WASC Pandemic Influenza Response Plan

PANDEMIC INFLUENZA PLAN Guidelines for Preparation & Response Title Revision Last Modified Document Owner Document Contact Classification WASC Richmond Pandemic Influenza Plan Version 1.5p - Public Version January 13, 2007 WASC Business Continuity Steering Committee Lisa F. Picard, Manager, Security & Business Continuity Level 0 - Public 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 PREFACE Purpose The purpose of the World Access Services Corporation Pandemic Influenza Plan is to provide guidelines for the preparation and response to pandemic scenarios that directly or indirectly impact company personnel, customers and clients, business operations and the profitability of company products and services. Audience The intended audience of the plan includes all associates of World Access Services Corporation. Some sections may be more useful to associates acting in a supervisory or management capacity if they are responsible for other associates, operation schedules or staffing levels required to meet client service level agreements. Content The plan is divided among three sections to detail the company's response, to pandemic influenza, encourage awareness and provide resources for additional information. 1. WASC Pandemic Response Plan The WASC Pandemic Response section provides guidance and instruction on how the company will respond to pandemic phases and scenario triggers, advising on the specific actions to be taken by WASC management and personnel. 2. Pandemic Awareness The Pandemic Awareness section provides general education and awareness on avian influenza, pandemic influenza and seasonal influenza and recommends activities and plans for individuals and families. 3. Resources The Resources Section explains roles and responsibilities of pandemic monitoring and response efforts around the world, and includes contact information for national and international organizations addressing pandemic influenza from the public and private sectors. Acknowledgements The WASC Pandemic Influenza Plan content was developed with deference to recommendations published by the World Health Organization (WHO), US Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Virginia Department of Health (VDH) and the Tourism Emergency Response Network (TERN). About the Author The WASC Pandemic Influenza Plan is a product of the WASC Business Continuity Steering Committee, the executive and strategic arm of the WASC Business Continuity Program. Public Page 2 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Table of Contents PREFACE Purpose Audience Content Acknowledgements About the Author 2 2 2 2 2 2 SECTION 0. EXECUTIVE SUMMARY Introduction Global Impact National Impact State Impact Local Impact Business Impact 4 4 5 5 5 6 4 SECTION 1. WASC PANDEMIC RESPONSE PLAN Response Management Inter-pandemic Period Pandemic Alert Period Pandemic Period Post-pandemic Period 8 10 11 14 15 7 SECTION 2. PANDEMIC AWARENESS Variations of Influenza Pandemic Flu Avian Flu Seasonal Flu 16 16 16 17 16 SECTION 3. RESOURCES National Resources International Resources Roles & Responsibilities Role of the World Health Organization Role of US Department of Health & Human Services, Centers for Disease Control & Prevention Role of the Virginia Department of Health Business Impact Considerations Business Continuity Considerations CDC Recommendations for Businesses 18 18 19 19 20 22 23 25 27 18 DOCUMENT MANAGEMENT Document Classification Approval Document History 29 29 29 29 Public Page 3 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 SECTION 0. EXECUTIVE SUMMARY Introduction The purpose of the World Access Services Corporation Pandemic Influenza Plan is to provide guidelines for the preparation and response to a pandemic scenario that directly or indirectly impacts company personnel, customers and clients, business operations and the profitability of company products and services. This plan integrates recommendations made by Global, International, US Federal and State experts and authorities who continue to monitor and respond to human health issues and provide guidance to businesses, individuals and families, municipalities, allied healthcare professionals, educational institutions and community organizations. This plan is a living document that may be modified as needed to remain current, accurate and effective. Global Impact Experts around the world agree that it is not a question of if, but when the next flu pandemic will strike. On average, three pandemics per century have been documented since the 16th century, occurring at intervals of 10 to 50 years. During a pandemic, it will not be business as usual. A flu pandemic could potentially cost the U. S. economy billions of dollars in lost productivity and medical expenses. Limitations on public gathering and fear among healthy people could limit or increase the demand for company products or services. Key supply and distribution networks could be significantly impacted. All businesses, hospitals and government agencies will feel the effects of a pandemic and unlike other disasters, a flu pandemic will impact every population in every part of the country and throughout the world. Government alone cannot resolve all the problems or challenges that a pandemic will bring to society. Estimates based on analysis and simulations using data from the 20th century pandemics of 1918, 1957 and 1968, approximate that 10 to 25 percent of the workforce is expected to be ill at any one time. Even if employees do not contract the flu, ill children and family members may cause employees to miss work. Close quarters and large gatherings, including cramped office spaces or large meetings, may encourage person-to-person spread of disease. Because a flu pandemic could potentially last for a year or more, infecting up to one-third of the population of the United States, moving operations to another location may not be a viable option. Because a Pandemic scenario impacts human health so dramatically, most company's business continuity plans and strategies cannot mitigate all the risks because rarely do companies staff up, cross train all key positions or maintain technological systems that can manage mission critical business functions without regular human intervention. Businesses must be creative and strategic in keeping their businesses afloat during a pandemic and helping to reduce the spread of disease among their workforce. Public Page 4 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 National Impact 1 If a new and severe strain of flu were to begin spreading across the globe, Virginia would not be spared from its impact. The severity of the next pandemic cannot be predicted, but modeling studies suggest that its effect in the United States could be severe. In the absence of any control measures (vaccination or drugs), it has been estimated that in the United States a "medium-level" pandemic could cause:  20 to 47 million people sick  314,000 to 734,000 hospitalizations  18 to 42 million outpatient visits  89,000 to 207,000 deaths  $71.3 to $166.5 billion economic impact State Impact2 The impact of pandemic influenza