Transcript No Slide Title

"Making Global Health News"
Health Security and Environment /
Epidemic and Pandemic Response /
International Health Regulations
Bernardus Ganter, MD
Geneva, 18-05-2008
World Health Organization
1
Emerging and re-emerging infections,
1996 – 2007
Legionnaire’s Disease
Cryptosporidiosis
Human Monkepox
Lyme Borreliosis
Multidrug resistant Salmonella
E.coli O157
BSE
E.coli non-O157
Malaria
E.coli O157
Typhoid
Severe Acute Respiratory
Diphtheria Syndrome (SARS)
West Nile Virus
West Nile Fever
E.coli O157
Influenza A(H5N1)
Reston virus
Echinococcosis
Lassa fever
Nipah Virus
Yellow fever
Venezuelan
Cholera 0139
Reston Virus
Equine Encephalitis
RVF/VHF
Buruli ulcer
O’nyong-nyong Dengue
Ebola
haemhorrhagic
fever
haemorrhagic
fever
Human
fever
Dengue
Ross River
Monkeypox
haemhorrhagic
Cholera
Marburg Cholera
Hendra virus
virus
fever
haemorrhagic
fever
nvCJD
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World Health Organization
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A Global problem

Arise from many different pathogens: viruses, bacteria, parasites

Spread in many different species: humans, insects, domestic and wild animals, aquatic

Take many different routes of transmission: direct contact, vectors, food, environmental

Affect all populations in all regions of the world
animals and sometimes breach barrier between animal
and humans
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World Health Organization
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Breaches in species barrier: selected emerging
infections in humans identified since 1976
Infection
adapted from Woolhouse et al. (2005)
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Ebola virus
HIV-1
E. coli O157:H7
Borrelia burgdorferi
HIV-2
Hendra virus
BSE/vCJD
Australian lyssavirus
H5N1 influenza A
Nipah virus
SARS coronavirus
Original
host
(confirmed/
hypothesized)
Bats
Primates
Cattle
Rodents
Primate
Bats
Cattle
Bats
Chickens
Bats
Palm civets
Year
reported
1976
1981
1982
1982
1986
1994
1996
1996
1997
1999
2003
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A Changing World
•
•
•
•
•
•
•
•
•
•
•
Population growth
Population ageing
Population movements
Urbanization
Biotechnologies
Food processing
Globalized trade
Access to remote biotopes
Industrial pollution
Climate change
…
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International Travellers 1950-2000
Increased to over 2 billion international travellers in 2006
1400 International airline passengers (millions)
1200
1000
800
600
400
200
0
1950
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1960
1970
1980
1990
2000
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Increased world trade in agricultural
products/animals, 1950 - 2006
World trade in agricultural products has increased 5-fold since 1950
160 export of agricultural products by volume
120
80
40
0
1950
1960
1970
1980
1990
2000
Source: WTO, 2000
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A Changing World

Collapse of public health
infrastructure in some places
(civil unrest)

Difficulties in vector control
programmes (e.g. Dengue,
Chikungunya)

Losing effective drugs,
emergence of antimicrobial
resistance (e.g. XDR-TB)

Worries about accidental or
deliberate release of biological,
chemical, or nuclear, agents

…
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The economic burden of SARS is
estimated at 50-90 Billion US$
Outbreak declared
over,10 July
8098 cases, 774 deaths
26 countries
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Estimated Economic Impact,
Pandemic Influenza
Source: Oxford Economic
Forecasting Group
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Why the International Health Regulations (IHR)??

Serious and unusual disease are inevitable

Diseases spread across national borders

Globalisation - problem in one location is now everybody’s headache

There is all ready an agreed code of conduct that PROTECTS against:
1 the spread of serious risks to public health
2 the unnecessary or excessive use of restrictions in traffic or trade
for public health purposes
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Concern about public health security
throughout the ages

