Oct 23, 2008 (CIDRAP News) So far this year no new countries have been hit by H5N1 avian influenza outbreaks, and fewer previously affected countries have reported fresh outbreaks, but the threat of an influenza pandemic has not changed, according to a recent progress report from the United Nations (UN) and the World Bank.
The 115-page update on the global avian influenza status and pandemic planning efforts was released in advance of an international conference on avian and pandemic flu that starts tomorrow in Sharm el-Sheik, Egypt, according to the UN's summary of the report, the fourth in an annual series.
The report is an analysis of survey responses that the UN's influenza coordinator compiled from 148 countries. The findings also include information that the World Bank provided on the international pledges, commitments, and expenditures for avian influenza prevention and control.
Too little testing
David Nabarro, the UN's influenza coordinator, told reporters at an Oct 21 press conference that despite widespread pandemic planning efforts, only 53% of countries have tested their plans in the past year. He said in a UN press release that the findings are sobering, particularly in light of a recent World Bank report that put the potential economic cost of a global influenza pandemic at up to $3 trillion, nearly 5% of the world's gross domestic product.
"When planning for an extraordinary concern like an influenza pandemic, it's not enough just to have a written plan and have everybody signing off on it," he said in an Oct 21 press release. "You also have to check it, test it, and make sure that it works, and then revise [it] on the basis of assimilation."
Pandemic plans need to include both social distancing and pharmaceutical strategies, but not all countries are prepared to apply both strategies, the report said. Some haven't established the logistical and legal provisions needed to enact social distancing measures.
The UN said it found great disparities in preparedness among countries, with, for example, wealthier countries more likely to have planned for pharmaceutical interventions. "Given the interdependence of countries when responding to a pandemic, preparedness within poorer countries will be a critical element of the world's readiness for the next pandemic," the report said.
Also, some individual countries have made progress on plans to maintain essential services during a pandemic, but more nations need to engage the private sector to accomplish multisector planning. The UN recommended that for 2009, countries develop protocols, frameworks, and indicators for longer-term multisector pandemic preparedness and fund the efforts through their all-hazard preparedness mechanisms.
In response to reporters' questions about pandemic planning transparency, Nabarro said he's noticed more openness among some countries, such as China. However, he said he was concerned that interactions among countries were "sometimes a bit tense."
Outbreaks and surveillance
In reporting that no new countries had H5N1 outbreaks through September, the UN report said for comparison, four countries reported the virus for the first time in the first 6 months of 2007. Only 20 countries have experienced outbreaks so far this year, down from 25 reported in 2007.
Bangladesh is the only new country that has reported a human H5N1 case this year, according to the UN's findings.
Nabarro said he was concerned about Nigeria and Togo, which have both reported recent H5N1 outbreaks.
The UN said effective surveillance, prompt detection, and rapid response have helped many countries eliminate outbreaks. The report notes that surveillance for animal diseases, including H5N1, has substantially improved over the past 3 years, with 75% of countries not reporting that they are able to detect highly pathogenic avian flu. For some countries, though, surveillance systems are still in the planning phase, and some planning hasn't included risk assessments to target priority areas.
However, the threat of further outbreaks in poultry and sporadic infections in humans persists, because the H5N1 virus is still entrenched in many countries. "The threat of an influenza pandemic remains unchanged," the report said.
Funding is eroding
The World Bank reported that the gap between what's needed to control avian influenza and boost preparedness and what world donors are pledging has been increasing since 2005. Though major donor nations have continued their support, the number slipped from 25 at the Beijing donor's conference in 2006 to 17 at the Bamako conference in 2006, and to 9 at the New Delhi conference in 2007.
Donors have pledged $2.7 billion, of which $2 billion has been committed. Of that amount, $1.5 billion has been disbursed, of which 59% was cash or loans and 41% was in-kind contributions. Declines in funding threaten the sustainability of control and planning investments that have already been made, according to the report.
"Such high commitment and disbursement rates within two and a half years of the establishment of the financing framework reflect the exceptional commitment of the donors and the efficient movement of grant funds," the report said.
East and Southeast Asian countries received 56% of the funds, Eastern Europe and Central Asia received 22%, and Sub-Saharan Africa, the Middle East, and North Africa got 20%, according to the report. Only $125 million remains in available funding, the World Bank said. "Grant finance will continue to be needed to sustain critical capacities and actions in the medium to longer term."
UN-World Bank report on avian influenza and pandemic readiness
UN-World Bank report summary
Oct 21 UN press release