Ambassador School Model United Nations 2014 Study Guide World Health Organization Strengthening Research, and Response Preparedness to Combat Pandemic Diseases By Sameeksha Bhatia and Madhovarshinii Rajesh General Assembly World Health Organization INDEX Introduction 6 Acronyms 7 History of the committee 8 Topic area: Strengthening Research, and Response Preparedness to Combat Pandemic Diseases Statement of the problem 9 Relevant UN actions 11 Regional Preparedness and Response coordination 12 Main threats 13 Case Study 14 Suggestions for further research 15 Requirements of a position paper 16 Closing remarks 17 Bibliography 18 World Health Organization Letter from the Secretary General Dear Delegates, Welcome to the World Health Organization (WHO). My name is Janak Bhojwani and I assure you that your journey through ASMUN with Sameeksha Bhatia as your chair and Madhovarshinii Rajesh as your co-chair will be memorable. They have written this study guide with a lot of dedication and with the hope that it will give you ample information for the basic knowledge of the topic. This year at World Health Organization the topic that you would be discussing is of paramount relevance as it is still faced by the United Nations today. In that sense, as a representative of a member State, you are expected to do a thorough analysis of the topic and your country's stance on it, while at the same time keeping perspective of the mandate of WHO. Bear in mind that the most substantial, assertive and enduring questions on the topic will be more than welcome during the discussion, as it will enrich our endeavors of making this committee the best learning experience it can be. So bring in the best of your skills for the heated debate and discussion during the sessions but always remember that diplomacy is the core of the proceedings. You will be judged on the basis of your grasp over the Rules of Procedure and as far as we can say a delegate is not the one who has the best research, but rather the one who uses his/her research and convinces the committee to act in a way that he/she wants with a adroit articulation of his/her relevant ideas and exhibition of discipline and professionalism. The best outcome will depend on your negotiation skills, diplomacy and will of cooperation. Go carefully through the study guide and if you have any concern, don’t hesitate to contact Sameeksha. Wish you the best of luck in this challenge! Sincerely, Janak Bhojwani (Secretary General) World Health Organization Letter from Director General Dear Delegates, It is with great pleasure that I welcome you to Ambassador School Model United Nations and World Health Organization. My name is Hrisha Jayshankar and I assure you that Sameeksha and Madhovarshinii of WHO will guide you and lead you towards the path of tremendous knowledge and bright success. This study guide will build the base for the research on Strengthening Partnerships, Research, and Response Preparedness to Combat Pandemic and Resistant Diseases. I request you, a fellow delegate, to use this guide religiously, as it makes up the foundation of your research. The topic chosen has been decided by WHO because it is one of the trending issues that the world faces today. I hope you are excited by the challenges and opportunities that lie ahead. Being a delegate will require your best efforts, and I am confident that you will properly prepare for this unique experience over the coming months. As a delegate at Model UN, you will be challenged to think critically. You will be presented with topics that require much research and analysis, and you will be pushed by your committee chairs to recognize the nuances and complexities of these issues. The more time and effort you devote to understanding your topic and your country's position, the more capable and convincing a delegate you will be. At Model UN, your skills as a leader will be tested and proven. Through the art of diplomacy and a commitment to respect, tolerance, and unity, you will excel as a delegate. These vital traits make the very foundation of the official United Nations as well. Model UN is not merely a chance to learn about the United Nations, nor is it simply the opportunity to debate the issues currently shaping our world - it is a critical moment to learn about ourselves, the connections we have to people around the globe, and the responsibility that those connections create. Model UN is an opportunity to recognize our roles as global citizens. It is a chance to look beyond our immediate selves, to think bigger and broader and to see the role that we can play in shaping and creating our world and global community. World Health Organization It is my sincerest hope that you walk away from this year's conference with respect for your chairs, and an appreciation for the tremendous power and responsibility you have to, in the prophetic words of UN Secretary General Ban Ki Moon, "help the world see and believe in a better future." Best of luck! Hrisha Jayshankar (Director-General) Janak Bhojwani Hrisha Jayshankar Secretary General Director General World Health Organization INTRODUCTION Today, there is growing recognition that an outbreak anywhere can potentially represent an emergency of international public