Progress and Impact of Efforts to Control Avian Influenza and Prepare for the Next Pandemic

1. Progress and Impact of Efforts to Control Avian Influenza and Prepare for the Next Pandemic David Nabarro United Nations System Influenza Coordination Peter C. Harrold Director, Operations Services, World Bank New Delhi International Ministerial Conference December 4, 2007

2. Looking back at the outcomes of Bamako conference December 2006 2. Outcomes from the Technical Workshop in Rome June 2007 3. Assessment of progress, gaps and remaining challenges

3. H5N1 in poultry & wild birds during 2007 During 2007 – 25 countries infected

4. H5N1 in humans during 2007

5. Looking back at the International Ministerial conference in Bamako December 2006

6. Bamako: Outcomes and Actions • Effective action needed especially in Africa • Incorporate avian influenza prevention into existing animal health work • Incorporate pandemic preparedness into existing health programmes – in all nations • Increased focus on non-health aspects • Better coordination of external assistance • Grants to the value of $474million were pledged

7. Rome: Technical Workshop June 2007

8. Rome: What the workshop confirmed • HPAI largely affecting poultry, occasionally spreading to humans and other mammals. H5N1 virus has not yet developed the capacity for sustained human-to-human transmission • Control of the disease in poultry remains the priority intervention • Un-infected countries need to prepare for possible virus incursions into poultry • All countries need to improve human health capacity to deal with the emergence of a novel pandemic strain

9. Rome: The key lessons identified • Reports of successful control and prevention of the disease in poultry as a result of efforts being made in many countries • Reports of several locations where infection is enzootic likely to remain so for some time • Field research reveals reasons for persistent infections: knowledge helps direct longer term measures (risk reduction, vaccination and surveillance) for sustaining gains

10. UN- World Bank: Assessment of Progress and impact of efforts to control Avian influenza and prepare for the next Pandemic Third Global Progress report (Based on responses from 146 countries)

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12. Assessment of Progress (1) • The H5N1 virus is considered enzootic in locations within at least 6 countries • Countries report improved capacity to respond to Highly Pathogenic Influenza (HPAI) infection (more rapid and more effective): a movement of hundreds of thousands of people • But veterinary capacity in many countries remains insufficient

13. Assessment of Progress (2) • Reports suggest insufficient coordination between animal and human health surveillance and response networks within most regions • Evidence indicates an improvement in human influenza virus diagnostic and surveillance capacity globally. However, capacity varies significantly between countries • Over 90% of countries report that they have developed pandemic preparedness plans • National preparedness for a pandemic responses is patchy

14. Assessment of Progress (3) • Few countries have (a) sufficiently tested their plans, (b) included wider social and economic impacts or (c) considered vulnerable groups including migrants. These concerns apply to wealthy and poor countries. • Humanitarian organizations and Red Cross Movement preparing for a pandemic at local level • 73% of countries have implemented communication strategies to create awareness around the threat posed by HPAI H5N1 (with significant assistance from UNICEF). • The impact varies: awareness does not always translate into behaviour change

15. Challenges: • Ensuring intensive responses where enzootic • Long term maintenance of animal health (using FAO guidance on biosecurity) and functioning veterinary services (following OiE international standards) • Integrated multi-sectoral pandemic preparedness– at local, national, regional and global levels • Implementation of the International Health Regulations (IHR 2005) and capacity to detect, confirm and contain influenza-like illness • Maintaining strong and continued political and financial commitments: • Increase solidarity between countries

16. Key Messages: • Underlying threat of a pandemic remains • Need to broaden focus to cover other zoonoses • Expand strategies to address medium and longer term challenges • Maintain high level commitment • Encourage convergence of animal, human and environmental health, as well as food safety and crisis management

17. Catastrophic Impact of a Pandemic

18. Global Response to Threat • Guidance from OIE, FAO, and WHO -- and support from other technical experts • Donors pledged more than $2.3 b to assist developing countries to respond to avian influenza and to prepare for pandemic • As of June 30, 2007, $1.7 b of pledges already committed, of which more than $1.0 b already disbursed

19. Challenge as of end-2007 (1) • Threat of avian influenza better understood, but fundamentally undiminished • Focus on prevention and rapid response and containment and control of AI in emergency response in 2005-2007 was appropriate – and should continue … but • Also need medium- and long-term strengthening of capacity of animal and human health systems • Investments in AI response have wider benefits, beyond AI

20. Challenge as of end-2007 (2) • Some countries are now preparing for their third (or even fourth) “avian flu season” • Less concern with how to respond – and more with how to sustain a response: e.g., Vietnam experienced resurgence of AI outbreaks (despite extensive control measures with good results)

21. Addressing Threat of Zoonotic Diseases • Medium-term and long-term investments in animal and human health systems so as to improve capacity for rapid response to control diseases • Coordination across institutional, sectoral, and territorial boundaries • Sustain successes achieved to date by promoting long-term systemic changes

22. Thank you. www.un-influenza.org www.worldbank.org/avianflu