Paper: Are We Prepared For A Pandemic In Low Resource Communities?

 

 

# 6713

 

One of the hard truths about pandemics is that they tend to disproportionately affect developing nations and low resource communities.

 

Back in 2006 we looked at a study that appeared in The Lancet that predicted, based on the 1918 pandemic experience, that a modern pandemic of similar virulence could claim 62 million lives, and that 96% of those deaths would occur in the developing world.

 

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918—20 pandemic: a quantitative analysis

Prof Christopher JL Murray DPhil , Prof Alan D Lopez PhD, Brian Chin ScB, Dennis Feehan AB , Prof Kenneth H Hill PhD

 

The authors cited as much as a 30-fold difference in mortality rates around the world in 1918. Countries in Asia, Latin America, and Sub-Saharan African were particularly hard hit.

 

Some of the reasons behind this disparity included.

 

• lack of access to adequate medical care
• weak public health infrastructures,
• housing conditions and population density
• nutritional status and
• co-existing medical conditions.

 

For the most part many of these conditions still persist, plus developed nations today are more likely to have earlier access to antibiotics, antivirals, and eventually vaccines. Leading the authors to write:

 

Interpretation

This analysis of the empirical record of the 1918—20 pandemic provides a plausible upper bound on pandemic mortality. Most deaths will occur in poor countries—ie, in societies whose scarce health resources are already stretched by existing health priorities.

 

 

A grim scenario, and part of the rationale behind the creation of a program called the H2P  (Humanitarian Pandemic Preparedness) Initiative geared towards promoting community & district-level pandemic flu preparedness and response in developing countries.

 

 

H2P (which began in 2007 & ended in 2010) was a joint effort by NGO’s and partner organizations, including USAID, IFRC, CORE Group (including American Red Cross, CARE, & Save the Children), AED, InterAction, & several UN agencies, including WHO, WFP, & UN OCHA.

 

During the 2009 pandemic I highlighted the H2P initiative’s efforts several times (see here, here, and here), and over the years have had occasional correspondence with Eric Starbuck at Save The Children, who was the H2P’s Public Health Advisor with the CORE Group.

 

I mention this past association because Eric is the lead author on a paper that appears today in the Journal Influenza and Other Respiratory Viruses, that looks at the challenges (and provides some solutions) for helping low resource communities deal with an influenza pandemic.

 

The full article is available online, and is well worth reading in its entirety. 

 

Are we prepared to help low-resource communities cope with a severe influenza pandemic?

Eric S. Starbuck, Rudolph von Bernuth, Kathryn Bolles, Jeanne Koepsell

Article first published online: 12 NOV 2012

Recent research involving lab-modified H5N1 influenza viruses with increased transmissibility and the ongoing evolution of the virus in nature should remind us of the continuing importance of preparedness for a severe influenza pandemic.

 

Current vaccine technology and antiviral supply remain inadequate, and in a severe pandemic, most low-resource communities will fail to receive adequate medical supplies.

 

However, with suitable guidance, these communities can take appropriate actions without substantial outside resources to reduce influenza transmission and care for the ill. Such guidance should be completed, and support provided to developing countries to adapt it for their settings and prepare for implementation.

View Full Article (HTML)     Get PDF (71K)

 

In regions where antivirals, antibiotics, and vaccines (and even basic nursing care) may be unavailable, the only realistic protection against an influenza pandemic is the implementation of NPIs (Non-Pharmaceutical Interventions). 

 

We’ve talked about NPIs many times before, but primarily in the context of a developed or industrialized community.

 

NPI’s and Influenza

Our First Line Of Defense

Study: Effectiveness of NPIs Against ILI's

 

As Eric and his team point out:

 

Nonpharmaceutical interventions (NPIs) to reduce influenza transmission at the household level may include keeping a distance from others, washing hands, covering one’s cough, and isolation of the ill.

