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Health security under the International Health Regulations

Health security under the International Health Regulations. Polio eradication progress 1988 - 2003. 2003 784 children 6 countries Equitable access to polio vaccine . 1988 350 000 children 125 countries Inequitable access to polio vaccine. Type 2 wild poliovirus last transmitted in 1999.

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Health security under the International Health Regulations

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  1. Health security under the International Health Regulations

  2. Polio eradication progress1988 - 2003 2003784 children6 countries Equitable access to polio vaccine 1988350 000 children 125 countries Inequitable access to polio vaccine Type 2 wild poliovirus last transmitted in 1999

  3. Challenge: suspension of polio immunization, Nigeria, August 2003 Polio Vaccines - Western Countries Exploit Developing Ones Says Kano State Governor ShekarauBYLINE: Daily TrustBODY:The Kano State governor, Malam Ibrahim Shekarau, has asserted that the people's objection to polio vaccines has confirmed that polio vaccination is damaging to young girls.

  4. International spread of polio from Nigeria, 2003-2005 Wild virus type 1 6 polio endemic countries 18 countries with imported virus Wild virus type 3

  5. Points for discussion • What are the international mechanisms that would help manage this situation? • Are there any other types of activity necessary?

  6. Vaccine safety • Testing of vaccines in Nigerian programme for presence of impurities/hormones: WHO Collaborating Centre South Africa and India • Provision of polio vaccines manufactured in an Islamic country • Personal discussions with governor of Kano and eventual decision to convene expert group of state paediatricians

  7. Political Advocacy for Polio 10th Islamic Summit Polio Resolution, Malaysia, 2003 Islamic Conference of Foreign Ministers Meeting Polio Resolutions (Turkey 2004, Pakistan 2007) 3rd Extraordinary Islamic Summit, Mecca, 2005 'Noting OIC countries now suffer the greatest burden of polio, call for political & financial support of OIC member states to finish eradication'

  8. Religious Advocacy for Polio Rulings & Fatwas on the need and safety of polio vaccines: • the Grand Imam of El Azhar Al Sharif, • International Union for Moslem Scholars • The Mufti of Egypt • Mawlana Fazul Rahman • The Islamic Fiqh Academy - Jeddah • Dr Y. Al Qaradawi, European Council for Fatwa and Research. Visit of Imam Cheik Cisse to northern Nigeria.

  9. Weekly epidemiological record6 AUGUST, 2004 The international spread of wild poliovirus On 30 June 2004, WHO highlighted an increasing risk of international spread of wild poliovirus1 and updated its advice for travelers on steps they could take to increase their personal protection against wild poliovirus. Subsequently, on 16 July 2004, an*Ad Hoc Expert Consultative Group on Polio and Public Health was convened by the Director-General of WHO to discuss potential measures to prevent or limit the international spread of wild poliovirus.

  10. Standing recommendation, International Health Regulations (2005) Evidence that booster dose of vaccine decreases time of wild virus carriage

  11. World Health Assembly • Resolution on polio eradication 1998 • Resolutions on continued/strengthened effort in remaining endemic countries • 2004 • 2006 • 2007 • 2008

  12. Avian inlufenza: a major risk to public health security 1918: Spanish Flu (H1N1) 1957: Asian Flu (H2N2) 1968: Hong Kong Flu (H3N2) 20-40 million deaths ~ 2.5 million deaths ~1 million deaths

  13. WHO influenza surveillance network: collective action to reduce vulnerability to influenza 115 national influenza centres WHO Collaborating Centres 1 laboratory > 1 laboratory national network

  14. Current Level of WHO Pandemic Alert

  15. Rapid containment response, early phase 4 pandemic alert • Interrupt transmission from human to human/prevent further spread: ring containment • Early detection and response • Prevention of human to human transmission using anti-viral drugs • Prevention of human to human transmission by vaccination using H5N1 vaccine

  16. Vaccines and antiviral drugs for H5N1 and pandemic influenza • Antiviral drugs • Production now exceeds demand • Market skewed towards industrialized countries • Some developing countries produce oseltamivir; few maintain stockpiles • H5N1 and Pandemic vaccine • Production capacity limited to 1.5 billion doses/six months for production • Market skewed towards industrialized countries • No developing countries produce influenza vaccines; few maintain stockpiles

  17. Minister of Health, Indonesia and H5N1 virus sharing: link sharing to more equitable benefits Indonesia Stands Firm In Bird Flu Virus Samples Row With WHOJAKARTA (AP)--Indonesia insisted Tuesday that it will only resume sharing bird flu virus samples with the World Health Organization if the body stops providing them to commercial vaccine makers. The defiant comments by Health Minister Siti Fadiliah Supari came as top WHO officials met with Indonesian counterparts and other global health chiefs in Jakarta to try to persuade the country to resume sharing its samples.

  18. Points for discussion • What are the international mechanisms that would help manage this situation? • Are there any other types of activity necessary?

  19. Meeting summary, Jakarta meeting on sharing in the benefits of virus sharing, March 2007 Types of benefits anticipated, developing countries: • Strengthening core laboratory capacities so that more developing country laboratories can qualify for WHO designation • Ensuring access to H5N1 and other potential pandemic influenza vaccines • Developing more transparent virus handling procedures so that location of any shared virus can be known in real time • Linking of virus sharing and vaccine production to sustained benefits

  20. Global Action Plan for Influenza Vaccines • Request for proposals from developing country vaccine manufacturers for technology transfer • 11 proposals received/reviewed • Initial grants (up to US $2.5 million each) to six manufacturers: • Brazil • India • Indonesia • Mexico • Thailand • Viet Nam

  21. Stockpiles for broader access toH5N1 and pandemic influenza vaccine vaccine • Meeting with manufacturers and possible donor countries, April 2007 • Individual meetings, Director General/CEOs of vaccine manufacturers, April - May 2007 • Announcement of H5N1 stockpile development, Pacific Health Summit, June 2007 (for rapid response and essential populations should H5N1 show pandemic changes) • Mechanism for procurement of pandemic vaccine being developed: conceptual phase

  22. Strengthening developing country capacity to participate globally • H5 reference laboratories established and certified: China, Indonesia, Brazil • H5N1 WHO Collaborating Centres being established: China, India Brazil • Regular training in laboratory and epidemiology including rapid response to early Phase 4 event

  23. Sharing of benefits: some of the requirements identified • Sustainability • Transparency • Bilateral versus multilateral

  24. World Health Assembly: sharing of influenza viruses and benefits • Resolution 2007: Intergovernmental process to ensure access to vaccine and other benefits • Initial intergovernmental working group meeting November 2007 • Open-ended working group meeting March 2008 • Open-ended working group meeting followed by intergovernmental meeting planned November 2008

  25. Pandemic influenza control 1918 International Health Regulations (2005): collective action for global public health security

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