World Health Organization 1 August 2008 Health security under the International Health Regulations

World Health Organization 2 August 2008 Polio eradication progress children 125 countries Inequitable access to polio vaccine children 6 countries Equitable access to polio vaccine Type 2 wild poliovirus last transmitted in 1999

World Health Organization 3 August 2008 Challenge: suspension of polio immunization, Nigeria, August 2003 Polio Vaccines - Western Countries Exploit Developing Ones Says Kano State Governor Shekarau BYLINE: Daily Trust BODY: The Kano State governor, Malam Ibrahim Shekarau, has asserted that the people's objection to polio vaccines has confirmed that polio vaccination is damaging to young girls.

World Health Organization 4 August polio endemic countries 18 countries with imported virus Wild virus type 1 Wild virus type 3 International spread of polio from Nigeria,

World Health Organization 5 August 2008 Points for discussion l What are the international mechanisms that would help manage this situation? l Are there any other types of activity necessary?

World Health Organization 6 August 2008 Vaccine safety l Testing of vaccines in Nigerian programme for presence of impurities/hormones: WHO Collaborating Centre South Africa and India l Provision of polio vaccines manufactured in an Islamic country l Personal discussions with governor of Kano and eventual decision to convene expert group of state paediatricians

World Health Organization 7 August 2008 Political Advocacy for Polio 10 th Islamic Summit Polio Resolution, Malaysia, 2003 Islamic Conference of Foreign Ministers Meeting Polio Resolutions (Turkey 2004, Pakistan 2007) 3 rd Extraordinary Islamic Summit, Mecca, 2005 'Noting OIC countries now suffer the greatest burden of polio, call for political & financial support of OIC member states to finish eradication'

World Health Organization 8 August 2008 Religious Advocacy for Polio Rulings & Fatwas on the need and safety of polio vaccines: –the Grand Imam of El Azhar Al Sharif, –International Union for Moslem Scholars –The Mufti of Egypt –Mawlana Fazul Rahman –The Islamic Fiqh Academy - Jeddah –Dr Y. Al Qaradawi, European Council for Fatwa and Research. Visit of Imam Cheik Cisse to northern Nigeria.

World Health Organization 9 August 2008 Weekly epidemiological record 6 AUGUST, 2004 The international spread of wild poliovirus On 30 June 2004, WHO highlighted an increasing risk of international spread of wild poliovirus1 and updated its advice for travelers on steps they could take to increase their personal protection against wild poliovirus. Subsequently, on 16 July 2004, an*Ad Hoc Expert Consultative Group on Polio and Public Health was convened by the Director-General of WHO to discuss potential measures to prevent or limit the international spread of wild poliovirus.

World Health Organization 10 August 2008 Standing recommendation, International Health Regulations (2005) Evidence that booster dose of vaccine decreases time of wild virus carriage

World Health Organization 11 August 2008 World Health Assembly l Resolution on polio eradication 1998 l Resolutions on continued/strengthened effort in remaining endemic countries – 2004 – 2006 – 2007 – 2008

World Health Organization 12 August 2008 Avian inlufenza: a major risk to public health security 1918: Spanish Flu (H1N1) 1957: Asian Flu (H2N2) 1968: Hong Kong Flu (H3N2) million deaths~ 2.5 million deaths~1 million deaths

World Health Organization 13 August 2008 WHO influenza surveillance network: collective action to reduce vulnerability to influenza 1 laboratory > 1 laboratory national network 115 national influenza centres WHO Collaborating Centres

World Health Organization 14 August 2008 Current Level of WHO Pandemic Alert 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.

World Health Organization 15 August 2008 Rapid containment response, early phase 4 pandemic alert l Interrupt transmission from human to human/prevent further spread: ring containment – Early detection and response – Prevention of human to human transmission using anti-viral drugs – Prevention of human to human transmission by vaccination using H5N1 vaccine

World Health Organization 16 August 2008 Vaccines and antiviral drugs for H5N1 and pandemic influenza l Antiviral drugs – Production now exceeds demand – Market skewed towards industrialized countries – Some developing countries produce oseltamivir; few maintain stockpiles l H5N1 and Pandemic vaccine – Production capacity limited to 1.5 billion doses/six months for production – Market skewed towards industrialized countries – No developing countries produce influenza vaccines; few maintain stockpiles

World Health Organization 17 August 2008 Minister of Health, Indonesia and H5N1 virus sharing: link sharing to more equitable benefits Indonesia Stands Firm In Bird Flu Virus Samples Row With WHO JAKARTA ( AP )--Indonesia insisted Tuesday that it will only resume sharing bird flu virus samples with the World Health Organization if the body stops providing them to commercial vaccine makers. The defiant comments by Health Minister Siti Fadiliah Supari came as top WHO officials met with Indonesian counterparts and other global health chiefs in Jakarta to try to persuade the country to resume sharing its samples.

World Health Organization 18 August 2008 Points for discussion l What are the international mechanisms that would help manage this situation? l Are there any other types of activity necessary?

World Health Organization 19 August 2008 Meeting summary, Jakarta meeting on sharing in the benefits of virus sharing, March 2007 Types of benefits anticipated, developing countries: – Strengthening core laboratory capacities so that more developing country laboratories can qualify for WHO designation – Ensuring access to H5N1 and other potential pandemic influenza vaccines – Developing more transparent virus handling procedures so that location of any shared virus can be known in real time – Linking of virus sharing and vaccine production to sustained benefits

World Health Organization 20 August 2008 Global Action Plan for Influenza Vaccines l Request for proposals from developing country vaccine manufacturers for technology transfer l 11 proposals received/reviewed l Initial grants (up to US $2.5 million each) to six manufacturers: – Brazil – India – Indonesia – Mexico – Thailand – Viet Nam

World Health Organization 21 August 2008 Stockpiles for broader access to H5N1 and pandemic influenza vaccine vaccine l Meeting with manufacturers and possible donor countries, April 2007 l Individual meetings, Director General/CEOs of vaccine manufacturers, April - May 2007 l Announcement of H5N1 stockpile development, Pacific Health Summit, June 2007 (for rapid response and essential populations should H5N1 show pandemic changes) l Mechanism for procurement of pandemic vaccine being developed: conceptual phase

World Health Organization 22 August 2008 Strengthening developing country capacity to participate globally l H5 reference laboratories established and certified: China, Indonesia, Brazil l H5N1 WHO Collaborating Centres being established: China, India Brazil l Regular training in laboratory and epidemiology including rapid response to early Phase 4 event

World Health Organization 23 August 2008 Sharing of benefits: some of the requirements identified l Sustainability l Transparency l Bilateral versus multilateral

World Health Organization 24 August 2008 World Health Assembly: sharing of influenza viruses and benefits l Resolution 2007: Intergovernmental process to ensure access to vaccine and other benefits – Initial intergovernmental working group meeting November 2007 – Open-ended working group meeting March 2008 – Open-ended working group meeting followed by intergovernmental meeting planned November 2008

World Health Organization 25 August 2008 Pandemic influenza control 1918 International Health Regulations (2005): collective action for global public health security