Influenza Pandemic: A Threats to Regional and National Health and Development CSRU, SEARD

“Timely production of sufficient vaccines remains the biggest challenge... antiviral production also remains inadequate” Facing up to flu. Editorial. Nature 2012; 482:131 “Ample supply of vaccine was not available until the after the second wave of H1N1 pandemic had subsided” Osterholf MT, Kelley NS. Mammalian-transmissible H5N1 influenza: facts and perspective. MBio 2012

YES OR NO, ARE YOU READY FOR A INFLUENZA PANDEMIC?

HOW DO YOU KNOW A PANDEMIC-READY NATIONAL SOCIETY WHEN YOU SEE ONE?

A PANDEMIC READY NS Policies and guidelines for Non-Pharmaceutical Interventions at the household and community level Adapted and updated tools and messages A functioning network with local stakeholders Trained human resources in all provinces and districts Detailed, multi-sectoral pandemic preparedness and response plan Access to funding

Why are we talking about influenza pandemic???? Enormous public health impact of the event Pandemics are inevitable – occur throughout history at irregular intervals There will be little warning between onset of a pandemic and it’s arrival Outbreaks will occur simultaneously in many areas SEA countries also shares the same risk as many countries do Recent outbreak of H7N9 and sporadic cases of avian influenza A(H5N1)

Border closures & travel restrictions are likely, & may delay spread of the virus, but are unlikely to stop it……

World Health Organization 平成31年4月14日 Another Pandemic Is a Matter of History Pandemics have occurred repeatedly for centuries Pandemics in 20th Century and Circulating Influenza Strains Influenza pandemic is rare but recurrent events. In 20th century, we experienced 3 pandemic influenza; Spanish flu in 1918, Asian flu in 1957 and Hong Kong flu in 1968. In 1918 we had Spanish Flu, which was said that 40 to 50 million were estimated death. Pandemic influenza seemed to be circulated the world with 30-40 years cycle, however, after Hong Kong Flu, we haven’t experienced pandemic for 37 years. This bar shows the major Influenza A subtype by year. As you see, Spanish flu is caused by H1N1. Asian Flu by H2N2, and today both H3N2 and H1N1 influenza subtype continue to co-circulate. This change of influenza type imply two things One: when you have new strain that is the time you have pandemic. Two : One type can never continue to be major strains and changes at some point. I don’t know the reason, but some virologist explain as antibody pressure, meaning that gradually many people become immune and at some point they have to change dramatically their antigenic characteristics to survive. Circulation of multiple influenza A subtypes at the same time is a relatively new phenomenon. No Pandemic for > 40 years

Another Pandemic Is a Matter of Science World Health Organization World Health Organization 14 April 2019 平成31年4月14日 Another Pandemic Is a Matter of Science Constant ongoing changes in influenza virus genes is fundamental process Mechanism by which animal viruses can adapt to people Transformation into a "human" influenza virus Capacity to sustain transmission among humans Example is community outbreaks of seasonal influenza 9

Another Pandemic Is a Matter of Modernization Modern social conditions favour faster spread & larger pandemics More international travel 1950: 25 million tourist trips per year 2005: >800 million 20 fold increase in trade Larger domesticated animal populations Larger cities with bigger populations

Public health Intervention Surge-generating event Pandemic Preparedness Baseline demand Outcomes Public health Intervention Surge capacity Surge in demand Surge-generating event Outputs Direct health impact (morbidity,mortality) Indirect health impacts

Avoidable deaths and potential gains through resource increases Given actual resource capacity Cumulative pandemic deaths If sufficient resource capacity Time

What we are planning?

Pandemic Influenza Preparedness Program Targeted Communities Activities at Country Level Country preparedness and contingency Plan Community based Interventions Advocacy campaign Capacity Building Mass and Social Media Pandemic Influenza Preparedness Program Program Initiation Program Planning Program Implementation Program Evaluation and Impact Development of Regional Standard Operating Procedure Technical support and Guidance Coordination and Networking Targeted Communities Activities at Regional Level Pandemic Preparedness Network Advocacy and Partnership Knowledge Management Updating tools and roster

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