Health Security
World Health Day on 7 April marks the founding of the World Health Organization (WHO). This year's theme is international health security. The aim of the Day is to urge governments, organizations and businesses to "Invest in health, build a safer future" (www.who.int/world-health-day/2007/en/index.html).
WHO mechanisms supporting Outbreak Alert and Response [4]
Global Public Health Intelligence Network
The Global Public Health Intelligence Network (GPHIN) was introduced in 1997 as a customized search engine that continuously scans open web sites, in six languages, for rumours and reports of suspicious disease events. GPHIN systematically searches for key words in over 950 news feeds and electronic discussion groups around the world. Human review and computerized text mining are used to filter, organize and classify the more than 18,000 items it picks up every day, of which around 200 merit further analysis by WHO. Over the past ten years, 40-50% of initial alerts to outbreaks, subsequently investigated by WHO, came from the media and other non-official sources.
Global Outbreak Alert and Response Network
The Global Outbreak Alert and Response Network (GOARN) was set up in early 2000 to ensure that a “strike force” of specialized staff and technical resources could be rapidly assembled and deployed for emergency investigations and on-the-spot assistance. This network currently interlinks, in real time, 120 existing networks and institutes which together possess much of the data, laboratory capacity, specialized skills, and experienced personnel needed to keep the level of international preparedness high. The Network formally complements GPHIN’s “artificial intelligence” as a first-hand human source of early information about outbreaks.
Networking WHO country offices
A new system of electronic communications was also set up to make better use of a unique geographical and strategic resource: WHO’s 141 country offices, concentrated in the developing world and located within or in close proximity to ministries of health. Although the size of these offices varies according to the disease situation in the country concerned, all offices are staffed with medical experts and often with epidemiologists, and all have the essential logistic equipment, including vehicles and local communications, needed for prompt on-the-scene investigation of outbreaks. During outbreak response, these offices facilitate the arrival of international staff by arranging flights, customs and immigration clearance, and accommodation.
International Health Regulations (2005)
In May 2005, the 192 member states of WHO unanimously adopted a significantly revised and modernized version of the International Health Regulations (IHR 2005), which constitute the only legal framework governing the reporting of outbreaks and prevention of their international spread. The revised regulations recognize that the infectious disease threat has grown in terms of both the number of diseases that need to be watched very closely and the risk that more new diseases will emerge. Scope has been expanded accordingly, and now encompasses all public health emergencies of international concern, including those caused by chemical agents and radionuclear materials. Secondly, reporting requirements and timeframes have been tightened, reflecting the heightened sense of urgency and the greater speed allowed by electronic communications. Thirdly, procedures have been put in place to compensate for weak detection and response capacities in many countries. The kinds of support offered by GOARN response teams are fully recognized. The regulations further acknowledge that strengthened national capacities are the best solution, as they aim to detect and stop an outbreak at the source; core capacity requirements for surveillance and response in individual countries are set out in an annex. The regulations also recognize that media reports may pre-empt official notification of an event, and include provisions for WHO actions in such a situation. Finally, by assigning responsibilities and establishing internationally agreed rules and procedures, the regulations can exert pressure on nations that fail to comply. IHR (2005) will come into force in June 2007.
[4] Adapted from Rodier G, Kindhauser MK (2006). Global health security: the WHO response to outbreaks past and future. Copenhagen, WHO Regional Office for Europe (unpublished), in Making Preparation Count: Lessons learned from the avian influenza outbreak in Turkey (WHO Regional Office for Europe, 2006) (written by WHCA for WHO Euro).