National plan for the prevention and control "Influenza pandemic"

Transcription

PRIME MINISTER
GENERAL SECRETARIAT FOR NATIONAL DEFENCE
♦ ♦
National plan for the prevention and
control
“Influenza pandemic”
n° 40 /SGDN/PSE/PPS of January 9th 2007
This plan abrogates and replaces governmental plan n° 1700/SGDN/PSE/PPS of 6 January 2006
2007
Third edition
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“Influenza Pandemic” National Plan
Warning
Warning
The world epidemiological situation, the extent of human mobility and the examples drawn from flu
pandemics in the 20th century have led the Government to draw up an initial plan in October 2004 in
order to combat a pandemic as well as launch a planned process for acquiring the means to prevent and
fight it. The rapid progress of this work has led to a second edition of the “ Influenza Pandemic”
prevention and control governmental plan, communicated on 6 January 2006.
The progress made since then, the evolution of the epizootic, the multiplication of human cases and the
teachings from the national “Influenza Pandemic 06” drill of 24 and 25 April 2006 have made it
necessary to update the governmental plan by also taking into account:
- the development of State intervention possibilities, allowing to precise the organisation that needs
to be promoted and the principles dictating how means of prevention and control should be used;
- the work led since the designation in August 2005 of an interministerial delegate for the fight
against avian influenza (Délégué interministériel à la lutte contre la grippe aviaire - DILGA),
particularly on issues concerning the organisation of the authorities, response strategies,
intervention principles, ethics, etc.;
- the fundamental principles of training, information and communication directed towards the
public and professionals, aiming at transparency and maintenance of a strong relationship of trust
between the population and the authorities in the event of a flu pandemic;
- the reinforcement of actions of international cooperation;
- the results of research and development work on pandemic flu, the H5N1 virus and the means
available to react to this threat.
The plan is three-fold:
- principles of action and organisational approach;
- information sheets to help decision-making;
- a table summarizing all the measures and indicating the ministries in charge of their preparation
and implementation.
Apart from reviewing the situations defined on the basis of precise criteria, both by the World Health
Organisation (WHO) and the French plan, this new edition attempts to increase the flexibility for
applying measures and take more adequate account of the uncertainty inherent to any crisis
context, in the case of a pandemic, the management of the period of epidemiological uncertainty.
In order to assist the risk manager during the uncertainty period that may arise between the rumour of
several grouped cases or the outbreak of an epidemic and the virological confirmation or an official
announcement the onset of a pandemic by the WHO, a quick response “Imminent risk of pandemic”
information sheet has therefore been added to the plan It must be used at the critical moment
when the possibility of an imminent switch to a pandemic is perceived, irrespective of the
situation at national level.
The measures detailed in the information sheets constitute propositions to be examined nationally
on a case-by-case basis according to the evolution of the situation.
In order to assist in decision-making, certain measures are accompanied by an evaluation of relevance
derived from the analysis of real epidemics or pandemics.
The governmental plan is accompanied by a collection of technical information sheets.
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Contents
Contents
Introduction
p. 4
PART ONE: PRINCIPLES OF ACTION AND ORGANISATIONAL APPROACH
Gradation of the Response
1. – International Alert Phases and Plan Situations
p. 6
General Strategy
2. - General Preparation and Response Strategy
3. – Pandemic Curbing Strategy
4. – Public Health Response Strategy
5. – Taking into Account International Aspects
6. – Continuity of Social and Economic Life
7. - Information, Training and Communication
8. – Management of French Nationals Abroad
p. 7
p. 9
p. 10
p. 12
p. 13
p. 14
p. 15
Principles Guiding Crisis Operational Conduct
9. – Governmental Management of the Crisis
10. – Territorial Management of the Crisis
11. - International Management of the Crisis: Communication Channels
p. 16
p. 19
p. 21
Preventing and Fighting Avian Influenza
12. - Prevention and Emergency Plan for Avian Influenza
p. 22
PART TWO: DECISION-MAKING AID SHEETS
Methodology for using Decision-Making Aid Sheets
Information sheet on the themes of interministerial meetings
Quick response “Imminent risk of pandemic” information sheet
“Situations and measures” information sheets
Situations relative to the animal disease
Situation 1 - No circulation of new highly pathogenic avian virus in animals or man
Situation 2A - Epizootic abroad caused by a highly pathogenic virus, without human cases (phase 2, WHO)
Situation 2B - Epizootic in France caused by a highly pathogenic virus, without human cases (phase 2, WHO)
Situations relative to the human disease
Situation 3A - Isolated human cases abroad without interhuman transmission (phase 3, WHO)
Situation 3B - Isolated human cases in France without interhuman transmission (phase 3, WHO)
Situation 4A – Limited and localised clusters of human cases abroad (phase 4, WHO)
Situation 4B - Limited and localised clusters of human cases in France (phase 4, WHO)
Situation 5A - Large foci of uncontrolled clusters abroad (phase 5, WHO)
Situation 5B - Large foci of uncontrolled clusters in France (phase 5, WHO)
Situation 6 - Influenza pandemic (phase 6, WHO)
Situation 7 - End of the pandemic wave
PART THREE: TABLE SUMMARISING THE MEASURES
ANNEXES
ANNEX 1 – Permanent actions at governmental level
ANNEX 2 – Fields of action and prerogatives of major international partners
ANNEX 3 – Glossary – Major reference documents – Web sites
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Introduction
Introduction
Influenza is an acute, contagious respiratory infection of viral origin. A winter seasonal epidemic can affect 5
to 15% of the population. The incubation time varies from one to seven days and clinical signs last for five to
ten days. The patient is contagious between 24 and 48 hours before the clinical signs of illness appear and
remains contagious for the whole symptomatic period of the disease.
An influenza pandemic, which is on a sharp rise all over the world in terms of space and time, cases and
gravity, is characterised by the emergence of a new influenza virus against which the immunity of
the population is low or nil. This can result from exchanges between human and animal strains, which
are constantly evolving, or progressive mutation of an animal virus.
The persistence of a highly pathogenic avian flu virus, H5N1, in the environment and in the wild and
domestic avian fauna in many countries since 2003 and the crossing of the species barrier observed under
natural conditions lead to fear the emergence of a pandemic flu virus from the H5N1 strain, which however
does not exclude that the pandemic might result from another influenza virus (H7 or H9 for instance, or even
H2).
The kinetics and impact of a pandemic have been modelised by the National Institute of Public Health
(InVS) on the basis of past pandemics. In the absence of public health intervention, the outcome in France
could mean 9 to 21 million patients and 91,000 to 212,000 deaths by the end of the pandemic, between
500,000 and 1 million people could develop complications requiring hospitalisation.
The spread of a pandemic usually takes place in successive waves which can become firmly established in
two to four weeks, each wave lasting between 8 and 12 weeks, with an interval of a few months or more
between waves. However, due to the globalisation of exchanges, a spread of the pandemic without
successive waves but peaks associated with a permanent background of cases is possible.
Apart from its major impact on health, a pandemic could, in the long term, cause:
-
disorganisation of the health system due to the rapid saturation of the healthcare system;
disorganisation of social and economic life;
partial paralysis of services essential for the functioning of the State and society.
The main objectives of the plan are to protect the French mainland and overseas population as well as
French citizens abroad against the threat of a flu pandemic. The aims are the following:
- preparing the country to face an epizootic of avian influenza due to a highly pathogenic virus,
managing patients suffering from such a virus, and dealing with a major flu pandemic;
- during the pandemic alert phase, detecting the first manifestation of a new flu virus and curbing its
spread in order to improve the level of preparation and the response capacity, limiting the number of
infected individuals and ensuring the optimal management of patients at home or in hospital according
to the seriousness of their condition;
- in a pandemic period, to slow down the progress of the virus as much as possible, ensure that the
population has the best possible access to prevention and care means, ensure the essential functions for
the continuity of governmental action, as well as for the security and every-day life of the population,
law and order and the preservation of economic activity;
- fulfilling France’s international commitments;
- preserving the relationship of trust between the population and the authorities, particularly through
well-coordinated, transparent and continuous communication;
- making use of the experience drawn from real events and national and international drills in order to
improve the preparation of the country in the face of major public health threats.
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Part One - Contents
Part One
Principles of Action and
Organisational Approach
CONTENTS
Gradation of the Response
1. – International Alert Phases and Plan Situations
p. 6
General Strategy
2. - General Preparation and Response Strategy
3. – Pandemic Curbing Strategy
4. – Public Health Response Strategy
5. – Taking into Account International Aspects
6. – Continuity of Social and Economic Life
7. - Information, Training and Communication
8. – Management of French Nationals Abroad
p. 7
p. 9
p. 10
p. 12
p. 13
p. 14
p. 15
Principles Guiding Crisis Operational Conduct
9. – Governmental Management of the Crisis
10. – Territorial Management of the Crisis
11. - International Management of the Crisis: Communication Channels
p. 16
p. 19
p. 21
Preventing and Fighting Avian Influenza
12. - Prevention and Emergency Plan for Avian Influenza
p. 22
5
“Flu Pandemic” National Plan
International Warning Phases and Plan situations
1 – International Alert Phases and Plan Situations
The situations presented in the plan use the phase numbering employed by the World Health Organisation
(WHO) in the flu pandemic nomenclature.
WHO Phases
phase 1
phase 2
phase 3
phase 4
phase 5
phase 6
phase 6
Situations according to the French plan
WHO Interpandemic period
no new influenza virus circulating among the Situation 1
human population
no new influenza virus circulating among the Epizootic abroad - Situation 2A
human population, despite an animal virus Epizootic in France - Situation 2B
giving rise to a substantial risk of human
disease
WHO Pandemic alert period (prepandemic)
Human infection by a new virus
Isolated human cases abroad(no interhuman transmission, or rare or
Situation 3A
isolated cases linked to close contact)
Isolated human cases in France - Situation
3B
grouped cases (“clusters”) of limited and
Limited and localized human clusters
localised interhuman transmission (virus
abroad – Situation 4A
incompletely adapted to humans)
Limited and localized human clusters in
France - Situation 4B
spread of clusters, still geographically
Large foci of uncontrolled clusters of cases
localised (the virus adapts to humans)
abroad - Situation 5A
Large foci of uncontrolled clusters of cases
in France - Situation 5B
WHO Pandemic period
Strong interhuman transmission among the Pandemic
population with rapid geographical spread 1 Situation 6
WHO End of pandemic wave
Situation 7
Most phases can correspond to the level of direct entry into the crisis, without having been preceded by the
lower degree phases. Conversely, up until the pandemic situation, the return to a previous situation and a
lower level is possible.
Each phase can be aggravated by the concomitant emergence of other epidemics such as SARS (severe acute
respiratory syndrome) or seasonal influenza epidemics.
1
The EU plan of 28 November 2005 subdivides this phase into four levels:
Level 1: no human cases in the European Union; Level 2: one case in the EU;
Level 3: one or more clusters of cases in the EU; Level 4: activity spread over one or more Member States.
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General Strategy
2 - General Preparedness and Response Strategy
The general strategy for preparedness and response aims at:
•
take into account the flu pandemic threat upstream by continuous monitoring of scientific and
technological advances, by an active research and development policy, by constant action in terms of
planning, information, organisation and drills, by encouraging the development of the production
capacity of anti-influenza vaccine, and by acquiring diversified means of protection and treatment;
•
help countries affected by the epizootic, by cooperating with the International Office of Epizootics
(IOE) and the Food and Agriculture Organisation (FAO);
•
prevent the emergence and development of avian flu foci on French territory by detecting and
eradicating them as early as possible;
•
cooperate with France’s international partners: with WHO, to ensure early intervention in
countries with clustered cases (prophylaxis using antiviral drugs and possibly a prepandemic
vaccine, isolation of affected zones, etc.); with the European Union, to promote reciprocal
information and harmonization of approaches of Member States, thereby facilitating goods
circulation continuity within the EU in such a context.
•
curbing the emergence and development of a new virus adapted to man on the French
territory, by adopting early and immediately drastic public health measures:
o
early detection and implementation, preferably in a hospital, of the first human imported or
indigenous cases and their contacts, with, in particular, the help of a network of surveillance,
diagnosis and warning;
o
postponing passenger links with affected countries, making boarder checks, limiting
travelling, launching ring protection actions around initial foci, using prepandemic vaccination if
necessary, keeping patients and people in contact with them at home, keeping personnel whose
activity may be suspended at home if necessary, limiting non essential movements;
o
limiting contacts in places with a high human concentration and presenting an increased risk
of transmission: limitation or temporary halt of public transport, closing of teaching and training
facilities, postponing of sports events, closing of entertainment halls, etc.;
o
accelerated development and production of a pandemic vaccine to be administered following
an order of priority defined according to the epidemiological characteristics of the virus, and in
particular to the most exposed professionals, people presenting a particular vulnerability or
likelihood of propagating the epidemic;
•
Sensitize health professionals, other exposed professionals and the public to the need for
respecting protection and hygiene measures in the case of contagious disease with an airborne or
hand-borne transmission;
•
Organising and adapting the public health system facing a pandemic:
o
As soon as the number of people affected becomes significant, treatment at home as long as
their condition allows for it. In the case of worsening symptoms, the patient’s hospitalisation will
be regulated by the SAMU-Centre 15;
o
Setting up of health and social coordination centres bringing together healthcare and home
care players;
o
Organisation of intermediary facilities grouping isolated patients whose condition does not
require hospitalisation
o
mobilization of public and private health facilities to the maximum of their capacity; with
sectorization of circuits for flu patients; implementing the “white plan” and its “Influenza
Pandemic” annex;
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General Strategy
o
optimal use of previously constituted health product reserves (especially antiviral drugs and
prepandemic vaccines, according to the expert’s conclusions, etc.), with a concern for
diversification allowing the replacement of a de facto less efficient product by another that turns
out to be efficient;
o
sustaining a suitable provision of health products, medical devices and protection equipment,
etc.;
•
organize the continuity of State action, social and economic life, public order and law
enforcement in a deteriorated context:
o
sustaining life conditions for people at home thanks to proximity service organization based
on neighbourhood solidarity and reinforced by local authorities;
o
maintaining, under all circumstances, actions essential for the continuity of State action and
for the security and life of the population (such as food provision), by relying on local authorities
and a given organisation (preserved new shifts, distance working) and on all available personnel
resources (reservists, young retirees, volunteers, inactive people, people having recovered, etc.);
o
maintaining economic activity at the highest possible level in all sectors whilst ensuring the
health protection of employees;
o
maintaining the security of dangerous facilities in the context of a lack of personnel;
o
preservation of law and order and of the observance of the law;
•
accompanying this strategy with a major effort in information and training which shall be
sustained and adapted to the international framework:
o
preparation of the country (population, professionals) for the management of this risk by
circulating a regular and pedagogical information about the risks linked to the pandemic, by
promoting a culture of prevention and encouraging solidarity between neighbours;
o
maintaining the civic spirit and social cohesion;
o
coordination of information between all players to ensure the coherence and efficiency of the
information on the crisis itself and on related elements.
•
ensure social consensus based on ethical principles is maintained:
A serious pandemic is an exceptional situation demanding the definition of priorities to access health
means, an effort of solidarity at all levels, and a commitment on the part of those whose missions involve
direct contact with patients. In such a situation, a consensus on shared ethical values will be essential to
preserve social cohesion. For example:
o the duty of solidarity at all levels, from the international level to the local level;
o the duty of providing care on the part of health professionals, the duty of society to
protect them, their families and those whose work leads them to be exposed (including
people collaborating occasionally with the public service), and the duty to ensure the
future of families of those who fall victim to the disease;
o an ethical approach in terms of the elaboration of priorities of access to limited
resources, including health products, and poster publicising of these priorities as soon as
they are issued;
o rejection of stigmatisation of isolated patients or quarantined people;
o the duty for everyone to participate in as much as possible in the effort to maintain the
continuity of the life of the country;
• constantly evaluate the degree of preparation of the system through drills at various levels of State
and the definition of preparation indicators.
Three categories of indicators are defined for evaluating the level of preparation: indicators for the level
of progress of preparatory measures defined in the plan, indicators of the operational level of the
measures and figure indicators measuring capacity. Each ministry draws up a list of indicators
concerning its services and activities, which it communicates to the interministerial delegate for the fight
against avian flu (DILGA).
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Curbing Strategy
3 – Pandemic Curbing Strategy
A curbing strategy aims at:
-
delaying the advent of the pandemic peak by a few weeks,
o
o
o
o
to allow better preparation of the response system;
to improve the vaccine preparation process so that it may be available, if possible, before a second
wave (one week gained resulting ultimately in 5 to 15 million extra doses produced in France,
including 0.45 to 1.35 million for national consumption);
to speed up the manufacturing of masks on national assembly lines and the pharmaceutical
formulation of bulk antiviral drugs, prepare distribution and start reconstituting the stocks;
if necessary, to allow the development of an immune reaction in people who have just received a pre
pandemic vaccine;
-
spreading the pandemic peak over time in order to reduce the risk of saturation of the health
system (intensive care units, paediatric facilities, load on private doctors and emergency medical
services, etc.) and reduce the impact on social and economic life;
-
reducing as much as possible the number of patients, hospitalisations and deaths.
This strategy takes the form of five objectives:
1st objective: limit the epidemic at the source in as much as possible by providing international assistance.
2nd objective: prevent patients from entering French territory as much as possible.
3rd objective: slow down the spread of the virus among the population from or around the first cases or foci
on French territory.
4th objective: as soon as the disease begins to spread, curb its geographical spread within the country as
much as possible.
5th objective: limit the level of viral transmission for the duration of the pandemic by strictly enforcing
barrier measures, hygiene reinforcement, vaccination, etc.
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Public Health Response Strategy
4 – Public Health Response Strategy
A single management strategy is applied during a pandemic (situation 6) irrespective of the magnitude of the
epidemic:
-
-
-
patients are treated at home or where they happen to be staying or residing at the time of onset of the
disease as long as their condition allows for it; if it worsens, hospitalisation is regulated by the SAMU
Centre 15
the system continues to manage other pathologies with prioritization of patients based on seriousness,
when necessary;
the players involved must have prior knowledge of their missions and the measures defined by the
system.
1. – General Organisation of the Care System
Private doctors, with the assistance of other health professionals if necessary, will treat all patients not
requiring intense medical management as outpatients. Other than clinically examining the patient in order to
diagnose the presence of influenza (or some other pathology), their role is to inform the patient and
immediate contacts, ensure follow-up and take all the necessary measures in case there is an aggravation of
the condition (need for hospitalisation). Access to individual means of protection is made easier for them.
Health and social coordination centres participate in the organisation of ambulatory medical care.
Ill residents in social and medico social facilities are managed on the spot, depending on their condition, while
respecting proper hygiene and isolation rules. Visits are reduced to a minimum.
Intermediary care facilities allow regrouping of patients that might be isolated at home, but whose
condition does not justify hospitalisation.
Public or private health facilities contribute to the management of patients requiring hospitalisation, the
latter being regulated by emergency medical services (SAMU-Centres 15). A particular effort is for
reanimation’s equipments and medical devices.
2. – Hygiene and Individual Protection Measures
Because the virus may be present on the hands of patients or on soiled objects, standard hygiene
measures must be taken (washing of hands, airing of rooms, isolation, etc.).
In addition to this, social distancing measures, such as limiting gatherings and developing distance working
and virtual conferences, must be taken.
The flu virus being essentially transmitted by the projection of exhaled aerosol particles (respiratory tract), the
patients wear an anti-projection mask, known as a “surgical mask”, in order to protect the people around them.
FFP2-type masks, known as individual respiratory protection (IRP) devices, are designed to protect
primarily people in close and repeated contact with patients or their biological samples; such masks will be
provided to all health professionals, safety professionals in identical situations and professionals responsible
for the rescue of victims. Similarly, essential staff and personnel in permanent and close contact with the
public and/or vulnerable people (social and medico social facilities in particular) should be provided with
FFP2-type masks.
For unaffected people, wearing an anti-projection mask may be recommended as a precautionary measure in
public places. The public is encouraged to buy such masks.
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Public Health Response Strategy
3. - Antiviral Products and Other Drugs
Recourse to antineuraminidase antiviral drugs, at the earliest time possible after the manifestation of the first
symptoms, or after exposure to a patient without adequate protection, may be fairly efficient. This efficiency
will be all the more significant if the drugs are administered early. This must be done very early, if possible
within 12 hours and not later than 48 hours, following manifestation of symptoms.
They are primarily destined for the treatment of patients as soon as the symptoms appear and will be
delivered free of charge by medical prescription. Based on a high patient estimation made by the Institute for
Health Monitoring (InVS), the ministry of health can ensure the availability of sufficient stocks to cover the
treatment needs of all patients.
Their preventive (prophylactic) use may be envisaged in certain cases 2 , following the indications of the
Ministry of Health and taking into account the volume of stocks.
A list of other drugs with the capacity to act on pandemic flu is constantly updated and measures are being
taken to ensure the provision of stocks.
4. - Vaccines
Beyond seasonal vaccines, presumably inefficient against the pandemic strain, laboratories are developing
prepandemic vaccines that protect against H5N1 avian viruses. Their possible efficiency against the
pandemic virus will need to be verified when interhuman transmission begins to be significant. If this is the
case, the stocks built up prior to the pandemic might be used while waiting for a pandemic vaccine.
The pandemic vaccine can only be developed once the pandemic strain has been isolated, attenuated and
transferred to industrial manufacturers (WHO phase 5 or 6), which means there is going to be a lag of several
months before the first batches of vaccine against the pandemic strain can be produced.
The groups to be vaccinated as a priority are the people most exposed owing to their activity (health
personnel, for instance), those presenting an elevated risk of complications due to pre-existing pathologies
and those people most likely to spread the epidemic.
Expert evaluation of the populations and age groups most affected by such a virus or playing a major role in
its spread, together with models taking into account the progressive availability of the vaccine with respect to
the kinetics of the pandemic, will allow refining the vaccination strategy.
Quick and sufficient provision of pandemic vaccine constitutes a priority objective.
Beyond anti-influenza vaccines, the public health strategy takes into account all the health products
likely to help fight the pandemic, and in particular the antipneumococcal vaccine, for people at
higher risk of bacterial secondary infection.
5. – Biological Tests
Quick tests to detect the serological status of persons can only be developed once the pandemic strain is
isolated; they will be required in large numbers to check the presence of antibodies in the blood:
- in order to make optimal use of the available vaccine: vaccination will be waived for people having
acquired immunity by contact with the virus (former patients, asymptomatic cases); efficiency of
injections will also be checked, etc.;
- in order to designate primarily people having acquired immunity by contact with the virus to carry out
exposed tasks.
2
For example: control of an affected zone at the beginning of the pandemic, protection of the family members of a patient, of health
personnel or similar, who might have been exposed without suitable protection.
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““Influenza Pandemic” National Plan
International Aspects
5 – Taking into Account International Aspects
Globalization of exchanges increases the combination and dissemination of pathogenic germs, in a context
where the various countries have unequal access to means of fighting these germs. Annex 2 reviews the
different areas of action and the attributions of the major international partners involved.
1. – The issue posed by avian flu now mobilizes all the players under the aegis of the United Nations
in order to make a global, determined, coordinated and transparent action possible.
France’s commitment is reflected in its support for three major organisations in terms of fighting the
disease: WHO (human health), the Food and Agriculture Organisation (FAO) and the International
Office of Epizootics (IOE) for animal health. It is also reflected in the reinforcement of its technical
cooperation, a special effort being made in Asia and Africa.
France is implementing the measures of the new international health regulations due to become
effective in 2007.
2. – Animal health measures are part of the Community domain and the European Union has
adopted strict measures to restrict imports, increase surveillance and reinforce bio security.
