KCDC Releases Revised Pandemic Response Plan - Japan MOH Releases Updated Pandemic Plan (7/17) - KCDC Final (Sept 6th)

[Michael Coston]

South Korea CDC Releases Revised ‘Influenza Pandemic Preparedness and Response Plan’

#18,138

In the first decade of the 21st century, when H5N1 was making its escape out of Southeast Asia into Europe, the Middle East and Africa, we followed the development of federal, state, and local pandemic plans, and the conducting of emergency drills, were given high priority across the nation and around the world.

A few (out of hundreds of) examples include:

• Hong Kong : Exercise Redwood - 2009
• UK Exercise: PPE Usage In A Pandemic –2008
• Singapore: Public Involvement In Financial Sector Pandemic Drill –2008
• Florida's Pandemic Simulation – 2008
• Idaho BlogEx : July 28th –2008
• UK: Lessons Learned From Winter Willow – 2007

In February of 2007, the CDC & HHS unveiled their Community Strategy for Pandemic Influenza Mitigation plan. This 108 page document covered a variety of topics, including the creation of a pandemic severity scale, and the expected role of NPI's (Non Pharmaceutical Interventions) in combating any pandemic outbreak (see The CDC Does NPI).

All 50 states were ordered to prepare individualized pandemic plans, although each was allowed to pick their own `likely' scenarios. As a result we saw a wide variance in the quality and
thoroughness of these reports.​

In 2009 we got an influenza pandemic, but instead of H5N1 it turned out to be a less virulent swine-origin H1N1 virus. Deaths were far less than expected (although younger people were hit hardest), and many countries scaled back their pandemic planning.

The CDC/HHS updated their pandemic plans in 2017 (see CDC/HHS Community Pandemic Mitigation Plan - 2017), but around the country (and around the world), actual pandemic preparedness had been largely put on a back burner.

As a result, we were caught flat-footed and unprepared for the COVID pandemic of 2020.​

Since COVID, we've seen very little progress in pandemic planning. In fact, we seem to have back-slid, having dismantled much of our surveillance and reporting systems.

While most governments are hoping for a decade or two's respite following COVID, viruses don't read calendars, and the threats keep accumulating. H5N1 (and other H5Nx viruses) are high on our worry list, but they aren't alone.

Today South Korea's CDC unveiled a draft of their new `Influenza Pandemic and Response Plan' at an expert symposium, calling for comments before the final version is released. The (translated) announcement follows, after which I'll have a bit more.

Revised ‘Influenza Pandemic Preparedness and Response Plan’ released

Created on 2024-06-20
Last modified date 2024-06-20
Department in Charge: Crisis Management Division
Contact number 043-719-9081

“In the event of a new or variant influenza pandemic, it can surpass COVID-19”... Revised ‘Influenza Pandemic Preparedness and Response Plan’ released

- Discussion of on-site promotion strategies through expert symposium -
o Global public health experts say, “The next pandemic will be influenza.”

o Reflecting lessons from COVID-19, establishing a strategy to protect the public and minimize social and economic damage even in the worst-case scenario of new and variant influenza (high transmissibility, high fatality rate)


The Korea Disease Control and Prevention Agency (Director Ji Young-mi) prepared a draft of a complete revision of the 'Influenza Pandemic Preparedness and Response Plan' to prepare for the next pandemic after COVID-19, released it through an expert symposium on June 20, and collected opinions.

The influenza pandemic preparedness and response plan is a plan to prepare for a pandemic caused by a new or variant type of influenza rather than the seasonal influenza that occurs every year. It was enacted in 2006 and has been revised twice in 2011 and 2018, and this is the first revision in 6 years. .​

This revision aims to minimize the scale of the epidemic, the severity rate, and the mortality rate based on the evaluation of the response to influenza so far and the lessons learned from the COVID-19 pandemic.