on Virginia includes the following estimates of mortality and morbidity:  1.08 to 2.52 million people sick  12,000 to 28,500 hospitalizations  575,000 to 1.35 million outpatient visits  2,700 to 6,300 deaths Local Impact Although local impact estimates have not been publicized, we can gain some idea of the potential impact by examining the anticipated seasonal influenza rates provided by the CDC and population estimates provided by the U.S. Census reports.3 Municipality 2005 Population 5% Seasonal Flu Rate 20% Seasonal Flu Rate Richmond Henrico Chesterfield Goochland Hanover Powhatan WASC 193,777 280,581 288,876 19,360 97,426 26,598 650 9,688.85 14,029.05 14,443.8 968 4,871.3 1,330 32.5 38,755.40 56,116.20 57,775.20 3,872 19,485.20 5,320 130 1 2 3 //www.vdh.state.va.us/PandemicFlu/index.asp //www.vdh.state.va.us/PandemicFlu/index.asp U.S. Census 2005. http://quickfacts.census.gov/qfd/states/51/51087.html Public Page 5 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Business Impact WASC has analyzed the potential risk to the business based on associate impact and line of business impact related to lost revenue and claims. If WASC associates contract the seasonal flu at the same rate as predicted by the CDC, between 5% and 20% will become ill. Business Continuity Plan Coordinators must be prepared to invoke business continuity plans related to health management and staffing, and deal with absenteeism for the duration of individual illness and through multiple waves of influenza that typically last a few months at a time. WASC Underwriters have run forecasts to predict the impact of a pandemic on the company's lines of business related to lost revenue and claims. Scenarios include SARs-like events locally, SARs-like events in Europe and a Global Pandemic with worst case infection rates. The forecasts are based on assumptions that include declining demand for WASC products and services and changes in claims volume and validity. Estimated Impact 2007 Scenarios Characteristics Lost Revenue LOB 1 LOB 2 LOB 3 Claims LOB 1 LOB 2 LOB 3 Scenario 1: "SARS-like" event Scenario 2: "SARS-like" event in Europe Scenario 3: Global Pandemic 25-40% infected Forecasting Assumptions Scenarios Lost Revenue LOB 1 LOB 2 LOB 3 Claims LOB 1 LOB 2 LOB 3 SARS 2003 Estimates 3x to 5x worse than SARS Almost no leisure travel for 2 years, thus no insurance Public Page 6 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 SECTION 1. WASC PANDEMIC RESPONSE PLAN The WASC Pandemic Response Plan represents the specific activities that will be performed in response to pandemic phase triggers that represent the pandemic scenario affecting the WASC geo-graphical region and subsequently, its workforce. With each trigger, it is assumed that the general public will be notified of the spread, virulence and impact of pandemic influenza by the World Health Organization. This information will be collected through various monitoring activities within WASC and used to notify internal divisions that may be required to take specific action. Details of activities and the assignment of specific roles and responsibility are 'operationalized' by each Division's Business Continuity Plan and additional procedures developed specifically for health related risk scenarios. For information on divisional plans and activities, refer to the assigned business continuity plan coordinators. The roster of plan coordinators is posted on the company intranet website devoted to business continuity: http://finance/BusinessUnitCoordinators2.html. Triggers and Actions Trigger WHO declares Pandemic Phase Guidance CDC, VDH, TERN and others advise public on appropriate actions Executive Planning Group Response  Prioritization  Budgeting  Resource Allocation  Strategy Approval Business Continuity Steering Committee Response  Enterprise Planning  Incident Monitoring  Communication  Prioritization Business Continuity Plan Coordinators Response  Communication  Divisional Plan Invocation     Business Continuity Actions Plan Monitor Communicate Coordinate Public Page 7 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Response Management Business Continuity WASC Business Continuity Program requires all business continuity plans to address the following key areas to enable the proper response to a variety of crisis or disaster scenarios:  Business Continuity Strategy  Business Continuity Planning Organization  Business Recovery Organization  Crisis Management Organization  Business Continuity Policy  Business Recovery Testing  Emergency Notification  Event Management  Media Inquiries and Public Relations Business continuity plans respond to the needs of specific business functions with unique plans that include the following information:  Notification Checklist  Notification Procedure  Notification Call List  Vendor Contact List  Personnel Location Control Form  Recovery Work Area Requirements  Directions to Recovery Site  Travel Request Form  Recovery Box Inventory  Critical Resource/Record Inventory  Continuity Team Activity Schedule  Business Impact Analysis Data Sheets  Business Productivity Continuity Procedures  Business Productivity Recovery Site Procedures  Business Productivity Recovery Plan Distribution Enhancements to existing plans are required to respond to the unique scenarios presented by a pandemic. Business Continuity Plan Coordinators should work with their business leaders to enhance response management in the areas of monitoring, communications, health management, associate management and supply management. Recommended enhancements enable the business to respond to different pandemic phases and perform required actions, some of which are unique to pandemic scenarios. Public Page 8 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Monitoring Monitoring functions focus on staying current with information published by the WHO, CDC, VDH, TERN and other credible sources. Currently, risk management functions of the Business Continuity Steering Committee and Business Continuity Manager address risk identification and event monitoring. Enhancements should include assigning multiple individuals to share the monitoring workload. Monitors will be assigned to individual organizations and to collect information specific to that organization's role in pandemic identification and response. Regularly scheduled meetings will be held to review new information and to decide if the information warrants a response. Communications Communication focuses on designating individuals or groups to share status and information and to explain any required business action. Currently, communication requirements and call trees are identified in the business continuity plans for each division within the company. Some communication templates have been prepared to notify management and leadership of any change in pandemic phase status. Enhancements should include frequent updates of call trees, backup assignments and utilization of available communication mediums. Health Management Health management focuses on the state of associate health. Currently, health related scenarios are included in the risks each Business Continuity Plan must address, along