1. EC/ECDC/WHO Uppsala Presentation by David Nabarro UN System Influenza Coordinator May 15 th 2006

2. PREPARING FOR PANDEMICS Building a Movement of Actors Being Alert to Pandemic Potential Working for Pandemic Prevention Readying for Pandemic Response –The H5N1 Wake-Up Call : Urgency and Focus Our Common Cause An International effort for the Global Good

3. 1BUILDING A MOVEMENT OF ACTORS WITH COMMON CAUSE Strategic Focus: Science Base Acting Locally, Nationally, Regionally, Globally Involving Political Leaders, Government Services, Professional Bodies, Civil Society Engaging key figures, institutions, systems, technical networks for the long term Sustaining and institutionalizing focus on health security Mobilizing funds…..

4. 2BEING ALERT TO PANDEMIC POTENTIAL –Local outbreaks: Global Impact (SARS - <1000 dead, $50 billion economic loss). –Significant loss of life: High absenteeism –IMF analysis: significant temporary impact Disrupted supplies (markets closed, access reduced, unreliable utilities, shortages of cash, telecom outages Reduced demand (affecting travel and leisure, restaurant and food industry) –Threats to Rule of law, Security, Continuity of Governance

5. H5N1 in Birds …… 3WORKING FOR PANDEMIC PREVENTION

6. H5N1 OUTBREAKS IN BIRDS: CHRONOLOGY 1996 TO DATE 1996 to 2003June 2004 December 2004 June 2005 December 2005 March 2006 China South Korea Indonesia Vietnam Thailand Cambodia Japan Laos Malaysia Kazakhstan Russia Mongolia Turkey Ukraine Romania Croatia Bulgaria Azerbaijan Iraq Iran Niger Nigeria Egypt France Switzerland Germany Italy Austria Bosnia Herzegovina Slovakia Serbia Montenegro Hungary Slovenia Greece Pakistan India 2000 miles 3000 miles 4000 miles 5000 miles 6000 miles 7000 miles Distance from Hong Kong Map compiled by WFP Emergency Preparedness and Response Branch (ODAP) 06.03.06

7. H5N1 in Birds –An Epizootic moving rapidly across the world: sporadic human cases and the potential to cause a pandemic –More than 30 countries reporting H5N1 since January 2006; –15 countries in the preceding 2.5 years 70% of new infections will come from the animal kingdom 3WORKING FOR PANDEMIC PREVENTION

8. Three Pandemic Scenarios Time Impact MODEL 3 - Rapid Onset / Widespread impact Little time for preparation, response is reactive and defensive MODEL 2 - Slow Onset / Moderate & Localized Impact Slowly acquires infectivity Containment may be successful Limited pandemic MODEL 1 - Extended Pandemic Phase 3 / Continued Outbreaks of Avian Influenza Impact on livelihoods due to culling of birds

9. 4BEING READY FOR PANDEMIC RESPONSE Human Survival and Health Human Survival and Health Rule of Law and Governance Rule of Law and Governance Vulnerable Livelihoods Vulnerable Livelihoods Financial Systems And Trade Financial Systems And Trade High illness & potentially higher death rates Overstretched health facilities Impact on persons with chronic disease Increased demand for governance & security Higher public anxiety, reduced capacity Potential exploitation Diminished coping & support mechanisms Shortage of basic necessities Vulnerabilities – & needs - of Contained Groups Trade & commerce disruptions Reduced availability of cash Interruption of logistics Basic Services and Utilities Basic Services and Utilities Absenteeism affecting manufacture and services Interruption of Electricity and Water Supplies Telecommunications overload

10. 5AGREED STRATEGY (November 2005) 1.Stop influenza in animals through stamping out the disease at the place where the infection starts 2.Prevent emergence of pandemic by limiting human exposure; if pandemic does start, contain it quickly; if containment is not possible, mitigate pandemic consequences.

11. IN PURSUIT OF THE STRATEGY Integrated National Influenza Plans Multiple Actors Engaged Financial Assistance Pledged (Jan 2006) Urgent Programmes Initiated National Plans Appraised External support for Implementation Emphasis on Coordination: Harmony, Synergy, Unity

12. Pandemic Prevention Reduce Animal Disease Bio-security and Disinfection Surveillance & Early Warning Laboratory Response to infection –Restriction on Movement –Culling –Compensation –Strategic Vaccination Veterinary Capacity Protect Human Health Early Warning Laboratory Response Public Health Promote Safe Behaviour Risk Communication Target Groups Messages and Media Synergy in Government Pandemic Management Contain Quickly Skilled Personnel Protective Equipment Consumables Ensure Services Health Care Basic Services for all Rights of vulnerable Enhance Continuity Governance Rule of Law Economic and Social Systems Coordinate and Communicate Inside Government Between States Initiate Recovery INTEGRATED COUNTRY INFLUENZA PLANS

