North American Plan for Avian & Pandemic Influenza

Courtesy of the State Department, we have a new North American Plan for Avian & Pandemic Influenza, which outlines a coordinated effort by Canada, the U.S., and Mexico to prepare for and respond to the threat of avian and/or pandemic flu.

Here's its stated purpose:

The North American Plan for Avian and Pandemic Influenza outlines how Canada, Mexico and the United States intend to work together to combat an outbreak of avian influenza or an influenza pandemic in North America.

That word "how" may be a bit misleading, as the plan is short on operational details. In many places it simply says the three countries will "develop a plan to do X." Some snags are inevitable during the development and implementation of the operational elements.

Still, the plan does seem to be based on the right principles. The plan is explicitly collaborative - appropriately so, as influenza ignores borders:

Coordination among Canada, Mexico and the United States will be critical in the event of an avian influenza outbreak or pandemic. The Plan, therefore, describes the organizational emergency management frameworks in each of the three countries and how they intend to coordinate their activities.

Of course, this isn't happening in a vacuum. Each country already has plans to deal with pandemic flu, including:

• The Canadian Pandemic Influenza Plan for the Health Sector
• [Canada's] Notifiable Avian Influenza Hazard Specific Plan
• The Government of Canada Coordination Contingency Plan for Avian and Pandemic Influenza
• An Emergency Management Framework for Canada
• [Mexico's] National Preparedness and Response Plan for Pandemic Influenza
• [U.S.] National Strategy for Pandemic Influenza
• [U.S.] National Strategy for Pandemic Influenza - Implementation Plan
• [U.S.] National Response Plan (NRP) (soon to be replaced by the NRF)
• [U.S.] HHS Pandemic Influenza Plan

The coordination among the three countries would be governed by:

• International Health Regulations (2005)
• World Organization for Animal Health (OIE) Terrestrial Animal Health Code (2006)

It's nice to see the plan pay attention to cascading effects, particularly critical infrastructure:

While influenza cannot physically damage critical infrastructure, a pandemic could weaken it by diverting essential resources or removing essential personnel from the workplace. This Plan, therefore, extends beyond the health sector to include a coordinated approach to critical infrastructure protection, including the importance of business continuity planning and recognition of interdependencies among sectors.

The coordination would start at the top:

Canada, Mexico and the United States have established the senior level Coordinating Body on Avian and Pandemic Influenza to facilitate planning and preparedness ... This Coordinating Body is to serve as the contact group in the event of an outbreak of highly pathogenic avian influenza or a novel strain of human influenza. It is to convene to support rapid and coordinated decision making, facilitate information sharing and address other coordination issues. Because the trilateral Coordinating Body includes senior officials from most of the key agencies that would be involved in supporting the response to an avian influenza outbreak or pandemic influenza, it is intended to play a significant role in promoting coordination among the three countries at senior official levels.

On the ground level, the plan calls for emergency response assistance in the event of a pandemic, as well as joint training in preparation for a potential pandemic:

Specifically, the authorities of Canada, Mexico and the United States intend to conduct trilateral or bilateral exercises to assess and strengthen their emergency response and contingency plans.

One of the more interesting parts of the plan is the communications strategy. The three countries intend to:

• Meet regularly on communications issues and seek opportunities to work together on communications planning and messaging;
• Establish procedures and pathways to exchange pre-release information during the event;
• Identify appropriate communications point persons from each country to maintain regular contact, share information, and identify and address emerging issues;
• Develop plans for communications coordination during the actual event of an outbreak of avian or pandemic influenza;
• Undertake the development of risk communications strategies to provide stakeholders with information on disease prevention, disease recognition, bio-security procedures and their responsibilities in the event of an incursion of avian or pandemic influenza;
• Pursue the development of risk communications strategies in relation to pandemic influenza to help decision makers and individuals make well-informed decisions and take appropriate actions on health risk issues to help reduce mortality, morbidity and socio-economic disruption;
• Develop key messages related to avian and pandemic influenza for the specific use of senior officials;
• Pursue the development of communications messages for avian influenza and both pre-pandemic and pandemic periods. Messages would focus on core themes such as efforts to control spread of avian influenza, import/export measures, border measure, etc.;

The three countries plan to share information in a variety of relevant areas, including outbreaks in animals, surveillance, epidemiology, traits of the virus, and vaccine development and production.

