Caribbean Unprepared for Avian Flu

The Caribbean is not fully prepared if the deadly influenza virus breaks out in the region – an occurrence that heath officials say could happen by 2010. As a result a number of organizations including the University of the West Indies (UWI) are working together to host a Caribbean Community Pandemic Influenza Workshop in Kingston, Jamaica from January 20-22, 2009.

“The focus of the Caribbean Community Pandemic Influenza Workshop is to increase understanding of gaps in pandemic influenza preparedness and discuss potential solutions among CARICOM nations,” said Dr. Eric Milstrey, Public health officer with the United States Southern Command (US SOUTHCOM). He was speaking to about 150 participants who recently attended the 3rd Caribbean Conference on Disaster Management hosted by the Caribbean Disaster Emergency Response Agency (CDERA) in Barbados.

In attendance were government representatives, development researchers and representatives from civil society from within and outside the region.
He noted that while a pandemic is a global concern with serious consequences for all countries, the Caribbean, which has smaller populations than developed countries, is extremely vulnerable to the crippling effects of Pandemic Influenza due to lack of adequate facilities and resources to prepare for and respond to such an emergency.

“The biggest problem for the Caribbean in relation to pandemic influenza is that (it) is not an emotional problem in the region.  Because here, there rarely is ever a heavy problem with influenza, the governments do no (routinely) immunize against it and there are very little deaths associated with influenza, but when it does occur, it can be very dramatic,” he said.

“Because of that lack of social recognition of influenza as a threat, either seasonal or as a pandemic, there is very little dedication by the medical community to request verification if certain illnesses are influenza.  The Central Caribbean Laboratory in Trinidad and Tobago receives less than 50 assessments per year for influenza in the region.  This dramatically decreases the capability of recognizing an outbreak of influenza in the region and it delays the region’s response to limit such outbreaks if they should occur.”

His concern is at least partially shared by the Pan American Health Organization (PAHO).

In 2005, PAHO developed a Draft Regional Strategic and Operational Plan for Responding to Pandemic Influenza, which supports a similar plan and programme of the World Health Organization.  The plan outlines activities for preparing the world for the next influenza pandemic as well as to lessen and contain its impact once it begins to spread worldwide.

PAHO describes influenza is a viral disease that affects millions of people worldwide and kills about one million people annually.  Children, two years and younger and adults older that 60, are more vulnerable to contracting the virus, and developing countries such as those in the region, with inadequate key social services and infrastructure such as health care systems, water and power supply and easy access to transportation to get emergency medical assistance, are also much more vulnerable than more developed countries.

The organization acknowledges that in general, public health authorities in the region recognize the risk of a pandemic and its potential impact on the population, but says the development of an Influenza Pandemic Preparedness Plan is not always a priority.
“Pandemic preparedness competes with many other public health issues and many countries lack the human resources needed to dedicate time and effort to a potential threat that is not tangible as other pressing threats,” PAHO noted in the online version of the document.

PAHO says it is very difficult to predict when the next influenza pandemic will occur, but notes that based on statistics it could occur in the next two years.
“It has been almost 37 years since the last pandemic. The longest recorded inter-pandemic interval is 39 years.”

The worldwide health organization says a global pandemic could have frightening medical and public health implications.

“(A global outbreak) can cause at least 2-7 million deaths and tens of millions requiring medical attention in a matter of months,” excerpts from the Draft Regional Influenza Pandemic Plan stated.

Three pandemics have occurred in the last century.  The most devastating was the Spanish Flu from 1918-1919 caused by the A/H1N1 virus, which caused approximately 50 million deaths worldwide.  The other two pandemics occurred 1957-1958, (Asian Flu A (H2N2) virus) and 1968-1969 (Hong Kong Flu, A (H3N2) virus), each responsibly for a estimated four million deaths worldwide when compared to non-pandemic years.

Milstrey warns against complacency and a mindset that it (Pandemic Influenza) is not going to happen to us, pointing out that air travel and international trade not only cause people to move from place to place and keep the world connected, but increases the risk of widespread devastation from viral illnesses that are highly contagious.

