PAHO Strategic and Operational Plan for Responding to Pandemic Influenza

1. PAHO Strategic and Operational Plan for Responding to Pandemic Influenza San José, Costa Rica; Central America. December 14-16, 2005

2. I had a little bird Its name was Enza I opened the window And in-flew-enza from a lullaby popular in USA during the early XX Century

3. Influenza: global Implications • The newly adopted International Health Regulation (IHR-2005) lists “human influenza caused by a new subtype” among the 4 diseases that need to be notified to WHO • The emergence and widespread circulation of a new highly pathogenic avian influenza A (H5N1) strain in Asia • This virus has the capacity to infect humans creating an opportunity to the occurrence of a new pandemic

4. Task Force on Epidemic Alert & Response • PAHO Director established an inter-programmatic and multidisciplinary Task Force on Epidemic Alert and Response • Advise, Enable, Coordinate, and Monitor: • PAHO activities for to influenza pandemic preparedness and response • Implementation of the International Health Regulations in the Region • Responsible for drafting the PAHO Strategic and Operational Plan for responding to pandemic influenza

5. Strategic & Operational Plan for Responding to Pandemic Influenza Objectives: • To direct PAHO Technical Cooperation activities to prepare the Region for an influenza pandemic • To assist countries in their Development of National influenza pandemic preparedness plans • To assist countries in the implementation of supporting actions which are needed for the effective response to a pandemic

6. Considerations for Development Strategic and Operational Plan • Directives given by PAHO and WHO’s Governing Bodies • The phase-specific approach set forth by the WHO strategic plan • WHO Global influenza Preparedness plan • WHO checklist for influenza pandemic preparedness plan • Other WHO documents • Countries existing NIPPPs • The newly adopted International Health Regulations (IHR-2005) • Ongoing Technical Cooperation

7. Impact of an Influenza Pandemic • Unparalleled tolls of illness and death expected. • Air travel could hasten viral spread and decrease available time for preparing interventions. • Health care systems could be rapidly overburdened, economies strained, and social order disrupted. • But it should be possible minimize the consequences by having prepared for the challenge in advance. • Essential to preparedness planning is to estimate likely impact of the next pandemic, including associated morbidity and mortality burden; health services surge capacity, and social & economic impact.

8. SARS, Ch, HK, SGP, Can $30-50 billion $50 bn $40 bn Estimated Cost Foot & Mouth Disease, UK $25-30 billion $30 bn $20 bn Avian Flu, Asia $8-12 bn BSE, UK $10-13 billion $10 bn BSE, US $3-5 bn BSE, Jap $1.5 bn FMD, Taiwan $5-8 billion BSE, Can $1.5 bn Avian Flu, NL $500 m Nipah, May $350-400 million HPAI, Italy $400 million Swine Fever, Nl, $2-3 bn 1990 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 2006 Source: Bio Economic Research Associates Economic Impact of Selected Infectious Diseases

9. Pandemic Preparedness • Development of National Influenza Pandemic Preparedness Plans are urgently needed. • Mandated by the 56th World Health Assembly and the 44th Pan American Health Organization Directing Council Resolutions • Guidelines • WHO Global Influenza Preparedness Plan • WHO Checklist for influenza Pandemic Preparedness Planning • WHO Strategic Action Plan for Pandemic Influenza 2006-2007 • Consider worst-case scenarios • No vaccines and antivirals drugs

10. Pandemic Preparedness Planning • Complicated by the unpredictability of the time of inception and severity a pandemic influenza strain • Public health authorities recognize risk and impact of pandemic • Development of plan not always a priority • Competes with other public health issues • Many countries lack the human resources to dedicate time and effort to something that is not yet real • WHO has revised guidelines to assist countries in the development of pandemic preparedness plans – PAHO has translated and disseminated them in the Region

11. Development of National Influenza Pandemic Preparedness Plans (NIPPPS) • New International Health Regulations (IHR-2005) recommends that countries develop their necessary core capacities to detect and respond to diseases like influenza • Pandemic preparedness should be built on existing processes and programs and cannot be disconnected from routine and current activities • Plan should seek to integrate National and local activities involved in the response to a pandemic

12. Implementation of NIPPS • Activities in pandemic preparedness plan should be subject to constant revision • Simulation exercises need to happen at different levels • including facility and local jurisdictions • enable the testing of contingency plans for patient care to deal with surges and delivery of services where there are problems of access • Importance of organizing national debriefings on response • when outbreak with pandemic potential occurs • conduct periodic reviews of the plan to include new evidence and technical developments

13. Interpandemic Period Phase 1. No new human influenza subtype. Low risk of infection of circulating animal influenza virus Phase 2. No new human influenza subtype. Circulating new animal influenza virus poses risk to humans Pandemic Alert Period Phase 3. Human infection with the new subtype but no human-to-human transmission Phase 4. Small clusters with limited human-to- human transmission. Phase 5. Larger clusters but human to human transmission still localized WHO Pandemic Phases • Pandemic Period • - Phase 6. Pandemic: increased and sustained transmission in general population 

14. Phase: pre-pandemic Promote the development of National Influenza Pandemic Preparedness Plans Strengthen the early warning system Support countries in making available pandemic vaccine & antivirals Plan for health-care services and infection control Reduce opportunities for human infection Implement a communication strategy and raise awareness to encourage pandemic planning Estimate potential impact of an influenza pandemic and assess additional information gaps to guide policy-making Build partnerships and strategic alliances Phase: emergence of pandemic virus Contain or delay early spread of the virus Phase-specific Approach and Objectives Phase: pandemic declared & spreading internationally • Reduce morbidity, mortality, and social disruption through a coordinated response • Quantify and monitor pandemic impact and epidemiology

15. ER 7.1Potential health impact of pandemic estimated, including economic impact to guide policy-making Indicator • Studies estimating Regional morbidity, mortality, and economic impact due to pandemic influenza conducted. • Framework for country level estimation of health and economic impact of influenza pandemic developed, validated and disseminated to the 21 countries of Latin America and CAREC. Key activities • Develop and validate tools for country level estimation of health and economic impact of influenza pandemic. • Conduct modelling studies of pandemic virus emergence considering possible pathways for viral emergence. • Conduct modeling studies to estimate burden of an influenza pandemic. • Conduct modeling studies to assess economic impact of an influenza pandemic. • Translate, adapt, and distribute the following WHO publications, pending publication: • Generic protocol for population-based surveillance to estimate the disease burden of influenza and other ARI from vaccine preventable or potentially preventable agents

16. Next Steps… • Development of a budget & timeline for implementation of activities detailed in Plan • Widen consultation on the Plan • Resource mobilization started • Capacity building of country-level resources, early 2006 • Development of National Influenza Pandemic Preparedness Plans with PAHO support; early 2006 • Consultation meeting on the implementation of Non Pharmaceutical Public Health Measures during a pandemic period. April 2006

17. Final Remarks CE137/5 • We urge all Ministries of Health of the Region not only to support but also take the lead in the development & implementation of National Influenza Pandemic Preparedness Plans. • The Development of the Plan should include other partners beyond the Health Sector, including the private sector. • PAHO will cooperate and support Member States in the mobilization of necessary technical & financial resources for the achievement of this goal. • PAHO will coordinate with partners to support countries in the development and implementation of the National Pandemic Plans

18. The role of public health is, whenever possible, to prevent epidemics, not to primarily describe them Thomas R Frieden No vale ver después. Lo importante es ver antes y estar preparados José Martí