International Health Regulations A response to global threats
Transcript of International Health Regulations A response to global threats
International Health RegulationsInternational Health RegulationsInternational Health RegulationsInternational Health Regulations
A response to global threatsA response to global threatsA response to global threatsA response to global threats
Kamel Senouci, MD, MSc
Pan American Health Organization / World Health Organization
From Guénaël Rodier, Director, IHR Coordination, WHO, Geneva
““““ Fifth annualFifth annualFifth annualFifth annual”””” One Medicine symposiumOne Medicine symposiumOne Medicine symposiumOne Medicine symposium
Globalization and emerging risks:
a one medicine approach to a changing world
Durham, NC, 12th December 2007
• Population growth
• Population ageing
• Population movements
• Urbanization
• Biotechnologies
• Food processing
• Globalized trade
• Access to remote biotopes
• Industrial pollution
• Climate change
• …
A Changing World A Changing World A Changing World A Changing World
A Changing World A Changing World A Changing World A Changing World
l Collapse of public health infrastructure
l Ineffective vector control programmes (WNV, Malaria, Chikungunya…)
l Development of antimicrobial resistance (e.g. XDR-TB)
l Worries about accidental or deliberate release of biological, chemical, or nuclear, agents
l …
Events of potential international public health concern, Events of potential international public health concern, Events of potential international public health concern, Events of potential international public health concern,
January 2001 – June 2007 (n=1976)
Avian Flu, EU$500m
1996 1997 1998 1999 2000 2001 2002 2003
$50bn
$40bn
$30bn
$20bn
$10bn
Estim
ate
dcosts
BSE, UK $10-13bn Foot&Mouth Disease
Taiwan, $5-8bn
1992 1993 1994 1995
Foot-and-Mouth DiseaseUK
$30bn
Avian FluAsia, US, Canada
$10bn
2004
BSE, US $3.5bn
BSE, Canada$1.5bn
Lyme diseaseUS, $2.5bn
SARSChina, Hong Kong,
Singapore, Canada,…$50bn+
Nipah, Malaysia$350-400m
Swine Flu, Netherlands
$2.3bn
BSE, Japan 1.5bn
Economic Impact of Economic Impact of Economic Impact of Economic Impact of
Recent EpidemicsRecent EpidemicsRecent EpidemicsRecent Epidemics
Estimated Economic Impact,
Pandemic Influenza
Source: Oxford EconomicForecasting Group
International Health Regulations (2005)
From control of borders to [also] containment at source
From 3 diseases to all public health threats
From preset measures to adapted responses
IHR(2005) entered into force on
15 June 2007 (or 18 July 2007)
What Countries Must Do: National Focal Point
►OBLIGATIONS
►Remaining accessible 24/7
►Sending urgent communications to WHO IHR Contact Points
►Consolidating inputs and disseminating information to relevant sectors - points of entry, public health services, clinics and hospitals and other government departments
ResponseVerificationAssessmentInvestigation
National SurveillanceSystem
National LaboratorySystem
Detection(Early
Warning)
Veterinarian SurveillanceSystem
Food Surveillance
Notification/Risk
Communication
National Health Emergency Response System
Health Care
Services
Public Health Measures
Health Care
Services
The Role of the
National Epidemic Alert
and Response System
Media, General Public
Authorities/Decision Makers
WHOInternational
Unofficial (Rumors)Sources
What Countries Must Do: National Core Capacities
► Assessment of events
►Using the annex 2
IHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentEvents detected by national surveillance system
Cholera
Pneumonic plague
YF, VHF, WNF,
Diseases with
national/regional
concern
Smallpox
Polio wild-type
HI new subtype
SARS
Any event
potentially
PHEIC
NOTIFICATION TO WHO
4 criteria for risk assessment
IHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrumentIHR(2005) Decision instrument4 CRITERIA FOR RISK ASSESSMENT
Is the PH impact of the event serious?
Is the event unusual
or unexpected?
Is there a significant risk
of international spread
Is there a significant risk of international
travel or trade restrictions?
Is the event unusual
or unexpected?
