WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-seventh session Auckland, New Zealand 18-22 September 2006 Provisional agenda item 10
WPRlRC57/5
31 July 2006 ORIGINAL: ENGLISH
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ASIA PACIFIC STRATEGY FOR EMERGING DISEASES, INCLUDING INTERNATIONAL HEALTH REGULATIONS (2005) AND AVIAN INFLUENZA
Emerging infectious diseases, including avian influenza A(H5Nl), continue to pose serious public health threats and have the potential to create substantial economic and social disruption throughout Asia and the Pacific. Experience gained in the early stages of the fight against avian influenza and from the 2002-2003 outbreak of severe acute respiratory syndrome (SARS) contributed to the considerable recent progress in improving disease surveillance and response capacity in the Western Pacific Region. But significant challenges, as well as gaps in surveillance and response, remain in many countries and areas of the Region. The Regional Committee for the Western Pacific, at its fifty-sixth session in September 2005, endorsed the Asia Pacific Strategy for Emerging Diseases as a road map for countries and areas to strengthen core capacities for effective preparedness, prevention, early detection of and rapid response to emerging infectious diseases.! The Committee also urged Member States to use the Strategy as a framework to guide national
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capacity-building programmes for emerging diseases and for the effective implementation of the International Health Regulations (2005). The Fifty-ninth World Health Assembly, in resolution WHA59.2, called upon Member States to comply immediately and on a voluntary basis with the provisions of the IHR (2005) considered relevant to the risk posed by avian influenza and pandemic influenza (Annex I). The Asia Pacific Technical Advisory Group (TAG) on Emerging Infectious Diseases, which has been established to oversee planning and implementation of the Strategy at the regional level and to provide technical support to countries and areas, held its first meeting in July 2006 to review the WHO workplan. It made recommendations on effective implementation of the Strategy at the country level. The Regional Committee is asked to discuss and endorse the TAG's recommendations (Annex 2).
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Resolution WPRJRC56.R4.
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1. BACKGROUND
The International Health Regulations (2005), adopted by the Fifty-eighth World Health Assembly in May 2005,2 enter into force in June 2007. The Regulations are a global legal framework for preventing and responding to the international spread of diseases while avoiding unnecessary interference with traffic and trade. They set out new obligations and provide new opportunities for Member States to strengthen the core capacities necessary for contributing to the achievement of national, regional and international health security. In Asia and the Pacific, a region comprised of the 48 countries and areas that make up the WHO South-East Asia and Western Pacific Regions, emerging infectious diseases, including avian influenza A(H5NI), continue to pose serious health threats and have the potential to create substantial economic and social disruption. To provide the countries and areas of the Western Pacific Region with strategic directions for enhancing capacities required for effective preparedness, prevention, early detection of and rapid response to emerging infectious diseases, the Regional Committee for the Western Pacific, at its fifty-sixth session in September 2005, endorsed the Asia Pacific Strategy for 3 Emerging Diseases. The Strategy was jointly developed by the Regional Offices for South-East Asia
and Western Pacific to confront new challenges in Asia and the Pacific. The Regional Committee urged Member States in the Western Pacific Region to use the Strategy as a framework to guide national capacity-building programmes for emerging diseases and as a stepping stone towards the effective implementation of the International Health Regulations (2005), or lliR (2005). The Fifty-ninth World Health Assembly, in resolution WHA59.2, called upon Member States to comply immediately and on a voluntary basis with the provisions of the IHR (2005) considered relevant to the risk posed by avian influenza and pandemic influenza (Annex I). In the Western Pacific Region, the effective implementation of the biregional Strategy to meet the IHR (2005) requirements is one of the highest priorities for countrie~;
and areas, WHO, and other partners to fight
the global influenza pandemic threat and prepare for the early detection of and rapid response to other potential public health emergencies that threaten national, regional and global health security.
