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Washington Global Health Alliance Discovery Series

Washington Global Health Alliance Discovery Series

Supamit Chinsuttiwat
May 22, 2008
'Response to Avian Influenza and Preparedness for Pandemic Influenza: Thailand's Experience'

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  • It’s my pleasure and honor to give a talk at Washington Global Health Alliance at University of Washington, under coordination and support of several sponsors including Bill and Malinda Gates Foundation and PATH, a leading non-profit organization in global health. Seattle and the State of Washington should be proud of PATH and outstanding asset, and I am proud to be a member of PATH. In a hour, I will be sharing Thailand’s experience in our response to avian influenza and preparedness planning for pandemic influenza that might follow as the consequence of the emergence of avian influenza.

WGHA Discovery Series: Supamit Chinsuttiwat WGHA Discovery Series: Supamit Chinsuttiwat Presentation Transcript

  • Thailand’s Experience in Avian Influenza Response and Pandemic Influenza Preparedness Supamit Chunsuttiwat Ministry of Public Health, Thailand 22 May 2008
  • Thailand
    • Area : 198,114 square miles, the size of the state of Texas .  
    • Population (as of 2003):
    • 64.2 million, about 8 million live in the capital city of Bangkok
    • Ethnics: Thai (80%), Chinese (10%), Malay (3%), the rest - minorities (Mons, Khmers, hill tribes)
    • Religions : Buddhism 95 % of population
    • Languages : Thai
    • Climate : warm and humid
    Bangkok . Cambodia Vietnam Laos China Myanmar Malaysia
    • Influenza viruses are common in mammals (eg. pigs, horses, seals, whales, birds and humans). Types A (of several subtypes), B and C.
    • Birds are important reservoirs of influenza viruses. Type A: 16 subtypes, highly pathogenicity (HPAI) and low pathogenicity (LPAI), where as in humans: Types A ( H1N1, H3N2) and B.
    • Avian influenza infections in humans since 1996 are caused by viruses H5N1, H9N2, H7N7, H7N3, H7N2.
    • H5N1 was first seen in Hong Kong in 1997, highly pathogenic in poultry and high fatality in humans.
    Avian influenza
  • Avian Influenza in Humans (As of 2 April 2004)
    • Year Area Cases/Deaths Subtype
    • 1997 Hong Kong 18/6 H5N1
    • 1999 Hong Kong 2/0 H9N2
    • 2003 Hong Kong 2/1 H5N1
    • 2003 Hong Kong 1/0 H9N2
    • 2003 Netherlands 86/1 H7N7
    • 2004 Vietnam 22/15 H5N1
    • 2004 Thailand 12/8 H5N1
    • Canada 2/0 H7N3
    • USA 2/0 H7N2
  • 2007 Total: 61 countries reporting infections in poultry and wild birds since 2003 28 countries in 2008 2004 2005 2006
  • Total human infections: 382 cases 241 deaths In 14 countries (30 April 08)
  • Reported human H5N1 infections 2003-2008 Source: WHO, as of 30 April 2008 241 382 24 31 59 88 79 115 43 98 32 46 4 4 Total 52 106 5 5 5 8 0 0 19 61 20 29 3 3 Vietnam 4 12 0 0 0 0 4 12 0 0 0 0 0 0 Turkey 17 25 0 0 0 0 3 3 2 5 12 17 0 0 Thailand 1 3 0 0 1 3 0 0 0 0 0 0 0 0 Pakistan 0 1 0 0 0 1 0 0 0 0 0 0 0 0 Myanmar 1 1 0 0 1 1 0 0 0 0 0 0 0 0 Nigeria 2 2 0 0 2 2 0 0 0 0 0 0 0 0 Laos 2 3 0 0 0 0 2 3 0 0 0 0 0 0 Iraq 108 133 13 16 37 42 45 55 13 20 0 0 0 0 Indonesia 22 50 3 7 9 25 10 18 0 0 0 0 0 0 Egypt 0 1 0 0 0 0 0 1 0 0 0 0 0 0 Djibouti 20 30 3 3 3 5 8 13 5 8 0 0 1 1 China 7 7 0 0 1 1 2 2 4 4 0 0 0 0 Cambodia 5 8 0 0 0 0 5 8 0 0 0 0 0 0 Azerbaijan D C D C D C D C D C D C D C Total 2008 2007 2006 2005 2004 2003 Country
  • Sources : UNSIC & World Bank
  • Progress of global AI control
    • S ubstantial progress has been made in the initial ( emergency ) phase of the global response to Highly Pathogenic Influenza (HPAI ) and threats to public health.
