WMA Statement on Avian and Pandemic Influenza

Adopted by the 57^th WMA General Assembly, Pilanesberg, South Africa, October 2006
and amended by the 69^th WMA General Assembly, Reykjavik, Iceland, October 2018 

Preamble

Pandemic influenza occurs approximately three or four times every century. It usually occurs when a novel influenza A virus emerges that can easily be transmitted from person-to-person, to which humans have little or no immunity. Infection control and social distancing practices can help slow down the spread of the virus. Vaccine development can be challenging as the pandemic strain may not be accurately predicted. Adequate supplies of antivirals are key for treatment of specific at-risk populations and controlling further spread of the outbreak.

Avian influenza is a zoonotic infection of birds and poultry, and can cause sporadic human infections. Birds act as reservoir and shed the virus in their feces, mucous and saliva. In addition, a new pandemic virus could develop if a human became simultaneously infected with avian and human influenza viruses, resulting in gene swapping and a new virus strain for which there may be no immunity. Humans are infected if they are exposed through the mouth, eyes, or from the inhalation of virus particles. Limited evidence of human to human transmission has been reported as well.

This statement alongside with WMA Statement on Epidemics and Pandemics provides guidance to National Medical Associations and physicians on how they should be involved in their respective country’s pandemic influenza planning and how to respond to Avian Influenza or pandemic influenza.

Recommendations

Avian Influenza

In the event of an avian influenza outbreak, the following measures should be taken:

• Sources of exposure should be avoided when possible as this is the most effective prevention measure.
• Personal protective equipment should be used and hand hygiene practices emphasized for personnel handling poultry as well as members of the healthcare team.
• All infected/exposed birds should be destroyed with proper disposal of carcasses, and rigorous disinfection or quarantine of farms.
• Stockpiles of vaccines and antivirals should be maintained for use during an outbreak.
• Antiviral medications such as neuraminidase inhibitors may be used for treatment.

Pandemic Influenza Preparedness

WHO and National Public Health Officials:

• The coordination of the international response to an influenza pandemic is the responsibility of the World Health Organization (WHO). The WHO currently uses an all-hazards risk based approach, to allow for a coordinated response based on varying degrees of severity of the pandemic.

The WHO should:

• Offer technical and laboratory assistance to affected countries if needed and continuously monitor activity levels of potential pandemic influenza strains continuously, ensuring that the designation of “Public Health Emergency of International Concern” is done in a timely manner if needed.
• Monitor and coordinate processes by which governments share biological materials including virus strains, to facilitate the production of and ensure access to vaccines globally.
• Communicate available information on influenza activity of concern as early as possible to allow for a timely response.

National governments are urged to develop National Action plans to address the following points:

• Ensure that there is adequate local capacity for diagnosis and surveillance to allow continuous monitoring of influenza activity around the country.
• Consider the surge capacity of hospitals, laboratories, and public health infrastructure and improve them if necessary.
• Identify legal and ethical frameworks as well as governance structures in relation to the pandemic planning.
• Identify the mechanisms and the relevant authorities to initiate and escalate interventions to slow the spread of the virus in the community such as school closures, quarantine, border closures etc.
• Prepare risk and crisis communication strategies and messages in anticipation of public and media fear and anxiety.
• Governments are also urged to share biological materials namely virus strains and others, to facilitate the production and ensure access to vaccines globally.
• Ensure that diagnostics and surveillance efforts are continued and that adequate vaccine and antiviral stockpiles are established.
• Establish protocols to manage patients in the community, carry out triage in healthcare facilities, provide ventilation management, and handle infectious waste.
• Allocation of vaccine doses, antivirals and hospital beds should be coordinated with experts.
• Priority for vaccination should be given to the highest risk groups including those required to maintain essential services, including health care services.
• Guidance and timely information to regional health departments, health care organizations, and physicians.
• Preparation for an increase in demand for healthcare services and absences of health care providers especially if clinical severity of the illness is high. In such cases prioritization and coordination of available resources is essential. This may include tapping into private sector capacity where state resources are insufficient.
• Ensure adequate funding is allocated for pandemic preparedness and response as well as its health and social consequences.
• Make sure that mechanisms are in place to ensure the safety of healthcare facilities, personnel and the supply chains for vaccines and antivirals
• Promote and fund research to develop vaccines and effective treatments with lasting effects against influenza.
• Encourage collaboration between human and veterinary medicine in the prevention, research and control of avian influenza.

National Medical Associations are urged to:

• Delineate their involvement in the national pandemic influenza preparedness plan, which may include increasing capacity building amongst physicians, participating in guideline development and communication with healthcare professionals.
• Help educate the public about avian and pandemic influenza.
• When feasible, coordinate with other healthcare professionals’ organizations as well as other NMAs to identify common issues and congruent policies related to pandemic influenza preparedness and response.
• Consider implementing support strategies for members involved in the response including mental health services, facilitation of health emergency response teams, and locum relief.
• Advocate before and during a pandemic, for allocation of adequate resources to meet foreseeable and emerging needs of healthcare, patients and the general public.
• Encourage health personnel to protect themselves by vaccination.
• Develop their own organization-specific business contingency plans to ensure continued support of their members.

Physicians:

• Must be sufficiently knowledgeable about pandemic influenza and transmission risks, including local, national and international epidemiology.
• Should implement infection control practices and vaccination, to protect themselves as well as other staff members during seasonal and pandemic influenza outbreaks.
• Must participate in local/regional pandemic influenza preparedness planning and training.
• Should develop contingency plans to deal with possible disruptions in essential services and personnel shortages.