3. – Human health issues are the responsibility of individual States, but a policy of harmonization
of national plans, together with adoption of surveillance, protection and public information measures
is actively pursued.
In accordance with the principle of subsidiarity, the European Commission will only take measures
if, as a result of scale or due to the effects of the action proposed, objectives will be better attained by
the EU than by its Member States.
Each State informs other States and the Commission (cf. decision 2119/98/CE of 24 September
1998) regarding the control measures it is planning to take or has taken in an emergency. Except in
an emergency, it is responsible for consulting Member States and the Commission. This consultation
is not tantamount to an obligation of harmonisation.
The Minister of Health (general health direction - DGS) informs the European Union of the measures
taken by means of an Early Warning Rapid System (EWRS) message.
4. - France is participating in a collective effort in order to protect its population and ensure the
continuation of economic life. It provides the same treatment for both French nationals and any
foreign residents on its territory.
Governmental action also applies to French nationals abroad and is being conducted in a manner
consistent with the actions of other European Union Member States.
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International Aspects
6 - Continuity of Social and Economic Life
In the face of a pandemic with limited public health consequences, the goal is to ensure conditions of
functioning of the country (public administration, companies, etc.) as near normal as possible, according to the
measures described in the G1 information sheet to be found among the governmental plan collection of
technical information sheets.
If the pandemic were to cause numerous victims from its onset, the priority of saving human lives would dictate
a temporary interruption of non-essential activities as soon as the country was hit in order to limit any contact
that might promote transmission.
The strategy maintaining the life and economic activity of the country is based on the following principles:
- the setting up of an economic continuity committee at the Ministry of the Economy; this committee,
foreshadowed by specialized work groups, is to be activated as soon as situation 4B is declared, or even earlier,
as soon as there is a threat of dysfunction affecting any vitally important sector of activity;
- the setting up of continuity plans for ministries, companies and operators. Such plans organize the measures
aiming to prevent interruption in the provision of essential products;
- the protection of personnel;
- measures making it possible to guarantee the provision of food, electronic communication, energy, necessary
transport, and the maintenance of money circulation and means of payment;
- the definition and monitoring of activity indicators, the organisation of zone observatories, and the principle
of collecting information from the bottom up. These indicators involve items including commerce, finance, the
consumption of electricity and other forms of energy, transport, electronic communication networks, and
absenteeism;
- constant evaluation of the situation and prevision of its evolution.
Companies, local authorities and their public facilities are invited to anticipate the crisis by making
continuity plans involving:
- the designation of a person in charge of the “flu issue”;
- evaluation of the needs in terms of activity continuity;
- the predicted number of staff present in the workplace at a time of crisis;
- the nature and volume of the protection means made available to personnel;
- the conditions of provision of goods in a deteriorated context thanks to a finely tuned knowledge of the
activities of contractors and sub-contractors;
- the maintenance of particularly crucial services (energy, communication, transport, drinkable water, etc.);
- the possible consequences of the pandemic on financial transactions and the flow of goods and people in
France, Europe and the world, as well as the consumption of goods and services in a degrade situation (hygiene
products, for example).
The objective consists in maintaining activity at its highest possible level whilst protecting personnel and
applying governmental instructions, which may involve giving priority to essential missions and reducing
activities the dormancy of which can be tolerated for a few weeks, if public health protection so requires.
Administrations and companies are encouraged to envisage several modes of organisation, to be applied
according to the seriousness of the epidemic:
- in the most favourable mode, available employees that do not present a particular risk of infecting other
people, come to work;
- in the most critical mode, employees whose presence is not essential remain at home.
Intermediate modes, involving redeployment of personnel, recourse to distance working, etc. must be
scheduled.
The conception of plan scenarios may be based on the following indications:
- a mean level of absenteeism of 25 % throughout the pandemic wave (8 to 12 weeks);
- a level of absenteeism of 40 % during the two peak weeks of the pandemic wave.
An initiative and civic surveillance committee, attached to the Minister of Health, was created by decree on
12 December 2006 in order to propose to the government any action likely to improve the population’s
appropriation of prevention and control measures in case of a flu pandemic or other exceptional health crises
and to contribute to strengthening the mobilisation of the population if a pandemic should occur.
13
Information, training, communication
7 - Information, Training and Communication
The efficiency of the system scheduled in the plan relies on the maintenance of a strong relationship of
trust between the authorities and the population. This implies the provision of transparent, continuous
and factual information giving the assurance that the authorities have the capacity to manage the health and
organisational components of the situation.
For the authorities, placed in the role of emitting information, communication also aims to inform and hence
attenuate the fears and anxiety of the population and prevent the risk of disinformation, rumours, or even
destabilization.
In this context, the communication objectives are to:
- inform about the ways in which one can delay the arrival of the epidemic on French territory;
- prepare the country for managing the risk of a pandemic;
- help manage the crisis and maintain the organisation of society during the pandemic;
- sustain trust and credibility;
- prepare for the end of the crisis and the resumption of normal activities.
To reach this goal, communication must be three-fold:
- informative communication relative to the health situation and the state of preparation;
- pedagogical communication on behaviour: the disease and its prevention;
- communication to elicit trust in the authorities: following the measures taken.
The challenge for information and training actions is to:
- meet expectations in terms of information on the risk of avian flu;
- inform the general population and the professionals involved about the precise way to use hygiene and
protection means;
- facilitate the adoption of appropriate behaviour and gestures by the general public and elicit the
acceptance of the logic used for the management of sometimes limited means;
- create favourable conditions for the management of a crisis in the case of a pandemic by prior
sensitization and by providing appropriate, transparent and coherent information;
- facilitate neighbourhood solidarity and individual responsibility in the face of risk.
The organisation of communication is crucial:
- the strategic axes of communication are defined by the Prime Minister;
- in the prepandemic phase, communication is decided by the Prime Minister and coordinated by the
Government information service (Service d’information du Gouvernement - SIG), in constant liaison
with the interministerial delegate for the fight against avian flu (DILGA). All opportunities, including
drills, are used to complement the training of the communication players and develop internal
communication within departments;
- as soon as the interministerial crisis committee is activated, the minister responsible for the
operational conduct of governmental action orchestrates all the communication efforts in a centralized
fashion, together with the Government information service;
- at the local level, the prefect, who can rely on local authorities, ensures communication; abroad, this
mission is assigned to the various ambassadors.
In this general framework, each ministry must prepare the communication elements pertaining to the
particular areas and populations they are responsible for, before the crisis.
14
French Nationals Abroad
8 – Management of French Nationals Abroad
In the case of a pandemic, measures should be set up in order to:
- protect French nationals;
- limit the impact on the functioning of the representational mission;
- support the international effort to delay the spread of the virus and the disease.
Heads of diplomatic missions, consuls-general or self-governing consuls implement abroad the “Foreign
Affairs Flu Pandemic” plan derived from the overall governmental plan. On this basis, they devise their own
plan, as appropriate for their environment. Heads of consular missions act under the authority of the
ambassador, who is responsible for the system set up to fight the pandemic in the country where he/she has
been accredited.
The “Foreign Affairs” plan follows the WHO phases and has scheduled the provision, as much as possible,
of protection and healthcare means for all French nationals abroad, together with the intervention of a French
resident doctor (or failing that, a local doctor) approved by the representational mission.
Antiviral treatment as well as FFP2-type and surgical masks, designed to ensure coverage comparable
to that achieved in France, have been scheduled on a preventive basis in all representational missions.
Further stock provisions can be made after evaluating the situation.
In all situations, the plan chooses the treatment of patients locally, as a first option. To do this, it is
envisaged that embassies and consulates might be given extra human means and supplies based on the
country or countries involved as well as the level of their facilities and the size of the French community.
As soon as situation 3A applies, the "flu pandemic" plan of each representational mission recommends the
activation of the communication network with the French community and its representatives. The latter has
been sensitized to the risks associated with pandemics during the meetings of the mission security
commission. Its website is regularly updated and provides links with governmental sites and the WHO site.
French representation maintains contact with the representational missions of other European countries and,
if necessary, local representatives of international health organisations, with regard to the pandemic issue.
At the start of situation 4A (limited human transmission), a crisis management platform to meet the needs
of the public will be opened at the Ministry of Foreign Affairs. Confinement – associated with healthcare, if
necessary – will be applied to French nationals present in an infected zone. Unless otherwise required for
public health reasons, returning to France will be recommended to French nationals residing in non-infected
zones but threatened due to proximity. Such decisions, and in particular the definition of gradual danger
zones around an initial focus of infection, will be previously examined by the French authorities, in liaison
with the foreign authorities, European partners and international health organisations.
In situation 5, the setting up of a consular and medical mission reinforcement will be considered after
obtaining the agreement of foreign authorities, depending on the means available locally. The transport of
passengers to and from affected countries is likely to be interrupted.
15
Governmental Management of the Crisis
9 - Governmental Management of the Crisis
1.- Governmental Action and Operational Running of this Action
The Prime Minister directs governmental action. He/she determines which situation of the plan France has
reached. Propositions of strategic planning are made at the level of the Prime Minister, who meets, as
required, with the ministers involved.
In situations 1 (absence of new virus), 2 (epizootic in the absence of human cases) and 3A (isolated human
cases abroad), the Minister of Agriculture leads the action aiming at preventing epizootics and controlling
foci of infection that might appear on French territory.
As soon as situation 3 is declared, the Prime Minister can entrust the operational conduct of governmental
action to the Minister of Health.
As soon as issues of civil defence, public order or continuity of collective living become predominant, and
never before situation 4B is reached, the Prime Minister may delegate the operational running of
governmental action to the Minister of the Interior. Protection of the population remains the priority
objective and the Minister of Health retains the responsibility of the operational management of health
issues.
The minister in charge of the operational running of governmental action is assisted by all the ministers as
well as the DILGA avian flu delegate (cf. Annex 1). The latter advises the Prime Minister and the minister
in charge of operational coordination.
2.- Interministerial Crisis Management Structures
1. From situation 3B onwards and as soon as is deemed necessary, the minister in charge of the operational
running of governmental action sets up a decision-making interministerial crisis committee, attached to
and relying on the structure of his ministry, and headed by his cabinet director. The committee includes a
communication bureau.
The interministerial crisis committee, whose meetings are led by the minister or his representative, comprises
representatives of the cabinets or directorates of the ministries involved (health, agriculture,
employment, justice, economy, finance and industry, foreign affairs, interior, defence, education, transport,
overseas, ecology, and tourism), of the national defence general secretariat, of the Government information
service, of the major health agencies (InVS, AFSSAPS, AFSSA, AFSSET) and the DILGA avian flu
delegate.
It ensures the constancy of the operational running of governmental action:
- it receives from the operational centre for the interministerial management of crises (COGIC) and the
operational centre of the Ministry of Health (ComSegur) the main items of information, summaries
and indicators sent by all the ministerial departments and bodies involved; it informs ministers
regarding the situation at national and international level;
- it prepares decisions and regulation acts for which government is responsible;
- it makes and formulates decisions within its scope of competence and conveys them down the
operational chain;
- it follows the progress of the crisis at the international level;
- it establishes the documents for governmental communication and directs the communication committee;
- it indicates the directions to follow and coordinates the action as a whole.
It is supported, as necessary, by all ministries and their services.
16
2. From situation 4B onwards, if he is not in charge of the operational running of governmental action, the
Minister of the Interior activates a committee of anticipation that is attached to him and responsible for preparing
the possible transfer of the operational running and of the interministerial crisis committee in his favour.
3. From the moment he is no longer in charge of operational running, the Minister of Health has at his
disposal a public health committee, to which the competent ministers are associated. With the scientific
advice of the ministry’s decision-making assistance committee, it draws up proposals intended to respond to
the threat to public health and prepares their implementation. If these proposals require a decision at
governmental or interministerial level, the Minister of Health sends them to the interministerial crisis
committee.
4. The committee for the continuity of economic activity, placed under the responsibility of the Minister of
the Economy, is set up as soon as situation 4B arises, or even earlier, if there is a threat of dysfunction of a
vitally important sector. It includes representatives of the directorates of the Ministries for the Economy,
Finance and Industry and provides for every contingency, representatives of the ministries in charge of the
Interior, Health, Employment, Transport, Agriculture and Ecology. It relies on specialized committees led by
their directorates (energy, financial and banking activity, State income and spending, electronic
communication, postal and delivery services, distribution, and economic communication).
5. The communication committee, attached to the interministerial crisis committee, is associated upstream
with information received and projects prepared by the crisis committee. Regarding governmental
communication, its missions are to ensure:
-
a national and international media watch as well as a watch on the state of public opinion;
governmental communication towards the general public, health professionals, the most implicated
professions other than health professionals, companies, etc.
the coordination of informative actions conducted by ministries;
the support and coordination of information conveyed by prefects at the local level;
internal communication towards decentralized services and State officials;
the coordination with the network of international and European communicators;
the support to the press relation’s service of the ministry in charge of the operational running of
governmental action.
The communication committee comprises:
- representatives of the Government information service, the high defence official for information, the
DILGA, representatives of ministries in charge of the interior, health, defence, transport, agriculture,
foreign affairs, economy, employment, justice and, as required, other ministries;
- teams dedicated to watch, press relations, the Internet, the drawing up of documents.
3.- Main Operational Task Chain at the National Level
The operational centre for the interministerial management of crises (COGIC) of the Ministry of the
Interior, with the support of the National Police operation centre (COBeauvau) and the intelligence and
operation centre of the Gendarmerie for public order, intelligence and the control of delinquency, assists
the interministerial crisis committee. It liaises with ministerial and regional operation centres and with the
European Monitoring and Information Centre (MIC).
The crisis centre of the ministry in charge of health (ComSégur) liaises with the COGIC and all the
health-related services at the international, European, national and regional level.
The watch committee of the Ministry of Foreign Affairs, constantly activated within the directorate for
French nationals abroad and foreign nationals in France, is transformed into a crisis management
committee by decision of the minister’s cabinet. It liaises with the crisis management committees of
diplomatic missions by incorporating the previously constituted “flu committees”.
17
The flowcharts below present the organisation depending on whether the crisis is predominantly a health or a
civil defence crisis.
Organisation flowchart: predominantly health-oriented crisis
President
of the Republic
STRATEGY
Committees
of ministers
Prime
Minister
Committee
of anticipation
Minister of
the Interior
COBeauvau
COGIC
CROGend
Minister
in charge of operational
conducting:
DILGA
Health
Interministerial
crisis committee
ComSegur
OPERATIONAL
RUNNING
Committee for
the continuity of
economic
activity
Decision-making
assistance
committee
Communication
committee
other
ministries
Minister
of the
Economy
CO
CO Bercy
Minister
of Agriculture
Animal health and
food watch
committee
Organisation flowchart: predominantly civil defence-oriented crisis
STRATEGY
President
of the Republic
Committees
of ministers
Prime
Minister
Minister
of Health
ComSegur
Public health
committee
Decision-making
assistance
committee
Minister
in charge of operational
conducting:
DILGA
Interior
Communication
committee
Minister
of Agriculture
CROGend
OPERATIONAL
RUNNING
other
ministries
18
CO Bercy
Committee for
the continuity
of economic
activity
Interministerial
crisis committee
COGIC COBeauvau
COGIC
Minister
of the
Economy
CO
Animal health and
food watch
committee
10 – Territorial Management of the Crisis
Prefects (i.e. representatives of the State at local level) implement the measures specified in the plan and
implementation circulars. They encourage local authorities to prepare themselves, particularly as regards
proximity assistance to patients and isolated individuals.
1. Departmental prefects exercise the powers they have been given under normal conditions and in the
context of the epidemic (law n°82-213 of 2 March 1982 relative to the rights and autonomy of communes,
departments and regions (article 34 in particular), article L. 2215-1 of the general code of local authorities,
decree n°83-321 of 20 April 1983 relative to the powers conferred to prefects regarding non military defence,
article L. 3110-1 of the code of public health, etc.).
Under the authority of prefects, departmental heads of health and social affairs (DDASS) orchestrate the
watch, information and medical/hospital intervention networks. They follow the progress of ambulatory
medical care capacities. Their services can be reinforced by the mutualisation of skills at regional level.
The departmental operational centre is activated as soon as animal cases (situation 2B) or human cases
(situation 3B) are detected in the department. All departmental operational centres are activated from
situations 4B or 5A onwards.
The prefect relies among other things on the reinforced “flu committee”, the role of which is to:
- analyse issues of organisation and continuity of care, and define how they can be suitably adapted;
- ensure the continuity of management of the most vulnerable individuals (institutions housing elderly
people and departmental medico social facilities, isolated persons with reduced mobility, operation of
emergency centres and shelter services).
The prefect also ensures the census of facilities that might be requisitioned in the situation of a pandemic in
order to receive patients that would be isolated if they were to remain at home (boarding schools,
gymnasiums, former military barracks, hospitality facilities, etc.); he ensures that he may be able to use them
and have them rapidly equipped if necessary.
Departmental prefects organize a pandemic drill every year on one of the themes chosen at national level.
Prefects orchestrate and coordinate local networks while respecting the skills of local authorities; they work
towards a convergence of efforts on the part of local authorities as part of applying the national plan.
2. Zone prefects (cf. modified decree n° 2002-84 of 16 January 2002 and article L. 3110-1 of the code of
public health) ensure the synthesis of information items emanating from Departments and convey them to the
ComSegur and the COGIC. They liaise with defence general zone officers and regional prefects, coordinate
civil and military means, analyse needs and determine reinforcement means that need to be provided to
Departments.
The zone operational centre (COZ) is mobilized as soon as animal cases (situation 2B) or human cases
(situation 3B) are detected in the zone. All COZ centres are activated from situations 4B or 5A onwards.
Zone prefects organize at least one drill per year in order to test and implement the measures of the plan that
require the setting up of a specific organisation at regional level. They also coordinate departmental drills.
Regional prefects, by delegation of zone prefects, ensure the coordination of the organisation of care and
any domain that requires it, by relying on regional directorates of health and social affairs (DRASS) and
regional agencies for hospitalisation (ARH). They exercise the powers given them in the context of an
epidemic (article L. 3110-1 of the code of public health). They activate a regional support committee for
health and social affairs, which ensures interfacing with the zonal system of crisis management.
19
3. – Regional and General Councils, though they have no operational responsibility in crisis management,
nonetheless contribute to the definition of local policies, the setting up of the means necessary in
collaboration with the State and communes; they finance and lead the networks of assistance to individuals,
orchestrate the local solidarity policy and play an important sensitization role.
4. - The mayor plays a major role in terms of public and health safety, particularly for the implementation of
strategies decided by the authorities. He stays in constant liaison with the State representative and
implements the measures of communal securing plans. He relies on the governmental plan and its
technical information sheets, and on circulars directly addressed to him. The basic principles that
guide his action are as follows:
-
limiting the risks of transmission;
maintaining the capacity of communal services to face the crisis;
-
protecting communal players from the crisis.
At the communal level, essential tasks involve:
- administrative policing: closure of teaching and day care facilities, obligation to wear a mask,
restriction or interruption of public transport, etc.;
- the maintenance of social and health links with the population: conducting a census of people’s needs,
coordination of volunteers, encouraging neighbourhood solidarity, etc.;
- the maintenance of missions that are essential for collective living: removal of garbage, production of
water for consumption, treatment of waste water, civil registration, maintenance of collective heating,
funeral services, etc.;
- contributing to organizing vaccination against the pandemic as soon as the vaccine becomes available.
Organisation of solidarity at the local level, by relying on the civil defence municipal reserve, associations,
and volunteers from all sources, whose action needs to be orchestrated, constitutes an essential area of their
action.
In the face of a serious pandemic, the delegation of responsibilities should be fully exercised, both for the
sake of greater efficiency and a quicker response to the emergency situation, and in order to allow higher
echelons to concentrate on problems where their intervention is essential.
5. Abroad, the State services mobilized to manage the crisis are placed under the aegis of the ambassador
who exercises the attributions assigned to him by decree n° 79-433 of 1st June 1979.
6. - Each citizen, from then on, becomes a crisis manager at his/her own level. This principle concerns
companies, services, shops, associations and individuals themselves.
In the face of the magnitude of the consequences, solidarity will need to be:
− civic, by volunteering to serve within associations, the civil defence municipal reserve, the National
−
−
Police reserve, military reserves, etc.;
professional, within the health profession and other professions of the private and public sector, in
order to limit absenteeism as much as possible and allow the activity to continue;
between generations and neighbours in a municipal setting, in order to manage isolated people,
particularly the elderly.
20
International Communication Channels
11 – International Management of the Crisis: Communication
Channels
1. – Political and technical communication of France with United Nation agencies, whether they
emanate from the directorates of the Ministry of Foreign Affairs or other ministries, are, for reasons of
governmental action consistency, the responsibility of the Office of the United Nations and International
Organisations and the Ministry of Foreign Affairs, who activates, according to the circumstances,
permanent representatives of France in Geneva, New York, Rome or Vienna. The latter are responsible for
making contact with United Nations agencies.
2. – Communication with international financial institutions, the World Bank and the International
Monetary Fund is the responsibility of the Ministry of the Economy, Finance and Industry. The
Directorate of economic and financial affairs at the Ministry of Foreign Affairs (MAE / DE) can be
associated with these actions depending on the subject treated.
3. – Concerning the European Union, for health operational issues:
Animal health: the Ministry of Agriculture is the contact for the permanent food chain and animal health
committee (who decides whether or not to disallow poultry imports) and the group of chief veterinary
officers (CVO).
Human health: the Ministry of Health and Solidarity is the contact for various groups and committees
following human health-related issues:
- the health safety committee (HSC),
- the network committee for epidemiological monitoring and the control of transmissible diseases,
- the Early Warning and Rapid Response System (EWRS),
- the European Centre for Disease Prevention and Control (ECDC).
Regarding civil defence issues, the Ministry of the Interior (COGIC) is the correspondent of the European
mechanism for civil defence (MIC).
Correspondence:
European diplomatic telegrammes relating to foreign and defence policy (PESC): use of the secured
telegraphic network COREU. For France, this network is managed by the foreign policy and common
defence service of the Ministry of Foreign Affairs (MAE / PESC).
Areas other than the PESC: the positions conveyed by France to European institutions are drawn up and
prepared by the secretariat general for European affairs (SGAE), through which the correspondence
addressed to European institutions is conveyed.
The Minister of Health (Direction générale de la santé – DGS) informs the European Union of any
measures taken by Early Warning and Rapid Response System (EWRS) message.
21
Avian Influenza
12 - Prevention and Emergency Plan for Avian Influenza
The Ministry of Agriculture watches for the presence of influenza virus among animals and ensures that:
-
regulatory measures for the protection of farmed birds are implemented with respect to the
risks of contamination from the wild or other breeding sources;
an effective watch and alert system is maintained;
-
the efficiency of departmental emergency plans is duly updated and verified.
A scale of epizootic risk for mainland territory is established as a function of the threat the virus represents in
the wild bird fauna. This scale encompasses the six following levels: negligible 1, negligible 2, low,
moderate, high and very high. Surveillance and protection measures applied to farmed birds depend on the
level of risk and the situation in or outside particular risk zones.
In an epizootic situation, the Ministry of Agriculture implements the national emergency plan in collaboration
with the Departments affected. It ensures the liaison with European and international authorities responsible
for animal health.
1. - Surveillance of farmed birds and wild fauna on French territory
Active surveillance conducted by departmental veterinary services aims at detecting the presence of H5 or H7
strains among the most sensitive poultry breeding stocks. Past epizootics have indeed shown that a highly
pathogenic strain most often appears a few weeks to a few months after the circulation of an H5 or H7 strain of
low pathogenicity in such farms. Such monitoring follows the recommendations of the European Commission,
to whom an annual account summary is addressed.
