ASEM WORKSHOP ON PUBLIC HEALTH EMERGENCY MANAGEMENT September 2014, Beijing China WHO Public Health Emergency Management CK Lee Team Leader, Emerging Disease Surveillance and Response 10 September 2014

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. SARS and the economy

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Asia-Pacific, a hotspot for EIDs Zoonosis from wildlife Figure 3: Global distribution of relative risk of an EID event. Drug-resistant pathogens Zoonosis from non-wildlife Vector-borne pathogens

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Human infection with avian influenza A(H7N9) as of 18 August 2014 First detected in April 2013 ERF grading: 2 Globally, 451 cases and 171 deaths – Majority of cases from mainland China – Ten cases reported by Hong Kong CHP – Four cases reported by Taipei CDC – One case reported by Malaysia MOH 4 As of 18 Aug 2014, n = 451 cases including 171 deaths (CFR: 38%)

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. MERS-CoV, Global 2012 – 2014 as of 18 August laboratory confirmed cases reported from 21 countries 294 deaths (CFR 35%) Median age 46 63% of cases (515/815) are male 27% reported as healthcare workers

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Ebola virus disease (EVD) Outbreak as of 21 August cases and 1427 deaths

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Air traffic connections from West African countries to the rest of the world Gomes MFC, Pastore y Piontti A, Rossi L, Chao D, Longini I, Halloran ME, Vespignani A. Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak. PLOS Currents Outbreaks Sep 2. Edition 1. doi: /currents.outbreaks.cd818f63d40e24aef769dda7df9e0da5.

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR (2005) as a Global Instrument A global legal framework for protecting global public health security A shared risk management for a shared vulnerability, calling for –regional and international alert and response systems –national surveillance and response systems (IHR core capacities) In force since June 2007 –7 years of implementation

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR: Public Health Emergency of International Concern Article 1 Definitions “public health emergency of international concern” means an extraordinary event which is determined, as provided in these Regulations: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response;

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. “PHEIC” (Public Health Emergency of International Concern) 4 diseases that shall be notified polio (wild-type polio virus), smallpox, human influenza new subtype, SARS. Disease that shall always lead to utilization of the algorithm: cholera, pneumonic plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, others…. Q1: public health impact serious? Q2: unusual or unexpected? Q3: risk of international spread? Q4: risk of travel/trade restriction? Insufficient information: reassess

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Procedural requirements WHO DG Various disease and event surveillance systems within a country National IHR Focal Points WHO IHR Contact Points Emergency Committee Other competent Organizations (IAEA etc.) Detect and report any urgent or unexpected events Notify WHO of any events that may constitute a PHEIC Receive, assess and respond to events notified Ministries/ Sectors Concerned Determine whether an event constitutes a PHEIC and recommend measures External advice Notify Communicate Report

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. 12 PHEIC Declaration Process precisely defined in the legal text Requires that DG convene and consult with an Emergency Committee

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Activation of IHR Emergency Committee Pandemic (H1N1) 2009: The first declared public health emergency of international concern (PHEIC) under IHR (2005), 25 April 2009 MERS-CoV 2012: The IHR Emergency Committee met six times between July 2013–June 2014 Polio: The second declared PHEIC on 5 May 2014 – the current international spread of wild poliovirus Ebola: The IHR Emergency Committee, convened on 6 – 7 August, 2014, advice the DG that the EVD constitutes a PHEIC

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR (2005) as a Global Instrument A global legal framework for protecting global public health security A shared risk management for a shared vulnerability, calling for –regional and international alert and response systems –national surveillance and response systems (IHR core capacities) In force since June 2007 –7 years of implementation

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. APSED as a Regional Tool The Asia Pacific Strategy for Emerging Diseases (APSED) –A bi-regional tool to help two WHO Regions (SEAR and WPR) meet IHR core capacity requirements –A common framework highlighting a shared vision and a set of agreed priorities Developed in 2005 and updated in 2010