    • C apacity to respond to (HPAI ) infection in poultry has improved.
    • Outbreaks are being detected more rapidly and the response is more effective. However, animal health services are still sub-standard in most countries ใ
    • T here has been an improvement in human influenza virus diagnostic and surveillance capacity globally. However, capacity varies significantly and is considered to be insufficient in a number of countries , particularly in Africa.
    • A n increase in the number of countries reporting that they are planning for pandemi c. Only a small proportion of preparedness plans focuses on sectors other than health .
    Source : Third UNSIC and World Bank Global Progress Report , 2007
  • Migratory bird flyways East Atlantic flyway East Atlantic flyway
  •  
  • Sector 1: Industrial integrated system; high level biosecurity Sector 2; Semi-vertical integrated system ; moderate biosecurity Sector 3: Small commercial poultry production; low biosecurity Sector 4: Village or backyard poultry ; no biosecurity
  • Source: BOE, MOPH Confirmed case Suspect case Maps of poultry outbreaks and human cases in 2004 Area of outbreak in poultry First round (Jan-May 2004) Second round (Jun-Oct 2004) 13 Dec 04
  • Initial responses in 2004 Government took the lead
    • Stated government policy on AI:
      • To take AI as a national agenda
      • To uphold transparency in management and report
      • To seek multi-sector and international cooperation
    • Provided financial support, esp. compensation for culled poultry
    • Appointed National Committee on Avian Influenza Control (and Pandemic Influenza Preparedness) chaired by Dep. PM
    • Initiated regional consultation: ASEAN +3 Avian Influenza Summit in April 2004 in Bangkok
    27 Mar 08
  • Government DLD/ Min.of Agric. Ministry of Public Health Private sector Other ministries Multi-sector AI response coordination at national level 27 March 2008 National Committee on AI response & PI preparedness MOPH AI operation center DLD AI operation center Government AI operation center Strategy WG
  • National Committee on AI Response & Pandemic Influenza Preparedness The Government Anim. 27 Mar 08 1 st Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2005-2007) 2 nd Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2008-2010)
  • Immediate response to AI outbreak: Stamping out infected poultry DLD
    • Routine surveillance
    • Passive report by owners and volunteers
    • Periodic active search in the community
    • Stamping out
    • Culling of infected flocks, followed by active surveillance, plus 30 days of movement control in 10 km radius
    • X-ray” campaign
    • Countrywide door-to-door search & culling diseased flocks 2 round/year
    • Poultry vaccination is not allowed.
    Poultry surveillance and control 30 Nov 07
  • Cleansing & disinfection campaign Targeting previously affected areas following “x-ray” campaign
  • Control of poultry movement
    • Zoning & compartmentali-sation of poultry farms
    • Movement of birds among zones and compartments is not allowed without certification of negative testing.
    • Industry farms
    • Promote EVAP – system, improve slaughter-houses to standard
    • Small farms
    • Improvement of poultry housing, integrate poultry raising
    • Backyard chicken
    • Promote building pens, use of nets, segregation from living quarters
    • Free ranging duck
    • Promote farming system with support loan a and allocate land for duck housing
    • Establish cooperatives of duck raising farmers
    Enhanced farm biosecurity -1 30 Nov 07
    • Fighting cocks
    • Registration of fighting cocks, ID (passport) issued.
