THE GLOBAL STRATEGY FORPREVENTION AND CONTROL

OF H5N1 HIGHLY PATHOGENICAVIAN INFLUENZA

THE GLOBAL STRATEGY FORPREVENTION AND CONTROL

OF H5N1 HIGHLY PATHOGENICAVIAN INFLUENZA

Revised March 2007

Rome, 2007FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

All rights reserved. Reproduction and dissemination of material in this information product for educational or other non-commercial purposes are authorized without any prior written permission from the copyright holders provided the source is fully acknowledged. Reproduction of material in this information product for resale or other commercial purposes is prohibited without written permission of the copyright holders. Applications for such permission should be addressed to the Chief, Electronic Publishing Policy and Support Branch, Information Division, FAO, Viale delle Terme di Caracalla, 00100 Rome, Italy or by e-mail to copyright@fao.org

© FAO 2007

Acknowledgements

The Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) acknowledge and are grateful to the World Health Organization (WHO) for the close collaboration and helpful discussions in producing this third revision of the Global Strategy; whereby correctly addressing the issues of prevention and control of avian influenza viruses with a zoonotic potential can avert human illness and a human pandemic.

The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

ISBN 92-5-000000-0

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Contents

Foreword v

Abbreviations vii

ExecutiveSummary ix

Background and rationale 1

THE STRATEGY 3

1. The vision 3

2. The priorities 3

3. Strategic domains 43.1Theglobaldomain 53.2Theregionaldomain 73.3Thenationaldomain 9

ANNEXES

Annex 1 Situation analysis 19A1.1Regionalanalysis 19A1.2Socio-economicimpact 24

Annex 2 Lessons learned 27A2.1Riskfactors 27A2.2LessonslearnedfromHPAIcontroltoolsandmethods 29A2.3Lessonslearnedfromregionalandglobalcoordination 32

Annex 3 Partnerships and implementation 35A3.1FAO’sGlobalProgrammeforHPAIPreventionandControl 36A3.2OIE’sProgramme 36A3.3Significantmilestonesandexpectedoutputs 38

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Foreword

Sincethecurrentpanzooticofhighlypathogenicavianinfluenza(HPAI)causedbyvirusesoftheH5N1sub-typefirstresultedintransboundarydiseaseinlate2003,itsubsequentlyspreadfromAsiatoEuropeandbothNorthandWestAfricain2005and2006.Ithascausedhighmortalitiesinaffectedpoultryflocks,withadditionallossesduetoculling.Farmersandtrad-ershavesufferedlossofincomeasaresultofmarketdisruptioncausedbycontrolactivitiesandalsomarketshockduetoconsumerconcernsforhumanhealth.ForFAO,OIEandothersconcernedwithsecuringthelivelihoodsofdevelopingcountrycommunities,thisissufficientjustificationinitselftomountamajorcampaigntopreventfurtherspreadofthedisease,con-tainthediseasewithininfectedareasandprogressivelyworktowardsitseradication.

However,itistheconcernforhumanhealth,particularlythethreatofahumaninfluenzapandemic,thathasdrawnworldattentiontoHPAIandstimulateddonorstosupportHPAIcontrolandpreparednessmeasuresforpandemichumaninfluenza.ItisgenerallyacceptedthatthemostimportantelementinaddressingthethreatofhumanpandemicinfluenzaistocontrolHPAIinpoultry,thuslimitingopportunitiesforexposureofhumanstothevirusandminimizingthepossibilityfordevelopment,throughadaptivemutationorreassortment,ofaviruswiththepotentialtospreadeasilyfromhumantohuman.

Following publication of FAO Recommendations on the Prevention, Control and Eradication of Highly Pathogenic Avian Influenza (HPAI) in Asia in September 2004, theFAO/OIE Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza (HPAI)wasfirstproducedinNovember2005.Sincethen,therehasbeenfurtherspreadofH5N1HPAIandasubstantialriseininternationalsupport,withanotableincreaseinactivi-tiesfundedthroughthegenerosityofalargenumberofdonors,includingnationalgovern-ments,andinternationaldevelopmentbanksanddevelopmentagencies,includingFAO.

TheOIE/FAOpublicationEnsuring Good Governance to Address Emerging and Re-emerg-ing Disease Threats - Supporting the Veterinary Services of Developing Countries to Meet OIE International Standards on Quality(lastupdatedinAugust2006),providesguidelinesonlimitingthespreadofepizooticdiseases,includingHPAI.Capacity-buildingformedthemainelementforelaborationofstrategiesfortheprogressivecontrolofHPAIinaffectedcountriesandpreventionofthedisseminationofthediseasetounaffectedcountries.

Although there remain serious gaps in knowledge, there has been an increasedunderstanding of the disease during this panzootic and experience with various controlapproacheshasallowedrefinementofstrategiesattheglobal,regionalandnationallevels.TherevisedglobalstrategypresentedhereisbasedontheexperienceandlessonslearnedfromtheinvolvementofFAOandOIEintheglobalcontrolofH5N1HPAIoverthelastthreeyears.Therevisedstrategyprovidesthelong-termvisionandgoals,identifiesprioritiesandstrategic approaches, and proposes short-, medium- and long-term actions at national,regionalandgloballeveltocontrolandultimatelyeradicatethedisease.

ThisstrategyhasbeendevelopedbyFAOandOIE-incollaborationwithWHOandanum-berofexpertsfromOIE/FAOreferencelaboratories-togiveaclearvisionfortheirapproachandtocommunicatethatvisiontoimplementingpartners,donorsandotherstakeholders.

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Abbre�iations

ASEAN AssociationofSoutheastAsianNations

AU-IBAR AfricanUnionInter-AfricanBureauforAnimalResources

CMC FAO/OIECrisisManagementCentre(AnimalHealth)

DPRK DemocraticPeoples’RepublicofKorea

ECO EconomicCooperationOrganization

ECTAD FAOEmergencyCentreforTransboundaryAnimalDiseases

EMPRES-i FAOinformationsystemfortransboundaryanimaldiseases

FAO FoodandAgricultureOrganizationoftheUnitedNations

GF-TADs FAO/OIEGlobalFrameworkforTransboundaryAnimalDiseaseControl

GLEWS FAO/OIE/WHOGlobalEarlyWarningSystem

Hong Kong SAR HongKongSpecialAutonomousRegionofPRChina

HPAI highlypathogenicavianinfluenza

H5N1 sub-typeofinfluenzavirus(H5haemagglutinin,N1neuraminidase)

Lao PDR LaoPeoples’DemocraticRepublic

OFFLU OIE/FAONetworkofExpertiseonAvianInfluenza

OIE WorldOrganisationforAnimalHealth

PR China Peoples’RepublicofChina

RT-PCR ReverseTranscriptionPolymeraseChainReaction(real-timelaboratorytechniquefordetectingviralnucleicacid)

PVS OIEPerformance,VisionandStrategy(toolforevaluationofnationalveterinaryservices)

SAARC SouthAsianAssociationforRegionalCooperation

TADs transboundaryanimaldiseases

UNDP UnitedNationsDevelopmentProgramme

UNEP UnitedNationsEnvironmentProgramme

UNICEF UnitedNationsChildren’sFund

UNSIC UnitedNationsSystemInfluenzaCoordination

WAHIS OIEWorldAnimalHealthInformationSystem

WHO WorldHealthOrganization

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Executi�e Summary

The FAO-OIE Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza (HPAI)wasfirstdevelopedbyFAOandOIEincollaborationwithWHOinresponsetoarecommendationfromtheFAO/OIERegionalMeetingonAvianInfluenzaControlinAsia(23-25February2005,HoChiMinhCity,VietNam).The strategyprepared inNovember2005wasfocusedpredominantlyoncontrolofthediseaseinEastandSoutheastAsia.Sincethen,theH5N1HPAIsituationhasevolveddramatically.

Thediseasehasspreadwidely inAsia,CentralandEasternEurope, theNearEastandAfrica,culminating in thecurrentsituation that isdescribed inAnnex1.AsofDecember2006, itwasestimated thatover240millionpoultryhaddiedorbeenculledworldwidedue to H5N1 HPAI. The widespread nature of the disease, ìts mounting socio-economicimpact,theincreasingnumberofhumaninfectionsanddeathsandthepotentialthreatofhumanpandemicinfluenzacontinuetounderlinetheneedforaglobalapproachtoH5N1HPAIpreventionandcontrol.TherevisedGlobalStrategypresentedheretakesintoaccounttheaccumulatedexperienceofnational,regionalandglobaleffortstodateandthelessonslearnedfromvariouseffortstocontrolthedisease(summarizedinAnnex2).

GLOBAL PROGRESS IN HPAI CONTROLSuperficial appraisal indicates that HPAI has spread since late 2005 to affect many morecountries.However, inreality,effortsoverthisperiodhavebeenlargelysuccessfulbothinimprovingtheHPAIsituationinpreviouslyinfectedcountriesandincontrollingoreliminatingthediseaseinnewlyinfectedcountries.

ThesituationhasimprovedgreatlyinChina,whereoutbreaksarenowmostlylimitedtocertainareasofthecountry.ProgressinThailandandVietNam,bothofwhichexperienceda high incidence of outbreaks in poultry and accompanying human infections has beensubstantial,withoutbreaksinpoultrynowgreatlyreducedandalmostcompletesuccessinpreventing human disease. Indonesia has struggled to establish appropriate HPAI controlmechanismsbutsystemsarebeingdeveloped,withsupportfrommanydonors.

India, Pakistan, Afghanistan, Myanmar, South Korea and Japan have all experiencedoutbreaksofHPAIthatwereeffectivelycontrolled,althoughinsomecountriesre-introduc-tionofdiseasehasoccurred.MostofthecountriesexperiencingoutbreaksinCentralAsia,EasternEuropeandtheMiddleEastwerealsoabletoeliminatethediseasealthoughagaintherehavebeensomerecentfreshoutbreaksofdiseaseinRussia,HungaryandTurkey.InAfrica,EgyptandNigeriaarebothfacingsubstantialchallengesinachievingeffectivecontrolof HPAI; they deserve particular international assistance, since such endemically infectedcountries represent thehighest riskbothforperpetuationof thediseaseandforpossibleemergenceofvirusstrainswithhumaninfluenzapandemicpotential.

LESSONS LEARNED FROM TOOLS AND METHODS USED FOR HPAI CONTROLRisk factorsIthasbecomeclearthatcountrieswithwelldevelopedveterinaryservices,withstrongearly

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diseasedetectionandresponsecapacities,caneffectivelycontrolandeliminateH5N1HPAI.Countriesthathavehadmostdifficultyinachievingeffectivecontrolarethosewithweakveterinarycapacitiesandthatfacemajorriskfactorssuchashighpoultrypopulationdensi-tieswithpoorbiosecurity,particularly related to largesmallholderproductionsectorsandsubstantial duckpopulations. Internalmovementof poultry, particularly through live birdmarketsandillegalmovementacrossinternationalborders,aremajorcontributorstospreadofthedisease.Migratorywaterfowlhavebeenimplicatedinglobalspreadofthedisease,althoughtheepidemiological significanceofH5N1virus infectionofwildbirdsandotherspecies,includingpigsandcats,isnotwellestablished.

Disease sur�eillanceIt has becomeevident thatmany countries lack the expertise todevelop and implementeffective national HPAI surveillance plans and to collect and analyse data. These weak-nesses have compromised efforts to clearly understand specific risk factors and diseaseepidemiology,poultryproductionandmarketingsystems,andtoproperlyassessvaccinationprogrammes.Additionaltechnicalsupportisrequiredtostrengthennationalcapacitiesandsuchsupportmustbecomplementedbyfurtherstrengtheningofnetworksforinformationcollection,analysisanddisseminationatregionalandgloballevels.Limitedaccesstocom-pensation funds and inefficient payment mechanisms discourage farmers from reportingsuspiciousdiseaseoccurrence.

