H1N1
SUMMARY OF H1N1 UNICEF INFLUENZA PANDEMIC ACTIVITIES
TACRO Region
Dr. Enrique Paz Health and Nutrtion Advisor UNICEF TACRO region
I. 2009 influenza pandemic background:
1. Generalities of the influenza pandemic:
In mid-March, 2009, the Mexican government reported an increase in the cases of
respiratory illnesses, characterised by cases of influenza accompanied by severe pneumonia.
Reporting of these cases began when cases of seasonal influenza were clearly decreasing.
The number of cases continued to grow in the first weeks of April, when a new strain of
influenza A was identified.
Due to the emergence of the new strain of influenza and its propagation around the world,
on 11 June, 2009, WHO declared a phase 6 pandemic. By 6 August, 2009, a total of 174,913
cases of influenza had been reported, including 1,411 deaths, in 166 countries and
territories. One of the most affected groups was healthy young adults. The majority of cases
presented light symptoms that included coughing, fever, sore throat, general discomfort
and headache; gastrointestinal symptoms were also observed. The severe illness was
characterised by pneumonia and respiratory insufficiency, while bacterial co-infection was
infrequent. The risk factors for the severe illness were pregnancy, heart disease, diabetes,
asthma, pulmonary emphysema, immunodeficiency and obesity.
In August of 2009, WHO urged northern hemisphere countries to prepare for a second wave
of the H1N1 influenza A pandemic. Countries with a tropical climate were to prepare for an
increase in the number of cases. Countries of the temperate areas south of the hemisphere
were to keep their surveillance systems active. The reality of the H1N1 A virus situation
required accelerating the efforts to mitigate its effects on children and women.
Concerned, diverse United Nations agencies issued a call to action to work together, with
NGO and civil society partners, to support governments and communities in reducing the
impact of the pandemic.
2. Epidemiology of the H1N1 influenza pandemic in Mexico, 2009:
-
The greatest number of cases occurred among children 1-19 years of age, with low
mortality.
The greatest mortality occurred in the 25-65 year-old age group, predominantly in
the 45-49 age group.
Increase in maternal mortality, women with influenza and pneumonia.
Impact on the health system due to the increase in number of doctor’s visits.
3. Regional plan for pandemic vaccination:
This plan was developed and distributed by the member states in May of 2009. The main
objectives were:
-
To strengthen seasonal influenza vaccination in the region.
To assist member states in their preparation for introduction of the vaccine against
pandemic H1N1 influenza A.
Considering that the available vaccine for pandemic influenza was limited, risk groups were
prioritised for vaccination. In July of 2009, the Strategic Advisory Group of Experts in
Immunisation (SAGE) recommended that countries should consider three objectives:
-
To protect essential health infrastructure (vaccinating health workers).
To reduce morbidity and mortality (vaccinating individuals with chronic pathologies).
To reduce transmission of the virus (vaccinating schoolchildren).
The population groups whose vaccination was recommended were:
-
Health workers
Pregnant women
Population over six months of age carrying chronic diseases
Healthy young adults 19-49 years of age
Preschool and school students 5 -8 years of age
Children between six months and four years of age
Healthy adults over fifty years of age
As in the case of any vaccine, surveillance of events supposedly attributed to vaccination or
immunisation is essential.
- Additional vaccination recommendations:
-
-
-
In order to reduce lost doses and ensure equitable access to influenza vaccine, the
adjuvant vaccine should be used wherever possible.
The industrialised countries of the Americas region with abundant vaccine are
encouraged to contribute to supplying vaccine to those with less access.
Recognising that Brazil and Mexico embarked on vaccine production, the TAG
encourages PAHO to carry out regional strategic planning that ultimately leads to
vaccine self-sufficiency.
In order to ensure equitable access to the vaccine against pandemic influenza,
countries should use the PAHO rotating fund to purchase vaccine.
Due to the high morbidity and mortality caused by seasonal influenza, vaccination
should not be suspended.
During introduction of the vaccine, countries should constantly monitor:
 Events attributed to vaccination that are considered serious
 New events
 Rumours
 Events that take place in the groups of individuals
 Programme errors
Countries should prepare social communication strategies aimed at:
 Maintaining public trust by informing in a clear and transparent way.



