IPT & RKI Partnership Symposium: Current Challenges of Biological Risks and Health Security”

IPT & RKI PARTNERSHIP SYMPOSIUM:
„CURRENT CHALLENGES OF BIOLOGICAL RISKS
AND HEALTH SECURITY”
Presentation of TUN-GER Program activities
Dr Rym BENKHALIFA
République Tunisienne
Ministère de la Santé
September, 22- 23, 2016
Ramada Plaza Hotel – Gammarth, Tunisia

2015-2019 United Nations Development Assistance
Framework (UNDAF)
UNDAF is structured around four strategic dimensions:
 democratic governance,
 inclusive, sustainable and resilient economic model,
 social protection
 equitable access to social services.
IPT & RKI Partnership Symposium
Gammarth, 22-23 September, 2016

Health is a human right
It highlights that :
•The State should ensure preventive and curative health services and
provides sufficient resources to guarantee security and quality of services.
•The State guarantees free health care for poor people.
• It guarantees also social protection as stated in law.
Article 38 of the new Constitution (2014)

Challenges
A health system reform is needed to implement an integrated approach,
based on :
- primary care
- focusing on prevention and health promotion,
- including provision of palliative care and rehabilitation following specialist
management, in order to respond better to the increased chronic and
infectious diseases and their risk factors and change in etiology of disability.
 This is a priority for the MOH.

State of the art in Tunisia

1990: Tunisian Occupational Health and Safety Institute
1995: Agency for Coastal Protection and Development
1996: International Centre for Environmental Technologies
2005: National waste Management Agency
Pleiad of texts has…
• strengthened the legislative and regulatory framework related to environmental
protection
 Against pollution
 For the conservation of water and soil
• established a national emergency intervention plan
 against marine pollution incidents
 for waste and control of their management and their disposal
 for air quality.

The Cartagena Protocol on Biosafety, ratified by Tunisia in 2002 , is an important instrument
that ensures the safe transfer, handling and use of GMOs.
but… up until 2009, no national consensus was reached between national departments in
the Tunisian government : only a draft law on GMO and GMO products was reviewed in
Tunisia.
In 2011, a new context emerged : National Plan and Strategy for Biosafety
 Control Device and institutional support
 Information and awareness
 Skills development : Capacity development through research and training
By 2014, the national technical biosafety commission drafted a new version of the law on
biosafety that integrates the issues of GMO, pathogens and invasive alien species.
Ministry of Environnement:
NationalStrategyandActionPlaninBiosafety

HEALTH POLICIES AND SYSTEMS
Other noteworthy developments in 2013-2014 are:
 National institute for accreditation in health including guidelines development
 National strategy on mental health
 National strategy for reduction of maternal and neonatal death
The Tunisian health system can build on well-developed public infrastructure throughout the
country :
2085 PHC centers and 109 district hospitals
a dynamic private sector and an extended workforce.
However, specialized resources (including in the private sector) are unevenly distributed.
Public sector = 2/3 of consultations and 90% of hospitalization
while most human and financial resources are being diverted to the private sector.

Cooperationfor Health
Present in Tunisia:
Various organizations of the United Nations are present in Tunisia:
(UNICEF, UNDP, FAO, UNFPA, UNIDO, IOM, UNAIDS, UN Women, UNOPS,
WFP, OHCHR, UNHCR, WB, UNESCO)
Several international donors (EU, ADB and the French, Italian, and
Spanish international cooperation agencies).
Renewed interest in investing in the health sector.

CBRN Risks
Within the security mission of the International Cooperation Office
of Tunisian Customs
• National Focal Point of Center of Excellence for Chemical,
Biological, Radiological and Nuclear risks management : UNICRI /
UE
IPT, ONMNE, Universities, Ministries

UNICRI / CoE CBRN risks management projects
National Focal Point : the International Cooperation
Office of Tunisian Customs
National Team: 1 member from each ministry
Project
23
Project
3
Project
26
Project
35
…….

National Experts Team : 6 NEs
 Colonel Professor Mohamed Ben Moussa : Military Hospital of Tunis (Ministry of Defense)
 Dr Anissa Chouikha : IPT (MoH)
 Mr Khaled Trabelsi : IPT (MoH))
 Mrs Hazar Belli : Department of Biodiversity and Genetic Ressources (Ministry of
Environnement)
 Mr Taha Chebbi: Legal Studies Centre (Ministry of Justice)
• Mr Chedy Bahleli : Directorate of Major Risks of Planning in the Office of the National
Civil Protection (Ministry of Interior)

German Partnership for Excellence in
Biologic and Health Safety

German Partnershipfor Excellence in
Biological and Health Safety
• The program lasts 3 years (2013-2016) and is part of the German
commitment to the global partnership of the G8.
• The program is guided by the available biological safety of the sub-
working group of the G8 on Biosafety (start).
• The program is funded and run by German Federal Foreign Office of
business.
République Tunisienne
Ministère de la Santé

