WHO/CDS/CSR/EPH/2002.18

Strengthening national preparedness & response tobiological weapons

Rome, Italy 6-8 March 2002

World Health OrganizationDepartment of Communicable Disease,Surveillance and Response

This document has been downloaded from the WHO/CSR Web site. The original coverpages and lists of participants are not included. See http://www.who.int/emc for moreinformation.

© World Health OrganizationThis document is not a formal publication of the World Health Organization (WHO), andall rights are reserved by the Organization. The document may, however, be freelyreviewed, abstracted, reproduced and translated, in part or in whole, but not for sale norfor use in conjunction with commercial purposes.

The views expressed in documents by named authors are solely the responsibility ofthose authors. The mention of specific companies or specific manufacturers' productsdoes no imply that they are endorsed or recommended by the World Health Organizationin preference to others of a similar nature that are not mentioned.

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WHO/CDS/CSR/EPH/2002.18English only

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Rome, Italy6-8 March 2002

Organized in collaboration with the Istituto Superiore di Sanità, Rome, Italy ,the National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy

and with the support of the Swiss Government.

World Health OrganizationDepartment of Communicable DiseaseSurveillance and Response

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Acknowledgements

The World Health Organization (WHO) wishes to acknowledge with gratitude the financial support from theGovernment of Switzerland and for this meeting as well as the Istituto Superiore di Sanità and the NationalInstitute for Infectious Diseases, L. Spallanzani for jointly organise and host this meeting.

WHO also wishes to thank all those who participated and contributed their expertise in the discussions (see Annex 2) and those who provided valuable comments on this document.

© World Health Organization 2002

This document is not a formal publication of the World Health Organization (WHO), and all rights are reservedby the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated,in part or in whole, but not for sale or for use in conjunction with commercial purposes.

The views expressed in documents by named authors are solely the responsibility of those authors. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsedor recommended by WHO in preference to others of a similar nature that are not mentioned. Errors andomissions excepted, the names of proprietary products are distinguished by initial capital letters.

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CONTENTS Page

1. INTRODUCTION--------------------------------------------------------------------------------------------------------- 1

2. CONCLUSIONS AND RECOMMENDATIONS------------------------------------------------------------------ 1

National core capacities and gap analysis for responding to biological weapons----------------------- 2Guidelines ----------------------------------------------------------------------------------------------------------------- 2Training--------------------------------------------------------------------------------------------------------------------- 2Resource mobilization -------------------------------------------------------------------------------------------------- 2Advocacy------------------------------------------------------------------------------------------------------------------- 2

3. BACKGROUND INFORMATION ----------------------------------------------------------------------------------- 3

4. WHO’S ROLE ------------------------------------------------------------------------------------------------------------ 4

4.1. Responding to the unexpected: The Global Alert and Response Network --------------------------- 44.2. Containing the known risks---------------------------------------------------------------------------------------- 44.3. Improving preparedness ------------------------------------------------------------------------------------------- 44.4 Other relevant activities on preparedness --------------------------------------------------------------------- 54.5 Strengthening national preparedness and response to release of biological weapons ------------ 5

5. REFERENCES ---------------------------------------------------------------------------------------------------------- 7

� ANNEXES

Annex 1: Resolution EB109.25Annex 2: List of participants Annex 3: Agenda

� FIGUREFigure: Emergency Risk Management adapted

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Strengthening national preparedness and response to biological and chemical weapons

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1. INTRODUCTION

These informal discussions were held to identify thecritical elements of the World Health Organization'stechnical support to Member States healthpreparedness and response programmes inresponse to the possible use of biological weapons(BW). These critical elements will guide WHO in:

(a) the development of guidelines for initiating orstrengthening national preparedness andresponse programmes;

(b) the establishment of an international networkof experts; and

(c) the organization of regional/national trainingworkshops.

These products should address the needs ofmanagers of public health emergency programmesand managers of infectious diseases surveillanceand control programmes. This activity follows on from Resolution EB109.R5 as endorsed by theWHO Executive Board in January 2002 ( see Annex1).

The conclusions and recommendations of thismeeting provides a strategic framework for WHOsupport to Member States who wish to implementand operationalize the policy guidance provided bythe 2nd edition of Public health response tobiological and chemical weapons: WHO guidance(1) (final publication to be released late in 2002).

