AFD - UK Preparedness

[sharon sanders]

UK : Military Unlikely To Help In A Pandemic




# 2069

http://afludiary.blogspot.com/

Perhaps the hardest reality about pandemics for most people to accept is that each community may be truly on their own. In far too many pandemic plans the assumption is made that the police, or the military, or relief agencies will be on hand to lend support.

And that may simply be wishful thinking.

While this report comes from the UK, much the same should be assumed by citizens around the world.

Militaries, relief agencies, and police are going to be crippled by any severe pandemic themselves. What little aid they may be able to provide is likely to be spread extremely thinly across a very wide landscape.



From The Times

June 14, 2008
Armed Forces could not help civilians in flu pandemic

Michael Evans

The Armed Forces would struggle to cope if the country was hit by a pandemic flu, with more than 50 per cent of military personnel laid low, an internal Ministry of Defence document indicates.

The Royal Navy, Army and RAF would be so badly hit in the ?worst-case scenario? because of their close working environment, particularly on warships, that no military personnel would be available to help the civil authorities, the study says.

?The priority ... will be maintaining critical military operations with little or no spare resource to provide military assistance to the civil authorities,? says the internal MoD document, which is in the form of a guide for defence personnel.

(Cont.)

Obviously, this isn't just a problem in the UK.

Last April, Lt. Joseph McClellan of the Alabama DHS here in the United States had these comments to make about the availability of outside help in a pandemic.

Lt. Joseph McClellan of the Alabama Department of Homeland Security said that law enforcement agencies and other first responders have to prepare to lose about half their work force because they will either be sick or caring for dying relatives.


<snip>

Security will need to be provided for mass burial sites, hospitals and pharmacies as fear and chaos could take hold of the community, McClellan said. Officers will have to reprioritize their calls; burglaries and robberies may not be on the top of the list.

While looking over various agencies' plans, McClellan said he's found that too many call for support from Alabama State Troopers.

There aren't enough state troopers to fill those spots," he said. Those plans need to be changed, he said.

Like it or not, communities are going to have to learn to handle much of the load during a pandemic, and they cannot rely on outside intervention.

As Secretary of Health and Human Services, Michael Leavitt, has said many times :

Local preparedness is the foundation of pandemic readiness. Leadership must come from governors, mayors, country commissioners, pastors, school principals, corporate planners, the entire medical community, individuals, and families.
Any community that fails to prepare-with the expectation that the federal government can or will offer a lifeline-will be tragically wrong. - Michael Leavitt Jan 24th 2006

Perhaps if we repeat that mantra often enough, it will finally sink in.

posted by FLA_MEDIC @ 6:06 PM

[sharon sanders]

Re: AFD - UK Preparedness - Military Unlikely To Help In A Pandemic

UK: Government Report Critical Of WHO



# 2160



Tonight we have two takes on a story out of the UK, where a House of Lords committee has heard evidence of the inevitability of another pandemic, and criticisms of the WHO's (World Health Organization) global surveillance and containment strategies.

Follow the links to read the entire articles. The first one is more in depth than the second.


Here is the Independent's Coverage of this story.

World warned over killer flu pandemic

By Ben Russell, Political Correspondent
Monday, 21 July 2008

The world is failing to guard against the inevitable spread of a devastating flu pandemic which could kill 50 million people and wreak massive disruption around the globe, the Government has warned.

In evidence to a House of Lords committee, ministers said that early warning systems for spotting emerging diseases were "poorly co-ordinated" and lacked "vision" and "clarity". They said that more needed to be done to improve detection and surveillance for potential pandemics and called for urgent improvement in rapid-response strategies.

The Government's evidence appeared in a highly critical report from the Lords Intergovernmental Organisations Committee, which attacked the World Health Organisation (WHO) as "dysfunctional" and criticised the international response to the threat of an outbreak of disease which could sweep across the globe.


The Government said: "While there has not been a pandemic since 1968, another one is inevitable." Ministers said it would could kill between two and 50 million people worldwide and that such an outbreak would leave up to 75,000 people dead in Britain and cause "massive" disruption.

(Cont. . . .)

This is how the Daily Telegraph is reporting this story.

Disease pandemic 'inevitable' in Britian warns House of Lords

By Andrew Porter, Political Editor
Last Updated: 11:49PM BST 20/07/2008
Britain faces an "inevitable" disease pandemic which will kill up to 75,000 people, says a powerful Lords Committee.




Changes in lifestyle are leading to new infections and providing them with opportunities to spread rapidly, the report warns.

An outbreak in Britain will cause "massive" disruption, it concludes. More should be done to provide early warnings.

