Fifth. Meeting of the Asia Pacific Technical Advisory Group

on Emerging Infectious Diseases

6-9 July 2010 Manila, Philippines

{ml~~\ World Health ~Ql§ Organization

___.,.~ ---Western Pacific Region

RS/2010/DSE/ll(P~)

REPORT

~H MEETING OF THE ASIA PACJFIC r ~~HNICAL ADVISORY GROUP ON

EMERGING INFECTIOUS DISEASES

6-9 July 2010

Manila, the Philippines

Convened by:

WORLD HEALTH ORGANIZATION

Not for sale

Printed and distributed by: World Health Organization

Regional Office for the Western Pacific Manila, Philippines

February 2011

WHOJWPRO LmRARY MANILA. PmLIPPINES

0 1 APR 2011

English Only

Note

The views expressed in the report are those of the participants in the Fifth Meeting of the Asia Pacific Technical Advisory Group on emerging Infectious Diseases in the Western Pacific Region and do not necessarily reflect the policies of WHO.

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Fifth Meeting of the Asia Pacific Technical Advisory Group on Emerging Infectious Diseases in the Western Pacific Region, held in Manila, Philippines, from 6 to 9 July 2010.

SUMMARY

The fifth meeting of the Asia Pacific Technical Advisory Group on Emerging Infectious Diseases (EID) was held in Manila, Philippines, from 6 to 9 July 2010.

The objectives of the meeting were:

(1) to review the overall implementation progress of the Asia Pacific Strategy for Emerging Diseases (APSED) and International Health Regulations (IHR) (2005), including pandemic preparedness and response;

(2) to discuss outcomes of the biregional consultation on the Asia Pacific strategy for Emerging Diseases and Beyond, held in May 2010; and

(3) to produce a fmal updated Asia Pacific Strategy for Emerging Diseases for consideration by the Regional Committee for the Western Pacific at its 61st session in October 2010.

The meeting consisted of country presentations, technical presentations and group discussions. Country presentations highlighted progress made in each of the five programme areas outlined under APSED. Members of the Technical Advisory Group (TAG) and WHO staff presented a revised and updated strategy - APSED 2010 - that sets the direction for future work to build on and expand the progress made under the existing strategy. Small group discussions were held to discuss the proposed strategy and suggested amendments were presented during plenary sessions. On the final day, observations and recommendations were summarized and proposed changes agreed by all participants. The Asia Pacific Strategy for Emerging Diseases (2010) was then endorsed.

Meeting Participants at the Fifth Meeting of the Asia Pacific Technical Advisory Group on Emerging Infectious Diseases

CONTENTS

Page

1. INTRODUCTION .................................................................................................................... !

1.1 Objectives., ............................. ..................... .. ...... ... .... .. .... .. .................... .. .... , ....... .. : ...... !

1.2 Opening Remarks ................ .......................................................................................... 1

1.3 Appointment of Chairs .. .... ............................................................................................ 2

2. PROCEEDINGS ....................................................................................................................... 2

2.1. Plenary 1. Overview of International Health Regulations (IHR) and APSED .............. 2

2.2 Plenary 2: APSED (2005) ............................................................. .. ... ................. .. .. ...... 4

2.3 Plenary 3: Introducing APSED (2010) ........................................................................ 13

2.4 Plenary 4: Introducing APSED (2010) .. .. .................... .. ................... .. ........... .. ............ 14

2.5 Plenary 5: Group Feedback (Focus Areas 1-5) ................................................... .. ...... 16

2.6 Plenary 6: Introducing APSED (2010) .. .... .. ................................................................ 17

2.7 Plenary 7: Group Feedback (Group Discussion 3 and 4) .................................... .. ...... 20

2.8 Plenary 8: Review of Draft APSED (2010): Summary ............................................... 21

3. CONCLUSIONS AND RECOMMENDATIONS .......................................................... ....... 22

3.1 General ......... ...... ........... .......... .. ..................... .. ........................................................... 22

3.2 Recommendations .................................... .. ......................................... .. ... ................... 22

ANNEXES:

ANl'ffiX 1

ANNEX2

PROGRAMME OF ACTIVITIES

LIST OF PARTICIPANTS

1. INTRODUCTION

The Asia Pacific Region continues to face serious public health threats arising from emerging infectious diseases (BIDs). In recent years, outbreaks of these diseases clearly have highlighted the need to strengthen the national and regional capacities required for early detection, rapid response, effective preparedness and strong partnerships for emerging infectious diseases.

Since 2005, Asia Pacific Strategy on Emerging Diseases (APSED) has provided countries and areas of the Asia Pacific Region with a common strategic framework to build capacity to address the threat of emerging diseases. In addition, the strategy acts as a road map for pandemic preparedness and for meeting the minimum core capacities outlined in the International Health Regulations (lliR) (2005).

Meetings of the TAG for BIDs have been held annually to monitor and review APSED and IHR (2005) implementation and recommend priority activities. The fourth TAG Meeting in 2009 recommended that an updated strategy be formulated to build and expand on the work carried out under the existing strategy.

APSED (2010) incorporates lessons learnt during implementation of APSED (2005) and during the response to pandemic influenza A (H1Nl) 2009. The draft strategy was formulated from a consultative and collaborative process with Member States and technical experts that included a common indicator assessment, individual country consultations, regional consultation meetings, including a biregional consultation on APSED and Beyond held in Kuala Lumpur in May 2010. The draft APSED (2010) document was presented for comment and review to the fifth meeting of the TAG BIDs.

The meeting was attended by more than 80 country participants and representatives, international experts and observers from 19 countries and partner agencies. The meeting's programme of activities and list of participants are attached in Annexes 1 and 2, respectively.

1.1 Objectives

(1) To review the overall implementation progress of APSED and IHR (2005), including pandemic preparedness and response.

(2) To discuss outcomes of the biregional consultation on APSED and Beyond held in May2010.

(3) To produce a final updated APSED for consideration by the Regional Committee for the Western Pacific at its 61st session in October 2010.

1.2 Opening Remarks

Dr Shin Young-Soo welcomed participants to the fifth meeting of the Asia Pacific Technical Advisory Group on Emerging Diseases and thanked TAG members for their commitment and contributions over the last five years. Members States were congratulated for

- 2 -

the enormous progress made towards securing the Region's health. Over the last five years, APSED has been used as a common framework to guide capacity-building in Member States to prepare, detect and respond to BIDs. Improvements in capacity were demonstrated during the response to pandemic influenza A (H1N1) 2009, particularly in the areas oflaboratory and information-sharing. But despite much progress, challenges remain. There is a need to continue to focus on emerging diseases while also addressing other public health threats as outlined in the IHR (2005). Following consultations with Member States and partners, a revised APSED strategy has been formulated and will be presented and reviewed at this meeting.

1.3 Appointment of Chairs

Dr Tatsuo Miyamura and Professor N. K. Ganguly have been selected as the meeting chair and co-chair, respectively. The following TAG members were selected as session chairs to facilitate the conduct of various sessions: Day 1: ProfTatsuo Miyamura; Day 2: ProfN. K. Ganguly, Dr Poh Liam Lim (parallel sessions); Day 3: Dr Anne Schuchat; Day 4: Dr Pratap Singhasivanon (Plenary 7), Prof John Mackenzie (Plenary 8 and 9).

2. PROCEEDINGS

2.1. Plenary 1. Overview of International Health Regulations CIHR) and APSED

2.1.1 Progress on APSED/IHR and pandemic preparedness in the Asia Pacific Region was reported on by Dato' Dr Tee Ah Sian, Director, Combating Communicable Diseases, WHO Western Pacific Regional Office.

The APSED is a conunon framework for general capacity-building for emerging diseases, meeting the core capacity requirements outlined in the IHR (2005) and improving pandemic influenza preparedness. The five core capacity areas identified in the strategy were surveillance and response, laboratory, zoonoses, infection control and risk conununication.

More than 25 countries in the Asia Pacific have conducted assessments using the APSED/IHR checklists and 20 countries have formulated and implemented national plans. In both the South-East Asian and Western Pacific Regions, significant progress has been made, with most progress made in surveillance and response. APSED advocates a two-tiered approach to pandemic preparedness -pandemic planning and increasing readiness. The pandemic readiness assessment conducted in 2008, 2009 and 2010 included national capacity for pandemic preparedness and has progressed well.

APSED has been a useful framework for Member States, WHO and partners to work collectively to strengthen national and regional capacities. Lessons learnt include the need to better conununicate the relationships between APSED, APSED work plans and IHR implementation and the importance of strong coordination mechanisms at the national level.

The proposed APSED (2010) is an updated strategy that builds on the progress made and lessons learnt over the past five years and the response to pandemic (HlNl) 2009.

- 3-

2.1.2 An update on IHR implementation and National Core Capacity Monitoring was given by Dr Xing Jun, Medical Officer, IHR Coordination, WHO HQ

The lliR (2005) are a legally binding agreement on Member States that ensures maximum public health security while minimizing interference with international transport and trade.

The tools currently available for monitoring lliR (2005) core capacity development include the monitoring checklist and indicators, the State Parties Questionnaire and a web-based tool. Challenges include fashioning global tools that are relevant for a diversity of countries, building on existing strategies and differences in the understanding of the primary purpose of tools between lower- and higher-income countries.

So far, 108 countries have submitted States Parties Reports (100% of Member States in the South-East Asia Region and 60% of Member States in the Western Pacific Region). The web tool was to go live in July 2010.

2.1.3 A final evaluation of the APSED approach was presented by Ms Praveena Gunaratnam, Programme Manager, Health and HIV Thematic Group, the Australian Agency for International Development (AusAID)

An independent evaluation of APSED was conducted in 2010 in order to evaluate the extent to which APSED had met its objectives and to draft recommendations for the next phase of APSED. The evaluation included a desk review, analysis of results from the Common Indicators Assessments, discussions with WHO staff and field visits to five countries in the Asia Pacific Region.

The evaluation found that APSED has provided a strategic framework to build country capacity in line with the IHR (2005), particularly through partnerships and the use of networks. More work needs to be done to raise awareness of these networks and to increase participation. While there have been significant achievements in each of the five programme areas, challenges also have been identified and should be addressed.

APSED remains relevant to country priorities, but there is a need to better integrate programme areas. Systems-strengthening approaches should be considered with a greater focus on knowledge and skills transfer. Issues of leadership and budget and human resource constraints must be addressed to ensure activities can become sustainable. Special consideration also should be given to gender and to how APSED should be applied in the Pacific.

The review also recommended that the lliR monitoring framework should serve as a self­assessment and monitoring tool in the next phase of APSED.

2.1.4 Plenary 1 questions and clarification

Donors were asked to comment on their perspective of APSED. AusAID acknowledged that APSED has worked in a difficult environment, but that clear progress has been made since the outbreak of severe acute respiratory syndrome (SARS). AusAID is interested in seeing a more systematic approach to capacity-building, with activities such as training and workshops leading to clearly identified outcomes. A systems-strengthening approach also should be considered. The Canadian International Development Agency (CIDA) commented that the emphasis on taking stock of progress made evident during the meeting should be maintained. Sustainability is an important consideration. While the need for initial support for lower-income

-4-

countries is acknowledged, the work eventually will need to be carried forward by Member States.

