APSED and beyond in the Western Pacific Region

i ii WHO Library Cataloguing in Publication Data APSED and beyond in the Western Pacific Region. 1. Communicable diseases, Emerging – prevention and control. 2. Western Pacific. I. World Health Organization. Regional Office for the Western Pacific. ISBN 978 92 9061 502 6 (NLM Classification: WA 110 ) © World Health Organization 2011 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). 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In no event shall the World Health Organization be liable for damages arising from its use. iii Table of Contents Introduction 1 Section 1 Progress in APSED Core Capacity Strengthening 2 Methodology 2 Design 2 Format 3 Assessment Implementation 4 Data Analysis 5 Results 7 Surveillance and Response 7 Laboratory 8 Risk Communications 9 Infection Control 9 Zoonoses 10 Conclusions 10 Section 2 The State of Pandemic Preparedness 12 Pandemic Preparedness Framework 12 Stage-wise Intervention 13 Multisectoral Approach 13 Two-tiered Approach 14 Methodology 15 Design and Format 15 Assessment Implementation 16 Data Analysis 17 Results 19 Group A 19 Group B 22 Conclusions 24 Section 3 Moving Beyond APSED 25 Findings 25 Current Five APSED Programme Areas 25 Future Scope 27 Identified Areas and Issues: High Frequency 28 Identified Areas and Issues: Medium Frequency 29 Identified Areas and Issues: Low Frequency 31 Conclusions and Suggestions 32 Next Steps 32 iv Section 4 - Annexes 34 Annex 1: APSED Assessment Aggregated Data Tables (n=6) 34 Annex 2: APSED Assessment Aggregated Data Graphs (n=6) 36 Annex 3: Common Indicators Assessment 2010 Aggregated Data Tables (n=4) 41 Annex 4: WHO WPRO Pandemic Preparedness Assessment Aggregated Data Tables 42 Annex 5: Beyond APSED Consultation Feedback Template 43 1Introduction The Asia Pacific Strategy for Emerging Diseases (APSED) was launched in 2005 as a five-year strategy to set a common framework for countries and areas of the Asia Pacific region to strategically strengthen core capacities needed to effectively prepare, detect and respond to threats posed by emerging infectious diseases (EID). APSED identified five programme areas for capacity-building in order to meet this goal: Surveillance and Response, Laboratory, Zoonoses, Infection Control and Risk Communications. These core capacities also are required by Member States to meet their obligations under the International Health Regulations (IHR), which were revised in 2005 to include both EID and other public health threats with the potential for international spread. In July 2009, the fourth annual meeting of the Technical Advisory Group (TAG) on Emerging Infectious Diseases recognized the value of APSED in helping Member States to implement IHR (2005) core capacity requirements and supported the continuation of APSED beyond its scheduled end in December 2010. The TAG thus recommended that the current APSED should be reviewed and a new APSED strategy be developed for a further five years. In addition, the TAG recommended that: “The scope of the next strategy should continue to focus on emerging infectious disease threats. However, the capacity and the mechanisms to respond to noninfectious disease events should also be addressed in the next 5-year strategy in line with the IHR requirements.” In late 2009, a number of processes were initiated to review the progress of APSED and to consult countries for their perspectives, ideas and opinions on the future direction of the revised APSED. These included implementation in 2010 of the APSED Common Indicators Assessment and comparison with 2007 baseline data and an intensive consultation process conducted with Member States on the future of APSED. The results of these activities are presented in this report. 2Section 1 Progress in APSED Core Capacity Strengthening Data analysis 2007–2010 In 2007, a baseline capacity assessment was undertaken in Western Pacific Region countries using the APSED Baseline Data Collection tool. In 2008, donors and the TAG on Emerging Infection Diseases recommended that a common indicator tool be devised to harmonize data and reporting between the South- East Asian and Western Pacific Regions. From this recommendation, the APSED Common Indicators Assessment was developed in consultation with Member States, using the WHO Western Pacific Regional Office baseline assessment as a foundation. This tool was presented at the fourth TAG meeting in Bangkok in 2009 and implemented in both regions in 2010 to collect updated data. In this report, the results of the 2010 assessment are measured against 2007 baseline data to evaluate the progress of Member States towards achieving APSED minimum standards and core capacity requirements in the five APSED programme areas. Figure 1. APSED timeline Methodology Design In order for the results of the two surveys to be comparable, the content of the Common Indicators Assessment was largely similar to the content of the 3Baseline Data Collection tool. But expectations of minimum standards in some areas had evolved since the establishment of the Baseline Data Collection survey in 2007. This resulted in two significant modifications to the original tool. The first modification was the removal of questions that addressed areas no longer viewed as essential APSED requirements. For example, questions about the existence of surveillance and response laws, as distinct from policy, were removed since laws no longer were regarded as an essential requirement in their own right. Secondly, a small number of new questions were added to reflect latest expectations and understanding of core requirements. In total, the Baseline Data Collection tool contained 172 questions. The Common Indicators Assessment contains 95 questions – 92 taken from the Baseline Data Collection tool and three new questions. Format The Common Indicators Assessment was a set of five individual surveys — one for each of the five APSED programme areas. In each programme area, questions were categorized according to “minimum systems and/or functional areas required”. Within each programme area, the following categories of “minimum systems and/or functional areas required” were defined: Table 1. Programme areas and minimum systems and/or functional areas required Programme Area Minimum system/functional area required Surveillance and Response Policy Event-based surveillance Indicator-based surveillance Response system Capacity-building (training) Essential IHR requirements and procedures Laboratory Laboratory capacity assessment, mapping and gap analysis National policy, standards, legal framework for laboratory Accurate laboratory diagnosis Biosafety Laboratory support of surveillance and response activities Laboratory networking Risk Communications Outbreak communication Education, training and capacity-building Infection Control National policy and strategy Education, training and capacity-building Zoonoses Risk reduction at the animal–human interface Surveillance for early detection and alert Collaborative response to zoonotic diseases 4For each question, respondents were asked to answer “Yes – Fully”, “Yes – Partially” or “No” and to provide additional comments if desired. Table 2. Extract from APSED Common Indicators Assessment (Surveillance and Response) APSED programme area Minimum systems and/or functional areas required Minimum standards or core capacity requirements Current status/level No Yes - Partially Yes - Fully REMARKS (e.g. explain if current level is same or worse than baseline level) Surveillance and Response Policy 1. Is there a national policy to support the surveillance and response system(s)? If yes, please list the name and year in the REMARKS section. 2. Has the national policy been reviewed and/or updated to support early warning and rapid response functions of the systems? Event-based surveillance 3. Is there a country-wide event-based surveillance system in operation? 