The farmers themselves and veterinarians with a health mandate achieve the passive surveillance
monitoring of poultry farms; farmers are informed about the criteria calling for reference to a veterinarian;
any sign that might in any way be linked to influenza demands that a declaration of suspicion be made to the
departmental director of veterinary services (DDSV). Suspicion entails the confinement and analysis of the
farm animals. The measures are lifted if all risks of infection have been discarded. Surveillance is reinforced as
soon as the level of epizootic risk is deemed moderate.
Surveillance of wild fauna is achieved by sampling campaigns on birds known to be “reservoirs” of lowpathogenicity strains and by running analyses in case of significant unexplained mortality. Surveillance is
reinforced as soon as the epizootic risk is considered to be low.
The International Office of Epizootics (IOE) ensures epidemiological surveillance watch on a global
level. The Ministry of Agriculture and the European Commission are in constant liaison with the IOE.
2. - Protection of Poultry Breeding Stocks and Other Birds
The Ministry of Agriculture decides, in liaison with the European Commission, on all measures that can limit
the introduction of the animal disease in the European Union. These measures involve forbidding the import of
live birds and non-treated poultry products from countries infected with avian influenza.
French animal farmers are regularly sensitized to health protection rules for farm animals:
- health barriers against people and vehicles coming from other breeding farms;
- regular cleaning and disinfection of facilities;
- prevention of close contact between domestic and wild birds.
In the case of a moderate risk level, breeders located in a risk zone where animals are not confined or
protected by an equivalent system must set up a bio security system involving the implementation of a guide
of good health practices. When a high risk is declared, all farmed birds on the mainland are subject to the
implementation of this guide.
Gathering of birds is forbidden in risk zones from the moment the risk level is low and throughout the
mainland territory as soon as the risk is deemed high.
22
Avian Influenza
Special measures are applied to certain categories of birds such as racing pigeons, farmyard poultry and calling
birds depending on the level of risk. A decree fixes the conditions whereby rare or protected species of birds
and hobby and ornamental birds, which cannot be confined or protected by an equivalent system, are to be
vaccinated.
A protocol between the Ministry of Health and the Ministry of Agriculture has scheduled exchanges on the
world epidemiological situation and immediate information of all partners when an influenza virus strain of an
H5 or H7 sub-type, whether pathogenic or not, is isolated.
3. – Emergency Plans
An emergency plan specifying the actions to be led in case of suspicion and confirmation of an avian influenza
focus in a breeding farm has been drawn up at national level.
Each department establishes an emergency plan according to the model devised at national level. This makes
provisions concerning:
- the actions to be led in case of suspicion or infection of one or more breeding stocks, including special
measures for facilities housing lineage birds or rare and/or protected bird species;
- the role and protection of the various players (including private service providers);
- stocks of supplies, products and equipment for individual protection;
- the preparation: making a census of breeding stocks, training and sensitization of the players involved, drills,
etc.
Part One: Measures in Case a Poultry Breeding Stock is Suspected
The most important measures when avian influenza is suspected in a poultry breeding stock are:
-
publishing of a prefectoral decree declaring the stock under surveillance;
sequestration of the stock;
sampling for analyses;
setting up of a system to control all movements (people, other animals, etc.) and disinfect vehicles
leaving the breeding farm;
an epidemiological survey aiming to determine which breeding stocks are the source of the infection,
which other stocks might have been contaminated by this particular breeding stock, and the products
and produce that might be contaminated.
Depending on the plausibility of infection and the risk of dissemination, preventive slaughter and the setting
up of regulated zones designed to limit movements around the focus of infection may be decided.
Part Two: Measures in the Case of a Verified Infection (Confirmed Focus)
The most important measures scheduled are:
- the issuing of a prefectoral decree declaring the presence of infection;
- measures concerning the infected breeding stock:
o if the virus is highly infectious, the immediate slaughter of the poultry on the premises;
o the destruction of the cadavers and all products that cannot be disinfected;
o the cleaning and disinfection of the facilities;
- measures around the infected breeding stock: the setting up of a protection zone (minimal radius of 3
km) and a surveillance zone (minimal radius of 10 km).
Under the authority of the prefect, the COD coordinates the activities of State services (DDSV, DDASS,
DDAF, DDE, Gendarmerie, SDIS) to carry out various actions, including livestock decontamination,
protection of people and road access control etc.
4. – Financial Elements that are the Responsibility of Veterinarian Public Health
The State takes charge of veterinarian control visits and laboratory analyses.
The State also takes charge of the losses incurred by breeders having poultry or birds declared infected: value
of replacement of the slaughtered animals, loss of production linked to the blocking of the farming business,
reimbursement of the products and produce destroyed by order of the authorities, fees charged for disinfection.
23
Part Two - Contents
Part Two
Decision-Making Aid Sheets
CONTENTS
Methodology for using Decision-Making Aid Sheets
Information sheet on the themes of interministerial meetings
“Situations and measures” information sheets
Situation 1 - No circulation of new highly pathogenic avian viruses in animals or man
Situation 2A - Epizootic abroad caused by a highly pathogenic virus, without human cases (phase 2, WHO)
Situation 2B - Epizootic in France caused by a highly pathogenic virus, without human cases (phase 2, WHO)
Situation 3A - Isolated human cases abroad without interhuman transmission (phase 3, WHO)
Situation 3B - Isolated human cases in France without interhuman transmission (phase 3, WHO)
Situation 4A - Limited and localized clusters of human cases abroad (phase 4, WHO)
Situation 4B - Limited and localized clusters of human cases in France (phase 4, WHO)
Situation 5A - Large foci of uncontrolled clusters abroad (phase 5, WHO)
Situation 5B - Large foci of uncontrolled clusters abroad in France (phase 5, WHO)
and Situation 6 – Influenza pandemic (phase 6, WHO)
Situation 7 - End of the pandemic wave
24
p. 25
p. 26
p. 27
p. 32
p. 32
p. 32
p. 33
p. 35
p. 38
p. 41
p. 44
p. 47
p. 52
p. 56
p. 64
Methodology for Using Decision-Making Aid Sheets
Methodology for Using Decision-Making Aid Sheets
Decision-Making Aid Sheets have been established for each of the situations identified.
These information sheets present a series of measures, grouped according to 18 objectives.
Objectives
abrev.
Number
measures
Reinforcing governmental, ministerial and territorial organisation
org
29
Avoiding the introduction of the epizootic in France and reinforcing watch on French
territory
Keeping in check the spread of the virus among animals and eradicating it
zoo
15
era
19
Preventing any transmission to man
trh
5
Preparing the national pandemic of response to a pandemic
pre
42
Assisting French Citizens abroad
fre
19
Postponing the introduction of cases on the national territory
imp
14
Assisting the affected countries
coo
2
Detecting and signalling human cases on French territory (on mainland and overseas
territories)
Taking care of suspicious cases, contact persons and diseases persons
det
7
cas
18
Keeping in check the spread of the human virus and eradicating it
erh
9
Slowing down the transmission of the virus on the national territory
bar
15
Maintaining essential activities
mtn
57
Assessing the situation and anticipating its developments
eva
11
Informing the general public, the managers, the professionals and the companies
inf
37
Preparing the national response system for a new pandemic wave
rep
7
Assisting the population and helping the resumption of social and economic activity
ass
6
Total number of measures
of
312
1. – Each information sheet is presented in two parts:
- major measures in terms of their impact and/or interministerial nature, to be examined as a priority
(in a red box);
- accompanying and implementation measures.
2. – A single information sheet deals with situations 5B and 6 because situation 5B (Large foci of
uncontrolled clusters of cases in France) corresponds in fact to the onset of the pandemic and justifies
examining the same set of measures as those called for in pandemic situation 6. In situation 5B, certain
measures may be applied more particularly to the affected parts of the territory, whereas in situation 6, the
national implementation of the majority of measures will be systematic.
3. - These measures constitute propositions that must be examined on a case-by-case basis according to the
circumstances. If necessary, they need to be adapted according to the epidemiological characteristics of the
virus, available means and techniques, and the attitudes of the various players.
4. – Consideration of the scenario using these information sheets may not correspond to the context,
particularly at the beginning of the pandemic (interhuman transmission of great magnitude). In order to deal
with this uncertainty, a quick response “Imminent risk of pandemic” information sheet has been drawn
up, which insists on the major measures to be taken into account during a transition period, irrespective of
the public health conditions that prevail on French soil.
25
Organisation of Interministerial Meetings
Information Sheet on the Themes of Interministerial Meetings
Interministerial committees and meetings presided by the Cabinet of the Prime Minister may deal among
other things with the following themes.
1.- Evaluation of the national and international situation and account summary of measures already
taken:
-
-
-
Level of the French plan and review of the principle measures already implemented (DILGA, SGDN)
Events relative to animal health abroad and in France (Ministry of Agriculture)
Events relative to human health abroad and in France (Ministry of Health)
Epidemiological situation abroad and in France: number of cases, countries affected and countries
threatened, French nationals affected or threatened, mapping of cases and graphic modelling of the
various scenarios envisaged, etc. (InVS);
Public health data: efficiency of treatment applied, information on vaccines, etc. (Decision-making
assistance committee of the Ministry of Health);
International public health situation via major organisations: phase of the WHO plan, etc. (International
committee of the Ministry of Health);
International situation and information gathered from diplomatic missions (Ministry of Foreign Affairs)
Economic consequences in France and abroad (Ministry of the Economy);
Situation relative to the life and safety of the population (Ministries in charge of the interior and social
affairs);
State of communication and information campaigns, monitoring of public opinion and the media
(Government information service).
2.- State of preparation of administrative bodies and operators:
-
Plans for the continuation of ministerial activity (ministries represented)
Summary on the preparation of major operators and companies (Ministry of the Economy)
3.- Propositions for zoning, which may serve as a basis for making risk management decisions (affected
zones, threatened zones, other zones)
4.- Organisation and follow-up of the response
- Presentation of the choice of measures including: the choice of immediate or post-poned implementation,
the time necessary for the preparation of each measure, monitoring means and means of evaluating
efficiency (indicators).
- Measures relative to animal health (Ministry of Agriculture),
- Measures relative to human health (Ministry of Health),
- Measures concerning French nationals abroad (Ministry of Foreign Affairs and Ministry of Health),
- Measures to ensure the continuity of social and economic life (ministries in charge of the interior, the
economy and social affairs),
- Measures concerning public order and the safety of the population (Ministry of the Interior).
5. - Preparation of documents to inform the players involved and the population on the situation and the
measures taken or envisaged.
6. - Operational running of governmental action: possible proposition of delegation to a minister.
From situation 3 of the French plan onwards, the Prime Minister may entrust the operational running of
governmental action to the Minister of Health and, from situation 4B onwards, either to the Minister of the
Interior or the Minister of Health depending on the nature of the crisis. From then on, an Interministerial
Crisis Committee is set up as early as possible.
The propositions that should be arbitrated by the Prime Minister can be examined by a Committee of
ministers.
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=
Quick response “Imminent risk of pandemic”
information sheet
This information sheet may be used whenever the onset of a pandemic
appears to be imminent
As soon as the onset of a pandemic appears to be imminent, drastic measures must be taken in order
to slow its momentum and protect the population, independently of the presence or absence of
confirmed cases on French territory.
Alert signs that may justify the use of this information sheet are as follows: the sudden declaration of
disease spread of great magnitude in some part of the world, with a large number of flu syndrome
cases (over a hundred), involving:
- a rate of aggravation leading to abnormally high levels of hospitalisation and/or mortality;
- and/or identification that the disease is due to a new influenza virus.
Conversely, interhuman transmission involving a limited number of cases, family-restricted for instance,
does not justify referring to this information sheet but rather examining the measures pertaining to situation
4.
The measures recommended constitute propositions to be examined on a case-by-case basis and
adapted to the context as required.
Principle Measures
Governmental organisation - Evaluation of the situation
org02. As soon as the triggering event has been confirmed, an interministerial meeting is held; a
proposal is addressed to the Prime Minister for delegating the operational conduct of
governmental action to the Minister of Health due to the prevalence of public health issues;
if the issues of civil defence, law and order or continuity of socio-economic life prevail over
the organisation of medical care, there is the possibility of transferring operational conduct
to the Minister of the Interior; the interministerial crisis committee is set up.
org19. Activation of zone and departmental operational centres.
eva00. Permanent updating of the epidemic situation and development forecast abroad and in
France, if applicable.
Measures aiming to delay the onset of the pandemic.
The objective of such measures is to delay the progression of the epidemic by a few days to 2 or 3
weeks in order to:
- allow the setting up of the response system and reduce consequences to the maximum
(organisation of ambulant medical care, up scaling of “SAMU Centres 15” emergency medical
services, etc.);
- provide extra time for the formulation of antiviral drugs, the production of pandemic vaccine,
the manufacturing of masks, possible prepandemic vaccination (time necessary for the
development of immunity), etc.
- spread the pandemic peak and thus reduce the strain on the healthcare system.
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1°) Hypothesis of a general reflex reaction (presumably high efficiency but short feasible duration
of implementation)
imp14. Boarder checks (efficient if implemented early, involving European coordination).
Maintenance of freight movement, as a priority.
imp15. Interruption of international passenger arrivals and departures (especially by air), which
constitute a vector for importing the epidemic 3 .
imp16. Upon arrival of flights from affected countries at the time interruption is decided, placing of
crew and passengers under quarantine (very limited capacity).
2°) Hypothesis of measures targeted on the geographical zone where the pandemic started
bar07. Protection of unaffected overseas territories (or protecting France from affected overseas
territories); restriction in the transport of passengers.
For countries affected by interhuman transmission, depending on seriousness and the degree of
contagiousness:
imp03. Suspension of air, sea or land passenger connections with the countries affected; for people
travelling from those countries at the time the decision is taken, preventive quarantine on
arrival (very limited capacity).
imp08. Suspension, in affected countries, of visa delivery to travel to France.
For countries neighbouring affected countries, either implementation of measures imp03 and 08
above, as in the case of affected countries, or:
fre09. Examination of the relevance and risks of an express recommendation to French citizens to
leave the countries neighbouring affected countries, with a health check upon leaving such
countries.
imp01. Request for an emergency meeting of European Union Member States to study the measures
to be taken at Community level (limitation of the delivery of visas and entries into the
Schengen space, restriction of air travel, quarantine on arrival, etc.); consultation of the
Member States and Commission on the nature and scope of control measures envisaged by
France (simple information in case of emergency).
imp10. Setting up of a system for the traceability of travellers on their arrival.
imp12. Quarantine measures (very limited capacity) or prophylactic treatment extended to French
nationals coming from countries neighbouring affected countries.
bar07. Protection of unaffected overseas territories (or of mainland France from an affected
overseas territory); restriction of passenger transport.
Reminder: nationals who are putative or confirmed cases are managed locally in the affected
country by relying on local health structures, and if necessary with the support of the avian
flu medical advisor and supply stock of the diplomatic mission.
Major public health measures to be examined prior to their implementation
pre31. Use of prepandemic vaccine stocks depending on the evolution of knowledge and/or
observed efficiency, based on the latest conclusions of expert evaluations.
pre41. Pharmaceutical companies get ready for the production of the pandemic vaccine.
This measure implies the cessation of company production of seasonal flu vaccine.
pre42. Reinforcement of platform facilities for the regulation of SAMU-Centres 15 medical
emergency services.
cas13. Launch of “Influenza Pandemic” annex of the “white” plans for health facilities and
“blue” plans for facilities housing elderly people.
cas10. Setting up of an adapted ambulatory care system.
cas18. Implementation of the plan for the distribution of health products and protection equipment.
3
Modelisations published in 2006 report a pandemic peak delay of about 1 to 2 weeks for a 90% restriction of arrivals
of all international passenger flights and 3-4 weeks or more for a 99% restriction. The efficiency seems to be higher if
the restriction is made at the level of departures from affected countries.
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All other preparative measures (“pre” according to the table in Part Three) must be implemented urgently
and checked.
Barrier measures
bar01 During the initial phase of the epidemic, interruption or reduction of some local public
transport facilities, which are potential places for viral transmission (depending on the
virulence of the virus and the necessity for ensuring their operation).
bar02. Closing of day nurseries, educational and training facilities, boarding schools, youth
facilities (a measure with proven efficiency, essential for limiting transmission during
influenza epidemics).
bar03. Suspension of group activities: shows, sports events, fairs and exhibitions, etc., and
adaptation of cultural activities.
bar12.Wearing of respiratory protection for health professionals, rescue personnel and anyone
whose mission implies repeated contact with diseased persons or those mentioned in §4.2 of
the plan ; patients must wear surgical masks.
pre40. Activation and implementation of the continuity plans of ministries, public facilities, local
authorities and companies.
Implementation and accompanying measures on the part of ministries
All ministries
Evaluation of the situation
eva01. Setting up and circulation of a daily summary of the situation by each ministry, based on the
indicators they have previously defined; surveillance intended to anticipate the possible
difficulties; to this effect, association of operators relevant to each ministry’s sector.
eva03. Diplomatic posts in affected countries shall inform the Ministry of Foreign Affairs and the
interministerial crisis committee of the means and measures engaged by foreign countries
for fighting the disease.
eva05. Collection, as soon as possible, of all the parameters and indicators for the follow-up of the
public health situation so as to adapt the system of response to the pandemic.
org11. Implementation of a committee for the continuity of economic activity, attached to the
minister in charge of the economy.
mtn05. Activation of zone committees for monitoring supplies and activities, attached to the zone
operational centre.
Other measures
Ministry of Defence
pre13. Antiviral health products: conditioning of bulk products into pharmaceutical form.
Ministry of the Interior
pre20. Implementation of securing measures for facilities storing protection supplies and health
products, health facilities, pharmacies, and the private medical profession.
Ministry of Transport
pre34. Initiating operation of the airport platform(s) dedicated to receiving airplanes likely to
transport flu patients.
Ministry of Justice
bar14. Setting up of specific measures for the protection of prison facilities.
All ministries
pre17. Precise nominative distribution of personnel essential for the running of facilities and
accurate planning of as many staff relief options as possible.
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Ministry of Health: preparing the national pandemic response system
All preparatory measures must be urgently implemented and checked.
pre00. Instructions to prefects for the implementation of adapted medical care:
1)ambulatory medical care system for patients; 2) health and social coordination centres; 3)
up scaling the “SAMU-Centres 15"; 4) “white” plans for health facilities along with their
“Influenza Pandemic” annex and “blue” plans for medico social facilities; 5) expanded
“white” plans; 6) intermediate treatment structures.
pre03. Verification of the pre-positioning of health products and protection equipment in France
and French overseas territories; reinforcement of the stocks of health products and
protection equipment in diplomatic posts.
pre06. Order by the Minister of Health in application of article L. 3110-1 of the code of public
health, including the measures of quarantine or isolation envisaged from WHO levels 4 or 5
onwards, implemented by prefects, as necessary.
pre07. Implementation of the antipneumococcic vaccination of vulnerable people (protection
against certain bacterial secondary infections).
pre11. Reinforcement of the production of masks by the French industry (Minister of Health in
collaboration with the minister in charge of industry).
pre33. Checking that biological tests for mass screening are locally available.
det01. Activation of InVS’s clinical and epidemiological assessment committee.
det02. Circulation of the protocol for managing possible cases to health facilities, emergency
medical services (including the SAMU-Centres15), airport medical services, employment
medical services and national influenza reference centres.
det04. Placement under alert and/or reinforcement of the two surveillance networks, GROG and
“Sentinelles” (Sentry).
det05. Reinforcement of the network of influenza diagnosis laboratories.
det07. In the event of suspicion, immediate recourse to InVS’s clinical and epidemiological
assessment committee; the InVS shall inform the Ministry of Health.
cas01. Organisation of patient management (preferably in a hospital setting).
cas03. Management of infected persons and possible cases according to the protocol stipulating the
conduct to be adopted in the presence of possible cases of influenza by a new viral subtype
with interhuman transmission.
cas04. Management of patients detected while travelling to France, following a specially defined
procedure (cf. D2 technical information sheet).
cas08. Suspension of the system of registration with one particular physician and implementation
of administrative measures to simplify patient management.
cas12. Implementation of a specific organisation for patient transport, laboratory analyses, etc.
cas16. As soon as there are too many suspected cases, management in healthcare facilities is
restricted to patients requiring continuous monitoring or intensive care, after orientation by
the SAMU-Centres 15 emergency medical services.
erh06. Specific measures for taking care of persons having been in contact with patients (quarantine
at home and, if necessary, prophylactic treatment using antineuraminidases).
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Ministry of Foreign Affairs
Context: As soon as the pandemic has started, all countries may be affected within a short time span
fre03. Medical care administered locally to possibly infected or infected French nationals in
affected countries using local healthcare structures, if necessary with the assistance of the
avian influenza medical advisor of and using the means available to the diplomatic post.
Delivery of protection products and equipment following previously defined instructions.
fre07. Limiting of the number of State officers abroad to essential posts only.
fre08. Closing of French schools and cultural centres in affected countries and neighbouring
countries, as appraised by ambassadors.
fre11. Setting up of a support system for tourists and non-resident French nationals who could not
been repatriated in time.
fre16. Modification of the Ministry of Foreign Affairs’ Web site “Advice for Travellers”.
fre18. Placing in alert mode and/or sending, upon agreement of the foreign local authorities, and in
liaison with the ministries in charge of health and defence, a reinforcement consular and
medical mission, depending on the resources of the countries affected and the means
available to the French representational mission.
fre19. Setting up, depending on the level of means available locally, a complement of care and
protection means appropriate for the number of people requiring assistance.
fre21. Activation of the crisis committee of the Ministry of Foreign Affairs.
fre22. Sending of the updated number of French nationals by the relevant diplomatic post(s).
Local authorities
pre18. Organisation of relevant general council services for the support of fragile people (old
people’s homes, handicapped people, children, etc.).
pre19. Organisation of municipal services for the support of the population: placement of the civil
defence municipal reserve under alert, contact with social and local associations, etc.
All ministries
inf02. Information of international airport and port business activities, travellers, travel agents and
transport businesses about prohibitions and restrictions and/or special measures concerning
international exchanges.
inf13. Information about the closure of day nurseries and teaching or training facilities.
inf17. Information (by the relevant ministry in charge) of private health professionals, regional flu
observation network (GROG) physicians, health facilities and SAMU-Centres 15 medical
emergency services, pharmacists, rescue services, biomedical analysis laboratories, armed
forces health services, employment medical services and educational facilities about
procedures, means of protection (masks) and appropriate conduct.
inf23. Information of the general public about the situation, the rules to follow and the behaviour to
adopt, including the immediate reporting of any flu symptoms and their aggravation; call for
neighbourhood solidarity.
inf40. Activation of telephone platforms of the ministries of health and foreign affairs, and of the
crisis department of the 3939 telephone platform.
mtn37. If a significant amount of time is available, people will be encouraged to build up a reserve
of non-perishable food and bottled water, and make grouped instead of repeated purchases,
which would lead to undesirable gathering of people during an epidemic; if there is little
time available, mass purchases likely to lead to unjustified shortages will be discouraged.
31
Situation
1
Situations and Measures
The measures indicated in the situation sheets are proposals to be examined on a case-by-case
basis according to the evolution of the crisis.
In order to assist in decision-making, certain measures are accompanied by an evaluation of
relevance derived from the analysis of real epidemics or pandemics.
Decisions for the implementation or lifting of measures are immediately communicated by the
SGDN or, if already designated, the minister in charge of the operational coordination of
governmental action to ministers whose duty it is to implement them. A confirmation message is
addressed to them.
