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 | January 9, 2020
WHO Top Ten Threats to Global Health…? ⚫ Air pollution and climate ⚫ Ebola and other high change threat pathogens ⚫ NCDs ⚫ Weak primary health care ⚫ Global influenza ⚫ Vaccine hesitancy pandemic ⚫ Fragile and vulnerable ⚫ Dengue settings ⚫ HIV ⚫ AMR 2 | January 9, 2020
Greatest potential risk for the future: INFLUENZA Global Population and Travel Trends, 1961-2010 25 1 Number People, Poultry, and Pigs in Billions ⚫ Factors for emerging 0.9 Number of Tourist Arrivals in Billions 20 0.8 influenza viruses: 0.7 – People 15 0.6 – Poultry 0.5 – Pigs 10 0.4 – Passengers 0.3 5 0.2 0.1 0 0 Year Poultry People Pigs Tourist Arrivals 3 | January 9, 2020
Influenza Pandemics Pandemic Area of Influenza A Estimated Estimated common origin virus attributable case fatality name and subtype excess year mortality 1918 Unclear H1N1 20-50 million 1-2% Pandemic (unknown) (Spanish Flu) 1957-58 Southern H2N2 1-4 million <0.2% Asian Flu China (avian) 1968-69 Southern H3N2 1-4 million <0.2% Hong Kong flu China (avian) 100,000 – 2009-10 North H1N1 0.02% A(H1N1) 2009 America (swine) 400,000 4 | January 9, 2020
Severity of 1918 Pandemic ⚫ 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 over the face, until it is hard to distinguish the coloured 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.” 5 | January 9, 2020
The 1918 Influenza Pandemic ⚫ Zoonotic origin ⚫ Overcrowding ⚫ Wartime conditions ⚫ Global transport of persons ⚫ Lack of medical countermeasures ⚫ Virus pathogenicity ⚫ Susceptibility of young adults ⚫ Multiple, closely-spaced, waves 6 | January 9, 2020
Current Pandemic Vulnerability & Readiness? ⚫ 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 7 | January 9, 2020
Economic impact can be considerable
Existing Global frameworks Health Security • International Health Regulations (2005) • Pandemic Influenza Preparedness (PIP) Framework • OIE Performance for Veterinary Services (PVS) Pathway Health Systems Strengthening • Essential Public Health Functions (WHA69 Resolution) • Universal Health Coverage (UHC) 2030 Disaster Risk Reduction • United National Plan of Action on Disaster Risk Reduction for Resilience (UNISDR) • Sendai Framework for Disaster Risk Reduction 2015 • Comprehensive Safe Hospitals Framework (WHO) 9 | January 9, 2020
IHR as a Public Health Good ⚫ If all countries, without exception – Are well prepared, and have good capacity for detection and response to all acute public health events, and… – Report serious events quickly, and provide other countries with information that help them to prepare ⚫ Then all countries will be more safe from unpredictable events, whenever they occur ⚫ The world would be a safer place…. ⚫ However… – One weak link in the chain… 10 | January 9, 2020 10
Joint External Evaluation (JEE) Tool 19 technical areas assessed, 19 areas for investment PREVENT RESPOND • National Legislation, Policy and • Preparedness Financing • Emergency Response • IHR Coordination, Communication and Operations Advocacy • Anti-microbial Resistance (AMR) • Linking Public Health and Security Authorities • Zoonotic Disease • • Food Safety Medical Countermeasures and Personnel Deployment • Biosafety and Biosecurity • • Risk Communication Immunization DETECT • Points of Entry (Ports, airports, ground crossings) • National Laboratory System • • Real Time Surveillance Chemical Events • Reporting • Radiation Emergencies • Workforce Development 11 | January 9, 2020
