Download Regional Response to Global Health Issues: The involvement of

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APISA 5, 24-25 november 2011, Taichung, Taiwan
Vincent ROLLET, PhD
Wenzao Ursuline College of languages, Taiwan
French Center for Research on Contemporary China (CEFC)
1. Progressive involvement of regional organizations (RO) to fight
infectious diseases in Asia and in Europe.
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Political commitment of RO to combat ID
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Regional strategies
Institutionalization of regional responses
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2. Role of the regional responses
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Prevention
Control ( H1N1 2009)
Research
3. Main challenges of these regional responses
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ASIA
> HIV
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5,23 million people were living with HIV/AIDS in Asia in 2010 (UNAIDS).
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Low prevalence / large number of infected people (India: 0,1 % = 2,3 millions
adults with HIV.
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Progress in Cambodia, Myanmar and Thailand
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No significant progress in Indonesia and Vietnam
>Tuberculosis
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In 2008, the largest number of new TB cases occurred in South-East Asia
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2350 deaths/day in Asia
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Drug-resistant TB (India, China,..)
>Malaria
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South-east Asia accounts for 15% (34 millions) of estimated cases worldwide
> Ancient diseases: leprosy, dengue, visceral leishmaniasis , lymphatic filariasis
> New and emerging diseases: SARS, avian influenza, Nipah virus disease,…
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EUROPE
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Europe is far from being a fortress again infectious disease!
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Respiratory tract infections (influenza, tuberculosis,..), sexually-transmitted infections (HIV,
hepatitis B and C,…) , emerging and vector-borne diseases (malaria, plague, chikungunya,..) and
vaccine-preventable diseases (measles, rubella,..) still pose a great challenge to the region.
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Each winter, hundreds of thousands of people in the EU become seriously ill and die as a result
of seasonal influenza.
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Re-emergence of TB fuelled by the HIV epidemic
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HIV epidemic : main public health threats posed by communicable diseases in Europe.
Continuing transmission of HIV in many European countries.
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Avian influenza and other EID also a concern for Europe
Progressive involvement of regional organizations to
fight infectious diseases in Asia and Europe.
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1980: 1st ASEAN Health ministers meetings (AHMM): “to strengthen and
coordinate regional collaboration in health among ASEAN countries”
notably in the domain of infectious diseases control.
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1991: 4th AHMM: Framework for the exchange of health information in
ASEAN with emphasis on AIDS
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1992: 4th ASEAN Summit, coordinated effort to curb the spread of
HIV/AIDS
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2000: “Healthy ASEAN 2020”: HIV/AIDS, disease surveillance, TB,
malaria, polio: “ to accelerate the implementation of an existing HIV/AIDS
action program as well as to pursue efforts to strengthen disease
surveillance and control of TB, malaria and polio”
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2003: Special ASEAN Leaders meeting on SARS / First ASEAN+3 Health ministers’
Special Meeting on SARS
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2004: ASEAN Strategic Framework on health and Development (2010-2015)
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2006: H5N1
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2007: MDG Goal 6 (HIV/AIDS, malaria and other diseases)
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2010: 10th ASEAN AHMM: “to strengthen our political commitment to intensify
ASEAN cooperation in health development and to mobilize resources at the
national, regional and international levels” notably in the domain of infectious
diseases.
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1997: 9th APEC Ministerial Meeting: need for further collaboration in health among APEC economy
members
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1998: The Third APEC Ministers' Conference on Regional Science and Technology Cooperation: support for
specific projects directed toward emerging infectious diseases (dengue) / better epidemiological
communication
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2000: APEC Leader Annual Summit: Commitment to fight HIV/AIDS and other infectious diseases
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June 2003: 1st APEC Health ministers Summit: engagement to fight SARS
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Oct. 2003: APEC leaders’ engagement to work to strengthen public health infrastructures to detect, respond
to, and prevent bio-terrorism and naturally occurring disease outbreaks
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2006:14th APEC Economic leaders ‘meeting; agreed to enhance cooperation within APEC on HIV/AIDS,
Avian and Influenza Pandemics
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2008 : 16th APEC Economic Leaders Meeting : “to strengthen the region's health systems and cooperation to
prevent and control emerging infectious diseases
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2009: 17th APEC Economic Leaders Meeting “to build up the ability of regional avian influenza and other
potential emergency and sub-emergency disease such as HIV/AIDS and Tuberculosis
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2010: 18th APEC Economic Leaders Meeting “ to improve the capacity of economies for responses to
infectious diseases, control of non-communicable diseases, and strengthening of health systems”
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Treaty on the functioning of the European Union (TFEU) formerly known as the Treaty of Rome (1958);
Article 168: “… coordination and cooperation to prevent major health threats such as human diseases and to
combat serious cross-border threats to health”
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2002: 1st Programme of Community action in the field of public health (2003-2008): to promote and improve
health, prevent disease, and counter potential threats to health while fully respecting the responsibilities of
the Member States
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2007: European Health Strategy (2008-2013): Commitment to combat HIV/AIDS reaffirmed / engagement to
cooperate at the regional level, where appropriate, to respond to influenza, TB and malaria.