 

However, several of these NPIs may not be very feasible in some settings, such as those with poor access to water or where many families live in small one-room dwellings.

 

Experience during the 2009 pandemic indicates that communication materials, such as those encouraging the practice of these NPIs, need to be adapted, tested, and approved for local use ahead of time. The absence of standardized, pretested messages was a challenge in 2009

 

A few samples of the type of guidance provided by H2P to low resource communities include:

 

 

The authors conclude:

 

We believe that detailed authoritative guidance for resource-poor settings on NPIs to reduce influenza transmission at community level in a severe pandemic should be developed.

 

In addition, support should be provided to governments in developing countries to adapt this and other important guidance to their settings and plan to roll it out if needed.

 

We are not aware of ongoing efforts of this kind, but believe that this should be an urgent priority. We are concerned about this apparent gap in the most basic kind of preparedness for a severe pandemic.

 

 

It doesn’t take a pandemic to put people living in low resource communities at greater risk. That happens every day.

 

Agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others are working around the world on a daily basis to combat poverty and disease, and are going to be on the front lines during any pandemic.

 

They could use your support.

 

These NGO’s do a great deal with very little, and even small donations can help make a difference.

 

A final note: For those curious about my mention in the acknowledgements section of this paper, I assure you my contribution was small, and unworthy of mention (but I’m appreciative, nonetheless). When asked, I suggested to Eric that the Journal Influenza and Other Respiratory Viruses might be interested in his paper.

Promoting Pandemic Preparedness In Resource Poor Nations

 

# 6027

 

 

With the release yesterday of the 2011 TFAH  report (see TFAH: 2011 Ready or Not Report) we are reminded of just how complex the problems are in protecting a nation during a natural disaster, pandemic, or bioterrorism attack.

 

Although total preparedness for a severe pandemic eludes even the richest of countries, there are many places in the world where pandemic preparedness barely exists at all.

 

In many regions antivirals, vaccines, antibiotics and professional medical care are scarce or unavailable altogether, and even the lack of soap and clean water can complicate the most basic of advice given during a pandemic; to wash your hands.

 

History has shown that resource poor nations are apt to suffer greater losses during a pandemic, although a lack of good record keeping has obscured the full impact.

 

While the overall fatality rate during the 1918 pandemic in the United States was estimated to be about 2.5% (and less than 1% in some northern European countries), in places like India and Asia some anecdotal reporting suggests as many as 10% of those infected died.

 

Agencies like the World Health Organization, USAID, and NGO’s like CARE and Save The Children are engaged in a daily battle against disease and poverty around the world. The already have to contend with the death and suffering caused by poverty, cholera, malaria, TB, HIV, and scores of other diseases. 

 

Adding a pandemic into this mix, even a `mild’ one, would undoubtedly stretch their resources even thinner  - and despite their best efforts – could potentially claim hundreds of thousands of lives around the world.

 

This reality has inspired agencies and NGOs to create initiatives like the H2P project – a three-year effort which ran from October 2007 through September 2010 - geared towards promoting community & district-level pandemic flu preparedness and response in developing countries.

 

That project came through the hard work of a number of NGO’s and partner organizations, including USAID, IFRC, CORE Group (including American Red Cross, CARE, & Save the Children), AED, InterAction, & several UN agencies, including WHO, WFP, & UN OCHA:

 

 

Recently, Rudolph von Bernuth, Director of Programmes at Save the Children International, addressed a UN/USAID conference in Rome where he warned of the dangers and challenges of inadequate pandemic preparedness in resource-poor populations.

 

You can read his entire speech at this link on Save the Children’s Avian & Pandemic Flu Updates & Guidelines webpage, but I’ve excerpted a small portion below:

 

 

We believe that it is important to look at preparedness from the perspective of the resource-poor districts and communities in which we work around the world, and ask:

 

What kind of actions is it realistic to hope that these communities and districts should be able take in response to a severe wave of pandemic flu?

