Presentation on theme: "ASEM Workshop on Avian Influenza Control"— Presentation transcript:
1 ASEM Workshop on Avian Influenza Control Global Update and Future Direction of Avian Influenza Control (in context of influenza pandemic preparations)ASEM Workshop on Avian Influenza ControlPresentation by David NabarroUN System Influenza CoordinatorTuesday November 12th 2007
2 Outline of ContentInfluenza Pandemic Prevention: Responses to the threat of Highly Pathogenic Avian Influenza H5N1Pandemic Preparedness: The importance of multi-sectoral approaches to human health securityPandemic Readiness: Testing preparedness to assess state of readinessInter-Governmental Approaches: Encouraging joint action by countriesFuture Directions: Preventing and being ready to respond to animal diseases that affected humans
3 Past Influenza Pandemics 19001850195020001847188919181957196842 yrs29 yrs39 yrs11 yrs
4 1918-19: a two year global crisis caused by an Influenza Virus 06/18?04/1803/1806/1805/18?01/1906/18C.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 2007Powerful 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 ChinaPotential for a marked increase in outbreaks during next few monthsUncertain epidemiologyContribution 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 humansH5N1 infected over 300 people since 2003Over 200 have died, mostly children and young adultsGenetic 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 2007Country20032004200520062007TotalcasesdeathsAzerbaijan85Cambodia4217China1332516DjiboutiEgypt1810203815Indonesia 5545373211290IraqLaosNigeriaThailand1712TurkeyViet Nam296119100469843115797147334205
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 spentThe 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 fundsOf 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 statusCommitments and Disbursements Received by International Organizations, $ millionCommitmentsDisbursementsWHO178.5126.8FAO89.965.8OIE28.520.4UNICEF68.566.9Other a/67.636.8Total433.0316.7Source: Donor reports to the World Bank polling exercise as of June 30, 2007.
12 Countries Receiving $10 million or More in Commitments RecipientsCountries Receiving $10 million or More in Commitments($ million)CountryCommitmentsDisbursementsVietnam10739Indonesia9753Nigeria5425Turkey4712Romania424India353Cambodia2813Lao PDRNepal191Bangladesh182Egypt157Afghanistan14West Bank & GazaArmenia5Georgia11MoldovaChina8
13 Human Cases, Deaths from H5N1 and Countries Affected
15 CONTRIBUTION OF ASIAN AND EUROPEAN COUNTRIES Improvements in Animal Health Surveillance SystemsCapacity for Disease Detection and ResponseImprovements in Bio-Security – in both family and commercial poultry production and in marketsMass Information to the General PublicWidespread Vaccination ProgrammesCapacity to Monitor and Adjust for better performanceDevelopment of new vaccines and diagnosticsImprovement in Public Health CapacityPandemic 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 casesUsing 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 systemsIntensify 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? Inter-pandemic periodPhase 1No new influenza virus detected in humans. If a new influenza virus presents in animals, the risk of human infection is considered to be low.Phase 2No human infections, but a circulating animal influenza virus poses a risk to humans.Pandemic alert periodPhase 3Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread.Phase 4Small cluster(s) with limited human-to-human transmission but spread is highly localized.Phase 5Larger cluster(s) but human-to-human spread still localizedPandemic periodPhase 6Increased and sustained transmission in general population.WHO has outlined 6 phases to help us understand where we are in relation to the threat of a severe global pandemicCurrently we are in Phase 3 where human infections with a new virus are present, but no (or very infrequent) human to human spread has occurredProgression to Phase 4 would require small clusters of human to human transmission in localized areas to presentIf the threat is elevated beyond Phase 4 a very quick progression from Phase 5 to Phase 6 (full pandemic) is likely to occurIt is important to note that:Further progression of the threat will depend not just on the nature of the virus, but also on the success of containment and other response actionsThe ability of WHO to accurately assess and call/announce an elevated threat is dependent on accuracy of analysis and reporting in country.Technical Note: WHO updated their pandemic phase definitions Feb/March and it was at this time that Phase ‘3’ was declared in the new system. The first human case of H5N1, however, was in 1997 in Hong Kong, and so technically we have been in phase 3 since that time.UN System Influenza Coordination