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2007: Bremen Declaration on Responsibility and Partnership in the fight against HIV/AIDS: to strengthen
responses to HIV/AIDS within the European Union / to provide the political leadership to fight this pandemic
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1992: ASEAN Regional Program on HIV/AIDS Prevention and Control
(1995-2000)
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2002: 2nd ASEAN Regional Work Programme on HIV/AIDS (20022005): HIV surveillance; prevention programs; access to drugs,….
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3rd ASEAN Work Programme on HIV and AIDS (2006-2010) :
improving regional responses, HIV/AIDS and mobility, HIV and
development,…
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2005, ASEAN Regional Framework for the Control and Eradication of
HPAI (2006-2008)
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2007: ASEAN Avian Influenza Pandemic Preparedness Project
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2008: ASEAN Regional Strategy for the Progressive Eradication of
HPAI (2008-2010)
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2004: ASEAN +3 EID program (funded by Australia)
4 priority areas:
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1) ASEAN institutional strengthening for EID project management,
2) surveillance and response ,
3) prevention and risk reduction and
4) enhancement of the regional pandemic response mechanisms.
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2005, the ASEAN Agreement on Disaster Management
and Emergency Response
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ASEAN Work Plan for multi-sectoral Pandemic
Preparedness and Response.
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2001: APEC Infectious Diseases Strategy
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2006: APEC Strategy on Emerging Infectious diseases
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prevention and control of EID into the overall planning of economic and social development
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economies’ surveillance and response capacity on EID
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collaboration in the prevention and control of EID
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technical and scientific cooperation and assistance for prevention and control measures among economies
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2006: APEC Action Plan on the Prevention and Response to Avian and Influenza
Pandemics
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2007:
APEC Functioning Economies in Time of Influenza Pandemic Guidelines
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Guidelines for creating an enabling environment for Employers to implement effective
workplace practice for people living with HIV/AIDS
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2003/ 2008: European Health Strategies
2005: Communication on Pandemic Influenza Preparedness and
Response Plan for the European Community
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2007: Framework Action Plan to Fight Tuberculosis in the European
Union
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2009: EU strategy on Pandemic influenza (H1N1)
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2009: EU Strategy on HIV/AIDS (2009-2013)
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ASEAN Task Force on AIDS (ATFOA)
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ASEAN Taskforce on Highly Pathogenic Avian Influenza (ASEAN HPAI Task
Force)
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ASEAN Technical Working group on pandemic preparedness and
response (ATWGPPR)
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ASEAN Secretariat Working group for One Health (ASEC One Health)
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ASEAN Expert Group on Communicable Diseases (AEGCD)
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Health Task Force (HTF) >> Health
Working Group (HWG)
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European Centre for Disease Prevention and
Control (ECDC)
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EC Health Security Committee (HSC)
What role for regional organizations in
the fight against infectious diseases?
1. Prevention : public health
surveillance / preparedness
2. Control: Outbreak control / risk
communication [ex: H1N1 (2009)]
3. Research
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Nov. 2007, Ministries of Health of ASEAN+3 countries agreed to
share through a specialized webpage (ASEAN EID Website),
surveillance information about nine infectious diseases as well
as any public health emergency of international concern (PHEIC).
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In 2010, ASEAN+3 established a regional network of laboratories,
the ASEAN Laboratory Partnership (ALP), enabling the
surveillance of thirteen infectious pathogens of particular
concern in the region.
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Training: To enhance surveillance capacities (structures) and
competencies (human resources)
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In 1996, APEC developed the APEC Emerging Infections
Network.
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APEC EInet is an events-based surveillance mechanism
(scans Internet and media continuously)
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Link between commerce and health officials in A-P.
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Training projects led by APEC economy members: To
strengthen surveillance capacities and competencies
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ECDC is responsible for the surveillance of infectious diseases
and shall maintain the databases for epidemiological
surveillance
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Data collection based on case-reporting from the Member
States.
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Routine surveillance of 46 diseases plus SARS, West Nile
Fever and Avian Influenza through the European Surveillance
System (TESSy)
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Collection, validation, cleaning, analysis and dissemination of
data at the European level.
