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
World Health Organization
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
World Health Organization
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
World Health Organization
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)
World Health Organization
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
World Health Organization
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
World Health Organization
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
World Health Organization
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
…
World Health Organization
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
World Health Organization
10Geneva, 18-05-2008
Estimated Economic Impact, Pandemic Influenza
Source: Oxford EconomicForecasting Group
World Health Organization
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
World Health Organization
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
World Health Organization
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
World Health Organization
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
World Health Organization
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
World Health Organization
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 …
World Health Organization
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"
World Health Organization
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
World Health Organization
19Geneva, 18-05-2008
Risk AssessmentRisk Assessment
Verification with Member StatesVerification with Member States
Initial ScreeningInitial Screening
Response Strategy and OperationsResponse Strategy and Operations
World Health Organization
21Geneva, 18-05-2008
Event Management System
PAHOPAHO
AFROAFRO
WPROWPRO
HQHQ
SEAROSEARO
EMROEMRO
EUROEURO
Plus 142 WHO Country Offices
World Health Organization
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
World Health Organization
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
… / …
World Health Organization
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)
World Health Organization
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)
World Health Organization
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
World Health Organization
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
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