with other scenarios. Enhancements should address preventative, detective and restrictive controls on the workforce, including: vaccine provisioning, absenteeism monitoring, on-site identification of symptoms, worksite restrictions, and providing assistance to associates whose job performance is impacted by family member illness. Health management must be incorporated into the Human Resources Business Continuity Plan because the division supports personnel provisioning, time-off policy and benefits for the organization. Associate Management Associate management focuses on staffing requirements, mission critical job functions, maintenance of standard operating procedures (SOPs), and provisioning of backup and surge resources. Currently, staffing requirements, mission critical functions and staff lists are identified in Business Continuity Plans (BCP) for each division within the company. BCP's do not include SOP's, which map to job descriptions and provide detailed scripts on how tasks within the job description are completed. Enhancements should include frequent updates and backup assignments for every critical function, SOP collection, development and storage in a central location. SOP's should be reviewed and enhanced as necessary to ensure they adequately support surge resources. Managers should support cross training and flexibility to ensure customers and clients are serviced during waves of pandemic influenza. Supply Management Supply management functions are focused on supply requirements, suppliers and provisioning. Currently, supply requirements and critical suppliers are identified in Business Continuity Plans (BCP) for each division within the company. Enhancements should include strategies to manage disruptions in supply, which may include establishing new or contingent supplier relationships, contingency provisioning (i.e utilities) and/or the intentional stockpiling of supplies. Facilities Management should develop a supply management plan. Public Page 9 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Inter-pandemic Period Phase 1 Phase 1 serves as a trigger for organizations to strengthen their general pandemic preparedness by including related scenarios in risk impact analysis and business impact analysis activities. Phase 2 Phase 2 serves as a trigger to increase focus on specific pandemic threats that show increased potential to threaten human health. Phase 2 actions should include efforts to minimize the risk of disease transmission. Trigger Action Action Description Inter-pandemic Period Phase 1: Increased but low risk to humans Include pandemic scenarios in Risk Impact Analysis and Plan Business Continuity scenario planning. Monitor Communicate Coordinate Phase 2: Monitor world health agency reports for pandemic threats. Share pandemic status with business continuity and risk management steering committee members. Responsible Division Business Continuity Business Continuity Business Continuity Maintain accurate and effective business continuity plans and Business Continuity strategies. Assemble Pandemic Team to facilitate review of existing busienss continuity plans against nature of pandemic threat. Team tospecific pandemic threat. Monitor instigate additional activities as necessary. Share pandemic status with business continuity and risk management steering committee members. Facilitate increased understanding of pandemic threats, continuity options and additional continuity requirements. Business Continuity Business Continuity Business Continuity Business Continuity Increased circulation of virus subtype in animal population Plan Monitor Communicate Coordinate Public Page 10 of 29 Ov er si gh 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Pandemic Alert Period Phase 3 Phase 3 serves as a trigger to increase the level of attention and activity in support of early detection, notification and response to disease cases. Trigger Action Pandemic Alert Period Phase 3: Plan Action Description Responsible Division Human infection identified but no human to human transmission Include pandemic scenarios in Risk Impact Analysis and Business Continuity scenario planning. Include plans for: - planned and unplanned headcount reduction response (alternate staffing and operations) - worker healthcare support, monitoring and response services - alternate suppliers and vendors for materials, products and services - alternate utilties, communications and transportation infrastructures - alternate private infrastructure for food, childcare of Develop models and forecasting for business impactand pandemic influenza on LOB's and business models. Develop models and forcasting for operations staffing strategies based on historical business impact of seasonal influenza and worker absenteeism due to contagious illness. Monitor worker absence due to illness. Monitor spread and viralence of pandemic influenza. Communicate Monitor government actions and response to pandemic influenza. Launch Pandemic Influenza Awareness Campaign - Distribute Pandemic Influenza Kits - Encourage influenza vaccination Support high standards of personal hygiene in the workplace: general hygiene awareness. Implement high standards of environmental hygiene in the workplace. - Ensure Facilities maintenance & custodial services change Formalize alternate supplier relationships were feasible. Minimize unnecessary travel high risk areas as determined by the World Health Organization. Human Resources Facilities Management Division Leaders Division Leaders Business Continuity Division Leaders Underwriting Operations Monitor Human Resources Business Continuity Business Continuity Business Continuity Coordinate Public Page 11 of 29 O ve rs ig 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Phase 4 Phase 4 serves as a trigger to fine-tune contingency and response plans, including specific measures to delay the spread of disease. Trigger Phase 4: Action Action Description Small clusters of human to human infection but spread is highly localized Plan Monitor Fine-tune plans as necessary. Monitor worker absence due to illness. Monitor spread and viralence of pandemic influenza. Monitor government actions and response to pandemic influenza. Communicate Maintain pandemic awareness. - Continue to encourage influenza vaccination Support high standards of personal hygiene in the workplace: general hygiene awareness. Maintain increased standards environmental hygiene in the workplace. - Change air filters frequently. - Clean high touch areas frequently with anti-viral cleaning agents. Limit travel. Limit group events. Envoke contingency operations where feasible to minimize business impact. Responsible Division Business Continuity Business Continuity Business Continuity Business Continuity Business Continuity Human Resources Facilities Custodial Staff O v e r Coordinate Division Leaders Human Resources Division Leaders Public Page 12 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Phase 5 Phase 5 serves as a trigger to maximize containment efforts. Trigger Phase 5: Action Action Description Larger clusters of human to human infection Plan Monitor Prepare to invoke plans. Monitor worker