Introduction to Influenza Pandemic Planning

Transcription

1 Introduction to Influenza Pandemic Planning Dr. Wan Noraini bt. Wan Mohamed Noor Head of Surveillance Sector Disease Control Division, MOH Malaysia 3 May 2018

2 Negative single stranded RNA virus, part of the Orthomyxoviruses family Seasonal Influenza: Influenza that occurs every year with gradual variations in the previous year s virus surface proteins (antigenic drift) Classified into types A, B, C and D INFLUENZA VIRUS Avian Influenza: A disease of birds that occasionally jumps species and infects humans. May become the source of new viruses in humans causing pandemics Influenza A can affect many species; including birds, humans, swine, canids, equids and bats Pandemic Influenza: A worldwide surge in cases caused by the introduction of a new type A surface protein (antigenic shift)

3 Influenza: Annual Epidemic & Unpredictable Pandemic Influenza pandemic are unpredictable but recurring events Threat persisting repeated zoonotic transmission to humans Avian viruses: H5, H7, H9 Variant viruses Since 2014: H1N1v, H3N2v, H5N1, H5N6, H7N2, H7N9, H9N2 & H10N8 Pandemic H1N Estimated R 0 (reproductive number): 1.1 to 1.8 a Estimated CFR: 0.12% b Estimated attributable excess mortality worldwide: 100, ,000 c Age groups most affected: Children and young adults a Fraser, C et al. Pandemic potential of a strain of Influenza A (H1N1): Early Findings. Science 2009, 324(5934): b Van Kerkhove MD et al. H1N1pdm serology working group. Estimating age specific cumulative incidence for the 2009 influenza pandemic: a meta-analysis of A(H1N1)pdm09 serological studies from 19 countries. Influenza and Other Respiratory Viruses, 2013, Jan 21. doi: /irv c Dawood FS et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza a H1N1 virus circulation: a modelling study. Lancet Infectious Diseases, 2012, 12(9):

4 Influenza Pandemic A Virus Problem Constantly evolving Multiple species Multiple directions Rapid spreading Without administrative boundaries Surveillance & control measures Timely Continuous Global

5 Potential Impacts on Non-Health Sectors (Pandemic flu could infect >35% of world s population) Decreased Supply Reduced production Disrupted transportation International trade of commodities Cross-sectoral interdependencies CARE FEAR ABSENTEEISM QUARANTINE Decreased Demand Retail trade Transportation Leisure travel Gastronomy ILLNESS / DEATH Breakdown of services Economic and Social Disruption Changed demands Lack of Business Continuity Plan (BCP) Increased Demand Military (support for logistics etc.) Mortuary & burial services Water & sanitation Telecommunication (phone & internet) ATM, online banking Health & life insurance Protection against insecurity Electricity / power supply Healthcare

6 1918: Spanish Flu Concept Forming 1933: The first human influenza virus was isolated 3 April 1947: 3 rd Session of Interim Commission Representative from the Netherlands, proposes setting-up a Committee on Influenza (surveillance, study & control) The milestones: 8 July 1948: WHO approves the establishment of the World Influenza Centre 15 June 1949: 2 nd WHA, the World Influenza Centre reports on influenza viruses isolated and development of experimental vaccine 21 February 1950: WHO Executive Board Resolution (EB3.R3) on the need for information on influenza available to WHO Geneva for dissemination Sept. 1952: Birth of Global Influenza Surveillance Network (GISN) & was renamed in 2011 as Global Influenza Surveillance & Response System (GISRS)

7 The Global Establishments In 1947, WHO s Interim Committee recognized the importance of influenza and started a globally-coordinated efforts for its surveillance, study and control. This led to the beginning of the Global Influenza Programme (GIP). In 1952, the WHO Executive Board decided that an influenza surveillance system was needed, thus GISRS was born. It is a unique long-lasting, global disease surveillance network built on voluntary contribution and reporting. FluNet is the global reporting and analysis platform of the WHO GISRS. Since its launch in 1997, this web-based platform allows NICs worldwide to share laboratory surveillance data with each other and with WHO on regular basis. The FluNet data are crucial for timely monitoring of global influenza virus activity.

8 GISRS was established in 1952 (formerly known GISN) and currently comprises of: 143 National Influenza Centres (NICs) 6 WHO Collaborating Centres (CCs) 4 WHO Essential Regulatory Laboratories 13 WHO H5 Reference Laboratories

9 International Health Regulations (2005) Entered into force on 15 June 2007 Defending against the international spread of disease in the 21st century, including influenza pandemic A global structure aimed at preventing and responding to the international spread of disease while avoiding unnecessary interference with traffic and trade The emergence of a new influenza virus in early 2009 was the first influenza pandemic since the adoption of the IHR (2005) and the first of the 21 st century

10 64 th WHA Resolutions (2011) Adoption of report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009 Adoption of Pandemic Influenza Preparedness (PIP) Framework