1000 2000 3000 4000 Km0
Soudan
TanzanieNigeria
Brésil
Tadjikistan
Ouzbékistan
Kazakhstan
Maroc Tunisie
Géorgie
Égypte
Pakistan
Kosovo
Sierra Leone
Cameroun
RD Congo
Mali
Guinée
Turkménistan
Kirghizistan
• 19 projects
• 22 countries
• budget: 23 millions €
• 2013 - 2016
At the international level
Côte d'Ivoire

Objectives
• Reduce the biological risk and enhance national safety
in health
• promote international scientific exchanges of qualified
scientific personnel
• contribute to the fight against dangerous diseases
• support a safe conduct against pathogens and toxins

Toolbox : 6 Key topics

Partnership
implemented by RKI
and GIZ
 Technical advice
 Trainings &
workshops
 Know-how
transfer
 Staff exchange
Since November
2013: GIZ, RKI,
MFA, MoH
• Meetings and
workshops in Tunis
• Visit study tour in
Germany
Assessment
• Identification of needs
• creation of a priorized list
Key areas of
cooperation
• Biosafety & Biosecurity
• Detection &
Diagnostics
• Surveillance

Kick off meeting: 17 february 2015

Tunisian Key Parteners
• Minister of Health
• Institut Pasteur de Tunis (IPT)
• Basic Health Care Directorate (DSSB)
• National Observatory of New and Emerging Diseases (ONMNE)

Institut Pasteur de Tunis
In 1958, a law defined Pasteur Institute of Tunis as "an institution for Scientific Research
according to the Pasteur methods." and Its role is "to conduct all investigations, missions
(diagnosis, research, vaccine and sera production), analysis or scientific research interest
is human or animal health, or economic development in Tunisia."
In January 1995, the IPT began a Public Establishment of Health
CommitteesfortheimplementationofastrategyofExcellenceandScientificResponsibility
• TheCommitteeofBiomedicalEthicsestablishedin1992
• The Committee on Health and Safety at Work: ensures compliance with health and safety
regulationsforwork
• December 1998 : The Quality Assurance department for the establishment of a quality
system for the development, production and control of vaccines and serums: In January
2015,creatingaQualityCommittee
• BiologicalResourcesCommitteecreatedin2014

NationalObservatoryof New and
Emerging Diseases: ONMNE
Missions:
Concerning new and emerging diseases
- Collect and analyze data to improve decision in the field of prevention,
- Establish specific information systems to enhance early detection capacity, rapid
reporting and investigation
- Monitor the international epidemiological situation to avoid or reduce the risk of their
cross-border introduction,
- Study and edit a scientific periodical on obtained results.
- Organize training sessions for health teams to improve their skills in the field
of Epidemiology and Prevention

http://www.santetunisie.rns.tn/
2058 Basic health centers
throughout the country provide health services to preventive and curative as
well as health education.
 Treatment of common diseases
 Maternal and infantile, including family planning;
 Prevention and control of communicable and contagious diseases,
including vaccination;
 Preschool medical benefits, schools and universities;
 Dissemination hygiene rules and rules on environmental protection;
 The collection and use of sanitary and epidemiological statistics.
Directorate of basic health care : DSSB

Key areas of cooperation
• Surveillance
• Formation et infrastructure permettant la collecte, la diffusion et
l’échange de données
• Training and infrastructure for the collection, dissemination and
exchange of data biosafety and biosecurity Working
• Detection et diagnostic
• Training, proper equipment and continuous monitoring of quality
• Biosafety and Biosecurity
• Adequate and sufficiently safe conditions
• Appropriate training,
• Responsible behavior and
• Adequate equipment

Activities in Tunisia

• How, when and where to report new cases of illness?
• What steps are necessary for the investigation of an outbreak?
How is an investigation team?
• What information to communicate to the public and when not
to generate panic?
• How can we protect the population, namely, to delegate and
prioritize multiple tasks under time pressure?

Be prepared in case of an outbreak :
Preparedness plan : P2R2
• The risk of epidemics for emerging diseases, but also for other endemic diseases can
be reduced by intervention epidemiology and this mostly by the rapid identification
of cases and an adequate response. For this reason the DSSB has developed a
technical guide to epidemiological investigations.
• In Tunisia, preparedness and response plans already exist health for certain diseases.
• Plan de Préparation pour la Riposte en temps de Risque Sanitaire (P2R2) is the
preparedness and response plan that can be adapted to answer to specific diseases.
• P2R2 refers to the existing specific guides
• P2R2 : response and resilience of epidemic-prone diseases in Tunisia, the
implementation of a national epidemiological teleconference system based
surveillance events.
Early Warning and Response system in Tunisia by integration of Event-Based
Surveillance to the traditional surveillance system, Emergency and General
practitioners networks, environmental data integration and mathematical modeling
using time series analysis.

