Coherence in Response to Globalisation Challenges
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Coherence in Response to Globalisation Challenges The Global Framework to Address Communicable Diseases – Can we do Better ?. Dr Mike Ryan, Director Global Alert and Response. Same Ingredients Different Recipe !. Policy System Protection Access Security Research. HEALTH. 1 st Millenium.

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Dr Mike Ryan, Director Global Alert and Response

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Dr mike ryan director global alert and response

Coherence in Response to Globalisation ChallengesThe Global Framework to Address Communicable Diseases – Can we do Better ?

Dr Mike Ryan, Director

Global Alert and Response


Same ingredients different recipe

Same Ingredients Different Recipe !

  • Policy

  • System

  • Protection

  • Access

  • Security

  • Research

HEALTH


Dr mike ryan director global alert and response

1st Millenium

Middle Ages

Spread of 1918 Influenza Pandemic in USA

Epidemics and Pandemics have shaped our history…


Dr mike ryan director global alert and response

They continue to threaten us..

…and place sudden intense demands on national and international health systems

….on some occasions have brought health and social systems to the point of collapse

WHO has detected and assessed more than 3,000 events between January 2001 and May 2010


Dr mike ryan director global alert and response

Context of emerging/epidemic disease in the 21st. century

  • Emergence of new or newly recognised pathogens (e.g. Avian flu (H5N1), SARS, Ebola, Marburg, H1N1)

  • Resurgence of well characterized outbreak-prone diseases (e.g. cholera, dengue, measles, meningitis, shigellosis, yellow fever)

  • Release (accidental or deliberate) of a biological agent (e.g. BSE /v CJD, smallpox, SARS, anthrax)


Drivers of epidemic risk

Drivers of Epidemic Risk

PANDEMICGlobal spread

Global travel and trade

  • Globalization

  • Global travel: people, animals, vectors

  • Global trade: animal and their products

EPIDEMICAmplification

  • Amplification

  • Urbanization

  • Population density

  • Agricultural Intensification

  • Technology And Industry

  • Vector distribution and densities

  • Transmission in health care centers

  • Successful A2H, V2H & H2H transmission,

Human to human

transmission

Amplification

OUTBREAKEmergence

  • Emergence

  • Human encroachment

  • Exploitation

  • Translocation

  • Climate variability

  • Vector density and distribution

  • Ecological Pressure

Human

Ecosystem

Environment

interface


The environment animal human interface

The Environment/Animal/Human Interface

Wildlife

Domestic Animal

Human outbreak

Climate

Vegetation

Environment

Number of Cases

Human

Amplification

Animal

Amplification

spill over

spill over

TIME


Human development index

Human Development Index

Data source UNDP 2009 and UNEP 2006.

The human development index (HDI) is calculated using three variables: life expectancy, education level and income.

Selected major wilderness areas

Human Development Index

No data

0,5

0,7

0,8

0,9

1

0,2

Selected terrestrial biodiversity hotspots


Countries with a critical shortage of health service providers doctors nurse midwives

Countries with a critical shortage of health service providers (doctors/nurse/midwives)

Country with critical shortage

Country without critical shortage

Data source WHO 2009. Global Atlas of Health workforce


Countries with crises and emergencies 1990 2010

Countries with crises and emergencies 1990-2010

Country with crises during 1990-2010

Country without conflicts

Data source WHO HAC cluster. http://www.who.int/hac/en/index.html


Dr mike ryan director global alert and response

Saudi Arabia

Cap Verde

Yemen

2009


44 megacities in 2020

44 megacities in 2020

Moscow

London

Beijing

Chicago

Paris

Seoul

Tokyo

Los Angeles

Tianjin

Istanbul

Lahore

New York

Shanghai

Osaka, Kobe

Tehran

Delhi

Wuhan

Baghdad

Karachi

Calcutta

Hong Kong

Mexico

Cairo

Dhaka

Riyadh

Surat

Chittagong

Ahmadabad

Metro Manila

Hyderabad

Mumbai

Chennai

Bangkok

Bogota

Pune

Lagos

Bangalore

Kinshasa

Lima

Belo Horizonte

Jakarta

Rio de Janeiro

Sao Paulo

Buenos Aires

30 millions habitants and more

15>29.9 millions habitants

10 >14.9 millions habitants

7 >9.9 millions habitants


Global aviation network

Global Aviation Network

Hufnagel et al, PNAS, 2004.


Dr mike ryan director global alert and response

The reality – we are vulnerable !

