Avian Flu - The Next Pandemic? Seminar

AVIAN INFLUENZA (BIRD FLU) – THE NEXT PANDEMIC?

SUMMARY OF SEMINAR PAPERS

Soundings Theatre, Te Papa, Wellington

1 November 2005, 1.00-5.00pm

AS/NZS 4360:2004 Risk Management: A Framework for Managing New Zealand’s Exposure to the Current Avian Influenza and Pandemic Risks

Roger Estall, NZ Society for Risk Management and Seminar Chairman

To discuss the framework for managing New Zealand’s risk for a global pandemic.

Mutation of current bird flu virus has probability between 0 and 1 as an event with potential to cause pandemic.

Considerable attention of risks but are they being managed effectively?

AS/NZS 4360:2004 codifies contemporary best risk management practice.

Papers in seminar have been chosen to improve understanding and knowledge of pandemic and bird flu risks, to understand how organisations are approaching the problem and to allow participations to challenge and critique the risk management approach being taken.

The Risk Management Context - DESC System

Pat Helm, Department of Prime Minister and Cabinet

Like many complex risks pandemic flu is low in probability and high in consequence.

Considerable uncertainties of likelihood and potential consequences if it occurs. New Zealand would be operating in unfamiliar territory if it happened because of a lack of recent experience in managing a large crisis.

Recommended two years ago that managing bird flu threat needed intensive government leadership.

The DESC system – Domestic and External Security Co-ordination – headed by Cabinet Committee of Prime Minister and relevant ministers and close engagement of the heads of relevant government departments and advisors. They assess information about crisis and set responsibility of a particular lead department i.e. Ministry of Health and supported by other government agencies.

DESC is a high-level collective decision-making arrangement with full power to act so decisions can be made, resources allocated and responses implemented quickly.

Whole of Government risk management system concentrates on four fundamental points in planning for management of H5N1 outbreak:

Government taking a precautionary approach in preparation for a possible H5N1 outbreak because of serious potential consequences but there is no pandemic at present and there may not be one.

A pandemic in NZ is neither inevitable nor apocalyptic even though human version of virus could cause most serious global crisis ever.

Spread and possible impacts of a pandemic could happen in different ways with a broad range of outcomes. Well-targeted mitigation measures coupled with the right community responses could moderate the virulence and total national impact.

NZ has geographical and strategic advantages for blocking, containing, controlling and surviving a global pandemic.

The Context – Influenza Pandemics

Steve Brazier, National Co-ordinator – Pandemic Planning, Ministry of Health

The problem - what is influenza?

Pandemic influenza is different

20th Century pandemics

Potential impacts of pandemic in 2005

Pandemic Planning in NZ

IPG planning groups

Interagency Pandemic Group (IPG)

Interagency Pandemic Group (PG)

MOH Planning

NZ Influenza Pandemic Plan outline

Aims and responses

current phase: Plan for it. Potential duration – ongoing.

pandemic overseas: Keep it out. Potential duration: >6 months

cluster/s in New Zealand: Stamp it out. Potential duration: weeks – months.

pandemic in New Zealand. Manage it. Potential duration: weeks – 2 months

The overall objective during these phases.

Aim and responses – pandemic ending: Recover from it. Potential duration: months.

The aim during all phases – To protect and Maintain Critical Services and Functions

Context and Summary of some key strategies.

NZ Society in 1918 and 2005: A Selective Contrast of Some Social and Economic Differences

Tony Fenwick, Ministry of Economic Development

Comparative look at some of the key differences in social and economic conditions in New Zealand between 1918 and 2005. For example, in terms of social differences, protection (medication and personal protective equipment) included suspect quality vaccines and relatively poor quality housing in 1918 while in 2005 we have improved medication and housing and a greater awareness of basic hygiene practices as well as affordable personal protective equipment.

Possible Economic Impacts of a Pandemic

Tony Fenwick, Ministry of Economic Development

For the purposes of this discussion a relatively severe pandemic has been assumed. But the following suggests some of the issues that might arise in evaluating the possible impact on New Zealand:

Frame of analysis – possibly based on measured GDP and value of lives lost

The dynamics – Phase I: anticipatory behaviour. Phase II: Onset of pandemic. Phase III: Recovery. Phase IV: Long-run implications

Overall: significant adverse developments likely, but offset to some extent by some self-correcting factors over time.

Areas to focus on (to keep society going).

The costs to society, and the private costs, of a pandemic can be minimised by good business continuity planning.

Current Risk Controls – Health

Andrea Forde, Acting Director of Public Health, Ministry of Health

Possible Public Health Interventions: isolation of sick and quarantine of exposed, contact tracing, restriction of gatherings and internal travel, closure of schools and educational institutions.

Medical advice: directed at community, workplaces, households and families; plan and prepare; personal hygiene; infection control measures; home nursing.

Antivirals

Tamiflu

Treatment

Prophylaxis vs Treatment and Prophylaxis itself

Supply situation

Usage policy under development

Sequential antiviral usage policy

Consider: have we missed a critical service and how critical is this service?

Vaccine: Ministry looking to obtain sufficient vaccine for the NZ population i.e. 8 million doses.

Rapid systems for administering antivirals and vaccine: not yet attempted on such a large scale in real time in NZ

Effectiveness: antivirals, vaccine, infection control measures and public health interventions

Moving the Public from Awareness to Preparedness

Gerry Morris, Managing Director, Morris Communications

The last five years has seen some of more horrific disasters across the world with terrorist bombings, tsunami, earthquakes, hurricanes and flooding being televised almost as it occurs. The rising concern of pandemic flu is the latest event to spark concern, particularly as such events can happen with little warning and cause massive devastation.

