PROJECT INFORMATION DOCUMENT (PID) APPRAISAL STAGE

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1 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Project Name PROJECT INFORMATION DOCUMENT (PID) APPRAISAL STAGE AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE Report No.: AB2025 Region EUROPE AND CENTRAL ASIA Sector Animal production (40%);Health (30%);Agro-industry (30%) Project ID P Borrower(s) GOVERNMENT OF TURKEY Implementing Agency Undersecretariat of Treasury Turkey Tel: (90 312) Fax: (90 312) Ministry of Agriculture and Rural Affairs Turkey Ministry of Health Turkey Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared December 7, 2005 Date of Appraisal December 13, 2005 Authorization Date of Board Approval March 2, Country and Sector Background (a) Introduction The continuing outbreaks of highly pathogenic avian influenza (HPAI), which begun in late 2003 in several Southeast Asian countries and have occurred more recently in Europe, have been disastrous to the poultry industry in the two regions and have raised serious global public health concerns. Nearly 140 million domestic poultry have either died or been destroyed and over 120 people have contracted the infection, of which 63 have died as of October Recent increases in the number of known cases of avian influenza (AI) transmission have raised concerns over the potential emergence of a pandemic, which could have devastating effects on human health and livelihoods. At the same time, it is important to emphasize that there are many uncertainties about whether and when a pandemic might occur, as well as about its potential impact. Humans are not very susceptible to the disease, but if infected with the Asian H5N1 strain, they could exhibit a high case fatality rate. The geographical spread of HPAI, the human dimension, and the potential enormous social and economic impact are unprecedented. Economic losses to the Asian poultry sector alone are estimated to date at around $10 billion. Despite control measures the disease continues to spread, causing further economic losses and threatening the livelihood of hundreds of millions of livestock farmers, jeopardizing smallholder entrepreneurship and commercial poultry production, and seriously impeding regional and international trade,

2 and market opportunities. The rural poor, who rely for a larger share of their income on poultry, have been particularly hard hit with income losses. It is impossible to anticipate when the next influenza pandemic may occur or how severe its consequences may be. On average, three pandemics per century have been documented since the 16 th century, occurring at intervals of years. In the 20 th century, pandemics occurred in 1918, 1957 and The pandemic of 1918 is estimated to have killed almost 50 million people in eighteen months, with peak mortality rates occurring in people aged years. The pandemics of 1957 and 1968 were milder, but many countries nevertheless experienced major strains on health care resources. If a major pandemic were to appear again, similar to the one in 1918, even with modern advances in medicine, an unparalleled toll of illness and death could result. Air travel might hasten the spread of a new virus, and decrease the time available for preparing interventions. Countries health care systems could be rapidly overwhelmed, economies strained, and social order disrupted. Through interventions as proposed in this Project, and in collaboration with other national and international partners, it should be possible to minimize a pandemic s consequences in Turkey through advance preparation to meet the challenge. (b) The regional dimension Cases of avian flu have already occurred in several countries, including most recently in Romania (a number of those within 10 km of the Ukrainian border), Greece, Turkey (which has prompted the ban by the EU on the import of poultry from these countries), and Croatia (H5N1 strain confirmed). There are also possible cases in Macedonia. The Russian outbreak of HPAI H5N1 has to date affected six administrative regions, beginning in the Ural Mountains and moving west to within 200 km of Moscow in the last several days. With AI reported in one country in the Balkan Peninsula (Croatia), other countries in the Balkan peninsula and the Caucasus are at risk due to their proximity to two main flyways, the East Africa-West Asia Flyway, which crosses Turkey, and the Central Asia Flyway. Both flyways cross areas in North-eastern Europe, where avian influenza in wild and domestic fowl has been diagnosed. In the first three weeks of August 2005, outbreaks in poultry of HPAI H5N1 were reported in four regions of northern and central Kazakhstan. The epidemic has severely affected poultry production in the country, with the death or culling to date at least 14,900 birds, according to government and media sources. Central Asian countries have become exposed to HPAI by migratory birds, spreading the disease from infected neighboring countries. From a geographical point of view, Central Asian countries represent a vast area in which introduction of AI is likely to occur, and where the sensitivity of the system for early detection of HPAI is low. All EU countries have plans to fight a possible avian flu pandemic. All countries in ECA have similar plans with the exception of Macedonia, Moldova and Turkmenistan. (c) The national dimension To date Turkey has