Mekong Country JEE Results: Prevent Laws, Policy & Finance 3 3 2 5 3 3.2 P.1.1 Legislation, laws, regulations, adm 3 4 2 4 3 3.2 P.1.2 The state can demonstrate that it h IHR Coordination 4 4 2 4 4 3.6 P.2.1 A functional mechanism is establis AMR 3 2 3 4 2 2.8 P.3.1 Antimicrobial resistance (AMR) de 2 1 3 3 2 2.2 P.3.2 Surveillance of infections caused b 2 3 1 3 3 2.4 P.3.3 Healthcare associated infection (H 2 1 1 2 2 1.6 P.3.4 Antimicrobial stewardship activiti Zoonotic Disease 2 3 3 4 4 3.2 P.4.1 Surveillance systems in place for p 3 3 3 4 4 3.4 P.4.2 Veterinary or Animal Health Workfo 3 3 2 4 3 3 P.4.3 Mechanisms for responding to infe Food Safety 2 2 2 3 3 2.4 P.5.1 Mechanisms are established and fu Biosafety & Biosecurity 2 2 2 4 3 2.6 P.6.1 Whole-of-government biosafety an 2 2 1 4 3 2.4 P.6.2 Biosafety and biosecurity training Immunization 4 3 3 5 4 3.8 P.7.1 Vaccine coverage (measles) as par 4 4 4 5 4 4.2 P.7.2 National vaccine access and delive Level 1 Level 2 Level 3 Level 4 Level 5
Mekong Country JEE Results: Detect Laboratory System 4 4 3 4 3 3.6 D.1.1 Laboratory testing for detection of 2 3 3 4 3 3 D.1.2 Specimen referral and transport sy 2 3 2 4 3 2.8 D.1.3 Effective modern point of care and 2 2 3 3 3 2.6 D.1.4 Laboratory quality system Real-Time Surveillance 4 4 4 4 4 4 D.2.1 Indicator and event based surveill 3 3 2 4 3 3 D.2.2 Inter-operable, interconnected, ele 3 4 3 4 3 3.4 D.2.3 Analysis of surveillance data 4 4 3 4 4 3.8 D.2.4 Syndromic surveillance systems Reporting 3 4 3 3 3 3.2 D.3.1 System for efficient reporting to W 2 4 2 3 2 2.6 D.3.2 Reporting network and protocols i Workforce Development D.4.1 Human resources are available to 2 3 3 4 3 3 3 3 3 5 4 3.6 D.4.2 FETP or other applied epidemiolog 2 2 3 3 3 2.6 D.4.3 Workforce strategy
Mekong Country JEE Results: Respond Preparedness 1 2 1 4 2 2 R.1.1 Multi-hazard National Public Heal 1 2 1 2 2 1.6 R.1.2 Priority public health risks and res Response Operations 2 2 2 3 2 2.2 R.2.1 Capacity to Activate Emergency Op 1 1 1 3 3 1.8 R.2.2 Emergency Operations Center Oper 1 3 2 3 3 2.4 R.2.3 Emergency Operations Program 1 2 2 3 3 2.2 R.2.4 Case management procedures are Public Health & Security 2 4 2 4 2 2.8 R.3.1 Public health and security authori Med Countermeasures 2 2 1 4 2 2.2 R.4.1 System is in place for sending and 2 2 2 4 2 2.4 R.4.2 System in place for activating and Risk Communication 2 2 1 4 3 2.4 R.5.1 Risk Communication Systems (plan 3 3 3 4 3 3.2 R.5.2 Internal and Partner Communicati 3 3 3 4 3 3.2 R.5.3 Public Communication 3 3 2 4 2 2.8 R.5.4 Communication Engagement with A 3 2 2 4 3 2.8 R.5.5 Dynamic Listening and Rumour Ma
Mekong Country JEE Results: Other hazards Points of Entry (PoEs) 3 3 2 4 3 3 PoE.1 Routine capacities are established 2 3 2 3 2 2.4 PoE.2 Effective Public Health Response a Chemical Events 2 1 1 4 2 2 CE.1 Mechanisms are established and fu 1 1 1 4 2 1.8 CE.2 Enabling environment is in place fo Radiation Emergencies 2 1 1 4 3 2.2 RE.1 Mechanisms are established and fu 2 1 1 4 2 2 RE.2 Enabling environment is in place fo
Advancing Country Core Capacities The Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III) • A bi-regional framework for action for two WHO Regions (SEAR and WPR) to advance IHR core capacities for health security • A common framework to prepare for and respond to all emerging diseases and public health emergencies • Developed in 2005, updated in 2010 and 2016 (APSED III) 16 | January 9, 2020
WHO Top Ten Threats to Global Health…? ⚫ The world will face another influenza pandemic ⚫ WHO has developed a Global Influenza Strategy (2019- 2030) 17 | January 9, 2020
Vision for 2030 Attainment of the highest possible influenza prevention, control and preparedness to safeguard the health of all people 18 | January 9, 2020
Building Capacity for Prevention, Preparedness and Response… ⚫ 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 19 | January 9, 2020
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