1. Welcome to Thailand Phi Phi Island Welcome EPRUS Team Mr.Thierry COUDERT, Prefect, Managing director of EPRUS Mr.Jean-Marc SREISSEL, Logistician, Project leader transport Mr.Jean-Michel Sap, Financial and administrative manager

2. At the Department of Disease Control (DDC), Ministry of Public Health (MoPH),Thailand 14 August, 2012 Organization of the stockpile of antivirals and Personal Protective Equipment (PPE)

3. Overview of Antivirals and PPE logistic system 1.History of Antivirals and PPE use in Thailand 2.Logistic system & Distribution 3.Warehouse at Department of Disease Control ( DDC)

4. Thailand  Area : 198,114 square miles, the size of the state of Texas.  Population (as of 2011): 64.07 million, about 8 million live in the capital city of Bangkok  <5 yr =13 million  15-59 = 48 million  65 + = 5 million  Ethnics: Thai (80%), Chinese (10%), Malay (3%)  Religions : 95% Buddhism  Languages : Thai  Climate : warm and humid Bangkok. Cambodia Vietnam Laos China Myanmar Malaysia

5. Distribution of AI in poultry and human cases, 2004-2012 Jan-May 04 Jun-Oct 04 Jul-Nov 05 Jan-Nov 07 Jun-Aug 06 Total 25 cases / 17 deaths Confirme d case Suspect case Poultry outbreak Human - July 2006 Poultry - November 2008

6. Stockpiling and logistics Stockpiling and logistics 3 Mar 06 Personal Protective Equipment : PPE Oseltamivir also provided to migrants / displaced people through local health authorities & international partners

7. Oseltamivir Stockpile 2004 Outbreak of AI - set up Tamiflu (R) stockpile with WHO support 2006 Bought Tamiflu ( R) from Diethelm Company 2007 Set up Vendor management inventory (VMI) 2008 Filling capsule - Oseltamivir (GPO-A-flu (R)) by Government Pharmaceutical Organization (GPO) Received Tamiflu (R) from ASEAN stockpile VMI system Completed 2009 Pandemic (H1N1) 2009 crisis, Distributed GPO-A-Flu by VMI system (operated by DDC & GPO) Bought Zanamivir form GSK Company Now Purchased by DDC Produced & distributed GPO-A-flu by VMI system

8. Structure of Ministry of Public Health : MoPH Department of Health Service Support Department of Medical Sciences Food and Drug Administration Department of Medical Services Department of Thai Traditional and Alternative Medicine Development Department of Mental Health Ministry of Public Health Office of the Minister Permanent Secretary Cluster of Medical Service Development Deputy Permanent Secretary Professional Councils National Health Board Cluster of Public Health Development Deputy Permanent Secretary Cluster of Public Health Service Support Deputy Permanent Secretary Office of the Permanent Secretary Provincial Administration Department of Disease Control : DDC Department of Health Government Pharmaceutical Organization : GPO (State Enterprise under MoPH)

9. Structure of Department of Disease Control Administration Development System Section Department of Disease Control : DDC Office of the secretary Finance Division Internal Auditor Section Personnel Division Planning Division Bamrasnaradura Institute (Infectious Hospital) Bureau of Occupational and Environment Diseases Bureau of General Communicable Diseases Bureau of Vector-Borne Diseases Bureau of Non- Communicable Diseases Bureau of AIDS and STDs Rajprachasamasai Institute (Leprosy Hospital) Office of Disease Prevention and Control 1-12 Bureau of Epidemiology Bureau of Emerging Infectious Diseases Bureau of TB Bureau of Public Relations

10. Upstream Middle stream Downstream - GPO - Private company - Other sources GPO Warehouse DDC Purchase - DDC Regional Office 1-12 - Provincial Health Offices - Large Provincial Hospital include Bangkok - Provincial & Community Hospital VMI Private Hospital bought from GPO Hospital Clinic Patient

