1. Pandemic Influenza: Preparedness & Response at Local Level Royal United Services Institute for Defence & Security Studies 20 July 2005 Joyshri Sarangi, CCDC Health Protection Director: Avon, Gloucestershire & Wiltshire © Reproduced Courtesy of Health Protection Agency/Influenza Respiratory Virus Programme Board Manager

2. Pandemic Influenza: Preparedness and response at local level Key Questions at local level  How is pandemic flu different from normal seasonal ‘flu’ ?  How will we ensure effective Health Protection action is taken in the event of a local suspect initial case/cases of pandemic flu?  What escalation steps are necessary to activate a coordinated wider response (local-regional-national) within a short timescale?  What can we do in advance to prepare for pandemic flu?

3. Local Implications of the Variation in Virus Structure Awareness of R&D activity for the development of a safe, effective vaccine Timeline for vaccine manufacture Site of production & delivery mechanisms ? Priority groups for vaccine administration How is Pandemic Flu different from seasonal flu?

4. Local Implications of the Animal Reservoir of Influenza A Detection of initial cases pandemic flu History of exposure to `reservoirs` The returning traveller with a fever HPA links to DEFRA How is Pandemic Flu different from seasonal flu?

5. Local Strategies Standing emergency planning arrangements & Exercising Threat specific approach to Civil Contingency planning Systematic awareness raising Development of Standard Operating Procedures for local HP response Lessons from SARS experience How will we ensure effective Health Protection action in the event of a local suspect initial case/cases of pandemic flu?

6. Local-Regional-National-International Standing cascade arrangements Agency specific Multi-agency co-ordination Timeframe Specific HP Actions What escalation steps are necessary to activate a coordinated wider response ? 2 - 4 weeks

7. What can we do in advance to prepare for pandemic flu? Historical Experience 1889-1892? A/H2N2 1900? A/H3N8 mild pandemic 1918A/H1N1 Spanish influenza 1957A/H2N2 Asian influenza 1968A/H3N2 Hong Kong influenza Shortest interval = 11 years Longest interval = 39 years Current interval = 37 years The window of opportunity

8. What can we do in advance to prepare for pandemic flu? Mortality during Pandemics  1918: unprecedented, 40-80 million deaths over 3 distinct ‘waves’ (198,000 in Britain)  1957: 1 million  1968: 0.8 million The Scale:

9. 0 20 40 60 80 100 120 140 160 0-45-9 10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84 85+ Death Rate per 1,000 4 st quarter 1 st quarter Age specific influenza death rates among females in England & Wales during 1st and 4th quarters of 1918 Ministry of Health, GB, 1919

10. PopulationClinical Cases GP* consultation s Minimum Hospitalisation required* Excess Deaths A GP list (1,000) 2505021 A Primary Care Trust (population 100,000) 25,0005,000150100 A Strategic Health Authority (population 1,000,000) 250,00050,00015001000 England and Wales total population (population 52,041,916 Census 2001) 13,000,0002,600,00072,00048,000 Modelling predictions based on 25% clinical attack rate and 0.37% case-fatality

11. Local-Regional-National-International Standing cascade arrangements Agency specific Multi-agency co-ordination Timeframe Specific HP Actions What can we do in advance to prepare for pandemic flu?

12. DH plan covers all of UK Covers role of DH as ‘lead government department’ inc. chains of command Covers NHS and wider issues such as essential services (civil emergency response) Covers DH responsibilities for policy and practice regarding antiviral drugs (oseltamivir: Tamiflu ® ) and vaccine (if/when available) Overarching CO & CCA arrangements Wider Contingency Planning for Pandemic Flu

13. Specific NHS Operational Guidance Document Logistics of Antiviral therapy distribution Prioritisation Key Workers concept Mass vaccination arrangements Timeline for development and delivery Logistics of distribution and administration Public sector infrastructure Business continuity planning Data sources of societal impact for NHSDH plan covers all of UK Wider Contingency Planning for Pandemic Flu (2)

14. Contingency Planning for Pandemic Flu: Health Protection Agency Specific Actions

15. What could `it` mean for the HPA Timely influenza surveillance activity from diverse sources on: – Suspect cases – Multi-agency data on sickness/absence at a regional/local level eg `blue light` Daily reporting requirement to DH/Cabinet Office - CfI/LaRS Civil Contingency Framework_- national/regional/local Likelihood of redeployment of staff at all levels with workload implications Likely interference with other activities - business continuity Increased demand for facilities support/management (Operations Room/Accommodation/Catering) HPA Staff sickness absence