Responses to Avian Influenza and State of Pandemic Readiness

This annual report on responses to avian influenza and pandemic influenza preparation includes the following sections, as well as maps and illustrative case studies:

• An Introduction
• Support for Country Responses
• Improving the Capacity of Animal Health systems to Reduce the Threats of Avian Influenza and Similar conditions
• Improving the Capacity of Human Health Systems to Detect and Respond to an Influenza Pandemic
• Preparedness for Mitigating the Impacts of the Next Influenza Pandemic
• Communication with Communities to Inform, Protect, and Mobilise
• Assessment of Progress Attained to Date and Recommendations

From the executive summary:

"The risk of a world-wide influenza pandemic is as great in late 2007 as it was in mid-2005. The World Health Report 2007 states that “There will be an influenza pandemic, sooner or later” with the potential to result in millions of deaths and severe social, economic and humanitarian consequences. We have a unique opportunity to prepare for the pandemic now and to significantly mitigate its potential impact. The current epizootic of Highly Pathogenic Avian Influenza (HPAI) is caused by type A virus H5N1 which has the capacity to infect humans (though, at the time of writing, less than 350 cases of sporadic human infection have been confirmed). There is concern that the genetic material in the avian virus could mutate or re-assort in a way that makes the virus capable of sustained transmission between humans. So far, this sustained human-to-human transmission has not been observed. However, HPAI continues to spread among poultry and other birds. The virus has been found in an additional five new countries so far during 2007: a total of 60 countries and territories have now reported H5N1 outbreaks either in poultry or wild birds or both. Continuous transmission of HPAI H5N1 occurs in some settings: the virus is considered to be entrenched (or enzootic) in parts of Indonesia, Egypt, Nigeria and (possibly) part of Bangladesh and China. Given the potential for wild birds to carry the virus over long distances, continued transmission of HPAI among poultry in any one country represents a threat to the world.

This is the third in a series of reports to document global progress with control of HPAI and preparedness for the next influenza pandemic. Once again it has been jointly produced by the United Nations System Influenza Coordinator (UNSIC) and World Bank. The description of progress in this report is based primarily on the data provided by national governments. Information was collected from 146 countries in response to a survey circulated by UNSIC during July 2007. This data gathering was complemented with case studies, key informant interviews and the analyses of experts from specialized UN system agencies, the World Bank, and the OIE. The information on pledges, commitments and disbursements in support of avian and human influenza control and pandemic preparedness has been collected by the World Bank from donor countries.

The report covers developments over the past two years, with a specific focus on the last six months (January – June 2007). It provides (a) an analysis of efforts made and financial assistance provided to date, and (b) an assessment of progress in the capacity of nations to respond to HPAI and their preparations for the next influenza pandemic. The report considers the implications of progress to date for future national and international investments in animal and human health security. The results presented in the report indicate that substantial progress has been made in the initial – emergency – phase of the global response to HPAI and threats to public health.

Data from countries suggest that capacity to respond to Highly Pathogenic Influenza (HPAI) infection in poultry has improved. Outbreaks are being detected more rapidly and the response is more effective. However, animal health services are still sub-standard in most countries – they lack necessary regulatory frameworks, budgets, laboratory capacity and implementation of bio-security measures. Country data also suggests that there has been an improvement in human influenza virus diagnostic and surveillance capacity globally. However, capacity varies significantly and is considered to be insufficient in a number of countries (particularly in Africa).

Whilst there has been an increase in the number of countries reporting that they are planning for pandemic influenza, the preparations pay insufficient attention both to operational readiness at the local level and to cooperation on pandemic preparedness between neighboring countries. Only a small proportion of preparedness plans focuses on sectors other than health.

Analysis of the ways in which pledged international assistance has been used reveals that virtually all grant funds have been committed and more than three quarters disbursed.

The following challenges are identified:

1. The need to expand from emergency, short-term responses to sustained medium- and longer-term strategies with an increased focus on bio-security in both family and commercial poultry production systems;
2. The importance of intensive responses in locations where there is continued transmission of HPAI H5N1 among poultry and where the virus is entrenched;
3. The requirement for sufficient capacity at country level for compliance with the International Health Regulations (2005);
4. The need for increased involvement of different economic and social sectors, as well as humanitarian organisations, in pandemic planning in order to mitigate social, economic and humanitarian impacts; and
5. The need for convergence in capacities for animal and human health, environmental health, food safety and crisis management to better prepare for threats to human security.

Many national authorities, especially in countries where HPAI is entrenched, will seek international technical and financial assistance as they respond to these challenges: additional grant finance will be required to ensure that the necessary assistance can be provided as and when needed, in a sustained manner.

In order to ensure proper control of avian influenza (and other zoonoses) and readiness for future health crises, an appropriate national, regional and international three to five year response to these challenges (and others identified in the forthcoming New Delhi International Conference on Avian and Pandemic Influenza) should be mapped out and agreed by governments. The resulting road map would serve as a valuable guide for policies, actions and outcomes, and as a measure against which future progress could usefully be assessed."