The comment was made that exercises should be conducted to test capacity to respond to EID, particularly cross-border cooperation and collaboration between the regions. Some exercises have been conducted by the Mekong countries as well as joint exercises on containment within the Western Pacific Region. These methods can be applied more broadly to other aspects of emerging diseases.

The need for mechanisms to ensure greater inter-country coordination was discussed. It was noted that while APSED has provided a firm base for cross-border cooperation, better mechanisms for inter-country coordination are needed under the United Nations system. There is a continuing need to identify and disseminate new knowledge. By taking a biregional approach, APSED can help move this knowledge forward. In this context, Fiji commented on its role as a hub in the Pacific and its potential to act as a regional champion. However, taking on a coordination role requires financial and technical resources.

The point also was made that there are a number of countries within the South-East Asia Region that face similar challenges to the Pacific island countries and areas. These countries should therefore also be given special consideration when implementing APSED.

The comment was made that while emphasizing progress is important, it is also important not to hide vulnerabilities and to continue to identify areas where further work is needed. This is particularly relevant now because there was some scepticism following pandemic influenza A (HlNl) 2009 about the need for continuing investment in emerging infectious diseases.

2.2 Plenary 2: APSED (2005)

Country Progress

2.2.1 Indonesia

In Indonesia, achievements in surveillance and response include the establishment of an outbreak command post, the training of district surveillance officers, the expansion of the sentinel network for influenza-like illness (ILl) and severe acute respiratory infection (SARI) and the piloting of an Early Warning and Response (EW AR) system in two provinces. Surveillance and rapid response have also been strengthened at ports and ground crossings and progress has been made in cross-border collaboration with Timor-Leste.

Training courses have been conducted and the capability oflaboratories to provide reference services for outbreaks ofEID has been assessed and strengthened. A work plan to strengthen infection prevention and control (IPC) in health care facilities has been strengthened and IPC guidelines and handbooks revised. IPC training has been conducted in 76 of 100 avian influenza referral hospitals.

An avian influenza coordinating committee has been established, with work covering surveillance and risk reduction. Risk communication training exercises have been conducted with a focus on avian influenza A (H5Nl ).

Gender issues have been taken into consideration with the formulation of policy guidelines along with a tool for development and implementation of gender-sensitive analysis.

- 5 -

2.2.2 The Lao People's Democratic Republic

Following the creation of a national work plan for EID (2007-2010), capacity in the Lao People's Democratic Republic in each of the five working areas has improved. Rapid response teams have been established at central and provincial levels, field epidemiology training (FET) has been established, a routine indicator-based surveillance system is in use nationwide and event-based surveillance has been strengthened.

The National Centre for Laboratory and Epidemiology (NCLE) has been included in the Global Influenza Surveillance Network and has begun the process of becoming a National Influenza Centre (NIC). A laboratory-based disease surveillance system is in place for ILl and acute lower respiratory infection (ALRI) at eight sentinel sites and for diarrhoea in the capital. Standard operating procedures (SOPs) for specimen collection, storage and transport have been established.

An Infection Control Coordination and Advisory Committee has been established and is partly operational. Infection control strategies also have been formulated and training conducted at central and health centre levels.

Collaboration between the animal and health sectors has been strengthened, with coordinated risk-reduction efforts at the animal-human interface. A memorandum of understanding for the sharing of information between the health and agriculture ministries has been signed and a draft zoonotic coordination mechanism has been formulated.

Efforts in risk communication have included the establishment of a task force for avian influenza communications and conducting risk communications.

2.2.3 Mongolia

Mongolia's work has been guided by the national APSED implementation plan 2008-2010. A national policy for surveillance and response has been updated. An EW AR system and rapid response teams have been established and an event-based surveillance system is operational at the national level. A Mongolian FET programme also has been established.

Laboratory achievements include improvements in diagnostic capacities and support for surveillance and response. A national reference laboratory has been established and guidelines and SOPs for laboratory activities updated.

A national Infection Control (NIC) Coordination Committee has been established along with teams at all levels of health facilities. The national IC guidelines were updated in May 2010 and a national resource centre is being established. A national IPC strategic plan also has been drafted and an IC training package created.

A mechanism for inter-sectoral collaboration between the animal and human health sectors has been established with SOPs for information-sharing, joint response and risk assessment. A joint response team is operational.

For risk communications, a national communications strategy has been drafted and training and a media communications plan conducted.

- 6 -

APSED has been a useful tool to advocate for funding, minimize duplication and improve coordination. However, more time is needed to fully implement APSED and build the capacities required by lliR (2005).

2.2.4 Sri Lanka

In Sri Lanka, a multi-sector steering committee is in place at the national level. Indicator­based surveillance is well established and an event-based system is in place. An electronic Internet-based disease surveillance system is ready for pilot testing. Capacity is being built through post-graduate training opportunities and in-service training, including FET. Rapid response teams have been established at the national and district levels and surveillance and response capacity at points of entry has improved.

Laboratory capacity for diagnosis has been enhanced and was being expanded to the district level. There is a well-established coordination mechanism between the animal and human health sectors, with a bottom-up information- and data-sharing process and top-down feedback. Infection control committees are available at the health care institution level. However, a national organizational structure is lacking. A specialized institution in the Ministry of Health has been assigned as the focal point for risk communication and intersectorallinks are in place.

Points to consider include whether the indicators in the assessment tools are sensitive enough to capture performance and preparedness and whether the high level of preparedness is sustainable.

2.2.5 Country progress questions and clarification

It was noted that a number of presentations highlighted the common progress made and the need to strengthen and refine the tools for assessment and that this should be addressed in APSED 2010.

It also was noted that the mobilization of private and public sector resources is important in responding to some outbreaks of infectious diseases.

The point was made that there are two main funding channels for infectious diseases. These are funds for specific diseases, such the global fund, and funds for systems strengthening. There is a need to synchronize these approaches to systematically build capacity to address all diseases.

Surveillance and Response

2.2.6 Web-based reporting system in China

The web-based reporting system has been in place in China since January 2004. The system is a real-time reporting system with four components. At the end of 2009 the system covered 100% of China CDCs at local levels, 98% of hospitals down to the county level and 84% of township level clinics.

The case-based surveillance system captures information on 39 notifiable diseases in three categories. It significant! y has improved the timeliness of infectious diseases surveillance. The system provides automatic alerts when unusual events are detected and generates daily, weekly, monthly and yearly reports, improving the ability to analyse and manage epidemics.

- 7 -

The Public Health Emergency Reporting System encompasses the notifiable diseases reporting system and syndromic surveillance, the auto-detection and alert system, a hotline and event-based surveillance.

2.2. 7 Surveillance system in the Federated States of Micronesia

The Federated States of Micronesia has a system in which medical records are uploaded onto a server and automatic weekly surveillance reports are generated. Sentinel surveillance for ILl has been established, with swabs sent each week for subtyping. These are collated and feedback provided via email to all health staff and private providers. Disease-specific programmes also submit quarterly reports to the coordinator.

The Epi-Net team assesses requests for assistance and assembles disease-specific task forces for response at the state level. Protocols are in place for requests for national and international assistance if capacity is not adequate at the state level.

Enhanced information technology (IT) connectivity and standardized International Classification of Diseases (ICD)-1 0 coding have facilitated the establishment of an electronic reporting system. The National Notifiable Disease List has been revamped and the reporting mechanism simplified.

As for response, stockpiles have been prepared and Emergency Preparedness Focal Points appointed in each state hospital. National and state public health institutions have participated in exercises, drills and training. Alternate care sites have been established for use during an emergency along with a registry of volunteers. Work will continue on increasing IT capacity, conducting training, formulating SOPs and strengthening collaboration between animal and human health sectors.

2.2.8 Surveillance and response questions and clarification

China was asked to provide a clarification about access to its web-based system. The system is accessed using a username and password and access is limited to the health sector (not the public).

The Federated States of Micronesia was asked how APSED assisted in the response to the Zika virus outbreak. Knowing where to go to get information and assistance was valuable. There was a tremendous response to calls for assistance.

It was noted that IT substantially may change surveillance systems, with the potential to improve timeliness and coverage and to support two-way flows of information.

China was asked about its public health emergency reporting system and how the system copes with the volume of reports received. Each level of Chinese Center for Disease Control and Prevention (China CDC) conducts analysis for its own jurisdiction. Daily reports are uploaded into the system and can be downloaded by users.

China also was asked about the extent to which the web-based system detects events or whether it is used primarily for analysis and further investigation once an event has been identified. Some events, such as melamine, were detected through other channels. Investigation of these events included detecting gaps in the reporting system that will be improved.

- 8 -

The Federated States of Micronesia was asked about its event-based surveillance system. The system works well for events reported on the main island. Events reported on other islands present challenges, including the unreliability of radio communication and the logistics of further investigation.

Poster Session on Outbreak Response

Eighteen posters were received from 15 countries. Posters were divided into four groups: enteric disease, pandemic HlNl 2009, vaccine-preventable diseases and nosocomial infections and zoonoses. Country representatives introduced their posters and then there were questions and discussions in the group. The posters were displayed during the meeting to share country experiences and lessons learnt about outbreak responses.

Laboratory

2.2.9 India

Existing laboratory networks in India are robust with established links among food, animal and public health laboratories and private and research laboratories. Laboratory data is integrated into surveillance systems. Biosafety guidelines have been established and BSL-4 capacity within the country is being developed. Training workshops for laboratory professionals are also raising awareness ofbiosafety and biosecurity practises. Quality systems, including participation in external quality assurance and national accreditation processes, are in place. Work is also under way towards a national framework for evaluation and quality assurance of diagnostic kits. Networking is regarded as a priority. India is addressing issues of convergence and institutionalization to make existing networks sustainable and to further build capacity.

2.2.10 Japan

In Japan, public laboratories are a crucial component of both patient and pathogen surveillance. Networking activities are facilitated by the Association of Public Health Laboratories for Microbiological Technology. National systems are in place to ensure accurate laboratory diagnosis. A biosafety manual has been published and harmful pathogens that could be used for terrorism are tightly controlled by legislation.

The pathogen surveillance system operates at the prefectural and national level. Data is analysed at the national level and disseminated online and through monthly and annual publications. Examples were given to highlight the functioning of Japan's laboratory networks, including the virological surveillance of pandemic influenza A (HlNl) 2009 and the identification of a number of foodbome outbreaks.

Future work will focus on integrating laboratory surveillance and patient surveillance and building the capacity of public health institutes.

2.2.11 VietNam

Progress in the laboratories has been made over the last five years and is continuing. National and regional laboratories have more specialized capacity for immunology, virology, bacteriology and molecular biology. At the provincial level, capacity is limited to basic technologies, with 20% of the provincial labs having polymerase chain reaction (PCR) capacity.