experienced one outbreak of avian influenza, in the Manyas district of Balikesir province. This outbreak was detected on October 1, 2005 when three turkeys died in a flock of 1,800 turkeys being raised by a medium sized poultry contract farmer in an outdoor grazing environment facility three kilometers south of Manyas Lake. This lake is a natural habitat for migratory birds, which were abundantly present at the time. Most of the rest of the flock died over the next three days, during which time the district veterinary service and a private veterinarian working for the poultry sector developed the diagnosis of avian influenza. Dead and live animals were sent to the Bornova reference laboratory (in Izmir), which detected the presence of the H5 strain (through inoculation and subsequent death in embryonated eggs). The EU reference laboratory in Weybridge (UK) confirmed the presence of the HPAI H5N1 strain on October 13. Sanitary measures had been promptly initiated by the provincial veterinary service on October 7, when a three kilometers protection zone was established with road sings and the presence of the military police. All backyard poultry (over 10,000 head) within the protection zone between October 8-16, and compensation was

3 granted by the private poultry industry itself to the affected farmers. Within the protection zone, there were also nine larger commercial holdings, seven of which were empty. The flock of almost 16,000 in the remaining two enterprises was slaughtered on October 9. In addition to the protection zone, a 10 km radius surveillance zone was established, which contained roughly 45,000 backyard poultry, and 10 active larger poultry farms with a stock of over 130,000 animals. Measure taken in the surveillance zone included a ban on the movement of live poultry, regulation of the transport of table and hatching eggs, prohibition of bazaar market trade of poultry and of hunting of wild birds, and an immediate local awareness campaign to instruct farmers to confine backyard poultry and avoid contact with wild birds. Although the avian influenza outbreak has been quickly contained, and there are no signs of any transmission to humans, the economic impact has been severe. Within two weeks of the outbreak, the consumption of poultry in Turkey (roughly 1.2 kilogram per capita per month) had dropped by 50 percent and retail poultry prices had fallen by 30 percent. (The market capitalization of the traded Turkish poultry firms dropped by over 30 percent in the first week). This is partly owing to the fact that Balikesir and the nearby regions of Bursa, Izmir, Manisa, and Sakarya account for over 40 percent of Turkey s broiler enterprises and poultry production. Egg production is similarly concentrated in these provinces, and its demand has fallen from 12 eggs per capita per month by a rate similar to that of poultry demand. As a result, the poultry and egg sector is incurring losses of roughly US$ 0.9 million daily. (Prior to the outbreak the GDP of the poultry and egg sector ranged US$ billion annually). 2. Objectives The overall objective of the Project is to minimize the threat in Turkey posed to humans by HPAI infection and other zoonoses in domestic poultry and prepare for, control, and respond to an influenza pandemic and other infectious disease emergencies in humans. To achieve this, three areas will be supported: (i) prevention, (ii) preparedness and planning and (iii) response and containment. Achieving these goals will contribute to diminishing the burden of disease and loss of productivity in Turkey, limiting the regional spread of HPAI, and enhancing economic and social prospects at the national, regional, and global levels. 3. Rationale for Bank Involvement The justification for the Bank is the Global Public Goods aspect of the HPAI, one of many emerging and re-emerging zoonoses, and its strong link to poverty reduction. HPAI control programs require a multidisciplinary approach to integrate technical, social, economic, political, policy, and regulatory issues in addressing a complex problem. The Bank is well placed to build upon its knowledge base on multi-disciplinary approaches needed in the proposed Project, which draws on evidence and lessons learned in the various regions regarding emergency preparedness responses and multi-disciplinary approaches. The Bank s experience in Turkey in multi-sectoral, emergency response, and risk-mitigation projects gives it considerable qualifications in bringing together the relevant ministries, government agencies, and the donor community, in understanding and addressing the social and economic impact, and in assuring high level political coordination. Given the Bank s work with FAO, WHO, OIE, EU and other partners in country and at the international level to address both preparedness and outbreaks and to assist with institutional assessments, the Bank can assist Turkey in leveraging additional resources from other international and bilateral agencies. In addition to its financial role, the technical assistance provided by the Bank has been important in similar global or regional emergency situations such as SARS, Tsunami relief, and HIV/AIDS. The Bank s national and regional support will be closely linked with the activities of FAO, WHO, OIE, and the EU, and the proposed Project is fully consistent with, and draws heavily on, the global strategies proposed by FAO and WHO.

