W O RL D HE AL TH O R GAN I ZA T I ON RE GI ON AL O FF I CE FO R EU RO PE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC71/17(D) 71st session Virtual session, 13–15 September 2021 5 August 2021 210795 Provisional agenda items 3 and 14 ORIGINAL: ENGLISH Midterm progress report on the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023 This report provides a midterm overview of the implementation of the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023. It is submitted to the WHO Regional Committee for Europe at its 71st session in September 2021, in line with resolution EUR/RC68/R7. EUR/RC71/17(D) page 2 Contents Introduction and background ..................................................................................................... 3 Strategic pillar 1: Build, strengthen and maintain States Parties’ core capacities required under the IHR (2005) ................................................................................................................. 4 Progress in strengthening IHR capacities as reported by Member States through the IHR Monitoring and Evaluation Framework .............................................................. 4 Progress in implementing key activities by Member States and WHO as outlined in the Action Plan ............................................................................................................. 6 Strategic pillar 2: Strengthen event management and compliance with the requirements under the IHR (2005) ................................................................................................................. 8 Notification and information sharing ................................................................................ 8 Emergency preparedness and response operations ........................................................... 9 Medical countermeasures and personnel deployment ...................................................... 9 Strategic pillar 3: Measure progress and promote accountability ............................................ 10 Mandatory annual reporting by States Parties ................................................................ 10 Assessment of capacities through use of voluntary tools ............................................... 10 Conclusions .............................................................................................................................. 10 EUR/RC71/17(D) page 3 Introduction and background 1. In resolution EUR/RC68/R7, the WHO Regional Committee for Europe urged Member States to implement actions presented in the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023, and requested that the WHO Regional Director for Europe monitor its implementation and report thereon, in a midterm evaluation to be presented to the Regional Committee at its 71st session (RC71) in 2021. 2. The Action Plan takes into account actions taken and lessons learned in the WHO European Region since the International Health Regulations (IHR) (2005) entered into force in 2007; it builds on the five-year global strategic plan to improve public health preparedness and response, 2018–2023, and is tailored to the needs of the Region. 3. The COVID-19 pandemic has underlined the importance of investing in emergency preparedness and response, including in the actions and commitments made in this Action Plan. While this progress report focuses on the implementation of the three strategic pillars of the Action Plan, the unprecedented response by Member States and WHO in 2020 to the COVID-19 pandemic is also considered. A detailed overview of activities implemented in 2019 can be accessed through the WHO Health Emergencies quarterly bulletin.1 The WHO Regional Office for Europe (WHO/Europe) pandemic response timeline and a summary of lessons learned through the pandemic response are available online.2,3 4. To assess the progress that has been made in implementing this Action Plan, IHR core capacity indicators reported by IHR States Parties in the Region through States Parties Annual Report (SPAR) and joint external evaluation (JEE) results have been used. Input was augmented through an online consultation with Member States, to which 25 responded. A detailed analysis of the survey results can be found in the related background document provided for RC71.4 1 See: https://www.euro.who.int/en/media-centre/newsletters/who-health-emergencies-whe-news. 2 A timeline of WHO's COVID-19 response in the WHO European Region. A living document (version 2.0), available at https://apps.who.int/iris/handle/10665/339983. An update to the timeline, covering the first six months of 2021, is available in an information document submitted to RC71. 3 WHO Regional Office for Europe COVID-19 Operational Update. A year in review: 2020. See: https://www.euro.who.int/__data/assets/pdf_file/0010/494056/WHO-EURO-COVID-19-Operational-Update.-A- year-in-review-2020.pdf. 4 Results of the Member States web-based consultation on the draft midterm progress report on the Action Plan to improve public health preparedness and response in the WHO European Region, 2018–2023. EUR/RC71/17(D) page 4 Strategic pillar 1: Build, strengthen and maintain States Parties’ core capacities required under the IHR (2005) Progress in strengthening IHR capacities as reported by Member States through the IHR Monitoring and Evaluation Framework States Parties’ annual reports5 5. Since 2018, regional progress has been reported for some of the 13 IHR core capacities. On the basis of SPAR submissions (the most recent reports were received on 20 July 2021), the overall average scores suggest that while almost all States Parties performed better in most capacities in 2020 than they had done in 2018, their performance in 2020 remained either at the same level or slightly lower than in 2019. In 2020, all capacities had either improved or remained the same since 2018. Chemical events, points of entry and risk communication were the weakest capacities reported through the full period. 6. Figure 1 presents the regional average score for each of the 13 capacity areas over time from 2018 to 2020 (submissions up until 20 July 2021 are included). In 2019, 52 of the 55 States Parties in the Region submitted a SPAR. A 2% increase in the overall regional average of capacities was reported in comparison with 2018. Forty-seven States Parties had submitted their 2020 SPAR as of 20 July 2021. An initial analysis reveals a mixed picture, where reported capacities have, on average, either remained the same or decreased slightly since 2019. Challenges in maintaining and improving implementation of the IHR core capacities remain and require further efforts and collaboration between States Parties, WHO and involved partners. Fig. 1. States Parties’ average score for each IHR core capacity, 2018–2020, WHO European Region6 5 All States Parties to the IHR (2005) have agreed to ensure implementation of the 13 IHR core capacities described in Annex 1 of the IHR (2005), which are required to effectively detect, assess, notify and respond to any potential public health event of international concern. Under Article 54, States Parties are required to annually report on implementation progress to the World Health Assembly through the mandatory SPAR process. 6 The graph includes SPAR submissions received until 20 July 2021. When interpreting the graph, the lower number of submissions received in the 2020 reporting cycle in comparison with the two previous reporting cycles should be taken into consideration. EUR/RC71/17(D) page 5 Joint external evaluations 7. At the time of writing, 18 JEE missions had been conducted in the Region. Quantitative and qualitative analyses of the 17 published JEE mission reports showed that the three technical areas in the Region with the highest average JEE scores were immunization (4.3), food safety (3.9) and radiation emergencies (3.8). The areas with the lowest average scores were biosafety and biosecurity (2.7), antimicrobial resistance (2.8) and points of entry (3.1). A summary of JEE scores across the technical areas is presented in Figure 2. Fig. 2. Summary of JEE scores across the technical areas, 2016–2019, WHO European Region (based on 17 JEE reports published to date) 8. Common themes in the recommended priority actions relate to strengthening of all- hazard and whole-of-government approaches, coordination and information exchange, development of national legislative frameworks, digitalization of surveillance and reporting systems, enhanced cooperation between sectoral laboratories, and risk mapping. Continuous training and awareness-raising activities on zoonotic diseases and antimicrobial resistance, and the need for regular multisectoral exercises, were often mentioned. Lack of sustainable funding and human resources were also key recurring themes. 