2. Emergence/re-emergence of infectious diseases and increased pace of spread
Globalization – public health event in one location can be a threat to others
Serious and unusual disease events are increasing and inevitable
Threat of deliberate use of biological and chemical agents
Laboratory and industrial accidents
Impact on health, economy, security
Global Health Security: Why are we concerned?
4. 1830-1847: Efforts begins with cholera epidemics in Europe
1851: First International Sanitary Conference, Paris
1951: First International Sanitary Regulations adopted by WHA
1969: Revised and renamed as International Health Regulations
1995: Resolution WHA 48.7 called for revision of IHR
1995 – 2005: 10 years of negotiations involving public health specialist, legal
experts, diplomats & political dignitaries
2005: IHR - an international agreement that is legally binding on State
Parties/WHO Member States
15 June 2007: Entry into force
Evolution of International Health Regulations
5. Broader Scope - from 3 diseases to all public health threats
- from control of borders to containment at source
- from preset measures to adapted response
Prevent, protect, and provide a public health response to the
international threat and spread of diseases
Avoid unnecessary disruption of international travel & trade
Applicable to health risks - irrespective of origin/ source
Follow evolution of diseases and factors affecting their
emergence and transmission
Scope and Purpose of IHR 2005
6. Global event management
– Global information system
– Coordination of international response
Core capacity requirements
– Prevent: 7 core capacities
– Detect: 4 core capacities
– Respond: 4 core capacities
– Others: 3 core capacities
Inter-sectoral approach
State sovereignty & international spread of diseases
Key Areas of IHR Implementation
9. Joint External Evaluation (JEE)
OBJECTIVES
1. Assess the implementation of
IHR capacities
2. Review all related documents
3. Develop a report describing the
progress and gaps
4. Recommend priority actions to
update and finalize the national
plan to achieve and maintain
IHR capacities
10. JEE History
2014: WHA recommended to move from exclusive self evaluation to
combined self evaluation, peer review and volunteer external evaluation
2015: Concept note discussed in WHO Regional Committee
2015: Revised M&E Framework in the 69th WHA
WHO developed a JEE tool
2015: Pakistan volunteered as first country in EMR and
fourth globally for JEE
2016: JEE conducted
2017-18: National Action Plan on Health Security developed
2018: First meeting of the National IHR Taskforce
11. A: PREVENT
1. National legislation, policy and
financing
2. IHR coordination,
communication and advocacy
3. Antimicrobial resistance
4. Zoonotic diseases
5. Food safety
6. Biosafety and
biosecurity
7. Immunization
IHR Core Capacities (measured through JEE)
B: DETECT
1. National laboratory system
2. Real-time surveillance
3. Reporting
4. Workforce development
12. C: RESPOND
1. Preparedness
2. Emergency response operations
3. Linking public health and
security authorities
4. Medical countermeasure and
personal deployment
5. Risk communication
IHR Core Capacities (measured through JEE)
D: OTHERS
1. Point of entry
2. Chemical events
3. Radiation emergencies
Reports on provinces and
federating areas
13. IHR Index for Pakistan
Based on JEE (19 capacities and 48 indicators): 116/240 = 48.3%
Reported Globally (13 core capacities) = 53%
Target: +80% (2030)
Target 2023: 60%
It is estimated that
41 million more people will be better protected from health
emergencies, in case Pakistan achieves IHR index of 60% by 2023
Global Target 2023: 1 Billion more people protected from health emergencies
14. Core Capacity wise Status
IHR Core
Capacity
Progress/Remarks
National
legislation policy
and financing
- "Pakistan Public Health Surveillance and Response Act 2010" available
- KP enacted public health act
- Federal/national act being finalized by NIH
Coordination
and NFP
Communications
- National Focal Point designated for IHR and GHSA
- Provincial focal points also notified
- A multi-sectoral and multi disciplinary task-force for IHR notified (One
health approach)
- IHR-NFP TORs developed
- NPHI development in progress
15. Core Capacity wise Status
IHR Core
Capacity
Progress/Remarks
Surveillance &
Response
- Disease specific multiple vertical programme engaged in surveillance
- Division of Field Epidemiology Disease Surveillance notified at NIH
- Communicable Disease data compiled at NIH for Alerts & Advisories
- Diseases Surveillance and Response Units established
- Disease prioritization exercise – List of diseases for surveillance
- Technical Working Group notified
- IDSRS framework developed – phase I to be launched
Preparedness - National Health Emergency Preparedness & Response Network (NHEPRN)
- NHEPRN in collaboration with WHO developed “preparedness and
contingency plan for the Communicable Disease”
- NIH to finalize pandemic preparedness plan and its implementation
16. Core Capacity wise Status
IHR Core
Capacity
Progress/Remarks
Risk
Communication
- Current coordination mechanism through "Health Clusters”
- Provincial focal person notified
Human
Resource
Capacity
- Around 125 Field Epidemiologist since 2007
- 90 under training (60 per year from 2016 onwards)
- Frontline launched (Shorter version)
Laboratory - NIH as referral laboratory and Multiple Lab based surveillance initiative
- BSL-3 functional
- National Laboratory Working Group (NLWG) notified
- Laboratory policy developed
- Provincial PH Labs being established
- Capacity building on cross cutting issues (BRM, LQMS, Info systems)
17. Core Capacity wise Status
IHR Core
Capacity
Progress/Remarks
AMR - Focal point notified
- Multi-sectoral/ multi disciplinary committee notified
- National AMR strategic framework and action paln developed
- Setting up sentinel surveillance using GLASS protocol
Biosafety &
biosecurity
- Assessment conducted
- National Biosafety/Biosecurity Policy endorsed
- Multiple trainings on BRM
EOC - Six EOC established (01 Federal, 4 provinces and 01 in FATA)
- Presently used only for polio
Immunization - Federal and provincial programmes in place
- GHSA grant with CDC for strengthening routine immunization
18. Core Capacity wise Status
IHR Core
Capacity
Progress/Remarks
Zoonotic
diseases
- Inclusion of animal and livestock sector professionals on different
forums including AMR, Laboratory system, Biosafety and Biosecurity,
Surveillance
- One health hub at NIH
- MoU with PARC & Global Change Impact study centre
Others - Food safety assessment mission conducted
- POEs assessment
- Trainings and capacity building
19. Key Challenges
Functional multi-sectoral coordination between federal & provincial levels
through a joint IHR Task force;
Implementation of 5 year costed National Action Plan on Health Security
for 19 technical areas against key priorities - Financing
Establishment of surveillance & laboratory systems with a ‘One Health
Approach’ to include human and animal health sector
Development of uniform regulatory standards in all areas of food security
Comprehensive national cross-sectional approach towards Antimicrobial
Resistance (AMR)
20. Role of Security Agencies
Active involvement of security agencies is a must, as health emergencies
have more serious implications (death, disease and disability - 3Ds with
No Borders along with Security & Economic loss) than actual warfare
Deliberate use of biological, chemical and radiological agents should be
prevented, detected and responded at an early stage
Developing IHR capacities both in civil sector and security agencies should
augment each others efforts
Some capacities (radiation and chemical warfare) are largely the domain
of the security agencies (a need for an agreed role of civil sector)
Poor IHR capacities in a country have a serious negative impact on
military defence preparedness