Situation 1:
No circulation of new highly pathogenic virus
in animals or man
Interpandemic period – WHO Phase 1
These measures come within a permanent security position and are to be implemented as
situation 1 arises, but also continued throughout the various situations.
Objective: avoiding the introduction of an epizootic in France and reinforcing watch on the
territory
zoo01. Surveillance of the circulation of avian influenza viruses in poultry farms.
Objective: preparing the national pandemic of response to a pandemic
pre01. Definition and testing of the capabilities and measures for preventing and controlling the
influenza pandemic.
pre35. Permanent surveillance of the worldwide circulation of avian and human flu viruses.
pre36. Permanent updating of the plans for the prevention and control of a flu pandemic.
pre37. Permanent updating of the plans for the prevention and control of avian flu.
pre38. Running of a research and development programme on avian influenza, pandemic flu and the
means to control them.
32
Situation
2A
Situation 2A:
Epizootic abroad caused by a highly pathogenic virus
in the absence of human cases
The measures recommended constitute propositions to be examined on a case-by-case basis.
The occurrence of a flu epizootic, even in the absence of verified human cases, represents a risk factor from
the moment the viral strain has been characterised as being highly pathogenic by a recognised laboratory.
Principle Measures
org26. Implementation, by the Minister for Agriculture, of the action necessary to prevent
epizootics and control avian outbreaks
zoo04. Prohibition of importing birds and animal products from affected areas, in liaison with the
European Commission (possible suspension of delivery of certificates for the import, export
and transport of animals).
zoo07. Specific measures for the protection of poultry farms.
zoo13. Definition of special rules for hunting: practices to be followed, restriction, prohibition, etc.
zoo14. Definition of a possible strategy for the vaccination of endangered species.
zoo16. Provisions relating to poultry markets, bird shops, bird exhibitions, etc.
Implementation and accompanying measures
Objective: reinforcing governmental, ministerial and territorial organisation
org04. Activation of the general office for food (DGAl) surveillance committee.
org12. Information provided by the Ministry of Agriculture (DGAl) to its partners (DGS, AFSSA,
InVS, national influenza reference centres) following the Agriculture-Health protocol.
org14. Informing the advisory committee for animal health and protection.
org25. Monitoring of national and international media; monitoring of the state of public opinion by
the government information service.
Objective: avoiding the introduction of an epizootic in France and reinforcing watch on the
territory
zoo02. Participation, under IOE and FAO supervision, in the control of the epizootic in the affected
countries; examination of the requests for technical assistance on the part of affected
countries.
zoo03. Activation of diplomatic post veterinary advisors in affected countries.
zoo05. Reinforcement of veterinary and customs checks.
zoo06. Instructions to bird farming professionals concerning vigilance and observance of good
hygiene practices for breeding activities.
zoo08. Surveillance of native species and spotted migrant species of birds.
zoo09. Assessment of the means of diagnostic and veterinary intervention as a function of risk.
zoo10. In the presence of a new subtype other than H5 or H7, inclusion of a new, potentially pandemic
strain on the list of dangerous infectious agents and publication of a decree limiting the
conditions of its possession and handling (modification of the decree of 30 July 2004).
zoo11. Specific protection of poultry farms producing eggs for making vaccines, in cooperation
with the Ministry of Health.
zoo12. Implementation of the emergency plans for ornithological and zoological parks.
33
Situation
2A
Objective: informing the general public, the managers, the professionals and the companies
Measures relative to avian influenza
inf01. Information of travellers and expatriates about the precautions to take in countries affected by
the epizootic.
inf09. Information of bird farmers, hunters and veterinarians about the risks linked to avian
influenza and respecting health protection rules for breeding stocks.
inf11. Training of school children, by teachers and health professionals, to use measures to avoid
contamination by birds with avian flu.
inf19. Information of the general public on the risk of avian influenza, the measures for limiting
contamination and the consumption of poultry.
inf25. Sensitization of the media to the problem of avian influenza.
inf35. Information of elected representatives about the measures to implement in the face of
epizootic foci and the measures for limiting contamination.
Measures to prepare for a possible human pandemic
forces health services, employment medical services and educational facilities about the
conduct to adopt in the situations defined by the governmental plan.
inf30. Sensitization of public and private companies about the problem of a flu pandemic and
encouragement to prepare for it.
inf34. Sensitization of elected representatives about the risks of pandemic and the measures to be
taken.
inf41. Training of school children, by teachers and health professionals, to adopt essential gestures
to prevent human transmission of respiratory diseases.
34
Situation
2B
Situation 2B:
Epizootic in France caused by a highly pathogenic virus
in the absence of human cases
The Ministry of Agriculture is in charge of watching for, alerting about and eradicating avian influenza foci. It is
responsible for developing and updating emergency plans. The Ministry of Health is in charge of preventing human
transmission and watching for and detecting the first human cases linked to exposure to a highly pathogenic avian
influenza virus.
Principle Measures
org26. Implementation, by the Minister for Agriculture, of the action necessary to prevent
epizootics and control avian outbreaks
era01. Activation of the Ministry of Agriculture’s emergency plan relating to avian influenza.
Implementation of planned measures of sequestration and destruction of poultry stocks, and
measures for setting up perimeters and destroying unsafe foodstuff.
era09. Specific measures for protecting overseas territories not affected by animal cases, or for
protecting France from an affected overseas territory.
era13. Over the whole or part of the territory, specific measures for the protection of poultry farms.
era18. Definition of special rules for hunting: practices to be followed, restriction, prohibition, etc.
era19. Vaccination of endangered species.
era20. Provisions relating to poultry markets, bird shops, bird exhibitions, etc.
trh04. By decision of the Minister of Health, chemoprophylaxis of exposed people.
trh05. By decision of the Minister of Health, vaccination of exposed people with a specific
vaccine.
org05. Activation of the general office for food (DGAl) national crisis committee.
org06. Activation of the decision-making assistance committee of the Ministry of Health.
org12. Information provided by the Ministry of Agriculture (DGAI) to its partners (DGS, AFSSA,
InVS, national influenza reference centres) following the Agriculture-Health protocole.
org15. Convocation of the advisory committee for animal health and protection.
org17. Activation of the departmental operational centre of the Department(s) affected.
Objective: keeping in check the spread of the virus among animals and eradicating it
era02. Alert instructions of the departmental veterinary services (DDSV) in the event of a
suspicious case; systematic information of the DGAl by the DDSVs regarding any
suspicious case.
35
Situation
2B
era03. Activation of an epidemiological investigation on suspicious or confirmed animals. If it
concludes that the wild bird fauna might have been the source of contamination or could
have been contaminated by the affected breeding stock, implementation of stock
surveillance and protection measures appropriate for the level of epizootic risk as defined by
the scale of epizootic risk. (§ 12).
era04. Sequestration of breeding stocks likely to have been contaminated or to have been the
source of contamination of the infected stock.
era05. As soon as a case is confirmed or highly suspected in a breeding stock, destruction of the
poultry on the farm and setting up of a protection perimeter (control of traffic, sequestration
of the stock, preventive slaughtering of the poultry within the perimeter if deemed
necessary) and a larger surveillance perimeter.
era06. Destruction or disinfection of foodstuff coming from the poultry farms that are infected or
located in the protection and surveillance areas.
era07. Inspection and verification of poultry farms located in protection and surveillance areas.
era08. Full capacity activation of the diagnosis laboratories network.
era10. Information of the European Commission and the International Office of Epizootics.
era11. Reinforcement of veterinary and customs checks.
era12. Instructions to bird farming professionals concerning vigilance and observance of good
hygiene practices for breeding activities.
era14. Over the whole or part of the territory, implementation of the emergency plans for
ornithological and zoological parks.
era15. Specific protection of poultry farms producing eggs for making vaccines.
era16. Surveillance of native species or spotted migrant species of birds.
zoo10. In the presence of a new subtype other than H5 or H7, inclusion of a new, potentially pandemic
strain on the list of dangerous infectious agents and publication of a decree limiting the
conditions of its possession and handling (modification of the decree of 30 July 2004).
Objective: preventing any transmission to man
trh01. In the presence of an identified source of epizootic with a highly pathogenic virus,
implementation of the actions provided for in the protocol stipulating the conduct to be
adopted in the presence of an avian influenza focus involving a highly pathogenic virus and
presenting a proven risk of human transmission during an epizootic in France or in nearby
areas, in order to prevent any contamination of people involved in poultry farming, relatives
of the breeders and involved veterinary inspectors.
trh02. Reinforcing measures of hygiene in affected or threatened poultry farms.
trh03. Setting up a medical surveillance of exposed people.
inf01. Information of travellers and expatriates about the precautions to take in countries affected by the
epizootic.
inf10. Recommendations to breeders, hunters and veterinarians and their families in case of
suspected or confirmed cases of avian influenza.
inf11. Training of school children, by teachers and health professionals, to adopt measures to avoid
inf20. Information of the general public on measures to prevent contamination in case of an
epizootic, on the consumption of poultry and the possible risks related to domestic animals.
36
Situation
2B
inf25. Sensitization of the media to the problem of avian influenza.
taken.
37
Situation
3A
Situation 3A:
Isolated human cases abroad without interhuman transmission
Prepandemic alert period – WHO phase 3
The measures relative to the epizootic are to be found in situations 2A and 2B information sheets
Principle Measures
pre04. Constitution of national stocks of health products and protection materials.
pre02. Provision of stocks (masks, health products) in health establishments and other storage
areas.
pre08a.Drafting of continuity plans by operators and business managers, especially those from
economic sectors of vital importance, to ensure the supply of goods and service in the long
term. Acquisition of means of protection by operators and businesses.
pre09. Reinforcement of the mask production capacity of the French industry.
pre12. For French citizens abroad, activation of a network of avian influenza medical advisors and
information of companies employing expatriates.
pre14. Production of a vaccine adapted to the present strains and contractual reservation of the
future pandemic vaccine.
pre26. Designation and equipment of one or two airport platforms dedicated, from situation 4
onwards, to receiving airplanes likely to transport flu patients.
org00.
org04.
org06.
org13.
Examining the maintenance or lifting of previously decided measures.
Activation of the general office for food (DGAl) surveillance committee.
Activation of the decision-making assistance committee of the Ministry of Health.
Reciprocal information according to the established protocol between the Ministry of Health
(DGS, AFSSA, InVS, national influenza reference centres) and the Ministry of Agriculture
(DGAI).
org14. Informing the advisory committee for animal health and protection.
pre05. Preparation of an order by the Minister of Health in application of article L. 3110-1 of the
code of public health, including the measures of quarantine or isolation envisaged as early as
WHO phases 4 or 5, setting up by the prefects.
pre22. Identifying, at departmental level, the health facilities that should stock safety supplies
(masks and health products).
pre23. Drawing up a plan, at departmental level, for the protection and securing of health facilities,
pharmacies and the private medical profession.
pre25. Preparation of associative action and mobilisation of volunteers in case of a pandemic.
38
Situation
3A
pre39. Analysing the last developments relative to useful health products and evaluating the
corresponding stocks (vaccines, antiviral drugs, adjuvant products).
emergency services.
Objective: assisting French citizens abroad
Principle: In the best interest of patients, management is ensured primarily in the country or region where
they happen to be, with the possible support of the diplomatic mission’s avian flu medical advisor. At this
stage, even if no human transmission has been found, isolation of patients is requested for the sake of
precaution and is associated with monitoring of people having been in close contact with them by the same
medical advisor.
avian influenza medical advisor of and the means available to the diplomatic post. Delivery
of protection products and equipment following previously defined instructions.
fre02. Depending on the local medical capacities for healthcare and on the condition of the patient,
possible health repatriation, to be decided on a case-by-case basis by joint decision of the
diplomatic post, the Ministry of Health’s decision-making assistance committee and the
patient’s insurer, provided guaranteeing the safety of the crew and medical assistance team
is possible; before departure, information of the Ministries in charge of Health and the
Interior so as to organise the patient’s reception and hospitalisation.
Objective: detecting and signalling human cases on the national territory (home country and
overseas)
det06. In the event of suspicion of an imported case, immediate recourse to the InVS’s clinical and
epidemiological assessment committee; the InVS shall inform the Ministry of Health.
det08. Despatch of biological samples to laboratories entitled to handle the avian virus or to the
national influenza reference centres for confirmation; as soon as confirmation is established,
the InVS shall inform the WHO and the European Commission.
Objective: taking care of suspicious cases, contact persons and diseases persons
inf01. Information of travellers and expatriates about the precautions to take in countries affected by
the epizootic.
inf20. Information of the general public on measures to prevent contamination in case of an
epizootic, the consumption of poultry and on the risks related to domestic animals.
39
Situation
3A
taken.
40
Situation
3B
Situation 3B:
Isolated human cases in France without interhuman transmission
This situation corresponds to either imported cases or cases linked to an epizootic focus on French territory. The nature
of the disease is unchanged. The life of the population should not be disrupted but psychological reactions and the
appearance of numerous false cases mobilising medical means must not be underestimated.
Principle Measures
org01. As soon as a strong suspicion arises or once the triggering event has been confirmed, an
interministerial meeting is held; proposal addressed to the Prime Minister for delegating the
operational conduct of governmental action to the Minister of Health. In that case, activation
of the interministerial crisis committee attached to the Minister of Health.
erh02. Setting up of health control and traffic barriers, including within French mainland and
overseas territory, intended to confine the virus within the areas affected and protect
unaffected areas.
pre09. Reinforcement of the mask production capacity of the French industry.
pre14. Production of a vaccine adapted to the present strains and contractual reservation of the
future pandemic vaccine.
pre26. Designation and equipment of one or two airport platforms dedicated, from situation 4
onwards, to receiving airplanes likely to transport flu patients.
pre27. Activation, on the instruction of prefects, of measures for the securing of facilities that stock
protection supplies and health products.
org00.
org05.
org06.
org13.
Examining the maintenance or lifting of previously decided measures.
Activation of the general office for food (DGAl) national crisis committee.
Activation of the decision-making assistance committee of the Ministry of Health.
Reciprocal information according to the established protocol between the Ministry of Health
(DGAI).
org15. Convocation of the advisory committee for animal health and protection.
org17. Activation of the departmental operational centre of the Department(s) affected.
41
Situation
3B
overseas)
det07. In the event of suspicion, immediate recourse to InVS’s clinical and epidemiological
assessment committee; the InVS shall inform the Ministry of Health.
cas02. Management of diseased persons and possible cases according to the protocol stipulating the
conduct to be adopted in the presence of possible cases of influenza presenting a new viral
subtype without interhuman transmission.
cas05. If the emergence of human cases reveals an epizootic outbreak in France, application of the
protocol stipulating the conduct to be adopted in the presence of an avian influenza outbreak
with a highly pathogenic virus and presenting a proven risk of human transmission during an
epizootic in France or nearby areas.
Objective: keeping in check the spread of the human virus and eradicating it
erh01. Follow-up of people having been in contact with the patient and, in case of presence of
animal foci in France, of people having been in contact with diseased animals.
Principle: In the best interest of patients, management is ensured primarily in the country or region
where they happen to be, with the possible support of the diplomatic mission’s avian flu medical
advisor. At this stage, even if no human transmission has been found, isolation of patients is
requested for the sake of precaution and is associated with monitoring of their close contacts by the
same medical advisor.
fre02. Depending on the local medical capacities for healthcare and on the condition of the patient,
possible health repatriation, to be decided on a case-by-case basis by joint decision of the
diplomatic post, the Ministry of Health’s decision-making assistance committee and the
patient’s insurer, provided guaranteeing the safety of the crew and medical assistance team
is possible; before departure, information of the Ministries for Health and the Interior so as
to organise the patient’s reception and hospitalisation.
42
Situation
3B
pre02. Provision of stocks (masks, health products) in health establishments and other storage
areas.
pre04. Constitution of national stocks of health products and protection materials.
pre05. Preparation of a decree by the Minister of Health in application of article L. 3110-1 of the
code of public health, including the measures of quarantine or isolation envisaged as early as
WHO phases 4 or 5.
pre08b.Updating of continuity plans by operators and business managers, especially those from
economic sectors of vital importance, to ensure the supply of goods and service in the long
term. Acquisition of means of protection by operators and businesses.
pre12. For French citizens abroad, activation of a network of avian influenza medical advisors and
information of companies employing expatriates.
pre21. Ensuring that biological products (blood, grafts, etc.) are virus-free.
pre25. Preparation of associative action and mobilisation of volunteers in case of a pandemic.
emergency services.
inf16. Information on the situation communicated by relevant ministries to private health
professionals, GROG network physicians, health facilities and SAMU-centres 15,
pharmacists, rescue services, biomedical analysis laboratories, health services of the Armed
Forces, employment medical services and educational communities; information on the
detection of cases, alert procedures and conduct.
inf21. Information of the general public about the situation and protection measures against the
virus.
inf26. Regular information of the media on the situation and the protection measures directed
towards the population in order to limit the transmission of the virus.
inf41. Promotion addressed to children, young people and teachers of elementary gestures for
preventing interhuman transmission of respiratory diseases.
43
Situation
4A
Situation 4A:
Limited and localized clusters of human cases abroad
This situation, if it indeed corresponds to a change in the nature of the virus, must be considered as an alert signal.
International cooperation in order to avoid export of the virus and the projection of health means to circumscribe
infectious foci, will no doubt constitute the most effective strategy.
Principle Measures
org01. As soon as a strong suspicion arises or once the triggering event has been confirmed,
interministerial meeting; proposal addressed to the Prime Minister of delegating the
operational conduct of governmental action to the Minister of Health. In that case, activation
of the interministerial crisis committee attached to the Minister of Health.
For affected zones, depending on the degree of transmissibility and seriousness of the disease.
imp02. Suspension of air, sea or land connections with the areas affected; for people travelling from
those areas at that time, preventive quarantine on arrival (very limited capacity).
imp04. If air connections with those areas are maintained, strong advice against travel to those areas
is expressed; no repatriation of diseased people; possible quarantine of people on their return
(very limited capacity).
For threatened zones.
imp01. Request for an emergency meeting of the European Union Member States to study the
measures to be taken at Community level (limitation of the delivery of visas and entries into
the Schengen space, restriction of air travel, quarantine on arrival, etc.); consultation of the
Member States and the Commission on the nature and scope of control measures envisaged
by France (simple information in case of emergency).
imp05. Non essential travelling is strongly discouraged.
fre04. Recommendation made to relatives of expatriates, to french students abroad and to nonindispensable agents of the State to return to their home country (decisions different
depending on whether the countries are affected or threatened).
coo01. Contribution to WHO action to help affected countries to contain the epidemic. Consultation
with affected countries in order to study the isolation measures to implement.
44
Situation
4A
org00. Examining the maintenance or lifting of previously decided measures.
org06. Activation of the decision-making assistance committee of the Ministry of Health.
org13. Reciprocal information according to the established protocole between the Ministry of
Health (DGS, AFSSA, InVS, national influenza reference centres) and the Ministry of
Agriculture (DGAI).
fre10. If necessary, and the international situation permitting, reinforcement medical teams will be
sent to assist the diplomatic posts particularly in demand.
fre12. Mobilisation of diplomatic missions to inform French nationals about the development of
the crisis. Assistance to people in mourning and seriously affected people.
fre21. Activation of the MAE/DFAE (Ministry of Foreign Affairs/Directorate of French nationals
abroad) crisis committee.
fre22. Sending of the updated number of French nationals by the relevant diplomatic post(s).
Objective: postponing the introduction of cases on the national territory
imp09. Reinforcement of health checks at boarders.
overseas)
subtype with interhuman transmission.
45
Situation
4A
pre03. Verification of the pre-positioning of health products and equipment in France and overseas;
reinforcement of the stocks of health products and protection equipment in diplomatic posts.
pre10. Verification of the availability of biological tests (PCR primers, quick tests).
pre11. Reinforcement of the production of masks by the French industry.
pre15. Preparation of the State services and operators concerned by the management, in the event
of a pandemic, of law and order, supplies to the population, the supply of energy, electronic
communications, mail and the banking services.
pre24. Checking the measures set up for the organisation of care in health facilities (white plan and
“Influenza Pandemic” annex) and for ambulatory medical care.
pre27. Activation, on the instruction of prefects, of measures for the securing of facilities that stock
protection supplies and health products.
pre28. Prepositionning of health products and protection equipment.
emergency services.
freight transport businesses about prohibitions and restrictions and/or special measures
concerning international exchanges.
inf05. Information for French citizens about the principle of managing possible cases and infected
persons on the spot, the precautions to observe and the delivery of protection products and
materials.
inf31. Information of public and private companies about the situation.
46
Situation
4B
Situation 4B:
Limited and localized clusters of human cases in France
The appearance of clustered cases in France, whatever their origin, leads to suspecting interhuman transmission and
constitutes a major event. If it corresponds to a change in the nature of the virus, it can precede its rapid spread and, in
a serious scenario, precede the pandemic itself. At this stage, it is possible to circumscribe the infectious foci and
concurrently take measures to avoid the spread of the virus within and beyond our frontiers.
Principle Measures
Organisation Measure
the organisation of medical care, operational conduct may be transferred to the Minister of
the Interior; the interministerial crisis committee is set up and attached to the appointed
minister.
org19. Activation of the zone and Departmental operational centres.
Measures for confining infectious foci
erh02. Setting up of health control and traffic barriers, including inside the national territory (in
France and overseas), intended to confine the virus within the areas affected and to protect
unaffected areas.
erh04. Request for an emergency meeting of the European Union Member States to study the
measures to be taken; consultation of the Member States and the European Commission on
the nature and scope of control measures envisaged by France; Inform the WHO and the
European Union on the measures decided (EWRS message transmitted by the DGS on the
initiative of the interministerial crisis committee).
erh09. Antiviral drug prophylaxis if necessary, by proposition of the Minister of Health.
erh05. Interruption or suspension of travel by air, sea and land to foreign countries and the overseas
territories (or to the home country if the overseas territories are affected). Freight to be
maintained if possible.
Major pandemic preparation measures, to examine prior to their implementation
pre30. Setting up of health and social coordination centres.
pre31. Using of prepandemic vaccine stocks depending on the evolution of knowledge and/or
observed efficiency based on the latest conclusions of expert evaluations.
47
Situation
4B
emergency services.
All preparatory measures for responding to a pandemic, i.e. all the “pre” measures of situation 4B,
must be urgently completed and checked.
Measures possibly restricted to affected zones
bar01. During the initial phase of the epidemic, interruption or reduction of some local public
bar03. Interruption of group activities: entertainment, sports events, fairs and exhibitions, large
meetings, etc. and curbing of cultural activities.
bar04. Restriction of visits and/or control of access to hospitals, old people’s homes, temporary
shelters, prisons, social and medico social facilities etc.).
bar05. Restriction of non-essential professional, social, educational and associative activities.
bar11. Wearing of respiratory protection for health professionals, rescue personnel and anyone
the plan; patients must wear surgical masks; recommendation that unaffected people wear a
surgical mask in public places, as a precaution.
org07. Permanent activation of the Ministry of Health’s decision-making assistance committee.
org09. If the Minister of the Interior is not in charge of the operational conduct of governmental
action, activation of an anticipation committee attached to him.
org10. If the operational conduct of governmental action is transferred to the Minister of the
Interior, a public health committee attached to the Minister of Health is activated.
org11. Implementation of a committee for the continuity of economic activity attached to the
org13. Reciprocal information according to the established protocol between the Ministry of Health
(DGAI).
48
Situation
Objective:
overseas)
4B
detecting and signalling human cases on the national territory (home country and
det05. Reinforcement of the network of influenza diagnosis laboratories.