9. More than 50 % of Member States responding to the survey reported full implementation of actions in the areas of notification and information sharing, mandatory annual reporting, and national policies, plans and legislation. For implementation of actions on One Health, 50% of the respondents reported full implementation, while 27% reported low-level implementation. Risk communication is one of the areas with the highest reported low-level implementation of actions (27%). Other areas with low-level implementation of actions are: synergies between emergency preparedness and response; health system strengthening and essential public health functions; and emergency preparedness and response operations. EUR/RC71/17(D) page 6 Progress in implementing key activities by Member States and WHO as outlined in the Action Plan National policies, plans and legislation 10. On the basis of the results of IHR monitoring and evaluation activities, WHO/Europe supported the development of national strategic action plans for health emergency preparedness and health security in five countries. IHR (2005) coordination, communication and advocacy 11. WHO/Europe supported the development of guidance, tools, training and advocacy materials aimed at improving multisectoral implementation of the IHR (2005) and the national IHR focal points (IHR NFPs) function. Regional platforms have been used to strengthen NFP networking and exchange best practices, including through regional and subregional meetings, workshops, tailored national training and the European IHR Knowledge Network. National laboratory systems 12. Armenia, Belarus and Kazakhstan joined the Better Labs for Better Health initiative at the end of 2017 and have established national laboratory working groups for laboratory system strengthening. 13. Between 2018 and 2020, 37 training sessions on quality and biosafety management, mentoring and sample transport were held in nine countries. WHO supported 39 laboratories in the implementation of their quality management systems by providing mentors. 14. WHO/Europe established the European Regional Laboratory Task Force for High Threat Pathogens in 2019. 15. WHO held joint workshops in Kyrgyzstan, Tajikistan and Uzbekistan in 2018 and 2019 on sample referral and veterinary, microbiology and environmental sampling. These workshops were followed by the endorsement of guidelines on national sample transport by Kyrgyzstan and Tajikistan. National surveillance systems 16. To enhance the quality and use of surveillance data on high threat pathogens, including novel influenza viruses with pandemic potential, anthrax, rabies, Crimean–Congo haemorrhagic fever, Rift Valley fever and cholera – and, in 2020, SARS-CoV-2 – WHO/Europe supported the following: (a) validation of surveillance data on high threat pathogen morbidity and mortality reported by Member States to WHO between 2006 and 2019 to improve the quality and completeness of the data, and creation of a single database to store all historical data; (b) implementation and evaluation of early warning systems by developing a regional early warning, alert and response strategy with an implementation tool; and (c) implementation of data-secure mechanisms on relevant platforms for the exchange of personal data for the purpose of coordinated contact tracing between NFPs. EUR/RC71/17(D) page 7 17. At the start of the COVID-19 pandemic, WHO/Europe supported countries in repurposing influenza networks and surveillance for COVID-19, including by preparing sentinel sites for influenza and severe acute respiratory infection surveillance to enable studies to monitor COVID-19 vaccine effectiveness. Over 100 technical webinars and online training resources for COVID-19 surveillance and response were provided, and country missions were undertaken to strengthen SARS-CoV-2 surveillance. Daily and weekly situation updates continue to be provided through the weekly surveillance bulletin on COVID-19 and the WHO/Europe COVID-19 dashboard. Risk communication 18. WHO/Europe has provided IHR States Parties with guidance, training, tools, and on-site and remote support as part of the emergency risk communication five-step capacity-building package and has supported the package’s integration into national action plans for health emergency preparedness. During 2018 and 2019, 12 States Parties received direct mission support. Additionally, the flagship SocialNet training and simulation for integrating behavioural and social science capacities into public health emergency response took place twice, in 2018 and 2019, with participation from 30 States Parties.7,8 19. Since the onset of the pandemic, 30 remote and online capacity-building webinars targeting more than 2500 risk communication and community engagement (RCCE) experts have been conducted, and the following have been provided: tailored workshops for country office and States Parties’ risk communication focal points; templates for RCCE strategies, including strategic operating procedures to support the establishment and functioning of national coordination mechanisms for RCCE; RCCE guidance and training modules on hotlines, contact tracing and repurposing of health worker, youth and journalist engagement for emergency readiness; and innovative RCCE tools, such as the HealthBuddy+ chatbot,9 which was translated into 19 languages, and the behavioural insight tool, which was rolled out in 27 countries and territories. Points of entry 20. WHO has produced tools, guidance, scientific briefs, e-learning courses, and regional webinars and training resources. Prior to COVID-19, WHO/Europe supported countries in the Region in assessing and enhancing public health capacities at points of entry and exit. In 2019, WHO/Europe conducted subregional training on the use of the assessment tool for core capacity requirements at designated airports, ports and ground crossings, which was attended by 50 participants from 13 priority countries. 21. Since January 2021, WHO has supported countries in mitigating the effects of introduction, exportation, and the potential spread of SARS-CoV-2, as well as cross-border risk management in the context of COVID-19, through tailored point-of-entry assessments and training. 7 Social science training enhances community engagement in health emergencies in 11 countries of the European Region. See: https://www.euro.who.int/en/countries/kyrgyzstan/news/news/2019/2/social-science-training- enhances-community-engagement-in-health-emergencies-in-11-countries-of-the-european-region. 8 SOCIALNET 2019: A real-life rehearsal on risk communication, community engagement and social science for the COVID-19 pandemic. See: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus- covid-19/news/news/2020/9/socialnet-2019-a-real-life-rehearsal-on-risk-communication,-community- engagement-and-social-science-for-the-covid-19-pandemic/socialnet-2019. 9 HealthBuddy+ can be accessed at https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus- covid-19/healthbuddy. EUR/RC71/17(D) page 8 Synergies between emergency preparedness and response, health system strengthening and essential public health functions 22. In 2019, WHO developed a toolkit for assessing and strengthening people-centred emergency care systems, which encompassed a full package of services: pre-hospital services, emergency medical services, intensive care units and hospital-based services, and out-of- hospital services including palliative and rehabilitation care. 23. During 2020, with the COVID-19 pandemic causing massive disruption of essential health services, WHO supported the repurposing of health system resources. WHO developed a comprehensive four-step approach to ensure country ownership and strengthen the leadership of health ministries in maintaining continuity of essential health service delivery. 24. Since 2019, WHO/Europe has supported hospital safety assessments based on the Hospital Safety Index in 11 countries as well as hospital response plan development in Albania and Georgia. 25. Mass casualty incident management training sessions developed by WHO/Europe, encompassing the fundamentals of emergency services, were conducted in Georgia and Kyrgyzstan for health care workers in 2019. One Health 26. WHO/Europe has supported countries in strengthening the human–animal health interface through the implementation of national bridging workshops and simulations. Since 2019, nine such workshops and two simulations have been conducted by WHO/Europe and the World Organisation for Animal Health (OIE). 27. WHO/Europe joined a tripartite partnership with the Food and Agriculture Organization of the United Nations and OIE on the establishment of a regional One Health coordination mechanism. 