The participants (see Annex 2) were welcomed byDr Ottorino Cosivi, Project Leader, Preparedness toDeliberate Epidemics, Department ofCommunicable Disease Surveillance andResponse, World Health Organization, Geneva. Professor Antonio Cassone1, Director, Laboratory ofBacteriology and Medical Mycology, IstitutoSuperiore di Sanità, Rome and Dr GiuseppeIppolito, Scientific Director, National Institute forInfectious Diseases, L. Spallanzani, Rome,welcomed the participants on behalf of the hostinginstitutions.

1 on behalf of Professor Garaci, President, Istituto Superiore diSanità, Rome.

The programme of the informal discussions wasapproved by the participants (Annex 3). After thepresentations, the participants were split into threegroups facilitated by Dr Bryan Davey, Dr MichaelHills and Dr Peter Uhthoff. The groups wererequested to identify priorities and approaches forWHO’s efforts in implementing operative paragraph2 of Resolution EB109.R5. The outcome of theworking groups were later discussed in a plenarysession leading to the conclusions andrecommendations here below.

2. CONCLUSIONS AND RECOMMENDATIONS

The responsibility for national preparedness andresponse to (BW) lies with Member States. Therole of WHO is to facilitate support for this purpose. When requested, WHO may provide technicaladvice and services, and expertise; can mobilizeand coordinate resources and assist in buildingcapacity, particularly in developing countries.

There is a wealth of existing tools, guidance andother resources that have relevance to nationalpreparedness and response programmes forbiological weapons, but which have not beendesigned nor used for BW. These should beadapted and integrated – duplication should beavoided.

This group re-emphasizes the important role ofpublic health in national emergency and disasterpreparedness, including epidemic surveillance andresponse, as basic prerequisites for effectivepreparedness to BW. This public health rolerequires effective and operational intersectoral andinterdepartmental coordination and collaboration atall levels.

WHO should be an advocate of the role of thepublic health sector in preparedness and responseto BW. Resources used for preparedness andresponse to BW should also lead to improvementand strengthening of the overall public healthsystem.

The group recommends that the following keyelements should form the basis of WHO’s supportfor national preparedness and response to BW.The internal WHO working group on CBW shouldbe the focal point for this work.

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National core capacities and gap analysis forresponding to BWThe ultimate objective of this component is tointegrate and operationalize preparedness andresponse to BW into national emergency anddisaster plans, including epidemic surveillance andresponse. It is essential to link epidemicpreparedness and capacity building with nationalemergency and disaster management plans.

This could be achieved for example by:

(a) developing a checklist of core capacities for thepublic health system of Member States that arerequired to be able to effectively respond to adeliberate release. Some of these capacitiesinclude: laboratory facilities, cooperation-communication - command mechanisms,partnerships, etc. The group highlighted thatMember States capacities must include a thoroughrisk management process.

(b) developing a gap analysis tool (e.g.survey/questionnaire) to identify current gaps incapacity.

(c) expert missions and facilitated workshops forgap assessment (qualitative and quantitativeanalysis of the need) leading to a national plan forstrengthening capacities, including theestablishment of an evaluation mechanism.

International resources inventoriesThe main purpose of this inventory is to provideinformation on current accessible resources foreffective country support. WHO should, through itspartners, support the development of suchinventories of accessible resources at global,regional and sub-regional levels for preparednessand response to BW (e.g. what is available, whereit is available, and could it be made available, underwhat circumstances and to whom). Some of theelements of the inventories include: experts andnetworks, existing guidelines, standard operatingprocedures, laboratory capabilities, equipment,vaccines/drugs, research.

The process to establish these inventories needs tobe developed, giving due attention to the reliabilityand sensitivity of such information. However,consensus should first be reached on the criteriaand components of these inventories.

GuidelinesThe collation, revision, adaptation and developmentof guidelines is essential for country support inorder to cover BW risks. The following areas needurgent attention: (a) risk communication; (b)national emergency and disaster management; (c)epidemic surveillance and response. All theseshould particularly address the needs of developingcountries.

TrainingThe objective of this component is to strengthenand support human resources development fornational preparedness and response to BW. Thegroup recommends simulations and case studyexercises as methods to achieve this objective. Abroad framework for training needs to bedeveloped. WHO should facilitate and support thedevelopment of training material (e.g. a modularsystem) and conduct pilot training and training oftrainers.

Resource mobilizationThe objective of this component is to secureresources to implement the recommendations ofthis group as well as to demonstrate commitment byMember States and donors.