4. Is there a central or national unit or office responsible for collecting, verifying and assessing reports, including unofficial information (e.g. rumours)? Assessment Implementation In early 2010, the APSED Common Indicators Assessment was sent to Member States via WHO Country Offices. Completion of the survey was supported by WHO Country Office staff and by missions of WHO staff from the Regional Office. A number of countries also used the Common Indicators Assessment as an opportunity to organize multisectoral national workshops to review national APSED progress to date. Due to differences in capacity, Pacific island countries were surveyed in 2007 with a simplified Baseline Data Collection tool – a version of the survey that contained fewer questions and less detail than that administered to other Member States. Since the Pacific island countries and areas1 had been surveyed 1 Pacific island countries and areas that responded to the simplified 2007 Baseline Data Collection survey were the Cook Islands, Fiji, the Federated States of Micronesia, Kiribati, 5with a different and incompatible tool, they were not included in the 2010 Common Indicators Assessment and subsequent progress assessment. Data Analysis In 2007, six Western Pacific Region countries completed the Baseline Data Collection tool (n=6): Cambodia, the Lao People’s Democratic Republic, Mongolia, the Philippines, Papua New Guinea and Viet Nam. In 2010, these countries also completed the Common Indicators Assessment. In addition, in 2010 four other countries, Brunei Darussalam, China, Malaysia and Singapore, completed the Common Indicators Assessment. However, to allow comparison with the available 2007 country sample set and data, these four additional countries were not included in the 2007-2010 progress assessment (aggregated 2010 Common Indicators Assessment data for these four countries can be found in Annex 3). Within each minimum system and functional area, the total number of “Yes – Fully”, “Yes – Partially” and “No” responses were totalled and then calculated as a percentage of the total number of answers for that category. To calculate the progress from baseline, the difference in responses as a percentage of total answers from the 2010 Common Indicators Assessment and the 2007 Baseline Data Collection survey was calculated. Note that this value represented a difference in percentage from the baseline, not a percentage increase or decrease from baseline. For each question, responses were mutually exclusive, i.e. only one response was allowed for each question: either “Yes – Fully”, “Yes – Partially” or “No”. Therefore, when comparing data between the 2007 and 2010 surveys, increases in one answer corresponded to decreases in one or both of the other possible answers. the Marshall Islands, Nauru, Niue, Palau, Samoa, the Solomon Islands, Tonga, Tuvalu and Vanuatu. 6Figure 2. Example of calculation of Progress from Baseline With the methodology described, progress from the baseline was regarded as positive if there was shown to be: • Negative score for “No” responses: - indicated a decrease in percentage of “No” responses from 2007 to 2010; - i.e. respondents that answered “No” in 2007 answered “Yes – Fully” or “Yes – Partially” in 2010. • Positive score for “Yes – Fully” responses: - indicated an increase in percentage of “Yes – Fully” responses from 2007 to 2010; - i.e. respondents that answered “No” or “Yes – Partially” in 2007 answered “Yes – Fully” in 2010. • Positive score for “Yes – Partially” responses concurrent with a negative score for “No” responses: - indicated an increase in “Yes – Partially” responses resulting from a decrease in “No” responses from 2007 to 2010; - i.e. respondents that answered “No” in 2007 answered “Yes – Partially” in 2010. However, a positive score for “Yes – Partially” responses concurrent with a negative score for “Yes – Fully” responses may have indicated negative progress: - indicated an increase in “Yes – Partially” responses resulting from a decrease in “Yes – fully” responses; - i.e. respondents that answered “Yes – Fully” in 2007 answered “Yes – Partially” in 2010 (this situation did not occur within this data analysis). 7Results Surveillance and Response By 2010, Member States had fully achieved the majority of core capacities required for event-based surveillance, indicator-based surveillance and capacity- building. The majority of capacities in policy and essential IHR requirements and procedures have not yet been reached fully, although a large majority of these capacities at least have been met partially. Table 3. Aggregated results from Surveillance and Response, Common Indicators Assessment 2010 Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Policy 41.7% 33.3% 25.0% Event-based surveillance 59.3% 37.0% 3.7% Indicator-based surveillance 60.0% 33.3% 6.7% Response system 59.5% 33.3% 7.1% Capacity-building (training) 50.0% 33.3% 16.7% Essential IHR requirements and procedures 27.8% 61.1% 11.1% The results reflected positive progress in all six identified systems or functional areas of this programme area since 2007. 1. Policy showed slight positive progress, with increases in “Yes – Fully” (+14.4%) responses directly correlated to decreases in “Yes – Partially” (-12.1%) and “No” responses (-2.3%). 2. Event-based surveillance also showed good positive progress with a considerable increase in “Yes – Fully” responses (+33.3%) directly correlated to decreases in “Yes – Partially” (-11.1%) and “No” responses (-22.2%). 3. Indicator-based surveillance also showed good positive progress with a considerable increase in “Yes – Fully” responses (+33.3%) directly correlated to decreases in “Yes – Partially” (-20.0%) and “No” responses (-13.3%). 4. Response system similarly showed good positive progress with a considerable increase in “Yes – Fully” responses (+35.7%) resulting directly from decreases in “Yes – Partially” (-23.8%) and “No” responses (-11.9%). 5. Capacity-building (training) is a newly identified functional area in 2010, thus progress since 2007 cannot be assessed in this analysis. 6. Essential IHR requirements and procedures also showed strong positive progress with increases in “Yes – Fully” (+16.0%) and “Yes – Partially” responses (+31.7%) resulting directly correlated to a large decrease in “No” responses (-47.7%). 8Laboratory In 2010, Member States had fully or partially achieved the majority of core capacities required in Laboratory. For instance, in accurate laboratory diagnosis, 93.4% of capacities have been met at least partially. Table 4. Aggregated results from Laboratory, Common Indicators Assessment 2010 Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Laboratory capacity assessment, mapping and gap analysis 16.7% 66.7% 16.7% National policy, standards, legal framework for laboratory 44.4% 44.4% 11.1% Accurate laboratory diagnosis 36.7% 56.7% 6.7% Biosafety 25.0% 50.0% 25.0% Laboratory support of surveillance and response activities 43.4% 32.9% 23.7% Laboratory networking 36.7% 50.0% 13.3% These results reflect positive progress in all identified systems or functional areas. In particular, strong progress was made in the areas of laboratory capacity assessment, mapping and gap analysis and biosafety. For this programme area, six minimum systems or functional areas were identified and assessed. 1. Laboratory capacity assessment, mapping and gap analysis showed strong positive progress, with increases in “Yes – Fully” (+16.7%) and “Yes – Partially” responses (+26.7%) directly resulting from a large decrease in “No” responses (-43.3%). 2. National policy, standards, legal framework for laboratory showed good positive progress with an increases in “Yes – Fully” (+16.7%) and “Yes – Partially” responses (+16.7%) directly resulting from a considerable decrease in “No” responses (-33.3%). 3. Accurate laboratory diagnosis showed good positive progress with a considerable increase in “Yes – Fully” responses (+33.2%) directly correlated to decreases in “Yes – Partially” (-22.6%) and “No” responses (-10.6%). 4. Biosafety also showed strong positive progress with an increases in “Yes – Fully” (+16.7%) and “Yes – Partially” responses (+25.0%) directly correlated to a large decrease in “No” responses (-41.7%). 5. Laboratory support of surveillance and response activities showed positive progress with an increase in “Yes – Fully” responses (+24.7%) 9resulting from decreases in “Yes – Partially” (-7.1%) and “No” responses (-20.3%). 6. Laboratory networking showed positive progress with increases in “Yes – Fully” (+12.5%) and “Yes – Partially” responses (+8.6%) correlated to a decrease in “No” responses (-21.1%). Risk Communications In 2010, Member States had fully or partially achieved a large majority of core capacities required for Risk Communications. Table 5. Aggregated results from Risk Communications, Common Indicators Assessment 2010 Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Outbreak communications 29.5% 61.5% 9.0% Education, training and capacity-building 9.8% 58.5% 31.7% Given the low baseline capacity levels in 2007, the results from 2010 reflected good positive progress, with substantial reductions in “No” answers correlated to increases in “Yes – Partially” and “Yes – Fully” answers. For this programme area, two minimum systems or functional areas were identified and assessed. 1. Outbreak communications showed positive progress, with increases in “Yes – Fully” (+21.8%) and “Yes – Partially” responses (+5.1%) directly correlated to a decrease in “No” responses (-26.9%). 2. Education, training and capacity-building showed strong positive progress, with increases in “Yes – Fully” (+7.3%) and “Yes – Partially” answers (+36.6%) resulting directly from a large decrease in “No” answers (-43.9%). Infection Control By 2010, Member States had partially or fully achieved the majority of core capacities required in Infection Control, with the proportion of capacities not achieved decreasing substantially since 2007. Table 6. Aggregated results from Infection Control, Common Indicators Assessment 2010 Minimum systems and/or functional areas required Yes - Fully Yes - Partially No National policy and strategy 35.4% 46.2% 18.5% Education, training, and capacity-building 41.7% 41.7% 16.7% 10 For this programme area, two minimum systems or functional areas were identified and assessed. 