28. In the context of COVID-19 and the zoonotic aspects of the disease, WHO/Europe conducted a survey of SARS-CoV-2 in mink farms in Member States and provided technical advice to Member States with fur-farming industries. WHO has also investigated the impact of COVID-19 on food control and food safety risk management and provided recommendations for governments and businesses to reduce the impact of food supply chain disruptions on food safety. Strategic pillar 2: Strengthen event management and compliance with the requirements under the IHR (2005) Notification and information sharing 29. WHO/Europe has been coordinating urgent communications under IHR Articles 6–10 for COVID-19 and non-COVID-19 public health events occurring in the Region. Annual assessments on the timeliness and completeness of NFP responses have been made available in an annual IHR implementation report since 2018. Information was shared by WHO through the Event Information Site (Article 11), Disease Outbreak News, featured media articles and dedicated dashboards. EUR/RC71/17(D) page 9 30. As at 21 July 2021, IHR States Parties in the Region had implemented a total of 3361 additional health measures in response to COVID-19, according to Article 43 of the IHR (2005). In accordance with that article, WHO shared information about these measures with all States Parties on a weekly basis through the Event Information Site. Emergency preparedness and response operations 31. To support Member States in all-hazard and hazard-specific emergency preparedness and response plans, WHO/Europe developed “off-the-shelf” packages on emergency operations planning and hazard-specific contingency plans and piloted them in four countries in 2019. 32. WHO/Europe has supported 10 countries in conducting national strategic risk assessments using the Strategic Tool for Assessing Risks since 2019. 33. During 2020–2021, several public health events required application of the WHO Emergency Response Framework in the Region, triggering emergency procedures to support response operations. WHO/Europe responded to the following seven graded emergencies, and several ungraded emergencies: • Grade 2, multi-country polio • Grade 3, global response to the COVID-19 pandemic • Grade 3, whole of Syrian Arab Republic response • Grade 2, multi-country measles • Grade 2, protracted crisis in Ukraine • Grade 2, conflict between Armenia and Azerbaijan (first graded on 6 October 2020) • Grade 1, earthquake in Albania Medical countermeasures and personnel deployment 34. WHO and its operational partners deploy experts and medical countermeasures to emergency settings. During non-emergency phases, WHO strengthens coordination mechanisms in preparedness for and response to emergencies, including those mechanisms set by the Health Cluster, emergency medical teams, the Global Outbreak Alert and Response Network (GOARN) and stand-by partners. 35. As of the end of April 2021, WHO/Europe has conducted 201 support missions and deployments to 23 countries and areas in response to COVID-19. 36. Twenty European GOARN partners were deployed during 2018–2019, through 81 deployments, to provide support to seven responses. In 2020–2021, WHO/Europe mobilized 24 GOARN partners to seven countries or areas. 37. A new European Regional Governance Structure for Emergency Medical Teams in the European Region was adopted. During the COVID-19 pandemic, WHO mobilized eight WHO-classified emergency medical teams to five countries in Europe requiring hands-on clinical support. EUR/RC71/17(D) page 10 38. Between February 2020 and April 2021, 428 shipments of critical supplies worth a total of US$ 64 million had been dispatched by the supply consortium established by WHO to 32 countries and areas in the Region. Five regional COVID-19 reference laboratories were immediately established to support international testing, shipping 1218 samples from 22 countries. Strategic pillar 3: Measure progress and promote accountability Mandatory annual reporting by States Parties 39. Since the launch of the Action Plan, WHO/Europe has continued to support coordinated assessments of national core capacities through four components of the IHR Monitoring and Evaluation Framework: SPAR, JEEs, intra-action and after-action reviews, and simulation exercises. 40. WHO has offered a digital platform that allows States Parties to report online, thereby facilitating reporting by the States Parties, as well as transparency and the real-time monitoring of reports submitted. The number of SPARs submitted by States Parties in the Region increased from 50 for 2018 to 52 for 2019. For 2020, 47 States Parties had submitted their reports as of 20 July 2021. Assessment of capacities through use of voluntary tools 41. As of 31 March 2021, 18 States Parties had conducted a voluntary JEE. In addition to improving evaluation tools, WHO has been developing a codebook of JEE recommendations to support countries in planning and prioritizing activities to strengthen emergency preparedness capacity. In 2020, as a result of travel restrictions, guidance for virtual and hybrid JEEs were developed by WHO. Several JEE kick-off workshops have been conducted virtually. 42. The Joint Assessment and Detection of Events simulation exercise for all 55 IHR NFPs was organized in the Region in 2018 and 2019. Subregional training for simulation exercise facilitators was conducted in the areas of natural disasters, mass casualty events and outbreaks. 43. Several countries in the Region were supported in conducting after-action reviews of their emergency operations to respond to outbreaks, such as measles, using the WHO after-action review methodology. Six intra-action reviews had been implemented in the Region as of March 2021. A joint WHO–European Centre for Disease Prevention and Control lessons learned webinar based on country intra-action review findings was organized in February 2021. 44. Translating findings and recommendations from the different IHR Monitoring and Evaluation Framework activities into funded priority actions to improve national emergency preparedness capacities remains a challenge. Conclusions 45. The COVID-19 pandemic highlights the need for intensified efforts and investment in accelerating the implementation of the Action Plan. IHR core capacities should be augmented by wider whole-of-government and whole-of-society approaches. To this end, the Regional EUR/RC71/17(D) page 11 Committee is invited to consider the development of a renewed action plan for resilience against health emergencies in the WHO European Region, 2022–2025, to replace the current one. = = =
W O RL D HE AL TH O R GAN I ZA T I ON RE GI ON AL O FF I CE FO R EU RO PE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC71/17(D) Rev.1 71st session Virtual session, 13–15 September 2021 30 August 2021 210795 Provisional agenda items 3 and 14 ORIGINAL: ENGLISH Midterm progress report on the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023 This report provides a midterm overview of the implementation of the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023. It is submitted to the WHO Regional Committee for Europe at its 71st session in September 2021, in line with resolution EUR/RC68/R7. EUR/RC71/17(D) Rev.1 page 2 Contents Introduction and background ..................................................................................................... 3 Strategic pillar 1: Build, strengthen and maintain States Parties’ core capacities required under the IHR (2005) ................................................................................................................. 4 Progress in strengthening IHR capacities as reported by Member States through the IHR Monitoring and Evaluation Framework .............................................................. 4 Progress in implementing key activities by Member States and WHO as outlined in the Action Plan ............................................................................................................. 6 Strategic pillar 2: Strengthen event management and compliance with the requirements under the IHR (2005) ................................................................................................................. 8 Notification and information sharing ................................................................................ 8 Emergency preparedness and response operations ........................................................... 9 Medical countermeasures and personnel deployment ...................................................... 9 Strategic pillar 3: Measure progress and promote accountability ............................................ 10 Mandatory annual reporting by States Parties ................................................................ 10 Assessment of capacities through use of voluntary tools ............................................... 10 Conclusions .............................................................................................................................. 11 EUR/RC71/17(D) Rev.1 page 3 Introduction and background 1. In resolution EUR/RC68/R7, the WHO Regional Committee for Europe urged Member States to implement actions presented in the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023, and requested that the WHO Regional Director for Europe monitor its implementation and report thereon, in a midterm evaluation to be presented to the Regional Committee at its 71st session (RC71) in 2021. 2. The Action Plan takes into account actions taken and lessons learned in the WHO European Region since the International Health Regulations (IHR) (2005) entered into force in 2007; it builds on the five-year global strategic plan to improve public health preparedness and response, 2018–2023, and is tailored to the needs of the Region. 