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UNDP Strategy for Avian Flu

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					                                 UNDP Guidance Note:
                          Avian and Human Pandemic Influenza


                                                                          21 December 2005
                                                                           UNDP Task Force
                                                               on Avian and Human Influenza


A) Background

Avian Influenza
There are many strains of Avian Influenza (AI) viruses, of which H5NI is a particular
strain. Likely scenarios of the introduction of AI from one country into another include the
scenario of transmission from migratory birds. Risks of AI introduction to countries
through migratory bird routes deserve further analysis to determine the potential
magnitude of the risk and to develop predictive approaches. Another probable scenario
of the introduction and transmission of AI relates to the many different ways of
interaction between humans, wild and pet birds and their products, including domestic
and international trade of wild and caged birds, increasing the possibility of disease
interactions that could allow the virus to pass between species and across borders.
When the natural resilience of ecosystems is stressed and barriers to disease
transmission are reduced; new pathogens such as the AI virus emerge often leading to
rapid spread and establishment of the pathogen in animal and human populations
causing high morbidity and mortality. 1 Clearly, the health implications of emerging
diseases such as AI require new strategies for prevention, surveillance, and monitoring,
as well as health management and conservation.2

Social, economic and environmental conditions make many developing countries prone
to develop AI outbreaks. In addition, the potential economic impacts of AI could
devastate national and local economies dependent on a range of industries and sectors
ranging from agriculture and livestock to tourism, with especially hard losses felt by
small, micro businesses and farmers, with women and children being the most
vulnerable. More significantly, transmission of AI to humans will be devastating to
developing countries especially in Asia and Africa as methods of surveillance, control
and prevention are lacking. Global socio-economic impacts of the potential AI human
pandemic will depend on the level of preparedness, the degree of virulence of the virus,
the transmission speed, supply side impacts and responses and demand-side
responses.3 Responsive capacities in developing countries will depend in a large part on

1
  This reference is drawn from an internal paper prepared by the BDP Energy and Environment
Group (October 2005) , with expert advice from Dr. Alonso Aguirre, Vice President for
Conservation Medicine, Wildlife Trust, entitled, “Policy Note on the Avian Flu”.
2
  A proactive approach to future outbreaks is needed, one that focuses on the fact that biological
diversity is important for the health of individuals, populations and ecosystems. Protecting
biodiversity and habitats will therefore help by diluting the effects of H5N1 virus and other
emerging infectious diseases. Furthermore, biodiversity provides a reservoir for finding a cure to
new diseases. Important plant based drugs include morphine, artemisinin and taxol. Artemisinin is
used for treatment of fevers and its more soluble derivatives are considered among the most
effective anti-malarial agents on the markets.
3
  This reference is drawn from an internal UNDP paper prepared by Dr. Robert Glofcheski
(September 2005) entitled, “The Economic Consequences of Pandemic Influenza”.


                                              Page 1                                     09/02/2010
the state of national preparedness, and in particular on public health care systems and
services in developing countries as well as the technical and human capacities of
individual governments and civil society groups including the private sector. The gravest
concern is that the AI human pandemic will disproportionately affect and wreak havoc in
the lives of poor men, women and children who currently lack access to basic needs and
adequate health care.

The UN System Response
Over the last several months, international responses to the avian and human pandemic
influenza have been rapidly expanding and intensifying. FAO and OIE are engaged in
strengthening the animal health sector while WHO focuses on public health challenges
to combat human influenza. The World Bank has launched a multi-donor trust fund,
making $300-500 million available from its own resources. Various bilateral donors are
accelerating their efforts to support developing countries through technical and financial
assistance.

In light of the increasing international responses as well as growing possibility of the
outbreak of avian and human pandemic, the strategy note, “A coordinated UN system
response to Avian and Human Influenza” was published in October 2005 (Annex I). The
note discusses the importance of UNDP’s role in support of national pandemic
preparedness processes.4

There is now an urgent need to clearly define the role and strategy of UNDP, which
would help guide the Country Offices and concerned Bureaus/Units to make an effective
and relevant response to the needs of programme countries. Based on experience to
date in several Asian countries, together with gaps identified at the Geneva conference
held on 7-9 November 2005, this note intends to offer a strategic framework for UNDP’s
programme response, focusing on the “preparedness” phase (i.e. assisting countries in
their preparations for avian and human pandemic influenza.)

