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Perspective from WHO on Ebola
preparedness & response in ASEAN+3
countries
Workshop on Strengthening Ebola Preparedness for Early Response among ASEAN+3
FETN Member Countries, 1-3 December 2014, Bangkok, Thailand
Rick Brown, WHO Thailand
What this presentation will cover
• What are the International
Health Regulations (2005)?
• Ebola preparedness and
response
• Outbreak response networks…
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What are the International Health
Regulations (2005)?
• An internationally agreed
instrument for global public health
security
• Represents the joint commitment by
all countries for shared
responsibilities and collective
defence against disease spread
• Legally binding for WHO Member
States since June 2007
Approach of the New IHR
• From controlling at borders, to containment ‘at source’
• From a list of diseases, to a very broad range of threats
• Focus on ‘risk-based’ assessment & response
• New ‘infrastructure’
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National IHR Focal points
WHO IHR Contact Points in Regional Offices
IHR Department in WHO Headquarters in Geneva, Switzerland
Annual reporting to the World Health Assembly
Secure Event Information Site (EIS)
Emergency Committee and a ‘review process’
What does IHR implementation mean…?
• Two very important aspects…
1. An immediate and ongoing requirement
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for countries to report some types of event when they occur, and
for WHO to provide assistance
2. A requirement, linked to a timeframe for countries to
establish capacities to detect and respond to public health
events (initially, by June 2012)
What should be reported to WHO?
• Any potential ‘Public Heath Event of International Concern’ (PHEIC)
• To help any decision, some criteria have been established
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Is the public health impact of the event serious?
Is the event unusual or unexpected?
Is there a significant risk of international spread?
Is there a significant risk of international travel or trade restrictions?
• A decision on whether to report an event will normally be made at
national level (by the national IHR focal point)
• Only the DG of WHO (advised by experts) can declare a PHEIC
IHR Core Capacities and APSED
• Eight “core IHR capacities”
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National legislation, policy and financing.
Coordination and National Focal Point (NFP) Communications.
Surveillance.
Response.
Preparedness.
Risk communication.
Human resources.
Laboratory.
• Points of Entry
• Capacities for IHR-relevant hazards (infectious diseases,
zoonoses, food safety, chemical, radio-nuclear)
• The Asia Pacific Strategy for Emerging Diseases (APSED) provides
this region with a framework for IHR implementation
IHR as a Public Health Good
• If all countries, without exception
– Are well prepared, and have good capacity for detection and
response to all acute public health events, and…
– Report serious events quickly, and provide other countries
that help them to prepare
• Then all countries will be more safe from
unpredictable events, whenever they occur
• The world would be a safer place….
• However…
– One weak link in the chain can threaten us all…
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IHR as a Public Health Good
Ebola Situation Update
• 15 935 reported cases of Ebola virus disease (EVD),
with 5689 reported deaths (23 November).
• 600 cases were reported in the three most-affected
countries in the past week.
• Case incidence is stable in Guinea, stable or declining in
Liberia, but may still be increasing in Sierra Leone.
• The case fatality rate across the three most-affected
countries in patients with a recorded definitive
outcome is approximately 60%.
• 592 health-care workers (HCWs) are known to have
been infected with EVD up to the end of 23 November,
340 of whom have died
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WHO Perspective in the Asia Pacific:
Ebola Preparedness and Response
• Likelihood of importation of a case low for any
country in the Asia Pacific Region
• However, consequences would be very high…
• Therefore all countries need to be prepared (on
a precautionary basis) for importation of cases,
and small outbreaks…
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Ebola preparedness and response?
• Eight “core IHR capacities”
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National legislation, policy and financing.
Coordination and National Focal Point (NFP) Communications.
Surveillance.
Response.
Preparedness.
Risk communication.
Human resources.
Laboratory.
• Points of Entry
• Checklists may be helpful….