3. The COVID-19 pandemic has underlined the importance of investing in emergency preparedness and response, including in the actions and commitments made in this Action Plan. While this progress report focuses on the implementation of the three strategic pillars of the Action Plan, the unprecedented response by Member States and WHO in 2020 to the COVID-19 pandemic is also considered. A detailed overview of activities implemented in 2019 can be accessed through the WHO Health Emergencies quarterly bulletin.1 The WHO Regional Office for Europe (WHO/Europe) pandemic response timeline and a summary of lessons learned through the pandemic response are available online.2,3 4. To assess the progress that has been made in implementing this Action Plan, IHR core capacity indicators reported by IHR States Parties in the Region through States Parties Annual Report (SPAR) and joint external evaluation (JEE) results have been used. Input was augmented through an online consultation with Member States, to which 25 responded. A detailed analysis of the survey results can be found in the related background document provided for RC71.4 1 See: https://www.euro.who.int/en/media-centre/newsletters/who-health-emergencies-whe-news. 2 A timeline of WHO's COVID-19 response in the WHO European Region. A living document (version 2.0), available at https://apps.who.int/iris/handle/10665/339983. An update to the timeline, covering the first six months of 2021, is available in an information document submitted to RC71. 3 WHO Regional Office for Europe COVID-19 Operational Update. A year in review: 2020. See: https://www.euro.who.int/__data/assets/pdf_file/0010/494056/WHO-EURO-COVID-19-Operational-Update.-A- year-in-review-2020.pdf. 4 Results of the Member States web-based consultation on the draft midterm progress report on the Action Plan to improve public health preparedness and response in the WHO European Region, 2018–2023. EUR/RC71/17(D) Rev.1 page 4 Strategic pillar 1: Build, strengthen and maintain States Parties’ core capacities required under the IHR (2005) Progress in strengthening IHR capacities as reported by Member States through the IHR Monitoring and Evaluation Framework States Parties’ annual reports5 5. Since 2018, regional progress has been reported for some of the 13 IHR core capacities. On the basis of SPAR submissions (the most recent reports were received on 20 July 2021), the overall average scores suggest that while almost all States Parties performed better in most capacities in 2020 than they had done in 2018, their performance in 2020 remained either at the same level or slightly lower than in 2019. In 2020, all capacities had either improved or remained the same since 2018. Chemical events, points of entry and risk communication were the weakest capacities reported through the full period. 6. Figure 1 presents the regional average score for each of the 13 capacity areas over time from 2018 to 2020 (submissions up until 20 July 2021 are included). In 2019, 52 of the 55 States Parties in the Region submitted a SPAR. A 2% increase in the overall regional average of capacities was reported in comparison with 2018. Forty-seven States Parties had submitted their 2020 SPAR as of 20 July 2021. An initial analysis reveals a mixed picture, where reported capacities have, on average, either remained the same or decreased slightly since 2019. Challenges in maintaining and improving implementation of the IHR core capacities remain and require further efforts and collaboration between States Parties, WHO and involved partners. Fig. 1. States Parties’ average score for each IHR core capacity, 2018–2020, WHO European Region6 5 All States Parties to the IHR (2005) have agreed to ensure implementation of the 13 IHR core capacities described in Annex 1 of the IHR (2005), which are required to effectively detect, assess, notify and respond to any potential public health event of international concern. Under Article 54, States Parties are required to annually report on implementation progress to the World Health Assembly through the mandatory SPAR process. 6 The graph includes SPAR submissions received until 20 July 2021. When interpreting the graph, the lower number of submissions received in the 2020 reporting cycle in comparison with the two previous reporting cycles should be taken into consideration. EUR/RC71/17(D) Rev.1 page 5 Joint external evaluations 7. At the time of writing, 18 JEE missions had been conducted in the Region. Quantitative and qualitative analyses of the 17 published JEE mission reports showed that the three technical areas in the Region with the highest average JEE scores were immunization (4.3), food safety (3.9) and radiation emergencies (3.8). The areas with the lowest average scores were biosafety and biosecurity (2.7), antimicrobial resistance (2.8) and points of entry (3.1). A summary of JEE scores across the technical areas is presented in Figure 2. Fig. 2. Summary of JEE scores across the technical areas, 2016–2019, WHO European Region (based on 17 JEE reports published to date) 8. Common themes in the recommended priority actions relate to strengthening of all- hazard and whole-of-government approaches, coordination and information exchange, development of national legislative frameworks, digitalization of surveillance and reporting systems, enhanced cooperation between sectoral laboratories, and risk mapping. Continuous training and awareness-raising activities on zoonotic diseases and antimicrobial resistance, and the need for regular multisectoral exercises, were often mentioned. Lack of sustainable funding and human resources were also key recurring themes. 9. More than 50 % of Member States responding to the survey reported full implementation of actions in the areas of notification and information sharing, mandatory annual reporting, and national policies, plans and legislation. For implementation of actions on One Health, 50% of the respondents reported full implementation, while 27% reported low-level implementation. Risk communication is one of the areas with the highest reported low-level implementation of actions (27%). Other areas with low-level implementation of actions are: synergies between emergency preparedness and response; health system strengthening and essential public health functions; and emergency preparedness and response operations. EUR/RC71/17(D) Rev.1 page 6 Progress in implementing key activities by Member States and WHO as outlined in the Action Plan National policies, plans and legislation 10. On the basis of the results of IHR monitoring and evaluation activities, WHO/Europe supported the development of national strategic action plans for health emergency preparedness and health security in five countries. IHR (2005) coordination, communication and advocacy 11. WHO/Europe supported the development of guidance, tools, training and advocacy materials aimed at improving multisectoral implementation of the IHR (2005) and the national IHR focal points (IHR NFPs) function. Regional platforms have been used to strengthen NFP networking and exchange best practices, including through regional and subregional meetings, workshops, tailored national training and the European IHR Knowledge Network. National laboratory systems 12. Armenia, Belarus and Kazakhstan joined the Better Labs for Better Health initiative at the end of 2017 and have established national laboratory working groups for laboratory system strengthening. 13. Between 2018 and 2020, 37 training sessions on quality and biosafety management, mentoring and sample transport were held in nine countries. WHO supported 39 laboratories in the implementation of their quality management systems by providing mentors. 14. WHO/Europe established the European Regional Laboratory Task Force for High Threat Pathogens in 2019. 