Objective: keeping in check the spread of the human virus and eradicating it
erh03. The InVS shall inform the WHO and the European Union about the emergence of clusters in
France (Early Warning Rapid System message - EWRS).
erh10. If new human cases are suspected, the DDASS shall immediately inform the InVS, DGS,
DHOS, DGT, ComSegur and COGIC by the prefect.
subtype with interhuman transmission.
cas05. If the emergence of human cases reveals an epizootic outbreak in France, application of the
protocol stipulating the conduct to be adopted in the presence of an avian influenza outbreak
with a highly pathogenic virus and presenting a proven risk of human transmission during an
epizootic in France or nearby areas.
pre16. Updating and preparing the implementation of continuity plans for administrative bodies,
local authorities and companies.
49
Situation
4B
pre24. Checking the measures set up for the organisation of care in health facilities (white plans
and “Influenza Pandemic” annex) and for ambulatory medical care.
mtn45. For municipalities, public facilities for inter-municipal cooperation and mixed syndicates in
charge of eliminating household waste:
- identification of sites for intermediate storage;
- acquisition and organisation of the distribution of plastic bags (with ties) for waste disposal
of home-based patients.
For health care facilities and hospitals:
- checking that manufacturers have enough stocks of ADR approved cardboard boxes to
store infectious health-care waste, in the case of a crisis.
- identifying in link with the prefectures and local communities, the opening storage
reserved for infectious health care waste if necessary.
Objectives: informing the general public, the managers, the professionals and the companies
persons on the spot, the precautions to observe and the delivery of protection products and
materials.
inf27. Regular information of the media and general public with maps of affected zones in France,
the situation in these zones and the precautions to be taken.
inf32. Information of public and private companies about the situation and rules to be adopted.
crisis department of the 39 39 telephone platform.
Measures possibly restricted to affected zones
org18. Activation of the operational centres of the Departments affected, assisted by the “influenza”
committee reinforced and run by the DDASS; preparation for the representation of the
committee at regional level.
org20. Activation of regional support committees (DRASS, ARHs, CIRE).
cas07. Implementation of the decree signed in application of article L. 3110-1 of the public health
code (measures of isolation, quarantine if necessary, etc.).
cas13. Launch of white plan “influenza pandemic” annex for health facilities, and “blue” plans for
facilities housing elderly people
50
Situation
4B
cas14. Implementation by the Department prefects of the extended “white plans”, which are the
coordination tools for all the health actors in a crisis situation.
bar06. Ring protection around initial cases; isolation measures; use of masks; management of
people in contact with disease cases.
bar10. Reminder and individual application of standard principles of hygiene (hand washing, etc.).
bar13. Limitation of individual movements to those strictly necessary, by appealing to the sense of
civil responsibility.
erh06. Specific measures for taking care of people having been in contact with disease cases
(quarantine at home and, if necessary, prophylactic treatment using antineuraminidases).
mtn39. Recourse to volunteers, based in as much as possible on existing associations; application of
the statute of occasional public service collaborator to volunteers overseen by these
associations and /or designated by administrative authorities.
mtn40. On the initiative of local authorities, census of people (isolated or homeless people, etc.) and
identification of their needs (food, medicine and essential products delivery; day nursery
needs, etc.).
mtn41. Assistance to people without resources as a result of the epidemic.
mtn43. Psychological support for relatives of victims.
mtn44. Care-taking of isolated children and non-infected dependent people.
mtn58. Call for the civil defence municipal reserve.
eva01. Setting up and circulation of a daily summary of the situation by each ministry, based on the
indicators it will have previously defined; surveillance intended to anticipate possible
eva02. Forecast, updated daily if possible, of the evolution of the epidemic, taking into account the
data relative to the activities of health facilities and the census of deaths at home or in health
facilities.
eva06. Follow-up of the balance between the consumption and supply of health products and
protection and hygiene equipment.
inf12. Information of the population in affected areas about the closure of day nurseries and
teaching or training facilities.
inf22. Informing the general public in contaminated zones about the behaviour to adopt; call for
solidarity.
51
Situation
5A
Situation 5A:
Large foci of uncontrolled clusters of human cases abroad
This phase constitutes the start of a pandemic. Without needing to wait for WHO confirmation, it shows the nature of
the virus has changed and calls for a mobilisation of public authorities in order to prevent the introduction of the virus
on French territory and prepare the country to face the pandemic.
Principle Measures
Organisation Measures
the organisation of medical care, operational conduct may be transferred to the Minister of
the Interior; the interministerial crisis committee is set up.
Measures for limiting the import of the disease
For countries affected by human transmission, depending on the seriousness and contagiousness of
the disease.
imp03. Suspension of air, sea or land connections with the countries affected; for people travelling
from such countries at the time, preventive quarantine on arrival (very limited capacity).
imp08. Suspension of visa delivery to travel to France in the affected countries.
fre11. Setting up, by the Ministry of Foreign Affairs, of a support system for tourists and nonresident French nationals who could not been repatriated in time.
For countries neighbouring affected countries.
imp06. Non essential travelling is categorically advised against.
fre07. Limiting of the number of State officers abroad to essential posts only.
fre09. Examination of the relevance and risks of an express recommendation to French citizens to
leave the countries neighbouring affected countries, with a health check on leaving those
countries.
imp01. Request for an emergency meeting of the European Union Member States to study the
measures to be taken at Community level (limitation of the delivery of visas and entries into
the Schengen space, restriction of air travel, quarantine on arrival, etc.); consultation of the
Member States and Commission on the nature and scope of control measures envisaged by
France (simple information in case of emergency).
imp09. Reinforcement of health checks at boarders.
52
Situation
5A
imp12. Quarantine measures (very limited capacity) or prophylactic treatment extended to French
nationals coming from countries neighbouring affected countries.
imp13. Setting up, if possible, of a sanitary check on leaving countries neighbouring affected countries.
Principle: In the best interest of patients, management is ensured primarily in the country or region
where they happen to be, with the means of protection and treatment provided by the diplomatic
mission and the possible support of its avian flu medical advisor.
Major pandemic preparation measures, to be examined prior to their implementation
pre06. Decree by the Minister of Health in application of article L. 3110-1 of the code of public
pre31. Use of the prepandemic vaccine, depending on the progress of knowledge and/or the
observed efficiency, based on the conclusion of the latest expert evaluations.
emergency services.
All preparatory measures for responding to a pandemic, i.e. all the “pre” measures above and on
pages 54 and 55 must be urgently completed and checked.
Measures for managing patients
cas01. Organisation of patient management (preferably in hospitals).
cas03. Patient management and possible cases according to the protocol of conduct to follow in the
event of influenza cases with new viral sub-types and interhuman transmission.
cas04. Management of patients detected while travelling to France according to the specify
procedure defined (see information sheet D2).
fre03. On-the-spot management of possible cases found in citizens or persons in affected countries,
using local health facilities, and if necessary, with the support of the avian flu medical
advisor at the diplomatic mission and the resources stored there. Products and protective
material should be delivered based on predetermined instructions.
Information Measures
inf23. Information of the general public about the situation, rules to follow and conduct to adopt,
particularly immediately reporting the appearance and worsening of all flu symptoms and
calling for neighbourhood solidarity.
Objective:
reinforcing governmental, ministerial and territorial organisation
org07. Permanent activation of the Ministry of Health’s decision-making assistance committee.
53
Situation
5A
org11. Activation of a committee for the continuity of economic activity attached to the minister in
charge of the economy.
org13. Reciprocal information according to the established protocol between the Ministry of Health
(DGAI).
fre18. Placing under alert and/or sending, upon authorisation by the foreign authorities concerned,
of a consular and medical support mission, depending on the resources of the affected
countries and the means available to the French representative mission.
overseas)
54
Situation
5A
pre16. Updating and preparing the implementation of continuity plans for administrative bodies,
local authorities and companies.
pre24. Checking the measures set up for the organisation of care in health facilities (white plans
and “influenza pandemic” annex) and for ambulatory medical care.
pre30. Setting up of health and social coordination centres.
pre32. Adaptation of the pandemic vaccination plan depending on the characteristics of the virus,
the populations most likely to spread the epidemic and the most affected populations (as a
function of age, health condition, etc.).
mtn45. For municipalities, intermunicipal public facilities and intermunicipal syndicates in charge
of eliminating household waste:
- acquisition and organisation of the distribution of plastic bags (with ties) for waste disposal
of patients at home.
For healthcare facilities and hospitals:
- checking that manufacturers have enough stocks or can rapidly produce sufficient
quantities of ADR-approved cardboard boxes to store infectious health-care waste,
- identification, in liaison with regional and local authorities, of storage sites available for
infectious health-care waste in the case of a crisis.
persons locally, the precautions to observe and the delivery of protection products and
materials.
inf28. Regular information of the media on the situation and appropriate behaviour for protection.
inf32. Information of public and private companies about the situation and the rules to adopt.
crisis department of the 39 39 telephone platform.
55
Situations
5B / 6
Situations 5B / 6
In 5B, large foci of uncontrolled clusters of human cases in France: This
situation is equivalent to the start of the pandemic on French territory and
justifies examining the same measures as for pandemic situation 6.
Flu pandemic
Prepandemic period – WHO Phase 6
Principle measures at the beginning of the pandemic
Organisation Measures
governmental action to the Minister of the Interior if the issues of civil defence, law and
order or continuity of socio-economic life prevail over the organisation of medical care, or
confirming the Minister of Health in this function if sanitary issues prevail; the
interministerial crisis committee is set up and attached to the minister in charge of
operational conduct.
Measures for limiting the import of the virus on French territory
Abroad, medical care administered locally to possibly infected or infected French nationals in
affected countries using local healthcare structures, if necessary with the assistance of the avian
influenza medical advisor of and using the means available to the diplomatic post.
Measures aiming at limiting the risk of importing the disease can still be useful in a pandemic
situation even if cases are already present in France. The objective of such measures is to delay the
progression of the epidemic by a few days to 2 or 3 weeks in order to:
- allow the setting up of the response system and reduce consequences to the maximum
(organisation of private medical care, upscaling of “SAMU Centres 15” emergency medical
services , etc.);
- provide extra time for the formulation of antiviral drugs, the production of pandemic vaccine,
the manufacturing of masks, possible prepandemic vaccination (time necessary for the
development of immunity), etc.
- spread the pandemic peak and thus reduce the strain on the healthcare system.
imp14. Boarder checks (efficient if implemented early, involving European coordination).
Maintenance of freight movement as a priority.
imp16. On arrival of flights from affected countries at the time interruption is decided, placing of
crew and passengers under quarantine (very limited capacity).
56
Situations
5B / 6
imp15. Interruption of international passenger arrivals and departures, especially by air, which
constitute a vector for importing the epidemic 4 .
Measures for implementing the public health strategy
cas06. Application of the public health strategy defined by the Minister of Health, indicating the
consequences for dealing with other illnesses (prioritisation), specifying the doctrine
followed for the use of antiviral medicines and proposing priorities for the use of limited
resources.
cas07. Implementation of the decree signed in application of article L. 3110-1 of the public health
code (measures of isolation, quarantine if necessary, etc.).
cas10. Setting up of an adapted ambulatory medical care system.
pre31. Use of the prepandemic vaccine, depending on the progress of knowledge and/or the
observed efficiency, based on the conclusion of the latest expert evaluations.
emergency services.
Barrier measures for curbing and limiting the spread of the disease
bar01. During the initial phase of the epidemic, interruption or reduction of some local public
bar03. Interruption of group activities: entertainment, sports events, fairs and exhibitions, large
meetings, etc. and curbing of cultural activities.
bar04. Restriction of visits and/or control of access to hospitals, old people’s homes, temporary
shelters, prisons, social and medico social facilities etc.).
bar05. Restriction of non-essential professional, social, educational and associative activities.
bar07. Protection of unaffected overseas territories (or of France from an affected overseas
territory); restriction of passenger transport.
bar08. Depending on the situation, encouragement or restriction of movements to make towns less
crowded and/or of interregional movements.
bar13. Limitation of individual movements to those strictly necessary, by appealing to the sense of
civil responsibility.
Measures for management of patients
cas09. Management of flu-infected patients and their contacts according to the procedure defined
for a pandemic.
4
The modellings that have been carried out converge to predict the pandemic peak would be delayed by about 1 to 2
weeks, for a 90% restriction of arrivals of all international passenger flights and 3-4 weeks for a 99% restriction. The
efficiency seems to be higher if the restriction is made at the level of departures from affected countries.
57
Situations
5B / 6
fre03. On-the-spot management of possible cases found in citizens or persons in affected countries,
using local health facilities, and if necessary, with the support of the avian flu medical
advisor at the diplomatic mission and the resources stored there. Products and protective
material should be delivered based on predetermined instructions.
Information Measure
inf23. Information of the general public about the situation, rules to follow and conduct to adopt,
particularly immediately reporting the appearance and worsening of all flu symptoms and
calling for neighbourhood solidarity
Organisation and Health Measures
org11. Implementation of a committee for the continuity of economic activity attached to the
org20. Activation of the regional support committees (DRASS, ARHs, CIRE).
org21. Coordination by the zone prefect, together with the general officer of the defence zone, of
the civil and military means placed at the disposal of Department prefects.
org22. Making the pandemic vaccine stockpile safe.
org23. Implementation of the plan for the distribution of health products and protection equipment.
org24. Confinement of personnel on alert.
fre10. If necessary, and the international situation permitting, reinforcement medical teams will be
sent to assist diplomatic posts under particular pressure.
cas11. Management of patients requiring continuous monitoring or complicated acts of
resuscitation in health facilities, following regulation by the SAMU-Centre 15.
cas13. Launch of “influenza pandemic” annex of “white” plans for health facilities and “blue”
plans for facilities housing elderly people.
cas14. Implementation by the Department prefects of the extended “white plans”, which are the
coordination tools for all the health actors in a crisis situation.
58
Situations
5B / 6
cas15. Setting up of intermediate structures to group patients who would otherwise be isolated at
home and whose medical condition does not require hospitalisation; these structures, which
do not perform the functions of medical facilities, will allow patients to receive medical care
and be visited regularly by doctors, as they would in their own home; transfer of patients to
hospital if their condition worsens.
cas17. Setting up of health and social coordination centres.
Objective: slowing down the transmission of the human virus on the national territory
bar06. Ring protection around initial cases; isolation measures; use of masks; management of
people in contact with disease cases.
bar09. As soon as the pandemic vaccine is available, implementation of the vaccination plan.
bar10. Reminder and individual application of standard principles of hygiene (hand washing, etc.).
bar11. Wearing of respiratory protection for health professionals, rescue personnel and anyone
the plan; patients must wear surgical masks; recommendation that unaffected people wear a
surgical mask in public places, as a precaution.
bar14. Implementation of specific measures for the protection of prison facilities.
pre32. Adaptation of the pandemic vaccination plan depending on the characteristics of the virus,
the populations most likely to spread the epidemic and the most affected populations (as a
function of age, health condition, etc.).
persons in affected countries, the precautions to observe and the delivery of protection
products and supplies.
inf24. Information of the public about the various means of support available (economic, social,
psychological).
inf28. Regular information of the media on the situation and appropriate behaviour for protection.
inf32. Information of public and private companies about the situation and the rules to adopt.
59
Situations
5B / 6
Maintenance of Activities
Objective: maintaining essential activities
mtn01. Gathering, by State services, of information coming from companies, distribution platforms
and purchasing groups so as to be able to organise supply according to the availability of
products over different zones.
mtn02. Strict observance, by people presenting influenza symptoms, of home confinement and
health regulation instructions.
mtn04. Verification by each ministry that the measures taken by socio-economic players and the
global government strategy are coherent.
mtn05. Activation of zone committees for monitoring supplies and activities, attached to zone
operational centres.
mtn51. Call for implementation of social distancing measures: distance working, teleconferences,
restriction of meetings and travel, etc.
mtn53. Mobilisation of cured or immune people, in particular for essential activities and tasks
requiring contact with patients.
Specific employment measures
mtn09. Use of alternative modes of organisation:
- development of distance working and teleconferencing;
- mutualisation of resources, extraordinary complementary missions performed by certain
categories of personnel, resort to persons made available by the closure of facilities,
etc…;
- resort to “young pensioners”, experienced students, reservists from the police force and
civil defence services, voluntary workers, people having recovered from the illness, etc.;
- local solidarity (agricultural sector for example);
- doubling of essential teams on separate work sites;
- transfer of activities to less affected regions, etc.
mtn52. On-line publication, by the national employment agency (ANPE), of non-assigned jobs, thus
allowing employees to be redirected toward priority activities.
mtn55. Implementation of measures relative to partial unemployment.
Specific legal measures
mtn06. Control of distribution of energy resources, raw materials, industrial products and products
necessary for supply.
mtn07. On proposal by the Minister of Finance, setting of price control measure.
mtn08. Requisitioning of persons, goods and services.
mtn10. Closed facilities (educational facilities, sports centres) made available by ministries and
local authorities to meet all needs having priority for the control of the epidemic or the
preservation of the country’s activity.
mtn54. Obligation to wear a mask in certain places.
Securing sensitive or dangerous facilities
mtn11. For facilities whose activities cannot be stopped (including certain research laboratories),
implementation of precautionary measures, such as keeping the teams on the premises or
having relief teams go through a “quarantine decompression chamber” (isolated room in
which the relief shift remains for the nominal duration of the incubation).
mtn12. Making safe pre-identified facilities which, if the numbers of staff present were insufficient,
might prove dangerous for the population; taking into account the time required for
industrial activities working continuously to come to a standstill; planning of relief staff
taken among the staff consigned at home since the beginning of the crisis.
60
Situations
5B / 6
Specific priorities
mtn14. Ministries’ chain of command and liaison: maintenance of full operational capacity.
mtn15. Defence: missions of continuity of governmental action for the preservation of strategic
military functions; missions of civil-military cooperation in the areas of governmental
continuity, contribution to security and assistance to the population.
mtn17. Law and order: conduct of missions according to priorities defined and updated by the
Ministry of the Interior, taking into account the needs expressed by ministries (protection of
hospitals, stocks and transport of protection equipment and health products, shops, etc.).
mtn18. Justice: penal activities essential for the preservation of law and order; for the penitentiary
administration, maintenance and monitoring of persons placed in the hands of justice.
mtn19. Production and distribution of energy: continuation of the production function, in degraded
mode if necessary; full preservation of the safety function; supply of priority modes of transport;
supply of domestic fuel for the heating of houses.
mtn20. Food supplies: supplying of the population, via shops and distribution platforms in
particular; collection of milk and milk products; food for farm animals.
mtn21. Financial circuits and means of payment:
- supply of bank notes to banks and ATMs; delivery of minimum social benefits, by post in
particular.
- maintenance of the continuity of interbank payments, financial markets, stock exchange
activities and the insurance sector.
mtn22. Electronic communication: 1) governmental liaisons; 2) liaisons concerning essential
activities, and in particular those essential for population health and safety.
mtn23. Pharmaceutical and medical industry: production of essential health products and medical
equipment; supply to the medical care system.
mtn24. Production of protection supplies, and cleaning and hygiene products: masks of all kinds,
single-use gloves, protection goggles, all virucidal and disinfecting products, soap,
disposable handkerchiefs, etc.
mtn25. Audiovisual: information of the various groups among the public on the course of the
pandemic and maintenance of audiovisual means.
mtn26. Transport: infrastructures and networks; control, regulation and commercial services;
planning of priority transport (for foodstuffs, health products, medical oxygen, water
treatment products (chlorine, etc.), hydrocarbons, biomedical waste, freight to overseas
territories); priority missions of Météo France (the French meteorological office).
mtn27. Continuous operation of drinking water production and distribution facilities.
mtn28. Maintenance of all the different information systems (networks, IT means, etc.).
mtn56. Redistributing transport activities (road, railways, sea, rivers) in favour of priority needs.
Specific measures for Defence
mtn29. Reincorporation of reservists of the operational military reserve to ensure, as a priority, the
operation of the organisational chain of territorial interarmed forces for defence.
mtn30. Restriction of and health control before access to deterrence facilities, facilities dedicated to
means of intervention, facilities on alert and crisis management centres.
mtn31. Restricted relief of military detachments in operation or stationed abroad.
61
Situations
5B / 6
mtn32. Restriction or interruption of non-essential activities (drills, training courses, missions, etc.).
mtn33. Specific rules applied to calls in ports or stopovers at airports, movements across borders
and multinational drills.
Specific measures for Justice
mtn34. Adaptation of penal and jurisdiction operation procedures.
Specific measures relative to rescue and fire brigade services
mtn35. Operational coverage of emergency missions by redeploying personnel; maintenance of the
regulation of emergency medical services by the SAMU-Centre 15.
Specific measures relative to funeral services
mtn36. Application of the provisions in the Ministry of the Interior’s methodological guide. Make
prefects take action by means of decrees aiming among other things at:
prescribing the immediate placing of bodies in coffins (art. R2213-18 of the CGCT code);
suspending legal time lags (art. R2213-33 and 35 of the CGCT code);
adapting the authorisation regimen regulating post-mortem operations;
making derogations for technical prescriptions applicable to funeral vehicles (art. R222358 of the CGCT code);
limiting the surveillance regimen for funeral operations and associated leave;
disallowing thanatopraxy rituals;
mobilising scheduled and appropriate support means.
Specific measures relative to food distribution, bottled water, and cleaning and hygiene products
mtn37. If a significant amount of time is available, people will be encouraged to build up a reserve
of non-perishable food and bottled water; and make grouped instead of repeated purchases,
which would lead to undesirable gathering of people during an epidemic; if there is little
time available, mass purchases likely to lead to unjustified shortages will be discouraged.
Specific measures relative to Education
mtn57. Broadcasting of pedagogical programs by audio and audiovisual means.
Specific measures relative to neighbourhood solidarity and everyday life assistance.
mtn38. Implementation, encouragement and supervision, by local communities, of solidarity
actions between neighbours for the benefit of isolated or dependent people, or of families
having to stay at home to take care of one or several patients; use of the lists of isolated
elderly and disabled people, instituted by decree No. 2004-926 of September 1st 2004, and
updated by town halls.
mtn39. Recourse to volunteers, based in as much as possible on existing associations; application of
the statute of occasional public service collaborator to volunteers overseen by these
associations and /or designated by administrative authorities.
mtn40. On the initiative of local authorities, census of people (isolated or homeless people, etc.) and
identification of their needs (food, medicine and essential products delivery; day nursery
needs, etc.).
mtn41. Assistance to people without resources as a result of the epidemic.
mtn42. Definition of appropriate modalities for the recovery of debts and credits for essential
services.
mtn43. Psychological support for relatives of victims.
mtn44. Management of non-diseased isolated children and dependent people.
mtn58. Call for the civil defence municipal reserve.
62
Situations
5B / 6
Specific measures relative to decontamination and household waste
mtn59. For municipalities, intermunicipal public facilities and intermunicipal syndicates in charge of
eliminating household waste:
- continuation of collection and disposal of household waste (including infectious waste);
- suspension of sorting in waste treatment facilities in order to reduce the risk of employee
exposure and concentration of means on the collection and disposal of residual household
waste;
- suspension of composting of certain waste products if this involves a risk of propagating the
epidemic;
- protection of waste collection employees (masks, gloves, goggles, etc.);
- maintenance of the activity of waste water treatment plants.
mtn60. For municipalities, intermunicipal public facilities and intermunicipal syndicates in charge of
eliminating household waste:
- authorisation/creation of intermediate storage sites;
- in case of shortage, distribution of plastic bags with ties for patients at home to dispose of
waste.
For healthcare facilities and hospitals:
- acquisition of sufficient stocks of cardboard boxes for the storage of infectious health-care
waste, if necessary;
- request for opening storage sites reserved for infectious health-care waste, if necessary.
