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What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
What does a pandemic look like? – Dr Graham Tallis
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What does a pandemic look like? – Dr Graham Tallis

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For more information see http://www.cba.org.uk/featured/pandemic-training-helps-bridge-the-gap-between-broadcasters-and-health-sector/

For more information see http://www.cba.org.uk/featured/pandemic-training-helps-bridge-the-gap-between-broadcasters-and-health-sector/

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  • 1. Pandemic Preparedness:What does a pandemic look like?Dr Graham TallisWHO Indonesia
  • 2. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Outline of PresentationWhy influenza pandemics occurCurrent pandemic threatsThe International Health Regulations and WHOPandemic Preparedness FrameworkResponding to a pandemicCommunication in a pandemic
  • 3. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Why influenza pandemics occurA pandemic is a global infectious disease outbreak
  • 4. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013The Pandemic ThreatThe Pandemic Threat
  • 5. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Influenza Pandemics MortalityH1N1H2N2 H3N21918: “Spanish Flu”1957: “Asian Flu”1968: “Hong Kong Flu”40-50 million deaths1-4 million deaths1 million deaths“Pandemic H1N1 (2009)”>18, 000 deaths*H1N1* Only Laboratory Confirmed
  • 6. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013What will happen during an influenza pandemic? Perhaps 2-3 waves, each lasting about 2-3 months Mortality impact greatest in vulnerable populations– Risk factors: overcrowding, malnutrition, poor access to healthcare, HIV– Can be reduced through known interventions: adequate pneumonia case management with antibiotics vitamin A supplementation antivirals if indicated and available Vaccines to prevent infection – takes time to develop
  • 7. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013What will happen during a pandemic?Heavy burden on health care facilities– Increased febrile respiratory illness (hard to distinguish fromother common illnesses)– Increased non-severe and severe pneumonia– Increased consumption of drugs (especially antibiotics) andsuppliesEconomic and social disruption– High workforce absenteeism, affecting critical governmentservicesThreats to Rule of Law and Security
  • 8. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Influenza A Virus – Some ScienceHemagglutinin (H)–16 subtypes(attachment, penetration)Neuraminidase (NA)–9 subtypes(release)8 viral genes(assembly, replication)M2 protein(penetration)Hemagglutinin (H)–16 subtypes(attachment, penetration)
  • 9. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Types of Influenza A•Many subtypes (16 H and 9N)•3 subtypes have causedhuman epidemics•H1N1•H2N2•H3N2•Subtypes that usuallyinfect birds but that havealso caused infections inhumans:H5, H7, and H9
  • 10. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Evolution of Influenza VirusesAntigenic Shift (Re-assortment)•A sudden shift in the antigenicity of a virus resulting fromthe recombination of the genomes of two viral strains.Antigenic shift occurs in HA and NA and is associated withpandemics.• No vaccine available but can be developpedAntigenic Drift (Mutation):•Viral genes are constantly mutating, producing new formsof antigens. Antigenic drift occurs in HA and NA, and isassociated with seasonal epidemics.• The reason flu vaccination needs to be updated everyyear
  • 11. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013How Human to Human Transmission Occurs
  • 12. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Current Influenza Pandemic ThreatsH5N1 and H7N9
  • 13. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013
  • 14. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013
  • 15. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013
  • 16. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013H7N9Completely new virus appeared in China in 2013Highly lethal in humans but not birdsHumans: 11 provinces in China and Taiwan– a total of 131 laboratory-confirmed cases of human infectionvirus have been reported.– 32 have died, and 44 have been discharged from hospital.– The majority of cases continue to have clinically severe illness.
