World Health Organization 1 Geneva, 18-05-2008 "Making Global Health News" Health Security and...

World Health Organization

1Geneva, 18-05-2008

"Making Global Health News""Making Global Health News"

Health Security and Environment /

Epidemic and Pandemic Response /

International Health RegulationsBernardus Ganter, MD


2Geneva, 18-05-2008

Emerging and re-emerging infections, 1996 – 2007

Marburghaemorrhagic fever

Cryptosporidiosis

Lyme Borreliosis

Reston virus

Venezuelan Equine Encephalitis

Dengue haemhorrhagic fever

Cholera

E.coli O157

West Nile Fever

Typhoid

Diphtheria

E.coli O157

EchinococcosisLassa feverYellow fever

Ebola haemorrhagic fever

O’nyong-nyong fever

Human Monkeypox

Cholera 0139

Dengue haemhorrhagic fever

Influenza A(H5N1)

Cholera

RVF/VHF

nvCJD

Ross River virusHendra virus

BSE

Multidrug resistant Salmonella

E.coli non-O157

West Nile Virus

Malaria

Nipah Virus

Reston Virus

Legionnaire’s Disease

Buruli ulcer

Severe Acute Respiratory Syndrome (SARS)

Human Monkepox

E.coli O157


3Geneva, 18-05-2008

A Global problemA Global problem

Arise from many different pathogens: viruses, bacteria, parasites Spread in many different species: humans, insects, domestic and wild animals, aquatic

animals and sometimes breach barrier between animal and humans

Take many different routes of transmission: direct contact, vectors, food, environmental Affect all populations in all regions of the world


4Geneva, 18-05-2008

Breaches in species barrier: selected emerging Breaches in species barrier: selected emerging infections in humans identified since 1976 infections in humans identified since 1976

Infection Original Yearhost reported(confirmed/hypothesized)

Ebola virus Bats 1976

HIV-1 Primates 1981

E. coli O157:H7 Cattle 1982

Borrelia burgdorferi Rodents 1982

HIV-2 Primate 1986

Hendra virus Bats 1994

BSE/vCJD Cattle 1996

Australian lyssavirus Bats 1996

H5N1 influenza A Chickens 1997

Nipah virus Bats 1999

SARS coronavirus Palm civets 2003 adapted from Woolhouse et al. (2005)


5Geneva, 18-05-2008

• Population growth

• Population ageing

• Population movements

• Urbanization

• Biotechnologies

• Food processing

• Globalized trade

• Access to remote biotopes

• Industrial pollution

• Climate change

• …

A Changing World


6Geneva, 18-05-2008

International Travellers 1950-2000

International airline passengers (millions)

1000

800

600

400

200

01950 1960 1970 1980 1990 2000

1200

1400

Increased to over 2 billion international travellers in 2006


7Geneva, 18-05-2008

Increased world trade in agricultural Increased world trade in agricultural products/animals, 1950 - 2006products/animals, 1950 - 2006

19500

40

80

120

160 export of agricultural products by volume

1960 1970 1980 1990 2000

Source: WTO, 2000

World trade in agricultural products has increased 5-fold since 1950


8Geneva, 18-05-2008

A Changing World

Collapse of public health infrastructure in some places (civil unrest)

Difficulties in vector control programmes (e.g. Dengue, Chikungunya)

Losing effective drugs, emergence of antimicrobial resistance (e.g. XDR-TB)

Worries about accidental or deliberate release of biological, chemical, or nuclear, agents

…


9Geneva, 18-05-2008

The economic burden of SARS is The economic burden of SARS is estimated at 50-90 Billion US$estimated at 50-90 Billion US$

Outbreak declared over,10 July

8098 cases, 774 deaths

26 countries


10Geneva, 18-05-2008

Estimated Economic Impact, Pandemic Influenza

Source: Oxford EconomicForecasting Group


11Geneva, 18-05-2008

Why the International Health Regulations (IHR)??Why the International Health Regulations (IHR)??

