2009
PAHO/WHO US-Mexico Border
Technical Cooperation: Promoting
health and preventing illness
Pan American
Health
Organization
Maria Teresa Cerqueira, M.Sc., Ph.D.
Chief, PAHO/WHO US-Mexico Border Office
2009
PAHO a Specialized Agency in Health
Organization of
American States
(OAS) Interamerican
System
United Nations
System
PAHO
PAHO
Technical Agency
Pan American
Health
Organization
Regional Office of the
World Health
Organization
2009
EURO
Copenhagen,
Denmark
HQ
Geneva,
Switzerland
WPRO
Manila,
Philippines
AMRO
Washington, DC
USA
EMRO
Alexandria,
Egypt
SEARO
New Delhi,
India
AFRO
Brazzaville,
Rep. Du Congo
Pan American
Health
Organization
WHO Global and Regional Structure
2009
PAHO Presence in the Americas since 1902
Antigua and
Barbuda
Argentina
Bahamas
Barbados
Belize
Bolivia
Brazil
Canada
Chile
Colombia
Costa Rica
Cuba
Dominica
Dominican
Republic
Ecuador
El Salvador
Grenada Guyana
Pan American
Health
Organization
Haiti
Honduras
Jamaica
Mexico
Nicaragua
Panama
Paraguay
Peru
Saint Kitts and
Nevis
Saint Lucia
Saint Vincent and
Grenadines
Suriname
Trinidad and
Tobago
United States
Uruguay
Venezuela
Associate Member
State
• Puerto Rico
Observer Member
States
• Spain
• Portugal
Headquarters
Field and Country
Offices
Member States
• France
• Netherlands
• Great Britain
WHO 1948
2009
Governing Bodies
• Spring: Subcommittee on Planning and Budget
takes recommendations from the previous year’s
executive committee and prioritizes
• Summer: Executive Committee reviews the
documents from the Planning and Budget
subcommittee and decides on resolutions and/or
recommendations
• Fall: Directing Council all Member States
participate and decide on PAHO plan of work and
budget – biennium and annually – every 5 years
the Pan American Sanitary Conference elects a
director and develops a strategic agenda
Pan American
Health
Organization
2009
PAHO Historical Aspects
1902
The International Sanitary Bureau was
formed by The First General International
Sanitary Convention of American
Republics
1942
The PAHO U.S.-Mexico Border Field Office
was established to provide technical
cooperation and support to local, state
and federal health authorities to binationally respond to the emerging
diseases at the border.
1943
June 15-16, El Paso, TX. The Field Office, with cooperation from Mexican
and US health authorities, celebrated the Pan American Border Health
Conference which was attended by the highest level of health authorities
from both countries.
They decided to establish the U.S-Mexico Border Public Health
Association (USMBHA) appointing the Border Office to act as the
Association's Secretariat.
Pan American
Health
Organization
2009
PAHO Mission, Vision and Values
MISSION
•
To lead strategic collaborative efforts among Member States and other partners to
promote equity in health, to combat disease, and to improve the quality of, and lengthen,
the lives of the peoples of the Americas.
VISION
•
The Pan American Sanitary Bureau will be the major catalyst for ensuring that all the
peoples of the Americas enjoy optimal health and contribute to the well being of their
families and communities.
VALUES
•
•
•
•
•
Equity- Striving for fairness and justice by eliminating differences that are unnecessary
and avoidable.
Excellence- Achieving the highest quality in what we do.
Solidarity- Promoting shared interests and responsibilities and enabling collective efforts
to achieve common goals.
Respect- Embracing the dignity and diversity of individuals, groups and countries.
Integrity- Assuring transparent, ethical, and accountable performance.
Pan American
Health
Organization
Health in THE
2009
AMERICAS 2007
www.paho.org/hia
www.borderinfo.org
The Willard Intercontinental Hotel
Pan American
Health
Organization
2009
1.