Laboratory capability and capacityNational veterinary diagnostic laboratory capacities are often poorly developed andresourced.OIE/FAOreferencelaboratorieshavemadeasignificantcontributioninsupport-ingnational laboratoriesbutadditionalsupport isneeded,especiallyattheregional level.Thereneedstobeimprovedsharingofvirussamplesandsequenceinformationgloballyandthereareopportunitiesfornationalpublichealthandveterinarylaboratoriestocollaboratemorestrongly.

Containment of outbreaksWhilestampingouthasprovedeffectiveforcontainingisolatedoutbreaks,effortsarecom-promisedbyweaknesses inpoultrymovementcontrolandsurveillancearoundoutbreaks.Thereisaninadequateknowledgeandcapacityforsafeandhumanecullinganddisposalofinfectedpoultry.Astheincidenceofoutbreaksincreases,diseasecontrolauthoritiescanrapidlybecomeoverwhelmedthroughlackofresources.

VaccinationVaccinationhasbeenaneffectiveresponseinreducingHPAIincidenceandvirusloadintheenvironment,thusminimizingtheriskoffurtherspreadandhumanexposuretoinfection.Planningmustanticipate the reinstallationofclassical controlmeasures suchas stampingoutwhenthenumberofoutbreaksislow.Vaccinationhasprovedveryeffectiveinhigh-riskcountrieswherere-introductionofdiseaseislikely,butitmustbeconductedinaccordancewith guidelines, involve vaccines of assured quality and be accompanied by appropriatemonitoringofimmuneresponseandinfectionstatusofvaccinatedflocks.

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Adjustment of poultry production and marketing chainsIn Asian countries where the disease has been present for a long period and where thegreatest combination of risk factors are present, experience indicates that stamping outof infected flocksprovides short-term improvements inHPAI statusbutdoesnotguaran-tee long-term freedom.Appropriate changesareneeded inpoultrydiseasemanagementpracticesonfarmsandtohigh-riskmarketingpracticessuchasuncontrolledmovementofpoultrythroughlivebirdmarkets.

CommunicationCommunication servesasa facilitatingmechanism forbuildinganenablingenvironment,throughwhichtheglobalstrategyforthepreventionandcontrolofHPAIcanbesuccess-fullyunderstoodand implemented. Inaddition,despite recognitionof the importanceofpublicawarenessandconsiderableeffortsmadetodate,therehasbeenonlylimitedsuccessinachieving thebehavioral changes required tocontrolHPAI. Ithasbecomeveryevidentthatover-reactionofcommunitiestoHPAIcanhaveanadverseaffectonpoultrymarkets.Balanced,consistentandscientificallysoundmessagesareneededtopromotesafepoultryproductionpracticesandappropriateconsumercaution,withoutprecipitatingunduemarketdisruptions.

MOVING TO A REVISED STRATEGyExperience and lessons learned at the global, regional and national levels in controllingH5N1HPAIpermitrevisionoftheglobalstrategywithgreaterunderstandingoftheissuesthat need to be addressed and the means of achieving progress. The strategy identifiesinternationalinitiativesatglobalandregionallevels,andapproachesthatareappropriatefornationalimplementation,ingeneraltermsbutalsoinlinewiththeHPAIstatusofindividualcountries.

THE VISIONThestrategyenvisagesaworldwithgreatlyreducedthreatofH5N1virusinfectioninpoul-try,leadingtoreducedpublichealthrisk,securednational,regionalandglobalmarketsandtradeinpoultryandpoultryproducts,andprotectionofanimportantelementoftheliveli-hoodsofpoorfarmingcommunities.

THE PRIORITIESTo achieve this vision, three priorities related to country HPAI status must be addressedconcurrently:

• In the smallnumberofendemically infectedcountries,particularattentionmustbegiventoreducingtheincidenceofHPAI.

• Incountries inwhichsporadicoutbreaksarecurrentlyoccurring, intensiveefforts toeradicate thediseasemustbesupported;given thecurrentdiseasesituation, this ispossible.

• In countries particularly at risk of incursion or in countries suffering severe conse-quencesasaresultof incursion,HPAIpreparednessandcapacityforearlydetectionandresponsemustbeimproved.

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STRATEGIC DOMAINSThestrategyproposesapproachesattheglobal,regionalandnationallevels.TheglobalandregionalapproachesarethosethatFAOandOIEwillfollowthemselvesandwilladvocatetootherdonorandimplementingagenciesinthesearchforaharmonizedapproachtoaddres-singtheneeds.ThenationalapproachesoutlineprinciplesthatFAOandOIErecommendasappropriatetovariouscountrysituations.

THE GLOBAL DOMAINThegoal is toprovideglobal leadership ingeneratingandprovidingsound technicalandpolicyadvice incoordinatingandharmonisingnational, regionalandglobalplans,and inimprovingtheeffectivenessandefficiencyofprogrammingandimplementationofdiseasepreventionandcontrol.

TheproposedactivitiesfocusonsupporttocountriesinplanningandimplementingtheirplansforHPAIpreventionandcontrol,includingprovisionoftechnicaladviceandoperatio-nalsupport,andinternationalcollaborativeinitiativesforsupportinginternationalresearch,surveillance,earlywarningandepidemiologicalanalysisofdiseaseoutbreaksandinforma-tiondissemination.TheapproachincludesthedevelopmentwithinFAOoftheEmergencyCentreforTransboundaryAnimalDiseases;withinOIE,theestablishmentoftheWorldAni-malHealthandWelfareFunddirectedtowardsimprovinggovernanceinveterinaryservicesworldwide; and theestablishmentof the FAO/OIECrisisManagementCentre to increasecapacityforearlyresponsetosignificantdiseaseevents.

Thestrategyalsocallsforgeneralpoliticalsupportatglobal,regionalandnationallevelsandmobilizationofdonorfundingtoaddresstheneedsofHPAIpreventionandcontrol.

THE REGIONAL DOMAINThegoalistoenhancecooperationandcollaborationamongregionally-groupedcountriesthroughgreaterengagementandcommitmentfromappropriateregionalorganizationsforaharmonizedandcoordinatedapproachtocontrolanderadicationofH5N1HPAI.

Thisapproachfocusesonthedevelopmentofformallong-termandsustainablecoope-rationandcollaboration,takingintoaccountregionalspecificities,forthedevelopmentofpoliciesandregulatoryframeworksrelatedtoregionaltradeinlivestockandlivestockpro-ducts,harmonizationofHPAIcontrolstrategies,HPAIsurveillanceandreportingandHPAIpreparedness planning. Regional organizations, including OIE Regional Commissions andtheelectedBureaus,areseenasthefocalpointsforsuchinitiatives,supportedbyOIEandFAORegionalAnimalHealthCentres,institutedwiththecoordinationofregionalGF-TADssteeringcommittees.Strategicinitiativesincludebuildingofregionalcapacityandenhancingtheroleofregionalandsub-regionalnetworksforepidemiologicalandlaboratoryexpertiseandnetworksof economists, social scientists andpoultryproduction specialists. Regionallaboratories will be identified and supported to provide reference services, reagents andtrainingtonationalpersonnel.

THE NATIONAL DOMAINThegoalistoprogressivelydefinethestatusofcountrieswithintheprioritycategoriesand,formostofthem,eliminateH5N1viruscirculationinpoultrypopulationsusinglivelihoods-

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sensitive approaches. In those countries in which HPAI is currently endemic, the diseasewilleitherbeeradicatedorgreatly reduced in incidence,with itsgeographicandsectoraldistributionwelldefined.

RecommendationsaremadeforgeneralmeasuresthatneedtobeaddressedforHPAIpreventionandcontrolandspecificmeasuresthatapplytodifferentdiseasesituations.Thebroadlyapplicablekeymeasuresare:

• strengtheningofveterinaryservicesandrelatednationalcapability,includingcompliancewithOIEstandardsandguidelinesonqualityandevaluationofveterinaryservices;

• poultryindustryadjustmentandchangesinhusbandrypracticestoimprovebiosecurity;

• strategicresearchinitiatives;• supportforpubliccommunication;and• provisionoftechnicalassistance,asrequiredKeyamongthese isoverallstrengtheningofnationalveterinaryservices, includingOIE

assistanceinassessingveterinaryservicesbyestablishedprocedures,strengtheningcapacityfordiseasesurveillanceandepidemiologicalanalysis,andimprovingoperationalcapacityfordiseasecontrol,forwhichearlydetectionandrapidresponseareessential.Poultryindustryadjustmentproposalsneedtotakeintoaccountnotonlythebenefitsofimprovedbiosecu-ritybutalsothepotentialthreatofadverselyaffectingthelivelihoodsofpoorfarmers.Thisthreatmustalsobeconsideredwhendesigningcontrolstrategies.PublicawarenessmustbesupportedtopromotepracticesthatlimittheriskofHPAItransmissionandreducetheriskofhumanexposuretoH5N1virus.

TherearesignificantgapsinourunderstandingoftheH5N1HPAIvirusandtechnologiesandtools tocontrol it.Thus thestrategypromotesstrategic research initiatives, includingepidemiological studies of HPAI in different farming systems (including risk analysis andcriticalcontrolpointdefinitionwithinmarketchains),continuousmonitoringofvariationinH5N1viruscharacteristics,monitoringofwildbirdinvolvementinH5N1virusdissemination,developmentofnewvaccinesanddiagnostics,andstudiesofthesocio-economicandbio-diversityimpactsofH5N1HPAIincursionandcontrol.

IMPLEMENTING THE STRATEGyThestrategyisdesignedasaguidetoFAOandOIEprogrammesofsupportforHPAIpre-ventionand control.However, it is alsoadvocated tootherglobal, regional andnationalimplementingagenciesanddonorsasameansofachievinguniformityofapproaches.ThisisdescribedinAnnex3,togetherwithproposedmilestonesformonitoringprogressinHPAIpreventionandcontrol.

Thestrategywillbeimplementedprogressivelyoverthenexttenyears,asfundsbecomeavailable,beginningwiththehighestprioritiesfor2006-2008.ItwillbecoordinatedjointlybyFAOandOIEandharmonizedwiththeWHOStrategicActionPlanforPandemicInfluenza2006-2007*.

* http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_2c.pdf

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Background and rationale

SinceoutbreaksofH5N1highlypathogenicavian influenza (HPAI) started inAsia in late2003andearly2004,therehavebeensomeverysubstantialdevelopments.InAsia,somecountriesthatsufferedextensivedisseminationofinfection,includingVietNam,PRChinaandThailand,haveregisteredgreatsuccessinbringingthediseaseundercontrol.Indonesiaremainsacountrywithcontinuingchallengesforsignificantcontrol.Othercountriesintheregion have suffered sporadic outbreaks but have achieved control or even eradication.FollowingspreadofthediseasetoEuropeandnorthernandwesternAfricafromthelat-terpartof2005,manycountrieswereabletoeliminatethedisease.NotableexceptionsareEgyptandNigeriawherethediseaseisstillendemic,andsomeotherAfricancountrieswhichareexperiencingsporadicoutbreaks.

Whilethefocusofinternationalattentionisontheoccurrenceofhumaninfectionanddeathsand thepotential fordevelopmentofpandemichuman influenza, thedisease inpoultry(andmeasurestakentocontrolit)hashadasignificantimpactonpoultryindustries.Ithasdirectlyaffectedfarmers,someofwhomhavebeendeprived,atleasttemporarily,oftheirlivelihoods,ithasdisruptednationalandinternationalpoultrymarketsandithascre-atedrecognitionthat,aswellaseliminatingthedisease,measuresareneededtominimizetheriskofrecurrenceofHPAIbyaddressingtheriskfactorsinvolvedinpoultryproductionandmarketing.