A regular budget should form part of the resourcesrequired. Extra-budgetary resources should bemobilized.

AdvocacyThe aim of this component is to harness the highestpossible commitment at national and internationallevel for an integrated public health response toBW.

Areas needing specific attention are:- advocacy - should be evidence-based and shouldraise relevant issues and promote practicalmechanisms for the effective implementation ofnational plans. Advocacy tools should be developedusing strategic opportunities such as theforthcoming World Health Assembly - liaison - with all stakeholders, including the media,donors and the public.

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3. BACKGROUND INFORMATIONThe majority of the world’s public health systemsare stretched to their limits coping with naturallyoccurring health hazards. Against such abackground, the additional threat represented bythe use of biological, chemical or radiologicalagents, or any other use of violence against peopleor goods with the intent to attain political objectives,might seem to be no more than a slight addition tothe existing burden. However, any emergencysituation that is intentionally caused is aimed atoptimizing the overall potential or perceived risks ofthe hazard so as to always exceed the responsecapacities of all the existing local or nationalsystems, health included.

Intentionally caused health emergencies may rangefrom small to large-scale incidents. No matter whatthe actual number of casualties, though, panic andfear may be the primary objectives of any attack. Anincreased demand for medical and otheremergency services at community and institutionallevels will always follow. Thus, even for small-scaleevents, the required resources to respond to theseevents may be beyond the availability of manycountries and be available, if at all, only throughinternational cooperation.

In 1970, technical guidance was made available toMember States by WHO in the publication Healthaspects of biological and chemical weapons (2).This study was instrumental in achieving theBiological and Toxins Weapons Convention of19722 and the Chemical Weapons Convention of19933. The latter convention is implemented by theOrganisation for the Prohibition of ChemicalWeapons (OPCW) established in The Hague, TheNetherlands in 1997. These conventions, along withthe 1925 Geneva Protocol4 are the internationallegal mechanisms banning these classes ofweapons. They also provide the internationalcommunity with mechanisms for assistance toaffected countries, particularly in case of chemicalincidents.

2 Convention on the prohibition of the development, production andstockpiling of bacteriological (biological) and toxin weapons and on theirdestruction which came into force in 1975.3 Convention on the prohibition of the development, production,stockpiling and use of chemical weapons and on their destruction whichcame into force in 1997.4 Protocol for the prohibition of the use in war of asphyxiating,poisonous and other gases, and of bacteriological methods of warfare.

The threat of use of biological or chemical nuclearweapons by the armed forces of states haschanged in the last decades of the 20th century. Itnow exists mainly in regions where states have notyet joined the conventions mentioned above. However, the risk that non-state entities might usesuch weapons remains a possibility in most areas.

The initial response to a release of infective or toxicagents against civilian populations is primarily alocal responsibility in many parts of the world. Localauthorities are in the best position to take action,and will generally be held accountable should theincident be mishandled. National and internationalresources will play an important long-term role; thusit is important that local and national officials havepreparedness plans in place before an incidentoccurs in order to be able to effectively respond.

A deliberately caused epidemic may be consideredfirst as a natural event, unless the agent wasspread overtly. Such outbreaks may prove verydifficult to distinguish from natural outbreaks ofemerging diseases.

In most Member States, emergency response to adeliberate attack has hitherto been concerned withovert events (e.g. use of explosives). Chemicalsused in terrorist attacks may have both immediateand obvious effects and long-term, delayedoutcomes. In the case of agents causing overtacute effects, an immediate response by lawenforcement, fire and emergency personnel willoccur. In the case of chemicals causing delayedeffects, a more comprehensive response by thehealth sector would be required, including long-termobservation of the exposed population.

The public health response to a covert release of abiological agent requires an additional dimension ofemergency planning that involves the public healthinfrastructure in the front line of all emergencyresponse activities. Like in natural outbreaks, acovert release of a biological agent will not have animmediate effect because of the incubation period;health personnel at the local level will identify thefirst cases; and in the case of a highly contagiousagent, only a small window of opportunity would beavailable between the time when the first case isidentified and the spread of secondary cases.Emergency preparedness and responseorganizations need also to consider the variousdelivery routes (e.g. aerosol, contamination of food,

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water or other products). The food chain and thedrinking-water supply are potential delivery routesfor a number of biological and chemical agents. Disruption in food supplies, straining oroverwhelming of public services, intense mediacoverage and adverse economic, social andpolitical effects have been experienced in recentmass outbreaks involving the natural or inadvertentcontamination of food and water.

