The continuing outbreaks of highly pathogenic avian influenza (HPAI) in recent years have caused substantial damage to the poultry industry in several regions of the world, resulted in the loss of human life, and raised concerns about a possible human pandemic. Large scale outbreaks began in 2003 in several Southeast Asian countries, including Laos.

 

The global response to the threat of Avian and Human influenza (AHI) in humans and domestic poultry, guided by the global strategies put forward by World Health Organization (WHO), Food and Agriculture Organization (FAO), and World Organization for Animal Health (OIE), comprises four key strategies: (i) progressively controlling and eradicating the spread of the disease in animals, thus lowering the animal-origin virus load in the environment and reducing the risks of human infection; (ii) preventing and limiting the spread of the disease among humans, thereby reducing the opportunity for the virus to improve its human transmissibility; (iii)in the event of a pandemic, helping affected populations cope with its effects; and (iv) minimize the social and economic impact from the threat of AHI.

 

AHI prevention and control involves many players in the areas of health, agriculture, natural disaster response, finance and planning, and a multi-sectoral approach is therefore essential. It is also recognized that individual countries are central to a coordinated and effective global response. Country strategies should be developed in accordance with country-specific needs and circumstances, and the strategies should be owned by the individual governments facing the threat of AHI.

 

In East Asia and the Pacific, cases of AHI have occurred in a number of countries, including Cambodia, China, Lao People’s Democratic Republic (PDR), Indonesia, Japan, Korea, Malaysia, Myanmar, Thailand and Vietnam. Responses to the outbreaks in domestic and wild fowl have included screening, surveillance, and precautions at the borders, controlling movement inside the country, culling programs, and control of wildlife reservoirs.

 

Several countries have already developed integrated regional plans. Specific strategies vary across countries, especially regarding issues such as the appropriateness of mass vaccination of poultry. Clearly the cross-country issues in dealing with AHI are critical in terms of transmission, information sharing, as well as coordination. The country specific strategies have been adapted to the specific conditions in-country. In addition, Lao PDR participates in a number of regional initiatives through ASEAN, APEC, Mekong Basin Surveillance, among others.

 

Lao PDR is a land-locked country that shares borders with countries affected by outbreaks caused by H5N1 (alternatively referred to as HPAI), specifically Vietnam, Thailand, Cambodia, and China. These borders are largely permeable, where crossing of food products, animals, and people occur. Although the population of Lao PDR is not large, 5.6 million, the majority of these people live in rural and remote mountainous areas, with the attendant challenges of communications, transport, and service provision. There are approximately 20 million poultry in Lao PDR of which, 20 percent is owned by approximately 120 commercial enterprises that serve the larger urban populations in Vientiane, Luang Prabang, Champasak, and Savanakhet. The remaining 80 percent is owned by subsistence farmers for family consumption.

 

In response to the situation, the Government of Lao PDR has prepared an integrated National Avian Influenza Control and Pandemic Preparedness Plan (the National Plan) covering the period 2006-2010. The National Plan is fully consistent with, and draws heavily on, the global strategies developed by FAO/OiE and WHO, and provides the basis for the program which the World Bank and other donors will support. The current international implementing agencies and their respective funding sources are as follows:

 

 

Lao PDR’s National Plan comprises five strategies, and the components of the World Bank support, which mirror these, are described below. 

Component 1: Animal Health, focuses on controlling the disease in poultry, and is in line with the recommendations made by the leading international technical agencies (FAO, OiE and WHO). Given the current status of HPAI in Lao PDR, the component is directed at investigation, surveillance, prevention, and preparedness for any new outbreak. Activities to reduce the risk of AI infection in backyard poultry, commercial, and fighting cock production are being supported, as are those to increase the capacity for laboratory diagnosis and early detection and response (including improving the national information system) at the field-level. Regional and international networking will be supported, as will the training of veterinarians, in response to the need to provide front-line veterinary services and surveillance. Financing is being provided for developing a compensation mechanism, and an indicative amount has been allocated to the fund. Access to the fund will require the development of guidelines that are acceptable to the World Bank.  

