1. Pandemic Planning and Preparedness Guidelines for the United Nations System AN OVERVIEW

2. 2 Contents Pandemic Basics UN System Strategy UN Planning Objectives UN Contingency Planning Process Timeline & Outputs

3. 3 Three Kinds of Influenza Bird virus - different from human influenza virus Spreads from birds to birds Can sometimes infect humans Can sometimes mutate into human virus Human viral respiratory infection Self-limiting, but can be serious & fatal in elderly & very young ~ 500,000 deaths globally each yr. Occurs seasonally Routine vaccination available Global outbreak of new human influenza (different from seasonal and avian influenza) Rare but recurrent event (every 10-42 years). Associated with increased morbidity & mortality. Last 3 pandemics in last 100 yrs – 1968 (3m deaths), 1957 (2m deaths and 1918 (50m deaths) Past 3 pandemics - avian viruses became a human virus Seasonal Influenza “The Flu” Avian Influenza “Bird Flu” Pandemic Influenza “A Pandemic”

4. 4 Pandemic Influenza Prerequisites A new influenza virus emerges to which the general population has little/no immunity 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 NOT TO DATE

5. 5 Threat of H5N1 Human Influenza ? Inter-pandemic PeriodPandemic Alert PeriodPandemic Period Circulating in wild birds and poultry since 2003 Highly contagious / deadly among birds Spreading from Asia to Europe, Middle East and Africa H5N1: Has infected humans in rare instances - resulting from close exposure to sick birds and/or their droppings If H5N1 evolves into a human virus it could cause a human influenza pandemic Also possibility that H5N1 never evolves into a human virus

6. 6 We are now at WHO Pandemic Phase 3 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 3Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread. Phase 4 Small human-to-human cluster(s) - less than 25 people, lasting less than 2 weeks, highly localized - virus is not well adapted to humans Phase 5 Larger human-to-human cluster(s) - between 25-50 people, lasting from 2-4 weeks, still localized but virus increasingly better adapted to humans Pandemic period Phase 6 Significantly increased and sustained transmission in general population

7. 7 Scenarios - 3 Broad MODELS Time Impact Does avian virus become efficiently transmissible from human to human? Does human influenza virus immediately spread rapidly with high caseloads and increasing mortality? Yes MODEL 3 - Rapid Onset / Widespread impact Little time for preparation, response is reactive and defensive Yes MODEL 2 - Slow Onset / Moderate & Localized Impact Slowly acquires human infectiousness. Depending on the evolution of virus it may be contained after its emergence. May also develop into a pandemic MODEL 1 – Extended WHO Phase 3 / Continued Outbreaks of Avian Influenza Impact on livelihoods due to culling of birds No

8. 8 Broad Risks of a Pandemic Food and income loss from poultry deaths/ culling & decreased economic activity High illness & potentially higher death rates Overstretched health facilities Disproportionate impact on vulnerable Increased demand for governance & security Higher public anxiety Reduced capacity due to illness & death Deterioration of coping & support mechanisms Interruption in public services Quarantine policies Trade & commerce disruptions Degraded labour force Interruption of regular supply systems Livelihoods Social & Humanitarian Needs Governance & Security Human Health Economic Systems

9. 9 Contents Pandemic Basics UN System Strategy UN Planning Objectives UN Contingency Planning Process Timeline & Outputs

10. 10 UN System Strategy HOW TO ADDRESS THE PANDEMIC THREAT Preparation to Minimise Pandemic Impact Engage Stakeholders to: Improve virus surveillance Prevent outbreaks Contain the disease Prevent human infection through public awareness of: - virus transmission - hygiene - poultry keeping Respond to livelihood shocks & increased vulnerability Mobilize required behavioral changes Prepare for containment response Diminish Pandemic Likelihood

11. 11 UN System Strategy HOW TO ADDRESS THE PANDEMIC THREAT Diminish Pandemic Likelihood Plan with Stakeholders to: Contain human influenza outbreaks Mitigate health & socio-economic impacts Preparation to Minimise Pandemic Impact

12. 12 Contents Pandemic Basics UN System Strategy UN Planning Objectives UN Contingency Planning Process Timeline & Outputs

13. 13 UN Objectives “Survive Well to Serve Well” Minimize a pandemic’s impact on Staff Health & Safety In order to maintain and sustain Operational Capacity In order to support National Preparedness and Response

14. 14 Planning Context Time: Uncertainties Where or when? How long it will last? Severity? Reach? Impact: Plans must be: Robust Flexible to address range of scenarios

15. 15 UN Roles & Responsibilities UNRC brings together - UNCT, Partners, NGOs & Donors UN Agencies address own operational and programme prioritisation while supporting national & UN contingency plans UNCT & Agency contingency plans should have common elements for staff health, safety, HR, communication etc Provide support for country to country coordination Work closely with regional bodies to ensure plans are aligned An SG-appointed UN System Influenza Coordinator aligns & harmonizes programmes of UN agencies, development banks, private sector and engagement of donor community Country Team Global Level Regional Level

