Japan-WHO Joint Meeting on Early Response to Potential Influenza Pandemic, Tokyo, Japan, 12 - 13 January 2006

Japan-WHO Joint Meeting on Early Response to Potential · Influenza Pandemic

Tokyo, Japan 12- 13 January 2006

( . World Health

~ Organization ~~

Government of Japan

Western Pacific Region

(WP)CSR/ICP/CSR/1.5/001 Report series number: RS/2006/GE/04(JPN)

English only

REPORT JAPAN-WHO JOINT MEETING ON EARLY RESPONSE TO POTENTIAL INFLUENZA PANDEMIC

Convened by: GOVERNMENT OF JAPAN AND WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Tokyo, Japan 12-13 January 2006

Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines Apri12006

NOTE

The views expressed in this report are those ofthe participants of the Japan-WHO Joint Meeting on Early Response to Potential Influenza Pandemic and do not necessarily reflect the policies of the World Health Organization.

This report has been printed by the Regional Office for the Western Pacific of the World Health Organization for the participants in the Japan-WHO Joint Meeting on Early Response to Potential Influenza Pandemic which was held in Tokyo, Japan, from 12 to 13 January 2006.

WORLD

HEALTH

ORGANISATION MONDIALE DE LA SANTE

ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

INTERREGIONAL MEETING ON THE IMPLEMENTATION OF THE STRATEGY ON HEALTH CARE FINANCING Ulaanbaatar, Mongolia

WPR/ICP/HFS/3.1/001/HCF(2)/2006/2 25 July 2006

ENGLISH ONLY

28 to 31 August 2006

GLOBAL OVERVIEW OF HEALTH CARE FINANCING (HCF) WITH FOCUS ON UNIVERSAL COVERAGE

by Dr David Evans

The issue of this document does not constitute formal publication. It should not be reviewed, abstracted or quoted without the agreement of the World Health Organization. Authors alone are responsible for views expressed in signed articles.

Ce document ne constitue pas une publication. II ne doit faire l'objet d'aucun compte rendu ou resume ni d'aucune citation sans l'autorisation de !'Organisation mondiale de Ia Sante. Les opinions exprimees dans les articles signes n'engagent que leurs auteurs.

SUMMARY

With the world facing a continuously growing pandemic threat from avian influenza A(H5N I), an important and timely meeting which focused on early response to a potential influenza pandemic was convened jointly by the Government of Japan and the World Ilealth Organization (WHO) in Tokyo, Japan, from I2 to I3 January 2006. In the early stages of the emergence of a potential pandemic, it may be possible, in some situations, to avert further virus spread by responding rapidly and, if appropriate, implementing containment measures, including large-scale administration of antiviral drugs to the population in the affected area(s) together with additional complementary public health measures. If such rapid interventions are successful, hundreds of millions of cases of serious illness, millions of deaths, and the adverse social and economic consequences expected to result from a future pandemic might be prevented. However, attempting rapid containment is realistic only if the earliest signals of a potential influenza pandemic are detected and reported swiftly, and comprehensive measures are implemented fully within a very short period. The window of opportunity for action is narrow. Containment measures require the rapid availability of antiviral drugs and additional supplies and equipment. The Government of Japan has made a commitment to assist in the stockpiling of 500 000 courses of antiviral drugs, and to provide other equipment to be used for rapid response and early containment activities in Asia. This important meeting focused on identifying key issues and recommending priority actions necessary to develop rapid response and containment capacity in Asia. The meeting discussed and provided recommendations on: (I) early response measures that should be implemented, if and when a potential human pandemic strain emerges; (2) regional and international coordination in several areas, including early detection and reporting of events with pandemic potential, stockpiling of antiviral drugs and other supplies, arid operational support; and (3) early response measures at the country level, particularly those related to early detection and reporting and the implementation of containment measures. More than I30 participants, representatives and experts attended the meeting from 14 Asian countries (including all those affected by the H5N I virus), donor countries and agencies, as well as regional and international organizations. Some countries were represented at ministerial level. Although containment of a potential influenza pandemic has never been attempted and could either succeed or fail, the participants called for urgent development of the national, regional and international capacities and effective mechanisms necessary for early response and rapid containment. Several unusually complex issues and possible solutions in such early interventions in Asia were identified and examined.

The main conclusions from the meeting were as follows : (1) The avian influenza A(H5N 1) virus has become entrenched in many parts of Asia, and has also spread to other regions. The virus has caused more than 140 human infections, mainly in Asia, but more recently in Turkey. The H5N 1 virus threatens increasingly to cause a pandemic and poses a serious global public health threat.

(2) An influenza pandemic has the potential to cause a health, social and economic catastrophe for the region and the world. Therefore, it is imperative for all countries in Asia and the international community to affirm their shared responsibilities and make every possible effort to prevent a pandemic. (3) Mounting a rapid response to contain the earliest emergence of pandemic influenza is critical. This requires that any events with pandemic potential are detected and assessed rapidly, and that appropriate decisions and actions are implemented in a timely manner. (4) Immediate action areas for reducing the threat of an influenza pandemic include: • • early detection and rapid reporting of any signals of a potential influenza pandemic among humans; development and implementation of a rapid response and pandemic response containment strategy, which should be integrated into national, regional and international influenza preparedness plans; and establishment of coordinated national, regional and international response mechanisms for facilitating such a rapid response.

•

(5) Top priorities in developing rapid response and containment capability are to strengthen national, regional and international capacities, particularly in the areas of surveillance, epidemiology, laboratory capacity, risk assessment and risk communication, and for countries to implement the new International Health Regulations as soon as possible. (6) Developing the capability to respond rapidly and contain a pandemic in its earliest stages will strengthen basic local, national and international capacities to respond to other public health emergencies of international concern. Given that a future human influenza pandemic may pose serious a public health threat to all countries and cause severe social and economic disruption in the globalized world, the participants agreed that any possible public health interventions with the potential to prevent a pandemic or delay its spread should be considered. Based on the major issues and challenges identified during the meeting, the participants recommended the following priority actions for countries, WHO and other partners: Recommendations to countries; (I) Countries should strengthen national and local capacities to detect and respond to early signals of a potential pandemic and any other public health event. Areas that should be strengthened include: (a) disease, virus and other surveillance measures, such as rumour surveillance; and

(b)

increasing community awareness and educating health workers to facilitate early detection and reporting.

(2)

Countries are strongly encouraged to comply, as soon as possible, with the provisions of the International Health Regulations (2005) that facilitate early recognition and reporting of events or warning signals of public health emergencies of international concern, such as a potential influenza pandemic. Countries should notify WHO immediately if early signals of a potential pandemic are detected. Urgent risk assessments of such signals should be conducted in collaboration with WHO. Countries should share specimens and virus isolates obtained from persons thought to be infected with a novel influenza virus, such as H5N I. Those specimens and isolates should be shared with the WHO Reference Laboratory Network in a timely manner. The results of the tests should be reported by the reference laboratories to the originating country and simultaneously to WHO as rapidly as possible. Countries, with the assistance of WHO, should review and test their relevant protocols and standard operating procedures (SOPs) to identifY important gaps and to allow necessary modifications to be made, including those reflecting unique or important considerations related to individual countries. Countries should identify and address all practical issues, including legal, logistical and operational issues that must be addressed to allow full implementation of rapid containment. Countries should integrate rapid response and containment concepts, strategies and implementation steps into national pandemic influenza preparedness plans. Countries should promote and facilitate collection of the scientific evidence needed to further develop an evidence-based strategy for rapid containment measures. Countries should establish intersectoral coordination mechanisms for national, regional and international partners.

(3)

(4)

(5)

(6)

(7)

(8)

(9)

Recommendations to WHO (1) WHO should, as a matter of urgency, help countries to develop and strengthen their national capacities to detect early signals of a potential pandemic. WHO and its partners should, as a matter of urgency, help countries to develop or strengthen their local and national laboratory facilities so that early signals of a potential pandemic can be confirmed rapidly. WHO should also continue to strengthen regional and global laboratory networks. WHO should establish a full-time working group immediately to further develop rapid response and containment strategies and to develop a concrete action plan that proposes protocols, a timeframe, coordination and participation of partners, and other critical elements.

(2)

q)

( 4)

WHO and its partners should, as a matter of urgency, draft a feasible overall strategy and related protocols and SOPs to allow and facilitate a rapid, coordinated and effective response to early signals of a potential pandemic. WHO, with the assistance of its partners, should develop training modules and programmes to educate and train local and international staff on important concepts, strategies and procedures related to early detection, rapid response and containment. WHO should, in collaboration with the United Nations Children's Fund (UNICEF) and other partners, coordinate the development of an appropriate risk communication strategy (including outbreak communication and communication for behavioural change). Appropriate messages should be formulated and provided to the general public and key groups about rapid response and containment, pandemic influenza, and other related and important topics. Such messages must be accurate and should enhance the effective social mobilization necessary to implement important public health interventions. WHO should establish a decision-making process as part of a rapid response and containment process that includes the establishment and utilization of an external advisory Influenza Pandemic Task Force. The Task Force would consist of public health and influenza experts and its purpose would be to provide an independent assessment of critical events related to pandemic influenza and make recommendations to WHO about responding to the pandemic threat. The Task Force would have a specific advisory role when assessing potential early signals of pandemic influenza. WHO should use its Global Outbreak Alert and Response Network (GOARN) and other necessary means to identify and mobilize the local and international staff and experts necessary to facilitate and implement rapid response and containment operations. Furthermore, WHO should provide training for those staff to make them as effective as possible in rapid response and containment operations.

(5)

(6)

(7)

(8)

Recommendations to other partners (1) International partners, in collaboration with WHO, should, as a matter of urgency, help countries to develop and strengthen their national capacities to detect early signals of a potential pandemic. International partners, such as UNICEF, should help develop communication strategies and appropriate materials in collaboration with WHO and countries. · Japan and countries of the Association of Southeast Asian Nations (ASEAN), in collaboration with WHO, are asked to develop a detailed operational plan on stockpiles, including antiviral drugs, and to share information on the operational plan with other Asian countries. All partners creating multinational stockpiles for rapid response should coordinate the supply contents and their release and use for rapid containment and other potential uses.

(2)

(3)

(4)

CONTENTS

I.

INTRODUCTION ................................................................................................................. I I.I Objectives ............................................................................................................ ......... 2 I.2 Participants ........................................................................................................... ......... 2 I.3 Organization .................................................................................................................. 2 I.4 Opening remarks ................................................................................................... .. ...... 3

2.

PROCEEDINGS ................................................................... ..... ............................. ............... 3 2.I Meeting objectives and agenda ..................................................................................... 3 2.2 Threat of pandemic influenza and options for response ............................................... 4 2.3 Steps and issues for responding to early pandemic events ............................................ 4 2.4 Issues and challenges for early response at country level ......................... ........... ......... 6 2.5 Round table discussion on rapid response to potential pandemic ................................. 7 2.6 Donor response to a potential pandemic threat ............................................................. 8 2.7 Group discussions ......................................................................................................... 9

3.