    • Monitoring fighting cock every 2 months
    • Improvement of biosecurity in fighting arenas and gathering places
    Enhanced farm biosecurity - 2 30 Nov 07
  • Distribution of AI in poultry and human cases, 2004-2007 Fujian-like virus (clade 2) in Nakornpanom Province, while all the rest is Vietnam-like virus (clade 1) 22 May08 Total 27 cases/ 17 deaths during 2004-2007, Since Jan 2008: 2 confirmed poultry outbreaks, no human infection found. Jan-May 04 Jun-Oct 04 Jul-Nov 05 Jan-Nov 07 Jun-Aug 06 Confirmed case Suspect case Poultry outbreak
  • AI outbreaks in poultry 2004-2005 Continuous decline in outbreaks and losses during 2006 – 2007, minimal in 2008 27 Mar 08 0. 417 M 3 M 30 M Number culled 5/2 5/4 12/8 Human case ( cases/deaths) 76% 58% 63% Backyard poultry ~0.18 M ~ 5 M ~ 130 M Compensation cost (USD) 55 784 ~ 890 Sub-district s 11 51 42 Provinces 75 1,539 190 Cases (No. flocks) 3 rd round 2005 2 nd round 2004 1 st round 2004 Indicators
  • PM’s move to ease public concern on food safety in 2007
  • Protection of high-risk groups Case management and infection control Infected wild and migratory birds Infected poultry Risk communication for the public Man Disease Surveillance Surveillance on infection Outbreak control in poultry (under DLD supervision) AI control strategies in animals and humans 30 Nov 07
  • Routine disease surveillance Since 1970s Epidemiologic surveillance Laboratory investigations 60 reportable Diseases (by report 506) Influenza & pneumonia surveillance Opportunity for surveillance improvement SARS Surveillance 2003 Syndrome and history of contact Avian flu Surveillance since 2004 Syndrome (ILI), history of contact, lab.tests Report system strengthening
  • MOPH Routine disease reporting system 65% of influenza and 90% of pneumonia cases are reported from hospitals 76 Provincial Health Offices Report 506 Aggregated in e-files Report 506 > 100 General hospitals & medical centers Report 506 > 800 Community hospitals Through district health offices Report 506 > 9000 Health centers Report 506 Private clinics Private hospitals Feed back in weekly and annual reports in publication and on internet websites
  • Surveillance and Rapid Response Team (SRRTs)
    • Roles:
    • Surveillance
    • Outbreak investigation
    • Initial disease control
    • Risk communication
    Central & Regional SRRTs Over 1000 SRRTs established 3 Mar 06 Village Health Volunteers & Community Leaders District SRRTs Provincial SRRTs Sub-district Health Centers
  • Specimen collection Autopsy / necropsy Environment investigation Community investigation SRRT Investigation of avian influenza cases
    • Specimen collection
    • Throat swab
    • NP swab/aspiration
    • Tracheal suction
    • Broncho-alv. lavage
    Indications: Influenza (clinical) Influenza-like illness Pneumonia (suspected of flu) Suspected avian flu
    • Quick tests at the hospitals
    • Supplied in early avian flu outbreaks
    • Later discontinued for poor validity and improved availability of conventional test.
    Laboratory investigation of avian influenza Conventional tests at lab. centers in network In viral transport media, immediate transport, under 2-8 C temperature
  • Conventional tests for influenza
    • Antigen/genome detections:
      • DFA
      • IFA
      • PCR (RT and real-time)
    • Antibody tests
      • ELISA
      • HI
      • Micro NT
    • Virus isolation & identification
    • Viral genome sequencing
    NIH/DMSc/ MOPH certified as WHO National Influenza Center (NIC) since 1972
  • 3 2 4 5 6 7 8 9 10 11 12 Influenza laboratory network
    • Dep. of Medical Science
    • WHO National Influ. Center
    • DMS lab. centers (12)
    • Mobile labs. (2)
    • Mahidol U. (Siriraj)
    • Mahidol U. (Ramathibodi)
    • Chulalongkorn U.
    • Chiangmai U.
    • Khonkaen U.
    • Songkhla U.
    • AFRIMS
    1
  • Population-based prospective influenza surveillance Sakeo Nakorn-panom
  • Case management & hospital infection control
    • Develop standard guidelines, train medical personnel on case management including application of triage, rational use of rapid test & antivirals, and hospital infection control
    • Improve hospitals infection control
      • Isolation rooms
      • Hand hygiene
      • PPE
    3 Mar 06
  • Notifiable and confirmed human AI cases in Thailand, 2004-2006 (as of 20 Jan 07) Notifiable cases Confirmed cases
    • Case characters
      • Cases: deaths 25 : 17
      • Male : Female 16 : 9
      • Children (<15): adol. & adult 12: 13
    • Risk factors:
      • Direct contact with sick or dead birds 15
      • Indirect contact with sick or dead birds 8
      • Close contact with cases 2
    200 400 600 800 1000 2004 2005 2006 Last: Aug 2006
  • Poultry husbandry practices of public health concern Fighting cocks fight! fight! my son. Fighting cocks Backyard Free-range ducks
    • Village health volunteers’ door-knocking campaign to provide risk communication
    • Hand washing and mask wearing campaigns
    • IEC through mass media eg:
      • Radio, TV, news papers
      • Brochures/ posters/ exhibitions
      • Call center / hotlines
      • Websites
    Risk communication & education 30 Nov 07
  • Roles of village health volunteers in AI control
    • Provide risk communication to the community
    • Assist in active disease detection – in animals & man
    • Participate in disease prevention and control activities in the community
    • Assist referrals of cases
    • Support SRRTs in operation
    30 Nov 07
  • Health volunteers & community leaders Coordination & support Missions Surveillance & control Diagnosis & treatment Hospital infection control Stockpiling and logistics Risk communication SRRTs 16 Nov 05 Organization of AI control and PIP at provincial level Local health Infra structure Mr Bird Flu
  • Health volunteers & community leaders SRRTs Mr Bird Flu Public health and animal health collaboration at provincial level 27 Mar 08 Livestock volunteers & community leaders District Livestock Officers & staff Prov. Livestock Officer Local health Infra structure Provincial committee Exchange & Cooperation Report Report Exchange & Cooperation
    • Chairs the Provincial Committee on Public Emergencies to coordinate preparedness & response
    • Commands local public authorities and coordinate multi-sector cooperation to ensure effective response to public emergencies / disasters, including avian influenza, disease epidemics and flu pandemic
    • Signs Provincial Orders (according to laws) to enforce disease control actions, eg. Closing of farms, schools; movement control; quarantine, etc.
