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Notes and Recommendations 18 Brunei Darussalam – Indonesia – Malaysia – Singapore – Thailand (BIMST) Public Health Conference 29 - 30 October 2014 Belitung Island, INDONESIA Opening session th Welcome address by the Host of the meeting [Indonesia] Dr. Untung Suseno, M.kes, The Secretary General of The Ministry of Health of The Republic of Indonesia delivered a welcome speech. He thanked Brunei Darussalam for hosting the 17th Brunei Darussalam – Indonesia - Malaysia – Singapore – Thailand (BIMST) Public Health conference with the success chairmanship year 2013-2014. He stated that the world is now facing the public health emergency on the outbreak of Ebola virus diseases. Further, the ministers of Health of BIMST member countries expressed their strong commitment at the 12th ASEAN Health Ministers’ Meeting (AHMM) highlighting that ASEAN countries need to strengthen the regional strategies, policy and capacities. He highlighted the importance of the theme “Prevention and Control of Emerging Infectious Diseases in BIMST Countries” to encourage the BIMST members to share the experiences on response of emerging infectious diseases. Finally, he wished all delegates to have successful discussion and have a memorable stay in a beautiful Belitung island. Remarks by Outgoing Chair (Brunei Darussalam) Dr. Pg Khalifah Pg Ismail, as an outgoing chair, thanked Indonesia for hosting the conference. He recalled the previous meeting with the theme of “Health Beyond 2015” as well as the fruitful roundtable discussions on the issues concerning vector borne diseases, nutritious food in schools, FCTC implementation, tobacco control and ageing. He also expressed the appreciation that Indonesia has chosen the topic of EID Prevention and control as the theme for 18th BIMST. He then handed over the chairmanship of BIMST to Indonesia. Election of Chairperson, Vice Chairperson and Rapporteur Indonesia was elected as the Chairperson of the meeting along with Malaysia as the Vice Chairperson and Thailand as the Rapporteur. Opening address by the Chair of the meeting (Indonesia) Dr. Muhammad Subuh, MPPM, Chairperson of the 18th BIMST Public Health Conference, once again welcomed all delegates. He expressed his appreciation to Brunei Darussalam for being a successful Chair for the period of 2013-2014 and for hosting of 17th BIMST. The previous 17th BIMST discussed on various issues including multisectoral approach to prevent and control of NCDs, maintaining the existing networking, the food safety standardization and FCTC. He hoped that the theme of “Prevention and Control of Emerging Infectious Diseases in BIMST Countries”, which the ministers had the commitment in the previous AHMM, will encourage delegates to share the experience on the best practise of EID prevention and control and wished that BIMST countries could make a significant progress towards this ultimate goal. The importance of collaboration within the BIMST was highlighted with benefits for all members, including the continuous of Post 2015 Health Development Agenda. Adoption of Agenda The agenda of the 18th BIMST Public Health Conference was adopted and conducted as scheduled. Review of Recommendations from the 17th BIMST Public Health Conference Meeting in Brunei Darussalam Brunei Darussalam shared the recommendations of the 17th BIMST meeting in Brunei Darussalam. BIMST Countries acknowledged that the Millennium Development Goals (MDGs) has been afforded to achieve for people’s wellbeing. Presentations of BIMST countries mostly highlighted the common regional response on Non-Communicable Diseases by addressing the underlying determinants of unhealthy lifestyle. Roundtable Discussion has been displayed in various topics such as vector borne disease control, food consumed by school children, tobacco control efforts, and ageing society management. Country’s Perspectives on Prevention and Control of Emerging Infectious Diseases (EIDs) 1. Brunei Darussalam Emerging infectious diseases remain a significant public health threat globally and regionally including in BIMST countries. Brunei Darussalam presented on the background of infectious diseases surveillance as well as status and updates of infectious diseases of concern within the country. Dengue and other climate sensitive vector borne diseases continues to be a significant public health threat together with MERS-CoV and Ebola posing an increasing threat. In this regard, Brunei Darussalam continues to strengthen its surveillance and preparedness activities including the endorsement of MERs-CoV and Ebola Preparedness Plan in response to the current global disease outbreak situation. The issue of managing infectious diseases highlighted the need for multi-sectoral collaboration nationally, regionally and globally and ongoing collaboration specifically sharing of information and experience with other BIMST countries on response to emerging infectious diseases has proven beneficial. 