A severe pandemic would harm health, economies, and communities in all countries, but especially in poor and fragile states. Pandemic prevention requires robust public health systems (veterinary and human) that collaborate to stop contagion promptly.
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March 5, 2013 -- In recent weeks, reports of H5N1 avian flu outbreaks have appeared in different corners of the globe, and the World Health Organization (WHO), and its sister organization, the World O... Show More +rganisation for Animal Health (OIE), are urging all countries to monitor a new coronavirus. Such news is a reminder that pandemics pose serious threats, and that preventing them should be a global health priority, according to World Bank health and agriculture experts.The world got a glimpse of the economic and human toll a serious pandemic could take in 2003, when the SARS outbreak was contained after it killed 800 of the 8,000 people infected. It cost the world $54 billion—an enormous price tag.The toll of the ongoing AIDS pandemic is also a sobering reminder of the high price of a contagion that was not detected and controlled early on. The most severe of the four flu pandemics in the last 100 years, the 1918 pandemic, killed between 50 million and 100 million people, out of a global population of 2 billion.Because a novel flu virus could infect 30-40% of all people, in a worst-case scenario, business and consumer confidence would plummet, worker absenteeism would rise sharply, and public services would falter, says Olga Jonas, economic adviser for the World Bank health team. “Disruptions would propagate across economies and could include breakdowns of food distribution and public order in megacities,” she says.A severe flu pandemic could cost 4.8% of global GDP, or more than $3 trillion—and it would hit the poor the hardest. The risk is rising because livestock and human densities increase alongside weak veterinary and public health systems in developing countries.Next pandemic could be zoonoticThree of four infectious pathogens and 80% of bioterror agents are now zoonotic – a category that includes influenzas, Ebola, brucellosis, rabies, leptospirosis. Zoonotic pathogens infect 2.4 billion people in developing countries every year, causing 2.2 million deaths.“This is a formidable development issue, where the poorest, who often live closest to livestock or hunt wildlife for food, are most at risk,” says Bank livestock advisor Francois Le Gall. ”Not only is animal disease costly to farmers, but it also affects nutrition, poverty, food security, and trade, and in the case of zoonoses public health” he says. Adding to these costs, pandemic risk arises when infectious pathogens are not rapidly and effectively controlled at their animal source and adapt to transmit readily from person to person.Modest investments, big benefitsTo reduce pandemic risk, disease outbreaks must be detected early, diagnosed correctly, and controlled effectively—which requires strong and coordinated veterinary and health systems.“This will help stop contagion at the animal source and keep costs down. Every country needs to have such systems since a global network of defenses is only as strong as the weakest link,” says Le Gall. Health risks at the animal-human-environment interface can be reduced by strong veterinary and public health systems that use the “One Health” approach, he says.To this end, veterinary and human health systems in developing countries will require $3.4 billion annually, compared with less than $450 million currently. A Bank report argues that this sustained level of investment is justified in view of at least $37 billion in annual expected benefits from prevented pandemics and other major outbreaks.Experts argue that animal and human health systems that are robust enough to control avian flu will also thwart cholera, yellow fever, Newcastle disease, foot and mouth disease, leptospirosis, brucellosis, rabies, and other infectious diseases, in humans and in their livestock. Such systemic approaches are also needed to prevent antimicrobial resistance, which will render antibiotics ineffective.From 2005-2010, donors contributed $3.9 billion to respond to H5N1 avian flu, financing systems to detect and control zoonotic diseases and prepare for a pandemic—the largest global multisectoral disease prevention program to date. Veterinary and human public health systems benefited from building capacity of staff in disease control, disease reporting and diagnostic capacities, enhancing preparedness, arranging compensation, and developing risk communication strategies.The Bank administered a $127 million Avian and Human Influenza Facility, where the European Commission was the lead donor and key partner. The Facility, IDA and IBRD together provided $1.3 billion for 72 operations in 60 countries; eight operations are ongoing but will close within two years. Since 2010, donors have sharply reduced their support to pandemic prevention. “But substantial disease control capacity gaps remain in many developing countries, especially in veterinary services,” says Maryse Pierre-Louis, World Bank lead health specialist.A new Bank policy note highlights the need to connect systems, professions, and disciplines to reduce pandemic risks. The Bank’s partnerships with the UN System Influenza Coordinator, OIE, WHO, and the Food and Agriculture Organization of the United Nations (FAO) remain key to advocating for global vigilance, prevention and preparedness. Show Less -
ResultsThe project conducted risk assessments on Highly Pathogenic Avian Influenza, vulnerability to and preparedness for human influenza pandemic, and hospital infection control. A manual on zoonotic... Show More + disease risk assessment has also been developed.The project initiated Avian Influenza surveillance among poultry in the country, expanded coverage of early warning and response system for human diseases and sustained surveillance among wild birds. A number of national policies and strategies were developed or revised. The project also helped develop working tools and technical guidelines, including:Incidence Response Information System (IRIS);Standard Operating Protocols for rapid response, command and control, surge capacity;guideline for exercise and drills, guideline for hospital infection control;risk communication plan for influenza.22 joint response teams (including health, agriculture, emergency management, professional inspection) have been set up across the country.Capacity for intensive care