  • 17. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Affected Provinces in China
  • 18. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013
  • 19. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013The International HealthRegulations and WHOPandemic PreparednessFramework
  • 20. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Emerging Diseases in Asia-Pacific
  • 21. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013The world is changing rapidly Population expansion Urbanization Increase in international travelSocial changes - New knowledge – New risks Rapid and widespread communication
  • 22. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013The International Health Regulations (2005) Established by negotiation between States Adopted at the World Health Assembly (2005)& legally binding on WHO’s Member States Entry into force on 15 June 2007– Voluntary early compliance – Avian Flu – 2006 WHA Five years to develop country core capacities
  • 23. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013PHEICMember States need to report any event that may constitutea “Public Health Emergency of International Concern”“an extraordinary event which constitutes a public health risk toother States through the international spread of disease andpotentially require a coordinated international response”– Relatively infrequent, determined by WHO (in consultation), resultsin global action– State actions under IHR more often based on lower thresholds– States report ‘potential PHEICs’ - lower threshold than actual PHEIC
  • 24. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013IHR - Event notification and determinationWHO DGVarious disease and event surveillancesystems within a countryNational IHRFocal PointsNational IHRFocal PointsWHO IHRContact PointsWHO IHRContact PointsEmergencyCommitteeOther competentOrganizations(IAEA etc.)Detect, verify,notify, respond tounexpected eventsCommunication channel:Notify WHO of potentialPHEICs, consult otherMinistries, feedbackinformation from WHOReceive, assess andrespond to eventsnotifiedMinistries/SectorsConcernedDetermine whether anevent constitutes aPHEIC andrecommend measuresExternaladviceCoordinateCommunicateReportReviewCommitteeWHO’sExpertRoster
  • 25. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013WHO Pandemic Phases
  • 26. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013The 2009 pandemic as a case study April 2009 outbreak of severe pneumonia in Mexico In USA, scientists identified North American and Eurasian swinelineages in this new influenza A(H1N1) virus This virus has never before circulated among humans and henceits pandemic potential While clinical presentations may be similar, this virus was notrelated to previous or current human seasonal influenza viruseswhich cause annual epidemics that peak during winter intemperate regions
  • 27. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Time Lines of Evolving Situation The first meeting of the WHO Emergency Committee was held on Saturday 25 April2009, involving 15 international experts. WHO Director-General determined that event constituted a public healthemergency of international concern (PHEIC), under the IHR. The Emergency Committee reconvened 27 April and raised the pandemic phase toFOUR DG WHO raised the pandemic phase to FIVE on 29 April Emergency Committee met on 5 June, and recommended no change in phase Following consultation with eight most affected Member States, further EC meetingheld on 11 June, and recommended conditions for a pandemic met DG WHO raised the pandemic phase to SIX the same day At an early stage, the pandemic was characterized globally as being moderate inseverity
  • 28. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Role of IHR in Pandemic (H1N1) 2009 Verification, reporting and notification of apotential pandemic event in April 2009 Joint pandemic risk assessment Determination of a Public Health Emergency ofInternational Concern (PHEIC) under the IHR(2005) Issuance of WHO recommended temporarymeasures Ongoing pandemic monitoring and informationsharing under the IHR framework
  • 29. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013IHR Temporary RecommendationsWHO recommended that all countriesintensify surveillancesurveillance for unusual outbreaksof influenza-like illness and severepneumoniaWHO also recommended– not to close borders AND restrict international travel– It was considered prudent for people who are ill to delayinternational travel and for people developing symptomsfollowing international travel to seek medical attention
  • 30. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Benefit and Value of New IHR IHR (2005) has been widely and well applied to the 2009pandemic response in a coordinated and collective way Proving to be a key framework for sharing information amongcountries and partners Timely notifications and reporting from countries have allowed– global and regional pandemic situation to be assessed and monitored– technical guidance to be developed in a timely manner
  • 31. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Report of the Review Committee on theFunctioning of the IHR on Pandemic InfluenzaSummary conclusion 1 The IHR helped make the world better prepared to cope with public healthemergencies. The core national and local capacities called for in the IHR are notyet fully operational and are not now on a path to timely implementation worldwide.Summary conclusion 2 WHO performed well in many ways during the pandemic, confronted systemicdifficulties and demonstrated some shortcomings. The Committee found noevidence of malfeasance.Summary conclusion 3 The world is ill-prepared to respond to a severe influenza pandemic or to anysimilarly global, sustained and threatening public health emergency. Beyondimplementation of core public health capacities called for in the IHR, globalpreparedness can be advanced through research, strengthened health-caredelivery systems, economic development in low- and middle-income countries andimproved health status.