1. National policy and strategy showed slight positive progress, with an increase in “Yes – Fully” responses (+15.9%) directly correlated to decreases in “Yes – Partially” (-2.2%) and “No” responses (-13.7%). 2. Education, training and capacity-building showed strong positive progress, with a considerable increase in “Yes – Fully” responses (+31.7%) directly correlated to decreases in “Yes – Partially” (-8.3%) and “No” responses (-23.3%). Zoonoses By 2010, Member States had partially or fully achieved the majority of core capacities. Capacity levels across all components of Zoonoses are relatively consistent, with similar proportions of capacities fully, partially or not met across the minimum systems / functional areas. Table 7. Aggregated results from Infection Control, Common Indicators Assessment 2010 Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Risk reduction at animal–human interface 36.1% 50.0% 13.9% Surveillance for early detection and alert 36.7% 50.0% 13.3% Collaborative response to zoonotic diseases 27.8% 61.1% 11.1% For this programme area, three minimum systems or functional areas were identified and assessed: 1. Risk reduction at animal-human interface showed positive progress, with an increase in “Yes – Fully” responses (+26.1%) directly related to decreases in “Yes – Partially” (-16.7%) and “No” responses (-9.4%). 2. Surveillance for early detection and alert showed positive progress with increases in “Yes – Fully” (+12.7%) and “Yes – Partially” (+10.0%) responses correlated to a decrease in “No” responses (-22.7%). 3. Collaborative response to zoonotic diseases showed positive progress, with an increase in “Yes – Fully” responses (+27.8%) directly related to decreases in “Yes – Partially” (-10.3%) and “No” responses (-17.5%). Conclusions Overall, good progress has been achieved in strengthening capacities in the five APSED programme areas. Of the 18 minimum systems or functional areas assessed in both the 2007 APSED Baseline Data Collection and 2010 APSED Common Indicators Assessment, all have shown progress towards achieving the standards required. 11 It should be noted that the low percentages of “Yes – Fully” responses in many cases can be attributed partially to extremely low baseline levels. In Laboratory, the area of laboratory capacity assessment, mapping and gap analysis in 2010 achieved only 16.7% of “Yes – Fully” answers. However, given the baseline level of 0%, the 2010 result in context indicates very good progress. A number of limitations should be considered when interpreting the results of this analysis. Firstly, the small sample size of the surveys (n=6) makes the direct application of the findings of this analysis to other countries in the Region difficult. Secondly, the qualitative nature of the survey should be taken into account when reading the data. To this effect, results should be interpreted as indicative of positive or negative change rather than precise quantitative measurements of change. For example, a 25 point increase in “Yes – Fully” responses from 2007 to 2010 may be a large and significant increase in capacity in that functional area. Thirdly, changes in qualitative answers also may reflect changes in attitudes towards capacities rather than real changes in capacity. For example, a recent disease outbreak may lead to a lowered opinion of capacity in Surveillance and Response and lower responses to the assessment. Conversely, a positive media report may lead to increased opinion of capacity in Risk Communication and higher responses to the assessment. Lastly, the surveys were completed with the support of WHO staff. Although this method may be viewed as impartial, institutional bias also should be considered when interpreting the data. Many countries experienced a significant lag between the time APSED was endorsed in 2005 and implementation of the strategy. To set any strategy in motion requires time – time to orientate and brief staff, time to establish the necessary structures and responsibilities, time to formulate implementation plans and begin activities. In some countries, APSED implementation only began in 2008. Therefore, the achievements of APSED to date should be considered in the context of actual implementation periods rather than the strategic 5-year span. Given this delay, the achievements of countries to strengthen their core capacities in a constrained period of time should be viewed in a very favourable light. With the consistent positive progress recorded in all programme areas in 2010, continuation of APSED to capitalize on the momentum already generated should be strongly considered. 12 Section 2 The State of Pandemic Preparedness Results of the WHO Pandemic Preparedness Assessment for the Western Pacific Region APSED was designed to assist Member States in strengthening the core capacities needed to respond to emerging diseases, including pandemic influenza. From 2009 to 2010, the outbreak and spread of pandemic influenza (H1N1) 2009 provided Member States and WHO with a real-time and real-life situation in which pandemic preparedness was tested. In the past year, the WHO Regional Office for the Western Pacific has devoted considerable efforts and resources to pandemic response, planning and preparedness activities. Pandemic preparedness requires an approach focused on two tiers: plan development and increasing readiness. Member States have made significant improvements in terms of readiness by implementing the APSED workplan to strengthen core capacities. Strengthening core capacities is a critical part of effective pandemic preparedness. A pandemic may have overwhelming and disastrous consequences on society by leading to the breakdown of essential services, including health care. Preparing for a pandemic therefore requires a strong focus on strengthening the core capacities of the health system to allow the health sector to be better prepared to respond to and cope with excessive surges in demand. Each year, an annual WHO Pandemic Preparedness Assessment for the Western Pacific Region is conducted to identify priority areas for Member States to focus on. In 2010, given the continuing H1N1 pandemic, this identification and preparation is particularly relevant. Pandemic preparedness is an ongoing activity and it is critical that activities continue to be focused strategically to best prepare countries and areas for response. Pandemic Preparedness Framework The WHO Regional Office for the Western Pacific outlines three key aspects to set a framework for pandemic preparedness: (1) stage-wise intervention (2) multisectoral approach (3) two-tiered approach. 13 Stage-wise Intervention Pandemic preparedness interventions are activated in three stages, with each stage correlated to WHO pandemic alert phases. • Averting Pandemic Influenza: Involves community and government activities to avert an influenza pandemic (correlated to WHO Pandemic Alert Phases 1–3). • Rapid Containment: Involves extraordinary measures aimed at stopping or delaying the spread of a novel human influenza at its source (correlated to WHO Pandemic Alert Phase 4). • Pandemic Response: Is activated if other measures are unsuccessful in stopping the development of a pandemic. Local authorities will need to mobilize and reallocate available resources to implement an all-of- society response since central government or international support may be difficult to access during this stage. The overall public health aim of pandemic response is to reduce the number of preventable deaths (correlated to WHO Pandemic Alert Phases 5–6). Figure 3. Stage-wise intervention Multisectoral Approach In addition to public health measures implemented by the health sector, the maintenance of other essential services is vital if societies are to keep functioning. The continuation of these services is also critical to allow the health sector to keep functioning. Effective pandemic preparedness therefore requires a multisectoral planning approach with involvement from all critical sectors of society. 14 Figure 4. Multisectoral approach to pandemic response In addition, local authorities and service providers will be at the forefront of the response. Capacity at local government and community levels also must be strengthened and local and national pandemic preparedness and response plans interlinked. Two-tiered Approach Member States in the Western Pacific Region all have a national pandemic preparedness plan. However, the existence of such a plan alone does not ensure that the plan can be implemented in a pandemic response. To ensure the capacity to properly implement plans, a two-tiered approach to pandemic planning should be applied: • Pandemic Planning: The first tier is to formulate a plan for each stage of the intervention. It must be recognized that effective pandemic plans are not merely finalized documents but are a continuous cycle of maintenance and development involving testing (via exercises), evaluation and revision. • Increasing Readiness: The second tier is to increase readiness and capacity to implement the actions in the plan. This involves both increasing readiness and capacity for emergency-specific actions (e.g. rapid containment) and actions based on routine activities (e.g. laboratory practices). 