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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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slide1
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

slide3
1st Millenium

Middle Ages

Spread of 1918 Influenza Pandemic in USA

Epidemics and Pandemics have shaped our history…

slide4
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

slide5
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

PANDEMIC Global spread

Global travel and trade

  • Globalization
  • Global travel: people, animals, vectors
  • Global trade: animal and their products

EPIDEMIC Amplification

  • 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

OUTBREAK Emergence

  • 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

slide13
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.

slide16
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
slide17
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

slide18
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

slide20
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

slide29
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

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

slide32
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
slide33
GOARN is a partnership of over 190 technical institutions and networks coordinating actions and resources to respond to public health events of international concern.
slide35
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

slide36
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 !
slide39
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
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…..)
slide43
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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