The Avian/Human Influenza Pandemic:
Why the Concern?
One NGO’s Response Priorities & Actions
Milton B. Amayun, MD, MPH
Sr. Technical Advisor, Hope Initiative
World Vision International
12 May 2006
What the Presentation Will Cover
• Why the concern?
– Not flu as usual
• Protection measures
• Pandemic priority: Business Continuity
– Global: Contain, Prepare, Respond
– World Vision: Educate, Respond, Engage
2
What are the signs and symptoms
• Regular/seasonal flu is
characterized by fever,
joint and muscle pains,
sneezing, runny nose
• Transmitted from
human to human
• Prone to mutations
• Vaccines available;
fairly good protection
• Yearly cycles
• Avian flu resembles
many symptoms of
regular or seasonal flu
• History of contact with
chickens, birds, fowl
• Still little evidence of
human-to-human
transmission
• No vaccine available
until pandemic starts
• Cycle?
3
Key Events So Far
• Numerous reports of birds dying in many countries
• Millions of poultry have been culled; farmers have
lost their livelihoods
• Started in Asia, now firmly in Europe and Africa
• Worst hit: Indonesia, Thailand, VN, China, Cambodia
• Nigeria, Burkina Faso, Egypt, Sudan report H5N1
• 200+ human deaths in several countries of SE Asia,
Egypt and Turkey
• WHO, World Bank and governments seriously
concerned
• Fortunately, current spring migration of birds back to
Europe did not expand transmission
4
5
Potential pandemic scenarios
W o rk in g S c e n a rio s – [W F P D E C 0 5 ]
AI / HI
S e ve rity
4.
G lo b a l P a n d e m ic
F a r, fa s t, fu rio u s
3.
M o d e ra te P h a s e 4-6
D o n o rs a n d H Q h it h a rd
Phase 6
M o d e ra te P h a s e 4-6
2.
V u ln e ra b le p o p u la tio n s
h it h a rd
Phase 5
Phase 4
1.
Phase 3
E x te n d e d
\
Phase 3
L ive lih o o d s
im p a c te d
Today
3
6
9
12
15
18
21
24
T im e
M o n th s
R e p re se n ta tio n o f fo u r w o rk in g sce n a rio s illu stra tin g d im e n sio n s o f se ve rity,
tim e a n d scale (size o f b u b b le ).
6
Occurrence of influenza pandemics
and epidemics
Disease incidence
Incidence of clinically manifest influenza
Pandemic
Pandemic
Interpandemic period
Epidemic
Epidemic
Epidemic
Epidemic
1
2
Introduction of
hypothetical
A HxNx virus
3
4
5
6
7
8
Time in years
Epidemic
9
10
Significant minor variation in A HxNx may
occur at any of these points. Epidemics may
or may not be associated with such variations
11
12
Introduction of hypothetical
A HyNy (major new
subtype), variant A HxNx
disappears
Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 5th ed. 2000:1829. Modified from
Kilbourne ED. Influenza. 1987:274, with permission.
7
WHO phases of pandemic alert
World Health Organization (WHO) Global Influenza Preparedness Plan
Phases of Alert
Period
Phase #
Inter-pandemic phase
(New virus in animals,
no human cases)
1
Low risk of human cases
2
Higher risk of human cases
3
Very limited human to human
transmission
4
Increased human-to-human
transmission
5
Significant human-to-human
transmission
6
Efficient and sustained human-tohuman transmission
Pandemic alert
(New virus causes human cases)
Pandemic
(Human-to-human transmission)
Phase
The world is presently in Phase 3: A new influenza subtype is causing disease in
humans, but it is not yet spreading efficiently and sustainably among humans.
WHO website: http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
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How severe would a pandemic be?
