Preventing and Mitigating EmergingInfectious Disease Threats

Dr Julie Hall, MBEWHO Representative to the Philippines

Presentation

• Outline the Asia Pacific Strategy for EmergingDiseases (APSED)

• Some of the basics of emerging infectiousdiseases planning

• Discuss some of the strengths and weaknessesunique to the Region in responding to suchthreats

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Part 1

• Outline the Asia Pacific Strategy for EmergingDiseases (APSED)

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•A-Zoonotic/wild •B-Zoonotic/domestic

•D-Vector-borne•C-Drug resistant

Asia Pacific region is a Hotspot of EIDs

Examples of outbreaks in WPR

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2003: SARS, H5N1 in China and Viet Nam2004-2006: Streptococcus suis in China, H5N1 in Asia

2008: EV-71 in China2009: Pandemic influenza A(H1N1), Leptospirosis in the Philippines,Cholera in PNG2010: Cholera in Cambodia and PNG, Anthrax in Mongolia2011: HFMD in Viet Nam, wild-type poliovirus in China, pertussis in PNG2012: EV-71 in Cambodia, Cholera in the Philippines2013- H7N9 in China, Dengue in Lao PDR, H5N1 in Cambodia (26 cases)2014- MERS-CoV in Malaysia, H7N9 in China and Malaysia, Heniph inPhilippines, Measles in Viet Nam and PNG, Dengue in Malaysia

2007: H5N1 in Lao PDR and ongoing in other countries

•2015- MERS-CoV in the Philippines

About IHR (2005)

• A global legal framework for protectingglobal public health security

• Shared risk management for a sharedvulnerability, calling for:– national surveillance and response

systems (IHR core capacities)– regional and international alert and

response systems• Entered into force since June 2007

– 7 years of implementation

Working at global, regional and national level:Coordinated WHO’s response to H7N9 event

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Information sharing through the IHRmechanism - outbreak

Event detected by thesurveillance system

National IHRFocal Point

•Two of the following:SeriousnessUnexpectedPotential to spread internationallyPossible restrictions to international travel ortrade

WHO Regional IHRContact Point

WHOHeadquarters

Event notified and information for EventInformation Site (EIS) shared

EIS posting sentEIS Post

•Disease Outbreak News•http://www.who.int/csr/don

APSED serves as a Regional Tool

• The Asia Pacific Strategy for EmergingDiseases (APSED)– A bi-regional tool to help two WHO

Regions (SEAR and WPR) meet IHRcore capacity requirements

– A common framework highlighting ashared vision and a set of agreedpriorities

• Developed in 2005 and updated in2010 (endorsed by RCM)

APSED (2010): Goal and Objectives

To build sustainable national and regional capacities andpartnerships to ensure public health security throughpreparedness planning, prevention, early detection and rapidresponse to emerging diseases and other public healthemergencies

1. Reduce the risk of emerging diseases2. Strengthen early detection3. Strengthen rapid response4. Strengthen effective preparedness5. Build technical partnership

Features of APSED

APSED facilitates effective preparedness andcapacity development:

• A common framework to develop generic capacitiesfor preparedness, alert and response – integratingEID/IHR/Pandemic Preparedness and other EIDs intoone single framework

• Step-wise approach to capacity development

• Connects stakeholders at national and regional levelfor collective management of health security threats

• Emphasises value of learning from real world events

APSED M&E System

Planning Implementation

Review

APSED story-line: building momentum

Expanded tonon-EID events

(food safety,chemical,

radiological..)

Expanded toEID events

(Anthrax, cholera,dengue…)

Focus onH5N1

Example of event-based surveillance(EBS) and rapid response team (RRT)development

2005 2010

Implementing APSEDto meet IHR core capacity requirements…

APSED as effective mechanism

The achievements of APSED are evidenced by thefollowing:

•IHR core capacity achievement– Annual States Parties Questionnaires

•Good response to several outbreaks and real worldpublic health events

– A(H7N9) virus– Dengue virus– MERS coronavirus

Part 2

• Some of the basics of emerging infectiousdiseases planning

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CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP26-28 August 2014. Manila, Philippines.

SARS and the economy

Response to Outbreaks & Emergencies

• WHO Emergency ResponseFramework (ERF):– Bohol Earthquake, 2013 (Grade 1)– H7N9 in China, 2013 (Grade 2)– Zamboanga Siege 2013 (Grade 1)– Typhoon Haiyan 2013 (Grade 3)– Mindanao 2015 (Grade 2)

• GOARN• Emergency Operations Centres

(EOC)

Global Outbreak Alert and Response Network(GOARN)

Functions• Alert• Respond• Preparedness

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Emergency Operation CentresEOC = facilities + functions

•EOC roomrenovated:Cambodia, LaoPDR, Mongolia,Viet Nam

•EOC roomrenovated:Cambodia, LaoPDR, Mongolia,Viet Nam

•Equipmentinstallation inprocess: Lao PDRand Mongolia

•Equipmentinstallation inprocess: Lao PDRand Mongolia

•EOC SOPdeveloped:Cambodia,Lao PDR

•EOC SOPdeveloped:Cambodia,Lao PDR

EOC activated:• Dengue in Lao

PDR• Measles in

Viet Nam

EOC activated:• Dengue in Lao

PDR• Measles in

Viet Nam

Regional surveillance and riskassessmentRegional Alert and Response System

WPRO: Regional event-based surveillance

Reported Events2008–2009† 2009–2010 2010–2011 2011–2012 2012–2013 2013–2014

n = 206 n = 218 n = 357 n = 297 n = 222 n = 295InfectiousDiseases* 142 174 206 114 71 61

Animal H5N1** 35 26 136 86 305 222

Disasters andothers*** 16 9 7 92 50 12

Chemical 13 9 8 2 1 0

Information source of initial reports

Unofficial 147 162 203 100 62 41

Official 59 56 154 194 160 254

• WPRO FieldEpidemiologyTraining Programme(FETP) Provides on-job-training onsurveillance and riskassessment– A total of 50 fellows

from 13 MemberStates since 2010

WPRO FETPfellowship program

Investment Partnership: FETP/FET+

Part 3

• Discuss some of the strengths and weaknessesunique to the Region in responding to suchthreats

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Asia Pacific Strategy for Emerging Diseases

APSED has proven to be an effective tool toimplement the International Health

Regulations (IHR)

What we learned from APSEDimplementation?

• Western Pacific Region is ahot spot of EmergingInfectious Diseases (EID)

• WPR is experienced, but notfully equipped againsthealth security threats

• Partnerships are key tomake difference

Challenges lie ahead…

APSED Partnerships

Investment in regional health securityduring a peaceful time

Thank you