World Health Organization 1 August 2008 Health security under the International Health Regulations.

World Health Organization

1August 2008

Health security under the International Health Regulations


2August 2008

Polio eradication progressPolio eradication progress1988 - 20031988 - 2003

1988

350 000 children

125 countries

Inequitable access to polio vaccine

2003

784 children

6 countries

Equitable access to polio vaccine

Type 2 wild poliovirus last transmitted in 1999


3August 2008

Challenge: suspension of polioChallenge: suspension of polio immunization, Nigeria, August 2003 immunization, Nigeria, August 2003

Polio Vaccines - Western Countries Exploit Developing Ones Says Kano State Governor Shekarau

BYLINE: Daily Trust

BODY:The Kano State governor, Malam Ibrahim Shekarau, has asserted that the people's objection to polio vaccines has confirmed that polio vaccination is damaging to young girls.


4August 2008

6 polio endemic countries

18 countries with imported virus

Wild virus type 1

Wild virus type 3

International spread of polio from Nigeria, 2003-2005


5August 2008

Points for discussionPoints for discussion

What are the international mechanisms that would help manage this situation?

Are there any other types of activity necessary?


6August 2008

Vaccine safetyVaccine safety

Testing of vaccines in Nigerian programme for presence of impurities/hormones: WHO Collaborating Centre South Africa and India

Provision of polio vaccines manufactured in an Islamic country

Personal discussions with governor of Kano and eventual decision to convene expert group of state paediatricians


7August 2008

Political Advocacy for PolioPolitical Advocacy for Polio

10th Islamic Summit Polio Resolution, Malaysia, 2003

Islamic Conference of Foreign Ministers Meeting Polio Resolutions (Turkey 2004, Pakistan 2007)

3rd Extraordinary Islamic Summit, Mecca, 2005

'Noting OIC countries now suffer the greatest burden of polio, call for political & financial support

of OIC member states to finish eradication'


8August 2008

Religious Advocacy for PolioReligious Advocacy for Polio

Rulings & Fatwas on the need and safety of polio vaccines:

–the Grand Imam of El Azhar Al Sharif,

–International Union for Moslem Scholars

–The Mufti of Egypt

–Mawlana Fazul Rahman

–The Islamic Fiqh Academy - Jeddah

–Dr Y. Al Qaradawi, European Council for Fatwa and Research.

Visit of Imam Cheik Cisse to northern Nigeria.


9August 2008

Weekly epidemiological record6 AUGUST, 2004

The international spread of wild poliovirus

On 30 June 2004, WHO highlighted an increasing

risk of international spread of wild poliovirus1

and updated its advice for travelers on steps

they could take to increase their personal protection

against wild poliovirus. Subsequently, on 16

July 2004, an*Ad Hoc Expert Consultative Group

on Polio and Public Health was convened by the

Director-General of WHO to discuss potential

measures to prevent or limit the international

spread of wild poliovirus.


10August 2008

Standing recommendation, International Standing recommendation, International Health Regulations (2005)Health Regulations (2005)

Evidence that booster dose of vaccinedecreases time of wild virus carriage


11August 2008

World Health AssemblyWorld Health Assembly

Resolution on polio eradication 1998

Resolutions on continued/strengthened effort in remaining endemic countries– 2004

– 2006

– 2007

– 2008


12August 2008

Avian inlufenza: a major risk to public Avian inlufenza: a major risk to public health securityhealth security

1918: Spanish Flu

(H1N1)

1957: Asian Flu

(H2N2)

1968: Hong Kong Flu

(H3N2)

20-40 million deaths ~ 2.5 million deaths ~1 million deaths


13August 2008

WHO influenza surveillance network: collective action to WHO influenza surveillance network: collective action to reduce vulnerability to influenzareduce vulnerability to influenza

1 laboratory > 1 laboratory national network

115 national influenza centres WHO Collaborating Centres


14August 2008

Current Level of WHO Pandemic Alert

Inter-pandemic period

Phase 1 No new influenza virus detected in humans. If a new influenza virus presents in animals, the risk of human infection is considered to be low.

Phase 2 No human infections, but a circulating animal influenza virus poses a risk to humans.

Pandemic alert period

Phase 3 Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread.

Phase 4 Small cluster(s) with limited human-to-human transmission but spread is highly localized.

Phase 5 Larger cluster(s) but human-to-human spread still localized

Pandemic period Phase 6 Increased and sustained transmission in general population.