4 4. Description The Project will finance activities under three components: (i) animal health, (ii) human health, (iii) public awareness and coordination support. Given the urgency of the situation, following the recent experiences with HIV/AIDS projects in Africa and the Caribbean, priority has been given to detailing the activities to be included in the first year of the project with subsequent activities for later years to be refined in more detail as part of annual project reviews. I. ANIMAL HEALTH COMPONENT The Project will support activities to cover the needs in the short, medium or long-term, and ranging from prevention, to control and total eradication of HPAI, which have been based on an assessment of the particular conditions, constraints and possibilities in Turkey (including a rapid assessment of veterinary services and recent assessments of the poultry sector). II. HUMAN HEALTH COMPONENT In the public health field, short-and long-term actions need to be taken and an appropriate balance struck between the two. While immediate steps can be taken to address the crisis, there is also a longer-term agenda given systemic shortcomings with respect to core public health functions. Work on both the short- and long-term fronts, therefore, needs to proceed in parallel, and efforts should be made to ensure that short-term responses are consistent with and contribute to proposed longer-term interventions. Setting priorities in both cases is essential. III. PUBLIC AWARENESS AND INFORMATION COMPONENT This component is designed to promote public awareness and improved coordination of the execution of the MARA and MOH Contingency Plans and the National AI Strategy. It would have dedicated subcomponents in each of those two areas. (Full costs of this component to be determined at appraisal.) IV. SUPPORT FOR CRITICAL IMPORTS This component would finance, under Emergency Recovery Assistance (ERA) procedures, a positive list of critically needed imports identified as necessary to a response program in the event an AI human pandemic were to occur. This list includes protective clothing and gear, pharmaceuticals and vaccines, medical supplies and equipment, and communication equipment and supplies. 5. Financing Source: ($m.) BORROWER 2.0 BENEFICIARIES 4.5 INTERNATIONAL BANK FOR RECONSTRUCTION AND 15.4 DEVELOPMENT BILATERAL AGENCIES (UNIDENTIFIED) 3.7 FOREIGN MULTILATERAL INSTITUTIONS (UNIDENTIFIED) 9.8 Total 35.4

5 6. Implementation The Project will be implemented by existing project implementation structures in the MARA and the MOH. However, institutional and implementation arrangements will be coordinated by the Office of the Prime Minister, in which a Secretariat of the existing National Zoonotic Disease Committee is to be established. This Committee has been established to deal with zoonotic emergencies and will provide general policies and guidelines for Project implementation. The Committee comprises representatives of the Ministry of Agriculture and Rural Affairs (MARA) and the Ministry of Health (MOH), but its composition need to be expanded to include representatives of the Ministry of the Interior, the Ministry of Environment and Forestry, and representatives of the poultry industry and consumer groups. The Committee will be responsible for reviewing annual work plans and the Secretariat will be responsible for ensuring coordination and linkages across relevant agencies and international partners. Since the Bank is financing both agricultural sector and health sector projects in Turkey, the existing project implementation structures within the MARA (the Central Execution Unit of the Agricultural Reform Implementation Project, CEU) and the MOH (the Health Transformation Project Implementation Unit, HTP PIU) will be entrusted with fiduciary tasks of procurement and financial management. (Additional staff will to be recruited in the MARA CEU and the MOH HTP PIU as needed for these fiduciary tasks.) One senior officer from the MARA and one from the MOH will be designated as Project Coordinators in charge of managing implementation of their relevant ministries project activities and liaising with the MARA CEU and MOH HTP PIU, respectively. These Project Coordinators will report to the Secretariat of the Committee and be members of the Committee. The Secretariat will recruit staff responsible for overall administration, public information, coordination of scientific issues related to animal and human health, and administrative support. At the local level, implementation will be the direct responsibility of each Provincial Directorate of Agriculture and Provincial Directorate of Health. The existing provincial level Zoonotic Disease Committees will be strengthened to set up provincial level secretariats (small coordination units) comprising officials from the Provincial Directorate of Agriculture and Provincial Directorate of Health to work under the supervision and guidance of the national Secretariat. A Project Operational Manual (POM) is to be prepared to integrate the relevant aspects of each of the Contingency Plans which have been prepared by the MARA and the MOH. This POM will guide the management and implementation of the Project. 