Non-Governmental Organizations’ Working Meeting on Avian and Human Influenza

1. Non-Governmental Organizations’ Working Meeting on Avian and Human Influenza Hosted by IFRC Presentation by David Nabarro UN System Influenza Coordinator October 4th 2006Update (5 min)

2. Three Kinds of Influenza • Human viral respiratory infection • Self-limiting, but can be serious & fatal in elderly & very young ~ 500,000 deaths globally each yr. • Occurs seasonally • Routine vaccination available Seasonal Influenza “The Flu” • Bird virus - different from human influenza virus • Spreads from birds to birds • Can sometimes infect humans • Can sometimes mutate into human virus Avian Influenza “Bird Flu” • Global outbreak of new human influenza (different from seasonal and avian influenza) • Rare but recurrent event (every 10-42 years). Associated with increased morbidity & mortality. Last 3 pandemics in last 100 yrs – 1968 (3m deaths), 1957 (2m deaths and 1918 (50m deaths) • Past 3 pandemics - avian viruses became a human virus Pandemic Influenza “A Pandemic”

3. AVIAN INFLUENZA • Birds frequently affected by influenza • H5N1 is a highly pathogenic influenza A virus • Moving across the world affecting domestic poultry; carriage by wild birds and through trade; • More than 30 countries reporting H5N1 since January 2006; • 15 countries in the preceding 2.5 years • Sporadic human cases (>200) • 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

5. Map prepared By US Government MYANMAR

6. Global Avian Influenza Situation: What is happening now? Continued H5N1 infections in Indonesia (enzootic) Re-emergence of H5N1 outbreaks in other East Asia countries • New outbreaks in the last few months of H5N1 have been confirmed in Thailand, Laos, China, Egypt, Nigeria • Human cases reported from Indonesia and Thailand • Bird Migration Zones – preparing for the next cycle • Unregulated Trade – an important source of spread • Major international response with strong international assistance • Next global stock-take Bamako December 2006 • Major income loss for poor people – especially women.

7. Sporadic Human Cases of Avian Influenza • Since 2003 H5N1 has infected 252 people • 148 have died, mostly children and young adults. • Human deaths have been confirmed from: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. • Vietnam and Indonesia account for more than 80 of the total deaths. • Human infection with H5N1 is rare, and usually the result of virus transmission from birds to humans. • No evidence of mutation to sustained human to human transmissibility Threat of Human Influenza Pandemic

8. 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

9. What is the current threat level? UN System Influenza Coordination

10. Influenza Pandemics in the 20th Century 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” > 40 million deaths 2 million deaths 1 million deaths H1N1 H2N2 H3N2

11. SOCIAL and ECONOMIC IMPACTS OF PANDEMIC • The next pandemic will start with local outbreaks but will have global impact • Compare with SARS - <1000 dead, $50 billion economic loss. • It could lead to significant loss of life and high absenteeism in all sectors • The IMF suggests a significant temporary impact • markets closed, unreliable utilities and telecoms, cash shortages • Reduced travel and leisure, impact on food industry • Poor and disadvantaged will suffer • There may be threats to Rule of Law, Security, and Continuity of Governance

12. LESSONS FROM SARS • Give priority to well-being of front line personnel • Do not withhold information • Engage communities • Encourage responsible, science-based and effective responses • Involve media • Global action is critical • Harness energies of multiple actors • Supportive Leadership – building effective coalitions

13. Six Factors for Avian Influenza Success • Consistent high level political engagement and direction, • Procedures, systems and finance for rapidly scaling up implementation of priority actions, • Strong risk analysis, information dissemination and communication systems to encourage compliance with reporting and social mobilization, • Mechanisms to sustain vulnerable livelihoods and relieve distress, • Strategic alliances across all levels of government, that engage private and voluntary sectors, and • Management systems that engage all stakeholders, encourage synergy, analyze progress review results and shift program emphasis when necessary.

