1. Preparedness, Coordination, Monitoring \ Prepared with the support of Peacepath Consulting

2. BOS 2 040317-GMH-FAO-Coordv05 Three Kinds of Influenza Seasonal Influenza -An annual pattern -Usually mild, but can be serious – even fatal – in elderly -Routine vaccination available Avian Influenza (“Bird Flu”) -Current epidemic of Highly Pathogenic Avian Influenza in Asia and entering Europe Pandemic Influenza -Intermittent, Major morbidity and mortality, Economic and social consequences

3. BOS 3 040317-GMH-FAO-Coordv05 Past Influenza Pandemics 1900 1850 1950 2000 1847 1889 1918 1957 1968 42 yrs 29 yrs 39 yrs 11 yrs 30 – 40 years cycle No Pandemic for > 35 years

4. BOS 4 040317-GMH-FAO-Coordv05 Mortality during the pandemic of 1918-19  3 epidemic waves in close succession  March 1918, Sept 1918, Feb 1919  Est 40 million deaths world- wide, A/H1N1 – Spanish influenza

5. BOS 5 040317-GMH-FAO-Coordv05 Pandemic Geographic spread: 1918-19 ? 01/19 03/18 04/18 06/18 05/18 06/18 ? C.W. Potter, Textbook of Influenza, 1998

6. BOS 6 040317-GMH-FAO-Coordv05 Pandemic Geographic spread: 1957-58 02/57 04/57 06/57 05/57 06/57 07/57 08/57 06/57 07/57 C.W. Potter, Textbook of Influenza, 1998

7. BOS 7 040317-GMH-FAO-Coordv05 Why is it a threat to humans?What is the “Bird Flu”? Overview 2. Influenza viruses can be highly transmittable (e.g. airborne) 3. The H5N1 virus could change and become transmissible between humans 1.The human population has demonstrated low immunity to the H5N1 strain with high mortality 2. Outbreaks have occurred in poultry, migratory birds and other fowl across SE Asia, Europe and Russia 3. This “Bird Flu” has caused millions of poultry deaths, affected household economies & infected humans 1.H5N1 is a new strain of influenza virus present in birds

8. BOS 8 040317-GMH-FAO-Coordv05 Threat of H5N1 Human Influenza Prerequisites for a pandemic: 1.A novel influenza virus must emerge to which the general population has little or no immunity and for which there is no effective vaccine 2.The new virus must be able to replicate in humans and cause disease 3.The new virus must be efficiently transmitted from one human to another ?

9. BOS 9 040317-GMH-FAO-Coordv05 What do we know…. Pandemic influenza will happen (at some point) It is more likely now than three years ago It could be mild It could be severe It could be extremely severe It affects younger age groups than "normal" influenza

10. BOS 10 040317-GMH-FAO-Coordv05 What do we know - Two It could come once or in waves It will probably come quickly Work forces will be badly affected Economies will be disrupted Maybe infectious before symptoms appear There are infections with no symptoms Modelling suggests that containment will not be easy The time between detection and effective response is very short

11. BOS 11 040317-GMH-FAO-Coordv05 What do we know - Three Influenza is infectious – but not as highly infectious as measles Not everyone will be infected There are ways of reducing the numbers affected If an infectious and damaging virus emerges, containment of people may be justified An effective vaccine will take several months to develop There will probably be many less anti-viral medicines available that will be requested by governments; the emergence of resistance is possible

12. BOS 12 040317-GMH-FAO-Coordv05 Strategy take action to contain the avian influenza epidemic through upgrading veterinary infrastructure, improving bio-security and changing patterns of bird trade, prepare for the next pandemic with vastly improved surveillance, stockpiled anti-virals and other medicines, protective clothing, containment plans, and be ready to respond to the pandemic in ways that keep vital services and societies going and minimise suffering. When the pandemic starts it will be too late to get prepared

13. BOS 13 040317-GMH-FAO-Coordv05 WHO has a classification for threat level … 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 3Human 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.

14. BOS 14 040317-GMH-FAO-Coordv05 Humanitarian Engagement Critical roles of statutory and voluntary bodies, at global, regional, national and local levels (National Governments, WHO, FAO…. Information Sharing: Risks, Threats, Preparedness and Response Agreed working relationships and protocols: International volunteer bodies, civil society at country level, National authorities, International organizations Preparedness planning among IASC membership through existing processes Preparedness planning, including scenarios and simulations, through dedicated new process

15. BOS 15 040317-GMH-FAO-Coordv05 The Coordination Challenge Uncertainties Nature of the AI / HI threat (severity, reach) When and where escalation will occur Duration of AI / HI presence Certainties Local threat with global implications Countries have variable capacity to prevent, prepare and respond Short window of opportunity for initial assessment and robust response Indirect behaviours (e.g. public reaction, media response, government actions) will influence the operating environment as much as the direct behaviours of the AI or HI virus Several factors influence the complexity of the AI/HI coordination challenge:

16. BOS 16 040317-GMH-FAO-Coordv05 Implications for Approach 1.Ensure accurate, timely, relevant and transparent exchange of information 2.Generate clear, consistent and timely messages on the status of the situation 3.Facilitate unprecedented levels of trust and joint action across agencies, actors and levels 4.Enable the international community to optimally deploy global resources (technical, human, financial) to minimize the global impact on lives and livelihoods 5.Build on existing processes where possible To succeed, Avian and Human Influenza coordination mechanisms must:

17. BOS 17 040317-GMH-FAO-Coordv05 Objective To facilitate a collaborative process among key actors to transform: A collection of organizations working independently toward individual objectives The inefficient use of collective experience, expertise and resources A community of organizations and active networks working together to achieve common objectives An optimal use of collective experience, expertise and resources

