The Avian/Human Influenza Pandemic: Why the Concern? One NGO’s Response Priorities & Actions

1. The Avian/Human Influenza Pandemic:Why the Concern?One NGO’s Response Priorities & Actions Milton B. Amayun, MD, MPH Sr. Technical Advisor, Hope Initiative World Vision International 12 May 2006

2. What the Presentation Will Cover • Why the concern? • Not flu as usual • Protection measures • Pandemic priority: Business Continuity • Global: Contain, Prepare, Respond • World Vision: Educate, Respond, Engage

3. Regular/seasonal flu is characterized by fever, joint and muscle pains, sneezing, runny nose Transmitted from human to human Prone to mutations Vaccines available; fairly good protection Yearly cycles Avian flu resembles many symptoms of regular or seasonal flu History of contact with chickens, birds, fowl Still little evidence of human-to-human transmission No vaccine available until pandemic starts Cycle? What are the signs and symptoms

4. Key Events So Far • Numerous reports of birds dying in many countries • Millions of poultry have been culled; farmers have lost their livelihoods • Started in Asia, now firmly in Europe and Africa • Worst hit: Indonesia, Thailand, VN, China, Cambodia • Nigeria, Burkina Faso, Egypt, Sudan report H5N1 • 200+ human deaths in several countries of SE Asia, Egypt and Turkey • WHO, World Bank and governments seriously concerned • Fortunately, current spring migration of birds back to Europe did not expand transmission

6. Potential pandemic scenarios

7. Occurrence of influenza pandemics and epidemics Incidence of clinically manifest influenza Pandemic Pandemic Interpandemic period Epidemic Epidemic Disease incidence Epidemic Epidemic Epidemic 1 2 3 4 5 6 7 8 9 10 11 12 Time in years Introduction of hypothetical A HxNx virus Significant minor variation in A HxNx may occur at any of these points. Epidemics may or may not be associated with such variations Introduction of hypothetical A HyNy (major new subtype), variant A HxNx disappears Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 5th ed. 2000:1829. Modified from Kilbourne ED. Influenza. 1987:274, with permission.

8. World Health Organization (WHO) Global Influenza Preparedness Plan Phases of Alert Period Phase # Phase Inter-pandemic phase 1 Low risk of human cases (New virus in animals, no human cases) 2 Higher risk of human cases Very limited human to human transmission 3 Pandemic alert (New virus causes human cases) Increased human-to-human transmission 4 Significant human-to-human transmission 5 Pandemic (Human-to-human transmission) Efficient and sustained human-to-human transmission 6 The world is presently in Phase 3: A new influenza subtype is causing disease in humans, but it is not yet spreading efficiently and sustainably among humans. WHO website: http://www.who.int/csr/disease/avian_influenza/phase/en/index.html WHO phases of pandemic alert

9. How severe would a pandemic be? • Best case scenario: • Significant amount of illness, but mostly not severe and few deaths • Hospitals still function • Medical insurance provides cover • Sufficient Tamiflu to provide treatment • Food and basic supplies continue to be available at reasonable cost • Airlines keep flying, staff can move freely • Communications not disrupted • No security issues

10. How severe would a pandemic be? • Worst case scenario: • Severe illness in population with many millions of deaths • Hospitalsoverwhelmed despite applying strict triage • Severe pressure on use of Tamiflu for treatment of cases and contacts • Severe disruption to food and basic supplies • Borders closed • Airlines not operational • Communications disrupted (telephones / Internet) • Major economic disruption • Security issues

11. Key Question • When do we expect a mutation of the virus? • The answer is: nobody knows • A mutation could result in human-to-human transmission • When that happens, a catastrophe is likely • The virus may have new properties. e.g., higher level of virulence

13. Contain avian flu epidemic • Upgraded veterinary infrastructure • Improved biosecurity • Changed bird trade patterns • Behavior change: no backyard chickens • Prepare for pandemic • Vastly improve surveillance • Stockpile anti-virals and other medications • Protective clothing & equipment • Containment plans Respond to pandemic--- keep vital services and societies going, minimize suffering and loss of income Global pandemic priorities "When the pandemic starts, it will be too late to get prepared." Dr. David Nabarro, United Nations System Coordinator for Avian and Human Influenza

14. Educate…inform • Staff & families • Public & communities • Respond • Overall response management • People…keep well & alive • Business…keep going • Engage • Communities & others • Rapid response & assistance • Health capacity building • Advocacy Proposed World Vision priorities Doing now Must do An opportunity

15. 1. Educate Doing now • Audiences • Internal: Staff & families • External: Public & communities • Messages, e.g. • Staff advisories • Frequently Asked Questions • Travel advisories • Methods, e.g. • Messages from leaders • Web postings • Handouts/posters/fliers • Media • Meetings/briefings