The Lords intergovernmental organisations committee says the "dysfunctional" World Health Organisation needs to be better organised to cope with the threat. The peers describe the Government's evidence to it as "sobering".
(Cont. . . . )

posted by FLA_MEDIC @ 7:38 PM

[sharon sanders]

Re: AFD - UK Preparedness - Military Unlikely To Help In A Pandemic

UK Govt. Report Elicits Criticisms



# 2161


Reactions to yesterday's story on a UK House of Lords Committee report that lambastes the WHO - while outlining the inevitability of another pandemic - have begun to show up in the media.

While several Australian scientists have labeled the report `simplistic', `overly negative', and `unhelpful' - none of them seem to be disputing the inevitability of the next pandemic.

The complaints appear to be mostly centered around the criticisms of the WHO.


While admitting that more needs to be done, particularly in third world nations, critics of this report are pointing out the progress that has been made over the past several years.


This report from ninemsn news

Grim flu report unhelpful: experts

18:21 AEST Mon Jul 21 2008

By Tamara McLean

Australian flu experts have dismissed as "unhelpful" a hard-hitting UK report claiming the world is ill-prepared for an inevitable influenza pandemic.


The British government report warns that most nations have poor early warning systems for disease spread which lack vision and clarity and are badly coordinated.


The World Health Organisation (WHO) was also criticised in the report by the House of Lords as having a "dysfunctional organisational structure" not designed to best fight emerging diseases.


But Australian specialists say the report is both overly simplistic and overly negative in a climate in which much has been done in recent years.


"It's more difficult to predict the path of these diseases than the House of Lords suggest," said Professor Greg Tannock, an RMIT University academic who sits on the federal government's national influenza pandemic action committee.


"We know a pandemic is coming, yes it's inevitable, but governments are doing a lot to prepare, as much as you realistically can."

(Cont. )

posted by FLA_MEDIC @ 7:18 AM

[tropical]

Re: AFD - UK Preparedness - Military Unlikely To Help In A Pandemic

"critics of this report are pointing out the progress that has been made over the past several years"

What progress?

An esigue number of experimental old-strain non-pandemic short shelf-life vaccines?

[sharon sanders]

Re: AFD - UK Preparedness - Military Unlikely To Help In A Pandemic

Tuesday, August 05, 2008

<!-- Begin .post -->UK To Double Pandemic Flu Drug Stockpile




# 2206




This is an idea that has been bandied about for nearly a year, but it now appears to have progressed into action. The UK currently has 15 million 10-pill courses of Oseltamivir for it's population of roughly 60 million.


It now plans to double that stockpile.


This from the London Telegraph.

Pandemic flu drug stockpile to be doubled


Stockpiles of drugs to combat pandemic flu are to be doubled so half the population can be treated in the event of a worldwide epidemic.



By Rebecca Smith, Medical Editor
Last Updated: 3:53PM BST 05 Aug 2008

Adverts will be published on Wednesday inviting drug companies to bid for contracts to supply antivirals, which can reduce the length and severity of flu symptoms.

Currently the UK only has enough stockpiled to treat one in four of the population.

The stockpile of antibiotics which will be used if flu victims develop complications such as pneumonia will also be increased.

It is feared up to 50,000 people in the UK would die if another flu pandemic strikes.

The drugs will be at the forefront of any defence against pandemic flu in the first months of the outbreak as scientists race to produce a vaccine.

(Continued . . . )

While a major (and welcomed) increase in their stockpile size, this move still falls short of the recommendations made last fall by the UK's SAG (Science Advisory Group).


They recommended a tripling of the current stockpile.

'Too few jabs' to fight flu epidemic



Last Updated: 2:44am GMT 11/11/2007

Stockpiles of drugs to fight a flu pandemic must be increased if the death toll from an outbreak of the virus is to be minimised, senior government advisers have warned

The latest research by the Pandemic Influenza Scientific Advisory Group claims that the number of antiviral doses held by the Government must be tripled if a flu pandemic is to be effectively controlled.


The current stockpile of 14.6 million courses of the antiviral drug Tamiflu covers 25 per cent of the population.

However, the group warned that "under no circumstances" would it be possible to limit effectively the number of cases and deaths with the existing stocks.

The United States, meanwhile, continues to build it's stockpile but remains short of its goal of 25% coverage for the nation.

For more information on the limitations of our strategic national stockpile, and the problems of only having 10-pill courses available, you might wish to check out an earlier blog of mine called:

How Much Tamiflu Is Enough?


For information on the government's recent call for the private sector to stockpile antivirals, you may wish to read:

The Ball Is In Our Court



posted by FLA_MEDIC @ 11:57 AM

[JJackson]

Re: AFD - UK Preparedness

The House of Lords report

http://www.publications.parliament.uk/pa/ld200708/ldselect/ldintergov/143/143.pdf

[JJackson]

Re: AFD - UK Preparedness

I do not want to dilute FLA_MEDIC’s excellent thread so if this is not a good place for this; editors please feel free to move, edit or delete this post.

