Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level: Minsk, Belarus, 11–12 February 2020: meeting report

Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level MEETING REPORT Minsk, Belarus 11-12 February 2020 Abstract The WHO Road map to enhance health sector engagement in the Strategic Approach to International Chemicals Management towards the 2020 goal and beyond, known as the WHO Chemicals Road Map, was approved by the World Health Assembly in 2017. An accompanying workbook was also developed to support Member States’ implementation efforts. The subregional meeting on 11– 12 February 2020 in Minsk, Belarus, aimed to assist central and eastern European countries in prioritizing actions to enhance the management of hazardous chemicals at a national level, and in planning activities to implement them. Examples of good practices, successful experiences and supportive documents needed to plan actions were presented to guide the identification of priority actions both at the meeting and during the development of national implementation plans. Key institutional elements to ensure stronger health sector involvement in chemicals management were also discussed to facilitate national activities. Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK–2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2020 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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Document number: WHO/EURO:2020-5544-45309-64850 iii Contents Abbreviations ........................................................................................................................................ iv Introduction ............................................................................................................................................ 1 The WHO Chemicals Road Map ........................................................................................................... 2 Planning the implementation of the WHO Chemicals Road Map at a national level............................ 3 Key frameworks for health secor involvement in sound chemicals management ................................. 5 Poisoning surveillance ........................................................................................................................... 8 Conclusions and next steps .................................................................................................................... 9 References ............................................................................................................................................ 10 Annex 1. Provisional programme ........................................................................................................ 11 Annex 2. List of participants ................................................................................................................ 13 iv Abbreviations ICCM International Conference on Chemicals Management IHR International Health Regulations PIC poison information centre SDGs Sustainable Development Goals SAICM Strategic Approach to International Chemicals Management UNITAR United Nations Institute for Training and Research WHO ECEH WHO European Centre for Environment and Health Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 1 Introduction Enhancement of health sector involvement in chemicals management is critical for the effective planning and implementation of risk-reduction measures and the protection of populations from the negative impact of chemicals. A resolution on the Strategic Approach to International Chemicals Management (SAICM) (1) adopted at the third session of the International Conference on Chemicals Management (ICCM) in 2009, identified the most important areas in which the health sector can and should contribute. In May 2017, the Seventieth World Health Assembly approved the Road map to enhance health sector engagement in the Strategic Approach to International Chemicals Management towards the 2020 goal and beyond (2), known as the WHO Chemicals Road Map. It identifies concrete actions in which the health sector should play a leading or supporting role, and recognizes the need for multisectoral cooperation. The WHO Chemicals Road Map Workbook (3) was developed to further support Member States’ efforts to choose priorities and plan activities, and a WHO network of focal points for chemicals and health was created to facilitate information exchange, the identification of shared priorities, and greater collaboration and coordination both within and beyond the health sector. At the regional level, the Sixth Ministerial Conference on Environment and Health, held in 2017 in Ostrava, Czechia, recognized chemical safety as one of seven priorities for the WHO European Region. Coordination of the implementation of the WHO Chemicals Road Map (2) and the Ostrava Declaration on Environment and Health (4) is needed to ensure the achievement of these global and regional priorities. The subregional meeting on 11–12 February 2020 in Minsk, Belarus, was organized in cooperation with WHO headquarters and the Ministry of Health of Belarus. It aimed to assist central and eastern European countries in prioritizing actions to enhance the management of hazardous chemicals at a national level, and in