Preparedness and Response Plan for Avian Influenza

Objectives

The national plan provides a phased framework for government and partners to prepare for, detect, contain and manage avian influenza and a possible influenza pandemic, with periodic review and adaptation to emerging evidence and international experience. Its overarching goal is to minimise effects on health, society and essential structures by preventing human infection where possible, delaying or containing transmission at source, reducing morbidity, mortality and social disruption, and monitoring response effectiveness.[1]

• Establish integrated pandemic preparedness and response management across the interpandemic, pandemic-alert and pandemic phases defined using the World Health Organization framework.[1]
• Prevent transmission of avian influenza to people, contain outbreaks in poultry and humans, and identify high-risk populations and geographical areas.[2][3]
• Strengthen coordinated surveillance in animal and human health systems to enable early detection, laboratory confirmation, assessment of transmission and continuing monitoring of disease spread.[4][5][6]
• Improve prevention and containment through poultry outbreak management, biosecurity, movement restrictions, animal destruction where required, safe carcass disposal, farm disinfection and border measures against illegal poultry imports.[7]
• Prepare the health system to provide case management, patient care, infection prevention and control, isolation capacity, medical supplies and continuity of essential services.[2][3][8]
• Build public awareness and participation among communities, civil society, the private sector, health workers and travellers through factual, timely and non-sensational risk communication.[7][9][3]

The plan escalates its actions according to pandemic phases, from animal infection and elevated human risk through overseas human clusters and sustained transmission, to sustained community transmission within Timor-Leste. Alert-phase priorities include assessing preparedness, identifying and closing gaps, strengthening surveillance and containment, maintaining health-system readiness and communicating with communities and travellers.[10][11][12][13]

Key operational priorities in pandemic-alert and pandemic phases are to monitor human transmission, rapidly investigate suspected cases and clusters, trace and monitor contacts, protect healthcare and laboratory workers, sustain laboratory referral arrangements, maintain antiviral and protective-equipment stocks, mobilise staff and resources, and activate contingency plans when health services are disrupted.[3][8][13]

Implementation

Implementation follows a multisectoral human-and-animal-health model led principally by the Ministry of Health and the Ministry of Agriculture, Forestry and Fisheries. A National Task Force, supported by technical working arrangements, coordinates preparedness, resource mobilisation, review of national and international developments, phase assessment, public communication and emergency response.[14][5][3]

• Coordinate government, private-sector, civil-society, professional, border-control, transport, quarantine, laboratory, hospital and emergency-management actors through the National Task Force and technical committees.[14][3]
• Collaborate with the World Health Organization, Food and Agriculture Organization, UNICEF, AusAID, USAID, UNOTIL and regional partners to exchange information, access technical assistance, coordinate emergencies and refer specimens to international laboratories.[14][6][10]
• Assign the Ministry of Agriculture responsibility for animal surveillance and outbreak containment, supported by community reporting, poultry surveys, serological testing, virus isolation, rapid tests and veterinarian networks.[14][6]
• Use the Ministry of Health Integrated Disease Surveillance system to monitor acute respiratory illness through primary health services, hospitals and laboratories; require weekly facility reports and notification of suspected outbreaks within 24 hours.[5]
• Conduct enhanced surveillance according to risk assessment, including influenza-like illness among poultry workers and illness among healthcare or laboratory personnel exposed to suspected or confirmed cases.[5][15][12]
• Manage human specimens through the Central Laboratory, develop procedures for collection, handling, storage and referral, train laboratory staff, and use rapid antigen testing during case or outbreak investigations.[6][7]
• Designate National Hospital Guido Valadares in Dili as the referral hospital for suspected and confirmed cases, while preparing other hospitals for triage, isolation or cohorting, treatment, staff information and training.[7][9]
• Maintain stocks of antivirals, antibiotics, antipyretics, personal protective equipment and rapid diagnostic kits, distribute them through existing storage arrangements, and routinely check stock availability and expiry dates.[9][8]
• Deliver risk communication through electronic and news media, churches, non-governmental organisations and community-based organisations, with media briefings intended to support accurate messages and reduce misinformation, anxiety and hysteria.[9][3]

Governance arrangements include a Task Force chaired by the Vice-Minister of Health and co-chaired by the Vice-Minister for Forestry and Coffee, alongside a Technical Working Group chaired by the Head of the Department of Communicable Disease Control and co-chaired by the Head of the Department of Livestock. Information on human cases is centrally held by the Ministry of Health communicable-disease lead, while poultry-related information is held by the livestock department lead.[14][5][16]

