A Sustainable and Multi-sectoral Approach to Pandemic Preparedness and Emerging Health Threats

1. A Sustainable and Multi-sectoral Approach to Pandemic Preparedness and Emerging Health Threats David Nabarro UN System Influenza Coordinator APEC Health Ministers Meeting Sydney, Australia 7 June 2007

2. 1968, Hong Kong Flu 1 Million deaths 1918, Spanish Flu <20 Millions deaths 1957, Avian Flu 1 Million deaths

3. Examples of Past Impacts • 1918 Spanish Flu • Merchants suffered because customers were too ill to shop • 10,000 railway workers in Montreal were ill • Telephone company in Boston, US requested that only essential calls were made • Auckland’s ambulance service not sufficient for the extraordinary demands • 1957 Asian Flu • 50% of the US, or 82,000,000 patients cost the nation 282,000,000 bed-days of disability • Public Health Service reported an increase of 122,650 cases in US in a week • 1968 Hong Kong Flu • In Chicago: Absenteeism among police and fireman – 3 times higher than normal; some companies reported absenteeism of 50 %

4. Lesson Learned from 1918 Pandemic Flu • Private and public sectors should work together • Importance of the media • Impact of the pandemic on essential services • Enormous needs for non-medical assistance • Tremendous effect on vulnerable populations Source: 1918 Pandemic Influenza in Maine, The State of Maine, US

5. SARS Impacts • 75% Decreased in Air Travel to Hong Kong at the Peak • 15% Declined in Retail Sales in Hong Kong at the Peak • 2% GDP Reduction* ($200 billion) in the 2nd Quarter of 2003, in East Asian Region Source: * East Asia Update - Economic Impact of Avian Flu, East Asia Update, November 2005, The World Bank

6. Possible Impact of Next Pandemic • Estimates 1.4 million* to multi-millions** deaths • High absenteeism in all sectors because of death, illness, care for sick family members and fear • Significant economic effects • Markets close, utilities become unreliable, telecoms break, cash in short supply • Travel and leisure travel reduces, demand for food changes • Threats to Rule of Law and Security • Need for Humanitarian Response • Countries might suffer very differently (small islands, developing countries, countries with high population density, etc.) Source: * WHO “Influenza” Fact Sheet, No. 211 (2003) ** Dr. Dmitry Lvov, Head of the Russian Virology Institute

7. Changed Demand • Water and Sanitation • Access to Telecommunication • (Phone and Internet) • Health Care Services • Home-based Services • Cleaning Supplies • Cash Withdrawal • Protection against Insecurity • Fuel and power supply • Food Distribution • Emergency Services • Mortuary and Burial services • Refuse collection Decreased Supply Decreased Demand • Retail Trade • Transportation • Leisure Travel • Restaurant • Reduced production • Disrupted supply • International trade of commodities Economic and Social Disruption • Lack of Maintenance • Disrupted Supply Chain (Transportation, Rescheduling and reprioritizing of cargo flows, etc.) Potential Impacts on Non-health Sectors Pandemic Flu Could Infect 35% of World’s Population Death Illness Absenteeism Care Anxiety Past experiences showed that Public health interventions (Quarantine, Social Distancing, Travel Restrictions) have delayed the spread but could not stop it

8. Key Elements of Preparedness • Need to be ready for any threat to global Human Security • Joint action by nations: solidarity, trust and transparency • International Health Regulations at core: Animal and Human Health working as one • Focus on Continuity of Essential Services • Authoritative Guidance based on Best Scientific Evidence • Prioritized Actions for implementation by Government, Private Sector, Civil Society, Humanitarians - together • Clear Lines of Direction and Control • Funds to Finance Responses • Single source of Information; failsafe communications • Sustain Preparedness: test plans; track progress

9. Preparing Response to Pandemic • Antiviral drugs • Vaccines, etc • Medical care, PPE Medical interventions Non-Medical interventions Public Health Measures • Personal hygiene • Travel restriction • Quarantine • Social distancing (closure of school etc) • Risk Communication • Security and Rule of Law • Food & water supply • Power supply • Transportation • Telecommunication • Financial and Banking services Social and Economic Systems (keep a society running) (Adapted fromDr. T. Kasai, WHO WPRO)

10. Conclusion of 2005 APEC Survey on Pandemic Influenza Planning • Pandemic influenza planning is underway in almost all APEC and Western Pacific economies • Barriers exist to planning and preparedness • Lack of multi-sectoral involvement is a major barrier • More information on pandemic health and economic impacts would increase focus on preparedness Source: Pandemic Influenza Planning and Preparedness: Situation Assessment for APEC and Western Pacific Economies, 2005, APEC and WHO

11. Coverage of contingency planning for essential services in National Pandemic Preparedness Plans in Asia Pacific (2007) Total economies = 15 (UNSIC/PIC May 2007)

12. Comprehensiveness of essential services contingency planning in National Pandemic Preparedness Plans of APEC member economies 2007 Total economies = 15 (UNSIC/PIC May 2007)

13. “Still surprisingly little focus on continuity of essential services …" • 5 out of 15 economies refer to external documents as a source for information on contingency plans for continuity of essential services: the other 10 are stand-alone plans • Of the 10 stand-alone plans none mentioned the telecommunication and banking/finance sectors. • Burial/mortuary and police/prison services are mentioned in about half of them. • There is Comprehensive planning for burial services in 3 plans; for private business in 1 plan. • Other services are presented only in 2 out of these 10 plans. • In conclusion, there is surprisingly little focus on continuity of essential services during an influenza pandemic in the economies’ contingency plans.

14. 5 Areas for Attention • Government (especially rule of law) functions despite high absenteeism • Financial systems (especially banking) continue to work • Public utilities (power and electricity, telecommunications, water and sanitation), remain accessible • People are fully engaged in the preparedness effort: well informed, know how to help others (especially the most vulnerable): simulations and drills at the community level. • Cross-border consistency in pandemic readiness • Government, Private Sector, Civil Society and Media working together

15. Media Interests Challenge of Sustainability SARS HUMAN CASES OF AVIAN INFLUENZA Alert & Commitment or Vigilance 2004 2005 2006 2007

16. Decision making structures, communication systems, financial sector planning, together with the protection of essential utilities and increased community resilience, are valuable elements of community and national preparedness for all adverse conditions.

17. Preparing for the consequences of an influenza pandemic represents a real opportunity to strengthen the solidarity between and within nations:, it is too good an opportunity to miss.

18. Q&A, Discussion