 

Component 2: Human Health - Surveillance and Response, supports surveillance of human health and establishes a mechanism for responding in the event of outbreaks. Activities include capacity building to improve the surveillance system and integration of routine surveillance systems and data. Financing for communication is being provided.

 

Component 3: Human Health – Curative Services will support key activities related to laboratory and curative care to strengthen the public health sector’s response in the event of an outbreak or declaration of a pandemic. The Government’s strategy includes strengthening human resources, infrastructure and border control. Support will be provided for developing and monitoring pandemic preparedness activities and improving hospital information systems. The National Plan includes an option to finance the construction of a new laboratory or rehabilitate and improve the biosafety of the existing laboratory, which could be financed under this component. Financing from the World Bank includes medical waste management, support for border control, improving information systems, and monitoring and evaluation of activities under this component. 

 

Component 4: Information, Education and Communication, supports the formulation and dissemination of a national awareness campaign on AHI. These activities will be participatory in nature and are targeted to the general population. The National Plan includes translation of the communication tools developed into local and minority languages is included. In order to reach children, messages will be provided through an existing school program. A knowledge, attitude and practice (KAP) survey will be undertaken to establish a baseline, with a second KAP conducted about 12 months later. Financing from the World Bank covers a final survey at the end of the Project.

 

Component 5: Program Coordination and Regulatory Framework will support planning for the multi sectoral activities necessary in the event of an outbreak (in either animals or humans), or a pandemic. Financing is available to review existing regulations to ensure that they provide the requisite authority and are sufficiently broad in scope to allow for a rapid response in the event of a declared emergency. A notional amount has been set aside for undertaking programmatic research or piloting activities that would inform the National Plan. In addition, support will be provided to the National Committee for Communicable Diseases (NC/CDC) and the National Avian and Human Influenza Coordination Office (NAHICO), which is charged with overseeing the implementation of the National Plan. Technical assistance, provided to NAHICO, will also provide capacity building to the implementing agencies in procurement, financial management, as well as monitoring and evaluation.

 

The Prime Minister’s Office, on May 11, 2006, issued an Agreement (No. 113/PMO) establishing the National Avian and Human Influenza Coordination Office (NAHICO) and naming a Chair, a Vice Chair and three Members and established the following four Units: (a) Coordination and Collaboration; (b) Planning and Finance; (c) Monitoring and Evaluation; and (d) Procurement. NAHICO is responsible for overall project coordination, and the following agencies are responsible for implementing the components:

 

Component 1: Department of Livestock and Fisheries (DLF), Ministry of Agriculture and Forestry (MoAF)

 

Component 2:  Department of Hygiene and Prevention (DHP), Ministry of Health (MoH)

 

Component 3:   Department of Curative Care (DCC) and NCLE, MoH

 

Component 4:  Ministry of Information and Communication, Ministry of Education, MoH, MoAF, and Mass Organizations (youth, trade, and women’s unions), with NAHICO providing overall coordination.

 

Component 5:  All but Program Management: MOH, MAF, the Ministry of Foreign Affairs, and the Ministry of Justice, with NAHICO providing overall coordination. NAHICO will have sole responsibility for Program Management.

 

In addition, the NAHICO is responsible for implementation of the World Bank project, which covers the major part of the activities stipulated in the National Plan. The project name is Avian & Human Influenza Control and Preparedness Project and its overall development objective is to contribute to Government’s National Plan which aims to minimize the threat posed to humans and the poultry sectors by highly pathogenic avian influenza (HPAI) infection and other zoonoses in Lao PDR, and to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans.

 

The Avian & Human Influenza Control and Preparedness Project, financed by the WB, consists of the following parts:

 

Part A: Animal Health

1. Introducing bio-security measures and regulations in commercial poultry production, including: (a) provision of information materials and training to poultry producer associations on HPAI risk reduction measures; (b) establishment of regulations for poultry movement control; and (c) development of safe practices at slaughtering places.

