international health regulations, preparedness and...

35th plenary meeting of the South-eastern Europe Health Network

22–24 June 2015, Belgrade, Serbia

International Health Regulations, Preparedness and Response for Health

Emergencies

Dr Guénaël Rodier, Director, Communicable Diseases, Health Security, & Environment

SEEHN Ministerial Meeting Belgrade, 22-24 June 2015



Introduction •  Health emergencies in Southern and Eastern Europe

•  International frameworks

International Health Regulations •  Purpose

•  Event management

•  Core capacity for surveillance and response

WHO support to Member States •  Health system assessment

•  Human rsource development

•  Hospital safety

Conclusion



Health emergencies associated with natural disasters

§  Floods

§  Heat wave

§  Extreme cold

§  Storm

§  Earthquake

§  Landslide

§  Volcanic eruption

§  Wild fire

§  … Bosnia and Herzegovina, June 2014



Health emergencies associated with (re)emerging infectious diseases

§  Influenza (H5N1, H7N9)

§  Measles / Rubella

§  Polio

§  MERS-CoV

§  Ebola

§  Dengue

§  Chikungunya

§  West Nile fever

§  Antibiotic-resistant strains

§  MDR-TB, HIV/AIDS

MERS-CoV, Korea, June 2015

Globally (20 June 2015) •  1334 cases (lab.+) •  incl. 471 deaths

Global Fund support to SEEHN countries has enabled

significant gains in the fight against HIV and TB

§  Positive signs of stabilization of the HIV epidemic particularly

among PWID and an increase number of people are linked to

care / initiated on ART.

§  TB incidence has declined in all countries, TB mortality steadily

decreasing (availability of quality-assured anti-TB drugs)

§  Global Fund’s performance-based funding approach shows an

improvement in data quality and availability, enabling countries to

more effectively respond to the epidemic.

These successes must be sustained,

Need to plan for transition! (by the end of 2016)



Health emergencies associated with industrial and large transport accidents

§  Chemical spill

§  Biological release

§  Radionuclear accident

§  Food-borne outbreaks

§  Transport (air crash,

train derailment, …)

§  … Flood of caustic red sludge, Hungary, Oct. 2010



Migration associated with emergency situation

§  Recurrent phenomenon in the WHO EURO Region

§  Causes: Civil/military conflicts, Economic Crises, Natural Disasters, Man-made Disasters, Climate change …

§  Health risks related to mass migration primarily affect migrants

§  Often a challenge for the health care system of the host countries.



Events by hazard, SEEHN Member States (as of 11 Jun 2015)

H1N1 H5N1 Floods

Source: WHO Event Management System (EMS)

May 2014: Floods in Bosnia and Herzegovina, Croatia and Serbia

2014-15: imported cases of MERS-CoV in Austria, Germany, Greece, the Netherlands, Turkey;

2014-15: 13 medical evacuations of Ebola viral disease and 3 locally acquired infection



Main International Frameworks §  Health 2020

http://www.euro.who.int/en/health-topics/health-policy/

§  International Health Regulations http://www.who.int/ihr/publications/9789241596664/en/

§  Decision of serious cross-border threats to health (EU Member States) http://ec.europa.eu/health/preparedness_response/policy/decision/index_en.htm

§  One Health Initiative http://www.onehealthinitiative.com/

§  The Global Health Security Agenda http://www.cdc.gov/globalhealth/security/

§  The WHO Emergency Response Framework (ERF)

http://www.who.int/hac/about/erf_.pdf

IHR Coordination Programme

“ to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade" (Article 2)

International Health Regulations (2005)

IHR (2005) in the WHO European Region

►  55 States Parties (includes Holy See and Lichtenstein which

are not WHO Member States)

►  Entered into force on 15 June 2007

►  Legally binding

►  No reservation

►  Self assessment

States Parties having Joined after 15 June 2007: §  Montenegro, 05 Feb. 2008 §  Liechtenstein, 28 Mar. 2012

Two main areas for implementation

►  National core capacity requirements

ü  National surveillance and response systems

ü  Capacity at points of entry

(Ports, airports, ground crossings)

►  Global "event" management

ü  Global information sharing system

ü  Coordination of international response

IHR Coordination Programme

Decision instrument (Annex 2)

4 diseases that shall be notified polio (wild-type polio virus), smallpox, human influenza new subtype, SARS.

Disease that shall always lead to utilization of the algorithm: cholera, pneumonic plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, others….

Q1: public health impact serious?

Q2: unusual or unexpected?

Q3: risk of international spread?

Q4: risk of travel/trade restriction?

Insufficient information: reassess



WHO IHR Contact Point

National IHR Focal Point

(One per State Party) (One per WHO Region)

►  Notification

►  Reports

►  Consultation

Verification ◄

IHR Event Information

Site

Responsible authorities: “National IHR Focal Point” means the national centre,

designated by each State Party, which shall be accessible at all times for

communications with WHO IHR Contact Points under these Regulations; (Article 4)

International Health Regulations Coordination

The importance of early outbreak/event detection

Event onset

Event detection

t0

Verification WHO Alert

Intervention Risk assessment

Median 15 days

Median 7 days

12-24 hrs Mobilisation within 24-72 hrs

… to rapidly trigger intervention, save lives, resources and reputation


Strengthening national alert & response capacity

Investing in –  Human resources (training, distance learning,

twinning programmes, drills…)

–  Infrastructure (buildings, equipment, EOC, logistics …)

–  Standard Operating Procedures (investigation, response, biosafety …)

In the areas of –  Epidemiology (disease surveillance, epidemic intelligence, field investigation,

data analysis, risk assessment, …)