18. BOS 18 040317-GMH-FAO-Coordv05 Levels of Coordination Coordination will be active at three broad levels: Country Level Coordination 1 Working Level Coordination 2 Global Level Coordination 3 Provide local leadership Integrate and inform global teams Implement preparedness & response Facilitate information exchange Set global standards Prioritize activities against objectives Align strategy Track progress Identify gaps and blocks Drive Resolution

19. BOS 19 040317-GMH-FAO-Coordv05 Proposed Framework To provide coordinated operational and technical support: National Coordination Mechanism (Country Led) Integrated Country Plan International Consortium on Avian & Pandemic Influenza (Countries, Agencies, Financiers, Civil Society) Working Level Coordination Financing Partners: MDBs, Bilaterals, etc Private Initiatives Regional Organizations: APEC, ASEAN, etc FAOOIEWHO IASC membership Alignment and Harmonization

20. BOS 20 040317-GMH-FAO-Coordv05 In Practice – Country Level Sector Stakeholders Beneficiaries National Government central actor in coordination Propose the use of existing coordination arrangements that bring in UN system agencies, Development Banks, OIE, Key Financiers, Other stakeholders (such as Red Cross, Private Sector, Civil Society) Strengthening capacities of regional networks and organizations, particularly so they can effectively support coordination on cross-border issues. Encourage cooperation on research and development Quick and flexible mechanism to draw down funding to finance control in event of a major outbreak. Ensuring specialized institutions (FAO, OIE, WHO and others) are equipped to provide standards, policy and technical guidance and to support capacity building, in response to country needs

21. BOS 21 040317-GMH-FAO-Coordv05 In Practice – Global Level To ensure collective responsibility for response to AI and pandemic threat (from new and emerging infections) from a global perspective within a set of agreed principles To take on High Level coordination functions (a) aligning strategy, (b) tracking progress, (c) identifying gaps and blocks, (d) driving progress to results Establish global goals, promote international standards, monitor regularly, and adjust the overall effort as needed Take on and address challenging policy, financing, and access issues, provide guidance on ways in which they can best be addressed Support could be provided jointly by UN System Influenza Coordinator, and World Bank with other relevant bodies Consortium composed of high-level representatives of countries affected or at risk, international technical agencies, financiers, regional bodies, civil society. Functions include:

22. BOS 22 040317-GMH-FAO-Coordv05 Strategy framework to guide integration and alignment of strategies generated by the working level teams UN System Coordinator Contributions 1 Tool for tracking progress against critical activities and objectives (e.g. dashboard) 2 Information on where and why resources required, upon which financiers can base investment decisions Targeted analysis to identify possible scenarios and risks as the situation evolves and implications for prevention, preparedness and response 3 4 The UN Coordinator will aim to provide the following inputs to the consortium:

23. BOS 23 040317-GMH-FAO-Coordv05 Coordinator for Avian and Human Influenza Instruments, information and systems for effective coordination within UN system and synergized UN system links with other involved parties Countries: Coordinated support (through RCs and UN/Bank Country Teams) (i) track  influenza situation,,  implementation of integrated national plan,  coordination of support  overall effectiveness of programmes (ii) stimulate effective actions, fill gaps, reduce duplication undo blocks UNDGO BCPR Whole UN Country Teams Harmonized communications on influenza issues;  consistent messages to communicate risk and stimulate specified behaviours  strategic dissemination of chosen messages  ensuring strategies are fully implemented through multiple networks  coordinated communication through UN system Preparedness and Contingency Planning: UN system R/Cs and IASC country teams, and regional offices, support cross-sectoral pandemic response and containment planning (a) both within and between countries; (from region to global), (b) between UN system and each country ’ s authorities (c) throughout the UN system at each level (and link efforts to keep staff safe): Seeking resolution on difficult policy decisions: (i) availability of stocks of antiviral medicines, their distribution in the event of need: (ii) means for triggering changes in alert levels (iii) vaccine development, (iv) response and containment, access to PPM (v) rapid improvement in animal health services (vi) marshalling of science and technology Engagement in Policy Initiatives: Constructive interactions between the UN system/World Bank/IASC and partnerships of decision makers) Working-level inter- agency coordination & synergy of UN system - external linkages  Interagency strategy;  Engagement by humanitarian agencies;  Engagement with private entities, NGOs, militaries, academics, foundations, prof assocs;  information network  financial tracking services Regional level: coordination support

24. BOS 24 040317-GMH-FAO-Coordv05 Potential Dashboard Tool Priority 1Priority 2Priority 3 Issue Human Vaccine SupplyVeterinary System Strengthening Increasing Public Health Laboratory Capacity Lead Agency WHOOiE / FAOWHO Status of Strategy  Complete  Level of stakeholder commitment  Assessment of alignment with other priorities Key Outcome Targets  xx% increase in global production capacity  xx funded trials of approaches to extend reach of doses (e.g. antigen sparing, intradermal)  xx% of forecasted global pandemic vaccine supply secured for central UN management and distribution Policy Initiatives  Global principles for revising regulatory pathways under pandemic risk Current Capacity  Deployed / Required  % Surge capacity  % regions covered Funding Required$xx M (USD) Funding Received$xx M (USD) % of Funding Targetxx%

25. BOS 25 040317-GMH-FAO-Coordv05 Pandemic Preparedness Strengthened capacity to successfully combat the AI / HI threat 1.Pandemic will have extraordinary impact on economic Avoids duplication of efforts 2.Optimizes use of global assets and resources 3.Facilitates knowledge transfer and active learning as the situation evolves 4.Provides a forum for building strong, effective working relationships before a full scale crisis hits

26. BOS 26 040317-GMH-FAO-Coordv05 Thank you