Influenza is a representative respiratory viral disease that has caused the greatest epidemic and death in history. Every year, seasonal influenza occurs as part of a gene is mutated (mutated), and a pandemic occurs when a new virus is born (mutated*) through the recombination of different viral genes.​

* Spanish flu (1918, 50-100 million people), Asian flu (1957, 2 million people), Hong Kong flu (1968, 2 million people), Swine flu (2009, 1.9 million people) (numbers are estimated deaths)​

Recently, highly virulent avian influenza has been occurring not only in birds such as poultry and migratory birds, but also in various mammals such as cats, pigs, and cattle. In particular, cases of death due to infection from animals to humans continue to be reported, and a recent case of avian influenza infection spreading between mammalian dairy cows in the United States* is a danger signal that transmission between humans is also possible.​

* (United States) As of June 2024, highly pathogenic avian influenza (H5N1) occurred on farms in 12 states, genetic similarity was confirmed as a result of analysis of infected livestock samples, and transmission factors such as movement of dairy cattle were reported.​

The World Health Organization (WHO) warned (January 2024) that the next pandemic could be a new type of influenza and urged people to learn from COVID-19 and prepare in advance. Accordingly, the Korea Disease Control and Prevention Agency has prepared a revised influenza pandemic preparedness and response plan for the second time since the COVID-19 pandemic, following Italy (January 2021).

In the event of a new or variant influenza pandemic, it can lead to a large-scale epidemic exceeding that of COVID-19 and seriousness and death. Therefore, in such a pandemic situation, the peak period of the epidemic should be delayed as much as possible to maintain a manageable level within the medical system and prevent the occurrence of seriously ill patients. Focused on strategies to minimize .

The differences between the existing plan and this revised plan are:​

△ detecting risk signals at a pre-epidemic stage through early surveillance and determining the most effective response measures,​

△ shortening the development of a key tool, a vaccine, to 100/200 days. Strategies for infection prevention and control, and​

△ joint surveillance and warning of zoonotic infections through the One Health strategy have been newly added to constitute key tasks in the preparedness stage, and strategies to minimize damage by epidemic stage have been specified and presented in each response stage.​

Detailed plans for preparedness include:​

△ expanding the scope of surveillance of overseas outbreaks and domestic inflows and outbreaks, developing testing methods to quickly identify mutant viruses, and​

△ stockpiling treatments and quarantine materials in advance at a level that can respond for the first 6 months.​

△ Develop various vaccine platforms and build a library by developing prototypes for selected priority pathogens in advance, Establish infrastructure such as vaccination centers for rapid large-scale vaccination in advance, and​

△ One Health integrated surveillance and management. It consists of developing an early warning system for​

In the response area, it is divided into the early stage of the epidemic, the spread stage, and the recovery stage, and contains the main tasks and quarantine strategies for each period, and the initial three-day plan is included as an example. In particular, social response measures to maintain essential social functions and minimize social and economic damage caused by long-term uniform lockdowns can be applied based on effectiveness and cost-effectiveness.

The Korea Disease Control and Prevention Agency will hold expert discussions on the revised influenza pandemic preparedness and response plan through a symposium today, and plans to finalize the final plan as soon as possible by collecting opinions from experts and related ministries.

Director Ji Young-mi of the Korea Disease Control and Prevention Agency said through an expert symposium, “We want to establish a strategy to prepare for new influenza that may occur at any time in the future,” and added, “Through the plan prepared this time, we will protect the public’s health and minimize social and economic damage.” “I will work hard for it,” he said.

He also added, “We will share this influenza pandemic preparedness and response plan with the international community in the future and use it as an opportunity to lead cooperation to respond to the global public health crisis.”​

Obviously, South Korea `gets it'.

That if you expect to have a viable pandemic plan available for the next global public health crisis, you'd better start writing it now. ​

Far too many nations, states, and agencies (and the private sector) have not updated their plans for many years, with some unchanged since 2007. Many of the older CDC pandemic guidance documents have broken links, have been `retired', or are difficult to find.

After some searching I finally found the CDC's Get your household ready for pandemic influenza - April 2017. And Ready.gov has a pandemic preparedness section.​

While we may skate through without H5N1 sparking a global health emergency, another pandemic is inevitable.

And the thing we'll wish we had the most when that happens is more time to prepare.

https://afludiary.blogspot.com/2024/06/south-korea-cdc-releases-revised.html
​

 

[Michael Coston]

Japan's Ministry of Health Unveils Revised Pandemic Plans







#18,189

While we saw a lot of pandemic preparedness in the first decade of the 21st century, the practice fell out of favor following the relatively `mild' 2009 H1N1 pandemic, and many countries continue to work with nearly 20-year-old plans.

