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20th century pandemics

Improving Preparedness and Response to Emerging Pathogens - ARO current approach & future needs D. Lavanchy Office of Alert & Response Operations (ARO) CSR WHO. 20th century pandemics. Credit: US National Museum of Health and Medicine. 1918: “Spanish Flu”. 1957: “Asian Flu”.

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20th century pandemics

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  1. Improving Preparedness and Responseto Emerging Pathogens -ARO current approach & future needs D. Lavanchy Office of Alert & Response Operations (ARO)CSRWHO

  2. 20th century pandemics Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 20-40 million deaths 1-4 million deaths 1-4 million deaths A(H1N1) A(H2N2) A(H3N2)

  3. Current context - 21st Century • Emergence of new or newly recognised pathogens (e.g. Avian influenza, Ebola, Marburg, Nipah, SARS) • Resurgence of well characterised outbreak-prone diseases (e.g. cholera, dengue, measles, meningitis, shigellosis, and yellow fever) • Accidental or deliberate release of a biological agent (e.g. BSE /v CJD, anthrax)

  4. The 21st Century - Approach Preparedness is the key A generic approach (flexible systems) Crisis management must be… • Multi-sectoral • Multilevel Inclusive networks Animal-human surveillance New technologies

  5. Global threat - global response • This global threat requires a global response to • investigate, characterise and assess the threat • reduce human suffering • contain national/international spread • minimize impact on travel and trade • WHO brings partners together to focus global resources on outbreaks!

  6. Coordination of Response • Epidemiology • Laboratory science • Clinical Management • Infection Control • Environmental health • Health education • Medical anthropology • Risk communication • Logistics • Others…

  7. CSR Alert and Response Operations • Detection, verification, characterisation, assessment and response to epidemic disease threats • Standardised processes and operational platform (intelligence, verification, stockpiling, logistics, partner mobilisation-GOARN) • Involves multiple Programmes and Departments (ARO, GIP, LYO, RAD, PCS, FOS, ZFK, CPE, EPI, Polio, HAC) • Requires deep operational co-ordination with Regional Offices and WHO Country Offices • May require involvement of Directors Office, MSU, IT, Travel, Security…DGO ! • 3 Teams • Assessment and Field Operations (AFO) • Epidemic Readiness and Mass Interventions (ERI) • Emerging and Dangerous Pathogens (EDP)

  8. Outbreak Response Operations • “Routine” Events – • Continual co-ordination required between disease focal point and ARO during outbreak alert and response process • Continuous work with “communications” group • Major events • require an even deeper collaboration with ARO providing overall event management co-ordination and the disease-specific programme focusing on the public health/scientific issues. • Generic surge capacity may be required at HQ by ARO and in the main has come from the Lyon teams and external partners in GOARN • Senior WHO staff may be needed as field teams leaders or mission specialists (Lyon have provided support on a number of occasions) • Requires involvement of Directors Office, MSU, IT, Travel, Security EVERY PROGRAMME HAS A STAKE IN OUTBREAK RESPONSE !

  9. Outbreak Alert and Response First Case Late Detection Delayed Response Opportunity for control CASES DAY

  10. Outbreak Alert and Response Early Detection Rapid Response Control Opportunity CASES DAY

  11. WHO Global Alert and Response • Systematic gathering of epidemic intelligence • Rapid verification with countries • Risk assessment and communications • Coordination of international technical support Intelligence Verification Response Follow-up

  12. No single institution has all the capacity

  13. SARS - GOARN partners • International Federation of Red Cross; Australian Collaborative Research Centre for Emerging Infectious Diseases; Centers for Disease Control and Prevention (CDC), USA; Centre for Health and Population Research (ICDDRB), Bangladesh; Centre for International Health, Curtin University, Australia; EPICENTRE, Centre for Research in Epidemiology and Control of Emerging Diseases, France; EPIET, the European Programme for Intervention Epidemiology; Field Epidemiology Programmes in Australia, Japan and Thailand; Global Emerging Infections System (GEIS), USA; Health Canada; Health Protection Agency (HPA), United Kingdom; MSF - Belgium; MSF - Switzerland; Institut national de Veille Sanitaire, France; Institut Pasteur, Paris, France; Institut Pasteur, Vietnam; Kunskapscentrum för Mikrobiologisk Beredskap (KCB), Smittskyddsinstitutet(SMI), Sweden; Leicester Royal Infirmary, North Manchester General Hospital, United Kingdom; National institute of Infectious Disease, Japan; Robert Koch-Institute, Germany; University Hospital, Frankfurt , Germany; National Institute of Public Health, Section for Infectious Disease Control, Norway; Southern Cone Surveillance Network and Epidemiology Department, MoH, Chile; National Board of Health and Welfare and SIDA, Sweden; UNDP and the Pacific Public Health Surveillance Network.

