Prevent, detect and respond –On the road to globalhealth security for infectious diseases

Jussi Sane, PhD, docent

Chief Specialist, Team Leader25.10.2019

What is out there?

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Hey, we are flying

Examples of threats to global health security

2001: USA 9/11 anthrax letters

2003: SARS-CoV China, Canada

Since 2005 :Avian influenzaH5N1, H7N9 etc

2009 ”swine flu” AH1N1-pdm09 pandemic influenza

2012 MERS-CoVThe Arabian Peninsula

2014 Ebola West-Africa

2015 MERS-CoVSeoul South Korea

+ a number of local or regional outbreaks with potential of internationalspread such as Zika, measlesAnd let´s not forget the ”slowly creeping” threats like HIV, TB, antimicrobialresistance

2018-2019 Ebola DRC

Outbreak are costly

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And vulnerability is not fairly distributed

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Security sector gets its share, what aboutHealth?

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Health Security – societal positioning from a FinnishComprehensive Security perspective

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Foreign affairs –Health diplomacy and healthcooperation

Border control,transport

UNIVERSAL HEALTH COVERAGE

Primary Healthcare DefenseEssentialPublicHealthFunctions

Bio-weapon

Quaran-tine

PoliceCriminalaction

Health Security

FoodstuffsAnimal disease

Environmentalprotection

Zo

on

oo

ses

Rescue services

Exportcontrol

Firstresponders

Treatmentand isolation

CD control

EnvironmentalHealth

25.10.2019

When and where will the next outbreak breakout?

• Prediction of epidemics is difficult, if not impossible in somesituations (pandemics)

• Crucial to focus resources on the rapid identification and prevention of outbreaks before they spread

• Research priorities?

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How can me measure preparedness in order to increase capacities/capabilities?

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Brief background to the International Health Regulations (IHR)

• A health threat in one country may be a health threat for another country• Not simply a national issue• Success in preventing global epidemics is not as much an issue of

finding the strongest links, as it is of finding the weakest ones

• Realisation of the need to strengthen Public Health functionswithin the Health and other sectors

• Reform of the International Health Regulations IHR (2005) entered into force 2007• Intended as an all hazards approach, cross-sector treaty

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Assesment of IHR capacities

• Long done as exclusively self-assessment

• Proved problematic

• By 2012 • 1/3 of member states notified to the WHO

that they had reached required capacity

• 1/3 said they didn’t and asked for moretime

• 1/3 did not report

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Self- Assessment

Post action review

External evaluation

Exercises

Self-assesment not working, need to change thestrategy

The JE E tool for assessing IHR core capacity by a peer-to-peer process

WHO Secretariat

(IHR CC Monitoring Experience)

GHSA Experts (GHSA Pilots)

Other expert inputs (e.g. OIE )

Voluntary evaluation characterized by openness and transparency

Multi-sectoral including agriculture, security, etc.

Joint peer-to-peer review based on discussion and consensus

with both external and country teams

Field visits support and inform technical area discussions

Final Report includes recommended priority actions; Publicly available

A common platform for broad donor and international support

Join External Evaluation Process (JEE):A different kind of evaluation

JEE Tool: 19 technical areas

• 48 indicators across 19 technical areas assess capacities to PREVENT, DETECT and RESPOND plus other IHR related hazards and PoEs

PREVENT1. National Legislation, Policy

and Financing2. IHR Coordination,

Communication and Advocacy

3. Anti-microbial Resistance (AMR)

4. Zoonotic Disease5. Food Safety6. Biosafety and Biosecurity7. Immunization

DETECT1. National Laboratory

System2. Real Time Surveillance3. Reporting4. Workforce

Development

RESPOND1. Preparedness2. Emergency Operation Centres3. Linking Public Health and Security Authorities4. Medical Countermeasures and Personnel

Deployment5. Risk Communication

Other IHR related HAZARDs and PoEs1. Point of Entries (PoEs)2. Chemical Events3. Radiation Emergencies

Indicator color scoring system

1 No Capacity Attributes of a capacity are not in place

2 Limited Capacity

Attributes of a capacity are in development (some are achieved and some are underway; however, implementation has started)

3Developed Capacity

Attributes of a capacity are in place; however, sustainability is an issue, as measured by lack of inclusion in operational plan in National Health Sector Plan (NHSP) and/or secure funding

4Demonstrated Capacity

Attributes are in place, sustainable for a few more years and can be measured by the inclusion of attributes or IHR (2005) core capacities in the NHSP

5Sustainable Capacity

Attributes are functional, sustainable and country is supporting other countries in their implementation. This is the highest level of achievement of implementation of IHR (2005) core capacities.

⚫ Every indicator has attributes that reflect various levels of capacity with scores of 1-5

Finland is playing an active role in Global Health Security arena

• THL and other experts involved in the JEE process and technical tool development

• Evaluation missions in multiple countries

• Bilateral IHR-capacity building project in Somaliland

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Research on JEE scores

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Hypotheses:• IHR core capabilities are a subset of

measures that reduce disease burden dueto infectious diseases and inadvertentexposure to toxic chemical and radionucleids

• If this is the case, the JEE scores should bereflected in population health status

• Data on population health status and socioeconomic parameters are availablefrom most countries and can becompared to JEE scores

Research areas

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KIITOS!

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@SaneEpi