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Resolution WHA58.3. 3 Op. cil. Ref. 1
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2. ISSUES
2.1
Continuing influenza pandemic threat Joint efforts in responding to the A(H5Nl) virus over the past several months by individual
countries and areas and the global community have strengthened the fight against avian influenza and improved pandemic preparedness. However, considerable challenges remain and the influenza
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pandemic threat continues to grow. Since July 2005, the virus has spread dramatically beyond Asia. As of June 2006, more than 40 countries in Asia, Africa, Europe and the Middle East had reported outbreaks in either domestic or wild birds, or both. This marks the most rapid documented geographical spread of any highly pathogenic avian influenza virus in history. In Asia, sporadic human infections of the virus continued to be reported in 2006 from Cambodia, China and Indonesia. Evidence shows that the A(HSNl) virus has now become endemic in domestic birds in many parts of Asia and the Pacific. Countries and areas of the Western Pacific Region need to continually monitor avian influenza and act when cases are suspected. Meanwhile, there also is an urgent need to move beyond immediate response to current avian influenza cases and focus greater attention on the mid- and long-term battle. This means preparing for rapid response and containment activities, including early warning, and for a worst-case scenario: a human influenza pandemic. These preparations include building national and
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regional capacities for rapidly detecting, reporting and assessing any early signal of an influenza pandemic such as clusters of human cases of avian influenza or unexpected and unexplained acute severe respiratory illnesses or deaths. In the early stages of a potential pandemic, it may be possible to stop or delay the spread of the VIruS by swiftly implementing pandemic influenza rapid response and containment measures, including the large-scale administration of antiviral drugs to the population in affected areas, together with additional complementary public health measures. If such rapid interventions are successful, the severe adverse health, social and economic consequences expected to result from a pandemic might be prevented. However, the window of opportunity for action is very narrow. Countries and areas must prepare for such an eventuality and develop operational capacities and coordinating mechanisms to swiftly implement rapid containment measures, when indicated. Rapid response and containment also requires close regional and international coordination and collaboration. While most attention is currently focused on the pandemic threat arising from the A(HSNI) virus, it also must be stressed that a future pandemic might be caused by a new subtype of the virus.
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Countries and areas must continue to prepare for a worst-case scenario: a pandemic, irrespective of virus subtype. In particular, there is an urgent need for many countries and areas to ensure multi sectoral involvement and full community participation during the pandemic planning process. Where feasible, countries and areas should take advantage of the heightened attention and current political commitment to influenza pandemic preparedness to develop generic public health emergency preparedness and response plans. Human and financial resources need to be made available to test national pandemic preparedness plans.
2.2
International Health Regulations (2005) requirements and core capacity gaps The International Health Regulations (2005) set out new obligations for the notification,
verification, assessment of and response to significant public health events, including those caused by emerging diseases. They also set out the minimum country core capacity requirements for surveillance and response, described in Annex 1 of the Regulations. Member States are required to assess the ability of existing national structures and resources by June 2009 and based on the assessment develop and implement plans of action to ensure these core capacities are present and functioning. While the pandemic threat persists in Asia and the Pacific, other newly emerging infectious diseases or potential public health emergencies may occur. This is primarily due to many risk factors such as close human-animal interaction, rapid globalization and urbanization, and increasing crossborder travel and trade in the region. It is vitally important to build, strengthen and maintain national and regional capacities to prevent, detect and respond rapidly and effectively to any kind of emerging disease and all events that may constitute a public health emergency of international concern. A 2004-2005 survey of the capacity of Member States in the Western Pacific Region to support the implementation of the IHR (2005) indicated that most countries and areas in the Region currently did not have all the required national and local core capacities in place. The level of development of each capacity area varied by country and area. Although most countries and areas in the Region have surveillance and response systems in place for selected communicable diseases, they usually do not function as early warning systems. Laboratory capacity to support surveillance and outbreak investigations and national laboratory networking in many countries and areas remains less than optimal. Such capacity gaps and a significant diversity in the levels of capacity development are challenges that need to be addressed in the Region. There is an urgent need for both Member States and the international community to mobilize resources nt'cessary for strengthening country capacity to meet the core capacity requirements under the IHR (2005). It is an essential and fundamental first step for countries and areas to be able to contribute to national, regional and global health security.
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2.3
Implementation of the Asia Pacific Strategy for Emerging Diseases The Regional Committee for the Western Pacific in September 2005 endorsed the Asia Pacific
Strategy for Emerging Diseases.