7. Sustainability Critical to the sustainability of the Project would be the continuous ownership of this initiative by the various stakeholders, coupled with strong political support and the availability of an adequate flow of financial resources to carry out project activities. In addition, institutional sustainability would be ensured by: (i) strengthening of programs to maintain public awareness of the threat of avian influenza and other rapid spreading infectious diseases; (ii) sustained surveillance and prevention and control activities, particularly in high risk regions; (iii) strengthened country capacity to manage at national and local levels the risk factors associated with the spread of avian influenza and other infectious diseases; and (iv) effectiveness of programs to control the spread of avian influenza from birds to the general population. 8. Lessons Learned from Past Operations in the Country/Sector Relevant lessons for the design of the proposed operation have been drawn from previous World

6 Bank/IDA and FAO-supported emergency recovery projects. All these experiences and lessons learned have been taken into account in the design of the proposed GPAI operation. These included the Vietnam Avian Influenza Emergency Recovery Project (approved in early FY05 under OP 8.50 procedures), which is the only project that has been approved by the Bank in response to the Avian Influenza so far. These lessons learned indicate that project success depends to a large extent on the speed of the response provided and, particularly when dealing with smallholders production systems, a speedy, efficient and transparent distribution of suitable key inputs is clearly a major factor in limiting the impact of a crisis and hastening recovery. A performance audit of some of the emergency projects supported by the Bank in various regions drew the following general lessons: (i) emergency projects should avoid policy conditionality; (ii) project design must be simple and take into account a realistic assessment of the existing Borrower s capacity; (iii) a speedy appraisal and approval are crucial to provide a prompt response and a substantial contribution to project success; (iv) procurement arrangements need to be flexible and should be finalized at an early stage; (v) mitigation and prevention measures should be included in the design to minimize impacts of a possible recurrence of the disaster; and (vi) realistic assessments should be made of counterparts absorption capacity, as well as of the effective communications and coordination mechanisms among all relevant stakeholders. Even though the Vietnam Avian Influenza Emergency Recovery Project has been in implementation for only about one year (effective on November 9, 2004), the main recommendations arising from its implementation have been the following: (a) Preparedness is a key factor. While Vietnam had a national strategy document to control Avian Influenza in the domestic poultry population, it was not clearly understood and shared by all relevant agencies and stakeholders and some aspects of the response have been lagging behind. (b) A two-pronged strategy is recommended. This should include: (i) the control of Avian Influenza at the source in high-risk regions (through aggressive measures including culling, movement control and vaccination campaigns for poultry and ducks); and (ii) simultaneously prepare with short and medium-term measures to minimize the risks to humans and prepare for an eventual pandemic. (c) A revised compensation framework is an essential element to obtain real cooperation from affected stakeholders (farmers/producers) and to ensure the efficacy of the surveillance and diagnosis mechanisms. (d) The importance of strengthening the technical, scientific and operational capacity of the relevant participating agencies should not be overlooked. The AI crisis highlighted several weaknesses in the animal health as well as public health services systems, including: poor surveillance at the local level, weak diagnostic capacity, lack of epidemiological expertise and information system, and inadequate operating budget to bear the additional costs of physical and human cost to contain the spread of the disease. (e) There is a urgent need to organize an effective national response, including all technical ministries in charge of agriculture/animal health and human health, as well as other relevant sectors, at the national and sub-national level, in case of a human epidemic. (f) It is extremely important to raise awareness in the public and private sectors from the initial moments, and to strengthen effective coordination mechanisms for the implementation of the necessary technical responses, involving the Government, the donor community, the private sector and the civil society. (g) Attention should be given to support the integration of each country to a regional and global framework for the control of HPAI, and more broadly of all trans-boundary animal diseases and other emerging infectious diseases, to increase cost-effectiveness and ensure the harmonization of activities and responses

