National Avian and Pandemic Influenza Preparedness and Response Plan

Objectives

The National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan for 2009–2011 provides Bangladesh with a multisectoral framework to prevent and control avian influenza, prepare for an influenza pandemic, reduce illness and deaths in animals and people, and minimise socioeconomic and environmental effects.[1][2][3]It covers pandemic-alert and pandemic periods, bringing together human health, animal health and wildlife action.[4][3]

• Develop a community-participatory, multisectoral response that strengthens institutional capacity, surveillance, laboratory diagnosis, clinical care, risk communication, operational research, and collaboration with bilateral, regional and international partners.[2][3][5]
• Improve programme management, disease surveillance, prevention and control, and case management during the pandemic-alert period.[2][3]
• Mobilise multisectoral resources, maintain essential services, ensure early detection and case management, contain transmission, and reduce social and economic disruption during a pandemic.[2][3][6][7]
• Implement five strategic areas of action: planning and coordination, surveillance, prevention and control, risk communication, and operational research.[2][3]
• Strengthen animal-health protection through improved poultry husbandry, trade regulation and monitoring, biosecurity, waste management, live-bird market and slaughterhouse improvement, outbreak response, stamping out infected poultry, compensation and rehabilitation measures.[8][9][10][11][12]
• Reduce animal-to-human and human-to-human transmission through early detection, safe case management, isolation, quarantine, social distancing, infection-control measures, pharmaceuticals and other appropriate interventions.[13][14][7]
• Increase public awareness, participation and protective behaviour; reduce panic, misinformation and stigma; and ensure timely, accurate communication to communities, professionals, policymakers and partners.[15][16]

Implementation

Implementation uses a phased, whole-of-government model, with leadership shifting from the Ministry of Fisheries and Livestock to the Ministry of Health and Family Welfare during the pandemic-alert period and to the Office of the Prime Minister during a pandemic.[1][5]The National Advisory Committee determines transition to the pandemic period in response to a World Health Organization pandemic declaration.[3]

• Coordinate national action through the National Advisory Committee, National Multisectoral Task Force, Communication Committee, Joint Technical Committee, National Coordination Cell, and separate National Technical Committees for health and livestock.[17][5][18][19][20]
• Deliver local implementation through District and Upazila Multisectoral Coordination Committees and national, district and upazila rapid response teams.[21][5][22][23][24]
• Assign the National Coordination Cell, located at the National Influenza Centre of the Institute of Epidemiology, Disease Control and Research, to provide information support for coordination.[2][8]
• Use the National Advisory Committee to monitor and review plan activities, while the National Multisectoral Task Force supports implementation and monitors activities across implementation stages.[2][18][25]
• Conduct surveillance and early warning in humans, poultry and wildlife, including outbreak investigation, case and contact investigation, virus characterisation, epidemiological assessment, disease mapping and information sharing with international partners.[8][5][26][6][7]
• Operate diagnostic networks for human and animal samples, strengthen laboratory biosafety and capacity, and link national laboratories with regional and World Organisation for Animal Health and Food and Agriculture Organization reference laboratories.[21][11][12]
• Implement rapid response through investigation, specimen collection and referral, outbreak management, stamping out, cleaning and disinfection, quarantine, post-outbreak surveillance and compliance checks before compensation, rehabilitation or poultry restocking.[9][27][22][23][24]
• Engage the Forest Department in wildlife surveillance, including surveys of wild and migratory birds, identification of migration routes and hotspots, reporting of sick or dead birds, awareness activity and support to rapid response teams.[9]
• Deliver risk communication through coordinated official, scientific, mass-media and interpersonal channels, including training, workshops, information materials, hotlines, websites, announcements and community mobilisation.[8][15][28][16]
• Prepare annual livestock-sector work plans with indicative budgets for National Technical Committee review and provide a flexible emergency budget for outbreak investigation.[26]
• Review the plan periodically as influenza epidemiology evolves, use operational research to assess implementation and revise strategies, and undertake government evaluations with national and international support.[1][8][3][29]

The plan identifies budgeted activities for human, animal and wildlife health during 2009–2011, but the supplied material does not specify financing sources, funding gaps, allocation rules or economic assumptions.[30][31]It also does not provide a complete quantified indicator set, reporting timetable, evaluation methodology or independent accountability mechanism.[8][3][6][19]

Monitoring & Evaluation

The plan establishes a multisectoral monitoring and response system for avian and pandemic influenza, centred on early detection in humans, poultry and wildlife; rapid investigation; laboratory confirmation; situation monitoring; information sharing; and periodic revision of strategies as epidemiology evolves.[2][3][5][6]

