Global
helseberedskap &
Det internasjonale helsereglementet (IHR)
April 2021
Frode Forland, MD, DPH
Fagdirektør, smittevern, FHI, [email protected]
Innhold
• Den globale situasjonen
• Internasjonalt samarbeid
• Det internasjonale helsereglementet
• Korleis arbeider ein med det?
• Kva er global samfunnsmedisin?
A Health threat anywhere is a Health threat everywhere
Source: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/S0140673612611519
Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable
ource: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/S0140673612611519
Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable
Globale tall, 15.04.2021, Covid-19
• Tilfeller: 137 541 598
• Dødsfall: 2 960 777
• Prosentvis økning fra uke 13 til uke 14: 11 % tilfeller og 7 % dødsfall.
• Størst økning og endring for Sørøst-Asia (63 % økning) og Midtøsten (22 %).
• Årlige dødsfall
• Tuberkulose 1 200 000
• AIDS 800 000
• Malaria 600 000
Surveillance and preparedness:
window of opportunity
Meldte tilfeller til MSIS
Antall innlagte i sykehus m covid-19
Covid-19 assossierte dødfall
• Testaktivitet
• Type tiltak
• Helsetjenester
• Innreiserestriksjoner
• Ressurser
• Klima
• Tillit
• Politikk
• Vaksine
Det epidemiologiske bilde
- hva utgjør de
geografiske forskjellene på smittespredningen?
Tilfeller per 1 million er hentet fra WHO, 15.01.2021.
IHR 2005
• International binding regulations
• Agreed by all WHO members (194)
• Deadline for implementation:
2012
• The role of WHO important
• Core capacities established
• In 2019, 82% of MS reported
• Still many gaps to fill
http://www.who.int/ihr/en/
Purpose of IHR (Art 2)
The purpose and scope of these Regulations are to prevent, protect against, control and provide a public health response to the
international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.
The IHR require
that all countries have the ability to do the following:
• Detect: Make sure surveillance systems can detect acute public health events in timely matter
• Assess and report: assess public health event and report to WHO through their National IHR Focal Point those that may constitute a public health emergency of international concern (PHEIC)
• Respond: Respond to public health risks and emergencies
Internasjonalt samarbeid
• Det internasjonale helseregelverket (IHR)
• Det Europeiske smittevernbyrået (ECDC)
• Nordisk samarbeid
Det internasjonale helseregelverket (IHR)
• Regler for varsling av og vern mot internasjonale helsetrusler, særlig epidemier.
• Reglementet stiller krav om innsamling og deling av informasjon med WHO og andre land.
• Fra 2005 har alle 194 medlemslandene til WHO forpliktet seg til regelverket.
WHO, 2021.
IHR capacities/ Coronakommisjonen
• National legislation, policy and financing - to be able to integrate the IHR requirements in national legislation
• National IHR focal points – to facilitate national and international coordination
• Surveillance system - to be able to detect an incident
• Response capacity - to mitigate consequences of an event
IHR capacities
• Updated and dimensioned preparedness plans and stockpiles
• Risk communication capacity
• Human resources - to be able to handle the event and to care for the sick
• Laboratory capacity - to be able to diagnose and determine features of infectious origin
• Points of entry, on border crossings
• 4 Hazards: radiological, chemical, zoonosis and foodborne events
Article 44 Collaboration and assistance
States Parties SHALL undertake to collaborate with each other, in:
• the detection and assessment and response to..
• the provision or facilitation of technical cooperation and logistical support..
• the mobilization of financial resources to facilitate implementation..
• the formulation of proposed laws and other legal and administrative provisions..
Det Europeiske smittevernbyrået (ECDC)
• Etablert i 2004 for å styrke den Europeiske union sitt forsvar mot smittsomme
sykdommer.
• Bidrar til å koordinerer fag, forskning og råd i Europa.
• Innhenter og distribuerer data fra EU, EØS og Schengen.
• Gir råd til medlemsland basert på forskning, som eksempelvis reiseråd gjennom:
• Insidens på regionalt og nasjonalt nivå
• Test rate
• Andel positive prøver
ECDC, 14.01.21
Nordisk samarbeid
• De Nordiske landene har
samarbeidet gjennom drøfting av tiltak og strategier gjennom hele pandemien.
• Hva har man fått ut av alle møtene og samarbeidet?
