Download 19th Brunei Darussalam – Indonesia – Malaysia – Singapore

19th Brunei Darussalam – Indonesia – Malaysia – Singapore – Thailand
(BIMST) Public Health Conference
10 - 11 September 2015
Kuantan Pahang, MALAYSIA
Opening session
Welcome and opening address by the Host of the meeting [Malaysia]
YBhg. Datuk Dr. Lokman Hakim bin Sulaiman, Deputy Director General of
Health (Public Health) of Ministry of Health Malaysia delivered the opening address.
He stated that Malaysia is delighted to Host the 19th BIMST International Public Health
Meeting which comprised of 21 BIMST Member State delegates and 32 observers
who were senior officers from Ministry of Health Malaysia. He highlighted the
importance of the theme “Global Health Security” emphasizing today’s increasingly
mobile world where there has been a paradigm shift whereby communicable diseases
have no borders. He looked forward to having an open and frank discussion as many
of our healthcare issues are indeed common between the neighbouring countries.
Remarks by Outgoing Chair (Indonesia)
Dr Wiendra Waworuntu, Director of Surveillance, Immunization and Health
Quarantine of Ministry of Health Indonesia, as outgoing chair, thanked Malaysia for
hosting this meeting. She realized that the meeting had inspired members to further
strengthen coordination of border agencies among BIMST member states. She
encouraged building strong multi-sectoral cooperation and national capacities in
addressing EIDs. She emphasized on the global and regional commitments which
are based on the International Health Regulation (IHR, 2005) framework. She also
highlighted the importance of border health cooperation in combating the spread of
communicable diseases. She then handed over the chairmanship of BIMST to
Malaysia.
Election of Chairperson, Vice Chairperson and Rapporteur
As per the alphabetical chronology for the BIMST Member States which is the
yearly practice, Malaysia was elected as Chair of the meeting along with Singapore
as Vice Chair. Subsequently, Brunei was then elected as the Rapporteur.
Adoption of Agenda
The agenda of the 19th BIMST Public Health Conference was adopted and
conducted as scheduled.
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Review of Recommendations from the 18th BIMST Public Health Conference
Meeting in Province of Bangka, Belitung Indonesia [Indonesia]
Indonesia shared the recommendations from the 18th BIMST meeting which
was held in Indonesia in October 2014. BIMST member states had agreed to
strengthen the mechanisms to accelerate cooperation in the prevention and control
of EIDs. This includes regular bilateral border meetings and continuous ongoing
simulation exercises on EID between member states that have and will be conducted
to achieve the agreed recommendations from the previous meeting.
Briefing on the theme “Global Health Security” by the Secretariat
“Global Health Security” was adopted as the theme for this meeting. This
theme is very timely as currently there is a concerted international collaborative drive
in the form of the Global Health Security Agenda (GHSA). Rapid globalization and
industrialization have led to a phenomenal rise in travel and trade. These inevitable
developments have in turn caused an increase in universal challenges to health
security. Public health logistics and laboratory services were emphasized as
essential parts of technical assistance in managing Public Health Emergencies of
International Concern (PHEIC).
Country Presentation on the theme “Global Health Security (GHS)”
1. Brunei Darussalam
Currently, Brunei has not formally signed on to the GHSA. Nevertheless,
Brunei is committed to global health security which is operationalised in 4 key areas
namely; strengthening disease surveillance activities for communicable disease;
laboratory strengthening and biosafety; enhancing health system preparedness for
EIDs; and Public Health Workforce Development. Brunei noted that the IHR (2005)
lays the foundation for global health security. Sharing of information and best
practices would assist member states to work synergistically.
2. Indonesia
Indonesia emphasized the following priority areas in the implementation of
IHR (2005) which includes regulations, policies and strategies; readiness of
healthcare facilities and surveillance; and coordination and communication.
Regulations related to IHR include laws on sea and air quarantine and
communicable diseases. The primary health care system will be strengthened by
increasing access, improving quality of health care and referral system regionally.