for severe respiratory infectious diseases has been built at 6 aimags (provinces) and the National Center for Communicable Diseases.3 provincial veterinary laboratories have been accredited for avian influenza outbreak detection.The project started building monitoring and evaluation (M&E) capacity in the country by developing manuals for it and establishing technical working groups.Significant progress has been made in the scale and speed with which test results are processed. This has enabled authorities to treat animals and human patients faster and more effectively: BeforeAfterPercentage of Poultry Mortality Events Investigated Annually75%100%Average Number of Days between Taking Suspected Influenza Specimen in the Field and Arrival at Reference Labs<3 days1-1.4 daysAverage Number of Days between Receipt of Biological Specimen in Lab and Lab Sending the Testing Results to the Requestor Avian Influenza7 days1 day Human Influenza8.7 days<1 dayTime from Start of AHI Investigation to Completion of File in National Information System Avian Influenza1 month5 days Human Influenza1 month4-4.5 daysBank Contribution and PartnersThe project was financed by a grant of US$ 4,656,463 from the Avian and Human Influenza Facility (AHIF), a trust fund administered by the World Bank and currently supported by 10 donor agencies led by the European Commission.A number of international organizations such as the World Health Organization (WHO), the United Nation’s Food and Agriculture Organization (FAO), Wildlife Conservation Society, the United Nations Children's Fund (UNICEF) and the United Nations Development Programme (UNDP) provided technical assistance to the project, or supervised the project implementation. Moving ForwardMongolia is an ideal place for ongoing Avian Influenza surveillance among wild birds. At least three migratory routes cross at the country. Many lakes are the summer habitats for migratory birds. This makes findings from the Avian Influenza surveillance among wild birds in Mongolia, which are imperative for the understanding of evolution of avian influenza virus, valuable to the global community.The project outcomes are highly sustainable since the One Health Approach is now set firmly in place in the country. Capacity to respond to other emerging infectious disease has been also improved and further improvement can be expected.BeneficiariesMs. Myagmar is a doctor at the Darkhan Uul Central Health Center. “Before, we used to screen and treat our patients using only a stethoscope. Today the in-patient department in my hospital has 8 different types of modern medical diagnostic equipment,” she said. Show Less -
BEIJING, August 10, 2012 -- Yesterday the China Emerging Infectious Disease Preparedness and Control Project was officially launched in Beijing by the Ministry of Agriculture (MoA) and Ministry of Hea... Show More +lth (MoH) of China and the World Bank. The project, supported by a grant of US$2.57 million from the Avian and Human Influenza Facility (AHIF), aims to assist China in strengthening its capacity to prevent and respond to emerging infectious diseases (EID).China is facing an increased risk from EIDs because of its sheer size of animal and human populations, its proximity to one of the potential epicenters of EIDs, its intensive animal farming practices, increasing trade with its neighboring countries as well as improved but still sub-optimal veterinary and human health services. Such a risk has been exemplified by the rapid increase of brucellosis and other EID outbreaks in the recent years."China as the world’s most populous developing country is also one of the countries affected by various infectious diseases. Most of the EIDs found in the last few decades have emerged in mainland China. Some of the infectious diseases that were previously put under control have re-emerged,” said Zhang Guoxin, Director of the Emergency Office of the MoH at the launch."We are facing a major challenge in IED prevention and control. While we increase our own investments and continue to build up our own capacities, we are keen to get attention and support from international organizations. Your support, both financial and technical, will help us enhance our capacities and level of IED prevention and control,” he said."We believe that China needs and can play a greater role in the global understanding of and fight against the EIDs,” said Philip O’Keefe, World Bank’s Human Development Sector Coordinator. “Clearly, China is heading to the right direction. The EID Project will serve as a platform, and be one of the important and initial steps for further advancing the theories and practices for EID prevention and control in China.”The project will help China to:establish a set of generic capacity including but not limited to risk assessment, surveillance, epidemiological capacity, infection prevention and control, risk communication, laboratory investigation, monitoring and evaluation for emerging infectious diseases, in particular, brucellosis, Highly Pathogenic Avian Influenza (HPAI) and human influenza; andimprove collaboration between China and its neighboring countries for emerging and re-emerging diseases prevention and control.The Avian and Human Influenza Facility is a multidonor, grant-making mechanism supported by the European Commission and nine other donors. The project is the third phase of a AHIF-funded project in China launched in 2007. The total funding from the AHIF for the three phases amounts to US$8. 72 million. The Bank has been working with the Ministry of Agriculture and Ministry of Health to implement "One Health Approach" for newly emerging infectious diseases, and contributed to the revision of the National Pandemic Influenza Preparedness Plan and Avian Influenza Prevention and Control policies."We have implemented ‘One Health’ approach and followed the principle of ‘timeliness, openness and transparency’ to keep the related international organizations and countries informed of new outbreaks of IEDs in animals,” said Zhang Hong, Deputy Director-General of the Veterinary Department of MoA."We have hosted and participated in a number of international workshops on animal disease prevention and control, supported and collaborated with the World Organization for Animal Health and other international organizations, and contributed to global animal health development while improving animal disease prevention and control in China,” said he.The launch ceremony was attended by senior officials from the Ministry of Finance (MoF), MoA, MoH and the State Audit Office, more than 80 participants from Inner Mongolia and Xinjiang -- the two project provinces, as well as representatives from the Food and Agriculture Organization (FAO) and World Health Organization (WHO).Also attending the launch was a delegation from Mongolia comprising officials from the Ministry of Food and Light Industry, National Emergency Management Agency, Ministry of Health and Dornod Province, as the project will serve as a pilot for cross-border collaboration in disease prevention and control. Show Less -
