Statement by Pierre Duplessis, Special Envoy of the IFRC Secretary General, at the International Ministerial Meeting on Avian and Pandemic Influenza, in Sharm El Sheikh
Thank you for allowing the International Federation of Red Cross and Red Crescent Societies to make a statement in this important International Ministerial Conference on Avian and Pandemic Influenza.
Our thanks go also to the Government of Egypt for his leadership in organising this conference and for his wonderful hospitality.
Our presentation today will underscore the role of the International Federation as well as the voluntary organisations in humanitarian pandemic preparedness, will draw some lessons after three years of intense involvement and reflect on the future.
As we said earlier in previous Senior Officials Meetings, it is the volunteers and professionals of civil society, particularly those of local and international NGOs who are going to do the most risky jobs and make the most difficult choices in time of a pandemic when borders will be closed, supply lines disrupted, health systems overwhelmed and social order threatened.
The capacity of those actors will be crucial to reduce the impact of the infection and concomitant health and non health issues. We knew that when the red flag went up with the resurgence of the highly pathogenic H5N1 in poultry.
The International Federation started to take important actions in 2005: a survey conducted among our 185 Red Cross/Red Crescent members at the time – survey that was repeated in 2007 –, an appeal launched to support financially our members, an ambitious series of programmes focusing on both avian influenza and pandemic preparedness designed, intense training-the-trainers done in countries, business continuity planning initiated.
More than 27 countries participated, the majority being concerned by a bird epizootic within their borders; many through the appeal, some through the assistance of Nordic Red Crosses, and a few with grants from international donors including, as mentioned in the previous presentation by Ambassador Lange, a large grant from USAID for pandemic preparedness.
In parallel we established joint collaboration agreements on pandemic preparedness with the UN system, and NGOs. We also catalyzed a commitment for collaboration, cooperation and complementary pandemic plans among 22 international organisations at top management level.
We would like to reflect with you today and draw some lessons from all those initiatives.
1. Working together: a necessity and a challenge
The balance sheet of our collaborative efforts is quite positive. We knew that any such work would produce the best results by - and only by - working together. And we resolutely decided to work together.
Let me discuss more in depth focusing on the community level, the organisational partnership and the international commitment.
Beginning with the community level, one of the most interesting initiatives on pandemic preparedness by the voluntary sector is certainly this four major organisation partnership with a common vision and shared capacities largely supported by a generous grant from USAID.
The Academy for Educational Development, the CORE Group with its 60 member organisations, InterAction and us (IFRC) are focusing on pandemic preparedness at community and household levels.
We are targeting 3 specific areas of interventions: health largely – through non pharmaceutical interventions –, food security and livelihoods.
Our collaborative efforts are expressed in choosing and assessing countries together, drafting joint protocols and generic programmes, designing curricula and implementing jointly.
Egypt for instance was the first country to enter into what is known as H2P or the Humanitarian Pandemic Preparedness Initiative. It took more than 6 months of hard work to come to a formal agreement between IFRC and the Egyptian Red Crescent.
Implementation that followed took another 4-5 months: we had to develop and adapt templates, select governorates, persuade people and decision makers, involve the community, work with other NGOs like SAVE the Children with whom we are doing a great job, agree on objectives and set evaluation framework.
We are proud today of the programmes put place by the Egyptian Red Crescent and proud of the partnership it established with the Egyptian Government.
What we learned is that to have a vibrant commitment, an engaged country and top quality programmes executed in partnership take time. Be it in Egypt, in Nepal, in Mali or anywhere, it takes time. Work elsewhere comes to the same conclusions as we will see with CARE Egypt presentation tomorrow (1).
My second point is at the management level of partner organisations. Here our collaborative efforts are seen in establishing decision making processes together, developing a common website (2), and preparing knowledge sharing regional meetings.
My third point is the inter agency top management level. A committing declaration of cooperation was signed in October 2007 by the voluntary sector, the UN agencies and three international organisations.
We followed up by conducting a tabletop exercise a month ago with 21 of those organisations. In the coming year we have the bold ambition to conduct more of those exercises at the regional level and to assess how complementary our protocols and guidelines are.
But some challenges remain. We have different missions, different interests, and although used to collaborate in time of disasters like tsunami, floods and earthquakes, or in development programmes like malaria, HIV/AIDS, tuberculosis, measles and vaccination, partnership is not an easy journey.
Fair to say that sometimes we are in competition: competition for the same dollars, same contracts, same media coverage. We also have different cultures, different procedures and rules of engagement. But fair to say that there is so much duplication and overlap.
What we learned is a true and genuine willingness to enter into partnership for everyone. What we learned is that complementary work takes time and goes much beyond one to two year of joint preparedness. And rightly so since we want it sustainable on the long term.
We want it broader than pandemic preparedness.
One other lesson we learned is that some important players are not around the table with us.
- Significant NGOs prefer to postpone joint action until phase 6 be declared. Such an attitude is not defendable: good and efficient response is by far much better done when good and efficient planning has taken place. A lesson we learned through hundreds and hundreds of disasters; nobody will argue. And good and efficient planning requires all players to get together before, not just during
- Key government actors like Defence are sometimes forgotten
- And last but by far not least, the private sector. We are not doing a good job in bringing the private sector on board, and we know how a key this one is.
Lastly with communities themselves, one has to understand that it takes time to internalize the concept and programmes otherwise programmes, whatever they are, will not be sustainable on the one hand. Engaging civil society volunteers and personnel on the other hand needs to be done adequately i.e. with proper training, proper protection including access to prophylaxis and treatment, and proper indemnification to those concerned and their families in case of infection and even death.
2. Influenza is no more a top priority
There is a pandemic fatigue and to some extent even an avian flu fatigue. It exists among the donors, public, media, organisations and even country authorities. This is the case in many countries we have visited. Even sometimes when infection in poultry is present, allocation of resources or interest on the part of the authorities can be low.
