Download Outbreak Response Operations

Improving Preparedness and Response
to Emerging Pathogens ARO current approach & future needs
D. Lavanchy
Office of Alert & Response Operations (ARO)
CSR
WHO
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20th century pandemics
Credit: US National Museum of Health and Medicine
1918: “Spanish Flu”
1957: “Asian Flu”
1968: “Hong Kong Flu”
20-40 million deaths
1-4 million deaths
1-4 million deaths
A(H1N1)
A(H2N2)
A(H3N2)
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Current context - 21st Century
Emergence of new or newly recognised
pathogens (e.g. Avian influenza, Ebola,
Marburg, Nipah, SARS)
Resurgence of well characterised outbreakprone diseases (e.g. cholera, dengue,
measles, meningitis, shigellosis, and
yellow fever)
Accidental or deliberate release of a
biological agent (e.g. BSE /v CJD, anthrax)
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The 21st Century - Approach
Preparedness is the key
A generic approach (flexible systems)
Crisis management must be…
Multi-sectoral
Multilevel
Inclusive networks
Animal-human surveillance
New technologies
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Global threat - global response
This global threat requires a global response to
– investigate, characterise and assess the threat
– reduce human suffering
– contain national/international spread
– minimize impact on travel and trade
WHO brings partners together to focus global
resources on outbreaks!
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Coordination of Response
Epidemiology
Laboratory science
Clinical Management
Infection Control
Environmental health
Health education
Medical anthropology
Risk communication
Logistics
Others…
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CSR Alert and Response Operations
 Detection, verification, characterisation, assessment and
response to epidemic disease threats
 Standardised processes and operational platform (intelligence, verification,
stockpiling, logistics, partner mobilisation-GOARN)
 Involves multiple Programmes and Departments (ARO, GIP, LYO, RAD,
PCS, FOS, ZFK, CPE, EPI, Polio, HAC)
 Requires deep operational co-ordination with Regional Offices and WHO
Country Offices
 May require involvement of Directors Office, MSU, IT, Travel,
Security…DGO !
 3 Teams
 Assessment and Field Operations (AFO)
 Epidemic Readiness and Mass Interventions (ERI)
 Emerging and Dangerous Pathogens (EDP)
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Outbreak Response Operations
 “Routine” Events –
 Continual co-ordination required between disease focal point and ARO during
outbreak alert and response process
 Continuous work with “communications” group
 Major events
 require an even deeper collaboration with ARO providing overall event
management co-ordination and the disease-specific programme focusing on
the public health/scientific issues.
 Generic surge capacity may be required at HQ by ARO and in the main has
come from the Lyon teams and external partners in GOARN
 Senior WHO staff may be needed as field teams leaders or mission specialists
(Lyon have provided support on a number of occasions)
 Requires involvement of Directors Office, MSU, IT, Travel, Security
EVERY PROGRAMME HAS A STAKE IN OUTBREAK RESPONSE !
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Outbreak Alert and Response
Late
Detection
First
Case
90
80
70
60
50
40
30
20
10
0
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A L E R T
A N D
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40
37
34
31
28
25
22
19
16
13
7
10
DAY
Opportunity
for control
4
1
CASES
Delayed
Response
Outbreak Alert and Response
Early
Detection
90
80
70
60
50
40
30
20
10
0
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A L E R T
A N D
R E S P O N S E
40
37
34
31
28
25
22
19
16
13
7
10
DAY
Control
Opportunity
4
1
CASES
Rapid
Response
WHO Global Alert and Response
Systematic gathering of epidemic
intelligence
Intelligence
Rapid verification with countries
Verification
Risk assessment and communications
Coordination of international technical
support
Response
Follow-up
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No single institution has all the capacity
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SARS - GOARN partners
 International Federation of Red Cross; Australian Collaborative Research Centre for
Emerging Infectious Diseases; Centers for Disease Control and Prevention (CDC),
USA; Centre for Health and Population Research (ICDDRB), Bangladesh; Centre for
International Health, Curtin University, Australia; EPICENTRE, Centre for Research in
Epidemiology and Control of Emerging Diseases, France; EPIET, the European
Programme for Intervention Epidemiology; Field Epidemiology Programmes in
Australia, Japan and Thailand; Global Emerging Infections System (GEIS), USA;
Health Canada; Health Protection Agency (HPA), United Kingdom; MSF - Belgium;
MSF - Switzerland; Institut national de Veille Sanitaire, France; Institut Pasteur, Paris,
France; Institut Pasteur, Vietnam; Kunskapscentrum för Mikrobiologisk Beredskap
(KCB), Smittskyddsinstitutet(SMI), Sweden; Leicester Royal Infirmary, North
Manchester General Hospital, United Kingdom; National institute of Infectious Disease,
Japan; Robert Koch-Institute, Germany; University Hospital, Frankfurt , Germany;
