May 2008 · Number 124 A regular series of notes highlighting recent lessons emerging from the operational and analytical program of the World Bank`s Latin America and Caribbean Region. DOMINICAN REPUBLIC 44694 South-South Cooperation in Action: Responding to Avian Influenza Indira Janaki Ekanayake1, Bari Rabin-Solomon2, and Jean Claude Balcet3 The Low Pathogenic Avian Influenza (LPAI) H5N2 vi- National Emergency Plan for AI to evaluate its com- rus was detected in the Dominican Republic (DR) late prehensiveness and to gauge the country's readiness for last year, causing a serious disruption in subregional implementation. Without the actual experience of having trade, poultry production and food security. In collabora- fought an AI outbreak in the DR, how could workshop tion with the World Bank, the DR Secretariat of State participants anticipate the Plan's performance on the for Agriculture organized a workshop to share regional ground? What must the country watch out for in terms of knowledge on preparedness for emergency actions to unexpected issues or outcomes? deal with avian flu. This note captures interesting themes from the workshop. To provide a reality backdrop to workshop analysis, a multi-country dialogue was organized to allow the Do- Expert Opinions at the Workshop minicans to ask many of the pressing questions they had With HPAI subtype H5N1 reported in more than 60 and to seek advice from those who have helped their own countries worldwide, the international community has countries fight this avian disease. rallied to provide sup- port for its prevention Within weeks, some and control. While 40 workshop partici- H5N1 has not been de- pants from the DR sat tected in the Americas facing a video confer- to date, countries in encing (VC) screen, the Latin America and immersed in a live the Caribbean Region discussion about AI (LCR) are already com- with agricultural sec- ing together to prepare tor experts in Chile, El for a potential outbreak Salvador, Guatemala of the virus. and neighboring Haiti. This just-in-time intra- A couple of months regional learning event, after the LPAI strain executed through the was identified in the DR, the Bank team supervising an Global Development ongoing grant-financed project and the DR's Ministry Learning Network (GDLN)a, raised important questions. of Livestock took the initiative to organize a two-day How was the disease detected in each country? How did workshop for stakeholders across all concerned sectors. it develop? What actions were taken in response? And, The aim of the meeting was to review the government's most importantly, what did these experts learn from the a The Global Development Learning Network (GDLN) is a partnership of over 120 learning centers (GDLN Affiliates) in nearly 80 countries around the world. GDLN Affiliates collaborate in holding events that connect people across countries and regions for learning and dialogue on development issues. http://www.gdln.org Box 1 ­What is Avian Influenza and what dangers does it present? · Avian influenza (AI) is a disease caused by a virus that has multiple strains or types, some of which are more dangerous than others. AI viruses can be divided into highly pathogenic (HPAI) and low pathogenic (LPAI) strains, based on their ability to cause disease in poultry. LPAI is a natural infection of waterfowl that may cause minimal-to-no signs of disease in domestic poultry and wild birds and is not a serious threat. HPAI is rarely found in waterfowl, but causes severe disease in domestic poul- try with a high death rate. · The H5N1 virus is the strain of HPAI that has infected numerous species of birds in more than 60 countries in Asia, Europe and Africa. To date, it has not been detected anywhere in the Americas. More than 300 million poultry have died or been culled in efforts to control the disease. · The widespread persistence of H5N1 in poultry populations poses two main risks for human health. The first is the extremely small risk of direct infection when the virus passes from poultry to humans and causes severe disease. Such infections are extremely rare so far ­ fewer than 400 people have been infected, despite trillions of interactions between infected poultry and people. However, of the very few AI viruses that have infected humans, the current H5N1 virus has caused the largest number of cases of severe disease and death. · The virus is not yet able to spread readily among humans. However, a second risk, one of much greater concern, is that the vi- rus - if given ample opportunity - might change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a pandemic (a global outbreak in humans), with the potential to kill millions of people worldwide. · If H5N1 does appear in birds and poultry in Latin America and the Caribbean, it will threaten the food security of the most vul- nerable groups in the region. In these countries, poultry generally accounts for more than 70 percent of animal protein consump- tion. Such an epizootic would also have serious repercussions on the economies of the Americas. Brazil, for example, the top poultry exporter in the region, sold 3.3 million tons of chicken overseas last year. (ANBA, "Chicken exports reach US$5 billion and break record", January 2, 2008; April 25, 2008, http://www.anba.com.br /ingles/ noticia.php?id=17172. experience of fighting AI and what recommendations it is detected to prevent its spread. He also recommended did they have for the DR? culling in primary sites because that is practically feasible for most country systems. At the same time, once H5N2 The lessons were plentiful and often similar across is found in commercial poultry, immediate and massive countries. Much of the discussion focused on which culling is difficult because of logistical constraints. actions should be taken