1374 Venice
Quarantine for Plague

1851 Paris
1st International Sanitary Conference

1947 Geneva
WHO Epidemiological Information
Service

1951 Geneva
International Sanitary Regulations

1969 Geneva
International Health Regulations
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Global outbreaks, the challenge:
late reporting and response
CASES
First
case
Late
reporting
Delayed
response
90
80
70
60
50
40
30
20
10
0
Lost opportunity for control/
risk of international spread
1
4
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31
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40
DAY
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Global outbreaks, the solution:
early reporting and response
CASES
Early
reporting
Rapid
response
Potential cases prevented/
international spread prevented
90
80
70
60
50
40
30
20
10
0
1
4
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10
13
16
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40
DAY
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International Health Regulations (2005)
From control of borders to [also] containment at source
From diseases list to all public health threats
From preset measures to adapted responses
IHR(2005) entered into force on
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15 June 2007
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Areas of work for IHR implementation
► Other Intergovernmental organizations
e.g. FAO, OIE, ICAO, IMO, UNWTO, …
► Development agencies
e.g. AFD, CIDA, DFID, JAICA, USAID, ADB, ASEAN, EC, MERCOSUR, WB …
► WHO Collaborating Centres and Technical partners
International Networks / National agencies / NGOs: e.g. GOARN, IANPHI, Pasteur IN,
MSF, TEPHINET, GEISS, CDC, ECDC, HPA, InVS …
► Industry associations e.g. ACI, IATA, ISF, ISO …
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► A commitment of countries (e.g. National budget line, human resources)
► WHO technical support
"As soon as possible but no later than five years from entry into force"
Timeline
2 years + 3 + (2) + (up to 2)
15 June 2007
Planning
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2009
2012
2014
2016
Implementation
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► At all times
• Access to medical service
• Transport of ill travellers
• Inspection of conveyances
(e.g. Ship Sanitation Control Certificate)
• Control of vectors / reservoirs
► For responding to events
•
•
•
•
Emergency contingency plan
Arrangement for isolation (human, animal)
Space for interview / quarantine
Apply specific control measures
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Initial Screening
Verification with
Member States
Risk Assessment
Response Strategy and Operations
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Event Management System
EURO
HQ
PAHO
EMRO
SEARO
WPRO
AFRO
Plus 142 WHO Country Offices
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e.g. Global
Influenza
Surveillance
Network
1 laboratory
1 laboratory
national network
WHO Human Influenza
Collaborating Centers
115 National Influenza Centers
(NIC) in 84 countries
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
Annual output
 175-200,000 samples
 15-40,000 isolates
 2-6000 viruses characterized
Seasonal
Vaccine
Composition
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Strengthen threat-specific control programmes
• Anthrax
• Anti-microbial resistance
• Arboviruses (e.g. Rift valley fever, West Nile fever)
• Chemical Safety
• Cholera and other epidemic diarrhoeal diseases
• Dengue
• Food safety
• HIV/AIDS
• Influenza (new subtype in human)
• Malaria
• Measles and other vaccine-preventable diseases
• Meningococcal meningitis
• Poliomyelitis eradication initiative (wild type poliovirus)
• Radiation and environmental health
• Smallpox
• SARS and other severe acute respiratory infections
• Tuberculosis
• Yellow Fever
• Viral haemorrhagic fevers (e.g. Ebola, Marburg, Lassa)
Geneva, 18-05-2008
► > 95% of day-
to-day threats
to international
public health
security
…/…
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Areas 5, 6

Sustain rights, obligations and procedures
(new legal mechanisms as set out in IHR are fully
developed)

Conduct studies and monitor progress
(Indicators are identified and collected regularly to
monitor and evaluate IHR implementation)
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Progress so far

Assessment tools and methods developed by Regional Offices to identify needs at
country level

Assessment tools developed for specific areas such national legal framework, ports of
entry, national laboratory network

Regional meetings with National Focal Points (NFP) improving communications and
understanding of responsibilities

Indictors to measure progress on implementation are being developed

Additional guidelines and training for specific risks are in progress such for pandemic
influenza preparedness, mass events, hospital infection control, sanitation of
conveyances, travel medicine etc.

Strengthening of WHO partnerships and response capacity (vaccine supplies, antiviral
…/…
drugs for pandemic influenza)
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WHA 61 Report

Obligation for State Parties and WHO to report on progress to
WHA (article 54 of IHR)

194 Member States, including Vatican.

192 have National IHR Focal Point for 24/7 communication with
WHO (exception Vatican, Somalia)

Over 50% of State Parties did an assessment of capacities

Over 50% reviewed national legal framework

More information will become available during agenda item
… / …on
IHR
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WHA 61 Report

For 63 WHA: report on functioning of IHR and Annex 2

Requesting SP:
improve communication with NF
strengthen core capacities
designate experts
collaborate with other State Parties

Request the DG:
prepare fro reports every 2 years
support countries with weak health systems
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…/…
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Thank you
www.who.int/ihr
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