I would like to thank the organizers of this conference for giving me the opportunity to speak here today on behalf of the International Federation of Red Cross and Red Crescent Societies, the NGO community and other humanitarian organizations.
It is a tribute and testament to the vital role that this sector has to play in pandemic preparedness and the avian influenza response.
I would also like to thank our hosts, the Government of India and, in particular, the Minister of Agriculture and the Minister of Health, for making us so welcome here in New Delhi. We will not forget this hospitality and, above all, what we have learnt from our Indian colleagues at this remarkable conference.
The purpose of my address is to highlight the following two points:
- the essential role of the humanitarian sector in pandemic preparedness and avian influenza preparedness and response;
- challenges facing the humanitarian sector.
The essential role of the humanitarian sector in pandemic preparedness and avian influenza preparedness and response
As we all know, a pandemic will strike randomly, affecting industrialized nations, emerging economies and developing countries alike. The SARS experience has shown us this in a scenario with two thousand million air travellers a year in the world.
It can therefore be assumed that countries with a high population density and urban agglomerations with millions of inhabitants will be, or are, at greater risk from a pandemic.
It also goes without saying that once a pandemic is established in a country, it will take a greater toll on the most vulnerable sectors of society, including the poor, the marginalized, the sick and other people in need.
The humanitarian sector, NGOs and charitable organizations have been operating in the field for many years, working with vulnerable people and venturing into the remotest corners of countries around the world, which means that they already have a significant degree of knowledge about local populations.
I think that this is true for all the countries around the world, and the Red Cross and Red Crescent is an eloquent example, with its 100 million volunteers, staff members and other contributors.
If we add to this the capacities of other organizations, such as CARE, World Vision, Save the Children, Caritas and OXFAM, to name but a few, then we have an extraordinary pool of resources, most likely covering 90% of the humanitarian work carried out in the world today.
The failure to involve such a sector would be a strategic error.
We are also all well aware that when the first wave of a pandemic strikes, many affected countries will not have access to a specific vaccine or antiviral drugs, or at least not enough of them.
Furthermore, as observed by my colleague from the World Health Organization, Dr Paul Gully, “community-level health strategies will be crucial in the first few days of a pandemic”.
With national absenteeism rates of between 25% and 30% – and public services seriously overstretched – who will meet the increased demand for services?
Who will deal with the bulk of non-pharmaceutical interventions?
Who will ensure that remote communities have access to a minimum level of care and services when they are affected?
Here again, humanitarian organizations and NGOs are in a unique position to provide health education and information on risks, promote “social distance” and quarantine measures, provide psychological support and assist in the initial stages of screening operations.
The list could go on, but these few examples clearly illustrate the added value of the sector.
In a pandemic, as in an epidemic or major disaster, it is best to fully involve the third sector – the public sector and the private sector being the first and second – as an essential player.
It is important to include it at the very outset and not as a last resort or as a second-rate, back-up sector.
In the first wave of a pandemic, in most, if not all, of the countries affected, this third sector is the one which – in the short term – will save most lives, have the greatest impact on limiting the spread of infection, be most effective in maintaining social harmony and implementing health measures and have the highest cost/benefit ratio.
And there is nothing to say that some of these advantages will not also be maintained in the medium term.
We ask governments and health authorities to consider the millions of hours contributed by the humanitarian sector in non-pharmaceutical interventions as a measure that is equally as important as the millions of doses of vaccine and the millions of antiviral pills.
They constitute an essential part of strategic resources.
Challenges facing the humanitarian sector
It is not my intention here to go into the importance of being well prepared. This subject has already been extensively addressed by many of my colleagues, not only here in New Delhi, but also in Bamako, Rome, Vienna, Geneva, Beijing and Washington.
Suffice it to say that there must be a balance between preparedness and surveillance measures, just as there must be a balance between human health and animal health.
What is the point of all our efforts if countries do not have an effective plan, validated by means of drills and supported by adequate resources, to deal with the situation when a pandemic does strike?
