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It is now nearly five years since H5N1 highly pathogenic avian influenza (HPAI) spread across Southeast Asia and
then to the rest of Asia, Europe and Africa. The rapid spread, significant socioeconomic losses, numerous
human deaths, and the potential threat of a human pandemic influenza triggered concerted global action to
control the disease and prepare for the next influenza pandemic.
Since then around US$2.7 billion has been pledged and US$1.5 billion disbursed globally by the donor
community to fight against HPAI and to aid pandemic preparedness. In addition, proportionately enormous
funding and human resources have been expended by countries affected and at‐risk of HPAI and in preparing
for a pandemic. The threat posed over the last 5 years has mobilized an unprecedented coming together of the
animal health, human health, disaster preparedness and communication sectors to work in a cross discipline,
cross sector and cross boundary way. At the last International Ministerial Conference on Avian and Pandemic
Influenza held in New Delhi (4‐6 December 2007) it was acknowledged that significant progress made towards
eliminating HPAI in many infected countries, but serious concerns remained.
In response to requests from participants at the New Delhi Conference, the United Nations System Influenza
Coordinator (UNSIC) and the World Bank have produced this Fourth Global Progress Report on Responses to
Avian Influenza and Pandemic Readiness. The report i) describes international financial assistance provided to
date; ii) assesses national capacities to respond to HPAI and prepared for the next influenza pandemic; iii)
analyses implications of this progress for animal and human health and iv) recommends some key next steps. It
focuses on progress with responses to avian influenza and with pandemic preparedness between June 2007
and June 2008, but also looks back over the last three years. Information was provided by national authorities
from 148 countries that responded to an UNSIC survey questionnaire supplemented by with case studies,
interviews and reports from UN system bodies and other partners. The information on donor pledges,
commitments and disbursements has been collected by the World Bank via a donor polling exercise.
A global analysis of the situation now in mid to late 2008 indicates fewer outbreaks in poultry, fewer newly
infected countries, fewer human cases and fewer deaths compared to the same period in 2006 and 2007. Over
50 of the 61 countries that have experience an H5N1 outbreak, have successfully eliminated the disease.
However, the virus remains entrenched in several countries and the threat of further outbreaks of HPAI in
poultry (and sporadic cases in humans) persists. The threat of an influenza pandemic remains unchanged. While
these findings suggest that HPAI strategies are successful when properly implemented, they also highlight that
sustained vigilance and continued investment is needed in both surveillance and capacity to respond to HPAI.
Significant progress has been made during the last year, and there is now near global awareness of the issue
and the need to enable nations and communities to prevent, prepare and be able to respond to HPAI and
pandemic influenza. Surveillance capacities have improved significantly over the past 3 years and there is now
greater awareness and more incentives for reporting. Significant efforts are still needed in biosecurity and
fundamental behavior change by poultry owners/ producers remains a long term objective. There is still the
need for high political commitment to improve and invest in animal and public health systems. Many countries
have made substantial progress for their national pandemic preparedness; in some regions sophisticated
advancements continue to be made in deepening and developing preparations. However, many of the plans
have not yet been fully endorsed or made operational – in particular at the local level and preparations in
sectors beyond health need to be strengthened. Whilst the threat remains, it can be concluded that the world
is significantly better prepared to respond to HPAI and to mitigate the impacts of the next influenza pandemic.
Need remains for continued advocacy, support and monitoring of preparations to ensure the capacity to
respond to the threat of HPAI (and in many cases other zoonosis) is strengthened and made sustainable. In
addition, it is essential to review, adapt and update pandemic preparations which will not only be of benefit in
the event of pandemic but for the general resilience of a country against other emergencies.
With the threat of HPAI came an increased awareness of health threats at the animal‐human‐interface, and of
the importance of a multi‐sectoral response. This better understanding needs to be sustained and advanced:
During 2009, the world’s nations should agree on ways to better prevent, prepare and respond to the health,
social, economic and political impacts of pandemics and emerging infectious diseases at the at the animalhuman‐
ecosystem‐interface.
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Box 1.1
Latest Research on the Continued Threat of Influenza Pandemic and the Transmissibility of H5N1
(Focus on 2008)
Five years after the re‐emergence of H5N1, sporadic cases and small clusters of human infections with H5N1 avian
influenza persist and the virus remains a substantial threat to global public health security. Other avian influenza A
sub‐types (H7, H9) also present a potential danger but to date H5N1 viruses constitute the most imminent and
important pandemic influenza threat. Thus far this year (between 1 January and 10 September 2008), 36 human
cases of H5N1 have been confirmed in five countries1 of which, Bangladesh reported its first human case. When
compared with the same period during the years 2005, 2006 and 2007, this year has witnessed the fewest number
cases. 2
There has been little reported change in epidemiological features. As with previous years, the case fatality rate of the
virus has been high; H5N1 human infections have, by a large majority, been sporadic and are believed to have been
acquired through avian‐to‐human transmission, usually following human exposure to sick or dead poultry.1,6 There
has been no report suggesting human‐to‐human transmission amongst the few cluster cases that emerged so far in
2008. Nevertheless, studies have suggested that, in the recent past, limited, non‐sustainable human‐to‐human
transmission has probably occurred amongst clusters of epidemiologically linked cases in a small number of
countries, including China, Indonesia and Pakistan. Since the re‐emergence of the threat in 2003, there has been no
evidence of sustained human‐to‐human transmission of H5N1 and the WHO alert level has remained at Phase 3 (no
or very limited human‐to‐human transmission).
However, despite the fact that there have been fewer cases in fewer countries thus far in 2008 when compared with
the same periods in the past couple of years, it is important to underscore that the virus is now entrenched in parts of
Asia and Africa and that the threat of an H5N1 pandemic influenza undoubtedly persists.
1 Bangladesh, China, Egypt, Indonesia and Vietnam
2 Year 2005: 69 cases (as of 16 September 2005); Year 2006: 97 cases (as of 08 September 2006); Year 2007: 64 cases (as of 31 August 2007)
Sources :
• Uyeki TM. Global epidemiology of human infections with highly pathogenic avian influenza (H5N1) viruses. Respirology 2008; 12: S2‐S9.
• WHO (2008). Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO
• Writing Committee of the Second World Health Organization Consulation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1)
Virus (Abdel‐Ghafar AN, Chotpitayasunondh T, Gao Z et al). Update on Avian Influenza A (H5N1) Virus Infection in Humans. N Engl J Med 2008;
368 (3): 261‐273.
• Wang H, Feng, Z, Shu Y et al. Probable limited person‐to‐person transmission of highly pathogenic avian influenza (H5N1) virus in China. Lancet
2008; 371 (9622): 1427‐34.
• Yang, Y, Halloran ME, Sugimoto J, Longini IM. Detecting Human‐to‐Human transmission of Avian Influenza A (H5N1). Emerg Infect Dis 2007;
13(9):1348‐53.
• WHO (2008). Avian influenza – situation in Pakistan ‐ update 2 (03 April 2008). Available at:
http://www.who.int/csr/don/2008_04_03/en/index.html .
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