Strategic issues in relation to preparing for an emergency

Media Research in October 2005 showed advertisers are not always using consumers’ favourite media and consumers believe that broadcast media conveys information and leads to action … but it can become background “noise”

Civil Defence Messages Buried but need to be addressed. For example, don’t think if, thin when, an emergency survival kit is a must, be prepared at work.

Successful campaigns raise questions in the minds of their audience and offer fairly simple answers at an appropriate delivery point for best effect. Understanding your audience is vital and there is a need to communicate credible reasons why.

The ideal message translates and manipulates information about the hazard making it accessible while always ensuring that information is consistent and clearly explained including specifying who is at risk.

What changes public behaviour – some examples: Wellington Waterfront ‘Stop the Wall’, NZ Fire Service Commission ‘Home Safe Home’, Hokitika Wildfoods Festival ‘Not Bigger, Just Better’.

Summary – Avian flu not yet tangible for New Zealanders and danger point unclear, credibility resulting from hyped issues like Y2K needs overcoming, pandemics rated well down civil defence priorities, moving community from awareness to preparedness is complex and resource-hungry.

Risk Communications – Infection Control

Suzanne Miller, Capital and Coast District Health Board

Samples of the Capital and Coast District Health Board infection control leaflets and posters displayed during the seminar

The Double Whammy – What If…

Mike O’Leary, Ministry of Civil Defence and Emergency Management

What if there is a major civil defence event (i.e. earthquake) or major incident at the site next door during a pandemic when there are too few people to respond?

What is the “double whammy” – that a civil defence emergency occurs at the same time as a pandemic.

Co-existing emergencies and what the risk is.

Ministry of Civil Defence and Emergency Management role in a pandemic – direct control and co-ordinate.

CDEM planning assumptions – shutting down is not an option, society must be maintained as close as possible to normal, at peaks there is no cavalry coming.

Current Risk Controls

John Ladd, Manager Business Development unit, Customs

Overview – planning, border management and decision making.

Border working group:

Members: Customs, Health, MAF, Immigration New Zealand, Auckland DHB, Defence, Transport, Maritime NZ, CAA, DPMC, Aviation Security, Tourism, MFAT, Police.

Objectives: identify possible border responses, develop a flexible suite of responses, identify decision making processes, logistical issues, legislative considerations and costs and implications, identify trigger points and responsible agencies.

Border management goals and implementation

Decision making key issues and advice for Ministers.

Airports issues and considerations in the event of a pandemic

Plans for recommencement and Quarantine issues and considerations

Marine environment issues and considerations

Work plan: identification of border management options, development of policy, briefings, planning for table top exercises at airports, development of “tool kits” for airports and ports and development of quarantine plans.

Pandemic Influenza – Will the Health Sector Cope

Dr Will Patterson, Professional Medical Adviser, Auckland Regional Public Health Service

WHO is lead agency to co-ordinate international response to pandemic influenza. Updated Global Influenza Preparedness Plan has strategic framework of six action phases.

Flurry of planning activity and daily media coverage of bird flu had generated fears of human pandemic, however, direct health risk is very low. Bird flu virus has been around since 1997 and remains one that is exceptionally difficult to transit to humans.

Not possible to predict timing, source or potential consequences of next influenza pandemic but planning is based on knowledge of previous pandemics, their spread and how they affected populations.

Risk communication is an essential element of pandemic planning and preparedness. The consequences of getting this wrong is an over sensitised public may loose confidence in the ability of health and other sectors to cope with a pandemic situation regardless of its severity.

Pandemic preparedness should be evidence based. Keeping pandemic influenza out of New Zealand and stamping it out are ambitious goals. Perhaps more important are effective screening and infection control capacities.

Health planners require accurate intelligence to guide them through any response to an emerging pandemic.

Operating Offshore and Conducting Business Travel in a Threatening Pandemic Environment

David White, International SOS

The presentation outlines who International SOS is and what their capabilities are specific to Global Crisis events.

Avian flu and pandemic preparedness – The problem: no-one knows when another influenza pandemic will occur nor which flu virus will be responsible.

Taking Care of People

Kristin Hoskin, Kestrel Group Ltd

Personal preparedness is key to the business continuity of any organisation in an emergency. In preparing for an AVI outbreak, the focus is likely to be on an organisations ability to function through the use of robust plans.

Often it is assumed that staff will be available to implement these plans.

The performance of an organisation in an emergency becomes reliant on staff resilience.

Encouraging staff to make personal plans for such events should be an extension of organisational planning for AVI and all emergencies.

Developing and Implementing Risk Reduction and Risk Treatment Plans

Dave Brunsden, Kestrel Group Ltd

Once the information on the context of an Avian Influenza pandemic is gathered, the likelihood and consequence appreciated, risks identified and analysed, treatment options development … how should this all be drawn together into a focused and effective plan?

The plan must cover preventative measures as well as response arrangements, and outline an interactive and ongoing process that can respond dynamically to unfolding circumstances.

This paper outlines the considerations in compiling an organisation-specific plan. Reference is made to the framework outlined in Appendix 4 of the Government’s Influenza Pandemic Planning: Business Continuity Planning Guide.

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