The humanitarian sector must also be made part of the national plan, offering the possibility of a response at the national, regional and community levels.
We urge governments to invite the main humanitarian actors in their countries to participate in the preparedness plan and to consider them as full partners in training, information, drills and deployment.
The humanitarian sector cannot go ahead on its own or be asked to jump onto a moving train, after the event, when the situation has already escalated.
The humanitarian sector is most valuable at the local level. It is here that the main challenge lies, because the most effective and efficient measures to deal with the first wave of a pandemic are taken at the local level.
The success of health measures will therefore depend on the degree of penetration in the community. This is why work must start now! Steps to ensure effective preparedness must be set in motion right now in order to raise the awareness of young people, by working closely with community leaders and building networks and partnerships.
Prevention and preparedness go hand in hand. My colleague, Dr Agarwal, who is Secretary General of the Indian Red Cross Society, translated half a million leaflets on hygiene and basic measures to prevent avian influenza into 11 languages and distributed them throughout his country.
Nonetheless, in a context in which a pandemic no longer seems as imminent as it did two or three years ago, in the eyes of public opinion, and in which so many priorities jostle for our attention, we acknowledge that one of the challenges we now face is to make people understand the importance of being prepared.
It should also be remembered that preparedness for a pandemic or an epizootic is also preparedness for other serious epidemics and for major disasters of any kind.
The message is clear, and we hope that it will be well understood.
A significant aspect of preparedness, one that is in itself a challenge, and a daunting challenge at that, is the quality of community workers and volunteers. A good workforce, even one formed by volunteers, is not free. It is necessary to train humanitarian workers well, establish protective measures for them, provide them with the tools they need to carry out their work and compensate them or their families if an accident occurs.
I must emphasize this last point, because a poorly protected workforce in the field can be tragic for the individuals concerned and for their families, not to mention the risk of them spreading infection.
Allow me to mention here the heroes of the Red Cross of the Democratic Republic of the Congo who assisted the public authorities during the worst of the Ebola epidemic.
At one point, almost half the victims were these humanitarian workers, who were doing everything, even burying the dead. The risks inherent in such work during an epidemic pose ethical issues that are sometimes difficult to resolve.
On the subject of recruiting workers, I must add that while it may well be easy to carry out a blitz campaign and recruit a large number of volunteers at any one time, keeping them motivated and maintaining the required level of knowledge and expertise at all times is quite another story. It is also very costly and warrants reflection beyond the immediate term.
I would also like to say a few words about the intersectoral dimension. The complexity of our work is such that no one organization or sector can do it successfully on its own.
For precisely this reason, CARE International and the International Federation last year launched a partnership with the participation of three other humanitarian organizations.
Interagency work has recently taken on a new dimension with the closer involvement of the United Nations system.
On 29 October, for example, the Federation and UNSIC brought together ten humanitarian organizations, 11 United Nations organizations and two international organizations to sign a declaration of intent on coordination, cooperation and working together.
Nevertheless, I am sure that you can appreciate how new it is for the “third” sector to accept coordination, complementariness and links with organizations that have not been habitual partners in the past. While on the subject of such partnerships, I would like to applaud the vision of UNSIC and, in particular, the valuable contribution of my colleague Dr David Nabarro.
Collaboration, cooperation and coordination are three key factors to be developed in a spirit of partnership between civil society and governments, as the Prime Minister observed yesterday.
I will finish by mentioning the still greater challenges ahead posed by work in countries’ border areas, cross-border action and the protection of migrants, displaced persons, wandering populations and refugees.
On a smaller and very local scale, the challenges involve the homeless in our cities, particularly children and the mentally ill, legal and illegal migrants and refugees. In short, all this work, all these efforts, must take the long term into account right now.
Being prepared is not just for today. Being prepared is a responsibility that we have to assume on a permanent basis. A realistic decision must be taken as to what resources and investments must be assigned to this task, taking into account other priorities and what we can and will be able to spend on this undertaking in the long term.
Any other approach is doomed to failure.