16. 2. Respond Must do • Overall response management • Prepare for potential Category III response • People---keep them well and alive • Business--keep it going--get work done • Analysis & risk assessment, e.g., essential services, time-based operational, economic & technical risks • Plans & preparation, e.g., work coverage, supply chains, cross training, alternative work sites The WVUS Crisis Management Plan provides a potential framework for responding to the pandemic threat

17. Inter-Pandemic Pandemic Alert Plan Recover Prepare Implement Pandemic Post Pandemic Response approach Actions aligned with WHO Phases & Country situation

18. Response Strategies - Examples Response Priorities

19. The overall coordination of the WVUS response to a crisis, in an effective, timely manner. This includes both people & business functions. Crisis Management Emergency Response Business Continuity (People) (Business Functions) Event Crisis Time The short term response, commencing immediately after an incident, that preserves the health and safety of all people involved. • The abilityto continue critical business functions within specified timeframes. • Analysis (Risk & Business Impact) • Plans, Preparations, Protections • Exercises, Maintenance World Vision US Crisis Management Plan

20. Examples of areas where strategies, policies and actions are needed • Employee education and communications • Staff risk assessment • Pandemic health protection(including personal health practices, seasonal flu vaccine, pandemic flu vaccine, PPE, Tamiflu, and other medical supplies) • Safe work environment(including personal health practices and use of PPE in workplace, meeting management, emergency response, workplace cleaning, HVAC, mail, security, etc.) • Evacuation/relocation • Travel • Illness management • Health benefits • Employee assistance • Compensation and leave • Work-from-home policies(including technical support) • Collaboration guidelines

21. 3. Engage An opportunity • Community resilience & education • Community-based surveillance & early warning • Rapid response & treatment assistance • Animal health capacity building as primary prevention • Advocacy & engagement with others Doesn't just apply to program countries… opportunities in donor countries like the US also

22. 3. Engage Collaboration underway • NGO sharing and collaborative efforts, e.g. • WV-US with CARE, CRS, SCF • WV-Indonesia with CARE, CRS, SCF, and MCI • IASC technical consultation at WHO • InterAction Avian Flu Working Group • WHO/FAO/OiE/World Bank meetings on Avian & Human Pandemic Influenza • Bangkok Tripartite Conference (governments, NGOs and private sector) This is very big, there's much to be done, and we have timely opportunity to collaborate and share.

23. 3. Engage What does WVI intend to bring to the situation? • Field presence • Governmental & community relationships • Local expertise • Established networks and staffs • Capital for chains of supply • Expertise to mentor local communities & NGOs • Accountability/fiscal credibility • Relationships with experts • Credible monitoring and evaluation

24. 3. Engage a) Community resilience & education • Education and behavior change communications—for human and animal health • Collaborative community risk assessments • Risk mitigation communications • Community response planning & exercises • Economic mitigation plans

25. Wash hands thoroughly with soap frequently Cover coughs and sneezes Wear a mask if symptomatic Don’t spit! Promote 4 actions now! 2. ‘Street-wise’ hygiene campaign

26. STOP BIRD FLU! Wash your hands thoroughly with soap!

27. 3. Engage b) Surveillance & early warning • Community surveillance/referral systems • avian and human influenza • Surveillance training • Early warning systems • Education, tools & protocols • Mobilizing community partners • Communication systems

28. 3. Engage c) Rapid response, containment, treatment • Community, village, provincial and national rapid response capacity • Planning & preparation • Surveillance information systems • Diagnostic confirmation capabilities • Humane culling & quarantine zoning • Treatment assistance • Lines of communication

29. 3. Engage d) Animal health as primary prevention • Prevent AI at the source • Small-scale/backyard poultry farms • Wild birds • Assess & strengthen veterinary services & capacity • Quality & reach • Vaccine centers & transport • Cold chain equipment • Humane culling • Poultry biosecurity & vaccination • Bio-safety and clinical equipment

30. 3. Engage e) Advocacy & engagement with others • Sharing and collaboration with others • Joint advocacy, risk communications and engagement • Media engagement, TV spots, posters, leaflets, booklets • Translation and localization of materials • Flexible funding mechanisms, e.g., Interagency Working Group, USAID, CIDA, AusAID • Sharing lessons learned, practices, tools, etc.

31. Where to get more information • WVI Website: www.WVI-AvianFlu.org • AvianFlu News Group • WV documents/plans • Web sites • WHO: www.who.int/csr/disease/influenza/pandemic/en • CDC Avian Flu: http://www.cdc.gov/flu/avian/ • FAO Avian Influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html • Flu Wiki: http://www.fluwikie.com/ • US Dept of State-Bird Flu http://usinfo.state.gov/gi/global_issues/bird_flu.html • Good read: The Great Influenza by John Barry, Penguin Books

32. Thank you! • E-mail your questions to: Iaimilton@aol.com