1. Result of gap analysis and framework of action required in coming five months 19-20 August 2009 3 rd Meeting of National Influenza Centres in the Western Pacific Region

2. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Why we urgently need to prepare (1) Mortality Distributions and Timing of Waves of Previous Influenza Pandemics Miller M et al. N Engl J Med 2009;10.1056/NEJMp0903906

3. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Why we need to prepare (2) Different stages of influenza spread to Pandemic Sporadic Cases School & Community Outbreaks Sustained Community Transmission National (and Global) Spread - Pandemic Japan Early NY Mexico NY Mild Severe Death How can we reduce the level of preventable deaths?

4. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Scenario Building – Bicol, Region 5 Population Sick Hospitalisations Death 0.1% 1,022 20% 2% 9% 0.5% 30% 91,97620,439 5,110 5,109,798 (Aug 07 census) 1,021,9601,532,939 0.1% 1,533 2% 9% 0.5% 137,96530,659 7,665

5. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Background of Gap Analysis how we conducted and how we interpreted Soon after the first report of influenza A(H1N1), WHO Offices of South East Asia Region and Western Pacific Region initiated the rapid assessment to identify gaps in pandemic preparedness in countries The rapid assessment was conducted through WHO country offices using modified framework of Asia Pacific Strategy for Emerging Diseases (APSED) Analysis elaborates the need for urgent action and allows WHO to further develop more focused action framework for coming five months

6. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) APSED AND WORKPLAN IHR (Public Health Emergencies of International Concern) Asia Pacific Strategy for Emerging Diseases (APSED) Bi-Regional Workplan Avian Influenza Pandemic preparedness

7. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) SURVEILLANCE COMMAND PUBLIC HEALTH INTERVENTION COMMUNICATION HEALTH CARE RESPONSE HEALTH SECTOR SOCIETAL LEVEL How to slow down the transmission Individual LEVEL Laboratory How to minimize preventable deaths Partnership

8. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Different stages of influenza spread to Pandemic and required intervention Nation wide (pandemic level) spread Sustained (extensive) community level School outbreaks + community Sporadic cases Health Care Response Public Health Intervention Surveillance Communication

9. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Command and planning Need to urgently update pandemic preparedness and response plan Need to reconfirm their line of command, roles and responsibility Need to conduct training for risk assessment that serves as foundation for public health intervention and health care response Need to organize planning meeting to facilitate the preparation at sub-national level 1.Both political and technical leaders at local authorities 2.Disaster Committee 3.Response Team 4.Laboratory Need to improve communication capacity: domestically and internationally (IHR) Need to improve their Business Continuity Plan

10. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Surveillance 1.Further strengthen central unit capacity to collect and analyse data and communicate with command post 2.Further strengthen influenza like illness surveillance and event based surveillance 3.Develop information collection system such as school absenteeism, if appropriate 4.Develop laboratory diagnostic strategy including surge capacity

11. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Health care response 1.Need to develop national guidelines on clinical management and infection control 2.Need to organize training: infection control, clinical management 3.Need to facilitate hospital management including infection control in pandemic response 4.Need to establish health care response system at sub- national level

12. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Public Health Interventions 1.Capacity to conduct risk assessment 2.Need further detail advance planning and SOP 3.Need to develop SOP including communication 4.Need to develop communication material (communication)

13. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Communication 1.Communication strategy and public information materials 2.Trainings for media/public/private sector staff responsible for risk communication 3.Protocols and procedures for risk communication collaborating with multi-agencies for pandemic response

14. Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) and South East Asia Regional Office (SEARO) Conclusion WPRO and SEARO conducted rapid gap assessment; country showed gaps in similar areas. Rapid gap assessment provided the opportunity to develop simple and focused framework of action for coming five months Every country required accelerated action to prepare for the extensive community level transmission Time is limited and action needs to be focused Planning and preparation needed not only at national but also at s ub-national level