    • Authorizes use of provincial contingency fund for emergency response
    27 Mar 08 Provincial Governors Provincial committee
  • Public health – animal health collaboration in avian flu surveillance Public Health Case detection at health services with the support of health volunteers Animal Health Poultry outbreak detection and Control by veterinary staff and volunteers Daily Exchange of information 27 Mar 08 info. on suspected poultry infection info. on affected areas Disease prevention and control in poultry Updated information Disease prevention and control in man Updated information
  • Public health - animal health cooperation for AI control
    • Information exchanges at central and provincial levels: websites, weekly reports, regular meetings
    • Joint outbreak investigations – both on human illnesses and animal outbreaks
    • Joint campaigns / press releases eg. Chinese New Year food safety campaign, National “X-ray” campaign for AI infection
    • Joint research &development
    • Expert groups and technical meetings
    • Sharing at national and provincial AI-PI committees
    • Veterinarians training in FETP
  • Social & economic impacts of AI
    • Health & life
    • Industry / jobs
    • Consumer confidence
    • Export of poultry products
    • Tourism
    • Country’s image
    Outbreak in a tiger zoo in 2007, 140 tigers put to sleep
  • 1. New influenza virus in animals low risk for human Path towards influenza pandemic… 10 Sep 06 2. High risk for human 3. Human infections, no or only inefficient man-to-man Tx 4. Increased man-to-man Tx, limited outbreak 5. Significant increase in man-to-man Tx, extended outbreak 6. Pandemic
  • 1 Aug 07 Avian Flu Pandemic Influenza
  • Source: WHO Influenza Pandemics in 20th Century 1918 Spanish Flu A(H1N1) 20 - 40 mill.deaths 1957 Asian Flu A(H2N2) 1- 4 mill.deaths Credit: US National Museum of Health and Medicine 1968 Hong Kong Flu A(H3N2) 1 - 4 mill.deaths
  • Past Influenza Pandemics observed 10-40 year cycles Is a new pandemic due / overdue? 1900 1850 1950 2000 1847 1889 1918 1957 1968 42 yrs 29 yrs 39 yrs 11 yrs
  • 30 Nov 07 Global cooperation for pandemic influenza preparedness Other regions preparedness SEA region preparedness National preparedness National preparedness National preparedness Thailand’s preparedness
  • FAO OIE Regional and international cooperation for AI and pandemic preparedness
    • Countries have taken preparedness and response to AI and pandemic influenza a priority national agenda. 144 countries have developed / are implementing national preparedness plans. Industrial countries provide financial support for international preparedness activities.
    • Regional forums -- APEC, ASEAN, EU have AI and pandemic influenza preparedness a major agenda.
    • International organizations such as UN, WHO, FAO, OIE are providing support to member countries to develop and implement their preparedness plans.
  • International funding for AI and pandemic preparedness
    • International Pledging Conference in Beijing, China, January 2006: 1,834 mill. USD
    • International Conference on AI and Pandemic Influenza, December 2006 in Bamako, Mali: 493 mill. USD , to support activities in Africa and the middle east
    • Ministerial meeting on AI and Pandemic Influenza, December 2007 in Delhi, India: 406 mill. USD
    • World Bank estimates additional 1200 mill. USD is need to support international preparedness in next few years.
