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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