- 9 -

At the district level, capacity is limited to bacteriology and specimen collection, storage and transport.

Biosafety is included in a law on communicable disease control. A decree in biosafety is being formulated, with biosafety regulations currently at the institutional level rather than at the national level. Work is under way on establishing BSL-3 laboratories and expanding PCR capacity. Quality assurance and control systems are being established at the national and regional levels.

2.2.12 Laboratory questions and clarification

India was asked about the proportion of cases that are laboratory-confirmed. Some have mandatory confirmation before treatment. Laboratory confirmation is prioritized during outbreaks.

India was asked about the sharing of data among laboratories. This is acknowledged to be highly important in addition to reporting to the national level. Reporting back to initiating laboratories was also being strengthened. There is a strong focus on laboratory integration into disease surveillance.

VietNam was asked about the engagement of private laboratories in reporting. Private laboratories were not included in laboratory surveillance. This emphasizes the importance of integration and governance.

Zoonoses

2.2.13 Maldives

In Maldives, the Agriculture Ministry was not involved in zoonotic disease control until the advent of avian influenza. A multisectoral task force has been established and capacity and infrastructure developed in both sectors. Quarantine facilities have been established at the international airport. The European Union has recognized the quality control system for tuna fish, a major export. Maldives is a net importer of food and food products and the government is concerned about imported food quality. The government recently decided to participate in the Codex Alimentarius Commission and activities of the World Organisation of Animal Health (OlE). There is strong political commitment for further building capacity.

Challenges within the country include the limited knowledge of emerging zoonoses, a lack of standards and guidelines and limited laboratory diagnostic facilities to generate scientific evidence.

Surveillance in both the animal and health sector has been strengthened with joint outbreak investigation and rapid response.

2.2.14 The Philippines

There is a long history in the Philippines of coordination between the animal health and human health sector. A national coordination committee was formally established in 2010, although many collaborative activities have been conducted since 2007. These include risk reduction activities, collaborative research and the designation of roles and responsibilities.

- 10-

The coordination mechanism is now called the Philippines Interagency Committee on Zoonosis and has responsibility for formulating a national strategic work plan on zoonosis, reviewing and establishing policies and programmes, fostering cooperation and commitment, recommending research priorities and monitoring and evaluating.

The response to the outbreak of Ebola Reston was used to illustrate how the animal and human health sectors worked together.

2.2.15 Zoonoses questions and clarification

Maldives was asked about links between animal and human disease surveillance. Different components of surveillance are still separated, with a lack of interest in other areas of work hindering integration.

It also was noted that Maldives has established a better network with the International Reference Laboratory for delivery oflaboratory specimens and diagnosis of unknown and emerging diseases during outbreaks in last five years.

The Philippines was asked to provide more detail on the structure and functioning of the Philippines Interagency Committee on Zoonosis. It is comprised of three major agencies, each with multiple sub-agencies. The lead agency for the coordination committee rotates biannually. Each agency contributes funds towards the committee's budget. Private industries are not yet involved, but this was under consideration.

Infection Control

2.2.16 Cambodia

Cambodia began work on infection control in 2003 following SARS. An IC policy was agreed in 2009 and a strategic plan for the period 2010-2015 has been formulated. Technical guidelines for IC have been established along with IC monitoring and evaluation tools. A national IC structure has been created, led by a steering committee for IC. There are plans to set up two centres of excellence a year and a national resource centre.

Lessons learnt in formulating a national policy include the need for cross-cutting collaboration among all levels ofhealth care and all vertical programmes. A limited budget and lack of IC professionals have been the biggest barriers.

Cambodia has made significant progress in IC over the last two years and this work will continue over the next five years.

2.2.17 Thailand

Thailand has a long history of working to improve IC in health care. There is a national policy on the surveillance of hospital-acquired infections, a variety of training activities are in place and there are three professional associations for infection prevention and control (IPC).

Recent activities have included a study tour for Thai IPC experts to the WHO Collaborating Centre in Hong Kong (China), and an evaluation of the IPC and health care facility preparedness components of the Thailand National Pandemic Strategic Response. IPC measures used during the pandemic (H1N1) 2009 included active screening, education and training,

- 11 -

promotion of personal protective equipment (PPE) and the use of isolation and quarantine services.

2.2.18 Infection control questions and clarification

Cambodia was asked about the role of APSED in improving efforts in infection control. IPC activities previously were implemented at the hospital level, but there was no national coordination. Over the last two years, one department has taken on responsibility for IPC, with Cambodia CDC still responsible at the community level. Efforts in IPC are linked to patient safety.

Cambodia was asked for more information on plans to apply to the fund for IPC support. A request for basic equipment will be made under health systems strengthening. The proposal targets a wider range of issues in addition to infection control.

The sustainability of efforts in IC also was discussed. The Secretariat of the Pacific Community (SPC) spoke about the infection control network under the Pacific Public Health Surveillance Network (PPHSN). The pandemic presented an opportunity to revive this network.

The comment was made that ensuring private facilities are involved in IPC activities is important, particularly within this Region. There is also a need to go beyond nosocomial infections and look at IPC in the community during an outbreak.

Risk Communications

2.2.19 Nepal

Nepal spoke about the process of implementing the risk communication activities implemented in response to pandemic (H1N1) 2009 and outbreaks of avian influenza A (HSNl).

Nepal's risk communication strategy consists of three components: advocacy, programme communication and social mobilization.

The pandemic (H1Nl) 2009 jump-started risk communication activities as the country switched into emergency rather than preparedness mode. There were three major priorities during the response: establishing an enabling environment by engaging stakeholders, media monitoring and management and limiting spread and transmission.

An example of a successful prevention method - using children as educators to affect behaviour change more broadly- was shared. Overall, the risk communication activities were successful in building a high level of trust, reducing public panic and securing the cooperation of stakeholders.

2.2.20 New Zealand

New Zealand spoke about its risk communication system, particularly lessons learnt during the response to pandemic (H1N1) 2009. In New Zealand, risk communication is integrated into risk management. The response depends on the location and scale of the event, with national government only involved in high-level decisions.

- 12-

The most important lesson learnt was that the right people should be used. Close partnerships between technical and communications experts were important at every level. The role of spokesperson needed to be explicit rather than a task added to another role.

Planning was essential both before and during the event with training of key staff and the involvement ofkey stakeholders such as the media. Providing a great deal of information was regarded as vital. When information was unknown, it was important to acknowledge uncertainty.

Persistent communication also was important and the system should not be built only around communications during an event. Pandemic flu messages are now beginning to merge into messages about influenza in general and other public health issues.

2.2.21 The Republic of Korea

The Republic of Korea's risk communication strategy during pandemic (H1N1) 2009 focused on consistent messages (one voice) and proactively identifying issues such as access to antivirals, vaccine and large events. Stakeholders in other government offices and academic institutes were involved in delivering key messages.

Activities included proactively engaging the press through briefings and the wide dissemination of information to both the press and the public, including through online channels. Efforts were made to target key groups within the population.

The evaluation of risk communication efforts found the response was consistent, well­coordinated and targeted and proactive in responding to rumours. Future work will focus on ensuring consistency and rapidity, enhancing a strategy for online responses, formulating guidelines and strengthening international coordination.

2.2.22 Risk communications questions and clarification

The comment was made that in the United States of America the media is involved in scenario planning. In New Zealand, engagement of the media included planning on how information would be shared and meetings to increase understanding and awareness.

New Zealand also was asked whether different approaches were used with hard-to-reach populations. Communication at the national level involved mainstream media, with local public health units taking responsibility for communication at the community level.

Nepal was asked to expand on its use of children as vehicles for change. This was the first time the model had been used and resulted largely from the involvement of UNICEF.

The Republic of Korea was asked to expand on its online strategies and targeting of particular audiences. The example of the use of cyber police to identify the source of a rumour was given. Middle-aged housewives were targeted for both the potential to disseminate positive messages, or rumours, through small villages meetings and messages on morning television.

All speakers emphasized the importance of having a plan in place. The comment also was made that the public can become tired of hearing the same message repeated too frequently, and there is a need to deliver a range of messages.

- 13-

2.3 Plenary 3: Introducing APSED (2010)

2.3 .1 The outcome of the Biregional Consultation on APSED and Beyond was discussed by Prof N.K. Ganguly, TAG member

A series of assessment and consultation activities were carried out to inform the Biregional Consultation conducted in May 2010 and the drafting of APSED (2010). The activities found that APSED has been a useful framework for Member States, WHO and partners to work collectively for a common goal. Significant progress has been made within the five APSED programme areas, and this provides a good basis to address the broader scope of challenges faced by the Asia Pacific Region.

Eight focus areas were suggested for APSED (2010): incorporating the original five programme areas with the addition of public health emergency preparedness, regional preparedness, alert and response and monitoring and evaluation. It also was suggested that a number of special considerations also be included in the strategy.

The discussion papers used to inform the APSED consultation meeting have been reviewed and revised during the May 2010 consultation meeting and are available in the document APSED (2010) Technical Papers.

2.3.2 An overview of the draft APSED (2010) was presented by Dr Tatsuo Miyamura, TAG member

The draft APSED (2010) strategy includes five sections. The first section outlines the scope, intended audience, guiding principles and use of the strategy. The second section describes the vision, goal and objectives. The third section describes the eight focus areas, each of which contains a small number ofkey components. Section four describes the areas of work that may require special consideration when strengthening national and regional core capacity. The fifth section describes key implementation issues. The details are shown in the working document draft APSED (2010).

2.3.3 Plenary 3 questions and discussion

CIDA commented that APSED (2010) incorporates the building of capacity at both the national and regional levels and that it is important that these processes move in harmony. CIDA also noted that in some higher-income countries risk communications is now seen as a cross­cutting issue rather than as a stand-alone category. The comment also was made that gender mainstreaming is not clearly reflected in the current structure of the strategy.

It was noted that there would be opportunities for further discussion on both risk communications and gender during later sessions. However, one of the strengths of APSED is that the focus areas are not regarded as independent but are areas in which there is a need to build capacity. For example, the approach to zoonoses has been to establish linkages between animal and human health sectors that cut across all areas of work. The focus area does not mean stand alone, but highlights it as an important area to strengthen its capacity. Risk communication is one of such examples.

The comment was made that there is a need for a management structure to facilitate specialist players to work together and to assist in prioritizing work areas. This should be considered at the country, regional and biregionallevels.

- 14-

2.4 Plenary 4: Introducing APSED (2010)

2.4 .1 Focus Area 1: Surveillance, Risk Assessment and Response, Dr Chin-Kei Lee, Epidemiologist, WHO/China

Five key components are identified under Surveillance, Risk Assessment and Response in APSED (2010). These are event-based and indicator-based surveillance, risk assessment, rapid response and field epidemiology training. Over the last five years, most countries have implemented an event-based system but many are still in the pilot phase. Indicator-based surveillance systems are better established, but more work is needed, including standardization of case definitions. The scope of training of rapid response teams should be expanded to support an all-hazards approach and risk assessment capacity should be strengthened at all levels. Risk assessment capacities become essential to inform timely public health actions. The use of appropriate information and communication technology (ICT) tools should also be considered in supporting surveillance, risk assessment and response activities.