Is there a significant risk
of international spread
NOTIFICATION TO WHO
REASSESS
no
yes
no
no
no
no
no
yes
yes
yes
yes
yes
The Role of NFP and The Role of NFP and
PAHO/WHOPAHO/WHO
IHR NATIONAL FOCAL POINT
IHR ReportsDisseminatePublic Health Information
Assistance Response
WHOWHO
Event Risk Assessment
•NOTIFICATION OF POTENTIAL
PUBLIC EMERGENCY OF INTERNATIONAL
CONCERN (PHEIC)
•CONSULTATION
Verification
OTHER SOURCES
INFORMAL / UNOFFICIAL INFORMATION
Initial screen
Initial screen
The Role of PAHO/WHOThe Role of PAHO/WHO
Epidemic Intelligence
Epidemic Intelligence
INFORMAL SOURCESGlobal Public Health Intelligence
Network (media), NGOs
FORMAL SOURCESWHO laboratory networks, (sub-)regional networks,
WROs & MoH, UNOs, OIE…
VerificationVerification
ResponseResponse Global Outbreak Alert and Response Network
COORDINATIONOPERATIONAL
SUPPORTRISK COMMUNICATIONPUBLIC HEALTH
SERVICES
Risk AssessmentRisk Assessment
HQREGIONAL OFFICESCOUNTRY OFFICES
• Epidemiology • Laboratory• Clinical
• Logistics • Communications• Security
• Social Mobilization• Behaviour Change
OFFICIALSOURCES
e.g. WRO, MoH, OIE, FAO
UNOFFICIAL SOURCES
E.g. NGOs, WHO CCs
►Activity from January 2007 to September 2007
0
5
10
15
20
25
30
35
40
45
50
WHO & NFP assessment
concluded
WHO & NFP assessment
ongoing
Information only
From Jan to Sept 2007, PAHO
identified 57 events of potential
importance for international public
health
43 (75%)
9 (16%)
5 (9%)
What Countries Must Do: National Focal Point
What Countries Must Do: National Core Capacities
► Core capacities for surveillance and response
►3 levels: National, Intermediate, Local
►Detection, verification, evaluation,
►All type of events
►Report to WHO
►Response
► Core capacities at Points of Entry
►Detection, verification, evaluation,
►Ports, airports, ground crossings
Areas of work for IHR implementation
► Other Intergovernmental organizations
e.g. FAO, OIE, ICAO, IMO, UNWTO …
► Development agencies
e.g. AFD, CIDA, DFID, JAICA, USAID, ADB, ASEAN, EC, MERCOSUR, WB …
► WHO Collaborating Centres and Technical partners
International Networks / National agencies / NGOs: e.g. GOARN, IANPHI, Pasteur IN, MSF, TEPHINET, GEISS, CDC, ECDC, HPA, InVS …
► Industry associations e.g. ACI, IATA, ISF, ISO …
• Health system
• Epidemiology
• Laboratory
• Preparedness
• Case management
• Infection control
• Social mobilisation
• Communication
• …
• Ports
• Airports
• Ground crossings
23 of 66 articles and 8 of 9 annexes
directly address travel, trade, and
transport.
