Emerging Viral Diseases The One Health Connection: Workshop Summary (2015) / Chapter Skim
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A5 Pandemic Preparedness and Response - Lessons from the H1N1 Influenza of 2009--Harvey V. Fineberg
A5 Pandemic Preparedness and Response - Lessons from the H1N1 Influenza of 2009--Harvey V. Fineberg
Pages 152-165
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From page 152... ...
. The committee secretariat was led by Nick Drager and included Dominique Metais, Faith McLellan, Mary Chamberland, Nadia Day, Alice Ghent, Sue Horsfall, Janet Kincaid, Phillip Lambach, Linda Larsson, Fabienne Maertens, Joan Ntabadde, Les Olson, Magdalena Rabini, Sarah Ramsay, Mick Reid, Chastine Rodriguez, Alexandra Rosado-Miguel, and Natasha Shapovalova.
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From page 153... ...
The 2009 H1N1 pandemic presented a public health emergency of uncertain scope, duration, and effect. The experience exposed strengths of the newly implemented IHR as well as a number of deficiencies and defects, including vulnerabilities in global, national, and local public health capacities; limitations of scientific knowledge; difficulties in decision making under conditions of uncertainty; complexities in international cooperation; and challenges in communication among experts, policymakers, and the public.
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From page 154... ...
On April 25, invoking its authority under the 2005 IHR, the WHO declared a public health emergency of international concern and convened the emergency committee called for in the regulations. The WHO also established a dedicated internal group to coordinate the response to the widening outbreaks.
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From page 155... ...
TABLE A5-1 World Health Organization (WHO) Pandemic-Phase Descriptions and Main Actions According to Phase Estimated Probability of Main Actions in Phase Pandemic Description Main Actions in Affected Countries Nonaffected Countries 1 Uncertain No animal influenza virus circulating Developing and implementing Same as in affected countries among animals has been reported to cause national pandemic-influenza infection in humans preparedness and response plans and harmonizing them with national emergency preparedness and response plans 2 Uncertain An animal influenza virus circulating in Same as phase 1 Same as phase 1 domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat 3 Uncertain An animal or human–animal influenza Same as phase 1 Same as phase 1 reassortant virus has caused sporadic cases or small clusters of disease in people but has not resulted in a level of human-to- human transmission sufficient to sustain community-level outbreaks 4 Medium to high Human-to-human transmission of an Rapid Containment Readiness for pandemic response animal or human–animal influenza reassortant virus that is able to sustain community-level outbreaks has been verified continued 155
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From page 156... ...
TABLE A5-1 Continued 156 Estimated Probability of Main Actions in Phase Pandemic Description Main Actions in Affected Countries Nonaffected Countries 5 High to certain The same identified virus has caused Pandemic response: each country Readiness for imminent sustained community-level outbreaks in at implements the actions called for in pandemic response least two countries in one WHO region its national plans 6 Pandemic in In addition to the criteria for phase 5, Same as phase 5 Same as phase 5 progress the same virus has caused sustained community-level outbreaks in at least one other country in another WHO region
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From page 157... ...
2005 International Health Regulations A number of provisions of the 2005 IHR proved helpful in dealing with the 2009 H1N1 pandemic. For example, the 2005 IHR established systematic approaches to surveillance, early-warning systems, and response in member states and promoted technical cooperation and sharing of logistic support.
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From page 158... ...
The 2005 IHR required, for the first time, that member states implementing unilateral measures that interfere with international traffic and trade inform the WHO and that they also provide a public health rationale and scientific justification for those measures. Most important, the 2005 IHR formally assigned to the WHO the authority to declare a public health emergency of international concern and take a leading role in the global response.
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From page 159... ...
The prospects of a pandemic depend on the transmissibility and virulence of the virus and on the susceptibility of the population, which may vary according to age and past exposure to influenza viruses. Although a catastrophic pandemic probably depends on the emergence of a new antigenic type of influenza virus, it does not follow that every newly emerging influenza virus will produce an especially severe burden of influenza.
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From page 160... ...
Similarly, the WHO kept confidential the identities of emergency-committee members convened under the provisions of the IHR, who would advise the WHO on the status of the emerging pandemic. Although the intent was to shield the experts from commercial or political influences, the effect was to stoke suspicions about the potential links between individual members of the emergency committee and industry (Flynn, 2010)
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From page 161... ...
Among the latter were variation among wealthier countries and manufacturers in their willingness to donate vaccine, concerns about liability, complex negotiations over legal agreements with both manufacturers and recipient countries, a lack of procedures to bypass national regulatory requirements for imported vaccine, and limited national and local capacities to transport, store, and administer vaccines. Some recipient countries thought that the WHO did not adequately explain that the liability provisions included in their recipient agreements were the same as the provisions accepted by purchasing countries.
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From page 162... ...
• Reinforce evidence-based decisions on international travel and trade • Ensure necessary authority and resources for all National Focal Points † • Strengthen the internal capacity of the WHO for sustained response • Improve practices for the appointment of an emergency committee • Revise pandemic-preparedness guidance • Develop and apply measures to assess the severity of a pandemic • Streamline the management of guidance documents • Develop and implement a strategic, organization-wide communications policy • Encourage advance agreements for vaccine distribution and delivery • Establish a more extensive public health reserve workforce globally • Create a contingency fund for public health emergencies • Reach an agreement on the sharing of viruses, access to vaccines, and other benefits • Pursue a comprehensive influenza research and evaluation program * The Event Information Site is a WHO website that, in the event of a pandemic, would serve as an authoritative resource to disseminate reliable, up-to-date, and readily accessible information related to the pandemic.
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From page 163... ...
In early 2013, the Food and Drug Administration approved the first trivalent influenza vaccine produced with the use of recombinant technology (FDA, 2013) , and other production methods are under active research and development.
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2013. FDA approves new seasonal influenza vaccine made using novel technology.
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2011b. Pandemic influenza preparedness framework for the sharing of influenza viruses and access to vaccines and other benefits.
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