absence due to illness. Monitor spread and viralence of pandemic influenza. Communicate Monitor government actions and response to pandemic influenza. Maintain pandemic awareness. - Continue to encourage influenza vaccination Support high standards of personal hygiene in the workplace: general hygiene awareness. Maintain increased standards environmental hygiene in the workplace. - Change air filters frequently. - Clean high touch areas frequently with anti-virals. - Maintain availability of personal hygiene and facility cleaning supplies throughout workplace. Restrict travel. Restrict or limit group events. Maintain contingency operations as needed to minimize business impact. Responsible Division Business Continuity Business Continuity Business Continuity Business Continuity Business Continuity Human Resources Facilities Custodial Staff Coordinate Human Resources Division Leaders Public Page 13 of 29 O v er si 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Pandemic Period Phase 6 Phase 6 represents the stage wherein the pandemic is active and spreading among the immediate population. This stage serves as a trigger to invoke contingency plans and work to minimize the impact of the pandemic through aggressive containment efforts. Trigger Action Action Description Responsible Division Pandemic Period Phase 6: Increased and sustained transmission in general population across cities and countries. Plan Monitor Invoke plans. Fine-tune plans as necessary. Monitor worker absence due to illness. Monitor spread and viralence of pandemic influenza. Communicate Monitor government actions and response to pandemic influenza. Maintain pandemic awareness. - Continue to encourage influenza vaccination Support high standards of personal hygiene in the workplace: general hygiene awareness. Implement workforce healthcare program to monitor worker health. Mandate containment strategies: - Worker health assessment - Sick worker restrictions - Well worker health sustaining activities Restrict travel. Restrict group events. Maintain contingency operations as needed to minimize business impact. - Alternate workforce - Remote workforce - Alternate suppliers Business Continuity Division Leaders Human Resources Division Leaders Business Continuity Business Continuity Business Continuity Human Resources Human Resources Human Resources Coordinate Division Leaders Human Resources Human Resources Operations Division Leaders Public Page 14 of 29 O v e r 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Post-pandemic Period The post-pandemic period serves as a trigger that scenarios are returning to an inter-pandemic period wherein the disease poses less risk to human health. Responsible Division Trigger Action Post-pandemic Period Plan Action Description Returning to Inter-pandemic period Perform post-mortems on business continuity plan performance and actual business impacts. Modify business continuity plans as required to promote more accurate, effective and efficient processes. Monitor inter-pandemic phase risks as reported by WHO and CDC. Communicate residual risks to workers, leadership. Restock supplies depleted during Phase 6 response. Business Continuity Monitor Communicate Coordinate Inter-pandemic Period Business Continuity Business Continuity Division Leaders Public Page 15 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 SECTION 2. PANDEMIC AWARENESS Variations of Influenza Pandemic Flu Pandemic influenza is a global outbreak of disease that occurs when a new influenza A virus appears in humans, causes serious illness and then spreads easily from person to person worldwide. Three major influenza pandemics swept the globe in the 20th century causing millions of deaths, and no one knows for sure when the next pandemic may strike. The pandemic of 1918 is estimated to have killed more than 40 million people in less than one year, with peak mortality rates occurring in people aged 20–45 years. The pandemics of 1957 and 1968 were milder, with 1–4 million estimated deaths, primarily in traditional risk groups such as the elderly, but many countries nevertheless experienced strains on health-care resources. If an influenza pandemic virus were to appear again similar to the one that struck in 1918, even taking into account the advances in medicine since then, unparalleled tolls of illness and death could be expected. Air travel might hasten the spread of a new virus, and decrease the time available for preparing interventions. Health-care systems could be rapidly overburdened, economies strained, and social order disrupted. Although it is not considered feasible to halt the spread of a pandemic virus, it should be possible to minimize its consequences through advance preparation to meet the challenge. Efforts are underway to plan for the complex issues and serious impact that a new influenza pandemic could cause. Avian Flu Bird flu is caused by avian influenza viruses, which occur naturally among birds. Worldwide, there are many strains of avian influenza virus that can be spread by migratory fowl. These viruses can cause varying degrees of illness in poultry. The spread of a highly pathogenic avian H5N1 virus across eastern Asia and into Europe and Africa represents a significant threat, with health professionals concerned about a potential human pandemic. This virus has passed from infected poultry to humans and other mammals, and has had devastating impacts on poultry farming in several nations. Numerous potential routes for introduction of the virus into the U.S. exist including illegal movement of domestic or wild birds, contaminated products, via an infected traveler, as a bioterrorism event, and the migration of infected wild birds. Bird migration and sampling for infection is being conducted around the world to predict and track the spread of disease around the globe. Avian influenza is expected to be introduced in to the continental US by way of Alaska. Birds from Alaska intermingle in both the Pacific and Central migratory flyways. Where flyways overlap, they create a path for potential disease transmission across continents enabling the mixing, re-assortment, and exchange of genetic material among strains from Eurasia and North America. In the US, Federal, State, university, Public Page 16 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 and non-governmental organizations are conducting monitoring and surveillance of migratory birds in Alaska, the Pacific Flyway, and Oceania; Central Flyway; Mississippi Flyway and the Atlantic Flyway. Surveillance and early detection of avian flu in wild birds is being monitored in the United States by a system implemented by the National Biological Information Infrastructure, Wildlife Disease Information Node.4 Domestic bird health is being monitored by the U.S. Department of Agriculture.5 Seasonal Flu The flu is a contagious respiratory illness caused by influenza viruses. There are differences between Seasonal Flu and Pandemic Flu. Refer to Table 2.2.3 Comparative Summary: Seasonal v. Pandemic Flu for specific explanations of the variance between the two types of influenza. Seasonal & Pandemic Flu Variance6 Seasonal Flu