Pandemic Influenza Simulation Exercise

Inter-agency Pandemic Influenza Simulation Exercise

Bhutan UNCT

01 - 02 March 2007

On 01-02 March 2007, an interagency pandemic influenza simulation was piloted in Bhutan with the participation of UNDP, UNFPA, UNICEF and WFP Country Offices. Unfortunately, WHO and FAO didn’t take part in the exercise. The simulation aimed to provide an opportunity for the UNCT to assess its level of preparedness in the event of a pandemic emergency. The exercise was facilitated by a team from UNICEF Regional Office for South Asia (ROSA). Representatives from the Royal Government of Bhutan (Ministry of Health, Ministry of Home Affairs and Ministry of Agriculture) participated as observers. The simulation was followed by a half-day debriefing exercise in which participants were guided through several exercises to capture key elements of learning from the simulation and to begin to develop an action plan to enhance the UNCT pandemic and emergency preparedness.

Summary

With regards to the objectives of the exercise the following results were achieved:

·  Test the UNCT pandemic preparedness:

·  To ensure UN Staff safety and security …..

·  To maintain UN priority programmes …..

·  To support RGoB for pandemic response

·  Assess gaps in UNCT pandemic preparedness and identify lessons learned

·  Identify key measures to improve UNCT level of preparedness for pandemic response.

·  Determine the contributions of each UN agency to support the Royal Government of Bhutan (RGoB).

·  Hands-on exercise using available information, guidelines, documentation, and tools helping to respond to a pandemic;

·  Strengthen team building for managing any emergency within each agency and at UNCT level

The exercise provided the following recommendations from:

UNCT and participants:

1.  ……

2.  ….

3.  ….

UNICEF Regional Office

1.  …..

2.  ….

3.  ….

Government :

1.  …..

2.  ….

3.  …

This report attempts to provide a clear and comprehensive record of the debriefing workshop for use by the UNCT in developing follow up actions.

1. Overview

The objectives of the pandemic influenza simulation are to:

·  Test the UNCT pandemic preparedness:

·  To ensure UN Staff safety and security

·  To maintain UN priority programmes

·  To support RGoB for pandemic response

·  Assess gaps in UNCT pandemic preparedness and identify lessons learned

·  Identify key measures to improve UNCT level of preparedness for pandemic response.

·  Determine the contributions of each UN agency to support the Royal Government of Bhutan (RGoB).

·  Hands-on exercise using available information, guidelines, documentation, and tools helping to respond to a pandemic;

·  Strengthen team building for managing any emergency within each agency and at UNCT level

Core concepts tested during the simulation:

Participants were tested during the simulation on these core concepts:

·  Knowledge of UN pandemic policies and WHO protocols

·  Fulfilment of minimum humanitarian standards in disaster response in a pandemic environment

·  Knowledge of Pandemic Influenza and how the nature of the virus impacts on implementation

·  Creativity in delivery mechanisms

·  Rapid recognition of the implications of the pandemic environment on office systems, ability to do planning, face to face meetings, logistics, supplies, etc.

·  Concern for staff safety and health in the new environment

·  Effectiveness of Inter-agency collaboration (among the UNCT members but also with the RGOB).

·  Ability to establish programme and operational priorities e.g. determining what programs will be stopped, what will be adapted, etc.

·  Ability to plan for and maintain operational continuity, e.g.deputize staff to take over new roles, start to cross train, actions taken to ensure the continuity of the UN offices by working from home, etc.

·  UNCT position on use of military in relief and care functions and to enforce social distancing or containment measures;

·  Staff coordination and communication practices when under personal stress and pressure;

·  Preparedness to act as advisor on risk communication to the RGoB;

·  Thinking on 'ethical decision points', e.g. Advocacy views on antiviral distribution or other health or service delivery issue in an impacted population; how is the decision made on who receives services/supplies. What will the UNCT advocate for?

·  Knowledge of security preparedness practices related to pandemic preparedness and response

2. Participants’ feedback on their experience

What was the predominant impact the simulation had on you?

