International Networks in Public Health & the linkage with National

Networks

Dr Maureen BirminghamWHO representative to Thailand

This presentation

• Definition of a network

• Roles of a public health network

• Examples - CDs, NCDs, surveillance

• What makes a good network?

What is a Network?

“an interconnected system of things or people”

“an association of individuals having a common interest, formed to provide mutual assistance, helpful information, or the like”

Role of Public Health Networks

• “Sharing” to strengthen capacity or inform those who need to know (on a specific issue)– Experiences– Knowledge– Expertise– Methods/tools– Information/data

• Collaborate on a specific issue or problem(e.g. research network)

• Advocate for needed actions/resources

Some examples

NCDnet

Global Network to combat Non-Communicable Diseases

NCDnet

Mission: Help implement the global Strategy Action Plan

Raise awareness Increase resource availability

Catalyze country-level implementation

10 million

15 million

20 million

25 million

High-income countries

Upper middle-income

Lower middle-income

Low-income countries

0.6M

0.5M

3.3M

2.3M

10.2M10.2M

3.3 M3.3 M3.0M

3.0M3.0M

3.0M

5.9M5.9M

2.3M

6.8 M6.8 M

3.7M

13.6M13.6M

1.1M0.9M

Low-income countriesGroup III - InjuriesGroup II – Other deaths from noncommunicable diseasesGroup II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventableGroup I – Communicable diseases, maternal, perinatal and nutritional conditions

Growing importance of Non-Communicable Diseases (NCDs)

Cause of deaths in the world

So

urce

:

Disease/risk factor

Intervention Cost of implementation

(Low = < I$1 per capita

High = > I$2 per capita)

Health impact

(DALYs per 1m popn) (Small = < 100

Large = > 1,000)

Cost-effectiveness

(I$ per DALY averted)(Very = < GDP per capita

Quite = 1-3 * GDP per capita)

Ris

k facto

rs

Tobacco use Excise tax on tobacco products Low Large Very cost-effective

Smoke-free workplaces Low Modest Quite cost-effective

Packaging, labelling and awareness countermeasures

Low Modest Very cost-effective

Comprehensive ad bans Low Modest Very cost-effective

Harmful use of alcohol Excise tax on alcoholic beverages Low Modest Very cost-effective

Unhealthy diet and physical inactivity

Reduce salt intake Low Large Very cost-effective

Food taxes (fat) and subsidies (fruit and vegetables)

Low Modest Very cost-effective

Intensive counselling Very high Large Quite cost-effective

NC

Ds

Diabetes Glycaemia control High Large Quite cost-effective

Cardiovascular diseases

Hypertension drug treatment Low Large Very cost-effective

Cancer Treatment of 1st stage breast cancer

Low Modest Very cost-effective

Cervical cancer screening (PAP smear) and treatment

Low Modest Very cost-effective

Respiratory disorders Inhaled corticoid-steroids for asthma

Low Small Quite cost-effective

Advocacy to promote action: There are low cost interventions to prevent NCDs…

World Economic Forum: Global Risk 2010 Report

Oil spikes

Retrenching from globalization

Asset price collapse

Food price volatility

Financial crisis

NCDs

Infectious diseases

Advocacy to create new perspectives on NCDs and investments to control them

2010

Communicating a clear global vision on how to move forward

2000

2003

2004

2008

Global Strategy for the Prevention and Control of Noncommunicable Diseases

WHO Framework Convention on Tobacco Control

Global Strategy on Diet,Physical Activity

and Health

Action Plan on the Global Strategy for the Prevention and Control of Noncommunicable Diseases

6 objectives:

1. Raise priority of NCDs; integrate NCDs control into all public policies

2. Strengthen national policies and programmes

3. Address risk factors

4. Prioritize research

5. Strengthen partnerships

6. Monitor NCD trends

Roadmap for implementation in countries

SEANET-NCD

Objectives• Contribute to the global efforts• Facilitate national NCD networks • Share experience, expertise, resources• Collaborate in research• Advocate & mobilize resources• Strengthen national NCD policies and strategies• Support capacity building

What is INFOSAN?

A global network of national food safety authorities, established in 2004 to:

Promote information exchange of important food safety issues

Respond to food safety emergencies

Help countries strengthen their capacity to manage food safety risks

As of today, there are 177 country members of INFOSAN

INFOSAN SecretariatInternational Food Safety Authorities Network

INFOSAN Focal point

in Agriculture

Sector

INFOSAN Focal point

in HealthSector

INFOSAN Emergency

ContactPoint

INFOSAN Focal point

in Food Safety

Authority

Counterparts across the farm to table continuum

Structure of INFOSAN

INFOSAN Focal point

in other Sectors

INFOSAN Focal point

in TradeSector

Advisory Group

WHO surveillance & response systems

ExampleMelamine Contamination of Infant Formula

• Melamine added in the primary production

sector (milk collection centres) to disguise

the dilution of milk with water

• 22 of 79 Chinese producers of powdered infant formula

were affected

• Products from affected producers exported

to 5 countries

• Levels detected range from <0.1 – 2600 mg/kg

>294,000 children ill

>50,000 hospitalized

6 deaths

Other products contaminated

• milk (powder), yoghurt, biscuits, instant & liquid

coffee preparations

• egg powder, fresh eggs, animal feed

• Sodium bicarbonate (raising agent)

• Exports reported all over the world

Measures Taken by INFOSAN

• Secured websitesINFOSAN provided regular updates of information to its emergency network

– Close collaboration with Chinese MOH

– Collaboration with affected countries to verify information and provide alerts

– Assistance to countries on laboratory information, analytical methods, safety limits etc.

