Perspective from WHO on Ebola preparedness & response in ASEAN+3 countries

Perspective from WHO on Ebola preparedness & response in ASEAN+3 countries Workshop on Strengthening Ebola Preparedness for Early Response among ASEAN+3 FETN Member Countries, 1-3 December 2014, Bangkok, Thailand Rick Brown, WHO Thailand

What this presentation will cover • What are the International Health Regulations (2005)? • Ebola preparedness and response • Outbreak response networks…

What are the International Health Regulations (2005)? • An internationally agreed instrument for global public health security • Represents the joint commitment by all countries for shared responsibilities and collective defence against disease spread • Legally binding for WHO Member States since June 2007

Approach of the New IHR • From controlling at borders, to containment ‘at source’ • From a list of diseases, to a very broad range of threats • Focus on ‘risk-based’ assessment & response • New ‘infrastructure’ • National IHR Focal points • WHO IHR Contact Points in Regional Offices • IHR Department in WHO Headquarters in Geneva, Switzerland • Annual reporting to the World Health Assembly • Secure Event Information Site (EIS) • Emergency Committee and a ‘review process’

What does IHR implementation mean…? • Two very important aspects… • An immediate and ongoing requirement • for countries to report some types of event when they occur, and • for WHO to provide assistance • A requirement, linked to a timeframe for countries to establish capacities to detect and respond to public health events (initially, by June 2012)

What should be reported to WHO? • Any potential ‘Public Heath Event of International Concern’ (PHEIC) • To help any decision, some criteria have been established • Is the public health impact of the event serious? • Is the event unusual or unexpected? • Is there a significant risk of international spread? • Is there a significant risk of international travel or trade restrictions? • A decision on whether to report an event will normally be made at national level (by the national IHR focal point) • Only the DG of WHO (advised by experts) can declare a PHEIC

IHR Core Capacities and APSED • Eight “core IHR capacities” • National legislation, policy and financing. • Coordination and National Focal Point (NFP) Communications. • Surveillance. • Response. • Preparedness. • Risk communication. • Human resources. • Laboratory. • Points of Entry • Capacities for IHR-relevant hazards (infectious diseases, zoonoses, food safety, chemical, radio-nuclear) • The Asia Pacific Strategy for Emerging Diseases (APSED) provides this region with a framework for IHR implementation

IHR as a Public Health Good • If all countries, without exception • Are well prepared, and have good capacity for detection and response to all acute public health events, and… • Report serious events quickly, and provide other countries that help them to prepare • Then all countries will be more safe from unpredictable events, whenever they occur • The world would be a safer place…. • However… • One weak link in the chain can threaten us all…

IHR as a Public Health Good

Ebola Situation Update • 15 935 reported cases of Ebola virus disease (EVD), with 5689 reported deaths (23 November). • 600 cases were reported in the three most-affected countries in the past week. • Case incidence is stable in Guinea, stable or declining in Liberia, but may still be increasing in Sierra Leone. • The case fatality rate across the three most-affected countries in patients with a recorded definitive outcome is approximately 60%. • 592 health-care workers (HCWs) are known to have been infected with EVD up to the end of 23 November, 340 of whom have died

WHO Perspective in the Asia Pacific: Ebola Preparedness and Response • Likelihoodof importation of a case low for any country in the Asia Pacific Region • However, consequences would be very high… • Therefore all countries need to be prepared (on a precautionary basis) for importation of cases, and small outbreaks…

Ebola preparedness and response? • Eight “core IHR capacities” • National legislation, policy and financing. • Coordination and National Focal Point (NFP) Communications. • Surveillance. • Response. • Preparedness. • Risk communication. • Human resources. • Laboratory. • Points of Entry • Checklists may be helpful…. • An Emergency Operations Centre can help with preparedness and response

Ebola ‘Event’ Reporting • Reporting a suspected / confirmed ebola case or outbreak will… • Demonstrate transparency, and a ‘pro-active’ approach • Help other countries to ramp up their preparedness • Allow WHO and other partners to provide more effective support

‘All-Hazards’ Preparedness? • An ‘all-hazards’ approach to ‘preparedness and response’ is rational and has some efficiency • Map all hazards in your country • Assess their relative risks • Develop SoPs (including surveillance and response) and stockpiles of critical logistic supplies • Develop, test and revise plans through tabletop / simulation exercise • Should build all capacities on existing health systems • Can expand scope of (or merge) plans ‘step-wise’ Influenza  EID  All Infectious Diseases  All-Hazards

Outbreak Response Networks: the Global Outbreak Alert and Response Network (GOARN) • Established in 2000 as a global technical partnership with a focus on outbreak response • The World Health Organization agreed to provide the Operational Support Team for the partnership, and to coordinate its activities. • GOARN and its aims were endorsed by the World Health Assembly in May, 2001

GOARN’s Primary Aims • Assist countries with disease control efforts by ensuring rapid appropriate technical support to affected populations • Investigate and characterize events and assess risks of rapidly emerging epidemic disease threats • Support national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats

GOARN's current structure 150+ Partner Institutions plus 37 Networks with 355 network members Offer people and resources in response to a request for assistance Operational Support Team (OST) Sustains Network and coordinates outbreak response operations Steering Committee (SCOM) Provide overarching guidance to the Network and oversees planning and implementation of Network activities Technical Working groups and Sub-Committees Established to focus on specific projects and issues.

Multidisciplinary teams…! • Field epidemiology • Laboratory science • Clinical management • Infection control • Environmental health • Health education • Medical anthropology • Risk communication • Outbreak Logistics • Others…

Over 150+ technical partners across the globe, plus many additional network members

Outbreak Response Training • Residential courses in international outbreak response and team leadership • Participative approach via role plays, case studies and practical exercises. • Coordination and leadership. • WHO role, objectives and procedures. • Personal and operational security and logistics. • Health on mission. • Field epidemiology. • Case management and infection control. • Social mobilization and anthropology. • Working in support of national partners. • Risk communication.

GOARN Operations and deployments 2012-2014* *As of 20 October 2014

Summary • The International Health Regulations exist to ensure / support Global Health Security • Preparedness for ebola is key, including being prepared to respond to cases and small clusters • Outbreak response networks can help to respond to a big event, because no single country has all the capacity required…

Thank you….! Rick Brown, WHO Thailand

Perspective from WHO on Ebola preparedness & response in ASEAN+3 countries