4. WHO’S ROLEWHO focuses on the possible public healthconsequences of such an incident, regardless ofwhether it is initially characterized as an act ofterrorism or a naturally occurring health emergency.The Organization’s basic activity in this area is tostrengthen disease alert and response systems atall levels, as such a system will detect and respondto diseases that may be deliberately caused (1).WHO contributes to the international efforts infighting these threats through its Global HeathSecurity (GHS) strategy. As recommended by theWorld Health Assembly in resolution WHA54.14,the GHS strategy includes three main pillars: (a)containing known infectious risk, by developing andenhance specific global surveillance and responsenetworks for some diseases and special initiativesfor monitoring emerging threats; (b) responding tothe unexpected by implementing diseaseintelligence and coordinating the internationalresponse and; (c) improving preparedness byproviding technical advice and support on nationalpreparedness. As a global partnership, WHO(headquarters, regional and country offices) isworking in close collaboration with otherinternational organizations, relevant WHOcollaborating centres, reference laboratories and inpartnerships with non-governmental organizations(NGOs) and industry. The revised InternationalHealth Regulations are expected to provide thelegal framework for the GHS strategy (3). Withspecific regard to BW, WHO is in a unique positionto play a key role in the following areas.

4.1 Responding to the unexpected: TheGlobal Alert and Response NetworkUnder the framework of the International HealthRegulations, WHO has a mandate to combat theinternational spread of epidemics. To carry out thisobjective, WHO has initiated the Global OutbreakAlert and Response Network, representing all majortechnical and humanitarian institutions, which can

effectively contribute to the rapid identification andcontainment of epidemics. It provides anoperational framework to link the expertise andskills needed to keep the international communityconstantly alert to the threat of outbreaks and ready

to support national authorities in their responseactivities to epidemics (4).

4.2 Containing the known risksWHO technical guidelines and other informationmaterial on diseases and intoxication which havebeen associated with biological and chemicalweapons are available, and/or being updated orprepared. These provide standards for bestpractice on clinical management of cases as well assurveillance and response. WHO has establishednetworks of experts on priority diseases withpotential BW application, such as anthrax,brucellosis, smallpox and plague (5).

4.3 Improving preparednessWHO has almost completed the 2nd edition of Publichealth response to biological and chemicalweapons: WHO guidance (1) (final publication to bereleased late in 2002). This policy documentprovides guidance on the risk management processas it may apply to BW preparedness and responseand on the identification of the elements essentialfor any plan to avert or mitigate the public healthconsequences of biological or chemical agentsreleased deliberately. The conclusions andrecommendations of this meeting provide astrategic framework for WHO technical support toMember States wishing to implement andoperationalize the policy guidance provided by the2nd edition.

The role of national public health surveillancesystems cannot be over emphasized for the earlydetection and rapid response to any outbreak ofdisease, whether naturally occurring, accidentally ordeliberately caused. As national surveillanceprogrammes are often weak, there is a need tosupport member countries in their surveillanceactivities. WHO’s strategy is to have acomprehensive assessment of national surveillancesystems, to ensure that each Member State has thecapacity to detect and respond to epidemic threats,to communicate these threats to the public. Thesurveillance strategy should be adapted accordingto the needs of each country.

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The WHO/CSR Office at Lyon is working to improvenational preparedness by strengthening countrycapacity in microbiology and epidemiology byimproving national public health laboratory capacity,field epidemiology training, and providingconnectivity in resource-poor countries. In addition,international biosafety standards and regulationsare now been revised, in collaboration with otherinternational bodies, to take into consideration therenewed concerns of biological weapons (6).

4.4 Other relevant activities on preparedness

As in any disaster, events caused by the possibleuse of BW involve a multitude of actors andstakeholders. Communities are directly affected andoften are the first to respond in any disaster. Local,provincial and national governments have theprimary responsibility for preparedness andresponse in any disaster. Civil and military securitylifelines, key facilities and structures (ambulance,fire services, bomb disposal, hospitals and otherservices) play pivotal roles. The United Nations(UN), including the WHO, as well as internationaland national NGOs are now part of disasterpreparedness and response. WHO, through itsDepartment of Emergency and Humanitarian Actionworks to strengthen the capacity of governments indisaster preparedness and response (7).Additionally, governments may request the UN andinternational humanitarian agencies to assist duringa disaster itself.