Monitoring, Evaluation, Health
Situation Analysis
The Essential Public 2. Surveillance of public health risks and
Health Functions
threats
3. Health Promotion
4. Social Participation
5. Health policy, planning and
management
6. Regulation y legislation
7. Access to health care
8. Human Resource development and
training
9. Quality assurance in health services
10. Research
11. Reduce the impact of emergencies and
disasters
Pan American
Health
Organization
http://www.paho.org/English/DPM/SHD/HP/EPHF.htm
2009
• Results of institutional
capacity mapping
• Establish healthy public
policy
• Empower communities
• Create healthy settings
• Develop skills and build
capacity
• Reorient health services
Pan American
Health
Organization
2009
La Guía de los Alcaldes
en Promoción de la
Salud y Calidad de Vida
l
Guía para llevar a cabo el proceso
en tres etapas
l
Información técnica sobre
prioridades de salud y programas
de OPS
l
Guía para orientar a los equipos
locales
l
Lista de referencias, sitios Web,
etc..
l
Direcciones de las oficinas de OPS
en los países
Pan A meric an Hea lth Orga nizati on •
Pan American
Health
Organization
http://www.paho.org
2009
10 states
48 US counties
80 Mexican municipalities
14 pairs of sister cities
13 million population
Pan American
Health
Organization
2009
U.S.-Mexico Border
The United States –Mexico border extends for 3.141 kilometers (1.952
miles), stretching from the Gulf of Mexico to the Pacific Ocean.
1983 La Paz Agreement defined the border as the land within 100 km
(62,5 miles) on either side of the international boundary.
Pan American
Health
Organization
2009
The Context of the
U.S.-Mexico Border Region
• The busiest and most traveled border
in the world > 400 million people
cross the border each year
• 90 million cars and 4.3 million trucks
via 24 official ports of entry
•
•
US$ 638 million in trade conducted
along the border each day
More than 3,000 maquiladoras located
along the border
Pan American
Health
Organization
PAHO/WHO Health in the Americas 2007
2009
The Context of the
U.S.-Mexico Border Region
• Immigration from Mexico increased notably
from an average of 30,000 people between
1961-1990 to around 400,000 between 20012005




Pan American
Health
Organization
New Mexico with 111,049 immigrants,
Arizona with 618,105,
Texas with 2,356,703, and
California with 4,026,219
2009
The Context of
the U.S.-Mexico Border Region
• With population growth trends the total population is expected to
reach 20 million by 2020
• 95% of the population live in urban centers in the San Diego,
Tucson, El Paso, Laredo
 McAllen and Reynosa is the fastest growing border city area
with population gains of almost 5% per year
• Border-crossing deaths have doubled from 241 deaths in 1999 to
472 in 2005
• Increase in deaths by heat exposure is due to a shift of migrant
traffic from urban areas like San Diego and El Paso to the SonoraArizona desert
Pan American
Health
Organization
2009
Population of some Border Sister Cities
Sister Cities
San Diego
Millions
2,936,609
%
24
25
Tijuana
Tucson
1,410,700
925,000
11
7.5
20
San Diego
Tijuana
Tucson
Nogales
El Paso
Cd. Juatez
McAllen
Reynosa
15
Nogales
194,517
2.5
10
El Paso
821,306
7
5
Juarez
1,383,338
11
0
McAllen
678,652
6
Reynosa
527,888
4
Pan American
Health
Organization
% Border Population
2009
The Context of U.S. Mexico Border Region
• Mexico’s border states have less poverty and highest
literacy rates in the country
• The U. S. border states are very diverse: 4/7poorest
cities and 5 of the poorest counties in the U.S. are on
Texas border, while San Diego is one of the wealthiest
cities in the U.S.
• Educational level of the population in U.S. border
counties is lower than elsewhere in the country with
exceptions
Pan American
Health
Organization
2009
Median Household Income of Sister
Cities participating in Ovations
Program
US$ per year (2006)
60,000
59,591
50,000
40,000
41,284
32,111
28,660
30,000
20,000
10,000
12,505
10,03911,097 9,561
San Diego
Tijuana
Tucson
Nogales
El Paso
Cd. Juarez
McAllen
Reynosa
0
Pan American
Health
Organization
PAHO/WHO Health in the Américas 2007
2009
The Context of U.S. Mexico Border Region
• The population on the border is relatively young
 29% on the Mexican side were less than 15 years
 23% on the U.S. side were younger than 15 yrs
• Life expectancy for U.S. border ranged from 77 years in Arizona
to 72 years in Texas
• Life expectancy for Mexican border ranged from 75 years in
Tamaulipas to 77 years in Baja California
• Mortality rate in the four U.S. border states: Texas, 700;
California, 675; Arizona, 778; and New Mexico, 790
• Mortality rates in the border states on the Mexico side:
Tamaulipas 430, Coahuila 477, Chihuahua 540, Sonora 506,
and Baja 530
Pan American
Health
Organization
2009
Challenges on the U.S. Mexico Border
Pan American
Health
Organization
2009
Issues and Challenges
on the Border
• Inequities in migrant and ethnic
minorities
• Family disintegration
• An aging population
• Advertising, publicity and internet
influences on lifestyles and values
• Access to health services
• Public health human resources
Pan American
Health
Organization
2009
Issues and Challenges on the Border
• Chronic Non-Communicable
Diseases
 Diabetes, CVD, Obesity,
Hypertension, Cancer,
• Violence
• Injuries
• TB is a growing concern
 MDR; XDR; Relation with other
diseases
Pan American
Health
Organization
2009
Issues and Challenges on the
Border
• Mental illness,
 psychosocial problems
 suicide, depression
 substance abuse
(alcohol, tobacco and
other drugs)
• HIV-AIDS
 Rates ranging from 10-15
(per 100,000) on the U.S.