·  Felt like it was real

·  Served as an “eye opener” and helped to familiarize with the situation

·  Realization that we have to be prepared and learn more

·  Provided an opportunity to test the contingency plan

·  Helped identify gaps in preparedness

·  Raised awareness on the need for

o  Better coordination

o  Clearly defined roles and responsibilities

o  Training in radio and in communication

·  Resulted in tension, stress and nervousness

·  Learned to be calm at time of emergency and not panicking

·  Was overwhelmed by the load of information

·  Helped to understand what it is to work under pressure

·  Hesitations on how to approach the death of a colleague, when no direct contact is recommended in the scope of the social distancing..

·  Reminded of previous experiences

·  Was a fun exercise

What were the main surprises during the simulation?

·  To realize how unprepared we are and how overwhelming such an emergency situation could be..

·  The great level of interaction among staff

·  The need for clearly defined roles and responsibility

·  The fact that external support may be limited in case of a pandemic

·  Importance of communication and coordination and the need for a single communication focal point

·  The seriousness and commitment of staff about the exercise

·  The quality and promptness of the Staff response despite time pressure, absence of some people forcing colleagues to have dual functions and fill in for those not participating. The pressure was even greater for agencies for a very small team.

·  Contingency Plan still have gaps

·  Tested performance under stress, pressure

·  Security phase

·  Pressure from the media for more information

·  Good relationships among colleagues become significant

·  About the scenario: Affected populations trying to escape from the containment zone;

·  The need to close UN offices at some point.

What factors supported the UNCT management of the pandemic?

·  Effective inter-agency cooperation and coordination (x4)

·  No duplication of UN agencies’ mandate

·  All agencies are flexible to go beyond their scope of support

·  Information sharing among agencies

·  Co-operation between UN agencies and government (x2)

·  UNCT Contingency plan (x 4)

·  Commitment of all staff (x2)

·  Team work

·  Good communication system, including internet access (x 2)

·  Commitment of the Government (x2)

·  Expertise amongst the agencies on how to respond to a pandemic

·  The presence of medical trained staff in 2 UN agencies

What factors hindered the UNCT management of the pandemic?

·  No joint needs assessment carried out

·  Too many meetings and emails, deadlines couldnt not be met (x2)

·  Information overload

·  Lack of correct information

·  Confusion on roles and responsibilities

·  Location of UNICEF office, outside the UN House (x4) made at times communication more difficult

·  Contingency Plan not operational enough

·  VHF radio breakdown and disruption of mobile telephone services

·  Essential staff working from home not having internet access

·  Missing WHO and FAO (leading organization)

·  Delayed government response to UN request (note: this was an element of the scenario and does not imply that the response of the RGoB would be slow)

3. Participants’ understanding of Pandemic Influenza and their Role & Function in Pandemic Preparedness & Response

What would participants like to know about pandemic influenza?.

This session was facilitated by the UNICEF Representative.

·  When does the infection take place?

A person is infectious, meaning he or she can spread the infection, from one day before the onset of the symptoms to around four days after the onset of the symptoms.

·  How do you mange dead bodies without getting infected?

We might want to check the exact WHO-instructions, but in principle it will be by protecting oneself with gloves, a mask etc, and after that washing your hands carefully.

·  Can Tamiflu and PPE project you from AI

Tamiflu can mitigate the symptoms of an influenza infection, and is also useful in treating the human cases of an Avian Influenza. Tamiflue is expected to have a prophylactic effect as well, and therefore it is reflected in the protocols to give frontline workers like medical staff a prophylactic, preventive dosage. However, this is not 100% proven. With the PPE, the Personal Protective Equipment, one prevents the transmission to take place. Very efficient, if well used.

·  How to differentiate between flu and pandemic influenza?

You can only differentiate it by doing a virological test, there is no real difference in the symptoms.

·  How can one be able to detect the bird flu fast?

If the Ministry of Agriculture has a good surveillance system, it will register the outbreaks among birds. If the people will report the outbreaks, we can detect it fast. Samples can be sent to the laboratory for testing here in Bhutan.

To detectFor the human cases of avian influenza, it is also a good surveillance system is also important , in addition to and the alertness of the clinician, who should ask people with flu-like symptoms whether they had contact with sick and/or dying birds. The actual confirmation of a human case of avian influenza is done outside Bhutan through a pseicial virological test.

·  How effective are face masks?

Masks do prevent the droplets to spread, but the masks need to changed regularly. It is effective, but not 100%.

·  Can we fully depend on Tamiflu?