15. WHO held joint workshops in Kyrgyzstan, Tajikistan and Uzbekistan in 2018 and 2019 on sample referral and veterinary, microbiology and environmental sampling. These workshops were followed by the endorsement of guidelines on national sample transport by Kyrgyzstan and Tajikistan. National surveillance systems 16. To enhance the quality and use of surveillance data on high threat pathogens, including novel influenza viruses with pandemic potential, anthrax, rabies, Crimean–Congo haemorrhagic fever, Rift Valley fever and cholera – and, in 2020, SARS-CoV-2 – WHO/Europe supported the following: (a) validation of surveillance data on high threat pathogen morbidity and mortality reported by Member States to WHO between 2006 and 2019 to improve the quality and completeness of the data, and creation of a single database to store all historical data; (b) implementation and evaluation of early warning systems by developing a regional early warning, alert and response strategy with an implementation tool; and (c) implementation of data-secure mechanisms on relevant platforms for the exchange of personal data for the purpose of coordinated contact tracing between NFPs. EUR/RC71/17(D) Rev.1 page 7 17. At the start of the COVID-19 pandemic, WHO/Europe supported countries in repurposing influenza networks and surveillance for COVID-19, including by preparing sentinel sites for influenza and severe acute respiratory infection surveillance to enable studies to monitor COVID-19 vaccine effectiveness. Over 100 technical webinars and online training resources for COVID-19 surveillance and response were provided, and country missions were undertaken to strengthen SARS-CoV-2 surveillance. Daily and weekly situation updates continue to be provided through the weekly surveillance bulletin on COVID-19 and the WHO/Europe COVID-19 dashboard. Risk communication 18. WHO/Europe has provided IHR States Parties with guidance, training, tools, and on-site and remote support as part of the emergency risk communication five-step capacity-building package and has supported the package’s integration into national action plans for health emergency preparedness. During 2018 and 2019, 12 States Parties received direct mission support. Additionally, the flagship SocialNet training and simulation for integrating behavioural and social science capacities into public health emergency response took place twice, in 2018 and 2019, with participation from 30 States Parties.7,8 19. Since the onset of the pandemic, 30 remote and online capacity-building webinars targeting more than 2500 risk communication and community engagement (RCCE) experts have been conducted, and the following have been provided: tailored workshops for country office and States Parties’ risk communication focal points; templates for RCCE strategies, including strategic operating procedures to support the establishment and functioning of national coordination mechanisms for RCCE; RCCE guidance and training modules on hotlines, contact tracing and repurposing of health worker, youth and journalist engagement for emergency readiness; and innovative RCCE tools, such as the HealthBuddy+ chatbot,9 which was translated into 19 languages, and the behavioural insight tool, which was rolled out in 27 countries and territories. Points of entry 20. WHO has produced tools, guidance, scientific briefs, e-learning courses, and regional webinars and training resources. Prior to COVID-19, WHO/Europe supported countries in the Region in assessing and enhancing public health capacities at points of entry and exit. In 2019, WHO/Europe conducted subregional training on the use of the assessment tool for core capacity requirements at designated airports, ports and ground crossings, which was attended by 50 participants from 13 priority countries. 21. Since January 2021, WHO has supported countries in mitigating the effects of introduction, exportation, and the potential spread of SARS-CoV-2, as well as cross-border 7 Social science training enhances community engagement in health emergencies in 11 countries of the European Region. See: https://www.euro.who.int/en/countries/kyrgyzstan/news/news/2019/2/social-science-training- enhances-community-engagement-in-health-emergencies-in-11-countries-of-the-european-region. 8 SOCIALNET 2019: A real-life rehearsal on risk communication, community engagement and social science for the COVID-19 pandemic. See: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus- covid-19/news/news/2020/9/socialnet-2019-a-real-life-rehearsal-on-risk-communication,-community- engagement-and-social-science-for-the-covid-19-pandemic/socialnet-2019. 9 HealthBuddy+ can be accessed at https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus- covid-19/healthbuddy. EUR/RC71/17(D) Rev.1 page 8 risk management in the context of COVID-19, through tailored point-of-entry assessments and training. Synergies between emergency preparedness and response, health system strengthening and essential public health functions 22. In 2019, WHO developed a toolkit for assessing and strengthening people-centred emergency care systems, which encompassed a full package of services: pre-hospital services, emergency medical services, intensive care units and hospital-based services, and out-of- hospital services including palliative and rehabilitation care. 23. During 2020, with the COVID-19 pandemic causing massive disruption of essential health services, WHO supported the repurposing of health system resources. WHO developed a comprehensive four-step approach to ensure country ownership and strengthen the leadership of health ministries in maintaining continuity of essential health service delivery. 24. Since 2019, WHO/Europe has supported hospital safety assessments based on the Hospital Safety Index in 11 countries as well as hospital response plan development in Albania and Georgia. 25. Mass casualty incident management training sessions developed by WHO/Europe, encompassing the fundamentals of emergency services, were conducted in Georgia and Kyrgyzstan for health care workers in 2019. One Health 26. WHO/Europe has supported countries in strengthening the human–animal health interface through the implementation of national bridging workshops and simulations. Since 2019, nine such workshops and two simulations have been conducted by WHO/Europe and the World Organisation for Animal Health (OIE). 27. WHO/Europe joined a tripartite partnership with the Food and Agriculture Organization of the United Nations and OIE on the establishment of a regional One Health coordination mechanism. 28. In the context of COVID-19 and the zoonotic aspects of the disease, WHO/Europe conducted a survey of SARS-CoV-2 in mink farms in Member States and provided technical advice to Member States with fur-farming industries. WHO has also investigated the impact of COVID-19 on food control and food safety risk management and provided recommendations for governments and businesses to reduce the impact of food supply chain disruptions on food safety. Strategic pillar 2: Strengthen event management and compliance with the requirements under the IHR (2005) Notification and information sharing 29. WHO/Europe has been coordinating urgent communications under IHR Articles 6–10 for COVID-19 and non-COVID-19 public health events occurring in the Region. Annual EUR/RC71/17(D) Rev.1 page 9 assessments on the timeliness and completeness of NFP responses have been made available in an annual IHR implementation report since 2018. Information was shared by WHO through the Event Information Site (Article 11), Disease Outbreak News, featured media articles and dedicated dashboards. 30. As at 21 July 2021, IHR States Parties in the Region had implemented a total of 3361 additional health measures in response to COVID-19, according to Article 43 of the IHR (2005). In accordance with that article, WHO shared information about these measures with all States Parties on a weekly basis through the Event Information Site. Emergency preparedness and response operations 31. To support Member States in all-hazard and hazard-specific emergency preparedness and response plans, WHO/Europe developed “off-the-shelf” packages on emergency operations planning and hazard-specific contingency plans and piloted them in four countries in 2019. 32. WHO/Europe has supported 10 countries in conducting national strategic risk assessments using the Strategic Tool for Assessing Risks since 2019. 33. During 2020–2021, several public health events required application of the WHO Emergency Response Framework in the Region, triggering emergency procedures to support response operations. WHO/Europe responded to the following seven graded emergencies, and several ungraded emergencies: • Grade 2, multi-country polio • Grade 3, global response to the COVID-19 pandemic • Grade 3, whole of Syrian Arab Republic response • Grade 2, multi-country measles • Grade 2, protracted crisis in Ukraine • Grade 2, conflict between Armenia and Azerbaijan (first graded on 6 October 2020) • Grade 1, earthquake in Albania Medical countermeasures and personnel deployment 34. WHO and its operational partners deploy experts and medical countermeasures to emergency settings. During non-emergency phases, WHO strengthens coordination mechanisms in preparedness for and response to emergencies, including those mechanisms set by the Health Cluster, emergency medical teams, the Global Outbreak Alert and Response Network (GOARN) and stand-by partners. 35. As of the end of April 2021, WHO/Europe has conducted 201 support missions and deployments to 23 countries and areas in response to COVID-19. 36. Twenty European GOARN partners were deployed during 2018–2019, through 81 deployments, to provide support to seven responses. In 2020–2021, WHO/Europe mobilized 24 GOARN partners to seven countries or areas. EUR/RC71/17(D) Rev.1 page 10 37. A new European Regional Governance Structure for Emergency Medical Teams in the European Region was adopted. During the COVID-19 pandemic, WHO mobilized eight WHO-classified emergency medical teams to five countries in Europe requiring hands-on clinical support. 