UNICEF Programme on Pandemic Prevention & Preparedness

1. UNICEF Programme on Pandemic Prevention & Preparedness

2. Science Quiz • What’s the difference between bird flu and avian influenza? • What is a pandemic? How is it related to bird flu? • What % of countries reported to UNISIC they have developed pandemic preparedness plans? • Why are we more vulnerable each year to new infectious disease threats? • Why is George Bush worried about the pandemic?

3. Threat of Human Influenza Pandemic Inter-pandemic Period Pandemic Alert Period Pandemic Period H5N1: • Circulating in wild birds and poultry since 1996 • Highly contagious & deadly among birds • Spread 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

4. Confusion between Avian Influenza and pandemic preparedness is common • Pandemic prevention requires: • Control of HPAI in birds • Prevent human H5N1 infections. • Pandemic preparedness is • largely unrelated to AI response • needed in every country, unlike AI response

5. THREE PANDEMIC SCENARIOS Scenario 3 - Rapid Onset / Widespread impact Little time for preparation, rapid action vital, movement restrictions, emphasis on mitigation: Major pandemic 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 No Pandemic Time

6. US mortality data, 1900-90 PAST PANDEMICS 1968: Bad regular influenza season 1957: Worse than very bad influenza 1918: Worst health event since "black death" of 14th century 1957 1968 1918

7. 1892 2,000 1,500 1918 DEATHS PER 100,000 POPULATION 1,000 1936 - non-pandemic yr. 500 1957 0 5 10 20 30 40 50 60 70 80 AGE Pneumonia & Influenza Deaths, USA (Source: Glezen WP. Epidemiologic Reviews 1996; 18(1): 64-76)

8. Global Vulnerability • Unprecedented population density • Threats from old and new microbes • Human pressure on habitats • new evolutionary pressures on ecosystems • Global increase in wealth • Demand for meat increasing • Over past 30 years average of 2 new microbes/year • ~70% of them come from animals (zoonoses) • Globalisation and interconnectedness • About 2 billion airplane trips per year, and rising • “Just-in-time” stock mgt. & efficiency • Little spare capacity …..

9. > 1100 events followed by WHO between January 2001 and May 2006..

10. ECONOMIC IMPACT OF PANDEMIC • Global economic cost estimated at $2 trillion • SARS - <1000 dead, $50 billion economic loss. • Deaths, absenteeism and attempts to avoid infection have consequences for supply and demand side of economy • Markets close, utilities unreliable, telecoms break • Travel and leisure travel reduces, demand for food changes • There may be threats to Rule of Law and Security

11. 1847 42yrs 1889 29yrs 1918 39yrs 1957 11yrs 1968 Past Influenza Pandemics ?H1 1850 ?H2 1900 H1N1 H2N2 1950 H3N2 2000 No Pandemic for 40 years

12. “Timing and severity of the next pandemic remain unknowable, but the opportunity to prepare is invaluable; especially when these preparations can benefit existing priorities.” UNICEF PPP Strategic Plan 2008-2009 Prediction & Action

13. What needs to be done? • Prevent a pandemic • Avian influenza control • Contain an emergent virus • Mitigate pandemic impact • Main risk is panic/anxiety reactions • Economic impact • -especially on poor & children • Health services will be strained • Other services may collapse

14. What is new since 2005? • Pandemic risk from H5N1 remains unchanged • Will H5N1 cause pandemic? How many mutations? • Risk from other influenza and other viruses • Many countries able to control HPAI outbreaks • But virus returns and remains widespread • Oseltamivir (Tamiflu) resistance (and side effects) • Logistics problematic • H5 vaccines licensed; WHO stockpile planned • use remain uncertain • Pandemic control • Role of airborne transmission unresolved (masks?)

15. Pandemic Prevention and Preparedness Strategic Plan: UNICEF Vision • Communities:active participation • generate and implement solutions • global and local disease threats to children, including A/PI. • Govt, NGOs, etc: mobilise & coordinate • responses to a range of threats, including A/PI. • UNICEF (coordinated UN response): support • prevent/control highly pathogenic avian influenza (HPAI) • prepare to respond to a novel human influenza virus, including the rapid containment responses.

16. UNICEF Programme Goals • Goal 1. Pandemic preparedness • to mitigate impacts on children and their families • Goal 2. Communication (C4D) • to support programme goals

17. Goal 1: Pandemic Preparedness Objective 1.1.Programmatic guidance for pandemic preparedness developed and implemented Objective 1.2. UNICEF programmes’ pandemic preparedness integrated into existing emergency preparedness Objective 1.3. UNICEF programmes’ preparedness tested and enhanced through simulation exercises Objective 1.4. Capacity of national EPI to rapidly distribute vaccine in pandemic in additional priority countries strengthened Objective 1.5.Pandemic-specific communication response to support non-pharmaceutical interventions is defined in terms of content, timing, and roles by 2008

18. Interagency agreement –Pandemic Influenza (PI)

19. WHO Pandemic Preparedness Guidelines • Working Groups established Dec 2007 (w UNICEF) • Strategic Policy Document • Communications and Social Mobilization • Public Health Interventions • Medical Interventions • Non-health sector preparedness • Global Consultation • 4-9 May, Geneva • Updated guidance expected Sep’ 08

20. Goal 2: Communication Objective 2.1.Map communication capacity and partners Objective 2.2.Capacity to use “routine” system for “emergency” communication response strengthened Objective 2.3.Role of communication support for AI control in enzootic and high risk countries

21. Interagency agreement – AI

22. A/PI Communication:Key Achievements • Advocacy with governments leading to enhanced inter-sectoral partnerships; • Evidence-based planning for behaviour change communication/ social mobilisation strategies; • Key behavioural actions for prevention of AI defined (Report, Separate, Wash, Cook) and disseminated widely; • Range of communication materials (print, audio, and TV) and tools developed - Shared through internet [http://www.unicef.org/influenzaresources]; • National and international media sensitised on AI.

23. A/PI Communication:Key gaps • Community-level communication plans and actions need to be strengthened • Dialogue rather than information dissemination • Analysis of feasibility of behaviours • How to address sociocultural and economic barriers • Sustained actions to reach vulnerable groups and generate local solutions • Inter-agency coordination remains challenging

24. Speaking points – Summary • UNICEF has been actively involved in A/PI activities since 2006 • Development of guidance to UNICEF offices and global guidance with technical partners • Disease evolution & global interest • Key investment areas (UNICEF); • Communication • Vaccines/logistics • Contribution to global guidance • Material development