Exploring Lessons Learned from a Century of Outbreaks Readiness for 2030: Proceedings of a Workshop (2019) / Chapter Skim
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Appendix A: Commissioned Paper
Appendix A: Commissioned Paper
Pages 149-182
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Chan School of Public Health Liana Rosenkrantz Woskie, M.Sc. Harvard Global Health Institute 149
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150 LESSONS LEARNED FROM A CENTURY OF OUTBREAKS ACRONYMS AND ABBREVIATIONS DG Director-General DON disease outbreak news DORS disease outbreak response system ED executive director EIS epidemic intelligence service EOC emergency operations centers ERF emergency response framework FAO Food and Agriculture Organization of the United Nations GHSA Global Health Security Agenda GOARN Global Outbreak Alert and Response Network HSS health systems strengthening IHR International Health Regulations ILAR Institute for Laboratory Animal Research IMF International Monetary Fund MERS-CoV Middle East respiratory syndrome coronavirus MOH Ministry of Health OIE World Organisation for Animal Health PHEIC public health emergency of international concern R&D research and development SARS severe acute respiratory syndrome SDG Sustainable Development Goal UHC universal health coverage UN United Nations UNGA United Nations General Assembly UNSG United Nations Secretary-General WHA World Health Assembly WHO World Health Organization WTO World Trade Organization
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the 2012–2015 Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia and in Korea.
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The IHR are the current framework for country preparedness for infectious disease outbreaks and require 196 State Parties to develop and maintain core health system capacities in the face of acute public health risks such as infectious disease threats of international concern. Core capacities in this framework are organized into three categories related to prevention, detection, and response, which include subdomains (e.g., health workforce, laboratories, data systems, and risk communication)
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Strong health systems are key: "Underresourced, understaffed, and fragmented health services are unable to contain outbreaks of serious infectious diseases or to adequately respond to health emergencies" (Save the Children, 2015)
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4. WHO is mandated to serve as the guardian of the International Health Regulations, and it may require involvement from multiple levels of the organization to accomplish this mandate (e.g., national country offices, regional offices, and headquarters)
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The papers reviewed, consistent with prior work, recognize that for both effectively preventing and mitigating outbreaks timely sharing of information of research and health technology efforts is critical. While this topic was less well explored than national core capacities or global governance, several papers have outlined problems with vaccine readiness, sample sharing, and other issues related to the handling of epidemiological, genomic, or clinical data both during as well as after pandemics.
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for diseases that largely affect the poor is deeply inadequate. Of the $214 billion invested in health R&D globally in 2010, less than 2 percent was allocated to neglected diseases" (UN High-level Panel on the Global Response to Health Crises, 2016)
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"The exchange of epidemiological information on infectious diseases, especially the emergence of new infections, should be strengthened between the health authorities in Mainland China and Hong Kong" (Hung, 2003)
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Prior to this time, many reports were produced by agencies themselves with minimal inward-looking recommendations or critiques of the global health system, however defined.
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4. WHO should establish a Program/Center for Health Emergency Preparedness and Response that is governed by an independent technical governing board.
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3. During health crises, humanitarian actors should have access to guidelines and standard operating procedures.
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and examining the need to tie together global health agendas, such as the IHR and universal health coverage (UHC) , as a primary component of the SDGs.
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2015. Global health security: The wider lessons from the West African Ebola virus disease epidemic.
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2015. Middle East respiratory syndrome coronavirus (MERS CoV)
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Identify the onset of the (R) Give protection and treatment priority to Influenza Pandemics 1968 Academy of pandemic for early health care workers to enable them to in Singapore Medicine intervention (however, perform their duties Singapore influenza remains a difficult surveillance target because it manifests in a variety of non specific symptoms)
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Use WHO, FAO, and OIE (R) Prioritize interventions in the backyard Avian Influenza Communicable jointly established Global rural farming system "wet markets" where Pandemic Threat Disease Early Warning and Response live poultry are sold in overcrowded and Surveillance System for trans-boundary often unsanitary conditions and Response animal diseases (R)
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Pandemic in Academy of was not applicable to H1N1-2009, both systems are critically and Response Plan developed for SARS was Singapore -- Public Medicine MOH and its stakeholders had to reframe important to informing useful in responding to H1N1 Health Control Singapore and relearn the context of public health pandemic situations (e.g., (F) Framework for organizing/coordinating Measures control measures mid-response monitoring the progression of "whole of government" strategy and creation Implemented and (F)
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Strengthen the relevant the Emergence of World Health public health and veterinary services infrastructures, surveillance Influenza A (H7N9) Organization during an emergency by engaging in joint systems, and response Virus in Humans in preparedness planning beforehand capacity in preparation for China: The Central future emergencies caused by Role of Prompt emerging or existing disease Information Sharing threats and Public Communication Avian Influenza A H7N9 2013 WHO (F)
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diagnosis challenging and relevant advice public with factual material, timely updates, NOTES: DORS = disease outbreak response system; FAO = Food and Agriculture Organization of the United Nations; IHR = International Health Regulations; ILAR = Institute for and relevant advice Laboratory Animal Research; MERS-CoV = system; East respiratory syndrome coronavirus; MOH = Ministry Nations; IHR = = World Organisation for Animal Health; Institute for NOTES: DORS = disease outbreak response Middle FAO = Food and Agriculture Organization of the United of Health; OIE International Health Regulations; ILAR = SARS = severe acute respiratory syndrome;=WHO = World Health Organization. Laboratory Animal Research; MERS-CoV Middle East respiratory syndrome coronavirus; MOH = Ministry of Health; OIE = World Organisation for Animal Health; 13 of 16 severe acute had relevant findings for this = World Health Organization.