• Public Websites

Special websites set up to provide continuous updates to the public

The global polio eradication initiative

Global Laboratory Network for Polio EradicationN = 145 laboratories

The designation employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organisation concerning the legal status of any country,territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

Specialised Reference Laboratory

Regional Reference LaboratoryNational/ Sub-national Laboratory

Training

QC

Isolates

Data

Isolates

DataTraining

QCNational Labs

N = 123Serves host country

Isolates & types viruses

Regional Reference LabsN = 15

Serves > 1 country

Isolates & types viruses Differentiates (ITD) wild & Sabin-like polio viruses

Distributes supplies as needed

GlobalSpecialized Labs

N = 7 Isolates & types viruses

Performs ITD & sequencing Prepares & distributes reagents

Prepares & distributes PT testResearch

Lia

ises

wit

h i

mm

un

iza

tio

n &

su

rvei

lla

nce

p

ers

on

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l

Structure of the polio laboratory networkEvery country need not have the same capacity: “networking” provides access to services

ACTMalaria FoundationArmed Forces Research Institute of Medical Sciences (AFRIMS)

American Refugee Committee (ARC)Asian Development Bank (ADB)

Bill & Melinda Gates Foundation (BMGF)CDC MOH Thailand (TUC)

Center for Disease Control (CDC) AtlantaFamily Health International (FHI)

Health Unlimited (HU)Institute Pasteur Cambodia

Institute of Tropical Medicine (ITM) Antwerp, Belgium International Office for Migrations (IOM)

INTERPOLJapanese Ministry of HealthKenan Institute Asia (Kenan)

Mahidol-Oxford-Wellcome-trust Research Unit (MORU)Malaria Consortium

Management Sciences for Health (MSH/RPM+)MEASURE / evaluation

Medecins Sans Frontieres (MSF)Medicine for Malaria Venture (MMV)

MEKONG COUNTRIES(MOH)National academies / Research Institutions

Partners for Development (PFD)Population Services International (PSI)

SEAMEO TROPMEDSOKHLO Malaria Research Unit (SMRU)

Tropical Diseases Research (TDR)University Research Co (URC)

US Pharmacopeia / DQIUSAID-RDM-Asia

World Food Programme (WFP)WHO Collaborating Centers

WHO

Mekong Malaria Programme networking

Technical Networking Workshop every 2-3 years since 1999

Last technical consultation in Phuket, Thailand in September 2007

Build evidence of malaria drug resistance, Prepare a multi-country response

Proportion of positive cases on day 3 (2001-2007)

Qinghaosu - Artemisinins

Rapid action, broad stage specificity, safe, gametocytocidal

More study sites of the intensified TES (Therapeutic Efficacy Studies) network to better understand malaria

drug resistance

x xx

x

xx

x

x xx

xxxx

xx

x

xxx

x

Artemisinin resistance, the doom scenario

EWGLINET

• European surveillance scheme for travel-associated legionnaires' disease network

• aims – reduce incidence of travel associated legionellosis– provide an early warning system

• objectives – maintain a European surveillance – detect a common source – inform all those need to know about travel-associated Legionellosis– inform the public

Strengthening Global Networksfor Health Security

Strengthening Global Networksfor Health Security

1st Millenium

Epidemics and Pandemics have Epidemics and Pandemics have shaped our history…shaped our history…

Middle Ages

20th Century

WHO has detected & assessed > 2,800 events during 2001 to 2009

They continue to threaten us..

Modeling EID events: Relative risk of an EID

Hot Spots: global distribution of relative risk of an EID event caused by zoonotic pathogens from wildlife, (Jones Nature, 2008).

The Global Outbreak Alert and Response Network (GOARN)

• Assist countries with disease control efforts

• Investigate events and assess risks of rapidly emerging epidemic disease threats

• Support national outbreak preparedness

GOARN includes > 190 technical institutions and networks coordinating actions and resources to respond

to public health events of international concern.

GOARN partners have provided experts for > 104 operations in 75 countries for 197 missions.

Disease #outbreaks

# Deployments

Ebola 10 286Avian Influenza 21 206Marburg 2 122SARS 5 81Yellow Fever 8 58Cholera 3 52Rift Valley Fever 5 42Tsunami 3 40Meningitis 2 14Other 17 168Total 76 1007

GOARN deployments (as of April 2009)

GOARN – direct technical assistance and field support

• Materials

• Expertsepidemiology, public health, infection control, case management, risk communication, crisis management, logistics, laboratory, contingency planning

• Teamsmulti-disciplinary experts

• Funding

GOARN and Specialist Networks

GOARNGOARN

EDPLN(BSL4 laboratories)

COMBI(Health education)

Clinical

What makes a good network

• Clear purpose• Mutual benefits for all involved• Ownership• Clear roles & deliverables• Complementary and efficient division of labor• Sufficient resources• Accountability• Spirit of ‘comradery’ & ‘togetherness’

Conclusion

• Networks exist usually to share something or solve something of shared interest

• Networks can help provide access to information, expertise, methods, tools

• Networks can be more efficient and effective than working alone

Thank you