planning activities to implement them (see Agenda 1 for the provisional programme). The meeting covered a number of topics, including:  the WHO Chemicals Road Map and its links to the 2030 Agenda for Sustainable Development (5) and other global and regional processes in the area of chemicals management;  experiences in health sector involvement in chemicals management at global and national levels;  key institutional frameworks for ensuring stronger health sector involvement in chemicals management; and  surveillance of acute and chronic poisonings and health disorders potentially caused by chemicals. Presentations, discussions and activities focused on enhancing participants’ knowledge and experience to facilitate national activities towards the implementation of the WHO Chemicals Road Map, and to strengthen capacities for the achievement of the Sustainable Development Goals (SDGs) (6), the fulfillment of the commitments of the Ostrava Declaration on Environment and Health (4) and the implementation of SAICM (1). Dr Siarhei Sychic, Director of the Scientific Practical Centre of Hygiene of the Ministry of Health of Belarus, opened the meeting by highlighting the significant contribution of the health sector to chemical Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 2 safety. He stressed the importance of organizing meetings of specialists in public health, toxicology and other allied areas for sharing the knowledge, experience and expertise needed to strengthen national capacities and facilitate actions. He warmly welcomed participants on behalf of the Ministry of Health, and expressed its gratitude to WHO for organizing the meeting. Ms Alena Drazdova, Deputy Director for Science of the Scientific Practical Centre of Hygiene of Belarus, and Mr Saulius Majus, Head of the Product Evaluation Division of the National Public Health Centre of Lithuania, co-chaired the meeting. Ms Maryna Anisovich was elected rapporteur. Thirty-five national and international experts from 19 countries attended the meeting (see Agenda 2 for the list of participants). The WHO Chemicals Road Map The introductory session of the meeting included a review of the WHO Chemicals Road Map, which was developed in consultation with Member States and other stakeholders following the 2016 adoption of World Health Assembly resolution WHA69.4 (2). The WHO Chemicals Road Map identifies four priority actions areas – risk reduction, knowledge and evidence, institutional capacity, and leadership and coordination – as well as a number of activities to achieve the overall objective of SAICM: to minimize the negative impact of chemicals on human health throughout their life cycle (1). Action areas of the WHO Chemicals Road Map interlink with one another and with other global strategies, including the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 (7), the Global Programme on Climate Change and Health (8), the Global Action Plan for Healthy Lives and Well-being for All (9) and the joint food safety initiatives of WHO and the Food and Agriculture Organization of the United Nations (10). Implementation of the WHO Chemicals Road Map will also contribute to achieving the 2030 Agenda and its SDGs (in particular targets 3.9, 6.3 and 12.4) (5,6), multilateral environmental agreements and the International Health Regulations (IHR) (2005) (11). Regionally, the WHO Chemicals Road Map links strongly with the portfolio of actions of the Ostrava Declaration on Environment and Health (4). The links between all of these programmes and processes should be considered when planning actions for improving chemicals management at a national level. The Global Chemicals and Health Network was created to facilitate the implementation of the WHO Chemicals Road Map. Currently, the Network represents 73 Member States, including 26 European Member States. It provides a platform for discussing emerging chemical safety issues, raising awareness of the health impact of hazardous chemicals, identifying common problems, and fostering greater inclusion of health sector perspectives in international discussions on chemicals. Meeting participants encouraged the WHO Regional Office for Europe to increase its participation in the Network. The WHO Chemicals Road Map is a living document that will be updated according to new developments by SAICM beyond 2020. An ongoing discussion of these developments was initiated after the 2015 ICCM meeting, and is currently underway through a number of intersessional meetings. To date, five strategic objectives have been agreed: national implementation; knowledge generation Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 3 and sharing; addressing issues of concern; risk prevention; and finance mobilization. The work continues to define targets, milestones and indicators. Independent evaluation identified the main issues to be addressed beyond 2020. These include addressing gaps between developed and developing countries, protecting workers’ rights, ensuring stable financial mechanisms and availability of resources, increasing collaboration between sectors and stakeholders, strengthening national capacities such as poison information centres (PICs), and boosting the involvement of industry and the scientific community. The vision of SAICM and its implementation