Avian Influenza and the Pandemic Threat

Agencies’ Achievements (against outputs and activities indicated in the logframe)

3.1 Human exposure to the virus

38. In the first six months of 2007, WHO received reports of events of possible human H5N1 infections, or other unusual acute respiratory illness from a variety of sources and followed up in 45 countries and territories. Ten missions have been conducted in response to confirmed outbreaks of avian influenza in humans. Multidisciplinary teams composed of experts from WHO and its partners in the Global Outbreak and Alert Response Network (GOARN) were rapidly mobilized to provide support as needed in efforts to control and contain the outbreaks. In addition, 30 assessment missions were conducted by teams from WHO headquarters, regional and country offices, often including national staff from ministries of health, agriculture and environment. These missions assessed national health infrastructures, availability of resources, clinical management and containment measures in place and the capacity of laboratories to diagnose and confirm infection with H5N1 and related influenza viruses. WHO is also focusing efforts on improving the capacities of national laboratories and WHO H5 Reference Laboratories. This task is particularly pressing given the complexity and inherent risks associated with laboratory diagnosis of H5N1 infections and the need to ensure the safe and rapid transport of specimens.

3.2 Early warning systems

39. Assessment missions conducted by WHO provided a better understanding of the alert and response mechanisms in place, including the capacities for national early warning and verification, and constituted the basis for successful interventions to mobilize communities to improve them when needed. WHO is also strengthening its own alert and response capabilities in preparation of the implementation of the revised International Health Regulations (IHR). A new event-management system is being established that will function as the official repository of all information relevant to an event that may constitute a public health emergency of international concern. It will facilitate communications within WHO and globally with all key partners that have specific functions in outbreak alert and response, including the National IHR Focal Points, and increase the efficiency, timeliness and inclusiveness of the Regulation’s decision-making processes by maintaining a record of operational activities and decisions. A field information management system has been developed to assist with data management of case-contact interactions during outbreak response. This system is being customized for use at the national level in several countries.

40. UNHCR is working at strengthening capacity for disease surveillance in refugee camps, using existing systems when possible. It recruited five Regional Epidemic Preparedness and Response Coordinators who were trained by technical people from UNHCR and other agencies (e.g. WHO and FAO) before being deployed to their respective places of assignment i.e. Cairo for Middle East and North Africa, Nairobi for East Africa, Pretoria for Southern Africa, Kinshasa for Central Africa and Dakar for West Africa.  The Coordinator for Asia will be based in Katmandu, Nepal shortly. IOM has been working in Kenya and Indonesia  on surveillance, investigation and response systems for suspected cases of human influenza in migrant settings, each time involving WHO and ministries of Health and Agriculture.

3.3. Rapid containment operations and responses for a newly emerging human influenza virus

41. WHO is finalizing an operational protocol to guide rapid interventions in the event of the emergence of an influenza pandemic. The protocol addresses roles and responsibilities of governments and agencies and describes standard operating procedures for the administration and monitoring of antiviral interventions, additional containment measures and communications strategies.

42. Avian influenza investigation kits, which will facilitate the rapid field investigation of suspected outbreaks, are being dispatched to 116 WHO country offices. The kits contain personal protection equipment, supplies of an antiviral medicine, sampling and shipment materials, and technical guidelines. In anticipation of larger-scale field investigations and outbreak response, additional response kits are strategically stockpiled as part of the alert and response logistics mobility platform in Geneva and Dubai. Also stockpiled in Geneva and Dubai, as well as in regional offices are three million doses of antiviral agent donated to WHO and to be used for rapid containment in the event of an influenza pandemic. An additional donation of two million doses of antiviral agent for use in countries currently experiencing human outbreaks of avian influenza has been included in the kits.

43. WHO has been conducting training on Rapid Response Containment in Indonesia, Cambodia and Kazakhstan. It developed a handbook for journalists and training modules on social mobilization and food safety as part of the standardized WHO training packages of H5N1 influenza control and preparedness for health ministries staff members (who have also been trained), along with members of the GOARN, for outbreak communications. As of today WHO has trained 120 staff from Ministry of Health, local Centers for Disease Control (CDC), and other regional staff. WHO has also designed an international training workshop on emergency preparedness and response for health-care facilities in collaboration with the Asian Disaster Preparedness Center and developed guidelines and training material in collaboration with UNHCR for workers providing first-line health and essential services to refugees and internally displaced people. UNHCR has started to strengthen health services at camp level with the provision of equipments and is preparing regional work plans in consultation with UNHCR management and health departments. UNICEF will support WHO’s containment efforts through communication strategies now being developed, and will ensure that children and their families in quarantined zoned have access to essential services.