Specific measures for the production and transport of energy (electricity, hydrocarbons, gas)
mtn46. Implementation of the Hydrocarbons resources plan.
mtn47. Immediate implementation, by operators and business managers, of a mode of operation with
reduced manpower and constitution of “reserve” relief teams, isolated from a health point of
view if necessary.
Specific measures for mail
mtn48. Encouragement and implementation of substitute solutions (electronic mail).
mtn49. Reduction of non-essential postal services (processing of advertising mail, etc.).
mtn50. Suspension of the distribution of advertising documents by carriers.
Objective: assessing the situation and anticipating its developments
eva01. Setting up and circulation of a daily summary of the situation by each ministry, based on
indicators it will have previously defined; surveillance intended to anticipate possible
eva02. Forecast, updated daily if possible, of the evolution of the epidemic, taking into account the data
relative to the activities of health facilities and the census of deaths at home or in health
facilities.
eva03. Diplomatic posts in affected countries shall inform the Ministry of Foreign Affairs and the
interministerial crisis committee of the means and measures engaged by foreign countries for
fighting the disease.
eva06. Follow-up of the balance between the consumption and supply of health products and protection
and hygiene equipment.
63
Situation
7
Situation 7:
End of the pandemic or period between two pandemic waves
In the absence of current criteria that allow making a distinction between the end of a pandemic wave
and the end of a pandemic, situation 7 can only be triggered if the following elements have been
observed:
WHO announcement of a decrease in the number of cases abroad;
- decrease in the number of cases below the epidemic threshold, as observed on the curve of cases
(experience from previous pandemics, that of 1918-1920 in particular, leads one to predict the end of a
wave when the number of registered cases over a one-week period falls below 10% of the number
observed during the peak week of the pandemic. A subsequent wave can nevertheless occur within a
relatively short time (two weeks to a few months).
Reconditioning of the response and monitoring system in the event of another wave
org25. Monitoring of national and international media; monitoring of the state of public opinion by the
government information service.
org29. Helping main services to resume, in terms of staff and resources.
org30. Retrospective evaluation of planned organisation and measures in all areas: health, social and
economical activities, etc.
org28 Urgent and essential adaptation of the government plan, ministerial plans and all other public or
private subsidiary plans.
Objective: assisting the affected countries
coo02. Sharing what has been learned with affected countries.
fre12. Mobilisation of diplomatic missions to inform French nationals about the development of the
crisis. Assistance to people in mourning and seriously affected people.
fre14. Local consultation with companies employing French expatriates
fre15. Reopening of French schools and cultural centres in affected countries and neighbouring
Objective: assessing the situation and anticipating its developments
eva07. Monitoring of health and socio-economic situation indicators.
eva08. Information of the Ministry of Foreign Affairs, by all diplomatic missions, on the economic,
social, geopolitical and health situation of the various countries.
eva09. Analysis of the problem of seriously affected businesses.
eva10. Analysis of the insurance issue.
eva11. Analysis of the problem of families having suffered particularly heavily from the pandemic.
64
Situation
7
Objective: preparing the pandemic response system in case of a new pandemic wave
rep01. Evaluation and replenishing of remaining stocks of health products and biomedical supplies.
rep02. Preparation of the Health Minister’s decrees in application of art. L. 3110-1 of the public health
code, for the modification or lifting of health measures.
rep03. Organisation of meetings on experience returns with operators and businesses.
rep04. Evaluation of the stock of masks and replenishment via dedicated production lines.
rep05. For French nationals abroad, maintenance of monitoring by a network of avian flu medical
advisors; information of companies employing expatriates.
rep06. Analysis of the efficiency of treatments and countermeasures (quarantine, prophylaxis, etc.);
updating of protocols.
rep07. Implementation or continuation of vaccination. Evaluation of pandemic vaccine stocks
(quantity, schedule, vaccination priorities).
Objectives: informing the general public, the managers, the professionals and the companies
While information aims not to be alarming, thus facilitating the resumption of normality, it must also
maintain the mobilisation in the face of a disease that can still return. It must allow everyone to know
the measures that are being maintained, those that are being modified and those that are lifted.
inf14. Information of the public about the lifting, modification or maintenance of barrier measures.
inf18. Information of private and hospital health professionals and pharmacists about the lifting,
modification or maintenance of health measures and about new measures to be implemented.
inf24. Information of the public about the various means of support available (economic, social,
psychological).
inf29. Information provided to the media about the situation and the evolution of measures.
inf33. Information of public and private companies about any measures that concern them.
Management of the post-crisis phase and resumption of normal activity
Objective: assisting the population and helping the resumption of social and economic activity.
ass01. Organisation of forum discussions on the pandemic and its consequences (work on resilience)
for the population and the players involved (health professionals, rescue services, etc.).
ass02. Support for families affected by the pandemic. Material assistance to people without resources.
Social and psychological management of vulnerable people.
ass03. Follow-up of procedures of compensation by insurance companies.
ass04. Collection by State services of information of all kinds in order to make a precise evaluation of
the socio-economic situation and its evolution. Identification of activities needing to be restarted as a priority.
ass05. Preparation of a system to re-start the economy.
ass06. Analysis of the mechanisms for helping sectors undergoing difficulties.
ass07. Progressive and coordinated lifting of exceptional measures by the prefect of the département
(health and social coordination centres, intermediate structures, “white” plans…).
65
ANNEX 3
Part Three
Table Summarising the Measures
The table presents all the measures listed in the decision-making aid sheets of the governmental plan,
classified by objective.
Left-hand columns illustrate the situations in the plan when such measures may be applied. The first
column corresponds to the quick response “imminent pandemic risk” information sheet.
The three right-hand columns respectively correspond to:
- the nomenclature code of the measure;
- the steering ministry or ministries responsible for implementation and/or initial transmission of the
order to bodies and services in charge of implementing the measure 5 .
- the name of the measure.
5
Code used: INT=Interior, SAN=Health; AGR=Agriculture; IND=Industry; ECO=Economy; MAE=Foreign affairs;
TRA=Transport; TRV=Employment; ECL=Ecology; DEF=Defence; OM=Overseas; RCH=Research; EDI=Education;
TRM=Tourism; JUS=Justice; JSP=Youth and sports; SGDN=General Secretariat for National Defence; SIG=Government
information service; SGAE=General Secretariat for European affairs; DDM=Office for the development of the media;
TOUS=All ministries and services.
66
"Influenza Pandemic" National Plan
RAP 1 2A 2B 3A 3B 4A 4B
Synoptique des mesures 1
5A 5B/6 7
Reinforcing governmental, ministerial and territorial organization
3A 3B 4A 4B
3B 4A
4B
RAP
5A 5B/6 7 org00
org01
Examination for the preservation or cancellation of the measures previously decided.
5A
As soon as the triggering event has been confirmed, an interministerial meeting is held; a proposal is addressed to the Prime Minister for delegating the operational conduct of
the governmental action to the Minister of Health due to the prevalence of public health issues; if the issues of civil defence, law and order or continuity of socio-economic life
prevail over the organisation of medical care, there is the possibility of transferring the conduct to the Minister of the Interior; the interministerial crisis committee is set up and
attached to the appointed minister.
As soon as the triggering event has been confirmed, an interministerial meeting is held; a proposal is addressed to the Prime Minister for delegating the operational conduct of
the governmental action to the Minister of the Interior if the issues of civil defence, law and order or continuity of the socioeconomic life prevail over the organisation of medical
care, or for confirming the Minister of Health in that function if sanitary issues prevail; the interministerial crisis committee is set up and attached to the minister in charge of the
operational conduct.
Activation of the general board of food’s national crisis committee.
Activation of the Ministry for Health’s decision-making assistance committee.
org02
5B/6
6
RAP
2B
3B
2B 3A 3B 4A
RAP
AGR
SAN
org07
org09
org10
SAN
4B
5A 5B/6
INT
Permanent activation of the Ministry for Health’s decision-making assistance committee.
If the Minister of the Interior is not in charge of the operational conduct of the governmental action, activation of an anticipation committee attached to him.
SAN
If the operational conduct of the governmental action is transferred to the Minister of the Interior, a public health committee attached to the Minister of Health is activated.
org11
org12
ECO
Implementation of a committee for the continuity of economic activity attached to the minister in charge of the Economy.
AGR
org13
AGR SAN
Information provided by the Ministry for Agriculture (DGAI) to its partners (DGS, AFSSA, InVS, national influenza reference centres) according to the Agriculture-Health
protocole.
Reciprocal information according to the protocole between the Ministry for Health (DGS, AFSSA, InVS, national influenza reference centres) and the Ministry for Agriculture
(DGAI).
org14
org15
org17
org18
AGR
5A 5B/6
5B/6
5B/6
org19
org20
org21
INT
SAN
INT DEF
Inform the advisory committee for animal health and protection.
Convocation of the advisory committee for animal health and protection.
Activation of the operational centre of the département (s) affected.
Activation of the operational centres of the départements affected, assisted by the “influenza” committee reinforced and run by the DDASS; preparation for the representation
of that committee at regional level.
Activation of the zone and départemental operational centres.
Activation of the regional support committees (DRASS, ARHs, CIRE).
Coordination by the zone prefect, in cooperation with the general of the defence zone, of the civil and military means placed at the disposal of département prefects.
5B/6
5B/6
5B/6
org22
org23
org24
SAN
Making the pandemic vaccine stockpile safe.
SAN DEF
TOUS
Implementation of the plan for the distribution of products and protection equipment.
Confinement of personnel on alert.
SIG
Monitoring of national and international media; monitoring of the state of the opinion by the SIG.
AGR
TOUS
Implementation by the Minister for Agriculture of the action necessary to prevent epizootics and fight against avian outbreaks
Urgent and essential adaptation of the governement plan, ministerial plans and all other public and private subsidiary plans.
Helping main services to resume, in terms of staff and resources.
TOUS
Retrospective evaluation of planned organisation and measures in all areas: health, social and economical activities, etc.
5A
3A
3B
3B
4B
4B
4B
RAP
org05
org06
5A
5A 5B/6
5A 5B/6
3A 3B 4A 4B
2B
2B
org03
4B
4B
4B
2A 2B
2A
As soon as the triggering event has been confirmed, interministerial meeting; proposal addressed to the Prime Minister of delegating the operational conduct of the
governmental action to the Minister of Health. In that case, activation of the interministerial crisis committee attached to the Minister of Health.
2A 2B 3A 3B 4A 4B
2A 2B
5A 5B/6 7 org25
org26
7 org28
7 org29
7 org30
AGR
INT
INT SAN
TOUS
Avoiding the introduction of an epizootic in France and reinforcing watch on the territory
zoo01
zoo02
AGR
2A
2A
2A
zoo03
zoo04
MAE AGR
AGR
Prohibition of importing birds and animal products from areas affected,in cooperation with the European Commission(possible suspension of the delivery of certificates for the
importation, exportation and transport of animals).
2A
2A
zoo05
zoo06
AGR ECO
AGR
Reinforcement of veterinary and customs checks.
Instructions concerning vigilance and the observation of good hygiene practices in the breeding activity given to the professionals in poultry farming.
1
January 9th 2007
MAE AGR
Surveillance of the circulation of avian influenza viruses in poultry farms.
Participation, under the supervision of the IOE and the FAO, in the fight against the epizootic in the countries affected; examination of the requests for technical assistance
made by the affected countries.
Activation of the advisors in veterinary affairs occupying diplomatic posts in the countries affected.
RAP 1 2A 2B 3A 3B 4A 4B
2A
2A
5A 5B/6 7
zoo07
zoo08
AGR
Specific measures for the protection of poultry farms.
AGR ECL
Surveillance of birds belonging to native species and to migrant species that have been signalled.
2A
zoo09
AGR
Assessment of the means of diagnostic and veterinary intervention according to the risk.
2A 2B
zoo10
SAN
In the presence of a new subtype other than H5 or H7, inclusion of a new, potentially pandemic strain on the list of dangerous infectious agents and publication of an order
limiting the conditions of its possession and handling (modification of the order of July 30th 2004).
2A
2A
2A
2A
2A
zoo11
zoo12
zoo13
zoo14
zoo16
AGR SAN
Specific protection of poultry farms producing eggs intended for making vaccines, in cooperation with the Ministry for Health.
Implementation of the emergency plans for ornithological and zoological parks.
Definition of special rules for hunting: practices to be followed, limitation, prohibition, etc.
AGR
AGR ECL
AGR
AGR INT
Determination of an eventual strategy for the vaccination of endangered species.
Provisions relating to poultry markets, bird shops, bird exhibitions, etc.
Keeping in check the spread of the virus among animals and eradicating it
2B
era01
AGR
2B
era02
AGR
2B
era03
AGR ECL
2B
era04
AGR
2B
era05
AGR INT
As soon as a case is confirmed or highly suspected in a poultry farm, destruction of the poultry of that farm and setting up of perimeter of protection (control of traffic,
sequestration of the poultry, preventive slaughtering of the poultry within the perimeter if deemed necessary) and of a larger perimeter of surveillance.
2B
2B
2B
2B
2B
2B
2B
2B
2B
2B
era06
era07
era08
era09
era10
era11
era12
era13
era14
era15
AGR
Destruction or disinfection of the foodstuffs coming from the poultry farms which are infected or located in the protection and surveillance areas.
Inspection and verification of poultry farms located in protection and surveillance areas.
Activation of all the capabilities of the diagnosis laboratories network.
Specific measures for protecting the overseas territories not affected by animal cases, or for protecting France from an affected overseas territory.
2B
2B
2B
2B
era16
era18
era19
era20
AGR ECL
2B
trh01
AGR SAN
In the presence of an identified source of epizootic with a highly pathogenic virus, implementation of the actions provided for in the protocol stipulating the conduct to be
adopted in the presence of an avian influenza centre with a highly pathogenic virus and presenting a proven risk of human transmission during an epizootic in France or in
neighbouring areas, in order to prevent any contamination of people involved in poultry farming, relatives of the breeders and involved veterinary inspectors.
2B
2B
2B
2B
trh02
trh03
trh04
trh05
AGR
Reinforcement of measures of hygiene in affected or threatened poultry farms.
Setting up of a medical surveillance of exposed people.
By decision of the Minister of Health, chemoprophylaxis of exposed people.
By decision of the Minister of Health, vaccination of exposed people with a specific vaccine.
AGR
AGR
OM AGR
Activation of the Ministry of Agriculture’s emergency plan relating to avian influenza. Implementation of planned measures of sequestration and destruction of poultry stocks,
and measures for setting up perimeters and destroying unsafe foodstuff.
Instruction regarding alert from the departmental veterinary services (DDSV) for any suspicious case; systematic information of the DGAl by the DDSVs on any suspicious
case.
Activation of an epidemiological investigation on suspicious or confirmed animals. If it concludes that the wild bird fauna might have been the source of contamination or could
have been contaminated by the affected breeding stock, implementation of stock surveillance and protection measures appropriate for the level of epizootic risk defined by the
scale of epizootic risk.
Sequestration of poultry likely to have been contaminated or to have been the origin of the contamination.
SGAE AGR Information of the European Commission and the International Office of Epizootics.
AGR ECO
Reinforcement of veterinary and customs checks.
AGR
AGR
AGR
AGR SAN
ECL AGR
AGR
AGR INT
Instructions concerning vigilance and the observation of good hygiene practices in the breeding activity given to the professionals in poultry farming.
Over the whole or part of the territory, specific measures for the protection of poultry farms.
Over the whole or part of the territory, implementation of the emergency plans for ornithological and zoological parks.
Specific protection of poultry farms producing eggs intended for making vaccines.
Surveillance of birds belonging to native species or to migrant species that have been signalled.
Definition of special rules for hunting: practices to be followed, limitation, prohibition, etc.
Vaccination of endangered species.
Provisions relating to poultry markets, bird shops, bird exhibitions, etc.
Preventing any transmission to man
SAN
SAN
SAN
Preparing the national system of response to a pandemic
pre00
RAP
January 9th 2007
SAN
Instructions to prefects for the implementation of adapted medical care:
1)ambulatory medical care system for patients; 2) health and social coordination centres; 3) upscaling the “SAMU-Centres 15"; 4) “white” plans for health facilities along with
their “Influenza Pandemic” annex and “blue” plans for medicosocial facilities; 5) expanded “white” plans; 6) intermediate treatment structures.
RAP 1 2A 2B 3A 3B 4A 4B
1
3A 3B
4A 4B
RAP
5A 5B/6 7
5A
3A 3B
3A 3B
RAP
RAP
Definition and test of the capabilities and measures for preventing and controlling the influenza pandemic.
SAN TOUS
Provision of stocks (masks, health products) in health establishments and other storage areas.
Verification of the pre-positioningof health products and equipment in France and overseas; reinforcement of the stocks of health products and protection equipment in
diplomatic posts.
pre04
pre05
SAN TOUS
SAN MAE
SAN
pre06
SAN
4A 4B
5A
pre07
pre08
a
SAN
pre08
b
ECO
pre09
pre10
pre11
pre12
pre13
pre14
pre15
ECO SAN
3B
3A 3B
3A 3B
3A 3B 4A 4B
3A 3B
4A
RAP
TOUS
5A
3A
RAP
pre01
pre02
pre03
4A 4B
4A 4B
4A 4B
5A
5A
5A
ECO
SAN
Constitution of national stocks of health products and protection materials.
Preparation of an order by the Minister of Health in application of article L. 3110-1 of the code of public health, including the measures of quarantine or isolation envisaged as
early as WHO levels 4 or 5, setting up by the prefects.
Order by the Minister of Health in application of article L. 3110-1 of the code of public health, including the measures of quarantine or isolation envisaged as early as WHO
levels 4 or 5, implemented by prefects, to provide for every contingency.
Implementation of the antipneumococcic vaccination of vulnerable people (protection against certain bacterial secondary infections).
Drafting by operators and business managers, in particular those of the economic sectors of vital importance, of their continuity plans intended to ensure, in the long term, the
supply of goods and services. a traduire
Updating by operators and business managers, in particular those of the economic sectors of vital importance, of their continuity plans intended to ensure, in the long term, the
supply of goods and services. a traduire
Reinforcement of the capacities of the French industry for producing masks.
ECO SAN
Verification of the availability of diagnostic tests (PCR primers, quick tests).
Reinforcement of the production of masks by the French industry.
MAE
For French citizens abroad, activation of a network of avian influenza medical advisors and information for the companies employing expatriates.
SAN
Antiviral health products: conditioning of products in bulk into pharmaceutical form.
Production of a vaccine adapted to the present strains and contractual reservation of the future pandemic vaccine.
Preparation of the State services and operators concerned by the management, in the event of a pandemic, of law and order, supplies to the population, the supply of energy,
electronic communications, mail and the banking services.
SAN
TOUS
4B
5A
pre16
TOUS
RAP
4A 4B
5A
pre17
TOUS
RAP
4A 4B
5A 5B/6
pre18
INT
RAP
4A 4B
5A 5B/6
pre19
INT
RAP
4B
5A
pre20
INT SAN
4B
5A
5A
pre21
pre22
pre23
pre24
pre25
pre26
pre27
pre28
pre30
pre31
SAN
pre32
pre33
pre34
pre35
pre36
pre37
SAN
updating and preparing the implementation of continuity plans for administrative bodies, local authorities and companies.
Carefully planned nominative distribution of the personnel indispensable for the operation of structures and accurate and careful planning of as many possibilities of staff relief
as possible.
Organisation of the services of general councils for the support of fragile people within their competence (old people’s homes, handicapped people, children, etc.).
3B
3A
3A
4A
3A 3B
3A 3B
3B 4A
4A
5A
4B
4B
RAP
5A
5A 5B/6
5A 5B/6
RAP
RAP
1
1
1
January 9th 2007
SAN
Organisation of municipal services for the support of the population: placement under alert of the civil defence municipal reserve, contact with social and local associations,
etc.
Implementation of safekeeping measures for facilities that stock protection supplies and health products, hospitals, pharmacies, and the private medical profession.
Ensuring that biological products (blood, grafts, etc.) are virus-free.
INT SAN
Identifying, at departmental level, the health facilities that should stock safety supplies (masks and health products).
Drawing up a plan, at departmental level, for the protection and safekeeping of hospitals, pharmacies and the private medical profession.
SAN
Check of the measures set up for the organisation of care in health establishments (white plans and influenza pandemic plans) and for private medicine.
INT
Preparation of associative action and the mobilisation of volunteers in case of a pandemic.
Designation and equipment of one or two airport platforms dedicated, from situation 4 onwards, to receiving airplanes likely to transport flu patients.
TRA
INT SAN
SAN
Activation, on the instruction of prefects, of measures for the safekeeping of facilities that stock protection supplies and health products.
Prepositionning of health products and protection equipment.
SAN
Setting up of health and social coordination centres.
SAN
SAN
TRA
AGR SAN
SGDN
AGR
Using of the prepandemic vaccine, depending on the progress of knowledge and/or the observed efficiency, based on the conclusion of the last expert evaluations.
Adapting the pandemic vaccination plan based on the characteristics of the virus and the population groups affected (age, state of health, etc.).
Checking that diagnostic tests for mass screening are locally available.
Initiating operation of the airport platform(s) dedicated to receiving airplanes likely to transport flu patients.
Permanent surveillance of the worldwide circulation of avian flu and human flu viruses.
Permanent updating of the plans for the prevention and control of a flu pandemic.
Permanent updating of the plans for the prevention and control of avian flu.
RAP 1 2A 2B 3A 3B 4A 4B
1
3A 3B 4A 4B
5A 5B/6 7
pre38
pre39
RCH SAN
Running a research and development programme on avian influenza, pandemic flu and the means to control them.
5A 5B/6
SAN
RAP
RAP
RAP
5A 5B/6
5A 5B/6
5A 5B/6
pre40
pre41
pre42
TOUS
activation and analysing the last developments relative to useful health products and evaluating the corresponding stocks (vaccines, antiviral drugs, adjuvant products).
Implementation of the continuity plans of ministries, public establishments, territorial communities and companies.
fre02
MAE
4A 4B
3A 3B 4A 4B
SAN
SAN
Pharmaceutical companies get ready for the production of the pandemic vaccine.
Reinforcement of platform facilities for the regulation of SAMU-Centres 15 medical emergency services.
Assisting French citizens abroad
3A 3B
Depending on the local medical capacities for health care and on the condition of the patient, possible health repatriation, to be decided case by case, by a joint decision of the
diplomatic post, the Ministry for Health’s decision-making assistance committee and the patient’s insurer, provided that it will be possible to guarantee the safety of the crew
and of the medical assistance team; before the departure, information of the Ministries for Health and the Interior so as to organise the welcome and hospitalisation.
RAP
3A 3B 4A
5A 5B/6
fre03
MAE
Medical care administered on the spot to possible cases or infected persons of French nationality in the countries affected, using the local healthcare structures, if necessary
with the assistance of the avian influenza medical advisor of the diplomatic post and using the means held by the diplomatic post. a traduire
fre04
MAE
fre07
fre08
fre09
MAE
5B/6
fre10
5A 5B/6
fre11
5A 5B/6 7 fre12
MAE
Examination of the relevance and risks of an express recommendation to French citizens that they leave the countries neighbouring the affected countries, with a health check
on leaving those countries.
If necessary, and the international situation permitting, reinforcement medical teams will be sent to assist the diplomatic posts particularly in demand.
MAE
Setting up of a support system for tourists and non-resident French nationals who could not been repatriated in time.
7 fre14
7 fre15
MAE
fre16
MAE
fre18
MAE
4A
RAP
RAP
RAP
4A
RAP
4A
4A
4A
5A
5A
5A
RAP
5A
RAP
MAE
MAE
Recommendation made to relatives of expatriates, to french students abroad and to non-indispensable agents of the State to return to their home country (decisions different
depending on whether the countries are affected or threatened).
