Dr. Julie Lyn Hall, WHO Country Representative for the Philippines, discusses the strategies of the WPRO in handling and preventing EIDs like Ebola and MERS-CoV in our region

1. Preventing and Mitigating Emerging
Infectious Disease Threats
Dr Julie Hall, MBE
WHO Representative to the Philippines

2. Presentation
• Outline the Asia Pacific Strategy for Emerging
Diseases (APSED)
• Some of the basics of emerging infectious
diseases planning
• Discuss some of the strengths and weaknesses
unique to the Region in responding to such
threats
2

3. Part 1
• Outline the Asia Pacific Strategy for Emerging
Diseases (APSED)
3

4. •A-Zoonotic/wild
•B-Zoonotic/domestic
•D-Vector-borne•C-Drug resistant
Asia Pacific region is a Hotspot of EIDs

6. Examples of outbreaks in WPR
6
2003: SARS, H5N1 in China and Viet Nam
2004-2006: Streptococcus suis in China, H5N1 in Asia
2008: EV-71 in China
2009: Pandemic influenza A(H1N1), Leptospirosis in the Philippines,
Cholera in PNG
2010: Cholera in Cambodia and PNG, Anthrax in Mongolia
2011: HFMD in Viet Nam, wild-type poliovirus in China, pertussis in PNG
2012: EV-71 in Cambodia, Cholera in the Philippines
2013- H7N9 in China, Dengue in Lao PDR, H5N1 in Cambodia (26 cases)
2014- MERS-CoV in Malaysia, H7N9 in China and Malaysia, Heniph in
Philippines, Measles in Viet Nam and PNG, Dengue in Malaysia
2007: H5N1 in Lao PDR and ongoing in other countries
•2015- MERS-CoV in the Philippines

7. About IHR (2005)
• A global legal framework for protecting
global public health security
• Shared risk management for a shared
vulnerability, calling for:
– national surveillance and response
systems (IHR core capacities)
– regional and international alert and
response systems
• Entered into force since June 2007
– 7 years of implementation

8. Working at global, regional and national level:
Coordinated WHO’s response to H7N9 event
8

9. Information sharing through the IHR
mechanism - outbreak
Event detected by the
surveillance system
National IHR
Focal Point
•Two of the following:
Seriousness
Unexpected
Potential to spread internationally
Possible restrictions to international travel or
trade
WHO Regional IHR
Contact Point
WHO
Headquarters
 Event notified and information for Event
Information Site (EIS) shared
 EIS posting sent
EIS Post
•Disease Outbreak News
•http://www.who.int/csr/don

10. APSED serves as a Regional Tool
• The Asia Pacific Strategy for Emerging
Diseases (APSED)
– A bi-regional tool to help two WHO
Regions (SEAR and WPR) meet IHR
core capacity requirements
– A common framework highlighting a
shared vision and a set of agreed
priorities
• Developed in 2005 and updated in
2010 (endorsed by RCM)

11. APSED (2010): Goal and Objectives
To build sustainable national and regional capacities and
partnerships to ensure public health security through
preparedness planning, prevention, early detection and rapid
response to emerging diseases and other public health
emergencies
1. Reduce the risk of emerging diseases
2. Strengthen early detection
3. Strengthen rapid response
4. Strengthen effective preparedness
5. Build technical partnership

12. Features of APSED
APSED facilitates effective preparedness and
capacity development:
• A common framework to develop generic capacities
for preparedness, alert and response – integrating
EID/IHR/Pandemic Preparedness and other EIDs into
one single framework
• Step-wise approach to capacity development
• Connects stakeholders at national and regional level
for collective management of health security threats
• Emphasises value of learning from real world events

13. APSED M&E System
Planning Implementation
Review

14. APSED story-line: building momentum
Expanded to
non-EID events
(food safety,
chemical,
radiological..)
Expanded to
EID events
(Anthrax, cholera,
dengue…)
Focus on
H5N1
Example of event-based surveillance
(EBS) and rapid response team (RRT)
development
2005 2010

15. Implementing APSED
to meet IHR core capacity requirements…

17. APSED as effective mechanism
The achievements of APSED are evidenced by the
following:
•IHR core capacity achievement
– Annual States Parties Questionnaires
•Good response to several outbreaks and real world
public health events
– A(H7N9) virus
– Dengue virus
– MERS coronavirus

18. Part 2
• Some of the basics of emerging infectious
diseases planning
18

19. CROSS-SECTORAL SECURITY COOPERATION ON BIO-PREPAREDNESS AND DISASTER RESPONSE WORKSHOP
26-28 August 2014. Manila, Philippines.
SARS and the economy

20. Response to Outbreaks & Emergencies
• WHO Emergency Response
Framework (ERF):
– Bohol Earthquake, 2013 (Grade 1)
– H7N9 in China, 2013 (Grade 2)
– Zamboanga Siege 2013 (Grade 1)
– Typhoon Haiyan 2013 (Grade 3)
– Mindanao 2015 (Grade 2)
• GOARN
• Emergency Operations Centres
(EOC)

21. Global Outbreak Alert and Response Network
(GOARN)
Functions
• Alert
• Respond
• Preparedness
21

22. Emergency Operation Centres
EOC = facilities + functions
•EOC room
renovated:
Cambodia, Lao
PDR, Mongolia,
Viet Nam
•EOC room
renovated:
Cambodia, Lao
PDR, Mongolia,
Viet Nam
•Equipment
installation in
process: Lao PDR
and Mongolia
•Equipment
installation in
process: Lao PDR
and Mongolia
•EOC SOP
developed:
Cambodia,
Lao PDR
•EOC SOP
developed:
Cambodia,
Lao PDR
EOC activated:
• Dengue in Lao
PDR
• Measles in
Viet Nam
EOC activated:
• Dengue in Lao
PDR
• Measles in
Viet Nam

23. Regional surveillance and risk
assessment
Regional Alert and Response System

24. WPRO: Regional event-based surveillance
Reported Events
2008–2009† 2009–2010 2010–2011 2011–2012 2012–2013 2013–2014
n = 206 n = 218 n = 357 n = 297 n = 222 n = 295
Infectious
Diseases*
142 174 206 114 71 61
Animal H5N1** 35 26 136 86 305 222
Disasters and
others***
16 9 7 92 50 12
Chemical 13 9 8 2 1 0
Information source of initial reports
Unofficial 147 162 203 100 62 41
Official 59 56 154 194 160 254

25. • WPRO Field
Epidemiology
Training Programme
(FETP) Provides on-
job-training on
surveillance and risk
assessment
– A total of 50 fellows
from 13 Member
States since 2010
WPRO FETP
fellowship program
Investment Partnership: FETP/FET+

26. Part 3
• Discuss some of the strengths and weaknesses
unique to the Region in responding to such
threats
26

27. Asia Pacific Strategy for Emerging Diseases
APSED has proven to be an effective tool to
implement the International Health
Regulations (IHR)

28. What we learned from APSED
implementation?
• Western Pacific Region is a
hot spot of Emerging
Infectious Diseases (EID)
• WPR is experienced, but not
fully equipped against
health security threats
• Partnerships are key to
make difference

29. Challenges lie ahead…

30. APSED Partnerships

31. Investment in regional health security
during a peaceful time

33. Thank you