“We recognize the urgency for all sectors within countries to be ready to implement Pandemic Influenza Policies into action when necessary. The workshop will focus on the Caribbean Community sustaining power, sewer, food, water, medical supplies, and other critical infrastructure, through an influenza pandemic crisis, and will address prevention strategies and economic recovery,” he disclosed.

He said prevention measures during an influenza pandemic, impact on critical infrastructure ad maintaining fuel and food resources to ensure trade continues, as well as sustainment of health care facilities and economic recovery plans following a pandemic.

The UWI is receiving assistance from a number of organizations in the United States including the United States Centre for Disaster and Humanitarian Assistance Medicine, the Center for Hemispheric Defense Studies and the United States Southern Command to host the workshop.

A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity, and for which there is no vaccine. The disease spreads easily person-to-person, causing serious illness, and can sweep across the country and around the world in very short time.

Since 2003, a growing number of human H5N1 cases have been reported in Asia, Europe, and Africa. More than half of the people infected with the H5N1 virus have died. Most of these cases are all believed to have been caused by exposure to infected poultry. There has been no sustained human-to-human transmission of the disease, but the concern is that H5N1 will evolve into a virus capable of human-to-human transmission.

In a paper titled Responding to an Influenza Pandemic in the Americas, authors, Peter DeShazo and Carissa Etienne examined the implication of an outbreak in the Americas.  Their predictions and recommendations are relevant to the Caribbean.

Both writers noted that the most vulnerable economies in the region would be those dependent on tourism, exporters of durable goods, and economies already under strain or where public health facilities are weak and overall public health is poor to begin with.

An influenza pandemic would at minimum, cause a short-term but substantial shock to the economies of the region that would vary in length and gravity, according to the attack rate of disease, the mortality rate, the pace of convalescence, and the number of waves of contagion.

The Caribbean is heavily dependent on tourism. Approximately 20 million tourists and more than 12 million cruise ship passengers visited the region in 1999 and in that same year, the Caribbean Tourism Organization estimated that tourism generated 900,000 direct and indirect jobs in the region.

An Influenza Pandemic would significantly reduce or stop tourists arrival to the island, at least until the epidemic is contained, due to travel bans and other methods of control aimed at limiting the spread of the virus.

The region has been taking action to try to prepare for this imminent threat. The 34 members of the Organization of American States mandated at the November 2005 Summit of the Americas that, with the support of PAHO, all countries in the region should have finalized National Influenza Pandemic Preparedness Plans by June 2006. By May 16th, all, except six Caribbean countries had submitted draft plans to PAHO, but only a minority of those is being implemented. The plans that have been developed require rigorous testing to determine if they are really operational, not just at the national level but locally, since a key objective in responding to a pandemic is to keep the outbreak as localized as possible.

Countries in the hemisphere that have not completed their National Influenza Pandemic Preparedness Plans are being urged to do so while those with completed NIPPPs need to make public and test their plans.

It is recommended that regional planners take advantage of previous planning to respond to other threats to public health and security, such as natural disasters, when formulating responses to the threat of pandemic influenza.  The planned regional workshop for next January in Kingston, seeks to build on those earlier efforts.

“We recommend that attendees representing your countries be from the following sectors, engineers or other personnel supporting critical infrastructure such as power, sewer, water, etc, public health or health care management and or emergency management or emergency preparedness.  The goal of this workshop is to corroborate with interagency and intergovernmental agencies that will be involved in the management of an influenza pandemic crisis across the region,” Milstrey explained. “Available staff will be significantly reduced during a crisis and plans must be in place to sustain the country.  Trade can also be impacted, not only reducing income, but delaying critical fuel or food supply deliveries.”

Milstrey said 11 countries had registered to attend and participate in the workshope so far but that the deadline for participants was still open. Interested persons can visit for more information. The conference will be held at the Pegasus Hotel.

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