Preparedness programmes often include both BWand Chemical Weapons (CW) risks. Incidentsinvolving chemicals are not a new phenomenon,occurring not infrequently as transportation spillsand industrial discharges. The threat of a possiblerelease of conventional hazardous chemicals orchemical weapons into the environment or placingthem in food and drinking-water supply to causeharm cannot be discarded. The InternationalProgramme of Chemical Safety (IPCS) (8)addresses principally the primary health care andpublic health aspects of chemical incidents;however, the roles and responsibilities of IPCStakes account of the possible use of CW to causeharm (9). In addition, the verification system of theGlobal Outbreak Alert and Response (see 4.1above) has now been expanded to improve earlydetection of rumours of disease outbreaksattributable to chemical exposure. A network ofnine institutions has been established to provide a

24-hour international enquiry response to MemberStates. The INTOX global network of poisonscentres (about 120 centres in 70 countries) (10) isable to identify and response to chemical incidentsand allow rapid access to toxicological, analyticaland clinical expertise.

During the last twenty-five years, the WHORegional Office for the Americas/Pan AmericanHealth Organization (PAHO), has been working withthe ministries of health of this region on disasterpreparedness to respond effectively to theconsequences produced by the effects of naturalevents such as hurricanes, floods, landslides,earthquakes, volcanic eruptions and others. Sometwenty years ago, PAHO extended its mandate toinclude man-made events, such as explosions,aircraft accidents, fires, terrorist bombings, socialuprisings, chemical spills, radiological and nuclearaccidents, and lastly biological warfare (11). Thislong established technical cooperation between thecountries has produced a large number of trainedpeople in every country that can act as firstresponders in case of a major event. In case of abiological, chemical or radiological (BCR) attack theresponse from the health sector would have to bedetermined by the nature of the health risk and notby the cause of the incident, whether accidental ordeliberate. PAHO developed a plan that seeks toreduce the national or regional health impact ofpossible terrorist acts in Latin American andCaribbean countries by building the capacity of thehealth services.

Coordination of the various WHO activities onpreparedness and response to the possible use ofbiological and chemical agents is assured throughworking groups at regional and headquarters levels(5).

4.5 Strengthening national preparedness andresponse to release of biological weaponsThere could not be an effective response to healthemergencies without good preparedness. Preparedness plans should include a systematicand logical framework of the planning process (seeFigure 1), and identify the areas that requireattention. Adopting a risk management approachprovides the necessary framework (1). While theterminology used in connection with biological orchemical incidents may be different from thatgenerally used in risk management, the principlesremain the same. Essential components of such

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plans are networks for the detection and effectivepublic health systems for the response to diseasethreats. This includes public health surveillanceand disease early warning systems so that unusualevents can be immediately recognized; adequatesecure laboratory facilities with trained front-linepersonnel; measures to deal with the medical,event; and effective mechanisms for coordination ofactivities with all other sectors involved in thepsychosocial and media-related aspects of anresponse such as civil defence, animal health, themilitary and the law-enforcement community at alllevels.

Figure 1: Emergency Risk Management adapted(12)

Cooperative agreements between these differentsectors and agencies would need to beoperationalized well in advance in order to providean effective response.The lack of integrated laboratory andepidemiological activities in many countries is still asignificant obstacle to the effective detection of andresponse to threats from biological and chemicalagents, especially during complex emergencies.

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REFERENCES

1. World Health Organization. Public healthresponse to biological and chemical weapons,WHO guidance, Geneva, 2001. http://www.who.int/emc/book_2nd_edition.htm

2. World Health Organization. Health aspects ofbiological and chemical weapons, Geneva. 1970.http://www.who.int/emc/book_1st_edition.htm

3. World Health Organization. The InternationalHealth Regulations, Geneva, 1969. http://www.who.int/emc/IHR/int_regs.html

4. David L. Heymann, Guénaël Rodier, and theWHO Operational Support Team to the GlobalOutbreak Alert and Response Network. Hot spots ina wired world: WHO surveillance of emerging andre-emerging infectious diseases. The LancetInfectious Diseases, 2001, 1:345-353.

5. World Health Organization. Health Aspects ofBiological and Chemical Weapons.http://www.who.int/emc/deliberate_epi.html

6. World Health Organization, CSR. Office in Lyon.http://www.who.int/emc/lyon/index.htm

7. World Health Organization. Department ofEmergency and Humanitarian Action (EHA).http://www.who.int/disasters/

8. World Health Organization. The InternationalProgramme on Chemical Safety (IPCS).http://www.who.int/pcs/

9. World Health Organization. Report of the WHOConsultation on the public health response tochemical incidents. Geneva, Switzerland, 3-5December 2001.