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Role in surveillance:
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Crucial role in the creation regional surveillance mechanisms to monitor the spread of several
infectious diseases in their region.
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ASEAN and EU : updated and frequent coverage of 13 (ASEAN) and 49 infectious diseases (EU) and a
clear picture of their evolution at the regional level.
ECDC : analysis of the epidemiological situation and share scientific and valuable advices to the
governments of the EU countries to help them to make decisions
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Help to reinforce national compliance to the requirements of the International Health Regulations (IHR
2005)
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Enhance directly the global surveillance of infectious diseases as they support capacity and
competencies development of their members (Training, )
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Offer a privileged and a medium-size platform for sharing experience and best practices related to
disease surveillance through workshops on surveillance.
2. Prevention (Preparedness)
APEC/ASEAN/EU: Facilitators for sharing
preparedness levels, experiences and
concerns :
Regional meetings, workshops, seminars or
videoconferences on preparedness
* APEC Workshop on Implementation of the APEC Action
Plan on Prevention and Response to Avian and Influenza
Pandemics (June 2007)
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Opportunity to share with other their level of
preparedness in line with the regional preparedness
strategies as well as best practices and concerns.
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An important tool for the regional organization to
improve regional preparedness as it allows
comparison between members and then sometimes
indirect pressure to the less prepared ones
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Monitoring MS level of preparedness
*ASEAN Regional Workshop on Multisectoral Coordination
in Pandemic Preparedness and Response (November 2007)
* Conference on Lessons learned from the influenza
pandemic A (H1N1)2009 in Europe” (July 2010) organized
by the EC and the Belgian presidency
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ASEAN: a potential supplier of complementary emergency treatment and
equipment to its MS.
Stock of medical supplies
Since 2007, ASEAN possess a stockpile of 500 000 courses of antivirals (Tamiflu and Relenza),
plus a large quantity of personal protective equipment (surgical mask, disposal gloves,
isolation suit and gown) provided by Japan and stockpiled in Singapore.
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EU: Coordinator of national vaccination strategy plans
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EC has helped EU countries to develop a EU Vaccination strategy
against pandemic H1N1 influenza :
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Timing of vaccination campaigns,
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Potential target groups and priority groups for vaccination
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The level of immunization coverage
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Encouraging good cooperation and communication between EU members
when they decide and implement their own vaccination strategy
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EU / ASEAN: Facilitator for the access to and supply of vaccines in a
region
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EU Commission and the European Medicines Agency (EMA) have worked together to
speed up the marketing authorization procedure of vaccine once a pandemic is declared
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European Commission proposed to set up a mechanism to help joint procurement of
vaccines for interested Member States
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ASEAN member states recently, proposed to explore the feasibility of joint procurement
to secure the availability of drugs and pandemic influenza vaccines as well as to explore
mechanisms for joint production of the drugs and vaccines
Benefits: Lower price // save administrative cost // increase the total number of doses rapidly
available at the regional level
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APEC/ASEAN/EU: Controllers of the level of preparedness of their ME/MS.
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Simulation exercises
APEC Desk-top Pandemic Response Simulation Exercise (2006)
ASEAN Panstop 2007 / Panstop 2009
EU Common Ground Exercise on an Influenza Pandemic
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Goal: to strengthen the effectiveness and the rapidity of the response to an epidemic
outbreak at the national, regional and global level.
!!! APEC gives the opportunity to Taiwan to test its preparedness level against ID in
coordination with other countries.
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ASEAN/EU: Initiators of inter-regional prevention cooperation between Asia and
Europe.
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Joint Declaration of the ASEAN-EU Commemorative Summit (2007): ASEAN and the EU have
pledged to “strengthen their cooperation in public health to address the threats of emerging
infectious diseases”
Initiatives:
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Through Global initiatives: Global Avian and Human Influenza Facility (AHIF)
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Through WHO: Implementation of the National Strategic Plan for Avian Influenza (INSPAI)
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Direct EU technical and financial assistance to ASEAN countries: ex. Vietnam (H5N1)
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Under ASEF : ASEF Public Health Network, expert and scenario-building workshops between
officials and professionals from Asia and Europe
3. Regional organizations & outbreak control:
The case of H1N1 (2009)
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23 April 2009: US CDC confirmed seven cases of
swine influenza A(H1N1) in humans (California and
Texas).
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23 April 2009 : Mexico reported 120 confirmed
cases of respiratory illness due to influenza and 20
deaths.
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11 June : WHO declares global swine flu pandemic
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10 August: WHO declares the H1N1 influenza
pandemic over:
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More than 318,925 H1N1 cases including 3917
deaths had been reported
The EU as provider of coordination, scientific support and public health
advice at the regional level.