Outbreaks follow predictable seasonal patterns; occurs annually, usually in winter, in temperate climates Usually some immunity built up from previous exposure Healthy adults usually not at risk for serious complications; the very young, the elderly and those with certain underlying health conditions at increased risk for serious complications Health systems can usually meet public and patient needs Vaccine developed based on known flu strains and available for annual flu season Adequate supplies of antivirals are usually available Average U.S. deaths approximately 36,000/yr Symptoms: fever, cough, runny nose, muscle pain. Deaths often caused by complications, such as pneumonia. Generally causes modest impact on society (e.g., some school closing, encouragement of people who are sick to stay home) Manageable impact on domestic and world economy Pandemic Flu Occurs rarely (three times in 20th century - last in 1968) No previous exposure; little or no pre-existing immunity Healthy people may be at increased risk for serious complications Health systems may be overwhelmed Vaccine probably would not be available in the early stages of a pandemic Effective antivirals may be in limited supply Number of deaths could be quite high (e.g., U.S. 1918 death toll approximately 675,000) Symptoms may be more severe and complications more frequent May cause major impact on society (e.g. widespread restrictions on travel, closings of schools and businesses, cancellation of large public gatherings) Potential for severe impact on domestic and world economy 4 5 http://wildlifedisease.nbii.gov/ai/index.jsp http://www.pandemicflu.gov/issues/index.html 6 //pandemicflu.gov/season_or_pandemic.html Public Page 17 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 SECTION 3. RESOURCES Many organizations have publicized considerable amounts of information about Pandemic Influenza and are providing resources to organizations and individuals to assist in planning and response activities. National Resources     US Department of Health and Human Services, Centers for Disease Control and Prevention US Centers for Disease Control & Prevention Pandemic Flu Virginia Department of Health Virginia Department of Health Pandemic Influenza National Biological Information Infrastructure National Highly Pathogenic Avian Influenza Early Detection Data System United States Department of Agriculture USDA Avian Flu International Resources          Tourism Emergency Response Network TERN Avian Flu World Health Organization FluNet (Global Influenza Surveillance Network) Public Health Agency of Canada Public Health Agency of Canada Pandemic Influenza Ontario Ministry of Health and Long-Term Care Ontario Ministry of Health and Long-Term Care - Influenza Bulletin European Influenza Surveillance Scheme (EISS) Weekly Surveillance Bulletins - Europe Health Protection Agency Weekly Influenza Activity Reports - U.K. Government of Hong Kong Special Administrative Region, Department of Health Influenza Surveillance Reports Australian Government National influenza surveillance New Zealand, Institute of Environmental Science and Research Influenza Surveillance Reports Public Page 18 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Roles & Responsibilities Roles and responsibilities for pandemic preparedness and response exist on global, international, national, US Federal, State, Local, private entity and individual and family levels. Many sources exist for information, resources and assistance. Role of the World Health Organization7 The World Health Organization places responsibility for management of the national risk of pandemic influenza primarily with the relevant national authorities. Every country is strongly urged to develop or update a national influenza preparedness plan according to the recommendations contained in the guidance document: 'WHO global influenza preparedness plan: The role of WHO and recommendations for national measures before and during pandemics.' The World Health Organization also defines phases of disease activity which assists authorities, organizations, businesses and individuals with common measurement criteria to use in creating their preparation and response plans. Pandemic Phases PANDEMIC PHASES Inter pandemic period Phase 1. No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low. Phase 2. No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Pandemic alert period Phase 3. Human infection(s) with a new subtype, but no human-tohuman spread, or at most rare instances of spread to a close contact. Phase 4. Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Ensure rapid characterization of the new virus subtype and early detection, notification and response to additional cases. Contain the new virus within limited foci or delay spread to gain time to implement preparedness measures, including vaccine development. Maximize efforts to contain or delay spread, to possibly avert a pandemic, and to gain time to implement pandemic response measures. PUBLIC HEALTH GOALS Strengthen influenza pandemic preparedness at the global, regional, national and sub-national levels. Minimize the risk of transmission to humans; detect and report such transmission rapidly if it occurs. Phase 5. Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Pandemic period Phase 6. Pandemic: increased and sustained transmission in Minimize the impact of the pandemic. general population. a The distinction between phase 1 and phase 2 is based on the risk of human infection or disease resulting from circulating strains in animals. The distinction is based on various factors and their relative importance according to current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically localized or widespread, and/or other scientific parameters. b The distinction between phase 3, phase 4and phase 5is based on an assessment of the risk of a pandemic. Various factors and their relative importance according to current scientific knowledge may be considered. Factors may include rate of transmission, geo-graphical location and spread, severity of illness, presence of genes from human strains (if derived from an animal strain), and/or other scientific parameters. 