ASEM WORKSHOP ON PUBLIC HEALTH EMERGENCY MANAGEMENT September 2014, Beijing China Focus Areas of APSED APSED (2005) 1.Surveillance and Response 2.Laboratory 3.Zoonoses 4.Infection Control 5.Risk Communication APSED (2010) 1.Surveillance, Risk Assessment and Response 2.Laboratory 3.Zoonoses 4.Infection Prevention and Control 5.Risk Communication 6.Public Health Emergency Preparedness 7.Regional Preparedness, Alert and Response 8.Monitoring and Evaluation APSED addressing cross-cutting issues

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Response “planning” by itself may not be enough … Exercise EvaluateRevise Develop FIRST TIER Emergency Planning  Actions specific to events  Actions based on routine activities SECOND TIER Increasing Readiness Plan

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. APSED (2010) Focus Area 6.1 vision “Member States in the Asia Pacific region will have an overarching, flexible national public health emergency preparedness and response plan (PHEP) and a national command, control, and coordination structure for health response that is supported by a functional emergency operation centre (EOC) within the health sector, to effectively respond to all acute public health emergencies of national and international concern, including an influenza pandemic.”

A functional EOC… Facilities + Functions

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Emergency Operation Centres EOC room renovated: Cambodia, Lao PDR, Mongolia, Viet Nam Equipment installation in process: Lao PDR and Mongolia EOC SOP developed: Cambodia, Lao PDR EOC activated during outbreaks: Dengue in Lao PDR Measles in Viet Nam EOC activated during outbreaks: Dengue in Lao PDR Measles in Viet Nam

ASEM WORKSHOP ON PUBLIC HEALTH EMERGENCY MANAGEMENT September 2014, Beijing China WPRO: From “Outbreak Room” to “EOC”

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Incident Management System A comprehensive management approach that: Integrates personnel, policies, procedures, facilities, and material under a common, flexible and scalable organizational structure, and Is applicable at all administrative levels, across all functional disciplines and organizations, and for operations of all types and complexities for public health events and incidents.

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Why use an IMS? Promotes rapid integration of staff and resources from multiple organizations within a unified management structure Provides cost-effective and efficient management – Flexible and scalable to operations of any type or complexity – Duplication of effort eliminated; accountability enhanced – Clarity of desired outcomes; management by objectives – Common terminology and functions

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IMS Example (WPRO)

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Focus Areas of APSED APSED (2005) 1.Surveillance and Response 2.Laboratory 3.Zoonoses 4.Infection Control 5.Risk Communication APSED (2010) 1.Surveillance, Risk Assessment and Response 2.Laboratory 3.Zoonoses 4.Infection Prevention and Control 5.Risk Communication 6.Public Health Emergency Preparedness 7.Regional Preparedness, Alert and Response 8.Monitoring and Evaluation APSED addressing cross-cutting issues

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. APSED: Public Health Emergency An occurrence or imminent threat of an illness or health condition, caused by bioterrorism, epidemic or pandemic disease, or novel and highly fatal infectious agent(s) or biological toxin or agents, that poses a substantial risk of a significant number of human fatalities or incidents or permanent or long- term disability. For the purpose of this document, a public health emergency mainly refers to an emergency caused by emerging diseases and/or other acute public health events such as food safety events. If not managed quickly, it may go beyond national borders and cause a public health emergency of international concern like an influenza pandemic.

