandemic
• We are NOT in the midst of a human influenza
  pandemic.
• Many countries are trying to cope with a major
  outbreak of highly pathogenic avian influenza
  caused by H5N1.

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Starting points

• There have been sporadic human cases with high
  fatality
• This virus is changing through genetic
  re-assortment or mutation
• If this results in sustained human to human
  transmission we would witness the next influenza
  pandemic.

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Past Influenza Pandemics
1850
1900
30 40 years cycle
1950
No Pandemic for gt 35 years
2000
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Pandemic of 1918-19
A/H1N1 Spanish influenza

• 3 epidemic waves in close succession
• March 1918, Sept 1918, Feb 1919
• Estimate 40 million deaths world-wide

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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
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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
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1 The Challenge

• We have to
• Cope with what is happening now
• Prepare for an uncertain future
• Be ready for major disruption
• A very difficult challenge

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2 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

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What do we know - Two

• It could come once or in waves
• It will probably come quickly
• Work forces will be badly affected
• Maybe infectious before symptoms appear
• An effective vaccine will take several months to
  develop
• There will not be anti-viral medicines for all
  who might want them
• The virus may be resistant to these medicines

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What do we know - Three

• Influenza is infectious
• But Not everyone will be infected
• There are ways of reducing the numbers affected
• Containment of affected people may be necessary
• Only a fraction of those who are infected will
  die
• Act as though it will start tomorrow

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3 The current reality
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The current epidemic of Avian Influenza

• There is an outbreak of Highly Pathogenic Avian
  Influenza caused by Virus H5N1
• It is spreading
• There have been sporadic human cases
• We must focus on stamping it out

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4 Strategy
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Strategy 1
Chain of Events
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Strategy 2

• Prevent or, at least, delay the human
  pandemic
• Control avian influenza at source
• Detect and cull infected bird flocks properly
• Compensate smallholders
• Limit human-bird interaction
• Vaccinate poultry
• Prepare be ready and quick to act
• Surveillance, Alert and Action
• Capacity to detect suspect clusters of human
  influenza
• Confirmation
• Rapid containment
• Respond Reduce illness, Keep services going
• Systems
• Triggers and rapid implementation
• Communicate clearly to all involved

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SARS Lessons Learned
SARS Case Study
Lessons Learned

• Killed less than 1,000 people
• Hit 6 countries in 9 months
• Shut down Asian travel for 3 months
• Caused economic impact of 30-50 Bn

• Local issue with global relevance
• Effective surveillance and transparent
  communication essential
• In-country capacity variable
• Indirect effects (e.g. media, fear, market
  response, etc.) drive impact as much as direct
  effects of virus

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Key Insights
Pandemic Mitigation

• The influenza threat has multiple dimensions that
  are highly inter-related
• Significant collaboration is required among all
  actors, across all sectors and at all levels
• Investing now, in advance planning and
  preparation is critical

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Limit the Pandemic as it starts

• Be ready to Intervene
• Mass treatment with pre-positioned antiviral
  drugs
• Broad public health measures (restriction of
  movements, quarantine)
• Protection for front line personnel
• A narrow window of opportunity to contain
• Need to act within days
• Extensive technical and logistic support is
  necessary
• A local issue with immediate global significance
  do not try to keep it quiet

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5 Potential for limiting the direction and impact
of the next pandemic
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• Once the Pandemic Starts we will try to contain
  it.
• Success will depend on
• The effectiveness of the medical and public
  health system (especially surveillance and
  response)
• The size of the outbreak when it is first
  recognized and the rate of increase of new cases
• The mobility of populations affected populations
  are they passing through an international hub for
  trade or travel?
• Whether different groups worked together well to
  implement early containment measures did they
  succeed?

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Ready to contain means

• Knowing what has to be done
• Having systems to communicate information about
  what needs to be done
• Setting up clear lines of direction and
  accountability
• Checking our plans by rehearsing them, and
  changing them if they do not work
• Making sure that our people are not exposed to
  unnecessary danger

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Lessons of the past

• SARS experience shows we must
• work together government, voluntary bodies
  (PMI), private sector. Media, international aid
• focus on the most important tasks
• keep people informed and adopt a humanitarian
  approach
• involve community-level groups
• do all we can to prepare and protect front
  line workers
• Focus on social and economic consequences

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6 UN system approach
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UN System Approach
Pandemic Mitigation
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Effective Deployment in Practice
Continuity
Preserve health, safety and intervention capacity
of UN staff
Ensure continuity of critical programmes
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Importance of country level coordination
National Coordination Mechanism (Country
Led) Integrated Country Plan
International Consortium on Avian Pandemic
Influenza(Countries, Agencies, Financiers, Civil
Society)
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Preparations for Donor Meeting

• Beijing 17 18 January 2006
• Focus on country needs
• UN system support
• Stockpiles
• Financing mechanism
• Direct Bilateral
• Via UN system
• Multidonor trust fund

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8 Red Cross Contribution
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Red Cross Participation .

• Humanitarian inputs to National and Local Action
• Early Warning and Surveillance
• Animal-Human Transmission Control
• Readiness for Pandemic Containment
• Training, Partnerships and Communication
• Systems, Roles and Responsibilities

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Last Word
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We are being put to the test. What we do now will
make a great difference to the overall pandemic
consequences. We must stamp out avian flu We can
get ready to reduce death rates. We can limit
economic impact