15 Figure 5. Two-tiered approach Methodology Design and Format The WHO Pandemic Preparedness Assessment for the Western Pacific Region is in the format of a questionnaire containing sections to measure capacity in each of the five APSED programme areas. Within each section, the questionnaire lists a series of activities marked to indicate the intervention stage to which they relate: * indicating Averting Pandemic Influenza ** indicating Rapid Containment *** indicating Pandemic Response. Respondents are asked to mark their level of capacity in that activity on a scale from zero (no capacity) to three (advanced). Measurement indicators are included in the questionnaire to guide responses. 16 Table 8. Extract from the WHO Pandemic Preparedness Assessment for the Western Pacific Region (Infection Control) INFECTION CONTROL LEVEL OF CAPABILITY Advanced 0 1 2 3 A PS ED P ri or it y A ct iv it ie s *Infection control multidisciplinary committees Do not exist or do not hold meetings Meet regularly and coordinate infection control activities at national level Meet and coordinate activities at national and within designated health care facilities Meet and coordinate activities at national level and within all health care facilities *Written infection control protocols and/or guidelines for pandemic- prone respiratory diseases Do not exist at national, subnational or local level Exist at national level Exist at national and subnational levels Exist at all levels of the health care system *Trained infection control designated official and/or practitioner(s) Do not exist at national level Trained and allocated to work at national level Trained and allocated for national level and at designated health care facilities Trained infection control personnel allocated in all health care facilities at central, provincial and district levels The WHO Pandemic Preparedness Assessment for the Western Pacific Region was established in 2007 to assess the level of readiness of Member States to implement essential public health activities for pandemic preparedness. In 2008, the United States of America Centers for Disease Control and Prevention (CDC) also designed a pandemic preparedness tool, including 12 capacities relevant to pandemic influenza preparedness and response. In order to avoid duplication and to use resources efficiently, these two tools were integrated into a single questionnaire called the “WHO Regional Office for the Western Pacific and CDC Joint Assessment Tool for Pandemic Preparedness”. (Note that this report addresses the results of the WHO Regional Office for the Western Pacific portion of this joint assessment only.) Assessment Implementation The “WHO Regional Office for the Western Pacific and CDC Joint Assessment Tool for Pandemic Preparedness” was sent to pandemic focal points in countries and areas of the Western Pacific Region via WHO Country Offices where present. Due to differences in scale and capacity, the activities and levels of capacity described in the assessment were not fully relevant to Pacific island countries and areas. It was also acknowledged that completing assessments would impose a significant burden, especially on those with limited human resources. For these reasons, Pacific island countries and areas are not included in this assessment. 17 Data Analysis Calculation for individual countries and areas For each country and area, responses for each APSED programme area were grouped and analysed according to the pandemic intervention stage. The median value of the capability scores for the activities relevant to that stage then was calculated. Table 9. Sample median value calculation ZOONOSES CAPABILITY SCORE *Establish a national intersectoral coordination committee for control and prevention of animal and human influenza 2 *Establish a mechanism for alert and response between animal and human health sectors 1 *Risk reduction intervention activities in live-bird market to prevent transmission of human AI 2 Median - *Averting avian influenza 2.0 Some activities are implemented in multiple intervention stages – for example, in the area of Laboratory, “quality assessment programmes” are required in the “averting pandemic influenza” and “rapid containment stages”. Thus, the response to this question was included in the score calculation for both of these stages. In the area of Infection Control, “written infection control protocols and/or guidelines for pandemic prone respiratory diseases” are required in all three intervention stages. Thus, the response to this question was included in the score calculation for all stages. 18 Table 10. Sample median value calculation LABORATORY CAPABILITY SCORE LABORATORY CAPABILITY SCORE *Standard operating procedures (SOPs) for Pandemic Influenza (PI) specimen collection, storage and transport within the country 2 *SOPs for PI specimen collection, storage and transport within the country 2 *SOPs for PI specimen collection, storage and transport internationally for countries without the capacity to detect Avian Influenza (AI) 2 *Training for people who handle PI specimens on collection, storage and transport 2 *SOPs for AI specimen collection, storage and transport from national influenza centres (NICs) to the WHO influenza Collaborating Centre 3 *Biosafety training has been provided to those laboratory staff handling specimens from suspected influenza patients 3 *Training for people who handle PI specimens on collection, storage and transport 2 *Quality assessment programmes 3 *National supply of packing materials and transportation plan for PI specimens in accordance with the International Air Transport Association (IATA) and the International Civil Aviation Organization (ICAO) standards 3 **System for rapid diagnosis of pandemic Influenza virus within the country, including SOPs, training of laboratory staff and the equipment to test specimens 3 *Biosafety training has been provided to those laboratory staff handling specimens from suspected influenza patients 3 **System for communication and reporting test information between laboratory specialists and outbreak response teams 2 *Quality assessment programmes 3 Median - **Rapid Containment 2.5 Median - *Averting Avian Influenza 3.0 Group aggregation and analysis Because of existing differences in capacity, assessed countries and areas were divided into two groups: • Group A: Countries with WHO Country Office presence (n=8: Cambodia, China, the Lao People’s Democratic Republic, Malaysia, Mongolia, the Philippines, Papua New Guinea and Viet Nam); • Group B: Countries and areas without WHO Country Office presence (n=8: Australia, Brunei Darussalam, Hong Kong [China], Japan, Macau [China], New Zealand, the Republic of Korea and Singapore). For each group, the percentage of median values (as calculated above) ≥ 2 was calculated. This figure represents the percentage of countries and areas with good (median score 2) to advanced (median score 3) capacity. 19 Results Group A Surveillance and Response: Significant improvement across all intervention stages. Capacity in “averting avian influenza” and “rapid containment stages” was reported as advanced by almost all respondents in 2010. Capacity was reported as lower in the “pandemic response stage”, in which contingency plans for business continuity are absent in almost all countries. Laboratory: Significant improvement leading to advanced capacity across all intervention stages. In 2010, capacity across all intervention stages was reported as good or advanced by most countries. No general weaknesses in the group were identified. Further requirements in this area may be assessed on an individual country basis. Risk Communications: Significant improvement across all intervention stages, but capacity in the “rapid containment” stage is lagging. Advanced capacity has been reached by almost all countries in “averting avian influenza” and “pandemic response” stages. Capacity in “rapid response” is lagging, with a major gap noted in evaluations conducted for communications staffing and resource needs for rapid containment and pandemic response stages. In the “rapid containment” stage, many countries also reported an absence of risk communication plans at the national, subnational and local levels. Some countries also reported gaps in multisectoral collaboration to conduct risk communication activities and the availability of information, education and communication (IEC) materials on rapid containment. Infection Control: Significant improvement across all intervention stages, but capacity still relatively low. Infection Control capacity has increased considerably since 2008, but gaps remain. In 2010, a significant need for improvement was identified for most countries in the ready availability of appropriate infection control supplies and presence of conditions for infection control. Plans for surge capacity in health care facilities to manage infectious patients are also weak in some countries and gaps were reported in the training of relevant staff in standard and transmission-based precautions, use of personal protective equipment (PPE) and health care facility pandemic plans. 