As a result, the world was caught flat-footed and largely unprepared for the COVID pandemic of 2020, and in many cases, surveillance and reporting today are arguably less robust than they were 5 years ago (see No News Is . . . Now Commonplace).​

Although most of the world's governments have been largely silent regarding the HPAI threat, we have seen some signs of movement.

A little less than a month ago, South Korea's CDC released a Revised ‘Influenza Pandemic Preparedness and Response Plan’, and we've seen recent calls from the WHO and from the ECDC to member nations to increase surveillance and preparedness.​

Today Japan unveiled their new `Government Action Plan Guidelines for Countermeasures against New Influenza and Other Infectious Diseases', which is divided into 13 sections (see below) that run the gamut from surveillance to vaccines to border control to burials and cremations.

These guidelines run well over 100 pages (all in Japanese), and the 5-page summary document I found (and translated) was pretty vague.​

For now, local media are concentrating on the provisions for stockpiling > 300 million medical masks (presumably for medical personnel, not the general public), along with other PPEs (gowns, gloves, goggles, etc.).

I expect additional details will emerge in the days ahead.​

First the `table of contents', after which I'll have a brief translated excerpt on controlling the spread of a novel flu virus.

Summary and materials​

Summary of Proceedings​

議事要旨［PDF形式：780KB］


Guidelines for the Government Action Plan for Countermeasures against Novel Influenza and Other Pandemics (Draft)​

[Document 1] Guidelines for information gathering and analysis [850KB]
[Document 2] Guidelines for surveillance [330KB]
[Document 3] Guidelines for information provision and sharing, and risk communication [281KB]
[Document 4] Guidelines for border control measures [237KB]
[Document 5] Guidelines for prevention of spread [1.1MB]
[Document 6] Guidelines for vaccinations (vaccines) [471KB]
[Document 7] Guidelines for medical care [564KB]
[Document 8] Guidelines for therapeutic drugs and treatment methods [298KB] 　
[Document 9] Guidelines for testing [429KB]
[Document 10] Guidelines for health [275KB]
[Document 11] Guidelines for securing supplies [193KB]
[Document 12] Guidelines for measures against new strains of influenza, etc. for businesses and workplaces [293KB]
[Document 13] Guidelines for smooth implementation of burials and cremations [125KB]​

From [Document 5] Guidelines for prevention of spread [1.1MB] we get the following (translated) introduction, which stresses the importance of reducing the spread of the virus, while not causing undo harm to society.

(1) Basic Concept of Measures to Prevent the Spread of Influenza

The purpose is to prevent the spread of influenza as much as possible, to minimize the damage to health, and to minimize the impact on people's lives and socio-economic activities.

In addition to providing appropriate medical care, it is important to take measures to prevent the spread of infection as necessary to prevent the spread of infection and to keep the speed and peak of the spread of infection and the number of patients requiring treatment within the range that the medical care system can handle. In particular, when there are no effective treatments or until vaccinations are available, prevention measures implemented from a public health perspective are important.

For this reason, risk assessments based on the characteristics of the pathogen (pathogenicity, infectivity, drug susceptibility, etc.) will be conducted in a timely and appropriate manner, and if there is a risk of a large-scale spread of infection that would overwhelm medical care even in an enhanced medical care system, measures to prevent the spread of infection, including priority measures to prevent the spread of new influenza, etc. (hereinafter referred to as "priority measures to prevent the spread") and emergency measures for new influenza, etc. (hereinafter referred to as "emergency measures") based on the Special Measures Act for Countermeasures against Novel Influenza, etc. (Act No. 31 of 2012, hereinafter referred to as the "Special Measures Act"), will be taken promptly for the areas, period, and targets considered necessary.

On the other hand, Article 5 of the Special Measures Act stipulates that if restrictions are imposed on the freedom and rights of citizens, such restrictions shall be the minimum necessary to implement measures against novel influenza, etc. In addition, measures to prevent the spread of infection have a significant impact on socio-economic activities, and in particular, when measures are taken against patients and close contacts, the burden on those involved in the measures, such as public health center staff, is heavy.