CONCLUSIONS AND RECOMMENDATIONS ............................... ....................... ........ I4 3 .I Conclusions ............................................................. ............................................ ........ I4 3.2 Recommendations .................................................. ..................................................... I4 ANNEXES: ANNEX l ~

LIST OF PARTICIPANTS, REPRESENTATIVES AND ....................... 17 SECRETARIAT PROVISIONAL AGENDA ........................................ .. ......... .. ................. . 37

ANNEX 2

Keywords: Influenza, Human - prevention and control I Influenza A virus, HSN I subtype I Disease outbreaks- prevention and control

1. INTRODUCTION

Since December 2003, avian influenza A(H5Nl) has swept through poultry populations across Asia and parts of Europe. The outbreaks are unprecedented in their scale and ge::ographical spre::ad. Evide::nce:: shows lhallhe:: H5Nl virus is mosllikely e::ndemic in many parls of Asia. It has established an ecologica,l niche in poultry, making it extremely difficult to prevent outbreaks. Outbreaks continue to occur despite aggressive control measures, including the culling of more than 160 million poultry. To date, more than 140 human cases of H5N 1, with an overall fatality rate of approximately 50%, have been confirmed in five Asian countries, namely Cambodia, China, Indonesia, Thailand and VietNam. More recently, confirmed human cases have been reported in Turkey. Most human infections can be linked to contact with infected poultry, but isolated instances of inefficient human-to-human transmission may have occurred. The risk of further human cases remains and, if the virus acquires the capability of efficient human-to-human transmission, a global pandemic could occur. It is expected that the next pandemic would have huge economic and social consequences, as well as an enormous impact on human health. Influenza viruses are genetically unstable and their behaviour cannot be predicted. For these reasons, the current outbreaks of influenza A(H5N 1) in poultry and humans in Asia have moved the world closer to a pandemic than at any time since 1968, when the last such event occurred. In the early stages of the emergence of a potential influenza pandemic, it may be possible, in some situations, to avert further virus spread by responding rapidly and implementing containment measures. If such rapid interventions are successful, hundreds of millions of cases of serious illness, millions of deaths and the adverse social and economic consequences expected to result from a future pandemic might be prevented. The term rapid response refers to rapid reporting, assessment and response of any kind after possible signals of a potential pandemic have been detected. The term rapid containment refers specifically to attempts to stop the spread of a potential pandemic virus. Containment measures may include large-scale administration of antiviral drugs to the population in the affected area(s), together with additional complementary public health measures, such as quarantine and social distancing. However, attempting rapid containment is realistic only if the earliest signals of a potential influenza pandemic are detected very rapidly and comprehensive measures are implemented fully within a very short period. The window of opportunity for action is narrow. Containment also requires the rapid availability of antiviral drugs and additional supplies and equipment. The Government of Japan has made a commitment to assist in the stockpiling of 500 000 courses of antiviral drugs, and to provide other equipment to be used for rapid response and early containment activities in Asia. As a critical step to move the above agenda forward, an important and timely meeting, focusing on early response to a potential influenza pandemic, was convened jointly by the Government of Japan and the World Health Organization (WHO) in Tokyo, Japan, from 12 to 13 January 2006.

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1.1

Objectives

The meeting aimed to discuss key issues and challenges in responding rapidly to a potential influenza pandemic and to recommended priority actions necessary to develop and implement rapid response and containment strategies in Asia. The specific objectives of the meeting were: (1)

to discuss the early response measures that should be implemented, if and when a potential human pandemic strain emerges; to discuss and recommend regional and international mechanisms, including early (2) detection and reporting of events with pandemic potential, stockpiling of antiviral drugs and other supplies, and operational support for early response efforts in Asia; and to recommend necessary actions to address major issues and challenges associated (3) with implementing early response measures at country level, particularly those related to early detection and reporting and the implementation of containment measures.

1.2

Participants

The meeting was attended by more than 130 participants, including country representatives from 14 Asian countries: Brunei Darussalam, Cambodia, China, Japan, the Lao People's Democratic Republic, Indonesia, Malaysia, Mongolia, Myanmar, the Philippines, the Republic of Korea, Singapore, Thailand, and VietNam. Some countries were represented at ministerial level. Participants from other countries, including Australia, Austria, Canada, France, New Zealand, Russia, United Kingdom of Great Britain and Northern Ireland, and the United States of America also attended the meeting. Representatives from regional and international partners were also in attendance, including the Association of Southeast Asian Nations (ASEAN) Secretariat, the Asian Development Bank (ADB), the European Commission (EC), the Food and Agriculture Organization (FAO), the United Nations Children's Fund (UNICEF), the World Bank, and Roche, as well as technical experts, mainly from Japanese institutions. The WHO secretariat, headed by Dr Shigeru Omi, WHO Regional Director for the Western Pacific, worked closely with the Government of Japan to provide the secretariat and technical support for the meeting. Annex I lists all the participants, representatives and secretariat members who attended the meeting. 1.3 Organization

The meeting was co-chaired by Dr Takahiro Shinyo, Director-General, Global Issues Department, Ministry of Foreign Affairs, Japan, and Dr Takashi Toguchi, Assistant Minister for Technical Affairs, Ministry of Health, Labour and Welfare, Japan Each of the two days was divided into presentations followed by discussions. On day one, a round table discussion on early response to a potential pandemic and other technical sessions were chaired by Dr Eiichi Seki, Ministry of Health, Labour and Welfare, Japan. The meeting presentations can be accessed at http://www. wpro. who. i nt/siteslcsr/data!Presentation TokyoMeeti ng. htm.

-" .)

Three working group discussions were held on day two, co-chaired by representatives from Asian countries. The Philippines and the Republic of Korea co-chaired Group 1 (early detection and reporting); Malaysia and Brunei Darussalam, Group 2 (Issues and challenges at country level); and the Lao People's Democratic Republic and Singapore, Group 3 (Regional and international coordinated response mechanisms). A member of the WHO secretariat served as rapporteur for each group. A final plenary session reviewed and agreed the main conclusions and recommendations of the meeting. 1.4 Opening remarks

Mr Katsutoshi Kaneda, Senior Vice-Minister for Foreign Affairs, Japan, welcomed participants to the meeting on behalf of the Government of Japan and expressed sincere gratitude to WHO for its contributions. He emphasized the growing threat arising from highly pathogenic avian influenza and the urgent need for countries to cooperate to stop a new influenza pandemic in the spirit of "human security". He explained that the Government of Japan has committed resources and taken actions to combat influenza pandemic threats in Asia, including the provision of an estimated US$ 135 million by March 2006, as announced by Japanese Prime Minister, Junichiro Koizumi, in December 2005. Japan's commitment will also include 500 000 courses of antiviral drugs for the purpose of rapid response in Asia. Ms Kyoko Nishikawa, Parliamentary Secretary for Health, Labour and Welfare, Japan, also welcomed the participants and expressed appreciation for WHO's contribution to the event. She emphasized the importance of the task ahead by mentioning the following points: (1) the tragedy of three influenza pandemics during the 201h century; (2) the experience and lessons learnt from severe acute respiratory syndrome (SARS); and (3) the need for a shift from broader discussions to concrete actions to prevent or minimize the harm of an influenza pandemic. She concluded her opening remarks by expressing her profound hope for meaningful discussions during the meeting. Dr Shigeru Omi, WHO Regional Director for the Western Pacific, began by thanking the Japanese Government for co-sponsoring the vitally important and timely meeting. He pointed out that Japan's involvement in the meeting was another reflection of the Japanese Government's commitment to the global fight against avian influenza. Dr Omi emphasized the following points: (1) while human H5N 1 cases have been reported recently in Turkey, Asia is still the epicentre of the threat to global health posed by the virus; (2) the world is dealing with a virus that is, not only very resilient, but also extremely unstable and unpredictable; (3) despite everybody's best efforts, the challenges are still considerable; ( 4) we should be ready to respond instantly with all the weapons al. our disposal should the early signs of an influenza pandemic appear. He called for a clear understanding of what needs to be done to contain a virus with pandemic potential and a focus on practical issues, such as the distribution of stockpiles of antiviral drugs. 2. PROCEEDINGS

2.1

Meeting objectives and agenda

The WHO secretariat briefly presented the background, objectives and agenda of the meeting. The speaker then posed the question "Why are we highly concerned about the growing risk of an influenza pandemic?" and illustrated this with a number of reasons including: the

- 4-

H5N 1 virus has become entrenched in Asia and is expanding to other regions; the unstable and unpredictable nature of the virus; risk factors are still not fully understood; the increase in human cases; and that a potential pandemic strain is likely to emerge from Asia. The speaker also said that the world needs to be better prepared for a potential pandemic, including joint efforts for rapid response and, where possible, containment at the earliest emergence of a potential influenza pandemic event, as no single institution or country has all the capacity. The meeting objectives (1.1) and the agenda (Annex 2) were also outlined. The speaker concluded by saying that the two-day meeting would provide an important platform for the countries in Asia and other partners to discuss key issues relating to rapid response and containment. 2.2 Threat of pandemic influenza and options for response

1 The speaker started by describing the impact of three pandemics in the 20 h century: 'Spanish Flu' (1918), 'Asian Flu' (1957) and 'Hong Kong Flu' (1968). Spanish Flu was the most devastating, with an estimated 40-50 million deaths worldwide. Since late 2003, avian influenza A (H5N 1) has been causing unprecedented outbreaks in poultry in Asia and the virus has also spread into other regions, particularly Europe. Human infections have been confirmed in five Asian countries (Cambodia, China, Indonesia, Thailand and VietNam), and more recently new human cases have been reported from Turkey. There is increasing international concern about a potential pandemic caused by the H5Nl virus.

To respond to this global challenge, all the affected countries and the international community have been working together to reduce the risk of a potential pandemic through various control measures in poultry and humans. However, if early signals of a potential pandemic are detected and reported rapidly, it may be possible to avert a pandemic by implementing containment measures. Critical actions for effective containment include the use of antiviral drugs for mass-prophylaxis, quarantine and other public health measures, including social distancing. There are several essential requirements for containment measures to be successful, including improved capacity for detection and reporting of early signals, rapid availability of regional and international stockpiles of antiviral drugs and other supplies, highlevel governmental commitment and coordinated international support. There is no guarantee of success for such measures. However, if fully successful, they could prevent an enormous number of deaths, illness and social and economic impacts. Even if complete containment is not possible, such measures could buy a significant amount of time for countries to become better prepared to respond to a pandemic. Regardless of the outcome, preparing for containment could significantly enhance national and international response capacities for pandemic influenza and all other emerging infectious diseases. 2.3 Steps and issues in responding to early pandemic events

Several key steps should be followed in implementing a rapid response, including rapid containment measures. There are many difficult issues and challenges at each step and these may include logistical issues, legal and policy issues, technical issues and resource issues. They should be addressed in advance so that countries and the international community can be better prepared for rapid response to the emergence of a potential pandemic. A hypothetical scenario of an event with pandemic potential was presented by the WHO secretariat to identify essential steps and a few major issues at each step. It must be emphasized that each step is not mutually exclusive; steps are interrelated. Steps for rapid response are as follows:

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Step 1:

Detection and reporting of early signals of a potential pandemic

The window of opportunity to contain a potential pandemic is very narrow. To be able to implement rapid response and containment measures, early signals of a potential pandemic should be detected and reported rapidly. However, detection and reporting are often delayed for various reasons, such as lack of effective early warning systems, lack of adequate laboratory capacity, and delays in reporting from local to central levels and from national level to WHO. Capacities and systems should be improved urgently to enable rapid detection and reporting. Step 2: Assessment and decision-making

As a second step, comprehensive assessment of the situation and the risk of a pandemic should be conducted in a short time period. Different types of information should be collected rapidly for proper risk assessment. International assistance may be necessary to conduct such assessment. WHO should establish a decision-making process as part of a rapid response and containment process that includes the establishment and utilization of an external advisory Influenza Pandemic Task Force. Each government should also establish mechanisms so that high-level decisions can be made quickly. Step 3: Mobilizing resources for containment measures

Once it is decided to implement rapid containment measures, a lot of resources need to be mobilized quickly to support the implementation. Antiviral drugs, personal protective equipment (PPE) and other supplies should be transported quickly to the affected area(s), and national and international experts should be identified and despatched to provide technical and operational support. There are many logistical challenges to be met, including customs clearance, transportation, security and storage of antiviral drugs and other equipment. It is also challenging to disseminate appropriate messages to the general public so that people in affected areas can understand and support containment measures. Step 4: Implementation of containment measures

Implementing containment measures, including mass chemoprophylaxis using antiviral drugs, quarantine and other public health measures such as social distancing, also poses a number of difficult challenges. It is necessary to give antiviral drugs to a large number of people in a·very short time. This requires huge operational support from national and international partners. Implementing quarantine measures may raise serious legal and ethical issues and the well-being of people in the quarantine area should also be ensured. Step 5: Monitoring and evaluation

Proper mechanisms should be established to monitor the implementation of measures. It is necessary to monitor different indicators, such as distribution and inventory of drugs, drug coverage, compliance with the drug regimens and adverse events associated with the drugs. It is also necessary to monitor epidemiological and virological changes, including changes in transmission pattern and antiviral resistance. Effective and feasible data man,::gement systems and detailed protocols should be established to monitor these indicators effectively.

