WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-eighth session Jeju, Republic of Korea 10–14 September 2007 Provisional agenda item 12
WPR/RC58/INF.DOC. 1 8 August 2007 ORIGINAL: ENGLISH
RECOMMENDATIONS OF THE SECOND MEETING OF THE ASIA PACIFIC TECHNICAL ADVISORY GROUP (TAG) FOR EMERGING INFECTIOUS DISEASES (EID) AND THE MEETING OF EID PROGRAMME MANAGERS AND NATIONAL IHR FOCAL POINTS IN THE WESTERN PACIFIC REGION 18-21 JULY 2007, NEW DELHI, INDIA
WPR/RC58/INF.DOC.1 page 2
Background The Asia Pacific Technical Advisory Group (TAG) on Emerging Infectious Diseases (EID) held its second meeting at the WHO Regional Office for South-East Asia in New Delhi, India, from 18 to 19 July 2007 to review progress in implementing the Asia Pacific Strategy for Emerging Diseases (APSED) and the International Health Regulations (2005), or IHR (2005), and to recommend priority actions on their further implementation. Following the second TAG meeting, the meeting of EID Programme Managers and National IHR Focal Points in the Western Pacific Region was held at the same venue from 20 to 21 July 2007 to review progress in the national implementation of APSED, to discuss the implementation of the TAG recommendations, and to provide an open forum for National IHR Focal Points to share their experiences on country compliance with the IHR (2005). The TAG members during their meeting made a number of general and specific recommendations in three areas of work: pandemic influenza; implementation of the WHO APSED workplan; and compliance with the IHR (2005). In the separate meeting of EID Programme Managers and National IHR Focal Points, participants made additional recommendations, based on their country experiences and needs, on implementing APSED and complying with the IHR (2005) in the Western Pacific Region. This paper presents the recommendations of the above meetings for consideration and possible endorsement by the Regional Committee for the Western Pacific in September 2007. General observations and recommendations from the TAG meeting • A number of countries in the Western Pacific Region have conducted an assessment of their existing surveillance and response systems and capacities, and based on the results of these assessments, some countries have developed draft plans of action. The TAG members commended these national efforts in implementing APSED to meet the IHR core capacity requirements. • TAG emphasized strongly that a multisectoral approach is key to combat the threats associated with future pandemic influenzas and other emerging infectious diseases, including zoonoses. TAG recommended that countries expand their capacity-building efforts for avian influenza to include emerging infectious diseases in general.
WPR/RC58/INF.DOC. 1 page 3
•
TAG emphasized the importance of distinguishing three phases of intervention: controlling avian influenza; containing an emerging human pandemic influenza (i.e. rapid containment); and responding to future pandemics (i.e. pandemic response). TAG therefore recommended the need for all countries and WHO to: (1) continue to strengthen avian influenza surveillance and response systems; (2) prepare for rapid containment, including the inclusion of a rapid containment component in National Influenza Pandemic Preparedness Plans; and (3) improve pandemic response, especially at the local level.
•
TAG recommended that APSED be further implemented by: (1) improving national capacities not only for avian influenza, but for all other emerging infectious diseases; (2) conducting APSED mid-term assessments in selected countries with the advice and participation of TAG members; and (3) strengthening operational research, including studies on the effectiveness of selected public health interventions.
•
TAG emphasized the need for training and sustainable human resources development for APSED implementation, and recommended that training plans be developed and implemented including a Field Epidemiology Training Programme (FETP) and short competency-based courses on epidemiology, infection control and bio-safety. Sustainable capacity should be developed through human resources assessment and planning.
•
TAG recommended that the following actions be taken to further comply with the International Health Regulations (2005): (1) strengthen the functions of National IHR Focal Points; (2) strengthen public health measures and capacity at designated international airports, ports and ground crossings; and (3) develop the core capacities required under IHR (2005) through effective APSED implementation.