 

What kind of support will these communities and districts need to take these actions?

 

Are developing country governments and organizations around the world prepared today to provide this kind of support?

 

We believe, that in a severe pandemic scenario, when all countries around the world, and all organizations responding to the pandemic, are themselves struck or preparing to be struck, that it is not realistic to hope that most resource-poor communities will receive substantial quantities of additional supplies like vaccine, anti-virals, or antibiotics.

 

 

In the face of these likely deficits in pharmacological supplies and assistance from outside sources, Save the Children is advocating:

 

. . .  the most important guidance includes that on non-pharmaceutical interventions (NPIs) to reduce flu transmission at household and community levels, along with guidance on home-based care of the ill.

 

Basic, but potentially lifesaving, interventions. 

 

Promoting pandemic preparedness in many resource poor nations has not been easy, or entirely successful, as internal resistance and donor constraints have limited what they can do.

 

But the threat of a severe pandemic has not diminished, and when one comes - ready or not – the world will have to deal with it.

 

And in many places around the world, much of that burden will be shouldered by NGOs.

 

 

As this is the time of year when many people give thought to making gifts or donations to worthy causes, I hope you’ll indulge my mentioning that agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others are working around the world to combat poverty and disease, and are on the front lines every day.

They could use your support.

These NGO’s do a great deal with very little, and even small donations can help make a difference.   You can find their websites and blogs in my sidebar.

Nov 2nd Is World Pneumonia Day

 

 

 

# 3923

 

Tomorrow, Monday November 2nd, is the first annual World Pneumonia Day which seeks to increase greater awareness and response to a treatable disease that kills 2 million children every year.

 

Pneumonia, as a cause of death in children, has largely been defeated in the developed world with the help of antibiotics and vaccines such as the Hib (Haemophilus influenzae type b) and Pneumococcal conjugate vaccines.

 

But in developing countries around the world, pneumonia continues to take a terrible toll.

 

 

 

WorldPneumoniaday.org brings together an impressive coalition of partners. 

 

The World Pneumonia Day Coalition is comprised of over 50 organizations including international NGO’s, faith-based groups, academic and medical institutions, professional societies, charitable and advocacy groups and developing country organizations. The Coalition receives technical support from the Centers for Disease Control and Unicef. We welcome new members.

If your organization would like to join the Global Coalition Against Pneumonia: Click here.

 

There are a variety of social media  tools, videos, and resources available on the WorldPneumoniaday.org  website.

 

Buttons: Use some of these button templates to make your own button to wear on November 2 and spread the word about World Pneumonia Day.

Fact Sheets and Key Messages: Use these quick and easy information sheets to learn more about who pneumonia is affecting and how we can stop it.  These facts are great things to tell friends, post on your blog, tweet on twitter or put on your social networking profile.

Logos and Flyers: Use one of our logos on your blog or facebook page!  We’ve got a great flyer about wearing blue jeans on November 2.  Pass it around to your office!

Maps & Other Links: These maps show the global disease burden and where life-saving vaccines are available.  These are fabulous visual references to show the global impact of pneumonia and vaccines.

Ressources en Français: Key messages about the disease burden, prevention, protection and treatment in French.  Also, for francphone countries, we have the the World Pneumonia Day Logo in French.

Slides: Find ideas and tips for commemorating World Pneumonia Day, and learn about the activities other countries are planning

Videos: These short video clips are great advocacy and education tools.  Pass them around to friends, family and colleagues.

Web Banner Ads: Show your support for World Pneumonia Day by installing one of our advertisements to your Web site, blog, or social networking profile.

 

Another great resource can be found at Save The Children, which is a coalition partner in World Pneumonia Day.   

 

 

You can do your part, by donating to any of the agencies around the world working to help eradicate this treatable scourge in children, such as CARE, SAVE THE CHILDREN, or UNICEF.

 

You can also show your support by using the social media tools to spread awareness.