Media training on risk and crisis communication
In the event of an outbreak of disease, public communication by health authorities plays a
key role in preventing panic among the population.
• Media training courses on risk and crisis communication for senior staff in Tunisian health
institutions.
• Press officers and selected representatives from health authorities learned :
communication during an outbreak of disease by simulated press conferences and
interviews and pandemic simulation exercises.

SimEx April 2016
 The evaluation of the simulation exercise SimEx has clearly demonstrated a
large existing knowledge.
 The treatment procedures to investigate the epidemiological outbreak or for
the risk assessment should be strengthened through appropriate training at
regional level.

0
20
40
60
80
100
120
Number Of
Workshops
Participants
Regional
Directorate Of
Health/
Departments
Experts
Protocol
Development
"Media
Training"
12 120 24 2
2P2R 9 30 6 1
Development
of National
Strategy of
Risk
Communicati
on in crisis
2 20
Communication
Experts
1
Media
Training VIP
1 20
EpiTec 2 24 1
EBS 1 24 8

Biosafety, Biosecurity, Detection and Diagnosis
Partner : IPT
Improved capacity in Biosafety and diagnosis of highly pathogenic
viruses
• Laboratory of Virology / EBOLA
• Rabies Laboratory / Rabies
• Study Visit in RKI
Joint Training
• Training in B & B and BM
• All IPT Staff
• doctoral students and interns
• Responsible research / dual use of concern / code of conduct
Institut Pasteur de Tunis, 28-29 juin 2016

IPT and biological risk management
WHO: The training of trainers in biological risk management and
biosecurity of laboratories. 2 experts
UNICRI, EU Centre of Excellence CBRN: project 3: the
development of knowledge and the transfer of best practices for
the biological risk management, biosafety and biosecurity : 2
experts
IPT & RKI Partnership Symposium Gammarth, 22-
23 September, 2016

RKI / IPT joint WORKSHOPS on B&B
• 2 workshops in october 2015: administratives staff, scientific and medical
doctors, head of laboratories, researchers, technicians
• 2 workshops in june 2016: researchers and lab technicians
• Training for IPT students (master and PhD) and trainees : November 2015 et May
2016
• Workshop for PhD students from the UTM Doctoral School september 2016,
Almost 100 participants…

Questions:
• Are there any risks associated with such
ability to generate genetic data on people?
• How to manage access to data?
• Our current regulations are they sufficient?
• What changes do they bring to the practice
of health professionals, industry or
research involved?
• What about discoveries called "incident
findings"?
• In the context, under which conditions
these data can they be used for research
of new knowledge on the understanding of
genomes?

Capacity building on B&B
Code of
conduct
Laws
Ethical
Committees
• The threat of biological
warfare and
bioterrorism.
• the dilemma of the dual
responsibilities of
researchers
• Implementation locally
of the Convention
against biological
weapons and terrorism

2014…
The Rome Declaration is now calling the European institutions, the Member States,
research and funding, as well as the private sector organizations and civil society to make
the Research and Innovation Responsability (R.I.R) a common goal and to find sustainable
and inclusive solutions to societal challenges which confront us collectively.

Side Event: Germanyand Tunisia - Biosecurity-
Biorisks – Bioethics
• Meeting of States Parties to the Biological Weapons
Convention; Palais des Nations, Geneva, December , 1-5 , 2014

 2 workshop in April 2015, then in June 2015
 Developed with the RKI experts, the IPT Committee of Biomedical Ethics
members and IPT B&B experts,
 finalized in July 2015.
IPT Code of conduct

S W
TO
• program achievements
skills
• Networks
• upgrading knowledge
• improved absorptions
events
Strengths
• multiplication
collaborations:
duplicates
• lack of intersectoral
communication
• no staff dedicated to the
project
• no internal budget
Weaknesses
• Continuity
• Extention to other
sensitive sectors
• Harmonization of existing
initiatives
Opportunities
• No budget for
implementation...
• political stability
ThreatsSWOT
Analysis

From IPT
• Hechmi Louzir
• Sana Masmoudi
• Anissa Chouikha
• Khaled Trabelsi
• CEBM members
• Abdeljelil Ghram
• Samir Boubaker
• Hichem Ben Hassine
• Souad Hajjam
• Ali Bouattour
• Naceur El Ouni
• ….
• Nissaf Ben Alaya and Colleagues from ONMNE
• Souad Bekri and Colleagues from DSSB
From RKI
• Walter Biederbick
• Nicole Hanschmann
• Luam Ghebreghiorghis
• Olena Kysil
• Iris Andernach
• Nadine Zeitlmann
• Stefan Klolth
• Christine Uhlenhaut
• Kristina Schmidt
• Barbara Burkin
• Matthias Nachtnebel
From GIZ
• Joachim von Bonin
• Annira Busch
• LillianHollenweger
• Nora Ben Ammeur
• Dilan Kücükali
• Zina Ben Jelloun

THANK YOU FOR YOUR ATTENTION

IPT & RKI Partnership Symposium: Current Challenges of Biological Risks and Health Security”

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