20 Zoonoses: Significant improvement, but capacity still relatively low. Overall, good progress has been made in the past year to address weaknesses in intersectoral coordination and alert systems and risk-reduction activities in live-bird markets. Zoonoses may still benefit from further efforts to strengthen capacity in all activities. Table 11. Group A 2010 Pandemic Preparedness Assessment results (n=8) Averting Pandemic Influenza Rapid Containment Pandemic Response Surveillance and Response 88% 88% 75% Laboratory 88% 88% 88% Risk Communications 88% 50% 88% Infection Control 75% 75% 75% Zoonoses 75% * * 21 F ig u re 6 . G ro u p A t re n d s 2 0 0 8 – 2 0 1 0 22 Group B In 2010, the WHO Pandemic Preparedness Assessment for the Western Pacific Region was completed by six of the eight Group B countries. With this sample size, care also should be taken when interpreting the data for 2010. In addition, all eight countries and areas completed the assessment in 2009 and seven countries completed the assessment in 2008. Due to the difference in sample size over previous years, care also should be taken when looking at trends over time for this group. All Group B countries and areas have achieved good to advanced capacity in almost all areas and intervention stages. Overall, it should be noted that low responses to individual survey questions generally came from countries and areas of extremely limited size. Activities with reported low capacity, such as the establishment of a national coordination committee for animal and human influenza, may not have equal weight in terms of pandemic preparedness in these settings. Table 12. Group B 2010 Pandemic Preparedness Assessment results (n=5) Averting Pandemic Influenza Rapid Containment Pandemic Response Surveillance and Response 100% 100% 100% Laboratory 100% 100% 100% Risk Communication 83% 100% 100% Infection Control 100% 100% 100% Zoonoses 67% * * The results in 2010 reflect a general trend of improvement in capacity or maintenance of good to advanced capacity in all areas and intervention stages. There are two exceptions to this trend. Firstly, reported Risk Communication capacity in the averting pandemic influenza stage has consistently decreased since 2008, when 100% of respondents reported good to advanced capacity to 88% in 2009, and 83% in 2010. Secondly, reported levels of good to advanced capacity in Zoonoses decreased 21% from 2009 to 2010, reversing the positive trend of the previous year. Although these two negative results reflect reduced reported capacity for countries in Group B, they should not be generalized to include all Group B countries. In these cases, the results were the products of low individual country responses rather than the trend of the entire group. This again highlights the stated limitations of sample size and consistency in this assessment and the need to take these into consideration when interpreting results. 23 F ig u re 7 . G ro u p B t re n d s 2 0 0 8 -2 0 1 0 24 Conclusions Overall, good progress has been achieved in strengthening pandemic preparedness in all three stages of intervention in surveyed countries and areas. In almost all areas and intervention stages, capacity levels have increased or been maintained every year since 2008. For Group A, in the one exception of Laboratory capacity in the “rapid containment” stage, negative progress in 2009 was compensated for by equal positive progress in 2010. For Group B countries and areas in 2010, good to advanced capacity has been almost universally achieved across all intervention stages and areas. For Group A countries, gaps still remain in the areas of Infection Control and Zoonoses. In addition, capacity in Surveillance and Response in the pandemic response stage and Risk Communications in the rapid containment phase both require improvement. Increasing readiness is a core tier of the two-tiered approach to pandemic preparedness and planning. The results of this assessment reflect capacity to perform activities specific to a pandemic emergency but also reflect capacity to perform routine activities. For example, the availability of PPE, infection control supplies and staff trained in their use is both a routine capacity and a pandemic preparedness capacity. Investment in pandemic preparedness, therefore, has returns in both emergency and normal times. The experience of pandemic H1N1 (2009) in the past year has been both a challenge and an opportunity to test pandemic preparedness. The good levels of preparedness capacity reported here by countries reflect the intensive efforts made to improve pandemic preparedness under the APSED framework. The overall positive progress reported since 2008 also indicates the relevance and usefulness of the APSED framework and two-tiered approach to pandemic planning and response capacity-building in these assessed countries and areas of the Western Pacific Region. 25 Section 3 Moving Beyond APSED Results of country consultations In December 2009, the WHO Regional Office for the Western Pacific initiated a consultative process with Member States to gain their perspectives, ideas and opinions about the future direction of the revised APSED. During these consultations, countries were asked to identify their key public health concerns and requirements for capacity strengthening in the next five years. Given the expanded scope of IHR (2005), countries were asked if they thought the existing five core APSED programme areas were useful and relevant and if they could identify additional necessary programme areas that should be included in order to address the wider scope. In addition to revised and new programme areas, countries were asked to identify key public health threats of concern, cross-cutting issues and other considerations that should be addressed in the revised strategy. Consultations were held with national counterparts in the Ministries of Health and partners from other sectors that were considered by countries to be relevant to future APSED implementation. Consultations were facilitated by WHO Country Offices and were held in various formal and informal formats (e.g. workshops, discussions) from December 2009 to April 2010. In total, seven countries in the Western Pacific Region were consulted through workshops and meetings: Cambodia, China, the Lao People’s Democratic Republic, Malaysia, Mongolia, the Philippines and Viet Nam. WHO staff supported or participated in these activities. A joint consultation also was held with Pacific island countries and areas at a meeting of Pacific IHR National Focal Points in Auckland, New Zealand, in March 2010.2 Findings Current Five APSED Programme Areas All countries agreed that the five current programme areas of APSED should be continued and strengthened. Significant progress has been achieved in all areas under the current phase of APSED. These achievements should be built upon by a revised APSED strategy through using the capacities and mechanisms already strengthened to address the expanded scope of the revised IHR (2005). 2 Meeting for Pacific IHR National Focal Points and PPHSN-EPINET Representatives on Syndromic Surveillance for the Pacific, Auckland, New Zealand, 23–26 March 2010. 