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This Strategy serves as a road map for countries and areas in the
Region to strengthen core capacities required to deal with emerging diseases. Implementation of the Strategy will help confront the increasing pandemic threat from avian influenza and help meet the core capacity requirements for surveillance and response under the lliR (2005). It also will help move from immediate response to the active mid- and long-term core capacity-building necessary for effective prevention, detection and preparedness and rapid response to emerging infectious diseases
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and other public health emergencies. If the Strategy is to be effective, there must be immediate action at every leveL The Regional Office for the Western Pacific has developed a draft regional plan of action for the implementation of the Strategy that incorporates the core capacity elements for surveillance and response required under the lliR (2005). The plan highlights regional implementation targets, priority actions and required resources. The Technical Advisory Group (TAG) on Emerging Diseases has been established to oversee planning and implementation of the Strategy at the regional level and to provide technical support to countries and areas. The first TAG meeting, held in July 2006, reviewed the WHO
workplan. It made recommendations on effective implementation of the Strategy at the country leveL A partners forum on emerging infectious diseases also was convened in July 2006 to improve donor coordination and establish better collaboration with key stakeholders in the Region.
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Most importantly, the countries and areas of the Western Pacific Region need to develop plans of action for the effective implementation of the Strategy. Country workplans for preventing and responding to avian influenza, improving influenza pandemic preparedness, and complying with the IHR (2005) core capacity requirements should be integral components of the country plans of action. The plan should address the need for overall country implementation planning, identification of capacity gaps, governmental commitment, multi sectoral participation and resource mobilization. As one of the highest priorities, countries and areas should take immediate action to strengthen the early warning functions of their public health surveillance and response systems. This should include, as a priority, building local and national capacities, including essential laboratory functions, for detecting, assessing and reporting early signals of a potential influenza pandemic and other significant public health events.
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Op. cit. Ref. \.
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Effective implementation of the Strategy requires Ii sustainable multisectoral approach. In addition, globalization has altered the traditional distinction between national and international health. The prevention of and response to emerging diseases :and potential public health emergencies of international concern require joint effort, as well as closer regional and international partnerships and collaboration.
3. ACTION PROPOSED
The Regional Committee for the Western Pacific is asked to discuss and endorse the recommendations of the first meeting in July 2006 of the Asia Pacific Technical Advisory Group on Emerging Infectious Diseases (Annex 2).
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FIFTY-NINTH WORLD HEALTH ASSEMBLY Agenda item 11.1
WHA59.2
26 May 2006
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Application of the International Health Regulations (2005) The Fifty-ninth World Health Assembly, Having considered the report on application of the International Health Regulations (200S); Recalling resolutions WHAS8.3 on revision of the International Health Regulations and WHAS8.S on strengthening pandemic-influenza preparedness and response; Reaffirming the serious risk to human health, including the possible emergence of a pandemic virus, arising from ongoing outbreaks in poultry of highly pathogenic avian influenza, caused by the HSNI strain of Injluenzavirus A, in parts of Asia and elsewhere; Noting with concern the persistence of outbreaks in poultry, the continuing occurrence of sporadic cases of severe human disease associated with these outbreaks, the endemicity of the virus in several countries, the spread of the virus through the migration of wild waterfowl to new areas, and its predicted further spread; Aware that these and other developments have increased the probability that a pandemic may occur; Highlighting the importance of WHO's global influenza preparedness plan and the control measures recommended therein;l Mindful that rapid detection ofhurnan cases, supported by adequate national capacity, and rapid and transparent reporting of findings underpin WHO's ability to issue a reliable risk assessment and declare an appropriate phase of pandemic alert, and are further needed to ensure that the earliest epidemiological signals of increased transmissibility of the virus among humans are not missed; A ware that several provisions in the International Health Regulations (200S) would be useful in ensuring a strengthened and coordinated response on the part of the international community to both the present situation and a possible pandemic; Further aware that strengthened capacity to respond to human cases of avian influenza and the corresponding pandemic threat will strengthen the capacity to respond to many other emerging and
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Document WHOICDS/CSRlGIP/2005.5.
