Template AF presentation New

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CEA Stockholm June 15th 2007
Europes pandemic preparedness Stock-taking on
Progress Prof Angus Nicoll CBE Influenza
Coordinator ECDC European Centre for Disease
Prevention and Control (ECDC)
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Why ECDC was Established in 2005

• One of Six EU Health Agencies
• Emerging and re-emerging communicable diseases
  revitalized through globalization, bioterrorism,
  interconnectivity, and EU without internal
  borders
• Health implications of EU enlarging 10 new MSs
  as of 2004 and two more in 2007
• Technical weakness in the Commission and no focus
  for public health and communicable disease in the
  EU family
• Strengthen EU Public health capacity to help meet
  EU citizens concerns
• Anthrax releases USA, SARS and threat of next
  pandemic

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Expanded Europe the Fifth Freedom

• Free Movement of People
• Free Movement of Services
• Free Movement of Goods
• Free Movement of Monies
• Free Movement of Micro-organisms
• Adapted from Summary of Legislation - Internal
  Market http//europa.eu.int/scadplus/leg/en/s7000
  0.htm

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Bird Flu Threat to the European Union Much
Reproduced Cartoon from Autumn 2005
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Broad health mandate initially for communicable
diseases onlyFounding Regulation 851/2004/EC

• Main mission Identify, assess communicate
  current emerging health threats
• Risk identification, monitoring, assessment and
  communication
• Surveillance
• Epidemic intelligence
• Risk Communication
• Preparedness and Response
• Training
• Scientific opinions and guidelines
• Advisory role to European Commission and Member
  States
• MS/EC/ECDC/WHO collaboration needed for success

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Bird Flu (H5N1) 2005-6 into Europe
Source http//ec.europa.eu/food/animal/diseases/a
dns/adns_wildbirds_09112006.pdf
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Confusion about risk and types of influenza
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H5N1 Human Risk Assessment

• H5N1 viruses in humans currently remain a group
  of influenza viruses of birds, poorly adapted to
  humans whom they find hard to infect except at
  high doses. They are dangerous as they are highly
  pathogenic in those few humans that do become
  infected, but then they generally do not transmit
  on to other humans. ..
• ECDC Risk Assessment October 2005, Updated June
  2006 http//www.ecdc.eu.int/Health_topics/Avian_In
  fluenza/pdf/060601_public_health_risk_HPAI.pdf

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Pandemic Strain of InfluenzaWhat is it?

• A novel strain of influenza (i.e. little immunity
  in humans)
• Well adapted to humans (infects and transmits)
• Note nothing about its pathogenicity how good
  it is at killing - I.e. pandemics can be mild

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How does it work Direct Infection of Humans and
Reassortment or Mutation to form a Pandemic Strain
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Estimated additional deaths if a 1918-1919
Pandemic occured now (Murray et al - Lancet 2006
368 2211-2218 )
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Preparing for a Pandemic -Some Givens

• A pandemic is inevitable
• We cannot predict when, what virus type or how
  severe it will be
• Even milder pandemics like those of 1957 and
  1968 will disrupt societies and result in many
  avoidable deaths
• By preparing we can save lives, and avoid
  disruption
• After two years of preparations EU citizens
  probably now expect us to be prepared!

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ECDC Report on EU preparedness for the
CommissionSee http//www.ecdc.eu.int/pdf/Pandemic
_preparedness.pdf A short Eurosurveillance
article on the Report http//www.eurosurveillance.
org/ew/2007/070222.asp1
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Findings the Good News

• EU overall made considerable progress since 2005
  in pandemic preparedness
• High level political commitment
• All countries have made major efforts to develop
  national preparedness plans
• Health sector priorities well addressed
• Work underway to operationalise these plans
• Much good practice
• Innovative approaches

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The Countermeasures

• The Three Ps
• Planning
• Preparation
• Practice
• Personal Measures hand-washing, go home if
  sick, respiratory hygine
• Public Health Measures home working?
• Business Continuity Planning
• Antivirals and Antibiotics
• Human Avian Influenza Vaccines
• Specific Pandemic Vaccines (6 months in) and
  limited