will be crystallized at the fifth session of the ICCM in October 2020. Planning the implementation of the WHO Chemicals Road Map at a national level The meeting’s second session included a presentation of the WHO Chemicals Road Map Workbook (3), designed to assist countries in identifying national priorities and planning implementation measures. It recommends four steps: determination of potential activities, prioritization, implementation of planning, and communication and sharing. Using the Workbook throughout the planning process can facilitate the involvement of other sectors and mainstreaming with other processes at national, regional and global levels. The Workbook also proposes prioritization criteria, such as opportunity to leverage, feasibility and flexibility for implementation, expected impact, and potential risks. Other criteria can be considered based on national context. According to the United Nations Institute for Training and Research (UNITAR) vision on planning of national chemical strategies, developing a national implementation plan saves time, effort and resources, and reduces risk of failure. The process of creating a national plan commonly includes the following elements:  engaging in preparatory tasks and considerations;  defining the plan’s purpose and scope with a statement of the problem and goals;  performing a situation and gap analysis;  setting objectives and indicators;  planning the details, including activities, timelines and resources; and  implementing and evaluating the plan. Well developed objectives should correspond to the SMART concept: specific, measurable, agreed, realistic and time dependent. Prioritization at all stages through the application of relevant criteria is the most challenging exercise in any planning process. A number of good examples of organizing a planning process under UNITAR leadership can be seen in countries of the WHO European Region (for example, Albania and Georgia). In their discussion, meeting participants drew attention to the strong influence of financial resource availability on the planning and implementation of national actions. An integrated approach involving Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 4 national, international and other donors is key. To ensure financing, it is also important to clearly state a country’s needs and goals. Participants agreed that a robust methodology should be used for planning national actions with the involvement of relevant stakeholder groups. A detailed analysis of the existing situation, including gaps and weaknesses, should precede planning. Mainstreaming chemicals management with other strategic policies at national and international levels opens up possibilities for securing sustainable financial support for implementation. During the practical exercise, participants gathered in small groups to practise planning the implementation of the WHO Chemicals Road Map at a national level using the Workbook. Their task was to go through the steps, including prioritizations and detailed planning of resources and timeframes for implementation. They reported several criteria to the plenary: impact on human health, how easily the objectives can be achieved (this includes the identification of so-called low-hanging fruit, which is important in a context of limited resources), cross-cutting impact, successful experience in other areas, and contribution to overall progress in the area of chemical safety. Participants agreed that the Workbook is a valuable instrument for supporting planning at the national level. However, they noted the need for further support from WHO. This could take the form of smaller-group meetings for national experts from different areas of chemicals management to plan national actions with support from international experts. Participants also briefly discussed opportunities for project applications while finalizing the exercise. National coordinators of the project “Establishment of key elements of national systems for the sound management of chemicals in selected countries in eastern Europe, Caucasus and central Asia” then shared the experience of developing a national chemical safety road map, which is a specific task of the project. In Belarus, the Government authorized the Ministry of Health to lead the establishment of a chemicals management system within the framework of its sustainable development strategy. In addition to setting out actions towards the successful implementation of chemical conventions and the technical regulations of Eurasian economic cooperation, the Belarusian road map builds links between the country’s economic and social development and the benefits of the sound management of chemicals throughout their life cycle. Establishing a system for the safer management of biocides is a priority for Georgia and an area of focus within the framework of its national environmental health action plan and its Association Agreement with the European Union. Thus, the Georgian road map is focused on this aspect of chemicals management. The country applied WHO’s recommended approach for developing the national road map, which reflects action areas of the WHO Chemicals Road Map. These action areas were defined through a screening assessment performed by the country with