Ensuring that individuals and their families use mitigation interventions for
prevention.
Ensuring that all of the population understand the recommendations and the
reason for vaccinating priority groups.
Understanding the general benefits and the risk of events associated with
vaccination that may occur.
4. The role of UNICEF in the 2009 H1N1 influenza pandemic:
During 2009, UNICEF instructed its regional and country offices to carry out some actions to
mitigate the influenza pandemic:
-
Mobilisation of local-level resources that include needs related to the H1N1 A
pandemic, allocating unused funds to immediate implementation of H1N1 activities.
Country offices should foster/accelerate specific pandemic programmes, such as C4D
for H1N1, WASH and health.
They should identify upcoming local-level meetings at which to introduce and discuss
H1N1, opportunities such as 15 October, world hand-washing day.
Updating of knowledge regarding the pandemic.
Fostering of inclusion of the H1N1 agenda in regular programmes.
Fostering of review of programmes in key sectors that can be speeded up according
to the potential impact of H1N1.
Supporting and monitoring preparation of response to the pandemic at country
level.
The role of UNICEF TACRO:
The role of TACRO in this process was in two areas:
In-house:
-
-
Creation of the TACRO pandemic working group to ensure sustainability, define roles
and programmes in the response to the pandemic, and provide technical support
and guides to the offices.
Facilitation of access to and management of knowledge regarding all pertinent
technical information, guides, documents and EIC material prepared.
Email from Regional Advisor. Enrique Paz to CO: Guideliens of funding used to
Country Offices: ( see email on Decembe 15, 2009 annex 1)
External:
-
Interagency collaboration: participation in follow-up of meetings of the interagency
communication working group and close cooperation with UNSIC, PAHO and WHO in
the response to the pandemic.
- The role of UNICEF in health
-
-
Providing support to remote areas of risk (diagnostic methods available only in
cities).
Advocacy for acquisition of paediatric TAMIFLU and medicines.
Carrying out personnel negotiations and effective coordination among levels and
sectors to organise the response of health services under decentralisation of the
service provision scheme.
Support to families with regard to health and mental health.
5. Funding:
UNICEF allocated funds to the influenza pandemic aimed at the specific activities defined
above.
In order to allocate funds to the regional offices, it was necessary to prioritise countries for
action.
UNSIC and WHO identified prioritisation criteria for United Nations support:
-
The 49 least developed countries (LDC) defined by the World Bank
The 72 eligible GAVI countries
UNICEF gave priority to the countries in which under-five mortality is high and in
which the impact of the pandemic would be great.
Adding both sets of countries and excluding those repeated in the two criteria, the
total was 77 countries.
To this end it was indicated that the regional offices should identify particularly vulnerable
countries and inform New York of them.
At world level, UNICEF will mobilise resources with the leaders of PARMO. The necessary
funds will be provided by the United Nations System Influenza Coordination (UNSIC).
II. Preparation for the 2010 influenza pandemic:
In LAC, the 35 countries of the Americas reported confirmed cases of H1N1 influenza A and
a significant number of deaths.
Due to this, UNICEF allocated funds to TACRO to be used in specific activities according to
three generalised scenarios of virus transmission. In addition, other enities, such as the US
Department of Health and Human Services (through its Office of Emergency Preparedness),
the Pan-American Health Organization and the Centers for Disease Control (CDC) executed
training, sample analysis and preparedness programmes in the various countries of the
region.
Funding of 2009-2010 pandemic influenza needs:
1. Communication for Development interventions:
Funding: 700,000.00 USD
Priority countries: Panama, Bolivia, Barbados, Costa Rica, Chile, the Dominican Republic,
Paraguay, Ecuador, Guatemala, Honduras, Nicaragua, El Salvador, Haiti, Belize, Jamaica and
Peru.
Orientation: UNICEF should focus on the execution and expansion of communication
programmes aimed at facilitating the adoption and reinforcement of preventive behaviours
and correct and veracious information for preparing for the second wave of H1N1 influenza
A:
-
-
Preparation for integrating behaviour change and social process change (C4D) in
UNICEF programmes (WASH, education, health, nutrition and child protection).