In light of this, it is important to consider the effectiveness and impact of measures in a comprehensive manner and to consider taking necessary measures to prevent the spread of infection. It is also important to review measures being implemented flexibly and promptly, such as reducing or suspending measures, in response to changes in the situation, such as information on the characteristics of infectious diseases and the properties of pathogens (pathogenicity, infectivity, drug susceptibility, etc.) and the development and dissemination of vaccines and treatments.



​

The above graphic is essentially the `flattening the curve' strategy (see below) which has long been part of the U.S. pandemic plan, to reduce a pandemic's impact on limited healthcare resources and essential workers. [TABLE="align: center, cellpadding: 0, cellspacing: 0"]
[TR]
[TD]

[/TD]
[/TR]
[TR]
[TD]Flattening the Curve - Credit CDC[/TD]
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[/TABLE]

While No Pandemic Plan Survives Contact With A Novel Virus, it is still vital to have a plan going into any crisis. The following quote is nearly 20 years old, but it is just as true today as it was in 2006:

“Everything you say in advance of a pandemic seems alarmist. Anything you’ve done after it starts is inadequate." - Michael Leavitt, Former Secretary of HHS​

Hopefully other countries are updating their own plans as well.



​https://afludiary.blogspot.com/2024/07/japans-ministry-of-health-unveils.html

 

[Michael Coston]

South Korea Releases Updated Pandemic Plan

#18,281

Two decades ago, when H5N1 was making its initial threatening moves in Southeast Asia, countries around the world began crafting pandemic plans, and conducting preparedness drills. Here in the United States, every state and territory, and every major government agency, was expected to craft a plan.

There was admittedly a wide variance in the quality of these plans, and many assumptions were never tested, but it was seen as significant progress.​

Following the unexpectedly mild 2009 H1N1 pandemic, many countries simply locked their plans away, and stopped preparing. Pandemics, they believed, had been over-hyped. Modern medicine (vaccines & antivirals) would save us.

When a novel coronavirus emerged in 2020, many countries were forced to rely on 15-year-old pandemic plans which only envisioned an influenza pandemic. Plans that often emphasized the rapid deployment of vaccines - that, in the case of COVID - wouldn't exist for at least a year.​

Despite years of dire warnings that the world was ill-prepared for a pandemic, we went into that COVID pandemic with long predicted critical shortages of ventilators and PPEs (masks, gowns, gloves). Much of what was stored in our Strategic National Stockpile had deteriorated with age.

You'd think that after enduring COVID, the nations of the world would be rushing to update, and improve, their pandemic response plans. But once again most countries seem to be ignoring the threat. Surveillance and reporting on infectious diseases is, in many cases, worse than it was a decade ago.

We have seen a few bright spots.​

Ten weeks ago South Korea's CDC unveiled a draft of their new `Influenza Pandemic and Response Plan' at an expert symposium, calling for comments.

Today they unveiled their final draft, which emphasizes the importance of `flattening the curve' during the opening months of a pandemic (see EID Journal: Evaluating Social Distancing Interventions To Delay or Flatten The Curve - COVID-19).

As you might expect, the document is in Korean (although it can be run through a translator). The (translated) summary, published by the South Korea CDC follows:

Disease Control Agency, Preemptive Preparation for New and Variant Influenza Pandemic



- Novel influenza is a strong candidate for the next pandemic, and the goal is to minimize health damage and social and economic impacts.


- A strategy to delay the peak of the epidemic from 110 to 190 days and reduce the maximum number of patients on the peak day by 35% in the worst-case scenario (high transmission rate and high mortality rate).

On September 6, the Korea Disease Control and Prevention Agency (KDCA) (Director Young-Mi Ji) announced the ‘New Influenza Pandemic Preparedness and Response Plan’ to prepare for the next infectious disease pandemic.

This plan is being completely revised for the first time in six years since it was established in 2006 and revised twice in 2011 and 2018, and reflects the recommendations of the World Health Organization, which strongly identifies a new type of influenza as the next pandemic and recommends that the country prepare for it as a priority in its national plan.

