ASEM Workshop on Avian Influenza Control Presentation by David Nabarro

1. Global Update and Future Direction of Avian Influenza Control (in context of influenza pandemic preparations) ASEM Workshop on Avian Influenza Control Presentation by David Nabarro UN System Influenza Coordinator Tuesday November 12th 2007

2. Outline of Content • Influenza Pandemic Prevention: Responses to the threat of Highly Pathogenic Avian Influenza H5N1 • Pandemic Preparedness: The importance of multi-sectoral approaches to human health security • Pandemic Readiness: Testing preparedness to assess state of readiness • Inter-Governmental Approaches: Encouraging joint action by countries • Future Directions: Preventing and being ready to respond to animal diseases that affected humans

3. Past Influenza Pandemics 1847 1850 42yrs 1889 29yrs 1900 1918 39yrs 1950 1957 11yrs 1968 2000

4. 1918-19: a two year global crisis caused by an Influenza Virus 06/18 ? 04/18 03/18 06/18 05/18 ? 01/19 06/18 C.W. Potter, Textbook of Influenza, 1998

5. 1 Influenza Pandemic Prevention The threat from Highly Pathogenic Avian Influenza H5N1

7. GLOBAL AVIAN INFLUENZA SITUATION • 15 countries have been affected by end 2005, 55 by end 2006, and 60 by November 2007 • Powerful efforts to respond to outbreaks successful in most cases. • Continued, often silent, transmission of H5N1 in bird population in parts of Indonesia, Egypt, Nigeria, Bangladesh, Vietnam and China • Potential for a marked increase in outbreaks during next few months • Uncertain epidemiology • Contribution of migrating birds? • Contribution of in-country and cross-border trade?

8. SPORADIC HUMAN CASES OF AVIAN INFLUENZA • Human infection with H5N1 is rare, and usually the result of virus transmission from birds to humans • H5N1 infected over 300 people since 2003 • Over 200 have died, mostly children and young adults • Genetic make-up of virus evolves but there is no evidence of sustained human to human transmissibility

9. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 5 November 2007

10. TECHNICAL AND FINANCIAL ASSISTANCE: PROGRESS SINCE 2006 • Of the $ 2323 million pledged in 2006, $1678 million (72%) has been committed and $1018 (43%) has been spent • The figures suggest that considerable funds are available for spending, but this is not the case. The original pledge included $1340 million of grant funds and $983 million of loan funds • Of the $1340 million grant funds that were pledged reveals that $1287 million (96%) has already been committed. $ 955 million (74%) of the committed grant funds have already been disbursed. • Over time countries have become more dependant on loans as the availability of grants has declined. • Of the $983 million loan funds that were pledged, approximately $592 million remained uncommitted as of end-June 2007. • Loans are used to finance medium-term integrated country programs, which take time to prepare, and developing countries prefer to use grants, rather than loans, to finance their integrated programs

11. Funding status

12. Recipients

13. Human Cases, Deaths from H5N1 and Countries Affected

14. H5N1 still a global issue end 2007….

15. CONTRIBUTION OF ASIAN AND EUROPEAN COUNTRIES • Improvements in Animal Health Surveillance Systems • Capacity for Disease Detection and Response • Improvements in Bio-Security – in both family and commercial poultry production and in markets • Mass Information to the General Public • Widespread Vaccination Programmes • Capacity to Monitor and Adjust for better performance • Development of new vaccines and diagnostics • Improvement in Public Health Capacity • Pandemic Preparedness Planning

16. NEXT STEPS IN AVIAN INFLUENZA CONTROL 2008 ONWARDS • Using a livelihoods perspective, regularly analyze the epidemiological determinants of outbreaks in poultry and of human cases • Using epidemiological and economic data, encourage long-term reduction in risk of HPAI and other diseases through improving biosecurity in (a) family poultry and (b) commercial poultry production and marketing systems • Intensify an monitor efforts to control HPAI in settings of continuous transmission (including with vaccination), maintaining an overview of implementation and impact of poultry vaccination

17. 2: Multi-sectoral Pandemic Preparedness Getting ready to detect and act decisively

18. THE CURRENT THREAT LEVEL? UN System Influenza Coordination

19. POTENTIAL IMPACTS OF AVIAN & PANDEMIC INFLUENZA Livelihoods • Food and income loss from poultry deaths, culling & decreased economic activity • High illness & potentially higher death rates • Overstretched health facilities • Disproportionate impact on vulnerable Human Health • Increased demand for governance & security • Higher public anxiety • Reduced capacity due to illness & death Governance & Security • Deterioration of coping & support mechanisms • Interruption in public services • Quarantine policies Social & Humanitarian Needs • Trade & commerce disruptions • Degraded labour force • Interruption of regular supply systems Economic Systems