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Give risk-prone (R) WHO to establish a Avian Influenza Communicable countries an incentive to surveillance program for Pandemic Threat Disease collaborate antiviral susceptibility testing, Surveillance internationally modeled on a similar program and Response for anti-tuberculosis drugs Global (R)
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WHO to coordinate and support the H7N9 response Global Health Ebola 2014 The Lancet (R) Use GHSA to make (R)
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IMF to include (R) Create an investigations among pandemic preparedness in intermediate alert level neighboring countries countries' Economic and before declaring a Policy Assessments PHEIC (R)
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World Bank should (R) IHR Review Committee to from Future Health Publication Committee to develop regional and sub-regional convene funders to develop mechanism to address Crises: UNSG's mechanisms to rapidly networks to strengthen linkages support lower-middle and undue adoption of trade and High Level Panel on address violations of and coordination, and thus to low-income countries to travel bans Global Response to PHEIC temporary enhance mutual support and achieve IHR (2005)
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core capacity compliance NOTES: DON = disease outbreak news; ED = executive director; EIS = epidemic intelligence service; EOC = emergency operations centers; ERF = emergency response framework; GHSA = Global Health Security Agenda; HSS = health systems strengthening; IHR = International Health Regulations; IMF = International Monetary Fund; MOH = Ministry of Health; PHEIC = public health emergency of international concern; SARS = severe acute respiratory syndrome; SDG = Sustainable Development Goal; UHC = universal health coverage; UNGA = United Nations General Assembly; UNSG = United Nations Secretary-General; WHA = World Health Assembly; WHO = World Health Organization; WTO = World Trade Organization. 10 of 16 publications had relevant findings for this category and were included.
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diseases, especially the emergence of new infections, between the health authorities in Mainland China and Hong Kong SARS in Singapore -- SARS 2003 Annals Academy (R) Develop very rapid and highly Key Lessons from an of Medicine sensitive tests for SARS infection, Epidemic Singapore which would substantially reduce the numbers of individuals that need to be quarantined without decreasing the effectiveness of the measure
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Most affected Avian Influenza Communicable pandemic vaccine (shorten the time at the source by establishing compare clinical countries were not Pandemic Threat Disease between emergence of a pandemic an international stockpile of data on human able to adequately Surveillance and virus and the start of commercial antiviral drugs, developing cases in order to compensate farmers Response Global production, and increase the supply of mass delivery mechanisms elucidate modes of for culled poultry. Influenza influenza vaccines)
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Address issues of drug quality, Security: The Wider which pose social, economic, and Lessons from the political challenges to health security West African Ebola by undermining ability to address Virus Disease diseases while eroding public Epidemic confidence in governments and international institutions (R) Prevent market forces from being the only driver of medical research The Neglected Ebola 2014 New England (R)
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Of the $214 billion Level Panel on Global invested in health R&D globally in Response to Health 2010, less than 2 percent was Crises allocated to neglected diseases (R) Dedicating resources to R&D on prioritized pathogens will ensure the greater availability of critical vaccines and treatments when they are most needed NOTES: ILAR = Institute for Laboratory Animal Research; R&D = research and development; SARS = severe acute respiratory syndrome; UNGA = United Nations General Assembly; UNSG = United Nations Secretary-General; WHO = World Health Organization.
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developed a framework for Response: An national health authorities Investment in to highlight areas of public Public Health health emergency response Preparedness that may need specific action for avian influenza (the framework was based on the Asia Pacific Strategy for Emerging Diseases [2010] , which covered the key technical areas [e.g., command and control, surveillance, risk assessment, etc.]
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WHO to revise Call: Lessons Children disease target and global support is how elections are from Ebola for Publication surveillance indicators to increased and better conducted for WHO the World's systems with hold globe aligned to help build officials, specifically: Health Systems strong regional accountable to suitable and improve transparency networks for UHC (key comprehensive health and democratic nature better health services, and increase of elections forecasting and services) and public financing for control for financial health risk protection (R)
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WHO to serve (R) WHO to increase Humanity from Publication clear line of contributions to WHO WHO Centre for as the single global investment in training Future Health command by at least 10 percent Emergency Response with health leader, health professionals at Crises: throughout the with a share a multisectoral advisory determining and national level UNSG's High UN system mandatorily directed board executing global (especially community Level Panel on (e.g., WHO DG to support the (R)
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Reflect WHO's the health workforce: cluster partners' of existing funding information management mandate (working engaging multiple capacities in mechanisms, such as and protocols for in outbreaks and actors from multiple emergency the Central information sharing emergencies) in the sectors and at multiple operations Emergency Response focus of its levels, rather than a (R)
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: assessment of judgment during a What Lessons patients pandemic because such Can We Learn? presenting guidelines are inevitably with febrile based on incomplete illness prior to evidence international air travel NOTES: DG = director-general; ED = executive director; ERF = emergency response framework; GOARN = Global Outbreak Alert and Response Network; IMF = International Monetary Fund; MERs-CoV = Middle East respiratory syndrome coronavirus; SDG = Sustainable Development Goal; UHC = universal health coverage; UN = United Nations; UNGA = United Nations General Assembly; UNSG = United Nations Secretary-General; WHO = World Health Organization.
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