in prevention and control of avian flu, such as whether to vaccinate birds, and how Participating from GDLN affiliate Universidad Rafael related decisions should be made. Landívar in Guatemala, Dr. Manuel Hoffman of the Country's National Association of Poultry Farmers as- Dr. Moises Vargas Terán of the Regional Food and serted, "(There) must be a strong alliance between the Agriculture Organization (FAO) Office in Santiago, productive sector (and government) in order to be able Chile spoke about global alliances formed to combat to implement plans for control and eradication (of Avian AI and the need to better understand its disease etiol- Influenza)" The need for sector coordination was echoed ogy for improved prevention and control. by each of the country panels. Experts in El Salvador emphasized the importance of including the private Mexico has learned some significant lessons from its sector when deciding on vaccination as a response. Dr. experience with vaccination. AI was declared eradicat- Marquez expressed optimism that the DR can still eradi- ed in 1995 yet later found to have been silently present cate AI through early detection, culling and with a real, over the last 14 years. Dr. Miguel Marquez, a Mexican effective partnership with the productive sector. veterinarian and avian pathologist who participated Experts from all participating countries highlighted in the workshop in person, stressed that "if a country the importance of epidemiological surveillance and of vaccinates, it should consider itself condemned to live anticipating the country's needs ahead of time. Panel- indefinitely with LPAI and the continuing need for vac- ists urged the DR to develop a clear idea of the costs cination." As a consequence, Dr. Marquez recommend- of response and to design a plan of action to be taken, ed that the DR eradicate the virus immediately when before an outbreak occurs. "The day that AI is identified 2 · May 2008 · Number 124 on commercial farms," Marquez stressed, "the decision Another suggested "that political authorities as well as to cull or vaccinate must have been made." Speaking of technical authorities participate, so that they can speak Mexico's lessons from its 1994­95 outbreak of AI, Dr. the same language. Poultry farmers should also partici- Marquez explained, "Mexico took too long to act at the pate; they are the most important part of this topic." onset of the outbreak and this had a terribly negative impact on controlling the spread of the virus." In Gua- World Bank expert Mario Bravo spoke on the theme of temala, Dr. Hoffman reaffirmed this view, saying, "Time communication, a topic which resonated strongly with has been our enemy, given how quickly the virus spreads participants, both during the GDLN dialogue and for the and can mutate." second day's on-site discussions. One evaluation rated communication as "undoubtedly" the most useful aspect In other recommendations, the Dominicans were encouraged of the workshop. In his presentation, Mr. Bravo empha- to be aware of cock fights, which are popular throughout sized that communication should be seen in partnership the island and which can easily facilitate the transmission of with other efforts - not just as an instrument. He also avian flu from birds to farm animals, especially given that noted that communication activities ­ whether for raising the birds are moved over significant distances. awareness, changing behaviors, mobilizing community resources or securing stakeholder buy-in - go beyond just Given the political climate when Mexico's AI crisis "messaging." They need to be carried out as a phased emerged and its hindering effect on response, Dr. Mar- program, he advised, in accordance with the epidemiol- quez cautioned the DR to separate the political dimen- ogy of the disease, and across related sectors (environ- sions from technical aspects when determining how ment, agriculture, health, tourism, etc.). best to address an AI outbreak. Chilean experts Álvaro González of the Ministry of Agriculture and Claus Ko- Following a presentation on trade relations by Dr. Eric brich of the University of Chile agreed, sharing the same Bolaños of the Instituto Interamericano de Cooperación advice from among their recommendations. Both partici- Agrícola (IICA), the local technical team of the upcom- pated by videoconference. ing Avian Influenza project presented its national emer- gency plan on AI. Implementation of the national plan is The multi-country exchange provided the basis for a rich financed through the Avian and Human Influenza Facil- set of discussions held on the second and final day of the ity at the World Bank with Agriculture Ministry collabo- workshop. Participants derived great benefit from the ac- ration (see Box 2). tivity, one rating the workshop's most valuable element as "learning about the situation that countries like Chile, With the expert inputs on the table, participants decid- Guatemala, El Salvador and Mexico have experienced ed which themes were most critical and divided into and seeing how they were able to deal with it." small working groups to work them through further. The priority areas were Communication, Surveillance As a whole, the workshop provided the stage for further and Economic issues. Participants were remarkably inter-sectoral coordination in the DR. Among the most candid in their opinions and inquiries. By day's end, valuable learning elements of the workshop were "the op- the three working groups had designed a set of actions portunity for integration of the different sectors," accord- and priorities to be carried out. These were presented ing to another participant. The donor community showed and discussed and additional thoughts were added to impressive support, with representatives participating the group plans. from