Avian Flu: European Commission publishes pandemic simulation report; Global survey says striking gap between employer concern and current pandemic preparedness

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Avian Flu: European Commission publishes pandemic simulation report; Global survey says striking gap between employer concern and current pandemic preparedness
By Finfacts Team
Mar 30, 2006, 13:57

The European Commission today published the final evaluation report on the Common Ground exercise on an influenza pandemic. A separate report says that while evidence of the global spread of avian flu increases, there is a striking gap between companies’ concern about the impact of a human pandemic and actual pandemic planning, according to a global survey by Mercer Human Resource Consulting.

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An Emergency Hospital for US Influenza Patients - The effect of the 1918/19 influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. Source: www.stanford.edu/group/virus/uda/

The two-day European Commission “tabletop” simulation was carried out on 23-24 November 2005 and aimed to test how national preparedness plans would work together in the event of an influenza pandemic, as well as testing coordination and communication between the Commission, Member States, EU agencies, international organisations and the pharmaceutical industry.

The evaluation report was prepared for the Commission by the UK-based Health Protection Agency which conducted the exercise. The report concluded that the exercise was “a successful event” which showed considerable improvements from an earlier exercise, and identified many issues for further improvement. The report sets out twelve recommendations to follow-up lessons learned from the exercise, notably to review and develop communications systems.

EU Health and Consumer Protection Commissioner Markos Kyprianou said: “To my knowledge, an exercise on this scale on human influenza pandemic preparedness is unprecedented. The main reason to carry out such an exercise is to learn from experience what works and what doesn’t when plans on paper are applied in practice. This report sets out important recommendations for the future and identifies areas of weakness in our pandemic preparedness plans where we need improvements. Work has already begun on addressing these weaknesses, and we will continue to refine, improve and upgrade our preparedness with Member States, the ECDC and our other partners.”

The Common Ground exercise

Common Ground took place on November 23-24 and involved hundreds of players across the Commission, EU agencies such as the European Centre for Disease Prevention and Control (ECDC), Member States, third countries and pharmaceutical industry, reacting to a series of fictitious emergency events with a new human flu strain starting a major pandemic in Europe. The exercise was designed to represent a period of 26 weeks. The aim was to test the execution and interaction of national plans and measures, (such as restriction of movement, business continuity, communications and distribution of vaccines), as well as examining the role of the Commission. The exercise involved crisis rooms in national Health ministries and agencies, linked up through early warning and monitoring secure systems.

Key findings and recommendations of the report

Considerable improvements were made with respect to an earlier, smaller scale simulation exercise, reflecting the willingness of the Commission and Member States to make improvements where necessary;
Exercises take place to provide reassurance that appropriate measures are in place and that policies and plans are fit for purpose, and so any weaknesses identified can be remedied. All participants identified the need for similar exercises in future which should include the lessons learned from previous exercises;
There were some obvious examples of coordination efforts by the Commission and ECDC during the exercise, particularly the holding of audioconferences which helped immediate issues, the ECDC set up a helpful web site and the Commission provided reporting forms which would be useful in a real crisis;
The Commission’s Early Warning and Response System (EWRS) is a robust system for the purpose for which is was intended and was used extensively. However, it became overloaded as it was used as a crisis management tool, when it was developed only for notification of cases and coordination of measures. EWRS should be reviewed and enhanced, and a system to improve the collection of information and situational awareness should be developed;
Back-up communications facilities should be considered, and teleconferencing facilities in some Member States should be improved;
Some national pandemic influenza plans did not sufficiently consider international aspects and certain operational issues beyond the health field, and these issues should be further considered;
The Commission should consider further developing its generic plan taking into account the international dimension of national plans to include a checklist of appropriate measures applicable to each phase of a pandemic;
Coordination and sharing of media messages in a crisis should be strengthened and a network of media contacts in national ministries should be established; and
Issues of common concern which need further consideration include antivirals, vaccines, travel restrictions, quarantining and border closures.