health concern. Outbreaks threaten the health of the world’s population. They require regional and global alert and response mechanisms to ensure rapid access to technical advice and resources and to support national public health capacity. No single institution or country has all of the capacities to respond to international public health emergencies caused by epidemics and by new and emerging infectious diseases. Being prepared to prevent, respond to, and recover rapidly from public health emergencies can save lives and protect the health and safety of the public and emergency responders. The effects that public health emergencies have on the wellbeing of our nation were obvious in the aftermath of such events as Hurricane Katrina in 2005, the outbreak of severe acute respiratory syndrome (SARS) in 2003, and the terrorist attacks of 2001. The Centers for Disease Control and Prevention (CDC) plays a key role in preparing our nation for public health threats that include natural, biological, chemical, radiological, and nuclear incidents. To prepare for public health emergencies, Congress appropriates Terrorism Preparedness and Emergency Response (TPER) funds to CDC. This funding supports a range of activities at CDC and state and local levels to help develop the capabilities and capacities needed to respond effectively to public health threats. In fiscal year (FY) 2007, Congress allocated approximately $1.5 billion for TPER projects. The same way WHO continues to track the evolving infectious disease situation, sound the alarm when needed, share expertise, and mount the kind of response needed to protect populations from the consequences of epidemics, whatever and wherever might be their origin. WHO ensures that countries have rapid access to the most appropriate experts and resources for outbreak response through the Global Outbreak Alert and Response Network (GOARN). World Health Organization and streamlined administrative processes to ensure rapid mobilization of field teams. ACRONYMS GOARN was created in April 2000 to improve the coordination of international outbreak responses and to provide an operational framework to focus the delivery of support to countries. GOARN’s primary aims are to: •Assist countries with disease control efforts by ensuring rapid and appropriate technical support to affected populations. •Investigate and characterize events and assess risks of rapidly emerging epidemic disease threats. •Support national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats. GOARN has helped to build consensus on guiding principles for international outbreak alert and response and to establish operational protocols to standardize field logistics, security, communications, EPR- Epidemic Preparedness and Response FAO- United Nations Food and Agriculture Organization OIE-International Animal Health Organization CDC- Centers for Disease Control and Prevention NHS-National Health Service IHRInternational Health Regulations GBD -Global Burden of Disease PED-Pandemic and Epidemic Disease SHOCStrategic Health Operations Centers PIPF- the Pandemic Infection Preparedness Framework GIPCGlobal Infection Prevention and Control World Health Organization HISTORY OF COMMITTEE THE The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that is concerned with international public health. The logo of the Organization features the Rod of Asclepius as a symbol for healing. Its predecessor, the Health Organization, was an agency of the League of Nations. It was established on 7 April 1948, with its headquarters in Geneva, Switzerland which has been there since 1966. W.H.O.’s Constitution came into force on 7 April 1948 – a date now celebrated every year as World Health Day. Its Constitution states that its objective is “the attainment by all people of the highest possible level of health". The use of the word "world", rather than "international", emphasizes the truly global nature of the organization. The W.H.O. was the first specialized agency of the United Nations to which every member subscribed. The first meeting of the World Health Assembly finished on 24 July 1948. Andrija Stampar was the Assembly's first president, and G. Brock Chisholm was appointed as DirectorGeneral of W.H.O. The first priorities of the committee were to control the spread of malaria, tuberculosis and S.T.D.s, and to improve maternal and child health, nutrition and environmental hygiene. Its first legislative act was concerning the compilation of accurate statistics on the spread and morbidity of disease. Some achievements of WHO are as follows: Malaria eradication-In 1955, a malaria eradication program was launched, although it was later altered in objective. Diabetes Report and IARC- 1965 saw the first report on diabetes and the creation of the International Agency for Research on Cancer. Health for all-In 1978, the ambitious goal of "health for all" was declared. Small pox eradication- After over two decades of fighting smallpox, the W.H.O. declared in World Health Organization 1980 that the disease had been eradicated – the first disease in history to be eliminated by human effort. Polio eradication- The Global Polio Eradication Initiative was established in 1988. HIV/AIDS initiative- In 2006, the organization endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed the basis for a global prevention, treatment and support plan to fight the AIDS pandemic. STATEMENT OF THE SITUATION It is due to the uncontrollable nature of the timing of outbreaks of the pandemic diseases, their severity, and their location that a cooperative globalized response is needed in order to contain the outbreak and limit the damage on human life. In order to fully achieve these goals, the World Health Organization acts as a massive umbrella organization to consolidate all of the data and research of many sub-committees and organizations with the aim of “intensifying communicable disease surveillance for early warning of outbreaks so that appropriate control measures can be implemented as soon as possible.” Among the organizations that WHO coordinate, are the Department of Pandemic and Epidemic Disease (PED), the Pandemic Infection Preparedness Framework (PIPF), the Strategic Health Operations Centers (SHOC), the Global Outbreak Alert and Response Network (GOARN), and the Global Infection Prevention and Control (GIPC) Network. The Department of Pandemic and Epidemic Disease (PED) recently identified the major pandemic prevention goals of WHO in the Twelfth General Program of Work, which was finalized 10-13 September 2012 in Malta by the Regional Committee for Europe. The goal of this session was to redefine the concept of “health” through strategic imperatives that are newly adapted to a world recovering from an economic downturn. One of the strategic imperatives created during this Twelfth General Program of Work addresses the need to reduce the burden of communicable disease through increased surveillance and effective response to disease outbreaks, while identifying HIV, tuberculosis, and malaria as the three most prevalent threats to global security. This document and its strategic imperatives became pivotal World Health Organization in the recent restructuring of the PED; and the PED now implements recommendations from the Twelfth General Program of Work throughout its 5 strategic imperatives of research, protection, preparedness, health care, and global response. The Global Outbreak Alert and Response Network (GOARN) is a collaboration of existing organizations that collects all the knowledge and resources within that network into an information pool to rapidly combat disease. GOARN allows information sharing through a cooperative system of Member States and the United Nations, which is vital to preemptively predicting a disease and coordinating international effort when one occurs. In contrast to GOARN, the Pandemic Infection Preparedness Framework (PIPF) uses the information it gathers in order to “improve pandemic influenza preparedness and response, and strengthen the protection against the pandemic influenza by improving and strengthening WHO global influenza surveillance and response system.” This means that the majority of their work is based in global need for influenza immunization, to coordinate accurate reports and date, and in the creation of “Essential Regulatory Laboratories,” which are WHO-approved research bases for research and production of influenza immunization. The Global Infection Prevention and Control (GIPC) Network was launched in June of 2011, and currently provides support to Member States through offering education on WHO policies and helping Member States develop their own effective national policies on disease prevention. Furthermore, the network focuses on studying the education of both patients and health-care providers globally in order to address basic pandemic requirements, such as sanitation and the impact of disease on the patient’s family. Finally, all of the information that is coordinated through these organizations is sent to the JW Lee Centre for Strategic Health Operations (SHOC), which is the center of WHO information of pandemic diseases. It is “the hub of alert and response operations”, and they are the center that will always make the final call on response to disease outbreaks. It is through the collaboration of these organizations, and the consolidation of their data through SHOC, that the international community is able to stay informed of any information regarding pandemic disease World Health Organization RELEVANT SOLUTIONS UN To prevent the occurrence and spread of a potential pandemic disease, support should be regularly given to countries in the area of the disease preparedness and response. Over the past few years WHO has extensively supported countries in the development, finalization and pilot testing of pandemic diseases preparedness and response plans Providing surveillance tools to state and local epidemiologists for detecting potential health threats Approximately 100 organizations used CDC’s Early Aberration Reporting System to improve health threat detection through analysis of data from diverse sources such as emergency departments, 911 calls, physician offices, and over thecounter drug sales . Improving Preparedness Health Monitoring and Surveillance Objective: Integrate and enhance the existing surveillance systems at local, state, national, and international levels to detect, monitor, report, and evaluate public health threats. BioSense