We can not depend fully on Tamiflu, as it only mitigates the symptoms and shortens the duration of the illness. Secondly, Tamiflu treatment is relatively expensive, and and in a pandemic scenarion, the demand might outstrip the supply.

·  What is the difference between Pandemic and Epidemic?

Epidemic is a disease outbreak amongst human beings, pandemic is a disease outbreak among humans covering the whole world. Apart from Influenza, HIV/AIDS is also an example of a recent pandemic.

·  Can Pandemic be contained within a containment area and for how long?

Yes, containment of a disease can be effective, the disease outbreak might burn itself out among the contained population and no new cases occur after a while. In case of influenza it might take about about 6-8 weeks. Please, note that ifIf a ‘pandemic’ is effectively contained, it didn’t develop into is not a pandemic, since the disease outbreak hasn’t covered the whole world.

·  For the confirmed cases will be or she be quarantined?

For confirmed cases or suspected cases, yes it is better to isolate them, meaning treating them separately from other cases.

·  When do we administer Tamiflu as a Prophylactic?

Tamiflu as a prophylaxis is proposed to be used for frontline workers, medical staff, who is treating patients in the health facilities, people going on the assessment missions, people involved in culling exercises etc.

·  When parents are infected, do you leave your children un-attended?

We should ensure that children are also taken care off, either with an arrangement within the family, or otherwise. It is a good question, which needs a bit more reflection. It is an area where health and child protection should work together in finding a suitable solution, as it needs more reflection..

What do you want to know re: your role, sector’s role, UNCT role, policies or procedures?

·  UN Policies

·  UN medical services & policies

·  What is the role of the UN without Royal Government of Bhutan’s request/clearance?

·  Specific Agency Roles?

·  Role of OCHA for Flash appeal.

·  Are agencies aware of UNICEF lead role for communication?

·  Staff roles & responsibilities

·  Response to different phase of pandemic.

·  When can we access regional support - expertise?

·  At which phase do we practice social isolation?

·  What are the flexibilities in terms of entitlement to staff member in Pandemic?

·  Do we follow the same procedure during emergency?

4. Feedback from the Facilitation Team on the UNCT Performance

The comments below are based on the facilitators’ observations as well as analysis of the documents submitted by the staff during the simulation.

General Comments:

·  Coordination among UN agencies: UN agencies worked well as a team. The RC was able to establish regular meetings with the other heads of agencies and at the same time leave sufficient time for each representative to work with their respective teams. Meetings always started with a brief overview of the main events and concluded by a summary of the key decisions and points for follow up. Good minutes produced following the meeting. Consensus from the very beginning on the importance of having a coordinated approach and speaking with one voice to the RGoB, the RO and HQ as well as the media.

·  Coordination with other UN levels (HQ/RO): Very early in the scenario, sent brief updates to their respective ROs and HQ. Regular communication was maintained with UNSIC Bangkok as well as WFP and UNICEF RO. Demands for more updates from UNICEF RO were answered. Concise and to the point. However, no further details were given on the CO requirements despite several offers from RO to provide support. Also, missed opportunity to warn/exchange information with neighbouring countries (the RC or UNICEF/WFP Country Offices), advise them to increase surveillance and request for some support.

·  Coordination within each agency: Time and staffing constraints did not allow the facilitation team to fully observe the dynamics in each agency except for UNICEF CO. Coordination in UNICEF was mostly through meetings. Emails exchanges were kept to the minimum.

·  Information flow: Important messages were circulated by head of agencies. Numerous sitreps and security incidents reports were produced (13 in total) although the simulation team was asking for three only. They were produced by the RC unit on behalf of the UNCT. Helped with saving time and speaking with one voice. Channeled to the right bodies (UNSIC, OCHA and UNDSS). Effective use of the information coming from the simulation base and re-packaged into a Sitrep. A word of caution though as some of them who simply report on rumors. We may want to reduce the frequency of the sitreps to take the time to cross-check information and focus on verified facts. Terminology, all the sitreps are titled “Avian flu outbreak”, including the very last ones confirming the declaration of a global pandemic by WHO. They provided good information on actions taken both by the government and the UN agencies. However, they could have been more comprehensive on UNCT planned actions (where we are going to) and funding needs. Some of this information was found in the two sitreps produced individually by UNICEF and WFP.