2.4.2 Focus Area 2: Laboratory, Dr Gyanendra Gongal, Technical Officer (Veterinary Public Health), WHO/South-East Asia Regional Office

Under APSED (2010), laboratory capacity-building will continue to focus on EID. These activities need to be coordinated with the Asia Pacific Strategy for Strengthening Health Laboratory Services and strategies on antimicrobial resistance. The key components remain similar, as in the previous APSED strategy, and include accurate diagnosis, laboratory support for surveillance and response, coordination and laboratory networking and biosafety.

2.4.3 Focus Area 3: Zoonoses, Dr Gyanendra Gongal, Technical Officer (Veterinary Public Health), WHO/South-East Asia Regional Office

APSED 2010 will continue to focus on the establishment of a coordination mechanism between the animal and human health sectors, avoiding the creation of separate, vertical programmes. The coordination mechanism will cover all areas of work, including risk reduction, information-sharing, coordinated response and research. The expansion of the coordination mechanism from the national to the regional level also will be promoted.

2.4.4 Focus Area 4: Infection Prevention and Control, Dr Satoko Otsu, Risk Communications Officer, WHO/Western Pacific Regional Office

There are two main issues to address within IPC. The first is to improve compliance of IPC practice during EID outbreaks. The second is to embed good practice in routine hospital care as a key to improve IPC during an outbreak. The strategic actions include the establishment or strengthening of national IPC programmes, including national and local committees, the designation of an IPC focal point and the establishment of a national IPC resource centre. IPC policies and technical guidelines should be established. Attention also should focus on enabling a supportive environment (including facilities, equipment and supplies) and on supporting national and regional experts and centres of excellence.

2.4.5 Focus Area 5: Risk Communications, Ms Wen Qing, Risk Communications Officer, WHO/Western Pacific Regional Office

Three key components for risk communications are identified in APSED (2010). These are health emergency communications, operation communications and behaviour change

- 15 -

communications. A more structured approach to building risk communication capacity is encouraged. The strategy recommends the establishment of a functional risk communication unit within the Ministry of Health.

2.4.6 Introducing APSED 2010 questions and clarifications

The scope of zoonoses work was discussed, with the point raised that many vector-borne diseases are zoonotic. There is a need for better coordination with the vertical programmes responsible for these diseases in some countries.

It was noted that the approach to zoonoses under APSED has been successful in many countries, and it is important not to lose the emphasis on partnership. The point was also raised that partnerships across multiple sectors, including veterinary, agriculture and fisheries, may be important in addressing zoonotic diseases.

Special Session

2.4. 7 Gender and Emerging Infectious Diseases, Ms Anjana Bhushan, Technical Officer, WHO/Western Pacific Regional Office

Ms Anjana Bhushan spoke about the links between health and gender differences between men and women. There is much evidence to suggest that communicable diseases may affect men and women differently. Examples of gender differences include exposure to risk factors, access and use of services, access to resources and decision-making power.

Gender analysis is the systematic consideration of gender issues to identify commonalities and differences between men and women, informing the implementation of activities. In the Western Pacific Regional Office, a framework for sex and gender in epidemic-prone infectious diseases has been formulated. The evidence suggests that gender roles and power relations have important effects on exposure, access to treatment and health care, stigma and consequence of disabilities and public participation in disease control measures. A gender analysis of SARS was used as to illustrate lessons learnt in relation to gender and EID.

2.4.8 Risk assessment, Dr Thomas Grein, Coordinator, Alert and Response Operations, WHO/HQ

Risk assessment is the starting point of any risk management cycle and should be a continuous process applied throughout the course of an event. Conducted systematically, risk assessments can support defensible and proportional decision-making where information is limited and help in communicating levels of risk.

Risk assessments involve identifying the threat, assessing the exposure and determining the vulnerabilities. Risk assessment matrices can help assign a level of risk and prioritize measures. An example was given of a risk assessment conducted on poliovirus transmission following importation into a polio-free country.

2.4.9 Special session questions and clarification

Difficulties in collecting information on gender in relation to disease surveillance were discussed. Sex disaggregated data is not enough. There is a need to understand why differences

- 16-

might appear, and systematic gender analysis is needed. It also was noted that equal sex distribution does not mean that there are no gender differences.

The point was made that there is no formal system for risk assessment and that this needs to be considered. Maldives reiterated the need for training to support routine and emergency risk assessment.

The use of software to determine probability was discussed. While this may be possible, probability is only one component of a risk assessment and always needs to be tied together with assessment of the impact.

2.5 Plenary 5: Group Feedback (Focus Areas 1-5)

Participants were divided into five groups. All groups were asked to comment on the draft strategy's vision, goals and objectives. Each group also was allocated one of the first five focus areas in the draft strategy. While most participants agreed to maintain the momentum of APSED, others suggested that the name of the strategy be expanded to reflect its broader scope, when appropriate. Comments also were made about the length and complexity of the vision and goals and a number of suggestions for improvement were given.

The Surveillance, Risk Assessment and Response group broadly agreed with the direction set out in the strategy. A number of comments were made on the use of key terms, with some clarifications recommended. It was suggested that additional terms such as risk assessment be included in the glossary.

The laboratory group agreed that the draft strategy included the suggestions provided by countries. A number of key issues in building laboratory capacity were discussed, including the need to focus on human resource development, especially at the peripheral level, and further strengthening coordination among different types of laboratories. Transportation of specimens from countries with limited laboratory capacity also was identified as an important issue. While the strategy will provide a broad strategic approach, the group noted that prioritization would need to occur at the country level.

The zoonoses group agreed that all components identified in the strategy would be relevant in the next five years. The importance of constant consultations between animal and human health sectors was stressed. The need to continue to focus on capacity- building and prevention activities also was raised, and it was suggested that zoonoses be linked to food safety and environmental issues. The participants also shared information on the current state of implementation within their respective countries. The level of coordination varies between countries and there is a need to expand coordination mechanisms to cover all diseases.

The discussion on IPC identified a number of challenges, including lack of infrastructure and a low priority accorded to IPC; advocacy was therefore viewed as crucial. It was suggested that needs assessment within this area of work should be included as a strategic action, given its significance.

The risk communication discussion group noted that capacity varied between countries and, in some places, was a relatively new concept. Challenges for risk communications were identified, particularly the impact of IT on both the speed of communications and access to information sources. Intercountry communications was identified as an important component of communications that should be noted in the strategy.

- 17-

2.5.1 Plenary 5 questions and clarification

The point was made that APSED (2010) will be used as a tool to help rally support and that the vision and goal should therefore be clear and easy to understand. It also was suggested that definitions of key terms be included.

The use oflaboratory kits was discussed. There is a need for WHO backing to support the validation of kits for accurate laboratory diagnosis, particularly those produced within the Region. The need to continue to facilitate links among laboratories, particularly intercountry links, was emphasized, as was the need to focus on the transport of specimens from countries in which laboratory capacity is limited.

The need for regional leadership and efforts at the national level was emphasized with regard to biosafety. This is particularly important in ensuring that biosafety is prioritized but does not hamper effective response and control efforts.

The point was made that there be a strong focus on the public sector within the strategy. The private sector and civil society also can make an important contribution in terms of funds and expertise. Including a reference to the potential for collaboration was suggested.

With regard to zoonoses, the OlE commented that the emphasis on parallel capacity­building in both human health and animal health sectors, as stated in the original APSED strategy, should be maintained.

The importance oflinking APSED with work carried out within other areas of WHO and with initiatives led by other international organizations also was discussed. This may need further elaboration and more concrete operational goals. The need for coordination with other initiatives was emphasized further with regard to IPC, where there is overlap with many other areas of work such as patient safety.

It was noted that by providing clear direction, APSED has been able to work more effectively with other initiatives, especially in building links with vertical programmes. The example of working with dengue programmes to strengthen surveillance systems was given.

It was noted that there is an international trend towards focusing on health systems strengthening. Work carried out under APSED can impact health systems and public health capacity more broadly. It was recommended that this should be emphasized, and would pot~ntially facilitate the mobilization of resources.

It also was noted that while there is a strong emphasis on national capacity building. Securing the Region's health requires capacity-building in all countries and areas because the Region only will be as safe as the weakest link. There is therefore a need to go beyond regional coordination to collaboration, ensuring all countries work together.

2.6 Plenary 6: Introducing APSED (2010)

2.6.1 Focus Area 6: Public Health Emergency Preparedness, Dr Nima Asgari-Jirhandeh, Public Health Specialist, WHO/Cambodia, and Dr Rick Brown, Medical Officer-Public Health Specialist, WHO South-East Asia Regional Office

- 18 -

It was important to strengthen public health emergency preparedness-building on the experience and lessons from the pandemic preparedness and response. Public health emergency preparedness encompasses six key components.

(1) Public health emergency planning helps to engage partners, build capacity and provide operational links to ensure a structured and coordinated response.

(2) National lliR Focal Points (NFPs) play an important role in facilitating lliR event communications and sharing information related to public health events and emergencies.

(3) Points of entry have new roles to play under the new lliR, including the application of border health measures during a public health emergency.

(4) Response logistics should be applied in situations in which there is an urgent need to provide rapid support, deploy human resources, set up communications, ensure security or even arrange for the collection and shipment of clinical specimens in a reduced time­frame.

(5) Clinical case management is critical in minimizing morbidity and mortality during any outbreak of an infectious disease.

(6) Health care facility preparedness and response highlights the need to plan in advance for situations in which the demand for care may exceed the normal delivery capacity.

2.6.2 Focus Area 7: Regional Preparedness, Alert and Response, Dr Tamano Matsui, Medical Officer/Epidemiologist, WHO/Western Pacific Regional Office

There are three key components within this focus area: regional surveillance and risk assessment, a regional information-sharing system and regional preparedness and response. The strategic actions include the establishment of a regional indicator-based surveillance system for priority diseases, creating rapia feedback mechanisms, technical guidelines and training. The use of the Global Outbreak and Response Network (GOARN) and other experts will be expanded and links between national and reference laboratories strengthened.

2 .6.3 Focus Area 8: Monitoring and Evaluation, Dr Ailan Li, Medical Officer, WHO/Western Pacific Regional Office

Two levels of monitoring and evaluation are proposed in APSED (2010). At the country level, country work plans will be formulated. The lliR monitoring framework indicators will be used to measure progress along with a minimum number of supplementary APSED indicators. At the regional level, the monitoring and evaluation function of TAG will be strengthened, including through the review of annual aggregated data from the lliR monitoring framework questionnaire.