Surveillance activities are continuously carried out by active and passive
surveillance. Current core capacities at designated ports of entry were reviewed to
identify gaps and challenges. Capacity building and multi-sectoral engagement were
carried out by disseminating information on IHR (2005) to improve collaboration
between multi-sectoral institutions, universities and private sectors.
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3. Malaysia
Malaysia highlighted on its commitment to accelerate progress towards a world
safe and secure from infectious diseases threat and to promote global health
security. Global Health Security Agenda (GHSA) is one of the initiatives towards
achieving global health security. For the benefit of all delegates, Malaysia highlighted
on what GHSA is, the main objective of GHSA which is “Towards a World Safe and
Secure from Infectious Diseases” and further elaboration was provided on the GHSA
action packages. Malaysia is the lead country together with Turkey in enhancing
Public Health Emergency Operation Centre (EOC). Malaysia has supported this
initiative since its inception in 2013 and details of the minimum common standards
for functioning of EOC were explained. Malaysia informed the meeting of the
chronology of events in developing GHSA and expanded on the current collaboration
with ASEAN member states. The presentation also illustrated the current GHSAEOC activities amongst ASEAN member states and this includes an exchange of
visits to MOH EOCs in the region; explore linking up in communications between
existing EOCs in countries such as through tele-conferencing, video-conferencing;
identification and sharing of country contact persons; and exploring the provision of
technical assistance. Currently there are five other ASEAN member states
supporting the GHSA EOC activities namely Brunei Darussalam, Singapore,
Indonesia, Thailand and Phillipines. Malaysia emphasized the need for an ASEANEOC network as a regional surveillance and response system in addition to the
current formal network through National IHR Focal Point. Malaysia also seeked
support from ASEAN member states on the establishment of ASEAN-EOC network
amongst ASEAN member states to enhance the effectiveness of regional
surveillance and response towards EID or public health emergencies.
4. Singapore
Singapore shared their preparedness for emerging infectious diseases and
public health threats. The key areas of preparedness include a robust communicable
disease surveillance system; effective outbreak response and investigations;
national public health laboratory capacities and capabilities; policies for prevention
and control of EIDs; operational readiness; and effective coordination with other
government agencies and stakeholders.
5. Thailand
Thailand presented the current global health issues on Epidemic and
Pandemic Infectious Diseases; EID, Emerging and Re-emerging Diseases;
International Trade that affects Health; Access to Essential Drugs and Vaccines;
Health Expenditure and Equity to Access to Healthcare; and Natural Disaster and
Environmental Health. Thailand is tackling the issues from the perspective of GHSA;
Antimicrobial resistance (AMR); international trade and its impact on health;
sustainability and security in health financing; and public health insecurity from
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natural disaster. The Cabinet Ministries of Thailand had accepted the Ministry of
Public Health, Thailand (MOPH)’s report on GHSA on 28 October 2014. Thailand
has contributed towards the Action Packages and has encouraged the border
provinces to implement the 12 GHSA targets. Thailand shared the strengths and
challenges faced with integrated framework on AMR.
Roundtable Discussion
1. Brunei Darussalam [E-cigarettes: Issues and Challenges in Tobacco
Control Measures]
Brunei shared findings of a tobacco question survey (TQS) which was
conducted in 2014. The survey showed an overall e-cigarette use of 5.6% in 1,294
individuals. E-cigarettes were mainly used by those between 15-24 years of age. A
WHO report noted that nicotine content in e-cigarettes varies widely between brands
and that toxicant levels in 3rd generation e-cigarettes can generate 5-15 times levels
of formaldehyde. Evidence for effectiveness of e-cigarettes as a cessation aid is also
limited. Current issues faced by Brunei Darussalam include the regulation of the use
of e-cigarettes as the current generation of e-cigarettes do not fall strictly under the
definition of ‘imitation of tobacco products’ plus presence or absence of nicotine is
unknown. Use of e-cigarettes in public places and prohibition of sales are other
challenges faced. Singapore has banned the use of e-cigarettes while other member
states are currently reviewing the policies and regulations concerning e-cigarettes.