Serious and unusual disease are inevitable

Diseases spread across national borders

Globalisation - problem in one location is now everybody’s headache

There is all ready an agreed code of conduct that PROTECTS against:

1 the spread of serious risks to public health

2 the unnecessary or excessive use of restrictions in traffic or trade for public health purposes


12Geneva, 18-05-2008

Concern about public health security throughout Concern about public health security throughout the agesthe ages

1374 Venice Quarantine for Plague

1851 Paris 1st International Sanitary Conference

1947 Geneva WHO Epidemiological Information Service

1951 Geneva International Sanitary Regulations

1969 Geneva International Health Regulations


13Geneva, 18-05-2008

Global outbreaks, the challenge: Global outbreaks, the challenge: latelate reporting and response reporting and response

0102030405060708090

1 4 7 10 13 16 19 22 25 28 31 34 37 40

Delayed response

DAY

CA

SE

S

Lost opportunity for control/risk of international spread

Late reporting

First case


14Geneva, 18-05-2008

010

2030

4050

6070

8090

1 4 7 10 13 16 19 22 25 28 31 34 37 40

Rapid response

CA

SE

S

Early reporting Potential cases prevented/

international spread prevented

DAY

Global outbreaks, the solution: Global outbreaks, the solution: earlyearly reporting and response reporting and response


15Geneva, 18-05-2008

International Health Regulations (2005)

From control of borders to [also] containment at source

From diseases list to all public health threats

From preset measures to adapted responses

IHR(2005) entered into force on 15 June 2007


16Geneva, 18-05-2008

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 …


17Geneva, 18-05-2008

► A commitment of countries (e.g. National budget line, human resources)

► WHO technical support

Timeline Timeline

15 June 2007 2009 2012 2014 2016

Planning Implementation

2 years + 3 + (2) + (up to 2)

"As soon as possible but no later than five years from entry into force"


18Geneva, 18-05-2008

► 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


19Geneva, 18-05-2008

Risk AssessmentRisk Assessment

Verification with Member StatesVerification with Member States

Initial ScreeningInitial Screening

Response Strategy and OperationsResponse Strategy and Operations


20Geneva, 18-05-2008


21Geneva, 18-05-2008

Event Management System

PAHOPAHO

AFROAFRO

WPROWPRO

HQHQ

SEAROSEARO

EMROEMRO

EUROEURO

Plus 142 WHO Country Offices


22Geneva, 18-05-2008

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


23Geneva, 18-05-2008

Strengthen threat-specific 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 (new subtype in human)• Malaria• Measles and other vaccine-preventable diseases • Meningococcal meningitis • Poliomyelitis eradication initiative (wild type poliovirus)• 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

public health

security

► > 95% of day-

to-day threats

to international

public health

security

… / …


24Geneva, 18-05-2008

Areas 5, 6Areas 5, 6

Sustain rights, obligations and procedures

(new legal mechanisms as set out in IHR are fully developed)

Conduct studies and monitor progress

(Indicators are identified and collected regularly to monitor and evaluate IHR implementation)


25Geneva, 18-05-2008

… / …

Progress so far

Assessment tools and methods developed by Regional Offices to identify needs at country level

Assessment tools developed for specific areas such national legal framework, ports of entry, national laboratory network

Regional meetings with National Focal Points (NFP) improving communications and understanding of responsibilities

Indictors to measure progress on implementation are being developed

Additional guidelines and training for specific risks are in progress such for pandemic influenza preparedness, mass events, hospital infection control, sanitation of conveyances, travel medicine etc.

Strengthening of WHO partnerships and response capacity (vaccine supplies, antiviral drugs for pandemic influenza)


26Geneva, 18-05-2008

… / …

WHA 61 Report

Obligation for State Parties and WHO to report on progress to WHA (article 54 of IHR)

194 Member States, including Vatican.

192 have National IHR Focal Point for 24/7 communication with WHO (exception Vatican, Somalia)

Over 50% of State Parties did an assessment of capacities

Over 50% reviewed national legal framework

More information will become available during agenda item on IHR


27Geneva, 18-05-2008

… / …

WHA 61 Report

For 63 WHA: report on functioning of IHR and Annex 2

Requesting SP:

improve communication with NF

strengthen core capacities

designate experts

collaborate with other State Parties

Request the DG:

prepare fro reports every 2 years

support countries with weak health systems


28Geneva, 18-05-2008

w w w . w h o . i n t / i h r

Thank you

World Health Organization 1 Geneva, 18-05-2008 "Making Global Health News" Health Security and...

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