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

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

3. 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

4. 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

5. 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

6. 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?

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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? ….

15. 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

16. 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?

17. 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

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

19. “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.