Follow-up measures and next steps

Following the Common Ground exercise the Commission has begun a number of initiatives which respond to several of the report’s findings, notably:

The Commission has started to work on the enhancement of its crisis-management tools, such as a situation-awareness platforms for decision makers known as HEDIS (Health Emergency and Diseases Information System) and its existing Early Warning and Response System;
The Commission has set up its interdepartmental crisis coordination unit which would become operational in the event of a crisis such as a pandemic;
Commissioner Kyprianou is liaising between Member States and the pharmaceutical industry on questions relating to the production, distribution and supply of antivirals and vaccines;
Following the informal Health Council meeting in Vienna on February 24^th, the Commission and ECDC are now coordinating a network of Member States’ press officers, in order to ensure the communication of clear and accurate messages to the public throughout Europe;
Pandemic preparedness plans will be reviewed again at a meeting of the Commission, Member States and WHO hosted by the European Centre for Disease Prevention and Control in Stockholm on 3 May and follow-up by Member States of lessons learned during the exercise will be discussed in June;
Workshops to share best practice on issues such as public health interventions, business continuity planning, border controls and quarantine will be held;
The Commission will start improving the coordination mechanism through training and role play between involved bodies and plans to run further exercises.

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Mercer global avian flu survey:Striking gap between employer concern & current pandemic preparedness

Australian companies have a heightened sense of concern regarding the impact of a pandemic but lag behind global counterparts in preparedness planning – only 12% have established a pandemic preparedness budget.
Globally, some 70% of businesses surveyed believe a pandemic would damage profitability, but only 47% have a business continuity plan in place and just 17% have budgeted for pandemic preparedness.
Companies in Asia are the best prepared — 25% have established a pandemic preparedness budget compared to 12% in Europe and 7% in the US.
Telecommunications and pharmaceuticals companies are the most likely to have developed a pandemic preparedness budget while few retail companies have done so.

While evidence of the global spread of avian flu increases, there is a striking gap between companies’ concern about the impact of a human pandemic and actual pandemic planning, according to a global survey by Mercer Human Resource Consulting.

The paradox is even more pronounced in Australia, where companies demonstrated a heightened sense of concern when compared with the global response, yet on each of the key indicators for establishing pandemic preparedness they fall behind their global counterparts.

Seventy-nine per cent of Australian companies believed a pandemic would have a negative impact on revenue, compared with 69% of companies globally. Despite this, only 12% of Australian companies have a budget for pandemic preparedness compared with a global total of 17%.

Loss of productivity due to employee absenteeism was also a concern for Australian companies, 100% believed employee absenteeism would have a moderate to high impact, and 92% anticipated a moderate to high impact due to loss of experienced labour. Again, this was higher than the global benchmarks of 90% and 78% respectively.

“Australian companies need to close the gap between concern and actual preparedness if they are to build the necessary level of business continuity planning to cope with the unique circumstances of a pandemic,” said Terry Stephens, Principal at Mercer Human Resource Consulting in Australia.

“The World Health Organisation advises that the window between pandemic emergence and global spread may be just a matter of weeks. This places Australian companies, particularly those with global or mobile workforces, at risk,” he said.

Globally, the survey established that only 47% of companies that responded have started a business continuity plan and just 17% have a pandemic preparedness budget. Yet some 90% of the survey respondents expect a moderate to high impact to their company from high rates of absenteeism and nearly 70% expect profitability to be adversely affected if a pandemic occurs.

Asian companies participating in the survey, particularly in Singapore, are furthest advanced in pandemic preparedness plans.

“About one in four Asian survey respondents have budgeted for preparedness, compared to 12% of the respondents in Europe and 7% in the US,” said Rosaline Chow Koo, head of Mercer’s Health & Benefits business for Asia Pacific. “This may be because Asia is at the epicenter of the avian flu outbreak and Asian companies were directly affected by the 2003 SARS crisis.”

Preparedness by industry

“A pandemic will severely impact consumer confidence, and industries that depend upon heavy foot traffic or people congregating in enclosed spaces could take a hit in a pandemic. Nevertheless, there is a gap between concern and specific planning actions to date,” Ms Koo observed.