support from the WHO European Centre for Environment and Health (ECEH). Kazakhstan’s road map was developed within the framework of the implementation of the national green economy strategy. It addresses the most important areas of chemicals management, including stronger legislation, institutional arrangements, health protection and the role of the health system, Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 5 minimization of pollution and the recovery of contaminated sites, innovation and cleaner technologies in industry and agriculture, stakeholder capacity, and information exchange. Special conditions were created to ensure multisectoral and multistakeholder involvement at all stages of the road map’s development. This involved collecting information for the situational analysis, holding wide discussions of the draft version, and forming working groups with representatives of nongovernmental organizations and 10 governmental agencies involved in chemicals management to guide the road map’s development. Following the presentations, participants expressed their gratitude for the valuable country experience that was shared. Wrapping up the day, the co-chair summarized the discussions of the methodology for planning actions within national contexts, the WHO Workbook and UNITAR guidance documents, and the examples of national experience. The co-chair highlighted that further steps should be taken at a national level. Key frameworks for health sector involvement in sound chemicals management The third session of the meeting emphasized that strengthening health sector involvement in chemicals management at all levels requires the creation of relevant frameworks. The basic elements of such frameworks were discussed at a meeting of Member States on 22–23 June 2015 in Bonn, Germany. They were identified as follows:  legislation that clearly defines the health sector role in chemicals management;  infrastructure at all levels of governance (a central agency, public health institutions, research institutions, analytical institutions and PICs);  sufficient, competent and resilient human resources (both public-health and health-care professionals) with clearly defined roles and responsibilities;  the collection and dissemination information to support decision-making on risk prevention, including evidence of the negative health impact of hazardous chemicals. The multisectoral management of chemicals is vital, and the health sector should play a major role by, inter alia, establishing robust channels of communication with relevant stakeholders to advocate for human health, and increasing awareness of the health risks of exposure to hazardous chemicals. PICs play an important role in responding to chemical emergencies, but also in the everyday management of chemicals. PICs should be available in every country irrespective of geographical or population size. At a minimum, a PIC is a centre with toxicological expertise capable of advising medical staff and the general population 24 hours a day and seven days a week by phone. For medical staff, PICs provide guidance on diagnosis, clinical management and prevention of poisoning (including availability and use of antidotes and potential sources of exposure such as products, substances, and toxic plants and animals) and first aid for poisonings. Other important functions of a PIC include detecting and quantifying relationships between toxic chemicals and illness, training emergency and public health staff, and advising on the prevention of negative health effects. Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 6 An adequately resourced PIC has sufficient staff in terms of expertise and number, and information resources including, at a minimum, a toxicological database, treatment protocols, a product database, and poisoning and other health surveillance databases. A PIC may also include or be strongly connected to a clinical treatment unit, laboratory service and/or research unit. Establishing and developing a PIC requires policy support and sustainable funding. Cooperation with other institutions for treatment and prevention is crucial for PICs at local, national and international levels. Approaches to establishing PICs differ from country to country depending on factors such as available resources, risk of chemical emergencies, etc. Several national PIC models were presented to the meeting participants. In Azerbaijan, the PIC is based in a clinic. In 2009, with support from WHO, an information unit was created to collect and analyse information on poisoning, analyse epidemiological information, and publish scientific and public information on the topic. The PIC staff respond to around 12 000 emergency calls annually. Through poisoning surveillance, they also identify chemicals of concern. Acetic acid, alcohol substitutes and drugs are currently the main agents of poisonings. The PIC in Azerbaijan faces a number of challenges, including difficulty monitoring poisonings due to lack of an obligatory reporting system or national statistics on poisoning; inadequate availability of antidotes; poor accessibility of international sources of information; lack of specialists at the local level, especially with knowledge of English or Russian; and lack of trainings. A proposal to