  • Epidemic diseases and other public health threats will continue to occur because of

    • Efficient adaptation of the microbial world

    • Vulnerability and poor adaptation of the human world,

  • Epidemics and other public health emergencies present a major threat to life, economies and security in an increasing inter-connected and inter-dependant world

  • These events often

    • expose existing weaknesses in public health and systems; and the need for rapid response drains resources, staff, and supplies away from other health priorities.

    • Stress social and political systems, often leading to inappropriate and ineffective adaptive behaviours.

  • Convergent risks require coherent responses


  • Dr mike ryan director global alert and response

    No single institution

    has all the capacity!

    CHALLENGE

    • Ensure that States and the their communities are on the alert and ready to cope with major biological risks and events.

    • Ensure that the international community can rapidly detect and contain major biological risk/events with potential for international consequences

    • Get immediate access to the appropriate expertise and interventions and utilise and focus these resources to support countries and communities facing disease threats in time to make a difference

    WHO and the EU bring partners together to focus and coordinate international resources


    Dr mike ryan director global alert and response

    Epidemic Management has Changed !!

    Barrier

    nursing

    Traditional

    healers

    Medical

    Anthropology

    Clinical

    Care

    Triage

    IN / OUT

    COMBI *

    Posters

    Psycho

    Social

    support

    Social Mobilization

    Burial/

    funerals

    Case Management

    Infection control

    Radio - TV

    Health Education

    Infection

    Control

    Discussion

    Community

    Media

    Information

    Environment

    Vector control

    Coordination

    Life

    Support

    Find Cases

    Diagnosis

    Surveillance

    Investigation

    Logistics

    Security

    Communications

    Track

    Contacts

    Field

    Comms

    Sampling

    + Testing

    Epi/lab

    Studies

    Data Analysis

    Transport

    Mobile teams

    Finance

    Vehicles

    (* COMBI = communication to change behaviors)


    The environment animal human interface1

    The Environment/Animal/Human Interface

    Animal

    Vaccin°

    Wildlife

    Domestic Animal

    Rapid

    Response

    Human outbreak

    Early

    detection

    Forecasting

    Readiness

    Control

    Opportunity

    Number of Cases

    Animal

    Amplification

    TIME


    Dr mike ryan director global alert and response

    The Rules have changed !

    IHR…..a paradigm shift

    From control at borders to containment at source

    From diseases list toall threats

    From preset measures toadapted response


    Strategic actions

    Strategic Actions

    • Strengthen National Systems & Capacities in disease prevention, Preparedness and response

    • Build the Global Alert and Response System

    • Manage specific health threat through Prevention, Risk Reduction and Preparedness

    • Enhance Global and Regional Operational, technical and Scientific Networks

    • Drive Knowledge generation, Innovation, Tools and Training for Improved epidemic Interventions

    • Improve availability and access to tools and interventions

    • Promote Inter-sectoral Cooperation

    • Regional & Global Health Leadership, Collaboration and Partnership


    Risk event management under ihr

    Risk/Event Management under IHR

    • WHO and it's Member States have new and explicit obligations to collectively approach the prevention, detection, and timely response to any public health emergency of international concern.

    • IHR defines a risk management process where Member States work together and through WHO to collectively manage acute public health threats

    • Increased responsibilities, greater scrutiny

    • WHO Director General responsible for the Organization's performance under IHR

    • The key functions of this global system are to

      • Identify

      • Assess

      • Assist

      • Inform

    …….Plus, in extra-ordinary circumstances, DG can declare a PHEIC and make global recommendations


    Key activities identify

    Key Activities - Identify

    Informal/Unofficial Information

    Notifications/Consultations

    Verification

    Initial screen

    Others sources

    IHR National Focal Points

    (Member States)

    WHO


    Key activities assess

    Key Activities - Assess

    Informal/Unofficial Information

    Notifications/Consultations

    Verification

    Initial screen

    Others sources

    IHR National Focal Points

    (Member States)

    WHO

    Event Risk Assessment


    Key activities assist

    Key Activities – Assist

    Informal/Unofficial Information

    Notifications/Consultations

    Verification

    Initial screen

    Assistance / Response

    Others sources

    IHR National Focal Points

    (Member States)

    WHO

    Event Risk Assessment


    Key activities inform

    Key Activities - Inform

    Disseminate Public Health Information

    Informal/Unofficial Information

    Notifications/Consultations

    Verification

    Initial screen

    Assistance / Response

    Others sources

    IHR National Focal Points

    (Member States)

    WHO

    Event Risk Assessment


    Risk event management process

    Risk/Event Management Process

    Disseminate Public Health Information

    Others sources

    Informal/Unofficial Information

    IHR Reports

    IHR National Focal Points

    (Member States)