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2.4

Issues and challenges in early response at country level

Presentations were made by countries with human cases of avian influenza A (H5Nl) on the issues and challenges faced in providing an early response to a potential pandemic event. Common themes to emerge from the session were the need to: • • • • • • increase laboratory capacity to aid detection of early signals of a potential pandemic event; increase human and financial resources; resolve stockpiling issues; engage with the private health sector; gain high-level political commitment; and coordinate national and international activities.

Summaries of the individual presentations are provided below. Cambodia: The flow of surveillance information from local health centres up to central level was presented. It was suggested that unusual clusters of acute respiratory disease might not be detected until several waves had occurred. That problem was said to be compounded by reliance on the private health sector for health care. Other issues highlighted were related to communications, logistics, keeping track of the distribution and administration of antiviral dugs, and adverse-event monitoring. China: The presentation focused on challenges and concerns related to antiviral drugs, their availability and research on their effectiveness for human avian influenza. The speaker also indicated the need to strengthen mechanisms for multisectoral communication and coordination at all levels and the awareness and capacity of health care facilities and health care workers to detect and report unusual clusters. The importance and necessity of enhancing local capacity for surveillance and response in rural areas was highlighted. Indonesia: The presentation began with a brief summary of the resources and structures required for a national rapid response and containment strategy in Indonesia. Operational issues which would delay the deployment of resources for an early response were identified as problems. Clinical and virological research needs were also discussed. Thailand: The speaker presented the current status of national influenza pandemic preparedness and how surveillance and response were being carried out at the local level under the direction of an emergency commander. Global preparedness depends upon regional and national preparedness and this would require appropriate training, information sharing and an antiviral drug stockpile. Trigger criteria for implementing other public health measures, such as quarantine and sustainable development of community-based reporting systems, were identified as issues.

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VietNam: Lack of laboratory capacity in the provinces was identified as a problem as it adversely impacts upon rapid detection and reporting. Provision of standard protocols, equipment and training for mobile teams would greatly aid rapid response measures. Implementing containment measures is another challenge. In particular, plans and coordination mechanisms for the distribution and mass administration of antiviral drugs and non-pharmaceutical interventions are required. 2.5 Round table discussion on rapid response to a potential pandemic

A round table discussion was conducted to discuss the requirements of a rapid response to a potential pandemic. In addition, the major issues and challenges that need to be addressed in order to implement rapid response and containment measures were also discussed. Although a rapid containment strategy remains untested and its success cannot be fully guaranteed, participants agreed on the urgent need for joint efforts in developing national, regional and international rapid response and containment capacities. Attempting rapid containment is realistic only if the earliest signals of a potential influenza pandemic are detected and reported very rapidly and comprehensive measures are implemented fully within a very short period of time. The round table session discussed and identified several complex issues and challenges in the area of early detection and reporting of the earliest signals of a potential pandemic influenza. It was concluded that country capacity building should be considered the highest priority. Developing the capacity to detect and respond rapidly to a potential pandemic will also strengthen basic capacity for other emerging infectious diseases. The key issues identified regarding capacity strengthening were as follows: • Most countries in Asia do not have national and local surveillance and response capacities to detect such early signals and to conduct timely risk assessment. To strengthen early warning systems, the value of rum our verification, syndromic surveillance and community-based reporting systems should be emphasized. Education of local health workers will be also vital for early detection and reporting. The lack of strong laboratory diagnostic capacity is almost a universal challenge in developing countries in Asia, making it extremely difficult to confirm rapidly whether suspect human cases are due to a novel influenza virus in local settings. The importance of strengthening laboratory capacity was emphasized repeatedly. Clear guidelines and protocols, including operational definitions of early signals of a potential pandemic, are not available. There is a need to further strengthen multisectoral coordination and collaboration at each level.

•

• •

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In order for rapid containment to be possible in Asia, participants recognized that a number of other important requirements should be met. The various requirements identified and discussed during this session included: • • • • • • • • • • • • • • 2.6 regional and global stockpiling of antiviral drugs and other needed supplies; strong coordination mechanisms at national, regional and international levels; mechanisms for rapid risk assessment and quick decision-making, such as national and global task forces; logistical and operational arrangements; standardized protocols and guidelines; information and data management systems; training for local, national and international staff; an effective risk communication strategy; national laws and legislation to support containment measures; ethical and liability issues; involvement and participation of the private sector; research on the effectiveness of antiviral drug prophylaxis and the dose requirements for children; establishment and increases in country production capacity for antiviral drugs; and agreement on the principles and limitations of the rapid containment strategy.

Donor response to a potential pandemic threat

Rapid response and containment measures require commitment, involvement and strong support from donor countries and agencies, regional and international organizations, and the private sector. Their efforts are essential components for developing rapid response and containment strategies for a potential influenza pandemic. Roche: Roche presented its actions to support global pandemic preparedness and its commitment to supporting rapid contairunent efforts. Given the limited availability of oseltamivir (Tamiflu®) Roche has taken actions to increase its production and global availability. Roche has reserved 30 million capsules (3 million treatment courses) as a WHO international stockpile for rapid containment, and is currently discussing with WHO a second donation to support the establishment of regional stockpiles. Japan: Japan has committed approximately US$135 million to assist Asian countries in preventing and responding to the threat of avian influenza and human pandemic influenza. One of the major components of the contribution will be focusing on strengthening rapid response capacities, including the provision of antiviral drugs and other supplies. There will also be funding to train personnel, strengthen surveillance capacities, improve communication and health education programmes in rural areas, and conduct research. The committed support would mainly be delivered in collaboration with relevant international organizations such as WHO, FAO, the World Organisation for Animal Welfare (OlE) and UNICEF.

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United States of America: The United States endorsed the coordinating role of WHO and its leadership in international health work. The United States has provided financial and technical support to Asian countries and further assistance will be provided to enhance surveillance for rapid detection and improve support for stockpiles of antiviral drugs, personal protection equipment and other supplies. Research on social distancing is currently being conducted. However, the need for coordinated international actions for rapid response and containment activities was emphasized. Asian Development Bank: The Asian Development Bank (ADB) has based its response to avian influenza and the risk of a potential human influenza pandemic on the experience of SARS. It estimated that the economic impact of SARS was around US$18 billion in East Asia, and that an influenza pandemic could cause much more significant economic damage. ADB's response encompasses the principles of capacity building, regional cooperation and coordination, flexible financing and easy disbursement. It is expected that US$38 million for the prevention and control of avian influenza in Asia and the Pacific will be approved by February 2006. Association of Southeast Asian Nations Secretariat: ASEAN's response and coordination mechanisms to combat avian influenza were established with the involvement of various sectors of governments and international agencies. At regional level, various experts and working groups have been directed to establish a coordinated multi-agency and multi sectoral approach. There are currently a number of initiatives for regional cooperation and intersectoral coordination in preventing and responding to highly pathogenic avian influenza (HPAI) and other emerging diseases, including the ASEAN HPAI Taskforce. European Commission : The European Commission (EC) expressed its concern that the EC is not well-prepared for the next influenza pandemic. The EC shared its recent efforts and activities to improve pandemic preparedness, which include conducting a simulation exercise in November 2005. The EC's position and commitment will be presented in more detail during the pledging meeting in Beijing, China, in January 2006. UNICEF: UNICEF has contributed to preparedness for avian influenza and a potential pandemic through developing and implementing a communication strategy and other efforts. The communication strategy focuses on engaging communities in effective prevention activities and influenza pandemic programme preparedness. The importance of providing appropriate and effective communication during all phases of a pandemic was highlighted. UNICEF also mentioned its experience in solving logistical issues. 2·.7 Group discussions

On the second day, participants were divided into three working groups to discuss key issues and challenges relating to different aspects of implementing rapid response and containment measures, and to recommend necessary actions to address those issues.

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2.7.1

Working group 1: Early detection and reporting

The success of rapid response measures to contain or delay the spread of a potential influenza pandemic virus depends on several assumptions. One of the most important requirements is that any early signal of an event with pandemic potential can be detected and reported rapidly. That requires very sensitive early warning systems and timely reporting to be in place in all countries. However, the current reality is that early warning systems are still very weak and there are a number of other barriers to reporting potential pandemic events rapidly. Discussions in working group 1 focused on four main issues, and a selected number of proposed actions are provided under each heading. Issue I: Lack of capacity for surveillance and epidemiological investigation • Develop appropriate systems to detect early signals of a potential pandemic event, such as pneumonia detection, cluster surveillance of acute respiratory syndrome, and influenza-like illness surveillance. Develop a clear flow of reporting from the grassroots level to the international level: who, what, when and how. Review existing laws or regulations to support the reporting system. Provide resources in a timely manner to facilitate the development of capacity for surveillance and epidemiological investigation.

• • •

Issue 2: Lack of laboratory capacity • • • • Promote the use of existing standard laboratory protocols for specimen collection, transportation and testing. Develop protocols for the use of mobile laboratories in the field, where appropriate. Identify a reference laboratory in the ASEAN region. Develop a protocol to address information sharing and intellectual property concerns regarding viral sequencing and other data. Ensure minimum diagnostic capacity at provincial level. Review and revise regulations to facilitate the rapid transportation of specimens to WHO reference laboratories. Ensure that recommended biosafety and biosecurity measures are followed at all levels. Ensure that laboratories report results in a timely manner. Establish quality assurance programmes, which should be carried out by each laboratory. Strengthen donors' and other international organizations' support to increase laboratory capacity and train the required human resources.

• • • • • •

- 11 -

Issue 3: Barriers to early reporting of events • Accelerate the implementation ofthe newly revised International Health Regulations (IHR 2005). Conduct training and capacity building regarding early detection and timely reporting in accordance with the IHR (2005) requirements. Identify and establish national IHR focal points. Ensure voluntary compliance with IHR (2005) as soon as possible.

• • •

Issue 4: Lack of established mechanisms to assess the risk of a pandemic • • • • • • 2.7.2 Develop exercises to test countries' capacities for risk assessment and rapid response. Establish a WHO Task Force for risk assessment and recommendations. Develop national plans for risk assessment and rapid response, which should be incorporated into national pandemic influenza plans. Establish national task forces for rapid risk assessment. Provide international assistance to enable implementation of rapid risk assessment and response mechanisms. Ensure coordination and collaboration with other sectors, such as agriculture. Working group 2: Issues and challenges at country level

While rapid containment is recognized as one of the most important rapid response strategies to stop the early spread of a novel influenza virus, it remains untested. However, influenza experts suggest that the measure might succeed, and there is, therefore, growing consensus that every effort should be made to develop and implement the strategy as one means of preventing a pandemic or delaying its international spread. To develop and implement rapid response measures effectively, especially rapid containment at country level, there remain many issues and difficulties. These issues, as identified and discussed by working group 2, are listed below, with a selection of associated proposed actions. Issue 1: Policies required for quarantine and social distancing • • • • • Develop policies and legal frameworks for quarantine and social distancing. Increase public awareness of necessary actions. Strengthen regional and international mechanisms for coordinated intercountry border-control measures. Consider the ethical and humanitarian issues associated with quarantine measures. Ensure the well-being of people in the quarantine area (s).

- 12-

Issue 2: Stockpiling for containment purposes • • • • • Create rapid response stockpiles. Manage and coordinate national, regional and international stockpiles. Establish an international coordinator for stockpiles. Develop standardized operating procedures (SOPs) for use of stockpiles. Define roles and responsibilities to address all logistical aspects (procurement, transportation, storage, security and distribution).

