asem workshop on public health emergency management 10-13 september 2014, beijing, china global...

ASEM Workshop on Public Health Emergency Management 10-13 September 2014, Beijing, China

Global Outbreak Alert and Response Network (GOARN)

Public Health Emergency Response:Guarantee, Organisation, Coordination

Dr Angela MerianosDivision of Health Security and EmergenciesWHO Regional Office for the Western Pacific

ASEM Workshop on Public Health Emergency Management10-13 September 2014, Beijing, China

AcknowledgementsWHO/HQ – GOARN Operational Support Team • Mr Pat Drury, Manager, GOARN • Ms Sameera Suri• Mr Armand Betjullahu• Ms Khristeen Umali• Ms Marion Jorgensen

WHO/WPRO • Mrs Janet Mina


Presentation overview

• GOARN mission, philosophy and objectives• A short history of outbreaks 2000 - 2014– GOARN in the Western Pacific Region– Ebola virus disease West Africa

• GOARN in disaster risk management– Typhoon Haiyan

• Moving forward


GOARN• What is GOARN?

– The Global Outbreak Alert and Response Network (GOARN) is a global technical partnership, coordinated by WHO

• Who are the members?– Technical institutions capable of providing international assistance

• What is the focus?– Outbreak response

• Aims– Provide rapid multi-disciplinary technical support for outbreak

response– Coordinated international teams providing best available expertise to

Member States


GOARN in 2014-15 Program BudgetGOARN activities are in the following categories, program areas and outputs in 2014-15 WHO Program Budget• Category 5: Preparedness, Surveillance And Response– Program Area: Alert And Response Capacities.• Output 5.1.2. WHO has the capacity to provide evidence-

based and timely policy guidance, risk assessment, information management and communications for all acute public health emergencies

– Program Area: Outbreak And Crisis Response • Output 5.6. All countries adequately respond to threats

and emergencies with public health consequences


GOARN at a glance…

• Established in April 2000, with a founding group of 60 institutions.

• Now it comprises of over 500 partners, network hubs and network members.

• Coordinated by 21 member Steering Committee.• GOARN Secretariat based in WHO HQ in Geneva.• As of 19 May 2014, GOARN conducted over 130

operations and deployed over 1580 experts.


GOARN Membership


GOARN partners in ChinaChinese Center for Disease Control and Prevention, (China CDC) Beijing Partner

Laboratory of Pathogenic Microbiology and Immunology Beijing Network memberWHO Country Office China Beijing Network memberSichuan Provincial Hospital of Integrated Western and Chinese Medicine Chengdu Network member

Sichuan Second Hospital of Traditional Chinese Medicine Chengdu Network memberCentre for Disease Control and Prevention of Guangdong Province Guangzhou Partner

Asia-Pacific Society for Medical Virology (APSMV) Hong Kong Network hubCenter of Research University of Hong Kong - Pasteur Institute Hong Kong Network member

University of Hong Kong Hong Kong PartnerWHO Collaborating Centre for Research, Training and Outbreak Response in Infection Control Hong Kong Network member

Centre for Health Protection (CHP), Department of HealthHong Kong Special Administrative Region

Partner

Asia Pacific Society of Infection Control (APSIC) Shanghai Network memberChinaCLEN Shanghai Network memberInstitut Pasteur de Shanghai, Académie des Sciences de Chine Shanghai Network member

The Chinese University of Hong Kong Shatin PartnerTaiwan Nongovernmental Hospitals & Clinics Association Taipei Network memberWanfang Medical Center Taipei Network member


Outbreak Response Challenge

Laboratory Case management Logistics

Infection control Epidemiology Coordination

No single institution has all the capacity!


GOARN Guiding Principles - excerpt

• There is a rapid response coordinated by the Operational Support Team to requests for assistance from affected state(s)

• The most appropriate experts reach the field in the least possible time to carry out coordinated and effective outbreak control activities

• Responses will be used as a mechanism to build global capacity by the involvement of participants from field-based training programmes in applied epidemiology and public health practice, e.g. Field Epidemiology Training Programmes (FETPs)


Rapid Alert and Response

0

10

20

30

40

50

60

70

80

90

1 4 7 10 13 16 19 22 25 28 31 34 37 40

Larger Control Opportunity

Small Control Opportunity

Detection Response

NU

MBE

R O

F CA

SES

DAYS


• GOARN secure website for partner organisations– Provides real-time updates of outbreaks and other

acute public health events worldwide– List of GOARN organisation– Technical resources– Operational communications


International alert

• Field Response is triggered by a formal request for support from a WHO Member State

• GOARN Secretariat issues an Alert, for early warning / preparedness and coordinating response planning

• Mission agreed with Country, and specific ToRs for each expert

• GOARN Secretariat issues a Request for Assistance to all GOARN institutions, specifying expertise, skills required for the outbreak response team


International response

• Institutions submit CVs of the staff who fulfill requirements (qualifications, experience, skills…)

• Country negotiations on support• Suitable candidate(s) are selected and informed• Deployment process initiated• Experts deployed and mission undertaken• Final mission report submitted / formal debrief


Deployment administration

• Current Curriculum Vitae• Passport Information• Complete online training for Basic and Advanced

Security in the field.• Security Clearance (arranged by GOARN OST).• Medical Form / Clearance• Admin forms (Declaration of Interests, Biodata,

