.. . ASEAN Community - AC One Vision, One Identity, One Community . .. 2553

*

ASEAN One communitycomes with opportunities and threats

Opportunities

Larger markets, higher economic growth More work opportunitiesBetter IT networkMore exchange and collaborations etc.

Threats Easier and more cross-border movements of people, workforce; hence, the source of infectionsInflux of poor quality foods, drugs, chemicals, alcohol & tobaccoMore accidentsOverload of health service Drainage of HCW etc.

ASEAN (Thailand, Malaysia, Indonesia, Philippines, Singapore, Brunei Darussalam, Viet Nam, Lao PDR, Myanmar, Cambodia) 600 ( 2555)

ASEAN+3 2,120 1 3 +ASEAN+6 3,352 1 2 Internet World Stats 30 2555 Total World Population 7,017,846,922China 1,343,239,923, India 1,205,073,612, Indonesia 248,645,008, Japan 127,368,088, South Korea 50,004, 441Australia 22.68 Million New Zealand 4.43 million

ASEAN 10 countries : 583 Millions of Pop. (9 % of the world's population)GDP 1,275 Billions USD (2% of the worlds GDP) ASEAN+3 : 2,068 Millions of Pop. (31 % of the world's population) GDP 9,901 Billions USD (18% of the worlds GDP) ASEAN+6 : 3,284 Millions of Pop. (50 % of the world's population)GDP 12,250 Billions USD (22% of the worlds GDP)

... 580 >GDP 1.5 = 1.61 =6 50 =60% 65 = 2

MOU ..----

MBDSASEAN APECACMECSGlobal health

Regional & Trans-regional APEC, ASEAN, Sub-regional - GMS, LMI, ACMECS, Bilateral - TUC, JICA, TICA, China, UK HPA, - Neighboring countries :Cambodia, Lao PDR, Myanmar, Malaysia UN Agencies - WHO, UNICEF, FAO, OIE, .. NGOs - MBDS, KENAN, .

ASEAN Socio-cultural Community - ASCC

Action lines under ASEAN Socio-Cultural Community BlueprintA. Human DevelopmentA.1. Advancing and prioritising educationA.2. Investing in human resource developmentA.3. Promotion of decent workA.4. Promoting Information and Communication Technology (ICT)A.5. Facilitating access to applied Science and Technology (S&T)A.6. Strengthening entrepreneurship skills for women, youth, elderly and persons with DisabilitiesB. Social Welfare and ProtectionB.1. Poverty AlleviationB.2. Social safety net and protection from the negative impacts of integration and globalizationB.3. Enhancing food security and safetyB.4. Access to healthcare and promotion of healthy lifestylesB.5. Improving capability to control communicable diseasesB.6. Ensuring a drug-free ASEANB.7. Building disaster-resilient nations and safer communitiesC. Social Justice and RightsC.1 Promotion and protection of the rights and welfare of women, children, the elderly, and persons with disabilitiesC.2. Protection and promotion of the rights of migrant workersC.3 Promoting Corporate Social Responsibility (CSR)

ASEAN Task Force on Non Communicable Disease (ATFNCD) ASEAN Health Ministerial Meeting (AHMM)ASEAN Expert Group on Commu-nicable Diseases (AEGCD)ASEAN Technical Focal Point on AIDS (ATFOA)

ASEAN Expert Group on Food Safety (AEGFS)

ASEAN Focal Point on Tobacco Control (AFPTC)

ASEAN Working Group onPandemic Preparedness and Responses (AWGPPR)

ASEAN Working Group on Pharma-ceutical Develop. (AWGPD)

Health & Communicable Diseases, ASEAN Secretariat, Provide coordinating support to AMS,4 staff, project based staffSenior Officials Meeting on Health Development (SOMHD)ASEAN+3 FETNAPL Risk Communication

ASEAN Task Force on Traditional Medicine (ATFTM)

