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

$Page 1: Preparedness, Coordination, Monitoring \ Prepared with the support of Peacepath Consulting$
Preparedness, Coordination, Monitoring

\

Prepared with the support of Peacepath Consulting

2040317-GMH-FAO-Coordv05

BOS

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


BOS

Past Influenza Pandemics

1900

1850

1950

2000

1847

1889

1918

19571968

42 yrs

29 yrs

39 yrs

11 yrs

30 – 40 years cycle

No Pandemic for > 35 yearsNo Pandemic for > 35 years


BOS

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


BOS

Pandemic Geographic spread: 1918-19

?01/19

03/1804/18

06/18

05/18

06/18

06/18

?

C.W. Potter, Textbook of Influenza, 1998


BOS

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


BOS

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 mortality2. 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


BOS

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

?


BOS

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


BOS

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


BOS

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


BOS

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


BOS

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 3 Human 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.


BOS

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


BOS

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:


BOS

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:


BOS

ObjectiveTo facilitate a collaborative process among key actors to transform:

A collection of organizationsworking 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


BOS

Levels of CoordinationCoordination will be active at three broad levels:

Country LevelCoordination

1

Working LevelCoordination

2

Global Level Coordination

3

Provide local leadershipIntegrate and inform global teamsImplement preparedness & response

Facilitate information exchangeSet global standardsPrioritize activities against objectives

Align strategyTrack progressIdentify gaps and blocksDrive Resolution


BOS

Proposed FrameworkTo 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 CoordinationFinancing Partners: MDBs, Bilaterals,

etcPrivate Initiatives

Regional Organizations:

APEC, ASEAN , etcFAO OIE WHO

IASC membership

Alignment and Harmonization


BOS

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


BOS

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:


BOS

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:


BOS

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

UNDGOBCPRWhole 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 networkscoordinated 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


BOS

Potential Dashboard ToolPriority 1 Priority 2 Priority 3

Issue Human Vaccine Supply Veterinary System Strengthening

Increasing Public Health Laboratory Capacity

Lead Agency WHO OiE / FAO WHO

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 Target xx%


BOS

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 resources3. Facilitates knowledge transfer and active learning as

the situation evolves4. Provides a forum for building strong, effective working

relationships before a full scale crisis hits


BOS

Thank you

Documents

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