• Best case scenario:
– Significant amount of illness, but mostly not severe
and few deaths
– Hospitals still function
– Medical insurance provides cover
– Sufficient Tamiflu to provide treatment
– Food and basic supplies continue to be available at
reasonable cost
– Airlines keep flying, staff can move freely
– Communications not disrupted
– No security issues
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How severe would a pandemic be?
• Worst case scenario:
– Severe illness in population with many
millions of deaths
– Hospitals overwhelmed despite applying strict triage
– Severe pressure on use of Tamiflu for treatment of
cases and contacts
– Severe disruption to food and basic supplies
– Borders closed
– Airlines not operational
– Communications disrupted (telephones / Internet)
– Major economic disruption
– Security issues
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Key Question
• When do we expect a mutation of the virus?
• The answer is: nobody knows
• A mutation could result in human-to-human
transmission
• When that happens, a catastrophe is likely
• The virus may have new properties. e.g.,
higher level of virulence
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12
Global pandemic priorities
Contain avian flu epidemic
–
Upgraded veterinary infrastructure
–
Improved biosecurity
–
Changed bird trade patterns
–
Behavior change: no backyard
chickens
Prepare for pandemic
–
–
–
–
Vastly improve surveillance
Stockpile anti-virals and other
medications
Protective clothing & equipment
Containment plans
Respond to pandemic--keep vital services and
societies going,
minimize suffering and
loss of income
"When the pandemic starts, it will be too late to get prepared."
Dr. David Nabarro, United Nations System Coordinator for Avian and Human Influenza
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Proposed World Vision priorities
Educate…inform
–
–
Staff & families
Public & communities
Respond
–
–
–
Overall response management
People…keep well & alive
Business…keep going
Engage
–
–
–
–
Communities & others
Rapid response & assistance
Health capacity building
Advocacy
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1. Educate
•
Audiences
–
–
•
Messages, e.g.
–
–
–
•
Internal: Staff & families
External: Public & communities
Staff advisories
Frequently Asked Questions
Travel advisories
Methods, e.g.
–
–
–
–
–
Messages from leaders
Web postings
Handouts/posters/fliers
Media
Meetings/briefings
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2. Respond
•
Overall response management
– Prepare for potential Category III response
•
•
People---keep them well and alive
Business--keep it going--get work done
–
–
Analysis & risk assessment, e.g., essential services, time-based
operational, economic & technical risks
Plans & preparation, e.g., work coverage, supply chains, cross
training, alternative work sites
The WVUS Crisis Management Plan provides a potential
framework for responding to the pandemic threat
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Response approach
Actions aligned with WHO Phases & Country situation
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Response Strategies - Examples
Plan
Prepare
Pandemic
Management
Develop
pandemic
management
protocols
Train managers
in pandemic
management
protocols
Implement
pandemic
management
protocols
Phase-in
resumption of
standard
protocols
People
Plan Staff
Training
Conduct Staff
Training
Implement
Personal Health
Protection
Practices
Cease
unnecessary
health
precautions
Assess staff
capability to
work at
home
Provide
technological
resources and
training
Implement workat-home plans for
essential functions
Phase-in returnto-work plans
Response
Priorities
Overall
Personal Health
Practices
Business
Work-at-home
Implement Recover
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The overall coordination of
the WVUS response to a
crisis, in an effective, timely
manner. This includes both
people & business functions.
Crisis Management
Crisis
Event
Emergency Response
(People)
The short term response,
commencing immediately after an
incident, that preserves the health
and safety of all people involved.
Business Continuity
(Business Functions)
Time
The ability to continue critical business
functions within specified timeframes.
Analysis (Risk & Business Impact)
Plans, Preparations, Protections
Exercises, Maintenance
World Vision US Crisis Management Plan
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Examples of areas where strategies, policies
and actions are needed
–
–
–
Employee education and communications
Staff risk assessment
Pandemic health protection (including personal health practices, seasonal flu
vaccine, pandemic flu vaccine, PPE, Tamiflu, and other medical supplies)
–
Safe work environment (including personal health practices and use of PPE in
workplace, meeting management, emergency response, workplace cleaning, HVAC,
mail, security, etc.)