Limitation of the number of agents of the State abroad strictly to the number of indispensable posts.
Closing of French schools and cultural centres in the countries affected and the neighbouring countries, on decision of ambassadors
MAE
MAE
Mobilisation of diplomatic missions to inform French nationals about the development of the crisis. Assistance to people in mourning and seriously affected people.
Local consultation with companies employing French nationals about the return to normal of their local staff numbers.
Reopening of French schools and cultural centres in the countries affected and the neighbouring countries, as appraised by ambassadors.
Modification of the Ministry of Foreign Affairs’ Web site “Advice for Travellers”.
Placing in alert mode and/or sending, upon agreement of the foreign local authorities, and in liaison with the ministries in charge of health and defence, a reinforcement
consular and medical mission, depending on the resources of the Countries affected and the means available to the French representational mission.
RAP
4A
RAP
RAP
4A
4A
5A
fre19
MAE SAN
fre21
fre22
MAE
Activation of the MAE/DFAE (Ministry of Foreign Affairs/Directorate of French nationals abroad) crisis committee.
MAE
Sending the updated number of French nationals by postal service(s).
Setting up, depending on the level of means available locally, a complement of care and protection means appropriate for the number of people requiring assistance.
Postponing the introduction of cases on the national territory
RAP
imp01
SGAE
imp02
TRA SAN
imp03
TRA SAN
imp04
MAE TRM
If air connections with those areas are maintained, strong advice against travel to those areas is expressed; no repatriation of diseased people; possible quarantine of people
on their return (very limited capacity).
imp05
imp06
TRM
Non essential travelling is strongly discouraged.
5A
TRM
imp08
imp09
MAE
4A
5A
5A
SAN
Non essential travelling is categorically advised against.
Suspension in the affected countries of the delivery of visas to travel to France.
Reinforcement of health checks at boarders.
4A
5A
imp10
SAN
Setting up of a system for the traceability of travellers on their arrival.
4A
5A
4A
5A
RAP
4A
4A
RAP
RAP
January 9th 2007
Request for an emergency meeting of the Member States of the European Union to study the measures to be taken at the EU level (limitation of the delivery of visas and
entries into the Schengen space, limitation of air travel, quarantine on arrival, etc.); consultation of the Member States and the Commission on the nature and scope of the
measures of control envisaged by France (simple information in case of emergency).
Suspension of air, sea or land connections with the areas affected; for people travelling from those areas at that time, preventive quarantine on arrival (very limited capacity).
Interruption of air, sea and land links with affected Countries; travellers already on their way from such Countries at the time the decision is taken must be placed under
preventive quarantine upon arrival (very limited capacity).
RAP 1 2A 2B 3A 3B 4A 4B
RAP
5A 5B/6 7
5A
imp12
MAE
5A
imp13
imp14
imp15
imp16
MAE
coo01
MAE SAN
Contribution to WHO action to help affected Countries to contain the epidemic. International consultation to study the isolation measures to be implemented, in collaboration
with affected Countries.
7 coo02
MAE SAN
Sharing of what has been learned with affected Countries.
5B/6
5B/6
5B/6
RAP
RAP
RAP
INT
TRA
SAN
Quarantine (very limited capacity) or prophylactic treatment measures extended to French nationals coming from neighbour Countries of affected Countries.
Setting up, if possible, of a sanitary check on leaving countries neighbouring the affected countries.
Boarder checks, which can be effective if they are put in place early enough (this implies European cooperation). Maintenance of freight movements as a priority.
Interruption of international passenger arrivals and departures, particularly by air, as they are a vector for importing the epidemic.
On arrival of the flights from affected Countries at the time interruption is decided, placing of crew and passengers under quarantine (very limited capacity).
Assisting the affected countries
4A
Detecting and signalling human cases on the national territory (home country and overseas)
RAP
3A 3B 4A 4B
5A
det01
SAN
Activation of the InVS’s clinico-epidemiologic assessment committee.
RAP
3A 3B 4A 4B
5A
det02
SAN
RAP
RAP
3A 3B 4A 4B
4B
3A
4A
3B
3A 3B 4A 4B
5A
det04
det05
det06
det07
det08
SAN
SAN
Circulation of the protocol for taking care of possible cases towards health facilities, emergency medical services including the SAMU and Centres 15, airport medical services
employee medical services and national influenza reference centres.
Placement under alert and/or reinforcement of the two surveillance networks GROG and “Sentinelles”.
Reinforcement of the network of influenza diagnosis laboratories.
In the event of suspicion of an imported case, immediate recourse to the InVS’s clinico-epidemiologic assessment committee; the InVS shall inform the Ministry for Health.
SAN
In the event of suspicion, immediate recourse to the InVS’s clinico-epidemiologic assessment committee; the InVS shall inform the Ministry of Health.
SAN
Despatch of biological samples to the laboratories entitled to handle the avian virus or to the national influenza reference centres for confirmation; as soon as confirmation is
established, the InVS shall inform the WHO and the European Commission.
RAP
5A
5A
SAN
Taking care of suspicious cases, contact persons and diseased persons
cas01
cas02
SAN
5A
cas03
SAN
5A
cas04
SAN TRA
cas05
AGR SAN
3B 4A 4B
3B
5A
RAP
4A 4B
RAP
3A 3B 4A 4B
RAP
3B
4B
4B
4B
RAP
RAP
4B
4B
4B
RAP
RAP
Management of patients detected while travelling to France, following a specially defined procedure (cf. technical information sheet D2).
If the emergence of human cases evidences an epizootic outbreak in France, application of the protocol stipulating the conduct to be adopted in the presence of an avian
influenza outbreak with a highly pathogenic virus and presenting a proven risk of human transmission during an epizootic in France or in the neighbouring areas.
Application of the public health strategy defined by the Minister of Health, indicating the consequences for dealing with other illnesses (prioritisation), specifying the doctrine
followed for the use of antiviral medicines and proposing priorities for the use of limited resources.
Implementation of the order signed in application of article L. 3110-1 of the public health code (measures of isolation, quarantine if necessary, etc.).
cas06
SAN
5B/6
5A 5B/6
5B/6
5B/6
5B/6
cas07
cas08
cas09
cas10
cas11
SAN
SAN
Setting up of an ambulatory care system in the community.
Care-taking of patients requiring continuous monitoring or complicated acts of resuscitation by health establishments, following regulation by the SAMU-Centre 15.
5B/6
5B/6
5B/6
cas12
cas13
cas14
SAN
Implementation of a particular organization for the transport of patients, laboratory analyses, etc.
SAN
Launch of “white” plans and flu pandemic plans for hospitals and “blue” plans for facilities housing elderly people.
Implementation by the département prefects of the extended “white plans”, which are the coordination tools for all the health actors in a crisis situation.
5B/6
cas15
SAN
Setting up of collective structures other than hospitals to receive housebound patients; in these structures, which do not perform the functions of hospitals, the patients will
receive medical care and be visited regularly by community doctors, in the same way as in their own homes; transfer of patients to a hospital if their condition worsens.
cas16
SAN
cas17
cas18
SAN
As soon as there are too many suspected cases, management in health care facilities is restricted to patients requiring continuous monitoring or intensive care, after
orientation by the SAMU-Centres 15 emergency medical services.
Setting up of health and social coordination centres.
Implementation of the plan for the distribution of products and protection equipment.
5B/6
5A 5B/6
January 9th 2007
Organisation of patient management (preferably in a hospital setting).
Care-taking of diseased persons and possible cases according to the protocol stipulating the conduct to be adopted in the presence of possible cases of influenza presenting
a new viral subtype without interhuman transmission.
Care-taking of infected persons and possible cases according to the protocol stipulating the conduct to be adopted in the presence of possible cases of influenza presenting a
new viral subtype with interhuman transmission.
5B/6
RAP
RAP
SAN
SAN
SAN
SAN
SAN
SAN DEF
Suspension of the system of registration with one particular physician and implementation of administrative measures simplifying the care of patients. [AP-HP]
Medical care of persons affected by influenza and of their contacts according to the procedure defined at different levels for a pandemic situation.
RAP 1 2A 2B 3A 3B 4A 4B
5A 5B/6 7
Keeping in check the spread of the human virus and eradicating it
erh01
SAN
Contact tracing of the index and subsequent human cases and, in case of outbreaks of the disease affecting animals in France, of the people who were in contact with
diseased animals.
4B
erh02
SAN INT
4B
4B
erh03
erh04
SAN
Setting up of health control and traffic barriers, including inside the national territory (in France and overseas), intended to confine the virus within the areas affected and to
protect unaffected areas.
The InVS shall inform the WHO and the European Union about the emergence of clusters in France (Early Warning Rapid System message - EWRS).
4B
erh05
TRA
4B
4B
4B
erh06
erh09
erh10
SAN
Request for an emergency meeting of the Member States of the European Union to study the measures to be taken; consultation of the Member States and the European
Commission on the nature and scope of the measures of control envisaged by France; Inform the WHO and the European Union on the measures decided (EWRS message
transmitted by the DGS on the initiative of the interministerial crisis committee).
Interruption or suspension of travel by air, sea and land to foreign countries and the overseas territories (or to the home country if the overseas territories are affected). a
traduire
Specific measures for taking care of contact persons (quarantine at home and, if necessary, prophylactic treatment using antineuraminidases).
SAN
Antiviral drug prophylaxis if necessary, by proposition of the Minister of Health.
3B
3B
RAP
SGAE
SAN
If new human cases are suspected, the DDASS shall immediately inform the InVS, DGS, DHOS, DGT, ComSegur and COGIC by the prefect.
Slowing down the transmission of the virus on the national territory
RAP
4B
5B/6
bar01
TRA
During the initial phase of the epidemic, interruption or reduction of some local collective transport facilities, which are potential places for viral transmission (depending on the
virulence of the virus and the necessity of ensuring their operation).
RAP
4B
5B/6
bar02
SAN EDU
AGR JSP
RAP
4B
4B
4B
4B
5B/6
5B/6
5B/6
5B/6
5B/6
5B/6
bar03
bar04
bar05
bar06
bar07
bar08
SAN INT
Closing of day nurseries, educational and training facilities, boarding schools, youth facilities (a measure with proven efficiency, essential for limiting transmission during
Interruption of collective activities: entertainment, sports events, fairs and exhibitions, large meetings, etc. and curbing of cultural activities.
Restriction of visits and/or control of access to hospitals, old people’s homes, reception centres, prisons, etc.).
Restriction of non-essential professional, social, educational and associative activities.
5B/6
5B/6
5B/6
bar09
bar10
bar11
SAN
bar12
TOUS
5B/6
bar13
SIG
As soon as the pandemic vaccine is available, implementation of the vaccination plan.
Reminder and individual application of the standard principles of hygiene (hand washing, etc.).
Wearing of respiratory protection for health professionals, rescue personnel and any other people whose missions imply repeated contact with diseased persons; wearing of
surgical masks for patients; recommendation that unaffected people wear a surgical mask in public places, as a precaution.
Wearing of respiratory protection for health professionals, rescue personnel and any other people whose missions imply repeated contact with diseased persons; wearing of
surgical masks for patients.
Limitation of individual movements to those strictly necessary, by appealing to the sense of civil responsibility.
5B/6
bar14
JUS
Setting up of specific measures to protect prison facilities.
5B/6
mtn01
ECO AGR
INT
Gathering by the State services of information coming from companies, distribution platforms and purchasing groups so as to be able to direct the organisation of supply
according to the way the products available are distributed over the different areas.
5B/6
5B/6
5B/6
mtn02
mtn03
mtn04
SAN
TOUS
Strict observance by people presenting influenza symptoms of the instructions of confinement at home and regulation by the health system
Implementation of the continuity plans of ministries, public establishments, territorial communities and companies.
Verification by each ministry that there is coherence between the measures taken by the socio-economic players in its own sectors of activity and the global strategy defined
by the Government.
5B/6
5B/6
5B/6
5B/6
5B/6
mtn05
mtn06
mtn07
mtn08
mtn09
ECO INT
Activation of zone committees for monitoring supplies and activities, attached to the zone operational centre.
ECO
Control of the distribution of energy resources, raw materials, industrial products and products necessary for supply.
ECO
On proposal by the Minister of Finance, establishment of price control.
Requisitioning of persons, goods and services.
Use of alternative modes of organisation :
- development of work at home and teleconferencing, at all hierarchical levels ;- mutualisation of resources, extraordinary complementary missions performed by some
categories of personnel, resort to persons made available by the closing of establishments, etc…;- resort to “young pensioners”, experienced students, reservists from the
police and the civil defence services, voluntary workers, people having recovered from the illness (immunised in principle) etc …;- local solidarity (agricultural sector for
example);- transfer of activities to less affected regions, etc.
RAP
4B
4B
RAP
4B
RAP
SAN JUS
TOUS
SAN
OM TRA
SAN INT
SAN
TOUS
Ring protection around initial cases; isolation measures; use of masks; management of people in contact with disease cases.
Protection of unaffected overseas territories (or of France from an overseas territory affected); restriction of passenger transport.
Depending on the situation, encouragement or restriction of movements to make towns less crowded and/or of interregional movements.
Maintaining essential activities
RAP
January 9th 2007
TOUS
TOUS
RAP 1 2A 2B 3A 3B 4A 4B
5A 5B/6 7
5B/6
mtn10
EDU JSP
TOUS
Closed establishments (educational establishments, sports centres) made available by all ministries and local authorities to meet all needs having priority in the control of the
epidemic or the preservation of the country’s activity.
5B/6
mtn11
TOUS
For facilities whose activities cannot be stopped (including some research laboratories), implementation of precautionary measures, such as keeping the teams on the spot or
having relief teams go through a “quarantine decompressionchamber” (isolated room in which the relief shift remains for the nominal duration of the incubation).
5B/6
mtn12
IND ECL
Making safe pre-identified facilities which, if the numbers of staff present were insufficient, might prove dangerous for the population; taking account of the time required for
industrial activities working continuously to come to a standstill; planning of relief staff taken among the staff consigned at home since the beginning of the crisis.
5B/6
5B/6
mtn14
mtn15
TOUS
Ministries’ control and link channels: preservation of the full operational capacity.
DEF
Defence: missions of continuity of the governmental action for the preservation of strategic military functions (deterrence, means of communication); missions of civil-military
cooperation in the fields of governmental continuity, contribution to security and assistance to the population.
5B/6
mtn17
INT
Law and order: conduct of missions according to the priorities defined and updated by the Ministry for the Interior, taking account of the needs expressed by the ministries
(protection of hospitals, stocks and transport of protection equipment and health products, commercial establishments, etc.).
5B/6
mtn18
JUS
Justice: penal activities essential for the preservation of law and order; for the penitentiary administration, maintenance and monitoring of persons placed in the hands of
justice.
5B/6
mtn19
IND TRA
5B/6
mtn20
AGR SAN
Production and distribution of energy: continuation of the “production” function, in degraded mode if necessary; integral preservation of the “safety” function; supply of transpor
having priority; supply of domestic fuel for the heating of houses.
Food supplies: supplying of the population, via commercial establishmentsand distribution platforms in particular; collection of milk; milk product industries; food for farm
animals.
5B/6
mtn21
ECO
5B/6
mtn22
ECO TOUS Electronic communications:
Financial circuits and means of payment:
- supply of bank notes to banks and ATMs; delivery of minimum social benefits, notably by post;
- maintenance of the continuity of interbank payments, financial markets, stock exchange activities and the insurance sector.
- governmental liaisons;
- liaisons concerning essential activities, and in particular those essential for population health and safety.
January 9th 2007
5B/6
mtn23
SAN
Pharmaceutical and medical industry: production of indispensable health products and of medical equipment; supply to the medical care system.
5B/6
mtn24
SAN IND
Production of protection materials, cleaning and hygiene products: masks of all kinds, single-use gloves, protection goggles, all viruskilling and disinfecting products, soap,
disposable handkerchiefs, etc.
5B/6
5B/6
mtn25
mtn26
SIG DDM
Audiovisual: information of the various public groups on the course of the pandemic, maintenance of audiovisual means.
TRA
5B/6
mtn27
SAN ECL
Transport: infrastructures and networks; services of control, regulation and exploitation; planning of transports having priority (foodstuffs, health products, medical oxygen,
water treatment products (chlorine, etc.), hydrocarbons, biomedical waste, freight to overseas territories); missions of Météo France (the French meteorological office) having
priority.
Continuous operation of drinking water production and distribution facilities.
5B/6
5B/6
mtn28
mtn29
TOUS
Maintenance of all the kinds of information systems (networks, means of data processing, etc.).
DEF
Reincorporation of reservists of the operational military reserve to ensure, as a priority, the operation of the chain of the defence interarmed forces territorial organisation.
5B/6
mtn30
DEF
Restriction and health control before access to deterrence facilities, facilities dedicated to means of intervention,facilities on alert and crisis management centres.
5B/6
5B/6
mtn31
mtn32
DEF
Limitations in the relief of military detachments in operations or stationed abroad.
DEF
Limitation or stoppage of non-essential activities (drills, training courses, missions, etc.).
5B/6
5B/6
5B/6
mtn33
mtn34
mtn35
DEF
Specific rules applied to calls in ports or stopovers at airports, movements across borders and multinational drills.
JUS
Adaptation of penal and jurisdiction operation procedures.
Operational cover of rescue missions by redeployment of manpower and use of the civil defence municipal reserve; preservation of the regulation of assistance to people by
the SAMU-Centre 15.
INT SAN
RAP 1 2A 2B 3A 3B 4A 4B
5A 5B/6 7
5B/6
mtn36
INT
Application of provisions from the Ministry of the Interior’s guide on methodology. Make prefects take action by way of decrees aiming among other things at:
- prescribing the immediate placing of bodies in coffins (art. R2213-18 of the CGCT code);
- suspending legal time lags (art. R2213-33 and 35 of the CGCT code);
- adapting the regimen for authorisations regulating post-mortem operations;
- applying derogations for technical prescriptions applicable to funeral vehicles (art. R2223-58 of the CGCT code);
- limiting the surveillance regimen for funeral operations and associated leave;
- disallowing thanatopraxy rituals
- mobilising scheduled and appropriate support means.
5B/6
mtn37
AGR
If a significant amount of time is available, people will be encouraged to build up a reserve of non-perishable food and bottled water; grouped purchases should be encouraged
instead of repetitive purchases of items in small quantities which would lead to an affluence of people, undesirable in a period of epidemic; if the time available is reduced,
mass purchases likely to lead to unjustified shortages will be discouraged.
5B/6
mtn38
INT SAN
Implementation, encouragement and supervision, by the local communities, of actions of solidarity between neighbours for the benefit of isolated or dependent people, or of
families having to stay at home to take care of one or several patients; use of the lists of isolated elderly people and disabled people, instituted by decree No. 2004-926 of
September 1st 2004, and updated by town halls.
4B
5B/6
mtn39
INT SAN
Recourse to volunteers, based in as much as possible on existing associations; application of the statute of occasional public service collaborator to volunteers overseen by
these associations and /or designated by administrative authorities.
4B
5B/6
mtn40
INT SAN
4B
5B/6
5B/6
5B/6
5B/6
mtn41
mtn42
mtn43
mtn44
mtn45
ECO
ECO
SAN
SAN INT
5B/6
5B/6
mtn46
mtn47
IND
On the initiative of local authorities, census of people (isolated or homeless people, etc.) and identification of their needs (food, medicine and essential products delivery; day
nursery needs, etc.).
Assistance to people without resources as a result of the epidemic.
Definition of appropriate modalities for the recovery of debts and credits for essential services.
Psychological support of relatives victims.
Care-taking of isolated children and non-infected dependent people.
For municipalities, public facilities for inter-municipal cooperation and mixed syndicates in charge of eliminating household waste:
- acquisition and organisation of the distribution of plastic bags (with ties) for waste disposal of home-based patients.
For health care facilities and hospitals:
- checking that manufacturers have enough stocks of ADR approved cardboard boxes to store infectious health-care waste, in the case of a crisis.
- identifying in link with the prefectures and local communities, the opening storage reserved for infectious health care waste if necessary .
Implementation of the Hydrocarbons resources plan.
Immediate implementation, by operators and business managers, of a mode of operation with reduced manpower and the constitution of “reserved” relief teams, if necessary
isolated according to a public health plan.
5B/6
5B/6
5B/6
mtn48
mtn49
mtn50
TOUS
IND
Encouragement and implementation of substitution solutions (electronic mail).
Reduction of non-essential postal services (processing of advertising mail, etc.).
Suspension of the distribution of advertising documents by carriers.
5B/6
5B/6
mtn51
mtn52
TOUS
Call for the implementation of social distanciation measures: distance working, teleconferences, limitation of meetings and travel, etc.
TRV
Setting up of a work exchange by the ANPE national employment agency in order to reassign employees to priority activities.
5B/6
mtn53
TOUS
5B/6
5B/6
5B/6
5B/6
mtn54
mtn55
mtn56
mtn57
SAN
TRV
Mobilisation of cured or immune people, in particular for essential activities and tasks requiring contact with patients.
Obligation to wear a mask in certain places.
Implementation of measures relative to partial unemployment.
TRA
Redistributing transport activities (road, railways, sea, rivers) in favour of priority needs.
5B/6
5B/6
mtn58
mtn59
INT
RAP
4B
4B
4B
4B
January 9th 2007
5A
ECL
TOUS
IND
EDU
ECL
Broadcasting of pedagogical programs by audio and audiovisual means.
Call for the civil defence municipal reserve.
- continuation of collection and disposal of household waste (including infectious waste);
- suspension of sorting in waste treatment facilities in order to reduce the risk of exposure of the employees involved and concentration of means on the collection and
disposal of residual household waste;
- suspension of composting of certain waste products if there is a risk it propagating the epidemic;
- protection of waste collection employees (masks, gloves, goggles, etc.);
- maintenance of the activity of waste water treatment plants.
RAP 1 2A 2B 3A 3B 4A 4B
5A 5B/6 7
5B/6
mtn60
ECL
- authorisation/creation of intermediate storage sites;
- in case of shortage, distribution of plastic bags with ties for home-based patients to dispose of waste.
For healthcare and hospital facilities:
- the acquisition of sufficient stocks of cardboard boxes for the storage of infectious health-care waste, if necessary;
- request for opening storage sites reserved for infectious health-care waste, if necessary.
Assessing the situation and anticipating its developments
RAP
RAP
5B/6
eva00
eva01
SAN MAE
4B
4B
5B/6
eva02
SAN
5B/6
eva03
MAE
4B*
5B/6
eva05
SAN
Forecast updated daily, if possible, of the evolution of the epidemic, taking account of the data of the activities of health establishments and the census of deaths at home or in
establishments.
Diplomatic posts in the affected countries shall inform the Ministry for Foreign Affairs and the interministerial crisis committee of the means and measures for fighting the
disease engaged by foreign countries.
Collection, as soon as it is possible, of all the parameters and indicators for the follow-up of the public health situation so as to adapt the system of response to the pandemic.
4B
5B/6
eva06
SAN
Follow-up of the balance between the consumption and supply of health products and protection and hygiene facilities.
eva07
eva08
eva09
eva10
eva11
ECO SAN
Monitoring of health and socio-economic situation indicators
MAE
Information of the Ministry of Foreign Affairs, by all diplomatic missions, on the economic, social geopolitical and health situation of the various Countries.
Analysis of the problem of seriously affected businesses.
Analysis of the insurance question.
Analysis of the problem of families having suffered particularly heavily from the pandemic.
RAP
RAP
7
7
7
7
7
TOUS
ECO
ECO
ECO
Permanent updating of the epidemic situation and development forecast abroad and in France if applicable.