2.6.4 Special Considerations, Dr Babatunde Olowokure, Medical Epidemiologist, WHO/VietNam

Within APSED (2010), those issues that are considered relevant but which cannot be directly addressed by the strategy have been included as special considerations. These are

- 19-

categorized in three groups. First, the special needs of countries and areas in the Pacific, which are geographically isolated and have limited resources, are considered. The second group comprises areas in which there are synergies, common elements and links with APSED and includes food safety, humanitarian emergencies, mass gatherings and deliberate release. The third group includes social and environmental factors such as social determinants of health and climate change, which should be taken into consideration wherever relevant and feasible.

2.6.5 Implementing APSED (2010), Dr Chusak Prasittisuk, Coordinator, Communicable Diseases Control, WHO/South-East Asian Regional Office

The basic requirements in implementing APSED are political commitment, a multisectoral approach, cooperation and coordination among stakeholders at all levels and adequate human and financial resources.

It was proposed that the coordination and management model for APSED (2010) will incorporate three components. The regional committees can be used to ensure political commitment, facilitate policy decisions and support implementation. TAG will continue to function as the key technical mechanism for advice on implementation and informal working groups will be convened as needed.

At the national level, countries may consider the designation of a national coordinator or office and/or a standing implementation committee with representation from senior public health officials and their counterparts from other sectors.

Recommended mechanisms for the mobilization of financial resources include using the national plan of action to strengthen preparedness-driven resource mobilization, strengthening existing and creating alternative financial mechanisms and strengthening advocacy.

2 .6.6 Plenary 6 questions and clarification

Implementation of the strategy either regionally or biregionally was discussed. The view was expressed that regional implementation will make achieving the goal of health security more difficult, will affect cross-border work and will limit opportunities to benefit from experiences across the two regions. The view that regional structures are also important was expressed, and it was suggested that TAG meetings occur at the regional and biregionallevel on an alternate basis.

It was suggested that other small countries such as Maldives, Timor-Leste and Bhutan be included along with Pacific island countries and areas for special consideration.

The impact of migration and immigration on infectious diseases was highlighted.

It was noted that APSED can play a role in identifying research gaps, in driving research agendas and in leveraging the results of research activities.

The need to ensure that social determinants of health are embedded in all areas of work and do not remain isolated was discussed. In particular, the importance of considering gender across all areas of work was emphasized. It was suggested that developing indicators related to this area of special considerations may address this issue.

-20-

Although the importance of the special considerations was recognized, there was the concern that the focus of the strategy on emerging infectious diseases should be maintained.

Several participants commented that the increased emphasis on monitoring and evaluation was a positive step. The importance of external evaluation was noted, with the view raised that this should be made more explicit in the document. However, it was noted that it is important to maintain a balance between independent evaluation and ensuring that monitoring and evaluation activities build a country's capacity. Governments should be accountable for work and monitoring conducted for the benefit of their own systems.

2.7 Plenary 7: Group Feedback (Group Discussion 3 and 4)

Participants were divided into four groups. All groups were asked to discuss the special considerations and implementation sections of the draft strategy. Each group was also allocated a component of the Focus Areas 6-8.

Several groups thought that special consideration for Member States in the Pacific should be extended to similar countries in the South-East Asian Region. Restructuring the special considerations section also was discussed. While the special considerations were regarded as relevant, there was a strong view that these issues should not detract from the focus on emerging diseases. Most groups agreed that the strategy should remain biregional in flavour while recognizing the difference in country needs and other aspects in two WHO regions. The importance of coordination between different sectors was stressed, as was the view that public­private partnerships should be encouraged.

In the discussion on public health emergency planning, Group A agreed that the strategy should not be prescriptive about generic vs. specific plans but suggested that technical guidance on key components of a plan would be useful. National Focal Points were viewed as a useful mechanism to improve communication both within and between countries. There were some instances in which greater clarity of roles and requirements was needed.

Group B agreed that a focus on response logistics was important. The key actions identified with regard to clinical case management were viewed as important, but some suggestions were made regarding the wording of this section. For health care facility preparedness and response, it was recommended that national coordination of health care facilities be included as a key action.

Group C endorsed the direction outlined in the strategy for regional preparedness, alert and response. The need to share rumour surveillance information more broadly was emphasized as was the need to build on existing structures, rather than reinventing the wheel, in establishing regional surveillance systems.

The countries participating in Group D's discussion on monitoring and evaluation shared information on current mechanisms. It was noted that APSED planning cycles are not always linked to country planning cycles. It was recommended that monitoring and evaluation of the new strategy should address the existing overlap between the APSED and IHR monitoring tools and should be synchronized across the two regions.

- 21 -

2.7.1 Partners' Forum

The Partners' Forum agreed that APSED is a useful tool to coordinate activities and mobilize resources. The importance of country ownership and prioritization was emphasized, as was the need for balance and coordination between horizontal and vertical programmes. The forum recommended the use of a results-based approach to reporting, clearly linking activities to outcomes. Attention should be given to aligning planning and budget cycle processes. Several partners also raised the importance of gender being incorporated as part of the strategy, with specific progress indicators.

2. 7. 2 Plenary 7 questions and clarification

The point was made that the strategy is a road map but that each country should devise its own plan based on a common framework and that this should be emphasized in the document.

Also discussed was the importance of ensuring that lessons from both responding to outbreaks such as the pandemic and from addressing vaccine-preventable diseases are used to inform work on BID.

The point was made that although there has been significant progress in the last five years, it is important not to give the impression that the task is done. There is a need to improve systems and build on the capacity built over the last five years. Continuing needs assessment is crucial.

The visibility of APSED at the country level was discussed, with the point made that this is particularly important in linking with other i.ninistries. A national APSED coordinator could play a key role. The suggestion also was made that Member States should allocate an independent budget for health security.

Monitoring and evaluation was discussed, with the point made that yearly progress towards achieving the minimum core capacities for lliR should be charted. It is also important to be able to measure progress across the Region as a whole.

The inclusion of ethics as a guiding principle also was recommended.

The use of GOARN was discussed, with the point made that GOARN can assist with preparedness efforts as well as response. The view was expressed that the relationship between GOARN and APSED could be made more explicit in the document.

2.8 Plenary 8: Review of Draft APSED (2010): Summary

Recommendations and observations made by participants during the meeting were collated and grouped into three categories. The first category consisted of those related to the content of the draft strategy document. The second category included observations and suggestions that will be captured within regional or country work plans. The third category consisted of editorial changes (both content and wording) to the draft strategy document. The TAG recommendation on each issue belonging to the first category was presented. Following some discussion, changes to the strategy were agreed.

--------------

- 22-

3. CONCLUSIONS AND RECOMMENDATIONS

The main conclusions of the workshop were as follows:

3.1 General

(1) The experience and lessons learned in the APSED (2005) implementation, evaluation and pandemic response clearly have demonstrated the value and importance of providing Member States, WHO and partners with a common framework to support national and regional capacity-building that is required for effective management of emerging disease threats in the Asia Pacific Region.

(2) Considerable achievements have been made towards strengthening national capacities in the five programme areas (surveillance and response, laboratory, zoonoses, infection control and risk communication) spelt out under APSED (2005) over the past three to five years. Progress also has been made in implementing the 2009 TAG recommendations. Such progress has made a significant contribution to the pandemic response and meeting the IHR (2005) core capacity requirements in the Region.

(3) Progress in implementing APSED (2005) has created a strong foundation in Member States to expand the scope of national capacity-building activities required for managing public heath threats arising from both emerging diseases and other public health emergencies, in line with the IHR (2005) requirements.

( 4) Continuing efforts and actions under a common framework are required at each level (national and regional) to ensure that a wide range of essential capacities are in place for effective prevention, early detection and rapid response to future emerging diseases and other public health events that may threaten regional health security.

(5) An updated strategic document, namely the Asia Pacific Strategy for Emerging Diseases (2010), has been formulated based on a consultative, cooperative and collaborative process since July 2009, including a Biregional Consultation in May 2010.

(6) The fifth TAG meeting reviewed and endorsed APSED (2010). The meeting concluded that APSED (2010) will play a vital role in guiding Member States, WHO and partners in the future efforts to build capacity for managing emerging diseases and other public health emergencies.

3.2 Recommendations

The group made the following recommendations:

(1) Member States, WHO and partners should advocate the importance of using APSED (2010) as a common framework to guide national and regional capacity- building efforts to contribute to regional health security.

-23-

(2) Member States and WHO should work closely to use APSED (2010) as a road map to formulate and implement work plans at both national and WHO levels, ensuring that the strategy is translated into action.

(3) Work plans formulated at regional and national levels should address the human and budgetary resources required for implementation.

(4) Taking account of the lliR monitoring tool, WHO should work with Member States and partners to develop a minimum set of APSED indicators and agreed mechanisms that should be used for result-based monitoring of APSED (2010) implementation progress.

(5) When implementing APSED (2010) Focus Areas (including work plans), relevant cross-cutting additional issues highlighted in the document should be embedded and their progress should be monitored.

ANNEXl

WORLD HEALTH

ORGANIZATION

w~~-~ ~ . l · ~ ORGANISATIONS MONDIALE ~ ~ rJ1 DE LA SANTE ~ 13 ~

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

FIFTH MEETING OF THE ASIA PACIFIC TECHNICAL ADVISORY GROUP

WPR/ !DSE/CSR(9)/201 0.1 04 July 2010

ON EMERGING INFECTIOUS DISEASES

Manila, Philippines 6- 9 July 2010

PROGRAMME OF ACTIVITIES

ENGLISH ONLY

Day 1-6 July (Tuesday)

08:30-09:00

09:00- 10:00

10:00- 10:30

10:30- 12:00 10:30- 11:00

11:00-11:20

11 :20 - 11 :40

11:40- 12:00

12:00- 13:00

Registration

Opening Session Opening remarks

-Dr Shin Young-sao, Regional Director Self introduction Objectives and agenda Nomination of Chairs and Rapporteur Administrative announcements Group photograph

Coffee break

Plenary 1: Overview of IHR and APSED Progress on APSED/lliR and pandemic preparedness in the Asia Pacific Region

- Dato' Dr Tee Ah Sian, Director, Combating Communicable Diseases, WHO WPRO

Update on lliR implementation and National Core Capacity Monitoring - Dr Xing Jun, Medical Officer, IHR Coordination, WHOIHQ

Final evaluation of APSED approach - Ms Praveena Gunaratnam, Program Manager, Health and HIV Thematic

Group, AusAID Questions and Clarifications

Lunch

Annex 1 WPR/DSE/CSR(9)201 0.1

- 2 -

13:00 -14:10 13:00-13:10 13:10-13:20 13:30- 13:40 13:40-13:50 13:50-14:10

14:10 -15:00 14:10-14:20 14:20- 14:30 14:30- 14:40 14:40- 15:00

15:00-15:30

15:30- 17:30

18:30

Plenary 2: APSED (2005) Country Progress Indonesia LaoPDR Mongolia Sri Lanka Questions and Clarifications

Surveillance and Response SMS-based surveillance in Bangladesh Web-based reporting system in China Surveillance system in the Federated States of Micronesia Questions and Clarification

