________________________________________________ 25 th Meeting of Ministers of Health Thimphu, Bhutan, 31 August – 1 September 2007 Provisional Agenda item 4 SEA/HMM/Meet.25/3 24 July 2007 International Health Security This document provides an explanation of the concept of International Health Security and explains the fact that health issues may be local but their impact and their causes are global in nature. The paper also provides a focus on this broad issue by looking into two areas of intervention relevant to the Region: 1) International Health Regulations (IHR) 2005 and 2) Systematic Emergency Preparedness and Response. The paper reflects suggestions made during the Joint Meeting of Health Secretaries of Countries of WHO SEA Region (HSM) and Consultative Committee for Programme Development and Management (CCPDM) held in WHO/SEARO, New Delhi, 2-6 July 2007. Below are the recommendations of that meeting on this agenda item: Action by Member States (1) Implement the short-term action plan in coordination with partners at the country level and WHO as part of the commitment to the Thimphu Declaration and legal obligation to IHR 2005. (2) In coordination with WHO, continue to work on strengthening core capacities for IHR and addressing benchmarks, standards and indicators for EPR. Action by WHO-SEARO (1) Develop a medium-term strategic framework and short-term plan of action (2008- 2009) to be endorsed by the Thimphu Declaration. (2) Provide continued technical support for building core capacities for IHR and achieving the benchmarks, standards and indicators for emergency preparedness and response. (3) Facilitate intercountry, and inter-Regional cooperation for issues relating to International Health Security.
SEA/HMM/Meet.25/3 Introduction 1. The idea of “International Health Security” lies in the realization that there is a need to reduce the vulnerability of people around the world to the escalation of existing, new, acute or rapidly spreading risks to health, particularly those that threaten to transcend international borders. In a globalized world, health issues present new challenges that go far beyond national borders and have an impact on the collective security of people around the world. 2. Globalization has brought with it a surge in international travel and trade which provides several opportunities for disease to spread across national frontiers quickly and with consummate ease. Epidemic-prone diseases (new as well as re-emerging ones), humanitarian emergencies, bio-terrorism, climate change and environmental degradation each hold the potential to turn into international public health emergencies. 3. No single institution or country has all the capacities needed to respond to international public health emergencies caused by epidemics, natural hazards, conflicts or epidemics of existing diseases, or new and emerging infectious diseases. 4. A clear example of the growing interdependence of health and security is the global spread of HIV/AIDS. Not only has it revealed the capacity of a disease to destabilize economies and societies and to push fragile states to the brink of failure, it has also shaken confidence in the advancement of science to combat new microbial threats. 5. Another serious cause for concern is the increasing number of new and emerging diseases such as avian influenza. As of 1 June 2007, the World Health Organization (WHO) has received reports of 309 human cases and 187 deaths. Five countries in WHO’s South- East Asia (SEA) Region, namely Bangladesh, Indonesia, India, Myanmar and Thailand, have reported avian influenza among poultry. 6. Bangladesh notified its first case of highly pathogenic H5N1 virus in poultry on 30 March 2007. The Ministry of Fisheries and Livestock, Government of Bangladesh, has reported confirmed outbreaks of H5N1 in poultry in 60 farms across the country to date. 7. Myanmar reported an outbreak among poultry in Yangon district on 28 February 2007, more than a year after its last outbreak. The last among the eight clusters in this district was reported on 1 April 2007. India also reported cases in poultry in the State of Maharashtra in March 2006. 8. Human cases of avian influenza have been reported from Indonesia and Thailand. Thailand has reported 25 cases with 17 deaths since December 2003, with the last human case reported in September 2006. WHO has reported 101 laboratory-confirmed human cases of avian influenza in Indonesia, with 80 deaths, since July 2005. 9. New diseases to which there is universal vulnerability could cause harm at a global level, which implies that countries can no longer manage certain types of outbreaks as though they were strictly domestic affairs. The absolute nature of national sovereignty has also been challenged by these events and by the need to secure collective defence against the emerging disease threats that know no geographical or political boundaries. SEA/HMM/Meet.25/3 Page 2 10. The potential inability of affected countries to engage fully in surveillance and sustain an emergency response system for months, if not years, in the case of a severe pandemic is the single most important obstacle to international health security. 11. The earth’s climate is changing inexorably. Temperatures are rising, tropical storms are increasing in frequency and intensity, polar ice caps and permafrost regions are rapidly melting. The acute impact of climate change-related events may be local, but the cause is global. When floods contaminate international waters, people migrate across borders to find food and shelter, or when disease patterns change due to an altered climate, the impact is felt internationally. As a result, predictions for changes in morbidity and mortality patterns all point to a rising trend. 