The newspapers obviously honed in on the ‘dysfunctional WHO’ bit and as I have taken on the self appointed role of defending the UN and WHO, where I think they deserve it, I was keen to see why they made the comment. Overall I thought the report well informed and accurate and the dysfunctional bit was specific to the relationship between WHO head office and its regional offices and – surprise, surprise – is due to the politically appointed (by the regions’ nations not by WHO) heads of the regional offices sometimes being more inclined to do what those who voted them into office wanted rather than what WHO Geneva wanted.

The conclusion to the WHO structure section.

111. Reforming WHO’s internal structure is an essential, though challenging, prerequisite of improving global health governance. While it is true that some progress has been made and that the Regional and Country Offices are now more willing to cooperate following the SARS experience, a more fundamental overhaul of the relationship between headquarters and regions and a review of the current procedures by which Regional Directors are appointed seems overdue. Given the threats to global health which we face from newly emerging infectious diseases, a dysfunctional organisational structure within the world’s principal policy-making, standard-setting and surveillance body simply cannot be afforded. We therefore recommend that the Government should bring its influence to bear, along with that of other like-minded Member States, to ensure that a fundamental review is initiated of the inter-relationship between WHO Headquarters and its Regional and Country Offices and of the system of appointment of Regional Directors so that WHO as a whole is better structured to meet the contemporary challenges of global health management.

The report also covers the IHR(2005) about which regular readers of this forum will note I have written ad nauseam.

105. This last point is important and calls for some clarification. Under the previous IHRs Member States had an obligation to report outbreaks of specified diseases to WHO. There was, however, no constitutional basis for WHO to challenge non-reporting if it suspected a cover-up by a Member State wishing to avoid the unwelcome consequences of disclosure for its international trade or travel. Under the new regulations, WHO is able to use other sources of information about infectious outbreaks—for example, the media or the internet—as a basis for approaching a Member State and requiring it to confirm or deny what is being alleged and, where necessary, to supply details. Though a non-declaring State might possibly continue in denial, such a situation is unlikely where the event in question is already receiving worldwide publicity. It is in the interest of the State being challenged either to come clean—and so to get international help—or to provide convincing evidence that the reports are incorrect. In this situation, though some witnesses expressed concern to us that the new IHRs remained unenforceable12 in the sense that formal international sanctions could not be employed against a non-compliant Member State, Professor Fidler is probably right that such sanctions are not necessary. “There is not an enforcement provision”, he said, “but look at the way in which the incentives and the dynamics of the rules are set up and you start to see that the enforcement of this starts to drive off the creation of reciprocal self-interest that States have to comply” (Q 965).

While I am happy to concede that the IHR(2005) is streets ahead of IHR(1969) the point I have been arguing since its publication is addressed in
“In this situation, though some witnesses expressed concern to us that the new IHRs remained unenforceable12 in the sense that formal international sanctions could not be employed against a non-compliant Member State”
Dr. Fidler seems to think that risking the loss of help from WHO will prevent states from exploiting this loophole while I would argue that Indonesia has decided to test that theory and that the WHO’s only options are to keep asking nicely or withdraw help but that will only leave the rest of the world less well off and risk collapsing the cooperation through trust which is its foundation. TheIHR(2005) left it no third path. I also have concerns regarding the concentration of power in the DG and the scope that leaves her/him with in its interpretation but that is not addressed here.

The report also makes good sense on the WHO’s funding and highlights how poorly funded it is. Its global budget is of the same order as the Gates foundation spends on health initiatives and the kind of budget the US CDC gets is a wild dream. They ask for a rebalancing of the Assessed and Voluntary contribution towards the assessed portion which is used for core functions and currently runs at about $1billion or a quarter of the total.

113. We therefore recommend that, when budgetary negotiations for the next biennium get under way, the Government should support a rebalancing of WHO’s budget in order to make more funds available for the core budget.

114. Infectious diseases pose a major threat both to this country and to the wider world, and we believe that WHO will need additional funding if it is to be able to respond effectively to these threats on behalf of the international community. The UK is already a major funder of WHO and we are mindful of current budgetary constraints. We recommend however that the Government, in concert with other Member States, should work towards an increase in financial contributions to WHO.

Another area of concern expressed by the committee is to do with the enormous number of different organization operating in conjunction/cooperation (or competition) with the WHO. Although the committee was too diplomatic to put it like this some donors are perhaps a little too interested in making sure the recipients know who they are where if it was channeled through WHO – and therefore used and strengthened the WHO infrastructure – it may not be as obvious who was paying for it. The net result is waste through duplication and an increased administrative burden due to the WHO’s precious resources being spent with the dozens of agencies operating in theater. If I manage to paste the alphabet soup diagram successfully you will get the idea.



