The potential for pandemic influenza is a growing global concern as health professionals warn that an outbreak is not a matter of "if" but "when." For nations that are unprepared, the disease will have major health, economic, and social consequences, particularly in countries of Africa and Asia where many nations lack a robust healthcare system and are plagued with diseases such as HIV/AIDS or malaria.

To address this concern, health and military professionals from the United States, Europe, and 18 African and Asian nations came together May 18, 2009, in Rome, Italy, for a five-day planning workshop to develop civil-military response plans for potential influenza pandemics.

The conference focuses on key logistical aspects of responding to pandemic influenza in Africa and Asia. It is co-hosted by U.S. Africa Command and the U.S. Pacific Command's Center of Excellence in Disaster Management and Humanitarian Assistance, with the support of the World Food Program, whose headquarters is in Rome.

"We don't know what's going to happen with H1N1 because flu viruses are notoriously difficult to predict," said AFRICOM's deputy to the commander for civil-military activities, Ambassador Mary Carlin Yates. "What we do know, is that due to globalization and the basic ease of travel today, it will be very difficult to contain a pandemic."

Yates opened the conference with remarks about the importance of preparedness and regional cooperation during a pandemic disaster, which is especially timely given the recent outbreak of the H1N1 flu.

Twenty-seven senior military officials and civilian health professionals from 11 African nations, including representatives from African regional health organizations, attended the event to learn more about pandemic response and to collaborate and share information on developing emergency national and regional plans. Also participating were 14 military and civilian representatives from seven countries in Asia.

While difficult to contain, an influenza outbreak can be slowed and deaths minimized by taking measures to plan a response system for a pandemic, according to experts. An effective national plan should encompass clear strategies to include external communication procedures, identification of health facilities, triage procedures, delivery of essential services, food security, protection of medical staff, and more.

According to Josette Sheeran, the World Food Program's executive director, there are four critical areas in preparing for and responding to a health crisis:
• There needs to be regional cooperation and global protocol regarding the flow between borders of food and basic medicines.
• It is important to pre-supply, to the extent possible, on food, medicine, and logistical support.
• A plan of action should be developed at the national and local government levels.
• A system for protecting emergency responders should be in place.

National militaries have a critical role in health crisis response by providing logistical support for the transfer of food and medical supplies to the affected regions, protecting medical staff, and maintaining order and security in a time of uncertainty. Therefore, it is important for civilian and military sectors to work together in developing a joint plan that addresses a "whole of government" approach.

Amir Abdulla, deputy executive director at WFP, stressed, "Now is not the time for complacency… It's not a time for planning when we are in reaction mode. When [a pandemic] happens we have to be ready to go with a series of plans."

During the plenary phase of the conference, at least one military representative and one civilian representative from each participating country and regional organizations listened to senior health officials speak on a variety of topics ranging from logistical considerations to the essentials of military planning and hazard analysis.

For the remainder of the conference, they will put this knowledge to use as they break into smaller working groups to develop regional cooperation agreements and national response plans.

Among the conference participants was Humpreys-Dzanjo Masuko, chief environmental health officer and focal person for Avian and Pandemic Influenza, Malawi's Ministry of Health.

Recognizing the important role played by a nation's military, Masuko said, "The military is part of our plan. They are a member of the national task force, and their role is to make sure that when we have the disease, and if we quarantine certain areas, they are there to make sure people are not coming out of their zone area or people from outside aren't going in. And also, [the military will] assist us in bringing in food to the area that has been quarantined."

Masuko hopes that this conference will help improve Malawi's preparedness in terms of planning.

Representing the Ghanian military, Colonel Samuel Bel-Nono emphasized the importance of regional cooperation in responding to a pandemic. "To Ghana's east is Togo, to Ghana's west is Cote D'Ivoire, and to Ghana's north is Burkina Faso. If we don't work together, policies will be difficult to implement," Denono explained. "Governments need to recognize us as regional units."

This conference is the first event of a series of engagements led by U.S. Africa Command through its Pandemic Response Program (PRP) to assist African militaries in strengthening their capacities to respond to Pandemic Influenza in the context of a larger national pandemic preparedness and response plan.

PRP is funded by U.S. Agency for International Development (USAID) as part of its umbrella program Humanitarian Pandemic Preparedness Initiative (H2P).

PRP's objectives are to train senior and mid-level military leaders in disaster management and humanitarian assistance, with a particular focus on pandemic preparedness; to ensure that militaries in targeted "pandemic preparedness" countries have developed detailed plans of action directly supporting national plans; and to conduct exercises to test the implementation of these plans and identify gaps or deficiencies.

Initial pandemic response assessments have been conducted in Tanzania and Ethiopia, and the first regional training exercise will take place in October 2009. Over the next three years, U.S. Africa Command plans to extend its PRP program to include 17 African nations.

The initial development of national pandemic response plans this week are an important step toward pandemic preparedness, but its value extends even further, providing nations with the skills and knowledge to respond to a wide variety of natural disasters.

"Although the focus here is on preparing for a pandemic response, perhaps one of the most daunting disasters that could occur," Yates said. "The lessons gained from this conference can be applied across the full spectrum of natural and manmade disasters as well."