7 In terms of public health, the following relevant lessons were derived from emergency operations: Key data needs should be anticipated and infrastructure developed to provide information that reduces the number of assumptions ( what is not known is as important as stating what is known ). The program should include mileposts for periodic re-evaluation, so that necessary changes can be made based on new information. External reviews of the program should be conducted periodically to increase objectivity and improve decision making. Ensure that all localities are able to respond to a pandemic and implement mass vaccination programs effectively. Provide funding to regional and local levels for preparedness and infrastructure development coupled with guidance and technical support. National oversight and assistance is important to assure nationwide protection and consistency of the response. Surveillance systems should be in place, preferably, before starting the program. Communications materials should be developed to educate health care providers and the public. Always keep in mind the principle: expect and plan for the unexpected. 9. Safeguard Policies (including public consultation) Safeguard Policies Triggered by the Project Yes No Environmental Assessment (OP/BP/GP 4.01) [X ] [ ] Natural Habitats (OP/BP 4.04) [ ] [ X] Pest Management (OP 4.09) [ ] [ X] Cultural Property (OPN 11.03, being revised as OP 4.11) [ ] [ X] Involuntary Resettlement (OP/BP 4.12) [ ] [X ] Indigenous Peoples (OD 4.20, being revised as OP 4.10) [ ] [X ] Forests (OP/BP 4.36) [ ] [X ] Safety of Dams (OP/BP 4.37) [ ] [X ] Projects in Disputed Areas (OP/BP/GP 7.60) * [ ] [X ] Projects on International Waterways (OP/BP/GP 7.50) [ ] X[ ] Since the Project is assessed as a B-category project, Environmental Management Plans would be prepared during Project implementation under each component and implemented with Project support. 10. List of Factual Technical Documents A.. BANK Guidance notes to country teams on responding to AI Rapid assessment of the economic impact of public health emergencies of international concern the example of SARS Milan Brahmhatt Vietnam Avian Influenza Emergency Recovery Project Memorandum of the President and Technical Annex Minutes of the meeting on the Emerging zoonoses and pathogens: A Global public goods concern implication for the World Bank, April 19, 2005 * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties claims on the disputed areas

8 Issues Note on Avian Influenza in Africa, September 27, François Le Gall and Ok Pannenborg B. OTHER DONORS A global strategy for the progressive control of HPAI FAO/OIE in collaboration with WHO May 2005 FAO s response to the avian influenza crisis September 19, 2005 Technical Cooperation Program Project descriptions for East Africa, West Africa, Europe and Central Asia, North Africa, and the Middle East WHO 2005 C. PUBLIC HEALTH RELATED Global avian influenza information from WHO Web site at Information on U.S. influenza preparedness available at: and WHO Responding to the avian influenza pandemic threat. Recommended strategic actions. Geneva. WHO WHO global influenza preparedness plan. The role of WHO and recommendations for national measures before and during pandemics. Geneva. United States Department of Health and Human Services Pandemic Flu Fact Sheet. United States Department of Health and Human Services Pandemic Influenza Preparedness and Response Plan. Draft. Browner, J., and Chalk, P The Global Threat of New and Reemerging Infectious Diseases. Reconciling U.S. National Security and Public Health Policy. Santa Monica, CA: RAND. Dowdle, W.R The 1976 Experience. J. Infect Dis 1997; 176 (suppl. 1): S Garcia-Abreu, A., Halperin, W., Danel I Public Health Surveillance Toolkit. A guide for busy task managers. Washington, D.C.: World Bank. Huffman, S., on the basis of report by Daniel Miller and Asel Ryskulova Epidemiologic Surveillance Systems in Eastern Europe and Central Asia: An Overview. Washington, D.C.: World Bank. Neustadt, R.E., Fineberg H.V The Epidemic That Never Was. Policy Making and the Swine Flue Scare. Vintage Books. D. ANIMAL HEALTH RELATED OIE website on Avian Flu Official reporting, Scientific information, Standards, Guidelines, and Recommendations ( FAO website on Avian Flu General information, Communication, Publications, Projects proposals and reports ( FAO/OIE. February Second FAO/OIE Regional Meeting on Avian Influenza Control in Asia. Ho Chi Minh City. FAO/OIE. February, Recommendations of the Joint FAO/OIE Emergency Regional Meeting on Avian Influenza Control in Animals in Asia. Bangkok. FAO/OIE. March Summary Report of the First Regional Steering Committee of GF-TADS (Global Framework for the Progressive Control of Transboundary Animal Diseases) in Asia and the Pacific. Tokyo.