ASEAN Task Force on Maternal and Child Health (ATFMCH)

ASEAN Mental Health Task Force (AMT)

Main Land ASEAN CLMVCambodia, Lao PDR, Myanmar, Vietnam

ForumMember CountriesAreas of Cooperation(Lead Countries)GMS - Greater Mekong Sub-region (China 2535)Cambodia, Loa PDR, Myanmar VietnamThailandChina ()HIV/AIDS EIDs LMI - Lower Mekong Initiative (USA 2553) CambodiaLoa PDR,Myanmar ( 2555)VietnamThailand Health (Cambodia)Education (Thailand)

ForumMember CountriesAreas of Cooperation(Lead Countries)ACMECS -Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy (Thailand 2549) Cambodia,Loa PDR MyanmarVietnamThailand -- Health : Avian Influenza and other emerging infectious diseases (Thailand)MBDSMekong Basin Disease Surveillance()Cambodia,Loa PDR MyanmarVietnamThailand MBDS

Globalization, Global Warming, Ageing Society AC and ASEAN Connectivity,.

Nothing on earth is more International thanDisease

Keerti Bhusan Pradhan, WHO

Distribution of migrants in Bangkok

2558

?Ever-Ready for emerging Infectious Diseases

King Rama VI

If we want peace, we need Preparedness

Preparedness forPublic Health Crisis is paid off

.... ... ... ............. ... 2 .. 2540.

: ..If we look at some faces in Bangkok we can surmise that they came from foreign countries illegally. We do not know what diseases they carried, there must be some. We have to seek out those who carry a disease to provide them with some medical treatment. Whether they came in illegally or not, the diseases they carry have also entered the country illegally. Nevertheless, we must fight the diseases regardless of whether it came legally or illegally. We must help, otherwise the disease will surge up and spread out again. This is the duty or it could be called the future mission that we have to do in the future. We cannot rest on our laurels after our victory, we cannot stop working. 2 .. 2540.

11 .. 2555 - 2559

1.

2.

3.

4.

2563

6. 3. 5. 4. 2. : . ..

() ()

( )

Plague OutbreaksIndia, 1994Economic Loss: 1,700 Mil.USD

Between 1348 and 1359 the Black Death wiped out an estimated 30 percent of the population in Europe and Asia.

Influenza A/H7N9 in ChinaFebruary 2013January 2014Sources = World Health Organization, Food and Agriculture Organization, OIE, ProMed, Flutrackers, and scientific publications through 1/23/14; * may be biased towards more-severe cases that are more-easily recognized. ** includes age, gender, location, clinical outcome, and dates for symptom onset, hospitalization, death (if applicable) in publicly-available reportsSummary of confirmed human infections*:Median age = 58 years (range: 3-91)72% cases maleApparent case fatality rate = 24%Cases in clusters (2 or more) = at least 5%Cases with connections to China = 100%Cases with likely contact with poultry = at least 34%Cases involving health workers = 0%Cases with basic data** = 55%^ Anhui (4), Beijing (2), Fujian (12), Hebei (1), Henan (4), Hunan (2), Jiangxi (6), Shandong (2), Taiwan (2)= male; = female

Chart1

4

31

96

2

0

2

0

0

4

3

16

61

cases

Reported human cases by month (n=219)

Sheet1

cases

Feb 134

Mar 1331

Apr 1396

May 132

Jun 130

Jul 132

Aug 130

Sep 130

Oct 134

Nov 133

Dec 1316

Jan 1461

Chart1

64

10

45

249

124

3515

3313

2011

184

10

male

female

Reported human cases by age group (n=219)

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malefemale

0-964

10-1910

20-2945

30-39249

40-49124

50-593515

60-693313

70-792011

80-89184

90-9910

Chart1

87

80

52

Sales

Reported human cases by outcome (n=219)

Sheet1

Sales

recovered87

hospital-ized80

died52

To resize chart data range, drag lower right corner of range.