26 Surveillance and Response: Excellent progress has been made in Surveillance and Response under the current APSED, notably in indicator- and event- based surveillance and response systems. The value of rapid response teams in particular was strongly recognized by countries, with a recommendation that this mechanism be expanded in a revised APSED to also include non-EID threats. Surveillance systems also could be expanded to include a broader scope of public health threats. To this end, countries also suggested that interdepartmental and ministerial coordination of response activities could be strengthened. A number of countries commented that improvements need to be made to data analysis and use. Firm views also were expressed about the need to strengthen risk assessment capacity. Support for information management also was suggested. Countries also strongly noted a need for support to monitor and evaluate surveillance systems and to better link indicator- and event-base surveillance. Laboratory: In order to address the scope of IHR (2005), countries acknowledged a need to expand the current EID scope of laboratory services. To address this need, all countries consulted identified closer laboratory networking and collaboration as a key approach for the future through cooperative agreements and possibly integrating laboratory facilities between national and local levels, national and regional levels and public health and clinical systems. The majority of countries also noted a need to continue activities to strengthen quality assurance and biosafety in laboratories. Zoonoses: The majority of countries recognized the value of zoonotic collaboration mechanisms and groups established during the first phase of APSED. Countries recommended that networks established to address avian influenza could be expanded to address other zoonotic diseases. Strengthened collaboration with other ministries also was suggested by some as a key approach for the future in terms of coordinated responses and exercises. Infection Control: Infection Control remains a programme area in which core capacities require strengthening. Nosocomial infections were noted as a key concern by most countries and most countries also identified basic resources and logistics as a continuing area to be addressed. A lack of expertise remains an issue, with many countries identifying needs for training, regional networking, study tours and centres of excellence in order to build knowledge. Strengthened links between public and private and public health and clinical sectors also was identified as a key approach for the future. Some countries consulted also recommended that clinical management be linked with this area of work. 27 Risk Communications: Half of the countries consulted identified a need to establish or strengthen risk communication structures and networks as a priority action for the future. The media were acknowledged as an influential source of information for communities and the need for good relationships noted. Countries also identified a need to better understand their audiences and to study the effectiveness of behaviour change communications (e.g. through monitoring and evaluation activities) to improve their messaging. Table 13. Current APSED programme areas Area Recommendation Suggested future actions Surveillance and Response Continue Expand activity scope of surveillance systems to include other public health threats Expand scope of rapid response teams to include other public health threats Strengthen interdepartmental and ministerial coordination of response activities Improve what is done with data – analysis and risk assessment Strengthen information management Monitor and evaluate surveillance systems Laboratory Continue Expand current EID scope of laboratory services Strengthen closer laboratory collaboration through networking and integrating laboratory facilities at national and local levels, national and regional levels, public health and clinical systems Strengthen quality assurance and biosafety Zoonoses Continue Recognize value in established zoonotic collaboration mechanisms and groups Expand scope of AI networks to other zoonotic diseases Establish and strengthen coordination with other ministries Infection Control Continue Address nosocomial infections Address basic resource and logistics management needs Address lack of expertise (e.g. require training, regional networking, study tours, centre of excellence) Strengthen links between public and private and public health and clinical sectors Link with clinical management Risk Communications Continue Establish or strengthen communications structure (unit, networks) Strengthen media relations Better understand audiences and study effectiveness of behaviour change communications Future Scope There was unanimous support for APSED to continue to address core capacities needed to combat EID. Member States also were strongly aware of the expanded mandate of the revised IHR (2005) to include other public health events of international concern (PHEIC) in addition to EID. To strengthen core capacities needed to prepare, detect and respond to such events, Member States proposed that the scope of APSED be expanded to include the following priority issues: 28 Identified Areas and Issues: High Frequency Public Health Emergency Preparedness: All countries consulted strongly supported the inclusion of public health emergency preparedness in the revised APSED. Structures and mechanisms established during multisectoral pandemic planning efforts could be expanded to address broader public health emergencies. Integration with existing disaster management plans and emergency response structures was recommended highly.3 Food Safety: This area was identified in almost all consultations as a priority to be included in the expanded scope of APSED. Outbreaks of foodborne disease are widely prevalent in the Western Pacific Region, particularly in resource-poor settings. In addition, the increasing industrialization of food production globally has raised the potential and frequency of food contamination events in both high- income and lower-income countries. Linkages with existing food safety networks were highly recommended by Member States – for example, strengthening links between National IHR Focal Points (NFPs) and the International Food Safety Authorities Network (INFOSAN). The existing APSED core capacity areas were regarded as complementary mechanisms that also could be used to detect and respond to food safety events. Clinical Management: Clinical management was identified as a potential core capacity area during the midterm review of APSED conducted in the Lao People’s Democratic Republic in 2008. This area again was identified by Member States during the 2010 country consultation process as a potential core capacity area to be included in the revised APSED. Specifically, countries identified case management (especially severe case management), clinician training, building of clinical networks, hospital preparedness and the strengthening of hospital surge capacity and preparedness plans as key areas of work. Some of these suggested areas overlap with those suggested for public health emergency preparedness, so careful consideration should be given when defining and establishing these core capacity areas in order to maximize synergies and avoid duplication. Health Care Response: Strengthening the response capacity of health care facilities was identified strongly by countries as an area to be considered in a revised APSED. Based on the experiences and lessons learnt from pandemic influenza (H1N1) 2009, specific issues identified to be addressed in this area included hospital surge capacity planning, hospital emergency preparedness planning, emergency treatment, stockpiling and corpse management. Natural Disasters: All countries strongly suggested that natural disasters be addressed in the expanded scope of APSED. Countries in the Western Pacific Region are regularly affected by disasters such as earthquakes, flooding, typhoons 3 Issues identified with high frequency by participants during the country consultation process. 3 29 and tsunamis. Countries suggested that existing systems could be expanded to address this issue with activities such as preparedness planning, stockpiling, risk assessment and post-disaster EID prevention and control. The revised APSED could be used to strengthen links to existing national disaster management bodies in order to strengthen the public health response to natural disasters. Human Resources: The building, maintenance and retention of quality human resources were key issues identified for all countries. For Pacific island countries and areas, small size, remote locations and limited career opportunities make the issue of adequate staffing even more critical and difficult. Countries also emphasized that effective assessment and revision of training and training approaches should be initiated to ensure effectiveness, not just delivery, of training. The Field Epidemiology Training Programme (FETP) was highlighted by a number of countries as a good example of an effective programme for strengthening human resources that should be continued. Table 14. Identified areas and issues – high frequency Area and/or Issue Frequency Identified Suggested Actions Public Health Emergency Preparedness High • Expand pandemic planning structures • Integrate with disaster management plans, emergency response structures Food Safety High • Strengthen linkages with existing food safety networks (e.g. INFOSAN) • Build on existing surveillance and response structures Clinical Management High • Address severe case management • Address clinician training • Build clinical networks • Strengthen hospital preparedness and surge capacity Health care Preparedness and Response High • Strengthen hospital surge capacity, hospital emergency preparedness planning, emergency treatment, stockpiling, corpse management Natural Disasters High • Strengthen preparedness planning, including stockpiling • Strengthen risk assessment • Address post-disaster EID prevention and control • Build on existing surveillance and response structures • Strengthen links to existing national disaster management bodies Human Resources High • Address as a key issue (especially in Pacific island countries and areas) • Ensure effectiveness of trainings • Strengthen and expand FETP Identified Areas and Issues: Medium Frequency4 Points of Entry: Strengthening core capacities at designated points of entry is a key requirement of IHR (2005). Since APSED is the regional approach to achieve IHR implementation, points of entry was suggested for inclusion in the revised strategy. This area originally was considered for inclusion in the first phase of 4 Issues identified with medium frequency by participants during the country consultation process. 