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Strengthening generic emergency preparedness & “mass gathering health”
Coordination meeting for operational international early warning and response to health threats with cross-border dimensions during the EURO 2012
Chief Sanitary Inspectorate, Warsaw, 9th February 2012
Some challenges for “Mass Gathering Health”
• Increased risks– weather-related conditions (heat, cold)
– trauma – crowd management
– imported (unfamiliar) and epidemic-prone diseases
– deliberate release of biological, chemical or radio nuclear substances
• Pressure on infrastructure– hotels, food caterers
– health system
• Challenge for control measures– integrated surveillance to provide intelligence
– potential for international spread
– mobile population (contact tracing)
• International attention– media
Developing tools and sharing guidance
Developing tools and sharing guidance
WHO Europe toolkit to assess preparedness
• WHO Europe toolkit to assess crisis management capacities of health systems developed with partners
• A structured tool - applicable also as self assessment method for countries to identify gaps and monitor progress in improving emergency preparedness
Rolling out assessments Developing and pilot testing the WHO Europe toolkit for “Assessing Health system crisis management capacities” (since 2008)
Three pilot missions:ArmeniaAzerbaijanRep of Moldova
Comprehensive assessment missions
CroatiaGreeceItaly (Lampedusa)KazakhstanKyrgyzstanMalta
PolandTurkey
Ukraine
Self assessment approachEnglandIsrael
Lviv – joint WHO ECDC workshop with Ukraine - Poland (April 2010)Recommendations:
• To establish joint technical working groups
• Conference for medical preparedness for major sport mass gatherings to discuss public health and surveillance concepts
• Guidance for Polish hospitals to strengthen emergency preparedness
• Hospital assessments in selected hospitals in the Ukraine
• To develop joint health promotion and health information material
Follow up activities in Poland• Conference for medical
preparedness for major sport mass gatherings in Warsaw (September 2010)
• WHO hospital preparedness workshop in Gdansk (October 2010)
• Workshop and hospital preparedness exercise in Wroclav (October 2011)
• WHO consultative meetings with the Ministry of Health in Warsaw (October 2011)
Follow up activities in Ukraine
• Joint WHO & ECDC mission (September 2011)
• Deployment of a VIAG member to the WHO country office in Kyiv to coordinate mass gathering preparedness support (2011 - 2012)
• Promoting hospital preparedness
• Supporting risk analysis
Legacy: Public health promotion (joint leaflet)
UEFA EURO 2012 - a smoke-free zone
The way forwardInteroperable “all-hazard” preparedness, based on the IHR
Exercises and drills - to test plans
Strengthened cross border collaboration – “crises don’t respect borders”
Enhanced coordination – multi sector approach
Capacity building - sharing expertise and good practice
Mass gatherings challenges
• Health systems are stretched to surge capacity• MG may require host countries to adopt additional measures to comply
with IHR (2005) - under intense media scrutiny• Business-as-usual behavioural health measures difficult/impossible to
implement• Require holistic approaches to risk mitigation across disciplines/ministries
• Introduction and dissemination of non-endemic diseases
• Communication of risk made difficult by international dimension (languages, cultures, etc) and media pressures
New requirements for international mass gatherings
1. Faster reaction times and lower thresholds for action
2. Extremely clear structures for command and control
3. Integrated procedures across sectors
4. International information exchange and coordination
Seoul 2002 FWC
Someone arrived with measles
Health promotion, 3 Fives, Five Keys
WHO's Conceptual model
Health Security
Health Promotion
Work with Int'l Organizing committees
Food safety training
Legacy for the host
Single Event"Acute"
Legacy for the event
Development of the public health infrastructure during an event
Improving host surge capacity for the eventOpportunity for IHR
Enhanced inter/national surveillance for the event
Health promotion, 3 Fives, Five Keys
2011 World Youth Day, Madrid
2008 World Youth Day Sydney
2010 Winter Olympics Vancouver
Enhanced surveillance and observers programme
2011 Umra and Hajj
3 million visitors each year
2010 FIFA World Cup South Africa
First time in Africa
2009 Athletics World Championship Berlin
Happened just after Phase 6 – H1N1
2010 Shanghai World Expo
73 milllion visitors in 6 months
2009 Caribbean Games Trinidad and Tobago
WHO Support to public health preparedness and response at mass gatherings
2009 South East Asian Games Vientiane
2008 European Cup Switzerland and Austria
2008 Presidential Inauguration
2008 Beijing Olympics
2007 Cricket World Cup
2011 Exit Music Festival, Serbia
2011 Rugby World Cup, New Zealand
Occurs after a large natural disaster
Early Warning and Response for Mass gatherings
• Risk assessments• Priority disease lists• National and international disease reporting
strategy• Building on routine structures• Health Operations Centres (command and
control)• Communication strategies
A revised approach for SA
• Designation of 17 priority conditions according to risk assessment
– Sensitisation of clinicians, especially FIFA affiliated– Data collection from venues (paper based)– Stress on reporting of both suspect and confirmed
cases– Workshops with provincial public health to
encourage reporting and MG aspects of response
• Daily reporting from provinces to national level from June 4 - July 17 (including zero reporting)
– Summary data forms (paper based)– Daily reporting from lab including private labs
(compiled by reference lab)– Matching of lab and clinical reports
