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Maintain a current knowledge base
A variety of sources of information are readily available regarding avian influenza and other health threats. Situation updates regarding avian influenza outbreaks are available from the CDC and WHO at their websites.
Situational updates can be found on CDC websites:
It is important to include surveillance of conditions at high risk locations via local health authorities and/or WHO. Also, a means of recording timing of travel, locations, and health status of employees who travel may assist in tracing any contacts of persons who might have been exposed to infection while abroad and thus mitigate risk.
Develop procedures based on WHO pandemic phases
The World Health Organization (WHO) has defined 6 phases of pandemic. The WHO has outlined a preparedness plan for a possible pandemic, and the various recommended actions for governments and health authorities correspond to each of the pandemic phases. Organizations developing their own preparedness plans would be well advised to utilize this systematic approach to decision-making. Most governments and agencies will use these designations to trigger their activities, and aligning corporate contingency plans with this framework is crucial. We are currently in the Pandemic alert period—Phase 3.
WHO PANDEMIC PHASES
| Interpandemic period |
| Phase
1: |
No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low. |
| Phase 2: |
No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. |
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| Pandemic alert period |
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Phase 3:
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Human
infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.
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Phase 4:
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Small
cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
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Phase 5:
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Larger
cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).
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Pandemic period |
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Phase 6:
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Pandemic: increased and sustained transmission in general population.
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Should the WHO declare a heightened state of pandemic alert, corporate actions may be considered which could include the following:
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Limiting employee travel to affected areas
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Relocating some or employees away from affected regions
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Closing units/plant in close proximity to an outbreak, such as within 5 km
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Screening employees
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Addressing employee stress
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Performing medical evacuation for ill persons suitable for transport
Many authorities feel that pandemic phase 4 might be the most appropriate time for staff relocation, as delaying until phase 5 might be too late to allow employees to avoid quarantine or border closings in affected countries.
Interface with local government and business before and during emergency
Close communication with local authorities and businesses will allow organizations to anticipate actions that might interrupt key functions or impact key personnel. Cooperating with authorities may gain valuable time to permit relocation of staff or supplies.
Identifying local resources for key personnel in high risk locations
Various employees might have differing health and safety needs. For example, executives, travelers, expatriates, and nationals each may experience unique risks. High priority individuals could include either those persons with greater health risk, or those who perform essential functions within the organization.
A thorough knowledge of local health care providers and systems will help to ensure access to care. Awareness of the limitations of local providers and any potential alternatives is also important, as local systems may be overwhelmed in an emergency.
Specific plans for obtaining, prescribing, and distributing antiviral medicines for treatment or prevention of Influenza A H5N1 remain a challenge for most organizations. Any draft plan needs to outline various options or solutions, and must be updated frequently to correspond to situational changes with respect to the status of the outbreak and the healthcare infrastructure.
Close cooperation with local governments, health authorities, and businesses regarding local supply of medicines is crucial.
Use of assistance organizations represents an additional option for corporations in their preparedness planning. MedAire has a number of resources that address the needs of corporate clients. These could include:
- MedAire Preparedness Planning Task Force—a source of updates
- Security services
- Travel services
- Medical services
1) 24/7 call in access to U.S. hospital-based physicians
2) Global Doctor clinics—local experts in the field
- MedAire Travel Monitor
Stockpiling antiviral medicines
Stockpiling of antiviral medicines by individuals or organizations is controversial, and currently the CDC and WHO support a policy of stockpiling for governments.
A limited supply of Tamiflu is available at this time. Tamiflu is made from parts of the star anise plants. It is difficult to manufacture and takes 10 steps, some of which are very complex. The time to manufacture Tamiflu is approximately 6-8 months for Roche, and could be longer for companies that have never before made the drug. Production capacity is the biggest obstacle to wide distribution of Tamiflu at this time.
A recent press release from Roche (Nov. 23, 2005) updates the current status of availability and manufacturing of Tamiflu.
- Roche has donated 3 million doses to the WHO for rapid deployment in the epicenter of a pandemic.
- Roche is actively working to increase the production capacity of Tamiflu, and projects an ability to produce 300 million doses annually by the end of 2006.
- Roche is negotiating with 8 drug manufacturers and also with the governments of Taiwan and Vietnam to establish other sites of production for Tamiflu.
To review this press release, please see:
http://www.roche.com/med_mbtamiflu05e.pdf
The decision to stockpile medicines for individuals or organizations should be based on the current status of the phase of pandemic and on assessing individuals’ risk status on the basis of their underlying health risk and/or their societal role.
Priority groups for receipt of antiviral medicines have been proposed by the U. S. Department of Health and Human Services:
- Hospitalized flu patients would be at the top of the list
- Next in line for treatment would be health care workers and ambulance crews who come down with the flu while caring for others,
- Thereafter are individuals such as pregnant women and people at high risk of hospitalization or death, such as those with compromised immune systems.
- Also a priority are local health care workers who administer vaccine, police and firefighters, and employees of the plants that make the drugs and vaccine
- Elderly and small children are also listed as priority persons
Details of the U.S. Pandemic Preparedness plans are posted at:
www.hhs.gov/pandemicflu/plan.
Other groups who might benefit from maintaining a stockpile of antiviral medicines could include those in the aviation/transportation industry.
Studies regarding the optimal approach of stockpiling of antiviral medicines can be found
here.
Communications
Communication is imperative, and needs to meet the needs of a variety of audiences, including employees, stockholders, customers, vendors, and local health and government authorities. Perceptions of the public and employees are very powerful, and it is critical that the organization issue clear statements about the corporation’s response to an adverse environment. It is also important to consider what information needs to be given to which audience at what time and through which medium.
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