3.4 Capacity to cope with a pandemic

44. WHO, working with UN country teams, has taken the lead in providing generic guidance to Member States on the contents and structure of national pandemic influenza preparedness plans for the health sector, as well as technical assistance to countries with limited resources. Regional offices are also formulating regional preparedness and response plans. To date 178 Member States have drafted national pandemic preparedness plans and WHO is helping them to evaluate and test these plans with tools and simulation exercises. In addition, toolkits and checklists are now available for supporting social mobilization by Member States and guiding public communication activities during a pandemic. Consultations have been held to identify and address ethical issues that Member States are likely to encounter in pandemic planning and response, including prioritizing access to scarce prophylactic and therapeutic measures, quarantine and isolation, the obligation of health-care workers during a pandemic, and the importance of international cooperation. A document on ethical considerations in pandemic influenza planning was published as a result.  

45. WHO has also been conducting training courses for Member States and partners in all regions on epidemic surveillance, alert and response, laboratory capacity and infection control as well as on the implementation of resolution WHA59.2 on voluntary compliance with the IHR (2005).  A series of guidelines and recommendations on the collection and transport of specimens, reduction of risk at the animal and human interface, food safety, infection control for health workers and case definitions of human infections of avian influenza has been issued in order to support the development of public-health response capacities for avian influenza in compliance with the IHR. The voluntary compliance of Member States with the requirements of the IHR is an opportunity to assess existing capacity across WHO and in individual Member States and identify priorities. A strategic plan for implementing the IHR is being finalized including avian influenza and influenza pandemic threats, with activities to strengthen existing integrated capacities for disease surveillance and response.

3.5 Global science and research for availability of a pandemic vaccine and antiviral drugs

46. The Global Pandemic Influenza Action Plan to Increase Vaccine Supply, launched in September 2006, is the product of consultations conducted by WHO, which included influenza experts, representatives from national immunization programmes and national regulatory authorities, and manufacturers of human vaccine from both industrialized and developing countries. The Plan identifies and prioritizes practical solutions for reducing the potential shortfall in pandemic influenza vaccine supply and improving the existing manufacturing output efficiency and timeliness by increasing the demand for seasonal influenza vaccines, developing new plants and promoting further research and development into more potent and effective vaccines. At the same time, WHO and UNICEF have been working in selected countries to enhance the capacity of the EPI cold chain and logistics system to enable rapid distribution of pandemic vaccines.

Remaining gaps and challenges

47. Since early 2007, influenza virus sharing has been at the forefront of public health security issues. The debate has centered on how to increase access of developing countries to benefits derived from the sharing of influenza viruses and access to technology with the associated necessary training while maintaining the functions of the GOARN, an essential tool for pandemic risk assessment, enhanced diagnostic tests and development of seasonal and pandemic vaccines. As soon as the World Health Assembly approved, in May 2007, resolution WHA60.28 "Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits", WHO has taken action on the establishment of an internal task force to drive the process and ensure the Organization meets in a timely manner the demands placed upon it by the resolution. In the coming months WHO will be holding consultations, including an intergovernmental meeting, to establish policies and mechanisms for influenza virus sharing as well as vaccine stockpiles. These critical recent developments require significant additional financial investments, in particular regarding vaccine stockpiles.

48. More funds are also required to attend in countries with restricted resources to the specific health needs of those who will be made more vulnerable by a pandemic influenza, including the migrant population, refugees, children and women. Indeed influenza is likely to cause a substantial proportion of deaths through pneumonia and diarrhea.  Therefore, improving the treatment of these conditions, especially in the community, will have a major impact in reducing deaths in a pandemic, taking into account that  these two conditions are the two leading causes of deaths in children under five. There is a need to invest in enhancing community and family knowledge and practice on learning care-seeking behaviors, improving communities’ access to health workers, and ensuring that the latter have adequate skills, knowledge, and medical supplies. Lack of funds have prevented UNICEF, UNHCR, IOM and ILO (all collaborating with WHO) to initiate and/or sustain their programmes in this regard.