In particular, as the risk level is increasing due to the continuous reports of human infections with avian influenza, the need to prepare preemptively before the risk of avian influenza outbreaks, such as the influx of migratory birds in the fall, has arisen.​

* A total of 907 cases of human infection with avian influenza A (H5N1) type reported in 24 countries since 2003 (`24.8.5., ECDC)
​

** Recent cases: Human infection from cattle (USA, April 24), Human infection with avian influenza death (Vietnam, March 24)

Before preparing the revision, the Korea Disease Control and Prevention Agency collected opinions from various experts and medical professionals regarding the limitations of the COVID-19 response and areas in need of improvement.

In addition, the scale of damage from a new or variant influenza pandemic was predicted. According to this, in a situation of high transmission rate and high fatality rate, if there is no quarantine intervention, it is estimated that up to 40% of the population will be infected within 300 days and it will take about 110 days to reach the peak. In this pandemic situation, a strategy was established to reduce the maximum number of patients occurring on the peak day to 35% through quarantine measures, delay the peak of the epidemic from 110 days to 190 days, and quickly develop a vaccine during that period.

This plan aims to minimize not only the health damage but also the social and economic impact in the event of a novel influenza pandemic, and includes the following as key tasks before a pandemic: ▲ surveillance system, ▲ resource securing, ▲ vaccine strategy, and ▲ establishment of a One Health integrated management system, as well as response strategies for each phase (initial phase, spread phase, recovery phase) in the event of an outbreak.

First, the surveillance system aims to detect the emergence of a new virus early, expand overseas information collection, establish an information verification system*, and expand the number of medical institutions conducting surveillance from 300 to 1,000 for domestic surveillance.

Laboratory surveillance for pathogen genetic analysis will also be expanded from the current 180 to 200 sites, and links between medical institutions and public testing agencies to identify avian influenza will be strengthened. In addition, a surveillance system for unknown causes for respiratory infection patients visiting emergency rooms and outpatient clinics will be newly established.
​

* Select local information → Request information from ODA agency → Analyze after verifying information through local dispatched personnel
​

In addition, we plan to develop a multidisciplinary prediction model using artificial intelligence and mathematics/statistics in collaboration with the private sector to improve the prediction of patient occurrence by epidemic stage, and to establish a basis for effective quarantine policies through analysis of the effectiveness of various pharmacological and non-pharmacological quarantine measures.

Second, in the resource sector, we will stockpile 25% of the total population of treatment drugs to be able to respond for the first six months, and we will also stockpile quarantine supplies such as protective gear and masks to enable rapid supply, and operate the Disaster Management Resources Integrated Management System*.

For rapid diagnosis, a new one-step test method** will be developed to enable confirmation within 12 hours, compared to the current 72 hours. In preparation for the demand for large-scale testing and hospital beds in the event of an epidemic, genetic-based testing and rapid testing infrastructure will also be expanded, and the number of infectious disease beds will be expanded from the current 1,100 to 3,500.
​

* Distribution and logistics ICT-based system for real-time integrated management of national disaster management resource information​

** Rapid diagnosis possible in case of human infection with subtypes (H5N1, H5N8, H9N2) that mainly occur in birds

Third, for vaccines, as a strategy to develop a vaccine within 100 or 200 days of an outbreak, we prepare for two situations: developing a vaccine or prototype* (trial product) for the predicted antigen type of the outbreak in advance and using it for rapid development (100 days) in the event of an outbreak, or starting from the strain introduction stage and developing anew (200 days) in the event of an outbreak with a strain different from the pre-developed antigen type.

Currently, the avian influenza H5N1 vaccine has been developed domestically, so if a pandemic occurs due to a subtype of this, a vaccine can be developed in just 90 days through the strain change procedure.
​

* Currently in possession of fertilized egg-based H5N1, pandemic H1N1, and additional development of H5N1, H7N9 based on various platforms​

In order to secure an mRNA platform for rapid vaccine development, the government promoted the 'Pandemic mRNA Vaccine Development Support Project (hereinafter referred to as the 'mRNA Vaccine Project') through a Cabinet meeting last August, and the National Research and Development Project Evaluation General Committee of the Ministry of Science and ICT recognized the need for rapid vaccine development and acquisition, and selected this project as a project exempted from preliminary feasibility study.