• Web based system as pilot only in some specific venues
Data collection
Health Surveillance system Other C&C
systemsInternational data
Other sources of information
Information analysis, decision making,
response coordination, communication, etc
Report to overall MG planning body
Civil defence
Local organization committee
Other command and control
Risk communication
Health Command and Control
Command and Control Issues Risk Management process during 2010 FIFA WC• Data collected on the ground (Emergency medical services, surveillance, environmental, other risks)• Upward dissemination to Provincial Health Operations Centres (PROVHOCs)• Upward communication from PROVHOCs to National Health Operations Centre (NATHOC)• Daily meeting of public health cluster and compilation of situation report• This sit rep merged with health data from other agencies at the daily NATHOC management meeting• Representative from NATHOC attended daily meeting at National Joint Operations Centre (NATJOC)
Downward dissemination of data from the NATJOC NATHOC PROV HOCs people on the ground
Public heath response to WYD08
WHO responsibilities during the FIFA World Cup
• Daily meeting between WHO and DOH staff (daily public health cluster risk assessment meeting)
• Communicate international disease surveillance to the DOH– Event based surveillance conducted by WHO team members – Event based surveillance reports from other sources (e.g. ECDC who sent daily event
based surveillance bulletin to WHO team members in South Africa)– The WHO Event Management System, where information was in public domain and
therefore did not contravene confidentiality with member states. – IHR channels were in place and operational
• Participate in response to health events as required by the DOH
• Maintain an event for the 2010 World Cup in the WHO Emergency Management System (EMS)
• Coordinate communications between different levels of WHO and between WHO and DOH (at all levels)
– biweekly sit reps (Monday and Thursdays) – Continued weekly teleconferences with all levels of the organisation
FIFA 2010 Experience in early warning & response
WHO responsibilities • Cross cutting and MG command and control issues
– Assisting with finalizing the command and control structure.
– Providing technical input into risk and control parameters for a risk assessment tool being trialed by DOH.
– Organising and participating in weekly teleconferences between HQ, AFRO, IST and country office to update areas of work and determine further actions.
– Developing a Traveller’s Health pamphlet that is accessible via several websites and will be disseminated at various points in South Africa.
• National and international disease surveillance and risk assessment• Food safety and training for food handlers• Points of entry and port health• World Cup related influenza pandemic vaccine distribution strategy
Decision instrument (Annex 2)4 diseases that shall be notified polio (wild-type polio virus), smallpox, human influenza new subtype, SARS.
Disease that shall always lead to utilization of the algorithm: cholera, pneumonic plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, others….
Q1: public health impact serious?
Q2: unusual or unexpected?
Q3: risk of international spread?
Q4: risk of travel/trade restriction?
Insufficient information: reassess
What do we do in ARO: IHR Framework
Accessibility at all times
Primary channel for WHO-NFP event-related communications
Disseminate information within WHO
"Activate" the WHO assessment and response system
Detect
Assess
Report
Respond
Accessibility at all times
Communication with WHO
Dissemination of information nationally
Consolidating input nationally
National surveillance and response systems
WHO IHR Contact Points
EmergencyCommittee
Determine Public Health Emergency of International Concern (PHEIC)
Make temporary and standing recommendations Review
Committee
ExpertRoster
WHO Director-General
Unusual health
events
Notification
Consultation
Report
VerificationNational IHR
Focal Points (NFP) Ministries and
sectors concerned
Other competent organizations
(IAEA etc.)
Risk AssessmentRisk Assessment
Event verificationEvent verification
Initial ScreeningInitial Screening
Response Strategy and OperationsResponse Strategy and Operations
WHO Event management
Initial screening and verification• Identifying events
– informal/unofficial information sources including electronic media and communications from WHO partners and networks
• Verification– Unknown disease– Potential for spread beyond national borders– Serious health impact or unexpectedly high rates of illness
or death– Potential for interference with international travel and trade– Strength of national capacity to manage the outbreak– Suspected accidental or deliberate release
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Event Risk Assessment
• RA process begins as soon as event is identified, but not considered complete until official information is received
• List of risk questions developed to allow rapid assessment, including:– Does the event fulfil the minimum notification
criteria of Annex 2 IHR?– vulnerability assessment: context of event,
population at risk, response capacity and support infrastructure
– Incidence/prevalence/morbidity/mortality– Control measures available?
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Outcome of risk assessment
• Discard: No risk, close event, document assessment
• Monitor: currently not of international importance, but requires continuous assessment
• Assist: Technical or in-country assistance required/likely
• Disseminate event information to international community
• Escalate to WHO senior management if required• Advise senior management to initiate PHEIC
determination procedure
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