30 APSED but later was removed to allow countries to focus first on building core capacities in other programme areas. In 2010, and after the experience and lessons learnt from pandemic (H1N1) 2009, most countries expressed an interest to include points of entry in the revised APSED. Environmental, Chemical and Occupational Hazards: Countries also suggested that the scope of APSED be expanded to include environmental, chemical and occupational hazards. Within APSED, these hazards may be included in an expanded surveillance and public health response function. Again, this should be carried out through strengthened links or collaboration with existing national environmental or disaster management bodies. Mass Gatherings: Mass gatherings were identified by about half of the consulted countries as a special situation to be considered in the revised APSED. This situation mainly was considered by countries in the context of public health emergency preparedness, with suggestions to include mass gatherings in emergency preparedness planning, training and simulation exercises. It also was thought that existing APSED capacities could be strengthened to detect and respond to public health threats arising from mass gatherings (e.g. outbreaks of communicable or foodborne disease). Bioterrorism: Bioterrorism was suggested by some countries to be included in the scope of a revised APSED. However, this threat was not a priority of all, particularly resource-poor, countries. If included, it was suggested that bioterrorism be addressed by APSED through the use of existing detection and response mechanisms, the strengthening of regional-level mechanisms and/or through the nomination of a public health focal point. Table 15. Identified areas and issues – medium frequency5 Area and/or Issue Frequency Identified Suggested Actions Points of Entry Medium • Strengthen points of entry role, building on experiences and lessons learnt from pandemic (H1N1) 2009 • Build core capacities at designated points of entry Environmental, Chemical and Occupational Hazards Medium • Build on existing surveillance and response structures • Strengthen links or collaboration with existing national environmental and disaster management bodies Mass Gatherings Medium • Consider in context of public health emergency preparedness • Strengthen existing APSED capacities to detect and respond to public health threats arising from mass gatherings Bioterrorism Medium • Use existing detection and response systems • Nominate a public health focal point • Strengthen regional-level mechanisms 5 Issues identified with medium frequency by participants during the country consultation process. 31 Identified Areas and Issues: Low Frequency Public Health Interventions: A small number of countries raised public health interventions as a special consideration to be included in the revised APSED. For this issue, risk assessment and formulation of guidelines were suggested as key areas of work. The issue of public health interventions – their application, enforcement and effectiveness – is an area that has not yet been explored thoroughly and empirically. This area may benefit from special consideration in the revised APSED, either on its own or together with other core areas of work such as points of entry or public health emergency responses. Climate Change: Some countries identified climate change as an issue of concern; however addressing this issue comprehensively within the scope of APSED may not be feasible. Instead, countries expressed the opinion that participation in initiatives and advisory groups to address the health effects of climate change may be a more practical way forward. Social Determinants of Health: The social determinants of health were identified by a small number of countries as an important consideration to be taken into account in the revised APSED. However, the low recognition of social determinants of health during the country consultation process should not be interpreted immediately as an indication that this area is not significant. Low awareness of decision-makers is a major challenge in this field. Action is made even more difficult by the broad and multidimensional nature of the scope of the issue, making it difficult to know where and how to start. Initially, the incorporation of social determinants into responses to disease outbreaks and public health threats may not seem relevant. However, by prioritizing and slowly integrating approaches that take these determinants into account – for instance, collecting gender disaggregated data on people accessing emergency health care or considering socioeconomic status when identifying target audiences for Risk Communications – real and practical action can be taken. Table 16. Identified areas and issues – low frequency Area and/or Issue Frequency Identified Suggested actions Public Health Interventions Low • Address risk assessment • Formulate guidelines • Consider in context of points of entry, public health emergency preparedness, etc. Social Determinants of Health Low • Raise awareness • Prioritize and integrate approaches that take social determinants into account Climate Change Low • Participate in initiatives and advisory groups 32 Conclusions and Suggestions From these consultations with Member States of the Western Pacific Region, the following conclusions and suggestions for a revised APSED strategy were reached: (1) The current five APSED programme areas are important and relevant to Member States in order to strategically strengthen their response and preparedness to EID. (2) All Member States identified EID as their main public health threat but also acknowledged other public health threats and hazards. (3) The current APSED has provided a firm foundation of existing systems and capacities. The scope of the revised APSED should build on this foundation and be expanded to address the core capacities required under the revised IHR (2005). (4) In a revised APSED: (a) the activity scope of the current five APSED programme areas should be expanded; and (b) new programme areas should be considered. (5) A number of critical cross-cutting issues and special considerations may also affect the implementation of APSED and should be addressed in the revised strategy. Next Steps The country consultation process identified many new potential programme areas, cross-cutting issues and special considerations to be taken into account when revising APSED. In order to establish a common understanding of these issues and their relevance to APSED, the WHO South-East Asia and Western Pacific Regional Offices have developed a volume of technical papers exploring each key topic and issue identified by the country consultation process. These papers were to be reviewed with the support of technical experts at the Biregional Consultation on the Asia Pacific Strategy for Emerging Diseases and Beyond, held in Kuala Lumpur from 24 to 27 May 2010. From this technical review of country-level inputs, the future strategic direction, approaches and main components of an updated APSED strategy are proposed for identification. From this process of incorporating intensive country inputs with guidance from technical experts and WHO, it is proposed that a revised APSED strategy will be formulated and presented at the Fifth TAG meeting from 6 to 9 July 2010. Once endorsed, the updated strategy then will be submitted to the Regional Committee for approval at its sixty-first session in October 2010. 33 Figure 8. Process for developing APSED (2010) strategy 34 S ec ti o n 4 - A n n ex es A n n ex 1 : A P S E D A ss es sm en t A gg re ga te d D a ta T a bl es ( n = 6 ) S u rv e il la n ce a n d R e sp o n se 2 0 0 7 B a se li n e D a ta C o ll e ct io n 2 0 1 0 C om m on I nd ic at or s A ss es sm en t P ro g re ss f ro m B a se li n e (m e a su re d a s ch a n g e i n % ) M in im um s ys te m s an d/ or f un ct io na l a re as r eq ui re d Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o Po lic y 27 .3 % 45 .5 % 27 .3 % 41 .7 % 33 .3 % 2 5 .0 % 1 4 .4 % -1 2 .1 % -2 .3 % Ev en t- ba se d su rv ei lla nc e 25 .9 % 48 .1 % 25 .9 % 59 .3 % 37 .0 % 3 .7 % 3 3 .3 % -1 1 .1 % -2 2 .2 % In di ca to r- ba se d su rv ei lla nc e 26 .7 % 53 .3 % 20 .0 % 60 .0 % 33 .3 % 6 .7 % 3 3 .3 % -2 0 .0 % -1 3 .3 % R es po ns e sy st em 23 .8 % 57 .1 % 19 .0 % 59 .5 % 33 .3 % 7 .1 % 3 5 .7 % -2 3 .8 % -1 1 .9 % C ap ac it y- bu ild in g (t ra in in g) - - - 50 .0 % 33 .3 % 1 6 .7 % n/ a n/ a n/ a Es se nt ia l I H R r eq ui re m en ts a nd p ro ce du re s 11 .8 % 29 .4 % 58 .8 % 27 .8 % 61 .1 % 1 1 .1 % 1 6 .0 % 3 1 .7 % -4 7 .7 % La b o ra to ry 2 0 0 7 B a se li n e D a ta C o ll e ct io n 2 0 1 0 C om m on I nd ic at or s A ss es sm en t P ro g re ss f ro m B a se li n e (m e a su re d a s ch a n g e i n % ) M in im um s ys te m s an d/ or f un ct io na l a re as r eq ui re d Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o La bo ra to ry c ap ac it y as se ss m en t, m ap pi ng a nd g ap an al ys is 0. 