Developmentofthisstrategytakesintoaccountanalysisofthecurrentsituation,whichisdescribedinAnnex1. It isalsobasedonlessonslearnedduringthethreeyearsofthepanzootic.Annex2reviewscurrentknowledgeofriskfactorsfordiseaseintroductionanddissemination,andexperiencewiththemeasuresthathavebeenapplied.Thereareweak-nessesindiseasesurveillanceandresponsecapabilities,soeffortstostrengthenveterinaryservices are an important component of the strategy. Vaccination has proved to be aneffective additional tool for substantially reducing disease incidence, provided that highqualityvaccineisusedandthatitisproperlyappliedwithappropriatemonitoring.EffectivepubliccommunicationisacriticalcomponentforsupportofHPAIpreventionandcontrolstrategiesandmustbesupportedbyinternationalefforts.

Sinceit isdifficulttopredictthefuturecourseofthepanzootic,thisstrategycallsforimplementation over a 10-year period. Caution is warranted in advocating approachesthatmustoftenbemodifiedaccordingtoparticularcircumstances.Recommendationsareformulatedasprinciplesthatneedtobeadaptedtoparticularcircumstances,especiallyatthenationallevel.Itisexpected,therefore,thatthestrategywillbereviewedperiodically.

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The strategy

1. THE VISIONThestrategyenvisagesaworldwithgreatlyreducedthreatofH5N1virusinfectioninpoul-try, leading to reducedpublichealth risk, securednational, regional andglobalmarketsandtradeinpoultryandpoultryproductsandprotectionofanimportantelementofthelivelihoodsofpoorfarmingcommunities.

Thisvisionaddressesthreemainissues:• TheimperativetosubstantiallyreducetheriskofexposureofhumanstoH5N1virus

andtodiminishthethreatofpandemichumaninfluenza.• Theneedtomitigate the impactsofHPAIand itscontrol indisruptingproduction,

marketsandtradeinpoultryproducts.• Theimportanceofsupportingthelivelihoodsofpoorcommunitiesheavilydependent

onpoultryforincomeandfoodsecurity.

2. THE PRIORITIESInrelationtocountryHPAIstatus,thestrategysetsoutthreeprioritiestoaddressconcur-rently:

• Inendemicallyinfectedcountries,particularattentionmustbegiventoreducingtheincidenceofHPAIinordertoreducetheexposureofhumanstoH5N1infectionandalsolimitthethreatofvirusdisseminationtoothercountries.

• Incountriesinwhichsporadicoutbreaksarecurrentlyoccurring,intensiveeffortstoeradicatethediseasemustbesupported;thiscanbeachievedgiventhecurrentdis-easesituation,althoughitdependsonprogressmadeinreducingHPAIinendemicallyinfectedcountries.

Reducing the threat - Mitigating the impact

Over the next 10 years, FAO and OIE will work towards significantly reducing H5N1

virus infection in poultry, as the necessary basis for

• reducing the risk of human exposure to H5N1, thereby diminishing the threat of

pandemic human influenza

• mitigating the negative impact of the disease and its control on production,

markets and trade in poultry products

• supporting the livelihoods of poor communities heavily dependent on poultry for

income and food security

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza�

• WhileallcountriesareatsomeriskofHPAIincursion,therearesomecountriesthatbyvirtueoftheirgeographiclocation,poultryproductionsystemsandlevelofeconomicdevelopmentareparticularlyatriskofincursionorofsufferingsevereconsequencesas a result of incursion; in these countries, HPAI surveillance, preparedness andresponsecapacitymustbeimproved.

Theseprioritiesarereflectedinthegoals,objectivesandactivitiessetoutinthestrategy.

�. STRATEGIC DOMAINS H5N1HPAIpreventionandcontrolmustbeaddressedattheglobal,regionalandnationallevels.TheglobalandregionalapproachesarethosethatFAOandOIEwillfollowthem-selves,buttheywillalsobeadvocatedtootherdonorandimplementingagenciesinthesearchforaharmonizedapproachtoaddressingtheneeds.NationalHPAIpreventionandcontrolstrategiesaretheresponsibilityofnationalauthoritiesbuttheyshouldincorporateprinciplesthatFAOandOIEproposeasappropriatetovariouscountrysituations.Theywillbepromotedforimplementationbynationalauthorities,supportedinFAOandOIEcountryactivities,andadvocatedtootherpartnerstoachieveuniformityinprogrammedelivery.

Global leadership, regional cooperation and national action

Through their joint strategy, FAO and OIE are tackling HPAI H5N1 at global, regional

and national levels.

Globally

• they will provide leadership in offering sound technical and policy advice,

• they will help coordinate and harmonise national, regional and global plans, and

• they will strive to improve programming and implementation of disease

prevention and control.

Regionally

• they will enhance cooperation and collaboration among regions,

• they will seek greater engagement and commitment from appropriate regional

organisations, and

• they will encourage a harmonised and coordinated approach to HPAI H5N1

control and eradication.

Nationally

• they will support national authorities in endemic countries in their efforts to

eradicate or greatly reduce the incidence of HPAI,

• they will support national authorities in most priority countries in their attempts

to eliminate H5N1 virus circulation,

• they will promote livelihoods-sensitive approaches in each country, and

• they will identify ways of preventing virus spread through surveillance, early

detection, reporting and response.

The strategy 5

�.1 The global domainThegoalistoprovidegloballeadershipingeneratingandprovidingsoundtechnicalandpolicyadviceincoordinatingandharmonisingnational,regionalandglobalplans,andinimprovingtheeffectivenessandefficiencyofprogrammingandimplementationofdiseasepreventionandcontrol.

TheglobalimplicationsofH5N1HPAI,itsdemonstratedabilitytospreadwidelyinbirdsthroughoutmuchoftheworldandthenatureofthegloballyknownandacceptedcontrolandprevention tools foraddressing thedisease1,make itnecessary toengagecountriesinternationallyanddevelopcommonlyagreedcontrolplans.FAO,OIEandWHOaretak-ingaleadinprovidinginternationaltechnicalsupporttocontributetothecoordinationofglobalcontrolofHPAI.FAO,throughitsEmergencyCentreforTransboundaryAnimalDis-eases(ECTAD)andtheOIE,throughtheWorldAnimalHealthandWelfareFund(directedtowardsimprovinggovernanceinveterinaryservicesworldwide),willcontinuetoprovideleadershipinHPAIpreventionandcontrolinpoultryandwillpromoteandfacilitatetechni-calsupportforregionalandsub-regionalnetworksandnationalprogrammesthroughOIE/FAOreferencecentresandtheOIE/FAONetworkofExpertiseonAvianInfluenza(OFFLU)2.Theglobal levelof thestrategy isalsoconcernedwithcoordinating thedevelopmentofnewmethodologiesandtechnologies,basedonanalysisofglobaldiseaseinformation.

Strategic objectives1.Ensurecoordination,collaborationand informationexchangeamongdonors, inter-

national and regional organizations, other agencies and national governments tofacilitateHPAIpreventionandcontrol.

2.Providetechnicalandoperationalsupporttocountriesforsurveillanceandprepared-nessplanning,emergencyoutbreakcontainmentandlonger-termdiseasecontrolandbiosecurityinterventions.

3.GeneratestrongpoliticalsupportforH5N1HPAIcontrolatthenational,regionalandgloballevelthroughadvocacyandregularcommunication.

4.Mobilizesignificantfinancialresourcesfromdonorstosupportfulfillmentofstrategicgoalsandobjectives,andensureprovisionofadequateemergencyfundsandman-powerforcountriesthatneedshort-termemergencyassistancetocontrolHPAI.

5.PromotearegionalapproachtocontrollingH5N1HPAIconsistentwiththeprinciplesandguidelinesagreeduponintheGF-TADs.

6.Improve understanding of the epidemiology of avian influenza viruses by promot-ingandsupportingstrategicandappliedresearchonknowledgegapsandissuestoimprovethequalityoftechnicaltools,methodsandstrategiesavailabletodecision-makersforcombatingHPAIandrehabilitatingpoultryindustries.

7.SupportcommunicationandbehaviourchangedirectedtowardsreducingthespreadofHPAIandminimizingtheriskofhumaninfectionwithH5N1virus.

1 SeeAnnex2fordetails.2 http://www.offlu.net

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza�

Main activities• Develop and coordinate centralized management of the FAO response to the

HPAIpanzootic through theEmergencyCentre forTransboundaryAnimalDiseases(ECTAD), including utilization of the FAO/OIE Crisis Management Centre (AnimalHealth)toprovideemergencytechnicalandoperationalsupporttocountriesaffectedbyHPAIandotheranimalhealthemergencies.

• Assistallinfectedandhighriskcountriestodevelopandimplementappropriatestrategiesandplansformedium-tolong-termcontrol,detectionandpreventionofH5N1HPAI.

• Enhance collaboration among major implementing partners, including FAO, OIE,WHO, UNDP and UNICEF, and clearly define roles among UN agencies for bettercoordinationandcommunicationoftheglobalHPAIcontrolstrategy,andtoaddresstheprioritiesofthelivestockandpublichealthsectors.

• Improve early warning and information analysis of GLEWS and EMPRES-i throughtheintegrationofdatabasesofagriculturalfactorsthataffectdiseaseoccurrenceandvirus ecology, andofficial reportingofHPAI through theOIEWorldAnimalHealthInformationSystem(WAHIS)andothersourcesoflivestockdiseaseinformation.

• ApplytheOIEPerformance,VisionandStrategy(PVS)toolundertheauspicesoftheOIEtoevaluatecapabilitiesandtheveterinaryservicesofcountriesagainstOIEqualitystandards.PVScanbeusedtoidentifyneedsandsupportthedevelopmentofpro-posalsforstrengtheninganimalhealthservices inkeyareas, includingthosecriticalforHPAIpreventionandcontrol.

• Support the OFFLU network to provide an expanded source of expertise for HPAIprogramming and to identify, plan and implement identified research initiatives.This includesdevelopmentof theGlobal InitiativeonSharingAvian InfluenzaData(GISAID)andsupporttoOIE/FAOavianinfluenzareferencelaboratoriestoassistcoun-tries inHPAIdiagnosis, trainingand sample testing, including confirmatory testingandisolatecharacterization.IdentificationofgapsinknowledgeandcoordinationofresearchproposalsisanotherOFFLUtask.

• Improveglobalcoordinationofepidemiologicalandvirologicalsurveillancedataanal-ysis,tobeseamlesslysharedwithWHO,includingdeterminationofhumanexposureriskvariables.

• Strengthen training of technical staff globally for international assignments in rel-evantdisciplines.

• CarryouteconomicandsocialimpactassessmentsofH5N1HPAIanditscontrolandembedtheresultsmorefirmlyincontingencyandlong-termstrategicplansforHPAIcontrol. Assessment should include livelihood, food security and gender impacts,analysisandmitigationofmarketshocks,poultrymarketchainanalysisandassess-mentoftraderisk,impactoflong-termchangesinmarketchains,andmappingofcross-bordertradingactivities

• Provideresearchandsupportforindustryrestructuringtoincreasebiosecurity,includ-ing elucidation of socio-economic consequences and support for national poultrychainrestructuringinitiatives.

• Assesstheimpactsonpoultrygeneticresourcesofthedisease,itscontrolandpoultryindustryadjustmentandrehabilitationmeasures.

The strategy �

• Develop the UN network on avian influenza socio-economics to promote sharingofknowledgeandplanningofcollaborativeactivitiesamongUNagencies,membercountrypartnersandotherdevelopmentagencies.

