1. ASDPE International Health Regulations (IHR 2005) Laboratory and Zoonosis update Dr Richard Brown, WHO Thailand Workshop on Laboratory Diagnosis for Zoonotic Pathogens 30 July – 01 August, Chonburi, Thailand

2. 2 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Priorities and context in the Asia Pacific Region? Priority Hazards to Public Health in the Asia Pacific Region..? –Emerging and re-emerging communicable diseases, including zoonoses –Anti-microbial resistance –Increasing incidence / recognition of chemical / toxic events –Increasing incidence of some natural disasters (typhoons & floods) A changing context… –Rapid economic development and industrialization –Increasing travel –Effects of climate change

3. 3 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) What are the revised International Health Regulations (2005)? An internationally agreed instrument for global public health security Represents the joint commitment of countries for shared responsibilities and collective defence against the spread of disease Legally binding for WHO Member States since June 2007

4. 4 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Revision means a new approach From control at borders, to containment at source From a‘list of diseases’ to a broad range of threats From preset measures to risk-based assessment / response –National IHR Focal points –WHO IHR Contact Points in Regional Offices –IHR Department in WHO Headquarters –Annual reporting to the World Health Assembly –Internet-based ‘Event Information Site’ –An IHR ‘Emergency Committee’ and an IHR ‘review process’

5. 5 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) What does IHR implementation actually mean…? Two very important aspects… 1.An immediate and ongoing requirement for countries to report some types of event when they occur, and for WHO to provide assistance  Joint risk assessment  Joint response 2.A requirement, linked to a timeframe for countries to establish ‘core capacities’ to detect and respond to public health events (initially, by June 2012)

6. 6 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) IHR as a Public Health Good

7. 7 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) What needs to be reported to WHO? Any potential ‘Public Heath Event of International Concern’ (PHEIC) To help any decision about what to report, some criteria have been established to describe a potential PHEIC 1.Is the public health impact of the event serious? 2.Is the event unusual or unexpected? 3.Is there a significant risk of international spread? 4.Is there a significant risk of international travel or trade restrictions? A decision on whether to report an event to WHO will normally be made by the national IHR focal point

8. 8 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) IHR Core Capacities Eight “core capacities” –National legislation, policy and financing –Coordination and National Focal Point (NFP) Communications –Surveillance –Response –Preparedness –Risk communication –Human resources –Laboratory (need to safely diagnose / exclude all important endemic or imported pathogens and support diagnosis of chemical / toxic ‘events’) Points of Entry Capacities for IHR-relevant hazards (infectious diseases, zoonoses, food safety, chemical, radio-nuclear)

9. 9 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Implementation of IHR Core capacities in the SEA Region

10. 10 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Laboratory Services

11. 11 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Laboratory Biosafety / Biosecurity

12. 12 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) IHR laboratory capacities: SEA Region

13. 13 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) IHR Laboratory capacities: WP Region

14. 14 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Current situation…. Many countries that did not achieve IHR core capacities by June 15 th 2014 have already applied for a second 2-year extension, until June 15 th 2016 When countries apply for an extension, they have to submit a detailed implementation plan In the South-East Asia Region, only Thailand and Indonesia have not requested an extension There is interest from US Government partners to fund capacity building, including support for leadership by Thailand

15. 15 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Thailand can play an important role in supporting other countries It is not feasible for all countries to develop high-level capacity for laboratory diagnosis of all infectious diseases –Small countries only need to have access to laboratory –International laboratory networks are more efficient for some purposes –Requires ‘arrangements’ for safe inter-country shipping of specimens Support can also be provided through –Assessing laboratory services in other countries –Delivery of training –Reviewing / developing guidelines –Supporting outbreak response ‘in the field’

16. 16 Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) Thank you!