In addition to the preparedness phase, there is need for UNDP to define its role in the
“response” (pandemic) phase. Some of the key questions to be answered in this regard
include, when a pandemic breaks out, what are the programmes/activities that UNDP
needs to maintain within its ongoing Country Programme and what are the possible new
responses that UNDP should make to support national governments. (Four working
scenarios developed by WFP would be useful to identify the different levels of UNDP’s
possible response to each situation. 5.) On this issue, UNDP is working closely with the
UN System Influenza Coordination (UNSIC) office to understand how UNDP can offer
effective support within the overall framework of UN system support.

Against this background, the guidance note should be viewed as a live document which
will be continually updated as we learn more about how UN Country Teams are
responding to the issue and working with governments in different countries.




4
  The UN System Coordinator (UNSIC) is currently finalizing an updated strategy paper. UNDP’s
expected role in supporting the development of national strategies will be further clarified in the
new strategy.
5
  Scenarios as developed by WFP, Avian and Human Influenza Scenarios, November 2005.


                                               Page 2                                      09/02/2010
B) Proposed Role of UNDP in Supporting Countries in Their Preparations for
   Avian and Human Pandemic Influenza

Recent national experiences in Southeast Asia have shown that one of the most critical
areas which requires urgent international support is the formulation and implementation
of a National Preparedness Plan for avian and human pandemic influenza. The national
plan generally consists of the following three interrelated, but different components6:

    -   Plan for avian influenza control to stop or reduce the spread of the disease
    -   Plan for influenza pandemic preparedness to prevent the outbreak of a
        pandemic, reduce the morbidity and mortality from influenza and be prepared to
        respond effectively to the pandemic.
    -   Plan for response actions during the pandemic period.

This guidance note highlights UNDP’s role in support of national preparedness
processes in relation to the first two components above. It is also useful at the outset to
note that there are two broad areas which require urgent attention.

First, there is an urgent need for improving public awareness and access to
information available to the public at the global, regional and national levels. Currently,
much of the public information related to AI and its potential for a human pandemic is
media generated and has generally stimulated short- lived and/or panic responses.
Better information would help assure the public that the most appropriate measures are
being taken with the knowledge available, which in turn would engender public support
for ongoing and future efforts undertaken to control the pandemic. UNDP proposals in
this area would need to fit within the overall framework of UN system support where
other UN agencies such as UNICEF have also clear expertise in this field.

The second broad area that requires attention related to the potential human pandemic
is the issue of improving access to effective, low cost, generic drugs especially for
those who may need them the most and can afford them the least. Clearly this is an area
which has long-proved hard to resolve at the global level, and the public health related
aspects of TRIPS have emerged to make it one of the most contentious of all WTO
agreements. Given the existing, overall tensions related to the upcoming WTO
Ministerial Meeting, it is not clear what the response will be regarding the implications of
TRIPS for access to drugs that respond to the human AI pandemic. Nevertheless, it is
important to note that TRIPS requires that all member countries provide patent
protection to both products and processes in all technologies including pharmaceuticals,
making pharmaceuticals expensive, and thereby restricting their access to the poor. The
provisions, also adversely affect generic medicines produced in developing countries
constraining production and/or export. These issues have been particularly stark in the
case of access to anti-retroviral treatment for HIV/AIDS. Since 2004. UNDP has been

6
 Thai Government "National Strategic Plan for Avian Influenza Control and Influenza Pandemic
Preparedness 2005-2007". http://epid.moph.go.th/invest/ai/bird%20flu.pdf
WHO website on National Influenza Pandemic Plan.
http://www.who.int/csr/disease/influenza/nationalpandemic/en/index.html



                                            Page 3                                   09/02/2010
working on the issue of Intellectual Property and Access to Low Cost Drugs Capacity
Building in the areas of HIV/AIDS and the lessons learnt from this initiative are useful to
consider in the context of a potential human AI pandemic. UNDP will be contacting WHO
to explore how our expertise on this issue can be best coordinated with their efforts.