11 Recommendations of the WHO Review Committee of the Functioning of the IHR (2005) in Relation to the 2009 H1N1 Influenza Pandemic Accelerate the implementation of the core capacities required by the IHR Enhance the WHO Event Information Site (EIS) Reinforce evidence-based decisions on international travel and trade Ensure necessary authority and resources for all IHR National Focal Point Strengthen the internal capacity of the WHO for sustained response Improve practices for the appointment of an emergency committee Revise pandemic-preparedness guidance Develop and apply measures to assess the severity of a pandemic Streamline the management of guidance documents Develop and implement a strategic, organization-wide communications policy Encourage advance agreements for vaccine distribution and delivery Establish a more extensive public health reserve workforce globally Create a contingency fund for public health emergencies Reach an agreement on the sharing of viruses, access to vaccines and other benefits Pursue a comprehensive influenza research and evaluation program The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency

12 Pandemic Influenza Preparedness (PIP) Framework A unique partnership between all the major players able to make the international response to pandemic influenza nimble, flexible, effective and equitable The PIP Framework has two objectives which are to be pursued on equal footing: improve the sharing of influenza viruses with the potential to cause a human pandemic; and establish more predictable, efficient and equitable access to the benefits that result from the sharing of such viruses, notably vaccines and antiviral medicines during future pandemics.

13 Pandemic Influenza Preparedness (PIP) Framework There are currently five (5) broad areas of work for pandemic preparedness within PIP Framework: Strengthening laboratory & surveillance capacities; Conducting burden of disease studies; Strengthening regulatory capacities; Strengthening risk communications; and Planning for deployment.

14 Pandemic Influenza Risk Management 2009 May 2017

15 Pandemic Influenza Risk Management What s new in this guidance? Applies the principles of all-hazards Emergency Risk Management for Health to pandemic influenza risk management Risk-based approach flexibility of the plan based on national risk assessment, taking account of the global risk assessment conducted by WHO Introduction of a revised approach to global phases and uncoupling global phases from national actions Pandemic Influenza Preparedness (PIP) Framework Pandemic Influenza Severity Assessment (PISA) transmissibility, seriousness of disease & impact

16 Pandemic Emergency Financing Facility (PEF) Developed by the World Bank Group, with the support of Japan, Germany and the World Health Organization BECAUSE time and time again, the world continues to follow the same pattern money isn t brought to the table until a major outbreak hits an explosive point PEF is a quick-disbursing financing mechanism that provides a surge of funds to enable a rapid and effective response to a large-scale disease outbreak Eligible countries can receive timely, predictable and coordinated surge financing if affected by an outbreak that meets PEF s activation criteria The PEF covers six viruses that are most likely to cause a pandemic Orthomyxoviruses (new infuenza pandemic virus A) Coronaviridae (SARS, MERS) Filoviridae (Ebola, Marburg); and Other zoonotic diseases (Crimean Congo, Rift Valley, Lassa fever)

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18 International Financial Assistance: The Options Briefly, what is it? UN Central Emergency Response Fund (CERF) CERF was introduced in 2006 as the UN s global emergency response fund to deliver funding quickly to humanitarian responders and kick-start life-saving action whenever and wherever crisis hit. WHO Contingency Fund for Emergency (CFE) The CFE was established by the World Health Assembly in May 2015 following a review of WHO s response to the 2014 Ebola outbreak in West Africa and as one element of the reform of WHO s work in emergencies with health and humanitarian consequences. The CFE is designed to provide funding during a critical gap - from the moment the need for an emergency response is identified, to the point at which resources from other financing mechanisms begin to flow. World Bank Pandemic Emergency Financing Facility (PEF) An insurance-based mechanism designed specifically to respond to outbreaks from a defined set of viruses with pandemic potential. Developed by the World Bank Group in collaboration with the World Health Organization and supported by Japan, Germany, as well as private sectors partners. The World Bank Group announced the creation of the PEF on 21 May 2017 at the G7 Ministers of Finance Meeting in Sendai. Japan and Germany came on as donors and allowed for the PEF's insurance window to be operational July The cash window will be operational in early Funds outbreak response? Rarely, when outbreak is considered a humanitarian emergency Yes. The WHO CFE is designed to respond to any type of emergency with health and humanitarian consequences, including natural disaster not only outbreaks with pandemic potential. Sometimes. The PEF will fund only disease outbreaks that have a potential to become epidemics and the PEF is activated once an outbreak crosses a pre-defined threshold of severity.

19 The Challenges From the influenza virus Further evolving and spreading of zoonotic viruses Competing priorities Long-term (?) investment vs. short-term needs Dynamics of the world Pandemic, epidemic, endemic, outbreak The challenge of policymakers and public health leaders to make decisions under conditions of stress and uncertainty Flu fatigue

20 Fighting Influenza 3 Key Messages Influenza remains a priority infectious hazard in a rapidly changing world, especially in the Asia Pacific Region Pandemic risk persists and the impact of a severe pandemic are beyond human imagination Pandemic influenza preparedness and response is a shared responsibility Globally: WHO commitment & coordination Locally: National capacity establishment & strengthening

21 The dedicated and well-informed health care worker is at the heart of the response to pandemic influenza. This is because the key challenge during a pandemic is to provide care to the many people who fall ill. Hence, being unprepared is never an option for us, the health care worker.