► A commitment of countries (e.g. National budget line)
► Build on existing national and WHO regional strategies for
surveillance and response
e.g. National Pandemic Preparedness Plans
► Direct support from WHO Regional Offices
► Technical guidance from WHO Offices
and WHO Collaborating Centres e.g. CDC, NIH, Universities …
June 2007 – June 2009
Assessing Public Health Resources
Surveillance and response capacity
– Early warning and detection systems (information, communications etc)
– Human resources (rapid investigation teams, surveillance officers, …)
– Equipment and drugs (PPEs, sampling materials, drugs, stockpiles)
– Who's doing what and where(NGOs, government, private )
June 2009 – June 2012
Implementing national action plans
Surveillance and response system
– Investigation/response team
– Safe transport of specimens
– Reference laboratory
– Laboratory EQA programme
– Epidemiology & data analysis
– Risk assessment
– Case management
– Communication
– Social mobilization
– Inter-sectoral collaboration
► At all times
• Access to medical service
• Transport of ill travellers
• Inspection of conveyances
(e.g. Ship Sanitation Control Certificate)
• Control of vectors / reservoirs
► For responding to events
• Emergency contingency plan
• Arrangement for isolation (human, animal)
• Space for interview / quarantine
• Apply specific control measures
(Annex 1B)
• Intelligence
• Verification
• Risk assessment
• Response (GOARN)
• Logistics
• …
• Influenza
• polio• SARS• smallpox• cholera• meningitis• yellow fever• food safety• chemical safety• radionuclear safety• …
Risk AssessmentRisk Assessment
Verification with Member States
Verification with Member States
Initial ScreeningInitial Screening
Response Strategy and OperationsResponse Strategy and Operations
► Notification
► Consultation
► Verification
IHR National IHR National IHR National IHR National
Focal PointFocal PointFocal PointFocal Point
WHO IHR Contact WHO IHR Contact WHO IHR Contact WHO IHR Contact
PointPointPointPoint
"Shall be accessible at all times" (Art. 4)
IHR Communications
WHO Regional
Office
Designated national
institutionEvent Management System
Event Management System
PAHOPAHO
AFROAFRO
WPROWPRO
HQHQ
SEAROSEARO
EMROEMRO
EUROEURO
PAHOPAHO
AFROAFRO
WPROWPRO
EMROEMRO
SEAROSEARO
Event Management System
WHO Portal
Operations
Member States
IHR Event Information Site for IHR Event Information Site for IHR Event Information Site for IHR Event Information Site for IHR Event Information Site for IHR Event Information Site for IHR Event Information Site for IHR Event Information Site for NFPsNFPsNFPsNFPsNFPsNFPsNFPsNFPs
GOARN: Institutions and Partner NetworkGOARN: Institutions and Partner NetworkGOARN: Institutions and Partner NetworkGOARN: Institutions and Partner Network
GOARN SiteGOARN SiteGOARN SiteGOARN Site
Operational Support Team
GOARN management
Field epidemiology unit
Logistics unit
Field logistics
Stockpiles
Logistics mobility unit (Dubai)
Electronic tools
Event Management System (EMS)
Field Information Management System (FIMS)
Early Warning Alert and Response System (EWARN)
Strategic Health Operations Centre (SHOC)
GOARN WHO Support SystemGOARN WHO Support SystemGOARN WHO Support SystemGOARN WHO Support System
1 laboratory
�1 laboratory
national network
Annual output
175-200,000 samples
15-40,000 isolates
2-6000 viruses characterized
WHO Human Influenza Collaborating Centers
115 National Influenza Centers (NIC) in 84 countries
Seasonal Vaccine
Composition
Seasonal Vaccine
Composition
e.g. Global Influenza
Surveillance Network
Strengthen threatStrengthen threatStrengthen threatStrengthen threat----specific control programmesspecific control programmesspecific control programmesspecific control programmes
• Anthrax
• Anti-microbial resistance
• Arboviruses (e.g. Rift valley fever, West Nile fever)
• Chemical Safety
• Cholera and other epidemic diarrhoeal diseases
• Dengue
• Food safety
• HIV/AIDS
• Influenza (seasonal, avian, and pandemic threat)
• Malaria
• Measles and other vaccine-preventable diseases
• Meningococcal meningitis
• Poliomyelitis eradication initiative
• Radiation and environmental health
• Smallpox
• SARS and other severe acute respiratory infections
• Tuberculosis
• Yellow Fever
• Viral haemorrhagic fevers (e.g. Ebola, Marburg, Lassa)
• Zoonoses
►> 95% of
day-to-day
threats to
international
health
security !
►> 95% of
day-to-day
threats to
international
health
security !
… / …
► IHR Roster of Experts
► Emergency Committee
► Review Committee
► Progress report to the World Health Assembly
► National and international awareness
►Playing “the game” or not…
► Intersectoral collaboration
• Health, Agriculture, Education, Defence, Transport, Trade
► Resource mobilization
• Countries (national budget) with initial support from bilateral
donors, WHO, foundations, private sector, …
• “Rich” countries supporting the “poor” countries…
Main Challenges
Kamel Senouci, MD, MScHealth surveillance and disease management, Communicable diseases
Epidemic Alert and Response Team, IHR regional focal pointPan American Health Organization / World Health Organization
Thank you
www.who.int/ihrwww.paho.org