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ASEM Workshop on Avian Influenza Control

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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 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
1900 1850 1950 2000 1847 1889 1918 1957 1968 42 yrs 29 yrs 39 yrs 11 yrs

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


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?

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 Country 2003 2004 2005 2006 2007 Total cases deaths Azerbaijan 8 5 Cambodia 4 2 1 7 China 13 3 25 16 Djibouti Egypt 18 10 20 38 15 Indonesia  55 45 37 32 112 90 Iraq Laos Nigeria Thailand 17 12 Turkey Viet Nam 29 61 19 100 46 98 43 115 79 71 47 334 205

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 Commitments and Disbursements Received by International Organizations, $ million Commitments Disbursements WHO 178.5 126.8 FAO 89.9 65.8 OIE 28.5 20.4 UNICEF 68.5 66.9 Other a/ 67.6 36.8 Total 433.0 316.7 Source: Donor reports to the World Bank polling exercise as of June 30, 2007.

12 Countries Receiving $10 million or More in Commitments
Recipients Countries Receiving $10 million or More in Commitments ($ million) Country Commitments Disbursements Vietnam 107 39 Indonesia 97 53 Nigeria 54 25 Turkey 47 12 Romania 42 4 India 35 3 Cambodia 28 13 Lao PDR Nepal 19 1 Bangladesh 18 2 Egypt 15 7 Afghanistan 14 West Bank & Gaza Armenia 5 Georgia 11 Moldova China 8

13 Human Cases, Deaths from H5N1 and Countries Affected

14 H5N1 still a global issue end 2007….

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

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

Inter-pandemic period Phase 1 No 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 2 No human infections, but a circulating animal influenza virus poses a risk to humans. Pandemic alert period Phase 3 Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread. Phase 4 Small cluster(s) with limited human-to-human transmission but spread is highly localized. Phase 5 Larger cluster(s) but human-to-human spread still localized Pandemic period Phase 6 Increased 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 pandemic Currently we are in Phase 3 where human infections with a new virus are present, but no (or very infrequent) human to human spread has occurred Progression to Phase 4 would require small clusters of human to human transmission in localized areas to present If the threat is elevated beyond Phase 4 a very quick progression from Phase 5 to Phase 6 (full pandemic) is likely to occur It 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 actions The 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

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 Economic Systems Trade & commerce disruptions Degraded labour force Interruption of regular supply systems

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

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

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

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-givers and children I 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 H5N1 But 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 income Her son might well be grieving for a favourite pet – perhaps even a member of his family.

31 Understand concerns of Householders

32 Appreciate the position of market workers

33 Use Clear Messages

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 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

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

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