Sharing personnel is a concern. The approach is rather encouraging - the plan is to expedite licensing recognition as well as create established liaison positions among public health personnel.

It is possible that a state or province will request additional health care personnel through its national government to respond to an emergency. Because each state or province in the United States and Canada, respectively, controls the licensure of health professionals, the national government should encourage its states or provinces to develop procedures for the exchange of licensed personnel that may include the temporary, rapid recognition of existing licenses or certificates. In the case of the Mexican states, the Federal Labor Law governs licensure. Thus, movement of personnel among and within the Mexican states and municipalities requires no additional procedures. Issues such as liability, indemnification and proper documentation necessary to work in the other countries should be addressed through relevant national, state or provincial authorities.

Canada, Mexico and the United States intend to establish protocols for the exchange of appropriate public health liaison officers. Each country, at the request of one of the other countries, should deploy a liaison officer to the public health department/agency of that country on an ongoing basis. The public health liaison officer should act as a liaison for the other national public health department/agency, facilitate communications among emergency operations centers (EOCs) and be a point of contact for the officer’s particular national public health agency.

The creation of dedicated liaisons should only help the collaborative efforts of the public health systems in the three countries. Dedicated liaisons will be able to create closer, more trusting relationships than ad hoc liaisons would be able to.

On critical infrastructure issues, the plan has the right intentions, if few details:

Where appropriate, governments should coordinate timely national, regional and local support among appropriate public and private sector resources.

This is a bit confusing:

The countries intend to develop mutually acceptable risk, vulnerability and interdependency assessment procedures and methodologies. The countries also intend to undertake joint and/or coordinated risk assessments.

Wait a minute. They're going to start by developing procedures and methodologies for evaluating the risk, vulnerability and interdependency of critical infrastructure sectors? And then they're going to conduct the risk assessments?

In the U.S., that work is supposed to be ongoing already, as part of the ongoing National Infrastructure Protection Plan (NIPP). While I grant that there may be specific ways in which cross-border interdependencies differ from intra-border interdependencies, the general interrelationships among critical infrastructure sectors ought to be similar whether you're examining the infrastructure in a nation or a region. So - are we doing the same work twice? (See these two posts for background on the NIPP's status.) Another problem: The risk assessments aren't due to be complete until December 2009.

Even without consulting a thorough risk assessment, the plan identifies the food sector as a particularly obvious vulnerability:

Given the significant degree of North American integration, the agri-food sector is particularly vulnerable to disruptions in cross-border trade, as there is significant cross-border movement in key farm inputs, intermediate agricultural products and final food products.

Here's a half-a-loaf idea:

The countries should develop contact lists of all appropriate key critical infrastructure public and private sector partners in order to improve coordination among all partners domestically and internationally during a pandemic. These lists should be updated regularly, perhaps annually, and should also include clearly established communications roles and responsibilities.

That's a good start, but the simple fact of the list isn't going to make collaboration better. To the contrary, the existence of the list may provide a false sense of security unless the key critical infrastructure partners actually do some on-the-ground coordination. To its credit the plan encourages this but also seems to equivocate on the idea, as the critical infrastructure owners are mostly private sector entities which can't be easily co-opted into the international plan. Here's some rather wishy-washy language for you:

To the best of their abilities, the three countries are to endeavor to include an array of relevant public and private sector critical infrastructure partners and appropriate public health officials in their pandemic preparedness training and exercises to help uncover potential weaknesses in established systems and to forge bonds among personnel.

That last bolded bit is good - it is a good reason to succeed in this effort. But the first two bolded bits already seem to indicate some backtracking in case the private sector partners don't want to play along.

As I said earlier, the plan does seem to have the right idea regarding coordinated effort. But it's easy to have the right idea at the outset of a project. When you get down to the operational level, that's the real test. Most of the tasks required by the plan are due to be completed within the next 12-18 months, and they'll give a better idea of the operational details. We'll see where it goes from here.