Coffee break

Poster Session: Outbreak Response

Reception

Day 2- 7 July (Wednesday)

Room 1

08:30-09:15 08:30- 08:45 08:45-09:00 09:00-09:15 09:15-09:20

09:20- 10:00 09:20 - 09:35 09:35 - 09:50 09:50- 10:00

Room2

08:30- 09:15 08:30 - 08:45 08:45- 09:00 09:00-09:15

09:15-10:00 09:15-09:30 09:30- 09:45 09:45- 10:00

10:00-10:30

Laboratory India Japan VietNam Questions and Clarification

Zoonoses Maldives Philippines Questions and Clarifications

Infection Control Cambodia Thailand Questions and Clarifications

Risk Communications Nepal New Zealand Questions and Clarifications

Coffee break

10:30-11:15 10:30- 10:45

10:45- 11:00

11:00-11:15

11:15 -12:00 12:00-13:00

13:00 -14:00 13:00-13:10

13:10-13:20

13:20- 13:30

13:30- 13:40

13:40- 13:50

13:50- 14:00

14:00- 15:30

15:30-16:00

16:00-17:00 16:00-16:30

16:30- 17:00

17:30-18:30

-3- Annex 1 WPR/DSE/CSR(9)/20 10.1

Plenary 3: Introducing APSED (2010) Outcome ofBi-regional Consultation on APSED and Beyond

-Professor NK. Ganguly, TAG member Overview of Draft APSED (2010)

-Dr Tatsuo Miyamura, TAG member Questions and Clarifications

Group Discussion 1: Vision, Goal & Objectives Lunch

Plenary 4: Introducing APSED (2010) (continued) Focus Area 1: Surveillance, Risk Assessment and Response

- Dr Chin Kei Lee, Epidemiologist, WHO/China Focus Area 2: Laboratory

- Dr Gyanendra Ganga!, Technical Officer, WHOISEARO Focus Area 3: Zoonoses

- Dr Gyanendra Ganga!, Technical Officer, WHOISEARO Focus Area 4: Infection Prevention and Control

- Dr Satoko Otsu, Medical Officer, WHOIWPRO Focus Area 5: Risk Communication

- Ms Wen Qing Yeo, Risk Communications Officer, WHO/WPRO Questions and Clarifications

Group Discussion 2: Focus Areas 1-5 - Group 1: Focus Area 1 -Group 2: Focus Area 2 - Group 3: Focus Area 3 -Group 4: Focus Area 4 - Group 5: Focus Area 5

Coffee break

Special Session Gender and Emerging Infectious Diseases

- Ms Anjana Bhushan, Technical Officer, WHO WPRO Risk Assessment

- Dr Thomas Grein, Coordinator, Alert and Response Operations, WHOIHQ

Meeting of TAG Members

Day 3-8 July (Thursday)

08:30 - 09:30 08:30-08:40 08:40- 08:50 08:50- 09:00 09:00-09:10 09:10-09:20 09:20- 10:00

10:00-10:30

Plenary 5: Group Feedback (Focus Area 1-5) Group 1 : Surveillance, risk assessment and response Group 2: Laboratory Group 3: Zoonoses Group 4: Infection prevention and control Group 5: Risk communication Questions and clarifications

Coffee break

Annex 1 WPR/DSE/CSR(9)20 10.1

-4-

10:30- 12:00 10:30-10:50

10:50- 11:00

11:00-11:10

11 : 10 - 11 :20

11 :20 - 11 :40

11:40- 12:00

12:00 -13:00

13:00- 15:00

15:00- 15:30

15:30-17:00

17:30-18:30

Plenary 6: Introducing APSED (2010) (continued) Focus Area 6: Public Health Emergency Preparedness

- Dr Nima Asgari-Jirhandeh, Public Health Specialist, WHO/ Cambodia - Dr Rick Brown, Medical Officer - Public Health Specialist, WHO SEARO

Focus Area 7: Regional Preparedness, Alert and Response - Dr Tamano Matsui, Medical Officer/Epidemiologist, WHO/WPRO

Focus Area 8: Monitoring and Evaluation - Dr Ailan Li, Medical Officer, WHOIWPRO

Special Considerations - Dr Babatunde Olowokure, Medical Epidemiologist, WHO/VietNam

Implementing APSED (20 1 0) - Dr Chusak Prasittisuk, Coordinator, Communicable Diseases Control,

WHOSEARO Questions and clarifications

Lunch

Group Discussion 3: Focus Areas 6-8 - Group A: Focus Area 6 (6.1-6.3) - Group B: Focus Area 6 (6.4-6.6) - Group C: Focus Area 7 - Group D: Focus Area 8

Partners' Forum

Coffee break

Group Discussion 4: Special considerations & implementing APSED (2010) -Group A: -Group B: -Group C: - GroupD:

Partners' Forum (continued)

Meeting of TAG Members

Day 4- 9 July (Friday)

08:30-09:30 08:30-08:40 08:40-08:50 08:50- 09:00 09:00-09:10 09:10-09:20 09:20- 10:00

10:00-10:30

Plenary 7: Group Feedback (Group Discussion 3 & 4) Group A Group B Group C GroupD Partners' Forum Questions and Clarifications

Coffee break

10:30- 12:00

12:00-13:00

13:00-15:00

15:00-15:30

- 5-

Plenary 8: Review of Draft APSED (2010)

Lunch

Plenary 9: Conclusions and Recommendations

Conclusions and Recommendations Next Steps Closing remarks

Coffee break

Annex 1 WPR/DSE/CSR(9)/20 10.1

ANNEX2

WORLD HEALTH

ORGANIZATION a~ ~ . l · ~ ORGANISATIONS MONDIALE

~ ~ rJJ. DE LA SANTE ---~

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

FIFTH MEETING OF THE ASIA PACIFIC TECHNICAL ADVISORY GROUP

WPR/DSE/CSR(9)/2010/IB/2 08 July 2010

ON EMERGING INFECTIOUS DISEASES

Manila, Philippines 6- 9 July 2010

ENGLISH ONLY

LIST OF TEMPORARY ADVISERS, PARTICIPANTS, OBSERVERS AND SECRETARIAT

1. TECHNICAL ADVISORY GROUP

Professor N.K. GANGULY, President, Jawaharlal Institute of Post Graduate, Medical Education and Research (JIPMER), Aruna Asaf Ali Marg, Distinguished Biotechnology, Research Professor, Transnational Health Science and Technology Institute, National Institute of Immunology, New Delhi, India, Tel. No.: (9111) 2674 1501, Fax No.: (9111) 2658 8662, E-mail: nkganguly@nii.res.in

Dr LIM Poh Lian, Senior Consultant, Department of Infectious Diseases, Tan Tack Seng Hospital, Senior Consultant (Infectious Diseases), Communicable Disease Division, Ministry of Health; Head, Travelers' Health and Vaccination Clinic, 11 Jalan Tan Tack Seng, Singapore 308433, Singapore, Tel. No.: (65) 6357 7919, Fax No.: (65) 6252 4056, E-mail: Poh_lian_lim@ttsh.com.sg, Lim_poh _lian@moh.gov.sg

Professor John MACKENZIE, Research Associate and Professor, Tropical Infectious Diseases, Curtin University, 20A Silver Street, Malvern VIC 3144, Australia, Tel. No.: (614) 3987 5697, E-mail: J.MacKenzie@curtin.edu.au

Dr Tatsuo MIY AMURA, Director-General Emeritus, National Institute of Infectious Diseases, 1-23-1 Toyama Shinjuku-ku, Tokyo 162-8640, Japan, Tel. No.: (813) 5285 1111, Mobile: (080) 3488 1942, E-mail: Tmiyam@aol.com

Dr Anne SCHUCHAT, RADM US Public Health Service, Director, National Centre for Immunization and Respiratory Diseases, Centres for Diseases Control and Prevention, 1600 Clifton Road, Mail Stop E-05, Atlanta GA 30333, United States of America, Tel. No.: (1404) 639 8200, Fax No.: (1404) 639 8626, E-mail: acsl@cdc.gov

Dr Pratap SINGHASIV ANON, Dean, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewee, Bangkok 10400, Thailand,Tel. No.: (662) 354 9199, Fax No.: (662) 354 9198, E-mail: tmpsh@mahidol.ac.th

WPR/DSE/CSR(9)/2010/IB2 page 2

2. RESOURCE PERSONS

Dr Hitoshi OSHIT ANI, Professor, Tohoku University, Graduate School of Medicine, Department of Virology, 2-1 Seiryo-cho Aoba-ku, Sendai 980 8575, Japan, Tel. No.: (81) 2717 8210, Fax No.: (81) 2717 8212, E-mail: oshitanih@mail.tains.tohoku.ac.jp

Dr Wei gong ZHOU, Chief, Immigrant, Refugee and Migrant Health Branch, Division of Global Migration and Quarantine, Centres for Disease Control and Prevention, Atlanta GA 30333, United States of America, Tel. No.: (1 404) 639 2555, Fax No.: (1 404) 248 4223, E-mail: waz6@cdc.gov

3. CONSULTANT

Ms Rhiannon COOK, 25 Laura Street, Newtown, Sydney NSW, Australia, Tel. No.: (614) 3225 0830, Mobile: (63) 919 413 2869, E-mail: cookrhiannon@hotmail.com

4. TEMPORARY ADVISERS I PARTICIPANTS

South-East Asia Region

Dr Abdul Azeez YOOSUF, Consultant in Internal Diseases, Chairman, Male' Health Services Corporation, Flat 2/A Radhebaige, Machangoli, Radhebaimagu, 2003, Male, Maldives, Tel. No.: (960) 777 2648, E-mail: azeez_yoosuf@hotmail.com

Dr Manas Kumar BANERJEE, Consultant, Public Health and Tropical Diseases, Swawalambi Marg, H. No. 215, Purano Sinarmangal- 35, Manohara Town Planning, Kathmandu, Nepal, Tel. No.: (977) 1499 0402, Mobile: 9841 282932, Fax No.: (977) 1552 7756, E-mail: banetjeemanas@gmail.com

Dr Risintha PREMARATNE, Consultant Epidemiologist, Epidemiology Unit, Ministry ofHealthcare & Nutrition, 231, De Saram Place, Colombo 10, Sri Lanka, Tel. No: (9411) 268 1548, Fax No.: (9411) 269 6583, E-mail: risintha@yahoo.com, risintha@gmail.com

Dr Polrat Wll..AIRATANA, Professor and Head, WHO Collaborating Centre for Clinical Management of Malaria, Faculty of Tropical Medicine Mahidol University, 420/6 Rajvithi Road, Rajthevi, Bangkok, Thailand, Tel. No.: (662) 354 9100 ext 1454, Fax No.: (662) 354 9158, E-mail: tmpwl@mucc.mahidol.ac.th

Dr Pasakorn AKARASEWI, Director, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 1100, Thailand, Tel no.: (662) 590 1776, Fax no: (662) 590 1784, E-mail: pasakorn.sewi@gmail.com