–
–
–
–
–
–
–
–
Evacuation/relocation
Travel
Illness management
Health benefits
Employee assistance
Compensation and leave
Work-from-home policies (including technical support)
Collaboration guidelines
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3. Engage
a)
b)
c)
d)
Community resilience & education
Community-based surveillance & early warning
Rapid response & treatment assistance
Animal health capacity building as primary
prevention
e) Advocacy & engagement with others
Doesn't just apply to program countries…
opportunities in donor countries like the US also
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3. Engage
Collaboration underway
• NGO sharing and collaborative efforts, e.g.
– WV-US with CARE, CRS, SCF
– WV-Indonesia with CARE, CRS, SCF, and MCI
• IASC technical consultation at WHO
• InterAction Avian Flu Working Group
• WHO/FAO/OiE/World Bank meetings on Avian &
Human Pandemic Influenza
• Bangkok Tripartite Conference (governments, NGOs and
private sector)
This is very big, there's much to be done, and we have
timely opportunity to collaborate and share.
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3. Engage
What does WVI intend to bring to the situation?
•
•
•
•
•
•
•
•
•
Field presence
Governmental & community relationships
Local expertise
Established networks and staffs
Capital for chains of supply
Expertise to mentor local communities & NGOs
Accountability/fiscal credibility
Relationships with experts
Credible monitoring and evaluation
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3. Engage
a) Community resilience & education
• Education and behavior change communications
—for human and animal health
• Collaborative community risk assessments
• Risk mitigation communications
• Community response planning & exercises
• Economic mitigation plans
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Promote 4 actions now!
Wash hands
thoroughly with
soap frequently
Cover coughs
and sneezes
Wear a mask if
symptomatic
Don’t spit!
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STOP BIRD FLU!
Wash your
hands
thoroughly
with soap!
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3. Engage
b) Surveillance & early warning
• Community surveillance/referral systems
– avian and human influenza
• Surveillance training
• Early warning systems
• Education, tools & protocols
• Mobilizing community partners
• Communication systems
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3. Engage
c) Rapid response, containment, treatment
• Community, village, provincial and national rapid
response capacity
• Planning & preparation
• Surveillance information systems
• Diagnostic confirmation capabilities
• Humane culling & quarantine zoning
• Treatment assistance
• Lines of communication
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3. Engage
d) Animal health as primary prevention
• Prevent AI at the source
– Small-scale/backyard poultry farms
– Wild birds
• Assess & strengthen veterinary services & capacity
–
–
–
–
Quality & reach
Vaccine centers & transport
Cold chain equipment
Humane culling
• Poultry biosecurity & vaccination
• Bio-safety and clinical equipment
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3. Engage
e) Advocacy & engagement with others
• Sharing and collaboration with others
• Joint advocacy, risk communications and
engagement
• Media engagement, TV spots, posters, leaflets,
booklets
• Translation and localization of materials
• Flexible funding mechanisms, e.g., Interagency
Working Group, USAID, CIDA, AusAID
• Sharing lessons learned, practices, tools, etc.
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Where to get more information
•
•
•
•
WVI Website: www.WVI-AvianFlu.org
AvianFlu News Group
WV documents/plans
Web sites
– WHO: www.who.int/csr/disease/influenza/pandemic/en
– CDC Avian Flu: http://www.cdc.gov/flu/avian/
– FAO Avian Influenza:
http://www.fao.org/ag/againfo/subjects/en/health/diseasescards/special_avian.html
– Flu Wiki: http://www.fluwikie.com/
– US Dept of State-Bird Flu
http://usinfo.state.gov/gi/global_issues/bird_flu.html
• Good read: The Great Influenza by John Barry, Penguin
Books
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Thank you!
• E-mail your questions
to:
[email protected]
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