7 //www.who.int/csr/disease/avian_influenza/en/index.html Public Page 19 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Role of US Department of Health & Human Services, Centers for Disease Control & Prevention8 The US Department of Health and Human Services, Centers for Disease Control & Prevention has provided guidance in the form of resources and checklists to aid individuals and entities in preparing for and dealing with a pandemic. Resources are targeted to the following audiences and objectives:  Federal Planning  State & Local Planning  Individual Planning  Business Planning  School Planning  Health Care Planning  Community Planning Federal Planning The National Strategy for Pandemic Influenza, issued by President Bush November 1, 2005, guides our nation's preparedness and response to an influenza pandemic, with the intent of: (1) stopping, slowing or otherwise limiting the spread of a pandemic to the United States; (2) limiting the domestic spread of a pandemic, and mitigating disease, suffering and death; and (3) sustaining infrastructure and mitigating impact to the economy and the functioning of society. The Strategy charges the U.S. Department of Health & Human Services with leading the federal pandemic preparedness. The Implementation Plan for the National Strategy, translates the Strategy into more than 300 actions for Federal departments and agencies and sets clear expectations for State and local governments and other non-Federal entities. It also provides guidance for all Federal departments and agencies on the development of their own plans. Federal Support for State & Local Planning A pandemic occurs in many localities - perhaps even worldwide - almost simultaneously. Because of this, much of the planning for a pandemic must be the responsibility of state and local governments. The 50 states, the District of Columbia, three local jurisdictions (New York City, Chicago and Los Angeles County), five U.S. Territories and three Freely Associated States of the Pacific are sharing $325 million in cooperative agreement emergency supplemental funds to fill gaps in their pandemic influenza preparedness plans and to test these plans. Funds were made available in two phases. Phase one, $100M, was announced January 12, 2006. Phase two, $225M, was announced July 11, 2006. 8 //www.pandemicflu.gov/ Public Page 20 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 To help coordinate planning, HHS and other federal agencies are holding pandemic planning summits with public health, emergency management, and response leaders in each state. HHS has also prepared a State & Local Planning Checklist, and will work with states to design exercises to evaluate preparedness. Individual Planning As individuals plan, it is important that they think about the challenges they may face, particularly if a pandemic is severe. It may take time to find the answers to these challenges. A checklist and fill-in sheets for family health information and emergency contact information have been prepared to help guide individual's planning and preparation. Business Planning In the event of pandemic influenza, businesses will play a key role in protecting employees' health and safety as well as limiting the negative impact to the economy and society. Planning for pandemic influenza is critical. Companies that provide critical infrastructure services, such as power and telecommunications, also have a special responsibility to plan for continued operation in a crisis and should plan accordingly. As with any catastrophe, having a contingency plan is essential. A Business Pandemic Influenza Planning Checklist has been developed for use by businesses in assessing and enhancing their own business pandemic plans. School Planning Developed by the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), and the Department of Education, these checklists can assist local educational agencies in developing and/or improving plans to prepare for and respond to an influenza pandemic. Health Care Planning Health care providers will play a crucial role in the event of a pandemic. Planning for pandemic influenza is key. The following checklists, toolkit, and guidelines will assist health care providers and service organizations in planning for a pandemic outbreak. Community Planning Faith-based and community organizations will play an integral role in the event of a pandemic. Health and Human Services (HHS) and Center for Disease Control (CDC) have developed a checklist to assist community organizations with their pandemic planning. The Medical Reserve Corps has adapted HHS planning checklists to create guidelines for Medical Reserve Corps (MRC) units. Public Page 21 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Role of the Virginia Department of Health9 The Virginia Department of Health (VDH) Pandemic Influenza Plan consists of preparedness and response components. There are eleven supplements to the plan, which mirror the supplements to the federal plan: Supplement 1: Surveillance Provides recommendations for disease surveillance throughout various pandemic phases. Supplement 2: Laboratory Diagnostics Addresses the role of the Virginia state public health laboratory in influenza surveillance for season flu as well as a novel influenza strain. It also provides recommendations for clinical, local public health and other laboratories. Supplement 3: Healthcare Planning Provides healthcare partners with recommendations for developing plans to respond to an influenza pandemic. Supplement 4: Infection Control Outlines strategies for limiting the spread of influenza. Supplement 5: Clinical Guidelines VDH endorses the recommendations in supplement 5 of the USDHHS Pandemic Influenza Plan. Supplement 6: Vaccine Distribution and Use Addresses vaccination of priority groups, vaccine procurement and distribution, seconddose planning, vaccine storage and shipment options, and vaccine monitoring, data collection and safety. Supplement 7: Antiviral drug Distribution and Use Addresses preparedness planning issues such as antiviral procurement, distribution to priority groups, legal preparedness, and data collection. It also includes recommendations for the use of antiviral drugs during the pandemic period. Supplement 8: Community Disease Control and Prevention Addresses disease containment strategies to prevent and decrease transmission during different pandemic phases. Supplement 9: Travel-related Risks Specifically addresses travel-containment strategies, such as health alert notices, interaction with federal quarantine stations, and management of travelers at points of entry into the Commonwealth. Supplement 10: Public Health Communications Outlines key influenza pandemic risk communications concepts. Supplement 11: Psychosocial Support Outlines services that will help in managing emotional stress during the response to an influenza pandemic. The Virginia plan is meant to be dynamic, and components will be revised and updated as new information is obtained. 9 //www.vdh.state.va.us/PandemicFlu/index.asp Public Page 22 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Business Impact Considerations10 The variety of potential impact to the business in a pandemic scenario can be categorized into several key areas: Communications, Transportation, Operations, Business Demand, Work Stoppage, Morbidity & Mortality, Social Instability and Liability. The following list of issues should be reviewed by Risk and Business leaders to understand what types of continuity strategies may be considered: Communications                   People will be seeking information from government authorities Businesses may need to exchange information with government authorities Countries and foreign governments will need to share information among each other Employee communications and awareness campaigns will be required Marketing communications need to address clients, customers and the press Transportation Transport systems may be disrupted due to work stoppage Transport systems may be disrupted due to government quarantine Movement of people may be restricted Panic-based evacuations may