2. Indonesia Indonesia has National strategic plan for controlling Influenza A (H5N1) which effectively decreased cases of the disease in poultry and human continually in overall and this plan has been used for pandemic preparedness of other EIDs. Implementation of strategies in EID prevention and control including 9 components i.e. international collaboration, command and coordination, surveillance, medical response and laboratory, pharmaceutical intervention, non-pharmaceutical intervention, risk communication, point of entry, and simulation. For early detection and response, Indonesia has already set up Rapid Response Team (RRT) and Early Warning Alert and Response System (EWARS) in 31 provinces including appointed hospitals and laboratories as referral health facilities. Surveillance and other response, moreover, were prepared to an outbreak of the disease accompanied with specific training programs for related officers. However, there are many challenges to control infectious diseases including geography, resource capacity, migration and culture which require collaboration from other sectors engagement. 3. Malaysia Malaysia presented that threat of EIDs was influenced by climate change, , population migration and increasing global interconnectedness. Nipah virus, SARS, H5N1, avian influenza A (H7N9) and MERS-CoV are the EID of concern in Malaysia. Malaysia developed National Influenza Pandemic Preparedness Plan (NIPPP) with regards to health security. There are key components of the preparedness including capacity building, infrastructure development and surveillance system. In the face of the threat of emerging diseases all related sectors should be working together towards common goal in order to address public health security risks. 4. Singapore The presentation showed the national mechanism for crisis management in Singapore. The prevention and control of Emerging Infectious Diseases (EIDs) emphasises on caring for cases, minimising import, containing spread, and mitigating impact for diseases that cannot be contained. The Disease Outbreak Response System Condition (DORSCON) Framework for infectious diseases has four alert levels represented by four colors (green=no disruption, Yellow = minimal disruption, Orange = moderate disruption and Red = major disruption). In planning for EID outbreaks, Singapore considers six areas namely surveillance and early detection, preventing spread, clinical management and laboratory testing, contact tracing, quarantine or phone surveillance, and public communications. Singapore shared its contingency plan for MERS-CoV compriseing eight areas such as legislation, risk communication, border control, Contact Tracing and Quarantine. 5. Thailand Emerging Infectious Diseases (EIDs) occurs every year. More than 70% of EIDs are zoonosis. The important EIDs in Thailand consist of Avian Influenza, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Ebola Virus Disease (EVD) and Multidrugresistant tuberculosis (MDR-TB). Nowadays, Thailand uses a National Emerging Infectious Diseases Strategic Plans (2013-2016) with 5 strategies for preparedness and response to EIDs. The National Emerging Infectious Diseases Strategic Plans compose of 8 steering sub-committee with Deputy prime minister as a chairman. Thailand conducts the preparation and response to EIDs in form of multisectoral coordination with one health concept such as Prince Mahidol Award Conference, Asia Partnership for Emerging Infectious Disease Research (APEIR), Thailand Partnership on Emerging Infectious Disease Research (TPEIR), and National Health Assembly. In conclusion, efficient command, control and management are the foundation of successful response to emerging infectious diseases and public health emergencies. Roundtable Discussion 1. Brunei Darussalam[National medicine policy] Brunei Darussalam National Medicine Policy (BDNMP) was launched recently. The objectives of BDNMP is to ensure the equitable and timely access to safe, effective and affordable medicines of good quality and promoting the quality use of these medicines with the aim of optimising health outcomes for all. There are eight elements of BDNMP which focuses on quality, safety and efficacy of medicines, medicines availability, medicines affordability, quality use of medicines, human resources development, research and development, technical cooperation and governance. This policy will remain dynamic and responsive to evolving global situations and advancement in technology and is a useful tool for preparedness to address EIDs. Furthermore, all stakeholders are expected to actively involved in its implementation, monitoring and evaluation. 2. Indonesia [BIMST Pandemic Alert and Preparedness] In the face of risk for EIDs, Indonesia addressed high risk for EIDs on BIMST members through the region which should have followed rocketing economic area, supply of labour, tourism destination, pilgrimage for Umrah and Hajj and point of entries between countries. Indonesia suggested the surveillance for international travellers should work on multi sectors approach to be the best fit activities to minimize the impact. Meanwhile, prompt communication between countries to anticipate potential EIDs importation also plays an important role. The strategy on strengthening pandemic alert and preparednessis a joint contingency plan on EID including outbreak simulation engangement multi-sectoral in border areas within BIMST countries. 