The WHO strategic framework for prevention and control of emerging and epidemic-prone diseases

Introduction

As a result of these recurring epidemic threats, WHO has taken steps to strengthen regional and national capacity to detect, verify and control emerging infectious diseases with epidemic and pandemic potential through the development of an integrated strategic framework for prevention and control of emerging and epidemic-prone diseases.

1. What are the major risk factors for the transmission of communicable diseases?

Infectious diseases and complex emergencies continue to remain major causes of high morbidity and mortality among vulnerable populations.

The major risk factors for the transmission of these communicable diseases include population movement, disruption of routine public health services, impeded access to health care, damage to safe water and sanitation infrastructure, overcrowding, and disrupted surveillance systems.

In addition, coupled with human population movements and rapid urbanization, especially in poor urban slum areas, other environmental factors contribute to the increased frequency and severity of outbreaks in the Region and affect the survival, reproduction and distribution of high threat pathogens, as well as their vectors and hosts.

Further, gaps in preparedness and response to these emergencies are exacerbated by knowledge gaps, for example on the transmission mechanisms of pathogens, genetic diversity and its impact, and the causes of under- and non-reporting.

Major epidemics outbreaks from emerging infectious disease with the potential for global spread
Those observed in at least 11 of the 22 countries in the Eastern Mediteranean Region Yellow fever in Sudan (2005 and 2012), Rift Valley fever in Sudan (2007), Monkeypox in Sudan (2005), Crimean–Congo haemorrhagic fever in Afghanistan (2010, 2016, 2017) and Pakistan (2010, 2016, 2017), Dengue fever in Yemen, Sudan and Pakistan (2012–2017), Chikungunya fever in Yemen (2010–2011) and Pakistan (2017), Cholera in Iraq (2007, 2008, 2012, 2015), Somalia (2007, 2010, 2015, 2016, 2017–2018) and Yemen (2016–2018). Middle East respiratory syndrome coronavirus (MERS-CoV), and its continuing transmission (since 2012) in Bahrain, Kuwait, Oman, Saudi Arabia, Qatar, and United Arab Emirates, Avian influenza A(H5N1) human infections in Egypt, a novel influenza virus with pandemic potential, currently pose two of the biggest threats to global health security.

2. What are the purpose and objective of the WHO strategic framework?

The framework, reviewed according to a country and regional context and endorsed by country representatives, will cover all emerging and re-emerging diseases with epidemic potential that are prevalent in a Region or have been reported in a Region in the past.

The framework outlines a roadmap for enhancing the capacity of the Member States to prevent, forecast, early detect and respond to epidemics and other emerging health threats. The document contains a set of evidence-informed best practices and disease-specific interventions for prevention and control of priority emerging diseases in a Region. This would be performed through strengthening inter-and intra-sectoral coordination mechanisms, disease surveillance, laboratory diagnostic capacities, case management, infection control, social mobilization, and other key components.

3. What about the WHO framework documents?

The framework is instrumental in moving a Region towards a future in which all Member States are equipped to prevent, prepare for, control, and respond to any and all outbreaks of epidemic- and pandemic-prone diseases.

Two key documents were reviewed, finalized and adopted during the meeting:

• The One Health framework for action;
• The strategic framework for prevention and control of emerging and epidemic-prone diseases specifically in the Eastern Mediterranean Region.

Participants spoke about various issues of concern, including a need for stronger preparedness and surveillance, enhanced vaccination and Water, Sanitation and Hygiene (WASH) programming, greater overall health investment, attention to antimicrobial resistance, and the importance of political will and funding support.

4. What are the main recommendations made by WHO to prevent epidemic diseases?

To Member States:

1. Adapt and operationalize the strategic framework to the national level and context, including by adding country-specific outcome and impact indicators;
2. Draft and share a list of national activities requiring WHO support;
3. Monitor, evaluate and regularly report to WHO on the implementation status of the strategic framework using a feasible time frame.

To WHO:

• Finalize the strategic framework based on the comments provided by the participants of the intercountry meeting, along with a built-in monitoring framework for measuring progress of implementation of the framework over time;
• Develop a baseline and targets for each of the indicators set for monitoring the progress of implementation of the strategic framework in consultation with Member States, and embed these in the framework;
• Develop standardized tools for the implementation of self assessment by Member States and share best practices, data and analysis on outbreaks, response and control activities;
• Support Member States with regular progress review and evaluation meetings including external evaluations of the implementation status of the strategic framework.

