Strengthening generic emergency preparedness & “mass gathering health”

1. 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

2. 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

3. Developing tools and sharing guidance

4. 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

5. Rolling out assessments • Developing and pilot testing the WHO Europe toolkit for “Assessing Health system crisis management capacities” (since 2008) • Three pilot missions: • Armenia • Azerbaijan • Rep of Moldova • Comprehensive assessment missions • Croatia • Greece • Italy (Lampedusa) • Kazakhstan • Kyrgyzstan • Malta • Poland • Turkey • Ukraine • Self assessment approach • England • Israel

6. 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

7. 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)

8. 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

9. Legacy: Public health promotion (joint leaflet) UEFA EURO 2012 - a smoke-free zone

10. The way forward • Interoperable “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

11. 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

12. New requirements for international mass gatherings • Faster reaction times and lower thresholds for action • Extremely clear structures for command and control • Integrated procedures across sectors • International information exchange and coordination

13. Seoul 2002 FWC Someone arrived with measles

14. Legacy for the event Work with Int'l Organizing committees Health Promotion Health promotion, 3 Fives, Five Keys Development of the public health infrastructure during an event Health Security Enhanced inter/national surveillance for the event Food safety training Improving host surge capacity for the event Opportunity for IHR Single Event "Acute" Legacy for the host WHO's Conceptual model Health promotion, 3 Fives, Five Keys

15. WHO Support to public health preparedness and response at mass gatherings 2010 Shanghai World Expo 73 milllion visitors in 6 months 2009 Athletics World Championship Berlin Happened just after Phase 6 – H1N1 2010 Winter Olympics Vancouver Enhanced surveillance and observers programme 2008 European Cup Switzerland and Austria 2008 Beijing Olympics 2011 Exit Music Festival, Serbia 2008 Presidential Inauguration 2011 World Youth Day, Madrid 2009 South East Asian Games Vientiane 2011 Umra and Hajj 3 million visitors each year 2007 Cricket World Cup 2009 Caribbean Games Trinidad and Tobago 2008 World Youth Day Sydney 2010 FIFA World Cup South Africa First time in Africa 2011 Rugby World Cup, New Zealand Occurs after a large natural disaster

16. 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

18. A revised approach for SA Designation of 17 priority conditionsaccording 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

19. Health Command and Control Civil defence Report to overall MG planning body Local organization committee Information analysis, decision making, response coordination, communication, etc Risk communication Data collection Other command and control Health Surveillance system Other sources of information Other C&C systems International data

20. 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

21. Public heath response to WYD08

23. 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

24. 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

26. 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

27. What do we do in ARO: IHR Framework Determine Public Health Emergency of International Concern (PHEIC) Make temporary and standing recommendations Emergency Committee Expert Roster WHO Director-General Review Committee Accessibility at all times Primary channel for WHO-NFP event-related communications Disseminate information within WHO "Activate" the WHO assessment and response system WHO IHR Contact Points Other competent organizations (IAEA etc.) Notification Consultation Report Verification Accessibility at all times Communication with WHO Dissemination of information nationally Consolidating input nationally National IHR Focal Points (NFP) Ministries and sectors concerned Detect Assess Report Respond Unusual health events National surveillance and response systems

28. WHO Event management Initial Screening Event verification Risk Assessment Response Strategy and Operations

29. 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 29

30. 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? 30

31. 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 31