• Develop communication tools, in partnership with WHO and UNICEF, to promoteinternationalandnationalawarenessofHPAIand toassist inbehaviourchange toreducetheriskofHPAIspreadandhumanexposuretoH5N1virus.

• Supportpilotstudiesto improvethecapabilityofHPAI infectedcountriesto imple-mentcompartmentalizationandtohelpunaffectedcountries includecompartmen-talizationintheirplanningandpreparednessforpossibleHPAIincursion.

�.2 The regional domainThegoalistoenhancecooperationandcollaborationamongregionally-groupedcountriesthroughgreaterengagementandcommitmentfromappropriateregionalorganizationsforaharmonizedandcoordinatedapproachtocontrolanderadicationofH5N1HPAI.

The strategy recognizes the importance of regional partnership in tackling problemsofatransboundarynature.ForHPAItobecontrolledwidelyinanyregionorsub-region,country-specificeffortsmustbeenhancedby thedevelopmentof formal long-termandsustainable regional and sub-regional cooperation and collaboration in disease control.Such regional/sub-regional cooperation will serve to develop a common set of policiesand regulatory framework related to regional trade in livestock and livestock products,standardizationandharmonizationofHPAIcontroltechnologies,includingdiagnostictestsandvaccines, surveillanceandmonitoringprotocols,andearly reportingandemergencypreparednessplans.Regionalorganizations(e.g.AU-IBARandASEAN)playanimportantrole in coordinating regional activities. To support regional initiatives, FAOhas locatedadecentralizedECTADunitinBangkok.OIEandFAOarejointlystrengtheningtheirRegionalAnimalHealthCentres,aninitiativewhich,althoughdrivenbythebroadertransboundaryanimaldiseasecontrolobjectivesofGF-TADs,will serve topromote regional support forHPAIpreventionandcontrol.

The five Regional Commissions of the OIE and their elected Bureaus, as well as theRegionalFAO-OIEGF-TADsSteeringCommitteeshostedbytheOIERegionalRepresenta-tions,arecrucialtoolsfortheregionalcoordinationofpolicies.

Strategic objectives 1.Strengthen the technical and management capacity of regional and sub-regional

organizationsinordertosupportregionalactivitiesrelatedtoHPAIcontrol.2.BuildregionalcapacitytosupportimplementationofHPAIprevention,detectionand

controlplans.3.Developregionaltechnicalandscientificinformationsystemsandsupportnetworks

toensurethatnationalplanscanbeimplementedinasustainable,technically-soundandsocially-equitablemanner.

4.Promote coordination and collaboration among global and regional organizationsanddonoragenciestomaximizesupporttocountriesandtofacilitatesynergyandefficiencyofdonorinputs

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza�

Main activities• Createandcontinuesupportforregionalnetworksofepidemiologicalandlaboratory

expertise (linked to OFFLU) and establish new networks to promote open andtransparent dialogue on improving and sharing disease information, developmentofharmonizedguidelinesandregulationsforthemanagementofanimalmovementandcontroloftransboundaryanimaldiseases,wildliferelatedissuesandadherencetoOIEguidelinestofacilitateregionaltrade.

• Enhance regional training in aquatic bird monitoring programmes and wild birddiseasesurveillanceprogrammes.

• Harnessandshareregionalresourcesandexperienceininformation,educationandcommunicationinitiatives.

• Createregionalgroupsofnationalexpertise(reinforcedwithinternationalexpertise)to provide guidance and leadership for emergency preparedness planning and topromotenational capacitydevelopment fordisease recognition,primarydiagnosis,surveillanceandstrategysetting.

• Create regional groups of national expertise drawn from government and fromcommercialpoultryorganizationstoguidein-countrycapacitydevelopment,monitorprogress,identifyconstraintsandfacilitatepeerpressurewhereneeded;ensurethatthesegroupsdevelopregionalstrategicplanstailoredtotheparticularcircumstancesoftheregions.

• Developrobust,regionallyappropriate,country-specificandsector-specifictechnicaloptionsforprevention,detectionandcontrolofHPAI.

• ExpanddecentralizedECTADregionalcentresandestablishOIE/FAORegionalAnimalHealth Centres in Bamako, Tunis, Beirut,Gaborone,Nairobi, Bangkok,NewDelhi,and later in other locations, to improve communication and collaboration withdonors, regional organizations and national governments and ensure appropriateoperationalsupportforimplementingprogressiveH5N1HPAIcontrolprogrammes.

• UnderthegeneralguidanceoftheGF-TADsRegionalSteeringCommittees,strength-ensupporttoregionalnetworksthatsupporttheHPAIpreventionandcontrolpro-grammesofeachcountry.ThroughFAOsupportwithintheGF-TADsframework,sub-regionalnetworksonepidemiology,laboratorydiagnosisandsurveillancehavebeenestablished in the Southeast Asia region; these will be further developed in otherregionsandultimatelyregionalorganizations(suchastheASEANHPAITaskforceandAU-IBAR) will be encouraged to contribute to managing such networks for long-term sustainability.Networkswill be further strengthened to liaise and collaboratewithpublichealthcounterpartswhereverappropriate.Theestablishmentofwildlifenetworksisalsoplanned.

• Identify and support regional veterinary and public health laboratories which canprovidetechnicalassistance,reagentsandtrainingtonationallaboratoriesandactasimmediateandintermediatereferencepointsforvirusstraincharacterization.

• Encourage twinning relationships between laboratories in developing regions andlaboratoriesinindustrializedregions.

• Establishnetworksofeconomists,socialscientistsandpoultryproductionspecialiststosharemethodologiesandresultsfromnationalexperiencesandtocontributeto

The strategy �

regional assessmentsofmarket chains, trade risks andpoultry production systemsthatcrossbordersinordertoimplementregionalpoliciesrelatedtoHPAIcontrol.

• ShareandmanageknowledgeandinformationonHPAIcommunicationinterventionsincountriesandregions.

�.� The national domain The goal is to progressively define the status of countries within the priority categoriesandformostofthem,eliminateH5N1viruscirculationintheirpoultrypopulationsusinglivelihoods-sensitiveapproaches.InthosecountriesinwhichHPAIiscurrentlyendemic,thediseasewilleitherbeeradicatedorgreatlyreducedinincidence,withitsgeographicandsectoraldistributionwelldefined.

FAOandOIEproposethefollowingstrategicobjectiveswith timeframes (short termfrom1-3years,mediumtermfrom3-7yearsandlongtermfrom7-10years),recognisingthateachcountryhastheresponsibilitytoimplementandmanageitsowndiseasecontrolprogrammes.

Strategic objectives 1.Defineandgreatlyreducethegeographicandsectoraldistributionandincidenceof

H5N1HPAIinChina(mediumterm),Egypt(mediumterm)andIndonesia(longterm)anderadicatethediseasefromNigeria(mediumterm).Vaccinationisakeyfirststepforthesecountries.

2.Achieve HPAI eradication from countries experiencing sporadic outbreaks of HPAIthrough intensive epidemio-surveillance, rapid elimination of foci of infection andenhancedbiosecurity(medium-term).

3.Improveborderprotection,enhanceveterinarycapacityand improvebiosecurityofpoultry production to strengthen HPAI prevention and rapid response capabilities,withanemphasisoncountriesathighriskorcountriesfacingthenegativeconse-quencesofHPAIintroductionorre-introduction(long-term).

4.Strengthenveterinaryservices,includinglaboratorycapacities,inthecontextoftheFAO-OIEGlobalFrameworkforProgressiveControlofTransboundaryAnimalDiseases(GF-TADs)(long-term).

Main activitiesThemainactivitiesareoutlined inTable1,whichsummarizessomeof thekey technicalandsupportivemeasuresthatshouldbeconsideredincountrieswithvaryinginfectionanddisease status.. The strategy cannot propose detailed, country-specific control measuresanddiseasecontroltoolssincethesewillvaryevenwithinacountryandmustbetailoredtomatcheachcountry’suniquesetsofcircumstances,riskfactorsandpoliticalconditionsandinfrastructure.

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza10

TAbLE 1Recommended measures for pre�ention and control of HPAI in countries of different disease status

Country status Action Specific measures Support measures

Disease free Preventionofdiseaseincursion

Emergencypreparedness

•riskassessmentofpotentialpathwaysofintroduction

•risk-baseddiseasesurveillanceforearlydetection,diagnosisandreporting

•reviewofpoultryproductionandmarketchainstoidentifyandaddressriskfactorsforHPAIdissemination

•regulationofpoultryimports,includingbordercontrol

•developmentandtestingofrealisticcontingencyplansbasedonactualcapacityofveterinaryservices

•addressinganycriticalneedsinveterinaryservices

•Veterinaryandcommunityawarenessandcommunication

•Poultrycensusandfarmingsystemsdefinedandmapped

•Negotiationofsocio-economicaspectsofdiseasecontrolwithcommunitydialogue(compensationandrehabilitationissues)

•Government/privatesectorengagementinsettingstandardsforcommercialpoultrysector

•Epidemiologicalinvestigationtodefineprogressofthediseaseandeffectivenessofcontrolmeasures

•Virologicalsurveillancetotrackevolutionofthevirus

•Ongoingcontactwithpublichealthauthorities

•Strengtheningofveterinaryservicesandeliminationofcriticaldeficienciesintheseservices

•StrengtheningofprivatesectorresponsibilityandcapacityforHPAIpreventionandcontrol

Confirmationoffreedomaftereradication

•risk-based,structuredsurveillancemeetingOIEguidelinestodemonstratefreedomfromH5N1circulationinpoultry

Isolated outbreaks

Activationofcontingencyplans

Rapidresponseactionsinanattempttocontainandeliminateinfectiousfocibeforespreadoccurs

As above, plus:

•earlyhumanecullingofinfectedanddangerouscontactflocks

•disposalanddisinfection

•quarantineofinfectedplaces

•surveillanceinsurroundingzones

•regulationofmovements(poultryandproducts)

•managementoflivebirdmarkets

•possibilityofearlyrecoursetovaccination,ifmultipleisolatedoutbreaksindispersedlocations,indicativeofunrecognizedvirusdispersion,aredetected

•ensuringappropriatereportingandsharingofdataandisolates

•informingpublichealthauthorities

Extensi�e outbreaks

Increaseinarea-baseddiseasecontrolascontrolareasaroundoutbreaksmerge

General measures as above, but also:

•possiblelimitationofcullingtoinfectedflocks

•ringvaccinationtocontrolspreadaroundinfectedplaces

•broaderstrategic,systematicvaccinationinidentifiedinfectedandat-riskareasandproductionsectors

•engagementofpublichealthsectortoprovideconsistentexposureriskreductionmessagesandmeasures

Endemic situation

Endemicdiseasecontrol

Similar actions to those above, plus:

•developmentoflong-termstrategicplans

•extensionofstrategicvaccination

•livelihoods-sensitivemodernizationofpoultryproductionandmarketingtoimprovebiosecurity

The strategy 11

3.3.1 Strengthening veterinary services and related national capability In addition to themeasures summarized in Table1, FAOandOIE are alsopursuing thegoalofstrengtheningthecapacityofstatestorapidlydetectthepresenceofHPAIorotheremergingdiseasesandtaketheappropriateemergencyactions,thusminimizingpathogenloadandeconomicimpact.Itisimportanttoensuretheefficacyofpublicservicesrespon-sibleforformulatingtherelevantlegislationandeffectivelycontrollingitsapplication.Effi-cientveterinaryservices,basedongoodcooperationbetweenlivestockownersandprivateveterinarians,constituteanimportancemechanismforearlydetectionofanimaldiseases.Buildingandmaintaininggoodepidemio-surveillancenetworkscoveringtheentirenationalterritory,potentiallyforallanimalsandanimaldiseases,includingzoonoses,isaninterna-tionalobligationofallFAOandOIEmembercountries.