10. World Health Organization, International LabourOrganization, United Nations Environment. TheIPCS INTOX Programme. http://www.intox.org/

11. World Health Organization. Pan AmericanHealth Organization. Disaster and HumanitarianAssistance. http://www.paho.org/disasters/

12. Emergency Management Australia. EmergencyRisk Management , Applications Guide. AustralianEmergency Manual Series. 2000.

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ANNEX 1

109th Session EB109.R5

Agenda item 3.13 17 January 2002

Global public health response to the deliberate useof biological and chemical agents, and

radio-nuclear attacks to cause harm

The Executive Board,

Having considered the report entitled “The deliberate use of biological and chemical agents to cause harm:public health response”;1

Recognizing the need to counter the increasing public health concerns of threats against civilianpopulations;

Acknowledging that the possible deliberate use of biological and chemical agents and radionuclear attackscan cause illness and death in targeted populations;

Aware that the local release of biological or chemical agents could have global public health implicationsand that working together is of global importance;

Noting the ministerial initiative on health security and bioterrorism as discussed in Ottawa, Canada on 7November 2001;

RECOMMENDS to the Fifty-fifth World Health Assembly the adoption of the following resolution:

The Fifty-fifth World Health Assembly,

Having reviewed the report on the deliberate use of biological and chemical agents to causeharm: public health response;

Seriously concerned about threats against civilian populations, including the possible deliberateuse of biological and chemical agents to cause illness and death in targeted populations;

Noting that such agents can be disseminated through a range of mechanisms, including thefood- and water-supply chains, thereby threatening the integrity of public health systems;

Acknowledging that the local release of biological or chemical agents designed to cause harm could haveserious global public health implications and jeopardize the public health achievements of the past decades;

Recalling resolution WHA54.14 on global health security: epidemic alert and response, which stresses theneed for all Member States to work together, with WHO and with other technical partners, in addressinghealth emergencies of international concern, and resolution WHA45.32 on the International Programme on

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Chemical Safety, which emphasized the need to establish or strengthen national and local capacities torespond to chemical incidents;

Recognizing that one of the most effective methods of preparing for deliberately caused disease is tostrengthen public health surveillance and response activities for naturally or accidentally occurring diseases.

1. URGES Member States:

(1) to ensure they have in place national disease-surveillance plans which are complementary to regionaland global disease-surveillance mechanisms, and to collaborate in the rapid analysis and sharing ofsurveillance data of international concern;

(2) to collaborate and provide mutual support in order to enhance national capacity in field epidemiology,laboratory diagnoses, toxicology and case management;

(3) to treat any deliberate use, including local, of biological and chemical agents and radio-nuclear attackto cause harm also as a global public health threat, and to respond to such a threat in other countries bysharing expertise, supplies and resources in order to rapidly contain the event and mitigate its effects;

2. REQUESTS the Director-General:

(1) to continue, in consultation with relevant intergovernmental agencies and other internationalorganizations, to strengthen global surveillance of infectious diseases, water quality, and food safety, andrelated activities such as revision of the International Health Regulations and development of WHO’s foodsafety strategy, by coordinating information gathering on potential health risks and disease outbreaks, dataverification, analysis and dissemination, by providing support to laboratory networks, and by making astrong contribution to any international response, as required;

(2) to provide tools and support for Member States, particularly developing countries, in strengthening theirnational health systems, notably with regard to emergency preparedness and response plans, includingdisease surveillance and toxicology, risk communication, and psychosocial consequences of emergencies;

(3) to continue to issue international guidance and technical information on recommended public healthmeasures to deal with the deliberate use of biological and chemical agents to cause harm, and to make thisinformation available on WHO’s web site;

(4) to examine the possible development of new tools, within the mandate of WHO, including modelling ofpossible scenarios of deliberate use, and collective mechanisms concerning the global public healthresponse to prevent, contain or mitigate the effects of deliberate use of biological, chemical or radiologicalagents to cause harm.

