UNICEF
Programme on
Pandemic Prevention &
Preparedness
Science Quiz
• What’s the difference between bird flu and avian
influenza?
• What is a pandemic? How is it related to bird flu?
• What % of countries reported to UNISIC they have
developed pandemic preparedness plans?
• Why are we more vulnerable each year to new infectious
disease threats?
• Why is George Bush worried about the pandemic?
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Threat of Human Influenza Pandemic
Inter-pandemic Period
Pandemic Alert Period
Pandemic Period
H5N1:
• Circulating in wild birds
and poultry since 1996
• Highly contagious &
deadly among birds
• Spread from Asia to
Europe, Middle East and
Africa
• Has infected humans in
rare instances - resulting
from close exposure to
sick birds and/or their
droppings
• If H5N1 evolves into a human
virus it could cause a human
influenza pandemic
• Also possibility that H5N1
never evolves into a human
virus
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Confusion between Avian
Influenza and pandemic
preparedness is common
 Pandemic prevention requires:
1. Control of HPAI in birds
2. Prevent human H5N1 infections.
 Pandemic preparedness is
 largely unrelated to AI response
 needed in every country, unlike AI response
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THREE PANDEMIC SCENARIOS
Scenario 3 - Rapid
Onset / Widespread
impact
Little time for preparation,
rapid action vital, movement
restrictions, emphasis on
mitigation: Major pandemic
Scenario 2 - Slow
Onset / Localized
Impact
Slowly acquires infectivity
Containment may be successful
Limited pandemic
Scenario 1 - Extended Phase 3 /
Avian Influenza outbreaks continue
Sporadic human cases
Impact on livelihoods due to culling of birds
No Pandemic
Time
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US mortality data, 1900-90
PAST PANDEMICS
1968: Bad regular influenza season
1957: Worse than very bad influenza
1918: Worst health event since "black
death" of 14th century
1957
1968
1918
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Pneumonia & Influenza Deaths, USA
2,000
1892
DEATHS PER 100,000 POPULATION
1,500
1918
1,000
1936 - non-pandemic yr.
500
1957
0
5
10
20
30
40
50
AGE
(Source: Glezen WP. Epidemiologic Reviews 1996; 18(1): 64-76)
60
70
80
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Global Vulnerability
• Unprecedented population density
– Threats from old and new microbes
• Human pressure on habitats
– new evolutionary pressures on ecosystems
• Global increase in wealth
– Demand for meat increasing
• Over past 30 years average of 2 new microbes/year
– ~70% of them come from animals (zoonoses)
• Globalisation and interconnectedness
– About 2 billion airplane trips per year, and rising
• “Just-in-time” stock mgt. & efficiency
– Little spare capacity …..
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> 1100 events followed by WHO between January 2001 and May 2006
..
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ECONOMIC IMPACT OF
PANDEMIC
• Global economic cost estimated at $2 trillion
– SARS - <1000 dead, $50 billion economic loss.
• Deaths, absenteeism and attempts to avoid infection
have consequences for supply and demand side of
economy
– Markets close, utilities unreliable, telecoms break
– Travel and leisure travel reduces, demand for food changes
• There may be threats to Rule of Law and Security
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Past Influenza Pandemics
1850
?H1 1847
42 yrs
?H2 1889
1900 H1N1
1918
29 yrs
39 yrs
1950 H2N21957
H3N21968
2000
11 yrs
No Pandemic for 40 years
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Prediction & Action
“Timing and severity
of the next pandemic
remain unknowable,
but the opportunity to
prepare is invaluable;
especially when
these preparations
can benefit existing
priorities.”
UNICEF PPP Strategic
Plan 2008-2009
What needs to be done?
• Prevent a pandemic
– Avian influenza control
• Contain an emergent virus
• Mitigate pandemic impact
– Main risk is panic/anxiety
reactions
– Economic impact
-especially on poor & children
– Health services will be strained
– Other services may collapse
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What is new since 2005?
• Pandemic risk from H5N1 remains unchanged
– Will H5N1 cause pandemic? How many mutations?
– Risk from other influenza and other viruses
• Many countries able to control HPAI outbreaks
– But virus returns and remains widespread
• Oseltamivir (Tamiflu) resistance (and side effects)
– Logistics problematic
• H5 vaccines licensed; WHO stockpile planned
– use remain uncertain
• Pandemic control
– Role of airborne transmission unresolved (masks?)
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Pandemic Prevention and Preparedness
Strategic Plan: UNICEF Vision
Communities: active participation
 generate and implement solutions
 global and local disease threats to children, including A/PI.
Govt, NGOs, etc: mobilise & coordinate
 responses to a range of threats, including A/PI.
UNICEF (coordinated UN response): support
 prevent/control highly pathogenic avian influenza (HPAI)
 prepare to respond to a novel human influenza virus,
including the rapid containment responses.
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UNICEF Programme Goals
 Goal 1. Pandemic preparedness
 to mitigate impacts on children and their families
 Goal 2. Communication (C4D)
 to support programme goals
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Goal 1: Pandemic Preparedness
Objective 1.1. Programmatic guidance for pandemic preparedness
developed and implemented
Objective 1.2. UNICEF programmes’ pandemic preparedness
integrated into existing emergency preparedness
Objective 1.3. UNICEF programmes’ preparedness tested and
enhanced through simulation exercises
Objective 1.4. Capacity of national EPI to rapidly distribute vaccine in
pandemic in additional priority countries strengthened
Objective 1.5. Pandemic-specific communication response to
support non-pharmaceutical interventions is defined in
terms of content, timing, and roles by 2008
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Interagency agreement –
Pandemic Influenza (PI)
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WHO Pandemic Preparedness
Guidelines
• Working Groups established Dec 2007 (w UNICEF)
–
–
–
–
–
Strategic Policy Document
Communications and Social Mobilization
Public Health Interventions
Medical Interventions
Non-health sector preparedness
• Global Consultation
– 4-9 May, Geneva
• Updated guidance expected Sep’ 08
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Goal 2: Communication
Objective 2.1. Map communication capacity and partners
Objective 2.2. Capacity to use “routine” system for “emergency”
communication response strengthened
Objective 2.3. Role of communication support for AI control in
enzootic and high risk countries
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Interagency agreement – AI
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A/PI Communication:
Key Achievements
Advocacy with governments leading to enhanced inter-sectoral
partnerships;
Evidence-based planning for behaviour change communication/
social mobilisation strategies;
Key behavioural actions for prevention of AI defined (Report,
Separate, Wash, Cook) and disseminated widely;
Range of communication materials (print, audio, and TV) and
tools developed
- Shared through internet [http://www.unicef.org/influenzaresources];
National and international media sensitised on AI.
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A/PI Communication:
Key gaps
Community-level communication plans and actions
need to be strengthened
 Dialogue rather than information dissemination
Analysis of feasibility of behaviours
 How to address sociocultural and economic barriers
Sustained actions to reach vulnerable groups and
generate local solutions
Inter-agency coordination remains challenging
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Speaking points – Summary
• UNICEF has been actively involved in A/PI activities since 2006
• Development of guidance to UNICEF offices and global guidance
with technical partners
• Disease evolution & global interest
• Key investment areas (UNICEF);
– Communication
– Vaccines/logistics
– Contribution to global guidance
– Material development
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