TheOIEhasconvincedcountriesandthemaininternationalmultilateralorganizationsconcerned,includingtheWorldBank,thatthecorefunctionsoftheveterinaryservicesarea“globalpublicgood”.OneofOIE’smainobjectivesistostrengthennationalveterinaryservices,inordertohelpmembercountriescomplywithinternationalstandardsandguide-linesforanimalhealthandwelfare,andforsafeinternationaltradeinanimalsandanimalproducts.ThisisaddressedbyapplicationofthePVStoolthroughwhich,incollaborationwithveterinaryservices,gapsanddeficienciesareidentifiedandnationalinvestmentpro-grammesfacilitated.Thisprovidesaframeworkforseekingfundingsupportfrominterna-tionaldonors,includingtheWorldBank,andfromdevelopedcountriesthathavepledgedsupporttodevelopingcountriesandcountriesintransitionforthestrrengtheningoftheirveterinaryservices.PVSevaluationsareconductedundertheauspicesofOIEandcanbeusedwithintheframeworkoftheFAO-OIECrisisManagementCentre.

Main activities• Encourage national veterinary authorities to conduct assessment of their services

andrectifydeficienciesinordertocontrolHPAIandothertransboundaryanimalandzoonoticdiseases.

• Strengthensurveillanceandearlydetectioncapacity(includingtraininginparticipa-tory epidemiology, and trainingof field veterinarians, para-veterinarians and farm-ers).

• StrengthensurveillancecapacityforH5N1infectioninwildbirdsinmostcountries.• Improvenational veterinary laboratory capacityandcapability to supportdiagnosis

and surveillance activities for HPAI and other zoonotic and transboundary animaldiseases.

• BuildoperationalcapacitytorespondtoincursionsofH5N1HPAIandotherzoonoticandtransboundaryanimaldiseases.

• Assistcountriesinimprovingtheircapabilitiestoundertakestructuredepidemiologi-calstudies.

• Develop appropriate policy support to institute measures for reducing risks in livepoultrymarkets, to improve risk reductionmeasures inpoultry-owninghouseholdsand along the poultry production and marketing chain, and to manage animalmovement more effectively to reduce the risk of HPAI dissemination and humanexposureinallcountries.

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza12

• Developcapacitytoprepareandimplementpublicawarenesscampaigns.• Encourage national veterinary services to form public-private partnerships to

undertakediseasesurveillanceandimplementHPAIpreventionandcontrolmeasures.This should include promotion of the involvement of para-veterinary personnel(originatingfromwithinfarmingcommunities)indiseasesurveillanceandreporting,includingparticipatoryapproaches.

• Ensurethatthediseasecontrolmeasuresandinterventionsdevelopedanddeployedpromotethelivelihoodsofpoorlivestockfarmers,andarebasedonsoundsocio-eco-nomicimpactstudiesandcost-benefitanalysisofvariousdiseasecontroloptions.

• Strengthencollaborationwithpublichealthauthoritiestoaddresspreparedness,con-trol,preventionandresponseforHPAIandotherzoonoticdiseases.

3.3.2 Poultry industry adjustmentEliminatingexistingfociofHPAIinpoultryisnotenoughtoachievesustainablereductioninHPAIoccurrence.Theriskofrecurrenceofdiseasemustbereducedbyaddressingcountry-specificshortcomings.Incountriesthathaveexperiencedprolongedorrepeatedwavesofinfection,adjustmentofpoultryproductiontoenhancebiosecuritycanbeconsidered.

Adjustmentcanbeadeliberateprocess(somecountrieshaveplansfor“modernization”oftheirpoultrysectors),itcanresultconsequentiallyfromchangingbiosecurityregulations,anditcanbeanintentionalchoiceofproducers.Itcaninvolvechangesinthetypeofproduc-tion,inthelocationofproduction,trade,slaughterandprocessing,andinhowthemarketchainisregulated.Usually,governmentregulationsprovideeitherincentivestochange(e.g.favourablecreditschemesortaxbreaks)ordisincentivestonotchange(e.g.feesorzoningregulations)towhichtheprivatesectorresponds.Large-scalecommercialproducersareofteninapositiontorespondfasterbecausetheyhavebetterinformationorfinancialcapacity,andthedifferenceinspeedofresponseindifferentpoultryproductionsectorscanalterthechar-acterofamarketchain.Changesimposedtoorapidlycandisadvantagesmallerproducers.

IncountriesthathavecomplexpoultrysectorsandsevereHPAIproblems,adjustmentmayneedtobepartofthestrategyforlong-termpreventionandcontrolofthedisease.However,itisextremelyimportanttoreviewanyadjustmentplansinadvancefortheirpos-sibleimpactsandtoensurethatbanningcertaintypeofproductionsystemsdoesnotleadtosmugglingwithconsequencesfornotificationofthediseaseifitappearsortodissimula-tioninthecontextofvaccinationcampaigns.Forexample,VietNamiscurrentlyreviewingthepossiblesocial,economicandenvironmentaleffectsofitspoultrysectorrestructuringplanandexpectstoinitiatepilotactivitiesundercontrolledcircumstances.

Goodpublicawarenesscommunicationofbiosecurityrequirementsandcleartechnicalmessagesaboutgoodmanagementpracticesforproducersineachsector(traders,marketownerandretailers)areanimportantcomponentofplannedadjustmentandofthestra-tegicapproachofFAOandOIE.

Dependingonhowitismanaged,adjustmentmayhavenegativeorpositiveimpacts.Forexample,itmay:

• makethesectormorebiosecureordriveactivitiesintotheblackmarket;• increaseproductionlevelsandcreatejobsorexcludepeopleanddestroytheirliveli-

hoods;

The strategy 1�

• improvefoodqualityandsafetyorwidenthegapbetweenrichandpoorconsumers.The strategy recommends activities that will increase the positive and minimize the

negativeimpacts.Therearealsolegitimateconcernsthatastrongshifttointensiveindus-try-basedpoultryproductioninevitablyputsanimalgeneticdiversityatriskandthisrequiressuitablemitigation.

Main activities• Review the structure of poultry production sectors and major market chains to

identifycriticalpointsforHPAIcontrol,needsforactivitiesthatmaydriveorresultinadjustmentand thepossibleeconomic consequencesof adjustment for vulnerablepeople.

• Incollaborationwithindustry,developandimplementauditablebiosecuritystandardsfor sector 1 and 2 farms3, and systems for demonstrating ongoing freedom fromH5N1HPAI.

• Developguidelines for relocationof farms,marketsorprocessingplantsbasedonexperiencetoensurethatrelocationisdoneinanenvironmentallysustainableman-nerthatdoesnotincreasetheriskofdiseasethroughpoorchoiceoflocation(e.g.alongmigratorybirdpathways)orexcessiveconcentrationoffarms.

• Develop and implement appropriate systems to prevent fomite4 carriage of virusfromslaughterhousesormarketstofarms,includingimprovementofbasichygienepractices.

• Developandtestsimple,lowinputsystemsthatresultintherearingandsaleofinfec-tion-freepoultryfromSector3farms,withspecialemphasisonnativepoultryandgrazingducks.

• Promoteandintroducecost-effectiveandculturallyacceptablemeasuresforimprovedbiosecurityinSector3and4poultryproduction,whichmayincludechangesinhus-bandryandpoultrymarketingregulationsbutnoteliminationofthesefarmingsys-tems.

• Developandpromotesustainablemeasures tominimizetheriskof introductionofHPAI intoSector4poultrythroughenhancedpreventionof infectionincommercialpoultry,especiallygrazingducks.

3 FAOhascategorisedfourpoultryproductionsectorsandthelevelofbiosecuritypractisedineachsectorisakey

considerationindevelopingdiseasecontrolstrategies:

Sector 1-industrialintegratedproductionwithhighlevelbiosecurityandbirdsorproductsmarketed

commercially.

Sector 2-commercialpoultryproductionwithmoderatetohighbiosecurityandbirdsorproductssoldthrough

slaughterhousesorlivepoultrymarkets.

Sector �-smallholdercommercialpoultryproductionincludingwaterfowl,generallywithlowbiosecurityand

birdsorproductsusuallysoldthroughlivebirdmarkets.

Sector �-villageorbackyardproductionwithminimalbiosecurityandbirdsorproductsconsumedlocally.Itis

recognisedthattherearegradationsbetweensectors.4 Aninanimateobjectorsubstancethatiscapableoftransmittinginfectiousorganismsfromoneindividualto

another.

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza1�

3.3.3 Strategic researchThe strategy recognizes that there are some significant gaps in our knowledge of virusecologyandepidemiologyandourunderstandingofthecomplexissuesrelatedtoH5N1HPAIcontrol.FAOandOIEadvocateresearchinanumberoftheseareasthatwouldbenefitaffectedcountriesandtheglobalcommunityasawholeinaddressingtheconstantthreatofthisvirus.Keyareasofresearchinclude:

• Epidemiological studiesofvariousdiseasesituationsandfarmingsystemstobetterunderstandthe infectionandtransmissiondynamicsof theH5N1virus, itsecologyandgeneticevolution.Thiswouldincludedirectedfieldresearch,coordinatedanalysisofsurveillancedataalreadybeinggeneratedfordeterminationofrisksanddevelop-mentofrationaldiseasecontrolstrategies.

• Coordinated local and global analysis of changes in the virus genome in order todevelopappropriatevaccinesanddiagnostic reagents (bothantigenicandmolecu-lar),aswellastotrackchangesthatassistinepidemiologicalstudiesandimprovedunderstandingofvirulencefactors,hostrangeandincreasedtransmissibilityamonghumans.Tothisend,both isolatedvirusesandtheirgenomicsequencesshouldbesharedwiththeinternationalscientificcommunityinatimelymanner(short-tolong-term).

• DeterminationofrisksassociatedwithHPAIspread,updatedcensusandmappingofdifferentpoultrysectors,marketchainanalysisanddevelopmentofcriticalpointsforcontroltoenabledesignofimprovedandtargetedH5N1HPAIcontrolapproaches.

• Investigationofwildbirdsandducksandtheirpotentialformaintenanceanddissemi-nationofH5N1viruses to include improvedunderstandingofH5N1virusecology;wildlifeecologyandmigration,andtheinterfacebetweentheagricultureandwildbirdsectors.

• Developmentofnewvaccinesanddiagnostics,includingmethodstodistinguishvac-cinatedfrominfectedanimalstoincludedevelopmentofcombinedandefficaciousH5andNewcastlediseasevaccines,andrapiddiagnosticteststodifferentiateHPAIandNewcastledisease.

• Improvementof vaccinedelivery strategies inorder to facilitatedeployment in thebackyardpoultrysector.

• Re-assessmentof thepublichealth risksassociatedwithongoingH5N1HPAI viruscirculationincollaborationwithWHO.Thisassessmentwouldincludeevaluationoffoodandenvironmental safety anddeterminationof specifichumanexposure riskvariables.

• Studies,includingcost-benefitanalysesandscenariodevelopmentandtesting,ofthesocio-economicandbiodiversity impactsofH5N1HPAI incursionandcontrolmea-sures,includingpoultryindustryrestructuring.

• Studies to improve understanding of the production and marketing environment(includingclosemonitoringofpathwaysthatarevulnerabletopotentialH5N1HPAIintroductionthroughpoultry,poultryproductsandassociatedfomitetransmission)inordertominimizehighriskpractices.

