Avian Influenza as a Global Challenge

Avian influenza (AI) is a contagious viral disease of poultry and other birds. There are different strains of the AI virus and the highly pathogenic strains, such as H5N1, kill almost 100% of infected chicken. The current spread of H5N1 is unprecedented. Since end of 2003, the disease has extended over various Asian countries, where it has become endemic, that is to say it is present in wild birds and not going to go away soon. In 2005/2006 the animal disease further spread to the Middle East, Europe and Africa (on actual situation, see OIE website). While trade in live birds and poultry products can disseminate the diseases from one country to another and appear to be the principal cause of the spread of H5N1, it has also been shown that migratory birds may play a role propagating the disease along their flyways. Wild birds are often carriers of avian influenza viruses without showing any symptoms, but their role as an ecologic reservoir for the disease is uncertain. Efforts to control the outbreaks have resulted in the culling or death of hundreds of million chickens worldwide, and the economic losses in the Asian poultry sector alone were estimated at around $10 billion in 2005.

Humans can get infected through close contact with affected birds, when live birds carrying infection are bought and sold and by contact with bird droppings or dirty equipment. So far, spread of H5N1 virus from person to person has been extremely rare and there is no general pattern of human-to-human transmission. For the latest number of human cases, please see the WHO website and for daily monitoring of AI, the Early Warning Web Service of the IASC. As long as the animal disease is not controlled, the risk of an imminent human influenza pandemic continues to rise. H5N1 is a strain with pandemic potential, since it might ultimately adapt into a strain that is contagious among humans. Once this adaptation occurs, it will no longer be a bird virus: it will be a human influenza virus. Influenza pandemics are caused by new influenza viruses that have adapted to humans.

The continuing spread of the animal disease raises the prospect of further economic losses. It threatens the livelihoods of millions of poor livestock farmers, jeopardizes smallholder entrepreneurship and commercial poultry production and may seriously impede regional and international trade. The rural poor are most at risk, because of the way they cohabit with their chicken. They are also the ones who rely for a larger share of their income on poultry and will be hit hardest by the income losses. Avian influenza has reached Africa, where veterinary services are not sufficiently prepared to deal with it. In the whole world, and particularly so in Africa, chicken and eggs are the most important source of protein for the poor. Avian influenza threatens progress in the fight against extreme poverty and hunger (reflected in the first Millennium Development Goal).

Shaping the Global Response: Some Milestones

1. Development of a Global Strategy by FAO (May 2005)

2. WHO draft strategic plan for responding to pandemic influenza

3. US President Bush announces the International Partnership on Avian and Pandemic Influenza (IPAPI), at the United Nations General Assembly on September 14, 2005.

4. Meeting of Health Ministers in Ottawa, Canada on Global Influenza Readiness, October 24-25, 2005

5. Meeting on Avian Influenza and Human Pandemic Influenza Geneva, Switzerland, 7-9 November 2005

6. Japan-WHO joint meeting on early response to Potential Influenza Pandemic Tokyo, Japan, 12-13 January 2006

7. The Government of the People’s Republic of China, the European Commission and the World Bank co-hosted the International Pledging Conference in Beijing (17-18 January 2006), which mobilised pledges for affected countries and countries at risk of USD 1.9 bn. The “Beijing Declaration” provides the basis for an enhanced International Partnership on Avian and Pandemic Influenza.

8. The Vienna Senior Officials meeting of 6th and 7th of June on Avian and Human Pandemic Influenza was organized by the Austrian Presidency of the European Union, in coordination with the Commission, the USA and China.

9. The Bamako International Conference on Avian Influenza - 6-8 Dec 2006 was co-organized by the Government of the Republic of Mali, the African Union and the European Commission

10. The Rome International Technical Meeting on Avian Influenza 27-29 June 2007.

11. The New Delhi International Ministerial Conference on Avian Influenza was held in India from 4 to 6 December 2007.

The EU has a number of legislative provisions in place to prevent and control avian influenza outbreaks in Europe. These measures are continually being updated to address new developments in the disease situation. All Member States have avian influenza contingency plans in place in case of an outbreak and the EU works closely with international partners such as the World Organisation for Animal Health (OIE) and the UN Food and Agriculture Organization (FAO) on this issue.