19 POTENTIAL IMPACTS OF AVIAN & PANDEMIC INFLUENZA LivelihoodsFood and income loss from poultry deaths, culling & decreased economic activityHigh illness & potentially higher death ratesOverstretched health facilitiesDisproportionate impact on vulnerableHuman HealthIncreased demand for governance & securityHigher public anxietyReduced capacity due to illness & deathGovernance &SecurityDeterioration of coping & support mechanismsInterruption in public servicesQuarantine policiesSocial &Humanitarian NeedsEconomic SystemsTrade & commerce disruptionsDegraded labour forceInterruption of regular supply systems
20 PANDEMIC IMPACT RELATED TO CONTINUITY OF… 1 Health ServicesMedicines, Commodities, Equipment, R and D, Patient Care, Lab services2 Financial ServicesBanking (cash and settlements), financial regulation, risk management and insurance3 Food and its distributionAgriculture and livestock, Distribution and retailing4 Utilities, Logistics, Personal ServicesElectricity, Water, Telecoms, Transport and Logistics, Postal services,5 Leisure and RecreationTourism and Travel, Airports, Sports6 Government, Security, MilitaryPublic Services, Law and Order, Judiciary and Correction, Private Security, Human Rights7 MediaBroadcast, Print; Podcast and Blog8 Environment and hygieneWildlife 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 planningEngage professionals from different levelsEnsure high level of popular awareness and understandingIS THE STRATEGY WIDELY UNDERSTOOD?Early Detection, Investigation and Confirmation, ContainmentSocial distancing, personal protection, movement restriction, maintenance of essential infrastructureSystematic 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 MovementsProtocols developed for use of stockpiles, emergency operationsHumanitarian NGOs, local government, Private Sector synchronizedCommunications systemPlans Simulated and Lessons Applied
23 GLOBAL READINESS - SEPT 2007 Preparedness Plans not always fully testedContainment protocols still to be taken forward by groups of countriesCivil Society and Private Enterprise NOT always involvedImportance of identifying and working with vulnerable populationsValue of clear communications protocolsReadiness 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 STRATEGYFAO/OiE/WHO/World Bank and Partners’ strategy meeting (Geneva November 2005) and review meeting Rome June 2006)INTERGOVERNMENTAL SOLIDARITYFinancial and political (Beijing and Bamako pledging Conference, Washington, Ottawa and Vienna High Level meetings)EXTERNAL ASSISTANCETechnical and financial support by specialized and donor agencies
27 PREREQUISITES FOR SUCCESS Political Commitment - to joint and effective action based on agreed strategiesResources – sufficient for incident responseFunctioning Alliances – government, public, private, mediaCombined operations – people’s health, livestock health, informed population, regulations properly enforced, data and samples sharedAdequate incentives – to report, to cull, to improve safetyMobilized 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
30 Understand perspectives of Care-givers and childrenI want you to look at this picture for a few minutes. wonder what you feel when you look at this picture:Discomfort, concern, fear? Im sure many of you will be seeing H5N1But H5N1 will probably not be top of their mind. Many tell us “Birds die all the time”.She is probably seeing the loss of a good egg layer, the family food source, and perhaps even a modest incomeHer son might well be grieving for a favourite pet – perhaps even a member of his family.
34 Explain Messages Repeatedly: Public Service Announcements viewed 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 surprise70% of them come from the animal kingdomThey pose a threat to the economic, social and human security of people throughout the worldCountries 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 warning70% of emerging diseases will come from AnimalsImportance of convergence: animal health, environmental health, food safety, human healthImportance of governments, voluntary sector, business and community responding together
38 Recap of ContentInfluenza Pandemic Prevention: Responses to the threat of Highly Pathogenic Avian Influenza H5N1Pandemic Preparedness: The importance of multi-sectoral approaches to human health securityPandemic Readiness: Testing preparedness to assess state of readinessInter-Governmental Approaches: Encouraging joint action by countriesFuture Directions: Preventing and being ready to respond to animal diseases that affected humans