• Maintain integrated surveillance through routine, sentinel, hospital-based, event-based, web-based and high-risk-group systems, with the Institute of Epidemiology, Disease Control and Research coordinating most human-health surveillance and national outbreak investigations.[32][33]
• Operate national, district and Upazila Rapid Response Teams to investigate suspected human and animal outbreaks, collect and refer specimens, manage outbreaks, supervise stamping out, and undertake post-outbreak surveillance.[22][23][24]
• Strengthen animal-health reporting through the Department of Livestock Services Epidemiology Unit, including farmer notification to Upazila Livestock Offices, immediate escalation of emergency events, monthly non-emergency reporting, disease mapping, interim Short Message Service reporting and planned web-based reporting.[34][9]
• Undertake active surveillance in high-risk areas, poultry holdings, live and wet markets, migratory birds and wildlife habitats; the Forest Department is responsible for wildlife surveys, reporting sick or dead birds and supporting response teams.[35][26][9]
• Maintain laboratory networks for human and animal samples, including national diagnostic networks, the National Influenza Centre, the National Reference Laboratory for Avian Influenza, Central Disease Investigation Laboratory and field laboratories; share relevant isolates and information with international partners.[21][13][26][11]
• Require immediate notification of positive field laboratory findings to the Chief Veterinary Officer and reporting of human avian-influenza outbreaks to the World Health Organization under the International Health Regulations.[15][27]
• Monitor pandemic magnitude, morbidity, mortality, resource and service effects, stock levels, bed capacity, staffing, treatment and countermeasure uptake, efficacy and safety, as well as changes in epidemiological, clinical and virological characteristics.[6][7]
• Use post-outbreak surveillance and compliance procedures, including at least 21 days of surveillance within 1 kilometre of infected premises and certification of cleaning, disposal and disinfection before compensation, rehabilitation support or restocking permission.[27]
• Review implementation through the National Advisory Committee, National Multisectoral Task Force, technical committees and subnational multisectoral committees. The National Advisory Committee meets at least annually, the task force every six months, the Communication Committee at least quarterly, and relevant technical and district committees at specified intervals.[18][25][36][19][20]
• Conduct operational research to assess awareness, disease burden, surveillance responsiveness, resource use, risk factors, diagnostics, antivirals, disinfectants and evolving virus characteristics, and use findings to revise strategies and activities.[8][28][6][7]

Reported surveillance outputs include testing 5,088 suspected animal cases after the first outbreak, detecting 288 highly pathogenic avian influenza cases, conducting active surveillance across 99 high-risk Upazilas in 2008, and operating hospital-based human influenza surveillance in 12 hospitals.[37][32]The plan calls for monitoring against indicators and periodic government evaluation with national and international support, but the supplied text does not provide a consolidated indicator set, reporting templates, full reporting timetable, formal evaluation methodology, performance targets or independent accountability sanctions.[29][18][25][36]

Costing & Financing

The 2009-2011 pandemic-alert budget presents a combined human, animal and wildlife requirement of 5,922,984,000 Bangladeshi taka, comprising stated human-health and animal-health totals and annual wildlife allocations.[30][31]The plan also identifies a combined budget for pandemic-alert and pandemic periods in Annex 26, but the supplied material does not provide a separate quantified pandemic-period budget.[17][4][29]

• Allocate 2,058,454,000 Bangladeshi taka to human health and 3,237,400,000 Bangladeshi taka to animal health for 2009-2011.[31]
• Present wildlife annual allocations of 627,130,000 Bangladeshi taka in each of 2009, 2010 and 2011; the displayed wildlife subtotal is blank.[31]
• Prepare sector budgets through the Health and Livestock National Technical Committees and include indicative budgets in annual livestock-sector work plans.[26][19]
• Allocate an emergency budget with flexible disbursement to support outbreak investigation.[26]
• Provide regular revenue-budget support for the Department of Livestock Services Epidemiology Unit and explore donor support for its continuing operation and strengthening.[9]
• Mobilise drugs, vaccines, logistics, equipment, human resources and communication materials during a pandemic, alongside routine assessment of supply, service-capacity and staffing needs.[6]
• Maintain compensation, rehabilitation, credit support, loan grace periods and loan rescheduling for affected poultry farmers, subject to approved requirements including compliance with restocking procedures.[8][12]

About 130 million taka was reportedly disbursed as compensation to affected farmers.[35]External support included Food and Agriculture Organization support for establishing the Department of Livestock Services Epidemiology Unit and joint Danish International Development Agency and Food and Agriculture Organization support for diagnostic kits, reagents and consumables.[35]Earlier reported avian-influenza programme allocations and expenditure are recorded for 2005-2006 to 2008-2009.[38]

Resource needs include laboratory infrastructure, transport, staffing, training, diagnostic supplies, surveillance technology, communication systems and emergency response capacity.[11][12]The plan identifies financial-resource constraints for enforcing animal-health legislation and shortages of funding and logistics for epidemiological capacity.[34][39]It does not specify funding sources for the 2009-2011 budget, financing shares, funding gaps, unit costs, resource-mobilisation targets or economic assumptions.[30][31]