38. Between February 2020 and April 2021, 428 shipments of critical supplies worth a total of US$ 64 million had been dispatched by the supply consortium established by WHO to 32 countries and areas in the Region. Five regional COVID-19 reference laboratories were immediately established to support international testing, shipping 1218 samples from 22 countries. Strategic pillar 3: Measure progress and promote accountability Mandatory annual reporting by States Parties 39. Since the launch of the Action Plan, WHO/Europe has continued to support coordinated assessments of national core capacities through four components of the IHR Monitoring and Evaluation Framework: SPAR, JEEs, intra-action and after-action reviews, and simulation exercises. 40. WHO has offered a digital platform that allows States Parties to report online, thereby facilitating reporting by the States Parties, as well as transparency and the real-time monitoring of reports submitted. The number of SPARs submitted by States Parties in the Region increased from 50 for 2018 to 52 for 2019. For 2020, 47 States Parties had submitted their reports as of 20 July 2021. Assessment of capacities through use of voluntary tools 41. As of 31 March 2021, 18 States Parties had conducted a voluntary JEE. In addition to improving evaluation tools, WHO has been developing a codebook of JEE recommendations to support countries in planning and prioritizing activities to strengthen emergency preparedness capacity. In 2020, as a result of travel restrictions, guidance for virtual and hybrid JEEs were developed by WHO. Several JEE kick-off workshops have been conducted virtually. 42. The Joint Assessment and Detection of Events simulation exercise for all 55 IHR NFPs was organized in the Region in 2018 and 2019. Subregional training for simulation exercise facilitators was conducted in the areas of natural disasters, mass casualty events and outbreaks. 43. Several countries in the Region were supported in conducting after-action reviews of their emergency operations to respond to outbreaks, such as measles, using the WHO after-action review methodology. Six intra-action reviews had been implemented in the Region as of March 2021. A joint WHO–European Centre for Disease Prevention and Control lessons learned webinar based on country intra-action review findings was organized in February 2021. 44. Translating findings and recommendations from the different IHR Monitoring and Evaluation Framework activities into funded priority actions to improve national emergency preparedness capacities remains a challenge. EUR/RC71/17(D) Rev.1 page 11 Conclusions 45. The COVID-19 pandemic highlights the need for intensified efforts and investment in accelerating the implementation of the Action Plan. IHR core capacities should be augmented by wider whole-of-government and whole-of-society approaches. To this end, the Regional Committee will be invited to consider the development of a renewed action plan for resilience against health emergencies in the WHO European Region, to eventually replace the current one. = = =
W O RL D HE AL TH O R GAN I ZA T I ON RE GI ON AL O FF I CE FO R EU RO PE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC71/17(D) Rev.1 71st session Virtual session, 13–15 September 2021 30 August 2021 210795 Provisional agenda items 3 and 14 ORIGINAL: ENGLISH Midterm progress report on the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023 This report provides a midterm overview of the implementation of the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023. It is submitted to the WHO Regional Committee for Europe at its 71st session in September 2021, in line with resolution EUR/RC68/R7. EUR/RC71/17(D) Rev.1 page 2 Contents Introduction and background ..................................................................................................... 3 Strategic pillar 1: Build, strengthen and maintain States Parties’ core capacities required under the IHR (2005) ................................................................................................................. 4 Progress in strengthening IHR capacities as reported by Member States through the IHR Monitoring and Evaluation Framework .............................................................. 4 Progress in implementing key activities by Member States and WHO as outlined in the Action Plan ............................................................................................................. 6 Strategic pillar 2: Strengthen event management and compliance with the requirements under the IHR (2005) ................................................................................................................. 8 Notification and information sharing ................................................................................ 8 Emergency preparedness and response operations ........................................................... 9 Medical countermeasures and personnel deployment ...................................................... 9 Strategic pillar 3: Measure progress and promote accountability ............................................ 10 Mandatory annual reporting by States Parties ................................................................ 10 Assessment of capacities through use of voluntary tools ............................................... 10 Conclusions .............................................................................................................................. 11 EUR/RC71/17(D) Rev.1 page 3 Introduction and background 1. In resolution EUR/RC68/R7, the WHO Regional Committee for Europe urged Member States to implement actions presented in the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023, and requested that the WHO Regional Director for Europe monitor its implementation and report thereon, in a midterm evaluation to be presented to the Regional Committee at its 71st session (RC71) in 2021. 2. The Action Plan takes into account actions taken and lessons learned in the WHO European Region since the International Health Regulations (IHR) (2005) entered into force in 2007; it builds on the five-year global strategic plan to improve public health preparedness and response, 2018–2023, and is tailored to the needs of the Region. 3. The COVID-19 pandemic has underlined the importance of investing in emergency preparedness and response, including in the actions and commitments made in this Action Plan. While this progress report focuses on the implementation of the three strategic pillars of the Action Plan, the unprecedented response by Member States and WHO in 2020 to the COVID-19 pandemic is also considered. A detailed overview of activities implemented in 2019 can be accessed through the WHO Health Emergencies quarterly bulletin.1 The WHO Regional Office for Europe (WHO/Europe) pandemic response timeline and a summary of lessons learned through the pandemic response are available online.2,3 4. To assess the progress that has been made in implementing this Action Plan, IHR core capacity indicators reported by IHR States Parties in the Region through States Parties Annual Report (SPAR) and joint external evaluation (JEE) results have been used. Input was augmented through an online consultation with Member States, to which 25 responded. A detailed analysis of the survey results can be found in the related background document provided for RC71.4 1 See: https://www.euro.who.int/en/media-centre/newsletters/who-health-emergencies-whe-news. 2 A timeline of WHO's COVID-19 response in the WHO European Region. A living document (version 2.0), available at https://apps.who.int/iris/handle/10665/339983. An update to the timeline, covering the first six months of 2021, is available in an information document submitted to RC71. 3 WHO Regional Office for Europe COVID-19 Operational Update. A year in review: 2020. See: https://www.euro.who.int/__data/assets/pdf_file/0010/494056/WHO-EURO-COVID-19-Operational-Update.-A- year-in-review-2020.pdf. 4 Results of the Member States web-based consultation on the draft midterm progress report on the Action Plan to improve public health preparedness and response in the WHO European Region, 2018–2023. EUR/RC71/17(D) Rev.1 page 4 Strategic pillar 1: Build, strengthen and maintain States Parties’ core capacities required under the IHR (2005) Progress in strengthening IHR capacities as reported by Member States through the IHR Monitoring and Evaluation Framework States Parties’ annual reports5 5. Since 2018, regional progress has been reported for some of the 13 IHR core capacities. On the basis of SPAR submissions (the most recent reports were received on 20 July 2021), the overall average scores suggest that while almost all States Parties performed better in most capacities in 2020 than they had done in 2018, their performance in 2020 remained either at the same level or slightly lower than in 2019. In 2020, all capacities had either improved or remained the same since 2018. Chemical events, points of entry and risk communication were the weakest capacities reported through the full period. 