Thus 80% of survey respondents in the hospitality and recreation sectors believe a pandemic would have a negative effect upon consumer demand and on revenue, but only 20% have established a budget for pandemic preparedness.

Similarly 86% of survey participants in the transportation sector are concerned about how their revenues would be affected, but only 18% have established a preparedness budget. For the retail sector, 65% believe a pandemic would have a negative effect upon consumer demand, but only 6% of the survey respondents said their company has established a pandemic preparedness budget.

A substantial minority of respondents in four industries expect that a pandemic would increase customer demand for their businesses.

In insurance, 39% of the respondents said customer demand would increase, while 36% said their company would experience a decrease in demand. In pharmaceuticals, 38% of those surveyed saw a pandemic leading to increased customer demand versus. 50% who forecast a decrease.

Some 24% of respondents in telecommunications predicted increased customer demand in a pandemic, while 38% forecast a decrease. Similarly, 24% of those in health care forecast positive customer demand while 47% predicted a decrease. The balance of respondents felt a pandemic would have no effect on demand.

Hong Kong and Singapore — equal preparation efforts, divergent forecast of impact

Mercer’s survey indicates that Hong Kong and Singapore, both affected by the 2003 SARS crisis, score among the best prepared geographies for a potential pandemic. Factors taken into account include establishing a budget for preparedness, forming a crisis management team, developing a communications strategy, and undertaking a skills inventory.

There is a significant divergence, however, in the expectations of respondents from these two locations of the impact on profits. Only 9% of respondents in Hong Kong expect that a pandemic would have a positive effect on their company’s profitability and 80% expect a negative impact.

By contrast, 22% of the Singapore respondents project a positive impact on profitability should a pandemic occur, with 56% expecting a negative effect. “This discrepancy may be due to the positive manner in which Singapore managed the SARS crisis,” said Ms Koo.

Europe and US preparedness

Preparedness for an avian flu pandemic in Europe and the US lacks the urgency of participants in Asia, according to the Mercer survey. “There are two key reasons for this divergence,” said Ms. Koo. “First, both the US and Europe were largely spared the scourge of SARS. Second, Western Europe has experienced no human fatalities while the US bird and human populations have, so far, escaped avian flu unscathed.”

In the event of an avian flu pandemic, 80% of the US respondents expect a negative impact on their company’s profits, but only 7% of these respondents said that their company had as yet established a budget for pandemic preparedness.

“Should a pandemic develop, however, US companies are prepared to throw money at the problem,” said Ms. Koo. “Some 39% of US companies surveyed said they would increase pay to employees who are required to take on additional responsibility, compared to a global average of 26%.

“About 11% of US companies said they would increase pay for employees working from home, compared to 7% of the global respondents. We believe that, to be effective, investments are better made at the planning stage. Once a pandemic occurs, such expenditure may be seen by some employees as a bribe to risk contracting life-threatening illness. Therefore this approach is unlikely to be the most effective way to address a crisis.

“The data from Europe is less conclusive overall, but of those that replied only 12% have budgeted for pandemic preparation measures,” said Ms Koo. “This is probably reflective of a 'wait and see' view from European leaders. It remains important, however, that a systematic approach is taken to business continuity and planning a response to this potential pandemic.”

About the Mercer Avian Flu Pandemic Preparedness Survey

The executive summary on the results of Mercer’s avian flu survey can be found at www.mercerhr.com/avianflu. The web site also contains valuable resources to help employers plan for a pandemic in order to protect their employees and to ensure ongoing operations of critical business functions.

The survey was completed in the first two weeks of March 2006 by 450 companies, spanning 38 countries and 26 industries. Respondents from Australia, Canada, People’s Republic of China, Hong Kong, Singapore, United Kingdom, and the US make up 75% of total survey respondents. The top six industries, comprising 60% of participants, were manufacturing, finance, professional services, computer services, insurance, and education.