2. Indonesia [Preparedness
outbreak in Indonesia]
and
Response
to
potential
MERS-CoV
The risk of importation of MERS-CoV to the region is high as a large
population in the region are Moslems who travel regularly to Middle East for their
pilgrimage. The virus continues to evolve and poses potential threats to international
travel. The outbreak of Mers-CoV is unpredictable due to lack of epidemiology and
scientific evidence regarding source of infection, reservoir, route of infection,
communicability and treatment. Indonesia has taken the following preparedness
measures as follows: strengthening the existing regulation on laboratory networks;
enhancing laboratory capacity; improve readiness respond to MERS-CoV and
logistic readiness.
3. Malaysia [Cross Border Health Issues]
Cross border health issues remains a serious problem especially with regards
to spread of emerging and re-emerging infectious diseases as well as the
implications to the healthcare delivery services in Malaysia. The implications include
overcrowding at primary care level and hospitals which affects service quality; and
overburdening of maternal and child health services. Disease mortality and morbidity
statistics in migrant populations would negatively affect the national health statistics.
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Therefore there is a need to strengthen surveillance and reporting of diseases
between border states and to continue bilateral discussion at the border areas.
4. Singapore [Hand Foot Mouth Disease (HFMD) – A Significant Public
Health Issue?]
HFMD is a common childhood disease that is largely mild and self-limiting.
From 2000-2012, over 226,000 cases were notified with eight deaths (case fatality
rate of 0.0035%).Local sero-prevalence studies and notification data in Singapore
estimated that 75% of HFMD cases were asymptomatic or mild. During an EV71
epidemic in 2006, the need for closure of pre-school centres was determined based
on number of cases in the centre, attack rate and transmission period. However,
evaluation of these measures showed that the benefit of mandatory closures was
limited. There was no significant difference in the reduction of attack rates and
closures did not delay the onset of the next HFMD cases. The mainstay of HFMD
control should focus on routine early detection and isolation of cases and
maintenance of good personal and environmental hygiene through targeted
education. The meeting suggested that a group of experts meet to review the
surveillance and control measures for HFMD.
5. Thailand[Thailand’s Experiences in Response and Control of MERS-CoV
and other EIDs]
Thailand shared their experience in dealing with a MERS-CoV case who had
travelled from Oman to Thailand. Subsequently, there were no cases reported after
all control measures were conducted. The measures implemented by MOPH
Thailand were risk assessment and prevention measures; risk communication
measures; advice for travellers visiting affected countries; health system
management for Hajj and Umrah pilgrims; and surveillance for MERS-CoV in animal
health. Thailand had conducted a VDO conference on MERS-CoV among the Health
Ministers in ASEAN plus Three Countries and the two WHO regional offices (SEARO
and WPRO). That meeting resulted in recommendations for awareness and
cooperation in the region. A National Committee on EIDs was established and a
strategic plan was laid out for 2013-2016. Lessons learned were that implementation
of National Strategic Plan should be monitored rigorously; an effective operational
plan is required to translate policy to real practice; and multi-sectoral collaboration is
essential. Thailand is working on strengthening national capacities for EID
surveillance, prevention and control and in enhancing regional and international
cooperation.
Recommendations from the 19th BIMST Public Health Conference
GHSA is an initiative to help countries achieve core competencies under IHR (2005).
In that context, BIMST member states agreed to accelerate cooperation in
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strengthening mechanisms for Global Health Security and to put into action,
wherever appropiate, the following activities:
1) Promote the establishment of ASEAN-EOC network through:
a) exchange of visits to share best practices;
b) regular communications between EOCs;
c) identification and sharing of country contact persons; and
d) sharing of technical assistance to strengthen existing EOCs.
2) Establish regular bilateral meetings among countries sharing common borders to
enhance cooperation in infectious disease prevention and control.
3) Enhance infection prevention and control in healthcare facilities through
implementation of national standards and accreditation at all levels.
4) Continue to invest and strengthen human resource capacities and capabilities.
5) Explore mechanisms to share surveillance data and information on AMR control
measures.
6) Form an expert group to review surveillance and control measures for HFMD.
Date and Venue of the 20th BIMST Public Health Conference
The 20th BIMST Public Health Conference will be held in Singapore in 2016.
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