The reports also discusses GOARN, GLEWS and TRIPS.
I will leave you with this last text box on TRIPS (which I wholeheartedly endorse) not that my government would actually act on the Lord’s recommendation as it seldom squares up against US policy interests. All of the expert testimony included in paragraphs 66# onward are well worth reading and one day, when I get around to it, I will try and write something a bit more comprehensive on TRIPS, IP rights and the Doha declaration.

75. We therefore recommend that the Government should support, within WHO and other relevant IGOs, the development of health diplomacy training to enable developing countries to make the fullest use of the flexibilities in the WTO’s Doha Declaration on TRIPS.
76. We recommend also that the Government should consider whether the UK might provide a lead either by establishing relevant training courses in this country, perhaps under the auspices of DFID, for suitable officials from developing countries or by sponsoring officials from developing countries to attend existing courses, such as the Summer Programme on Global Health Diplomacy at the Graduate Institute of International Studies in Geneva or by seconding suitably trained UK officials to support selected developing countries in their negotiation of individual agreements.
77. We further recommend that the Government should throw its weight against the inclusion, in bilateral or regional trading agreements, of proposals inhibiting the use by developing countries of the Doha flexibilities.

[sharon sanders]

Re: AFD - UK Preparedness

Thank you Jonathan for that excellent commentary. Fla Medic's blogs are placed on FT for this kind of productive discussion.

I am not too familiar with the level of pandemic preparedness in the UK, but I agree that WHO is woefully underfunded and lacks the enforcement capability to make it the final authority on world public health. This problem works hand-in-hand with the global inequities in the investigation, development, manufacture, and distribution of pharmaceuticals.

I look forward to your next comments.

[JJackson]

Re: AFD - UK Preparedness

As is usually the case with these kinds of reports the committee put out a list of questions to a wide array of interested parties and then the report is based on the answers. The 69 page report is much shorter than the vast mass of written and oral evidence all of which can be accessed as the second volume of the report.

http://www.publications.parliament.uk/pa/ld200708/ldselect/ldintergov/143/14302.htm#evidence

I obviously have a bit of a masacistic streak as I rather like wading through this stuff as it is often more enlightening than the final report.

These were the question

The Issues
This Call for Evidence is addressed to a wide range of organisations. Some of them are national and others international bodies; some of them fall within government while others are non-government organisations; and some are focused on the control of specific diseases while others are concerned with the field more generally. In responding, therefore, you will need to be selective and to answer those questions in which you consider you have an interest.
The principal issues on which the Committee would welcome your views are:
1. A recent report on Communicable Diseases by the UK Department of Health stated that "post-war optimism that their conquest was near has proved dramatically unfounded". What is your assessment of the overall position? More specifically, is it simply that not enough progress is being made in reducing the spread of such diseases? Or is the global situation actually deteriorating? Would it be an exaggeration to talk of a crisis?
2. What reliable data exist regarding the numbers of people infected globally with the four diseases on which the Committee is focusing particular attention? What trends are discernible in both the numbers infected and the patterns of infection? And what are the main underlying causes of infection and of any changes in its incidence and pattern?
3. What intergovernmental surveillance systems exist to give early warning of outbreaks of infectious diseases? Are these systems adequate? And what improvements might be made?
4. Given the continuance of current or planned intergovernmental programmes to prevent or control the four diseases, what predictions can be made of their likely spread and pattern over the next 10 years?
5. What do you consider to be the principal blockages to achieving progress in the prevention or control of the four diseases? And how might these blockages be removed by more, or better-targeted or better-coordinated intergovernmental action?
6. What role does your organisation play in combating the four diseases? Do you believe that it is correctly configured and adequately resourced to do the job? With which other organisations do you collaborate? How would you assess the degree of synergy?
7. What are the main non-health causes (e.g. global warming, poverty, changes in land use, international travel, lifestyle, population) of the spread of the four diseases? To what extent can intergovernmental action in non-health fields contribute to alleviation of their spread? What action is taking place or planned in these areas? And what more needs to be done? Do you consider that there is sufficient 'joined-up' thinking in approaching the problem?
8. Cases of Tuberculosis fell progressively in the UK until the mid-1980s but started to rise again in the early 1990s. Around 6,500 cases are now reported each year, an increase of about a quarter since the early 1990s. What are the main factors of the revival of Tuberculosis infections in Britain? And how could intergovernmental action help to reverse the trend?
9. Tuberculosis is potentially curable by long-term antimicrobial therapies. Yet the numbers of reported cases worldwide seem to be rising. Are the necessary medicines not getting through to patients? What are the barriers to effective long-term therapy? Are we now seeing infections which stem from other conditions—e.g. HIV/AIDS? Or are there other reasons why a treatable disease should be spreading? How might intergovernmental action help to deal with this situation?
10. To what extent do you believe that the 2004 Stockholm Convention limiting the use of DDT against Malaria-carrying mosquitoes has been a factor of increases in the spread of the disease? Has any risk analysis been carried out comparing the relative dangers to human health posed by DDT and Malaria?
11. What intergovernmental action is planned or in hand for early detection of the transmission of Avian Flu from birds to humans and of human-to-human transmission in potential source countries? Is this proving sufficiently effective to prevent an Influenza pandemic? What more could be done?
12. To what extent do you consider that the rise in infections in the four diseases is attributable to increased microbial resistance to antibiotics? What intergovernmental action is taking place in this area?
13. In a number of countries, including the UK, there is a problem with hospital-acquired infections. What intergovernmental sharing of knowledge is taking place to help bring this problem under control?
14. Are there any difficulties with regard to patents or intellectual property which are impeding the flow of medicines or other control methods to those infected? Is intergovernmental action needed to improve the situation?
15. What interchange exists between States in regard to knowledge of and training in the diagnosis and treatment of the four diseases or regarding preparations for dealing with outbreaks? What improvements might be made through intergovernmental action?
16. The International Health Regulations 2005 are intended to provide a global framework for the rapid identification and containment of public health emergencies. How effective do you consider this response system to be? Do improvements need to be made?
17. What intergovernmental planning has been undertaken to cope with the impact of an outbreak of infectious disease caused by deliberate release of micro-organisms into the environment? Is there adequate liaison between the various agencies involved, including intelligence, law enforcement and health care professionals? How could action by intergovernmental bodies help further?
18. Though our remit is focused specifically on known infectious diseases, we would be interested to know how you view the global threat from new or previously unrecognised ones and from the transmission of infections from animals to humans.
19. What resources (subscriptions, staff, training, medicines etc) does the UK Government commit to intergovernmental bodies to help in the fight against the four diseases listed? 20. Do you wish to provide any other relevant information in addition to what you have said in answer to the above?