The strategy 15

3.3.4 Strategic communication and awarenessCommunicationservesasafacilitatingmechanismforbuildinganenablingenvironment,throughwhichtheglobalstrategyforthepreventionandcontrolofHPAIcanbesuccess-fullyunderstoodandimplementedinordertoreducetheoccurrenceofH5N1virusinfec-tioninpoultry,therebyreducingtherisktopublichealth,protectingthelivelihoodsofpoorfarmingcommunities,andsecuringnational,regionalandinternationalmarketsandtradeinpoultryandpoultryproducts.

StrategiccommunicationwillpromoteplanningandimplementationofnationalHPAIcommunication campaigns, with specific communication objectives and implementationmechanisms,covering:

• Advocacy,toinfluenzathepoliticalagendaandenvironment,whichcanbestbedoneinadvanceofoutbreaks;

• Behaviour change communication, to informandempower communities to adoptpreventivepractices;

• Socialmobilizationtobuildconsensusandstrengthenpartnershipsamongallstake-holdersandatalllevels;and

• Capacity-building, to strengthen and sustain communication response capabilitiesandcapacities.

Publicawarenesscommunicationwillfocuson:• Extensionofknowledgeonhomeslaughterandcarcasspreparationaswellasfood

hygienemeasurestominimizetheriskoftransmissionofdiseasetohumans,givingabalancedmessagethatdoesnotcauseunreasonableconcern.

• Improved awareness of husbandry andbiosecuritymeasures that canbe takenbypoultryproducersateveryleveltopreventintroductionandspreadofHPAIandexpo-sureofpoultryhandlers

• Encouragementofpeople,especiallypoultryproducers,toreportanyoccurrenceofhighmortalitythatcouldbeHPAI;communicationofexistingcompensationmecha-nismsiscrucial.

3.3.5 Other general measuresThestrategyrecommends implementationofanumberofsupportingmeasures thatareimportantandintegraltothedeploymentoftechnicaltoolstocontrolH5N1HPAI.

Producer capacity and capabilityCreateproducerresponsibilityformorebiosecurepoultryproductionthroughgreaterpub-licawarenessandimprovedcapacityforappropriatetechnicalresponses.

• Developcommunity-basedtraining,utilizingbothprivateandpublicsectors.• Promotepoultryproducerassociationsorcooperativesforcollaborationto improve

biosecurity,includingcontractproductionforlargercommercialsectors.

Market researchReviewpoultryproductionandmarketchains,identifyandaddressriskareas,definepoul-trycensusesandmapfarmingsystemsinordertodevelopappropriatetechnicalguidelinesforsaferpractices.

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza1�

Compensation and rehabilitation strategiesNegotiatesocio-economicaspectsofdiseasecontrolwiththeparticipationofcommunitiesandcommercialinterests.

International trade in birds and poultry productsStrengthen veterinary services, including implementation of appropriate legislation, andimprovegoodgovernancetomakesafetradepossibleaccordingtoOIEstandards.

• Review legislation for import controlsofpoultry andpoultryproducts,ornamentalbirdsandfightingcocks.

• Strengthencapacityforimplementingcontrolmeasures.• Reviewmethodsofillegalimportationofproductswithaviewtostrengtheningbor-

dercontrols,includingcollaborationwithneighbouringcountries.

Non-production domestic birds Birds kept for reasons other than production also fall within the scope of the strategy.Movementofallbirdsacrossinternationalbordersshouldbecontrolled.Publicawarenesscommunicationsshouldincludethegoalofpromotingawarenessofsafepracticesinhan-dlingallbirdstoavoidpossiblehumanexposuretoH5N1viruses.

FightingcocksandhuntingbirdsmayrepresentasignificantriskforHPAItransmissionbecause they are moved over considerable distances and come into contact with otherbirds.FightingcockshavealsobeenstronglyimplicatedasasourceofhumanexposuretoH5N1virus.Considerationshouldbegiventorequiringvaccinationand/orregistrationorcertificationfortheirmovement.

CagedpetbirdsandbirdsinzoologicalgardensaregenerallyisolatedfromothersandareprobablyatlowriskofacquiringHPAI,butsincetheymaybeofhighvalueconsidera-tionmaybegiventoallowingthemtobevaccinated.Ornamentalbirdmarkets,however,represent considerable risk for viral exchangebetween species and in the eventofout-breaksshouldbesubjecttoregulation.

Wild birdsGiventhelikelyroleofwildbirdsintransmissionofH5N1virusesoverlongdistances,thestrategyspecificallysupportsthefollowingactivities:

• Coordinationandcollaborationamongrelevantnationalauthorities,veterinarians,biolo-gistsandotherwildlifesurveillanceoravianecologymonitoringorresearchprogrammes.

• Communicationoffindingsfromfieldstudies(includingvirologicaldata,surveillanceeffortsandtelemetrydata)andimplicationsforwildbirdandpoultryhealth.

• Guidance,trainingandfacilitationforaquaticbirdmonitoringprogrammesanddis-easesurveillanceprogrammes.

• Facilitationand support towildbird surveillanceandecology studies for improvedunderstandingofH5N1virusecologyatnationalandregionallevels.

• Transdisciplinarytrainingonwildbirdmonitoringtechniques,wildbirdcapture,han-dlingandsampling,wildlifeecologyandmigration,epidemiologystudiesthatevalu-atetheinterfacebetweenagricultureandthewildbirdsector,andtabletopoutbreaksimulationexercises.

• Supportforandestablishmentoftrainedwildlifeoutbreakinvestigationteams.

The strategy 1�

3.3.6 Measures appropriate for particular disease statusTable2indicatesrecommendedmeasuresaccordingtotheparticularHPAIstatusinacoun-try.Someofthekeymeasuresmeritfurtherconsideration:

• AllcountriesthatarefreefromH5N1HPAIshouldhavecontingencyplansdevelopedfortheeventofadiseaseincursion5.Theplansshouldbenegotiatedwithstakehold-ersandtestedinsimulationexercisestoensurethattheycanbeimplementedwithavailableresourcesandthatpersonnelarefamiliarwiththeirresponsibilities.Partoftheplanningprocessistoidentifyriskfactorsandweaknessesinpreparednessandaddressthoseissuesinadvanceofanoutbreak.

• IfoneorasmallnumberofoutbreaksofHPAIoccur,therecommendedresponseistoeliminatethefociofinfectionbystampingout.However,ifthefirstidentificationofHPAIindicatesthatitisalreadydisseminatedandisunlikelytobecontainedbeforefurtherspreadoccurs,itmaybepreferabletoimmediatelyinstitutemodifiedstamp-ingoutwithringvaccination.Thisimpliesaprolongederadicationprocessbutitmaybemorecost-effectiveandlessdamagingtolivelihoods.

• Inprinciple,cullingofinfectedordangerouscontactpoultryasapublicgoodshouldbeaccompaniedbycompensation toowners.Plans forcompensationmechanismsandprovisionforfundingshouldbemadeinadvance.VaccinationratherthancullingofdangerouscontactpoultrymayreducethecostofHPAIcontrolandislikelytogainmuchgreatercommunitysupport.

• IfHPAIdisseminationbecomesmoreextensive,possiblyprogressingtoendemicsta-tus, it is likely thatwideareavaccinationwillbecomeappropriateasakeycontrolmeasure.As thediseasecontrol responsebecomesmoreprolongedandextensive,improvementstobiosecurityasawaytolimitvirusspreadwillbecomeprogressivelymorecritical,Biosecuritymeasuresarelikelytoincluderestructuringofpoultrypro-ductionandaddressingrisksassociatedwithpoultrymarketing.

• AscontroleffortsresultinfreedomfromHPAIindefinedareasorproductionsectors,compartmentalizationandzoningasdefinedinOIE’sTerrestrial Animal Health Code6maybecomeappropriate.

• After HPAI has been eradicated, carefully structured risk-based surveillance will beessentialtoconfirmthefreestatusofacountry.

5 TheFAOpublicationPreparingforHighlyPathogenicAvianInfluenzaisausefulreference.

http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html6 UnderOIEnomenclature,compartmentalizationisaprocessinwhichdefinedcompartmentsundera

commonbiosecuritysystem,suchasindividualproductionenterprisesorproductionsectors,canmaintainand

demonstratefreedomfromadisease,evenifitisendemicwithinotherproductionsectorsorunitswithina

country.

1�

Annex1

Situation analysis

Highly pathogenic avian influenza (HPAI) caused by viruses of the H5N1 sub-type hasspreadwidelyinAsia,CentralandEasternEurope,theMiddleEastandAfricaaftertheini-tialreportingofoutbreaksofthediseaseineightEastandSoutheastAsiancountriesinlate2003andearly2004.Theunprecedentedgeographicalspreadofthiszoonosishasbeencharacterizedbyhighmortalityandmorbidityinpoultryanddiseaseanddeathsinhumans,severalothermammalianspeciesandwildbirds.ByDecember2006,ithadbeenestimatedthatover240millionpoultryhaddiedorbeenculledduetoH5N1HPAIworldwide.Asof20March2007,WHOreportedthat169ofthe281humansinfectedwiththevirushaddied.Thewidespreadnatureofthedisease,thecontinuingsocio-economicimpactsand,inparticular,thepotentialthreatofhumanpandemicinfluenzaaretheprincipaldriversandjustificationforaglobalapproachtoHPAIcontrol.

Analysisofthepresentdiseasesituation,thelessonslearnedsincethebeginningoftheHPAIpanzooticandidentificationofstrengths,weaknessesandopportunitiesareanimpor-tantstartingpointfordevelopmentofrationalstrategiesforglobalcontrolofthedisease.Currently, robustepidemiologicaldataon thediseaseare scarcebutabroadanalysisofvariousnationalandregionaldiseasesituationsinthecontextoffarmingsystems,poultryandhumandensity,geographicallocation,socio-politicalsituation,policyenvironmentandcapacitytocontroltransboundaryanimaldiseasesenablespreliminaryidentificationofpos-sibleriskfactorsandimprovedtargetingofinterventionsforHPAIcontrol.

Success in 200� ...

• thediseasewaseliminatedfrommanynewly-infectedcountries• there was a substantial fall in HPAI incidence in most previously infected

countries• progresswasregisteredinthefightagainstHPAIH5N1inendemicallyinfected

countries... but with limitations

• theH5N1viruswas still circulating in somepartsofAsiaandAfricacausingpermanentriskofinfectionorre-infectionofnewcountries

A1.1 Regional analysisTable2liststhecountriesthathaveexperiencedH5N1HPAI,indicatingthedateofthelastreported outbreak, together with reported human cases and deaths (as of 20 February

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza20

2007).Thenumberofcountriesexperiencingnewoutbreaksinlate2006andearly2007hasagainincreased.Thisrecentupsurgeisnotunexpectedgiventhatinfluenza,includingH5N1HPAI,isaseasonaldisease.