16. 16 Contents Pandemic Basics UN System Strategy Objectives & Planning Context UN Contingency Planning Process Timeline & Outputs

17. 17 UN Contingency Planning Process National Pandemic Response Plans and Actions What are risks to staff, operational continuity and operating environment? Which risks should be planned and prepared for? How might selected contingencies affect staff, operational continuity and operating environment? Prepare and share plans Plan rehearsal, updating as necessary, new factors? Hazard/Risk Analysis Contingency Prioritization Scenario- Building Agency Plan UNCT Plan Preparedness Actions & Plan Maintenance

18. 18 Hazard/Risk Analysis Appoint a pandemic influenza coordinator Identify risks affecting staff health and safety, program and operational continuity List hazards/risks and implications - who it could impact and how it could impact them -Identify vulnerable populations -Consider effects of prevention, containment and mitigation measures -Include factors from national pandemic plan -Align UN System with National Plan & non-UN partners Action Information sources Section 7 Section 7.2, Box 4. Critical Risk Analysis Guide Hazard/Risk Analysis

19. 19 Contingency Prioritization Prioritise: -Risks (which threaten UN System Objectives?) -Programmes & operational activities (which should be continued?) -Prevention, containment & mitigation measures -Building national capacity -Contingency addressing threats to staff health & safety Conduct a joint sectoral analysis of gaps and national priorities Action Information sources Section 8 Section 7.2, Box 4. Critical Risk Analysis Guide Contingency Prioritization

20. 20 Scenario Building Develop the hazard, risk and contingency analysis into detailed scenarios -Extend 3 Scenario MODELS -Identify key driving forces: existing insecurity, poverty, rights issues, food insecurity strengths/ weaknesses of govts, movement restrictions etc. -Produce a set of planning assumptions to be used as bases of plan -Consult with national authorities and key non-UN partners Action Information sources Section 9 Section 3, Box 1. Representation of three MODEL frameworks Section 7.2, Box 4. Critical Risk Analysis Guide Scenario Building

21. 21 Preparing and Sharing Plans Produce detailed Plans that address: -each of the 3 MODELS -hazard/risks -UN System objectives Focus Plans on prevention, containment, mitigation actions and continuation of essential services Incorporate key elements of Agency plans & harmonize with national plans Work with Agencies to determine staff critical to perform priority operations & functions during a pandemic & ensure they are trained Action Information sources Section 10 Annex E - Checklist Annex F - Template Agency Plan UNCT “Triggers” for start of particular response actions should be clearly linked to WHO Pandemic Phase Levels

22. 22 Preparedness Actions & Maintenance Test plans through simulations and rehearsals in conjunction with national plan and other stakeholders Procure health items as described in Medical Contingency Plan Train and sensitise staff Pre-position other supplies for operational continuity Regularly review preparedness status Monitor progress Action Information sources Section 11 Medical Services Guidelines Annex A - Abridged Medical Services Staff Contingency Plan Preparedness Actions & Plan Maintenance

23. 23 Contents Pandemic Basics UN System Strategy Objectives & Planning Context UN Planning Process Timeline & Outputs

24. 24 Timeline & Output Stage 2 - Operationalise Stage 1 - Finalise Plan & Determine Resources Before 30 May 2006 Finalisation of UN Contingency Plan at Country Team level The country team, regional offices and headquarters to determine resources required to both maintain operations and establish new programmes - Must include human, material & financial resources Before 15 June 2006 Plans operationalised as per preparedness actions

25. 25 What is in the Guidelines? THE MAIN BODY of the Pandemic Planning and Preparedness Guidelines provide broad scenarios and key pointers to UNCT members when creating or updating harmonized UNCT pandemic plans with agency plans ANNEX A: UN Medical Services Staff Contingency Plan ANNEX B: Pandemic Influenza Safety and Security Guidelines ANNEX C: UN HR Network Administrative Guidelines ANNEX D: Psychosocial Contingency Plan ANNEX E: Pandemic Influenza Contingency Planning & Preparedness Checklist ANNEX F: Contingency Plan Template ANNEX G: UN System Country Level Roles ANNEX H: Glossary

26. 26 Where can I find more information? The World Health Organization provides good information about avian influenza and the possibility of a pandemic: –http://www.who.int/csr/disease/avian_influenza/en/ The Food and Agriculture Organization provides additional information, including on food safety issues: –http://www.fao.org/AG/AGAInfo/subjects/en/health/diseases- cards/special_avian.html A website has been created for UN system staff and their families: –http://avianinfluenza.staffinfo.un.inthttp://avianinfluenza.staffinfo.un.int There is a contingency planning toolbox on the UNSIC site –http://www.undg.org/content.cfm?id=1611