JSPS Frontiers of Influenza Research

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Pandemic Preparedness

• Zsuzsanna Jakab
• Director, ECDC

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European Union Pandemic Preparedness Status
Report

• European Centre for Disease Prevention and Control

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Purpose of the Report

• Requested by the Commissioner
• Describe the process of strengthening pandemic
  preparedness in the European Union (EU)
• Summarise the pandemic preparedness status within
  the EU as at October 2006
• Identify what next needs to be done the policy
  options

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Methodology

• Survey of performance with assessment tool and
  against preparedness indicators,
• Workshops with national representatives
• Ongoing programme of joint national assessments
  that ECDC has been undertaking with Member States
  since mid 2005 16 EU countries assessed
• Iteration of the draft report with national
  representatives and the Commission

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Infectious disease is one of the great
tragedies of living things - the struggle for
existence between two different forms of life -
incessantly the pitiless war goes on, without
quarter or armistice - a nationalism of species
against species

• Hans Zinsser, Rats Lice and History, 1935

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(No Transcript)
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How Hard?Additional Deaths and Hospitalizations
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Estimated additional deaths if a 1918-1919
Pandemic occured now (Murray et al - Lancet 2006
368 2211-2218 )
Austria 13000 Latvia 13 800 Netherlands 23100
Belgium 14900 Lithuania 18800 Poland 155 200
Bulgaria 47100 Germany 116400 Portugal 25 100
Czech Rep 34100 Greece 27400 Romania 149 900
Cyprus 1900 Hungary 37700 Slovenia 5000
Denmark 7300 Ireland 6700 Slovakia 20600
Estonia 6100 Italy 95200 Spain 87100
Finland 8100 Luxembourg 500 Sweden 13300
France 89600 Malta 1100 UK 93000
EU Total 1.1m Iceland 420 Norway 5800
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How hard?

• Up to 30 of staff not available for work for
  significant period at peak of local epidemics

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How Hard Greater Vulnerability in Developed
Societies and better health care?

• More travel so pandemic will move quicker
• Demographic change older populations and more
  peope living with ill health
• Hospitals more complex and much more vulnerable
  to infections than before
• Health care and services can deliver more today
  and thus save more, e.g. Antivirals

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Planning, Preparedness and Practiceall Sectors
- not just Health all Levels International,
National, Regional and especially local

• A Five Year Enterprise

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The Standards and Guidelines

• WHO Pandemic Plan 2005
• WHO Global Influenza Preparedness Plan.
  http//www.who.int/csr/resources/publications/infl
  uenza/WHO_CDS_CSR_GIP_2005_5.pdf
• European Commission Communication 2005
• Communication from the Commission to the
  Council, the European Parliament, the European
  economic and social committee and the committee
  of the regions on pandemic influenza preparedness
  and response planning in the European Community,
  at
• http//europa.eu.int/eur-lex/lex/LexUriServ/site/
  en/com/2005/com2005_0607en01.pdf
• Published European Pandemic Preparedness Tool and
  Indicators
• http//www.ecdc.eu.int/Health_topics/Pandemic_Inf
  luenza/Assessment_tool.html

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No League Tables, no ranking Assessments Have
Taken Place over 18 months in 16 countries (
soon 18 and by end 2007 all 27 3 EU countries )

• Assessments are not shared outside ECDC and the
  MS without permission of the MS

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The Good News All Countries Have Made Major
Efforts to Addess the Major National Health
Sector Priorities
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Two to three more years of work Key areas where
further work is especially needed-

• Integrated planning across governments.
• Making plans operational at the local level.
• Interoperability at the national level.
• Stepping up prevention efforts against seasonal
  influenza.
• ? Extending influenza research

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Local Issues 3 of the ECDC Acid Tests