and these were the parties asked

APPENDIX 3: LIST OF WITNESSES



The following witnesses gave evidence. Those marked * gave oral evidence.
Academy of Medical Sciences Association of Port Health Authorities British Association for Sexual Health and HIV British Infection Society * Centers for Disease Control and Prevention Center for Global Development * Dawn Primarolo MP, Minister of State for Public Health * Gillian Merron MP,Parliamentary Under-Secretary of State for International Development * European Centre for Disease Prevention and Control * Professor David Fidler, Indiana University School of Law Food and Agriculture Organization of the United Nations (FAO) * GAVI Alliance GlaxoSmithKline * Global Fund to Fight AIDS, Tuberculosis and Malaria Global Influenza Surveillance Network Health and Safety Executive * Health Protection Agency * HM Government * Imperial College London International Civil Aviation Organization (ICAO) * International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) * International HIV/AIDS Alliance International Organization for Migration (IOM) International Pharmaceutical Federation (FIP) * International Union Against Tuberculosis and Lung Disease * Liverpool School of Tropical Medicine * London School of Hygiene and Tropical Medicine London School of Hygiene and Tropical Medicine—Malaria Centre * Malaria Consortium * Professor Sir Michael Marmot, University College London Medical Research Council Merlin Nuffield Council on Bioethics One to One Children's Fund * Organisation for Economic Co-operation and Development (OECD) Research Councils UK RESULTS UK * Royal College of General Practitioners * Royal College of Pathologists * Royal College of Physicians Royal College of Physicians and Surgeons of Glasgow * Professor Harvey Rubin, Institute for Strategic Threat Analysis and Response (ISTAR), University of Pennsylvania * Stop TB Partnership * Swiss Federal Office of Public Health * Target Tuberculosis * TB Alert * Terrence Higgins Trust * UNAIDS United Nations Association of the UK (UNA-UK) United Nations Population Fund (UNFPA) United Nations High Commissioner for Refugees UNICEF * UNITAID United Nations System Influenza Coordination (UNSIC) * University College London * University of Oxford Wellcome Trust * World Health Organization (WHO) * World Intellectual Property Organisation * World Organisation for Animal Health (OIE) World Trade Organization

I hope to have a look at some of them and if I find anything particularly interesting I will post extracts.

This was from Global Influenza Surveillance Network (GISN) submition
(the bold is mine JJ)

12. Different answers for different pathogens


HIV drug resistance is not yet the major reason for continued spread.

TB drug resistance is an important contributor to continued spread.