Increasing presentation to key individuals and target groups in order to apply
prevention information and facilitate the adoption and reinforcement of key
preventive behaviours.
Provision of technical assistance to support COs in integrating preparation for H1N1
influenza and the pandemic in local communication campaigns, promoting a culture
of hygiene and the prevention of risk. The proposal should be aimed towards good
practices and lessons learned in the response to H1N1 (first wave) and previous
events in which communication strategies that promoted behavioural change were
applied, such as SARS and avian influenza.
2. Health:
Funding: 400,000.00 USD
Priority countries: Argentina, Guyana, Bolivia, Colombia, Guatemala, Honduras, Surinam,
Ecuador, Nicaragua, Haiti and Peru.
Orientation: The interventions should be aimed at reflecting the results of the technical
meeting of the PAHO/WHO/UNICEF advisory group. Interagency coordination is aimed at
supporting countries in identification of the epidemiological situation focussed on:
-
-
Support with diagnostic methods in areas of risk.
Advocacy for the existence of basic products at points of delivery (including
paediatric TAMIFLU) and advocacy to promote equitable access in the distribution of
vaccine.
Support to primary and community care for children and at-risk pregnant women.
Strengthening of negotiations with health personnel and coordination among the
various levels of the system (central, state, federal, municipal, government) and
among sectors in order to organise the response of health services under
decentralisation of health care delivery aimed at excluded populations and at-risk
populations.
3. Education:
Funding: 240,000.00 USD
Priority countries: Mexico, Venezuela, Nicaragua and Haiti.
Orientation: These activities should be coordinated with C4D.
-
Planning for and response to the second wave of the pandemic in schools (parents,
children, teachers and community) in order to promote and strengthen hygiene
-
behaviour messages and early detection of suspicious cases, linked with UNICEF
work in WASH, nutrition and health.
Preparation of a strategy for ensuring the continuation of learning, in the case of
closed schools.
The total funding sent was 1,340,000.00 USD, and this budget was spent by the countries
according to the abovementioned guidelines as follows:
Table 1: UNICEF TACRO H1N1 expansion funds, 2009-2010
Object of
Assistance
PBA Reference
Expiry Date
FLS Allotment
Requisition
Expenditure
Unreq. Balance
Req %
Exp %
Extra funds
requested for
2010
Situation
ARGENTINA
GS/2009/0034
23/11/2010
35,000
0
0
35,000
61%
42% No information
BELIZE
GS/2009/0043
23/11/2010
45,000
0
0
45,000
100%
100% No information
BOLIVIA
GS/2009/0040
23/11/2010
80,000
59,039
45,015
20,961
100%
75%
Vaccine
rejection in the
population
CARIBBEAN
REGIONAL
Barbados and
the Eastern
Caribbean (for
10 islands
ranging from
Grenada to
Turks and
Caicos)
GS/2009/0029
23/11/2010
45,000
0
0
45,000
98%
58%
C4D and
hygiene
CARIBBEAN
REGIONAL
(Suriname)
GS/2009/0030
23/11/2010
45,000
0
0
45,000
100%
46%
C4D and cold
chain
CHILE
GS/2009/0050
23/11/2010
45,000
45,000
44,997
-
100%
100%
All spent/
earthquake
COLOMBIA
GS/2009/0051
23/11/2010
35,000
0
0
35,000
0%
0%
COSTA RICA
GS/2009/0055
23/11/2010
45,000
45,000
45,000
-
100%
100%
Requested
additional
funding (ICON)
2010
ICON didn’t
work
Negotiation
w/MOH Plan
Developed C4D
need children
materials
All spent
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Object of
Assistance
PBA Reference
Expiry Date
FLS Allotment
Requisition
Expenditure
Unreq. Balance
Req %
Exp %
Extra funds
requested for
2010
Situation
DOMINICAN
REPUBLIC
GS/2009/0058
23/11/2010
45,000
0
0
45,000
91%
90% Funding will be
disbursed by
the end of July
ECUADOR
GS/2009/0059
23/11/2010
80,000
0
7,000
80,000
48%
18%
EL SALVADOR
GS/2009/0060
23/11/2010
45,000
0
0
45,000
33%
25% No information
GUATEMALA
GS/2009/0065
23/11/2010
80,000
0
0
80,000
100%
GUYANA
GS/2009/0042
23/11/2010
35,000
0
0
35,000
99%
99% October Health,
child
protection,
emergencies
HAITI
GS/2009/0068
23/11/2010
130,000
0
0
130,000
15%
13% No information
HONDURAS
GS/2009/0069
23/11/2010
130,000
97,810
90,338
32,190
99%
99%
JAMAICA
GS/2009/0073
23/11/2010
45,000
0
0
45,000
0%
MEXICO
GS/2009/0084
23/11/2010
60,000
0
0
60,000
100%
99%
Negotiation.