provided situational awareness during national events such as the Super Bowl and the State of the Union Address. In addition, BioSense detected data anomalies related to health problems associated with California wildfires. The National Poison Data System enhanced government response to the melamine outbreak in pet food and toothpaste. Poison control centers submit data to the system every 4 minutes to 10 minutes. Tracking hazardous substances and alerting emergency partners about accidental releases The Hazardous Substances Emergency Events Surveillance program provided more than 1,600 alerts leading to evacuations of more than 35,000 people. Improving research and assessing sciences Objective: Support and strengthen human and technological World Health Organization epidemiologic resources to prevent, investigate, mitigate, and control current, emerging, and new public health threats and to conduct research and development that lead to interventions for such threats. Assessing the vaccine and treatment options for anthrax CDC assessed the current administration routes and dosage for the licensed anthrax vaccine, with the goal of maintaining effectiveness with fewer side effects. Developing methods to detect the presence of anthrax in potentially contaminated areas CDC developed, field tested, and is refining a new sampling strategy to better detect anthrax contamination. Evaluating emergency medicine kits for at-home use CDC evaluated a strategy to provide emergency MedKits containing antibiotics for home use in the event of an anthrax release. The MedKit prototype is currently undergoing additional testing. Enabling secure and rapid communication to detect health threats CDC’s web-based Epidemic Information Exchange (Epi-X) alerted health officials about incidents including Salmonella infections, foodborne botulism, travel-related measles, and an outbreak of a rare type of adenovirus. REGIONAL PREPAREDNESS AND RESPONSE COORDINATION Implementation of the Preparedness plan will require major investment at the Regional, sub-regional and country levels. This investment will only be effective if countries have access to evidence based standards and guidelines, technical support and immediate access to operation support in the face of emergent pandemic World Health Organization diseases. Therefore, the following activities are imperative for enhancing regional preparedness and response to the pandemic: • Activate the Regional task force on Pandemic disease. Members should include WHO (EPR, IHR, GBD, CDS, NHS and HPR), regional panel of experts and FAO, OIE • Reinforce the existing laboratory network on the Disease, • Reinforce and re orient the EPR network of consultants on the disease • Develop guidelines for coordination of capacity building by various health organizations • Provide briefing materials and technical advice on acceleration of drug registration and licensing. • Facilitate procurement and propositioning of medical supplies and vaccines • Collate surveillance data on disease; identify clustering of cases and hotspots to guide resource allocation. • Establish a regional outbreak verification and response operational center. MAIN THREATS HIV/AIDS Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are retroactive autoimmune diseases that originated in west-central Africa during the early 20th century. HIV can be spread through three methods: sexual contact, exposure to infected body fluids and from mother to child during pregnancy. AIDS was officially recognized in the 1980’s by the World Health Organization, and since that point, WHO has thoroughly readdressed their policies regarding contagious diseases and pandemics. With the AIDS pandemic, WHO transformed its approach from one of collecting information at a distance into taking action on the front lines by providing both aggressive antiretroviral treatment (ART) and new, consolidated international guidelines for the treatment of at-risk people. SARS In late 2002, Severe Acute Respiratory Syndrome (SARS), a viral respiratory disease, first appeared in Southern China and spread to 37 other countries within a matter of weeks. Because of this, SARS had a 9.6% fatality rate, and was therefore unique in both its severity and its high rate of World Health Organization transmission. Dr. Anarfi AsamoaBaah, Assistant Director General (Communicable Diseases for WHO) identified SARS at the time as the first disease whose spread was likely due to the effects of globalization. However, he assured WHO that previous methods of dealing with pandemics could be adopted to meet differing needs, and in June 2003,WHO held their first Global Conference on SARS in Kuala Lumpur, with the goal of creating an international scientific task force to combat SARS.As a result of this, in October of 2004, WHO released an official framework on risk assessment and preparedness entitled the SARS Risk Assessment and Preparedness Framework that was to be used at both the international and the national level. H1N1 The H1N1 virus, an influenza A subtype colloquially known as “swine flu” which broke out in 2009, forced WHO to retract their previous reporting and data requirements for infectious diseases.H1N1 could spread faster, when compared to most other