06/06/2012 a ihr implementation and pe sd - aseanaseanregionalforum.asean.org/files/archive/19th/arf...

06/06/2012

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ASDPEIHR Implementation and Strengthening GOARN

Division of Health Security and Emergencies (DSE)WHO Western Pacific Regional Office (WPRO)

Dr Li Ailan

2Division of Health Security and Emergencies (DSE)WHO Western Pacific Regional Office (WPRO)

Outline

• IHR implementation in Asia Pacific Region

• Regional strategy for strengthening national and regional surveillance and response systems

• Development of the Global Outbreak Alert and Response Network (GOARN) in the Region


International Health Regulations

• A global legal framework for global public health security

• Call for shared responsibilities and collective defence against disease spread

• Legally binding for WHO Member States since June 2007


Purpose of IHR (2005)

“To prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoidunnecessary interference with international traffic and trade” – Article 2

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IHR Provide a Legal Framework…

• To strengthen national system and core capacities– for surveillance and response– at designated international points of entry

• To ensure a functional international system to detect, assess and respond to any disease outbreaks or acute public health events of international concern


National surveillance & response capacity

- IHR (2005) timeline

• Timeline

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 …" (Articles 5, 13)


International surveillance and response system

• IHR (2005) emphasize the importance of collectively managing acute public health threats globally

• The key functions of this global system are to

• Detect• Verify• Assess• Inform• Assist


Roles of the National IHR Focal Points

SeniorManagement

NFP (24/7)

WHO (24/7)

Functions within the country• Consolidating info• Disseminating info

Functions (with WHO):• Consultation • Notification of a potential PHEIC• Information sharing• Other reports• Verification• Determination of a PHEIC • Coordinated response to a PHEIC

Relevant depts/agency•Surveillance & response•POE•Food safety authority •MoA•Others

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IHR implementation in the Region

• Through implementation of the Asia Pacific Strategy for Emerging Diseases (APSED)

– APSED (2005)

– ASPED (2010)

• A common regional strategic framework for national and regional surveillance and response system strengthening, required under IHR (2005)


APSED (2005) Achievements

0102030405060708090

100

2007 2008 200910

12

14

16

18

20

2003 2004 2005 2006 2007 2008 2009

Year

Med

ian

(day

s)

Time from onset to official reporting for H5H1 human

infection

Percentage of countries with the minimum surveillance capacity


Geographical distribution of a subset of outbreaks confirmed and reported to WHO, 1996‐2009

Source: Emily h. Chan etc, PNAS, Dec 2010

398 WHO-verified outbreaks

- 53% occurred in Africa

- 18% in WPR and SEA

- 7% in Europe


Achievement of the IHR core capacities in the WPR

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Event‐bases surveillance system


Risk Assessment

15Division of Health Security and Emergencies (DSE)WHO Western Pacific Regional Office (WPRO) 16Division of Health Security and Emergencies (DSE)

WHO Western Pacific Regional Office (WPRO)

Moving forward: APSED (2010)…• An updated common framework for

countries, WHO and partners to strengthen national and regional systems for managing emerging diseases and public health emergencies

• APSED (2010)– continues to focus on primarily building

capacity for emerging diseases

– also addresses other acute public health events in line with IHR requirements, such as food safety events caused by chemical contamination

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Process of Developing APSED (2010)

Country Consultations

Bi-Regional Consultation on APSED and Beyond

24-27 May 2010

5th TAG Meeting 6-9 July 2010

RCM (Oct 2010)

DiscussionPapers

Draft APSED (2010)

Independent Review


Structure of APSED (2010)

VisionAn Asia Pacific region prepared to mitigate the risk and impact of emerging diseases and other public health

emergencies through collective responsibility for public health security.

GOALTo build sustainable national and regional capacities and partnerships to ensure public health security through preparedness planning,

prevention, early detection and rapid response to emerging diseases and other public health emergencies.