0% 40 .0 % 60 .0 % 16 .7 % 66 .7 % 1 6 .7 % 1 6 .7 % 2 6 .7 % -4 3 .3 % N at io na l p ol ic y, s ta nd ar ds , le ga l f ra m ew or k fo r la bo ra to ry 27 .8 % 27 .8 % 44 .4 % 44 .4 % 44 .4 % 1 1 .1 % 1 6 .7 % 1 6 .7 % -3 3 .3 % A cc ur at e la bo ra to ry d ia gn os is 3. 4% 79 .3 % 17 .2 % 36 .7 % 56 .7 % 6 .7 % 3 3 .2 % -2 2 .6 % -1 0 .6 % B io sa fe ty 8. 3% 25 .0 % 66 .7 % 25 .0 % 50 .0 % 2 5 .0 % 1 6 .7 % 2 5 .0 % -4 1 .7 % La bo ra to ry s up po rt o f su rv ei lla nc e an d re sp on se ac ti vi ti es 16 .0 % 40 .0 % 44 .0 % 43 .4 % 32 .9 % 2 3 .7 % 2 7 .4 % -7 .1 % -2 0 .3 % La bo ra to ry n et w or ki ng 24 .1 % 41 .4 % 34 .5 % 36 .7 % 50 .0 % 1 3 .3 % 1 2 .5 % 8 .6 % -2 1 .1 % 35 R is k C o m m u n ic a ti o n s 2 0 0 7 B a se li n e D a ta C o ll e ct io n 2 0 1 0 C om m on I nd ic at or s A ss es sm en t P ro g re ss f ro m B a se li n e (m e a su re d a s ch a n g e i n % ) M in im um s ys te m s an d/ or f un ct io na l a re as r eq ui re d Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o O ut br ea k co m m un ic at io n 7. 7% 56 .4 % 35 .9 % 29 .5 % 61 .5 % 9 .0 % 2 1 .8 % 5 .1 % -2 6 .9 % Ed uc at io n, t ra in in g, a nd c ap ac it y- bu ild in g 2. 4% 22 .0 % 75 .6 % 9. 8% 58 .5 % 3 1 .7 % 7 .3 % 3 6 .6 % -4 3 .9 % In fe ct io n C o n tr o l 2 0 0 7 B a se li n e D a ta C o ll e ct io n 2 0 1 0 C om m on I nd ic at or s A ss es sm en t P ro g re ss f ro m B a se li n e (m e a su re d a s ch a n g e i n % ) M in im um s ys te m s an d/ or f un ct io na l a re as r eq ui re d Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o N at io na l p ol ic y an d st ra te gy 19 .5 % 48 .3 % 32 .2 % 35 .4 % 46 .2 % 1 8 .5 % 1 5 .9 % -2 .2 % -1 3 .7 % Ed uc at io n, t ra in in g, a nd c ap ac it y bu ild in g 10 .0 % 50 .0 % 40 .0 % 41 .7 % 41 .7 % 1 6 .7 % 3 1 .7 % -8 .3 % -2 3 .3 % Z o o n o se s 2 0 0 7 B a se li n e D a ta C o ll e ct io n 2 0 1 0 C om m on I nd ic at or s A ss es sm en t P ro g re ss f ro m B a se li n e (m e a su re d a s ch a n g e i n % ) M in im um s ys te m s an d/ or f un ct io na l a re as r eq ui re d Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o Ye s - Fu lly Ye s - Pa rt ia lly N o R is k re du ct io n at t he a ni m al –h um an in te rf ac e 10 .0 % 66 .7 % 23 .3 % 36 .1 % 50 .0 % 1 3 .9 % 2 6 .1 % -1 6 .7 % -9 .4 % S ur ve ill an ce f or e ar ly d et ec ti on a nd a le rt 24 .0 % 40 .0 % 36 .0 % 36 .7 % 50 .0 % 1 3 .3 % 1 2 .7 % 1 0 .0 % -2 2 .7 % C ol la bo ra ti ve r es po ns e to z oo no ti c di se as es 0. 0% 71 .4 % 28 .6 % 27 .8 % 61 .1 % 1 1 .1 % 2 7 .8 % -1 0 .3 % -1 7 .5 % 36 A n n ex 2 : A P S E D A ss es sm en t A gg re ga te d D a ta G ra p h s (n = 6 ) 37 La bo ra to ry 38 O ut br ea k Co m m un ic at io ns Ed uc at io n, tr ai ni ng a nd ca pa ci ty -b ui ld in g O ut br ea k Co m m un ic at io ns Ed uc at io n, tr ai ni ng a nd ca pa ci ty -b ui ld in g 2 1 .8 % 7 .3 % 5. 1% 36 .6 % -2 6. 9% -4 3. 9% -8 0 % -6 0 % -4 0 % -2 0 % 0 % 2 0 % 4 0 % 6 0 % Ri sk C om m un ic at io ns O ut br ea k Co m m un ic at io ns Ed uc at io n, tr ai ni ng a nd ca pa ci ty -b ui ld in g 39 O ut br ea k C om m un ica tio ns Ed uc at io n, tr ai ni ng a nd ca pa ci ty -b ui ld in g O ut br ea k C om m un ica tio ns Ed uc at io n, tr ai ni ng a nd ca pa ci ty -b ui ld in g O ut br ea k C om m un ica tio ns Ed uc at io n, tr ai ni ng a nd ca pa cit y- bu ild in g 40 41 Annex 3: Common Indicators Assessment 2010 Aggregated Data Tables (n=4) n=4 (Brunei Darussalam, China, Malaysia, Singapore) Surveillance and Response Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Policy 75.0% 25.0% 0.0% Event-based surveillance 80.6% 13.9% 5.6% Indicator-based surveillance 65.0% 27.5% 7.5% Response system 82.1% 17.9% 0.0% Capacity-building (training) 75.0% 0.0% 25.0% Essential IHR requirements and procedures 91.7% 8.3% 0.0% Laboratory Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Laboratory capacity assessment, mapping and gap analysis 25.0% 50.0% 25.0% National policy, standards, legal framework for laboratory 66.7% 8.3% 25.0% Accurate laboratory diagnosis 55.0% 30.0% 15.0% Biosafety 50.0% 0.0% 50.0% Laboratory support of surveillance and response activities 52.0% 34.0% 14.0% Laboratory networking 30.0% 35.0% 35.0% Risk Communications Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Outbreak communication 76.0% 14.0% 10.0% Education, training, and capacity-building 39.1% 30.4% 30.4% Infection Control Minimum systems and/or functional areas required Yes - Fully Yes - Partially No National Policy and Strategy 77.6% 14.1% 8.2% Education, training, and capacity-building 87.5% 12.5% 0.0% Zoonoses Minimum systems and/or functional areas required Yes - Fully Yes - Partially No Risk reduction at the animal–human interface 60.9% 13.0% 26.1% Surveillance for early detection and alert 61.1% 16.7% 22.2% Collaborative response to zoonotic diseases 25.0% 58.3% 16.7% 42 A n n ex 4 : W H O P a n d em ic P re p a re d n es s A ss es sm en t fo r th e W es te rn P a ci fi c R eg io n A gg re ga te d D a ta T a bl es G ro up A Su rv ei lla nc e an d R es po ns e La bo ra to ry R is k C om m un ic at io ns In fe ct io n C on tr ol Z oo no se s A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e 20 08 50 % 50 % 13 % 88 % 88 % 88 % 50 % 25 % 3 8 % 3 8 % 1 3 % 2 5 % 2 5 % - - 20 09 88 % 88 % 50 % 88 % 75 % 88 % 88 % 38 % 3 8 % 6 3 % 3 8 % 6 3 % 2 5 % - - 20 10 88 % 88 % 75 % 88 % 88 % 88 % 88 % 50 % 8 8 % 7 5 % 7 5 % 7 5 % 7 5 % - - 20 08 -9 ( n= 8) : C am bo di a, C hi na , La o Pe op le ’s D em oc ra ti c R ep ub lic , M al ay si a, M on go lia , Pa pu a N ew G ui ne a, P hi lip pi ne s, V ie t N am 20 10 ( n= 7) : C am bo di a, C hi na , La o Pe op le ’s D em oc ra ti c R ep ub lic , M al ay si a, M on go lia , Ph ili pp in es , V ie t N am G ro up B S ur ve ill an ce a nd R es po ns e La bo ra to ry R is k C om m un ic at io ns In fe ct io n C on tr ol Z oo no se s A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e A ve rt in g Pa nd em ic In flu en za R ap id C on ta in m en t Pa nd em ic R es po ns e 20 08 86 % 86 % 71 % 10 0% 10 0% 43 % 10 0% 86 % 8 6 % 1 0 0 % 1 0 0 % 1 0 0 % 6 7 % * * 20 09 10 0% 10 0% 75 % 10 0% 10 0% 75 % 88 % 10 0% 8 8 % 1 0 0 % 1 0 0 % 1 0 0 % 8 8 % * * 20 10 10 0% 10 0% 10 0% 10 0% 10 0% 10 0% 10 0% 10 0% 1 0 0 % 1 0 0 % 1 0 0 % 1 0 0 % 8 0 % * * 20 08 –2 00 9 (n = 8) : A us tr al ia , B ru ne i D ar us sa la m , H on g K on g (C hi na ), J ap an , M ac au ( C hi na ), N ew Z ea la nd , R ep ub lic o f K or ea , S in ga po re 20 10 ( n= 5) : A us tr al ia , H on g K on g (C hi na ), M ac au ( C hi na ), N ew Z ea la nd , S in ga po re 43 Annex 5: Beyond APSED Consultation Feedback Template Country: Date: 1. Vision, Mission and Goal Suggestion for Mission Statement of APSED 2011-2015 (What do we want to see in terms of country capacities for managing emerging diseases and public health events by 2015?) 2. Scope Scope of APSED 2011-2015 (e.g. both Emerging Infectious Diseases, and other Public Health Events and Emergencies to be addressed under IHR) 44 3 . E x is ti n g A P S E D C o re C o m p o n e n ts A P S E D C o re C o m p o n e n t K e y a ch ie v e m e n ts Le ss o n s le a rn t fr o m A P S E D i m p le m e n ta ti o n P ri o ri ty a ct iv it ie s th a t sh o u ld b e c o n ti n u e d o r in cl u d e d S u g g e st io n s o n im p le m e n ta ti o n a p p ro a ch o r m e ch a n is m s? S ur ve ill an ce a nd R es po ns e La bo ra to ry Z oo no se s In fe ct io n C on tr ol R is k C om m un ic at io n 4 . P o te n ti a l C o re C o m p o n e n ts C o re C o m p o n e n t P ri o ri ty a ct iv it ie s th a t sh o u ld b e i n cl u d e d S u g g e st io n s o n i m p le m e n ta ti o n a p p ro a ch o r m e ch a n is m s? • • N ot e: P ot en ti al c or e co m po ne nt s m ay i nc lu de e m er ge nc y pr ep ar ed ne ss , cl in ic al m an ag em en t, h os pi ta l ca re , pu bl ic h ea lt h in te rv en ti on , et c. 45 5 . S p e ci a l S it u a ti o n a n d C ro ss -C u tt in g I ss u e s S p e ci a l si tu a ti o n o r is su e s P ri o ri ty a ct iv it ie s th a t sh o u ld b e i n cl u d e d S u g g e st io n s o n i m p le m e n ta ti o n a p p ro a ch o r m e ch a n is m s? N ot e: S pe ci al s it ua ti on o r is su es t o be a dd re ss ed m ay i nc lu de n at io na l di sa st er s, d el ib er at e re le as e of b io lo gi ca l ag en ts , m as s ga th er in g, h um an r es ou rc e de ve lo pm en t, c lim at e ch an ge , et c. 6 . O th e r N o te s