viruses, in six weeks than most diseases could spread in six months. In 2009, WHO released a pandemic briefing stating that they would change the data needed for risk assessment. WHO issued nearly immediate consultations on restricting mass gatherings and shutting down classrooms? The result was that while these measures were effective on a local level, they were expensive and did not prevent transmission on a large scale. As well, issues of discrimination were present, and WHO began advising Member States that epidemiology should be their utmost priority above social and class separation concerns. Member States in East Asia found that encouraging citizens to wear masks in public areas prevented disease spread, and that communication was vital to ensure that key transportation routes and borders could remain open. CASE STUDY: Situation with MERS-CoV Currently, WHO is dealing with an emerging pandemic threat called Middle East Respiratory Syndrome Coronavirus (MERS-CoV), an avian flu that is spreading through the Middle East and Southern Europe with a fatality rate of 50%. At the time that this guide was written, MERS-CoV has been seen in 9 countries, with cases increasing. However, WHO has been utilizing their previously successful strategy of a secret Emergency Committee to combat the outbreak; and as it continues, they are consistently updating WHO with news and data. WHO is also emphasizing global communication and collaboration, and has a strong emphasis on preventative World Health Organization measures, as according to the new policies implemented during the AIDS and SARS pandemics. It is likely due to these preventative measures that on 17 July 2013, the Director-General of WHO has accepted the Emergency Committee’s assessment that the current MERSCoV situation is ‘serious and of great concern, but does not constitute a Public Health Emergency of International Concern (PHEIC) at this time.’. This, above all other successes, proves the effectiveness of the recent restructuring of WHO policies, in that their new preventative measures have essentially averted MERS-CoV from being classified as a pandemic at this time. Conclusion In conclusion, it is through the work of international subsidiary bodies under WHO, and through the recent global pandemics of HIV/AIDS, SARS, and H1N1 that WHO has been able to restructure their outbreak policies to ensure current and future pandemic-shutdown success. However, there are still areas left that are not addressed by the current policies that impede WHO from reaching full global success in combating pandemics and diseases, especially in social and political areas. These missing areas will need to be addressed in the immediate future with the increasing threat of a potential MERS-CoV pandemic in the Middle East currently proving to be of mounting concern for WHO. Moving forward, delegates should consider questions such as: How can exist flaws in the current international infrastructure are improved to aid in quicker response to potential outbreaks? What can be done to address the political and social issues affected by outbreaks, such as social stigma and political unrest? How can we encourage Member States to possess accountability for the Global Burden of Disease Project’s suggestions? How should we analyze WHO’s response to MERS-CoV, considering that it is a current outbreak? What can be done preemptively to aid in issues of low supply and high demand of vaccines during outbreaks? Although many aspects of this field have been addressed before, there are still challenges remaining in order to combat pandemic and resistant diseases. SUGGESTIONS FOR FURTHER RESEARCH The topic is vast and we have covered only a small portion of it so as to give you a starting point for research. It is definitely best to use online materials, the most recent publications and the speeches given by big personalities regarding your topic when you prepare for the conference. I will recommend you to divide the topic World Health Organization and take one area at a time to do the research. The advancements in our topic are ever evolving thanks to the high volume of research that the scientific community is currently conducting on the topic. Therefore, while it may be useful to consult older resources and books to learn about the history of the topic, you should use mostly recent materials to develop your nation’s current position on the issue. As you can see through the bibliography of this study guide, one of the best resources that will serve you over the next few months is the World Health Organization’s website. The WHO website contains a plethora of publications, web pages, and documents on this topic. While the sheer amount of information may be overwhelming, the WHO does a great job categorizing the information into topics like background, policy, projects, publications, partnerships, and links to further materials. Finally, I want to really emphasize that your job is to represent your country’s stake in this issue. This guide provides an overview of how this topic affects the world at large and how diverse the health concerns are globally. However, it is your responsibility to really explore how the topic is relevant to your nation and then report that to the