AHI + Humanitarian Action Sources: UNSIC, UNICEF, WFP, Other.

Purpose of presentation AHI basics Update on IASC + AHI Next steps

Three Kinds of Influenza Seasonal Influenza An annual pattern Usually mild, but can be serious – even fatal – in elderly Routine vaccination available Avian Influenza (“Bird Flu”) Current epidemic of Highly Pathogenic Avian Influenza in Asia and entering Europe Pandemic Influenza Intermittent, Major morbidity and mortality, Economic and social consequences

Past Influenza Pandemics 1847 1889 1918 1957 1968 1850 42 yrs 29 yrs 39 yrs 11 yrs 1900 30 – 40 years cycle 1950 No Pandemic for > 35 years 2000

Why is it a threat to humans? What is the “Bird Flu”? Why is it a threat to humans? 2. Outbreaks have occurred in poultry, migratory birds and other fowl across SE Asia, Europe and Russia 3. This “Bird Flu” has caused millions of poultry deaths, affected household economies & infected humans H5N1 is a new strain of influenza virus present in birds The human population has demonstrated low immunity to the H5N1 strain with high mortality 2. Influenza viruses can be highly transmittable (e.g. airborne) 3. The H5N1 virus could change and become transmissible between humans So what is the “ Bird Flu” and why is it of concern? [BUILD] slide, presenting each point in sequence

Prerequisites for a pandemic A novel influenza virus must emerge to which the general population has little or no immunity and for which there is no effective vaccine The new virus must be able to replicate in humans and cause disease The new virus must be efficiently transmitted from one human to another ? 2 of the 3 prerequisites for a human pandemic have been met A novel influenza virus has emerged and the general population has demonstrated little or no immunity And the new virus has been able to replicate in humans The main questions that remains are: Will the virus will develop into a form that is efficiently transmitted from one human to another? (thus meeting the criteria for a pandemic) If so, where, when, how quickly, and how severely?

Inter-pandemic period WHO classification Inter-pandemic period Phase 1 No new influenza virus detected in humans. If a new influenza virus presents in animals, the risk of human infection is considered to be low. Phase 2 No human infections, but a circulating animal influenza virus poses a risk to humans. Pandemic alert period Phase 3 Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread. Phase 4 Small cluster(s) with limited human-to-human transmission but spread is highly localized. Phase 5 Larger cluster(s) but human-to-human spread still localized Pandemic period Phase 6 Increased and sustained transmission in general population. WHO has outlined 6 phases to help us understand where we are in relation to the threat of a severe global pandemic Currently we are in Phase 3 where human infections with a new virus are present, but no (or very infrequent) human to human spread has occurred Progression to Phase 4 would require small clusters of human to human transmission in localized areas to present If the threat is elevated beyond Phase 4 a very quick progression from Phase 5 to Phase 6 (full pandemic) is likely to occur It is important to note that: Further progression of the threat will depend not just on the nature of the virus, but also on the success of containment and other response actions The ability of WHO to accurately assess and call/announce an elevated threat is dependent on accuracy of analysis and reporting in country. Technical Note: WHO updated their pandemic phase definitions Feb/March and it was at this time that Phase ‘3’ was declared in the new system. The first human case of H5N1, however, was in 1997 in Hong Kong, and so technically we have been in phase 3 since that time.

Interventions P R E P A R E 1 2 Strategic Actions Prevent Contain Respond Chain of Events Right now, we are in the prevent and contain phase, where we must contain the spread of avian influenza and prevent its transmission to humans.

Some knowns A pandemic will happen at some point Short time between detection and response Vaccine will take x months to be developed Pandemic is different; unique features: - surge in mortality & morbidity rates - dramatic impact on social, economic, and governance systems - social distancing/reduced human contact

Some unknowns  How severe it will be?  Where it will start?  When it will occur, how quickly it will spread, how long it will last?  How governments and societies will react

The epidemiological case for “Chicken Little” More human cases More countries affected More deaths Multiple species affected Timing right for pandemic cycle—looks like 1918 but with greater chicken-human contact, faster transportation Inadequate vaccines, anti-virals Modernization, just in time inventory, outsourcing, globalization make us more vulnerable

The epidemiological case for ostriches No human to human transmission documented Y2K, Swine flu (1976, US) over-reactions Better medical care Better communications technology No WWI to accelerate viral spread, no wartime censorship to hide epidemics Denial, fatalism

Search for wise “owls” As we try to make decisions under conditions of uncertainty, we would like to find some prescient experts to guide our decisions and scenarios but the experts themselves vary from Chicken Little to ostriches…how can we try to find the owl’s wisdom? ….

Implications of a severe pandemic for humanitarian action  humanitarian staff levels will decrease  humanitarian operations disrupted  current humanitarian caseload dramatically affected  numbers of vulnerable will increase  essential services stretched/overwhelmed

Programme & operations continuity How to continue business if …. Borders closed Travel restrictions, staff at home, etc. Staff at risk? Which activities/services to continue? Which staff are key to new roles?

Challenges to continuity of humanitarian operations  Reliance on voluntary donations  Just-in-time management system for staff & supplies  Physically decentralized but centralized management system  High proportion of expatriates in management functions  Relatively little investment in preparedness  Uneven partnerships with national NGOs

Next Steps Meeting in Geneva, 22-24 February Mid-March IASC WG meeting in Rome

“What we do now will make the difference of whether it’s 5 million or 150 million” David Nabarro, UN System Senior Co-ordinator for Avian Flu, 2005.