Pandemic preparedness in a changing world

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Leonard Booker
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1 Pandemic preparedness in a changing world Annual Conference on Disaster Preparedness and Response January 2018 Hong Kong, China Dr Li Ailan WHO Regional Emergency Director

2 Preparing for a pandemic Pandemic threat is real and becomes more complex in a changing world Investment in pandemic preparedness saves life, promote health, keep the world safe Pandemic preparedness requires a multisectoral approach and cross-border planning

3 Learning from the past

4 Influenza pandemics in the 20 th century Credit: US National Museum of Health & Medicine 1918: Spanish Flu million deaths A(H1N1) 1957: Asian Flu 1-4 million deaths A(H2N2) 1968: Hong Kong Flu 1-4 million deaths A(H3N2)

5 Global Spread of Pandemic (H1N1) 2009 April February 2010 April 2009 May 2009 (1 month) July 2009 (3 months) September 2009 (5 months) December 2009 (8 months) February 2010 (10 months)

Current Global Health Emergency Situation As of 5 January 2018, WHO is

Management System), vshoc (Virtual Strategic Health Operations Center)

6 Current Global Health Emergency Situation As of 5 January 2018, WHO is responding to more than 100 public health emergencies globally, including 50 graded events. Nine of these events are grade 3 emergencies, the highest grade under WHO s Emergency Response Framework. Information sharing through internal platforms such as EMS (Event Management System), vshoc (Virtual Strategic Health Operations Center) and the Emergency Dashboard. Ungraded 64 Disaster Grade 3 9 Grade 2 17 Grade 1 24 Infectious 87 Infectious Disaster Food safety Zoonoses Undetermined 6

Response Risk Assessment Surveillance WHO Western Pacific Regional Surveillance

(Media, ProMed, GPHIN, etc) Unofficial Information (IHR notification, Member States,

Verification Collect additional information (WHO CO/HQ, Member States) Collect

7 Response Risk Assessment Surveillance WHO Western Pacific Regional Surveillance Regional Event Based Surveillance (EBS) and Risk Assessment Unofficial Information (Media, ProMed, GPHIN, etc) Unofficial Information (IHR notification, Member States, WHO CO/HQ, FAO, etc) Initial screening of events (initial risk assessment) Verification Collect additional information (WHO CO/HQ, Member States) Collect additional information (WHO CO/HQ, Member States) Response Action Information sharing Monitoring Archiving 7

WHO Western Pacific Regional Surveillance Regional Event Based Surveillance (EBS) and Risk Assessment PHEIC Graded events WHO 3-level Risk Assessment 1-2 events/month WHE

8 WHO Western Pacific Regional Surveillance Regional Event Based Surveillance (EBS) and Risk Assessment PHEIC Graded events WHO 3-level Risk Assessment 1-2 events/month WHE Programme-wide Risk Assessment 2-5 events/week HIM Team Risk Assessment 5-10 events/day Epidemic Intelligence Officers-Event Screening official/unofficial reports/day

WHO Western Pacific Regional Surveillance In 2017, WPRO Epidemic Intelligence Officers (EIOs) scanned thousands of official and unofficial information sources to detect 1,448 signals requiring

9 WHO Western Pacific Regional Surveillance In 2017, WPRO Epidemic Intelligence Officers (EIOs) scanned thousands of official and unofficial information sources to detect 1,448 signals requiring further assessment. From these, more than 77 events of public health importance were detected. WHO responded to more than one-third of acute events, providing technical advice, deploying experts to the field and/or distributing emergency supplies. Public Health Emergencies in the Western Pacific, by country and area, % Public Health Emergencies in the Western Pacific, by hazard type, % 49% Infectious Diseases Animal Disasters Chemical 24%

Risks in the Western Pacific Region The Western Pacific is a hotspot for emerging infectious diseases and disasters Pandemic Risk World Risk Index Modelling studies suggest that the Western Pacific

10 Risks in the Western Pacific Region The Western Pacific is a hotspot for emerging infectious diseases and disasters Pandemic Risk World Risk Index Modelling studies suggest that the Western Pacific Region is likely to be where the next pandemic will originate. Disaster Risk Eight of the 15 highest ranked countries for a disaster risk due to natural hazards are in the Western Pacific Region. Rank Country (WPR) Risk (%) 1 Vanuatu Tonga Philippines Guatemala Bangladesh Solomon Islands Costa Rica Cambodia El Salvador Timor-Leste Papua New Guinea Brunei Darussalam Mauritius Nicaragua Fiji