committee during our conference. While you may be able to find all of the information through the Internet and online databases, you can also contact your nation’s health ministries and interview health officials if you are feeling brave! REQUIREMNTS OF A POSITION PAPER Your position paper must have your countries stand on the topic. It must one and a half page long with 3 distinct paragraphs, where in the first and second paragraphs build up to your third and final paragraph which should make the bulk of your paper. Your paper should be 14 point times new roman. With your name, country name, school, and topic area in the upper right hand corner. The first paragraph should talk about your country’s experience on regarding the topic. For example- Has your country ever faced a pandemic disease? What did it do to control it? So far has the research work strengthened? Does your country have a response team? If yes how strong is it? The second paragraph should discuss your nation’s policy on the issues, as supported by relevant national documents. This differs from the first paragraph because it should also include a short description of agreements, statements, and lessons World Health Organization learned from your history and choices in the past. You should also discuss your current diplomatic arrangements with relevant nations in this paragraph. Research for this paragraph could include speeches given by heads of state or ambassadors, or national studies and policy statements. The third paragraph, which is the most important, should be about what your country’s plan of going ahead especially in the matter discussed through your position paper (the topic). It should answer questions like- what is the best course of action for your country? What priorities does your country assign to different matters, and why? This paragraph should be a mixture of your past experiences, results and the most swiftest and effective method of addressing any pandemic breakouts. This paragraph includes facts as well as for power of creative ways to solve issues. Understanding your country, however, is important for creating a plan to undertake on an international level, and I highly encourage you to conduct your investigations and learning with vigor and curiosity. And of course absolutely do not hesitate to contact me with questions. CLOSING REMARKS Thank you very much for taking the time and effort to read through that material! While this guide has indeed explained some of the chief concerns, it has also shown how diverse these concerns can be. However, in my opinion, this represents the beauty of such a topic. There are no simple answers and no easy compromises. You will really have to delve deeply into the fundamental issues at stake and work together to make health a central element of climate change discussions, actions, and policies. I highly encourage you to research as much as you can about your nation’s role in this subject and how it interacts with the roles of other member states. There are countless reports and research materials ‘strengthening research and response preparedness to combat pandemic diseases’, so while you may not be able to get through it all, you should find the most relevant information for your country. By doing your share of the research, you will benefit us all during the conference and allow us to learn more about how the topic relates to different countries and situations. Additionally, being a good delegate not only requires a comprehensive understanding of your topic, but also a desire and willingness to negotiate and develop resolutions to these issues. If you truly treat ASMUN World Health Organization Dubai 2014 as an opportunity to assume the role of an ambassador, you will definitely broaden your perspective on the critical world health issues of our time and the challenges that accompany them. Ultimately, however, you should have fun with it! Although it is sometimes difficult to bridge conflicting viewpoints and foster compromise, I hope you take some enjoyment in the challenge. If you have any questions or concerns during the course of your research and studying, do not hesitate to contact me. Get ready for some awesome simulations, and aim to make the most of your weekend – after all, you only have two days to come up with a resolution! BIBLIOGRAPHY http://www.who.int/healthinfo/nationa lburdenofdiseasemanual.pdf http://cid.oxfordjournals.org/content/4 6/2/155.long http://cid.oxfordjournals.org/content/5 2/suppl_1/S8.full http://www.nmun.org/ny_committee_ guides.html http://emergency.cdc.gov/publications /jan09phprep/pdf/jan09phprep.pdf http://www.afro.who.int/index.php?op tion=com_docman&task=doc_downlo ad&gid=3762 http://csis.org/files/publication/10062 3_Nieburg_StengthenGlobalHealth_ Web.pdf http://www.who.int/csr/alertresponse/ shoc/en/ http://www.who.int/features/qa/05/en/ http://www.who.int/csr/resources/publ ications/WHO_CDS_2005_28en.pdf http://whqlibdoc.who.int/publications/ 2008/9789241580410_eng.pf http://www.who.int/csr/disease/swinef lu/frequently_asked_questions/pande mic/en/index.html http://www.globalphilanthropy.org/pdf/malaria.pdf http://whqlibdoc.who.int/publications/ 1983/9241580070.pdf http://www.who.int/csr/sars/country/t able2004_04_21/en/