‘Global helse er lokal helse’
Global helseberedskap er lokal helseberedskap
• Pandemien er ikke over, før den er over for alle. Den har understreket staters gjensidige avhengighet og vist hvordan resultater av global
vaksine- og helseforskning kan være veien ut av pandemien. Gjennom investeringer og innsats fra norske fagmiljøer kan Norge bidra til viktig kunnskap for å møte internasjonale helseutfordringer.
• Sterke helsesystemer er nødvendige for å håndtere disse
utfordringene. Svake helsesystemer og beredskap påvirker ikke bare bekjempelsen av viruset, men også evnen til å tilby andre nødvendige helsetjenester.
• Alt som starter lokalt kan i vår tid også raskt få globale konsekvenser.
• (fra kronikk innlevert i går)
GLOBVAC 2021
Usikkerhet framover
• Hvor mange blir smittet
• Mutasjoner, mer alvorlig sykdom, mer smittsomt virus
• Tiltak og sosial kontakt, etterlevelse
• Reiseaktivitet, importsmitte
• Vaksine-effekt
• Vaksinesvikt
• Vaksinebivirkninger
• Vaksinemotstand
• Kapasitet i kommuner og helsetjenesten
• Behandlingsmuligheter
• Samfunnskostnader
• Vann, miljø og klima?
• Faktor X
Hva er viktig for å stå bedre rustet mot en framtidig ny epidemi?
• IHR (det internasjonale helseregelverket)
• Planverk og lovverk
• Oppdatert kunnskap
• Beredskap på alle nivå, og i alle sektorer
• Kommune
• Regionalt
• Nasjonalt
• Globalt
• Global solidaritet, COVAX, CEPI, ACT-A
• Flere vaksineplattformer
The relation between level of confidence and time
Illustrasjon: Frode Forland
Article 44
(a) The evaluation and assessment of their public health
capacities in order to facilitate the effective implementation of these Regulations;
(b) The provision or facilitation of technical cooperation and logistical support to States Parties; and
(c) the mobilization of financial resources to support developing countries in building, strengthening and maintaining the capacities provided for in Annex 1”.
The role of WHO in facilitating collaboration and
technical assistance in capacity-building is mandated in Article 44.2 of IHR (2005), which states that “WHO shall collaborate with States Parties, upon request, to the extent possible, in:
Global Strategic Preparedness Network GSPN
Sustainable Health Emergency Preparedness
Multisectoral
Public-private partnerships, civil-military collaboration, foreign policy, health financing, parliamentarian networks, etc.
Technical Capacity Building
Supports medium and long-term preparedness
Mobilization
Sharing of expertise and information to support country priorities and better alignment
Article 44 of IHR (2005)
Supports country to country technical cooperation
01 02
03 04
Rapport fra Lilongwe Malawi, 15.01.2021
• Med høye smittetall, mutasjonen fra Sør-Afrika, samt at Malawi
verken har menneskelige, materielle eller økonomiske ressurser til å teste tilstrekkelig, smittespore eller gi adekvat behandling til syke er det med stor bekymring vi sender inn denne rapporten.
• Smitten blant ledende politikere (to ministre døde) og andre sentrale yrkesgrupper kan på litt sikt påvirke evnen til å handle, spesielt om det vil føre til at det allerede svake helsesystemet vil kollapse.
• Situasjonen er uklar og utfordrende og det er få som tør å spå hvor dette vil ende.
• (Fra ambassaden i Malawi)
Moldova, 15.04.2021
• There are reports about shortages of equipment and health personnel. Presently more than 4300 covid-19 patients are hospitalized, 106 health personnel who have lost their lives,
• There is a rising incidence of cases due to the British virus variants.
• Few people are vaccinated and access to vaccines is difficult.
• RKI:Based on our latest information, the situation is deteriorating with increasing numbers of hospitalized cases and deaths, while basically all response capacities are waning, and population-based vaccination is pending.
Objectives of the Global Health Prepraredness Program (2014)
• The first is to assess, give priority to, and support implementation of specific IHR core capacities in selected partner countries.
• The second, mostly done through collaboration with WHO, is to
contribute at global level to enhance capacity and approaches to IHR implementation
• The third is to strengthen institutional capacity in the Public Health Institutes in partner countries.
Time Service level
Norway
African LMIC IHR
Preparedness and response level after major event
Event
The role of IHR?
IHR Implementation
Better Health Preparedness
Improved Health Nationally
Improved Health Globally
Global health preparedness is building national health preparedness
‘Infections do not differentiate between poor and rich. In order to stop the spread of infections, it is important to detect and report cases of the disease as soon as possible. This applies whether an outbreak occurs in rural Africa or in cities in Europe.