Setting up and circulation of a daily synthesis of the situation by each ministry, based on the indicators that it will have previously defined ; surveillance intended to anticipate
the difficulties that may arise; to this effect, association of the operators with its competence.
Informing the general public, the managers, the professionals and the companies
Information of travellers and expatriates about the precautions to take in Countries affected by the epizootic
4A 4B
inf01
5A 5B/6 7 inf02
MAE
TRA
4A 4B
5A 5B/6
inf05
MAE
inf09
AGR
Information of French nationals about the principles of local management of putative cases and disease cases.
Information of bird farmers, hunters and veterinarians about the risks linked to avian influenza and respect of health protection rules for breeding stocks.
inf10
inf11
inf12
inf13
7 inf14
inf15
AGR
Recommendations to breeders, hunters and veterinarians and their families in case of suspected or confirmed cases of avian influenza.
SAN EDU
Training of the school population by teachers and health professionals in order for it to learn about measures to avoid contamination via avian-flu affected birds.
Information of the population in affected areas about the closure of day nurseries and teaching and training facilities.
Information about the closure of day nurseries and teaching and training facilities.
Information of the public about the lifting, modification or maintenance of barrier measures.
2A 2B 3A
RAP
2A
2B
2A 2B 3A 3B
4B
RAP
2A 2B 3A
3B 4A 4B
5A 5B/6
RAP
2B 3A
January 9th 2007
SIG
SIG
TOUS
Information (by the relevant ministry in charge) of private health professionals, regional flu observation network (GROG) physicians, health facilities and SAMU-Centres 15
medical emergency services, pharmacists, rescue services, biological analysis laboratories, armed forces health services, employment medical services and educational
establishments about the conduct to adopt in the situations defined by the governmental plan.
inf16
TOUS
Information on the situation communicated by relevant ministries to private health professionals, GROG network physicians, health facilities and SAMU-centres 15,
pharmacists, rescue services, biomedical analysis laboratories, health services of the Armed Forces, employment medical services and educational communities; information
on the detection of cases, alert procedures and conduct.
inf17
TOUS
Information (by the relevant ministry in charge) of private health professionals, regional flu observation network (GROG) physicians, health facilities and SAMU-Centres 15
medical emergency services, pharmacists, rescue services, biological analysis laboratories, armed forces health services, employment medical services and educational
establishments about the procedures to follow, means of protection (masks), and conduct.
SAN
Information of private and hospital health professionals and pharmacists about the lifting, modification or maintenance of health measures and about new measures to be
implemented.
SIG
Information of the general public on the risk of avian influenza, measures for limiting contamination and the consumption of poultry.
Information of the general public on measures to prevent contamination in case of an epizootic and on the consumption of meat and poultry and the possible risks link to the
domestic animals.
7 inf18
2A
SIG
Information of international airport and port business activities, travellers, travel agents and freight transport businesses about prohibitions and restrictions and/or special
measures concerning international exchanges.
inf19
inf20
SIG
RAP 1 2A 2B 3A 3B 4A 4B
3B
4B
RAP
2A 2B
3B
4B
2A 2B 3A 3B
4A 4B
2A 2B 3A
2A
RAP
4A 4B
2A 2B 3A 3B 4A
5A 5B/6 7
inf21
inf22
inf23
SIG
5B/6 7 inf24
SIG
inf25
inf26
inf27
5A 5B/6
inf28
7 inf29
inf30
5A 5B/6
inf32
7 inf33
inf34
inf35
5A 5B/6
inf40
SIG
5A
EDU SAN
5A 5B/6
inf41
SIG
SIG
Information of the general public about the situation and protection measures against the virus.
Regularly inform the general public in contaminated zones about the behaviour to adopt; call for solidarity between citizens.
Information of the general public about the situation, the rules to follow and the behaviour to adopt, including the immediate reporting of any flu symptoms and their
aggravation; call for neighbourhood solidarity.
Information of the public about the various means of support available (economic, social, psychological).
SIG SAN
Sensitization of the media to the problem of avian influenza.
Regular information of the media on the situation and the protection measures directed towards the population in order to limit the transmission of the virus.
Regular information of the media and the public about the map of affected zones in France, the situation in these zones and the precautions to be taken.
Regular information of the media on the situation and appropriate behaviour for protection.
SIG SAN
Information provided to the media about the situation and the evolution of measures.
SIG
Sensitization of public and private companies about the problem of a flu pandemic and encouragement to prepare for it.
SIG
Information of public and private companies about the situation and the rules to adopt.
Information of public and private companies about any measures that concern them.
SIG SAN
SIG SAN
ECO
INT
INT AGR
TOUS
Sensitization of elected representatives about the risks of pandemic and the measures to be taken.
Sensitization of elected representatives about the measures to implement in the face of epizootic foci and the measures for limiting contamination.
Activation of telephone platforms of the ministries of health and foreign affairs, and of the crisis service of the 3939 telephone platform.
Promotion addressed to children, youngsters and teachers of elementary gestures for preventing the transmission of respiratory diseases.
Preparing the national response system for a new pandemic wave
7 rep01
7 rep02
7 rep03
SAN
TOUS
Evaluation and replenishing of remaining stocks of health products and biomedical supplies.
Preparation of the Health Minister’s decrees in application of art. L. 3110-1 of the public health code, on the modification or lifting of health measures.
Organisation of meetings on experience returns with operators and businesses.
7 rep04
7 rep05
SAN
Evaluation of the stock of masks and replenishing via dedicated production lines.
7 rep06
7 rep07
SAN
For French nationals abroad, maintenance of monitoring by a network of flu medical advisors; information of companies employing expatriates.
Analysis of the efficiency of treatments and countermeasures (quarantine, prophylaxis, etc.); updating of protocols.
SAN
Implementation or continuation of vaccination. Evaluation of pandemic vaccine stocks (quantity, schedule, vaccination priorities).
SAN TOUS
MAE
Assisting the population and helping the resumption of social and economic activity
January 9th 2007
7 ass01
TOUS
7 ass02
ECO SAN
7 ass03
7 ass04
ECO
TOUS
7 ass05
7 ass06
7 ass07
ECO
ECO
ECO
Implementation of forum discussions on the pandemic and its consequences (work on resilience) for the population and the players involved (health professionals, rescue
services, etc.).
Support for families affected by the pandemic. Material assistance to people without resources. Social and psychological management of vulnerable people.
Follow-up of procedures of compensation by insurance companies.
Collection by State services of information of all kinds allowing to make a precise evaluation of the socio-economic situation and its evolution. Identification of activities
needing to be re-started as a priority.
Preparation of a system to re-start the economy.
Analysis of the mechanisms for helping sectors undergoing difficulties.
Progressive and coordinated lifting of exceptional measures by the prefect of the département (health and social coordination centres, intermediate structures, “white”
plans…).
ANNEX 1 Permanent Actions at Governmental Level
The Prime Minister defines the interministerial system for preventing and controlling the influenza pandemic.
He/she relies on:
-
the ministerial delegate for the fight against avian flu (DILGA), who coordinates governmental action to
control this risk and follows the implementation of measures decided as part of the plan; the missions of the
delegate are defined by decree n°2005-1057 of 30 August 2005; the delegate ensures the implementation of
measures against a possible avian epizootic, works to prevent a pandemic and, if necessary, organises patient
management; the delegate also works to develop international cooperation and ensure consistency between
governmental action and the action of international organisations, non-governmental organisations, local
authorities and companies;
the SGDN (General Secretariat for National Defence), who permanently updates the “Influenza pandemic”
governmental plan and organises major drills;
the SGAE (General Secretariat for European Affairs), who participates in developing France’s position on
issues treated by European institutions and conveys this to the permanent French European Union
representatives;
the high defence official in charge of information, responsible for the circulation of governmental
communications to the population in a pandemic situation;
-
the government information system (SIG) takes part in preparing and implementing the communication
strategy. It ensures the coordination of public information and the sharing of information between all players.
Each minister permanently takes all necessary measures of anticipation, planning and organisation:
-
to guarantee the implementation of priority missions in his/her sector during the epidemic. To this effect,
he:
oensures he has the capacity to execute the governmental plan measures and permanently updates his
continuity plan, including its health protection aspect, in the event of a pandemic;
oensures the preparation and updating of plans for public facilities placed under his responsibility, makes sure
operators in the sectors of activity attached to his ministry are informed, and encourages them to prepare
continuity plans.
oprepares the information concerning particular fields for communication to selected groups among the
public;
odefines the indicators of the status of critical resources and their availability in the event of a pandemic, as
well as the information channels to acquire and convey the data;
odetermines the activities that would require protection by security forces, particularly in the event of a breach
of peace during a pandemic period;
-
to ensure that the means, equipment and supplies within his field of competence are available in sufficient
quantity and are, if necessary, distributed before the triggering of the pandemic phase and/or are available
throughout the pandemic. To achieve this, he:
oinforms the Minister of Health of his needs in terms of preventive means of any kind : masks (at the expense
of each ministry), vaccines and the needs of the sectors of activity he is responsible for;
oindicates to the Minister of Transport the supplies to be maintained as a priority (hydrocarbons, food,
medical and health products, hygiene and cleaning products, chlorine for drinking water networks, etc.)
and the recommended means of transport;
oidentifies the facilities that may prove dangerous to the population if insufficiently staffed and may have to
be made safe in a situation of staff shortage. Particular attention is given to Seveso sites.
The Minister of the Economy, Finance and Industry, in liaison with other ministers,
- prepares the measures to manage priorities for the supply and distribution of first necessity products, to
control prices and to fight against fraud.
- coordinates the development and gathering of economic indicators,
-
Publish guides of good practice developed in collaboration with the various sectors of activity in order to
prepare company continuity plans.
The Minister of Health:
-
-
-
-
-
ensures an epidemiological surveillance relative to influenza;
prepares all the measures ensuring that, in the event of a pandemic, the health strategy is implemented by
all health professionals, whether working in the private or public sector;
ensures the good quality of medical management in mainland and overseas French territories as well as for
French nationals abroad; ensures that appropriate measures are put in place in French mainland and
overseas territories for the organisation of care in health facilities (white plans) and via ambulatory
medical care;
makes reserves, or has reserves made, of prophylactic or therapeutic products and equipment, of tests for
the detection of the virus or antibodies directed against it, and makes plans for their distribution;
- defines the vaccination policy; prepares the plans for vaccination, and ensures there is an appropriate
supply of pandemic vaccine, vaccine against the avian virus and antipneumococcal vaccine; proposes, if
necessary, a reinforcement of the production infrastructure on national territory;
keeps an updated record of production capacities, orders and supplies of medical means, medicines
(antiviral medicines, immunoglobulins, etc.), vaccines and means of injection; makes sure they are
available in sufficient quantity in the event of a pandemic, estimates additional needs and proposes all
measures to meet them; determines the national dependence with regard to the supply of intermediate or
final products and proposes all measures to reduce this dependence;
oversees the national influenza reference centres and directs their activity;
plans the organisation of biomedical analysis laboratories in the event of a pandemic;
takes the necessary measures to reduce the time for authorising the pandemic vaccine(s);
in relation with the WHO’s recommendations, encourages vaccination against seasonal influenza, in
particular for vulnerable populations and certain professional categories, independently of any pandemic
threat;
defines the rules that will ensure virological safety and the availability of biological products (blood,
grafts, etc.) in the event of a pandemic.
During a pandemic, the Minister of Health and the Minister of the Economy, Finance and Industry take the
steps required to meet primary needs in products that are not specifically medical but contribute to the public
health response: masks, means of protection and hygiene (clothes, goggles, disinfectants), medical thermometers,
etc. In collaboration with manufacturers, they promote the adaptation of the production required to implement
the plan.
The Ministry of the Interior:
- steers and coordinates the action of State civil services in the Departments;
- guarantees public order;
- ensures the preparation of emergency medical services;
- encourages local authorities to prepare themselves, particularly as regards proximity assistance to patients
and isolated individuals;
-
ensures that health products and protective equipment are safe, in collaboration with the Ministers of
Defence and Health; ensures the safety of health facilities, pharmacies and private physicians;
transmits at departmental level any governmental communication on the pandemic.
The Minister of Agriculture:
-
-
watches for the presence of flu viruses in birds and animals in general. He follows the circulation of
influenza A viral strains of low-pathogenicity sub-types; he ensures the surveillance of breeding stocks,
the implementation of necessary health protection measures and follows the world epidemiological
situation, in liaison with the International Office of Epizootics;
ensures the supply of food resources.
He is also in charge of:
- studying the measures aiming at limiting the risks of introduction of an animal disease into the European
Community;
- regular action to make breeders aware of the necessity of complying with the rules of public health
protection;
-
monitoring the elaboration of Departmental emergency plans, according to a model defined at national
level;
the closure of farming education establishments, as soon as it is decided.
The Minister of Foreign Affairs drafts the measures required for protecting and taking care of French citizens
abroad as well as those concerning the international aspects of the crisis.
He informs foreign Governments about the progress of the French system and, if necessary, sends them requests.
Exchanges of information with EU Member States, the EU Council and the Commission, as well as with
international organisations, are achieved according to the data presented in chapter 11.
Cross-border coordination is ensured within the framework of existing mechanisms.
The Minister of Defence takes part in preparing the national system and takes all necessary measures to
preserve strategic military functions and, in the event of a pandemic, allow the participation of the Armed Forces
in civil defence missions, within the limits of the numbers available by the operation of the ministry in degraded
mode and the attrition resulting from the pandemic.
The Minister of Justice prepares the elements of penal policy allowing regulations dictated by the authorities in
charge of managing the pandemic crisis to be respected.
The Minister of Transport prepares the measures for distributing products indispensable to economic life and
any measure to limit public transport, decided by the Government or State representatives; he ensures that
transport operators and travellers are informed. The Minister of Tourism ensures that travel agencies are
informed.
The Minister of Overseas Departments and Territories makes sure that the specificities of overseas territories
are taken into account in the preparation of the plan and ensures it is implemented according to the principle that
the same level of equipment supply and medical care must be provided for overseas and mainland French
territories. It is up to the ministries concerned to integrate these provisions in their requirements. In the Pacific
territories, the representatives of the State operate in collaboration with the representatives of local institutions.
The Employment Minister participates in the information of companies on the risk of epizootic and flu
pandemic, and on the measures of prevention, the implementation of which he controls. To achieve this, he
mobilises the work inspection services. He proposes adaptations of work regulation, if necessary. He ensures the
information and mobilisation of employment health services. He ensures the continuity of payment of social
transfers within his realm and mobilises employment aid services made necessary by the situation, in liaison with
the other ministries concerned, and in particular with the Ministry of the Economy, Finance and Industry.
The Minister of Education ensures the public health education of pupils and the information of school health
professionals. He is responsible for the implementation of the closure and, in liaison with territorial authorities,
the use of educational facilities as part of the plan. He ensures the continuity of education during the time
facilities are closed (via distance learning).
The Ministry for Youth, Sports and Associative Life ensures the information of the sports community, youth
and educational associations. He is responsible for suspending the normal activity and use of national public
facilities placed under his responsibility, as part of the plan.
The Minister of Ecology anticipates, in collaboration with the Minister of Industry, the possibility of making
safe the operation of facilities that have become dangerous due to staff shortage. He contributes to organising the
management of waste, whether contaminated or otherwise. He ensures that hunters and ornithologists are
informed. He takes appropriate measures for protecting nature and policing hunting activities. He informs public
facilities under his responsibility regarding the movement of birds.
The Ministers of Research, Agriculture, Health, the Economy and Defence take all necessary measures to
reinforce the actions of research and development intended to improve the response to the pandemic. Under the
aegis of the Ministry of Research, and with the collaboration of an expert committee, they update the assessment
of issues requiring further research action, on the basis of which they develop and ensure the implementation of
the corresponding R&D programme.
ANNEX 2
ANNEX 2 Fields of Action and Prerogatives of Major International
Partners
Human health: The World Health Organisation (WHO)
The World Health Organisation:
- coordinates epidemiological surveillance and analyses the virological and epidemiological data communicated
by the different States. It declares alert phases, and the beginning and end of the pandemic;
- coordinates the technical assistance to affected countries and the mobilisation of international expertise. It
issues recommendations to anticipate or limit the spread of the virus:
- it relies on a network of expert laboratories to isolate the pandemic viral strain and sends it to specialised
laboratories for the development of the vaccine strain that is then provided to vaccine manufacturers.
- builds up a stock of vaccines and antiviral medicines for emergency intervention.
The vaccine purchasing policy and the vaccination strategy are under the responsibility of each of the Member
States.
Animal health: The Food and Agriculture Organisation of the United Nations (FAO) and the
International Epizootic Office (IEO), still known as the World Organisation for Animal Health
The Food and Agriculture Organisation, a United Nations agency, has the competence to:
-
evaluate epidemiological situations,
- make recommendations to governments and regional bodies,
-
develop guidelines to develop methods for controlling disease,
implement projects in support of national, regional and international programmes for the prevention and
control of avian flu (support to players and facilities involved).
The IEO is an intergovernmental organisation gathering 197 countries. One of its aims is to provide transparency
in the global animal disease situation and to set standards for international trade in animals and animal products.
Joint IOE / FAO actions cover:
- the sending of veterinarians on emergency missions (rapid epidemiological diagnosis, reinforcement of
veterinary services and laboratories, recommendations to governments);
- the development of policies and programmes to control avian flu.
Economic consequences: the World Bank and the International Monetary Fund
The World Bank has carried out an evaluation of the economic consequences of an avian flu epidemic and a
possible human pandemic. It is advising about thirty countries on the preparation of projects destined to be
financed as part of its avian flu programme. It follows the implementation of donator commitments. The
International Monetary Fund evaluates the economic consequences of a human pandemic, and in particular the
impact on banking and financial systems throughout the world.
ANNEX 2
3. European organisations
The European Union (EU)
The planning of the response to an influenza pandemic is not within the exclusive competence of the European
Union.
The European Union can be given the task of:
- centralising the information on the status of the national plans of response to a pandemic;
- encouraging concerted action regarding measures of prevention and control, and their harmonisation,
particularly at borders;
- providing support for influenza monitoring systems in the European Union;
- cooperating in the development of new vaccines, together with WHO and the European Agency for the
Evaluation of Medicinal Products (EMEA); the Commission maintains a platform provided by its
pharmaceutical committee in order to treat issues concerning research, and the development,
authorisation, availability and building of stocks with industry;
- managing the measures to protect the European territory against an epizootic coming from outside its
borders, and validating the systems implemented by any affected Member State in order to protect the
other Member States.
In the face of emergence of isolated cases of human infection by a new influenza virus and limited interhuman
transmission, the European Union:
- convenes the Network Committee and the Community Influenza Pandemic Preparedness Group;
- keeps in regular contact with the World Health Organisation;
- provides assistance to third-party States, in cooperation with the World Health Organisation.
During the pandemic period, the European Union:
- activates the Community Influenza Pandemic Preparedness Group and its plan of action;
- reports the evolution of the epidemic and the measures taken by the Member States and brought to its
knowledge.
The European Centre for Disease Prevention and Control (ECDC).
The European Centre for Disease Prevention and Control
- provides analyses and advice for Member States and European institutions;
- coordinates the watch and epidemiological alert by activating the EWRS (Early Warning and Rapid
Response) System 24 hours a day;
- provides technical assistance, in case of an emergency, in terms of investigation and reaction; in the case
of a threat outside the EU, it evaluates the risks of contamination of Member States and makes
recommendations to both Member States and the Commission.
- ensures appropriate communication with the Commission and the public;
- can reinforce the reaction of the affected country or countries, upon WHO request, if such an action
contributes to the safety of the European Union.
The European Union Joint Situation Centre (SITCEN)
Attached to the General Secretary / High representative for Foreign Policy and Common Security (FPCS), the
Joint Situation Centre endows the EU with a permanent capacity to gather and analyse information as well as
give the alert.
ANNEX 3
ANNEX 3 Glossary – Main Reference Documents – Web Sites
AFSSA
AFSSAPS
AFSSET
ANPE
ARH
CIC
CIPPG
CIRE
CNR
COBeauvau
COD
COGIC
ComSegur
COZ
CROGend
DDASS
DDSV
DFAE
DGAC
DGAl
DGS
DGT
DHOS
DILGA
DRASS
EWRS
GROG
HFD
INPES
InVS
MAE
IOE
WHO
SAMU
SGAE
SGDN
SGG
SIG
EU
Agence française de sécurité sanitaire des aliments - French food safety agency
Agence française de sécurité sanitaire des produits de santé - French agency for the safety of health
products
Agence française de sécurité sanitaire de l’environnement et du travail - French agency for the safety of
the environment and workplace
Agence nationale pour l’emploi - National employment agency
Agence régionale d’hospitalisation - Regional agency for hospitalisation
Cellule interministérielle de crise - Interministerial crisis committee
Community Influenza Pandemic Preparedness Group
Cellule interrégionale d’épidémiologie - Interregional epidemiology committee
Centre national de référence [de la grippe] - National influenza reference centre
Centre opérationnel Beauvau - Beauvau operational centre
Centre opérationnel départemental - Departmental operational centre
Centre opérationnel de gestion interministérielle des crises - Operational centre for the interministerial
management of crises
Centre opérationnel du ministère chargé de la santé - Operational centre of the Ministry of Health
Centre opérationnel de zone - Zonal operational centre (activated 24 hrs/day)
Centre de renseignement et d’opération de la gendarmerie - Intelligence and operation centre of the
Gendarmerie
Direction départementale des affaires sanitaires et sociales - Departmental office of health and social
affairs
Direction départementale des services vétérinaires - Departmental office of veterinarian services
Direction des Français à l’étranger et des étrangers en France - Office of French nationals abroad and
foreign nationals in France
Direction générale de l’aviation civile - Office general of civil aviation
Direction générale de l’alimentation - Office general for food
Direction générale de la santé - Office general for health
Direction générale du travail - Office general for employment
Direction de l’hospitalisation et de l’organisation des soins - Office for hospitalisation and the
organisation of healthcare
Délégué interministériel à la lutte contre la grippe aviaire - Interministerial delegate for the fight against
avian flu
Direction régionale des affaires sanitaires et sociales - Regional office for health and social affairs
Early Warning Rapid Response System
Groupes régionaux d’observation de la grippe - Regional influenza observation groups
Haut fonctionnaire de défense - High defence official
Institut national de prévention et d’éducation pour la santé - National institute for prevention and health
education
Institut de veille sanitaire - National Institute of Public Health
Ministère des affaires étrangères - Ministry of Foreign Affairs
International Office of Epizootics, also called World organisation for animal health
The World Health Organisation
Service d’aide médicale d’urgence - Emergency medical assistance service
Secrétariat général des affaires européennes - Secretariat general for European affairs
Secrétariat général de la défense nationale - Secretariat general for national defence
Secrétariat général du gouvernement - Secretariat general of the Governement
Service d’information du gouvernement - Government information service
European Union
Main reference documents – Web sites
-
Collection of technical information sheets of the “Flu Pandemic” governmental plan
National “avian pests” emergency plan of the Ministry of Agriculture (DGAL/SDSPA/N2001-8095 of 10 July 2001)
-
Circular to prefects (NOR/INT/E/06/00014/C of 20/1/2006) concerning the action of mayors
Memento and guide of the DDSC (Office for defence and civil security), relative to the common securing plan –
November 2005
Sites: www.grippeaviaire.gouv.fr (Government information service); www.sante.gouv.fr (Ministry of Health);
www.diplomatie.gouv.fr (Ministry of Foreign Affairs).
-

National plan for the prevention and control "Influenza pandemic"

Transcription

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