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Vincent ROLLET, PhD Wenzao Ursuline College of languages, Taiwan French Center for Research on Contemporary China (CEF

Regional Response to Global Health Issues: The involvement of regional organizations in the fight against infectious diseases in Asia and Europe. Vincent ROLLET, PhD Wenzao Ursuline College of languages, Taiwan French Center for Research on Contemporary China (CEFC).

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Vincent ROLLET, PhD Wenzao Ursuline College of languages, Taiwan French Center for Research on Contemporary China (CEF

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  1. Regional Response to Global Health Issues: The involvement of regional organizations in the fight against infectious diseases in Asia and Europe. Vincent ROLLET, PhD WenzaoUrsuline College of languages, Taiwan French Center for Research on Contemporary China (CEFC) APISA 5, 24-25 november 2011, Taichung, Taiwan

  2. Outline 1. Progressive involvement of regional organizations (RO) to fight infectious diseases in Asia and in Europe. • Political commitment of RO to combat ID • Regional strategies • Institutionalization of regional responses 2. Role of the regional responses • Prevention • Control ( H1N1 2009) • Research 3. Main challenges of these regional responses

  3. Emergence and re-emergence of infectious diseases in Asia and Europe • ASIA > HIV • 5,23 million people were living with HIV/AIDS in Asia in 2010 (UNAIDS). • Low prevalence / large number of infected people (India: 0,1 % = 2,3 millions adults with HIV. • Progress in Cambodia, Myanmar and Thailand • No significant progress in Indonesiaand Vietnam >Tuberculosis • In 2008, the largest number of new TB cases occurred in South-East Asia • 2350 deaths/day in Asia • Drug-resistant TB (India, China,..) >Malaria • South-east Asia accounts for 15% (34 millions) of estimated cases worldwide > Ancient diseases: leprosy, dengue, visceral leishmaniasis , lymphatic filariasis > New and emerging diseases: SARS, avian influenza, Nipahvirus disease,…

  4. EUROPE • Europe is far from being a fortress again infectious disease! • Respiratory tract infections (influenza, tuberculosis,..), sexually-transmitted infections (HIV, hepatitis B and C,…) , emerging and vector-borne diseases (malaria, plague, chikungunya,..) and vaccine-preventable diseases (measles, rubella,..) still pose a great challenge to the region. • Each winter, hundreds of thousands of people in the EU become seriously ill and die as a result of seasonal influenza. • Re-emergence of TB fuelled by the HIV epidemic • HIV epidemic : main public health threats posed by communicable diseases in Europe. Continuing transmission of HIV in many European countries. • Avian influenza and other EID also a concern for Europe

  5. Part 1 Progressive involvement of regional organizations to fight infectious diseases in Asia and Europe.

  6. 1. A clear political commitment • 1980: 1stASEAN Health ministers meetings (AHMM): “to strengthen and coordinate regional collaboration in health among ASEAN countries” notably in the domain of infectious diseases control. • 1991: 4th AHMM: Framework for the exchange of health information in ASEAN with emphasis on AIDS • 1992: 4th ASEAN Summit, coordinated effort to curb the spread of HIV/AIDS • 2000: “Healthy ASEAN 2020”: HIV/AIDS, disease surveillance, TB, malaria, polio: “ to accelerate the implementation of an existing HIV/AIDS action program as well as to pursue efforts to strengthen disease surveillance and control of TB, malaria and polio”

  7. 2003: Special ASEAN Leaders meeting on SARS / First ASEAN+3 Health ministers’ Special Meeting on SARS • 2004: ASEAN Strategic Framework on health and Development (2010-2015) • 2006: H5N1 • 2007: MDG Goal 6 (HIV/AIDS, malaria and other diseases) • 2010: 10th ASEAN AHMM: “to strengthen our political commitment to intensify ASEAN cooperation in health development and to mobilize resources at the national, regional and international levels” notably in the domain of infectious diseases.

  8. 1997: 9th APEC Ministerial Meeting: need for further collaboration in health among APEC economy members • 1998: The Third APEC Ministers' Conference on Regional Science and Technology Cooperation: support for specific projects directed toward emerging infectious diseases (dengue) / better epidemiological communication • 2000: APEC Leader Annual Summit: Commitment to fight HIV/AIDS and other infectious diseases • June 2003: 1st APEC Health ministers Summit: engagement to fight SARS • Oct. 2003: APEC leaders’ engagement to work to strengthen public health infrastructures to detect, respond to, and prevent bio-terrorism and naturally occurring disease outbreaks • 2006:14th APEC Economic leaders ‘meeting; agreed to enhance cooperation within APEC on HIV/AIDS, Avian and Influenza Pandemics • 2008 : 16thAPEC Economic Leaders Meeting : “to strengthenthe region's health systems and cooperation to prevent and control emerging infectious diseases • 2009: 17thAPEC Economic Leaders Meeting “to build up the ability of regional avian influenza and other potential emergency and sub-emergency disease such as HIV/AIDS and Tuberculosis • 2010: 18thAPEC Economic Leaders Meeting “ to improve the capacity of economies for responses to infectious diseases, control of non-communicable diseases, and strengthening of health systems”

  9. Treaty on the functioning of the European Union (TFEU) formerly known as the Treaty of Rome (1958); Article 168: “…coordination and cooperation to prevent major health threats such as human diseases and to combat serious cross-border threats to health” • 2002: 1stProgramme of Community action in the field of public health (2003-2008): to promote and improve health, prevent disease, and counter potential threats to health while fully respecting the responsibilities of the Member States • 2007: European Health Strategy (2008-2013): Commitment to combat HIV/AIDS reaffirmed / engagement to cooperate at the regional level, where appropriate, to respond to influenza, TB and malaria. • 2007: Bremen Declaration on Responsibility and Partnership in the fight against HIV/AIDS: to strengthen responses to HIV/AIDS within the European Union / to provide the political leadership to fight this pandemic

  10. 2. Regional strategies to respond to infectious diseases • 1992: ASEAN Regional Program on HIV/AIDS Prevention and Control (1995-2000) • 2002: 2ndASEAN Regional Work Programme on HIV/AIDS (2002-2005): HIV surveillance; prevention programs; access to drugs,…. • 3rdASEAN Work Programme on HIV and AIDS (2006-2010) : improving regional responses, HIV/AIDS and mobility, HIV and development,… • 2005, ASEAN Regional Framework for the Control and Eradication of HPAI (2006-2008) • 2007: ASEAN Avian Influenza Pandemic Preparedness Project • 2008: ASEAN Regional Strategy for the Progressive Eradication of HPAI (2008-2010)

  11. 2004: ASEAN +3 EID program (funded by Australia) 4 priority areas: • 1) ASEAN institutional strengthening for EID project management, • 2) surveillance and response , • 3) prevention and risk reduction and • 4) enhancement of the regional pandemic response mechanisms. • 2005, the ASEAN Agreement on Disaster Management and Emergency Response • ASEAN Work Plan for multi-sectoral Pandemic Preparedness and Response.

  12. 2001: APEC Infectious Diseases Strategy • 2006: APEC Strategy on Emerging Infectious diseases • prevention and control of EID into the overall planning of economic and social development • economies’ surveillance and response capacity on EID • collaboration in the prevention and control of EID • technical and scientific cooperation and assistance for prevention and control measures among economies • 2006: APEC Action Plan on the Prevention and Response to Avian and Influenza Pandemics • 2007: • APEC Functioning Economies in Time of Influenza Pandemic Guidelines • Guidelines for creating an enabling environment for Employers to implement effective workplace practice for people living with HIV/AIDS

  13. 2003/ 2008: European Health Strategies • 2005: Communication on Pandemic Influenza Preparedness and Response Plan for the European Community • 2007: Framework Action Plan to Fight Tuberculosis in the European Union • 2009: EU strategy on Pandemic influenza (H1N1) • 2009: EU Strategy on HIV/AIDS (2009-2013)

  14. 3. Institutionalization of the regional responses • ASEAN Task Force on AIDS (ATFOA) • ASEAN Taskforce on Highly Pathogenic Avian Influenza (ASEAN HPAI Task Force) • ASEAN Technical Working group on pandemic preparedness and response (ATWGPPR) • ASEAN Secretariat Working group for One Health (ASEC One Health) • ASEAN Expert Group on Communicable Diseases (AEGCD)

  15. Health Task Force (HTF) >> Health Working Group (HWG)

  16. European Centre for Disease Prevention and Control (ECDC) • EC Health Security Committee (HSC)

  17. Part. 2 What role for regional organizations in the fight against infectious diseases?

  18. 1. Prevention : public health surveillance / preparedness 2. Control: Outbreak control / risk communication [ex: H1N1 (2009)] 3. Research

  19. 1. Prevention (Surveillance) • Nov. 2007, Ministries of Health of ASEAN+3 countries agreed to share through a specialized webpage (ASEAN EID Website), surveillance information about nine infectious diseases as well as any public health emergency of international concern (PHEIC). • In 2010, ASEAN+3 established a regional network of laboratories, the ASEAN Laboratory Partnership (ALP), enabling the surveillance of thirteen infectious pathogens of particular concern in the region. • Training: To enhance surveillance capacities (structures) and competencies (human resources)

  20. In 1996, APEC developed the APEC Emerging Infections Network. • APEC EInet is an events-based surveillance mechanism (scans Internet and media continuously) • Link between commerce and health officials in A-P. • Training projects led by APEC economy members: To strengthen surveillance capacities and competencies

  21. ECDC is responsible for the surveillance of infectious diseases and shall maintain the databases for epidemiological surveillance • Data collection based on case-reporting from the Member States. • Routine surveillance of 46 diseases plus SARS, West Nile Fever and Avian Influenza through the European Surveillance System (TESSy) • Collection, validation, cleaning, analysis and dissemination of data at the European level.