14. Global Strategy Agreed Nov 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; • if pandemic does start, contain it quickly; • if containment is not possible, mitigate pandemic consequences. • Financing arrangements agreed Jan 2006

15. Political commitment (IPAPI and 6 monthly Conferences) • Strong political commitment from Heads of Government and International Community • Maintained through International Partnership • Meetings in Washington and Ottawa 2005, Beijing, Vienna, now Bamako 2006, and – in 2007 – New Delhi

16. AHI FUNDING SITUATION • Funds pledged in Beijing mid-January 2006 (for countries and UN) • pledged : $ 1.865 million • committed : $ 1.150 million • disbursed : $ 331 million • Biggest donors: European Commission, USA, Japan, UK, Norway, Australia • Not sufficient for countries, not sufficient for UN

17. Financial Assistance: June 2006 Review • Donors have made substantial pledges: many are tightly earmarked. • Funds can be accessed by a Government (a) if they are available, and (b) once the national plan has been appraised by the World Bank and donors • Appraisals must be speeded up so that disbursement rates continue to increase. . • Overall funds available are insufficient: especially for Africa and for some parts of the UN system.   • Important to have quick access to cash for specified urgencies when Avian Influenza is detected

18. Coordination is a must • Meeting together • Sharing Information with each other • Agreeing to work together with one strategy • Achieving Harmony (No discord) • Working in Synergy (Better than the sum of the parts) • Establishing Trust and Unity (working as one) • When coordination fails people suffer and die

19. Communicating information that clarifies risks and mobilizes communities to act

20. Participatory disease surveillance and community-based responses • Avian Influenza through the eyes of affected communities • Gaps in government infrastructure • Unpredictable compensation arrangements • Impact of private sector poultry producers • Vital contribution of civil society and NGOs: watching, reporting, following up, assisting recovery

21. RESPONSE BEYOND HEALTH… Human Survival and Health • High illness & potentially higher death rates • Overstretched health facilities • Impact on persons with chronic disease • Absenteeism affecting manufacture and services Interruption of Electricity and Water Supplies • Telecommunications overload Basic Services and Utilities • Increased demand for governance & security • Higher public anxiety, reduced capacity • Potential exploitation Rule of Law and Governance • Diminished coping & support mechanisms • Shortage of basic necessities • Vulnerabilities – & needs - of Contained Groups Vulnerable Livelihoods • Trade & commerce disruptions • Reduced availability of cash • Interruption of logistics Financial Systems And Trade

22. PANDEMIC INFLUENZA IMPLEMENTATION PLANS • All of Government Involved • Federal, State and Local Tiers • Engage Private and Voluntary Sectors • Action Items Indicated • Responsible Bodies Identified • Plan Tested • Revised Regularly • Sustain engagement

23. Consolidated UN Action Plan • 6 success factors • Identifying and addressing the challenges in implementing the 7 objectives • 3 levels of intensity for prioritized interventions

24. UN System Action PlanResource mobilization strategy Logframe UN System Action Plan Agencies Donors Cash People Tools Funding Fundraising

25. UN System Action PlanResource mobilization strategy HOW: • Dissemination (Donor dissemination matrix) • Speaking with one voice • Combining bilateral funding with pooled funding

26. Seven Objectives

27. A focus on groups at a disadvantage (Bellagio Checklist) • Community workers and governments seek guidance • Checklist for response to avian influenza • Checklist for pandemic containment • Issues to be addressed in Pandemic Response

28. The Bamako Meeting • December 6 to 8 2006 • African Union and Government of Mali • Global Stock-take • African Focus • Likely outcome?

29. Ten Conclusions • Animal diseases threaten human security • Investment in Animal Health is insufficient • Political commitment for pandemic readiness • People at the centre – engaged, active, not fearful • A target drives action: Pandemic ready by 2007 • Unity around a common purpose • Coordination for harmony and to achieve synergy • Include Private & Voluntary sector, Military, Media • Ensure clear responsibility and accountability • Credit for success is shared

31. Thank you nabarro@un.orgwww.influenza.undg.org