Within the UN system, FAO and WHO have been playing a key role in national planning
process in the area of animal health and human health respectively. At the same time,
there is increasing recognition that the avian and human pandemic response is a multi-
dimensional issue that requires cross-sectoral, highest-level interventions. In other
words, the issue needs to go beyond animal and human health dimensions and include
broader issues, such as emergency response capacity, preparedness at all levels, public
relations, etc.

The multiple nature of the issue makes coordination critical. The issue must be
addressed in a cross-sectoral manner, and at the highest level of the government. This,
in turn, makes UNDP’s role important in supporting the governments’ capacity to plan
across sectors and to engage a wide variety of stakeholders.

As part of UNCT, therefore, UNDP Country Office can play a complementary role to
support programme countries in formulating and implementing a national plan for
avian and human pandemic influenza through coordination, partnership, disaster
risk management approaches, and capacity building.

More specifically, UNDP’s role would be useful in the following areas:

   Coordination
    - Assisting with bringing the issue to the highest level of national government, by
      bringing together different ministries and all relevant stakeholders.
    - Formulation and implementation of a UN joint programme to support an effective
      national response.

   Partnership
    - Coordination with IFI’s and bilateral donors under the joint programme
    - Collaboration with CSOs, the private sector and media in order to share accurate
       information and promote awareness regarding public health issues related to the
       human pandemic.

   Disaster Risk Management
    - Incorporation of a sustainable, effective and coordinated disaster risk
       management perspective into a national preparedness plan

   Capacity building
    - Support to national planning process
    - Provision of capacity building support to implement a national preparedness plan
    - Support for economic and social cost analysis, and alternative livelihood
       opportunities

Some of the above roles have been already played by the Country Offices in some of
the Southeast Asian countries. Depending on the needs and capacity of a country, and
in coordination with the rest of UNCT, UNDP Country Office needs to clearly identify the
area where it can be most effectively engaged to support national preparedness effort. It


                                          Page 4                                  09/02/2010
is also necessary to assess the programme resource requirements and identify sources
of funding to meet these needs, including repriotization of the existing
programme/corporate resources.


C) Strategy for UNDP programme response

Building upon experience in some of the Southeast Asian countries, this section outlines
a proposed strategy for UNDP to help programme countries design and implement a
national plan for avian and human pandemic influenza.

a. Summary of UNDP experience in Southeast Asia

Together with the rest of UNCTs, UNDP Country Offices in Vietnam, Cambodia and
Laos, have been assisting their national counterparts to prepare a national pandemic
preparedness plan. UNDP also participated in the inter-agency mission in these three
countries, Vietnam (6-9 September), Cambodia (25-28 October) and Laos (1-4
November).

In general, the objective of the inter-agency mission is to assist (1) the Government and
UNCT to prepare a national pandemic preparedness plan and (2) the UNCT to finalize
the contingency plan of the UN system, with a view towards aligning the UN system
contingency plan with the national pandemic preparedness plan.

The following table provides the status of the national preparedness plan in each country
and the areas where the UN system provided support. It is important to note that
Thailand has prepared its own preparedness plan without the inter-agency support.




                                         Page 5                                 09/02/2010
Examples of experience in Southeast Asia