Issue 3: Effective communication • • • Identify national focal points for rapid information sharing. Develop a package of outbreak and risk communication messages. Develop strategies for effective and transparent risk communication at national, regional and international levels.

Issue 4: lntersectoral coordination • Strengthen intersectoral coordination to develop and implement the rapid response and containment plan.

Issue 5: Decision-making • • Develop pre-existing guidelines and protocols for implementation (who, what, when, where and how). Develop guidelines on antiviral use in different containment scenarios.

Issue 6: Capacity building for rapid response • • • 2.7.3 Provide training for early response teams. Ensure the availability of necessary equipment (including PPE) and reagents. Develop training modules for health care workers. Working group 3: Regional and international coordinated response mechanisms

The experience and lessons learnt from SARS and avian influenza A(H5Nl) have clearly demonstrated that no single country has all the capacities to address and respond to significant public health emergencies of international concern, especially those caused by emerging infectious diseases. In order to implement rapid containment measures to stop the spread of a potential pandemic influenza virus in a timely manner and a coordinated way, one essential requirement is to develop effective regional and international coordinated response mechanisms. Such mechanisms should be designed to allow the international community to make critical decisions quickly. The investment in such an international effort would add long-term value and would

- 13 -

benefit regional and global capacities and preparedness to respond to any emerging infectious disease threat. The key issues discussed and actions recommended during the discussion of working group 3 were as follows: Issue 1: Coordination of the release and use of various stockpiles • Develop effective coordination mechanisms for the supply, release and use of national, regional and international stockpiles of antiviral drugs and other supplies. Develop a detailed operational plan for Japan's contribution to regional stockpiles, including the location of the stockpiles and other logistical issues, in consultation with ASEAN countries. Discuss further the issues in establishing, managing, releasing and using regional stockpiles in Asia.

•

•

Issue 2: Strengthening capacity for rapid response and containment at country level • • Conduct a quick inventory survey of national operational and logistical capacity for rapid response and containment. Provide support to strengthen national capacity to implement rapid response and containment measures, including training of staff and provision of operational support.

Issue 3: Clear guidelines and standard operating procedures • • Develop clear WHO guidelines, standard operating procedures (SOPs) and training modules on rapid response and containment. Use and adapt WHO guidelines and protocols based on country situations.

Issue 4: Communication and social mobilization • Develop an effective and feasible communication strategy at country and international levels to ensure full implementation of rapid response and containment measures. Identify and disseminate full, timely and accurate messages to the general public and concerned groups about rapid response and containment measures. Enhance effective social mobilization efforts to minimize social disruption in the country of the outbreak.

• •

- 14-

3. CONCLUSIONS AND RECOMMENDATIONS

3.1 ( 1)

Conclusions The avian influenza A(H5N 1) virus has become entrenched in many parts of Asia, and has also spread to other regions. The virus has caused more than 140 human infections, mainly in Asia, but more recently in Turkey. The H5NI virus threatens increasingly to cause a pandemic and poses a serious global public health threat. An influenza pandemic has the potential to cause a health, social and economic catastrophe for the region and the world. Therefore, it is imperative for all countries in Asia and the international community to affirm their shared responsibilities and make every possible effort to prevent a pandemic. Mounting a rapid response to contain the earliest emergence of pandemic influenza is critical. This requires that any events with pandemic potential are detected and assessed rapidly, and that appropriate decisions and actions are implemented in a timely manner. Immediate action areas for reducing the threat of an influenza pandemic include: • • early detection and rapid reporting of any signals of a potential influenza pandemic among humans; development and implementation of a rapid response and pandemic response containment strategy, which should be integrated into national, regional and international influenza preparedness plans; and establishment of coordinated national, regional and international response mechanisms for facilitating such a rapid response.

(2)

(3)

(4)

• (5)

Top prior"ities in developing rapid response and containment capability are to strengthen national, regional and international capacities, particularly in the areas of surveillance, epidemiology, laboratory capacity, risk assessment and risk communication and for countries to implement the new International Health Regulations as soon as possible. Developing the capability to respond rapidly and contain a pandemic in its earliest stages will strengthen basic local, national and international capacities to respond to other public health emergencies of international concern. Recommendations

(6)

3.2

3 .2.1 Recommendations to countries (I) Countries should strengthen national and local capacities to detect and respond to early signals of a potential pandemic and any other public health event. Areas that should be strengthc,lcJ incluJ..:. (a) (b) disease, virus and other surveillance measures, such as rumour surveillance; and increasing community awareness and educating health workers to facilitate early detection and reporting.

- 15-

(2)

Countries are strongly encouraged to comply, as soon as possible, with the provisions of the International Health Regulations (2005) that facilitate early recognition and reporting of events or warning signals of public health emergencies of international concern, such as a potential influenza pandemic. Countries should notify WHO immediately if early signals of a potential pandemic are detected. Urgent risk assessments of such signals should be conducted in collaboration with WHO. Countries should share specimens and virus isolates obtained from persons thought to be infected with a novel influenza virus such as H5Nl. Those specimens and isolates should be shared with the WHO Reference Laboratory Network in a timely manner. The results of the tests should be reported by the reference laboratories to the originating country and simultaneously to WHO as rapidly as possible. Countries, with the assistance of WHO, should review and test their relevant protocols and standard operating procedures (SOPs) to identify important gaps and to allow necessary modifications to be made, including those reflecting unique or important considerations related to individual countries. Countries should identify and address all practical issues including legal, logistical and operational issues that must be addressed to allow full implementation of rapid containment. Countries should integrate rapid response and containment concepts, strategies and implementation steps into their national pandemic influenza preparedness plans. Countries should promote and facilitate collection of the scientific evidence needed to further develop an evidence-based strategy for rapid containment measures. Countries should establish intersectoral coordination mechanisms for national, regional and international partners.

(3)

(4)

(5)

(6)

(7)

(8)

(9)

3.2.2 Recommendations to WHO ( 1) WHO should, as a matter of urgency, help countries to develop and strengthen their national capacities to detect early signals of a potential pandemic. WHO and its partners should, as a matter of urgency, help countries to develop or strengthen their local and national laboratory facilities so that early signals of a potential pandemic can be confirmed rapidly. WHO should also continue to strengthen regional and global laboratory networks. WHO should establish a full-time working group immediately to further develop rapid response and containment strategies and to develop a concrete action plan that proposes protocols, a timeframe, coordination and participation of partners, and other critical elements. WHO and its partners should, as a matter of urgency, draft a feasible overall strategy and related protocols and SOPs to allow and facilitate a rapid, coordinated and effective response to early signals of a potential pandemic.

(2)

(3)

(4)

- 16-

(5)

WHO, with the assistance of its partners, should develop training modules and programmes to educate and train local and international staff on important concepts, strategies and procedures related to early detection, rapid response and containment. WHO should, in collaboration with the United Nations Children's Fund (UNICEF) and other partners, coordinate the development of an appropriate risk communication strategy (including outbreak communication and communication for behavioural change). Appropriate messages should be formulated and provided to the general public and key groups about rapid response and containment, pandemic influenza, and other related and important topics. Such messages must be accurate and should enhance the effective social mobilization necessary to implement important public health interventions. WHO should establish a decision-making process as part of a rapid response and containment process that includes the establishment and utilization of an external advisory Influenza Pandemic Task Force. The Task Force would consist of public health and influenza experts and its purpose would be to provide an independent assessment of critical events related to pandemic influenza and make recommendations to WHO about responding to the pandemic threat. The Task Force would have a specific advisory role when assessing potential early signals of pandemic influenza. WHO should use its Global Outbreak Alert and Response Network (GOARN) and other necessary means to identify and mobilize the local and international staff and experts necessary to facilitate and implement rapid response and containment operations. Furthermore, WHO should provide training for those staff to make them as effective as possible in rapid response and containment operations.

(6)

(7)

(8)

3.2.3 Recommendations to other partners (1)

International partners, in collaboration with WHO, should, as a matter of urgency, help countries to develop and strengthen their national capacities to detect early signals of a potential pandemic. International partners, such as UNICEF, should help develop communication strategies and appropriate materials in collaboration with WHO and countries. Japan and countries of the Association of Southeast Asian Nations (A SEAN), in collaboration with WHO, are asked to develop a detailed operational plan on stockpiles, including antiviral drugs, and to share information on the operational plan with other Asian countries. All partners creating multinational stockpiles for rapid response should coordinate the supply contents and their release and use for rapid containment and potential other uses.

(2)

(3)

(4)

- I7ANNEX I

LIST OF PARTICIPANTS, REPRESENTATIVES AND SECRETARIAT I. PARTICIPANTS

South East Asia Region (SEAR) INDONESIA Dr Sitanggang Maura Linda, Director, Drug and Biological Product Evaluation, National Agency of Drug and Food Control, JL. Percetakan Negara No. 23, Jakarta Pusat._Fax no.: (2I) 428 85404 Tel no.: (2I) 424 5459 ext. I05. E-mail : Penilaianobat@pom.go.id Mrs Catharina Yekti Praptininosih, Head of Sub-Directorate of SARS, Ministry of Health, JL. Percetakan Negara No. 29, Jakarta Telefax: (2I) 4287 34I6. E-mail : yektioompl@yahoo.com Dr Sardikin Giriputoro, AI Outbreak Response Team, National and Infectious Diseases Hospital, (Sulianti Saroso Hospital), JL. Sunter Persai Raya, Jakarta. Fax no.: (2I) 640I4II Tel no.: (2I) 6506567. E-mail : sardikin_dr@yahoo.com MYANMAR Dr Ne Win, Professor, Department of Medicine, University of Medicine, Med Unit I+2, Yangon General Hospitai; Yangon. Fax no.: (95-I) 379 873. Tel no.: (95-I) 256 II2-130 (Ext.808). E-mail : newindr@myanmar.com.mm Dr Kyee Myint, Deputy Director (Medical Care), Department ofHeatlh, No. 36, Thein Phyu Road, Yangon. Fax no.: (95-I) 379 004 Tel no.: (95-I) 379 021 Dr Khin Mar Cho, Microbiologist, Food and Drug Administration, Department of Health, No. 36, Minkyaung Street, Dagon Township Yangon. Fax no.: (95-1) 2IO 652. Tel no.: (95-I) 229 299 THAILAND Dr Narongsakdi Aungkasuvapala, Deputy Permanent Secretary Office of the Permanent Secretary, Ministry of Public Health, I1000 Nonthaburi. Fax no.: (662) 591 8506. Tel no.: (662) 590 I012 E-mail : aungka@health.moph.go.th Dr Wanna Hanshaoworakul, Epidemiologist, Bureau of Epidemiology, Ministry of Public Health, II 000 Nonthaburi. Fax no.: (662) 591-8579. Tel no.: (662) 590-I882. E-mail : wanna@health.moph.go.th Dr Rungrueng Kitpathi, Senior Medical Officer, Coordinating Center for Testing and Laboratory Surveillance (CCTLS), Department of Medical Sciences, Ministry of Public Health, 11000 Nonthaburi. Fax no.: (662) 951 5449. Tel no.: (662) 95t' 0000 ext. 99447. E-mail : rungrueng@dmsc.moph.go.th

- 18Annex 1

Western Pacific Region (WPR) BRUNEI DARUSSALAM

Dr Ibrahim Abdul Latif, Special Duty Officer, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan. Fax no.: (673) 238 4154. Tel no.: (673) 238 4153. E-mail : Latif281 @hotmail.com Dr Ahmed Fakhri Junaidi, Medical Officer, Disease Control Division, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan. Fax no.: (673) 238 2755. Tel no.: (673) 238 2023 E-mail : akhri@doctors.org.uk Mr Wee Shyue Liang, Senior Pharmacist, State Medical Store, Ministry of Health. Telefax: (673) 222 6224 E-mail : shyueliang@brinet.bn