the APHIS US Department of Agriculture, US Agency for International Development, and embassies Evaluating the Approach of France, China and the UK. Regional organizations, Looking back on the event and the knowledge shar- including IICA, FAO and OPS, were also present. The ing approaches employed, one in particular enabled the military also sent a participant, given the security issues workshop to be regional in scope, despite a limited bud- anticipated from an AI outbreak. get. That method is the Global Development Learning Network. Experts in three countries were able to advise Nevertheless, for some participants, not all stakeholders the Dominicans, together with a group in Haiti, which were present. In suggestions for future events, one recom- shares the island of Hispaniola - all without any time or mended "involving more people who are part of the poul- expense lost to travel and lodging. Incorporating a dis- try farming chain, the press, and the public in general." May 2008 · Number 124 · tance learning component into the workshop facilitated Box 2 ­ Avian and Human Influenza (AHI) Facility timely south-to-south learning and collaboration. Support GDLN's capabilities are clearly more than "just video The AHI Facility was created in 2006 to assist develop- conferencing." The institutions that host and develop ing countries meet financing gaps in their AHI integrat- GDLN are, in the case of LCR, the countries' best uni- ed country programs in order to minimize the risk and versities. As such, the organization of a learning event is socioeconomic impact of avian and, possibly, human carried out locally and the formation of expert panels and pandemic influenza. Donors have pledged $125 million the generation of audience members is achieved by those to this Facility, with the European Commission making best suited to identify the country's expertise on a given the largest contribution (Euro 71 million). The Facility subject. It also provides an organizational agility that is provides grant financing for activities that are part of na- conducive to just-in-time events on topics of urgent need. tional integrated AHI response programs, including: As often transpires in multi-country dialogues, the end · Communications and coordination to raise aware- result of the regional AI exchange was a kind of "the- ness and trust among the population and to mobilize matic matchmaking" among experts. To cultivate the partners key to managing an outbreak; staying power of new communities that emerge among · Surveillance systems; technicians, practitioners and decision makers, an on-line · Strengthening of human health systems to deal with tool called a "DGroup" was introduced during the work- infectious disease occurrences; shop. DGroups are group online collaboration spaces · Rapid outbreak containment plans and operations; made available through a development partnership which · Support for reference laboratories; includes the World Bank (see http://www.dgroups. · Evaluation and strengthening of veterinary systems org). They encourage the sharing of resources and the and services; and exchange of ideas on development themes, around the · Cross-country coordination activities Region and the World. In 2005 a DGroup on AI in LCR was launched and, as a follow up to the DR workshop, participants were invited to join. The DGroup provides impact the organization or delivery of the workshop a virtual meeting place for continuing collaboration that and to seek a resolution. begins with face-to-face or distance learning modalities. · Advantages of a strong counterpart team. The DR counterpart, a government agency, set higher stan- The workshop in the DR was the second recent gather- dards for the workshop than past counterparts. They ing of the regional AI team for the topic in LCR. When it were notably willing to engage in debate with the comes to preventing and controlling AI, there are lessons private sector and to deal with conflicts that arose. and improvements to be made in the GDLN-workshop · Need for technical"synchronization" among GDLN approach, according to Indira Ekanayake, the Bank's sites. A technical problem with either microphones or the LCR AHI regional coordinator. VC equipment in the DR site caused an interruption in the quality of the audio. This was a distraction for participants Having organized an event previously in Honduras, what and came up as an issue in participant evaluations. lessons have the team learned? · Follow-up to the GDLN event. The project in prepara- · Time is of the essence when it comes to organization. tion with DR will engage the different sectors that par- The team knew that such an activity needed far more ticipants confirmed as important during the workshop. time than the few weeks dedicated to organizing the first · Bringing in the right expertise. Inputs in terms of workshop. With two months given to coordinating with experts were right on target and made a tremendous counterparts on selecting a site, choosing expert speakers, contribution to the quality of the workshop. The organizing the Global Dialogue and prioritizing partici- ability to involve international experts via the GDLN pant invitations above all, a total of 42 people participated removed any barriers to their participation. locally, with another 30 contributors through VC. · Identify counterpart (internal) dynamics upfront. About the Authors Given past experience, the team knew to determine 1 Senior Agriculturist, 2 Consultant, Senior Economist, ahead of time what, if any, institutional matters might LCSAR, SDN-World Bank, Washington DC. "en breve" is produced by the Knowledge and Learning Team of the Operations Services Department of the Latin America and the Caribbean Region of the World Bank - http://www.worldbank.org/lac 4 · May 2008 · Number 124