–  Laboratory quality systems (EQA programme, biosafety, specimen collection, lab regional network …)

–  Case management (clinical care, ICP, …)

–  Risk communication (social mobilization, media, web …)

–  Logistics / Administration / IT


►  At all times •  Access to medical service •  Transport of ill travellers •  Inspection of conveyances

(e.g. Ship Sanitation Control Certificate)

•  Control of vectors / reservoirs

►  For responding to events •  Emergency contingency plan •  Arrangement for isolation (human, animal) •  Space for interview / quarantine •  Apply specific control measures

(Annex 1B)

Core capacity requirements for designated airports, Ports and ground crossings


WHO Technical Support http://www.euro.who.int/en/health-topics/emergencies/



WHO toolkit to assess national capacity

•  WHO Europe “toolkit to assess

crisis management capacities

of health systems” finalized with

partners

•  A methodology for country

assessments - applicable also as

self assessment method for

countries to identify gaps and

monitor progress in improving

emergency preparedness



Roll out in SEEHN Countries

–  Rep of Moldova 2008

(one of three pilot

countries)

–  Croatia 2011

–  Israel 2012

(self-assessment

approach)

–  Rep of Moldova 2015

(re-assessment)



WHO Hospital Safety Index

•  The WHO tool to assess hospitals’

vulnerabilities and strengthen

preparedness to ensure hospitals keep

functioning during emergencies

•  Second edition released in 2015

•  Assessments of all hospitals in Rep. of

Moldova done with the first edition in

2009/2010, re-assessments planned

with the second edition



Public Health Emergency Management Training 9 - 13 March 2015, Belgrade

•  5 day Training of Trainers on emergency management and

coordination, including a one day Simulation Exercise

•  Senior managers of Ministries of Health, Ministries of Interior and

Public Health Institutes from Albania, Bosnia and Herzegovina,

Croatia, Montenegro, Serbia, Slovakia and the Former Yugoslav

Republic of Macedonia.

•  28 September – 2 October 2015 planned in Rep. of Moldova

•  3 Courses in Israel in 2008, 2009 and 2012



§  Support to the Government of

Turkey and work with national and

international health partners

§  Health coordination

§  Health needs assessments

§  Information management

§  Technical expertise

§  Provision of core services.

WHO Field Support in Emergencies

WHO Europe Field Office in Gaziantep, (2013 – Present)



•  30 participants from various key

government institutions from the

3 affected countries

•  Topics, including removal of

animal carcasses, soil cleaning,

the use of disinfection barriers,

and insurance policies

discussed.

•  Exchange of experiences

WHO lessons-learned workshop on flood response 7-8

November 2014, Belgrade

§  Developing and piloting a

Toolkit for assessing health

system capacity to manage

large influxes of migrants.

§  Assessments with MoH in

Italy, Portugal, Malta, Spain,

Greece and Cyprus,

Bulgaria, upcoming Serbia,

Hungary and Turkey.

Public Health Aspects of Migration in Europe (PHAME) project



Support to Preparedness of Mass Gathering Events

•  EURO 2012, Ukraine, Poland

•  Olympics 2012, London

•  Global Forum on Youth Policies, Baku,

October 2014

•  European Games, Baku, 12–28 June 2015

•  …

WHO IHR capacity building activities, SEEHN, 2014-15

§  Workshop on national emergency plan and IHR – Serbia (planned Sept. 2015)

§  Workshop on cross-border collaboration on IHR – Bosnia and Herzegovina (planned Sept. 2015)

§  Workshop on Risk Communications in Health Crises - Moldova (planned July 2015)

§  Expert exchange between Albania and Italy on infectious diseases control (planned late June 2015)

§  IHR Ship Sanitation Certificates - a training course for port health officers/

inspectors – Ljubljana, Slovenia (8-12 June 2015)

§  National IHR Focal Points training workshop – Skopje, FYR Macedonia (Jan. 2015)

§  National workshop on the implementation of IHR and risk communications –

Tirana, Albania (9 Dec. 2014)

§  Workshop on Risk Communications in Health Crises - Serbia (14–16 Oct. 2014)

§  In line with WHO 12th General Programme of Work

“prepare for the unexpected, no matter whether an event results

from new and re‐emerging diseases, from conflicts, or from natural

disasters”. An all-hazards approach

§  To strengthen WHO’s capacity in supporting Member States for their

national preparedness to emergencies with health consequences

§  To contribute to WHO surge response capacity

§  To be a WHO Geographically Dispersed Office (GDO) located in

Istanbul with direct support from the Government of Turkey (EUR/

RC63(2)

A WHO European Centre for Country Emergency Preparedness

§  Ministry of Health

§  Ministry of Social Affairs

§  Ministry of Interior

§  Ministry of Foreign Affairs

§  Ministry of Agriculture

§  Ministry of Environment

§  Ministry of Transports

§  Ministry of Education

Health Emergency Preparedness and Response

A multisectoral agenda

§  Civil defence / Private sector / NGOs / Communities

Challenges

§  Insufficient awareness of / preparedness for: §  existing risks, potential impact (on health, on economy, on

society)

§  existing international frameworks (IHR, Health 2020, etc.)

§  Intersectoral work (emergency procedures, shared

resources, coordination)

§  Long term effort (recurrent cost of personnel,

infrastructure, equipment, supply etc.)

§  Regional collaboration (e.g. SEEHN, EU)

Thank you

w w w . w h o . i n t / i h r

Note: Ongoing Reform of WHO’s work in emergency (Ebola response review)

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