Avian and Human Influenza (AHI): Review of the Consolidated Action Plan for Contributions of the UN System and Partners (UNCAPAHI)
The changing context for Avian Influenza response and Pandemic Preparedness
Two years ago we were working in a climate of widespread international concern about a potential pandemic, including unprecedented media coverage and political engagement. At the time, highly pathogenic avian influenza (HPAI) outbreaks in birds, caused by H5N1, had been reported by 17 countries (of which 13 countries in poultry); and 98 cases (43 deaths) of confirmed human H5N1 infection reported by 5 countries. As of today, 60 countries and territories have reported H5N1 HPAI outbreaks (of which 43 in poultry) and 12 countries reported 327 cases (200 deaths) of confirmed human H5N1 infections1. We are no more certain, now, about the H5N1 pandemic risk in the next 2-3 years than we were in 2005. Such uncertainty makes preparedness planning difficult - including the level of resources to commit, the nature of preparedness to be attained, and the best ways in which the issue can be communicated to those constituencies with an interested as well as to the general public- but vital given the potential scale of the pandemic's impact. Although the issue is now receiving a lower (and probably more appropriate) level of media coverage it still receives attention from political leaders the world over. Rightly so: the threat of an influenza pandemic is at least as great as it was in 2005. However political decisions about responses to HPAI and pandemic threats are now being made in a more measured and less pressured way and decision makers seek well-considered, evidence-based advice.
The context within which decisions are being made has changed in other ways too:
- In most countries HPAI outbreaks are rapidly stamped out; in others H5N1 has become entrenched in birds (enzootic) where there is no sustained and effective national response. Similarly, some countries are well prepared to detect, confirm and contain persons suspected of being infected with a potential pandemic influenza virus. Other countries have far to go. These differences reflect the ways in which veterinary and health services are governed, managed, and financed. External assistance has to take these national realities into account and to support the world's poorest communities in developing profitable livelihoods that do not place them or the global community at increased risk of emerging diseases.
- The coming into force of the International Health Regulations (2005) creates exciting new opportunities, the potential for combined action by countries in response to infectious disease threats and the joint engagement of veterinary and human health professionals on the epidemiology, pathology and molecular biology, therapy and immunology of emerging diseases.
- There is increasing involvement of sectors other than health (such as finance, food, tourism, environment, governance and humanitarian action) in getting ready to mitigate the community-level consequences of an influenza pandemic. The more local communities can be ready to avert, and (if necessary) tackle the humanitarian crises that would be associated with an influenza pandemic, the better: coordinated community actions are likely to determine the pandemic's impact on individuals.
- Nations are engaged together in a political response to these global threats in an unprecedented manner, often at very high level. There have been regular intergovernmental meetings (linked to the September 2005 International Partnership on Avian and Pandemic Influenza), substantial pledges of resources made for country, regional and global actions, and the adoption of common strategies. At the same time, national governments have invested substantial time and effort in negotiating the conditions under which information and virus samples are shared, and sought to ensure that they can benefit equitably from vaccines and diagnostic materials that are derived from them. These negotiations are expected to continue placing demands on UN systems' agencies.
Within this evolving context, agencies, funds and programmes are pursuing actions that are reflected in the UN system Consolidated Action Plan for Avian and Human Influenza (UNCAPAHI). They have linked up with government, voluntary, private sector, regional and international bodies. The emphasis has been on finding opportunities through which both the human and financial resources, and the time and energy invested in responses to HPAI and preparedness for the next influenza pandemic can yield a return far beyond a response to influenza-related threats. Strengthening surveillance and laboratory capacities, health infrastructures, humanitarian response capacity, public understanding and bio-safety will impact positively on the level of preparedness for, and response to, any kind of zoonotic diseases.
Experts convened by FAO, OIE , WHO and UNICEF met in Rome in June this year to review the strategies used to control HPAI and prepare for the next influenza pandemic. Are these strategies technically appropriate for the range of challenges now being addressed? Are they achieving the desired impact?
This Review of the UNCAPAHI takes its cue from the results of the Rome meeting, and - given the ever changing context within which we work - reports on the progress made by UN Systems' agencies and their partners in relation to the Action Plan's objectives. It asks "What impact has been achieved through the efforts of the UN system?". It pinpoints gaps in the current UN system response and shows ways in which the gaps will be filled, sometimes through changes in the agencies' activities. For example more attention will be given to pandemic preparedness by those who specialize in humanitarian action and by sectors other than health (objectives 6 and 7 of the Action Plan).
The review also describes the first months of the new Central Fund for Influenza Action (CFIA) and provides an overview of the financial situation of the 13 agencies, funds, programmes, coordinating bodies and partners who make up the Action Plan.
The way in which communities, nations and the world as a whole respond to the threats posed by infectious diseases in animals and humans will determine both the security of today's world and the fate of generations to come. The UN system, by working in synergy and responding to the needs of local, national and regional authorities, is seeking to make its contribution to this vital goal, and this review charts its progress.
UN System Senior Coordinator for
Avian and Human Influenza
(1) Sources OIE and WHO