Progress and Impact of Efforts to Control Avian Influenza and Prepare for the Next Pandemic David Nabarro United Nations System Influenza Coordination Peter C. Harrold Director, Operations Services, World Bank New Delhi International Ministerial Conference December 4, 2007

Looking back at the outcomes of Bamako conference December 2006 2. Outcomes from the Technical Workshop in Rome June 2007 3. Assessment of progress, gaps and remaining challenges

H5N1 in poultry & wild birds during 2007 During 2007 – 25 countries infected

H5N1 in humans during 2007

Looking back at the International Ministerial conference in Bamako December 2006

Bamako: Outcomes and Actions Effective action needed especially in Africa Incorporate avian influenza prevention into existing animal health work Incorporate pandemic preparedness into existing health programmes – in all nations Increased focus on non-health aspects Better coordination of external assistance Grants to the value of $474million were pledged Bamako Declaration: - Effective action, especially in Africa - Agreed that the Global vision for action was working Outcomes: 1. Development of animal & human health capacities Enhanced collaboration between animal and human health sectors Pandemic preparedness efforts extended to all nations Increase focus on non-health aspects Communications to empower behavior change 2. Continued monitoring of external assistance Ensuring effective coordination at country level Severely affected countries supported in coordinated manner 3. Ensuring involvement at all levels of voluntary and private sectors - Issues like compensation, communications and coordination continue to receive careful attention

Rome: Technical Workshop June 2007

Rome: What the workshop confirmed HPAI largely affecting poultry, occasionally spreading to humans and other mammals. H5N1 virus has not yet developed the capacity for sustained human-to-human transmission Control of the disease in poultry remains the priority intervention Un-infected countries need to prepare for possible virus incursions into poultry All countries need to improve human health capacity to deal with the emergence of a novel pandemic strain Organised jointly by FAO, OIE, WHO, UNICEF and UNSIC Attended by technical experts from the agencies, independent experts, representatives of donor agencies, development banks and senior veterinary officials Objectives: Consolidated information and opinion derived from earlier work on this disease Examined contentious technical issues relating to disease control Achieved consensus on the technical issues surrounding prevention and control Highlighted areas where further work should be focused or refocused to progressively reduce the threat of this disease to poultry and to humans

Rome: The key lessons identified Reports of successful control and prevention of the disease in poultry as a result of efforts being made in many countries Reports of several locations where infection is enzootic likely to remain so for some time Field research reveals reasons for persistent infections: knowledge helps direct longer term measures (risk reduction, vaccination and surveillance) for sustaining gains

UN- World Bank: Assessment of Progress and impact of efforts to control Avian influenza and prepare for the next Pandemic Third Global Progress report (Based on responses from 146 countries)

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Assessment of Progress (1) The H5N1 virus is considered enzootic in locations within at least 6 countries Countries report improved capacity to respond to Highly Pathogenic Influenza (HPAI) infection (more rapid and more effective): a movement of hundreds of thousands of people But veterinary capacity in many countries remains insufficient Outbreaks: Continue during the past 9 months even among better resourced countries. Improvement: Outbreaks are being detected more rapidly and the response is more effective. Veterinary Capacity: animal health services are not performing adequately with a lack of the necessary legislation and regulations; poor working relations between official veterinarians, private practitioners and farmers; insufficient budget for veterinary services and limited laboratory capacity, both in country and within regions.

Assessment of Progress (2) Reports suggest insufficient coordination between animal and human health surveillance and response networks within most regions Evidence indicates an improvement in human influenza virus diagnostic and surveillance capacity globally. However, capacity varies significantly between countries Over 90% of countries report that they have developed pandemic preparedness plans National preparedness for a pandemic responses is patchy Outbreaks: Continue during the past 9 months even among better resourced countries. Improvement: Outbreaks are being detected more rapidly and the response is more effective. Veterinary Capacity: animal health services are not performing adequately with a lack of the necessary legislation and regulations; poor working relations between official veterinarians, private practitioners and farmers; insufficient budget for veterinary services and limited laboratory capacity, both in country and within regions.

Assessment of Progress (3) Few countries have (a) sufficiently tested their plans, (b) included wider social and economic impacts or (c) considered vulnerable groups including migrants. These concerns apply to wealthy and poor countries. Humanitarian organizations and Red Cross Movement preparing for a pandemic at local level 73% of countries have implemented communication strategies to create awareness around the threat posed by HPAI H5N1 (with significant assistance from UNICEF). The impact varies: awareness does not always translate into behaviour change Continued insufficiencies in a number of countries and regions (in particular Africa). Countries are increasingly developing their capacities in accordance with the IHR (2005) to be in a position to detect and respond to influenza-type viruses and the early stages of pandemic containment. Pandemic plans: 95% of reporting countries report ‘some efforts” in pandemic preparedness planning There is insufficient attention to sectors other than health and to making plans operational, especially at the local level. In many countries much more work is needed to ensure that local and national stakeholders with experience in crisis response and humanitarian action are ready to respond to a full blown influenza pandemic. Communications: 73% of reporting countries indicate campaign has been launched to raise awareness of avian and human influenza Communication underpins much of the implementation of any integrated national plan An increased number of communication strategies have helped create awareness around the threat posed by HPAI H5N1 but variation exists Awareness does not always translate into behaviour change Behaviour change depends on multiple factors including identifying and targeting the correct audience

Challenges: Ensuring intensive responses where enzootic Long term maintenance of animal health (using FAO guidance on biosecurity) and functioning veterinary services (following OiE international standards) Integrated multi-sectoral pandemic preparedness– at local, national, regional and global levels Implementation of the International Health Regulations (IHR 2005) and capacity to detect, confirm and contain influenza-like illness Maintaining strong and continued political and financial commitments: Increase solidarity between countries

Key Messages: Underlying threat of a pandemic remains Need to broaden focus to cover other zoonoses Expand strategies to address medium and longer term challenges Maintain high level commitment Encourage convergence of animal, human and environmental health, as well as food safety and crisis management

Catastrophic Impact of a Pandemic

Global Response to Threat Guidance from OIE, FAO, and WHO -- and support from other technical experts Donors pledged more than $2.3 b to assist developing countries to respond to avian influenza and to prepare for pandemic As of June 30, 2007, $1.7 b of pledges already committed, of which more than $1.0 b already disbursed

Challenge as of end-2007 (1) Threat of avian influenza better understood, but fundamentally undiminished Focus on prevention and rapid response and containment and control of AI in emergency response in 2005-2007 was appropriate – and should continue … but Also need medium- and long-term strengthening of capacity of animal and human health systems Investments in AI response have wider benefits, beyond AI

Challenge as of end-2007 (2) Some countries are now preparing for their third (or even fourth) “avian flu season” Less concern with how to respond – and more with how to sustain a response: e.g., Vietnam experienced resurgence of AI outbreaks (despite extensive control measures with good results)

Addressing Threat of Zoonotic Diseases Medium-term and long-term investments in animal and human health systems so as to improve capacity for rapid response to control diseases Coordination across institutional, sectoral, and territorial boundaries Sustain successes achieved to date by promoting long-term systemic changes

Thank you. www.un-influenza.org www.worldbank.org/avianflu