be attempted Employee travel policy Operations Offices may be voluntarily closed Offices may be closed by health authorities Suppliers may be forced to close Remote access feasibility, cost, security & compliance Business Demand Customer base may decline as client organizations are forced to close, or people avoid populated environments such as shopping centers Travel may decline Healthcare and assistance claims may increase Demand for products or services that serve a non-transient, home bound or quarantined population will increase. Work Stoppage    Key personnel may be unavailable for lengthy periods (permanently in a worst case scenario) – apart from those falling to the disease, many people may choose to stay at home rather than risk exposure Salary continuation and sick leave human resource policy Ancillary workforce options 10 Whittet, Leslie T. , MACS MBCI . Representative for the Australian Capital Territory,, Business Continuity Institute. www.continuitycentral.com/feature0251.htm Public Page 23 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Morbidity and Mortality     Authorities may not be able to cope if numbers of sick and dying exceed expectations Social Instability Law and order may suffer Liability Litigation may result from claims centered around air conditioning, duty of care, etc. Companies may relax security and controllership to compensate for work stoppage or quarantine, which may be exploited by criminals or deviants or result in regulatory, statutory, policy or contractual non-compliance. Feasibility of CDC recommendations. Some business continuity recommendations, including those promoted by the CDC that instructs companies to allow work-at-home solutions may not be feasible due to statutory or regulatory compliance requirements related to security and privacy. Public Page 24 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Business Continuity Considerations11 Preparing for Pandemic Influenza leverages some aspects of traditional business continuity planning frameworks, but may not address the human dependencies that will create the greatest vulnerabilities. Business Continuity functional areas to review include Knowledge Management, Communications, Operational Models, Transportation, Supply Chain, Product & Client Analysis and Security, The following list of issues should be reviewed by Business Continuity leaders and plan coordinators to understand the sufficiency of the organization's existing Business Continuity Plans and strategies. Knowledge Management                     Completion of a critical records analysis; Provision of Standard Operating Procedures; Cross-skilling for key employees; Ensuring that knowledge and skills is distributed across interstate or geographically dispersed branch offices; Succession planning; Capture and management of critical information; Off-site storage of copies of all critical information. Communications Ensure that all contact lists are up to date and maintained; Evaluate all communication options to keep personnel informed – mobile network, PSTN, 1800 number (in Australia) , radio, internet, intranet, etc; Establish means to communicate with suppliers; Establish means to communicate with your customer base; Establish an authorized and competent team to communicate with key stakeholders and the media; Consider remotely hosted email and website options; Consider alternate telephone providers if this gives you redundant systems. Operational Models Working from interstate/branch offices; Working from home; Moving personnel to other locations (may need to accommodate families); Leasing remote facilities (safe areas) and relocating personnel; Developing key resourcing requirements for each of the options; Your business continuity plans will need to cater for all of these options including provision of ICT facilities, etc. 11 Whittet, Leslie T. , MACS MBCI . Representative for the Australian Capital Territory,, Business Continuity Institute. www.continuitycentral.com/feature0251.htm Public Page 25 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 Transportation                      Contract with a bus company to provide private transport for employees; Establish a car pool system. Supply Chain Contract multiple suppliers; Look for geographic dispersion (even international); Know who are other key customers and where you stand in the “pecking order”; Ensure that your suppliers have effective and thoroughly tested business continuity plans. Product & Client Analysis Can you expand upon your existing customer base; Are there distribution and delivery options that reduce the need for movement of people; What about global markets; Can you diversify your product set and expand your customer base; What hedging opportunities may be available to spread your risk. Security Do you have arrangements in place to secure your premises for short and long term periods of vacancy; Know who else uses the services of your security provider and what priority you will receive if the security provider receives multiple demands for increased resources; Consider plans for security of personnel at all times – in the office, traveling between home and office, security at home; Consider planning for secure provision of consumer staples – food, drink, essential household items. This could involve bulk purchasing arrangements, escorted shopping groups, etc; Have a named contact within the police and emergency services organizations and provide them with a named contact and alternate within your organization. Your contact must be able to make decisions; Meet with and understand the plans and limitations of local police and emergency services. Liability & Compliance Carefully examine all aspects of your insurance policies – are you covered for all cases of business cessation including voluntary closure, mandatory closure (emergency services), etc; Are you adequately covered for loss of income; If an employee contracts the disease will you have any liability, are you insured; Ensure that you regularly inspect air conditioning plant and all shared washroom facilities to guarantee health standards. Public Page 26 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 CDC Recommendations for Businesses12 The CDC has base-lined minimum planning criteria for businesses and established a checklist of components that should be used to measure business continuity plans. Any gaps identified between the businesses plans and the CDC recommended plan components should be evaluated for relevancy and feasibility. Business Pandemic Influenza Planning Checklist 1.1 Plan for the impact of a pandemic on your business: Identify a pandemic coordinator and/or team with defined roles and responsibilities for preparedness and response planning. The planning process should include input from labor representatives. Identify essential employees and other critical inputs (e.g. raw materials, suppliers, sub-contractor services/products, and logistics) required to maintain business operations by location and function during a pandemic. Train and prepare ancillary workforce (e.g. contractors, employees in other job titles/descriptions, retirees). Develop and plan for scenarios likely to result in an increase or decrease in demand for your products and/or services during a pandemic (e.g. effect of restriction on mass gatherings, need for hygiene supplies). Determine potential impact of a pandemic on company business financials using multiple possible scenarios that affect different product lines and/or production sites. Determine potential impact of a pandemic on business-related domestic and international travel (e.g.quarantines, border closures). Find up-to-date, reliable pandemic information from community public health, emergency management, and other sources and make sustainable links. Establish an emergency communications plan and revise periodically. This plan includes the identification of key contacts (with back-ups), chain of communications (including suppliers and customers), and processes for tracking and communicating business and employee status. Implement an exercise/drill to test your plan, and revise periodically. 