12. Humanitarian emergencies arise from the effects of crises such as natural hazards, food and water shortages and armed conflict. Just as these situations affect individuals, they also impact the already stressed health systems that people rely on for maintaining health security. The World Disasters Report 2006 1 indicates that around 58% of the total number of people killed in natural disasters during the decade 1996–2005 were from countries of the SEA Region. During this decade, the Asia Region 2 had the highest number of natural disasters (1273 reported events) and technological disasters (1387 reported events). Disaster preparedness strategies and humanitarian response operations together can create a balanced approach to alleviating the negative impact of natural disasters. Both rely on planning, collaboration and coordination of roles of the various sectors involved. Scope of International Health Security within the context of the SEA Region 13. Considering all these elements of International Health Security vis-à-vis the risks and hazards in the Region, it would be practicable to focus on two key aspects: 1) International Health Regulations; 2) Systematic Emergency Preparedness and Response. The International Health Regulations (2005) 14. The revised International Health Regulations (IHR) (2005) unanimously adopted by the World Health Assembly came into force from 15 June 2007. Their implementation will help build and strengthen effective mechanisms for alert and response for events of public health concern at the national and international levels. 15. Member States of the Region will work towards the implementation of the IHR (2005), and towards greater collaboration across borders and in between sectors to counter the negative influences on health posed by globalization, disasters, climate change and existing and emerging diseases. 16. Key elements of the IHR (2005) are as follows: 1 International Federation of Red Cross and Red Crescent Societies, World Disasters Report 2006. 2 In this case definition of Asia Region countries follows that of the World Disasters Report 2006, International Federation of Red Cross and Red Crescent Societies, 2006. SEA/HMM/Meet.25/3 Page 3 • This legal framework seeks to protect against, control and provide a mechanism to initiate a public health response to the threat of international spread of disease of biological, chemical or radio-nuclear origin. • IHR (2005) is a major paradigm shift from IHR (1969). Its key focus is on: – Containment at the source of a possible Public Health Emergency of International Concern (PHEIC) as opposed to merely restricting it within borders. – All public health threats as opposed to a few diseases. – Adapted response as opposed to pre-set measures. – Facilitating the development of proactive systems as opposed to reactive ones. 17. As a binding global legal framework, the adoption of the IHR (2005) requires certain requirements for Member States. These requirements are as follows: • Designating a national IHR focal point. • Strengthening core capacity to detect, report and respond rapidly to events that pose a threat to public health. • Assessing events occurring in their territory and notifying WHO, within 24 hours, of all events that may constitute a PHEIC. • Providing routine inspection and control activities at international airports, ports and some ground crossings. • Building a legal and administrative framework in line with the requirements of IHR (2005). 18. In keeping with these needs, WHO is committed to supporting the development of core capacities in health systems for IHR to be fully functional in countries. This includes its own institutional readiness to support Member States in appropriate staffing, conducting global surveillance and health intelligence gathering, providing technical assistance and guidance to Member States, developing guidelines and measures for PHEIC and updating the IHR (2005) as appropriate to maintain its scientific and regulatory validity. Systematic Emergency Preparedness and Response 19. A multisectoral group from Member States of the SEA Region identified a set of 12 benchmarks to periodically assess the emergency management capacity of the health delivery system. The benchmarks are divided into the following broad themes: community empowerment, multisectoral coordination and capacity building. 20. The key elements of the 12 benchmarks are as follows: (1) Legal framework and functioning coordination mechanisms. (2) Regularly updated disaster preparedness and emergency management plans. SEA/HMM/Meet.25/3 Page 4 (3) Emergency financial, physical and human resource allocation and accountability procedures. (4) Rules of engagement (including conduct) for external humanitarian agencies. (5) Comprehensive community plans for risk management. (6) Community-based response and preparedness capacity developed and supported with training and regular simulation/mock drills. (7) Local capacity for emergency provision of essential services and supplies. (8) Advocacy and awareness. (9) Capacity to identify risks and assess vulnerability at all levels. (10) Human resource capabilities being continuously updated and maintained. (11) Health facilities built/modified to withstand expected risks. (12) Early warning and surveillance systems for identifying health concerns. 21. A review conducted in June 2006 indicated that the Member countries have made significant, although varied, progress in achieving the benchmark indicators. 22. During the recent evaluation in April 2007, the Emergency Focal Points of the Member countries further refined the indicators to make them more specific and quantifiable in the medium and long term. 23. The benchmarks, standards and indicators serve as a tool to measure the progress in emergency preparedness and response, guiding the work of WHO in Member States in the medium and long term. Conclusions 24. Emergence of new infectious diseases and environmental changes are interrelated and cause health and security interdependence. With rapid global changes and the increasing vulnerability of human beings, public health has to adapt to new strategies to deal with emerging problems. 25. The IHR and the benchmarks for EPR frameworks both allow for a systematic monitoring of improvements of health systems that will address threats to national and international security. In this context, Member States have been requested to invest in installing elements of these complementary systems. WHO is committed to supporting these efforts for better systems that will ensure health security in Member countries of the Region. ganization 2005. ISBN92 9061 209 6.