Jakarta Workshop on Avian Influenza

1. Jakarta Workshop on Avian Influenza Four Seasons’ Hotel 14th September 2006 David Nabarro

2. Presentation • Global Situation • Highly Pathogenic Avian Influenza • Threat of human influenza pandemic • State of Response • Selecting and Implementing Interventions • Public Sector Role • People’s Participation • Private Sector engagement • Political backing • International support • Analysis • Urgent action needed • Must be sustained over longer term

3. and FAO Map courtesy of FAO using data from OIE

4. Map prepared By US Government MYANMAR

5. Global Avian Influenza Situation: What is happening now? • New outbreaks in the last few months of H5N1 have been confirmed in China, Thailand and Laos • Human cases reported from Thailand and suspected in Vietnam • Continued outbreaks in birds and human cases in Indonesia • Reports of HPAI from Russia, Eastern Europe and Africa • Bird Migration Zones – the cycle continues • Unregulated Trade – an important source of spread • The importance of encouraging safe poultry rearing and healthy human behaviour • Intense pandemic preparedness work in Asia and the Pacific

6. Sporadic Human Cases of Avian Influenza • Human infection with H5N1 is rare, and usually the result of virus transmission from birds to humans. • Since 2003 H5N1 has infected 241 people • 141 have died, mostly children and young adults. • Human deaths have been confirmed from: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. • Vietnam (42) and Indonesia (46) account for more than 80 of the total deaths. • No evidence of mutation to sustained human to human transmissibility

7. Economic Impact of Next Pandemic • The next influenza 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 • There may be threats to Rule of Law, Security, and Continuity of Governance

8. EXPERIENCES FROM SARS • Give priority to well-being of front line personnel • Do not withhold information • Clarity on roles of Public Sector, Private Sector • Engage communities • Prepare all sectors to be engaged in response (go beyond health) • Involve media • Regional and global action essential • Harness energies of multiple actors • Leadership and accountability vital: calls for effective coalitions

9. 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.

10. Experiences of the Response to Avian Influenza: 2005 - 06 Personal Perspective

11. Reacting to Avian Influenza: Selecting and Implementing Interventions • Selecting Interventions • Surveillance and Response • Effective Culling • Incentives and Compensation • Vaccination Strategies • Improving Biosecurity • Implementing Interventions • Commercial Poultry Producers • Backyard Producers • Unresolved issues • Which interventions to select in situations where HPAI is enzootic? • How to incorporate action research in implementation

12. Reacting to Avian Influenza: The Key role of the Public Sector • Public Sector Institutions (Livestock Departments, Veterinary Services, Laboratories) • Procedures for prevention, surveillance, detection, response, follow-up • Skilled persons, adequate finance, data collection, reporting • Management Systems to ensure consistency and predictability and review progress • Unified approach at all levels (centre, province, district) • Full engagement of private sector • Unresolved issues: • Sustained finance to build functioning systems

13. Reacting to Avian Influenza: Popular Participation Reacting to Avian Influenza: Popular Participation • Helping people (public, farmers, officials) to understand threats, respond appropriately, reduce danger, sustain livelihoods • Encouraging people’s participation in prevention, surveillance and response • Engaging community based organizations • Bio-security for all! • Unresolved issues: • Separate mobilization to engage public, farmers, district officials • Ways to sustain popular engagement : how to increase involvement of civil society and NGOs • Helping people (public, farmers, officials) to understand threats, respond appropriately, reduce danger, sustain livelihoods • Encouraging people’s participation in prevention, surveillance and response • Engaging community based organizations • Bio-security for all! • Unresolved issues: • Separate mobilization to engage public, farmers, district officials • Ways to sustain popular engagement : how to increase involvement of civil society and NGOs

14. Reacting to Avian Influenza: Popular Participation • Encouraging people’s participation in prevention, surveillance and response • Coordinated Communication of Meaningful Messages that help all people to understand threats, respond appropriately, reduce danger, sustain livelihoods • Engaging community based organizations • Special messages for farmers, officials, producers • Same messages for internal and external audiences • Unresolved issues: • Separate mobilization to engage public, farmers, district officials • Ways to sustain popular engagement: how to increase involvement of civil society and NGOs

15. Reacting to Avian Influenza: Private Sector Engagement • Private enterprises are affected and engaged (poultry industry, restaurants, travel and tourism…) • Unresolved issues: • How to ensure maximum impact of private sector involvement, especially at community level? • How can private sector contribute • to better functioning veterinary services and biosecurity? • to increased public participation?

16. Reacting to Avian Influenza: Political Leadership and Direction • Asian experience shows that political leadership is critical in responding to complex issues • Influences on engagement of politicians • Is avian influenza recognized as having major economic and social impact? • Are major private sector stakeholders making the case for political action? • Do political leaders perceive that the reaction to avian influenza will succeed? • Unresolved issue • How best to maintain political engagement at Cabinet level in countries affected by multiple challenges? • How to maximize external investment and coordination in face of inconsistent national political engagement?

17. Reacting to Avian Influenza:International Support • Global Perspectives • Avian influenza perceived as a critical global issue primarily because of concern about an influenza pandemic: emergency actions initiated in 2006 • National responses to avian influenza requires sustained action to change poultry rearing practices, improve veterinary services, introduce biosecurity: a ten year programme • Need for interface to reflect mutual understanding and solidarity: not easy for either side • Unresolved issues • Value of recognizing in-country progress while reflecting on further challenges to be addressed • Need for milestones agreed between donors and national authorities

18. Reacting to Avian Influenza: Preparing for the Pandemic • Unresolved issue: • Need to establish in-country procedures for responding to human incidents that might represent change in transmissibility of H5N1 • Need to respect national sensitivities while reflecting on global significance of virus change • Need to set up and test the procedures now given that the timing of virus change cannot be predicted

19. Progress in Indonesia • Selecting and Implementing Interventions • Institutions in the Public Sector • Communication for People’s Participation • Engagement of the Private Sector • Political commitment and direction • International support • Preparing for the Pandemic • We are on the way .. It’s a partnership with a focus on results .. Still a long way to go .. no turning back

20. Conclusion • No simple answers to any of the continuing challenges we all face • The eyes of many are on us • It is imperative that we work together to address these challenges, engaging communities, private entities, different levels of government, political leaders, international community as we do it • We depend on Forums in which we can discuss these issues and review how we are getting on without fear of attack and recrimination • We need to sustain an alliance in which we move together as one