UNICEF Programme on Pandemic Prevention

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UNICEF Programme on Pandemic Prevention
Preparedness
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Science Quiz

• Whats 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
H5N1

• Circulating in wild birds and poultry since 1996
• Highly contagious deadly among birds
• Spread from Asia to Europe, Middle East and Africa

• 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
• Control of HPAI in birds
• 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
Scenario 3 - Rapid Onset / Widespread
impact Little time for preparation, rapid action
vital, movement restrictions, emphasis on
mitigation Major pandemic
Scenario 2 - Slow Onset / Localized Impact Slowly
acquires infectivity Containment may be
successful Limited pandemic
Impact
Scenario 1 - Extended Phase 3 / Avian Influenza
outbreaks continue Sporadic human cases Impact on
livelihoods due to culling of birds No Pandemic
Time
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US mortality data, 1900-90
PAST PANDEMICS 1968 Bad regular influenza
season 1957 Worse than very bad influenza 1918
Worst health event since "black death" of 14th
century
1957
1968
1918
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Pneumonia Influenza Deaths, USA
(Source Glezen WP. Epidemiologic Reviews 1996
18(1) 64-76)
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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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gt 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 - lt1000 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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Past Influenza Pandemics
?H1
1850
?H2
1900
H1N1
H2N2
1950
H3N2
2000
No Pandemic for 40 years
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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 Preparedness

• Objective 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 Communication

• Objective 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 CommunicationKey Achievements

• Advocacy 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/i
  nfluenzaresources
• National and international media sensitised on
  AI.

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A/PI CommunicationKey gaps

• Community-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