WPRlRC57f5 pageS Annex 1 WHA59.2
epidemic-prone infectious diseases, and thus increase global public-health security against the threat of infectious diseases; Noting that the International Health Regulations (2005) will not enter into force until IS June 2007; Recalling the main conclusions reached, and recommended actions agreed on, during a joint meeting convened by WHO, FAO, OlE and the World Bank on avian influenza and human pandemic influenza (Geneva, 7-9 November 2005); Responding to the specific request made during that meeting to put forward proposals to the Fifty-ninth World Health Assembly through the Executive Board at its I 17th session for immediate voluntary compliance with relevant provisions of the International Health Regulations (2005), 1. CALLS UPON Member States to comply immediately, on a voluntary basis, with provisions of the International Health Regulations (2005) considered relevant to the risk posed by avian influenza and pandemic influenza;
2. DECIDES that relevant provisions of the Intemational Health Regulations (2005) shall include the following: (I) Annex 2, in so far as it requires prompt notification to WHO of human influenza caused by a new virus SUbtype;
(2) Article 4 pertaining to the designation or establishment of a National IHR Focal Point within countries and the designation of WHO IHR Contact Points, and the definition of their functions and responsibilities; (3) Articles in Part II, pertaining to surveillance, information-sharing, consultation, verification and public health response; (4) Articles 23 and 30-32 in Part V pertaining to general provISIons for public health measures for travellers on arrival or departure and sp'ecial provisions for travellers; (5) Articles 45 and 46 in Part VIII pertaining to the treatment of personal data and the transport and handling of biological substances, reagents and materials for diagnostic purposes; 3. NOTES that such voluntary compliance is without prejudice to the position of any Member State with regard to the International Health Regulations (2005); 4. URGES Member States:
(I) to designate or establish immediately a National IHR Focal Point, as provided for in Article 4 of the Regulations, and inform WHO accordingly within 90 days, the said Focal Point having the authority to communicate official information and for the Focal Point to provide support for, and if so decided by the Member State, to participate in, collaborative risk assessment with WHO; 2
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Annex 1 WHA59.2
(2) to follow, in matters pertaining to human cases of avian influenza, mechanisms and procedures set out in the Regulations for a disease that may constitute a public health emergency of international concern; (3) to provide transparent and urgent notification and subsequent continued communication to WHO of any probable or confirmed human cases of avian influenza, including exported or imported cases; (4) to disseminate to WHO collaborating centres information and relevant biological materials related to highly pathogenic avian influenza and other novel influenza strains in a timely and consistent manner; (5) to develop domestic influenza vaccine production capacity or to work with neighbouring States to establish regional vaccine production capacity, in order to promote adequate supplies of vaccine, in the event of a public health emergency of international concern caused by a novel influenza virus; (6) to strengthen collaboration on human and zoonotic influenzas among national organizations responsible for human and animal health in order to strengthen surveillance and implement immediate measures to control outbreaks of avian influenza in humans and animals; (7) to respect time frames stipulated in the Regulations for undertaking and completing urgent activities and communications, particularly for the reporting of human cases of avian influenza, verification of events, and response to requests for further information from WHO; (8) to collaborate, including through the mobilization of financial support, to build, strengthen, and maintain the capacity for influenza surveillance and response in countries affected by avian influenza or pandemic influenza;
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(9) to follow recommendations issued by the Director-General, with technical advice from the influenza pandemic task force, considered necessary for the international response to avian influenza or pandemic influenza; (10) to inform the Director-General of the measures that they have taken compliance with the International Health Regulations (2005); III
voluntary
(11) to initiate a process of identifying and addressing the constraints - administrative and legal- for timely implementation of the Regulations with a view to promoting intersectoral participation; 5. REQUESTS the Director-General:
(1) to designate immediately WHO IHR Contact Points, as provided for in Article 4 of the Regulations; (2) to implement, in so far as feasible and relevant for the purpose of this resolution, measures in Parts II and III of the Regulations falling under the responsibility of WHO; (3) to further accelerate steps to establish a roster of experts and to invite proposals for its membership, pursuant to Article 47; 3
WPRlRC57/5 page 10 Annex 1 WHAS9.2
(4) to use the influenza pandemic task force as a temporary mechanism until entry into force of the International Health Regulations (2005) in order to advise the Organization on the response to avian influenza, the appropriate phase of pandemic alert and the corresponding recommended response measures, the declaration of an influenza pandemic, and the international response to a pandemic; (5) to collaborate with Member States in implementation of the present resolution, and in voluntary compliance with the International Health Regulations (2005), as appropriate, including through: (a) provision or facilitation of technical cooperation and logistical support;
(b) mobilization of international assistance, including financial support, in consultation with Member States, especially for avian influenza or pandemic influenza-affected countries lacking sufficient operational capacity;
(c) production of guidelines as support to Member States in development of capacities for a public-health response specific to the risk posed by avian influenza and pandemic influenza; (d) reasonable stockpiling of necessary drugs;
(e) facilitating, in collaboration with international partners, development and commercial production of vaccines against avian influenza and pandemic influenza; (6) to collaborate with Member States to the extent possible in providing support to developing countries in building and strength<:ning the capacities required under the International Health Regulations (2005); (7) to immediately search for solutions to reduce the current global shortage of, and inequitable access to, influenza vaccine, and also to make them more affordable for both epidemics and global pandemics; (8) to mobilize and dedicate WHO's technical resources where possible, using capacities available in regional offices and collaborating centrl~s, in order to expand and accelerate training efforts in the areas of epidemic surveillance, alert and response, laboratory capacity, including regional networking of laboratories, biosafety, and quality control, in order to provide support to Member States in implementation of the International Health Regulations (2005); (9) to report to the Sixtieth World Health Assembly through the Executive Board at its I 19th session on implementation of this resolution, and to report annually thereafter on progress achieved in providing support to Member States on compliance with, and implementation of, the International Health Regulations (2005).