Seventh meeting, 17 January 2002EB109/SR/7

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ANNEX 2LIST OF PARTICIPANTS

Professore Generale Raffaele D'Amelio, Comando Logistico A.M., II Facoltà di Medicina e Chirurgia,Università di Roma "La Sapienza", Viale dell'Università 4, 00185 Rome, Italy. Tel.: +39 06 4986 6902; Fax: +39 06 4986 6019; Email: raffaele.damelio@flashnet.it

Professor Antonio Cassone1, Laboratory of Bacteriology and Medical Mycology, Istituto Superiore di Sanità(National Health Institute), Viale Regina Elena, 299, I-00161 Rome, Italy.Tel.: +39 06 4990 3332; Fax: +39 06 4938 7112 ; Email: cassone@iss.it

Dr Michael Hills, Associate Director, Critical Response Coordination, South East Health, PO Box 430, KogarahNSW 2217, Australia.Tel.: +61 2 9947 9835; Fax: +61 2 9947 9891; E-mail: HillsM@sesahs.nsw.gov.au

Dr Giuseppe Ippolito, Scientific Director, Istituto Nazionale per le Malattie Infettive, IRCCS, "L. Spallanzani",Via Portuense, 292, I-00149 Roma, Italy.Tel.: +39 06 5594 223; Fax: +39 06 5594 224; E-mail: ippolito@spallanzani.roma.it

Dr Marci Layton, Assistant Commissioner, Communicable Disease Program, New York City Department ofHealth, 125 Worth Street, Box 22A, NY, NY 10013, USA.Tel.:+1 212 295 5650; Fax:+1 212 295 5421; E-mail: mlayton@health.nyc.gov

Dr Roque Monteleone-Neto, Director, Department of Nuclear Affairs and Sensitive Assets, Ministry ofScience and Technology, SAI/SO Area 5 - Quadra 3 - Bloco F-1 andar, 70610-200 Brasilia DF, Brazil.Tel.: +55 61 411 5600; Fax: +55 61 411 5630; E-mail: Roque@cis.epm.br

Dr Uma Nagpal, Co-ordinator, Communicable Disease Control National Department of Health, Pretoria,South Africa.Tel.: +27 12 312 0403; Fax: +27 12 323 8626; E-mail: nagpal@health.gov.za

Dr Eric K Noji, Senior Medical and Public Health Advisor, Emergency Operations & Information Center, Officeof Homeland Security (OHS), Executive Office of the President, The White House, 1600 PennsylvaniaAvenue NW, Washington, DC 20500, USA.Tel.: +1 202 456 6175; Fax: +1 202 456 6180; E-mail: exn1@cdc.gov

Dr Sumol Pavittranon, Senior Medical Scientist, National Institute of Health of Thailand,Department of Medical Sciences, Ministry of Public Health, Tivanon Road, Muang Nonthaburi, 11000Thailand.Tel.: +662 951 9717; Fax: +662 591 5436; Email: sumola@health.moph.go.th

Dr Martin Schuetz, Head of Biology Department, Spiez Laboratory, 3700 Spiez, SwitzerlandTel.: +41 33 228 1597; Fax: +41 33 228 1402; E-mail: martin.schuetz@gr.admin.ch

Dr John Simpson, PHLS Communicable Disease Surveillance Centre, South East, Lower Ground floor, 40,Eastbourre Terrace, London W2 3QR, United Kingdom.Tel.: +44 20 7725 2613; Fax: +44 20 7725 3460; Email: j.simpson@cdsc.nthames.nhs.uk

1 Document EB109/26. 851 on behalf of Professor Garaci, President, Istituto Superiore di Sanità, Rome

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Dr Peter Uhthoff, Chief, Counter-terrorism Coordination and Medical Intelligence Division, Office of PublicHealth Security, Centre for Emergency Preparedness and Response, Population and Public Health Branch,Health Canada – 0900B, Tunney’s Pasture, Ottawa, Ontario K1A 0L2, Canada.Tel.: +1 613 957 2948; Fax: +1 613 952 8286; E-mail: peter_uhthoff@hc-sc.gc.ca

Other organizations

Dr Brian J. Davey, Head, Health and Safety Branch, Organisation for the Prohibition of Chemical Weapons(OPCW) Johan de Wittlaan 32, 2517 JR The Hague, The Netherlands.Tel.: +31 70 416 3501; Fax: +31 70 416 3307; E-mail: bdavey@opcw.org

WHO Secretariat

Ms Rachel Bauquerez, Technical Officer, Emerging Public Health Risks including Drug Resistance,Department of Communicable Disease, Surveillance and Response, World Health Organization, AvenueAppia 20, CH-1211 Geneva 27, Switzerland.Tel.: +41 22 791 2705; Fax: +41 22 791 4893; E-mail: bauquerezr@who.int

