Download IFMSA Policy Statement Control of Emerging Infectious Diseases

IFMSA Policy Statement
Control of Emerging Infectious Diseases
Adopted during the 64th August Meeting General Assembly in
Ohrid, FYR of Macedonia, 7th August 2015
Summary
The International Federation of Medical Students’ Associations (IFMSA) recognizes the need
to strengthen preparedness for control of Emerging Infectious Diseases and response to
public health disasters as a means to reducing the occurrence of disease outbreaks and
further catastrophe in case of an outbreak. Most recently, the ongoing outbreak of Ebola in
West Africa, which has overwhelmed local health systems and shocked the world in its
severity, has become a catalyst for a long-needed global discussion about this issue.
The IFMSA regrets the thousands of deaths and immeasurable suffering caused by
Emerging Infectious Diseases outbreaks, the risk of which remains a major public health
concern and will have many long-term impacts on the societies and economies of the
affected countries. Furthermore, the IFMSA believes strong action is required to improve
preparedness and respond better to future outbreaks. The IFMSA therefore calls for a
coordinated public health emergency response with relation to strengthening and setting
clear guidelines on the mechanisms of detection, control and prevention of Emerging
Infectious Diseases involving all relevant parties including the World Health Organization,
NGOs and national governments.
Introduction
Emerging Infectious Diseases (EIDs) are infectious diseases ‘whose incidence in humans
has increased in the past 2 decades or threatens to increase in the near future.’ From 1940
to 2004, 335 EID events are thought to have emerged, of which 60% have been from animal
reservoirs. EIDs may cause localised epidemics, or become pandemics if given the correct
environmental factors, causing significant suffering and deaths worldwide. Historical
examples of EIDs include H1N1 influenza, which killed over 20 million people worldwide
after arising from an avian source , and HIV/AIDS, with an incidence of 2.3 million in 2012 .
Outbreaks in recent years which had previously remained localised have since become
major public health concerns, notably the emergence and spread of chikungunya fever
through the Americas since 2013, causing over 1 million cases , and the West African Ebola
epidemic, which has caused over 15,000 confirmed cases and over 6,000 deaths . Middle
East Respiratory syndrome coronavirus (MERS-CoV) has seen an increase in incidence
since May 2015 with the Republic of Korea investigating the largest known outbreak outside
the Arabian Peninsula, including 182 confirmed cases and 33 deaths .
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Factors driving disease emergence
Zoonotic diseases are a major player in EIDs. Although many zoonotic diseases are difficult
to track, those that are vector borne are directly affected by environmental factors . Climate
change is predicted to have a profound influence on emergence of infectious diseases with
zoonotic vectors in the coming decades, altering disease incidence and placing millions
more people at risk . Economic development can increase disease emergence, as dam
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construction provides new habitats for disease vectors and improved transport infrastructure
accelerates human-to-human transmission across international borders .
Weak health systems and a lack of skilled healthcare personnel can leave communities
vulnerable to changing patterns of disease virulence or geographic spread. Infection
prevention and control measures are insufficient in many poorly resourced countries, with
key infrastructure such as isolation rooms not in place. Inadequate support for public health
provision, surveillance and disease monitoring is a key influence on the emergence of
infectious disease in new locations and can have a devastating impact on local healthcare
systems. War and conflict can also drive infectious disease emergence, by damaging health
and civic infrastructure as well as displacing people and accelerating migration .
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Global nature of disease emergence
Emerging Infectious Diseases are affecting nations across the world and have demonstrated
their capacity to overload existing healthcare systems in diverse circumstances. The
emergence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile
have been driven by global inappropriate use of antibiotics . These emergent and reemergent pathogens have demonstrated their ability to overwhelm public health systems,
causing widespread fear and mistrust of health facilities, even in highly resourced healthcare
institutions.
Changing patterns of human migration, increasing levels of international air travel and novel
processes in the agricultural industry present new risks and challenges as new strains of
influenza emerge. The spectre of pandemic influenza is an ever-present threat to global
health and in 2015, the WHO declared that the world must be on “high alert” for the spread
of new strains of influenza .
These EIDs have devastating effects on the economies of the countries affected. In the
example of Ebola, at least 40 countries issues travel restrictions to Guinea, Sierra Leone and
Liberia, resulting in a further detrimental impact on trade . Societal cohesion was also
disrupted during instances of violence against healthcare workers and security forces. The
ineffectiveness of rapid response mechanisms and subsequent scale of the epidemic left
governments unable to cope with the emergency, clearly demonstrating the need for efforts
to strengthen health systems around the world .