Eighth plenary meeting, 26 May 2006 A59NRJ8
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ANNEX 2
RECOMMENDATIONS OF THE ASIA PACIFIC TECHNICAL ADVISORY GROUP ON EMERGING INFECTIOUS DISEASES
The Asia Pacific Technical Advisory Group on Emerging Infectious Diseases held its first meeting at the WHO Western Pacific Regional Office in Manila, Philippines, from 18-20 July 2006.
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The nine-member Technical Advisory Group (TAG) was joined by experts in such fields as microbiology, virology, infectious disease control, epidemiology and community health
administration, as well as technical staff from the WHO Western Pacific and South-East Asia Regional Offices, various WHO country offices, and representatives of health ministries from more than a dozen countries in the Regions, The TAG members were asked to review and reVlse the draft WHO Workplan for the Implementation of the Asia Pacific Strategy for Emerging Diseases 2006--2010. The members also were asked to identify priorities and make recommendations on future steps on emerging infectious disease response. Following a review of the draft implementation plan, the Technical Advisory Group made six general observations and recommendations, as well as a number of specific observations and
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recommendations for Member States and for WHO.
General observations and recommendations
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The Asia Pacific Strategy for Emerging Diseases and WHO Workplan for the Implementation of the Asia Pacific Strategy for Emerging Diseases 2006--2010 (APSED Workplan) should act as the framework and guidance for countries and partners to meet the commitments of the International Health Regulations (2005) and for strengthening biregional capacity and the capacity of individual countries and areas for communicable disease surveillance and response.
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The APSED Workplan is necessary to meet the surveillance and response requirements under the International Health Regulations (2005), and the TAG strongly endorses its implementation.
WPRlRCS7/S page 12 Annex 2 • High-level political commitment and appropriate long-term resourcing at all levels involved in implementation of the Workplan are essential for sustainability. • Human resource development, including training, recruitment and retention of staff, and appropriate health financing are essential for the implementation of the Workplan. • The development of regional and national baselines and evaluation measures are necessary to ensure the effectiveness of the W orkplan. • Aspects of the APSED Workplan concerning avian influenza and pandemic influenza should be implemented on a priority basis across the Asia Pacific region. These activities will also strengthen surveillance and response capacity for other emerging infectious diseases.
Recommendation for Member States
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Each country should develop a national implementation plan to support the establishment and maintenance of the core capacities required under the International Health Regulations (2005) and to ensure the implementation of the Asia Pacific Strategy for Emerging Diseases.
Recommendations (or WHO
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Working groups should be convened for each of five key activity areas-surveillance and response, laboratory, zoonosis, risk communication, infection control-to drive implementation.
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Indicators, outputs and outcomes should be defined and related to the terminology used in the Asia Pacific Strategy on Emerging Diseases.
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The preamble to the APSED Workplan should clearly explain the relationship between the Asia Pacific Strategy for Emerging Diseases and the APSED Workplan.
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WHO should prioritize its support to Member States, taking into account existing country capacities.
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Annex 2 • WHO should develop a document based on the APSED Workplan to be used by countries as a check list and tool for country-level workplan development. • The APSED Workplan should be reviewed and revised, as appropriate, on an annual basis with TAG assistance. • Information on laboratory capacity and capabilities in all Member States should be collected on a priority basis as part of the implementation of the APSED Workplan
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and should be included in country profiles.
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