CAMBODIA

Dr Mam Bunheng, Secretary of State for Health, #151-153, Kampuchea Krom Avenue, Phnom Penh. Fax no.: (855) 23-426841 Tel no.: (855) 12-813501. E-mail : MOH@camnet.com.kh; mbh.peu@bigpond.com.kh Dr Sok Touch, Director, Communicable Disease Control Department, #151-153, Kampuchea Krom Avenue, Phnom Penh. Fax no.: (855) 23-882317. Tel no.: (855) 12-856848 E-mail : touch358@online.com.kh; chhanly@yahoo.com Mr Chea Chhiv Srong, Director, Central Medical Store, (Pharmacist), #3, St139, Khan 7 Makara, Phnom Penh. Tel no.: (855) 12-998940 E-mail : cmsmoh@online.com.kh

CHINA

Dr Li Jianguo, Deputy Director General, Office of Health Emergency, Ministry of Health, No. 1 Xizhimenwai Nanlu Xicheng District, Beijing 100044. Fax no.: (8610) 6879 2590. Tel no.: (8610) 6879 2878. E-mail : lijg@moh.gov.cn Dr Wang Maowu, Deputy Director, Office of Disease Control and Emergency Response, China Center for Disease Control and Prevention, No. 27, Nanwei Road, Xuanwu District, Beijing 100050. Fax no.: (8610) 6304 7378 Tel no.: (8610) 6304 5571 E-mail : cdcwmw@sohu.com Dr Li Zhengmao, Section Chief, Office of Health Emergency, Ministry of Health, No.1 Xizhimenwai Nanlu, Xicheng District, Beijing 100044. Fax no.: (8610) 6879 2646. Tel no.: (8610) 6879 2976. E-mail : lizm@moh.gov.cn Dr So Pui Sheung, Kellie, Senior Medical and Health Officer (Epidemiology Section), Surveillance and Epidemiology Branch, Centre for Health Protection, 2/F, 14FC Argyle Street, Kowloon, Hong Kong. Fax no.: (852) 2572 7582. Tel no.: (852) 2768 9710. E-mail : smo_esl@dh.gov.hk

- 19Annex 1

Dr Lo Yee Chi Janice, Consultant/Medical Microbiologist, Public Health Laboratory Branch, Centre for Health Protection, Department of Health Public Health Laboratory Centre, 382 Nam Cheong Street, Shek Kip Mei, Kowloon, Hong Kong. Fax no.: (852) 2776 5758 Tel no.: (852) 2319 8254, E-mail : janicelo@dh.gov.hk JAPAN

Honourable Katsutoshi Kaneda, Senior Vice-Minister for Foreign Affairs, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Honourable Masao Akamatsu, Senior Vice-Minister of Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Honourable Kyoko Nishikawa, Parliamentary Secretary for Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Ambassador Takahiro Shinyo, Director-General, Global Issues Department, Ministry ofForeign Affairs, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Dr Takashi Toguchi, Assistant Minister for Technical Affairs, Minister's Secretariat, Ministry of Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Mr Masaru Tsuji, Deputy Director-General, Global Issues Department, Ministry of Foreign Affairs, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Dr Eiichi Seki, Director, Blood and Blood Products Division, Pharmaceutical and Food Safety Bureau, Ministry of Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Dr Masaru Umeda, Counsellor, Health Service Bureau, Ministry of Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Dr Taro Tsukahara, Director, Tuberculosis and Infectious Diseases Control Division, Health Service Bureau, Ministry ofHealty, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Mr Takeshi Osuga, Director, Global Issues Policy Division, Global Issues Department, Ministry of Foreign Affairs, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Mr Masami Tamura, Senior Coordinator, Regional Policy Division, Asian and Oceanian Affairs Bureau, Ministry of Foreign Affairs, 2-2-1 Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo

-20Annex I

LAO PEOPLE'S DEMOCRATIC REPUBLIC

Dr Bounlay Phommasack, Deputy Director-General, Department of Hygiene and Prevention, Ministry of Health, Simuang Road, Sisattanak District, Vientiane. Fax no.: (856) 21-242981. Tel no.: (856) 21-242980. E-mail : bsack@laotel.com Professor/Dr Sithat Insisiengmay, Deputy Director, Department of Hygiene and Prevention, Ministry of Health, Simuang Road, Sisattanak District, Vientiane. Fax no.: (856) 21-31534 7. Tel no.: (856) 21-9801753. E-mail : ncle@laotel.com Dr Lamphone Syhakhang ,Director of the Drug Control Division, Food and Drug Department, Ministry of Health, Simuang Road, Sisattanak District, Vientiane. Fax no.: (856) 21-214015. Tel no.: (856) 21-214013. E-mail : drugctrl@laotel.com

MALAYSIA

Mr Wong Abdullah Muhammad Farid, Principal Assistant Director, Pharmaceutical Service Division, Ministry of Health, Lot 36, Jalan University, 46350 Petaling Jaya. Fax no.: (603) 7968 2222. Tel no.: (603) 7968 2213, (6019) 2370 2221 E-mail : faridwng@moh.gov.my Haji Rahmat Bin Ramlee, Director, Disease Control Division, Ministry of Health, 3rd Floor, Block EIO, Parcel E. Persint 1, Putrajaya. Fax no.: (603) 8888 0643. Tel no.: (603) 8888 4419 E-mail : ramlee@moh.gov.my Dr Balasubramaniam Vijayamalar, Senior Clinical Virologist, Virology Unit, Infectious Disease Research Centre, Institute for Medical Research, Jln Pahang, 50588 Kuala Lumpur. Fax no.: (603) 2693 6323. Tel no.: (603) 2616 2665 I 2671. E-mail : malar@imr.gov.my

MONGOLIA

Dr Shagdarsuren Enkhbat, Vice Minister of Health, Ministry of Health, 210648, Zasgiin Gazrin VII Bair, Olimpis Street 2, Ulaanbaatar Fax no.: (976-11) 327 872. Tel no.: (976-11) 327 066 E-mail : enkhbat_sh@mongol.net Dr Navaansodovyn Tsend, Deputy Director, National Centre for Communicable Diseases, Na Muyi Jui Street, 14 Khoroo, Bayanzurkh District, Ulaanbaatar. Fax no.: (976-11) 454 921. Tel no.: (976-11) 9111 5001, E-mail : Tsend@magicnet.mn Dr Dorj Narangerel, Senior Officer, Communicable Disease Control Ministry ofHealth, 210648, Zasgiin Gazrin VII Bair, Olimpis Street 2, Ulaanbaatar. Telefax: (976-11) 263 631. E-mail : naraa61 us@yahoo.com

- 21 Annex 1

PHILIPPINES

Attorney Emilio Polig, Jr., Legal, Information and Compliance Division, Bureau of Food and Drugs, Department of Health, Civic Drive, Filinvest Corporate City, Alabang, Muntinlupa City. Fax no.: (632) 807 0751. Tel no.: (632) 807 8386. E-mail : emilio.jrp@yahoo.com Dr Enrique Tayag, Officer-in-Charge/Director III, National Epidemiology Centre, Department of Health, Ground Floor, Building 9, San Lazaro Compound, Sta. Cruz, Manila. Telefax : (632) 743 1937 E-mail : erictayag4health@yahoo.com Dr Ma. Luningning Villa, Medical Specialist IV, Programme Manager for Emerging Infections, National Center for Disease Prevention and Control, Department of Health, Building 13, San Lazaro Compound, Sta. Cruz, Manila. Telefax: (632) 711 6808. E-mail : eliovilla@yahoo.com

REPUBLIC OF KOREA

Dr Kidong Park, Director, Communicable Disease Control Team, Korea Centre for Disease Control and Prevention (KDCD), 194 Tongilo, Eunpyung-Gu, 122-701 Seoul. Fax no.: (82-2) 354 2723 . Tel no.: (82-2) 380 1573, E-mail : pkidong@mohw.go.kr Dr Angela Chow, Deputy Director, Communicable Diseases Surveillance, Ministry of Health, College of Medicine Building, 16 College Road, Singapore 169854. Fax no.: (65) 6221 5528 5538 Tel no.: (65) 6325 9039. E-mail : Angela_Chow@moh.gov.sg Mr Tran Van Hung, VietNam Administration of Preventive Medicine, Ministry of Health, 138A Giang Vo Street, Ba Dinh District, HaNoi Fax no.: (844) 736 6241. Tel no.: (844) 845 6255. E-mail : tranhung@yahoo.com.vn Dr Nguyen Tran Hi en, Director, National Institute of Hygiene and Epidemiology (NIHE), No. 1, Yersin Street, Hai Ba Trung District, HaNoi. Fax no.: (844)821 0853/(844)9723180 Tel no.: (844) 821 2416. E-mail : thiennihe@vnn.vn Mr Vu Dinh Tien, Drug Administration, Ministry of Health 138A Giang Vo Street, Ba Dinh District, HaNoi. Fax no.: (844) 823 4758. Tel no.:(844) 823 0794 E-mail : tienvd_ qldvn@yahoo.com. vn

SINGAPORE

VIETNAM

2. OTHER REPRESENTATIVES

ASEAN SECRETARIAT

Dr Adelina Kamal, Senior Officer, ASEAN Secretariat 70A Jl. Sisingamangaraja, 12110 Jakarta, Indonesia. Fax no.: (62) 21 726 2991. Tel no.: (62) 21 726 2991 E-mail : lina@aseansec.org

-22Annex l

Dr. Bounpheng Philavong, Senior Official, ASEAN Secretariat, 70A Jl. Sisingarnangaraja, 12110 Jakarta, Indonesia. Fax no.: (62) 21 739 8234, 724 3504. Tel no.: (62) 21 724 3372, 726 2991(ext.423). E-mail : b.philavong@aseansec.org ASIAN DEVELOPMENT BANK

Dr Jacques Jeugmans, Principal Health Specialist, Asian Development Bank, #6 ADB Avenue, Mandaluyong City, Philippines. Fax no.: (632) 636 2409. Tel no.: (632) 632 4444. E-mail : jjeugmans@adb.org Mr Alison Airey, Counsellor, Australian Embassy, 2-l-14, Mita, Minato-ku, Tokyo. Fax no.: (81-3) 5232 4140. Tel no.: (81-3) 5232 4151. E-mail : alison.airey@dfat.gov.au Mr Arnold Obermayr, Attache (Culture and Science Technology), Austrian Emba&sy, 1-1-20, Moto Azabu, Minato-ku, Tokyo. Fax no.: (81-3) 3451 8283. Tel no.: (81-3) 3451 8281. E-mail : tokio-ob@bmaa.gv.at Dr Paul Gully, Deputy Chief Public Health Officer, Public Health Agency of Canada, 130 Colonnade Road, Ottawa, Ontario KIA OK9. Fax no.: (613) 954 8529. Tel no.: (613) 954 9663. E-mail : paul_gully@phac-aspc.gc.ca Mr Michael Daley, Logistics Representative, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-D08, Atlanta, 30333 Georgia. Fax no.: (404) 639 2095. Tel no.: (404) 639 2629 E-mail : cty8@cdc.gov Dr James LeDuc, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-D08, Atlanta, 30333 Georgia. Fax no.: (404) 639 3163, Tel no.: (404) 639 3574

AUSTRALIA

AUSTRIA

CANADA

CENTERS FOR DISEASE CONTROL AND PREVENTION

EUROPEAN COMMISSION

Mr Patrick Deboyser, Minister-Counsellor, (Health and Food Safety) Delegation of the European Commission to Thailand, Kian Gwan House II (13th Floor), 140 Wireless Road, 10330 Bangkok, Thailand. Fax no.: (66-2) 255-3113. Tel no.: (66-2) 305 2680. E-mail : Patrick.Deboyser@cec.eu.int Mr Paolo Caridi, First Secretary, European Union, Delegation of the European Commission in Japan, Europa House, 9-15 Sanbancho, Chiyoda-ku, 102-0075 Tokyo. Fax no.: (81-3) 3261 5194. Tel no.: (81-3) 3239 0462, E-mail : Paolo.Caridi@cec.eu.int Ms Saori Nakasone, Senior Research Officer, European Union, Delegation of the European Commission in Japan, Europa House, 9-15 Sanbancho, Chiyoda-ku, 102-0075 Tokyo. Fax no.: (81-3) 3261 5194. Tel no.: (81-3) 3239 0466. E-mail : Saori.Nakasone@cec.eu.int