  • 32. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Responding to a pandemic
  • 33. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Strategic actionsHealth sector strengtheningPublic health measuresPharmaceutical interventionsSurveillanceWhole of Society Approach for Pandemic PreparednessRisk Communication
  • 34. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Surge capacity in health care settings Protocols for the patients triaging (worried well) Protocols for patient testing and laboratory confirmation Infection control protocols– Protection of the health care workers– Protection of the other patients Training package for new staff Supply (PPE, soap, laboratory reagents, antiviral, antibiotics,antipyretic…) Reduction of excess mortality due to other causes
  • 35. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Public health measuresEg School closure Various measures: school closure, class dismissal, school entry screening Decision based on local assessment bearing in mind :– Timing; Before the spread of the disease, to reduce speed of transmission (7-14 days); When widespread community outbreak : because no teacher or no pupils/students– Consequences :; Work absenteeism of the parents; Less useful if kids gather somewhere else; Nutrition - Education loss Other examples: cancellation of public gatherings, isolation ofcases, quarantine of their contacts, social distancing
  • 36. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Pharmaceutical interventionsAntiviral medication (like tamiflu)Limits spread in population and shortens illness inindividualsVaccineTakes 4 – 6 months to be readyPrevents infection in most people
  • 37. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Surveillance1. Important for measuring progress of pandemic2. Identifying high risk groups to target control measures– Eg pregnant women in 2009 pandemic1. Measure impact of pandemic2. Develop laboratory diagnostic strategy to monitor viral changes
  • 38. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Potential impacts on Non Health SectorsPotential impacts on Non Health SectorsPandemic could infect 25 - 35% of World’s PopulationPandemic could infect 25 - 35% of World’s Population
  • 39. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013The Readiness Framework forWhole 0f Society Approach1. WHOLE-OF-SOCIETYAPPROACH3. CRITICALINTERDEPENDENCIES2.PREPAREDNESSAT ALLLEVELS4. SEVERITY-BASEDRESPONSE5. RESPECT FOR ETHICAL NORMS
  • 40. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Business Continuity PlanningBusiness Continuity Planning(Organizations, facilities, departments)(Organizations, facilities, departments)Step 2Identify your business’core services, essentialstaff and skillsStep 1Establish apandemic/contingencyplanning teamStep 3Plan for staff absencesConsider effects of supplyshortages, lack or excessdemand on operationsStep 4Step 5Identify &communicate criticalinterdependencieswith other sectorsStep 6Test your plan, revise itand know when toactivate and when tode-activate itMaintainMaintainessentialessentialservicesservicesBusinessBusinessContinuityContinuityDevelop measures formaintaining services(HR, IT, relocation, etc.)
  • 41. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Communication in apandemic
  • 42. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013What does risk communication do?Three paradigms:1. Low concern → increase concern, motivate them toappropriate action.2. Excessive alarm → diminish concern, deter themfrom unnecessary and harmful action.3. Justifiable concern→ harness and guide intoappropriate action
  • 43. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013People see things differentlyPublicPublic healthofficialsBacteria, virus, fungi,other microbesDiseaseSymptomsFeverCoughSore throatBody acheDiarrheaHard work,Stress,Getting wet inthe rain,Mosquitoes,Evil eye/Superstition
  • 44. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Risk Communication1. Trust – without trust, audience will not believe in,or act on, health information2. Announcing early – forms important firstimpression.3. Transparency – maintaining trust requirestransparency,4. Listening – to understand audience perceptionof risk5. Planning
  • 45. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013…All in a High-Pressure SituationLimitedtreatmentoptionsUncertain,rapidlyevolvingsituationProbably no vaccineMay not directlyreach all people withinterventionPolitical sensitivityEconomicimpactMultiple playersinvolved, each withown goals
  • 46. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Emergency Communication Demand Analysis further suggests it is not only workload that increases Emergency communication typically has unique characteristics:– Shift from national to international interest– Non-health media involvement– Economic consequences– Direct involvement of senior political actors
  • 47. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Bridging the gap between the mediaand public health experts: Regular health sector/WHO meetings with media helps both sides tounderstand the needs and constraints faced. During health emergencies, the health sector should have a spokesperson andensure regular briefings for the media and provide key technical points inwriting to ensure accuracy in reporting. The health sector should adopt the use the internet technologies to bridge theinformation gap in a fast-moving situation, (virtual press conferences, uploadlatest information on home pages, SMS alerts). Health sector should use social media proactively to disseminate healthmessages to the media, to local doctors and the public, particularly to countermisinformation. Media briefings should be in simple language to ensure their correctunderstanding.
  • 48. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Bridging the gap between the mediaand public health experts: Field visits set up by the health experts are extremely useful in demonstratingkey health issues and serve to enthuse journalists and also in providing themwith new and surprising angles for their stories. Where the health sector can provide video clips/video news release, it helpselectronic media to carry a story with ready visuals. Health organizations should add to the technical information with examplesand “human interest” stories to help the media and public relate to themessages emotionally as well as intellectually. There should be more training/public health courses for health journalists toprovide them with a greater understanding of public health issues.
  • 49. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013ConclusionsPandemics will occur, threats existPreparedness still neededResponding to a pandemic is multi sectoralCommunications is a vital component of a pandemicresponse
  • 50. Asian Media Summit Pandemic WorkshopManado Indonesia 28 May 2013Thank You

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