  14. GARN • GOARN is a global technical partnership, coordinated by WHO: • to provide rapidinternationalmulti-disciplinarytechnical support for outbreak response

  15. Outbreak Field Operations • 2000/2004 • 26 countries • Over 40 GOARN partners • Over 350 experts • 30 outbreak responses and investigations

  16. Outbreak Field Operations • 2000/2004 • 26 countries • Over 40 GOARN partners • Over 350 experts • 30 outbreak responses and investigations

  17. Primary Aims • Assist countries with disease control efforts by ensuring appropriate technical support to affected populations rapidly. • Investigate and characterize events and assess risks of rapidly emerging epidemic disease threats. • Sustain containment and control of outbreaks: contribute to national outbreak preparedness by ensuring that acute responses contribute to sustained containment of the epidemic threat.

  18. Other areas of Essential Collaboration • Focusing more energy on “RESPONSE” capacity strengthening • Developing response protocols for deliberate epidemics • Regional multidiciplinary laboratory networks (response, biosafety, quality assurance, capacicy strengthening) • Research during outbreaks (e.g. Ebola, Influenza, SARS) • Safe clinical management during outbreaks • Mass gathering events (CSR-wide policy and guidance)

  19. Network Structure Steering Committee + Operational Support Team Regional Networks Public Health institutions Specialised Networks WHO CCs National Centres NGOS UNOs/IGOs

  20. Alert and Verification Number of events of potential international public health concern between 1 January 2001 - 31 December 2003 by source (N=636) 500 300 417 Number of events 219 100 Informal sources Official sources • 636 events detected in 136 countries (2001 - 2003)

  21. SARS - lesson for global response • Communication is key • highest political commitment required • between WHO and countries, with the public and the media • multi-sector event (health, veterinary, food safety, economy, transport, etc.) • Evidence-based action/transparency/confidence • efficient alert and response system in all countries • rapid sharing of data/information • Global partnership • globalization – no borders • no country can do it alone, global resources needed rapidly • unique role of WHO: technical, neutral, partnership with countries

  22. Communications • Dissemination of information to a global audience: • Disease outbreak news • Outbreak Verification list • Active media interface • Operational Readiness • confidential communication with GOARN

  23. Advocacy: strategy • Strategy: • “Give the right message to the right people at • right time with the intended effect” • message: identifiable image; consistent; adaptable • delivery: be ready; be opportunistic; be timely • audience: customize message; use SAC

  24. Advocacy: the audience

  25. International Health Regulations • Protection for:developing countries, developed countries, transportation infrastructure and industry • Protection through:national & international epidemic alert and response, relevant routine preventive measures • Protection from: public health emergencies, avoidable travel restrictions and loss

  26. IHR Protection • Protection for:  developing countries  developed countries  transportation infrastructure and industry • Protection through: epidemic surveillance and response national & international  relevant routine preventive measures • Protection from:  public health emergencies unnecessary restrictions to travel and trade

  27. Revision proposals and disease surveillance • Revised IHR will NOT establish a surveillance system for specific diseases – (cf. current IHR) • Establish mechanism for early warning of events that require an immediateresponse in order to prevent spread of disease or risk of disease • Disease based surveillance is important at both national and international levels but is not helped by international legal obligations

  28. Current Context • Countries expect faster response: • more systematic interventions • more defined contribution to sustained control • Partners expect a stronger operational platform in the field, and the opportunity to engage in consultations from home institutions.

  29. THANK YOU

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