-23Annex I

FOOD AND AGRICULTURE ORGANIZATION

Mr Norio Kuniyasu, Food and Agriculture Organization of the United Nations, Liaison Office in Japan, Yokohama International Organization Center, Pacificio Yokohama, I-I-1 Minato Mirai, Nishi-ku 220-0012 Yokohama. Fax no.: (8I- 45) 222 II03. Tel no.: (8I- 45) 222 I101. E-mail : norio.kuniyasu@fao.org Dr Yves Miaux, Attache for Life Sciences, French Embassy in Japan 4-li-44, Minami-Azabu, Minato-ku, I 06-85I4 Tokyo. Fax no.: (81-3) 5420 8920. Tel no.: (81-3) 5420 8879. E-mail : attache.sdv@ambafrance-jp.org Mr Matthieu Rosenberg, Adjunct Attache for Life Sciences, French Embassy in Japan, 4-II-44, Minami-Azabu, Minato-ku, I06-85I4 Tokyo. Tel no.: (8I-3) 5420 8800

FRANCE

FUKUOKA QUARANTINE

Dr Takeshi Tanaka, Director, Quarantine and Sanitation Division, Fukuoka Quarantine Station, Ministry of Health, Labour and Welfare, 8-I, Okihama, Hakata-ku, 8I2-003I Fukuoka. Fax no.: (8I-92) 282 I 004 Tel no.: (8I-92) 29I 4IOI, E-mail : t-tanaka@forth.go.jp Dr Tamotsu Nakasa, Director, 2nd Expert Service Division, Bureau of International Cooperation, I-2I-I Toyama, Shinjuku-ku, I62-8655 Tokyo. Fax no.: (8I-3) 3205-7860. Tel no.: (8I-3) 3202-7181 E-mail : tnakasa@it.imcj.go.jp Dr Kazuo Miyamura, 2nd Expert Service Division, Bureau oflnternational Cooperation, I-2I-I Toyama, Shinjuku-ku, 162-8655 Tokyo. Fax no.: (81-3) 3205-7860. Tel no.: (81-3) 3202-7181 E-mail : k-miyamura@it.imcj.go.jp Dr Toru Chosa, Bureau oflnternational Cooperation, 1-21-1 Toyama, Shinjuku-ku, 162-8655 Tokyo. Fax no.: (81-3) 3205-7860. Tel no.: (81-3) 3202~7I81. E-mail : t-chosa@it.imcj.go.jp Dr Yutaka Ishida, Medical Officer, Chief oflnfectious Disease Control, Expert Service Division, Bureau oflnternational Cooperation, I-21-1 Toyama, Shinjuku-ku, 162-8655 Tokyo. Fax no.: (81-3) 3205-7860. Tel no.: (81-3) 3202-7181. E-mail : y-ishida@it.imcj.go.jp Dr Akihiko Kawana, IMCJ, 1-21-1 Toyama, Shinjuku-ku, 162-8655 Tokyo. Fax no.: (81-3) 3207-1038. Tel no.: (81-3) 3202-7181 E-mail : akawana@imcj.hosp.go.jp Dr Kouichiro Kudo, Director, Disease Control and Prevention Center (DCC), IMCJ, l-2I-l Toyama, Shinjuku-ku, 162-8655 Tokyo. Tel no.: (81-3) 3202 7181. E-mail : kkudo@imcj.hosp.go.jp

INT'L. MEDICAL CENTER OF JAPAN

-24Annex 1

INTERNATIONAL Professor Cecil Czerkinsky, Deputy Director-General for Laboratory Sciences Division, International Vaccine Institute, SNU Research Park, VACCINE San 4-8, Bongcheon-7 dong, Kwanak-gu, 151-818 Seoul, Korea. INSTITUTE Fax no.: (82-2) 881 1239. Tel no.: (82-2) 881 1157 E-mail: cczerkinsky@ivi.int/pchoi@ivi.int JAPAN BANK OF INTERNATIONAL COOPERATION

Mr Kazushi Hashimoto, Director General, Sector Strategy Development Department, 1-4-1 Ohtemachi, Chiyoda-ku, 100-8144 Tokyo. Fax no.: (81-3) 5218 9684. Tel no.: (81-3) 5218 9649 E-mail : ka-hashimoto@jbic.go.jp Mr Hideo Ezaki, Advisor, Sector Strategy Development Department, 1-4-1 Ohtemachi, Chiyoda-ku, l 00-8144 Tokyo. Fax no.: (81-3) 5218 9684. Tel no.: (81-3) 5218 9649 E-mail : h-ezaki@jbic.go.jp Mr Kazuhiro Yoshida, Director, Social Development Division, Sector Strategy Development Department, 1-4-1 Ohtemachi, Chiyoda-ku, 100-8144 Tokyo. Fax no.: (81-3) 5218 9684. Tel no.: (81-3) 5218 9649. E-mail : k-yoshida@jbic.go.jp Ms Emi Inaoka, Social Development Specialist, Social Development Division, Sector Strategy Development Department, 1-4-l Ohtemachi, Chiyoda-ku, l 00-8144 Tokyo. Fax no.: (81-3) 5218 9684. Tel no.: (81-3) 5218 9649. E-mail : e-inaoka@jbic.go.jp

JAPAN INTERNATIONAL COOPERATION AGENCY

Mr Akira Hashizume, Executive Technical Advisor to the Director-General, Human Development Department, Shinjuku Maynds Tower Building, 8F 2-1-1, Yoyogi, Shibuya-ku, 151-8558 Tokyo. Fax no.: (81-3) 5352 5320. Tel no.: (813) 5352 5221. E-mail : Hashizume.Akira@jica.go.jp Dr Kunio Yukishita, JMA, 2-28-16, Honkomagome, Bunkyo-ku, 113-8621 Tokyo. Fax no.: (81-3) 3946 6295. Tel no.: (81-3) 3946 2121. E-mail : jmaintl@po.med.or.jp Mr Hisashi Tsuruoka, Manager, International Affairs Division, Japan Medical Association (JMA), 2-28-16, Honkomagome, Bunkyo-ku, 113-8621 Tokyo. Fax no.: (81-3) 3946 6295. Tel no.: (81-3) 3946 2121.

JAPAN MEDICAL ASSOCIATION

.l\"IINISTRY OF AGRICULTURE, FORESTRY AND FISHERIES

Dr Satoshi Maema, Deputy Director, Animal Health Division, Food Safety and Consumer Affairs Bureau, MAFF, 1-2-1 Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Fax no.: (81-3) 3502 3385. Tel no.: (81-3) 3502 8295. E-mail : satoshi_maema@nm.maff.go.jp Dr Noriko Kawaguchi, Section Chief, Animal Health Division, Food Safety and Consumer Affairs Bureau, MAFF, 1-2-1 Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Fax no.: (81-3) 3502 3385 Tel no.: (81-3) 3502 8295. E-mail : noriko_kawaguchi@nm.maff.go.jp

-25Annex I

MINISTRY OF EDUCATION, CULTURE, SCIENCE AND TECHNOLOGY NATIONAL INSTITUTE OF INFECTIOUS DISEASES

Mr Takashi Miyazaki, Senior Specialist, MEXT, 2-5-1 Marunouchi, Chiyoda-ku, I 00-8959 Tokyo. Fax no.: (81-3) 6734 3669. Tel no.: (81-3) 5253 4111(ext.2032). E-mail : ysumika@mext.go.jp

Dr Masato Tashiro, Director, Department of Virology, NIID, 4-7-1 Gakuen, Musashimurayama-city, 208-0011 Tokyo. Fax no.: (81-425) 65 2498. Tel no.: (81-425) 61 077l(ext.351). E-mail : mtashiro@nih.go.jp Dr Nobuhiko Okabe, Director, Infectious Disease Surveillance Center, NIID, 1-23-1 Toyama, Shinjuku-ku, 162-8640 Tokyo. Tel no.: (81-3) 5285-1111 Dr Satoshi Miyake, NIID, 1-23-1 Toyama, Shinjuku-ku, 162-8640 Tokyo. Tel no.: (81-3) 5285-1111 Dr Kensuke Nakajima, Director, Office of International Cooperation, NIID, 1-23-1 Toyama, Shinjuku-ku, 162-8640 Tokyo. Tel no.: (81-3) 5285-1111 Dr Kazutoshi Nakashima, Infectious Disease Surveillance Center, NIID, 1-23-1 Toyama, Shinjuku-ku, 162-8640 Tokyo. Tel no.: (81-3) 5285-1111 Dr Yoshinori Yasui, Infectious Disease Surveillance Center, NIID, 1-23-1 Toyama, Shinjuku-ku, 162-8640 Tokyo. Tel no.: (81-3) 5285-1111

NATIONAL HOSPITAL ORGANIZATION NATIONAL INSTITUTE OF ANIMAL HEALTH NEW ZEALAND

Dr Shuichi Nishimura, National Hospital Organization (NHO)

Dr Takehiko Saito, Senior Researcher, National Institute of Animal Health 3-1-5 kannondai, Tsukuba, 305-0856 Ibaraki. Fax no.: (81-29) 838 7760. Tel no.: (81-29) 838 7764. E-mail : taksaito@affrc.go.jp

Mr Anthony Shimpson, Second Secretary, New Zealand Embassy, 20-40 Kamiyama-cho, Shibuya-ku, 150-0047 Tokyo. Fax no.: (81-3) 3467 6843. Tel no.: (81-3) 5478 9677. E-mail : anthony.simpson@mfat.govt.nz Dr Yoshinobu Okuno, Osaka Prefectural Institute of Public Health, 3-69, Nakamichi 1-chome, Higashinari-ku, 537-0025 Osaka. Fax no.: (81-6) 6972 2393. Tel no.: (81-6) 6972 1321 E-mail : okuno@iph.pref.osaka.jp

OSAKA PREFECTURE

-26Annex l

RIKEN

Dr. Yoshiyuki NAGAI, Director, Center ofResearch Network for Infectious Diseases, Yurakucho-Denki Bldg. North 7th Floor, l-7-l Yuraku-cho, Chiyoda-ku, 100-0006 Tokyo. Fax no.: (81-3) 5223 6060. Tel no.: (81-3) 5223 8731. E-mail : yoshi-nagai@riken.jp Dr Yoshiko Okamoto, Business Management Section, Center of Research Network for Infectious Diseases RIKEN, Yurakucho-Denki Building North 7th Floor, 1-7-1 Yuraku-cho, Chiyoda-ku, 100-0006 Tokyo. Fax no.: (81-3) 5223 6060. Tel no.: (81-3) 5223 8766 E-mail : yoshiko-okamoto@riken.jp