A pandemic is the biggest possible epidemic: a disease that spreads around the globe. Avian influenza refers to different influenza viruses that primarily affect birds. On rare occasions, these bird viruses can infect other species, including humans. A human influenza pandemic happens when a new subtype emerges that has not previously circulated in humans and therefore the human immune system has no defence against it (nor is a vaccination ready at the point in time the pandemic breaks out). H5N1 is a strain with pandemic potential, since it might ultimately adapt into a strain that is contagious among humans and can cause a pandemic. Influenza pandemics are rare but recurrent events. Three pandemics occurred in the previous century: “Spanish influenza” in 1918, “Asian influenza” in 1957, and “Hong Kong influenza” in 1968. The 1918 pandemic killed an estimated 40–50 million people worldwide. It was exceptional and is considered one of the deadliest disease events in human history.

The current H5N1 strain first infected humans in Hong Kong in 1997, causing 18 cases, including six deaths. Since mid-2003, this specific virus has caused the largest and most severe outbreak in poultry on record. In December 2003, infections in people exposed to sick birds were identified. Since then, more than 138 people have been infected, and half of them died. It should be stressed that up to now this virus has not caused a pandemic, but it raises the concern of health experts that a new pandemic may come closer. Once a fully contagious pandemic virus were to emerge, its global spread is considered inevitable. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it. Therefore, as far as a human pandemic is concerned, all countries are at risk. Each and every country has to be prepared for this eventuality.

The European Commission has identified influenza in general as a priority area within the Community Network for Communicable Diseases, which is an intra-EU network for epidemiological surveillance and control of communicable diseases and has developed a Community Influenza Preparedness Plan, which the Commission adopted on 26 March 2004.

On 2-3 March 2005, the Commission together with WHO organised a large meeting in Luxembourg with representatives from the 52 countries of the WHO European Region to discuss national preparedness plans for influenza pandemics. The meeting helped to determine the stage of pandemic planning in the different European countries, facilitated planning for influenza pandemic preparedness and discussed the main components of such national planning. The same exercise was be repeated between 25 and 27 September 2007.

The Commission's public health services are closely collaborating with the European Centre for Disease Prevention and Control (ECDC) based in Stockholm and the World Health Organization (WHO), to improve influenza pandemic preparedness. The European Influenza Surveillance Scheme EISS funded by the European Commission provides valuable data on seasonal influenza activity in 22 European countries. The latest information on Europe preparedness to a possible pandemic is available with ECDC.

For over 5 years the European Commission has been supporting research on influenza in both humans and animals. Already under the 5th Framework Programme for Research (1998-2002) -FP5- approximately € 6 million were spent on avian and pandemic influenza in 22 institutions and national reference laboratories across 8 European countries. Moving into the 6th Framework Programme (2002-2006), FP6, activities were extended and reinforced with a set of new projects launched in both the animal and human health sectors and with more than an almost tenfold increase in the EU contribution (more than € 50 million plus share in several larger projects dedicated to influenza as well as other viral infections), demonstrating a strong EU commitment to support this emerging research field as well as essential support to EU policies. In the longer term perspective, influenza will remain a top priority. In the Commission’s proposal for the 7th Framework Programme proposed to cover the years 2007-2013, FP7, human pandemic influenza will be addressed in the “Cooperation Programme”, Theme 1 "Health" under the sub-heading "Emerging (Infectious) Epidemics" and avian influenza in animals will be dealt with in Theme 2 “Food, Agriculture and Biotechnology Research”. For the first time, a heading on emerging infectious diseases in humans has now been introduced that will be able to address any unforeseen threats from infectious diseases.