Border states
 2-5 (per 100,000) on the
Mexico Border states
Pan American
Health
Organization
2009
Issues and Challenges
on the Border
Environmental Health
Problems:
• water and soil
contamination,
• air pollution,
• exposure to organic
compounds,
• heavy metals and
pesticides;
• vectors: (dengue, West
Nile)
• Emergency and
disaster preparedness
and mitigation of
vulnerability
Pan American
Health
Organization
2009
Issues and Challenges on the Border
• Support multi-sector and cross border collaboration
• Strengthen coordination, communication, consensus and clarity
of who does what, when and where
• Increase access to information for policy and decision making
and support academic institution to have less fragmented data
bases
• Insufficient institutional capacity to promote health and reduce
risk factors, support
 Research





Translation of knowledge to practice
Resource mobilization
Evaluation
Dissemination of good practices
Training and development of the public health workforce
Pan American
Health
Organization
2009
PAHO/WHO
US-MEXICO BORDER OFFICE
2008 – 2009
BIENNIAL WORK PLAN
Pan American
Health
Organization
2009
Guidelines to Set Priorities for Technical
Cooperation in the Americas
• WHO program of work
• WHO Commission on the Social
Determinants of Health
• The UN Millennium Development
Goals
• WHO International Health Regulations
• PAHO Strategic Plan 2008- 2012
• The Health Agenda for the Americas
• National Health Plans, Programs and
Priorities
• Healthy Border 2010
• Border 2012 Environment Program
Pan American
Health
Organization
2009
Border
Environmental
Program 2012
Healthy Border 2010
objectives
1.
2.
3.
4.
5.
6.
Access to Health Care
Cancer
Diabetes
Environmental Health
HIV/AIDS
Immunization and Infectious
Diseases
7. Injury Prevention
8. Maternal, Infant and Child
Health
9. Mental Health
10. Oral Health
11. Respiratory Diseases
1.
2.
3.
4.
5.
Reduce water contamination
Reduce air contamination
Reduce soil contamination
Improve environmental health
Reduce exposure to chemical
contamination and terrorism
Improve environmental
performance, strengthen
compliance with environmental
legislation and strengthen
leadership in environmental
protection.
http://www.epa.gov/r6border/intro.htm
Pan American
Health
Organization
http://www.borderhealth.org/healthy_border_2010.php?curr=programs
2009
Projects
Goal: To improve the quality of healthy life years and
reduce health disparities on the U.S.-Mexico
Border (Healthy Border 2010)
1.
2.
3.
4.
5.
6.
Health Analysis and Information Systems
Health Determinants and Public Policy
Prevention of Non-Communicable Diseases
Environmental Health and Emergency
Preparedness
Prevention of Psychosocial and Behavior Risks
Knowledge Management and Sharing
Pan American
Health
Organization
2009
Health Diplomacy
• The art and practice of building consensus and
collaboration
• International agreements to protect public health and
the environment
• Negotiations at multiple levels and with multilateral
partners and stakeholders
• Interact in various political environments at
international and global scenarios
Pan American
Health
Organization
2009
Project 2: Health Determinants
and Public Policy
PURPOSE: To strengthen health promotion capacities and
intersectoral and interdisciplinary collaboration, promote healthy
public policies to improve social determinants of health.