5. What are examples of specific global roadmaps for the prevention and control of emerging and epidemic-prone diseases?

Global roadmaps for the prevention and control of epidemic disease are already established for various cases:

For ending cholera, a recent global roadmap details measures that will help eliminate 90% of cholera infections by 2030 and full elimination in up to 20 countries. The Global Task Force on Cholera Control is confident that using existing and proven measures to prevent and treat cholera, and by focusing on so-called cholera hotspots make this goal realistic goal.

For influenza, a global strategy for 2019–2030 has been developed that will improve coordination of global research and build country capacity. The WHO Global Influenza Surveillance and Response System (GISRS) was also discussed, particularly how to avoid overload of the system. Annually there are approximately 1 billion cases of seasonal influenza, 3–5 million severe cases, and 290 000–650 000 influenza-related respiratory deaths. in the past century, four pandemics have each caused the loss of 0.5–4.8% of global GDP.

To eliminate yellow fever epidemics, the Global Strategy includes three key strategic objectives to protect at-risk populations, prevent international spread, and contain outbreaks rapidly. A global coalition of countries and partners to address its increased risk of epidemics is focusing on the 40 countries which are most vulnerable to outbreaks, 27 of which are in the WHO African Region). The strategy.

For rabies, a “One Health approach” is the key to addressing this threat effectively and efficiently. Rabies causes the death of 59 000 people annually, the vast majority from dog-mediated rabies.

For MERS-CoV and other emerging zoonotic respiratory pathogens, a list of priority public health strategies and best practices, knowledge gaps and research agenda, and opportunities to prevent or control it was presented including public health priorities for improved preparedness and readiness.

For the control of vector-borne diseases, a Global Vector Control Response, was discussed including available tools and strategies for the prevention, control and opportunities to reduce the burden and threat of arboviral diseases.

6. Why a WHO meeting specific to the Eastern Mediterranean Region?

The countries in the WHO Eastern Mediterranean Region continue to be hotspots for emerging and re-emerging diseases, including infectious disease outbreaks, which have a significant impact on health and economic development in the Region.

Over the past decade, the public health landscape of the Region has rapidly changed, as is evident from its vulnerability to repeated outbreaks from emerging infectious diseases. At least 11 of the 22 countries in the Region have reported major epidemics from emerging infectious disease with the potential for global spread.

With the aim to promote evidence-based interventions, guidance and best practices for control and elimination of infectious diseases, the World Health Organisation (WHO) held a meeting in December 2018 with representatives of the ministries of health from 21 countries of the Region which has completed a systematic review of all prevailing health threats in the Mediterranean Region, risk factors for propagating disease transmission, and inhibiting factors for disease control and elimination.

7. What was the outcome of the meeting which were more specific to the Region?

The strategic direction for universal health coverage in the Region in the context of emergencies was discussed, and the elements of health system resilience in complex emergencies, the linkage between universal health coverage and the Sustainable Development Goals of the United Nations, and ways to strengthen universal health coverage outlined.

To ensure support for the framework and obtain feedback from key stakeholders, the meeting’s objectives were:

1. To review and finalize the strategic framework for prevention and control of emerging and epidemic-prone diseases in the Eastern Mediterranean Region;
2. To assess and map current and past threats from emerging and reemerging diseases with epidemic potential that are prevalent in the Region;
3. To better understand the underlying reasons and risk factors for commonly prevalent emerging and epidemic-prone diseases that are specific to the Region;
4. To discuss and agree on the disease-specific elimination and control programme through understanding evidence-informed interventions and their effectiveness for the control and elimination of epidemic prone diseases targeted for control or elimination;
5. To review and finalize the principles and strategic directions for prevention and control of emerging and re-emerging diseases that are specific to the Region;
6. To agree on an implementation plan for the framework, including a monitoring mechanism to assess progress over time.

At the end, the participants’ understanding of underlying causes and risk factors for common pathogens in the Region was improved, based on the latest scientific and operational research, and the expertise that was shared.