                                                             Areas Highlighted for UN
 Country                  Actions to Date
                                                                      Support
                Joint Programme presented at large          Joint programme is very
                 donor meeting by UN and Govt.                time consuming (need for
                UNRC advocated for joint programme,          extra resources)
Vietnam
                 got agencies to coordinate and              BCPR provided $70,000
                 mobilised resources                          from TRAC 3 to the CO to
                Donors directed to channel fund              finance a coordinator to
                 through a joint programme that UNDP          support implementation of
                 administers                                  the joint programme
                                                             Technical guidance
                                                             Support inter-country
                                                              cooperation
                                                             TA to help planning
                Interagency mission (including UNDP)
                                                              process
                 to lead a joint UN/ Govt workshop to
                                                             Document translation
                 develop comprehensive plan
Cambodia                                                     Simulation exercises for
                CO is working on developing a
                                                              pandemic
                 coordinated UN response
                                                             Govt does not have
                                                              capacity to compensate
                                                              farmers (implications for
                                                              poverty and incentive to
                                                              report)
                                                             UNCT proposed a
                Interagency UN team (including
                                                              dedicated UN avian flu
                 UNDP) facilitated National Technical
                                                              coordination unit to
                 Workshop for planning response
                                                              support the govt
                Team assisted with general
Laos PDR                                                     Additional roles as with
                 awareness raising, supported govt
                                                              Cambodia, together with
                 production of a plan and indicative
                                                              assistance in donor
                 budget
                                                              mobilisation, coordination
                                                              and financial frameworks
                                                             FAO and WHO provided
Thailand        National Strategic Plan in place             technical support to
                                                              national planning
UNDP
                Participation of BCPR Regional Disaster Reduction Advisor in inter-
Regional
                 agency missions. (A full-time inter-agency coordinator is under
Centre in
                 recruitment)
Bangkok




                                         Page 6                                 09/02/2010
b. Model Process of Inter-Agency Support for National Preparedness Plans and
   Role of UNDP

Drawing from UNDP’s experience in the inter-agency support process, the following
chart outlines the steps and process that UNDP Country Offices should go through to
support national planning efforts.


Proposed Timeline of Actions/ Assistance from UNDP

                                               5.   Planning for
                                                    wider sectoral
                                                    impacts              6.   UNDP
                                               •    Impacts outside of        Programme
                                                    health and                interventions
1.   Identify lead                                  livestock sector     •    To target capacity
     govt agencies    3.   Joint Programme     •    Response of               shortages in govt
     for planning     •    Between UN and           emergency            •    To support
•    RC and UNDP           Govt                     services                  livelihood systems
•    Plan for         •    Coordinated by RC   •    Economic
     Interagency      •    UNDP to                  considerations
     Mission               administer                                                      GOAL
                                                                                      In the event of a
                                                                                      flu pandemic the
                                                                                          Govt has a
                                                                                        National Plan
                                                                                        of Action and
                                                                                       the capacity to
      2.   Interagency mission                                                          implement it
           for awareness and
           comprehensive             4.   Ongoing Joint Programme Mgmt
           planning                  •    Administration of basket fund
      •    Coordinated by RC         •    Donor coordination and resource
      •    Workshop with                  mobilisation
           UN/Govt                   •    Updating of programme
      •    Facilitated by UNDP


1. Identify lead government agencies for planning
 In conjunction with UNCT, UNDP to make initial contacts with lead ministries
   (Agriculture/ Livestock, Health, Land, Planning, Finance, Local Development etc)
 UNDP to provide tools for advocacy (including improved public information resources
   to press the importance of the issue and improve access to prevention, control and
   mitigation of impacts)
 In conjunction with UNCT, UNDP to establish dates for interagency mission and
   planning workshop
 UNDP to provide support to the government for the setting up of a national steering
   committee with a view towards ensuring participation of all relevant stakeholders.

2. Interagency mission for awareness and comprehensive planning
 UN joint mission to comprise of members from key technical agencies (FAO, WHO,
   UNICEF) and UNDP as overall coordinator.
 Interagency mission to meet with key ministers to ensure support for the issue.



                                                Page 7                                      09/02/2010
   UNDP to facilitate joint UN/Govt workshop to put in place comprehensive plan
    (detailed emergency planning for health and livestock sectors) and then to include
    space in the future for wider sectoral planning, including socio-economic and
    environmental impacts.
   UNDP to advise on coordination, resources and budgeting processes

3. Joint programme
 Programme to include a coordinated UN (all agencies) and government response,
   including participation of all stakeholders (including civil society and private sector
   representation.)
 UNDP to provide practical support to the drafting of the programme
 UNDP, with support from government, to establish itself as the administrating agent
   for the programme (The joint programme in Vietnam provides an example of what
   this may look like)


                         National
                         Steering             Programme
                        Committee              Steering
                          for AI              Committee
    Donor
    Donor
    Donor                      Administrative Agent (UNDP)




                             FAO                     WHO


                         Ministry of               Ministry of
                         Agriculture                Health


