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

Introduction

As a result of 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. This report describes this strategic framework and relates an intercountry meeting organised by the WHO end 2018 to apply more specifically this global approach to the Eastern Mediterranean Region.

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

The major risk factors for the transmission of 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, environmental factors contribute to the increased frequency and severity of outbreaks in the Region especially in poor urban slum areas.

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.

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

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 framework covers 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. It contains a set of evidence-informed best practices and disease-specific interventions for prevention and control of priority emerging diseases in the Region.

Two key documents were reviewed, finalized and adopted:

• 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.

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

Among the 13 recommendations which are made:

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 the WHO:

1. 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;
2. 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;
3. 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;
4. Support Member States with regular progress review and evaluation meetings including external evaluations of the implementation status of the strategic framework.

4. 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;
• For influenza, a global strategy for 2019–2030 has been developed that would improve coordination of global research and build country capacity;
• 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;
• For rabies, a “One Health approach” is the key to address this threat effectively and efficiently. Rabies causes the death of 59 000 people annually in the Region;
• 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.

5. Why a specific meeting of the WHO for the Eastern Mediterranean Region?

The countries in the 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 this Region 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.

End 2018, the WHO held a meeting with representatives of the ministries of health from 21 countries of this Region with the aim to promote evidence-based interventions, guidance and best practices for control and elimination of infectious diseases. The main issues of concern included 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.

6. What was more specifically discussed in this meeting for the Eastern Mediterranean Region?

To ensure support for the framework and obtain feedback from key stakeholders in this Region, the meeting reviewed:

1. The strategic framework for prevention and control of emerging and epidemic-prone diseases in the Eastern Mediterranean Region;
2. The current and past threats from emerging and reemerging diseases with epidemic potential that are prevalent in the Region;
3. The underlying reasons and risk factors specific to the Region;
4. The principles and strategic directions of a disease-specific elimination and control programme for the control and elimination of epidemic prone diseases that are specific to the Region;
5. The implementation plan for the framework, including a monitoring mechanism to assess progress over time.

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.