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Regional event-based surveillance Reported Events 2008–2009†2009– – – – –2014 n = 206n = 218n = 357n = 297n = 222n = 295 Infectious Diseases* Animal H5N1** Disasters and others*** Chemical Information source of initial reports Unofficial(e.g. Media reports) Official(e.g. IHR NFPs, WHO COs) † Fiscal year for TAG(technically advisory group meeting): July – Next June * Excluding animal avian influenza events ** Based on FAO report since 2012 ** Others include 'Pharmaceutical-related', 'Unknown', and 'Food-related'; Monitoring and reporting of disaster events became formalized mid 2011 and in 2013 became further modified based on the official Centre for Research on the Epidemiology of Disasters (CRED) criteria

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. 29

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. H7N9: WHO system to connect the world 30

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. WPRO’s Response to Outbreaks & Emergencies WPRO Emergency Operations Centre (EOC) WHO Emergency Response Framework (ERF): – 3 policies: Surge policy; Health emergency leader policy; No-regrets policy – 4 functions: Leadership; Information; Technical expertise; Core services

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. WHO’s grade definitions Ungraded: An event that is being assessed, tracked or monitored by WHO but that requires no WHO response at the time. Grade 1: a single or multiple country event with minimal public health consequences that requires a minimal WCO response or minimal international WHO response. Organizational and/or external support required by the WCO is minimal. The provision of support to WCO is coordinated by a focal point in the Regional Office. Grade 2: a single or multiple country event with moderate public health consequences that requires a moderate WCO response and/or moderate international WHO response. Organizational and/or external support required by the WCO is moderate. The provision of support to WCO is coordinated by an Emergency Support Team run out of the Regional Office. Grade 3: a single or multiple country event with substantial public health consequences that requires a substantial WCO response and/or substantial international WHO response. Organizational and/or external support required by the WCO is substantial. The provision of support to WCO is coordinated by an Emergency Support Team run out of the Regional Office.

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Grading purpose Grading is an internal WHO process that is conducted to: 1.inform the Organization of the extent, complexity and duration of Organizational and or external support required; 2.prompt all WHO offices at all levels to be ready to repurpose resources in order to provide support; 3.ensure that the Organization acts with appropriate urgency and mobilizes the appropriate resources in support of the affected Member State, partners, and the WHO Country Office; 4.trigger WHO’s Emergency Response Procedures (ERPs) and Emergency Policies, and WHO Performance Standards implementation; 5.remind HWCO to apply WHO’s Emergency Standard Operating Procedures (SOPs); and 6.expedite clearance /dissemination of communications. Using SCALE&URGENCY risk assessment criteria + COMPLEXITY&CONTEXT 

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. 34 WHO’s new way of working: ERF The new WHO Emergency Response Framework (ERF) provides a useful guide to facilitate WHO response H7N9 in China, 2013 (Grade 2) Dengue in Lao PDR, 2013 (Grade 1) Typhoon Haiyan(Yolanda) in Philippines, 2013 (Grade 3) Solomon Islands flooding, 2014 (Grade 1) Ebola Virus Disease in West Africa (Grade 3)

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. What is GOARN? GOARN was born in 2000 Coordinated by WHO A technical collaboration of existing institutions and networks who pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance Recognized as the operational arm of the IHR

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR (2005) as a Global Instrument A global legal framework for protecting global public health security A shared risk management for a shared vulnerability, calling for –regional and international alert and response systems –national surveillance and response systems (IHR core capacities) In force since June 2007 –7 years of implementation

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR Extension – Western Pacific (As of 12 July 2014)

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR Status: Requests for extension

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. IHR Core Capacities: Regional Progress (as of 12 July 2014)

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Summary International/Regional collaboration are often required – Asia Pacific as a hotspot – EID/PHE goes beyond national borders Building on existing momentum on collaboration – IHR: regional and international alert and response systems – APSED addressing cross-cutting issues

CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP August Manila, Philippines. Strategic actions Support countries in meeting the IHR core capacity requirements through implementation of the Asia Pacific Strategy for Emerging Diseases or APSED (2010) Promote cross-cutting capacities that serve as foundation for all emergency risk management Respond to major emerging disease outbreaks and emergencies swiftly and in coordinated matter (WHO Emergency Response Framework) “One country is at risk” means “no country is safe” DSE aims at connecting people

ASEM WORKSHOP ON PUBLIC HEALTH EMERGENCY MANAGEMENT September 2014, Beijing China Thank you!