TAbLE 2Summary of confirmed HPAI outbreaks in poultry and human H5N1 infection (asof20February2007)

Region and country Last reported outbreak

Human cases/deaths

Region and country Last reported outbreak

Human cases/deaths

Europe Asia

Albania 9Mar2006 - Afghanistan 4Apr2006 -

Azerbaijan 18Mar2006 8/5 Cambodia 24Aug2006 6/6

Denmark 26May2006 - China 5Oct2006 22/14

France 26Apr2006 - China(HongKongSAR) 9Feb2007 18/6

Germany 2Aug2006 - India 18Apr2006 -

Hungary 23Jan2007 - Indonesia 28Aug2006 81/63

Romania 6Jun2006 - Japan 30Jan2007 -

RussianFederation 16Feb2007 - Kazakhstan 10Mar2006 -

Serbia 16Mar2006 - Korea,Rep.of 9Feb2007 -

Sweden 26Apr2006 - Lao,PDR 3Feb2007 -

Turkey 15Feb2007 12/4 Malaysia 21Mar2006 -

Ukraine 11Jun2006 - Mongolia June2006 -

UnitedKingdom 27Jan2007 Myanmar 25Apr2006 -

Pakistan 16Feb2007 -

Africa Thailand 23Jan2007 25/17

VietNam 22Jan2007 93/42

BurkinaFaso 20May2006 -

Cameroon 28Mar2006 - Near East

Côted’Ivoire 9Nov2006 -

Djibouti 9Apr2006 1/0 Iraq(H5) 1Feb2006 3/2

Egypt 15Feb2007 22/13 Israel 30Mar2006 -

Niger 1Jun2006 - Jordan 23Mar2006 -

Nigeria 14Feb2007 1/1 WestBank&GazaStrip 2Apr2006 -Sudan 4Aug2006 -

A1.1.1 AsiaIn termsof achieving sustainable control anderadicationofH5N1HPAI,Asia is still theregionofgreatestconcern.However,overthethree-yearperiodsincetheinitialdispersalof the disease, very significant progress has been made. Four countries (PR China, VietNam,Thailandand Indonesia)haveexperiencedwidespreaddisease inpoultry.Ofthese,PR China has achieved significant success in controlling the disease in many provinces,ThailandandVietNamhavecontrolledthediseasetotheextentofenjoyinglongperiodswithno reportsofoutbreaks,but they still suffer sporadicoutbreaks. Indonesia stillhaswidespread endemic disease. Several other Asian countries, including Malaysia, Myan-mar, India, Pakistan and Afghanistan have experienced outbreaks and have apparently

Annex 1 - Situation analysis 21

eliminatedthedisease.Insomeofthosecountries,weaknessesindiseaseinvestigationandreportingmayraisequestionsastowhetherH5N1virusesarestillcirculating.Somerecentlyidentifiedoutbreaksinsomeofthesecountriescouldbearesultofsuchcirculationorofre-introductionofthevirus.

PR China reported outbreaks in 1997, 2003, 2004, 2005 and 2006. China’s poultrypopulationisestimatedatfivebillion,ofwhichabouthalfisinpoultryproductionsectors3and4,mainlyinpoorerinlandprovinces.Akeycontrolcomponentismandatoryvaccina-tionofallpoultry,includingducks,thelatterrepresentingabout70percentoftheworld’spopulation.Thisprogramme,withpotentiallyover14billionpoultrytobevaccinatedtwiceannually,isthelargestintheworld.ChinaispoliticallycommittedtoHPAIcontrolandhasachievedsubstantial success,particularly in thecoastalprovinceswithmore resourcesattheirdisposal,whererestructuringofindustryhassignificantlyreducedtheriskofdissemi-nationofthedisease.Thecountryhasadequateresourcesandstrongcapacityinallaspectsofdiseasecontrol,includingdiagnosisandresearch.

Indonesia becameinfectedwithH5N1HPAIafterthediseasefirstemergedinSoutheastAsiain2003-04.Indonesiahashadwidespreadoutbreaksofthedisease,andhasrecordedthehighestnumberofhumandeathsassociatedwithH5N1virus in theworld.There iswidespread use of several different types of HPAI poultry vaccine, mostly of undefinedqualityandefficacyandderivedfromanumberofsources.ThecontinuedspreadofHPAIand increasingnumberofhumancasesofH5N1 infectiondemonstrate that thecurrentdiseasecontrolmethodsneedtobegreatlyimproved.ThecountryhasoneofthelargestsmallholderpoultryproductionsectorsinSoutheastAsia,embeddedlargelyinthedenselyinhabitedareasofgrowinghumanpopulation.Throughoutthisvastarchipelagoofsome13,000 islands, the decentralized veterinary services are moderately developed but notuniformlyso,HumanandfinancialresourcesareinsufficienttotacklethescaleoftheHPAIproblem and other emergency priorities, including the tsunami and earthquakes, havestretchedgovernmentresources.

Thailand and Viet Nam were among the first countries to be infected following theintroductionandspreadofH5N1HPAIinSoutheastAsia.Bothcountrieshaveapproacheddiseasecontroldifferently.Thailandhasconsistentlyusedamodifiedstampingoutpolicy,enhancedbiosecurity andan improvedand intensive farm level surveillanceprogrammesupportedbyawellcoordinatedandadequatelyresourcednationaldiseasecontrolstrat-egy.These,coupledwithappropriatepoliciesrelatedtocompensation,animalmovementandprogressiverestructuringofmixedfarmingsystemsseparatingdomesticchickensfromducks,havesignificantlyreducedH5N1incidenceinthecountry.

Viet Nam has also dramatically reduced disease incidence both in domestic poultryandhumansthroughacombinationofstampingoutpolicy,massvaccinationof itspre-dominantlysmallholderpoultrysector,closureoflivebirdmarkets,banningofduckbreed-ing, public education and shifts to centralized slaughtering. Viet Nam has continued tostrengthenitsveterinarycapacityandhasmobilizedsignificantnationalandinternationalresources for implementing HPAI control projects in the field. The government’s strongpolitical commitment to control the disease has resulted in enhanced disease reportingfromthegrassrootsleveltointernationallevel.

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza22

ThailandandVietNamhavereportedoutbreaksofHPAIinpoultryinrecentmonthsandarelikelytohaveH5N1virusstillcirculatinginpoultry.OutbreakscurrentlybeingreportedinVietNamaremainlyinduckflocksandthoughttoindicateafailuretohavevaccinatedsuchflocks.

India experienced extensive outbreaks of HPAI in commercial poultry in MaharastraStateearlyin2005,whichweresuccessfullycontrolledbyaggressiveactionofbothgov-ernmentandindustry.ThecountryhasreportednofurtheroutbreakssincedeclarationoffreedominJuly2005.CambodiaandLaoPDRhaveexperiencedcontinuingbutsporadicoutbreaks of disease, apparently without establishment of endemic disease. Apparently,outbreaks in Myanmar, Pakistan and Afghanistan have been eliminated without furtherspread and recent outbreaks are likely tobedue to re-introductionof thedisease. Thisdemonstratesthatmostofthesecountries,togetherwithsomecountriesthathavenotyetexperiencedoutbreaks (notablyBangladeshandSriLanka),areconsideredtobeathighrisk of re-infection and, with generally weak veterinary capacity, could experience greatdifficultyineliminatingthedisease.

ThefirstreportsofH5N1HPAIcamefromHongKongSARin1997,followedbyreportsin2001,2002and2003. Ithas controlled thedisease successfully inpoultry throughacombinationofmeasuresincludingstampingout,strictcontroloversourcesofpoultryandtheirmovement,enhancementstobiosecurity,changes inmarketmanagementandvac-cinationofallcommercialpoultry.

Japan, Republic of Korea and Malaysia became infected during the early spread ofH5N1 HPAI in 2003-04. With their strong veterinary capacities supported by adequatefinancial resources, theyeliminated thedisease. In late2006andearly2007, JapanandRepublicofKoreaexperiencedfurtheroutbreakswhichhavebeencontrolledbyaggressivestampingout.

A1.1.2 EuropeDenmark, France,GermanyandSwedenbecame infected in2006 following the spreadof H5N1 HPAI from Asia. They were able to eradicate the disease using stamping out,enhancedbiosecurity,partialbansonfree-rangingpoultryandmovementcontrol.Thesecountrieshavewell-developed,predominantlycommercial,poultryproductionsectors.TheveterinaryservicesarestrongandfinancialresourcescanbemobilizedtostampoutHPAIrapidly,shoulditrecur.

Other European countries, including Russia, Kazakhstan, Albania, Azerbaijan, Serbia,MontenegroandTurkey sufferedoutbreaksofdisease thatproveddifficult to control inmanycases.Allofthesecountriesultimatelyeliminatedthediseasealthoughthereissomespeculation thatH5N1virusesmay stillbecirculatingorhavebeen re-introduced. Infec-tionhasagainbeendetected inHungaryandRussia, indicatingeithercontinuedcircula-tionofthevirusor itsre-introduction.OneoutbreakhasrecentlyoccurredintheUnitedKingdom.

SeveralEuropeancountriesidentifiedH5N1HPAIinwildbirdswithoutexperiencingdis-easeinpoultryandtherefore,consistentwithOIEnorms,areconsideredtohavehadHPAIoutbreaks.TheseoccurrencesdemonstratethatthegeographicextentoftheriskofHPAIintroductioniswiderthanisindicatedbyreportsofpoultryoutbreaks.

Annex 1 - Situation analysis 2�

A1.1.3 AfricaEgyptandWestAfricahavebecomethemainareasoutsideofAsiawherethereisaseriousandprotractedproblemforH5N1HPAIcontrol.

NigeriaandEgyptwerethefirsttwoAfricancountriestobeinfectedwithH5N1HPAIinearly2006.InNigeria,large-andmedium-scalecommercialenterprisesarewellrepre-sentedbutaresetwithinaverylargeandextensivesmallholderpoultryproductionsystem.Thegovernmenthasusedacombinationofdiseasecontrolapproaches, includingmodi-fiedstampingoutandmovementcontrol.Vaccinationisbeingusedbysomecommercialoperatorsevenwhennotofficiallysanctioned.Deficienciesindiseasereportingareclearlyrecognized, particularly in smallholder production systems and in free-range urban andperi-urbanandvillagepoultry.Virusisprobablycirculatinginthesesectorsandthuscontroleffortsneedtobesustainedandsurveillancecapacityenhanced.

InEgypt,theresponseofregulatoryauthoritiestothefirstoutbreaksinearly2006weremasscullingofinfectedpoultry,restrictionsondomesticpoultrybreeding,marketingandlocalslaughteroperations,particularlyinurbanareas,andlatervaccinationofbothlargecommercialpoultryflocksandsmallholderpoultry.Despitethis,thediseaseinpoultryhasresurfaced in different locations demonstrating that virus circulation has become firmlyestablishedinpoultry.Domesticpoultrybreedingiswidespreadandeconomicallyvitaltomillionsof low income families in Egypt. Poultryproduction ismainly confined to areasalongtheNileandinthelargercities,wheremostofthehumanpopulationresides.Out-sideAsia,EgypthashadthehighestnumberofhumaninfectionsanddeathsduetotheH5N1virus.

OutbreaksofdiseaseoccurredinSudan,possiblyduetospreadfromEgyptandhaveapparentlybeensuccessfullycontrolled.OneoutbreakwasreportedfromDjiboutibutitisbelievedthatthereisnocurrentHPAIthere.InWestAfrica,BurkinaFaso,Cameroon,Côted’IvoireandNigerhavealsoreportedoutbreaks,probablyduetodirectorindirectspreadfromNigeria.Someofthesecountrieshavenotreporteddiseaseinrecentmonthsbut,ingeneral,theirH5N1HPAIdiseasestatuscannotbefullydeterminedduetolackofordif-ficultyinobtainingadequatesurveillancedataasaresultofpoorcapacity.ItisthoughtthatthediseasehasdisappearedatleastfromCameroonandNiger.

A1.1.4 Near EastOutbreaksofH5N1HPAIoccurredduring2006 in Israel, Jordan, IraqandWestBank&Gaza Strip. All outbreaks were controlled and these countries are now apparently freefromdisease.

A1.1.5 Other regionsMostofthecountriesintheworldhaveneverreportedH5N1HPAIinfection,amongthemlarge parts of eastern, central and southern Africa, all of the Americas, Australia, NewZealandandthePacificIslands.