4. Ongoing joint programme management
 UNDP as the administrating agent of the programme is to liaise with regional and
   global focal points to ensure effective information sharing etc
 UNDP is responsible for donor coordination around the programme and the
   channelling of funds to UN agencies and government ministries
 This function (or part of it, for example the donor coordination role) may require the
   recruitment of additional personnel

5. Planning for wider sectoral impacts
 Once the initial emergency support plan is in place (where focus of WHO ad FAO
   guidelines are), UNDP can initiate the drafting of a strategy for responding to the
   wider development (socio-economic and environmental) consequences of a
   pandemic




                                          Page 8                                 09/02/2010
   With assistance from the Natural Disasters BCPR team, UNDP should assist
    government with the planning process
         o How to maintain specific services in event of crisis (transport routes, public
            services etc)
         o Compensation for the economic impacts, measures to reduce potential
            economic impacts
   Close liaison with the World Bank and NGOs working at the local level to bolster
    livelihoods

3. UNDP programme interventions
 With national plans in place, UNDP should evaluate where the critical gaps are and
   which groups are most vulnerable to AI and its impacts.
 UNDP can establish specific programmes to support groups who for example have
   their lives at risk, their livelihoods in jeopardy, and/or who are in need of capacity
   development support to help them respond or adjust to impacts of AI.

There is no one solution or framework response that can be applied to all countries as
national response mechanisms are contingent upon national needs and capacities.
Consequently, UN COs should not feel constrained to replicate only the model employed
in Vietnam but should be flexible in terms of delivery of coordinated support. With
programme and capacity building support for example, UNDP’s assistance could take
the form shown below:

                             National
                             Steering                   Programme
                            Committee                    Steering
                           for Influenza                Committee
    Donor

    Donor

    Donor                            Administrative Agent (UNDP)




                          FAO                        WHO                   UNDP



                      Ministry of                  Ministry of           Ministry of
                      Agriculture                   Health               Planning




                                          Page 9                                09/02/2010
D) Support Strategy

One of the greatest challenges in this strategy is how quickly and effectively the Country
Offices can get equipped to provide necessary support to the national preparedness
planning process. The following are the possible areas that the HQs should consider to
strengthen the CO’s capacity to carry out the above strategy:

a. Rapid needs assessment of the current response and capacity
   - Review the status of national responses and identify priority countries where UN
      system support is required in terms of national planning efforts.
   - Assessment of additional coordination capacity needed at country, regional and
      HQ level

b. Coordination with key partners and Resource Mobilization
   - Ensure coherence of UN system response, including a clear definition of the role
     that each agency should play (through the UNSIC and the associated working
     groups)
   - Explore access to additional funds, especially in the context of the Beijing donor
     funding conference in January (i.e. the WB multi-donor trust fund)

c. Knowledge management
   - Establish a web site as corporate information platform on avian and human
      influenza pandemic
   - Work with key partners in information gathering and information sharing
      mechanisms/tools that focus on relevant international and national responses to
      the pandemic.
   - Share lessons learnt and research on SARS experience in terms of AI related
      national preparedness planning.
   - Knowledge sharing through CPRU net




                                         Page 10                                 09/02/2010
Annex I
                                    Strategy Note
     A coordinated UN system response to Avian and Human
                           Influenza
                                   October 5th 2005

H5N1 is a highly pathogenic avian influenza (HPAI) virus that poses two major problems
for the world. Firstly, since the disease first reappeared in Asia in late 2003 and early
2004, HPAI has had a disastrous impact in several Southeast Asian countries. Nearly
140 million domestic poultry have either died or been destroyed. Economic losses to the
Asian poultry sector are estimated at around $10 billion, but despite control measures
the disease continues to spread. HPAI is threatening livelihoods of hundreds of millions
of poor livestock farmers, jeopardizing smallholder entrepreneurship and commercial
poultry production and seriously impeding regional and international trade and market
opportunities. Secondly, and in addition to the immediate agricultural problems posed by
H5N1, this virus also poses a threat of the highest magnitude to human health. It has
the potential to become easily transmissible among people and to cause a global
outbreak - or pandemic of severe disease. Some past pandemics have led to extremely
high global death and illness rates. This document outlines steps that the UN system
should take in response to these related threats.