 

2. Introducing and implementing concepts of quarantine and safe movement practices for fighting cocks through education and public awareness campaigns.

 

3. Enhancing the capacity of veterinary workers for early detection and early warning of HPAI outbreaks at the field level through the following activities: (a) provision of vehicles to veterinary field workers for immediate response to HPAI outbreaks; and (b) formulation of guidelines, procedures, and legal frameworks to regulate the operations of international border check points and internal interprovincial check points.

 

4. Strengthening the Recipient's capacity for laboratory diagnosis by completion of the National Animal Health Center.

 

5. Provision of technical assistance to undertake research on monitoring of national and international poultry movements for zoning or compartmentalization of infected and uninfected areas to facilitate inter-provincial trade.

 

6. Improving a national disease information system through provision of required communication equipment.

 

7. Enhancing the Recipient's capacity for rapid and effective response to HPAI outbreaks through the following activities: (a) facilitating effective field response by central, provincial, and district veterinary staff through provision of operational support; (b) developing regulations relating to compensation to owners of culled poultry and providing compensation to owners of culled poultry out of the proceeds of the Compensation Fund; and (c) rental of earth-moving equipment to facilitate burial for culled poultry.

 

8. Enhancing regional, national, and international networking and communication on HPAI related matters through supporting conferences, meetings, and field visits.

 

9. Strengthening the Recipient's veterinary capacity through supporting the undergraduate training of selected veterinary workers.

 

Part B: Human Health: Surveillance and Response

1. Provision of training to staff of NCLE on HPAI surveillance and response.

 

2. Improving the Recipient's influenza disease surveillance systems through provision of mobile phones and other operating support.

 

3. Strengthening the capacity of the Recipient's rapid response teams (RRTs) to investigate and respond to emerging influenza diseases through provision of vehicles to RRTs.

 

4. Implementation of HPAI outbreak response measures in the event of an HPAI outbreak, including travel restrictions and HPAI virus screening.

 

5. Implementation of HPAI outbreak response measures in the event that a pandemic is declared, including financing of Eligible Imported Goods.

 

6. Monitoring and evaluating the progress of the activities under this Part B of the Project.

 

Part C: Human Health: Curative Services

1. Improving the capacity of hospitals and health clinics to deliver curative services through the following activities: (a) provision of about five (5) ambulances and related operating support; (b) provision of technical assistance to hospitals and health clinics to develop hospital waste management plans; (c) provision of required equipment, supplies and operating support to carry out said hospital waste management plans; and (d) training of hospital staff in hospital waste management.

 

2. Improving the Recipient's HPAI communications capacity through the establishment of information systems in about five (5) hospitals, and provision of training and operating support therefore.

 

3. Improving the Recipient's laboratory capacity through construction and/or upgrading of laboratory facilities.

 

4. Provision of operating support to staff international border and internal checkpoints in the event that an HPAI outbreak or pandemic is declared.

 

5. Monitoring and evaluating the progress of the activities under this Part C of the Project.

 

Part D: Information, Education, and Communication

Carrying out the information, education, and communication (IEC) program, including surveys on HPAI diseases.

 

Part E: Proiect Coordination, Proiect Management, and Regulatory Framework

1. Strengthening the capacity of NCCDC in the areas of: (a) developing pandemic preparedness plans; (b) undertaking desktop simulation exercises; (c) training in disaster management; (d) developing HPAI risk communications materials; and (e) Project monitoring and supervision.

 

2. Provision and management of a minimum stockpile of essential HPAI response supplies for implementation of the above-mentioned pandemic preparedness plans.

 

3. Reviewing existing regulatory framework related to HPAI pandemic preparedness, making recommendations thereon, building consensus to advocate for making the necessary changes to said regulatory framework, and drafting new regulations if needed.

 

4. Undertaking research on HPAI pandemic preparedness topics, and piloting innovative activities to reduce the risks of HPAI infection.

 

5. Strengthening the capacity of NAHICO in Project management in the areas of procurement, financial management, monitoring and evaluation, supervision, and coordination through provision of required equipment and operating support.