20. PANDEMIC IMPACT RELATED TO CONTINUITY OF… 1 Health Services Medicines, Commodities, Equipment, R and D, Patient Care, Lab services 2 Financial Services Banking (cash and settlements), financial regulation, risk management and insurance 3 Food and its distribution Agriculture and livestock, Distribution and retailing 4 Utilities, Logistics, Personal Services Electricity, Water, Telecoms, Transport and Logistics, Postal services, 5 Leisure and Recreation Tourism and Travel, Airports, Sports 6 Government, Security, Military Public Services, Law and Order, Judiciary and Correction, Private Security, Human Rights 7 Media Broadcast, Print; Podcast and Blog 8 Environment and hygiene Wildlife conservation, Cleaning, Maintenance, Refuse management.

21. 3: Getting Ready: The importance of checking preparedness to decide State of Readiness

22. PANDEMIC READINESS • IS THERE A RISK-BASED APPROACH TO PLANNING? • Use of epidemiology, modeling, risk-based planning • Engage professionals from different levels • Ensure high level of popular awareness and understanding • IS THE STRATEGY WIDELY UNDERSTOOD? • Early Detection, Investigation and Confirmation, Containment • Social distancing, personal protection, movement restriction, maintenance of essential infrastructure • Systematic use of anti-viral therapy (oseltamivir) • Rapid development and equitable distribution of effective vaccines (Major controversy: will poor countries have access) • HAVE PROCEDURES BEED TESTED AND MODIFIED? • Crisis plan to mitigate effects of pandemic on Economies, Governance, Basic Needs, Border Movements • Protocols developed for use of stockpiles, emergency operations • Humanitarian NGOs, local government, Private Sector synchronized • Communications system • Plans Simulated and Lessons Applied

23. GLOBAL READINESS - SEPT 2007 • Preparedness Plans not always fully tested • Containment protocols still to be taken forward by groups of countries • Civil Society and Private Enterprise NOT always involved • Importance of identifying and working with vulnerable populations • Value of clear communications protocols • Readiness being tracked by UN (PIC) and by regional bodies (eg ECDC and APEC)

24. 5: Inter-Governmental Approaches: Encouraging joint action by countries

25. Governments Working Together GLOBAL STRATEGY • FAO/OiE/WHO/World Bank and Partners’ strategy meeting (Geneva November 2005) and review meeting Rome June 2006) INTERGOVERNMENTAL SOLIDARITY • Financial and political (Beijing and Bamako pledging Conference, Washington, Ottawa and Vienna High Level meetings) EXTERNAL ASSISTANCE • Technical and financial support by specialized and donor agencies

26. Support to Integrated National Programmes

27. PREREQUISITES FOR SUCCESS • Political Commitment - to joint and effective action based on agreed strategies • Resources – sufficient for incident response • Functioning Alliances – government, public, private, media • Combined operations – people’s health, livestock health, informed population, regulations properly enforced, data and samples shared • Adequate incentives – to report, to cull, to improve safety • Mobilized populations – informed and ready to act for safe food, healthy animals and health

28. 6: A Way Forward: Popular Movements and Networks for Human Health Security: Case study from Indonesia

29. Engaging community members

30. Understand perspectives of Care-giversand children

31. Understand concerns of Householders

32. Appreciate the position of market workers

33. Use Clear Messages

34. Explain Messages Repeatedly:Public Service Announcementsviewed by more than 120 million people

35. Involve Leaders: Politicians, Imams, Government Officers, Professionals

36. Our societies are threatened by microscopic adversaries that are well-equipped to invade, evade, and surprise • 70% of them come from the animal kingdom • They pose a threat to the economic, social and human security of people throughout the world • Countries are responding together, within the framework of the International Health Regulations. • Collective response calls for shared responsibility, systems and costs

37. HUMAN SECURITY - ONE WORLD, ONE HEALTH • Diseases do not respect borders and can emerge without warning • 70% of emerging diseases will come from Animals • Importance of convergence: animal health, environmental health, food safety, human health • Importance of governments, voluntary sector, business and community responding together

38. Recap of Content • Influenza Pandemic Prevention: Responses to the threat of Highly Pathogenic Avian Influenza H5N1 • Pandemic Preparedness: The importance of multi-sectoral approaches to human health security • Pandemic Readiness: Testing preparedness to assess state of readiness • Inter-Governmental Approaches: Encouraging joint action by countries • Future Directions: Preventing and being ready to respond to animal diseases that affected humans