November 29, 2005

Dear Panel Chairman, ladies and gentleman,

It is my privilege here today to share with you Hong Kong’s preparedness for Influenza Pandemic.  
I will first clarify some concepts of avian influenza, and influenza pandemic; then I will talk about the government’s policy, legal basis for disease control, our preparedness plan and finally, what are our vision and long term planning.  

The Disease
Influenza is a highly infectious viral disease. Infection caused by influenza A viruses is more common. Influenza A viruses are differentiated by two types of surface proteins: you may just call them H and N. Different types of H and N in different combinations give rise to different strains.
Seasonal influenza refers to the influenza that normally we encounter. The peak season for seasonal flu in HK traditionally last from Jan to March and July to Aug.  We can prevent seasonal flu by annual vaccination, however, such vaccines offers no protection to either avian flu or pandemic flu, simply because they are not available.
On the other hand, up until now, we have evidence that avian influenza normally infects birds and, less commonly, pigs and some mammals. While all bird species are thought to be susceptible to infection, poultry are especially vulnerable to infections resulting in epidemics. Some strains of avian influenza can be transmitted from infected birds, like the H5N1, directly to humans. Up to this moment, evidence suggests that human-to-human transmission has been inefficient. 
Avian influenza is not new to Hong Kong.  Five outbreaks of avian influenza A, H5N1 have been reported in poultry populations since 1997. In the 1997 outbreak, 18 people were infected, of whom six died; and in February 2003, two imported cases were detected, one of whom died. Another outbreak of Influenza A (H9N2) occurred in 1999 with two persons affected; and one case was reported in 2003. With our rapid control actions, Hong Kong has been free from avian influenza since early 2004 despite the regional outbreaks.
Ladies and gentleman, these human infections reminded us that avian influenza is capable of setting off a widespread infections.
For influenza pandemic to occur, three criteria must be fulfilled.  A completely new virus should emerge to which human has no immunity, and that the virus should be able to replicate itself inside human body, and lastly, it has acquired the ability to transmit efficiently from one person to another.  Therefore, if an avian influenza acquires the ability to transmit efficiently from human to human, then a pandemic will occur. With regard to the present situation, this can happen at any time, although unpredictable.
While seasonal influenza occurs every year around the world, a pandemic influenza occurs roughly every 10 to 50 years.  Pandemic influenza spreads quicker around the globe, cause more deaths and associated with much more serious social and economic impact.
The Asian Development Bank has estimated that a severe pandemic would likely lead to a global recession, costing the region up to US$290 billion loss to the effects of reduced consumption, investment, and trade. The WHO estimates that globally the loss can amount to over US$800 billion.

Government Policy
We adopt five strategic principles in pandemic preparedness.  They include reducing risk of human infections by separating humans from poultry, ensuring early detection of pandemic influenza, enhancing emergency preparedness and response, fostering collaboration with Mainland and international health authorities, and providing rehabilitation support in post-pandemic phase.

Legal Basis for Disease Control
The Director of Health is responsible for the enactment of the Quarantine and Prevention of Disease Ordinance (Cap. 141).  Avian influenza infection by H5, H7 H9 has been included. The Director of Health can implement public health measures in relation to avian influenza.
Public Health infrastructure
As you may be aware, HWFB is our policy bureau for health. The DH is the Government's adviser on health issues. The Centre for Health Protection, in short, CHP was set up last year to strengthen Hong Kong health system in prevention & control of diseases. There are six branches under the CHP. 

Ongoing Preparedness
The Health, Welfare and Food Bureau has assumed a proactive role in coordinating inter-departmental and inter-sectoral efforts to combat infectious diseases. The underlying tenet is a population-based, cross-sectoral approach vital for effective disease prevention and control. The Government cannot fight infectious diseases alone; it was our concerted community effort and the growing community awareness of personal hygiene that eventually controlled the spread of SARS.
We have put in place all-round measures targeting source of virus and its reservoirs, such as vaccination of all chickens, enforcing market rest days, stringent hygienic requirements of markets and so on.  The biosecurity measures in live poultry farms are enhanced. Bird –proof facilities are installed. We have enhanced also the wild bird surveillance and implemented the segregation policy of waterfowl and land-based poultry. Closure of Mai Po marshes and walk-in aviaries will be considered if viruses are deteced.
Our public health measure for disease prevention and control covers surveillance, investigation and control measures, laboratory support, infection control, antiviral stockpile, vaccination, port health measures, risk communication and public education.
We have also solicited the assistance of doctors, nurses, pharmacists, paramedical staff, social workers, and non-governmental organizations by recruiting volunteers to serve the public sector as needed during influenza pandemic.
You may also have noticed that we have launched a very intensive publicity programme ranging from internet, health resources production and mass media publicity on prevention of avian influenza. We believe free and transparency in information flow is an effective tool to reduce public anxiety and misunderstanding. Clear and timely information would allow the public to play an active role in protecting themselves from contracting an infectious disease.
Following our innovative application of IT to contribute to rapid response of coordination and effective management in times of the SARS crisis, we will continue to invest in IT as a strategic health protection tool. 
Our relations with long-time strategic partners outside Hong Kong have gone from strength to strength. We have now institutionalized the epidemic intelligence exchange and experience with  Beijing and Guangdong health authorities, and have more or less done so with the WHO and US CDC. A strategic alliance has been formed between the Health Protection Agency of England and Wales and our Centre for Health Protection (CHP). 

Emergency Response
Within the government's Preparedness Plan for Influenza Pandemic, a clear command and response coordination structure is established to ensure the government's swift formulation of strategies. Early this year the Government has issued the preparedness plan for influenza pandemic.  The plan has established a three-tiered Response Levels: the Alert, Serious and Emergency Response Levels. Each of this level prescribes a given set of public health actions to achieve defined public health objectives.

I just highlight some of our enhanced public health actions at each level. At Alert Level, we have extended our temperature screening for incoming travelers at Airport and land borders; and we maintain a very close liaison with the WHO to keep abreast of the epidemics occurring in the Region.
At Serious Response, we will re-institute quarantine of close contacts of the patients. Culling actions will be implemented if poultry outbreaks are detected.
At Emergency Level, we may recruit the surge capacity, for example doctor volunteers from private sector to maintain essential medical services.  If on-going transmission of disease is detected in specific settings, we will consider closure of such settings.
In the post pandemic phase, we plan to provide speedy support to the needy patients and their families through our social security system with effective resource reallocation/donation mechanism. We have developed relevant social service scheme for  recovering the resilience and stability of the community
To ensure workability of the plan and to familiarize the government departments of their respective roles, we have conducted a number of exercises and drills at territory-wide, hospital and individual department levels. Just last week Exercise POPLAR was conducted and our CE, Mr Donald Tsang, was also involved.

Vision and Plans
Ladies and gentleman, we believe that only those who prepared well can respond well.  Our plan is to decrease local poultry population by way of voluntary surrender of poultry farm licenses and license conditions, to minimize the risks and ensure that all poultry can be speedily culled if needed. We will implement a number of measures to increase the separation of human from poultry. One example is to segregate live poultry from customers by means of acrylic panels. In the long run, we are aiming at slaughtering poultries in regional slaughtering plants instead of wet markets. We have already begun a feasibility study on private participation in operating such a regional slaughtering plant. 
Let me empahsize that all the planning cannot be realised withour your support as part of the community.
I now leave to Dr P Y Lam our Director of Health to share with you the business continuity salient points duing in fluenza pandemic.