Trying to persuade to prepare for a pandemic in such a context is not an easy job, and we run the risk of an ephemeral implementation with no sustainability after the grant money is over.
What we learned is the necessity to “package” in a different way a serious threat to humanity when the infection is a protracted one and no pandemic is happening.
The A/H5 and the important viral activity of the influenza virus currently are of concern. The public believes nothing will happen since nothing happened. The conclusion is the threat is over. And so do the media. In this new packaging effort, we thought a sugar coat would be that pandemic preparedness is in fact “preparedness at large”: it will improve country/organisations/communities capacities in general. Which is true. Which helps – no doubt – and is the way forward. But it seems not as a strong convincing argument as we thought it would.
Pandemic preparedness remains a hard sell in vulnerable countries.
Why is that? Beyond fatigue, which is not always the case, the absorption capacity is simply exceeded.
To the credit of States, they are sometimes struggling with real life and death “immediate” priorities which push pandemic preparedness down to a low level. And rightly so.
Scanning the IFRC website disaster section (3), one can read a catastrophic situation just few months ago in China (May), Myanmar (May), Bangladesh (June), Philippines (June), Nepal (August), Haiti (July) to name just a few. There were 18 new appeals for disasters over the last 10 months.
Added to this distressful situation in many States, the HIV/AIDS, malaria, tuberculosis, on a food crisis background plus three weeks ago a world financial crash. This is how tragic it is for vulnerable countries.
But there are elements of solution. We believe we can learn from other programmes – HIV/AIDS or seasonal influenza surveillance and vaccination – which succeeded in drawing attention and resources on a continuous basis.
Influenza pandemic preparedness needs to become routine: it has to be part of a culture of preparedness, part of any country disaster plans.
It has to be incorporated in the government catastrophic event planning cycle. And it has to be integrated: “One World One Health” is an eloquent example.
To achieve this will require information and communication. And once again, it will take time.
We have to be ready to invest more than just a few years in it.
3. The country plans: work in progress
Governments play a key role in pandemic preparedness and without their commitment, planning efforts, expertise and resources, we are going nowhere. Be it civil society, the UN system, international assistance, our role is nothing but to support what governments will put in place.
We certainly all agree that a corner stone of pandemic preparedness is the country plan. Without such a road map, there is no definition of roles and responsibilities, no trigger mechanisms, no coordination and no concerted action defined.
We were happy to note the existence of such plans in almost all countries visited and part of our programmes. This is corroborates studies to that effect (4). There are several main issues however:
- almost all are not sufficiently operational
- in many of these the civil society’s role is not taken into consideration
- addressing the community level is non existent
- for many, the country plan is the Ministry of Health or Ministry of Agriculture’s plan, which is not good enough
Another lesson learned is our role as raising awareness. Every country where we have been and had an open discussion behind closed doors on those issues, mindset changed and plans improved. Willingness is there, no doubt; what is missing is the information.
In line with this, such plans – including our own plans, us civil society, not just the country ones – need to include many annexes. Let me name just a few:
- protocols and guidelines including those on social distancing and quarantine
- repatriation of foreign personnel and citizens abroad and vice versa for evacuation
- measures for special populations like IDPs, refugees and moving populations
- contingency plans for essential services of ministries, critical departments and other sectors
- draft promulgations for exceptional measures and special powers
- draft authorizations for special budget allocations - MOUs with neighbouring countries on border, trade and transportation matters.
Moreover, those plans should be updated and tested through exercises and simulations (5).
4. Looking ahead
We are lucky to have had - and are likely to have - a bit of time to prepare before the next pandemic hits.
We did reasonably well to date although we are lagging behind while there is so much to do. We got into action both on the avian flu front and the pandemic preparedness one without sufficient planning: we were nervous to deliver quickly and in other instances, we felt enormous pressure to get immediately into action.
We learned that quality does not exist in a rush and that sustainability goes through an “internalization” process.
Partnership is there to last and to get more and more efficient. But organisational boundaries have to adapt to modern times: more mobility between organisations. Why not envisage a sort of “Schengen space” for the voluntary sector (6)?
And there are a lot of other practical steps to achieve otherwise pandemic preparedness efforts will remain planning exercises among voluntary agencies, at least on our side.
One of the biggest challenges is to transform competition into complementary roles and responsibilities.
And it is possible to do so without losing our purpose, our identity or infringing upon our mission.
Minister Chairpersons, we see this international ministerial meeting as having an important catalytic role in moving forward and we thank you again for the opportunity to allow us to contribute to this session.
ENDNOTES
(1) http://icarenews.care.org/avianflu.html and http://avianflunetwork.blogspot.com/
(2) InterAction is designing a website for pandemic preparedness to include mapping of all related partner activities http://preparedness.interaction.org/map
(3) http://www.ifrc.org/Docs/Appeals/statistic/cover0607_emer.pdf
(4) Ortu, G.; Mounier-Jack, S.; Coker, R.; Pandemic influenza preparedness in Africa is a profound challenge for an already distressed region: analysis of national preparedness plans. Health Policy Plan, 2008; 23(3):161-9 and Mounier-Jack, S.; Jas, R.; Coker, R.; Progress and shortcomings in European national strategic plans for pandemic influenza. Bull. World Health Organ, 2007; 85(12):923-929
(5) InterAction is offering tabletop exercises to CEOs of NGOs as an example in civil society sector
(6) Borrowing from the Schengen Agreement among 25 European countries where physical borders are abolished namely for the circulation of their citizens, voluntary organisations should find mechanisms to emphasize exchange programmes for their senior executives, secondment of expertise and personnel in national and regional offices, and increase inter-organisation mobility