Infectious Disease Movement in a Borderless World Workshop Summary (2010) / Chapter Skim
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5 Global Disease Surveillance and Response
5 Global Disease Surveillance and Response
Pages 231-262
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and the likely far greater consequences of pandemic influenza, "business, trade, and tourism stakeholders, and those who support them, such as the insurance industry, have a strong vested interest in working with public health authorities to promote global health security." However, he observes, many representatives of trade and tourism are unfamiliar with the concept of global health security and the IHR 2005, and they may not realize how their participation in efforts to advance a global health agenda can serve their specific business interests. Bell suggests that the private sector could be effectively (and profitably)
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A representative of another of the "three sisters," workshop speaker Alejandro Thiermann of the OIE discusses global surveillance and health security from the perspective of animal health in this chapter's third essay. Focusing on the obligation of OIE member nations to report cases of known zoonotic disease threats, as well as of any "emerging disease with significant morbidity or mortality, or zoonotic potential," Thiermann compares and contrasts the OIE's disease surveillance program with its human-health counterpart, the IHR 2005.
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In the final essay of this chapter, workshop speaker David Nabarro of the UN reflects on his experience as that organization's coordinator for avian and human influenza and for global food security. While attempting to respond to the increasingly worrisome prospect of an avian influenza pandemic in humans, Nabarro and colleagues collaborated with stakeholders from the public, private, and volunteer sectors and found that most recognized the value of working together on disease surveillance, reporting, and response.
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According to the Unites States Con gressional Research Service, trade disruptions during a pandemic could include countries banning goods from infected regions, travel bans due to protective health measures, or supply-side constraints caused by health crises in exporting countries. For these reasons, business, trade, and tourism stakeholders, and those who support them, such as the insurance industry, have a strong vested interest in working with public-health authorities to promote global health security.
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On the bright side, national economic interests, such as protecting tourism, can promote government actions consistent with global health security. In late 2006, the Indonesian government suspended sharing influenza virus samples with WHO due to intellectual-property issues regarding vaccine development, thus compromising the global surveillance of influenza.
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These companies may not realize the benefits of early detection and contain ment to their own risk-management strategy, or the daunting challenges faced by public-health authorities in implementing early measures. That is, stakeholders may have an implicit understanding of the importance of health security for trade security, but not as a goal they should pursue.
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It is unrealistic to expect developing countries to bear the economic consequences of disease-control measures unassisted. The experience gained in compensating poultry farmers for culling to contain avian influenza outbreaks illustrates that such programs can be helpful when appro priately designed and implemented and that international financial and technical assistance may be required.
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Conversely, technical and scientific partnerships are required to effectively address emerging infectious diseases. Many such part nerships focus on the prevention of foodborne and zoonotic diseases as an important means to protect public health, as well as to promote the production of food of animal origin and facilitate international trade in animals and animal products.
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FAO, OIE, and WHO WHO pursues collaborations to address emerging infectious diseases with many different organizations and partners, and at multiple levels, but for those infectious agents originating from animals and animal products its primary rela tionships are with the OIE and FAO. The ambitious, overarching definition employed by the WHO -- that "health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity" -- subsumes the goals of the FAO (food security and poverty alleviation)
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Collaborative Approaches Addressing Zoonoses, Food Safety, and Veterinary Public Health GLEWS A formalized initiative of the WHO, FAO, and OIE, GLEWS is a public and animal health early warning system intended to reduce incidence of emerging infectious diseases. Partners in GLEWS, which incorporates both agriculture and public health sectors, share information on disease outbreaks in real time and coordinate their responses, as shown in Figure 5-1.
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This also means that emergency information related to foodborne diseases and contamination in some cases do not only reach countries through this FAO/WHO mechanism focusing of food safety authorities
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. The GFN promotes integrated, laboratory, and epidemiologically based foodborne disease surveillance, which is expanding to incorporate zoonotic diseases.
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This meeting suggested that the international community looks beyond avian flu to the next important global health risk related to the human-animal interface. In October 2008, a plan aiming at diminishing the threat and minimiz ing the global impact of epidemics and pandemics due to highly infectious and pathogenic emerging infectious diseases for humans and animals was presented at a follow-up International Ministerial Conference on Avian and Pandemic 7 For more information http://www.panaftosa.org.br/ (accessed May 29, 2009)
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The following six specific objectives and related activities have been determined in the document: 1. Develop international, regional, and national capacity in infectious disease surveillance, making use of international standards, tools, and monitoring processes.
