UNICEF Programme on Pandemic Prevention & Preparedness

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Science Quiz• What’s the difference between bird flu and avian

influenza?• What is a pandemic? How is it related to bird flu?• What % of countries reported to UNISIC they have

developed pandemic preparedness plans?• Why are we more vulnerable each year to new infectious

disease threats? • Why is George Bush worried about the pandemic?

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Threat of Human Influenza Pandemic

Inter-pandemic Period Pandemic Alert Period Pandemic Period

• Circulating in wild birds and poultry since 1996

• Highly contagious & deadly among birds

• Spread from Asia to Europe, Middle East and Africa

H5N1:• Has infected humans in

rare instances - resulting from close exposure to sick birds and/or their droppings

• If H5N1 evolves into a human virus it could cause a human influenza pandemic

• Also possibility that H5N1 never evolves into a human virus

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Confusion between Avian Influenza and pandemic preparedness is common Pandemic prevention requires:

1. Control of HPAI in birds2. Prevent human H5N1 infections.

Pandemic preparedness is largely unrelated to AI response needed in every country, unlike AI response

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THREE PANDEMIC SCENARIOS

Time

Impa

ct

Scenario 3 - Rapid Onset / Widespread impactLittle time for preparation, rapid action vital, movement restrictions, emphasis on mitigation: Major pandemic

Scenario 2 - Slow Onset / Localized ImpactSlowly acquires infectivityContainment may be successful Limited pandemic

Scenario 1 - Extended Phase 3 / Avian Influenza outbreaks continueSporadic human casesImpact on livelihoods due to culling of birdsNo Pandemic

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US mortality data, 1900-90

1918

1957 1968

PAST PANDEMICS1968: Bad regular influenza season1957: Worse than very bad influenza1918: Worst health event since "black death" of 14th century

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Pneumonia & Influenza Deaths, USA

(Source: Glezen WP. Epidemiologic Reviews 1996; 18(1): 64-76)

2,000

1,000

500

0

1,500

5 10 20 8030 40 50 60 70

1892

1918

1936 - non-pandemic yr.

1957

DE

ATH

S P

ER

100

,000

PO

PU

LATI

ON

AGE

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Global Vulnerability• Unprecedented population density

– Threats from old and new microbes

• Human pressure on habitats– new evolutionary pressures on ecosystems

• Global increase in wealth– Demand for meat increasing

• Over past 30 years average of 2 new microbes/year– ~70% of them come from animals (zoonoses)

• Globalisation and interconnectedness– About 2 billion airplane trips per year, and rising

• “Just-in-time” stock mgt. & efficiency– Little spare capacity …..

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> 1100 events followed by WHO between January 2001 and May 2006..

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ECONOMIC IMPACT OF PANDEMIC• Global economic cost estimated at $2 trillion

– SARS - <1000 dead, $50 billion economic loss.

• Deaths, absenteeism and attempts to avoid infection have consequences for supply and demand side of economy– Markets close, utilities unreliable, telecoms break– Travel and leisure travel reduces, demand for food changes

• There may be threats to Rule of Law and Security

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1900

1850

1950

2000

1847

1889

1918

19571968

42 yrs

29 yrs

39 yrs

11 yrs

No Pandemic for 40 years

Past Influenza Pandemics

H1N1

H2N2H3N2

?H2

?H1

Prediction & Action“Timing and severity of the next pandemic remain unknowable, but the opportunity to prepare is invaluable; especially when these preparations can benefit existing priorities.”

UNICEF PPP Strategic Plan 2008-2009

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What needs to be done?• Prevent a pandemic

– Avian influenza control

• Contain an emergent virus• Mitigate pandemic impact

– Main risk is panic/anxiety reactions

– Economic impact -especially on poor

& children– Health services will be strained– Other services may collapse

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What is new since 2005?• Pandemic risk from H5N1 remains unchanged

– Will H5N1 cause pandemic? How many mutations?– Risk from other influenza and other viruses

• Many countries able to control HPAI outbreaks– But virus returns and remains widespread

• Oseltamivir (Tamiflu) resistance (and side effects)– Logistics problematic

• H5 vaccines licensed; WHO stockpile planned– use remain uncertain

• Pandemic control– Role of airborne transmission unresolved (masks?)

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Pandemic Prevention and Preparedness Strategic Plan: UNICEF Vision

Communities: active participation generate and implement solutions global and local disease threats to children, including A/PI.

Govt, NGOs, etc: mobilise & coordinate responses to a range of threats, including A/PI.

UNICEF (coordinated UN response): support prevent/control highly pathogenic avian influenza (HPAI) prepare to respond to a novel human influenza virus,

including the rapid containment responses.

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UNICEF Programme Goals

Goal 1. Pandemic preparedness to mitigate impacts on children and their families

Goal 2. Communication (C4D) to support programme goals

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Goal 1: Pandemic PreparednessObjective 1.1. Programmatic guidance for pandemic preparedness

developed and implemented

Objective 1.2. UNICEF programmes’ pandemic preparedness integrated into existing emergency preparedness

Objective 1.3. UNICEF programmes’ preparedness tested and enhanced through simulation exercises

Objective 1.4. Capacity of national EPI to rapidly distribute vaccine in pandemic in additional priority countries strengthened

Objective 1.5. Pandemic-specific communication response to support non-pharmaceutical interventions is defined in terms of content, timing, and roles by 2008

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Interagency agreement –Pandemic Influenza (PI)

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WHO Pandemic Preparedness Guidelines• Working Groups established Dec 2007 (w UNICEF)

– Strategic Policy Document– Communications and Social Mobilization– Public Health Interventions– Medical Interventions– Non-health sector preparedness

• Global Consultation– 4-9 May, Geneva

• Updated guidance expected Sep’ 08

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Goal 2: CommunicationObjective 2.1. Map communication capacity and partners

Objective 2.2. Capacity to use “routine” system for “emergency” communication response strengthened

Objective 2.3. Role of communication support for AI control in enzootic and high risk countries

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Interagency agreement – AI

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A/PI Communication:Key AchievementsAdvocacy with governments leading to enhanced inter-sectoral

partnerships;

Evidence-based planning for behaviour change communication/ social mobilisation strategies;

Key behavioural actions for prevention of AI defined (Report, Separate, Wash, Cook) and disseminated widely;

Range of communication materials (print, audio, and TV) and tools developed- Shared through internet [http://www.unicef.org/influenzaresources];

National and international media sensitised on AI.

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A/PI Communication:Key gapsCommunity-level communication plans and actions

need to be strengthened Dialogue rather than information dissemination

Analysis of feasibility of behaviours How to address sociocultural and economic barriers

Sustained actions to reach vulnerable groups and generate local solutions

Inter-agency coordination remains challenging

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Speaking points – Summary• UNICEF has been actively involved in A/PI activities since 2006• Development of guidance to UNICEF offices and global guidance

with technical partners• Disease evolution & global interest• Key investment areas (UNICEF);

– Communication– Vaccines/logistics– Contribution to global guidance– Material development