6. Figure 1 presents the regional average score for each of the 13 capacity areas over time from 2018 to 2020 (submissions up until 20 July 2021 are included). In 2019, 52 of the 55 States Parties in the Region submitted a SPAR. A 2% increase in the overall regional average of capacities was reported in comparison with 2018. Forty-seven States Parties had submitted their 2020 SPAR as of 20 July 2021. An initial analysis reveals a mixed picture, where reported capacities have, on average, either remained the same or decreased slightly since 2019. Challenges in maintaining and improving implementation of the IHR core capacities remain and require further efforts and collaboration between States Parties, WHO and involved partners. Fig. 1. States Parties’ average score for each IHR core capacity, 2018–2020, WHO European Region6 5 All States Parties to the IHR (2005) have agreed to ensure implementation of the 13 IHR core capacities described in Annex 1 of the IHR (2005), which are required to effectively detect, assess, notify and respond to any potential public health event of international concern. Under Article 54, States Parties are required to annually report on implementation progress to the World Health Assembly through the mandatory SPAR process. 6 The graph includes SPAR submissions received until 20 July 2021. When interpreting the graph, the lower number of submissions received in the 2020 reporting cycle in comparison with the two previous reporting cycles should be taken into consideration. EUR/RC71/17(D) Rev.1 page 5 Joint external evaluations 7. At the time of writing, 18 JEE missions had been conducted in the Region. Quantitative and qualitative analyses of the 17 published JEE mission reports showed that the three technical areas in the Region with the highest average JEE scores were immunization (4.3), food safety (3.9) and radiation emergencies (3.8). The areas with the lowest average scores were biosafety and biosecurity (2.7), antimicrobial resistance (2.8) and points of entry (3.1). A summary of JEE scores across the technical areas is presented in Figure 2. Fig. 2. Summary of JEE scores across the technical areas, 2016–2019, WHO European Region (based on 17 JEE reports published to date) 8. Common themes in the recommended priority actions relate to strengthening of all- hazard and whole-of-government approaches, coordination and information exchange, development of national legislative frameworks, digitalization of surveillance and reporting systems, enhanced cooperation between sectoral laboratories, and risk mapping. Continuous training and awareness-raising activities on zoonotic diseases and antimicrobial resistance, and the need for regular multisectoral exercises, were often mentioned. Lack of sustainable funding and human resources were also key recurring themes. 9. More than 50 % of Member States responding to the survey reported full implementation of actions in the areas of notification and information sharing, mandatory annual reporting, and national policies, plans and legislation. For implementation of actions on One Health, 50% of the respondents reported full implementation, while 27% reported low-level implementation. Risk communication is one of the areas with the highest reported low-level implementation of actions (27%). Other areas with low-level implementation of actions are: synergies between emergency preparedness and response; health system strengthening and essential public health functions; and emergency preparedness and response operations. EUR/RC71/17(D) Rev.1 page 6 Progress in implementing key activities by Member States and WHO as outlined in the Action Plan National policies, plans and legislation 10. On the basis of the results of IHR monitoring and evaluation activities, WHO/Europe supported the development of national strategic action plans for health emergency preparedness and health security in five countries. IHR (2005) coordination, communication and advocacy 11. WHO/Europe supported the development of guidance, tools, training and advocacy materials aimed at improving multisectoral implementation of the IHR (2005) and the national IHR focal points (IHR NFPs) function. Regional platforms have been used to strengthen NFP networking and exchange best practices, including through regional and subregional meetings, workshops, tailored national training and the European IHR Knowledge Network. National laboratory systems 12. Armenia, Belarus and Kazakhstan joined the Better Labs for Better Health initiative at the end of 2017 and have established national laboratory working groups for laboratory system strengthening. 13. Between 2018 and 2020, 37 training sessions on quality and biosafety management, mentoring and sample transport were held in nine countries. WHO supported 39 laboratories in the implementation of their quality management systems by providing mentors. 14. WHO/Europe established the European Regional Laboratory Task Force for High Threat Pathogens in 2019. 15. WHO held joint workshops in Kyrgyzstan, Tajikistan and Uzbekistan in 2018 and 2019 on sample referral and veterinary, microbiology and environmental sampling. These workshops were followed by the endorsement of guidelines on national sample transport by Kyrgyzstan and Tajikistan. National surveillance systems 16. To enhance the quality and use of surveillance data on high threat pathogens, including novel influenza viruses with pandemic potential, anthrax, rabies, Crimean–Congo haemorrhagic fever, Rift Valley fever and cholera – and, in 2020, SARS-CoV-2 – WHO/Europe supported the following: (a) validation of surveillance data on high threat pathogen morbidity and mortality reported by Member States to WHO between 2006 and 2019 to improve the quality and completeness of the data, and creation of a single database to store all historical data; (b) implementation and evaluation of early warning systems by developing a regional early warning, alert and response strategy with an implementation tool; and (c) implementation of data-secure mechanisms on relevant platforms for the exchange of personal data for the purpose of coordinated contact tracing between NFPs. EUR/RC71/17(D) Rev.1 page 7 17. At the start of the COVID-19 pandemic, WHO/Europe supported countries in repurposing influenza networks and surveillance for COVID-19, including by preparing sentinel sites for influenza and severe acute respiratory infection surveillance to enable studies to monitor COVID-19 vaccine effectiveness. Over 100 technical webinars and online training resources for COVID-19 surveillance and response were provided, and country missions were undertaken to strengthen SARS-CoV-2 surveillance. Daily and weekly situation updates continue to be provided through the weekly surveillance bulletin on COVID-19 and the WHO/Europe COVID-19 dashboard. Risk communication 18. WHO/Europe has provided IHR States Parties with guidance, training, tools, and on-site and remote support as part of the emergency risk communication five-step capacity-building package and has supported the package’s integration into national action plans for health emergency preparedness. During 2018 and 2019, 12 States Parties received direct mission support. Additionally, the flagship SocialNet training and simulation for integrating behavioural and social science capacities into public health emergency response took place twice, in 2018 and 2019, with participation from 30 States Parties.7,8 19. Since the onset of the pandemic, 30 remote and online capacity-building webinars targeting more than 2500 risk communication and community engagement (RCCE) experts have been conducted, and the following have been provided: tailored workshops for country office and States Parties’ risk communication focal points; templates for RCCE strategies, including strategic operating procedures to support the establishment and functioning of national coordination mechanisms for RCCE; RCCE guidance and training modules on hotlines, contact tracing and repurposing of health worker, youth and journalist engagement for emergency readiness; and innovative RCCE tools, such as the HealthBuddy+ chatbot,9 which was translated into 19 languages, and the behavioural insight tool, which was rolled out in 27 countries and territories. Points of entry 20. WHO has produced tools, guidance, scientific briefs, e-learning courses, and regional webinars and training resources. Prior to COVID-19, WHO/Europe supported countries in the Region in assessing and enhancing public health capacities at points of entry and exit. In 2019, WHO/Europe conducted subregional training on the use of the assessment tool for core capacity requirements at designated airports, ports and ground crossings, which was attended by 50 participants from 13 priority countries. 21. Since January 2021, WHO has supported countries in mitigating the effects of introduction, exportation, and the potential spread of SARS-CoV-2, as well as cross-border 7 Social science training enhances community engagement in health emergencies in 11 countries of the European Region. See: https://www.euro.who.int/en/countries/kyrgyzstan/news/news/2019/2/social-science-training- enhances-community-engagement-in-health-emergencies-in-11-countries-of-the-european-region. 