• An Emergency Operations Centre can help with preparedness
and response
Ebola ‘Event’ Reporting
• Reporting a suspected / confirmed ebola case or
outbreak will…
– Demonstrate transparency, and a ‘pro-active’ approach
– Help other countries to ramp up their preparedness
– Allow WHO and other partners to provide more effective
support
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‘All-Hazards’ Preparedness?
• An ‘all-hazards’ approach to ‘preparedness and response’ is
rational and has some efficiency
– Map all hazards in your country
– Assess their relative risks
– Develop SoPs (including surveillance and response) and stockpiles of critical
logistic supplies
– Develop, test and revise plans through tabletop / simulation exercise
• Should build all capacities on existing health systems
• Can expand scope of (or merge) plans ‘step-wise’
Influenza  EID  All Infectious Diseases  All-Hazards
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Outbreak Response Networks: the Global Outbreak
Alert and Response Network (GOARN)
• Established in 2000 as a global technical partnership
with a focus on outbreak response
• The World Health Organization agreed to provide the
Operational Support Team for the partnership, and to
coordinate its activities.
• GOARN and its aims were endorsed by the World
Health Assembly in May, 2001
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GOARN’s Primary Aims
• Assist countries with disease control efforts
by ensuring rapid appropriate technical support
to affected populations
• Investigate and characterize events and
assess risks of rapidly emerging epidemic
disease threats
• Support national outbreak preparedness by
ensuring that responses contribute to sustained
containment of epidemic threats
GOARN's current structure
150+ Partner Institutions plus 37 Networks with 355 network
members
Offer people and resources in response to a request for assistance
Operational Support
Team (OST)
Steering Committee
(SCOM)
Sustains Network and
coordinates outbreak
response operations
Provide overarching guidance
to the Network and oversees planning and
implementation of Network activities
Technical Working groups and Sub-Committees
Established to focus
on specific projects and issues.
Multidisciplinary teams…!
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Field epidemiology
Laboratory science
Clinical management
Infection control
Environmental health
Health education
Medical anthropology
Risk communication
Outbreak Logistics
Others…
Over 150+ technical partners across the globe,
plus many additional network members
Outbreak Response Training
• Residential courses in international outbreak
response and team leadership
• Participative approach via role plays, case
studies and practical exercises.
– Coordination and leadership.
– WHO role, objectives and procedures.
– Personal and operational security and
logistics.
– Health on mission.
– Field epidemiology.
– Case management and infection control.
– Social mobilization and anthropology.
– Working in support of national partners.
– Risk communication.
GOARN Operations and deployments
2012-2014*
Ebola Outbreak Response, West Africa 2014
256
Disaster/Conflict response mission, Philippines 2013
35
Cholera Outbreak Response, Sierra Leone, 2012
15 6
53
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MERS-CoV Multiple locations in Eastern Mediterranean, 2013 12 5
Ebola Haemorrhagic Fever, DRC, 2012
88
Marburg Outbreak Response, Uganda 2012 45
Cholera assessment mission, Iraq 2013 42
MERS-Cov Outbreak, Tunisia 2013 33
Cholera outbreak response, South Sudan 2014 3
Cholera assessment mission, Iraq 2014 3
Food Insecurity, Sahel region 2012 2
Cholera Outbreak Response Mission, Philippines 2012 2
BHF Outbreak Response, Bolivia 2012 2
Yellow Fever Outbreak Response, Sudan 2012 11
Dengue and Zika outbreak response, French Polynesia 2013 1
Ebola Outbreak Response, Uganda 2012 4
Ebola Haemorrhagic Fever, Uganda, 2012 1
Conflict, Central African Republic, 2013 1
0
GOARN Institutions Experts
50
100
WHO Experts
150
200
250
300
*As of 20 October 2014
Summary
• The International Health Regulations exist to
ensure / support Global Health Security
• Preparedness for ebola is key, including being
prepared to respond to cases and small clusters
• Outbreak response networks can help to
respond to a big event, because no single
country has all the capacity required…
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Thank you….!
Rick Brown, WHO Thailand