RUSSIA

Mr Alexander Anatolyevich Pankin, Deputy Director, Department of International Organization, Ministry of Foreign Affairs of the Russian Federation, Smolensakya, Sennaya 32/34, Moscow. Fax no.: (495) 244 2401. Tel no.: (495) 244 4211. E-mail : sasmapankin@mail.ru Dr Emiko Iwasaki, Director, Sendai Quarantine Station, Ministry of Health, Labour and Welfare 3-4-1, Teizan-dori, Shiogama 985-0011 Miyagi. Fax no.: (81-22) 362-3293. Tel no.: {81-22) 367 8100 E-mail : emikomd@sam.hi-ho.ne.jp Dr Basil Rodriques, Regional Immunization Officer, UNICEF EAPRO, 19 Phra Atit Road, P .0. Box 2-154, I 0200 Bangkok, Thailand. Tel no.: (66-2) 356 9427 Dr Susan MacKay, Regional Programme Communication Officer, Eastern Asia and Pacific Regional Office/UNICEF, 19 Phra Atit Road, P.O. Box 2-154, 10200 Bangkok, Thailand. Tel no.: (66-2) 356 9427 Dr Gepke Hingst, UNICEF Coordinator for A vi an Influenza Health Section, UNICEF House, 3 United Nations Plaza, Mailcode H-8A, Room842,NewYork, 10017NY, USA. Fax no.: (1-212)8246460. Tel no.: (1-212) 326 7200. E-mail : ghingst@unicef.org

SEND AI QUARANTINE

UNICEF

UNICEF TOKYO

Mr Yoshiteru Uramoto, Director, UNICEF Tokyo (Office for Japan and the Republic of Korea), UN House 8F, 5-53-70, Jingu-mae, Shibuya-ku, 150-0001 Tokyo. Fax no.: (81-3) 5467 4433. Tel no.: (81-3) 5467 4433 Mr Yasushi Katsuma, Programme Coordinator, UNICEF Tokyo (Office for Japan and the Republic ofKorea), UN House 8F, 5-53-70, Jingu-mae, Shibuya-ku, 150-0001 Tokyo. Fax no.: (81-3) 5467 4433 Tel no.: (81-3) 5467 4433. E-mail: ykatsuma@unicef.org Ms Kyoko Okamura, Assistant Programme Officer, UNICEF Tokyo (Office for Japan and the Republic of Korea), UN House 8F, 5-53-70, Jingu-mae, Shibuya-ku, I 50-0001 Tokyo. Fax no.: (81-3) 5467 4433 . Tel no.: (81-3) 5467 4433. E-mail : kokamura@unicef.org

-27Annex I

UNITED KINGDOM

Mr Edward Wright, UK Foreign and Commonwealth Office, British Embassy, Tokyo, I Ichiban-cho, Chiyoda-ku, I 02-8381 Tokyo. Fax no.: (8I-3) 3230-4800. Tel no.: (8I-3) 52Il 1322 E-mail : Edward.Wright@fco.gov.uk Dr Daniel Singer, Senior Medical Policy Advisor, Bureau of Oceans and International Environmental and Scientific Affairs, U.S. Department of State, 2201 C Street Room 7817, 20520 Washington, DC. Fax no.: (202) 736 7336. Tel no.: (202) 64 7 3017 E-mail : singerda@state.gov Dr Nancy Jo Powell, Ambassador, U.S. Department of State, 2201 C Street Room 7817,20520 Washington, DC. Fax no.: (202) 736 7336. Tel no.: (202) 734 7419. E-mail : powellnj@state.gov Dr Charles R. Aanenson, Counsellor, Embassy of the United States of America in Japan, 1-10-5 Akasaka, Minato-ku, 107-8420 Tokyo. Fax no.: (8I-3) 3224-5880. Tel no.: (81-3) 3224-5015 E-mail : AanensonCR@state.gov Mr Yuriy Fedkiw, Embassy of the United States of America in Japan, I-I0-5 Akasaka, Minato-ku, 107-8420 Tokyo. Fax no.: (81-3) 3224-5880 Tel no.: (81-3) 3224-50I5

UNITED STATES OF AMERICA

US AGENCY Dr Peter Morris, U.S. Agency for International Development, FOR 1300 Pennsylvania Avenue, 20523 Washington, D.C. INTERNATIONAL Tel no.: (202) 7I2 5009, E-mail : PMorris@USAID.gov DEVELOPMENT Dr Dennis Carroll, Senior Infectious Diseases Advisor and Director of the Avian and Pandemic Influenza Preparedness and Response Unit, Bureau for Global Health, U,S. Agency for International Development, 1300 Pennsylvania Avenue, 20523 Washington, D.C. Tel no.: (202) 712 5009, E-mail : DCarroll@USAID.gov

WORLD BANK

Dr Jacques Baudouy, Director, Health Nutrition and Population, World Bank, 1818 H StNW, 20433 Washington D.C. Fax no.: (202) 522-3234. Tel no.: (202) 473 2525 E-mail : jbaudouy@worldbank.org

3. OTHER PARTICIPANTS Dr Hiroshi Kida, Research Center for Zoonosis Control, Hokkaido University, Kita 18, Nishi 9, Kit~-ku, Sapporo, 060-0818 Hokkaido. Fax no.: (81-11) 706 5273. Tel no.: (81-11) 706 5207. E-mail : kida@vetmed.hokudai.ac.jp

-28Annex 1

Dr Yoshihiro Sakoda, Associate Professor, Laboratory of Microbiology Graduate School ofVeterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, 060-0818 Hokkaido. Fax no.: (81-11)706 5273. Tel no.: (81-11)706 5209 E-mail : sakoda@vetmed.hokudai.ac.jp Dr Aikichi Iwamoto, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, 108-8639 Tokyo. Tel no.: (81-3) 5449 5359. Fax no.: (81-3) 5449 5580 E-mail : aikichi@ims.u-tokyo.ac.jp Dr Kazuyoshi Ikuta, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamagaoka, Suita, 565-0871 Osaka. Fax no.: (81-6) 6879 8310. Tel no.: (81-6) 6879 8307 E-mail : ikuta@biken.osaka-u.ac.jp Dr Kouichi Morita, Institute of Tropical Medicine, Nagasaki University 1-12-4 Sakamoto, Nagasaki-city, 852-8523 Nagasaki. Fax no.: (81-95) 849 7830, Tel no.: (81-95) 849 7827 E-mail : moritak@net.nagasaki-u.ac.jp Dr Osamu Kunii, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-city, 852-8523 Nagasaki. Fax no.: (81-95) 849 7830. Tel no.: (81-95) 849 7827 Dr Atsuko Aoyama, Department of International Health, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550 Nagoya. Fax no.: (81-52) 744 2114. Tel no.: (81-52) 744 2108. E-mail : atsukoa@med.nagoya-u.ac.jp Dr Reiko Saito, Department of Public Health, Graduate School of Medicine and Dental Science, Niigata University. Fax no.: (81-25) 227 0765. Tel no.: (81-25) 227 2129. E-mail : jasmine@med.niigata-u.ac.jp Dr Kuo Hsu-Sung, Director, Taiwan Center for Disease Control, Department of Health, 9F, 6, Linsen S. Road, Taipei. Fax no.: (886) 2 2391 8543. Tel no.: (886) 2 2391 8509. E-mail : director@cdc.gov.tw Ms Lee Tsui-Feng, Center for Disease Control, Department of Health, 2F, 20, Wen-SinS. 3 Road, Taichung City. Fax no.: (886) 4 2473 9774. Tel no.: (886) 4 2473 4525. E-mail : leetf@cdc.gov.tw Dr. CHANG Shan-Chwen, Director, Division of Infectious Diseases, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei. Fax no.: (886) 2 2395 8721. Tel no.: (886) 2 2312 3456. E-mail : sc4030@ha.mc.ntu.edu.tw

-29Annex 1

Dr David Reddy, Global Pandemic Task Force Leader, Pharma Business, F. Hoffmann-La Roche Ltd Pharmaceuticals Division, Grenzacherstrasse 183 Building 074/40.307 CH-4070 Basel, Switzerland. Fax no.: (41-61) 688 8336. Tel no.: (41-61) 687 1634 E-mail : David.Reddy@roche.com Ms Ludi Schlageter, International Public Policy Manager, Pharma Business, F. Hoffmann-La Roche Ltd Pharmaceuticals Division, Grenzacherstrasse 183 Bldg. 074/40.307 CH-4070 Basel, Switzerland. Fax no.: (41-61) 688 8336. Tel no.: (41-61) 687 0298 E-mail : Ludmilla.schlageter@roche.com Mr Tetsuya Yamaguchi, Strategy Group Manager, Corporate Planning Department, Chugai Pharmaceutical Co., Ltd., l-1 Nihonbashi-Muromachi 2-Chome, Chuo-ku, Tokyo 103-8324. Fax no.: (81-3) 3281-2706 Tel no.: (81-3) 3273 0804. Mr Ken Uesono, Leader/Tamiflu Product Manager, Infectious and CNS Disease Products Group, Medical Business & Science Department, Chugai Pharmaceutical Co., Ltd., 1-1 Nihonbashi-Muromachi 2-Chome, Chuo-ku Tokyo 103-8324. Fax no.: (81-3) 3281-2706. Tel no.: (81-3) 3273 0804 Dr Monsieur Ulf NEHRBASS, Director, Institut Pasteur of Korea, 39-1, Hawolgok-dong, Sungbuk-gu, I36-79I Seoul, Korea. Fax no.: (82-2) 958 6794. Tel no.: (82-2) 329 902I4. E-mail : nehrbass@pasteyr.or.kr.

4. SECRETARIAT GOVERNMENT OF JAPAN MINISTRY OF HEALTH, . LABOUR AND WELFARE

Dr Masaharu Nakajima, Director-General, Health Service Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, I 00-8916 Tokyo. Tel no.: (81-3) 5253 1111

Dr Yukio Matsutani, Director-General, Health Policy Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, I 00-89I6 Tokyo. Telno.: (8I-3)5253Il1I Mr Kenji Tsunekawa, Assistant Minister, Minister's Secretariat, I-2-2, Kasumigaseki, Chiyoda-ku, I00-8916 Tokyo. Tel no.: (8I-3) 5253 Ill I Ms Atsuko Okajima, Councillor, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, I 00-89I6 Tokyo. Tel no.: (81-3) 5253 1III

-30Annex 1

Dr Kazuhiko Adashi, Director, Health Sciences Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, I 00-8916 Tokyo Tel no.: (81-3) 5253 1111 Dr Yasuhiro Suzuki, Director, Research and Development Division, Health Policy Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Dr Senya Toyama, Director, National Hospital Division, Health Policy Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Te1no.: (81-3)52531111 Dr Toshiro Nakagaki, Director, Safety Division, Pharmaceutical and Food Safety Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Mr Yutaka lwabuchi, Director, International Planning Office, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Dr Kaname Kanai, Director, International Cooperation Office, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Mr Toshiyuki Suda, Deputy Director, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, I 00-8916 Tokyo. Telno.: (81-3)52531111 Dr Hajime Inoue, Deputy Director, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Fax no.: (81-3) 3501 2532. Tel no.: (81-3) 5253 1111. E-mail : inoue-hajime@mhlw.go.jp Mr Akira Kido, Deputy Director, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Telno.: (81-3)52531111 Ms Mitsuko Imai, Deputy Director, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Mr Shinichiro Noda, Deputy Director, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo Telno.: (81-3)52531111 Dr Koji Nabae, Deputy Director, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, I 00-8916 Tokyo. Fax no.: (81-3) 3501 2532. Tel no.: (81-3) 5253 1111. E-mail : nabae-koji@mhlw.go.jp

- 31 Annex I

Dr Reiko Akizuki, Section Chief, International Affairs Division, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Faxno.: (81-3)35026678. Telno.: (81-3)52531111 E-mail : akizuki-reiko@mhlw.go.jp Mr Takashi Minagawa, Director, Social Insurance Operation Center, Social Insurance Agency. Dr Yasuhiro Nishijima, Section Chief, Tuberculosis and Infectious Diseases Control Division, Health Service Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Dr Yumiko Kanari, International Infectious Disease Advisor, Tuberculosis and Infectious Diseases Control Division, Health Service Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Telno.: (81-3)52531111 Mr Daisaku Sato, Deputy Director, Blood and Blood Products Division, Pharmaceutical and Food Safety Bureau, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Dr Masami Sakoi, Director, Office of Health Emergency Preparedness and Response, Minister's Secretariat, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Mr Atsufumi Miyazaki, Secretary of Senior Vice-Minister of Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 Mr Koji Uchiyama, Secretary of Parliamentary Secretary for Health, Labour and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, 100-8916 Tokyo. Tel no.: (81-3) 5253 1111 MINISTRY OF FOREIGN AFFAIRS

