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Outline of Workshop in FUKUOKA on pandemic preparedness and response in the region CSR/WPRO The 3rd Meeting of Nation al Influenza Centre in the Western Pacific and South East Asia Regions 19 August 2009 BEIJING, CHINA Outline of the presentation 1. Overview of “Workshop on the revised WHOGuidance on pandemic influenza preparedness and response” in Fukuoka 2. Pandemic preparedness and response in the region to the current situation 2| Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Fukuoka Workshop: Overview • Objectives – Review progress of pandemic preparedness in the Region – Introduce the ‘Revised WHO guidance on pandemic influenza preparedness and response’ – Identify future steps to update Member States’ pandemic preparedness plans • Structure – 3-5 March 2009 (3½ days) – More than 70 participants/observers from 14 Member States of the WHO Western Pacific Region. – Six plenary sessions and two group discussions with poster presentation. 3| Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Pandemic Preparedness Progress • Significant progress made by each Member State – Significant increase in level of understanding of pandemic influenza preparedness • All Member States have developed a national pandemic preparedness and response plan – • Focus of the plan and involvement of stakeholders differs between countries Most Member States have conducted exercises to validate their plans – 4| Many parties involved in plan development and exercises Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Areas for Improvement • Integrating pandemic response into emergency management processes • Developing (more) operational plans that include rapid containment, including local level plans • Strengthening risk communication • Incorporating the “whole of society” approach in pandemic preparedness planning • Establishing or strengthening comprehensive influenza surveillance systems 5| Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Recommendations: Timing and Scope of Plans (I) • All Member States should consider revising their national plans in consideration of updated WHO guidance – Member States are encouraged to revise their plans by June 2010. • The "whole of society approach” should be incorporated in the updated plans – Member States should identify and define the roles and responsibilities of central and local level authorities. – Advocacy for high level support is needed. The Ministry of Health should take the technical lead on this effort. – Communication strategies for community involvement in pandemic preparedness should be developed by each Member State. 6| Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Recommendations: Timing and Scope of Plans (ll) • A multi-sector rapid containment plan should be developed and integrated into the national plan – – • National emergency management should be activated for rapid containment Rapid containment guideline can also be used to help countries take action to stop the spread of the disease from the first national cases – even when the global rapid containment may no longer be feasible Surveillance for pandemic influenza is needed and should be included in the national plan – 7| The national pandemic preparedness process should facilitate the strengthening of a comprehensive national influenza surveillance system Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Recommendations: Testing Plans and Monitoring Progress • Exercises should be conducted regularly to test and validate national plans • Each Member State should assess their pandemic preparedness annually with the ‘WHO WPRO and CDC Joint Assessment Tool for Pandemic Preparedness’ 8| Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Recommendations: WHO Support • Provide technical support for plan revision as requested by Member States • Convene forums – Rapid containment for health and emergency management officials – How to advocate for a multi-sector approach to Member States • Continue to assist with conduct of pandemic preparedness and rapid containment exercises – AND disseminate exercise program information and lessons learned • Assist with assessing comprehensive influenza surveillance, including pandemic influenza surveillance capacity 9| Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Outline of the presentation 1. Overview of “Workshop on the revised WHOGuidance on pandemic influenza preparedness and response” in Fukuoka 2. Pandemic preparedness and response in the region to the current situation 10 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Stage-Wise Intervention Different public health strategy and interventions are required at the different stages of response Pandemic Response Rapid Containment Averting Pandemic Influenza Inter Pandemic (1 -3) 11 | Pandemic Alert (4) Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Pandemic (5-6) A Two-Tiered Approach to Pandemic Preparedness Influenza Pandemic specific Core capacity building; APSED Work plan 12 