Government’s approach to a flu pandemic: planning and response Bruce Mann Head of Civil Contingencies Secretariat Cabinet Office Business Advisory Group on Civil Protection 26 June 2006

Key facts 3 types of flu: –Seasonal flu –Avian flu – mainly a disease of birds. Readily controllable in the West. –Pandemic flu – the emergence of a new flu virus that causes illness and spreads easily between people leading to worldwide spread of disease. Highly pathogenic H5N1 avian influenza virus is spreading fast. In most continents save Americas. In 13 EU Member States: –Sporadic cases in wild waterfowl. –4 outbreaks in domestic poultry (France, Germany, Sweden, Denmark) Increased likelihood that will be found in UK (autumn migration).

Priority World Health Organisation: –“Experts agree that another pandemic is likely to happen but are unable to say when.” –“The specific characteristics of a future pandemic virus cannot be predicted …” –“Governments and their partners need to develop strategies and programmes to prepare for a pandemic.”

Planning Assumptions – the virus “A new pandemic will be due to a new sub-type of influenza A.” “A pandemic strain… “could first emerge anywhere, including the UK, but is most likely to emerge in China or the Far East.. “In the event of a novel influenza virus causing significant outbreaks of human illness elsewhere in the world, it is unlikely that the UK could prevent importation (except by closing all borders); even a 99.9% restriction on travel into the country would only be expected to delay importation of the virus by up to two months” “Spread from an origin in Asia is likely to follow the main routes of travel and trade.” “Spread from the source country to the UK … is likely to take around a month … modern travel may result in wide international spread even more rapidly than this.”

Planning Assumptions – UK spread “… following arrival in the UK it will take a further 2-3 weeks until cases are occurring across the whole country.” “Once influenza levels exceed [the] baseline threshold … influenza activity in the UK may last for 3-5 months, depending on the season, and there may be subsequent waves, weeks or months apart.” “All ages will be affected, but children and otherwise fit adults could be at relatively greater risk, particularly should elderly people have some residual immunity from exposure to a similar virus earlier in their lifetime.”

Planning Assumptions – UK impact UK Influenza Pandemic Contingency Plan: “for planning purposes the base scenario, based on previous pandemics in the 20 th century, is a cumulative clinical attack rate of 25% of the population (the figure advised by the WHO) over one or more waves of around 15 weeks each, weeks or months apart. The second wave may be the more severe... 10% and 50% attack rates have also been considered..” “The impact of overall case fatality rates between 0.37% and 2.5% have been considered.” 10% attack rate 25% attack rate 50% attack rate 0.37% CFR21,50053,700*107, % CFR56,700141,800283, % CFR141,800354,600709,300 Range of possible excess deaths, UK population

Potential consequences Each pandemic is different. Nature of the virus and its impacts cannot be known in advance. Previous pandemic have led to markedly different outcomes. Little or no immunity to new virus – higher level of illness and death compared to normal flu season Direct effects – illness and deaths Indirect effects – absences from work and impacts on essential services and wider economy Response measures could lead to further absences and disruption CCS economic impact assessment (illustrative – would depend on virus) - current year GDP reduced by roughly ¾ % [around £7-8 bn]

Planning workstreams Gathering information and getting it to those who need it, at all levels. Modelling – the virus; its spread; its impact; response measures. The medical response – vaccines; anti-virals; masks; treatment protocols and clinical guidelines Policies on response in particular settings – schools; further and higher education; social care; courts; prisons; transport. Management of the dead. British nationals overseas Ensuring business continuity Communications. Crisis management arrangements. Exercises and other testing and assurance. Wider international engagement.

Planning during 2005 and 2006 DH is Lead Department, supported by CCS Cross-departmental planning underway since early working group chaired jointly by the Head of the Civil Contingencies Secretariat and the Chief Scientific Adviser to the Department of Health. To plan the response arrangements (all aspects, all levels) for possible pandemic. Cross-departmental Ministerial Committee, chaired by Secretary of State for Health is providing further impetus to planning AND reviewing progress with planning across all sectors Wide range of communications material available. Contingency material for use in pandemic being developed. Getting message out to plan - Sponsor Departments, regional and local government, Devolved Administrations, and dedicated stakeholder groups (business sector and Cat 1 responders)

Guidance Guidance issued to assist planning UK Health Depts’ Pandemic Influenza Plan – March 2005 and October Basis for planning in health sector. See Dept Health website for this Plan, plus further info: –Explaining Pandemic Flu –Pandemic Flu Key Facts –Pandemic Flu, important information for you and your family Additional guidance available for the non-health sector (Cabinet Office guidance issued in Feb 2006 and Business Continuity Check list in May 2006 – on & Expect to issue further guidance over coming months (schools, managing dead) Testing plans Two table top exercises to test the central Government response held in National level exercise held in June and further one planned for early Regional and local level exercises during 2005 and 2006

Response: command and control Fully tested plans in place all sectors and levels! National, regional and local structures to manage the consequences: –Department of Health – lead –Civil Contingencies Committee (“COBR”) for central Government Based on understanding of the virus, COBR will issue firm advice on the full range of response policies –Regional Civil Contingencies Committees. Leadership being established. –Local “multi-agency GOLD” crisis co-ordination arrangements –International dimension – WHO; EU; G8.

Snippets from CO guidance (Feb 2006): Overall message ‘ business as usual’ Uncertainty…evolving info and policies….flexibility Medical countermeasures – not ‘silver bullet’ solution for business continuity (current policies). Staff absences – assumptions – at peak in large organisation could be up to 15% for 2-3 weeks; small businesses or critical teams – plan for 30% absence at peak. possible additional social measures and travel restrictions may be considered by COBR (evidence base is light and/or not convincing) –Possibly considered early in UK epidemic –presumption against imposing such measures; unlikely to use CC Act/emergency powers to implement such measures –BUT local planning should consider how to implement in the event that COBR recommends/advises such measures

Questions?

What you need to do: Ensure that business continuity plans are ready for possible pandemic and its consequences, including identifying core business that must be sustained and planning for expected staff absences. Ensure that suppliers delivering critical services to your organisation also have appropriate plans in place. Hold exercises to test plans. Ensure that senior staff/board are engaged in planning and exercising