Dr Stella Chungong, Medical Officer, National Capacity Strengthening, Department of CommunicableDisease, Surveillance and Response, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27,Switzerland.Tel.: +41 22 791 2377; Fax: +41 22 791 4667; E-mail: chungongs@who.int

Dr Ottorino Cosivi, (Secretary to the meeting), Project Leader, Emerging Public Health Risks including DrugResistance, Department of Communicable Disease, Surveillance and Response, World HealthOrganization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.Tel.: +41 22 791 2531; Fax: +41 22 791 4893; E-mail: cosivio@who.int

Dr Denis Coulombier, Epidemiology Team Coordinator, Epidemiology Strengthening Department ofCommunicable Disease, Surveillance and Response, World Health Organization Office in Lyon, 58 AvenueDebourg, 69007 Lyon, France.Tel.: +33 472 716 477; Fax: +33 472 716 471; E-mail: coulombierd@lyon.who.int

Dr Gaya Gamhewage, Emergency Health Intelligence and Capacity Building, Department of Emergency andHumanitarian Action, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.Tel.: +41 22 791 4030; Fax: +41 22 791 4844; E-mail: gamhewageg@who.int

Dr Kersten Gutschmidt, Scientist, International Programme on Chemical Safety (IPCS), Protection of theHuman Environment, Department of Sustainable Development & Healthy Environments, World HealthOrganization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Tel.: +41 22 791 3731; Fax: +41 22 791 4848; E-mail: gutschmidtk@who.int

Dr Daniel Lavanchy, Project Leader, Bio-safety, Department of Communicable Disease, Surveillance andResponse, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.Tel.: +41 22 791 2656; Fax: +41 22 791 4878; E-mail: lavanchyd@who.int

Dr Luis Jorge Perez, PAHO-PED, World Health Organization Regional Office for the Americas/PanAmerican Sanitary Organisation, 525, 23rd Street, N.W., Washington, D.C., USA.Tel.: +1 202 974 3616; Fax: +1 202 775 4578; E-mail: perezlui@paho.org

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Dr Robert Steffen Scientist, contact address: Institute for Social and Preventive Medicine of the University,Sumatrastrasse 30, CH-8006 Zurich, Switzerland.Tel.:+41 1 634 4620; Fax: +41 1 634 4984; E-mail: roste@ifspm.unizh.ch

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ANNEX 3PROGRAMME

� Wednesday, 6 March: 14.00 – 17.30 p.m.

� Welcome address, introduction of the participants, objectives and expected outcome of the meeting (Dr Ottorino Cosivi, Dr Giuseppe Ippolito, Professor Antonio Cassone)

� WHO's current activities on national and international preparedness for infectious diseases

Global Health Security and national preparedness to biological weapons: current and plannedactivities (Dr Ottorino Cosivi)Assessment of disease surveillance systems (Dr Stella Chungong)Strengthening national laboratories and epidemiology capabilities, and biosafety(Dr Denis Coulombier)

� WHO's activities on chemical incidents (Dr Kersten Gutschmidt)� Interdisciplinary and intersectoral coordination for emergency and disaster preparedness (Dr Gaya

Gamhewage) � Biological weapons as a multi-hazard approach (Dr Luis Jorge Perez) � Lessons for the health sector from past use of biological agents and from the Biological Weapons

Convention strengthening process (Dr Roque Monteleone-Neto)� Questions/Discussion

� Closure

� Thursday, 7 March

� Reports from national preparedness and regional programmes:

Australia (Dr Michael Hills)Canada (Dr Peter Uhthoff)Italy (Dr Giuseppe Ippolito6)Latin America and the Caribbean (Dr Luis Jorge Perez) South Africa (Dr Uma Nagpal)United Kingdom (Dr John Simpson)United States of America (Dr Marci Layton and Dr Eric K Noji) Thailand (Dr Sumol Pavittranon)

� Preparedness activities of the Organisation for the Prohibition of Chemical Weapons (OPCW) (DrBryan Davey)

� Questions/Discussion� Introduction to group discussion and identification of core elements of a national preparedness plan� Working groups

� Closure

� Friday, 8 March

Plenary discussion to finalize the working group output

� Conclusions and recommendationsClosure

6 on behalf of Dr Fabrizio Oleari, Ministry of Health, Rome, Italy