CAIRO, 18 November 2008 (IRIN) - Egypt, the country hit hardest by avian flu in the Middle East, is working on preventative measures to stop a potential human influenza pandemic.

The government, the UN World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE) have put together a national contingency plan [http://ocha.unog.ch/drptoolkit/HazardInfo&MonitoringTools/Pandemic/39%20Steps%20Governments%20Should%20Take%20To%20Prepare%20for%20Pandemic.doc] to boost rapid containment procedures, and build capacity to cope with a pandemic.

A potential human influenza pandemic could come about if the H5N1 bird flu virus mutates to allow human to human transmission.

Training exercises - involving the simulated conditions of a pandemic - are being organised in all 26 governorates. So far training teams have been formed and assigned to the governorates of al-Beheria, Menia, Gharbiya, Munufiya, and Sharqiya.

Muhammad Fawzi, director of a committee at the Centre for Future Studies - a government research institution with representatives from the ministries of defence, military production, health and population, interior affairs, environment, and foreign affairs - worked with governors to create the plan, based on WHO and Egyptian government recommendations.

"The two main concerns should a pandemic occur would be to keep the functions and services of the state running while containing the spread of the pandemic in the most efficient manner. We came up with a series of probable outcomes in case of a pandemic and from there began envisioning solutions with necessary procedural, executive responses from the state and the governors," Fawzi told IRIN in Cairo.

Critical decisions

Key officials have been designated who would make critical decisions such as when to utilise defence forces to maintain security and order in affected areas, or checkpoints at borders between governorates, or when to block certain public services to reduce the spread of the pandemic, Fawzi said.

John Jabbour, a consultant for emerging diseases at WHO, told IRIN Egypt's preparations appeared to be on the right track: "We have seen very good progress from the Ministry of Health and governorates. Their plan encompasses a macro and micro dimension at the national and sub-national level: from the top executive level of the state down to the single role of every village doctor and the response team assisting him," he said.

Simulation exercises

Desk simulation exercises conducted by the Health Ministry and WHO medical teams in Gharbiya (northwest of Cairo) and Munufiya (south of Gharbiya and north of Cairo) were deemed successful by WHO in testing the tracking methods and reporting procedures of hospitals and police stations in the two governorates. The Munufiya and Gharbiya pandemic plans were recommended as models for other governorates.

Zuhar Hallaj, an acting WHO representative, however, is concerned about the extent to which desk simulations are adequate forms of preparation.

"The experiences of Munufiya and Gharbiya are successful by WHO's standards." said Hallaj. "However, these are desk exercises carried [out] over the course of a day. No field simulation exercises have been carried out and we need to ensure that governorates which have had no cases of infection are as prepared as the ones that did report infection."

WHO has repeatedly advised the Health Ministry to carry out field simulation exercises. Initially, the government's Information and Decision Support Centre advised against these for fear of causing panic among residents.

"Field exercises are difficult to carry out because there is bound to be a misunderstanding or rumour through the media that an actual pandemic has hit the area where the field exercise is occurring," said Fawzi. "This would cause a huge dilemma for security and order in Egypt."

Vaccine

Both WHO and the Health Ministry predict that a vaccination for the human to human virus would be available, but in limited quantities.

"The maximum global level of vaccine production is 900 million vaccines. This is certainly not enough for the whole world should a global pandemic hit," warns Hallaj.

The humanitarian implications are serious. Since vaccine manufacturers would probably pass on only small amounts to developing countries, countries like Egypt would have to give vaccination priority to a select few, according to the pandemic preparedness plan.

"Key persons whose prospective illness would be costly to the functioning of main services and government institutions will be given vaccination priority. The rest of the population would be treated with Tamiflu which would be used as chemoprophylaxis" (preventative medication as oppose to treatment of infection), said Hallaj.

Business continuity plans have also been put in place: "Any disruption in key services could cause Egypt trillions of dollars in losses. We have to ensure that people can still draw money from banks and ATM machines during a pandemic; that food and medical supplies are available, water and electricity are running," Amr Qandil, a WHO representative at the Ministry of Health, said.

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