11 Influenza pandemic risk

12 Epidemic curve of human infection with avian influenza A(H7N9), Feb 2013 Dec 2017 N=1565 in China The last reported to WHO on Dec 2017 (onset: Nov 2017) 12

13 Are we ready for the next pandemic? We are simply not prepared to deal with a global epidemic. Bill Gates OpEd, The New York Times, 2015

14 Are we ready for the next pandemic? 1. Growing populations and urbanization 2. Encroaching into new environments 3. Climate change 4. Global travel 5. Civil conflict 6. Fewer doctors and nurses in outbreak regions 7. Faster information Source: CNN, Meera Senthilingam, 2017

15 Are we ready for the next pandemic? The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency.

16 National Pandemic Influenza Preparedness Plans 102 of 194 (53%) Member States either have not yet developed a plan or plans are not yet publicly available Of the 92 Member States with a publicly available plan, only 24 (26%) updated their plans since 2009 pandemic

17 Evolution of WHO Guidance on Pandemic Preparedness Planning: Pandemic Influenza Risk Management (PIRM),

Pandemic Influenza Risk Management Risk-based and Integrated Approaches Promote all-hazards approach to Emergency Risk Management for Health Strengthen whole of government and whole of society

18 Pandemic Influenza Risk Management Risk-based and Integrated Approaches Promote all-hazards approach to Emergency Risk Management for Health Strengthen whole of government and whole of society approach to risk management Emphasize risk-based approaches with high-level guidance on risk and severity assessment Uncouple global phases from national actions Introducing flexibility in countries for planning and response Incorporate new developments e.g. PIP Framework

Whole-of-Society Approach A pandemic will test the resilience of nations, businesses and communities, depending on their capacity to respond Three

19 Whole-of-Society Approach A pandemic will test the resilience of nations, businesses and communities, depending on their capacity to respond Three major groups: governments, business and civil society at all levels Multisectoral approach: all sectors should be involved in pandemic preparedness 19

20 Business continuity planning Identify the critical functions that need to be sustained Identify the personnel, funding, supplies and equipment vital to sustain critical functions Consider how to deal with staff absenteeism Provide clear command structure, delegations of authorities Identify services that could be downsized or closed Assign and train staff for critical functions Consider the need for family and childcare support, psychosocial support, recovery and so on

cross-border collaboration is vital, including through IHR

21 Cross-border planning No single agency or country can prepare for and respond to a pandemic on its own, international and cross-border collaboration is vital, including through IHR system, GOARN, GISRS, UN cluster approach, cross-border agreements and arrangements

Potential to spread internationally Possible travel or trade restrictions National IHR Focal Point WHO Regional

22 IHR provides a global system for alert, information sharing and response DON (Disease Outbreak News) EIS Posting Event detected by national and international surveillance system Two of the following: Seriousness Unexpected Potential to spread internationally Possible travel or trade restrictions National IHR Focal Point WHO Regional IHR Contact Point Event notified and information for Event Information Site (EIS) shared EIS posting sent WHO Headquarters

23 Regional Actions to guide pandemic preparedness APSED III serves as an upgraded regional framework for action to advance IHR core capacities including pandemic preparedness, thus protecting health security

24 A decade regional investment: Good foundations

Regional framework for action: Focus Areas APSED III focuses on the core components for public health emergency preparedness and response Vision An Asia Pacific region able to prepare for, detect and

25 Regional framework for action: Focus Areas APSED III focuses on the core components for public health emergency preparedness and response Vision An Asia Pacific region able to prepare for, detect and respond to public health emergencies through collective responsibility for managing health security Goal To strengthen public health emergency preparedness and response capacity by improving core public health systems, increasing regional connectivity and coordination, and investing in ongoing performance improvement 25

26 Public health emergency preparedness in the broader context

27 APSED guiding principles Putting people first and placing countries at the centre Investing in preparedness (forward-looking) System thinking and a step-by-step approach Learning culture for continuous improvement Connecting the world for health security

28 A Framework for pandemic preparedness

29 THANK YOU

Promoting Public Health Security Addressing Avian Influenza A Viruses and Other Emerging Diseases

Promoting Public Health Security Addressing Avian Influenza A Viruses and Other Emerging Diseases Masaya Kato, WHO Viet Nam OIE Regional Workshop on Enhancing Influenza A viruses National Surveillance