OBJECTIVES:
2.1 Increase equitable access to vaccines
2.2 Strengthen institutional health promotion capacities
2.3 Support public policies to address the social determinants of health
2.4 Strengthen intersectoral collaboration to address social and
economic determinants of health
2.5 Promote gender-and ethnic-sensitive policies and programs with
human rights emphasis
2.6 Support the development of healthy policies for healthy diets and
physical activity.
Pan American
Health
Organization
2009
U.S. - Mexico Border
VACCINATION WEEK IN THE AMERICAS
US NATIONAL INFANT IMMUNIZATION WEEK
MEXICO HEALTH WEEK
2008
Pan American
Health
Organization
2009
CARAVAN FOR HEALTH
APRIL 21, 2008 (TBC)
• Parade Celebration with
customized cars, families,
children and health
personnel celebrating the
existence of Immunizations.
• The Caravan will depart from
NM, make a stop in TX and
be received at CHIH. by
Federal, State and local
authorities, families, health
personnel and media in a
Coordination of: NM-TX-CHIH.
local event.
Departments of Health; ORO’s;
Local Depts. of Health; Immunization
Pan American
Coalitions; BHC; CDC; SSA; PAHO
Health
Organization
2009
Project 3: Prevention of NonCommunicable Diseases
PURPOSE: To contribute to reduce non-communicable
diseases and the risk factors associated with the diseases
among the U.S-Mexico Border population.
OBJECTIVES:
3.1 Guidance for policy and programs to prevent and control
NCD along the US- Mexico Border region
3.2 To improve the organization, management and delivery of
health care service in diabetes with border health services
3.3 To contribute implementing integrated strategies to
prevent NCDs risk factors as unhealthy diets and physical
inactivity
3.4 Border States supported in the development and
strengthening of nutrition plans
Pan American
Health
Organization
2009
A Coalition of Centers of
Excellence to Counter
Chronic Disease on the
U.S. Mexico Border
Pan American
Health
Organization
2009
10 states
48 US counties
80 Mexican municipalities
14 pairs of sister cities
13 million population
Pan American
Health
Organization
2009
Pan American
Health
Organization
2009
Framework
Pan American
Health
Organization
2009
US- Mexico Border Diabetes
Prevention and Control Project
.
Pan American
Health
Organization
2009
Pan American
Health
Organization
2009
San Diego, California
Imperial, California
Tijuana, BajaTraining
California
Sites
Mexicali, Baja Cal.
Santa Cruz, Arizona
Pima, Arizona
Yuma, Arizona
Guadalupe, Sonora
Nogales, Sonora
Deming, New Mexico
Ciudad Juárez, Chihuahua
Ojinaga, Chihuahua
El Paso, Texas
Las Cruces, New Mexico
Piedras Negras, Coahuila
Ciudad Anahuac, N. Leon
Laredo, Texas
Nuevo Laredo, Tamaulipas
Harlingen, Texas
Reynosa, Tamaulipas
Matamoros, Tamaulipas
Pan American
Health
Organization
2009
Project 4: Environmental Health and
Emergency Preparedness
Contribute to the improvement of health and
well-being of transborder populations through the
reduction of environmental risks.
PURPOSE:
OBJECTIVES:
4.1 Facilitate communication & coord. to strength local
gov. in preparation & response to epidemic and
pandemic influenza
4.2 Promotion of healthy environment initiatives on the
local level, through intersectoral partnerships.
4.3 Advocacy and information to build public opinion &
awareness of the importance of environmental health.
Pan American
Health
Organization
2009
Pan American
Health
Organization
http://www.paho.org/
2009
• Water and Sanitation
• Hygiene education
• Reduce exposure to toxic
substances
• Children’s environmental health
indicators
• Reduce environmental risk with
indigenous groups
• Workshop on road paving and
health
• Disaster preparedness and
emergency response
• Workshop on climate variation
and health
• Border Environment Program
2012
Pan American
Health
Organization
Environmental
Health
2009
Water Project with Kumiai communities
in Baja California
• Water quality
• Environmental health
indicators
• Reduce gastrointestinal illness
due to polluted water
• Strengthen water systems and
infrastructure for potable
water
Pan American
Health
Organization
2009
• Waste tire disposal project and dengue
prevention in Matamoros, Tamaulipas
(CDC, University of Colorado, Texas Department of State
Health Service, Jurisdicción Sanitaria 3, Tamaulipas;
Brownsville Department of Health)
• Environmental health education and
indicators in rural communities in the
Valle de Juárez, Chihuahua (COCEF, UACJ,
Comisión Estatal para la Protección contra Riesgos
Sanitarios (COESPRIS), COLEF, AQUA 21, Instituto
Tecnológico de Ciudad Juárez (ITCJ), Junta Municipal de
Agua y Saneamiento de Cd. Juárez, UTEP).
