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1 IoM Forum on Microbial Threats Ethical & Legal Considerations in Mitigating Pandemic Disease pandemic influenza preparedness pandemic influenza preparedness regional planning efforts Oscar J Mujica MD Epidemiologist; Communicable Diseases Unit Washington DC; September 19, 2006
2 regional planning efforts in The Americas Current global threats, including influenza pandemic preparedness, requires a concerted effort by all those capable of effective action. WHO s Regional Office for the Americas, PAHO, recognizes the importance of partnerships and is actively engaged in close collaboration with several key stakeholders: USAID, CDC, CIDA-Canada, IADB, World Bank, FAO, UNICEF, IICA, OiE, among others;
3 regional efforts & steps to strengthen NIPPPs multidisciplinary, intersectoral involvement; knowledge sharing & information exchange; implementation of NIPPPs self-assessment tools; priority short- and medium-term actions to ensure NIPPPs implementation.
4 NIPPP workshop roadmap Epidemiology Laboratory Immunization Animal Health Civil Defense Health Services Social Comunication simulation tabletop exercise group review: WHO Global Plan up-to-date lectures group review: WHO Checklist Emergency Preparedness Epidemiologic Surveillance Case Management Population Containment Essential Services Continuity Research & Evaluation National Plan implementation Animal-Human Health Interface Communication Strategy Local level implementation group review: NIPPP core elements country team review: NIPPP selfassessment Timeframe Activities Responsible Parties Deadlines Technical Cooperation country team review: NIPPP action priorities plenary & simulation tabletop exercise DAY 1 DAY 2 DAY 3 DAY 4 DAY 5
5 WHO Checklist: 7+ core NIPPP components 1. emergency preparedness 2. epidemiological surveillance 3. case management 4. population containment 5. essential services continuity 6. research & evaluation 7. implementation of the National Plan 8. animal-human health interface 9. communication strategy 10. implementation at the local level
6 pandemic preparedness readiness: Southern Cone Emergency Preparedness 100% Implementation of the National Plan 80% 60% Epidemiological Surveillance 40% 20% 0% Research & Evaluation Case Management Essential Services Continuity Population Containment
7 pandemic preparedness readiness: Andean Area Emergency Preparedness 100% Implementation of the National Plan 80% 60% Epidemiological Surveillance 40% 20% 0% Research & Evaluation Case Management Essential Services Continuity Population Containment
8 pandemic preparedness readiness: Central America Emergency Preparedness 100% Implementation of the National Plan 80% 60% Epidemiological Surveillance 40% 20% 0% Research & Evaluation Case Management Essential Services Continuity Population Containment
9 pandemic preparedness readiness: The Caribbean Emergency Preparedness 100% Implementation of the National Plan 80% 60% Epidemiological Surveillance 40% 20% 0% Research & Evaluation Case Management Essential Services Continuity Population Containment
10 emergency preparedness 1 EMERGENCY PREPAREDNESS 1.1 Political mobilization 1.2 Command & control 1.3 Risk assessment 1.4 Risk communication public communication internal communication 1.5 Legal & Ethical issues legal issues ethical issues 1.6 Response plan by pandemic phase
11 emergency preparedness: legal & ethical issues legal issues Existence of a legislative framework in place for the national response plan Legal dispositions for contingencies (maintenance of essential services and other crisis management measures) Legal basis for travel & movement restrictions assessed Legal basis for closure of educational institutions assessed Legal basis for isolation & quarantine of infected persons or of persons suspected of being infected assessed Legal basis for prohibition of mass gatherings assessed Standing policy & legal basis for influenza vaccination of essential personnel assessed Legal issues (liability, insurance, licencing) related to the mobilization of temporary workers assessed Liability for unforeseen adverse events attributed to vaccine & antiviral use considered Legislative framework for compliance with the International Health Regulations in effect Inclusion of pandemic influenza in national legislation for the prevention of occupational diseases considered ethical issues Ethical review on the limitation/restriction of access to scarce resources Ethical review on the compulsory nature of vaccination of essential personnel Ethical review on the limitation of personal freedom & movement Ethical framework for research during the influenza pandemic established