    Verification

    WHO

    Public Health Emergency of International Concern (PHEIC) Assessment

    Initial screen

    Event Risk Assessment

    Assistance / Response


    Dr mike ryan director global alert and response

    Public Health Event Response

    under the International Health Regulations

    "Payload and Platform" concept of operations

    Specialist Programmes

    CHEMICAL

    RADIATION

    FOOD

    EPIDEMIC

    Chemical

    Food

    Radiation

    EPIDEMIC

    Prediction

    Prevention

    Risk Reduction

    Detection

    Verification

    Assessment

    Event and

    Intervention

    Management

    Operational

    Support &

    Logistics

    Information Mgt

    & Risk

    Communication

    Event Management System (HQ/RO/CO)

    WHO Senior Management


    Dr mike ryan director global alert and response

    EMS current events 2010-06-09


    Key features of the global ems who s event management system

    Key features of the global EMS (WHO's Event Management System)

    WHO internal tool for public health event-based information management

    Secure platform

    Custom-built for decision support

    Being rolled-out to 3 levels of WHO

    IHR (2005) compliant

    All-hazards approach

    Risk assessment driven

    Phase II enhancements being planned


    Dr mike ryan director global alert and response

    Risk communication products

    • EMS feeds information to the Global Outbreak Alert and Response Network (GOARN) site and the Event Information Site for IHR National Focal Points


    Dr mike ryan director global alert and response

    GOARN is a partnership of over 190 technical institutions and networks coordinating actions and resources to respond to public health events of international concern.


    Dr mike ryan director global alert and response

    GOARN partners have provided experts for over 104operations in 75 countries


    Dr mike ryan director global alert and response

    Epidemic Meningitis Disease: Districts in Alert and EpidemicAfrican Meningitis Belt, 2009

    28 million Doses of Meningococcal Vaccines (AC/ACW) Distributed in Africa through the ICG.

    2006-2009


    Dr mike ryan director global alert and response

    • 61 million people immunized in West Africa through emergency and preventive vaccination campaigns

    • 12 million more by end 2010

    Districts protected through mass vaccination campaigns, 2004-2010


    Can we do better yes

    Can we do Better ? YES!!

    • Forecasting/Prediction

    • Prevention/Preparedness/Readiness

    • Detection/Verification/Investigation

    • Risk Assessment & Communication

    • Response/Control

    • Evaluation


    Conclusions i

    Conclusions - I

    • Globalization is a fact !

      • Benefits

      • Risks

    • Our Weaknesses are our strengths !

      • Inter-connectedness

      • Inter-dependance

    • Risks are Manageable !

      • All Hazards

      • All Sectors

    • Systems/Tools/Networks/People !


    Dr mike ryan director global alert and response

    Conclusions - II

    • WHO is most effective when it works through partnership and in a co-ordinated fashion with

      • member states and other international Organizations

      • technical partners in the public, academic and private sector

    • Effective working relationships have been forged when collaboratively dealing with major threats/events

    • These relationships have been based on mutual need, collective responsibility, solidarity, transparency, personal commitment, and pride in our organizations and systems

    • This is not reproducible or sustainable without a major investment in national, regional and global public health infrastructure


    Dr mike ryan director global alert and response

    THANK YOU !

    [email protected]


    Follow ups

    FOLLOW UPS


    Who relevance

    WHO Relevance

    • Mandate and International Agreement(IHR)

    • Decentralized Structure & Capacity

      • 6 regional and 142 country offices

    • Our collective Experience in managing public health events

    • The Networks and Partnerships that we have developed and rely on (e.g. GOARN, regional and sub-regional networks, specialist networks, WHO CCs, GISN…..)


    Dr mike ryan director global alert and response

    WHO Support to Public Health Preparedness and Response at Mass Gatherings

    2009 Athletics World Championship Berlin

    2010 Winter Olympics Vancouver

    2012 European Cup Poland and Ukraine

    2012 Summer Olympics London

    2010 Commonwealth Games Delhi

    2009 Universiade Belgrade

    2008 European Cup Switzerland and Austria

    2010 Shanghai World Expo

    2004 Summer Olympics Athens

    2009 South East Asian Games Vientiane

    2009 Umra and Hajj

    2009 Caribbean Games Trinidad and Tobago

    2014 FIFA World Cup Brazil

    2008 World Youth Day Sydney

    2004 Summer Olympics Rio de Janeiro

    2010 FIFA World Cup South Africa

    Past MG events

    Up-coming MG events


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