Malaria drug resistance has been the most important factor in the past. If drug resistance to the new family of drugs arises it will have enormous impact. MMV the medicine for malaria initiative considers this possibility and seeks out new drugs for the pipeline. Again we are in a better position than five to 10 years ago.

Avian influenza is not spreading amongst humans yet. However, I think it is extremely likely that an avian influenza that became capable of efficient human-to-human spread would very rapidly acquire drug resistance which would then render useless our proposed drug-based control strategies.

16. The 2005 IHRs allow WHO to "use" unofficial sources although it states that it will "verify with countries before taking any action". This is an important step forward as it allows WHO to (at least partially) benefit from internet based sources of information. I assume you know about Promed www.promedmail.org. However the IHRs are largely about sharing information and expertise. It would be a mistake to rely on them to prevent the spread of infection. We would just know about it sooner and be able to help a source country with interventions. That could stop a pandemic for some infections but almost certainly won't for something like pandemic influenza.
18. We think there is a real threat from Dengue. Bacterial infections of childhood and from food are an important and growing threat to health. Our past vaccines have mostly remained effective for a long time. Newer vaccines may be much less durable (because of differences in the underlying biology of the pathogens they protect against). It would be prudent to be aware that vaccine resistance may become a public health problem in the future.

[gsgs]

Re: AFD - UK Preparedness

Of course, what they really want to know is the (subjective) expectation
value of damage from these diseases.
That's basically what they base -and should base- their decisions upon,
their budgets.

But they don't dare to ask directly ... there is some strange taboo
for this, as we learned over the years in flublogia.

[sharon sanders]

Re: AFD - UK Preparedness

Thursday, August 07, 2008

<!-- Begin .post --> UK: Pandemic Risk Seen Trumping All Others



# 2216



Actually, we've heard speculation on this in the past, but now apparently the official list of threats and risks facing Britain have been released, and an influenza pandemic sits at number one.


This from the Times Online.

August 8, 2008
Flu pandemic beats terrorism and flood in official table of reasons to be fearful

Michael Evans, Defence Editor

A pandemic flu bug would pose a greater threat to Britain than terrorism, according to a register of risks that has been kept secret until today. Deaths from global flu will be on a scale far beyond anything related to such an attack, the Government will say.

Until now, the official list of threats and risks facing Britain has been kept confidential, although MI5 has for some time published on its website the terrorist threat level, currently defined as severe.

Plans to publish a risk register were announced by the Prime Minister in March during a statement to the Commons on national security strategy. Top of the list is pandemic flu because of the conviction in Whitehall that it is ?not a question of if but when? and that it could kill 750,000 people.


The Cabinet Office risk-register report does not include a top-ten list of threats as this was deemed unhelpful in trying to inform people of the kind of threats facing Britain.


Instead, the report has a graph with two lines highlighting the ?relative impact? and ?relative likelihood? of various threats. Pandenic flu is way ahead on potential impact but terrorism is highest in terms of a likely occurrence. The other main risks include climate change, flooding, severe weather and attacks on critical national infrastructure.

(Continue. . .)

posted by FLA_MEDIC @ 7:15 PM

[sharon sanders]

Re: AFD - UK Preparedness

UK: National Risk Register Now Online



# 2219



The Cabinet Office of the UK has published their national risk register, as promised in this morning's papers. Here is a representative sample of the reporting on this document's release.

Flu pandemic 'biggest threat to UK'



Last Modified: 08 Aug 2008
Source: PA News
A flu pandemic poses a greater threat to Britain than terrorism, an official Government risk assessment is warning.

The Cabinet Office is publishing a "risk register" which compares the impact of a range of incidents, plus new information on the chances that they might take place.

Some of the information has previously been kept secret.

But Prime Minister Gordon Brown pledged to make more details available to the public when he published the National Security Strategy in March.

The document is expected to look at risks over the next five years, and provide advice to families and organisations on what they can do to protect themselves.

The `advice' as to what families and organizations can do to protect themselves in this document appears fairly tepid.

Here is their advice for a loss of utilities service (gas or electric).

Loss of Mains Electricity or Gas

4.8 Power cuts can affect household appliances, lighting, and other electronic equipment. Prolonged loss of electricity can also result in loss of mains water, sewerage and mobile communications.


Nationally, schools and offices may close temporarily unless they can find alternative power sources or may have to alter their hours to accommodate rota cuts. You may want to think about the following points to minimise disruption:


? If you have children, you may wish to discuss
back-up arrangements for childcare with neighbours/ friends in the event of schools being closed.


? Storing key contact details separately from your
mobile phone.


? Creating a core stock of essential supplies.
This could include bottled water, a battery powered radio, torch, tinned food and alternative heating sources.