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Further 2 to 3 years effort needed for EU
countries to be confident they can respond well
to a pandemic especially from their citizens
point of view
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Conclusions on European Preparations

• A lot done, but not yet ready and a lot more to
  do.
• Preparedness has become more complex with more
  parties becoming involved
• Two to three years more hard work needed in the
  five areas
• Integrated planning across governments.
• Extending influenza research
• Interoperability at the national level
• Making plans operational at the local level
• Stepping up prevention efforts against seasonal
  influenza
• We need your help to keep governments on track

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Thank You for Staying AwakeDialogue Please
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Influenza Pandemics 20th Century
Credit US National Museum of Health and Medicine
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
20-40 million deaths
1-4 million deaths
1-4 million deaths
A(H1N1)
A(H2N2)
A(H3N2)
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Increasing European Vulnerability to the coming
pandemic

• Demographic and health care trends more older
  people and people with chronic illnesses living
  productive lives
• Ever increasing international movements of people
  
• More dependency on centralized essential services
  and systems (IT, communications, power etc) and
  Just in time supply systems for commodities.
• More devolution within EU countries, including
  for public health services potentially resulting
  in weaker concerted action,

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Increasing European Vulnerability to the coming
pandemic

• Trends to weaken public health capacity in the EU
  in favour of increased spending on health care
  services
• Hospitals that are more high-tech and so more
  vulnerable to epidemic disease like pandemic
  influenza,
• Fragmentation of primary care services that find
  it harder to deliver interventions such as timely
  anti-virals and pandemic influenza vaccines.

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Dangers of Queues
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Five Key areas where further efforts needed

• Integrated planning across governments.
• Extending influenza research
• Interoperability at the national level
• Making plans operational at the local level
• Stepping up prevention efforts against seasonal
  influenza

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Being prepared locally the ECDC Acid
Testshttp//www.ecdc.eu.int/Influenza/AssessmentT
oolPandemicInfluenzaPreparedness_13_9_2006.pdf

• Can you ensure? Some examples from the tests
• At Primary Health Service level
• Timely deliver antiviral treatments for all with
  symptoms within 24 or 48 hours of symptoms
  starting
• Hospitals
• Deliver acute care for influenza patients
• Continue to provide essential treatment for
  non-influenza related conditions
• Essential services continue to function locally
• Power
• Food
• Fuel supplies
• Pandemic vaccine will arrive within 6 months of
  start of pandemic at primary care

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Planning Assumptions

• Duration one or more waves of 15 weeks (3-4
  months)
• How many people affected 35-35
• Around 4-5 of these need hospitalisation
• Fatality rates? Previously observed 0.2 to 2
• Work absenteeism 20-30 for a three week period
• Key Uncertainties
• Groups most affected young or old
• The fatality rates
• How successful will countermeasures be

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Estimated Elderly Population Immunized
(Percentage) N 18 EU countries Forty Fold
Variation 2 to 80ECDC Survey April 2006
Source Population (2003) Data Eurostat
http//epp.eurostat.cec.eu.int/portal/page?_pageid
1996,45323734_dadportal_schemaPORTALscreenw
elcomerefopen/productEU_MAIN_TREEdepth1
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Street Hand-Washing Facilities USA and Hong Kong
in the EU?
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Hong Kong and Influenza Prevention
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Infectious disease is one of the great
tragedies of living things - the struggle for
existence between two different forms of life -
incessantly the pitiless war goes on, without
quarter or armistice - a nationalism of species
against species

• Hans Zinsser, Rats Lice and History, 1935

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Pandemic Risk from LPAIs?

• The three pandemics of the 20th Century have come
  from Avian Influenza
• No reason to think genetic material in HPAI and
  LPAI any higher or lower risk of contributing to
  the next pandemic virus
• So why are we still so worried about H5N1?
• Its highly pathogenic in humans
• Its stable and around in many parts of the
  world