The European Commission published a catalogue listing all EU influenza funded projects on influenza (including avian and pandemic influenza). The most recently selected influenza projects (not included in the publication) are described in a separate press release.

b) The European Commission Response Outside the EU

At the Beijing Conference on 17-18 Jan 2006, Commissioner Kyprianou pledged 100 M€ on behalf of the Commission to combat avian influenza and prepare for a possible human pandemic.  20 M€ is being spent on scientific research projects via the 6th Framework Programme, and the remaining 80 M€ via assistance projects outside the EU.  The EU (Member States plus European Commission) together pledged 214 M€. In total, $1.9 billion was pledged in Beijing, $1 billion in grants and $900 million in loans.

The Vienna Senior Officials meeting of 6th and 7th of June on Avian and Human Pandemic Influenza was organized by the Austrian Presidency of the European Union, in coordination with the Commission, the USA and China. Political meetings were co-chaired by Presidency, Commission, the USA and China, as host of the Beijing conference. The meeting had the following objectives: (i) review current situation of Avian Influenza and Human Influenza Pandemic Preparedness; (ii) update on mobilizing the pledges made in Beijing; (iii) structuring the partnership. The Vienna SOM has been a new success and a new step forward in the partnership against AI. The agreement between the Commission and the World Bank on the set up of a multi donor trust fund (“Avian and Human Pandemic Influenza Financial Facility”) based on the principles agreed in Beijing and administered by the World Bank, was signed on 8 June in Vienna. The African Union has announced in Vienna its offer to host the next international meeting in Bamako, Mali 6-8 December 2006.

The European Commission has moved fast to make the pledge of Beijing a reality. In order to allow swift deployment of Community resources where needs and financing gaps are highest, most of the Commission funds from the budget lines for Asia and Latin America (€30 million), TACIS (€10 million) and MED (€10 million) were channelled through a Multi-Donor Trust Fund administered by the World Bank, known as the Avian and Human Influenza Facility (AHIF). The funds for ACP countries (€30 million) are channelled through the already existing ALive trust fund and the International Bureau for Animal Resources of the African Union.

The main actions funded through the AHIF are:

• To assist countries in improving and completing their integrated national action plans, covering both animal health and human health;

• To assess requests for funding for actions from the national plans of less-developed countries and other low-income countries in Asia;

• To award grant funding, in most cases to national governments, for the implementation of national action plans; in some cases funds may also be granted to regional and international organizations and actors;

• To monitor and report in a harmonized way on the execution of the actions being funded and on results/impact achieved.

Financing from the AHIF are being used to fill funding and capacity gaps that would otherwise undermine the effective and efficient implementation of integrated country programmes. In parallel to the AHIF, the European Commission has reserved some funds to support the implementation of regional and international coordination actions in cooperation with international agencies and regional bodies.

Governments that want to receive AHIF funds must prepare an Integrated National Action Plan, including details of how it is to be funded both from government and other sources, and have it reviewed by donors and international agencies. The relevant World Bank Country Director should convene an in-country meeting to assess which parts of the Plan (if any) require AHIF funding. The recommendation of this meeting will be sent to World Bank Headquarters, where an internal Review Committee will take a decision on funding. If the size of the request for funding exceeds $US 3 million, then the Advisory Board (where donors are represented) must be consulted. The Commission and the World Bank signed an Administration Agreement committing 46 million EUR to AHIF in June 2006. The Commission made a first disbursement of 23 million EUR to the Bank in the same month. In June 2007, grants have been identified for the entire amount committed by the Commission and a replenishment of 23 additional million EUR was made in December 2007. Thirty-one grant agreements have been approved and 24 projects have already been signed. There are 8 other donors to AHIF (UK, Australia, Russia, China, South Korea, Iceland, Slovenia and Estonia) who contribute between them more than 100 million EUR (figures January 2008). The sole European Commission is contributing with more than 72 million EUR.

More information on AHIF can be found on the World bank dedicated website.

In addition to the pledges made in Beijing, and since the epidemiological pattern of the disease is evolving, with the African continent already hit by Avian Influenza, the Commission committed and started disbursing additional funds, out of decentralized financial provisions available for Commission delegations in Africa. Such additional contributions amount to approximately 30 millions EUR.

