Global Update and Future Direction of Avian Influenza Control (in context of influenza pandemic preparations) 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 ControlPresentation by David Nabarro

UN System Influenza CoordinatorTuesday November 12th 2007

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

Past Influenza Pandemics

1900

1850

1950

2000

1847

1889

1918

19571968

42 yrs

29 yrs

39 yrs

11 yrs

1918-19: a two year global crisis caused by an Influenza Virus

?01/19

03/1804/18

06/18

05/18

06/18

06/18

?

C.W. Potter, Textbook of Influenza, 1998

1 Influenza Pandemic Prevention

The threat from Highly Pathogenic Avian Influenza H5N1

GLOBAL AVIAN INFLUENZA SITUATION

• 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?

SPORADIC HUMAN CASES OF AVIAN INFLUENZA

• 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

Country 

2003 2004 2005 2006 2007 Total

cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths

Azerbaijan 0 0 0 0 0 0 8 5 0 0 8 5

Cambodia 0 0 0 0 4 4 2 2 1 1 7 7

China 1 1 0 0 8 5 13 8 3 2 25 16

Djibouti 0 0 0 0 0 0 1 0 0 0 1 0

Egypt 0 0 0 0 0 0 18 10 20 5 38 15

Indonesia  0 0 0 0 20 13 55 45 37 32 112 90

Iraq 0 0 0 0 0 0 3 2 0 0 3 2

Laos 0 0 0 0 0 0 0 0 2 2 2 2

Nigeria 0 0 0 0 0 0 0 0 1 1 1 1

Thailand 0 0 17 12 5 2 3 3 0 0 25 17

Turkey 0 0 0 0 0 0 12 4 0 0 12 4

Viet Nam 3 3 29 20 61 19 0 0 7 4 100 46

Total 4 4 46 32 98 43 115 79 71 47 334 205

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

5 November 2007

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

TECHNICAL AND FINANCIAL

ASSISTANCE: PROGRESS SINCE 2006

Funding status

Countries Become More Dependent on Loans as Grants

Decline

0

50

100

150

200

250

300

350

Up to April '06 May-Oct. '06 Nov. '06-J une '07

Reporting Period

In Kind Grant Loans

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.

Recipients

AHI Commitments by Region($ million)

98

14%

295

42%

172

24%

12

2%

41

6%

88

12%

Africa East Asia & Pacif ic

Europe & Central Asia Latin America & Caribbean

Middle East & North Africa South Asia

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 25 12

Nepal 19 1

Bangladesh 18 2

Egypt 15 7

Afghanistan 14 1

West Bank & Gaza 14 4

Armenia 13 5

Georgia 11 3

Moldova 11 2

China 11 8

Human Cases, Deaths from H5N1 and Countries Affected

46

98

115

71

32

43

79

47

60

9

16

55

0

20

40

60

80

100

120

2004 2005 2006 2007

Num

ber

as r

eport

ed t

o W

HO

0

10

20

30

40

50

60

Num

ber

as r

eport

ed t

o O

IE

Human cases (per year, left axis)

Human deaths (per year, left axis)

Countries w ith H5N1 in animals (cumulative, right axis)

As of Nov. 5

Human Cases, Deaths from H5N1 and Countries Affected

H5N1 still a global issue end 2007….

CONTRIBUTION OF ASIAN AND EUROPEAN COUNTRIES

• 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

NEXT STEPS IN AVIAN INFLUENZA CONTROL 2008 ONWARDS

• 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

2: Multi-sectoral Pandemic Preparedness

Getting ready to detect and act decisively

THE CURRENT 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 Pandemic alert periodalert period

Phase 3Phase 3 Human infection(s) with a new virus, but no (or Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread.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.

UN System Influenza Coordination

POTENTIAL IMPACTS OF AVIAN & PANDEMIC INFLUENZA

LivelihoodsLivelihoods

Human HealthHuman Health

Governance &Security

Governance &Security

Social & Humanitarian Needs

Social & Humanitarian Needs

Economic SystemsEconomic Systems

• Food and income loss from poultry deaths, culling & decreased economic activity

• High illness & potentially higher death rates• Overstretched health facilities• Disproportionate impact on vulnerable

• Increased demand for governance & security• Higher public anxiety• Reduced capacity due to illness & death

• Deterioration of coping & support mechanisms• Interruption in public services• Quarantine policies

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

PANDEMIC IMPACT RELATED TO CONTINUITY OF…

1 Health ServicesMedicines, Commodities, Equipment, R and D, Patient Care, Lab services

2 Financial ServicesBanking (cash and settlements), financial regulation, risk management and insurance

3 Food and its distributionAgriculture and livestock, Distribution and retailing

4 Utilities, Logistics, Personal Services Electricity, Water, Telecoms, Transport and Logistics, Postal services,

5 Leisure and RecreationTourism and Travel, Airports, Sports

6 Government, Security, MilitaryPublic Services, Law and Order, Judiciary and Correction, Private Security, Human Rights

7 MediaBroadcast, Print; Podcast and Blog

8 Environment and hygieneWildlife conservation, Cleaning, Maintenance, Refuse management.

3: Getting Ready: The importance of checking

preparedness to decide State of Readiness

PANDEMIC READINESS• IS THERE A RISK-BASED APPROACH TO PLANNING?

– 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

GLOBAL READINESS - SEPT 2007

• 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)

5: Inter-Governmental Approaches:

Encouraging joint action by countries

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

Support to IntegratedNational Programmes

PREREQUISITES FOR SUCCESS

• 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

6: A Way Forward:

Popular Movements and Networks for Human Health Security:

Case study from Indonesia

Engaging communityEngaging community members members

Understand perspectives of

Care-givers and children

Understand concerns of Householders

Appreciate the position of market workers

Use Clear Messages

Explain Messages

Repeatedly:

Public Service Announcements

viewed by more than 120 million people

Involve Leaders: Politicians, Imams, Government Officers, Professionals

• 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

HUMAN SECURITY - ONE WORLD, ONE HEALTH

• 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

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