9 FAO/OIE/WHO. February, FAO/OIE/WHO Technical Consultation on the Control of Avian Influenza, 3-4 February, 2004: Conclusions and Recommendations. OIE. May, OIE Report of the First Meeting of the Steering Committee of the Joint OIE/FAO Network of Expertise on Avian Influenza (OFFLU). OIE. Paris. OIE/ASEAN. August The Southeast Asia Foot and Mouth Disease Campaign: Business Plan for Phase III ( ). OIE/FAO. Network of Expertise on Avian Influenza (OFFLU). Paris. OIE/FAO. April, International Scientific Conference on Avian Influenza, OIE Paris, France 7-8 April 2005: Recommendations. Paris. E. BIBLIOGRAPHY OF RECENT REPORTS & OTHER DOCUMENTS Bell, Clive and Maureen Lewis. October The Economic Implications of Epidemics Old and New. Working Paper Number 54, Center for Global Development. Washington, DC. (see also Powerpoint presentation, Economic Implications of Epidemics Old and New ). OIE Emerging Zoonoses and Pathogens of Public Health Concern. Rev. sci. tech. Off. int. Epiz., 2004, 23 (2). FAO/OIE. February Second FAO/OIE Regional Meeting on Avian Influenza Control in Asia. Ho Chi Minh City. FAO/OIE. February, Recommendations of the Joint FAO/OIE Emergency Regional Meeting on Avian Influenza Control in Animals in Asia. Bangkok. FAO/OIE. March Summary Report of the First Regional Steering Committee of GF-TADS (Global Framework for the Progressive Control of Transboundary Animal Diseases) in Asia and the Pacific. Tokyo. FAO/OIE/WHO. February, FAO/OIE/WHO Technical Consultation on the Control of Avian Influenza, 3-4 February, 2004: Conclusions and Recommendations. Ferguson, Neil et al Strategies for Containing an Emerging Influenza Pandemic in Southeast Asia. Nature. OIE. May, OIE Report of the First Meeting of the Steering Committee of the Joint OIE/FAO Network of Expertise on Avian Influenza (OFFLU). OIE. Paris. OIE/ASEAN. August The Southeast Asia Foot and Mouth Disease Campaign: Business Plan for Phase III ( ). OIE/FAO. Network of Expertise on Avian Influenza (OFFLU). Paris. OIE/FAO. April, International Scientific Conference on Avian Influenza, OIE Paris, France 7-8 April 2005: Recommendations. Paris.

10 Sandman, Peter and Jody Lanand Bird Flu: Communicating. Perspectives in Health, Vol. 10, No. 2. Pan American Health Organization. Washington, DC. Schudel, A. August Tackling Avian Influenza at Source. Avian Influenza Technical Discussion & Coordination Meeting (powerpoint presentation). Washington, DC. Smolinski, Mark, Margaret A. Hamburg, and Joshua Lederburg (Editors) Microbial Threats to Pandemic Influenza. National Academies Press. Washington, DC. WHO WHO Global Influenza Preparedness Plan: The Role of WHO and Recommendations for National Measures Before and During Pandemics. Department of Communicable Disease Surveillance and Response, Global Influenza Program. Geneva. WHO. January Influenza Pandemic Preparedness and Response: Report by the Secretariat. Executive Board, 115 th Session, Agenda Item Geneva. World Bank. July 2, Technical Annex for a Proposed Credit of SDR3.5 million to the Socialist Republic of Vietnam for an Avian Influenza Project. Washington, DC. 11. Contact point Contact: Mark R. Lundell Title: Lead Agriculture Economist Tel: (202) Fax: (202) Mlundell@worldbank.org 12. For more information contact: The InfoShop The World Bank 1818 H Street, NW Washington, D.C Telephone: (202) Fax: (202) Web: wb P:\TURKEY\RURENV\GENERAL\Turkey-Avian Flu\PID - Appraisal Stage -2.doc 01/09/ :29:00 AM