Western Pacific Region

Dr Andrew PENGll..LEY, Senior Medical Adviser, Nationalllffi. Focal Point, Office of Health Protection, Department of Health and Ageing, Central Office, GPO Box 9848, Canberra ACT 2601, Australia, Tel. No.: (612) 6289 3520, Fax No.: (612) 6289 7791, E-mail: Andrew .Pengilley@health.gov.au

Dr Ahmad Fakhri Dato Paduka Haji JUNAID I, Medical Officer, Disease Control Division, Department of Health Services, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan BB3910, Tel. No.: (673) 238 2755, Fax No: (673) 238 2755, E-mail: fakhri@doctors.org.uk

Dr SOK Srun, Deputy Director, Department of Hospital Services, Ministry of Health, #151-153, Kampuchea Krom Avenue, Phnom Penh 12251, Cambodia, Tel. No.: (855) 1291 2122, Fax No.: (855) 6376 0360, E-mail: soksrun@camnet.com.kh

WPRIDSE/CSR(9)/2010/IB2 page3

Mr TEK Bunchhoeung, Senior Officer, Communicable Disease Control Department, Ministry of Health, #151-153, Kampuchea Krom Avenue, Pnom Penh, Cambodia,_Tel. No.: (855) 7799 0566, Fax No.: (855) 2388 2317, E-mail: bunchhoeung@yahoo.com

Dr N1 Daxin, Director, Unknown-Cause Disease Prevention and Control Division, Chinese Centre for Disease Control and Prevention, Office of Disease Control and Emergency Response, Ministry of Health, No. 155, Changhai Road, Changping District, Beijing 102206, Tel. No.: (8610) 5890 0501, Fax No.: (8610) 5890 0561, E-mail: jsndx@vip.sina.com

Dr YANG Zhiguang, Principal Staff Member, Bureau of Disease Prevention and Control, Ministry of Health, No. 1 Xizhimenwai, South Road, Beijing 100044, Tel. No.: (8610) 6879 2508, Fax No.: (8610) 6879 2554, E-mail: Yangzhg@moh.gov.cn

Mr LID Zhiqiang, Division of Precaution, Office ofHealth Emergency, Ministry of Health, No. 1 Naolu Xizhimenwai, Beijing 100044, China, Tel. No.: (8610) 6879 2647, Fax No.: (8610) 6879 2646, E-mail: ying-jian2@163.com

Dr WONG Christine Wang, Principal Medical and Health Officer (Surveillance Section), Centre for Health Protection, Department of Health, 147C Argyle Street, Kowloon, Hong Kong (China), Tel. No.: (852) 2125 2288, Fax No.: (852) 3145 1544, E-mail: christine_wong@dh.gov.hk

Dr LAM Chong, Coordinator, Control of Communicable Diseases, CDC-NDN, Health Bureau, 7th Floor, Building "Hot Line", No. 335-341, Alameda Dr. Carlos d'Assumpcao, Macao (China), Tel. No.: (853) 2853 3525, Fax No.: (853) 2853 3524, E-mail: lamc@ssm.gov.mo

Dr Samuela KOROVOU, Divisional Medical Officer Northern, Ministry of Health, P.O. Box 104, Ro Qomate, Labasa, Fiji, Tel. No.: (679) 881 2522, Fax No.: (679) 881 4080, E-mail: samuela.korovou@govnet.fj, skorovou@yahoo.co. uk

Dr Takeshi EN AMI, Deputy Director, Infectious Diseases Control Division, Health Services Bureau, Ministry of Health, Labour and Welfare, 1-2-2 Kasumigaseki, Chiyodaku, Tokyo, Japan, Tel. No.: (813) 3595 2257, Fax No.: (813) 3581 6251, E-mail: enami-takeshi@mhlw.go.jp

Dr ARCHKHA WONGS Sibounhom, Director, Disease Prevention Division, Department of Hygiene and Prevention, Ministry of Health, Vientiane, Lao People's Democratic Republic, Tel. No.: (856 20) 980 4821, Fax No.: (856 21) 241 924, E-mail: sbh_dohp@yahoo.com

Dr Phengta VONGPHRACHANH, Director, National Centre for Laboratory and Epidemiology, Ministry of Health, Km 3 Thadeua Road, Vientiane, Lao People's Democratic Republic, Tel. No.: (856 21) 312 351, Fax No.: (856 21) 350 209, E-mail: v.phengta@gmail.com

Dr Lokman Hakim bin SULAIMAN, Director, Disease Control Division, Ministry ofHealth, Level8, Block E10, Parcel E, Federal Government Administrative Centre, Putrajaya 62590, Tel. No.: (603) 8883 4003, Fax No.: (603) 8883 4150, E-mail: lokman.hakim@moh.gov.my

Dr NORHIZAN Ismail, Deputy Director of Disease Control (Surveillance), Ministry of Health, Level3, Block E10, Parcel E, Putrajaya 62590, Malaysia, Tel. No.: (603) 8883 4382 I 4370, Fax No.: (603) 8888 6271, E-mail: dmorhizan@moh.gov.my

Dr Lisa Ann BARROW, National Laboratory Coordinator, Department of Health and Social Mfairs, PO Box PS-70, Palikir, Pohnpei, Federated States ofMicronesia,_Tel. No.: (691) 320 8300, Fax No.: (691) 320 8460, E-mail: lbarrow@fsmhealth.fm

Dr Dulmaa NY AMKHUU,National IHR Focal Point, General Director, National Centre for Communicable Diseases, Ministry ofHealth, Administrator's Building, Nam Yan Ju Street, Byanzurch District, 13th Horoolol, Ulaanbaatar 210648, Tel. No.: (976) 9910 0155, Fax No.: (976) 1145 8699, E-mail: dnyamkhuu@yahoo.com, DNyamkhuu@nccd.gov.mn

WPRIDSEICSR(9)12010/IB2 page4

Dr Narangerel DORJ, Senior Officer, Communicable Diseases Control, Ministry of Health, Government Building Vill, Olympic Street 2, Sukhbaatar District, lnaanbaatar 51 , Tel. No.: (976) 9916 4451 I 9811 4511, Fax No.: (976) 1126 3631, E-mail: naraa61 us@yahoo.com

Mr Berry ROPA, National Surveillance Officer, Department ofHealth, P.O. Box 807, Waigani NCD, Papua New Guinea, Tel. No.: (675) 301 3730, Fax No.: (675) 323 6171, E-mail: berry-ropa@health.gov.pg

Dr Joy Althea P ABELLON, Epidemiologist, Event Based Surveillance and Response Unit Head, Applied Public Health Division, National Epidemiology Center, Department of Health, Building 9, San Lazaro Compound, Rizal Avenue, Sta Cruz, Manila 1003, Philippines, Tel. No.: (632) 743 8301 locall937, Fax No. : (632) 743 6076, E-mail: joypabellon@gmail.com

Dr Ma. Vicenta Rosario VASQUEZ, Medical Officer VII, Epidemiologist, Chief, International Health Surveillance Division, Bureau of Quarantine, Department of Health, 25th Delgado Street, Port Area, Manila, Philippines, Tel. No.: (632) 523 2708 I 301 9104, Fax No.: (632) 527 4678 I 301 9103, E-mail: mamulOll@gmail.com, mamulOll@yahoo.com

Dr Jun-wook KWON, Director, Division of Communicable Disease Control, Korea Center for Disease Control and Prevention, Ministry of Health and Welfare, 194, Tongil-ro, Eunpvung-gu 122-701, Republic ofKorea, Tel. No.: (822) 380 2631, Fax No.: (822) 354 2723, E-mail: kjw9925@mw.go.kr, jwk9925@hanmail.net

Sr Filoiala SAKAIO, Hospital Matron, Princess Margaret Hospital, Funafuti, Tuvalu, Tel. No.: (688) 20480, Fax No.: (688) 20481, Email: filoialasakaio@yahoo.com,

Dr TRAN Nhu Zuong, Deputy Director, National Institute of Hygiene and Epidemiology, No.1 Yersin Street, HaNoi, VietNam, Tel. No.: (844) 3971 5679, Fax No.: (844) 3971 6497, E-mail: trannhuduong@gmail.com

5. OBSERVERS

Dr Jacques JEUGMANS, Practice Leader (Health), Regional and Sustainable Development Department, Asian Development Bank, 6 ADB Avenue, Mandaluyong City, Manila 1550, Philippines, Tel. No.: (632) 632 6392, Fax No.: (632) 636 2409, E-mail: jjeugmans@adb.org

Ms Praveena GUNARATNAM, Program Manager, Health and IllV Thematic Group, Australian Agency for International Development, P.O.Box 887, Canberra ACT 2601, Australia, Tel. No.: (612) 6206 4490, Fax No: (612) 6206 4720, E-mail: Praveena.Gunaratnam@ausaid.gov.au

Dr Anthony Paul STEW ART, Medical Epidemiologist, Burnet Institute, GPO Box 2284, Melbourne VIC 3001, Australia, Tel. No.: (613) 9282 2111, Fax No.: (613) 9282 2126, E-mail: tonys@burnet.edu.au

Mr Jeffery ELZINGA, Southeast Asia Regional Program, Asia Branch, Canadian International Development Agency, Government of Canada, 200 Promenade du Portage, Gatineau Quebec KIA OG4, Canada, Tel. No.: (819) 997 3185, Fax No. : (819) 997 0968, E-mail: jeffery.elzinga@acdi-cida.gc.ca

Ms Myrna JARILLAS, Senior Program Officer, Canadian International Development Agency, Levels 8, Tower 2 RCBC Plaza, 6819 Ayala Avenue, Makati City 0707, Philippines, Tel. No.: (632) 857 9139, Fax No.: (632) 843 1083, E-mail: Myma.Jarillas@international.gc.ca

Dr Carolyn Anne BENIGNO, Animal Health Officer, Food and Agriculture Organization, Regional Office for Asia and the Pacific, Bangkok, Thailand, Tel. No.: (662) 697 4330, Mobile: (668) 1684 7890, E-mail: Carolyn.Benigno@fao.org

WPR/DSE/CSR(9)/2010/IB2 pageS

Dr Shako OGAWA, Second Secretary, Economic Section, Embassy of Japan, 2627 Roxas Boulevard, Pasay City 1300, Philippines, Tel. No.: (632) 551 5710, Fax No.: (632) 551 5783, E-mail: shoko.ogawa@mofa.go.jp; keizai4@japanembassy.ph

Dr LEE Han-Sung, Medical Officer, Division of Communicable Disease Control, Korea Centre for Disease Control and Prevention, Ministry for Health and Welfare, 194, Tongil-ro, Eunpyung-gu, Seoul122-701, Republic ofKorea, Tel. No.: (822) 380 2639, Fax No.: (822) 354 2723, E-mail: out4 fun2@naver.com

