1. Emergency and Disaster Systems in a pandemic phase as a response of the Health services Pan American Health Organization World Health Organization

2. Multiple epidemics have caused great human death rates throughout history. These epidemics have had and will continue to have a very different impact on society, a critical point being the difficulty in the management of the crisis that countries face with any catastrophe. The number of cases in a pandemic can be less relevant than the presence of the disease in itself. The six deaths by anthrax in the United States and the 44 deaths by SARS in Canada caused enormous social and economic repercussions which shows that we are not very prepared for the management of such crisis.

4. Pandemic Crises Require a multi sector and inter disciplinary focus Health is only a part of the entire context, the fundamental problem is the integral health of the population.

5. COE Multi-sector COE HEALTH EPIDEMIOLOGY SHELTER ATTENTION AND CONTROL EDAN HEALTH MENTAL HEALTH MATERNAL YOUTH COMMUNICATIONS AND INFORMATION LOGISTICS EXTERNAL COOPERATION PUBLIC RELATIONS PRE AND HOSPITAL ATTENTION INFRASTRUCTURE AND ENVIRONMENT FOOD AND NUTRITION SAFETY

6. Characteristics of Sanitary Crises Fear –Decision making influence –Rumor investigation –Health personnel and public health Safety –Health is not in charge of the situation! Specific technical aspects –Possibility of unknown agents Economy –Economic criteria tends to prevail

8. Countries face many risk problems and one of the risks today is the possibility of an influenza pandemic.Countries face many risk problems and one of the risks today is the possibility of an influenza pandemic. A balance must be kept between the most important priorities in terms of development as well as risks.A balance must be kept between the most important priorities in terms of development as well as risks. Each month more than 1 million people die from transmissible diseases and in a short period of time AIDS will be the greatest human pandemic with 45 million infected people and 22 million deaths.Each month more than 1 million people die from transmissible diseases and in a short period of time AIDS will be the greatest human pandemic with 45 million infected people and 22 million deaths. Avoid distracting resources

9. Build a general response capacity: It is impossible to be prepared for all scenarios. It is necessary to work with all the players within and outside of the health sector, especially with parties related to individual and massive emergencies. Coordinate with the responsible national institutions responsible for the prevention and attention of disasters.

10. National Players Within the same country, other spokespersons compete for the lead role as well as national and international attention Agricultural Sector Health Sector Civil Protection Presidency of the Republic

11. Contacts outside of the Country COUNTRY AFFECTED BY THE CRISIS INTERNATIONAL COMMUNITY FOREIGN RELATIONS PRESIDENCY HEALTH MINISTRY CIVIL DEFENCE RED CROSS/ NGO’s MUNICIPALITIES HOSPITALS

12. International Players OPS/OMS IFRC ICRC MSF OXFAM CARE CRS PADF MERCOSUR OCHA WFP UNHCR UNFPA UNICEF CDERA CAN/CAPRADE SICA/CEPREDENAC OAS CIDA USAID DFID ECHO ORAS/CONHU IDB IADB IICA WB Cruz Roja CDC

13. Bird Influenza

15. Human cases of Avian Influenza

16. The current priority is to control the bird influenza

18. Beginning of the pandemic The first cases generate a crisis. There will be an economic impact before it becomes a sanitary emergency.

19. text 19 Potential Impact of Avian Influenza in LAC Population at risk – 600 million people in LAC – 194 million people living in rural areas – 5 billion domestic birds in LAC Economy – Poultry production (around US$ 18,5 billion dollars). – Egg production (around US$ 5 billion dollars). – Imposition of barriers to commerce. Food Safety – Poultry comprises 40% of the animal protein consumed in the Region. Employment in poultry production chain Environment (carcass disposal) Tourism – The tourism sector in the Caribbean contributes to 31% for the Gross Domestic Product and employs 500,000 people.

21. Multi sector Response The influenza pandemic will require a multi sector response: –Mobilization of many public and private institutions National and local mechanisms exist for the response to emergency and disasters. The health sector must lead the response to the influenza pandemic. Countries and hospitals with proven plans will be in a better place to make decisions and take actions quickly.

23. Dissemination Delaying the initiation of the pandemic is essential to get more time for the institutionalization of the response mechanisms. Once the pandemic virus is disseminate, it will affect all the public and private services.

25. Scenario at the beginning of the Pandemic Absence and then competence of the first available vaccines. Health services will be saturated by the public searching for medical attention. Many hospitals will need to adapt their services including the flow of patients, hospitalization, emergency, intensive care, etc. The government will have to decide whether to close or not places where people are concentrated such as schools, markets, stadiums, malls and other places and buildings. Disorder due to fear and disease in the security forces, schools, economic sector, health personnel, etc, Scarcity or lack of antivirals. This could create conflicts in their distribution.

26. Mechanisms for national response Implementation of the contingency plan. Activate the Committee and Emergency Operations Center. Mobilize multi sector capacity for a fast preparation and initiation of the response Mobilize emergency response equipment. Mobilize financial resources for the pandemic response. Implement procedures and logistics mechanisms.

27. Other Actions Risk Communication Extension of the health services capacity. Distribution and prescription of antivirals. Vaccination of high risk populations. Non-pharmaceutical interventions: –Quarantine and distancing mechanisms. –Travel and business restrictions. –Recommendations for international transportation.

28. Conclusions It is possible that the people not participating in the seminars, simulations, planning, etc, are the ones that will really make the decisions. Authorities in other sectors will be essential at the beginning, during and after the pandemic. No emergency or disaster takes place in accordance with what is planned. The sending of human and logistics resources will require a well planned mobilization. Each week in the delay and containment is important in order to reduce the economic and social impact. New problems will require new resources.