1. 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

2. 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

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

4. H5N1 in humans during 2007

5. Looking back at the International Ministerial conference in Bamako
December 2006

6. 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

7. Rome:
Technical Workshop
June 2007

8. 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

9. 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

10. 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)

11. .

12. 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.

13. 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.

14. 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

15. 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

16. 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

17. Catastrophic Impact of a Pandemic

18. 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

19. 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 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

20. 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)

21. 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

22. Thank you.