Bangkok Workshop

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RESPONDING TO AVIAN INFLUENZA AND PREPARING FOR
THE NEXT PANDEMIC

• Presentation by David Nabarro
• November 15 2006
• Harvard Faculty Club, Boston

UN System Influenza Coordination
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Three Kinds of Influenza
Seasonal Influenza The Flu
Avian Influenza Bird Flu
Pandemic Influenza A Pandemic
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The evolving Avian Influenza Situation and
Pandemic Threat
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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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From US Govt Sources
MYANMAR
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H5N1 a rapid death
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Egypt Location of AI infections
Established in 22 Governorates, 822
Villages,24 Positive site from 7581 Samples taken
allover these Governorates
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Egypt Reporting of Infected Foci Distributed
(Feb. June 2006)
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SPORADIC HUMAN CASES OF AVIAN INFLUENZA

• Human infection with H5N1 is rare, and usually
  the result of virus transmission from birds to
  humans.
• H5N1 infected at least 256 people since 2003
• 151 have died, mostly children and young adults.
  
• Human deaths have been confirmed from
  Azerbaijan, Cambodia, China, Egypt, Indonesia,
  Iraq, Thailand, Turkey and Vietnam.
• Average deaths/month now at highest level.
• Indonesia accounts for gt50 of the total deaths.
• Pandemic Alert Level Phase 3

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HUMAN CASES OF (C) AND DEATHS (D) DUE TO
INFLUENZA TYPE A H5N1 VIRUS (Confirmed)
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THREAT OF HUMAN INFLUENZA PANDEMIC
Inter-pandemic Period
Pandemic Alert Period
Pandemic Period
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H5N1

• Circulating in wild birds and poultry since 2003
• Highly contagious / deadly among birds
• Spreading from Asia to Europe, Middle East and
  Africa

• Has infected humans in rare instances - resulting
  from close exposure to sick birds and/or their
  droppings

• If H5N1 evolves into a human virus it could cause
  a human influenza pandemic
• Also possibility that H5N1 never evolves into a
  human virus

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THREE PANDEMIC SCENARIOS
Scenario 3 - Rapid Onset / Widespread
impact Little time for preparation, rapid
containment vital, movement restrictions, social
distancing, emphasis on mitigation
Scenario 2 - Slow Onset / Localized Impact Slowly
acquires infectivity Containment may be
successful Limited pandemic
Impact
Scenario 1 - Extended Phase 3 / Avian Influenza
outbreaks continue Sporadic human cases Impact on
livelihoods due to culling of birds
Time
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ECONOMIC IMPACT OF NEXT PANDEMIC

• The next influenza pandemic will start with local
  outbreaks but will have global impact
• It could lead to major loss of life and high
  absenteeism in all sectors
• Historical evidence
• There will be significant economic effects
• Compare with SARS - lt1000 dead, 50 billion
  economic loss.
• Markets close, utilities become unreliable,
  telecoms break, cash in short supply
• Travel and leisure travel reduces, demand for
  food changes
• There will be threats to Rule of Law and Security

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Responding to Avian Influenza and the Pandemic
Threat
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GLOBAL STRATEGY AGREED NOVEMBER 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 3 If pandemic does
start, contain it quickly 4 If containment is
not possible, mitigate pandemic
consequences. Financing arrangements agreed Jan.
2006
UN System Influenza Coordination
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NATIONAL RESPONSES TO AVIAN AND PANDEMIC
INFLUENZA THREATS

• Sustained improvement in Animal Health through
  biosecurity, detection of disease, and response

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• 2. Stronger Human Public Health Systems for
  detection and containment of human infections
  with a Highly Pathogenic Influenza Virus
  (Protective equipment, anti-virals, vaccines)

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• 3. Mass Mobilization by Peoples Organizations
  based on effective risk communication

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• 4. Nationwide preparation for the next Influenza
  Pandemic
• One Government Response - synergy across
  government and with civil society, private sector
  and media partners
• Procedures that ensure continuity of access to
  basic services, of rule of law, of financial
  services and of societies
• Increased reserve capacity for large-scale Relief

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• 5. Coordinated Financial, Technical and
  Institutional support for effective
  Implementation

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SUCCESS OF NATIONAL ACTION ON AVIAN INFLUENZA
THREATS

• Pre-requisite An Effective strategy (Right
  actions, right place, right time)
• Success Factors
• Political direction From the Top
• Rapid Scale Up capacities (including lab
  services), cash, skilled people, procedures
• Engaging Communities around risks responses
• Incentives for prompt reporting and joint action
• Alliances all of government partners
• Management information, analysis, change
• Biotechnology Diagnostics, Treatments, Vaccines

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Prioritizing actions
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communication strategy

• Social Mobilization
• Media relations and advocacy
• National advertising
• Road shows and events
• Corporate/celebrity support

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Questionnaire for care-givers
and children
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Questionnaire for poultry farmers
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Questionnaire for market workers
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Public Service Announcementsviewed by more than
120 million people
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billboard
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religious leaders support the campaign
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Engaging community members fully in the response
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Indonesia PSA 1 Cuci Masak
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Indonesian PSA 2 Jangan Sentuh
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Indonesia PSA 3 Periksakan
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Indonesia PSA 4 Pisakhan
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MAKING SUCCESS HAPPEN

• There has to be recognition
• That ill health threatens human security
• That animal diseases threaten the human race
• That the threats are real (HIV, SARS, Ebola)
• That health sectors cannot cope alone
• That governments cannot cope alone

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MAKING SUCCESS HAPPEN

• There has to be acceptance
• That better functioning systems are the key for
  animal health, human health and crisis
  preparedness
• That the systems depend on strong popular support
  
• That we need to secure popular support for these
  systems
• That human security depends on coordinated social
  movements for health

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Goal Coordination that works

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

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Determinants

• We are called on to take action.
• Private sector, voluntary agencies and the media
  are key to these movements
• Movements need consistent and synergized support
  funds, skills, systems, technologies and
  institutional backing
• They must be built on international
  collaboration
• They depend on networks that link committed
  people the world over (company employees,
  scientists, livestock producers, consumer groups,
  continuity planners etc)

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• Private sector networks are a critical part of
  the response
• Umbrella organizations within the Private Sector
  have a vital catalytic and enabling role
• The UN system is needed to suggest where to go,
  what to do and when to do it
• The movements will be driven by efforts of large
  numbers of people themselves
• We must take care not to disempower

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I thank Bio-Era Associates for the invitation to
todays event I hope the material here will
hasten the global effort to take control of avian
influenza and to prepare adequately for the next
influenza pandemic (and other zoonotic disease
threats)In this presentation I have made
extensive use of material developed by FAO,
UNICEF, WHO, OiE, World Bank, Tufts University
and Governments of Egypt, Indonesia, and
Cambodia, and financed by a range of groups
especially the people of Australia Japan and USA
(through their Governments)I am responsible for
the overall product if wish to follow up contact
me on nabarro_at_un.org
Acknowledgements