consider the creation of a (sub)regional stock of antidotes, the organization of international conferences on a regular basis, and technical and financial support for establishing/strengthening the country’s PIC was addressed to WHO at the meeting. The PIC in Hungary functions within the country’s Public Health Institute. Medical and laboratory services are functionally linked to the PIC at central and local levels. European Union legislation has affected the operation of the PIC in terms of, for example, the registration of hazardous products. Its free information service for both the public and health workers includes information on clinical symptoms, first aid, antidotes, treatment and products. In 2018, three quarters of the calls to the PIC were from the public and one quarter were from paramedics and doctors. Reporting cases of poisoning to the PIC is mandatory and takes place through a designated reporting system. A poisoning database and a database on the properties of substances and mixtures are in both place. The telephone number of the PIC is marked on products containing hazardous chemicals. In Serbia, the PIC is located in the Military Medical Academy. It provides treatment, prevention and toxicology research services. It benefits from the resources of the clinical departments and the Institute of Occupational Medicine’s Department of Toxicology. Local hospitals are capable of quickly recognizing the symptoms of poisoning by snake venom and toxic plants, and only in difficult cases do they contact the Academy for advice. The PIC monitors and analyses cases of poisoning, and collects and stores data from 12 hospitals and three additional institutions. Information is available online. National laboratories and coordination services (for example, veterinary services) also participate in the national poison monitoring programme. Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 7 The functions of the Serbian PIC are divided among institutions according to their mandate. The Department of Toxicology, the Military Medical Academy and some laboratories carry out human biomonitoring; educational institutions develop and deliver curricula and courses; and authorized institutions provide laboratory services (chemical, veterinary, etc.). As a whole, the system covers all functions laid out in existing WHO documents and recommendations. In a practical exercise, participants clustered in working groups to list the expectations and functions that can be assigned to a PIC in different areas: clinical services; laboratory services; information services; surveillance/toxicovigilance; and research. The results of the working group discussions are summarized below. Clinical services  Diagnosis, treatment and, if needed, reanimation, including through the use of specialized equipment (dialysis, plasmapheresis, oxygen therapy delivery systems, etc.)  Provision of professional psychotherapy (in case of suicide attempts)  Consideration of the special needs of children and provision of relevant therapies (paediatric services);  Diagnosis and treatment of poisonings at workplaces (occupational diseases)  Development of protocols for diagnosis, treatment and prevention  Training of toxicologists working at the local level and public-health and health-care professionals, and education of the public and other allied professionals  Development of recommendations on the use, planning needs, stocking and provision of antidotes Laboratory services  Clinical and laboratory analysis for identification and quantification of toxic agents in biological samples (human biomonitoring)  Chemical analysis of environmental, food and product samples to identify sources of exposure to a toxic agent  Clinical laboratory investigations for diagnosis and treatment Information services  Provision of information 24 hours a day, seven days a week to the public and medical staff  Organization of meetings, trainings and awareness-raising campaigns  Analysis and sharing of information, including statistical data, with supervisory authorities and other stakeholders  Collection of information on hazardous chemicals and products and toxic plants and animals  Support of operability of databases and availability of information to relevant stakeholders  Monitoring of media reports and interaction with the media Surveillance/toxicovigilance  Identification of risk of poisoning and assessment of risk groups  Monitoring of the number of poisonings, their structure and trends  Monitoring and maintenance of lists of toxic chemical products and natural toxins  Control and monitoring of narcotic drugs in the country, including illegal ones Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 8  Notification of health and other authorities; development of measures for prevention, diagnosis, treatment and provision of antidotes; and other organizational measures  Continuous analysis of data, and creation and maintenance of a database Research  Conduct of epidemiological studies of exposure to chemicals  Poisoning profiling  Study of the relationship between hazardous chemicals and noncommunicable diseases  Study of the toxicological properties of chemicals, including their toxicokinetics and toxicodynamics  Education and public awareness-raising  Early detection of unusual