School
prevention
NICARAGUA
GS/2009/0087
23/11/2010
85,000
28,060
25,000
56,940
48%
48%
Purchase of
supplies/
reagents
PANAMA
GS/2009/0142
10/12/2010
45,000
0
0
45,000
0%
99%
June-Sept.
80,000 raised
500,000 USD
from other
donors
Negotiations
w/MOH this
month
C4D, vaccines,
training
0% No information
0% July-September
will complete
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Object of
Assistance
PBA Reference
Expiry Date
FLS Allotment
Requisition
Expenditure
Unreq. Balance
Req %
Exp %
Extra funds
requested for
2010
Situation
PARAGUAY
GS/2009/0091
23/11/2010
45,000
1,106
1,106
43,894
45%
PERU
GS/2009/0092
23/11/2010
80,000
59,039
29,991
20,961
100%
89%
C4D in Indian
populations
(Fabiola Quiroz)
VENEZUELA
GS/2009/0113
23/11/2010
60,000
0
0
60,000
100%
90%
Negotiation.
Hand washing
and disease
prevention
1,340,000
335,054
288,447
1,004,946
25%
22%
Subtotal for
TACRO
44% Cold chain and
C4D materials
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Appendix 1.
Letter to Health and Communication officers from Enrique Paz, FA1 Advisor Health, Nutrition and
WASH on December 15, 2009
Dear network colleagues
Following RD's email to our Representatives, I am sending to you as information tools the following
attachments that should help you address the H1N1 response.








Nick Allipui email for Funds allocation.
Health section power point including C4D, Emergency response and partnerships in H1N1 etc
Program guidance issued from HQ NY, please share with other sections, in nutrition,
education , C4D, WASH etc
H1N1 Desk Review
C4D H1N1 Guidelines
Pan flu Communication guidelines
C4D position paper
PAHO Technical Advisory Group recommendations (August 26 2009) on the use of influenza
A(H1N1) vaccines for our region, which we, UNICEF, fully endorse
Our region might have a pandemic of different characteristics and special attention should be given to
health prevention messages; interventions in hygiene practices in schools, hospitals, and open
population; WASH infrastructure; adequate and timely treatment in vulnerable populations, such as
pregnant women, patients with underlying chronic conditions, children under 5, elderly citizens and
young adults at risk. Most fatal cases arrive to emergency rooms in critical conditions therefore the
need to support health systems and hospitals that have been overburden and use this funds to
leverage addition resources to enhance the health systems.
For the immunization efforts, one of the most delicate aspects from a communication perspective is
that any messages to the general public should contribute to their understanding of the need to
prioritize vaccination to high risk groups. Further, the issue of vaccine procurement, etc. must be
looked at on a country by country basis. Please support PAHO in that capacity.
I look forward to a successful year and to use this funds to position UNICEF response in Health with
the MOH and partners and be ready to prevent any outbreak possible of a second wave of the
pandemic and don’t hesitate to contact TACRO for support in the areas of technical assistance,
strategic representation and quality assurance of H1N1.
Please program your funds around these issues, for any help don't hesitate to contact me, Paulo,
Jesus in the Health, Nutrition and WASH section, and Tamar and Ivan in the communication section
or Gianluca and Claudio in the Emergency Preparedness and Response.
I hope this helps and if you need to discuss any further or want more information please just let me
know. Abrazos and merry Christmas and happy new year
Enrique
Documento prepared by Miriam Fuentes Navarrete and Arlene Calvo
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Documento prepared by Miriam Fuentes Navarrete and Arlene Calvo
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