Monitoring combines routine and sentinel surveillance, immediate notification, case-based reporting, epidemiological analysis, contact monitoring, laboratory testing and referral, animal testing, and communication of unusual events. Surveillance data are to be analysed routinely, shared with stakeholders monthly, and supplemented by rapid field investigations, including investigation of possible human cases within 24 hours during advanced alert and pandemic phases.[5][11][13]

Review mechanisms include regular technical, expert and situation meetings, becoming weekly during Phase 6B, to assess preparedness gaps, infection patterns, intervention effectiveness, health-service burden, essential-service disruption and the need to activate contingency plans.[11][17][13]The source does not specify comprehensive quantitative indicators, independent audit arrangements, accountability sanctions, a total monetary budget, financing allocations or funding-gap estimates.[5][6][13]

Monitoring & Evaluation

Monitoring and evaluation centre on integrated human and animal surveillance, rapid notification, laboratory confirmation, epidemiological investigation, situation review and coordination by national technical and task-force structures. The plan seeks early detection of avian influenza, monitoring of transmission and geographical spread, assessment of high-risk groups and areas, and evaluation of preparedness, response effectiveness and disruption to essential services.[1][14][3][8]

• Maintain Integrated Disease Surveillance for epidemic-prone diseases and acute respiratory illness through primary health-care services, hospitals and laboratories, with weekly facility reporting and notification of suspected outbreaks within 24 hours.[5]
• Conduct active and enhanced surveillance for influenza-like illness, particularly among high-risk groups, poultry workers, healthcare workers, laboratory workers and people in areas reporting poultry deaths or unexplained respiratory illness.[2][5][18][15]
• Strengthen animal surveillance through community reporting, poultry surveys, testing of infected flocks and other species, serology, virus isolation, rapid diagnostic testing and referral of specimens where necessary.[6][10][19]
• Investigate reported possible human cases within 24 hours, collect and transport specimens, trace and monitor contacts, and use international reference laboratories for confirmation where national capacity is insufficient.[3][11][12][13]
• Analyse acute respiratory illness data routinely, share surveillance information with stakeholders monthly, and issue prompt alerts when unusual events occur.[5]
• Monitor regional and global developments through liaison with the World Health Organization and Food and Agriculture Organization, using available evidence and expert advice to determine or declare the applicable pandemic phase.[14][10][19]
• Review readiness, gaps, intervention effectiveness, disease burden and pressure on health and essential services through National Task Force, National Technical Committee and expert-group meetings, with more frequent meetings as transmission intensifies.[8][11][12][17]
• Check designated-hospital readiness, isolation capacity, surveillance capability, availability and expiry dates of medicines and supplies, and the functioning of reporting and information-dissemination arrangements.[9][20]

Accountability is principally operational: the National Task Force coordinates preparedness and response, the Ministry of Agriculture is responsible for animal surveillance and containment, and the Central Laboratory manages relevant human clinical and animal samples.[14]In Phase 6B, the Head of the Ministry of Health Communicable Disease Department is the central repository for human-case information, while the Head of the Department of Livestock holds poultry-related information.[13][16]District public health officers collect epidemiological information and disseminate medical information, while district livestock officers provide information on avian influenza and the epizootic situation.[16]

Quantitative performance indicators, standard reporting templates, audit procedures, independent review mechanisms and accountability sanctions are not specified in the available extracts. However, the plan includes concrete reporting mechanisms, including immediate notification, weekly health-facility reports, case-based reporting where feasible, private-practitioner reporting, community detection networks, feedback arrangements and regular coordination meetings.[5][3][8][21][11]

Costing & Financing

Costing information is limited. A summary workplan and budget is structured around five strategies and the interpandemic, pandemic-alert and pandemic phases, and the budget table is denominated in United States dollars.[2]The supplied material provides no budget amounts, expenditure estimates, unit costs, allocations, financing sources, funding-gap estimates or economic assumptions.[2][14][11]

• Mobilise government and other resources through the National Task Force for preparedness and response activities.[14]
• Mobilise national and international resources as contingency planning and response needs escalate, including during sustained community transmission.[17][13]
• Maintain and distribute stocks of antivirals, antibiotics, antipyretics, personal protective equipment, rapid diagnostic kits and other medical supplies through established health-system storage and request procedures.[9][8][20]
• Provide resources for surveillance, laboratory logistics and specimen referral, workforce training, outbreak investigation, infection control, hospital isolation capacity, animal destruction, carcass disposal, disinfection, border measures, risk communication and continuity of essential services.[7][3][8][10]
• Consider compensation for communities affected by poultry stamping-out, although no amount or financing mechanism is provided.[7]

Resource planning is therefore expressed mainly as requirements for supplies, personnel, logistics and operational preparedness rather than as a quantified financing framework.[8][20]The medicine-and-supplies annex includes columns for activities, number and remarks, but the available extract contains no completed numerical entries.[16]