1. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 Pandemic Preparedness Zsuzsanna Jakab Director, ECDC

2. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 European Union Pandemic Preparedness Status Report European Centre for Disease Prevention and Control

3. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Purpose of the Report Requested by the Commissioner :  Describe the process of strengthening pandemic preparedness in the European Union (EU);  Summarise the pandemic preparedness status within the EU as at October 2006;  Identify what next needs to be done – the policy options

4. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Methodology Survey of performance with assessment tool and against preparedness indicators, Workshops with national representatives Ongoing programme of joint national assessments that ECDC has been undertaking with Member States since mid 2005 – 16 EU countries assessed; Iteration of the draft report with national representatives and the Commission

5. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 “Infectious disease is one of the great tragedies of living things - the struggle for existence between two different forms of life - incessantly the pitiless war goes on, without quarter or armistice - a nationalism of species against species” Hans Zinsser, Rats Lice and History, 1935

6. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007

7. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 How Hard? Additional Deaths and Hospitalizations

8. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Estimated additional deaths if a 1918-1919 Pandemic occured now (Murray et al - Lancet 2006 368: 2211-2218 ) Austria 13000 Latvia 13 800 Netherlands 23100 Belgium 14900 Lithuania 18800 Poland 155 200 Bulgaria 47100 Germany 116400 Portugal 25 100 Czech Rep 34100 Greece 27400 Romania 149 900 Cyprus 1900 Hungary 37700 Slovenia 5000 Denmark 7300 Ireland 6700 Slovakia 20600 Estonia 6100 Italy 95200 Spain 87100 Finland 8100 Luxembourg 500 Sweden 13300 France 89600 Malta 1100 UK 93000 EU Total 1.1m Iceland 420 Norway 5800

9. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 How hard? Up to 30% of staff not available for work for significant period at peak of local epidemics

10. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 How Hard – Greater Vulnerability in Developed Societies and better health care? More travel so pandemic will move quicker Demographic change – older populations and more peope living with ill health Hospitals more complex and much more vulnerable to infections than before Health care and services can deliver more today and thus save more, e.g. Antivirals

11. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 Planning, Preparedness and Practice all Sectors - not just Health all Levels International, National, Regional and especially local A Five Year Enterprise

12. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 The Standards and Guidelines WHO Pandemic Plan 2005 WHO Global Influenza Preparedness Plan. http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CS R_GIP_2005_5.pdf European Commission Communication 2005 Communication from the Commission to the Council, the European Parliament, the European economic and social committee and the committee of the regions on pandemic influenza preparedness and response planning in the European Community, at http://europa.eu.int/eur- lex/lex/LexUriServ/site/en/com/2005/com2005_0607en01.pdf Published European Pandemic Preparedness Tool and Indicators http://www.ecdc.eu.int/Health_topics/Pandemic_Influenza/Assessment_ tool.html

13. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 No League Tables, no ranking Assessments Have Taken Place over 18 months in 16 countries ( soon 18 and by end 2007 all 27 + 3 EU countries ) Assessments are not shared outside ECDC and the MS without permission of the MS

14. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 The Good News: All Countries Have Made Major Efforts to Addess the Major National Health Sector Priorities

15. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Two to three more years of work Key areas where further work is especially needed:- Integrated planning across governments. Making plans operational at the local level. Interoperability at the national level. Stepping up prevention efforts against seasonal influenza.  Extending influenza research

16. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Local Issues – 3 of the ECDC ’Acid Tests’ whether local services can deliver anti-virals to most of those that need them inside the 48 hour limit? whether local primary and secondary care have identified what non-influenza core services they will sustain and what they will stop and how they will increase intensive care for influenza patients? whether business continuity planning has been completed such that essential non-influenza related core health services have been identified and could be delivered with significant numbers of personnel being unavailable for work? http://www.ecdc.europa.eu/pdf/Acid%20Tests.pdf

17. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 “The current report shows that the EU countries have made great progress in preparing for a possible influenza pandemic. However, we cannot be complacent, as it is clear that there is still much to do. In this regard, the report also highlights areas where further progress needs to be made” Zsuzsanna Jakab – Director

18. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Low scoring (under 80%) against the twenty preparedness indicators Availabilty of data on uptake of seasonal influenza vaccine? – 73% National contingency plan for maintenance of non-health essential services? - 50% Public Material on pandemic influenza ready? 65% National group for determining strategy for community non- pharmacological public health measures (travel, mass gatherings, etc) ? 77% National pandemic vaccination strategy developed? 75% Planning document issued to local health services which includes the nationally agreed parameters for local services (expected range of cases and percentage of staff off sick)? 78% National communication strategy for a pandemic? 75% Joint work undertaken with neighbouring countries) on mutually relevant policy areas? 52% National level health sector exercise? 58%

19. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 Policy Options The Potential Gaps

20. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Pandemic preparedness - Planning, coordination and maintaining essential services  Develop scientifically-based estimates of the numbers of people likely to be affected by pandemic influenza needing medical and social care in the EU.  Improve the exchange of planning presumptions between MS.  Extend planning and preparations down to regional and local levels and front line staff within the MS.  Define key target groups for specific preventive messages and protection such as health and emergency personnel within the MS.  Develop plans for providing surge capacity and coping with staff absenteeism over months within the MS.  Develop preparedness and business continuity plans across the non-health sectors at national and regional levels within the MS.  Federalised countries to consider how they can best ensure preparedness and interoperability at regional level where health is a devolved responsibility.

21. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Surveillance, situation monitoring and assessment  Continued development, by ECDC and MS, of a schematic plan for surveillance in a pandemic, including specific plans for each of the WHO-defined pandemic phases and with particular attention to pandemic phase 6 including lists of critical information that will be needed early in a pandemic.  Consideration of how best to set up systems for monitoring health and non-health sectors within the MS in order to know how these are functioning and whether they are coping or need more resources.

22. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Prevention and reduction of transmission  Production of guidance on a menu of personal and public health measures that can be expected to reduce transmission in a pandemic.  Development of background guidance on the approach to human H5N1 vaccines.  Finalised plans for acquiring and delivering pandemic vaccines within the MS.

23. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Health service response  Integration of pandemic preparedness within primary and secondary health care systems,  Training of all health care workers as needed  Prioritisation of which core health care functions are to continue during a pandemic  Development of practical plans within the MS for maintaining essential hospital services in a pandemic including strategies for supplies of antibiotics and other medication  Practical plans for expanding intensive care (ventilation) in a pandemic

24. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Antivirals for therapy and public health purposes  Provision, by ECDC, of background scientific information on the use of antivirals for public health purposes.  Development of practical plans for delivering antivirals to citizens within a 48 hour window from first symptoms Development and comparison of documentation on the principles of antiviral delivery and some of the alternative models of delivery being developed in MS.  Consideration, by MS together with EMEA and ECDC, of mechanisms to monitor effectiveness, side-effects and resistance through real time surveillance.

25. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Communications  Continue the network of EU and Member State communication officers dealing with influenza and test the systems with exercises as and when issues arise.  EU development of coordinated messages on seasonal and pandemic influenza.  Develop background documentation on preparing material for health care workers.  Review communication ‘surge capacity’ for a pandemic within MS.  Develop and continue to refine pre-agreed pandemic messages and materials within countries and between countries where possible, and consider how best to reach minority populations and foreign nationals, including addressing language barriers.

26. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Interoperability between countries  Systematic discussions between working level policy officials in the MS in order to share scientific information and learn from each other on planning and policy development.  Determine the legal implications of travel restrictions and other interoperability issues.  Improved interaction by MS with bordering countries in and outside the EU to discuss and agree on a list of issues such as compatible arrangements for primary and secondary care, common communication strategies and messages, to share triggering mechanisms and conduct cross-border exercises.

27. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Seasonal influenza  Adopt or re-commit to EU-wide vaccination coverage standards based on the goals agreed at the WHO’s World Health Assembly for immunisation in target groups.  Ensure that the jointly adopted EU standards for vaccine uptake are met and establish regular monitoring of effectiveness of the vaccine.  Adopt communication messages and educational materials concerning seasonal influenza for the public and health care workers based on the best examples in Member States (MS).  Undertake research to improve vaccines, and on mechanisms of influenza transmission, infection control and the effectiveness of public health measures and antivirals.

28. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 Avian influenza  Resume the joint CMO and CVO meetings but expand discussions to include other zoonoses as well as avian influenza.  Prepare or strengthen common health and veterinary plans or linked plans to develop mechanisms in the animal and human health sectors of the MS to timely and efficiently share human-avian data.

29. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 Q - What More for ECDC to Do? A – A Lot!

30. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 Supporting the Commission, other EU Agencies, WHO and especially the Member States during those Intensive Two to Three Years of Work

31. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 More Specifically - ECDC Influenza Workplan 2007 Continuing the weekly Influenza Newsletter Finishing the National Pandemic Preparedness Self Assessments in 2007 – 12 more to go (plus EEA countries) Developing the Member State to Member State Approach to disseminate good practice (the Innovations) Then repeating the EU Status Assessment Developing a Menu of Advice on the Public Health Measures (school closures, social distancing) to inform the Commission and Member States Providing Scientific and Public Health Advice e.g. on the effectivensss of antivirals, antiviral resistance and human H5N1 vaccines Developing international links especially with neighbourhood countries

32. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 More Specifically - ECDC Influenza Workplan 2007 Developing and distributing guidance on antiviral distribution, communicating with health care workers, preparing hospitals for pandemics and interoperability Developing plans for surveillance in a pandemic for MS and the EU Working with the Commission to determine who does what on vaccine development and use Establishing routine measurement of seasonal vaccine uptake in the EU Establishing routine evaluation of vaccine effectiveness in the EU Developing simple multi-lingual materials for the public on influenza Very little on avian influenza (we hope)

33. JSPS Frontiers of Influenza Research Karolinska Institute March 9th 2007 A provocative thought – what is pandemic preparedness in medium and resource poor countries? “There will be some things in common and others quite different…. for example in relative terms protecting some functions the non-health sectors (security, food distribution, telecommunications) may be more important in the medium and resource poor countries…. expecting the health sector to cope will be less realistic and less important, especially when it comes to secondary (hospital) care. “

34. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 A Conclusion for the EU

35. JSPS Frontiers of Influenza Research Karolinska Institute - March 9 th 2007 “This report is instrumental in underpinning the importance of sustained efforts at all operational levels and across all government policies. Only after recognising the task ahead and giving it the necessary priority, can we reach an adequate level of pandemic preparedness throughout Europe” Markos Kyprianou Commissioner for Health and Consumer Protection Foreword to the Report