    22 May 08 Beijing, China, 2006 Delhi, India 2007
    • Urges member states:
    • To continue support, strengthen and improve WHO Global Influenza Surveillance Network
    • To support and promote research into improvement of prevention, detection, diagnosis and management of influenza viral infection.
    • Requests the Director General:
    • To identify mechanisms to ensure fair and equitable sharing of benefits from virus sharing.
    • To establish international stockpile of H5N1 vaccine
    • To formulate mechanisms and guideline for fair and equitable distribution of pandemic influenza vaccine.
    60 th World Health Assembly May 2007 5 July 07
    • Mainly for rapid containment of pandemic at origin.
    • WHO-HQ, Geneva
    • WHO Regional Offices
    • ASEAN, Singapore
    International stockpiles of Oseltamivir 5 July 07 WHO Geneva PAHO EURO EMRO AFRO WPRO SEARO Sub-reg. Stockpile BKK
  • Estimated pandemic influenza impact in Thailand Deaths 260,000 deaths 65,000 Tremendous social and economic implications 16 Apr 05 Cases 6,500,000 Cases rate 10% CFR 1 % Cases 26,000,000 Case rate 40% CFR 1%
  • National Committee on AI Response & Pandemic Influenza Preparedness The Government Anim. 27 Mar 08 1 st Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2005-2007) 2nd Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2008-2010)
  • Pandemic influenza preparedness Multi-sector & international cooperation Surveillance in animals and man Safe animal husbandry Pandemic influenza Avian influenza 2nd Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2008-2010)
  • Private sector Public sector Essential service sector Energy, water supply, transportation, communication/IT, banking/financing, security, etc Health Multi-sectoral pandemic influenza preparedness 30 Nov 07
  • Pandemic preparedness strategies Modified from: David Nabarro at APEC-HMM, Sydney 8 June 2007 Risk communication Personal hygiene Travel restriction Social distancing Quarantine Security and rule of law Food and water supply Power supply Transportation Telecommunication Financial and banking Antivirals Vaccine, PPE Medical care 27 Mar 08 Non-medical / non-pharmaceutical Medical / Pharmaceutical Socio-economic, security and governence (to keep society running)
  • Risk com. and public Education Emergency response: Non-medical, medical Multi-sector & international cooperation Essential services/ business continuity planning Stockpiling and logistics Surveillance and control 30 Nov 07 Pandemic influenza preparedness strategies Expand on AI response Initiate and escalate
  • Stockpiling and logistics 3 Mar 06 Seasonal influenza vaccine For health personnel Personal ProtectionEquipment
  • Strategies toward pandemic vaccine access
    • Short term
    • Stockpiling of finished pandemic / pre-pandemic vaccine
    • Long term
    • Establishing capacity for development and production of pandemic vaccine
    • increasing use of seasonal influenza vaccine
    • Strengthening capacity for vaccine regulatory, logistics and delivery
  • Drive toward pandemic influenza vaccine capacity
    • 2005-2006, MOPH working group to study and plan pandemic influenza vaccine access
    • Early 2007, Thailand requested WHO support under GAP for development of pilot production of pandemic influenza vaccine.
    • Mid 2007, MOPH requested government support for establishing manufacture of influenza vaccine, the project approved May 2007
    • June 2008 MOPH will launch national influenza vaccination program, initially targeting the elderly with chronic diseases.