National Institute of Public Health, Section for Infectious Disease Control, Norway;
Southern Cone Surveillance Network and Epidemiology Department, MoH, Chile;
National Board of Health and Welfare and SIDA, Sweden; UNDP and the Pacific
Public Health Surveillance Network.
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G ARN
GOARN is a global technical
partnership, coordinated by WHO:
– to provide rapid international
multi-disciplinary technical
support for outbreak response
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Outbreak Field Operations
2000/2004
– 26 countries
– Over 40 GOARN partners
– Over 350 experts
– 30 outbreak responses and
investigations
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Outbreak Field Operations
2000/2004
– 26 countries
– Over 40 GOARN partners
– Over 350 experts
– 30 outbreak responses and
investigations
E P I D E M I C
A L E R T
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Primary Aims
 Assist countries with disease control
efforts by ensuring appropriate technical
support to affected populations rapidly.
 Investigate and characterize events and
assess risks of rapidly emerging epidemic
disease threats.
 Sustain containment and control of
outbreaks: contribute to national outbreak
preparedness by ensuring that acute
responses contribute to sustained
containment of the epidemic threat.
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Other areas of Essential
Collaboration
 Focusing more energy on “RESPONSE” capacity strengthening
 Developing response protocols for deliberate epidemics
 Regional multidiciplinary laboratory networks (response,
biosafety, quality assurance, capacicy strengthening)
 Research during outbreaks (e.g. Ebola, Influenza, SARS)
 Safe clinical management during outbreaks
 Mass gathering events (CSR-wide policy and guidance)
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Network Structure
Regional
Networks
Public Health
institutions
Specialised
Networks
Steering Committee
+
Operational
Support Team
WHO CCs
National
Centres
NGOS
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UNOs/IGOs
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Alert and Verification
636 events detected in 136 countries (2001 - 2003)
Number of events
Number of events of potential international public
health concern between 1 January 2001 - 31
December 2003 by source (N=636)
500
300
417
219
100
Informal sources
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Official sources
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SARS - lesson for global response
Communication is key
– highest political commitment required
– between WHO and countries, with the public and the media
– multi-sector event (health, veterinary, food safety, economy,
transport, etc.)
Evidence-based action/transparency/confidence
– efficient alert and response system in all countries
– rapid sharing of data/information
Global partnership
– globalization – no borders
– no country can do it alone, global resources needed rapidly
I D E M I C
A L E R T A Nneutral,
D R E S P Opartnership
N S E
– unique role ofE PWHO:
technical,
with countries
Communications
Dissemination of information
to a global audience:
– Disease outbreak news
– Outbreak Verification list
– Active media interface
Operational Readiness
– confidential communication
with GOARN
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Advocacy: strategy
Strategy:
“Give the right message to the right people at
right time with the intended effect”
• message: identifiable image; consistent;
adaptable
• delivery: be ready; be opportunistic; be timely
• audience: customize message; use SAC
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Advocacy: the audience
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International Health Regulations
Protection for: developing countries,
developed countries, transportation
infrastructure and industry
Protection through: national & international
epidemic alert and response, relevant
routine preventive measures
Protection from: public health emergencies,
avoidable travel restrictions and loss
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IHR Protection
Protection for:
 developing countries
 developed countries
 transportation infrastructure and industry
Protection through: epidemic surveillance and response
 national & international
 relevant routine preventive measures
Protection from:
 public health emergencies
 unnecessary restrictions to travel and trade
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Revision proposals and disease
surveillance

Revised IHR will NOT establish a surveillance system for
specific diseases – (cf. current IHR)

Establish mechanism for early warning of events that
require an immediate response in order to prevent spread
of disease or risk of disease

Disease based surveillance is important at both national
and international levels but is not helped by international
legal obligations
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Current Context
Countries expect faster response:
– more systematic interventions
– more defined contribution to sustained
control
Partners expect a stronger operational platform
in the field, and the opportunity to engage
in consultations from home institutions.
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THANK
YOU
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