This is, however, the first time I've seen advice to families to stockpile water, food, and other essential supplies from the UK. Quantities are not suggested, and it is buried pretty deep in this document, but at least it's there.

Specific advice about human diseases, or a pandemic is generic at best, as illustrated by the following excerpt.

Human Diseases

4.14 People can adopt simple and basic hygiene measures to protect themselves against disease and to reduce the risk of spreading viruses. Measures may include:


? Staying at home when ill provided there is no need to go to hospital or visit a doctor. You may wish to contact NHS Direct or NHS 24 for further advice on what to do.


? Covering the nose and mouth with a tissue when coughing or sneezing.


? Disposing of dirty tissues promptly and carefully.


? Washing hands frequently with soap and warm water to reduce the spread of the virus from the hands to the face, or to other people, particularly after blowing the nose or disposing of tissues or coming in from outside.


? Regularly cleaning frequently touched hard surfaces, such as kitchen worktops and door handles.


4.15 In the event of a pandemic, the Government will provide clear and considered messages to the public to advise them on other required action.

Given that a pandemic is being heralded as being the biggest threat to the UK, you'd think there would be more than a `we'll get back to you later' message about pandemic preparedness here.


In fact, in Chapter Four: Considerations for Individuals, families and Communities - this is the only occurrence of the word `pandemic' in that section of the document.

A hat tip to UK-Bird on the Wiki for quickly posting the link to this new document.

Last updated: 08/08/2008

National Risk Register


As announced in the National Security Strategy, the Government has published a National Risk Register which sets out our assessment of the likelihood and potential impact of a range of different risks that may directly affect the UK.

The National Risk Register is designed to increase awareness of the kinds of risks the UK faces, and encourage individuals and organisations to think about their own preparedness. The register also includes details of what the Government and emergency services are doing to prepare for emergencies.

Please send any comments on what you did not and did find useful in the document to NRRFeedback@cabinet-office.gov.uk and we will consider them the document is updated.

• Introduction <small>[PDF 5 pages, 126KB]</small>
• Risks <small>[PDF 23 pages, 456KB]</small>
  • Natural Events
  • Major Accidents
  • Malicious Attacks
• Considerations for Organisations <small>[PDF 7 pages, 189KB]</small>
• Consideration for Individuals, Families & Communities <small>[PDF 5 pages, 167KB]</small>
• The Risk Assessment Process <small>[PDF 3 pages, 81KB]</small>

• Full National Risk Register <small>[PDF 52 pages, 1MB]</small>

posted by FLA_MEDIC @ 7:07 AM 0 comments
<!-- End .post --><!-- Begin #comments --><!-- End #comments --><!-- Begin .post --> Indonesia: Culling In Village With Suspected Bird Flu Cases




# 2218



Nearly 48 hours since the first stories broke from North Sumatra and we still don't know if any of the 13 hospitalized patients from the Air Batu village are suffering from the H5N1 `bird flu'.


Tests are pending, and we are reliant on an increasingly recalcitrant Indonesian government to relay the results to the press. One can only hope that the vigorous attention being paid by the local and international media will help convince authorities to release this data quickly.


As far as the three fatalities in the Air Batu village, their bodies were quickly buried and no samples were taken for testing. We will probably never know what they died of.


While test results for the remaining patients are awaited, culling of birds and disinfecting of backyard coops is underway in the affected village.


For now, while bird flu is suspected, we don't know the cause of this outbreak.



This from The Australian.

Birds slaughtered as flu breaks out

From correspondents in Jakarta | August 08, 2008
HUNDREDS of chickens and ducks have been slaughtered to contain a suspected bird flu outbreak in Indonesia as 13 people with flu-like symptoms await laboratory results.


Thirteen people were hospitalised earlier this week with fevers and respiratory problems after a large number of chickens died suddenly in their village in North Sumatra province.


Two of them, a baby boy and a seven-year-old girl, have been put in a bird flu isolation unit at a hospital in the provincial capital Medan.


"We have taken measures since Tuesday when we found strong indications of bird flu virus in some 100 chickens and ducks in several places in Air Batu village," said local husbandary office chief Oktoni Eryanto.


At least 400 birds have been slaughtered and burned, and officials were continuing to spray backyard coops with disinfectant, he said.


"We don't need to send samples from the poultry to a laboratory because it's pretty clear that the cause is the bird flu virus," he said.


"Preventive action is more important to control it.

(Continue . . .)

posted by FLA_MEDIC @ 6:38 AM

[sharon sanders]

Re: AFD - UK Preparedness

UK: GP's Would Be Overwhelmed In A Pandemic


# 2303



The UK uses a higher attack rate assumption (50%) than most other countries, but retains the relatively low (4%) hospitalization rate, and fatality rate of (2.5%).


In truth, nobody knows what the next pandemic will bring.


