Click to edit Master title style

Planning for the next Pandemic

IMAC Immunisation Workshop

5 September 2019

Angie Perry – Senior Advisor

Diana Murfitt – Senior Advisor

Click to edit Master title styleOverview

• Why do we need to be prepared?

• Planning to date

• Brief overview of our most recent pandemic

• Pandemic scenario

• Planning a Mass Immunisation Programme

• Next steps

Click to edit Master title stylePrevious influenza pandemics

1918 1957 1968 2009

A(H1N1) A(H2N2) A(H3N2)

“Hong Kong Flu”

20 - 40 m deaths 1 - 4 m deaths 1 - 4 m deaths

“Spanish Flu” “Asian Flu”

A(H1N1)

“Swine Flu”

0.3 m deaths

Click to edit Master title styleWhy do we need to be prepared?

• May occur at anytime with

little warning

• Unpredictable in severity

and who will be most affected

• Not “if” but “when”

• Impacts on the National

Security System

Click to edit Master title styleNational Health Emergency Plans

National Health

Emergency Plan: H5N1

Pre-Pandemic Vaccine

Usage Policy

National Health

Emergency Plan:

National Reserves

Click to edit Master title styleNew Zealand Influenza Pandemic Plan (NZIPAP)

Objective: to minimise deaths, serious illness & disruption to communities & the economy

• outlines all-of-government approach

• overarching framework for actions

• overview of activities to ensure NZ is prepared for and responds to a pandemic

• focuses on pandemic influenza but could be applied to other respiratory type pandemics

• Scalable

Click to edit Master title stylePandemic Response Strategy

HumanTo minimise the impact of the

disease, and to mitigate its effects on the people of NZ without increasing health inequalities

SocietalTo enable society to continue to function as normally as possible

during and after a pandemic

EconomicTo minimise and mitigate the economic consequences of a

pandemic on NZ

Plan for itManage it – post peak

Keep it

OutStamp it

outManage it

Recover from it

Plan and prepare

to reduce the

health, social and

economic impact

of a pandemic on

New Zealand

Prevent, or delay to

the greatest extent

possible, the arrival

of the pandemic

into NZ

Control and/or

eliminate any

clusters found in

New Zealand

Reduce the impact

of pandemic

influenza on New

Zealand’s

population

Expedite recovery,

and prepare for a

re-escalation of

response

Expedite the recovery of

population health,

communities and society

where affected by the

pandemic, pandemic

management measures,

or disruption to normal

services

Click to edit Master title styleNational Reserve Supplies

National Reserve Supplies

Stored by DHB Stored by Ministry

Volumes held by Ministry

P2 and General Purpose masks

√ 17 million units compiled of P2 & general purpose masks

Personal protective equipment

√

Clinical equipment √

Antivirals (Tamiflu & Relenza)

√ √ 1.3M courses

Pandemic antibiotics √

H5N1 pre-pandemic vaccine √ 150,000 courses (300,000 doses)

Vaccination supplies √ 10.2M syringes & 40,000 sharps bins

Body bags √ 24,700

Click to edit Master title style2009 A(H1N1) Influenza Pandemic

• WHO declared Pandemic → by 30 April A(H1N1) was notifiable in NZ

• A(H1N1) was highly infectious → both symptomatic and asymptomatic infections

• 18% of NZers (800,000) infected during the first wave

• 1 in 3 school aged children & 1 in 4 preschoolers were infected

• Older people had pre-existing immunity which provided protection

• From 1 April to 31 December 2009

- 3211 confirmed cases

- 1122 hospitalisations

- 35 deaths

• Highest notification rates - <1s

• High notification & hospitalisation rates – Maori and Pacific peoples

Source: ESR (2010) Seroprevalence of the 2009 influenza A (H1N1) pandemic in New Zealand. Available at www.health.govt.nz/publication/seroprevalence-2009-influenza-h1n1-pandemic-new-zealand

Click to edit Master title styleEarly Protection Immunisation Programme

2010 Influenza Immunisation Programme

- Part 1: Early protection - 1 February

- Part 2: Annual Influenza Immunisation Programme - 8 March

Early Protection Immunisation Programme – H1N1 monovalent vaccine

- For front line health care workers & those at high risk e.g. pregnant

women, morbidly obese

- Two doses required at least three weeks apart

- DHB run clinics

- 10 dose vials

- Vaccine must be used within 3 hours

Early Protection

Immunisation

ProgrammeInformation pack

Click to edit Master title styleImagine this pandemic scenario…

• 40% of NZers (>1.9 million) have been sick in last 8 weeks

• Peaking at weeks 3-5: 1.5 million sick, convalescing or just recovered

• 38,000 deaths over 8 weeks peaking at 23,500 in week 4 (NZ weekly death rate around 600)

Click to edit Master title stylePandemic immunisation scenario

• Pandemic vaccine purchased – arriving in 26 weeks

• 100% population coverage

• 2 dose course- given 3 weeks apart

• Multi-dose vial

• Vaccine must be used within 3 hours

• MVP implementation planning

underway by Ministry & DHBs

Click to edit Master title styleQuestions

• What are your learnings from past outbreak immunisation responses?

• What additional resources do you think you would need to effectively run a MVP in your area?

• List your top three considerations for a MVP

• What guidance & support would you need to enable you to successfully achieve a MVP in your region (from your PHO/DHB and at the National level)?

Click to edit Master title styleNext steps

• Update NZIPAP

• Ongoing review of the NRS supply policy and stock

• Review suite of supporting guidance and tools that support the activities of the NZIPAP e.g. NZIP