WORLD BANK RESPONSE TO INFLUENZA A(H1N1) Rakesh Nangia Director, Strategy & Operations Human Development Network Tokyo, July 2009
World Bank Response to A(H1N1) Influenza A(H1N1) Global Health and Risks A(H1N1) and Health Systems Strengthening International Response World Bank Response World Bank Resources for Avian & Human Influenza Pandemic Preparedness A(H1N1) Lessons Learned
A(H1N1) Global Health and Risks Global Health as of July 7 th, 135 countries, territories and areas have officially reported almost 95,000 confirmed cases of H1N1, including 429 deaths. Factors Affecting Emerging Infectious Diseases Agricultural intensification Habitat changes Globalization Risks Global Pandemic Mutation Economic Impact Mild pandemic could lead to an additional 1.4 million deaths Severe pandemic (similar to 1918-19 Spanish flu) could kill 70+ million. Economic losses from illness and death in the first year could amount to 1.3% of world GDP or more. Combined with preventive costs of 2% of GDP, total costs could exceed 3% of world GDP. Perception Threat is Low Prevention Low Priority
A(H1N1) and Health Systems Strengthening H1N1 outbreak reinforced the need for health systems strengthening The health system is vital at all stages in the response to the pandemic Disease surveillance system Prevention and control of infectious diseases Health communications Detection and confirmation of cases Providing care, treatment and advice to those affected H1N1 support should be firmly embedded in medium term health sector development plans to help more broadly with future emergency health threats as they occur Building institutional and technical capacity, especially in low-income countries, is needed if the world is to mount an effective response Many countries are not well positioned to confront a potential pandemic, either in terms of their preparedness plans, their capacity to access medicines and vaccines, or the strength of their health systems Securing finance for building this capacity will be essential
International Response Inter-agency H1N1 Task Group (UNSIC, WHO, WB, UNICEF, FAO, etc) Strategic Framework for Coordinated Support to Developing Country Responses Presented at ECOSOC meeting on July 6, Geneva, by UN Sec Gen and WHO DG, including global work plan and budget Analysis and response at country level: Capacity for planning and direction Disease surveillance Health care response systems and measures Public health interventions Communication strategies Whole of society preparedness and response Preparedness support by UN agencies, funds, programs and partners Formation of a member-state based contact group Analysis and response at global level: Monitoring disease progression Generation and transfer of knowledge Accelerating access to vaccines Accelerating access to antivirals
Bank strategy follows a two-tiered approach 1. Reallocating existing operations and providing new lending support Many operations support similar objectives 2. Expansion and extension of Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI ): extended one year to June 2010; and expanded the ceiling from $500 million to $1 billion. Gap Analysis Review existing and portfolios and lending pipeline Identify clients exposed to lack of Bank support Direct client engagement to reassess needs and provide support Coordination World Bank Response High-level discussions between agencies and partners Inter-agency Technical Working Group on Influenza Inter-agency H1N1 Task Group Multi-sectoral approach; internal and external
World Bank Resources for Avian & Human Influenza Pandemic Preparedness Avian and Human Influenza Facility Total pledges: $125.4 million Paid-in contributions: $107.6 million 44 Grants approved: $84.2 million GPAI $1 billion ceiling Commitments: $421 million 59 operations in 57 countries Japan Policy and Human Resources Development Trust Fund for Avian and Human Influenza $19.5 million H1N1 New Lending 15 countries have requested and/or explored support
A(H1N1) Lessons (part 1) Political commitment paramount international, regional and national levels Need renewed support and stakeholder buy-in Need country level champions at highest levels Importance of core human health and animal health systems and functions Public Health: public health program planning and coordination; national public health surveillance systems; health system response capacity; and essential medical services. Animal Health: preventative bio-security measures; enhanced passive surveillance; and active surveillance. Communication and coordination internal and external Sustained investments and vigilance
A(H1N1) Lessons Learned (part 2) High-level Summit on H1N1 Lessons Learned, Mexico, July 1-3 Countries will experience a tidal wave of cases, a sharp peak, followed by a steep decline. Once the virus sweeps through a susceptible population, transmission may continue, but at a much lower intensity. The full clinical spectrum of H1N1 is not yet fully understood, nor the predictive factors for severe or fatal infections. The majority of patients experience mild symptoms and make a full recovery within a week, often in the absence of any medical treatment. Most cases of severe and fatal infection occur in people with underlying medical conditions. Pregnant women are at increased risk of complications. For reasons that are poorly understood, some deaths occur in perfectly healthy young people, and some patients experience a very rapid clinical deterioration, leading to severe, life-threatening viral pneumonia that requires mechanical ventilation. Constant, random mutation is the survival mechanism of the microbial world, so like all influenza viruses, the full future of H1N1 is uncertain.