Assessment of the threat

1      In all respects bar one, conditions are now ripe for a pandemic of human
influenza. Based on past experience, this could kill between millions of people
within months and have economic consequences valued at more than a trillion
dollars, making it a strong candidate to cause the next pandemic in Asia. This
avian influenza virus has already infected more than 110 people (killing >50% or
those infected) but so far, has not yet developed the ability to transmit easily from
person to person.

2      Since 2002 a devastating epidemic of avian - or bird - influenza caused by
the highly pathogenic H5N1 virus, has predominantly affected poultry flocks in
East Asia - particularly in Vietnam, Thailand, Laos, Cambodia, Indonesia and
China. It is spreading into Russia and Kazakhstan, and into populations of
migratory wild-fowl. It has already had severe consequences on the economies
of affected countries and on poor farmers’ livelihoods.

3       Influenza pandemics develop when a new hybrid influenza virus is created
naturally by the mixing of animal and human influenza virus genes or when an
animal influenza virus is able to "jump species" and becomes adapted to and
highly infectious for people. The proven ability of H5N1 to persist in large regions
among many birds and animals - and its ability to infect a limited number of
people - already makes this virus a very strong candidate to evolve further and
cause pandemic. Although it is not certain that the H5N1 will escalate into a
pandemic, most experts believe that "it is only a matter of time…." before the



                                         Page 11                                 09/02/2010
next pandemic occurs, either from H5N1 or another influenza virus.




Overview of the response strategy: The need for a coordinated UN system
response.

4       Basic Strategy: The global strategy is simultaneously to (a) control H5N1
infections among bird populations and so prevent, or at least reduce the
possibility of, human infections while (b) work on preparedness plans and
activities if the situation deteriorates and a pandemic develops. Within these
main areas are several opportunities for reducing the impact of both the avian flu
outbreak in birds and the eventual human influenza pandemic:

4      Steps: The first step is to control the disease at source in animals, i.e. to
control H5N1 infections among poultry flocks in affected countries. This will
prevent the poultry sector from socio-economic disaster and will reduce
opportunities for human infection. Ministries of Agriculture and the Environment
are key players - they must focus relentlessly on early detection (surveillance and
diagnosis) of disease in poultry, wild birds and animals, and eradication of
outbreaks when detected. Targeted vaccination of birds can reduce the number
of outbreaks, the quantity of virus circulating and the rate of virus spread.

5.      The second step is to prevent human infections by avian influenza viruses
by reducing the opportunities for humans to be infected with H5N1. This could
immediately reduce the risk of serious illness from this virus among the residents
of affected countries and also the likelihood that a "pandemic virus" might. Key
actions are control of the disease in birds and prevention of infection in humans
through protective measures. Where there is no animal infected, there is little
risk of human infection (as is the case for Thailand with no human case for nine
months and a massive reduction in the outbreak among poultry). In areas
affected by avian flu, opportunities for contact between birds and humans must
be minimized, and animal markets controlled. This calls for widespread
community involvement and high levels of public awareness (though not panic).
Over time, animal husbandry practices will have to be examined and perhaps
changed.

6      If a pandemic virus does emerge despite efforts to control avian influenza,
the next step will be to try and contain the initial outbreaks if circumstances
permit and to prevent it becoming established in the wider population. Monitoring
influenza viruses and identifying early pandemic activity will be possible only if
there are excellent viral and epidemiological surveillance systems operating in all
countries. Surveillance is essential to identify cases of human to human
transmission promptly, and to initiate effective action. If the outbreak is identified
early enough, antiviral drugs may be used to try and reduce the spread. If spread
continues to occur, then development of a pandemic vaccine will be the main


                                        Page 12                               09/02/2010
option for providing specific protection for individuals. Care is needed to ensure
the right public reaction when first cases are identified. Prompt and appropriate
reactions will only occur if communities are involved in both prevention and
preparedness.