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The main focus should always be the prevention of human disease but these efforts can be advanced through existing animal and human disease surveillance networks that need to be strengthened and enabled to communicate across sectors, and by defining research priorities addressing the needs of the most vulnerable regions of the world. National and regional capacity-building is key to infectious disease prevention and mitigation.
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9The need to fight animal diseases at the global level led to the creation of the Office International des Epizooties (OIE)
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(OIE, 2006) The scope of Article 5 was later enlarged by covering a broader list of animal diseases, including zoonoses, and by addressing emerging diseases (even if they are not OIE-listed diseases)
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• Old world screwworm (Chrysomya bezziana) • Paratuberculosis • Q fever • Rabies • Rift Valley fever • Rinderpest • Surra (Trypanosoma evansi)
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• Infection with Perkinsus olseni • Duck virus hepatitis • Infection with Xenohaliotis californiensis • Fowl cholera • Fowl typhoid • Highly pathogenic avian influenza and low pathogenic avian influenza in poultry as per Chapter 10.4. of the Terrestrial Animal Health Code • Infectious bursal disease (Gumboro disease)
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The recent epidemiologic event of the first reported evidence of an infec tion in pigs with this novel strain constituted a case for emergency notification. Canada, demonstrating an efficient surveillance system and transparent reporting, immediately notified the OIE and thereby the international community became aware.
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OR • Does the disease exhibit significant morbidity at the level of a countr y or zone? YES NO YES EXCLUDE INCLUDE EXCLUDE INCLUDE FIGURE 5-3 OIE's disease notification criteria.
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monthly, and every six months; it is also presented by entire countries by month and for the six-month period. Finally, there is an annual report that summarizes country submissions not only on the listed diseases, but also provides relevant information on non-OIE-listed diseases; information on the veterinary infrastructure of the country; reports from the vari ous reference laboratories; any relevant information to animal census conducted; the summary of human cases of zoonotic diseases; as well as any information on the production of vaccines.
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While the IHR 2005 of the WHO has recently received much visibility, the animal disease information system of the OIE has been long established and experienced but, nevertheless, is not that well known. Despite its long history and impressive collection and presentation of information, the benefits of the WAHIS have been known primarily by veterinary services and those engaged in international trade of animals and animal products.
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As experienced during the avian influenza H5N1 crisis, it 12 See http://www.oie.int/eng/Edito/en_edito_mars07.htm.
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This service is currently being considered to assist developing countries affected by other significant animal diseases. In conclusion, the recent avian influenza crisis, as well as other emerging and reemerging disease outbreaks, has shown that disease notification can not be dealt with in isolation: obligations must be accompanied by incentives and benefits.
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However, to be prepared for future challenges, whether coming from avian influenza or a new emerging disease, the international community as well as leadership at the national level will have to improve and broaden their spirit of interdependence and collaboration. INCENTIVES AND DISINCENTIVES TO TIMELY DISEASE REPORTING AND RESPONSE: LESSONS FROM THE INFLUENZA CAMPAIGN13 David Nabarro, M.D., C.B.E, F.R.C.P. United Nations International Health Regulations 2005 as the Framework for Action During the past few years, we have witnessed the agreement and application of the revised International Health Regulations (IHR 2005)
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Agreement on the Science In 2005, there was broad agreement on the scientific basis of work being undertaken on avian and pandemic influenza: outstanding research questions were also clear. These include a better understanding of risks associated with the movement of highly pathogenic avian influenza among poultry (particularly in ducks)
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Stakeholders from the public, private, and voluntary sectors have valued the opportunity for coherence, joint working, and participa tion. They have worked together on disease surveillance, reporting, and response.
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WHO provides data to ministries of health and their institutions; and the World Tourism Organization, the International Civil Aviation Organization, the International Monetary Fund, and the International Organization for Migration have provided similar services. This interaction enabled people with a stake in pandemic preparations to feel that they are informed and are part of the global effort.
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The third challenge is to maintain trust. Committed professionals from countries in Southeast Asia worked with the Rockefeller Foundation to build the Mekong Basin Disease Surveillance Program over many years.
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2008. Contributing to One World, One Health: a strategic framework for reducing risks of infectious diseases at the animal–human–ecosystems interface, http://www.oie.int/downld/AVIAN%20INFLUENZA/ OWOH/OWOH_14Oct08.pdf (accessed May 29, 2009)
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2008. Contributing to One World, One Health: a strategic framework for reducing risks of infectious diseases at the animal–human–ecosystems interface.
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