Chart1

30

41

83

29

36

Sales

Reported human cases by province (n=219)

Sheet1

Sales

Jiangsu30

Shanghai41

Zhejiang83

Guang-dong + Hong Kong29

9 others^36

To resize chart data range, drag lower right corner of range.

Components of Communicable Disease Control MeasuresOutbreakCommunicationCrisis Communication(All Hazards)Risk Communication

Success Stories in Thailand Plague eliminated (1952) Smallpox eradicated (1962) Yaws (no cases since 1966) few cases re-emerged in some years, 22 cases in 2004 Poliomyelitis (no cases since 1997) Vaccine preventable diseases Human diseases (Diphtheria, Pertussis, Tetanus, Mump, JE) Zoonoses (Anthrax, Rabies,) Filariasis, Leprosy (under controlled) HIV/AIDS (substantially controlled)

New infectious diseases New geographical areas Re-emerging infectious diseasesAntimicrobial resistant organismsDeliberate use of bio-weaponsEmerging Infectious Diseases (EIDs)

EIDs of Major Concerns Avian influenza and Pandemic influenza Re-emerging TB (MDR and XDR) Drug Resistant Malaria, HIV/AIDS (more focus in youths) Severe HFMD (Enterovirus 71, .) EIDs and Re-EIDs from abroad e.g. - Plague, SARS - Encephalitis (Nipah, West Nile..) - Hemorrhagic Fever (Ebola, Marburg.), Yellow Fever - Chikungunya - Vaccine preventable diseases (diptheria,.) Antimicrobial resistance pathogens

??Risk for areas with recent local transmission of SARSLow (+)Medium (++)High (+++)Case in area of exportationLow (+) : Imported probable SARS case(s) have produced only one generation of local probable cases, all of whom are direct personal contacts of the imported case(s)Medium (++) : More than one generation of local probable cases, but only among persons that have been previously identified and followed-up as known contacts of probable SARS casesHigh (+++) : High transmission pattern other than described above in (+) and (++)Uncertain : Insufficient information available to specify areas or extent of local transmission?!!!

SARS ! Global cooperation

National transparency

National preparedness

Naming diseases carefully

2547 2549( 25 17 .. 49) H5N1 Fujian-like (clade 2) H5N1 Vietnam-like (clade 1)

..-.. 47

..-.. 47

..-.. 48

..-..49

..-..50

Intregrated management of HPAI at provincial level

Voices of reason quieter than voices of panicHilary M Babcock, MD, MPH

() 2009

Response in Public Health EmergencyBotulism Outbreak (163 cases) from Canned Bamboo shoot, Nan, 2006

2555

, PHER, Orphan drugs, Risk Communication

Expected roles of national health authorityPolicy and strategy developmentKnowledge managementTechnology assessment & development Standardization of disease control practices SurveillanceRegulatoryInternational cooperation (Medical Hub, , )monitoring and evaluationFinancing Information manpower development

(DCCD) (DHS) IHRs(2005)

(Surveillance and Rapid Response Team : SRRT) .

()

MBDS

HIV/AIDS, TB, Malaria, EIDs (Avian Flu, Plague, Diptheria, Emerging Zoonoses, .)

Event-based surveillance (Public Health Emergency of International Concern : PHEIC)

.. 2005International Health Regulations (2005) : IHRs (2005)

(Points of Entry check list)- - PoE (Routine)- PoE (PHEIC)

cholera, plague and yellow fever

National IHR Core Capacity Requirements8 Core capacities Legislation and Policy. ......... CoordinationSurveillanceResponsePreparednessRisk CommunicationsHuman ResourcesLaboratory

3 levels National IntermediatePeripheral/CommunityPotential HazardsBiologicalInfectious Zoonoses Food safety Chemical Natural DisasterRadiological and nuclearEvents at Points of Entry WHO

MBDSASEAN APECACMECSGlobal health

/ . . / /

Disease Control Competent District (DCCD)

:

(District Health System : DHS) (DCCD) Health Promotion Hospitals - PCU (Close to client)

(District Health System : DHS)UCARE : Unity - Community - Appreciation - Resource sharing - Essential care -

45 1 ../ / / .

