Improving%20Preparedness%20and%20Response%20to%20Emerging%20Pathogens%20-%20ARO%20current%20approach%20

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

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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

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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!

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Coordination of Response

• Epidemiology
• Laboratory science
• Clinical Management
• Infection Control
• Environmental health
• Health education
• Medical anthropology
• Risk communication
• Logistics
• Others

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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, SecurityDGO !
• 3 Teams
• Assessment and Field Operations (AFO)
• Epidemic Readiness and Mass Interventions (ERI)
• Emerging and Dangerous Pathogens (EDP)

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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
  !

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Outbreak Alert and Response
CASES
DAY
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Outbreak Alert and Response
CASES
DAY
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WHO Global Alert and Response
Intelligence

• Systematic gathering of epidemic intelligence
• Rapid verification with countries
• Risk assessment and communications
• Coordination of international technical support

Verification
Response
Follow-up
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No single institution has all the capacity
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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.

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G ARN

• GOARN is a global technical partnership,
  coordinated by WHO
• to provide rapid international
  multi-disciplinary technical support for outbreak
  response

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Outbreak Field Operations

• 2000/2004
• 26 countries
• Over 40 GOARN partners
• Over 350 experts
• 30 outbreak responses and investigations

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Outbreak Field Operations

• 2000/2004
• 26 countries
• Over 40 GOARN partners
• Over 350 experts
• 30 outbreak responses and investigations

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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.

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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)

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Network Structure
Regional Networks
Public Health institutions
Specialised Networks
WHO CCs
National Centres
NGOS
UNOs/IGOs
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Alert and Verification

• 636 events detected in 136 countries (2001 -
  2003)

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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

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Communications

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

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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

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Advocacy the audience
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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

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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

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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 immediate response 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

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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.

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THANK YOU