11. Oseltamivir Stockpile, as of 14 august 2012 noList (Capsules) Total (2012) Dispense 14 August 2012 Balance 14 August 2012 1 1,990,7 00 634,3501,356,350 2 392,310193,080199,230 3 356,060155,910200,150 Total 2,739,070 1,755,730 4 1,056 47 1,009 Population 64.07 million - Oseltamivir 2,739,070 capsules 2012 : Coverage 4.27 % of all population Oseltamivir 75 mg ( GPO -A- Flu ) Oseltamivir 45 mg 10's Oseltamivir 30 mg 10's Zanamivir (inhaled)

12. Country Olseltamivir Stockpile Stockpiles sites: by VMI system 12 DDC, Other MoPHand, GPO (national level), 12 DDC regional offices, 77 provincial health offices, all district, general and regional hospitals, Other MoPH hospitals and other offices in Bangkok, Total 1,277 sites Objectives : - For treatment of Avian Influenza patients - For rapid response and containment of pandemic influenza near its source

13. Capsules Region al Offices Provinci al Offices Large Provinci al Hospital Provincial Hospital Communi ty Hospital Oseltamivir 75 mg 500 1,000 200 Oseltamivir 45 mg 200300500 100 Oseltamivir 30 mg 200300500 100

14. From Offices and Hospital VMI Management : Vender Manage Inventory

15. Warehouse Oseltamivir Registration No capsules date remark cost/caps total(baht) expire date lot Summary of Oseltamivir Registration : 2004-now

16. Dispensation Registration Code no balance Record date Cost / lotTotal key Date time Lot no bill no

17. Drug Dispensation Management of Oseltamivir by VMI : Vender Manage Inventory Inventory

18. Personal Protective Equipment PPE Objectives : 1.For rapid containment (Provided by DDC) 2. For health care worker protection (Purchased by hospitals with National Health Security Office (NHSO) support List of PPE 1) Goggles 2) Face shield 3) protective gown 4) Reusable surgical gown 5) Disposable surgical gown 6) Disposable safety coverall 7) Face mask etc.

19. PPE…. how we get PPE…. what we have Provided by DDC for rapid containment Purchased by hospitals with National Health Security Office (NHSO) support for health care worker protection Supported by JICs through ASEAN regional stockpile 2008

20. List (piece) Region al Offices Provinc ial Offices Hospital centre General Hospital Commun ity Hospital N95300200100 30 Goggle300200100 30 Protective gown 300200100 30 Face Mask2,0001,0002,000 500 Face shield 200 100 30 Reusable surgical gown 201050 5 Minimum requirement recommended for PPE stockpile in each level

21. DDC supported sites 1 National 12 Regional 77 Provincial Total 90 sites Risk groups : - Poultry worker - Surveillance Rapid Response Team (SRRT)

22. NoList Total (Jan 2012) Dispense 14 august 2012 Balance 14 august 2012 1.Face mask : Adult153,000152,450550 2.Face mask : Child24,50022,4502,050 3.Reusable surgical gown12010110 4.Disposable surgical gown120- 5.Face shield24050190 6.Goggle29,80029,71882 PPE Stockpile, as of 14 august 2012 + Hospital purchasing

23. GPO & DDC Warehouse : antivirals and PPE PPE at DDCAntivirals GPO BEID

24. Room Temperature Room PPE at 1 floor BEID building

25. Conclusion History of Antivirals and PPE use in Thailand – Antivirals & PPE stockpiles were set up since AI outbreak in 2004 with purchasing, support from WHO and domestic manufacturer (GPO-A-Flu) – PPE has been use for 2 purposes : Rapid containment and health care worker protection Logistic system & Distribution – Antivirals have been distributed by Vendor management inventory ( VMI ) system to all levels for maintenance of minimum requirement recommended. – PPE supplied for rapid containment has been distributed by Department of Diseases Control (DDC) whilst for HCW protection, hospitals has purchased with National Health Security Office (NHSO) financial support DDC Warehouse – Quick Rotation Warehouse (Goods requiring prompt distribution)

26. Thank you Merci