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
Some challenges for “Mass Gathering Health”
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Increased risks
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weather-related conditions (heat, cold)
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trauma – crowd management
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imported (unfamiliar) and epidemic-prone diseases
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deliberate release of biological, chemical or radio
nuclear substances
Pressure on infrastructure
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hotels, food caterers
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health system
Challenge for control measures
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integrated surveillance to provide intelligence
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potential for international spread
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mobile population (contact tracing)
International attention
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media
Developing tools and sharing
guidance
WHO Europe toolkit to assess preparedness
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WHO Europe toolkit to assess crisis
management capacities of health systems
developed with partners
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A structured tool - applicable also as self
assessment method for countries to identify
gaps and monitor progress in improving
emergency preparedness
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
Lviv – joint WHO ECDC workshop
with Ukraine - Poland (April 2010)
Recommendations:
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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
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)
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
Legacy:
Public health promotion (joint leaflet)
UEFA EURO 2012 - a smoke-free zone
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
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
New requirements for international
mass gatherings
1. Faster reaction times and lower thresholds for
action
2. Extremely clear structures for command and
control
3. Integrated procedures across sectors
4. International information exchange and
coordination
Seoul 2002 FWC
Someone
arrived
with
measles
WHO's Conceptual model
Legacy for the
event
Health Promotion
Health Security
Enhanced inter/national surveillance
for the event
Improving host surge
capacity for the event
Opportunity for IHR
Single Event
"Acute"
Development of the
public health
infrastructure during
an event
Work with Int'l
Organizing
Healthcommittees
promotion,
3 Fives,
Health promotion, 3
Five Keys
Fives, Five Keys
Food safety
training
Legacy for the host
WHO Support to public health preparedness and
response at mass gatherings
2010 Winter Olympics
Vancouver
Enhanced surveillance and
observers programme
2008 European Cup
Switzerland and Austria
2008 Presidential
Inauguration
2009 Athletics World
Championship Berlin
2010 Shanghai
World Expo
Happened just after Phase 6 –
H1N1
73 milllion visitors in 6
months
2008 Beijing
Olympics
2011 Exit Music
Festival, Serbia
2011 World Youth Day,
Madrid
2011 Umra and Hajj
2007 Cricket
World Cup
2009 Caribbean Games
Trinidad and Tobago
2010 FIFA World
Cup South Africa
First time in Africa
3 million visitors each year
2009 South East Asian
Games Vientiane
2008 World Youth
Day Sydney
2011 Rugby World Cup, New Zealand
Occurs after a large natural disaster
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
A revised approach for SA
•
Designation of 17 priority conditions
according to risk assessment
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Daily reporting from provinces to national
level from June 4 - July 17 (including zero
reporting)
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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
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
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 C&C
systems
International
data
Other sources
of information
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)
NATHOC and PROVHOCs operational May 25 July 20
Downward dissemination of data from the NATJOC
PROV HOCs
people on the ground
NATHOC
Public heath response to WYD08
WHO responsibilities during the FIFA
World Cup
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Daily meeting between WHO and DOH staff (daily public health cluster risk
assessment meeting)
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Communicate international disease surveillance to the DOH
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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
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Participate in response to health events as required by the DOH
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Maintain an event for the 2010 World Cup in the WHO Emergency
Management System (EMS)
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Coordinate communications between different levels of WHO and
between WHO and DOH (at all levels)
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biweekly sit reps (Monday and Thursdays)
Continued weekly teleconferences with all levels of the organisation
FIFA 2010 Experience in early
warning & response
WHO responsibilities
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Cross cutting and MG command and control issues
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Assisting with finalizing the command and control structure.
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Providing technical input into risk and control parameters for a risk
assessment tool being trialed by DOH.
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Organising and participating in weekly teleconferences between HQ, AFRO,
IST and country office to update areas of work and determine further actions.
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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
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
What do we do in ARO: IHR Framework
Determine Public Health Emergency of
International Concern (PHEIC)
Make temporary and standing
recommendations
Emergency
Committee
WHO
Director-General
Review
Committee
Expert
Roster
Accessibility at all times
Primary channel for WHO-NFP eventrelated communications
Disseminate information within WHO
WHO IHR
Contact Points
Notification
"Activate" the WHO assessment and
response system
Other competent
organizations
(IAEA etc.)
Consultation
Report
Accessibility at all times
Communication with WHO
Dissemination of information nationally
National IHR
Focal Points (NFP)
Verification
Consolidating input nationally
Detect
Unusual health
Assess
events
Report
Respond
National surveillance and response systems
Ministries and
sectors concerned
WHO Event management
Initial Screening
Event verification
Risk Assessment
Response Strategy and Operations
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
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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?
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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
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