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Preparedness for disease outbreak control
Preparing for emerging disease threats involves not only complying to international
regulations, but also strengthening laboratory capacity and communicating appropriately with
the public. In some recent cases, these preparatory tasks have been inadequately
undertaken due to chronic underinvestment in health care systems. The international legal
framework for disease outbreak control - the International Health Regulations (IHR) - require
that countries declare Public Health Emergencies of International Concern (PHEIC)
promptly, and mandate a response from World Health Organization (WHO). They also
require that countries strengthen surveillance capacity to monitor epidemics, and that
countries make every effort not to introduce travel restrictions which would further damage
international trade . However, in the context of fragile socio-political situations such as those
in West Africa during the recent Ebola outbreak, a PHEIC was not reported promptly, which
lead to the call for a semi-autonomous international body as heard at the World Health
Assembly 2015.
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Despite the many challenges present in the control of zoonotic diseases, success in this
prevention would be both cost-effective and directly beneficial to the burden on the human
population. However, certain strategies such as culling are disproportionately dependent on
farmers who receive inadequate compensation, as demonstrated in the outbreak of H5N1
avian influenza in 2006 . Education and advocacy are also imperative, as mechanisms must
be in place to disseminate information to the public in order to ensure that health messages
are coherent and quickly transmissible through the media. The absence of such processes
can lead to long-term socio-economic damage, such as the reaction to bovine spongiform
encephalopathy (BSE) in England in the 1990s causing large economic losses that extended
well beyond the timeframe of the outbreak .
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Main Text
The unprecedented nature of the recent Ebola epidemic has demonstrated the inadequacies
of existing organizational structures and international frameworks to respond to Emerging
Infectious Diseases. It is certain that novel infectious diseases will continue to emerge and
our global response must learn the lessons of this recent catastrophe.
The IFMSA acknowledges:
1. The efforts being made towards developing a coherent, coordinated response to the
continued emergence of infectious diseases from the international community.
2. The efforts that have been undertaken so far by the West African nations, the
International community, health workers, students and NGOs in fighting the Ebola epidemic.
3. The sacrifices made by local communities in order to reduce the transmission of Ebola
and the great progress that has been made towards ended this crisis.
The IFMSA promises to:
1.
Promote education and advocacy efforts to increase infection prevention and control
amongst both medical students and the general public in situations of Emerging Infectious
Diseases.
2. Continue to advocate for an effective and coordinated public health response to current
and future Emerging Infectious Diseases.
3. Work with all relevant stakeholders to develop effective global mechanisms to combat
emerging diseases, including the envisaged Global Health Emergency Workforce proposed
at World Health Assembly 2015.
4.
Promote collaboration between animal and public health stakeholders to allow for
thorough understanding of zoonotic diseases and successful control of emerging zoonoses.
We call upon healthcare providers to:
1. Continue to improve infection control practices to prevent spread of Emerging Infectious
Diseases.
2.
Recognise the vulnerability of healthcare workers and train their medical personnel
accordingly in emergency treatment, prevention and infection control strategies.
3.
Commit to provide culturally sensitive and ethically sound care as well as maintain
clinical competency in the context of emergency situations.
We call upon national governments to:
1.
Invest in laboratory capacity in order to better detect the presence of pathogens,
including drug resistant pathogens.
2.
Work with public health associations and other relevant parties to strengthen their
current health systems as a matter of urgency.
3. Strengthen commitment and implementation of International Health Regulations.
4. Ensure investment in cost effective research for neglected infectious disease treatment
and manufacture cost-effective, accessible and affordable treatments and vaccines.
5.
Educate communities to raise awareness on disease prevention and infection control
practices needed to stop the spread of current and future Emerging Infectious Diseases,
having in mind the cultural and religious circumstances of the population.
6.
Respond in a more transparent way to Emerging Infectious Diseases, ensuring the
necessary information is provided for populations and visitors.
We call upon the WHO to:
1. Lead coordination of the Health Cluster in disaster response for future outbreaks whilst
including all relevant international, governmental, non-governmental and local stakeholders.