Whileallcountriesareatpotentialriskofincursion,therisksandpotentialconsequenc-esofHPAIintroductionvary,dependingonanumberoffactors.Manyofthesecountriesare developing economies with inadequate veterinary services and poor financial andhumanresourcesandarelikelytohavedifficultiesindetectingandcontrollingthedisease.

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza2�

Theriskofdiseasebecomingendemicinsuchcountriesmaybeparticularlyseriousifhighdensitypoultrypopulationspredominateinsectors3and4,wherethelevelofbiosecurityisgenerallypoor.

A1.2 Socio-economic impactInadditiontothehumandeathsthathaveoccurredduetoH5N1virus,andlargelyasaresultofthat,theHPAIpanzootichascausedthreenotableeconomicandsocialimpacts:

• marketshocks;• negativeconsequencesforlivelihoodsasaresultofthediseaseandthecontrolpro-

cessesappliedtocontainit;and• changes to the structure of poultry market chains, induced either by heightened

biosecurityregulationsorcreatedthroughgovernmentpolicy.MarketshockwasthefirstvisibleeconomiceffectofH5N1infectionandhasoccurred

evenincountriesandregionsthathavenotexperiencedoutbreaks.Internationaldemandandpriceshavebeendisruptedbyconsumer fearsand importbansof tradingpartners.Internationalbans reducedvolumesofglobal trade inpoultryproductsbyeightpercentbetween2003and2004.The reduction in supplyofpoultryproducts increasedpoultrypricesbynearly20percentafterHPAIoutbreaksin2004andthefirsthalfof2005.Globaltraderecoveredin2005and2006,althoughlessthanhadbeenpredictedbeforetheHPAIpanzooticcommenced.SourcingofpoultryproductsforinternationaltrademovedtowardsSouthAmerica,withAsia(notablyThailandandPRChina)losingtheirmarketshare.Therewerealsosubstitutioneffectsasconsumersswitchedtootherproteinsources.

Domesticmarketshockhasbeenevidentininfectedcountries,thoseinwhichHPAIwassuspectedandevenincountriesthathavesufferednoincursionofH5N1HPAI.Domesticreductionsindemandandpricespaidforpoultryhavecausedatleasttemporaryhardshipforproducersthroughlossofmarkets.

Disease control processes, including culling birds without compensation and marketclosures,havecauseddisruptionandrestrictedmarketoperations.Fewofthedevelopingcountries affected by HPAI had compensation systems in place in 2004. HPAI has mostseverelyaffectedcountriesinwhichsmall-scale,lessbiosecurepoultryflockspredominate(Sectors3and4).Restrictingmarketoperationshashadlivelihoodimplicationsforproduc-ersandtradersevenbeyondtheimmediateareaofoutbreaks.Allproducerssufferfromreduced access to markets following HPAI occurrence. However, smallholders tend torecovermoreslowlyandtendtolosemarketsharetolarge-scalecommercialoperations.InVietNam, it tookmanyweeks to restockbackyard flocks after culling, but themainimpactin2005wasfromtheclosureofmarkets.Thegenderimpactsofthismeritfurtherinvestigation,sinceincomefromsmallholderpoultryproductionisunderdirectcontrolofwomen,andincomecontrolledbywomeninpoorhouseholdsisoftenusedforfoodandeducationforchildren.

Wherecertainpoultry farming systemshavebeen seenasa threat forHPAIdissemi-nation, including thegrazingofducks in rice fields and scavengingducks and chickensforbackyardproduction,banshavebeenintroducedinanattempttoforcesmallholdersintochangingtheirhusbandrypractices.Suchbanshavegenerallynotbeensuccessfulinpreventing disease spread. However, they have adversely affected livelihoods and some

Annex 1 - Situation analysis 25

smallholdershavebeentemporarilyorpermanentlyforcedoutofpoultryproduction.Thelimited studies that have been undertaken to date indicate that heightened biosecuritymeasureschangethestructureofmarketchains.SupportingtheneedsofamodernizedpoultrysectorrequiresinvestmentthatmanysmallholderscannotaffordandtheoutcomeofchangesisthatfewerbirdsareproducedinSectors3and4,whileproductionincreasesinSectors1and2. Inanumberofcountries inwhichstructuralchange is takingplace,sometimeswithoutadequateplanningorattoofastapace,FAOhasexpressedconcernaboutthenegativeeffectsonlivelihoods.

2�

Annex2

Lessons learned

AnalysisofthebehaviourofHPAIduringthepanzooticandthesuccessofdifferentdiseasecontroleffortspermitsanumberofbroadobservationsregardinglessonslearned,suchasidentificationofkeyriskfactors,problemsassociatedwiththeapplicationofwell-definedtoolsforHPAIcontrol,andregionalandinternationalcoordination.

Markers for the future

Just over three years after the current HPAI panzootic started in Asia, the international

scientific and technical community, strongly supported by FAO and OIE, has learned much

about the disease and the best efforts to control and prevent it. These lessons are invalu-

able markers for the future and form the backbone of the FAO/OIE global strategy.

• HPAI prevention and control requires further strengthening of OIE compliant

national veterinary services

• while migrating wild birds have been implicated in HPAI global spread, more

attention should be given to the movement of poultry and poultry products

• national disease surveillance capacity needs more support

• stamping out is the best way of containing outbreaks but only if backed by fair

compensation, effective movement control and surveillance

• vaccination is effective in reducing HPAI incidence if applied according to guide-

lines, if quality vaccine is used and if supported by close monitoring and an exit

strategy

• long-term HPAI prevention and control will require changes in some poultry hus-

bandry and marketing practices

• advocacy and communication can help create political support for H5N1 HPAI

control at the national, regional and global levels

• public awareness is vital for HPAI control to gain community support, create rec-

ognition of safe practices and avoid market shocks

A2.1 Risk factors• Countrieswithstrongnationaleconomiesgenerallyhavewell-developedveterinary

servicesandstrongdiseasedetectionandcontrolcapacityforstampingoutofHPAIshoulditbedetected.Suchcountriesalsotendtohavewell-organizedandregulatedcommercialpoultrysectorswithahighlevelofbiosecurityandarethereforeatrela-tively lowrisk forHPAI incursion.Conversely,countrieswithweakeconomieshavedifficultiesindetectingandstampingoutHPAIduetoweakveterinaryservicesand

The Global Strategy for Prevention and Control of H5N1 Highly Pathogenic Avian Influenza2�

inadequatecapacityinallaspectsofdiseasecontrol,andinsufficientmanpowerandfinancialresources.Suchcountriesalsotendtohavepredominantlysmallholdercom-mercialandbackyardpoultryproductionsectors,inwhichbiosecurityispoor.

• Wherebiosecurity ispoorandpoultrydensityhigh, thediseasecanspreadrapidly,causinghighmortalityinchickens.Wherepoultrydensitiesarelow,evenifbiosecurityispoor,thediseasespreadsslowlyandisoftenself-limiting.

• MarketactivitiesrepresentaseriousriskfordisseminationofHPAI,especiallypoorlycontrolledlivebirdmarketswherethereisariskofdevelopmentofinfectioncycleswithinmarkets,transferofvirusviafomitesorbybirdsbeingtakenalivefromamar-ket,eithertobereturnedtotheirsourceortransportedelsewhere.

• TheriskformaintenanceofH5N1HPAIisincreasedifducksareanintegralpartofthesmallholderproductionsystembecauseduckflocksarecapableofactingasreservoirsofH5N1infection.

• Internationaltrade,especiallyunregulatedorillegal,inpoultryandpoultryproductsrepresentsasignificantriskforinternationalspreadofHPAI.Thespecificriskfactors(riskof transmission fromspecificproductsoraccompanying fomites) arenotwelldefined and international market chains are not well characterized. Non-infectedcountriessharingborderswithH5N1-infectedcountriesareathighriskifunregulatedandinformaltradeinpoultryoccurs.RegulatedlegaltradeinpoultryinaccordancewithOIEregulationsposesaverylowrisk.

• TherearestrongindicationsthatmigratorywaterfowlhavebeenresponsibleforlongdistancedisseminationofH5N1viruses.Countrieswithlargewetlandsthataredes-tinationsforwildbirdmigratingdirectlyfrominfectedcountriesareconsideredtobeatrelativelyhighriskofHPAIvirusincursion,particularlyinareasofhighagriculturalproductivityandwherepoultryareincontactwithwildbirds.

• Otherwildbirdspeciesandalsosomemammalianspecies,includingcatsandpigs,havebeenshowntobeinfectedwithH5N1viruses.Theirepidemiologicalsignificanceisnotwellestablished.Atpresentitisthoughttobeminor,althoughinplaceswheretheseanimalsareknowtohavebeeninfected,investigationsneedtobeconductedtoestablishwhetherviruscontinuestocirculateintheseanimals.

• Inthesocio-politicalenvironmentofmanycountries,governanceissuesandwarandother emergencies confound application of various HPAI control programmes andcompromisetheabilityofinternationalagenciestosupportcontrolefforts.

• Disease prevention or control measures which are perceived by communities asunreasonableorwhich are impracticalwithin a country context becauseof estab-lishedculturalnormsoreconomicimperativeswillnotbecompliedwith.Measuresthatareacceptable,eveniftechnicallyweaker,aremorelikelytobesuccessfulinHPAIcontrol.Newlawsorregulationsnotaccompaniedbysomelevelofenforcementwillalsobeineffective.

• EndemicdiseasefociinmanycountriespresentaconstantriskofH5N1HPAIspreadgloballyandthereforemustremainafirstpriorityforcontrolanderadication.

Annex 2 - Lessons learned 2�

A2.2 Lessons learned from HPAI control tools and methodsAnumberofwell-definedandtesteddiseasecontrolmethodologiesandtechnologiesareavailable7. These include surveillance and early detection using various diagnostic tests,biosecurity,stampingoutbyculling,animalmovementcontrol,useofvaccines,cleaninganddisinfection,andimprovedfarmandmarketmanagement.SincethestrategyrecommendstheuseofthesetoolsinthecontrolofH5N1HPAI,somekeyobservationsontheirapplicationaregivenbelowalongwithsomeofthelessonslearnedfromcommunicationinitiatives.

A2.2.1 SurveillanceEffective surveillance supports effective disease control through early detection of thedisease,definitionofriskfactors,betterassessmentofvaccinationprogrammes,improvedunderstandingofgeneticevolutionofthevirus,andclearerelucidationoftheepidemiol-ogyofthedisease.Sinceearlydiseasedetectionisaprerequisiteforlimitingexposureofanimalsandhumans,itmustbesupportedbytrainedprofessionalsatthefieldlevelandbackedbyspecialistpersonnelatdiagnosticlaboratoriesandepidemiologyunits.

Majorweaknessesandstrengthsidentifiedinsurveillancesystemsgloballyare:• SurveillanceinmostoftheHPAI-infectedcountriesisweak.Asaresult,robustepide-

miologicalinformationondiseaseincidence,infectionandtransmissiondynamicsislacking,precludingdevelopmentandimplementationofrisk-basedcontrolmeasureswhicharecost-effectiveandpractical.

• Many countries do not appear to have the expertise to develop and implementnationalsurveillanceplans.

• Manycountrieswithweakeconomiesdonothavewell-establisheddiseaseinformationsystemsandthusdonothaveeffectivecapabilitiestoshareandanalysenationaldata.

• Farmlevel,participatoryandcommunity-basedsurveillanceprogrammessuchasinten-siveactivesurveillance(e.g.‘X-ray’surveillanceinThailandusingthousandsofvillagevolunteers)andpilotparticipatorydiseasesurveillance(PDS)inIndonesia,appeartobeworkingwell fordetectionofHPAI.However, these require considerable investmentandtechnicalsupportforimplementationandsustainabilityonanationalscale.

• International HPAI surveillance is compromised by weaknesses in national diseas