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Operationalizing Health Security as a regional public good The next Global Pandemic: Is the region prepared? Dr. Richard Brown WHO Thailand 3rd Meeting of the GMS Working Group on Health Cooperation Bangkok, Thailand: December 12, 2019 1 |
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WHO Thailand 3rd Meeting of the GMS Working Group on Health Cooperation Bangkok, Thailand: December 12, 2019
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0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 5 10 15 20 25
Number of Tourist Arrivals in Billions Number People, Poultry, and Pigs in Billions
Year
Global Population and Travel Trends, 1961-2010 Poultry People Pigs Tourist Arrivals
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Pandemic common name and year Area of
Influenza A virus subtype Estimated attributable excess mortality Estimated case fatality 1918 Pandemic (Spanish Flu) Unclear H1N1 (unknown) 20-50 million 1-2% 1957-58 Asian Flu Southern China H2N2 (avian) 1-4 million <0.2% 1968-69 Hong Kong flu Southern China H3N2 (avian) 1-4 million <0.2% 2009-10 A(H1N1) 2009 North America H1N1 (swine) 100,000 – 400,000 0.02%
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⚫ Classic flu symptoms in most ⚫ Pneumonia in 10-20% of cases ⚫ Case fatality proportion >2.5% ⚫ ‘Purple Death’ often in 24 hrs
– “They very rapidly develop the most vicious type of pneumonia that has ever been seen.” – “Cyanosis extending from their ears and spreading all
men from the white.” – “It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce.” – “Bodies stacked in the morgue from floor to ceiling like cord wood.”
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⚫ World more crowded, more connected, and the worlds of humans and animals converging ⚫ If 1918 pandemic were to occur today, estimated 105- 110 million deaths
– Infection in 20-30% of global population
⚫ Disruption of transportation and supply chains
– Food, Energy, Medical Supplies
⚫ Disruption of healthcare services ⚫ Potential high economic costs
– $181B estimated for pan flu pandemic – SARS cost $30 billion in only 4 months
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(UNISDR)
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10
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Financing
Advocacy
DETECT
RESPOND
Operations
Security Authorities
and Personnel Deployment
airports, ground crossings)
Laws, Policy & Finance
P.1.1 Legislation, laws, regulations, adm
3 3 2 5 3 3.2
P.1.2 The state can demonstrate that it h
3 4 2 4 3 3.2 IHR Coordination
P.2.1 A functional mechanism is establis
4 4 2 4 4 3.6 AMR
P.3.1 Antimicrobial resistance (AMR) de
3 2 3 4 2 2.8
P.3.2 Surveillance of infections caused b
2 1 3 3 2 2.2
P.3.3 Healthcare associated infection (H
2 3 1 3 3 2.4
P.3.4 Antimicrobial stewardship activiti
2 1 1 2 2 1.6 Zoonotic Disease
P.4.1 Surveillance systems in place for p
2 3 3 4 4 3.2
P.4.2 Veterinary or Animal Health Workfo
3 3 3 4 4 3.4
P.4.3 Mechanisms for responding to infe
3 3 2 4 3 3 Food Safety
P.5.1 Mechanisms are established and fu
2 2 2 3 3 2.4 Biosafety & Biosecurity
P.6.1 Whole-of-government biosafety an
2 2 2 4 3 2.6
P.6.2 Biosafety and biosecurity training
2 2 1 4 3 2.4 Immunization
P.7.1 Vaccine coverage (measles) as par
4 3 3 5 4 3.8
P.7.2 National vaccine access and delive
4 4 4 5 4 4.2
Level 1 Level 2 Level 3 Level 4 Level 5
Laboratory System
D.1.1 Laboratory testing for detection of
4 4 3 4 3 3.6
D.1.2 Specimen referral and transport sy
2 3 3 4 3 3
D.1.3 Effective modern point of care and
2 3 2 4 3 2.8
D.1.4 Laboratory quality system
2 2 3 3 3 2.6 Real-Time Surveillance
D.2.1 Indicator and event based surveill
4 4 4 4 4 4
D.2.2 Inter-operable, interconnected, ele
3 3 2 4 3 3
D.2.3 Analysis of surveillance data
3 4 3 4 3 3.4
D.2.4 Syndromic surveillance systems
4 4 3 4 4 3.8 Reporting
D.3.1 System for efficient reporting to W
3 4 3 3 3 3.2
D.3.2 Reporting network and protocols i
2 4 2 3 2 2.6 Workforce Development D.4.1 Human resources are available to 2 3 3 4 3 3
D.4.2 FETP or other applied epidemiolog
