The Global Fight Against Avian Influenza Lessons for the Global Management of Health and Environmental Risks and Crises Aline Leboeuf February 2009 les Health and Environment Reports n° 2 rapports The Institut Français des Relations Internationales (Ifri) is a research center and a forum for debate on major international political and economic issues. Headed by Thierry de Montbrial since its founding in 1979, Ifri is a non-governmental and a non-profit organization. As an independent think tank, Ifri sets its own research agenda, publishing its findings regularly for a global audience. Using an interdisciplinary approach, Ifri brings together political and economic decision-makers, researchers and internationally renowned experts to animate its debate and research activities. With offices in Paris and Brussels, Ifri stands out as one of the rare French think tanks to have positioned itself at the very heart of European debate. The opinions expressed in this text are the responsibility of the author alone. ISBN : 978-2-86592-408-0 © All rights reserved, Ifri, 2009 IFRI IFRI-BRUSSELS 27 RUE DE LA PROCESSION RUE MARIE-THÉRÈSE, 21 75740 PARIS CEDEX 15 - FRANCE 1000 - BRUSSELS, BELGIUM TÉL. : 33 (0)1 40 61 60 00 TÉL. : 00 + (32) 2 238 51 10 FAX: 33 (0)1 40 61 60 60 Email: [email protected] Email: [email protected] WEBSITE: www.ifri.org THE HEALTH & ENVIRONMENT REPORTS The “Health and Environment: from Safety and Security Issues to New Governance Options?” programme of Ifri seeks to elucidate the linkages that can exist between health and environmental issues and security considerations, and to analyse the impacts of such linkages in terms of efficiency and of the governance options available to international actors. The programme also wishes to stimulate a wider debate within the global civil society and bring to the fore innovative perspectives on these issues, through the linking together of practitioners within a dedicated network. As part of the Health and Environment programme of Ifri, a minimum of three case-studies on global health and environmental issues are published each year: the Health & Environment Reports . All reports have an empirical, comparative and policy-oriented approach, and comprise: - An empirical analysis of the health and/ or environmental issue under study; - A prospective analysis of the future developments of the issue under study; - Policy-oriented recommendations. The Health and Environment programme of Ifri is supported by the Taipei Representative Office in France. Editorial Board: Editor: Aline Leboeuf Deputy Editor: Emma Broughton Layout assistant: Cécile Grima CONTENTS EXECUTIVE SUMMARY ...............................................................5 ABBREVIATIONS .......................................................................9 INTRODUCTION .......................................................................13 FIGHTING AI, A DIGEST ...........................................................19 ON THE HUMAN AND ANIMAL FRONT : MULTISECTORAL ISSUES ................. 19 From a vertical approach to “One World, one Health”? .........................................................................20 Communication ..........................................................................................................................................22 The transparency requirement.................................................................................................................23 The right message and the right vector for the right audience .................................................................25 Surveillance ................................................................................................................................................29 Global surveillance, a strong improvement ..............................................................................................29 At the country level, different approaches to surveillance systems..........................................................30 Emergency versus development ..............................................................................................................36 Research .....................................................................................................................................................39 Norms and guidelines: development and implementation.....................................................................42 Health and Environment Reports , n° 2, February 2009 The Global Fight against Avian Influenza CONTROLLING AI OUTBREAKS ON THE ANIMAL FRONT ............................. 49 Culling and the compensation issue ........................................................................................................49 Vaccination .................................................................................................................................................51 The food chain and Biosecurity................................................................................................................53 The wild card: wild birds and the ecosystem ..........................................................................................54 ON THE HUMAN FRONT : T OWARDS GLOBAL HEALTH SECURITY ?............... 57 Responding to the H5N1 outbreaks in humans.......................................................................................57 Pandemic preparedness............................................................................................................................63 Virus-sharing issue: a North/South debate?............................................................................................71 GOVERNING THE FIGHT AGAINST AI.........................................77 A MULTIPLAYER GAME ......................................................................... 79 States and national actors: the raw material of any global initiative.....................................................79 Intergovernmental organisations: the cement to support the global governance process ................83 The regional level: a facilitating level.......................................................................................................86 LEARNING FROM SPECIFIC AI G OVERNANCE OPTIONS ............................. 88 Mobilising a lasting international momentum .........................................................................................88 Coordinating a global fight........................................................................................................................92 2 / 119 Health and Environment Reports , n° 2, February 2009 The Global Fight against Avian Influenza CONCLUSION : A FORESIGHT ATTEMPT .....................................97 RECOMMENDATIONS .............................................................101 INTERVIEWS ..........................................................................107 BIBLIOGRAPHY .....................................................................111 3 / 119 EXECUTIVE SUMMARY The term “Avian Influenza” (AI) refers both to: 1/ the existing and related avian influenza epizooty and epidemic, and 2/ the possibility of an influenza pandemic, that would result from a mutation of the H5N1 virus. The issue of AI therefore implies two necessities: 1/ the need to control the existing avian influenza virus and 2/ the need to prepare for the next pandemic. The reaction to the AI issue has thus articulated itself, over the years, in two movements: 1/ a strong solidarity drive, from the better prepared, to the less prepared and 2/ a “national preparedness drive”, as the majority of countries strove to strengthen their own capacity to respond to an AI outbreak/pandemic. The tension between those two dimensions of the management of AI contributed to the build-up of a strong mobilisation, from very different communities (animal health, human health, environmental health, security, media, private sector, etc.). This process of mobilisation resulted in the emergence of what appears to be, with the benefit of hindsight, a real “global fight against avian influenza”, which reaps significant results, as this report highlights. Such a dynamic may not last forever, however, as a lurking fatigue with the issue seems to be spreading amongst actors, and threatening past and current efforts. The new “One World One Health” agenda could, in this regard, prove to be a necessary option to remobilise actors, and consolidate the outcomes of the fight against AI. Before highlighting some key lessons from the fight against AI, one should draw some key features of the architecture of the global governance of avian influenza. Which Global Governance of AI? - Governing AI at the global level has been a fluid process , as it took some time to structure the large range of actors that had mobilised. Today still, as the agenda One World One Health is gains momentum, the exact role played by the different institutions involved in this process might start to shift again. - States are the key actors , as they raise political momentum at the global level, and as no possible response/control/preparedness is possible without them. Health and Environment Reports , n° 2, February 2009 The Global Fight against Avian Influenza - Intergovernmental Organisations are very important supporting actors in the fight against AI; it is important in this regard to understand their role and limits. If IOs are faced with some problems (i.e. bureaucratic problems, traditional aid issues), they also proved to