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Transcript of Global Update and Future Direction of Avian Influenza Control (in context of influenza pandemic...
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