Avian Influenza and the potential for a human pandemic : International Response

1. Avian Influenza and the potential for a human pandemic : International Response Presentation by David Nabarro UN System Influenza Coordinator June 14th 2006

2. 1 What is Avian Influenza

3. AVIAN INFLUENZA • Birds frequently affected by influenza • H5N1 is a highly pathogenic influenza A virus • Moving across the world affecting domestic poultry; some asymptomatic carriage by wild birds; • More than 30 countries reporting H5N1 since January 2006; • 15 countries in the preceding 2.5 years • Sporadic human cases (>200) • Potential (if there is mutation) to cause a pandemic • Most human cases have had contact with infected birds • Virus attaches to receptors in lower respiratory tract • Clusters of Human Cases need careful investigation • The threat is not unique: 70% of new human infections will come from the animal kingdom

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

5. Map prepared By US Government

6. Sporadic Human Cases of Avian Influenza • Since 2003 H5N1 has infected 227 people • 129 have died, mostly children and young adults. • Human deaths have been confirmed from: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. • Vietnam and Indonesia account for 80 of the total deaths. • Human infection with H5N1 is rare, and usually the result of virus transmission from birds to humans. • No evidence of mutation to sustained human to human transmissibility

7. DETERMINANTS OF PANDEMIC INFLUENZA A new influenza virus emerges to which the general population has little/no immunity The new virus must be able to replicate in humans and cause disease NOT TO DATE The new virus must be efficiently transmitted from one human to another

8. ESTABLISHING PANDEMIC THREAT

9. WHAT DO WE KNOW…. • Must distinguish between Seasonal Influenza, Avian Influenza and Pandemic Influenza • Pandemic influenza will happen (at some point) • It is more likely now than three years ago • It could be mild • It could be severe • It could be extremely severe • It affects younger age groups than "normal" influenza

10. WHAT DO WE KNOW - TWO • An effective pandemic influenza vaccine will take several months to develop • There will probably be few anti-viral medicines available close to the affected location and the emergence of resistance is possible • Need a global plan for rapid response to pandemic

11. WHAT DO WE KNOW - THREE • Influenza is infectious – but not as highly infectious as measles • Not everyone will be infected • There are ways of reducing the numbers affected: Maintain distance, Stay at home • If an infectious and damaging virus emerges, restriction on people’s movement may be justified • Need for epidemiological information to guide action: often hard to get such information quickly

12. 2 What Measures are being put in place to increase capacity for surveillance, detection and diagnosis internationally

13. Global Strategy Agreed Nov 2005 • 1 Stop influenza in animals through stamping out the disease at the place where the infection starts • 2 Prevent emergence of pandemic by limiting human exposure; • if pandemic does start, contain it quickly; • if containment is not possible, mitigate pandemic consequences. • Financing arrangements agreed Jan 2006

14. Key International Bodies • Food and Agriculture Organization • Crisis Management Centre • Regional Centres (Bangkok. New Delhi, Bamako, Gaborone, Nairobi, Budapest, Buenos Aries) • Monitoring and Risk Assessment • World Organization for Animal Health (oiE) • Standards for animal health • Reporting systems • Response strategies

15. Key International Bodies • World Health Organization • Revised International Health Regulations • (agreed May 2006) • Epidemic and Pandemic Alert and Response Team • Global Outbreak Alert and Response Network • Other United Nations Bodies (UNICEF, UNDP, WFP, OCHA, UNHCR) • Inter-agency Humanitarian Committee (IASC) • United Nations General Assembly • International Partnership on Avian and Pandemic Influenza (launched by US Government Sept 05)

16. 3 What are the predicted economic impacts of a global influenza pandemic

17. ECONOMIC IMPACTS OF PANDEMIC • The next 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

18. 4 What action is being taken to help people understand the risks they may face and prepare for a possible pandemic

19. THREE PANDEMIC SCENARIOS MODEL 3 - Rapid Onset / Widespread impact Little time for preparation, response is reactive and defensive MODEL 2 - Slow Onset / Moderate & Localized Impact Slowly acquires infectivity Containment may be successful Limited pandemic Impact MODEL 1 - Extended Pandemic Phase 3 / Continued Outbreaks of Avian Influenza Impact on livelihoods due to culling of birds Time

20. RESPONSE BEYOND HEALTH… Human Survival and Health • High illness & potentially higher death rates • Overstretched health facilities • Impact on persons with chronic disease • Absenteeism affecting manufacture and services Interruption of Electricity and Water Supplies • Telecommunications overload Basic Services and Utilities • Increased demand for governance & security • Higher public anxiety, reduced capacity • Potential exploitation Rule of Law and Governance • Diminished coping & support mechanisms • Shortage of basic necessities • Vulnerabilities – & needs - of Contained Groups Vulnerable Livelihoods • Trade & commerce disruptions • Reduced availability of cash • Interruption of logistics Financial Systems And Trade

21. LESSONS FROM SARS • Give priority to well-being of front line personnel • Do not withhold information • Engage communities • Encourage responsible, science-based and effective responses • Involve media • Global action is critical • Harness energies of multiple actors • Supportive Leadership – building effective coalitions

22. Pandemic Influenza Implementation Plans • All of Government Involved • Federal, State and Local Tiers • Engage Private and Voluntary Sectors • Action Items Indicated • Responsible Bodies Identified • Plan Tested • Revised Regularly

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

24. 5 What steps can organizations take to limit the risk of employee exposure to the avian influenza virus

25. BEST PRACTICE PANDEMIC PREP…. • Make sure that there is Health Care cover • Look at the business. • Establish core functions vital for business continuity • Focus on Economic, Travel, Logistics, Governance, and Social issues • Check out the plans of the local authorities • Liaise with Community-Based Organizations • Test procedures for Crisis Management • Establish protocols for critical cross-country actions • Use simulations to plan for different outcomes • Do not delay

26. PLANNING PROCESS Hazard/Risk Analysis Contingency Prioritization Scenario-Building The Plan PreparednessActions & PlanMaintenance What are risks to staff, operational continuity and operating environment? Which risks should be planned and prepared for? How might selected contingencies affect staff, operational continuity and operating environment? Prepare and share plan Plan rehearsal, updating as necessary, new factors?

27. WHAT SHOULD I DO? • Work through the issue with colleagues • Participate in Pandemic Simulations • Make sure that front line personnel get adequate support and protection • Emphasise the importance of keeping essential services going • Prepare to “hunker down” – supplies, stocks: six weeks? • Sustain the capacity for a respond of several months • Now is the time to get ready • Do not get complacent if disease incidence is low

28. Much achieved: much more to do It is up to all of us, together We are all held to account

29. Thank you david.nabarro@undp.orgwww.influenza.undg.org