7        Once a pandemic virus appears, and even before a pandemic is declared
formally, actions must be taken to slow international spread and to protect lives
and livelihoods, and minimize social disruption. For effective actions to be
possible governments and community groups must be prepared well in advance -
it is too late to prepare once the pandemic is upon us. Preparedness means the
ability to handle a very large number of expected situations, for example,
ensuring that all emergency workers are trained to handle a contagious infection
or an outbreak, to deal with anxieties about access to treatment, to have plans in
place so that medical facilities know what to do if they have large increases in
patients, to manage cross-border tensions and to assess risks of infection
associated with different forms of transport, such as airplane travel, and trade.
Training for emergency personnel, through simulation of pandemic conditions to
test decision making and response capacities, is essential, as is a clear
communications strategy designed to manage panic and alarm. In addition, there
is a great need to have a clear communication policy between all actors involved
and the media to ensure dissemination of accurate information. These are just a
few of the many issues that countries and organizations must be prepared to
handle. This means involving non-governmental organizations from the start.
Only a few governments have started to involve civil society (particularly the Red
Cross movement) and private entities. Governments, NGOs and other
stakeholders also need policies for handling influenza cases among their staff,
and for workforce protection, and to allow the organization to maintain critical
functions and capacity.

8       The strategy to be adopted by national governments is three-fold -
prevention, preparedness and response. Activities undertaken should be those
which will have the greatest impact. This means bringing together different
government and non-governmental health (animal and human) stakeholders to
develop strategies and plans jointly that cut across government departments. It
means member states working closely with WHO and FAO and with the OIE so
that all plans reflect sound technical and scientific guidance. But these technical
agencies cannot - on their own - do all that is needed to support concerted
prevention and preparedness efforts within countries. That task must be
shouldered by the whole of the international community. The world's
governments need a responsive international system that can help ensure the
best possible efforts in country. And they need the political impetus and support
that enables them to take extraordinary action in the face of a substantial, but
intangible, threat.

9     Several Governments (including the US, France and Canada) and
regional bodies (such as ASEAN) have embarked on political initiatives designed



                                       Page 13                              09/02/2010
to help countries respond to the avian flu outbreak and the threat of a human
influenza pandemic. Private sector groups are also starting to demonstrate their
commitment to pandemic prevention and preparedness. Voluntary groups are
indicating their keenness to start action. And there are already signs of disputes
related to anti-viral medicines, vaccines that may prevent human infection,
protective clothing and hospital care - both within and between countries. The
bitterest dispute will be the international handling of scarce resources between
the haves and have nots.

10      A co-ordination mechanism is being established to make the international
system as responsive as possible. This will ensure common strategies and joint
action within the UN system, and between the UN and development banks,
donor agencies, private entities, non-governmental groups, humanitarian
agencies and professional bodies. At the country level, coordination of UN
efforts will revolve around the Resident Co-ordinator and UN country team,
reflecting primary guidance by WHO and FAO. In some countries it will require a
dedicated pandemic influenza task team staffed by competent persons from
different agencies and organizations. UNDP's support of national processes,
including risk assessment and management, and identification of the most
vulnerable, will be a valuable contribution to preparedness. When the world is at
imminent risk of pandemic influenza, the UN humanitarian co-ordinator and the
country inter-agency humanitarian team (IASC) within countries will be mobilized
and ready for response. .

11      At the global level, the UN system coordinator for avian and human
influenza will ensure consistency of UN approaches to control and prevention of
influenza in animals and pandemic prevention and preparedness in humans.
The co-ordinator will work through the agencies within the UN Development
Group. The UN Office for the Coordination of Humanitarian Affairs will support
readiness and response in the event of a pandemic. The common services that
are managed by OCHA - such as the joint humanitarian logistics service and
civil-military liaison - will be needed during the response phase. Through OCHA
the standing committee of humanitarian agencies (IASC), comprising the UN
system, Red Cross and Red Crescent bodies, the major international NGOs and
the IOM, will also be engaged. Certain population groups will be particularly
vulnerable - especially stateless persons, as well as women and children.
UNHCR, UNIFEM, UNFPA and UNICEF will wish to work with the population
groups that are at the centre of their concerns, and be ready for a more
substantive contribution to the overall response if needed.