Objective 1Reduce risk

Objective 5Build sustainable partnerships

Surveillance, Risk

Assessment and

Response

Laboratories Zoonoses Infection Prevention and Control

Risk Communicat

ions

Public Health

Emergency Preparednes

s

Regional Preparedness, Alert and Response

Monitoring and

Evaluation

Focus Areas

Objective 4Strengthen effective

preparedness

Objective 2Strengthen early

detection

Objective 3Strengthen rapid

response


GOAL of APSED (2010)

To build sustainable national and regional capacities and partnerships to ensure public health securitythrough preparedness planning, prevention, early detection and rapid response to emerging diseases and other public health emergencies


APSED Five Objectives

1. Reduce the risk of emerging diseases

2. Strengthen early detection

3. Strengthen rapid response

4. Strengthen effective preparedness

5. Build technical partnership

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Expanded Scope: 8 Focus Areas

APSED (2005)1. Surveillance & Response2. Laboratory3. Zoonoses4. Infection Control5. Risk Communication

APSED (2010)1. Surveillance, Risk Assessment

and Response

2. Laboratory

3. Zoonoses

4. Infection Prevention and Control

5. Risk Communication

6. Public Health Emergency Preparedness

7. Regional Preparedness, Alert and Response

8. Monitoring and Evaluation


Surveillance, Risk Assessment and Response

• Surveillance for early detection and rapid response

• Key components– Event‐based surveillance– Indicator‐based surveillance– Risk assessment capacity– Rapid response capacity – Field epidemiology training


and Response

2. Laboratory

3. Zoonoses







Surveillance, Risk assessment and Response

Event‐based Surveillance

Rapid detection, reporting, confirmation and assessment of public health events including:

•clusters of disease•rumours of unexplained deaths

Commonly: •Immediate reporting

ResponseLinked to surveillance

National and subnational capacity to respond to alerts

Indicator‐based Surveillance

Routine reporting of cases of disease, including: •notifiable dis. surveillance systems•sentinel surveillance•laboratory‐based surveillance

Commonly: •Health care facility‐based reporting•Weekly, monthly reporting

Risk Assessment


Risk assessments for acute PH events

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25First Meeting of the Asia Pacific Technical Advisory Group on the Asia Pacific Strategy for Emerging Diseases (2010)26-28 July, Manila, Philippines

APSED‐Zoonoses

ResearchAnalysis

Surveillance information from human health

sector*

Surveillance information from animal health

sector*

Coordination Mechanism

ResearchAnalysis

Coordinated Risk Reduction

Coordinated Response

(And other sectors*)


Regional Preparedness, Alert & Response

• Enduring a collective regional system– No single country alone can manage

all acute public health events

• Key components– Regional surveillance and risk

assessment– Regional information‐sharing system– Regional preparedness and response


and Response

2. Laboratory

3. Zoonoses







Regional surveillance system

• Regional event‐based surveillance (EBS)– Rumour surveillance (informal sources of information, e.g. media reports)

– IHR event communications between WHO and the National IHR Focal Points (NFP)

• Regional indicator‐based surveillance (IBS)– Reporting of routinely collected national priority disease data to the regional level, accompanied by timely analysis and risk assessment (e.g. dengue)

– Provide an additional early warning system for Member States (e.g. influenza surveillance)


Public health events reported: SEAR & WPR

Reported events, July 2010 to June 2011 (N=389)Infectious diseases 232 (60%)‘Animal health’ events 140 (36%) Radio‐nuclear 8 (2%)Undetermined 9 (2%)

Information source of initial reportsMedia reports 213 (55%)Reported by WHO country offices 77 (20%)Official websites + others 99 (25%)

Event Management System and ESR Outbreak Monitoring and Alert News

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Strengthening the regional system…

Information productsOther products

WHOMemberStates

-IBS-EBS-RA-RRT-FET

Weekly report

IHR

Risk Assessment

Disease/event Surveillance

Response

WPSAR

IBS

EBS

National level Regional level

Member States

Relevant sectors

RC for publicEOC

Networks-GOARN-Clinical-Lab

Stockpile

ICT

Other sources

FETP


Regional information sharing system:

