David Nabarro

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RESPONDING TO AVIAN INFLUENZA AND PREPARING FOR
THE NEXT PANDEMIC

• David Nabarro
• February 27th 2007
• ABAC Seattle Meeting (Pandemic Preparedness)

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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Pandemic of 1918-19
A/H1N1 Spanish influenza

• 3 epidemic waves in close succession
• March 1918, Sept 1918, Feb 1919
• Estimated 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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AVIAN INFLUENZA

• Birds frequently affected by influenza
• Current virus - H5N1 - is highly pathogenic
• 15 countries affected 2003 05
• More than 30 countries reporting H5N1 since
  January 2006
• Viral variability (2 clades and sub-clades)
• Incidence continues (Indonesia, Republic of
  Korea, Nigeria, Egypt, Azerbaijan, Sudan,
  Pakistan, Afghanistan, Hungary, UK, Vietnam,
  Russia)
• Sporadic human cases (gt270) with over 50 dead

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HIGHLY PATHOGENIC AVIAN INFLUENZA
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HUMAN CASES OF (C) AND DEATHS (D) DUE TO
INFLUENZA TYPE A H5N1 VIRUS (Feb 2007)
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Threat of Human Influenza Pandemic
Inter-pandemic Period
Pandemic Alert Period
Pandemic Period
?
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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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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THREE 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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IMPACT OF NEXT PANDEMIC

• High absenteeism in all sectors
• 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
• Threats to Rule of Law and Security
• Need for Humanitarian Response

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GLOBAL STRATEGY

• Promoting Bio-secure Livestock Systems (public
  and private action compensation for culled
  birds incentives for change
• Safeguarding human health (70 of new infectious
  disease outbreaks will be zoonoses)
  surveillance, outbreak detection, confirmation,
  containment, communication
• Mobilizing societies to act act for good
  hygiene and health . effective transmission of
  clear messages
• Limiting the social, economic, governance
  consequences of disease outbreaks planning,
  preparations, procedures and exercises

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EXTERNAL ASSISTANCE

• Supports national AHI programme and plan
• International Financing (Donors and World Bank)
• 1.9 billion pledged Beijing January 2006,
• 0.5 billion pledged December 2006
• Next review November 2007
• Need 0.5 - 1 billion per year
• Technical help from WHO, FAO, UNICEF, OiE
• Careful monitoring of spending and progress
• Private and voluntary sectors engaged

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DETERMINANTS OF SUCCESS

• Political leadership and functioning alliances
  with civil society and private sector,
• Resources and capacity to scale up, with
  effective management systems
• Support for long term reduction in risks of
  animal and human disease
• Effective communication and community engagement.

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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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The Links

• Diseases threaten our future (HIV, SARS, Ebola)
• Diseases do not respect borders
• Diseases appear without warning
• Animals are a key source
• Governments, voluntary sector and business
  community must be engaged

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Focus

• Personal Safety and Security
• Corporate Continuity
• Continued functioning of Government, Economy and
  Rule of Law
• Local, national and international levels

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Action

• Plan identify critical functions that must be
  maintained
• Prepare put in place key steps to ensure that
  they can be maintained
• Put to test simulate a major catastrophe (such
  as pandemic) to see if the preparation works
• Promote make sure that people know what they
  have to do (match message to audience)
• Proceed Make it happen

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Benefits All Round

• Continuity in the event of an influenza pandemic,
  a disease outbreak, a major catastrophe
• Anticipation of risks and threats faced
• Excellence in Management and Governance
• Good Human Resource practice

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