Specific recommendations from the TAG meeting and the meeting of EID Programme Managers and National IHR Points in the Western Pacific Region Avian and pandemic influenza • Countries should continue to test or validate their pandemic influenza preparedness plans through appropriate exercises and by engaging the participation of high-level decision- makers, as well as those in non-health sectors, local governments and
WPR/RC58/INF.DOC.1 page 4
communities. Key stakeholders, including non-health governmental sectors, should be involved in planning. • Countries should develop the minimum capacities required for pandemic response that were included in their pandemic preparedness plans (i.e. increasing readiness). • Countries that have established the minimum capacities for avian influenza control should begin preparing for rapid containment at the initial emergence of a pandemic influenza, as well as for pandemic response. • WHO should provide technical assistance, including the provision of tools for the design of exercises, and facilitate the sharing of information and practices on pandemic exercises among countries. • WHO should update its technical guidelines (e.g. pandemic influenza checklists) related to pandemic influenza preparedness with emphasis on preparedness of nonhealth sectors. • WHO should assist countries in improving readiness (i.e. the minimum capacities) required to respond to an avian influenza outbreak, pandemic influenza rapid containment and pandemic response through effective implementation of urgent activities in the APSED workplan. APSED implementation • Countries that have not done so should conduct an assessment of their existing systems and capacities, using the APSED checklists. The results of the assessments should help countries develop and/or implement their workplans, including budgets for resource mobilization. • Countries and WHO should explore ways to monitor and evaluate APSED implementation with measurable indicators. • WHO should continue to assist countries in conducting their assessments and workplan development and in strengthening the core capacity in each APSED programme area. In particular, WHO should strengthen its capacity to support infection control and risk communication.
WPR/RC58/INF.DOC. 1 page 5
•
WHO should work closely with countries to implement the APSED sub-workplans, including those related to strengthening national influenza surveillance systems, Field Epidemiology Training Programmes (FETP) and laboratory biosafety.
•
WHO Regional Offices for South-East Asia and the Western Pacific are encouraged to strengthen biregional harmonization of common programmes, such as the FETP and laboratory quality-assurance programmes.
Surveillance and response • Further develop event-based surveillance systems, including practical guidance for countries and emphasis on the critical capture of information for analysis and early warning. • Strengthen links between events and indicator-based surveillance; between surveillance and response; between animal and human surveillance, and response; and between laboratory, and surveillance and response. Laboratory capacity • Determine need for laboratory capacity-building and mapping of laboratory capability and strengthen the laboratory network for collaboration and utilization of available resources. • Implement standard protocols for the transport of potentially infectious diagnostic samples. • • Zoonoses • Since most emerging diseases arise from wild or domestic animals, TAG recommended that multisectoral approaches and mechanisms for the exchange of zoonotic disease information and coordination of responses to zoonoses be developed and implemented. Further develop external quality assurance. Strengthen laboratory bio-safety programmes.
WPR/RC58/INF.DOC.1 page 6
•
The zoonosis coordination mechanism should be further developed at the national level.
Infection control • TAG determined that the workplan for infection control had not progressed satisfactorily in the first period of APSED implementation. TAG emphasized the crucial nature of infection control because of the role of health care facilities in amplifying transmission and the early detection of significant events. TAG therefore recommended that this area of work be given more emphasis in the next year. Risk communication • Use and promote best practices on risk communication drawing on the successful experience from avian influenza. • • Develop partnerships and support a regional risk communication network. Conduct an assessment, mapping and gap analysis of information, education and communication and related communication products. • Routinely incorporate risk communication into preparedness and response.
WHO regional functions • • Continue to support avian influenza surveillance and outbreak response. Further strengthen regional outbreak alert and response capacity through strengthening the Global Outbreak Alert and Response Network (GOARN) and the roster of experts for long-term support. • Ensure adequate staffing for communicable disease surveillance and response at the regional offices. • • Encourage technical collaboration with regional networks and technical institutions. Document examples of best practices.
WPR/RC58/INF.DOC. 1 page 7
Complying with IHR (2005) • Countries should further strengthen the functions of National IHR Focal Points (NFPs) by ensuring the availability and accessibility of basic means of communication (i.e. telephone, e-mail and fax), maintaining up-to-date contact lists of relevant governmental sectors, and developing and implementing effective communications or operating procedures. • Countries should improve their information sharing and management systems (including the use of the IHR event information website), conduct staff training and capacity-building (including minimum communications and language skills) for NFPs, as well as conduct or participate in appropriate IHR exercises. • Countries should start strengthening public health measures and response capacities at designated points of entry, especially designated international airports and ports. • WHO should assist countries in improving IHR communications by providing technical guidance to National IHR Focal Points and by facilitating appropriate IHR exercises, when necessary. • WHO should assist countries in their efforts to improve public health measures and capacity at designated points of entry through the provision of technical guidelines and tools, and the mobilization of regional expertise.