What is being done for UN staff protection?

12    Because of pandemic concerns, the medical services of the UN
organizations have gone ahead to draft a contingency plan for UN staff in the
advent of a pandemic. These plans cover steps for the medical care and


                                      Page 14                             09/02/2010
protection of staff, steps to provide for the maintenance of essential
organizational functions, and the movement of UN personnel.


Critical issues that will call for high level UN action:

13       Pandemic Influenza is quickly becoming a major political issue: An
effective response requires both leadership and a consortium approach to obtain
agreement and coordination which involves national governments, civil society
and the private sector, as well as regional and international bodies. Political
initiatives being established by UN member states have great potential for
stimulating more effective country level action and mobilizing resources; at the
same time they can destabilise technical experts’ efforts to take forward effective
action. The political arms of the UN system - the Security Council and General
Assembly - need to be involved so that they can guide and then support the
different political initiatives underway, and create a stable environment within
which the UN Secretariat can take forward its support to in-country processes.
In this way, technical agencies (FAO and WHO) can drive the coordinated
programmes and agencies within the UN system so that they give effective
assistance at the country level. UN system Resident Co-ordinators have critically
important roles in stimulating and supporting a range of difficult government
processes. The political, institutional and technical engagement of the whole UN
system is needed to help stakeholders handle politically delicate and ethically
difficult issues, bring in a range of in-country resources to support prevention and
preparedness, and present different kinds of flu-related threat to the public via
news media.
14     Science and Technology, Research and Development: The UN system -
through the office of the Secretary General - can add weight to WHO's and
FAO's engagements with the pharmaceutical and vaccines industry - both to help
improve the availability of vaccines and drugs more rapidly and to ensure
equitable access among countries to vaccines and antivirals. In order that the
preparedness and response effort is based on evidence, engagement of the R
and D community (economic and social science, as well as biology and
medicine) is critical. On the animal health side, FAO and OIE have launched a
network (OFFLU) of research laboratories and epidemiology centres (reference
laboratories and collaborating centres); similar networks supported by WHO
contribute human influenza research. Both need the kind of stimulus and visible
support that the Secretary General is able to provide.
15       Resource Mobilization: Governments, agencies and organizations will
seek the support of the UN system as they seek the substantial funds they need
(totalling in the multi-millions) to prevention and preparedness. Key contenders
for new money are (a) compensation for those who have culled poultry flocks, (b)
vaccination and biosecurity programmes, (c) programmes to reduce risky
behaviours, and (d) the strengthening of animal and human health surveillance,
as well as longer term agricultural sector recovery work. Some donors will want


                                       Page 15                              09/02/2010
to move funds through multi-donor financing mechanism, others through bilateral
assistance, but an overall resource mobilization partnership allowing coordination
among governments, civil society, private sector, development banks and UN
agencies must be advocated by the Secretary General and UN system heads. A
strong and co-ordinated UN - working closely with FAO, OIE and WHO - will be
expected to join the partnerships: a poorly co-ordinated UN will be excluded.
Major meetings are coming up: the US-led international influenza partnership
(October 7th), Canada (health ministers) October 25th, and a four day technical
planning and resource mobilization effort, organized by FAO OIE, WHO and
World Bank, and planned for November 7th 2005 in Geneva.
16      Advocacy for urgency: WHO, FAO and OIE have embarked on a
campaign of advocacy and awareness which is bearing fruit, thanks to the
engagement of an effective group of concerned print and broadcast journalists.
The advocacy function in governments needs to go beyond Ministers of Health to
Heads of State: they will have to respond with clarity to concerns about the next
pandemic that are being raised by private entities and trade associations, labour
unions and airlines, and all branches of the media. Balanced communication of
key issues, presented as unambiguous messages, is needed to stimulate and
sustain constructive public responses and local-level action. This is a particular
role for the UN System Influenza Coordinator's office. At the higher level, the UN
Secretary General has a critical role to play, in combination with the Director
Generals of both WHO and FAO, in highlighting the urgency of prevention and
response preparedness, and in confirming that - if done well - this would greatly
reduce both the scale and the overall impact of both the current avian epidemic
and a future human pandemic.




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