Equipping Moldova to Respond to Infectious Disease Outbreaks

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 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Moldova's laboratory equipment was outdated.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.

At the request of the Government of Moldova, the World Bank stepped in to coordinate a multi-donor effort to strengthen Moldova's capacity to respond and mitigate outbreaks of avian influenza and other infections, and increase the country's preparedness for possible pandemics.

The task was a tough one, as it had to address human, institutional and financing constraints. The first challenge was to increase the country's ability to diagnose viruses in people and animals. This was done through a full-fledged rehabilitation of Moldova's main human and animal virology labs. A second step was to build surveillance, response and treatment capacity across the entire spectrum of healthcare and veterinary institutions in charge of infectious disease response.

Adoption of IT-based, real-time tools for human epidemiological surveillance has meant that health authorities now have accurate data on the scale and extent of the spread of dangerous viruses. Improvements in the ability to monitor the health of poultry make it easier and more effective to localize and contain outbreaks.

But the financial costs of a government response are measured by the extent to which financing and compensation capacity can support a system under stress. Moldova's traditional dependence on agriculture and the high level of subsistence farming raised greater challenges for farmers and authorities. Livelihoods in rural Moldova had to be maintained.

The World Bank joined with the government to establish streamlined and transparent compensation mechanisms to assist farmers whose chickens had to be culled. Regional simulation exercises carried out under real life scenarios polished the quality and quickness of interventions and increased capacity all the way down to the local level.

On the human health side, the renovation of an intensive care unit within the premises of the National Infectious Diseases Hospital has meant that every Moldovan infected with a deadly strain of influenza virus now has a better chance of survival. Indeed, this was tested in 2009 when Moldova experienced hundreds of cases of swine flu. Had it not been for improved diagnosis and treatment of infected patients, supported by the project, the number of fatalities would have exceeded by far the registered figures.

The project's lasting effect is that it has also managed to change people's attitudes and behavior when it comes to prevention of infectious diseases. Extensive communication and public awareness campaigns targeted all age groups and stimulated a high level of social awareness.

"Moldova's improvements have built a shield around the country. Moldova today has the best indicators in the region, including the Balkans, when it comes to responding to infectious disease outbreaks," said Ion Bahnarel, General Director, National Center of Public Health.