Mr Makoto Iyori, Principal Deputy Director, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Ms Kyoko Hokugo, Deputy Director, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234 Tel no.: (81-3) 5501 8000 Mr Jun Yamada, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Ms Orie Miyachi, Official, Global Issues Policy Division, Global Issues Department, 2-2-l, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000

-32Annex 1

Mr Isamu Yamaguchi, Deputy Director, Specialized Agencies Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Dr Taro Yamamoto, Deputy Director, Aid Planning Division, Economic Cooperation Bureau, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Ms Masako lso, Official, Global Issues Policy Division, Global Issues Depilrtment, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Mr Yusuke Suzuki, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Mr Koichi Koeda, Deputy Director, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Ms Yoko Terakawa, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Mr Kotaro Masuda, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000. Ms Mami Taniyama, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Mr Yukio Matsubayashi, Official, Global Issues Policy Divisi•~ n, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Ms Megumi Uchida, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Ms Ritsuko Okuno, Official, Global Issues Policy Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, I 00-8919 Tokyo. Fax no.: (81-3) 5501 8234. Tel no.: (81-3) 5501 8000 Mr Yohei Takamura, Researcher, United Nations Administration Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Mr Yasukata Fukanori, Deputy Director, Regional Policy Division, Asian and Oceanian Affairs Bureau, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo

-33Annex I

Mr Masaki Okuyama, Official, United Nations Administration Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Ms Yumi Yamamoto, Official, Specialized Agencies Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Ms Minami Hiromori, Official, Human Rights and Humanitarian Affairs Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Ms Akane Serikawa, Official, Humanitarian Assistance Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo Ms Saori Taguchi, Official, Global Environment Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, I 00-8919 Tokyo. Ms Mariko Miura, Official, Global Environment Division, Global Issues Department, 2-2-1, Kasumigaseki, Chiyoda-ku, 100-8919 Tokyo. JICWELS

Mr Shinjiro Nozaki, Director, International Programme Department, Shinjuku Takasago Building 1OF, 16-5 Tomihisa-cho, Shinjuku-ku, 162-0067 Tokyo. Fax no.: (81-3) 3225-6590. Tel no.: (81-3) 3225-6591 E-mail : nozaki@jicwels.or.jp Mr Kiichi Inagaki, Deputy Director, International Programme Department, Shinjuku Takasago Building 10F, 16-5 Tomihisa-cho, Shinjuku-ku, 162-0067 Tokyo. Fax no.: (81-3) 3225-6590. Tel no.: (81-3) 3225-6591 E-mail : inagaki@jicwels.or.jp Ms Chisato Takahashi, Programme Coordinator, International Programme Department, Shinjuku Takasago Building 10F, 16-5 Tomihisa-cho, Shinjuku-ku, 162-0067 Tokyo. Fax no.: (81-3) 3225-6590. Tel no.: (81-3) 3225-6591. E-mail : takahashi@jicwels.or.jp Ms Yuka Matsushiba, Programme Coordinator, International Programme Department, Shinjuku Takasago Building I OF, 16-5 Tomihisa-cho, Shinjuku-ku, 162-0067 Tokyo. Fax no.: (81-3) 3225-6590 Tel no.: (81-3) 3225-6591. E-mail : matsushiba@jicwels.or.jp

WHO/WPRO

Dato' Dr Tee Ah Sian, Director, Combating Communicable Diseases, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines. Fax no.: (632) 521 1036. Tel no.: (632) 528 9701 E-mail : teeas@wpro.who.int Dr Yojiro Sato, Medical Officer, Programme on Technology Transfer, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines. Fax no.: (632) 521 1036. Tel no.: (632) 528 9933 E-mail : satoyo@wpro.who.int

-34Annex l

Dr Babatunde Olowokure (Responsible Officer), Acting Regional Adviser, Communicable Disease Surveillance and Response, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines. Fax no.: (856) 521 1036. Tel no.: (632) 528 9730. E-mail : olowokureb@wpro. who.int Dr Li Ailan, Medical Officer, Communicable Disease Surveillance and Response, WHO Regional Office for the Western Pacific, P.O. Box 2932 1000 Manila, Philippines. Fax no.: (632) 521 l 036. Tel no.: (632) 528 9784. E-mail : lia@wpro.who.int Dr Futoshi Hasebe, Laboratory Specialist, Communicable Disease Surveillance and Response, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines. Fax no.: (632) 521 1036. Tel no.: (632) 528 9919. E-mail : hasebef@wpro.who.int Mr Peter Cordingley, Public Information Officer, WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines. Fax no.: (856) 521 1036. Tel no.: (632) 528 9992. E-mail : cordingleyp@wpro.who.int Dr Hitoshi Oshitani, Short Term Consultant, Professor, Tohoku University Graduate School of Medicine, 2-l Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan. Fax no.: (81-22) 717 8021. Tel no.: (81-22) 717 8210, E-mail : oshitanih@mail.tains.tohoku.ac.jp WHO/HQ Dr Keiji Fukuda, .Scientist, WHO Global Influenza Programme, Department of Communicable Disease, Surveillance and Response, World Health Organization, Room L417, 1211 Geneva 27, Switzerland. Fax no.: (41-22) 791 4878. Tel no.: (41-22) 791 3871 E-mail : fukudak@who .int Mr Dick Thompson, Leader, Pandemic Communications (Communications Officer), Communicable Disease, World Health Organization, Room Ll59, 1211 Geneva 27, Switzerland. Fax no.: (41-22) 791 4666. Tel no.: (41-22) 791 2684. E-mail : thompsond@who.int Dr Robert Holden, Technical Officer, Operations Management, Emergency Response and Operations, World Health Organization, Room C224, 1211 Geneva 27, Switzerland. Fax no.: (41-22) 791 4198 Tel no.: (41-22) 791 2510. E-mail : holdenr@who.int Mr James Atkinson, Technical Officer, Epidemic and Pandemic Alert and Response, World Health Organization, 1211 Geneva 27, Switzerland. Fax ho.: (41-22) 791 4198. Tel no.: (41-22) 791 2802 E-mail : atkinsonj@who.int

-35Annex 1

WHO/SEARO

Dr Jai Narain, Director, Department of Communicable Diseases (CDS), WHO Regional Office for South-East Asia, Indraprastha Estate, New Delhi 110 002, India. Fax no.: (91-11) 2337 0197 Tel no.: (91-11) 2337 0804 ext. 26125. E-mail : narainj@whosea.org Dr Subhash Raghunath Salunke, Regional Adviser, Communicable Disease Surveillance and Response, WHO Regional Office for South-East Asia, Indraprastha Estate, New Delhi 110 002, India. Fax no.: (91-11) 2370 5663. Tel no.: (91-11) 2330 9127. E-mail : salunkes@whosea.org Dr Sampath Kumar Krishnan, National Professional Officer Communicable Disease Surveillance, Office of the WHO Representative in India, Nirman Bhawan, New Delhi 110 011, India. Fax no.: (91 11) 2306 1505. Tel no.: (91 11) 2306 1955 E-mail : krishnans@searo.who.int Dr Krisantha Weerasuriya, Regional Adviser, Essential Drugs and Medicines Policy, WHO Regional Office for South-East Asia Indraprastha Estate, New Delhi 110 002, India. Faxno.: (91-11)23370197. Telno.: (91-11)23309314 E-mail : weerasuriyak@whosea.org Dr Steven Bjorge, Technical Officer, Malaria and Vectorborne Diseases Office of the WHO Representative in Indonesia, Jakarta, Indonesia Fax no.: (66 21) 520 1164. Tel no.: (66 21) 520 1166 E-mail : somchai@whothai.org Dr Adik Wibowo, WHO Representative to Myanmar, WHO Country Office, 7th Floor, Yangon International Hotel, 330 Alone Road, Dagon Township, Yangon, Myanmar. Fax no.: (951) 212 605. Tel no.: (951) 212 607. E-mail : wibowoa.whomm@undp.org Dr Somchai Peerapakorn, National Professional Officer (Programme) Office of the WHO Representative in Thailand, 4th Floor, Permanent Secretary Building 3, Tiwanon Road, Nonthaburi, Thailand. Fax no.: (66 2) 591 8199. Tel no.: (66 9) 799 6797. E-mail : somchai@whothai.org

-3 6 ~

- 37ANNEX2

Government of Japan

~~§ Organization ---> '<""'-"

{0fl~\ World Health WPR/ICP/CSR/1.5/001/CSR(1)/2006.1 9 January 2006

JAPAN-WHO JOINT MEETING ON EARLY RESPONSE TO POTENTIAL INFLUENZA PANDEMIC

Tokyo, Japan 12-13 January 2006

ENGLISH ONLY

PROVISIONAL AGENDA

08:00-09:00 09:00-09:30

Registration Opening session - Chaired by Dr Takahiro Shinyo, Director General for Global Issues Department, Ministry of Foreign Affairs (MOFA), Japan; and Dr Takashi Toguchi, Assistant Minister for Technical Affairs, Ministry of Health, Labour and Welfare (MHLW), Japan • • • Honorable Mr Katsutoshi Kaneda, Senior Vice-Minister, MOF A, Japan Honorable Kyoko Nishikawa, Parliamentary Secretary, MHLW, Japan Dr Shigeru Omi, Regional Director, World Health Organization, Western Pacific Regional.Office (WHO/WPRO)

09:30-09:40 09:40- 10:00 10:00- 12:00

Group Photo Coffee break Session 1- General overview -Chaired by Dr Toguchi (MHLW, Japan) and Dr Shinyo (MOFA, Japan) • • • Objectives of the meeting (Dr Babatunde Olowokure, WHO/WPRO) Pandemic influenza threat and options for response- (Dr Keiji Fukuda, WHOIHQ) Coordinated approach for responding to early pandemic events Different steps and possible major issues in each step (Dr Hitoshi Oshitani, WHO/WPRO)

12:00- 13:30

Lunch

- 38Annex 2

13 :30 - 15:00

Session 2 -Country presentations -Chaired by Dr Eiichi Seki, Director for Blood and Blood Products Division, MHL W, Japan Issues and • • • • • challenges in affected countries for early response Cambodia China Indonesia Thailand VietNam

15:00 - 15:30

Coffee break

15:30- 17:00 Round table discussion on early response to potential pandemic - Chaired by Dr Seki, MHL W, Japan Discussions may focus on the following • Key issues on early detection and reporting • Major issues and obstacles at country level (based on country presentations) • Key issues on regional and international coordinated response mechanisms • Major requirements for implementing rapid contaminant strategy in Asia 18:00-20:30 Reception hosted by the Japanese Government

08:30 - 09:15

Session 3 - Donor presentations -Chaired by Dr Shinyo (MOFA, Japan) and Dr Toguchi (MHLW, Japan) • Brief description of plans of donors/partners • Roche • Japan • United States • Asian Development Bank • ASEAN

09:15 - 09:30 Instruction for group discussions (WHO) . -Chaired by Dr Seki, MHLW, Japan 09:30- 10:30 Group discussions • • • Group 1: Early detection and reporting (Rapporteur: WHO/WPRO) Group 2: Issues and challenges to implement rapid response measures at country level (Rapporteur: WHO/SEARO) Group 3: Regional and international coordinated response mechanisms (Rapporteur: WHO/HQ)

10:30 - 11 :00

Coffee break

- 39Annex 2

11:00- 12:00

Group presentations and plenary discussions -Chaired by Dr Seki, MHLW, Japan

12:00- 14:00 Lunch 14:00- 15:30 Conclusions and recommendations --Chaired by Dr Seki, MHLW, Japan Closing ceremony -Chaired by Dr Toguchi (MHLW, Japan) and Dr Shinyo (MOFA, Japan)

15:30-15:45

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