8 SOCIALNET 2019: A real-life rehearsal on risk communication, community engagement and social science for the COVID-19 pandemic. See: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus- covid-19/news/news/2020/9/socialnet-2019-a-real-life-rehearsal-on-risk-communication,-community- engagement-and-social-science-for-the-covid-19-pandemic/socialnet-2019. 9 HealthBuddy+ can be accessed at https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus- covid-19/healthbuddy. EUR/RC71/17(D) Rev.1 page 8 risk management in the context of COVID-19, through tailored point-of-entry assessments and training. Synergies between emergency preparedness and response, health system strengthening and essential public health functions 22. In 2019, WHO developed a toolkit for assessing and strengthening people-centred emergency care systems, which encompassed a full package of services: pre-hospital services, emergency medical services, intensive care units and hospital-based services, and out-of- hospital services including palliative and rehabilitation care. 23. During 2020, with the COVID-19 pandemic causing massive disruption of essential health services, WHO supported the repurposing of health system resources. WHO developed a comprehensive four-step approach to ensure country ownership and strengthen the leadership of health ministries in maintaining continuity of essential health service delivery. 24. Since 2019, WHO/Europe has supported hospital safety assessments based on the Hospital Safety Index in 11 countries as well as hospital response plan development in Albania and Georgia. 25. Mass casualty incident management training sessions developed by WHO/Europe, encompassing the fundamentals of emergency services, were conducted in Georgia and Kyrgyzstan for health care workers in 2019. One Health 26. WHO/Europe has supported countries in strengthening the human–animal health interface through the implementation of national bridging workshops and simulations. Since 2019, nine such workshops and two simulations have been conducted by WHO/Europe and the World Organisation for Animal Health (OIE). 27. WHO/Europe joined a tripartite partnership with the Food and Agriculture Organization of the United Nations and OIE on the establishment of a regional One Health coordination mechanism. 28. In the context of COVID-19 and the zoonotic aspects of the disease, WHO/Europe conducted a survey of SARS-CoV-2 in mink farms in Member States and provided technical advice to Member States with fur-farming industries. WHO has also investigated the impact of COVID-19 on food control and food safety risk management and provided recommendations for governments and businesses to reduce the impact of food supply chain disruptions on food safety. Strategic pillar 2: Strengthen event management and compliance with the requirements under the IHR (2005) Notification and information sharing 29. WHO/Europe has been coordinating urgent communications under IHR Articles 6–10 for COVID-19 and non-COVID-19 public health events occurring in the Region. Annual EUR/RC71/17(D) Rev.1 page 9 assessments on the timeliness and completeness of NFP responses have been made available in an annual IHR implementation report since 2018. Information was shared by WHO through the Event Information Site (Article 11), Disease Outbreak News, featured media articles and dedicated dashboards. 30. As at 21 July 2021, IHR States Parties in the Region had implemented a total of 3361 additional health measures in response to COVID-19, according to Article 43 of the IHR (2005). In accordance with that article, WHO shared information about these measures with all States Parties on a weekly basis through the Event Information Site. Emergency preparedness and response operations 31. To support Member States in all-hazard and hazard-specific emergency preparedness and response plans, WHO/Europe developed “off-the-shelf” packages on emergency operations planning and hazard-specific contingency plans and piloted them in four countries in 2019. 32. WHO/Europe has supported 10 countries in conducting national strategic risk assessments using the Strategic Tool for Assessing Risks since 2019. 33. During 2020–2021, several public health events required application of the WHO Emergency Response Framework in the Region, triggering emergency procedures to support response operations. WHO/Europe responded to the following seven graded emergencies, and several ungraded emergencies: • Grade 2, multi-country polio • Grade 3, global response to the COVID-19 pandemic • Grade 3, whole of Syrian Arab Republic response • Grade 2, multi-country measles • Grade 2, protracted crisis in Ukraine • Grade 2, conflict between Armenia and Azerbaijan (first graded on 6 October 2020) • Grade 1, earthquake in Albania Medical countermeasures and personnel deployment 34. WHO and its operational partners deploy experts and medical countermeasures to emergency settings. During non-emergency phases, WHO strengthens coordination mechanisms in preparedness for and response to emergencies, including those mechanisms set by the Health Cluster, emergency medical teams, the Global Outbreak Alert and Response Network (GOARN) and stand-by partners. 35. As of the end of April 2021, WHO/Europe has conducted 201 support missions and deployments to 23 countries and areas in response to COVID-19. 36. Twenty European GOARN partners were deployed during 2018–2019, through 81 deployments, to provide support to seven responses. In 2020–2021, WHO/Europe mobilized 24 GOARN partners to seven countries or areas. EUR/RC71/17(D) Rev.1 page 10 37. A new European Regional Governance Structure for Emergency Medical Teams in the European Region was adopted. During the COVID-19 pandemic, WHO mobilized eight WHO-classified emergency medical teams to five countries in Europe requiring hands-on clinical support. 38. Between February 2020 and April 2021, 428 shipments of critical supplies worth a total of US$ 64 million had been dispatched by the supply consortium established by WHO to 32 countries and areas in the Region. Five regional COVID-19 reference laboratories were immediately established to support international testing, shipping 1218 samples from 22 countries. Strategic pillar 3: Measure progress and promote accountability Mandatory annual reporting by States Parties 39. Since the launch of the Action Plan, WHO/Europe has continued to support coordinated assessments of national core capacities through four components of the IHR Monitoring and Evaluation Framework: SPAR, JEEs, intra-action and after-action reviews, and simulation exercises. 40. WHO has offered a digital platform that allows States Parties to report online, thereby facilitating reporting by the States Parties, as well as transparency and the real-time monitoring of reports submitted. The number of SPARs submitted by States Parties in the Region increased from 50 for 2018 to 52 for 2019. For 2020, 47 States Parties had submitted their reports as of 20 July 2021. Assessment of capacities through use of voluntary tools 41. As of 31 March 2021, 18 States Parties had conducted a voluntary JEE. In addition to improving evaluation tools, WHO has been developing a codebook of JEE recommendations to support countries in planning and prioritizing activities to strengthen emergency preparedness capacity. In 2020, as a result of travel restrictions, guidance for virtual and hybrid JEEs were developed by WHO. Several JEE kick-off workshops have been conducted virtually. 42. The Joint Assessment and Detection of Events simulation exercise for all 55 IHR NFPs was organized in the Region in 2018 and 2019. Subregional training for simulation exercise facilitators was conducted in the areas of natural disasters, mass casualty events and outbreaks. 43. Several countries in the Region were supported in conducting after-action reviews of their emergency operations to respond to outbreaks, such as measles, using the WHO after-action review methodology. Six intra-action reviews had been implemented in the Region as of March 2021. A joint WHO–European Centre for Disease Prevention and Control lessons learned webinar based on country intra-action review findings was organized in February 2021. 44. Translating findings and recommendations from the different IHR Monitoring and Evaluation Framework activities into funded priority actions to improve national emergency preparedness capacities remains a challenge. EUR/RC71/17(D) Rev.1 page 11 Conclusions 45. The COVID-19 pandemic highlights the need for intensified efforts and investment in accelerating the implementation of the Action Plan. IHR core capacities should be augmented by wider whole-of-government and whole-of-society approaches. To this end, the Regional Committee will be invited to consider the development of a renewed action plan for resilience against health emergencies in the WHO European Region, to eventually replace the current one. = = =