Health security and the IHR: a humanitarian perspective

Size: px

Start display at page:

Download "Health security and the IHR: a humanitarian perspective"

Linda Francis
6 years ago
Views:

2 Health security and the IHR: a humanitarian perspective European Health Forum Gastein 2 October 2015 Forum 8: Securing health - Importance of the implementation of the IHR Philippe Calain, MD, PhD, MSc, DTM&H Philippe.calain@geneva.msf.org

3 International Health Regulations 2005 An historical necessity An innovative framework Binding to State Parties (only!) Two underlying and problematic concepts: - global health security - global health surveillance

4 Report of the Ebola Interim Assessment Panel The Ebola crisis has again highlighted the shortcomings of this instrument and its application by States and the WHO Secretariat as it now stands: (i) Member States have largely failed to implement the core capacities, particularly under surveillance and data collection, which are required under the International Health Regulations (2005); (ii)in violation of the Regulations, nearly a quarter of WHO s Member States instituted travel bans and other additional measures not called for by WHO, [ ] (iii)significant and unjustifiable delays occurred in the declaration of a Public Health Emergency of International Concern (PHEIC) by WHO.

5 Global Public Health Surveillance (S) and Response (R) S1 (event-based) Global PH S2 (case-based) COUNTRY S PH? R R

6 Detection of Ebola outbreaks YEAR PLACE INDEX CASE DIAGNOSTIC TIME 1995 Kikwit, DRC 13 January May days 2014 Meliandou, Guinea 26 Dec March days

7 Data sources for public health surveillance CASE-BASED diseases, syndromes EVENT-BASED rumors, unofficial reports State actors Non-state actors Article 9, IHR (2005) WHO may take into account reports from sources other than notifications or consultations...

8 Securitization of public health Community benefits Health systems

9 Whose security? National security - international security Human security (UNDP 1994) Health and security (WHO Constitution) Global health security (WHA 54.14, IHR 2005, GHSI 2001) International public health security (World Health Report 2007) Biosecurity, biodefense

Global security and global public health surveillance (Nature 2005, 434: 686) If countries should perceive WHO staff or consultants as intelligence agents with a dual responsibility to investigate

10 Global security and global public health surveillance (Nature 2005, 434: 686) If countries should perceive WHO staff or consultants as intelligence agents with a dual responsibility to investigate treaty violations as well as health matters, the result could be unwillingness to report outbreaks at their onset and reluctance to request the help of WHO or permit its entry. These reactions would seriously impede efforts to control the global spread of disease (Woodall 2005).

11 From response to awareness WHO 2005 (IHR) Surveillance means the systematic ongoing collection, collation and analysis of data for public health purposes and the timely dissemination of public health information for assessment and public health response as necessary. Homeland Security Presidential Directive 10 Biodefense for the 21 st Century. April 28, 2004

12 From response to awareness WHO 2005 (IHR) Homeland Security Presidential Directive 10 Biodefense for the 21 st Century. April 28, 2004 The term biosurveillance means the process of active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health whether infectious, toxic, metabolic, or otherwise, and regardless of intentional or natural origin in order to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity;

13 Ebola, West Africa Index case Laboratory confirmation SC 2177 Operation United Assistance UNMEER

14 Securitization of public health Community benefits Health systems

16 Benefit sharing: surveillance of Ebola virus disease Natural reservoir (fruit bats?) Primates Community outbreak Nosocomial transmission Bioterrorism! Laboratory accident Cross-border spread (rare)

17 MSF a confirmé qu'une «foule en colère» a attaqué le Centre de traitement du virus Ebola ACE News, 4 April

18 Securitization of public health Community benefits Health systems

19 Global Public Health Surveillance seen from field practitioners - Redundancy between PH surveillance programs - Ambiguity: planning vs. early warning systems - Administrative burdens vs. lack of feedback - Opportunity costs (time, human resources) - User fees - Outbreak response often delayed or too invasive

20 DEVELOPMENT AGENCIES [ADB] INDUSTRIALISED COUNTRIES [U.S.A., Japan] Collaborating centers Roster of experts Public-private partnerships DEVELOPING COUNTRY Health care providers MINISTRY OF HEALTH National regulations (public health laws) Core surveillance functions Support surveillance capacities Funding WORLD HEALTH ORGANIZATION International Health Regulations Technical assistance Technical standards Funding

21 Conclusion: an issue of credibility 1. Specify the exact meaning and aims of global health security 2. Examine the consequences of the dual use of biosurveillance 3. Consider the disruptive impacts of GPH surveillance initiatives on fragile health systems 4. Consider reciprocity and solidarity as core values for outbreak response (instead of domestic security)

22 Andre Carhilo, Huffington Post 10/8/2014

23 Elements of a controversy (i.) 1. The final wording of the IHR (2005) avoids any mention of deliberate epidemics. (Article 7: Information-sharing during unexpected or unusual public health events ) 2. Debates among Member States over the scope and interpretation of IHR (2005): reservations, understandings and objections 3. Statements by WHO officials and their participation in the BWC new process agenda support the view that global public health surveillance is a dual use investment

24 Elements of a controversy (ii.) 4. WHO is engaged in bilateral technical partnerships underpinned by a clear security agenda [e.g. US Global Pathogen Surveillance Act] under the umbrella of IHR (2005) 5. A WHO - Security Council collaboration on intentional release of infectious agents is defined under the 2004 Report of the UN Secretary General s High Level Panel on Threats, Challenges and Change

JOINT STATEMENT OF ASEAN PLUS THREE HEALTH MINISTERS SPECIAL MEETING ON EBOLA PREPAREDNESS AND RESPONSE Bangkok, Thailand, 15 December 2014

JOINT STATEMENT OF ASEAN PLUS THREE HEALTH MINISTERS SPECIAL MEETING ON EBOLA PREPAREDNESS AND RESPONSE Bangkok, Thailand, 15 December 2014 We, the Health Ministers of Brunei Darussalam, Cambodia, Indonesia,