6)) (Myanmar) (Laos) (Cambodia) (Malaysia).645 21 2555101182 . 2 ,,,,. 3 (5 .) ( 25 .). 3.1 (2 .) ,. 3.2 (5 .) ,. 3.3 (4 .). 3.4 (6 .). 3.5 (8 .). 4 (4 .) ( 22 . ). 4.1 (10 .),. 4.2 (3 .). 4.3 (5 .). 4.4 (4 .). 11 (5 .)( 33 ). 11.1 (5 .), . 11.2 (9 .) ,. 11.3 (8 .). 11.4 (6 .). 11.5 (5 .). 12 (4 .) ( 23 ). 12.1 (5 .). 12.2 ( 7 .) ,. 12.3 ( 6 .) . 12.4 ( 5 .) ( 3 .) (3 .) . 6.1 ( 3 ) , , . 6.2 ,,. 6.3 ,. 5 (4 .) (12 .). 5.1 (3 .). 5.2 (2 .). 5.3 (4 .). 5.4 . (3 .).9 (3 .) (15 .) . 9.1 ,, ( 5 .) . 9.2 ( 3 .) . 9.3 () (7 .) . 7 (3 .)(3 .) . 7.1 ,, , ( 3 . ). 7.2 , . 7.3 . 8 (2 .) ( 4 ). 8.1 , ( 2 .). 8.2 , ( 2 .). 10 (5 .) ( 30 ). 10.1 (10 .). 10.2 (3 .). 10.3 (7 .),. 10.4 (7 .),. 10.5 ( 3 .),

. 1 1. 2. 3. 4. 11

International Organizations for Technical Support Development Partners TICA, JICA, USAID, MBDS, KINAN, etc. Bilateral Collaboration TUC /(Twin Cities) - -, -, -, -, -- -, -, -- -, -, - Bilateral/ Multilateral/ Regional Collaboration

/ Global Fund () WHO, USA (USAID, LMI, TUC.) JICA (Training, Disaster) China (GMS, Bilateral,) UK HPA (PHEM, Mass gathering..) : , , , , ... : , Lab, PHEM (ICS,.. ), ,.....

/ ( 2556) /. ., ., . . () Thailand International Development Cooperation Agency (TICA) Training

2557

() PPP (Public-Private Partnership) (NGOs)

Is it a beautiful network ?

The 4 words starting with coSuccessin controlling diseases is dependent not only on the authoritiesefforts but also on local people's active participation and supports in the efforts. For securing the participation and supports we need the following.

Communication coordination collaboration cooperation

Communication is a prerequisite for the rest of the words.

Shiro Yoshimura, OIE Coordination, Bangkok Sub-Regional Office for SEA, August, 2007

: ?Networks

Policy, Strategy, System, Mechanism

Action plan

Emergency response plan

Resources

Core capacities IHRs (2005)

10 (Declaration of ASEAN Concord II Bali Concord II) .. 2558 (.. 2015) 3 (pillars) (ASEAN Politicaland Security Community - APSC) ) (ASEAN Economic Community - AEC) ) (ASEAN Social and Cultural Community - ASCC)

**** 25 17 3 48 4 49 *This flow chart demonstrated the inter-relationship both reporting the disease and command of disease control operation from the provincial level down to the village level. It is advised from the central authorities that the integrated operations especially from livestock and public health side are key for effective disease control.*. .. 2523 ( 13, 14) () () () () ()() () () () () () () ()

IHR 2005 POE check list IHR 2005 3 2.1 2.2 PoE (Routine)2.3 PoE (PHEIC)***