Given that a fatality rate of 2.5% is anticipated, I find it hard to buy into the `4% may require hospital admission' assumption.

Now, if the statement read `only 4% are likely to receive hospital treatment', I might believe it. A subtle, but important, difference.

In any event, there is no doubt that GPs, and all other healthcare providers, will be inundated during a pandemic.


While the problems facing GPs seem pretty evident, realistic solutions are harder to find.


This from Pulsetoday.co.uk

GPs face deluge if flu pandemic hits


16 Sep 08

GPs could be deluged with tens of thousands of appointments according to dire Department of Health predictions of the impact of an outbreak of pandemic flu.

A document published by the DH?s pandemic influenza preparedness team sets out guidance on how GPs and other healthcare professional can manage the potentially huge increase in patients during a flu pandemic.

The document warns that an outbreak of ?pandemic influenza will be a widespread, rising-tide phenomenon rapidly threatening to overwhelm health services in the UK.?

The model predicts that as many as half of the population may show clinical symptoms of influenza? over the course of a pandemic.


This could result in the total appointments and admissions for influenza-like illness rocketing from around one million in a ?normal? season up to 30 millions.

Of those developing symptoms, 4% may require hospital admission and up to 28.5% will require assessment and treatment by a healthcare professional ? with GPs set to be thrust into the frontline.

Statistical modelling shows that an extra 14,250 GP consultations would be needed for per 100,000 of the population, assuming 50% of the population are infected, at a rate of 3,135 per week.

?This is the reasonable worse case scenario that local health planners should plan for?, the report states.

Surprisingly, while UK government reports continue to paint a dire picture of what a pandemic could bring to Britain, there is very little preparedness advice offered to the peoples of the UK.


It has been stated in the past that, as much as possible, the UK government would like to promote a `business as usual' atmosphere during a pandemic.


This from an article that appeared in The TimesOnline after the 2007 Winter Willow exercise, outlining the key points of the UK's pandemic plan.

Crisis targets

?The aim is to keep the nation open for business

?International flights will not be banned, although airline companies must prevent the sick from travelling

?There are to be no road blocks outside cities

?Ministers do not want armed troops on the streets or afflicted communities treated like 17th century plague villages

?Police will guard antiviral drug supplies and vaccines

?Employers are to stagger working hours so that a reduced public transport system will be able to cope

?Healthy people are expected to go to work. An absenteeism rate of 15-30 per cent is expected in each business including MPs and peers in Parliament, which itself will not close

An ideal situation, perhaps. But it simply may not be possible.

In the United States, citizens are urged to stockpile at least 2-weeks worth of food, water, and emergency supplies, and to obtain a month's extra supply of essential prescription drugs.

Not so in the UK.


Of course, the recommendations here in the United States don't seem to be swaying very many people.


But at least here, when millions of people are queued up in relief lines, we can say `We told you so'.

[sharon sanders]

Re: AFD - UK Preparedness

UK: Surge Capacity And Prioritisation In Health Services


# 2307




From the UK's Department of Health, a draft guidance document on surge capacity and prioritization during an influenza pandemic.


Public comment, particularly from individuals and organizations involved pandemic influenza planning and preparedness, is being solicited until October 31st.

Pandemic influenza: Surge capacity and prioritisation in health services (draft for comment)

• Document type:
  Publication
• Author:
  Department of Health
• Published date:
  4 September 2008
• Publication format:
  A4 electronic only
• Gateway reference:
  10282
• Pages:
  113
• Copyright holder:
  Crown

This document is designed to give guidance on managing the surge capacity needed to respond to an increased volume of patients during an influenza pandemic

• Download Pandemic influenza Surge capacity and prioritisation in health services (draft for comment) (PDF, 786K)

[tropical]

Re: AFD - UK Preparedness

From #1 ("Military Unlikely To Help In A Pandemic"):
"would be so badly hit in the “worst-case scenario” because of their close working environment, particularly on warships, that no military personnel would be available to help the civil authorities, the study says."


If the above is an research result, than the structures must admit that the worst-case scenario wasn't the one with 2&#37;CFR, but much upper.

If stating it is not, how the study explain the 1918 pandemic 2%CFR which still enable the military be engaged in a I. w.war?

If the above study projection was real, than the mil. sector 1918 can't resist to make war (or that's the reason to stop it 1919?).

So, this study in an easily manner seems to handwashing, instead of suggesting the worldwide mil. to be prepared to give an contribute to the inner state of the countries also, with their logistic.

If the mil. prepare themself for wars, that obviously includes at./chem./bio. responses, so it's not clear why their civilian citizens which they must defend as the borders (that's one of the reason of mil. egsistence) will be not given help (at least an trying of help), but left them on their own in such events!