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Background • “WHO WPRO and CDC Joint Assessment Tool for Pandemic Preparedness” (May – June 2009) • Sent to WPRO Member States and territories (via Country Office if present) • Results analysed in 2 groups – Group A (Countries and territories with CO presence) – Group B (Countries and territories without CO presence) 13 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Data Analysis • Questions scored from 0 – 3 – – – – 0 = no capacity 3 = advanced capacity Moving from one level of capability to the next demonstrates improvement in public health functions Score ≥ 2 considered ‘good’ • Median values used to calculate the level of capability in APSED program area, for each stage of intervention • Proportion of countries at capability level ≥ 2 calculated 14 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Group A: Trends Summary Group A (2008) 100% 90% Gains • Significant improvement (38%) in 2008 % responses ≥ 2 80% 70% 60% 50% 40% • 30% 20% Surveillance and Response and Infection Control in all 3 intervention stages Improvements in Risk Communication 10% 0% Group A (2009) Surveillance and Response 100% 90% Laboratory Risk Communication Infection Control Zoonosis Averting Pandemic Influenza APSED Priority Area 2009 Rapid Containment Pandemic Response % responses ≥ 2 80% Areas for Improvement • Infection Control capacity • 70% 60% • 50% 40% 30% 20% 10% | 16 Surveillance and 0% Response (increased, but still low) Zoonosis capacity (no improvement) Risk Communication – particularly in Rapid Containment and Pandemic Response intervention stages Communicable Disease Surveillance & Response (CSR) Risk Communication Infection Control Zoonosis WHO Western Pacific Regional Office (WPRO) Laboratory Averting Pandemic Influenza Group B: Trends Summary Group B (2008) 2009 100% 90% 2008 • 80% % responses ≥ 2 Gains 70% 60% • 50% 40% 30% 20% 10% Group B (2009) 0% Surveillance and Response Laboratory % responses ≥ 2 70% 60% 50% 40% 30% 20% 10% | 18 Surveillance and 0% Response Infection Control Zoonosis 2008 APSED Priority Area 2009 80% Risk Communication Averting Pandemic Influenza 100% 90% Improvements in Surveillance and Response Significant increase in Laboratory capacity at Pandemic Response stage (32%) Rapid Containment Pandemic Response Areas for Improvement • Capacities in Pandemic Response intervention stage (lowest or equal lowest in all areas) • Risk Communication during Averting Pandemic Influenza stage (decreased by 13%) Communicable Disease Surveillance & Response (CSR) Laboratory Risk Communication Infection Control Zoonosis WHO Western Pacific Regional Office (WPRO) Averting Pandemic Influenza Assessment Recommendations • WHO to continue technical support to Member States in strengthening preparations for pandemic response – Shift from Containment to Mitigation strategies – Adjust to local context and risk assessment • Assess pandemic preparedness and response capabilities before June 2010 – Evaluation of progress or achievement of these goals 19 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Pandemic Response: Stages of Spread Sporadic Cases Clustering (limited communitylevel transmission) Community level outbreak (sustained transmission) Pandemic level spread (extensive transmission) How can we reduce preventable deaths close to the level of a developed country? Death Early stage of USA Japan Severe Mild E.g. Mexico 20 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) E.g. USA Shift from Containment to Mitigation Sporadic Cases Clustering (limited communitylevel transmission) Community level outbreak Pandemic level spread (sustained transmission) (extensive transmission) CONTAINMENT To stop or delay the spread of the virus by detecting cases and taking vigorous actions, such as contact tracing, treatment and/or quarantine of contacts To slow the spread of the virus in the community and minimize transmission to vulnerable populations To ensure healthcare for those who need it most To minimise social disruption and other negative consequences MITIGATION 21 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) Framework for Action SURVEILLANCE Laboratory PARTNERS COMMUNICATION COMMAND HEALTH SECTOR HEALTH CARE RESPONSE How to minimize preventable deaths PUBLIC HEALTH INTERVENTIONS INDIVIDUAL LEVEL 22 | How to slow down transmission Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO) SOCIETAL LEVEL Conclusions and Next Steps • Continue strengthening core capacities through implementation of the APSED workplan – Will provide the basis to prepare and respond to an influenza pandemic, as well as other infectious diseases • Accelerate pandemic preparedness and response by prioritizing key areas to be strengthened – Pandemic H1N1 2009 response – Key areas outlined in the Framework of Action for response; Command, Surveillance, Health Care Response, Public Health Interventions and Communication 23 | Communicable Disease Surveillance & Response (CSR) WHO Western Pacific Regional Office (WPRO)