3. Malaysia [Global Health Security Agenda] Malaysia is committed to accelerate progress towards a world safe and secure from infectious disease threat and to promote global health security as an international priority. Malaysia which serves as the lead country for GHSA package (Respond 1) whereby enhancing public health EOCs capacity is the main pillar. Malaysia urges BIMST member countries to have exchange of visits of EOCs to share best practices, explore communication link ups and provision of technical assistance to strengthen existing EOCs. The strategy “Global Health Security Agenda (GHSA)” is based on shared responsibility by collaborating countries and international organizations with an objective of “Developing an interconnected global network of Emergency Operation Centers” followed by adopting an action package on concerned issues. The purpose of its action package is to prevent (Antimicrobial Resistance, Zoonotic Diseases, National Biosafety and Biosecurity system, Immunization) detect (Nationwide Laboratory System, Surveillance, Reporting, Workforce) and respond (EOCs, Multisectoral Respond, Countermeasure and Personnel to health concerns GHSA steering Group will require high-level political support to ensure that these objectives remain a priority and the working level support team will provide technical and administrative support to both of these groups, facilitate information sharing across partners and encourage replication across regions via single contact point on each BIMST country. 4. Singapore[Leveraging Social Media for Disease Surveillance and Public Sensing] During the outbreak of human infection with avian influenza A (H7N9) in China, Chinese social media, called “Sina weibo”, was used as a complementary tool for reporting and risk communication. The result of the study found the number of weibo posts on H7N9 increased with the daily number of H7N9 cases reported during the outbreak. Rumours of cases had started even before official health authorities released the information. . In addition, reporting of new cases on Weibo was significantly faster than those on the conventional public health channels; Weibo was on average 1 hours earlier than China NHFPC reporting, compared to WHO notification which was 1day later than NHFPC reporting. Using of Weibo during H7N9 outbreak was showed to have several benefits. Social media could be used as a tool for risk communication, timely reporting of cases, crowdsourcing of information, , and public sensing for response measures. However, there are many challenges in using social media such as knowing the right social media platform to use, veracity of the information, language barrier, , etc. 5. Thailand[Response to pandemic of Ebola Virus] Ebola virus disease outbreak in the West Africa impacts on every countries in the world. As a result, World Health Organization (WHO) announced the endemic of Ebola Virus Disease (EVD) as Public Health Emergency of International Concern (PHEIC). In spite of low risk of importing EVD in Thailand, the Ministry of Public Health (MOPH) announced EVD as dangerous communicable disease. MOPH established measures to prevent and control EVD; composing of surveillance systems among humans and animals, treatment and infection control at hospitals, laboratory testing and management. In addition, risk communication to general people, healthcare workers, and travellers visiting in endemic area is the most important to prevent and control EVD in Thailand. Recommendations from the 18th BIMST Public Health Conference We agree to accelerate our cooperation in the prevention and control of EIDs by strengthening mechanism amongst BIMST countries and put into action, wherever appropiate the following activities : 1) Exchange of particulars of border health contact point and relevant institutions including list of health facilities and referal mechanism. . 2) Sharing of Lessons Learnt and best practices on EIDs outbreak prevention and control. 3) Exchange of information on BIMST current regulation and policies on EIDs Prevention and control 4) Strengthening border agency coordination between relevant BIMST member countries and utilizing existing platform such as IHR mechanism and relevant ASEAN Health Clusters Focal Points. 5) Developing Border Contingency Plan for EIDs Preparedness and Response, taking into consideration their respective Preparedness Plan of each member state 6) Conducting joint Multisectoral Outbreak Simulation in the relevant border areas Date and Venue of the 19th BIMST Public Health Conference The 19th BIMST Public Health Conference will be held in Kuala Lumpur Malaysia year 2015