New Connections, New Communities, and New

Applications

Dr. Jacqueline Brown, Pacific Wave

Dr. Andrew Howard, AARNET

Professor Gwen Jacobs, Montana State University and the Lariat Project

Professor Louis Fox, University of Washington

APEC EINet: Advanced Networking and Biopreparedness for Emerging

Infections in the Asia Pacific

“Timely Information for Health”

Topics for today:

• Context of emerging infections

• Background on APEC/APEC EINet

• Vision of common preparedness for Asia Pacific

Our Region: Continuing Common Challenges of Emerging Infections

• Demographic pressures• Infrastructure challenges• Rapidly increasing travel,

trade linkages• Common challenges in

antimicrobial resistance• Emergence of new

agents, Nipah, Influenza, Enterovirus, SARS

• Major economic impacts

Factors of Emergence of Infectious Diseases: The Convergence Model

Human

GENETIC AND BIOLOGICAL FACTORS

PHYSICALENVIRONMENTAL

FACTORS

Microbe

ECOLOGICAL FACTORSSOCIAL, POLITICAL ANDECONOMIC FACTORS

Source: Microbial Threats to Health, Institute of Medicine

Factors of Emergence Revisited,2003 IOM Report

• Microbial adaptation and change

• Human demographics and behavior

• Breakdown of public health

• Technology and industry

• International travel and commerce

• Economic development and land use

• Human susceptibility to infection

• Climate and weather• Changing ecosystems• Poverty and social

inequality• War and famine• Lack of political will• Intent to harm

Human Disease as Travelers on the Global Express - How Can We Keep Up?

APEC: A closer and closer community

Washington PostSource: World Health Organization/CDC

The SARS Outbreak: May 6, 2003

The Asia Pacific Economic Community

• Ongoing efforts to combat emerging infections

• EINet operates within this larger effort, supporting and innovating

• Networking is our central strategy

• We continuously envision and work towards new frontiers in networking

APEC Leaders SummitOctober 2001, Shanghai, ground

breaking for Health in APEC

Leaders Declaration Los Cabos, 2002

“We instructed Ministers to build on work underway to establish a regional public health surveillance network and an early warning system to monitor and respond to critical disease outbreaks in the region and critical threats such as bio-terrorism.”

APEC Six Strategic Action Areas

• Electronic networking

• Surveillance

• Outbreak response

• Capacity building

• Partnering across sectors

• Political and economic leadership

APEC Leaders’ Statement on Health

Security, Bangkok, 2003 • “Pursue focused efforts to monitor

diseases, contain outbreaks, especially those that could have international consequences, and coordinate responses via mechanisms such as the APEC Emerging Infections Network and, in the event of a disease outbreak, in collaboration with relevant multilateral organizations.”

APEC and APEC EINet- a capsule history

• APEC Founded in 1989, APEC Combined GDP $19 trillion, 47% of global trade

• “Health” initiative begun in 1995, APEC EINet first “proof of concept” of policy initiative

• EINet has continuously operated for 9 years• APEC 21 member economies (includes Taipei), 2.5

billion people, EINet reaches 19 economies• Focus on Infectious Disease Control supported by

Leaders in 2001, 2002, 2003• First Health Ministers meeting July 28, 2003, related

to SARS.

APEC/EINet Today

• User based information exchange on emerging infections

• Over 800 users in region from health, trade,19 of 21 economies

• Enhanced website with library gateway, teaching tools, www.apec.org/infectious

• Demonstrated efficacy

So with common challenges, how can networking help?

• When there is a trade-related infection, collaborative approach to prevention and control will be most timely and appropriate.

International scenario experience: Global Mercury Exercise, GHSAG hosted by

Health CanadaInitiation Stage • Decision to undertake exercise reached at GHSAG meeting, Oct 2002. • Canada developed Exercise Planning Structure.Planning Stage• Designated exercise planning group• Decisions taken by consensus regarding exercise delivery• Determined training objectives, time frame and methodology• Evaluate international communications using “star” structureConduct Stage• Opening scenario- smallpox self-inoculation, migration • Time compression• Summarize key findingsReporting Stage• Review by local evaluators regarding exercise• Lessons learned by controllers and evaluators• Preparation of report and review

Problem Posed:

• A “flat” communications plan, point-to-point is evidently preferred by economies. This increases traffic.

• Routine communications infrastructure cannot bear the “surge” traffic of a crisis based on such a plan.

• How can we proactively identify, share and learn communications solutions BEFORE a crisis situation?

• How can we begin to factor international communications into emergent public health outbreak response?

APEC/APRU/APAN: a promising alliance for Public Health

• Leverage investment by research universities in advanced networking

• Access, test new technologies in communications for Public Health

• Enhance redundancy, security of communications through innovation

Asia Pacific Economic Communities (APEC)

• The premier forum for facilitating economic growth, cooperation, trade and investment in the Asia-Pacific region.

• No treaty obligations required of its participants.

• Decisions made within APEC are reached by consensus and commitments are undertaken on a voluntary basis.

The Association of Pacific Rim Universities (APRU)

“Bridging the Pacific Rim Community through Education, Research and Enterprise”

Consortium of 36 leading universities from 16 economies in the Pacific Rim: AU, CA, CL, CN, ID, JP, KR, MY, MX, NZ, PH, RU, SG, TH, TW, US

Selection criteria:• Academic Excellence• Research Intensity• Global Outlook• Innovative Dimension

Asian Pacific Advanced Networks (APAN)

Objectives:

Coordinate the development of an advanced networking environment for the research and education communities

Encourage and promote global cooperation to achieve the above

Primary members: AU, BD, CN, HK, IN, JP, KR, MY, PH, PK, SG, LK, TW, TH

An Australian View

APEC Economies Prepare

• Most economies are working to assure national preparedness

• Diverse approaches, strategies in play

• Challenge is to share common lessons learned, develop timely communications strategy

Type of Preparedness Exercises

Adapted from Carl Osaki’s “Designing and Facilitating Tabletop Exercises”, Northwest Center for Public Health Practice

Exercise Strategy

Description

Orientation Familiarize staff to agency’s emergency response plan. Discussions of roles/responsibilities, brainstorming, case-study method.

Drill Teach procedures through repetition. Tests training, response time, communication, manpower and equipment capabilities.

Tabletop Exercises

Emphasize training, not testing. Constructive problem-solving.One step towards full scale or functional exercise.

Functional Test and evaluate capabilities of emergency response system. Events/situations depicted as they would occur.

Full Scale Test and evaluate emergency operations plan interactively over extended period of time. Extended into field with on-site use of simulated victims, equipment and manpower.

APEC Region- Preparedness “environment”

• Strong political endorsement for control of Emergent Disease at highest level of APEC

• Rapidly increasing speed, access of internet in region

• Exercises can identify multisectoral response “policy gaps” prospectively

• Creating exercises has value for partners individually

• Collectively partners benefit from sharing common exercise

Frontiers in Networking: Our Destination

Strong working relationships among sectors within economies and among economies

Reliable accurate information exchange through tested means

Real time outbreak investigation and control collaboration

High quality network performance