Dr. Maria Almiron Epidemic Alert and Response Team

Communicable Diseases Proyect

Public Health Emergency Management in the Region

Context – 58 World Health Assembly (WHA 58)

Establish specific mandates

For member States:

• To build, strengthen and maintain the capacities required under the International Health Regulations (2005), and to mobilize the resources necessary for that purpose;

• To collaborate actively with each other and WHO in so as to ensure their effective implementation;

Establish specific mandates

For the Organization:

• To build and strengthen the capacities of WHO to perform fully and effectively the functions entrusted to it under the International Health Regulations (2005), in particular through strategic health operations that provide support to countries in detection and assessment of, and response to, public health emergencies.

Context – 58 World Health Assembly (WHA 58)

Event Management process

IHR National Focal Point(s)

IHR Reports Disseminate Public Health Information

Assistance / Response

WHOWHO

Event Risk Assessment

Initial screen

Public Health Emergency of International

Concern (PHEIC) Assessment

Verification

Others sources Informal/Unofficial Information

IHR National Focal Point(s)

IHR Reports Disseminate Public Health Information

Assistance / Response

WHOWHO

Event Risk Assessment

Initial screen

Public Health Emergency of International

Concern (PHEIC) Assessment

Verification

Others sources Informal/Unofficial Information

Event detection

– Surveillance system data– Official sources– Unofficial Information Sources– Personal communication– Third Member States – Other UN Agencies

IHR reports througth IHR National Focal Points

• Events notifications.

• Information sharing during an unusual or unexpected event.

• Consultation.

• Others reports.

Event notification:

• Risk assessment: decision instrument/ 4 criteria

• Serious public health impact.

• Unusual or unexpected.

• Significant risk of international spread.

• Significant risk of international travel or trade restriction.

• Notification:– Through the IHR NFP to WHO IHR contact Point.

– Within 24 hours of assessment of public health information

– Including health measure implemented in response to those events.

Timely, accurate and sufficiently detailed public health information available update on the notified event

A component of the early detection, alert and notification process.

Information-sharing during unexpected or unusual public health

events

• If a State Party has evidence of – an unexpected or unusual public health

event within its territory,

– irrespective of origin or source, and

– which may constitute a public health emergency of international concern.

Consultation and other reports

• Consultation: events that not requiring notification in particular those for which there is insufficient information available to complete the decision instrument. State Party may nevertheless – keep WHO advised thereof through the National IHR

Focal Point – consult with WHO on appropriate health measures

• Otros informes: evidence of events outside their territory that may cause international disease spread.

Escalate – Public Health Emergency of International Concern (PHEIC) Declaration

• PHEIC: an extraordinary event which is determined, as provided in these Regulations:– to constitute a public health risk to other States

through the international spread of disease and

– to potentially require a coordinated international response;

• Event:means a manifestation of disease or an occurrence that creates a potential for disease.

Only the Director-General shall determine a PHEIC, on the basis of :

• on the basis of the information received, in particular from the State Party within whose territory an event is occurring;

• decission instrument;

• advice of the Emergency Committee.

• scientific principles and evidence available.

• an assessment of the risk to human health.

Escalate – Public Health Emergency of International Concern (PHEIC)

Declaration

Event Management SystemEvent Management System

Information channel

States Parties Operations

PAHOPAHO

AFROAFRO

WPROWPRO

EMROEMRO

SEAROSEAROEUROEURO

Dissemination of public health information

• Web site• Tecnical bulletins• Maps and dinamic reports

Recomendation to prevent and reduce the international spread of diseases

• Temporary: opinion on appropriate health measure to be implemented temporary and according to specific risk in response to a PHEIC.

• Standing: opinion on appropriate health measures for routine or periodic application for specific, ongoing public health risks in order to prevent or reduce the international spread of disease and avoid unnecessary interference with international traffic.

Event management: a systematic process

• To protect the international public health by:– an early detection of events;

– an appropriate reaction base on scientific evidence;

– Timely, transparent and accurate information sharing

to international community;

– International assistance - when required- to control the

risk at local level and reduce economic, social and human lost.

Risk assessmentRisk assessment

Verification Verification

DetectionDetection

Strategies and Response Operations

Strategies and Response Operations

Prevention and Response to pulic health emergencies

0

20

40

60

80

100

120

140

160

180

Nu

mb

er o

f ev

ents

2007 2008 2009

Year

Events recorded in Americas by final designation Jun 2007 - Dec 2009

Pandemia

No verificable

Confirmados

< 2 criterios

Descartado

0%

10%

20%

30%

40%

50%

60%

PAHO/WHO Gob Agencyno IHR-NFP

IHR-NFP IHR-NFP Thirdparty

Gob AgencyThird party

Initial Source of Information

Events recorded in Americas by initial source of information Jun 2007 - Dec 2009

2007

2008

2009

Results

020406080

100120140160180

Nu

mb

er

of

Ev

en

ts

2007 2008 2009

Year

Events recorded in Americas by hazard and year Jun 2007 a Dic 2009

Pandemic

Others

Product

Infectious

Food safety

Animal

200720082009

Substantiated Event recorded in Americas June 2007 – December 2009

Annex 2 – Concordance study

• 74% of NFPs provided complete responses.

• 2. 70% of participants declared that they had applied Annex 2 ‘rarely’ or ‘never’ in the previous 12 months.

• For the given scenarios and compared with the relative “gold standard”, NFPs demonstrated, on average, high sensitivity and moderate specificity in their notification decisions. This finding is in contrast with the “real world” experience of recent years.

• There was no major difference in concordance scores between subgroups of NFPs formed according to self reported experience with Annex 2, Gross National Income, WHO region, length of professional experience, and number of years in current position.

Annex 2 – Concordance study

Conclusions• The event management process will adhere to the principles of

– Consistency– Timeliness– Technical excellence– Transparency and accountability

• The experiencie show that each event is different and not everything can be anticipated to the least detail .

• Having a broad and flexible procedure that it is adjusted to one wide range of circumstances facilitates the management of complex emergency. – Established structure for events management.– Clear Identification of roles and responsibilities at all levels. – Organized response 0perations with appropriate logistical support.

Conclusions

• The risk assessment is ongoing and iterative process; from de detection until the event is close.

• The IHR (2005) prescribe a very specific and rigorous process which WHO must undertake before declare a PHEIC.

• Information exchange in real time facilitates decision-making.

• Most of the registered events were not a PHEIC.

Challenges

• Strengthening of surveillance and response core capacities is key for event detection and control at local level.

• Strengthen the information management and risk communication.

• Demonstrate the added value of the timely report and encourage the participation of the IHR National Focal Point in reporting events.