• whether local services can deliver anti-virals to
  most of those that need them inside the 48 hour
  limit?
• whether local primary and secondary care have
  identified what non-influenza core services they
  will sustain and what they will stop and how they
  will increase intensive care for influenza
  patients?
• whether business continuity planning has been
  completed such that essential non-influenza
  related core health services have been identified
  and could be delivered with significant numbers
  of personnel being unavailable for work?
• http//www.ecdc.europa.eu/pdf/Acid20Tests.pdf

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The current report shows that the EU countries
have made great progress in preparing for a
possible influenza pandemic. However, we cannot
be complacent, as it is clear that there is still
much to do. In this regard, the report also
highlights areas where further progress needs to
be made

• Zsuzsanna Jakab Director

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Low scoring (under 80) against the twenty
preparedness indicators

• Availabilty of data on uptake of seasonal
  influenza vaccine? 73
• National contingency plan for maintenance of
  non-health essential services? - 50
• Public Material on pandemic influenza ready? 65
• National group for determining strategy for
  community non-pharmacological public health
  measures (travel, mass gatherings, etc) ? 77
• National pandemic vaccination strategy developed?
  75
• Planning document issued to local health services
  which includes the nationally agreed parameters
  for local services (expected range of cases and
  percentage of staff off sick)? 78
• National communication strategy for a pandemic?
  75
• Joint work undertaken with neighbouring
  countries) on mutually relevant policy areas? 52
• National level health sector exercise? 58

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Policy Options

• The Potential Gaps

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Pandemic preparedness - Planning, coordination
and maintaining essential services

• ? Develop scientifically-based estimates of the
  numbers of people likely to be affected by
  pandemic influenza needing medical and social
  care in the EU.
• ? Improve the exchange of planning presumptions
  between MS.
• ? Extend planning and preparations down to
  regional and local levels and front line staff
  within the MS.
• ? Define key target groups for specific
  preventive messages and protection such as health
  and emergency personnel within the MS.
• ? Develop plans for providing surge capacity and
  coping with staff absenteeism over months within
  the MS.
• ? Develop preparedness and business continuity
  plans across the non-health sectors at national
  and regional levels within the MS.
• ? Federalised countries to consider how they can
  best ensure preparedness and interoperability at
  regional level where health is a devolved
  responsibility.

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Surveillance, situation monitoring and assessment

• Continued development, by ECDC and MS, of a
  schematic plan for surveillance in a pandemic,
  including specific plans for each of the
  WHO-defined pandemic phases and with particular
  attention to pandemic phase 6 including lists of
  critical information that will be needed early in
  a pandemic.
• ? Consideration of how best to set up systems for
  monitoring health and non-health sectors within
  the MS in order to know how these are functioning
  and whether they are coping or need more
  resources.

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Prevention and reduction of transmission

• ? Production of guidance on a menu of personal
  and public health measures that can be expected
  to reduce transmission in a pandemic.
• ? Development of background guidance on the
  approach to human H5N1 vaccines.
• ? Finalised plans for acquiring and delivering
  pandemic vaccines within the MS.

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Health service response

• Integration of pandemic preparedness within
  primary and secondary health care systems,
• Training of all health care workers as needed
• Prioritisation of which core health care
  functions are to continue during a pandemic
• Development of practical plans within the MS for
  maintaining essential hospital services in a
  pandemic including strategies for supplies of
  antibiotics and other medication
• Practical plans for expanding intensive care
  (ventilation) in a pandemic

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Antivirals for therapy and public health purposes

• ? Provision, by ECDC, of background scientific
  information on the use of antivirals for public
  health purposes.
• ? Development of practical plans for delivering
  antivirals to citizens within a 48 hour window
  from first symptoms
• Development and comparison of documentation on
  the principles of antiviral delivery and some of
  the alternative models of delivery being
  developed in MS.
• ? Consideration, by MS together with EMEA and
  ECDC, of mechanisms to monitor effectiveness,
  side-effects and resistance through real time
  surveillance.