products, chemicals and active agents Poisoning surveillance The meeting’s final session focused on poisoning surveillance. Poisoning surveillance is a key function of a PIC and a core capacity within the framework of the IHR (2005) (11). It is critical for the early detection and verification of disease outbreaks, and should be in place in each country. According to the IHR, an event should be evaluated based on rapid risk assessment, which entails assessing the agent hazard, assessing exposure and clinical symptoms, and describing the event. Toxicovigilance is an essential part of poisoning surveillance. It is an active process of identifying and assessing risks from exposure to various types of chemicals within a community or at the population level. Toxicovigilance involves monitoring data to identify new risks and trends, to alert authorities of a sudden event, to prevent and manage risks, and to treat cases in time. It requires collaboration between PICs, toxicological laboratories, public health agencies, safety agencies and other stakeholders. PICs commonly perform toxicovigilance by identifying emerging hazards; collecting detailed data on demographics, agents and circumstances of exposure; performing clinical functions during emergencies and in everyday life; and sharing extensive information and expertise on the effects of exposure to chemicals. They maintain access to product and toxicological databases, and can immediately instruct hospital physicians on diagnosis and treatment and recommend prevention measures in earlier stages of an outbreak. Qualified and trained poison information staff are needed to ensure the proper operation of a PIC. Other expertise may need to be involved in certain cases. Unfortunately, the agent causing a disease outbreak cannot always be identified in the initial stages; in these cases, specific investigation must be carried out. To guide countries in performing such investigations, WHO is developing a manual for investigating a suspected outbreak of illness of possible chemical aetiology, which will be published in 2020. A number of factors determine the complexity of the identification and verification of cases when the clinical picture is non-specific: when exposure occurs over a prolonged period and across a wide geographical area; when exposure to multiple agents takes place; and when expertise is lacking due to the uniqueness of a case. Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 9 To practise the investigation of an unknown disease outbreak, participants applied the principles and recommendations outlined in the manual during a simulation exercise. Information was added to the initial case description as participants worked through the five steps of investigation:  detection and notification of cases;  information gathering and evaluation;  a preliminary assessment of the outbreak;  a field investigation; and  identification of the source of the event and development of appropriate preventive interventions. Participants highly appreciated the training, noting that it fostered better understanding of the investigation process and allowed them to identify the types of expertise that should be involved. They encouraged WHO to continue organizing trainings on toxicovigilance. Conclusions and next steps The two-day subregional meeting on health sector involvement in chemicals management yielded the following conclusions.  The WHO Chemicals Road Map Wordbook is a practical instrument that can guide planning at a national level.  The guiding documents on planning activities towards sound chemicals management developed by UNITAR provide countries with a methodology for planning and prioritizing actions. Used in tandem with the Workbook, they contribute to effective planning at a national level.  Criteria for prioritization at each step of a planning process can differ from country to country and should be identified at a national level. However, these criteria may be the same for countries with chemical management systems at a similar level of development, and planning processes could be organized at a subregional level for smaller groups of countries (for example, those of the south-eastern European region).  Planning for the implementation of the WHO Chemicals Road Map at a national level should be streamlined with national priorities to ensure political support and financial resources.  The rapid publication of WHO guidance documents on PICs and the manual for investigating a suspected outbreak of illness of possible chemical aetiology would be welcomed.  Regular trainings on toxicovigilance are needed to strengthen national capacities and support the activities of PICs. Participants also requested that WHO consider organizing trainings at a national level to support the creation/strengthening of PICs upon countries’ requests, and that it consider planning WHO Chemicals Road Map pilot projects at a subregional level. Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 10 References 1. Strategic Approach to International Chemicals Management (SAICM) [website]. Geneva: United Nations Environment Programme; 2020 (http://www.saicm.org/, accessed 4 March 2020). 