12 emergency preparedness readiness: Southern Cone Response plan by pandemic phases Political mobilization 100% 80% 60% 40% 20% 0% Comand & control Legal & ethical issues Risk assessment Risk communication
13 emergency preparedness readiness: The Caribbean Response plan by pandemic phases Political mobilization 100% 80% 60% 40% 20% 0% Comand & control Legal & ethical issues Risk assessment Risk communication
14 emergency preparedness readiness: Central America Response plan by pandemic phases Political mobilization 100% 80% 60% 40% 20% 0% Comand & control Legal & ethical issues Risk assessment Risk communication
15 emergency preparedness readiness: Andean Area Response plan by pandemic phases Political mobilization 100% 80% 60% 40% 20% 0% Comand & control Legal & ethical issues Risk assessment Risk communication
16 PAHO/CDC pandemic impact assessment workshops to estimate the burden of disease attributable to influenza pandemic: excess of deaths, hospitalizations, and outpatient visits to evaluate the response capacity (i.e., the potential to cope with excess demand) from hospitals and outpatient health facilities (surge capacity) to estimate the magnitude of the loss of workdays to derive gross estimates of direct economic impact attributable to pandemic influenza
17 FluSoftware: FluAid, FluSurge & FluWorkLoss
18 pandemic potential impact in Latin America & The Caribbean clinical attack rate = 25%; first pandemic wave (8 weeks) FluAid/FluSurge modeling Pandemic Impact Subregional Workshops Nov/Dec 2005 probable health impact deaths * hospitalizations outpatient visits moderate severe 334,163 2,418,469 [131, ,960] [627,367-5'401,035] 1,461,401 11'798,613 [459,051-1'937,503] [3'189,747-16'418,254] 76,187,593 68'470,386 [59'738, '207,769] pandemic scenario [58'114,124-92'227,761] * annual average burden of mortality observed': 3'410,000 deaths
19 pandemic surge capacity in Latin America & The Caribbean (AR25%; scenario 1968; 1 st pandemic wave) Potential Impact on Hospital Surge Capacity Hospital Admission Hospital Capacity ICU Capacity Ventilator Capacity Daily # of admissions week weekly admissions 88, , , , , , ,346 88,408 peak admissions/day 43,626 43, N of influenza patients in hospital 40,138 66, , , , ,611 81,515 52,813 % of hospital capacity needed 26% 43% 65% 82% 84% 70% 53% 34% N of influenza patients in ICU 13,261 28,123 43,187 57,046 61,737 60,057 47,722 32,952 % of ICU capacity needed 98% 209% 321% 423% 458% 446% 354% 245% N of influenza patients on ventilators 6,631 14,061 21,594 28,523 30,868 30,029 23,861 16,476 % usage of ventilator 344% 730% 1122% 1482% 1604% 1560% 1240% 856% Days of outbreak
20 costs of work days lost due to pandemic influenza ($ppp) in Latin America & The Caribbean Costs of Work days lost ($ppp); LAC scenario % 25% 35% most likely 9,004,942,587 15,008,237,645 21,011,532,703 minimum 8,262,422,778 13,770,704,630 19,278,986,482 maximum 10,029,486,711 16,715,811,186 23,402,135,660 Costs of Work days lost ($ppp); LAC scenario % 25% 35% most likely 12,760,378,982 21,267,298,343 29,774,216,459 minimum 9,901,190,869 16,501,980,870 23,102,776,169 maximum 15,617,331,932 26,028,888,071 36,440,441,997
21 regional planning efforts: key products a validated set of pandemic simulation tabletop exercises; trained teams, with a practical set of tools, in the estimation of potential impact scenarios due to pandemic influenza; shared, and detailed knowledge of the WHO Global Plan and WHO Checklist for pandemic preparedness; a reviewed, adapted, agreed, and applied Checklist for assessing pandemic preparedness; a comprehensive, honest, user-friendly, self-assessment of the pandemic preparedness in each country; a clear, agreed priority plan of immediate action for completion and implementation of NIPPPs.
22 regional planning efforts: key achievements Significant advances in the preparation of the NIPPPs. Important intersectoral involvement, primarily at the international level (OiE, FAO, IICA, OIRSA, Development Banks, other UN agencies, etc) Some countries begin to perceive IHR at the driver seat, pandemic influenza as their cart Model for interagency collaborations (PAHO, WHO, CDC, USAID, CIDA-Canada) Inclusion of pandemic influenza preparedness in the Health Agendas of the Regional Integration Systems (MercoSur, CariCom, CAN, SISCA)
23 regional planning efforts: key challenges Implementation at the local level Increased sensitivity of surveillance systems to detect new types of influenza viruses Mobilization of resources Access to drugs, vaccines, and other supplies Intersectoral involvement and commitment
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