Professional cooperation and a common system to be able to prevent disease outbreaks and prevent the spread of infections, is a good
strategy for international cooperation. Supporting poor countries in building solid health preparedness is good help for self-help.’
Global health preparedness
Concept note, application for funding
No single country can build global health security on its own. Increased globalization intensifies the need for strengthening health preparedness in low- and middle income countries so that the global community are capable of addressing public health threats and incidents. Implementation of the International Health Regulations (2005) provides a framework for ensuring that all countries have the capacity to detect, assess, report, monitor and respond to events of public health significance in a timely manner. In this application the Norwegian Institute of Public Health propose to establish collaboration with the WHO and sister institutes in a limited number of low- and middle income countries to strengthen and develop global preparedness and health surveillance, built on its role as national focal point for the health regulations and through utilizing its expertise and capacity in the field of health and disease monitoring. This proposal can be seen as a stand-alone application or be linked to the Health Security Agenda launched by the US administration.
Global Health Security Agenda
US Secretary of Health, Kathleen Sebelius
• ‘Infectious diseases constitute a growing international threat to humanity and the global economy.
• No single country can achieve global health security – a world safe
and secure from the global threat posed by infectious diseases – on its own.
• Ensuring that all nations have in place the capacities required to
implement the International Health Regulations (IHR 2005) is central to this vision’
GSHA work-packages
• Prevent
• AMR
• Zoonotic diseases
• Biosafety and Biosecurity
• Immunization
GHSA work packages
• Detect
• National Laboratory Systems
• Real-time Surveillance
• Reporting
• Workforce Development
GHSA work packages
• Respond
• Emergency Operations Centers
• Linking Public Health with Law and Multisectoral Response
• Medical countermeasures and personnel deployment
• Overall strategies
• US, Norway,
https://www.youtube.com/watch?v=bQTrSIu6I-M
MOH, Bent Høie
• “Bacteria and viruses know no boundaries, and may within hours spread around the world with humans and food travelling.
• We need a ‘One Health Approach’ to secure global health and a healthy globe for present and future generations.
• Norway is committed to support Low and Middle Income countries in this endeavor
• The Ebola outbreak in West-Africa is a strong reminder of the importance of investing in health systems before the emergency occurs.
• The only way to secure Global Health Security is to make basic health services available, affordable and accessible for all.”
Høie: ‘Support to public health institutes’
• Norway's focus area will be to support the establishment of
institutions in line with the Norwegian Institute of Public Health in several countries.
• Today, we have committed to spending NOK 60 million on this global health security program.
• The money will primarily be used to strengthen public health
institutes that can strengthen preparedness, conduct infection control and disease surveillance.
Global helseberedskap
Reiserapport Malawi
• Project: Global health preparedness and support to national public health institutes MALAWI, 11 –24 October 2014
• Meetings were held in Lilongwe, Malawi to discuss project plan with stakeholders, understand the political and donor view of the establishment of PHIM and its role within the Malawian health system, to discuss health surveillance and response issues in Malawi, for example which areas are important to each stakeholder, which areas to prioritize and what the Malawian challenges are with regard to public health preparedness, and to start discussions on more specific scientific issues.
•
• During the first week we had meetings with:
• Norwegian Embassy
• WHO
• CDC
• Secretary for Health
• Dept of Planning and Development, MoH
• JSI/USAID DELIVER Project
• University of Malawi
• REACH Trust
• PHIM
• Drug Fight Malawi
• Malawi Alcohol Policy Alliance
• Police Headquarters, Traffic unit
• SSB
FHI -
The global village
• Ebola
• Zika
• MERS
• SARS
• Swineflu
• Birdflu
• vCJD (mad cow disease)
• Multiresistent tuberculosis
• Chikungunya
• Nipah
• Covid-19
• Next?
Joint External Evaluation Tool
• The Joint External Evaluation Tool - International Health Regulations (2005) is intended to assess country capacity to prevent, detect, and rapidly respond to public health threats
• The purpose of the external evaluation process is to measure country specific status and progress in achieving the targets.
• The first time the external evaluation is conducted, it will establish a baseline measurement of the country’s capacity and capabilities.
FHI - 22.04.2021
FHI - 22.04.2021
A Health threat anywhere is a Health threat everywhere
Source: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/S0140673612611519 ource: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/S0140673612611519