The International Ministerial Conference in Bamako has been the second high level meeting after the Beijing Conference. The conference was organised by the Inter-African Bureau for Animal Resources of the African Union AU/IBAR in co-ordination with the European Union, including the European Commission, and in partnership with other development partners, including the technical agencies of the United Nations. Its objectives were (i) to strengthen the global partnership against Avian and Pandemic Influenza taking stock of what has been achieved after Beijing; (ii) exchange technical experience and (iii) mobilise additional resources where most urgently needed through an International Pledging Conference at Bamako (particularly, but not exclusively for Africa). The main results of the Bamako Conference were to confirm that the efforts of the joint partnership were going in the right direction, with strong impact in the countries, to embark the African continent aboard the partnership, and to gather additional financial pledges for a total amount of approximately 370 million EUR. The sole additional commitment of the European Union amounts at 103 million EUR. The Bamako Declaration was unanimously adopted by the participants.

The International Ministerial Conference in New Delhi has been the high-level official meeting of 2007, as a continuation of the process initiated in Beijing, and consolidated in Vienna and Bamako. The conference was organized by the Government of India in coordination with the International Partnership on Avian and Pandemic Influenza, the European Union, WB, OIE and UN agencies. One-hundred and eleven countries and 28 international organizations attended the conference. Delegates and experts confirmed the positive achievements made by the international community both in the response to the AI crisis in birds and in pandemic preparation worldwide. Experts and Ministers however concurred that AI is entrenched in some countries, that the risk of a pandemic has not disappeared and that efforts have to be maintained. The key-note address by the Prime Minister of India on the morning of Day 2 gave to the event a particular solemnity. Dr Manmohan Singh insisted on the need to “strike against the institutional fatigue on AI” and called for a “long-term vision”. The meeting was without any doubt a success and converted into a new milestone in this unprecedented global effort against a major sanitary crisis.

The conference produced a “Road Map on AI for 2008”, offered by India to the world as a template and a conference summary by the host (both documents available on the Conference official website). In addition, New Delhi set the basis for a multi annual global strategic framework of a “One World, One Health” global approach, broadening up the global effort on AI to other sanitary crisis of the same nature.

New pledges were made, for a total of 406.1 million USD. The EU alone offered a new contribution of 93.8 million EUR (Commission alone: 78.4 million EUR). The EU remains the second largest global contributor on AI with a current total investment of more than 413 million EUR. The total international contribution to the AI crisis response is now close to 2.8 billion USD, in addition to the considerable efforts financed at home by a majority of countries in the world.

Egypt announced their intention to host the next global conference on AI in Sharm-El-Sheikh from 24 to 26 October 2008. See dedicated website. The strategic mid-term framework “One World, One Health” will be a central issue of that new meeting.

Study on the Gender Aspects of the Avian Influenza Crisis in Southeast Asia

The European Commission took the initiative to launch the first study mission on the gender aspects of the AI crisis. Three Asian countries, Thailand, Vietnam and Laos were chosen as case study countries.

The study had four major objectives:

1) To answer to the following key-questions:

- has the HPAI crisis a gender-sensitive impact?
- can such impact be described or measured?
- are gender issues being taken into consideration into current government and donors’ funded AI actions, including communication?
- what data are possibly missing for gender-assessment or gender-mainstreaming in AI and how can they best be collected?

2) To compare the gender dimension of the AI crisis in the countries visited and draw common lessons or standard conclusions (that could possibly by inference be replicated for other countries with similar social and gender patterns).

3) To propose mitigation measures and/or enlighten aspects to be taken into consideration for the definition of the actions to be funded from 2008 onwards at national level (in relation with integrated national strategies and action plans against AI).

4) To propose a monitoring methodology and key-agreed indicators, to follow-up on gender-mainstreaming in AI response actions. The full final report published in June 2008 is available here.

List of news items  12/2005 - 10/2008

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