Avian Flu Diary: BMC Infect. Dis.: Pandemic Influenza Preparedness In The WHO African Region

Epidemics of the 21st Century Credit WHO

#13,684

Over the past (nearly) 14 years of this blog we've looked at scores of pandemic drills and exercises - and dozens of pandemic guidance documents - from all around the world, including:

CDC: 2018 Interim Guidance On Allocating & Targeting Pandemic Influenza Vaccine

CLADE X: Archived Video & Recap

CDC/HHS Community Pandemic Mitigation Plan - 2017

Community Pandemic Mitigation's Primary Goal : Flattening The Curve

ECDC: Guide To Revising The Influenza Pandemic Preparedness Plan

Hong Kong Holds Novel Flu Pandemic Exercise `Garnet'

NIOSH: Options To Maximize The Supply of Respirators During A Pandemic

UK: Updated Pandemic Response Plan & Exercise Cygnus

Despite this admirable attention to the pandemic threat, the consensus summed up last year by the World Bank remains intact; the World Remains Ill-Prepared For A Pandemic.

And the reasons are many, including that we don't know what form the next pandemic will take, how severe it will be, and whether (or how long until) a vaccine will be available.

Most of these plans recognize that we could be faced with unusual or unexpected situations, and while they may not directly address every scenario, they do provide a general framework which can be adapted as needed.

These plans also have something else in common. Most of them are created by, and designed for, developed countries; like the United States, the EU, UK, New Zealand, Australia, Japan, and Hong Kong.

For large swaths of the world - particularly in low resource countries - little or no pandemic planning appears to be in place.

And as has happened in previous pandemics, those regions with the least resources are likely to be the hardest hit (see Frontiers Cell & Inf Bio.: Lessons Learned From the 1918 Pandemic).

In a 2006 paper, "Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis" Christopher J.L. Murray, Alan D. Lopez, Brian Chin, Dennis Feehan, Kenneth H. Hill (Lancet 2006; 368:2211-2218) estimated that the Case Fatality rate in central India may have been 39 times higher than that of northern Europe.

The authors went on to predict that based on a 1918-like pandemic scenario, a future pandemic could claim as many 62 million lives, and that 96% of those deaths would occur in developing countries.

In 2012, a Paper: Are We Prepared For A Pandemic In Low Resource Communities? by Eric Starbuck DrPH, MPH et al., looked at the challenges (and provided some solutions) for helping low resource communities deal with an influenza pandemic which we revisited again last year.

One of the problems with global pandemic preparedness is we don't know how prepared - or unprepared - many nations really are. Which brings us to a new open access research paper that tries to evaluate the level of pandemic planning across 47 countries in the WHO African region.

Having a written plan does not guarantee a government's ability to implement an effective pandemic response, but it is the first - and arguably, most important - step.

And based on the following report, a lot of African nations appear to have a lot of work to do just to complete that first important step.

Pandemic influenza preparedness in the WHO African region: are we ready yet?

Evanson Z. Sambala,Tiwonge Kanyenda, Chinwe Juliana Iwu, Chidozie Declan Iwu, Anelisa Jaca and Charles S. Wiysonge

BMC Infectious Diseases201818:567

https://doi.org/10.1186/s12879-018-3466-1

© The Author(s). 2018
Received: 23 May 2018
Accepted: 31 October 2018
Published: 14 November 2018

Background

Prior to the 2009 pandemic H1N1, and the unprecedented outbreak of Highly Pathogenic Avian Influenza (HPAI) caused by the H5N1 virus, the World Health Organization (WHO) called upon its Member States to develop preparedness plans in response to a new pandemic in humans. The WHO Member States responded to this call by developing national pandemic plans in accordance with the International Health Regulations (IHR) to strengthen the capabilities of Member States to respond to different pandemic scenarios. In this study, we aim to evaluate the quality of the preparedness plans in the WHO African region since their inception in 2005.

Methods

A standard checklist with 61 binary indicators (“yes” or “no”) was used to assess the quality of the preparedness plans. The checklist was categorised across seven thematic areas of preparedness: preparation (16 indicators); coordination and partnership (5 indicators); risk communication (8 indicators); surveillance and monitoring (7 indicators); prevention and containment (10 indicators); case investigation and treatment (10 indicators) and ethical consideration (5 indicators). Four assessors independently scored the plans against the checklist.

Results

Of the 47 countries in the WHO African region, a total of 35 national pandemic plans were evaluated. The composite score for the completeness of the pandemic plans across the 35 countries was 36%.

Country-specific scores on each of the thematic indicators for pandemic plan completeness varied, ranging from 5% in Côte d’Ivoire to 79% in South Africa.

On average, preparation and risk communication scored 48%, respectively, while coordination and partnership scored the highest with an aggregate score of 49%. Surveillance and monitoring scored 34%, while prevention and containment scored 35%. Case investigation and treatment scored 25%, and ethical consideration scored the lowest of 14% across 35 countries.

Overall, our assessment shows that pandemic preparedness plans across the WHO African region are inadequate.

Conclusions

Moving forward, these plans must address the gaps identified in this study and demonstrate clarity in their goals that are achievable through drills, simulations and tabletop exercises.

(Continue . . . )

Understandably - for many of these countries - malaria, drought, civil insurgencies, food insecurity, and a host of other diseases of poverty and neglect are a far more pressing problem than any potential pandemic sometime down the road.

It is admittedly hard to worry about the creek rising when your house is on fire.

Equally concerning, but less understandable, is despite the obvious pandemic concerns of our own federal government, and others around the globe - local, state, and private sector preparedness for the next pandemic have languished for the past decade.

Many continue to rely on their initial 2006-2008 pandemic plan, and exercises and drills - once fairly common in the second half of the last decade - are rarely held today.

It's almost as if world has decided we had our pandemic in 2009, it wasn't so bad, and another one probably won't come around for another 30 years. It will happen - if it happens - on the next guy's watch.

The evidence, alas, doesn't support such a rosy outlook.

The first two decades of the 21st century have already been marred by a number of infectious disease epidemics, with 9 of 11 of those kicking off in the past 10 years.

SARS

H5N1

H1N1 Pandemic

Cholera in Haiti

MERS-CoV

H7N9 in China

Ebola In West Africa

Zika in the Americas

Yellow Fever in Central Africa/Brazil

Cholera In Yemen

Plague in Madagascar

Like it or not, our highly mobile and interdependent world of the 21st century is increasingly vulnerable to the effects of a severe pandemic (see WHO: On The Inevitability Of The Next Pandemic).

Two months ago, in JAMA: Osterholm Interview - Our Vulnerability To Pandemic Flu, we looked at some of the reasons why a future pandemic could equal or even exceed the toll of the Spanish flu of 100 years ago.

All reasons why, we - along with the rest of the world - need to find the foresight, fortitude, and political will to do something substantial to prepare before the next crisis strips us of that opportunity completely.

For more on pandemic planning and preparedness, you may wish to revisit: