International Networks in Public Health & the linkage with National Networks

1. International Networks in Public Health & the linkage with National Networks Dr Maureen BirminghamWHO representative to Thailand

2. This presentation • Definition of a network • Roles of a public health network • Examples - CDs, NCDs, surveillance • What makes a good network?

3. What is a Network? “an interconnected system of things or people” “an association of individuals having a common interest, formed to provide mutual assistance, helpful information, or the like”

4. Role of Public Health Networks • “Sharing” to strengthen capacity or inform those who need to know (on a specific issue) • Experiences • Knowledge • Expertise • Methods/tools • Information/data • Collaborate on a specific issue or problem(e.g. research network) • Advocate for needed actions/resources

5. Some examples NCDnet

6. Global Network to combat Non-Communicable Diseases NCDnet Catalyze country-level implementation Raise awareness Increase resource availability

7. Growing importance of Non-Communicable Diseases (NCDs) Cause of deaths in the world 25 million 2.3M 6.8 M Source: 20 million 2.3M 3.7M 15 million 10.2M 13.6M 10 million 0.5M 5.9M 0.6M 3.3 M 3.3M 3.0M 3.0M 1.1M 0.9M Lower middle-income High-income countries Upper middle-income Low-income countries Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions

8. Advocacy to promote action: There are low cost interventions to prevent NCDs…

9. Oil spikes Retrenching from globalization Asset price collapse NCDs Food price volatility 2010 Financial crisis Infectious diseases Advocacy to create new perspectives on NCDs and investments to control them World Economic Forum: Global Risk 2010 Report

10. Global Strategy for the Prevention and Control of Noncommunicable Diseases 2000 WHO Framework Convention on Tobacco Control 2003 2004 Global Strategy on Diet,Physical Activityand Health 2008 Action Plan on the Global Strategy for the Prevention and Control of Noncommunicable Diseases Communicating a clear global vision on how to move forward

11. Roadmap for implementation in countries 6 objectives: 1. Raise priority of NCDs; integrate NCDs control into all public policies 2. Strengthen national policies and programmes 3. Address risk factors 4. Prioritize research 5. Strengthen partnerships 6. Monitor NCD trends

12. SEANET-NCD Objectives • Contribute to the global efforts • Facilitate national NCD networks • Share experience, expertise, resources • Collaborate in research • Advocate & mobilize resources • Strengthen national NCD policies and strategies • Support capacity building

13. What is INFOSAN? A global network of national food safety authorities, established in 2004 to: • Promote information exchange ofimportant food safety issues • Respond to food safety emergencies • Help countries strengthen their capacity to manage food safety risks As of today, there are 177 country members of INFOSAN

14. Structure of INFOSAN INFOSANSecretariat International Food Safety Authorities Network WHO surveillance & response systems Advisory Group INFOSAN Focal point in Food Safety Authority INFOSAN Focal point in Agriculture Sector INFOSAN Focal point in other Sectors INFOSAN Emergency Contact Point INFOSAN Focal point in Health Sector INFOSAN Focal point in Trade Sector Counterparts across the farm to table continuum

16. ExampleMelamine Contamination of Infant Formula • Melamine added in the primary production sector (milk collection centres) to disguise the dilution of milk with water • 22 of 79 Chinese producers of powdered infant formula were affected • Products from affected producers exported to 5 countries • Levels detected range from <0.1 – 2600 mg/kg >294,000 children ill >50,000 hospitalized 6 deaths

17. Other products contaminated • milk (powder), yoghurt, biscuits, instant & liquid coffee preparations • egg powder, fresh eggs, animal feed • Sodium bicarbonate (raising agent) • Exports reported all over the world

19. Measures Taken by INFOSAN • Secured websites INFOSAN provided regular updates of information to its emergency network • Close collaboration with Chinese MOH • Collaboration with affected countries to verify information and provide alerts • Assistance to countries on laboratory information, analytical methods, safety limits etc. • Public Websites Special websites set up to provide continuous updates to the public

21. The global polio eradication initiative

22. The designation employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organisation concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Global Laboratory Network for Polio Eradication N = 145 laboratories Specialised Reference Laboratory Regional Reference Laboratory National/ Sub-national Laboratory

23. Global Specialized Labs N = 7 Isolates & types viruses Performs ITD & sequencing Prepares & distributes reagents Prepares & distributes PT test Research Data Training Training Isolates QC QC Regional Reference Labs N = 15 Serves > 1 country Isolates & types viruses Differentiates (ITD) wild & Sabin-like polio viruses Distributes supplies as needed Data Isolates National Labs N = 123 Serves host country Isolates & types viruses Structure of the polio laboratory network Every country need not have the same capacity: “networking” provides access to services Liaises with immunization & surveillance personnel

24. Mekong Malaria Programme networking ACTMalaria Foundation Armed Forces Research Institute of Medical Sciences (AFRIMS) American Refugee Committee (ARC) Asian Development Bank (ADB) Bill & Melinda Gates Foundation (BMGF) CDC MOH Thailand (TUC) Center for Disease Control (CDC) Atlanta Family Health International (FHI) Health Unlimited (HU) Institute Pasteur Cambodia Institute of Tropical Medicine (ITM) Antwerp, Belgium International Office for Migrations (IOM) INTERPOL Japanese Ministry of Health Kenan Institute Asia (Kenan) Mahidol-Oxford-Wellcome-trust Research Unit (MORU) Malaria Consortium Management Sciences for Health (MSH/RPM+) MEASURE / evaluation Medecins Sans Frontieres (MSF) Medicine for Malaria Venture (MMV) MEKONG COUNTRIES(MOH) National academies / Research Institutions Partners for Development (PFD) Population Services International (PSI) SEAMEO TROPMED SOKHLO Malaria Research Unit (SMRU) Tropical Diseases Research (TDR) University Research Co (URC) US Pharmacopeia / DQI USAID-RDM-Asia World Food Programme (WFP) WHO Collaborating Centers WHO

25. Technical Networking Workshop every 2-3 years since 1999 Last technical consultation in Phuket, Thailand in September 2007

26. Build evidence of malaria drug resistance, Prepare a multi-country response

27. Qinghaosu - Artemisinins Rapid action, broad stage specificity, safe, gametocytocidal

28. x x x x x x x x x x x x x x x x x x x x x More study sites of the intensified TES (Therapeutic Efficacy Studies) network to better understand malaria drug resistance

29. Artemisinin resistance, the doom scenario

30. EWGLINET • European surveillance scheme for travel-associated legionnaires' disease network • aims • reduce incidence of travel associated legionellosis • provide an early warning system • objectives • maintain a European surveillance • detect a common source • inform all those need to know about travel-associated Legionellosis • inform the public

33. Strengthening Global Networksfor Health Security

34. 1st Millenium Middle Ages 20th Century Epidemics and Pandemics have shaped our history…

35. They continue to threaten us.. WHO has detected & assessed > 2,800 events during 2001 to 2009

36. Modeling EID events: Relative risk of an EID Hot Spots: global distribution of relative risk of an EID event caused by zoonotic pathogens from wildlife, (Jones Nature, 2008).

37. The Global Outbreak Alert and Response Network (GOARN) • Assist countries with disease control efforts • Investigate events and assess risks of rapidly emerging epidemic disease threats • Support national outbreak preparedness

38. GOARN includes > 190 technical institutions and networks coordinating actions and resources to respond to public health events of international concern.

39. GOARN partners have provided experts for > 104operations in 75 countries for 197 missions.

40. GOARN deployments (as of April 2009)

41. GOARN – direct technical assistance and field support • Materials • Expertsepidemiology, public health, infection control, case management, risk communication, crisis management, logistics, laboratory, contingency planning • Teams multi-disciplinary experts • Funding

42. GOARN and Specialist Networks COMBI (Health education) EDPLN (BSL4 laboratories) Clinical GOARN

43. What makes a good network • Clear purpose • Mutual benefits for all involved • Ownership • Clear roles & deliverables • Complementary and efficient division of labor • Sufficient resources • Accountability • Spirit of ‘comradery’ & ‘togetherness’

44. Conclusion • Networks exist usually to share something or solve something of shared interest • Networks can help provide access to information, expertise, methods, tools • Networks can be more efficient and effective than working alone

45. Thank you