15August 2008

Rapid containment response, early phase 4 Rapid containment response, early phase 4 pandemic alert pandemic alert

Interrupt transmission from human to human/prevent further spread: ring containment– Early detection and response

– Prevention of human to human transmission using anti-viral drugs

– Prevention of human to human transmission by vaccination using H5N1 vaccine


16August 2008

Vaccines and antiviral drugs for H5N1 Vaccines and antiviral drugs for H5N1 and pandemic influenzaand pandemic influenza

Antiviral drugs– Production now exceeds demand

– Market skewed towards industrialized countries

– Some developing countries produce oseltamivir; few maintain stockpiles

H5N1 and Pandemic vaccine – Production capacity limited to 1.5 billion doses/six

months for production

– Market skewed towards industrialized countries

– No developing countries produce influenza vaccines; few maintain stockpiles


17August 2008

Minister of Health, Indonesia and H5N1 virus sharing: Minister of Health, Indonesia and H5N1 virus sharing: link sharing to more equitable benefitslink sharing to more equitable benefits

Ind

onesia S

tand

s Firm

In B

ird F

lu V

irus S

amp

les Row

With

WH

OJA

KA

RT

A (AP

)--Indonesia insisted Tuesday that it w

ill only resume sharing bird flu virus sam

ples with the W

orld Health O

rganization if the body stops providing them

to comm

ercial vaccine makers.

The defiant com

ments by H

ealth Minister S

iti Fadiliah S

upari came as top W

HO

officials met w

ith Indonesian counterparts and other global health chiefs in Jakarta to try to persuade the country to resume sharing its sam

ples.


18August 2008

Points for discussionPoints for discussion

What are the international mechanisms that would help manage this situation?

Are there any other types of activity necessary?


19August 2008

Meeting summary, Jakarta meeting on sharing in the Meeting summary, Jakarta meeting on sharing in the benefits of virus sharing, March 2007 benefits of virus sharing, March 2007

Types of benefits anticipated, developing countries:– Strengthening core laboratory capacities so that more

developing country laboratories can qualify for WHO designation

– Ensuring access to H5N1 and other potential pandemic influenza vaccines

– Developing more transparent virus handling procedures so that location of any shared virus can be known in real time

– Linking of virus sharing and vaccine production to sustained benefits


20August 2008

Global Action Plan for Influenza VaccinesGlobal Action Plan for Influenza Vaccines

Request for proposals from developing country vaccine manufacturers for technology transfer

11 proposals received/reviewed Initial grants (up to US $2.5 million each) to six manufacturers:

– Brazil– India– Indonesia – Mexico– Thailand – Viet Nam


21August 2008

Stockpiles for broader access toStockpiles for broader access toH5N1 and pandemic influenza vaccine vaccineH5N1 and pandemic influenza vaccine vaccine

Meeting with manufacturers and possible donor countries, April 2007

Individual meetings, Director General/CEOs of vaccine manufacturers, April - May 2007

Announcement of H5N1 stockpile development, Pacific Health Summit, June 2007 (for rapid response and essential populations should H5N1 show pandemic changes)

Mechanism for procurement of pandemic vaccine being developed: conceptual phase


22August 2008

Strengthening developing country capacity to Strengthening developing country capacity to participate globallyparticipate globally

H5 reference laboratories established and certified: China, Indonesia, Brazil

H5N1 WHO Collaborating Centres being established: China, India Brazil

Regular training in laboratory and epidemiology including rapid response to early Phase 4 event


23August 2008

Sharing of benefits: some of the requirements Sharing of benefits: some of the requirements identifiedidentified

Sustainability

Transparency

Bilateral versus multilateral


24August 2008

World Health Assembly: sharing of influenza World Health Assembly: sharing of influenza viruses and benefitsviruses and benefits

Resolution 2007: Intergovernmental process to ensure access to vaccine and other benefits– Initial intergovernmental working group meeting November 2007

– Open-ended working group meeting March 2008

– Open-ended working group meeting followed by intergovernmental meeting planned November 2008


25August 2008

Pandemic influenza control 1918Pandemic influenza control 1918

International Health Regulations (2005):

collective action for global public health security

World Health Organization 1 August 2008 Health security under the International Health Regulations.

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Transcript of World Health Organization 1 August 2008 Health security under the International Health Regulations.