When avian flu outbreaks in 2005 hit Central and Eastern Europe hard, governments, healthcare and veterinary institutions went on high alert. Countries rallied efforts to design contingency plans and ... Show More +boost their emergency services to respond to imminent epidemics.A series of outbreaks near Moldova's western border with Romania and Ukraine that resulted in the culling of thousands of birds showed how possible, and how risky, it would be for avian flu to cross borders. It underscored the need for sound and well-planned interventions to address the spread of infection.Moldova's laboratory equipment was outdated. Its medical and veterinary personnel had little training and experience detecting the virus, and the public was poorly aware of risk associated with avian flu and other infectious diseases. What's more, there was little compensation for farmers whose chickens had to be culled. All of this presented a big challenge to an effective government response. Show Less -
In late October, the Yerevan Office communications team led a group of local journalists to Meghri, a city located in the southern province of Syunik by the Armenian-Iranian border, for the opening of... Show More + the first Border Inspection Post, financed under the Avian Influenza Preparedness project. Journalists representing seven local media, including two TV stations, three news agencies, and two Armenian online news portals, joined the tour for a 400 km long trip to see the results of the Bank's work on the ground.The newly constructed station aims to support the Armenian veterinary, food safety, and plant quarantine services to improve surveillance on the Armenian-Iranian border to limit the imports of contaminated food and infected animals. It also provides facilities for disinfection and decontamination of infected consignments. The Post allows for a continuous inspection of consignments with food and live animals.At the Border Inspection Post opening ceremony, Country Manager Jean-Michel Happi and Minister of Agriculture Gerasim Alaverdyan welcomed the media and held a joint press conference. During the one-on-one interviews, the journalists asked Jean-Michel about the Bank's current project portfolio in Armenia, the future projects, and the country's macroeconomic and post-crisis recovery trends. Operations Officer Artavazd Hakobyan was available to answer the journalist's questions on the Avian Influenza Preparedness and the Rural Enterprise and Small-scale Commercial Agriculture Development projects.During the tour, the communications team asked some of the journalists about their overall impressions, including whether they found the visit useful and how it enhanced their understanding of the work the Bank is doing in the country.Siranush Gevorgyan, a journalist from ArmeniaNow online, considered it to be a great opportunity to see how things are with her own eyes. "I found this trip very important and enriching. When you witness the actual event and are physically present on the site, your article becomes more credible and interesting, as compared to just reporting on a World Bank news conference held back in Yerevan," said Siranush. "Besides, the fact that I was able to speak in person to the Bank and government representatives in charge of the project, gave me a better understanding of what is being achieved on the ground."Gagik Baghdasaryan, editor of a major local news agency ARKA, believes that media tours to project sites are critical to conveying information about the Bank's work and activities to the public. "Seeing the fruits of the work done on the ground gives the journalists a stance to speak about the results of the project from the point of view of an eye witness and, to some extent, as a participant. This adds more weight to our reports and articles," Gagik said. "I'd like to see more such tours, especially for large projects that support the development of entire sectors in the economy."The media tour was organized as part of the Armenia Country Office public information services outreach program which focuses on working with a variety of stakeholders, such as the media, NGOs, youth, business community, academia, and the public at large. One of the program's goals is to raise awareness and understanding of the Bank's development objectives and its work program in Armenia. Project-specific outreach and, in particular, the media tours for targeted journalists, are some of the tools and strategies set out in the Armenia communications strategy to further the country program goals and operations."Media tours provide the journalists with a real sense and grasp of what is being done on the ground and how it is done. The results may not be as self-evident otherwise. They tell a story in a way that no off-site news briefings or press releases can. Speaking to project beneficiaries in the communities simply validates our messages," says Armine. The media tour format also helps the World Bank experts to develop better dialogue and communications with the journalists, and positions the Bank as a truly open, transparent, and knowledge institution.The October trip to Meghri was one such example in the series of many such Bank-media outreach interactions. This calendar year, the Armenia communications team held several media site tours, including visits to the Alapars pumping station and to Charentsavan town in Kotayk province, under the Municipal Water and Wastewater project, and media visits to the medical centers of Ijevan, Armavir, and Ararat, under the Health System Modernization project. A visit was also organized to the Central Veterinary Laboratory in Yerevan, as part of showing the results of the Bank's work under the Avian Influenza Preparedness project.The Armenian journalists stay tuned and ready for subsequent media tours to other World Bank project sites in the near future. The newly rehabilitated Goris Medical Center in Syunik province is the next planned tour on the Armenia World Bank Office's agenda. Show Less -