Through this project, we aim to secure an mRNA vaccine platform by 2028, and in the first year, 2025, we submitted a government budget proposal to the National Assembly to invest 29 billion won to support non-clinical and clinical trials for mRNA vaccine development. The total project scale and period, etc. will be finalized after reviewing the feasibility of the business plan.

The fourth is One Health Integrated Management. Influenza is a zoonotic disease that infects both animals and humans. Influenza from birds such as chickens and ducks can spread to mammals such as cattle and pigs, and if it crosses the species barrier and infects humans, it can cause a pandemic. Therefore, One Health surveillance and response are required for the entire chain of infection transmission, including animals and the environment.

Surveillance of animal influenza will expand the current system centered on poultry and wild birds to include mammals and companion animals. In addition, an early warning system will be established to identify risks early and take preventive measures by tracking viruses originating from humans and animals and linking and analyzing information such as habitats and migratory bird movements.

In addition, we will regularize joint mock training among relevant ministries to strengthen real-time joint epidemiological investigations and responses to protect high-risk groups such as livestock workers or contacts in the event of an animal influenza outbreak. We plan to establish One Health policies and implementation plans and check their implementation through an inter-ministerial consultative body comprised of relevant ministries.

In response to an outbreak, strategies were specified according to the characteristics of each epidemic situation. In the early stages, plans were specified for minimizing transmission, preventing severe cases and deaths during the spread period, and effective recovery and reorganization during the recovery period. The “Initial 3 Days” plan was presented as an example to focus on rapid initial response.

In the early stages of an outbreak, pathogen characteristics and epidemiological information are insufficient, so pathogen information is quickly obtained through in-depth epidemiological investigations of early cases. A crisis response system is activated to establish a patient management system including screening and isolation of confirmed cases, and diagnostic testing methods are established and distributed, while crisis response R&D is activated to secure vaccines.

This is a time when stable medical resource management is required. In addition, the vaccination infrastructure prepared in the preparation stage will be activated for priority vaccination of high-risk groups and short-term, simultaneous, and rapid vaccination.

In the recovery phase, tasks are carried out to reorganize for the next pandemic, including effective damage recovery according to priorities and supplementary measures through response evaluation.

Meanwhile, on the morning of Friday, September 6, the Korea Disease Control and Prevention Agency reported on the “Plan to Prepare for and Respond to a Novel Influenza Pandemic” at the State Affairs Ministerial Meeting at the Government Complex Seoul, and held a public briefing on the plan with experts* that afternoon.
​

* Professor Jaegap Lee (Hallym University)

Ji Young-mi, the director of the Korea Disease Control and Prevention Agency, emphasized that “a pandemic can affect not only the health of the people but also essential social services, education, industry, and other areas, so advance preparation is important.” She added, “Since we have vaccines and antiviral drugs to respond to influenza, we will develop vaccine prototypes that match the characteristics (antigenic types) of new influenza and accelerate the development of vaccine platform technologies such as mRNA so that we can quickly secure vaccines in the event of a new virus outbreak.” She added that “We will also prepare by sufficiently stockpiling treatments and quarantine supplies in advance so that we can respond appropriately in the early stages of a pandemic.”

The Korea Disease Control and Prevention Agency requested cooperation from relevant ministries to ensure that the “Plan to Prepare for and Respond to a Novel Influenza Pandemic” is implemented well, and will continue to check for any obstacles in the field where the plan is to be implemented and evaluate its effectiveness. In addition, it explained that it will share this plan with the international community to support each country in establishing its own plan, and prepare for the next pandemic together.​

​

While it is true that No Pandemic Plan Survives Contact With ANovel Virus, having a framework for dealing with a crisis, and running realistic exercises, can be invaluable in a crisis.

But most importantly, it provides a road map for what can be done today to prepare for the inevitable public health threats of tomorrow.​

Which, based on our past performance, would be a novel response to a novel virus.


​https://afludiary.blogspot.com/2024/09/south-korea-releases-updated-pandemic.html