WPSAR ‐Western Pacific Surveillance and Response

• Aim to create a platform for sharing quality information on the surveillance of and response to public health events in the region

• Free access, web based peer‐reviewed journal

• Information for action


Global Outbreak Alert and Response Network

•GOARN, established in April 2000

a global technical network of partner institutions that can provide support to those who need

•GOARN, coordinated and supported by WHO, provides rapid technical team support to countries for outbreak response


00

“In the face of a big outbreak, we can't do it alone, so we work in partnership with others."

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GOARN as Part of APSED (2010)

Strengthening Regional Response Capacity = Strengthening GOARN in the Region

Strengthening GOARN contributes to APSED implementation

to develop sustainable technical collaboration within the Asia Pacific

to support in‐country capacity building such as outbreak response


How do we strengthen GOARN?Regional GOARN Package

• Annual regional meeting

• Training

• Advocacy visits

• Operation

• Development of rapid deployment procedures


• Knowledge:Working with GOARN in the field – Understand roles, and responsibilities in the field

– Become familiar with WHO approach in outbreak response

• Skills development:– Learn how to deal with critical technical and operational challenges in an international GOARN mission

Scenario‐based GOARN Training


Venue THE VENUE

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Training Room


Local Transport

39First Meeting of the Asia Pacific Technical Advisory Group on the Asia Pacific Strategy for Emerging Diseases (2010)26-28 July, Manila, Philippines 40

First Meeting of the Asia Pacific Technical Advisory Group on the Asia Pacific Strategy for Emerging Diseases (2010)26-28 July, Manila, Philippines

Examples of GOARN missions

A number of GOARN missionsconducted 2009‐2010 in the Western Pacific Region, such as:

• Pandemic (H1N1) 2009 response, Malaysia, Mongolia

• Post‐disaster Leptospirosis outbreak in the Philippine, 2009

• Cholera and shigelloses outbreak response in PNG, 2009

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Cholera and shigelloses, PNG

• Multiple outbreaks ongoing – Cholera, Shigelloses, Influenza

• High number of deaths associated with bloody diarrhoea

• Rapid spread of Cases of watery diarrhoea• Request for

– Field team coordinator– Logistics support

• Large procurement of supplies (WHO, international partners)

– Epidemiologist – Clinical management – Risk communication

• Field team assisted MoH to coordinate with partners in the field


Leptospirosis, Philippines• The GOARN team = 10 participants from 6

different GOARN partners

• The request for assistance came from a GOARN partner (also NFP)– National Centre for Epidemiology, Philippines

• ToR: to support the Department of Health to conduct an outbreak investigation of suspected leptospirosis including:– Revision of clinical management guidelines – Review of proposed control measures– Development of a post‐disaster disease surveillance

system


Strengthening GOARN….

• Continue the development of GOARN in the Asia Pacific Region

• Expand GOARN to include technical partners in the areas of logistics, chemical events, animal human interface and to include non‐infectious disease events in GOARN training and deployment


Approach to address deliberate events

• Use and strengthen existing national surveillance and response systems, networks and coordination mechanisms to detect and respond to events related to the deliberate release of CBRN

• Identify and strengthen regional and international mechanisms to support preparedness planning, detection and response

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45Division of Health Security and Emergencies (DSE)WHO Western Pacific Regional Office (WPRO)45

Conclusion

The Asia Pacific Region has been an epicentre for health security events, resulting in significant impacts on health, social and economic development

Managing regional health security threats requires both strong national and regional systems to detect, assess and respond to all acute public health events

IHR provide a global legal framework and APSED serves as a common regional tool to manage health security threats, including those caused by deliberate release of biological, chemical and radiological/nuclear Agents


Thank youThank you

06/06/2012 a ihr implementation and pe sd - aseanaseanregionalforum.asean.org/files/archive/19th/arf...

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