  22. Role in surveillance: • Crucial role in the creation regional surveillance mechanisms to monitor the spread of several infectious diseases in their region. • ASEAN and EU : updated and frequent coverage of 13 (ASEAN) and 49 infectious diseases (EU) and a clear picture of their evolution at the regional level. ECDC : analysis of the epidemiological situation and share scientific and valuable advices to the governments of the EU countries to help them to make decisions • Help to reinforce national compliance to the requirements of the International Health Regulations (IHR 2005) • Enhance directly the global surveillance of infectious diseases as they support capacity and competencies development of their members (Training, ) • Offer a privileged and a medium-size platform for sharing experience and best practices related to disease surveillance through workshops on surveillance.

  23. 2. Prevention (Preparedness) APEC/ASEAN/EU: Facilitators for sharing preparedness levels, experiences and concerns : Regional meetings, workshops, seminars or videoconferences on preparedness * APEC Workshop on Implementation of the APEC Action Plan on Prevention and Response to Avian and Influenza Pandemics (June 2007) *ASEAN Regional Workshop on MultisectoralCoordination in Pandemic Preparedness and Response (November 2007) * Conference on Lessons learned from the influenza pandemic A (H1N1)2009 in Europe” (July 2010) organized by the EC and the Belgian presidency • Opportunity to share with other their level of preparedness in line with the regional preparedness strategies as well as best practices and concerns. • An important tool for the regional organization to improve regional preparedness as it allows comparison between members and then sometimes indirect pressure to the less prepared ones • Monitoring MS level of preparedness

  24. ASEAN: a potential supplier of complementary emergency treatment and equipment to its MS. Stock of medical supplies Since 2007, ASEAN possess a stockpile of 500 000 courses of antivirals (Tamiflu and Relenza), plus a large quantity of personal protective equipment(surgical mask, disposal gloves, isolation suit and gown) provided by Japan and stockpiled in Singapore.

  25. EU: Coordinator of national vaccination strategy plans • EC has helped EU countries to develop a EU Vaccination strategy against pandemic H1N1 influenza : • Timing of vaccination campaigns, • Potential target groups and priority groups for vaccination • The level of immunization coverage • Encouraging good cooperation and communication between EU members when they decide and implement their own vaccination strategy

  26. EU / ASEAN: Facilitator for the access to and supply of vaccines in a region • EU Commission and the European Medicines Agency (EMA) have worked together to speed up the marketing authorization procedure of vaccine once a pandemic is declared • European Commission proposed to set up a mechanism to help joint procurement of vaccines for interested Member States • ASEAN member states recently, proposed to explore the feasibility of joint procurement to secure the availability of drugs and pandemic influenza vaccines as well as to explore mechanisms for joint production of the drugs and vaccines Benefits: Lower price // save administrative cost // increase the total number of doses rapidly available at the regional level

  27. APEC/ASEAN/EU: Controllers of the level of preparedness of their ME/MS. • Simulation exercises • APEC Desk-top Pandemic Response Simulation Exercise (2006) • ASEAN Panstop 2007 / Panstop 2009 • EU Common Ground Exercise on an Influenza Pandemic Goal: to strengthen the effectiveness and the rapidity of the response to an epidemic outbreak at the national, regional and global level. !!! APEC gives the opportunity to Taiwan to test its preparedness level against ID in coordination with other countries.

  28. ASEAN/EU: Initiators of inter-regional prevention cooperation between Asia and Europe. • Joint Declaration of the ASEAN-EU Commemorative Summit (2007): ASEAN and the EU have pledged to “strengthen their cooperation in public health to address the threats of emerging infectious diseases” Initiatives: • Through Global initiatives: Global Avian and Human Influenza Facility (AHIF) • Through WHO: Implementation of the National Strategic Plan for Avian Influenza (INSPAI) • Direct EU technical and financial assistance to ASEAN countries: ex. Vietnam (H5N1) • Under ASEF : ASEF Public Health Network, expert and scenario-building workshops between officials and professionals from Asia and Europe

  29. 3. Regional organizations & outbreak control: The case of H1N1 (2009) • 23 April 2009: US CDC confirmed seven cases of swine influenza A(H1N1) in humans (California and Texas). • 23 April 2009 : Mexico reported 120 confirmed cases of respiratory illness due to influenza and 20 deaths. • 11 June : WHO declares global swine flu pandemic • 10 August: WHO declares the H1N1 influenza pandemic over: • More than 318,925 H1N1 cases including 3917 deaths had been reported