Bank details, Declaration of Beneficiary)


Deployment process

• GOARN code of conduct respected• WHO contract issued• GOARN covers operational costs (e.g. flight

ticket, per diem, logistics)


GOARN pre-deployment administrative process #1

• Step 1 - Initiate WHO contract– Read• Basic information for outbreak response short-

term consultant• Code of Conduct for team members

– Submit• Copy of valid passport• Copy of latest CV / resume


• Step 2 – WHO Medical Clearance– Read• Health and safety in the field• WHO Stress Management Pocket Guide

– Submit• WHO medical form• WHO vaccinations form




• Step 3 – UN Security Clearance– Submit• Basic and advance Security in the Field certificates

• Step 4 – Finalise WHO Contract– Submit• Signed copy of WHO contract


GOARN Deployments 2000 - 2014

N=1581


Top 10 Expertise Deployments (n=625)

Number of deployments

WHOOther


Technical Experts Deployed 2000 – 2014*

Number deployedPerson days in the field

* 2014 incomplete


GOARN and Typhoon HaiyanDamage - “beyond human imagination”

WPRO staff (Paul and Patricia) in Tacloban, 10-14 Nov 2013

Photo: Paul Carlson


How GOARN helped • Three waves of deployment for Haiyan• In total 30 experts recruited through GOARN and 4

for another emergency in Zamboanga


How GOARN helped #2• 18 institutions from 12 countries contributed

– Australia (Australia Network, Curtin University, Department of Health NSW, Department of Health Victoria)

– Canada (Fraser Health Department, Public Health Agency Canada)

– China (China CDC)– Ireland (Public Health Surveillance Centre)– Italy (EPIET)– Lebanon (Ministry of Health)– Malaysia (State Health Department, Penang)– Norway (Norwegian Institute of Public Health, EPIET)– Singapore (Ministry of Health)– Spain (EPIET)– Sweden (Swedish Institute of Communicable Disease)– United Kingdom (Public Health England, EPIET)


First Wave: Mid November – mid December (n=9)

• Joint Public Health Risk Assessment published 16 Nov 2013• 7 epidemiologists, 1 logistician, 1 risk communications

arrived mid November• 5 epidemiologists assigned to hubs to work alongside

regional and provincial epidemiology and surveillance staff• 2 epidemiologist remained in Manila to assist with data

analysis and publication of joint weekly EWARN report• Surveillance, response plans, EWARN• Rapid investigation


Second Wave: Mid December – Mid January (n=8)

• 4 epidemiologists and 1 expert in management of the dead

• 3 epidemiologists assigned to hubs , 1 stayed in Manila to edit EWARN• SPEED, EWARN• Rapid investigation • Contingency planning and clinical, epi and surveillance

training• Measles outbreak• Relieve workload of local staff and provide some

‘holiday cover’


Third Wave – mid January to mid July 2014 (n=15)

• 15 people recruited through GOARN for variety of tasks during transition from response to recovery• EWARN to routine surveillance transition• Stocktake: routine immunization, maternal health, cold

chain assessment• Health cluster coordination and transition/exit planning

with international partners• Field investigation as needed• After action reviews


What worked?

• Rapid deployment of high quality staff• Range of skills to select from• Effective selection criteria relevant for needs of each

different wave• Willingness to be flexible and to be part of very

diverse team • Most culturally sensitive and aware of supporting

role to government• Right skills at the right time• Zamboanga – Spanish language

Ebola Virus Disease, West Africa, 2014

Response in countries with widespread and intense transmission


GOARN deployments Ebola Virus Disease, West Africa, Mar - 11 Sep 2014 (n=224)

Guinea Liberia Nigeria Sierra Leone Switzerland (blank)

121

3425

40

2 2


GOARN deployments Ebola Virus Disease, West Africa, Mar - 11 Sep 2014 (n=224)

Emergency Response Man-agement

Social mobilisation

Anthropology

Mental Health

Data Management

Public health specialist

Coordination

Logistics

Communications

Infection Prevention and Control

Case management

Epidemiology/Surveillance

Laboratory

1

1

1

1

5

6

8

8

9

17

29

51

87


Ebola Virus Disease West Africa, GOARN person days deployed from Mar - 11 Sep 2014

Social mobilisation

Emergency Response Management

Anthropology

Mental Health

Data Management

Public health specialist

Communications

Coordination

Logistics

Infection Prevention and Control

Case management

Epidemiology/Surveillance

Laboratory

13

19

30

31

88

112

133

146

229

340

504

1056

1796

Total to date ~4500 person days; 12.3 person years


GOARN deployments (person days) by duty station, EVD West Africa, Mar – Sep 2014

Mac

enta

Guin

ea

Cona

kry

Guéc

kédo

u

Lofa

Libe

ria

Foya

Mon

rovi

a

Lago

s

Lakk

a

Free

tow

n

Kaila

hun

Kene

ma

NA

Guinea Liberia Nigeria Sierra Leone Not Stated

16 38

12881359

14 17 36

371462

100 101

301 330

59


Thank [email protected]

asem workshop on public health emergency management 10-13 september 2014, beijing, china global...

Documents

asem workshop

china goarn membership

china goarn partners

public health consequences

goarn secretariat

information management

china global outbreak

response program area