13. MULTIPLE ACTORS ENGAGED National execution with external technical assistance reflecting international standards and operational support with pandemic planning and response National civil society International NGOs and Red Cross Private entities (local, national, international) Networks (scientific, relief) Technical Assistance Coordination –Animal Health (FAO, OiE) –Human Health (WHO) –Communications (UNICEF) –Governance and Coordination (UNDP) –Pandemic Preparedness (OCHA) –Logistics and Vulnerability issues (WFP) Financial Assistance Intergovernmental Organization

14. FINANCIAL ASSISTANCE AVAILABLE Extent of required international technical and financial assistance estimated during November and December 2005 Multi-pathway Financing and coordination framework: Countries direct bilateral support, multi-donor trust fund, UN system support Loans – IDA, IBRD Regional Regional Institutions and Networks Global Intergovernmental bodies (OiE) Multilateral System (FAO, WHO, UNICEF International NGOs Support pledged in Beijing mid-January 2006: overall value $1.9 billion; implementation principles agreed Not sufficient for countries, not sufficient for UN

15. NATIONAL PROGRAMMES STARTED Urgent action to contain animal disease Medium term action to improve performance of animal and human health sectors –Substantial commitment to investment by Government –A strong evidence base –Institutional development and capacity building –Long-term technical assistance Readiness for Rapid Containment; Prepare for Pandemic Country by Country

16. NATIONAL PLANS APPRAISED A realistic reflection of ongoing processes? Purposeful direction from highest political level? Risk and capacity analyses, evidence base Sound Technical Strategy with Priority Actions (Behaviour Change, Animal Health, Human Health, Pandemic Preparedness, ) Plans for Community Engagement? Implementing Capacity Addressed? Triggers for crisis mode, standard procedures, pandemic readiness tested? Inputs : national, regional and international

17. EXTERNAL HELP TO IMPLEMENT National level task force: Government, Bilateral Donors, Development Banks, NGOs, Private Entities, Specialized International Agencies, Wider UN system (harmony, synergy) Single Integrated Programme and Plan: Evolving from crisis to longer term – cash and technical support (like a SWAP) Joint finalization, appraisal, prioritization: Negotiation: Financing conference, support for elements of plan Challenge: Managing the appraisals, financing short-term action (culling, compensation)

18. HARMONY, SYNERGY, UNITY THE ONLY WAY TO RESPOND IS TO WORK TOGETHER In Country Inter Agency Inter-country Inclusive National Leadership Join up government departments, civil society and partners, as one Implement and monitor together Share information Agree global standards Support national efforts Monitor achievements jointly Align national strategy for global good Assess progress together Fill gaps and surmount blocks Face up to the difficult issues first

19. BEST PRACTICE 05 - 06 Sound, evidence-based national strategy and plan Focus on immediate (under one year) and medium term (up to 5 years) Primary focus to animal health (including veterinary services and livestock sectors), Emphasise effective systems for public health Inter-sectoral approaches to pandemic preparedness. Fully-costed operational plan Implementation and management arrangements Regular reviews of relevance and utility Transparent analyses of achievements

20. MAKING BEST PRACTICE HAPPEN 1.POLITICAL LEADERSHIP FOCUSING ON TOUGH ISSUES 2.THE WHOLE OF GOVERNMENT INVOLVED, MORE THAN HEALTH AND AGRICULTURE …PRIVATE AND VOLUNTARY SECTORS TOO 3.MASS MEDIA CAMPAIGNS TO PROMOTE HEALTHY ACTIONS AND PANDEMIC READINESS 4.MANAGEMENT SYSTEMS: FUNDS AND STANDARD PROCEDURES DISTRIBUTED, KEY PEOPLE MADE RESPONSIBLE AND ACCOUNTABLE – AT NATIONAL AND LOCAL LEVELS 5.INCENTIVES AND COMPENSATION SCHEMES TO REDUCE VULNERABILITY AND SUSTAIN LIVELIHOODS 6.REGULAR REVIEWS OF PROGRESS BY ALL STAKEHOLDERS, ANALYZING PROGRESS, TRACKING FUNDS, AND MODIFYING PROGRAMME DIRECTION 7.EXTERNAL COMMUNITY WORKING TOGETHER IN SUPPORT OF NATIONAL ACTION

21. 6INTERNATIONAL ACTION Risks posed by avian Influenza and potential pandemic –Sharing information on threats to livelihoods, to continuity of services, to health; joint response to uncertainty Information and Support for Behaviour Change –Encouraging an international movement for reduction of pandemic risks: a joint approach reflecting best practice Technical support for better Animal Health –Inter-country support for surveillance, incentives, prompt reporting, responsiveness, bio-security, strategic vaccination and recovery Technical support for Pandemic Containment –Inter-country support for public health systems: surveillance, information, containment; access to vital supplies Continuity and well-being during Pandemic –Intergovernmental mechanisms to sustain health outcomes, equity, continuity, and recovery Applying science to animal and human influenza –International epidemiological initiatives; Development of Vaccines and Diagnostics

22. ASKING QUESTIONS OF OURSELVES…. Are we working together, as a team –making the weak links strong, wherever they may be? –Being ready to raise our game - at a moments notice? –Moving as one, holding our shape, keeping fluid, whatever the challenges we face? –At ease with uncertainty about what will happen but determined to get the right result?