• Community education and participation
for the prevention of pesticide
intoxication (California Department of Public Health,
Office of Binational Border Health California-Baja
California Integrated Pesticide Illness Surveillance and
Exposure Prevention Project Working Group).
Pan American
Health
Organization
PROJECTS
2009
PROJECTS
• Asthma in los children living in
the El Paso – Ciudad Juárez
region. Indicators of air pollution
associated to motor vehicle
traffic (Emory University, UTEP,
IMSS)
• Environmental changes,
pollution and health on the Río
Grande from Laredo, Texas, to
the Golf of México (Iniciativa de
Salud Fronteriza (BEHI), USGS)
Pan American
Health
Organization
2009
Faces, Voices and Places Project
Environmental risk prevention,
healthy housing and communities
with indigenous groups
Migrant RARAMURI (TARAHUMARA)
in CIUDAD JUAREZ, collaboration
with NGOs VOCES INDIGENAS.
Pan American
Health
Organization
2009
Project 5: Prevention of Psychosocial
and Behavior Risks
PURPOSE: Capacity of local institutions and communities on the
US/Mexico border strengthened to implement healthy public
policies and programs, as well as to monitor and reduce social
and behavioral risk factors and promote mental health.
OBJECTIVES:
5.1 Support border coordination to prevent risk factors associated
with tobacco, alcohol, substance abuse and unsafe sex
5.2 Strengthen health research on border priorities including
psychosocial and behavior risks, violence and injuries.
5.3 Support improved access, quality and use of medical products
and technologies
5.4 Border States supported with guidelines in risk assessment
5.5 Border States supported to mobilize communities against to HIV
and TB
Pan American
Health
Organization
2009
Partners in Technical Cooperation
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
USMBHA (AFMES) and BHC (COBINAS)
USMBHC
Border Governors Conference – health table
Border Legislators Conference
BECC – COCEF
Universities – COLEF, UABC, UACJ, UAT, UTEP, UA, UNT,
CDC
SSA
EPA
HRSA
NIH-Fogarty, NHLBI
Coalition of Border Mayors
Consortium of HSHS
PAHEF, ICF, Paso del Norte Health Foundation
FUNSALUD - INP
NGOs
Pan American
Health
Organization
2009
Plan for the Control and
Elimination of Congenital Syphilis
and Prevention of HIV
Transmission in Ciudad Juarez
Servicios de Salud de Chihuahua
Departamento de Salud del Estado de Texas
Organización Panamericana de la Salud OPS/OMS
Pan American
Health
Organization
2009
Violence and Injury Prevention
Pan American
Health
Organization
2009
Road Injuries
WHO Website & Publications
http://www.who.int/violence_injury_prevention/road_traffic
Pan American
Health
Organization
2009
Juarez VIP Observatory
Problema y Contexto
Epidemiología
Funciones
Acuerdos
Objetivos
Productos Esperados
Estructura
Organizativa
Propuesta
Metodológica
Participantes
Pan American
Health
Organization
2009
Framework Convention on Tobacco Control
• Signed into adoption at the 56th World Health
Assembly in 2003, by 192 Member States
• Next steps: ratify and monitor implementation
• Eliminate publicity
• Increase visible warnings on
packages
• Extend smoke free spaces in all
public places
• Increase price with taxes
• Put in place legislation to curtail
contraband
• Refuse any deals or supports from
tobacco companies
Pan American
Health
Organization
Convenio Marco de
Control del Tabaco
ORGANIZACIÓN MUNDIAL DE LA SALUD
2009
Other strategies and programs
• Partnerships and alliances
• Community Mobilization and
participation
• Research capacity building
• Resource Mobilization
• Training and institutional
capacity building
• Guidelines
• Community Guide to prevent
and treat TB
Pan American
Health
Organization
2009
Project 6: Knowledge Management
and Sharing
PURPOSE: To facilitate the production, dissemination
and sharing of knowledge and evidence-based
scientific-technical information on public health .
OBJECTIVES:
6.1 Facilitate the access and dissemination of technicalscientific knowledge & information in public health in the
Border.
6.2 Increasing the use of scientific knowledge in public health
policy-making.