1.2 Plan for the impact of a pandemic on your employees and customers: Forecast and allow for employee absences during a pandemic due to factors such as personal illness, family member illness, community containment measures and quarantines, school and/or business closures, and public transportation closures. Implement guidelines to modify the frequency and type of face-to-face contact (e.g. hand-shaking, seating in meetings, office layout, shared workstations) among employees and between employees and customers (refer to CDC recommendations). Encourage and track annual influenza vaccination for employees. Evaluate employee access to and availability of healthcare services during a pandemic, and improve services as needed. Evaluate employee access to and availability of mental health and social services during a pandemic, including corporate, community, and faith-based resources, and improve services as needed. Identify employees and key customers with special needs, and incorporate the requirements of such persons into your preparedness plan. 12 //www.pandemicflu.gov/plan/business/businesschecklist.html Public Page 27 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 1.3 Establish policies to be implemented during a pandemic: Establish policies for employee compensation and sick-leave absences unique to a pandemic (e.g. nonpunitive, liberal leave), including policies on when a previously ill person is no longer infectious and can return to work after illness. Establish policies for flexible worksite (e.g. telecommuting) and flexible work hours (e.g. staggered shifts). Establish policies for preventing influenza spread at the worksite (e.g. promoting respiratory hygiene/cough etiquette, and prompt exclusion of people with influenza symptoms). Establish policies for employees who have been exposed to pandemic influenza, are suspected to be ill, or become ill at the worksite (e.g. infection control response, immediate mandatory sick leave). Establish policies for restricting travel to affected geographic areas (consider both domestic and international sites), evacuating employees working in or near an affected area when an outbreak begins, and guidance for employees returning from affected areas (refer to CDC travel recommendations). Set up authorities, triggers, and procedures for activating and terminating the company’s response plan, altering business operations (e.g. shutting down operations in affected areas), and transferring business knowledge to key employees. 1.4 Allocate resources to protect your employees and customers during a pandemic: Provide sufficient and accessible infection control supplies (e.g.hand-hygiene products, tissues and receptacles for their disposal) in all business locations. Enhance communications and information technology infrastructures as needed to support employee telecommuting and remote customer access. Ensure availability of medical consultation and advice for emergency response. 1.5 Communicate to and educate your employees: Develop and disseminate programs and materials covering pandemic fundamentals (e.g. signs and symptoms of influenza, modes of transmission), personal and family protection and response strategies (e.g. hand hygiene, coughing/sneezing etiquette, contingency plans). Anticipate employee fear and anxiety, rumors and misinformation and plan communications accordingly. Ensure that communications are culturally and linguistically appropriate. Disseminate information to employees about your pandemic preparedness and response plan. Provide information for the at-home care of ill employees and family members. Develop platforms (e.g. hotlines, dedicated websites) for communicating pandemic status and actions to employees, vendors, suppliers, and customers inside and outside the worksite in a consistent and timely way, including redundancies in the emergency contact system. Identify community sources for timely and accurate pandemic information (domestic and international) and resources for obtaining counter-measures (e.g. vaccines and antivirals). 1.6 Coordinate with external organizations and help your community: Collaborate with insurers, health plans, and major local healthcare facilities to share your pandemic plans and understand their capabilities and plans. Collaborate with federal, state, and local public health agencies and/or emergency responders to participate in their planning processes, share your pandemic plans, and understand their capabilities and plans. Communicate with local and/or state public health agencies and/or emergency responders about the assets and/or services your business could contribute to the community. Share best practices with other businesses in your communities, chambers of commerce, and associations to improve community response efforts. Public Page 28 of 29 21d21402-8158-4b2b-8db2-2fc1be78253b.doc WASC US - Richmond is currently operating under Pandemic Alert Phase 3 DOCUMENT MANAGEMENT Document Classification This document has been designated with the following classification: Level 1 - Internal. Internal Information is defined as 'information for business internal use only.' This business information is typically required for normal day to day work. Internal is the default level of classification and applies to the Mondial Assistance Group Operating Entities, provided that information contained in the document is not classified as confidential. Information belonging to this level can be restricted by the information owner. Approval This document has been approved for enterprise wide release as of <>. The effective date of this plan is <>. _________________________________ Jonathan M. Ansell President and Chief Executive Officer _________________________________ Mark Huntley Chief Financial Officer _________________________________ Lisa F. Picard Security & Business Continuity Manager Document History Version 1.0 1.1 1.2 1.3 1.4 1.5 1.5p Description of Changes Original DRAFT Version Approved by Business Continuity Steering Committee Enhancements Enhancements Enhancements Enhancements Public Version Date Modified 8/29/2006 10/29/06 11/9/06 11/10/06 11/12/06 11/13/06 01/13/07 Public Page 29 of 29