2. Road map to enhance health sector engagement in the Strategic Approach to International Chemicals Management towards the 2020 goal and beyond. Geneva: WHO; 2017 (https://www.who.int/ipcs/saicm/ChemicalsRoadMapbrochure_en.pdf?ua=1, accessed 4 March 2020). 3. WHO chemicals road map workbook. Geneva: WHO; 2018 (https://apps.who.int/iris/ bitstream/handle/10665/273136/9789241513630-eng.pdf?ua=1, accessed 4 March 2020). 4. Declaration of the Sixth Ministerial Conference on Environment and Health. Copenhagen: WHO; 2017 (http://www.euro.who.int/__data/assets/pdf_file/0007/341944/Ostrava Declaration_SIGNED.pdf, accessed 4 March 2020). 5. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015 (https://sustainabledevelopment.un.org/post2015/transformingourworld, accessed 4 March 2020). 6. Sustainable Development Goals [website]. New York: United Nations; 2020 (https://sustainabledevelopment.un.org/sdgs, accessed 4 March 2020). 7. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO; 2013 (https://apps.who.int/iris/bitstream/handle/10665/94384/978924 1506236_eng.pdf;jsessionid=5D2BAB52EF0C32AB1251A85290291B6D?sequence=1, accessed 4 March 2020). 8. WHO global programme on climate change and health [website]. Geneva: WHO; 2020 (https://www.who.int/globalchange/mediacentre/news/global-programme/en/, accessed 4 March 2020). 9. Stronger collaboration, better health: global action plan for healthy lives and well-being for all. Geneva: WHO; 2019 (https://www.who.int/publications-detail/stronger-collaboration- better-health-global-action-plan-for-healthy-lives-and-well-being-for-all, accessed 4 March 2020). 10. Food safety [website]. Geneva: WHO; 2020 (https://www.who.int/health-topics/food-safety/, accessed 4 March 2020). 11. International Health Regulations. Third edition. Geneva: WHO; 2005 (https://apps.who.int/ iris/bitstream/handle/10665/246107/9789241580496-eng.pdf?sequence=1, accessed 4 March 2020). Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 11 Annex 1. Provisional programme 11 February 2020 9:00–9:30 Registration 9:30–10:00 Opening of the meeting Ms Nataliya Zhukova, Ministry of Health of the Republic of Belarus Election of co-chairs Adoption of the agenda 10:00–10:15 Scope and purpose of the meeting Ms Irina Zastenskaya, WHO European Centre for Environment and Health (ECEH) 10:15–11:00 Session 1. Introduction WHO Chemicals Road Map (linkages with Sustainable Development Goals, WHO and other global programmes, the Ostrava Declaration) Ms Magdalena Frydrych, WHO Ms Irina Zastenskaya, WHO ECEH WHO Global Chemicals and Health Network Ms Magdalena Frydrych, WHO Сhemicals management beyond 2020 Ms Brenda Koekkoek, Strategic Approach to International Chemicals Management (SAICM) Secretariat (via remote connection) 11:30–13:00 Session 2. Planning the implementation of the WHO Chemicals Road Map at a national level WHO Chemicals Road Map Workbook – introduction Ms Magdalena Frydrych, WHO Prioritization of chemicals and actions Developing a national implementation plan: approaches, main elements and steps Mr Andrea Cararo, United Nations Institute for Training and Research (UNITAR) Discussion 14:00–15:45 Practical exercise 1: developing a national plan to implement the WHO Chemicals Road Map 16:15–17:00 Reporting on working group discussions Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 12 17:00–17:45 Presentation of national experience in developing road maps towards sound chemicals management Ms Irina Iliukova, Belarus Ms Nana Gabriadze, Georgia Ms Nasima Zhunusova, Kazakhstan 17:45–18:00 Wrap up and closure of the day 12 February 2020 9:00–11:00 Session 3. Key frameworks for health sector involvement in sound chemicals management Overview of framework elements in the health sector for sound chemicals management Ms Irina Zastenskaya, WHO ECEH Poison information centres (PICs): role and resources European network of PICs Ms Monique Mathieu, France National PICs: organization and functions Mr Ismayil Afandiyev, Azerbaijan Ms Nikoletta Marosvölgyi, Hungary Ms Branislava Matic, Serbia Practical exercise 2: establishing a PIC according to WHO recommendations 11:30–13:00 Session 4. Poisoning surveillance Requirements of the IHR Ms Irina Zastenskaya, WHO ECEH Poisonings surveillance and toxicovigilance Information exchange and databases Ms Monique Mathieu, France WHO recommendations on investigation of poisonings Ms Irina Zastenskaya, WHO ECEH Discussion 14:00–15:30 Practical exercise 3: investigation of an unknown disease outbreak of possible chemical aetiology 16:00–16:30 Plenary discussion of the meeting outcomes 16:30–17.00 Next steps and closure of the meeting Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 13 Annex 2. List of participants Albania Lindita Tafaj Head of Sector National Reference Laboratory Institute of Public Health Rr. Aleksander Moisiu, Nr. 80 1001, Tirana Armenia Ruben Grigoryan Head of Department of Environmental Hygiene National Center for Disease Control and Prevention 12, Mkhitar Heratsi Str., Yerevan Tamara Vardanyan Epidemiologist Department of Epidemiology of Non-Communicable Diseases and Nosocomial Infections National Center for Disease Control and Prevention 12, Heratsi Str., Yerevan Azerbaijan Ismayil Afandiyev Chief Toxicologist Ministry of Health 1, Mirqasimov Str. AZ1022, Baku Belarus Drazdova Alena Deputy Director of Science Scientific Practical Centre of Hygiene 8, Akademicheskaya