  30. The EU as provider of coordination, scientific support and public health advice at the regional level. • The EC provided coordination through the organization of daily audio-conferences which enable the participating Member States to share experiences and to learn from each other • Two main agreements reached by the EU Member States on travel and on school closure: • the Agreement on advice to persons planning to travel to or returning from affected areas (18 may 2009) • the Statements by the Health Security Committee and the Early Warning and Response System (EWRS) on school closures (13 August 2009). > represent indeed the result of the EC efforts to coordinate and to harmonize the regional response in these two domains

  31. EU acts also as a scientific and technical adviser through its ECDC which provided risk assessment as well as scientific and technical support on response to Member States • The H1N1 crisis in 2009 also revealed that in the future, the EU could play an important role as supporter and coordinator of the efforts made by Member States to create joint procurement of vaccines

  32. ASEAN acting as provider of information, facilitator of communication and multiplier of external help for its region. • Provider of disease surveillance data, good practices, laboratory-based surveillance information, activity updates, capacity development resources and daily news flashes through the EID website • Facilitator of the communication between the AMS through its EID website, meeting and video conferences (Assessment report > positive impression, useful, reduce the unknown). • Multiplier of external support to outbreak control : ASEAN+3 Health Ministers Special meeting on Influenza A (H1N1) (May 2009). Meeting between US CDC and AMS.

  33. APEC as an H1N1 information supplier and supporter of the empowerment of business leaders in the region • APEC encouraged all its economies to work individually and cooperatively to implement the APEC Action Plan on Prevention and Response to Avian and Influenza Pandemic • Supplier of H1N1 epidemiological updates to all its economies through the APEC EiNet. • Empowered business leaders to make their decision during the H1N1 crisis by offering them the possibility to receive tips to improve their response and ability to cope with the influenza virus after answering a series of questions through an online checklist.

  34. 3. Research support • Research in the EU: poorly financed (+/- 2% of GDP) and fragmented. • European Commission’s Framework Programmes (FP) • HIV/AIDS projects funded by the 1st Framework Program (1984-1988) • FP 5 (1998-2002) +/- 6 million euros spent on avian and pandemic influenza • FP6 (2003-2006)+ FP7 (2007-2013) • Since 2000, the EU has spent more than 100 million euros on influenza (54 projects) • F7: 55 million euros on ongoing research projects focusing on other viral diseases such as hemorrhagic fever, Chikungunya, West Nile virus,… TB 125 million euros Malaria 150 million euros HIV/AIDS214 million euros on (57 projects)

  35. No such regional mechanism within ASEAN and APEC. • BUT ASEAN and APEC MS/ME joint EU FP research projects on ID. Ex: • Taiwan and China : SARS Control project led by the University Medical Center Rotterdam in 2005 • Vietnam, Cambodia and China, partners to a project on innovative diagnostic tools and therapeutic approaches for dengue disease led by the Institut Pasteur

  36. Part. 3 Main Challenges

  37. 1. Implementation challenges a. Disparity in the level of development of the national preparedness plans • ASEAN: Thai-plan retained the format of a strategic framework rather than an operational guide • EU: still serious gaps in the plan .Persistence disparities in the level of preparation of MS notably between “old” and “new” EU MS. Source: E. Morris, S. Schneider, Pandemic Emergency Preparedness in the European Union (2009) presented at the 2010 International Disaster and Risk Conference, Davos

  38. b. Difference in the levels of national surveillance of infectious diseases • EU • Influenza surveillance: Not entirely comparable between countries. • Variabilityin the data (size and representativeness of the sentinel networks, accuracy of the estimation,…) • Differences between countries in the rigor and resources devoted to collecting and validating this data • TB, STI,… • ASEAN and APEC: • Despite progress made in dengue surveillance in Asia, many challenges remain: standardization of classification of dengue, limited resources and infrastructure for surveillance and control, quality of diagnostics,… • No obligation to report infectious diseases to a regional surveillance system

  39. 2. Resources challenge • Financial resources devoted by regional organizations to infectious diseases regional projects are quite limited or strongly rest on outside donors. • APEC: small-budget projects or financed by one country • ASEAN: • Mainly financed by non-regional actors (Australia, US,…) • Political commitment not synonymous of financial commitment for regional initiatives • ASEAN MS have preference for bilateral cooperation • Human resources • Only five people currently take care of the ASEAN EID website management while EC and its ECDC relies on much larger team.

  40. 3. Other challenges • Regional risk communication challenge • EU Risk Communication (H1N1): a complete failure • Regional coordination challenge • Not an easy task notably during health crisis • Affected by political, ethnic and religious tensions between and within countries …

  41. THANK YOUFor your attention !

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