2. Encourage the international community to continue assisting the countries affected by
infectious diseases; this will include, but not be exclusive to donating protective gear used in
handling patients, medicines and contributing to research and development of vaccines.
3. Create and invest in a well-funded, international outbreak control organisation, which is
always prepared to respond to the emergence of new pathogens in areas with weak health
systems.
4. Work closely with all nations and especially low income countries to strengthen health
systems, in order to be better prepared for public health threats such as Ebola, in the future.
5.
Improve collaborations with relevant stakeholders in the control of emerging zoonotic
diseases.
References
1.
Background and Goals - Emerging Infectious Disease, CDC 2014, Available from:
http://wwwnc.cdc.gov/eid/page/background-goals.
2.
Jones, Kate E, Nikkita G Patel, Marc A Levy, et al. 2008. Global trends in Emerging
Infectious Diseases. Nature 451, no. 7181: 990-993.
3.
Belshe, Robert B. 2005. The origins of pandemic influenza—lessons from the 1918
virus. New England Journal of Medicine 353, no. 21: 2209-2211.
4.
Maartens, Gary, Connie Celum, and Sharon R Lewin. 2014. HIV infection:
epidemiology, pathogenesis, treatment, and prevention. The Lancet 384, no. 9939: 258-271.
5.
Número
de
casos
acumulados
PAHO/WHO.
Available
from:
http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&Itemid=&gid=
30199&lang=es.
6. Situation summary - Ebola data and statistics, World Health Organization, 2015. Available
from: http://apps.who.int/gho/data/node.ebola-sitrep.ebola-summary?lang=en.
7. CDC (2015). MERS-CoV | Home | Middle East Respiratory Syndrome | Coronavirus |
CDC. [online] Available at: http://www.cdc.gov/coronavirus/mers/ [Accessed 30 Jun. 2015].
8.
WHO (2015). WHO | Middle East respiratory syndrome coronavirus (MERS-CoV).
[online]
Available
at:
http://www.who.int/entity/mediacentre/factsheets/merscov/en/index.html [Accessed 30 Jun. 2015].)
9. WHO. Report on the WHO/FAO/OIE joint consultation on emerging zoonotic diseases.
Geneva, Switzerland; 2004.
10. A Marm Kilpatrick, Sarah E Randolph, Drivers, dynamics, and control of emerging
vector-borne zoonotic diseases, The Lancet, Volume 380, Issue 9857, 1–7 December 2012,
Pages 1946-1955, http://dx.doi.org/10.1016/S0140-6736(12)61151-9.
11. Morse, Stephen S. "Factors in the emergence of infectious diseases." Emerging
Infectious Diseases 1.1 (1995): 7.
12. Morens DM, Fauci AS (2013) Emerging Infectious Diseases: Threats to Human Health
and Global Stability. PLoS Pathog 9(7): e1003467. doi:10.1371/journal.ppat.1003467
13. Warning signals from the volatile world of influenza viruses, World Health Organization,
2015. Available from: http://www.who.int/influenza/publications/warningsignals201502/en/
14. Plan to reform WHO after Ebola to be unveiled by Angela Merkel, 2015. Available from:
http://www.theguardian.com/world/2015/may/18/angela-merkel-plan-restructure-worldhealth-organisation
15. Heymann, David L et al. "Global health security: the wider lessons from the west African
Ebola virus disease epidemic." The Lancet 385.9980 (2015): 1884-1901.
16. International Health Regulations, World Health Organization, 2005. Accessed 29 Jun.
2015 http://www.who.int/topics/international_health_regulations/en/
17. Heymann David L, Dar Osman A. Prevention is better than cure for emerging infectious
diseases 2014; 348 :g1499
18. Forbes, Ian. "Making a Crisis out of a Drama: The Political Analysis of BSE Policy‐
Making in the UK." Political studies 52.2 (2004): 342-357.
Note:
Policy statements should be submitted to the General Secretary ([email protected] and
[email protected]) no later than the 1st of February for the March meeting and 1st of July for
the August meeting.
Please, take into consideration that you need to submit a call for input on the topic
available to all NMOs until January 10 for March Meeting and June 10 for August
Meeting.
Policy statements can also be submitted as urgency policy statements during the
General Assembly itself. Urgency policies should arise as an outcome of working group
discussions at the General Assembly. The proposer of an urgency policy should be
prepared to justify why their policy should be considered immediately, and not deferred
until the following meeting.
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