6.3 Support for training and learning activities.
Pan American
Health
Organization
2009
Information Dissemination
• Exhibit Module – Distributional Materials
• Promotion of PAHO/WHO Publications
• Promotion of the U.S.-Mexico Border Office
Projects and Technical Cooperation Activities
• Poster Presentations
Pan American
Health
Organization
2009
English: http://www.borderinfo.org
Español: http://www.infofrontera.org
Pan American
Health
Organization
2009
CONTENTS
Bibliographic databases
Scientific Electronic
Journals
Trilingual Vocabulary
Directories: Institutions,
Projects & Researchers
Events Calendar
Website database
Index of Journals
Pan American
Health
Organization
2009
VHL - BIREME
VHL Network: 2000 Institutions
8
53
25
Partners
3
10
26
5
19
17
1
10
23
5
14
85
53
8
6
2
30
Sección México
865
57
48
33
30
165
8
Pan American
Health
Organization
centros.bvsalud.org
11
2009
PAHO/WHO Bibliographic CD-ROMs
FULL-TEXT PUBLICATIONS
THEMATICS:
•U.S.-Mexico Border Office Publications
•Chronic Diseases
•Health Promotion & Leadership
•Influenza
•Blood Safety
•Tuberculosis & HIV
•Tuberculosis & Tobacco
•World Health Report 1998-2007
Pan American
Health
Organization
2009
Project 1: Health Analysis and
Information Systems
PURPOSE: Contribute to strengthening information systems
and build the evidence to support public health policies
along the U.S-Mexico-Border Region.
OBJECTIVES:
1.1 Enhance capacity of U.S. - Mexico border institutions in
integrated health information systems on the border
1.2 Contribute to increase knowledge and application of the
International Health Regulations (IHR) on the border
1.3 US-Mexico Border surveillance and monitoring systems
strengthened
1.4 Border States supported to establish a set of core health
indicators
Pan American
Health
Organization
2009
The current WHO phase of
pandemic alert is 6
http://www.who.int/csr/disease/avian_influenza/phase/en/index.htm l
Pan American
Health
Organization
2009
• 28/August: 2,200 deaths, 210,000 aseos, 177 countries
Pan American
Health
Organization
2009
Pan American
Health
Organization
2009
Border situation
Pan American
Health
Organization
2009
Core capacity requirements for surveillance and response (Annex 1A):
“capacity to detect, assess, notify and report events …”
• Timeline
2 years + 3 + (2) + (up to 2)
2007
2009
Planning
Implementation
2012
2014
2016
Possible extensions
"As soon as possible but no later than five years from entry into force …"
Pan American
Health
Organization
15 June 2009
2009
Recommended actions before, during and
after a pandemic
• Planning and coordination
• Situation monitoring and
assessment
• Reducing the spread of disease
• Continuity of health care
provision
• Communications
Pan American
Health
Organization
2009
Influenza A (H1N1) at the Border
Providing technical cooperation to prepare workshops for
health professionals and community health workers on:
– International Health Regulations
– WHO Pandemic Alert Phases
– Recommendations
– Information Sources
Global Pandemic
Preparedness
Pan American
Health
Organization
2009
Distributional
Materials
Reminders at the
work place
Pan American
Health
Organization
http://www.who.int/gpsc/5may/tools/en/index.html
2009
Influenza A (H1N1)
at the Border
• Working with partners
and media to keep
community informed
Pan American
Health
Organization
2009
Geographic
distribution
Pan American
Health
Organization
2009
Tendency
Pan American
Health
Organization
2009
Intensity
Pan American
Health
Organization
2009
Impact
Pan American
Health
Organization
2009
International Health Regulations
Mexico detects
new A/H1N1 09
(pandemic)
virus
Pan American
Health
Organization
1st Mtg of IHR
Emergency
Committee
25 April 2009
DG determines
is a PHEIC
2nd & 3rd
Mtgs of EC
27 April 09
5 June 09
DG:
Temporary
Recomm's &
Pandemic
Phase(s)
4th Mtg of EC
11 June 09
DG raises to
Pandemic
Phase 6
2009
Pan American
Health
Organization
2009
Maria Teresa Cerqueira, MS, PhD
Chief, United States-Mexico Border Office
Pan American Health Organization (PAHO)
Regional Office of the World Health Organization (WHO)
cerqueim@fep.paho.org
Pan American
Health
Organization