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The EC provided coordination through the organization of daily
audio-conferences which enable the participating Member States to
share experiences and to learn from each other
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Two main agreements reached by the EU Member States on travel
and on school closure:
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the Agreement on advice to persons planning to travel to or returning from affected areas
(18 may 2009)
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the Statements by the Health Security Committee and the Early Warning and Response
System (EWRS) on school closures (13 August 2009).
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represent indeed the result of the EC efforts to coordinate and to
harmonize the regional response in these two domains
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EU acts also as a scientific and technical adviser through its ECDC which
provided risk assessment as well as scientific and technical support on
response to Member States
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The H1N1 crisis in 2009 also revealed that in the future, the EU could play
an important role as supporter and coordinator of the efforts made by
Member States to create joint procurement of vaccines
ASEAN acting as provider of information, facilitator of
communication and multiplier of external help for its region.
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Provider of disease surveillance data, good practices, laboratory-based
surveillance information, activity updates, capacity development resources
and daily news flashes through the EID website
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Facilitator of the communication between the AMS through its EID website,
meeting and video conferences (Assessment report > positive impression,
useful, reduce the unknown).
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Multiplier of external support to outbreak control : ASEAN+3 Health Ministers
Special meeting on Influenza A (H1N1) (May 2009). Meeting between US
CDC and AMS.
APEC as an H1N1 information supplier and supporter of the
empowerment of business leaders in the region
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APEC encouraged all its economies to work individually and cooperatively to
implement the APEC Action Plan on Prevention and Response to Avian and
Influenza Pandemic
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Supplier of H1N1 epidemiological updates to all its economies through the
APEC EiNet.
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Empowered business leaders to make their decision during the H1N1 crisis
by offering them the possibility to receive tips to improve their response and
ability to cope with the influenza virus after answering a series of questions
through an online checklist.
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Research in the EU: poorly financed (+/- 2% of GDP) and fragmented.
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European Commission’s Framework Programmes (FP)
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HIV/AIDS projects funded by the 1st Framework Program (1984-1988)
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FP 5 (1998-2002) +/- 6 million euros spent on avian and pandemic influenza
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FP6 (2003-2006)+ FP7 (2007-2013)
HIV/AIDS
214 million
euros on
(57 projects)
TB
125
million
euros
Malaria
150 million euros
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Since 2000, the EU has spent more than 100 million euros on influenza (54 projects)
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F7: 55 million euros on ongoing research projects focusing on other viral diseases such
as hemorrhagic fever, Chikungunya, West Nile virus,…
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No such regional mechanism within ASEAN and APEC.
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BUT ASEAN and APEC MS/ME joint EU FP research projects
on ID.
Ex:
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Taiwan and China : SARS Control project led by the
University Medical Center Rotterdam in 2005
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Vietnam, Cambodia and China, partners to a project on
innovative diagnostic tools and therapeutic approaches for
dengue disease led by the Institut Pasteur
Main Challenges
a. Disparity in the level of development of the national
preparedness plans
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ASEAN: Thai-plan retained the format of a strategic
framework rather than an operational guide
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EU: still serious gaps in the plan .Persistence disparities
in the level of preparation of MS notably between “old”
and “new” EU MS.
Source: E. Morris, S. Schneider, Pandemic Emergency Preparedness in the European
Union (2009) presented at the 2010 International Disaster and Risk Conference, Davos
b. Difference in the levels of national surveillance of
infectious diseases
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EU
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Influenza surveillance: Not entirely comparable between countries.
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Variability in the data (size and representativeness of the sentinel networks, accuracy of the
estimation,…)
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Differences between countries in the rigor and resources devoted to collecting and validating
this data
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TB, STI,…
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ASEAN and APEC:
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Despite progress made in dengue surveillance in Asia, many challenges remain:
standardization of classification of dengue, limited resources and infrastructure for
surveillance and control, quality of diagnostics,…
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No obligation to report infectious diseases to a regional surveillance system
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Financial resources devoted by regional organizations to
infectious diseases regional projects are quite limited or
strongly rest on outside donors.
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APEC: small-budget projects or financed by one country
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ASEAN:
Mainly financed by non-regional actors (Australia, US,…)
Political commitment not synonymous of financial commitment for
regional initiatives
ASEAN MS have preference for bilateral cooperation
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Human resources
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Only five people currently take care of the ASEAN EID website
management while EC and its ECDC relies on much larger team.
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Regional risk communication challenge
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EU Risk Communication (H1N1): a complete failure
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Regional coordination challenge
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Not an easy task notably during health crisis
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Affected by political, ethnic and religious tensions
between and within countries
…
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