  • 21 Feb 08 Exercising the preparedness plans Hypothetical scenarios:
    • In-country pandemic origin
    • Cross-border introduction
  • Hypothetical scenario: (1) 30 Jan 06 Day 30
  • 30 Jan 06 Day 60 Hypothetical scenario: (2)
  • 30 Jan 06 Day 90 Hypothetical scenario: (3)
  • 30 Jan 06 Day 120 Hypothetical scenario: (4)
  • 30 Jan 06 Day 150 Hypothetical scenario: (5)
  • 30 Jan 06 Day 180 Hypothetical scenario: (6)
  • 30 Jan 06 Day 240 Hypothetical scenario: (7)
  • 30 Jan 06 Hypothetical scenario Epicurve of pandemic in Thailand
  • Pandemic build-up ; Early phase Ro = 2 Later stage Ro = 4 Narrow window of opportunity for containment 16 Nov 05
  • Exercises of pandemic influenza preparedness plans Central level Provincial level Service center level 7 Feb 05 Functional drills Table-top exercise
  • Hypothetical scenarios Hospitals overloaded Sick hospital staff Medical supply Shortage Sick students & teachers School closed Shortages of food and commodities Sick security forces Energy shortage Telecommunication interrupted Busses stopped
  • TTX in Nakorn-nayok
  • Tabletop exercises at provincial level
  • Tabletop exercises at MOPH Departments 27 Mar 08
  • Tabletop exercises at MOPH 27 Mar 08
  • Tabletop exercises on pandemic preparedness Started 2006 and to repeat annually 27 Mar 08 Started 2006 and to repeat annually Government To initiate ASAP Rachaburi province N.Nayok province Other provinces DMS DDC Other departments MOPH
  • AI control and pandemic influenza preparedness integrated in National Public Emergency Preparedness 27 Mar 08 National Strategic plan on Avian Influenza and Pandemic Influenza Preparedness National Committee on Avian Influenza Control and Pandemic Influenza Preparedness (chaired by Dep. PM) National policy on Public Emergency Preparedness 2005 National plan on Civil Public Emergency Preparedness National Public Emergency Preparedness Committee (chaired by PM) National Committee on Civil Public Emergency Preparedness (chaired by MOI)
  • Business continuity planning Businesses, industries, markets, department stores, hotels, travel & tourism, communications & IT, transportations, power plants, gas stations, water supply, banks, hospitals, etc.
    • Safety of staff
    • and owners
    • Continuation of
    • business during
    • pandemic
    • Cooperation with
    • public sector in
    • pandemic response
    • Rapid recovery
    • after pandemic
    Getting prepared 27 Mar 08
  • Private sector preparedness
  • Regional and international cooperation for AI and PIP APEC ASEAN+3 27 Mar 08 APEC ASEAN+3
    • C ollaboration among Mekhong Basin countries
    • Surveillance and information exchange
    • Personnel training
    • Laboratory investigations
    • Logistics support
    • Joint outbreak investigations
    • Other
    OIE FAO
  • Participation in regional exercises for pandemic preparedness
    • APEC Pandemic Response Exercise, June 2006
    • Mekhong Basin Countries Workshop on Pandemic Influenza Preparedness, Siemriep, Cambodia, March 2007
    • Workshop on Pandemic Influenza Preparedness, Yangon, Myanmar, early 2007
    • Public Health Safety Exercise, WHO, June 2008
    22 May 2008
  • What….if an influenza pandemic does not come in recent years? A waste of time and resources, a non-productive investment? On the contrary, it’s a most cost-beneficial investment: building of national capacity for future public emergency responses.
  • Preparedness for response to PHEs Botulism outbreak in Nan Province of northern Thailand in 2006, total 163 cases, after consumption of canned bamboo shoot, no death. Medical support moved in from other provinces and antitoxin shipped in from several countries.
  • Lessons from SARS, AI and other public health emergencies
    • An emerging infectious disease can cause extensive and profound social & economic and political impacts.
    • Efficient command, control and management are the foundation of successful response to emerging infectious diseases and public health emergencies.
    • Effective responses to EIDs and PHEs are based upon the strength of existing infrastructure and manpower.
    • Public confidence and cooperation is crucial and the media has important role in this area.
    • Inter-sector partnership and regional / international cooperation are essential.
    27 Mar 08
  • Problems & limitations encountered
    • Governments change – continuity of command, control and coordination to be guaranteed by active partners in all sectors
    • Differences in opinion and conflicts of interest among groups (eg. farmers, businesses, political groups) are common – to be settled with compromise, reconciliation
    • Continuous and sufficient concern and cooperation of partners are not easily obtained – to be ensured through persistent coordination, information exchange and education.
    • Manpower shortage persists which limits management efficiency – to be handled in immediate term by networking and in longer term by human resource development
    27 Mar 08
  • Conclusion
    • Thailand has been struggling to control and prevent H5N1 AI on animal health and public health fronts with continuous improvement. Infections in poultry are under control, no new human cases have been seen since August 2006.
    • In awareness of the risk of pandemic influenza, the country is joining global efforts in pandemic preparedness. National preparedness plan highlights national capacity for self-reliance and regional / international cooperation.
    • Effective AI response & pandemic preparedness rely on:
      • Government’s leadership and support
      • Strength of existing infrastructure and manpower
      • Extent and quality of multi-sector cooperation
      • Knowledge and understanding of partners & the public
    • Problems and limitations prevail and change with time, need to be continuously managed among partners, with perseverance, reconciliation and transparency.
    22 May 08
  • Thank You