Str., Minsk Iryna Ilyukova Head of Prophylactic Toxicology Laboratory Scientific Practical Centre of Hygiene 8, Akademicheskaya Str., Minsk Igor Grigoriev Head of Republican Toxicology Centre Deputy Chief Medical Officer for Civil Defence and Mobilization Work Minsk Сity Emergency Hospital 58, Lieutenant Kizhevatova Str., Minsk Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 14 Andrej Bogdan Specialist Health Committee Minsk City Executive Committee 22/2, Mayakovsky Str., Minsk Olga Volkova Deputy Chairman Nongovernmental organization (NGO) “Ecological Initiative” 26-1, Griboedova Str., Minsk Kulik Yury Consultant NGO “Ecological Initiative” 26-1, Griboedova Str., Minsk Kapustinskaya Tatsiana Head of Department of Community Hygiene Republican Centre for Hygiene, Epidemiology and Public Health 50, Kazintsa Str., Minsk Bosnia and Herzegovina Aida Vilić-Švraka Specialist Department of Hygiene and Health Ecology Public Health Institute of Bosnia and Herzegovina Mehmed-paše Sokolovića 17/3 71000, Sarajevo Croatia Dubravka Marija Kreković Senior Adviser Sector for Public Health Protection Ministry of Health Ksaver 200 A 10000, Zagreb Nataša Janev Holcer Head of General Environmental Health Department Croatian Institute of Public Health Rockefellerova 7 10000, Zagreb Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 15 Estonia Kristo Kleemann Chief Specialist Public Health Department Ministry of Social Affairs Suur-Ameerika 1 10122, Tallinn Marilin Lutsoja Chief Specialist Health Department Ministry of Social Affairs Public Sõpruse pst 33-25 10615, Tallinn Georgia Lali Ebanoidze Head of Legal Division National Center for Disease Control and Public Health Kakheti Highway #99 0198, Tbilisi Nana Gabriadze Head of Environmental Health Division National Center for Disease Control Public Health Kakheti Highway #99. 0198, Tbilisi Hungary Nikoletta Marosvölgyi Head of Unit Department for Chemical Safety and Competent Authorities National Public Health Center Albert Flórián út 2–6. H-1097, Budapest Latvia Solvita Muceniece Head of Department Health Inspectorate Klijanu 7 Riga, LV-1012 Anita Segliņa Senior Expert Division of Environmental Health Ministry of Health Brīvības 72 Riga, LV-1011 Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 16 Lithuania Rosita Marija Balčienė Deputy Director National Public Health Surveillance Laboratory Žolyno 36 LT 10210, Vilnius Regina Burbienė Adviser National Public Health Centre Kalvariju Str. 153 LT-08221, Vilnius Saulius Majus Head of Product Evaluation Division National Public Health Centre Kalvariju Str. 153 LT-08221, Vilnius Montenegro Mira Radović Adviser Directorate for Public Health and Programme Health Protection Ministry of Health Roma Square 46 81000, Podgorica Poland Agnieszka Jankowska Chief Specialist Department for Risk Assessment Bureau for Chemical Substances Dowborczykow 30/34 90-019, Lodz Republic of Moldova Iurie Pinzaru Head of Public Health Protection Department National Agency for Public Health Gh. Asachi, 67-a 2028, Chisinau Russian Federation Mariya Pushkareva Head of Department of Support of Experts in Chemical Safety Center for Strategic Planning and Management of Medical and Biological Health Risks Antonie van 10 b.1, Pogodinskaya St. 119121, Moscow Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 17 Serbia Zorica Blagojević Laboratory for Ecotoxicology Institute of Public Health Dr Subotica 5 11000, Belgrade Branislava Matić Savićević Head of Department of Environmental Health and School Hygiene Institute of Public Health Dr Subotića 5 11000, Belgrade Ukraine Ruslan Koval Head of Hygienic Regulation Committee Ministry of Health 75, Saksagansky Str. 01033, Kyiv Nataliia Kurdil Senior Researcher L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety Str. Geroyiv Oborony, 6 03680, Kyiv Tatiana Skapa State Extert Expert Group on Protection and Preservation of Health and Prevention of Non-communicable Diseases Ministry of Health Hrushevskogo, 7 01601, Kyiv Temporary advisers Monique Mathieu Physician Poison Centre Lille University Hospital 2 Avenue Oscar Lambret, Lille 59000, France Nassima Zhunussova Head of Department of Non-communicable Diseases National Centre for Public Health 8 Mangilik El Avenue, 18B entrance Nur-Sultan, Kazakhstan Health sector involvement in chemicals management: implementation of the WHO Chemicals Road Map at a national level 18 Representatives of other organizations United Nations Institute for Training and Research Andrea Cararo Chemicals and Waste Programme Palais des Nations 1200 Geneva, Switzerland World Health Organization Regional Office for Europe Irina Zastenskaya Technical Officer WHO European Centre for Environment and Health Platz der Vereinten Nationen 1, Bonn, Germany Headquarters Magdalena Frydrych Chemical Safety and Health 1200 Geneva, Switzerland Interpreters Jana Tarasevich Minsk, Belarus Petr Dobrusov Minsk, Belarus Rapporteur Maryna Anisovich Minsk, Belarus World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: euwhocontact@who.int Website: www.euro.who.int The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations creted in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North Macedonia Norway Poland Member States Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan WHO/EURO:2020-5544-45309-64850