3 3 3 5 4 3.6
D.4.3 Workforce strategy
2 2 3 3 3 2.6
Preparedness
R.1.1 Multi-hazard National Public Heal
1 2 1 4 2 2
R.1.2 Priority public health risks and res
1 2 1 2 2 1.6 Response Operations
R.2.1 Capacity to Activate Emergency Op
2 2 2 3 2 2.2
R.2.2 Emergency Operations Center Oper
1 1 1 3 3 1.8
R.2.3 Emergency Operations Program
1 3 2 3 3 2.4
R.2.4 Case management procedures are
1 2 2 3 3 2.2 Public Health & Security
R.3.1 Public health and security authori
2 4 2 4 2 2.8 Med Countermeasures
R.4.1 System is in place for sending and
2 2 1 4 2 2.2
R.4.2 System in place for activating and
2 2 2 4 2 2.4 Risk Communication
R.5.1 Risk Communication Systems (plan
2 2 1 4 3 2.4
R.5.2 Internal and Partner Communicati
3 3 3 4 3 3.2
R.5.3 Public Communication
3 3 3 4 3 3.2
R.5.4 Communication Engagement with A
3 3 2 4 2 2.8
R.5.5 Dynamic Listening and Rumour Ma
3 2 2 4 3 2.8
Points of Entry (PoEs)
PoE.1 Routine capacities are established
3 3 2 4 3 3
PoE.2 Effective Public Health Response a
2 3 2 3 2 2.4 Chemical Events
CE.1 Mechanisms are established and fu
2 1 1 4 2 2
CE.2 Enabling environment is in place fo
1 1 1 4 2 1.8 Radiation Emergencies
RE.1 Mechanisms are established and fu
2 1 1 4 3 2.2
RE.2 Enabling environment is in place fo
2 1 1 4 2 2
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Vision for 2030 Attainment of the highest possible influenza prevention, control and preparedness to safeguard the health
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⚫ Influenza is a good example of a “poster child” for capacity- building ⚫ Why: influenza affects every country every year ⚫ Major principle: Programmes for seasonal influenza surveillance, prevention & control are essential for pandemic preparedness
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Influenza Influenza Related NOT needed for Influenza
Prevent
Financing
Communication and Advocacy
Detect
Respond
Security Authorities
and Personnel
Other
13th Bi-Regional Meeting of the National Influenza Centres and Influenza Surveillance in the Western Pacific and South-East Asia Regions
21-23 August 2019 | Ulaanbaatar, Mongolia
2018 survey of pandemic preparedness conducted with WHO Member States
100% Asia Pacific countries have a national pandemic influenza preparedness plan Plans have been updated since they were originally developed
pandemic (H1N1)
publication of WHO guidance Pandemic influenza risk management (2017) 81% Asia Pacific countries have conducted simulation exercises
86% Forty-two exercises have been conducted in the past 5 years. Table top (43%), functional (21%), drill (19%) and field (17%).
Tabl e top Functional Drill Field
13th Bi-Regional Meeting of the National Influenza Centres and Influenza Surveillance in the Western Pacific and South-East Asia Regions
21-23 August 2019 | Ulaanbaatar, Mongolia
Countries in the Asia Pacific reported having: 100% At least one laboratory that can perform routine influenza diagnostics, typing and subtyping using RT-PCR An established mechanism to share specimens with WHO collaborating centres for influenza 95%
24% 38% 38% Not established
Have established In the process of establishing
influenza surveillance, and a further 8 countries (38%) are in the process of doing so.
currently or plan to conduct severity assessment. Systematically use information collected through event-based surveillance in risk assessments SOPs for conducting systematic risk assessment for influenza using surveillance data 67% 76% Laboratory testing strategies for different phases of an influenza pandemic
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⚫ ‘Overall’ lack of investment – still need to make a better case for investment... ⚫ ‘Orphan’ technical areas of work (mismatch between ‘need’ and support provided) ⚫ Preparing for an outbreak of Disease ‘X’ ⚫ Strengthening ‘all of society’ pandemic preparedness... ⚫ Working with the Private Sector (business continuity is everyone's concern) ⚫ Leveraging public private partnerships (e.g. Arup is supporting work on natural ventilation for IPC through their portfolio for CSR)