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Communications

• ? Continue the network of EU and Member State
  communication officers dealing with influenza and
  test the systems with exercises as and when
  issues arise.
• ? EU development of coordinated messages on
  seasonal and pandemic influenza.
• ? Develop background documentation on preparing
  material for health care workers.
• ? Review communication surge capacity for a
  pandemic within MS.
• ? Develop and continue to refine pre-agreed
  pandemic messages and materials within countries
  and between countries where possible, and
  consider how best to reach minority populations
  and foreign nationals, including addressing
  language barriers.

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Interoperability between countries

• ? Systematic discussions between working level
  policy officials in the MS in order to share
  scientific information and learn from each other
  on planning and policy development.
• ? Determine the legal implications of travel
  restrictions and other interoperability issues.
• ? Improved interaction by MS with bordering
  countries in and outside the EU to discuss and
  agree on a list of issues such as compatible
  arrangements for primary and secondary care,
  common communication strategies and messages, to
  share triggering mechanisms and conduct
  cross-border exercises.

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Seasonal influenza

• ? Adopt or re-commit to EU-wide vaccination
  coverage standards based on the goals agreed at
  the WHOs World Health Assembly for immunisation
  in target groups.
• ? Ensure that the jointly adopted EU standards
  for vaccine uptake are met and establish regular
  monitoring of effectiveness of the vaccine.
• ? Adopt communication messages and educational
  materials concerning seasonal influenza for the
  public and health care workers based on the best
  examples in Member States (MS).
• ? Undertake research to improve vaccines, and on
  mechanisms of influenza transmission, infection
  control and the effectiveness of public health
  measures and antivirals.

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Avian influenza

• Resume the joint CMO and CVO meetings but expand
  discussions to include other zoonoses as well as
  avian influenza.
• ? Prepare or strengthen common health and
  veterinary plans or linked plans to develop
  mechanisms in the animal and human health sectors
  of the MS to timely and efficiently share
  human-avian data.

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Q - What More for ECDC to Do?

• A A Lot!

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Supporting the Commission, other EU Agencies, WHO
and especially the Member States during those
Intensive Two to Three Years of Work
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More Specifically - ECDC Influenza Workplan 2007

• Continuing the weekly Influenza Newsletter
• Finishing the National Pandemic Preparedness Self
  Assessments in 2007 12 more to go (plus EEA
  countries)
• Developing the Member State to Member State
  Approach to disseminate good practice (the
  Innovations)
• Then repeating the EU Status Assessment
• Developing a Menu of Advice on the Public Health
  Measures (school closures, social distancing) to
  inform the Commission and Member States
• Providing Scientific and Public Health Advice
  e.g. on the effectivensss of antivirals,
  antiviral resistance and human H5N1 vaccines
• Developing international links especially with
  neighbourhood countries

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More Specifically - ECDC Influenza Workplan 2007

• Developing and distributing guidance on antiviral
  distribution, communicating with health care
  workers, preparing hospitals for pandemics and
  interoperability
• Developing plans for surveillance in a pandemic
  for MS and the EU
• Working with the Commission to determine who does
  what on vaccine development and use
• Establishing routine measurement of seasonal
  vaccine uptake in the EU
• Establishing routine evaluation of vaccine
  effectiveness in the EU
• Developing simple multi-lingual materials for the
  public on influenza
• Very little on avian influenza (we hope)

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A provocative thought what is pandemic
preparedness in medium and resource poor
countries?

• There will be some things in common and others
  quite different.
• for example in relative terms protecting some
  functions the non-health sectors (security, food
  distribution, telecommunications) may be more
  important in the medium and resource poor
  countries.
• expecting the health sector to cope will be less
  realistic and less important, especially when it
  comes to secondary (hospital) care.

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A Conclusion for the EU
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This report is instrumental in underpinning the
importance of sustained efforts at all
operational levels and across all government
policies. Only after recognising the task ahead
and giving it the necessary priority, can we
reach an adequate level of pandemic preparedness
throughout Europe

• Markos KyprianouCommissioner for Health and
  Consumer Protection
• Foreword to the Report