Dr Bounkong SYHA VONG, Deputy Director, Mahosoth Hospital, Sethathirath Road, PO Box 2769, Vientiane, Lao People's Democratic Republic, Tel. No.: (856 21) 240 656, Fax No.: (856 21) 214 020, E-mail: bounkongs@yahoo.com

Dr Felix Ll, Minister Counsellor (Health), Embassy of Canada, 19 Dongzhimenwai Dajie, Beijing 100600, People's Republic of China, Tel. No.: (8610) 5139 4058, Fax No.: (8610) 5139 4454, E-mail: Felix.Li@international.gc.ca

Dr Seini KUPU, Pandemic Influenza Preparedness Specialist, Secretariat of the Pacific Community, B.P. D5- 98848, Noumea, New Caledonia, Tel. No.: (687) 262 000, Fax No.: (687) 263 818, E-mail: SeiniK@spc.int, seinik@spc.int

Dr Rodney HOFF, Executive Director, Regional Emerging Diseases Intervention Centre, 10 Biopolis Road, 02-01, Singapore 138670, Tel. No.: (65) 6874 7030, Fax No.: (65) 6874 7031, E-mail: rhoff@redi.org.sg

Dr Hitoshi MURAKAMI, Regional Coordinating Officer, United Nations System Influenza Coordination (UNSIC), Asia-Pacific Regional Hub, c/o UN OCHA Regional Office for Asia and the Pacific, 2nd Floor, UNCC Building, Rajdamnenern Nok Avenue, Bangkok 10200, Thailand, Tel. No.: (662) 288 2429, Fax No.: (662) 288 1078, E-mail: murakami2@un.org

Ms Carrie RASMUSSEN, Health Officer, United States Agency for International Development, 8th Floor, PNB Financial Centre, Diosdado Macapagal Avenue, Pasay City, Philippines, Tel. No.: (632) 552 9865, Fax No.: (632) 552 9999, E-mail: crasmussen@usaid.gov

Dr Alexandre BOUCHOT, DVM-EUIHPED Project Manager, SEAFMD Technical Adviser, World Organization for Animal Health, OlE Sub-Regional Representation for South East Asia, c/o DLD, 69/1 Phaya Thai Road, Ratchathewi 10400, Bangkok, Thailand, Tel. No.: (662) 653 4864, Fax No.: (662) 653 4904, E-mail: a.bouchot@oie.int

Dr Ronello ABILA,Sub-Regional Representative, World Organization for Animal Health, OlE Sub­Regional Representation for South East Asia, c/o DLD, 69/1 Phaya Thai Road, Ratchathewi 10400, Bangkok, Thailand, Tel. No.: (662) 653 4864, Fax No.: (662) 653 4904, E-mail: r.abila@oie.int

6. SECRETARIAT

WHO/WPRO

Data' Dr TEE Ah Sian, Director, Combating Communicable Diseases, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9701, Fax No.: (632) 521 1036, E-mail: teea@wpro.who.int

Dr Takeshi KASAl (Responsible Officer), Coordinator, Health Security and Emergencies, and Regional Adviser, Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9730, Fax No.: (632) 521 1036, E-mail: kasait@wpro.who.int

Ms Jenny BISHOP, Technical Officer, Food Safety, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9872, Fax No.: (632) 526 0279, E-mail: bishopj@wpro.who.int

WPRIDSEICSR(9)12010/IB2 page6

Ms Emma Jane FIELD, Surveillance and Response Officer, Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9948, Fax No.: (632) 521 1036, E-mail: fielde@wpro.who.int

Ms Qiu Yi KHUT, Technical Officer (Communicable Disease), Communicable Disease Surveillance Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9920, Fax No.: (632) 521 1036, E-mail: khutq@wpro.who.int

Dr LI Ailan, Medical Officer (IHR), Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9784, Fax No.: (632) 521 1036, E-mail: lia@wpro.who.int

Dr Tamano MATSUI, Medical Officer (FETP Coordinator), Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9828, Fax No.: (632) 521 1036, E-mail: matsuit@wpro.who.int

Dr ONG Bee Lee, Zoonotic Epidemiologist, Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9914, Fax No.: (632) 521 1036, E-mail: ongb@wpro.who.int

Dr Satoko OTSU, Medical Officer (Pandemic Preparedness), Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9916, Fax No.: (632) 521 1036, E-mail: otsus@wpro.who.int

Dr Arturo PESIGAN, Technical Officer, Emergency and Humanitarian Action, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9810, Fax No.: (632) 528 9072, E-mail: pesigana@wpro.who.int

Mr Munsyi SEKSIANTO, Logistician, Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9915, Fax No.: (632) 521 1036, E-mail: seksiantom@wpro.who.int

Dr Charuni SEN ANA Y AKE, Technical Officer (Programme Budget), World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9839, Fax No.: (632) 521 1036, E-mail: senanayakec@wpro.who.int

Ms YEO Wen Qing, Risk Communication Officer, Communicable Disease Surveillance and Response, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9944, Fax No.: (632) 521 1036, E-mail: yeow@wpro.who.int

Miss Anjana BHUSHAN, Technical Officer, Health in Development, Health Care Financing Unit, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines, Tel. No.: (632) 528 9814, Fax No.: (632) 521 1036, E-mail: bhushana@wpro.who.int

WHO/SEARO

Dr Chusak PRASITTISUK, Coordinator, Communicable Diseases Control, World Health Organization, Regional Office for South-East Asia, lndraprastha Estate, New Delhi 110 002, India, Tel. No.: (9111) 2337 0804 Ext. 26324 I 26323, Fax No.: (9111) 2337 0197 I 112 3309324 E-mail: chusakp@searo.who.int

Dr Richard BROWN, Medical Officer- Public Health Specialist, World Health Organization, Regional Office for South-East Asia, Fourth Floor, Building 3, Office of the Permanent Secretary, Ministry of Public Health, Tiwanon Road, Nonthaburi 1100, Thailand, Tel. No.: (662) 580 7535, Fax No.: (662) 580 7537, E-mail: brownr@searo.who.int

WPRIDSE/CSR(9)/201 O/IB2 page 7

Dr Gyanendra GONGAL, Technical Officer, Veterinary Public Health, World Health Organization, Regional Office for South-East Asia, Mahatma Gandhi Marg, Indraprastha Estate, New Delhi 110 002, India, Tel. No.: (9111) 2337 0804 Ext. 26647, Fax No.: (9111) 2337 0197, E-mail: gongalg@searo.who.int

WHO INDIA

Dr Sampath KRISHNAN, National Professional Officer, Focal Point for Disease Surveillance and Epidemiology, World Health Organization, Office ofthe WHO Representative to India, Rooms 531-537, 'A Wing, Nirman, Bhavan Maulana Azad Road, New Delhi 110 002, India, Tel. No.: (9111) 4759 4800, Fax No.: (9111) 2306 2450, E-mail: krishnans@searo.who.int

WHO INDONESIA

Dr Vason PINYOWIW AT, Medical Officer, CSR Team, WHO Representative Office for Indonesia, c/o Bina Mulia 1 Building, 9th Floor, TI.HR. Rasuna Said, Kav. 10, Jakarta, Indonesia, Tel. No.: (6221) 5204349,Fax No.: (6221) 5201164, E-mail: pinyowiwatv@searo.who.int

WHO/CAMBODIA

Dr Nima ASGARI-JIRHANDEH, Team Leader, Public Health Specialist, Communicable Disease Surveillance and Response, World Health Organization, No 177-179 Pasteur Street (corner 51 and 254), P.O. Box 1217, Sangkat Chaktomouk, Khan Daun Penh, Phnom Penh, Cambodia, Tel. No.: (855) 1244 3877, Fax No.: (855) 2321 6211, E-mail: asgarin@wpro.who.int

WHO/CHINA

Dr Chin Kei LEE, Epidemiologist, Communicable Disease Surveillance and Response, World Health Organization, 401 Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie, Chaoyang District, Beijing 1000600, People's Republic of China, Tel. No.: (8610) 6532 7189, Fax No.: (8610) 6532 2359, E-mail: leec@wpro.who.int

WHO/MALAYSIA

Dr Harpal SINGH, Technical Officer, World Health Organization, 1st Floor, Wisma UN, Block C, Komplek Pejabat, Damansara, Jalan Dungun, Damansara Heights, Kuala Lumpur 50490, Malaysia, Tel. No.: (603) 2093 9908, Fax No.: (603) 2093 7446, E-mail: singhha@wpro.who.int

WHO/PHILIPPINES

Dr Maria Nerissa DOMINGUEZ, National Professional Officer, Communicable Disease Surveillance and Response, World Health Organization, Building 3, Department of Health, San Lazaro Compound, Sta Cruz, Manila, Philippines, Tel. No.: (632) 528 9766, Fax No.: (632) 338 8605, E-mail: dominguezn@wpro.who.int

WHO/SOUTH PACIFIC

Dr Boris P A VLIN, Epidemiologist, Communicable Disease Surveillance and Response, World Health Organization, Department of Health and Social Affairs, PO Box PS 70, Palikir, Pohnpei 96941, Federated States ofMicronesia, Tel. No.: (691) 320 2619, Fax No.: (1866) 868 3940, E-mail: pavlinb@wpro. who.int

WHONIETNAM

Dr Babatunde OLOWOKURE, Medical Epidemiologist, Communicable Disease Surveillance and Response, World Health Organization, 63 Tran Hung Dao Street, Roan Kiem District, HaNoi, Socialist Republic of VietNam, Tel. No.: (844) 943 3734 I 3735 I 3736, Fax No.: (844) 3943 3740, E-mail: olowokureb@wpro.who.int

WPRIDSE/CSR(9)/2010/IB2 pageS

WHO/GENEVA

Dr Thomas GREIN, Coordinator, Alert and Response Operations, Global Alert and Response, World Health Organization, 20 Avenue Appia- CH 1211, Geneva, Switzerland, Tel. No.: (4122) 7911652, Fax No.: (4122) 791 1397, E-mail: greint@who.int

Dr Xing JUN, Medical Officer, National Capacity Monitoring, International Health Regulation Coordination, World Health Organization, 20, Avenue Appia- CH 1211, Geneva, Switzerland, Tel. No.: (4122) 791 2193, Fax No.: (4122) 791 4667, E-mail: xingj@who.int

Dr John Siu Lun TAM, Scientist, Public Health Research Agenda for Influenza, Global Influenza Programme, Health Security and Environment, World Health Organization, 20 A venue Appia - CH 1211, Geneva, Switzerland, Tel. No.: (41) 22 791 4231, Fax No.: (41) 22 791 4878, E-mail: tams@who.int

WHO/LYON

Dr Christopher OXENFORD, Laboratory Specialist, Laboratory Quality and Management Strengthening, International Health Regulation Coordination, World Health Organization, WHO Lyon Office, 58 Avenue Debourg, Lyon 69007, France, Tel. No.: (334) 2699 0158, Fax No.: (334) 7271 6471, E-mail: oxenfordc@who.int

t•\ World Health ~-J Organization ~

Western Pacific Region www.wpro.who.int