Visit to Geneva, 31 January, Principal
1. Baroness Finlay of Llandaff, Lord Rea
and Lord Soulsby of Swaffham Prior represented the Committee on
this visit. They were supported by Julius Weinberg, Specialist
Adviser and Rebecca Neal, Clerk of the Committee.
2. The Committee met Dr Gro Harlem Brundtland,
Director-General, Dr David Heymann, Executive Director, Communicable
Diseases, Dr G Rodier, Director, Communicable Disease Surveillance
and Response, Dr J Schlundt, Director, Food Safety Programme,
Dr G Moy, Food Safety Programme, Dr R Williams, Coordinator, Communicable
Disease Surveillance and Response, Dr C Dye, Coordinator, Tuberculosis
Monitoring and Evaluation, Dr T Boerma, Coordinator, HIV Surveillance,
Research and Monitoring and Evaluation, Dr K Stohr, Mapping and
Drug Resistance, Communicable Disease Surveillance and Response,
Dr P Braam, Strategy Development and Monitoring of Zoonoses, Foodborne
Diseases and Kinetoplastidae, and Mrs S Block Tyrrell, Coordinator,
Communicable Disease Communications, Media and External Relations.
United Kingdom support
3. The Committee heard that the UK provides
valuable technical aid to WHO, supporting 22 WHO Collaborating
Centres in specific communicable disease areas and five national
4. In April 2000, largely thanks to support
from the Department for International Development, WHO had developed
an international network of technical associates in order to collaborate
in alerting others to possible outbreaks and to respond to those
outbreaks: Global Outbreak and Response Network (GOARN). (http://www.who.int/emc/pdfs/network.pdf).
The Communicable Disease Surveillance Centre of the PHLS is a
member of GOARN.
5. GOARN established detailed standard operating
procedures and guidelines for how to verify and respond to an
outbreak and procedures for alerting others. It had been used
to control Ebola haemorrhagic fever in Gulu, Uganda (2000) and
Crimean-Congo haemorrhagic fever in Kosovo (2000); to investigate
febrile deaths of unknown cause in young adults in Bangladesh
(2001); and to prevent epidemics of yellow fever in Côte
6. This network placed as fundamental to
its success central coordination, engaging national and international
partners, an effective communication strategy and quick response
7. This network needed to recruit and retain
full time, highly motivated, and skilled experts. It also was
imperative that it could access short term aid from partners,
such as through laboratory support and experts on secondment.
8. A number of countries had made available
funds for this purpose, Centres for Disease Control in the US
for example had a budget dedicated to international work.
9. The UK did not have a formal means of
supporting GOARN's work in terms of financing short-term international
assignments. It was to be hoped that the Health Protection Agency
could encourage the Government to support and co-ordinate these
activities, perhaps through a single interface by which such contributions
could be facilitated. The Committee heard that the Department
for International Development had been supportive of World Health
Organisation capacity building in several areas.
10. If the UK were able to establish a fund/mechanism
for short-term international assignments, it would be able to
benefit even more from sharing resources with WHO through contributing
to international communicable disease control and therefore reducing
likelihood of outbreaks in the UK, providing experience and training
for staff and for developing networks and enhancing global communication
in this area.
International Health Regulations
11. There had been a long term failure in
the arena of public health to recognise the importance of the
World Trade Organisation and those international trade rules which
have an impact on health (for eg Codex Alimentarius).
12. WHO-CSR was coordinating the major revision
of the International Health Regulations (IHR), which currently
could only take into consideration plague, smallpox, cholera and
yellow fever, to make them more responsive to public health needs.
IHRs should make clear the duties of nation states to share information
when they identify infections which could have an impact on another
13. There was a need to coordinate across
different arenas: for example people involved in food quality
control should communicate with food retail sector and insurance
businesses. The food trade increasingly had a global outlook and
therefore ensuring food safety should also be considered as a
14. WHO hoped that the Health Protection
Agency would promote the importance of public health in relation
to trade and agriculture.
15. WHO organised twice yearly meetings
to decide upon the constituents of the vaccine needed to combat
likely influenza outbreaks in the near future.
16. Historically the UK, and NIMR and the
PHLS in particular, contributed significantly to influenza surveillance
and prevention. However this role was diminishing with, at present,
only two people working in the UK's global influenza lab. There
were much better resources now in CDC, Melbourne and Tokyo.
17. It was important to develop surveillance
of animals in order to predict potential problems in humans.
18. Surveillance and protection activities
should be linked rather than isolated activities.
19. WHO was increasingly using information
technology to identify possible communicable disease events.
20. There were a number of electronic discussion
groups, some of which had free and unrestricted subscription,
which were based on emerging infection problems or disease areas.
These sites either had an international scope (such as ProMed,
TravelMed), regional (such as PACNET in the Pacific region) or
a national scope (such as Sentiweb in France).
21. The Committee heard that the Global
Public Health Information Network (GPHIN) was an electronic surveillance
system which Health Canada developed and maintained in collaboration
with WHO. It had powerful search engines that actively trawled
the World Wide Web looking for reports of communicable diseases
and communicable disease syndromes in electronic discussion groups,
on news wires and elsewhere on the Web. GPHIN had begun to search
in English and French and would eventually expand to all official
languages of the World Health Organization. On a number of occasions
reports to this site had then been investigated and verified by
the local unit responsible for surveillance.
22. There was a global dearth of people
trained in epidemiology.
23. The World Health Organization, Centres
for Disease Control and Rockefeller had developed field epidemiology
training programmes which ran in a number of countries.
24. There was a European wide programme
in intervention epidemiology training being developed in Europe
which was part funded by the EU.
25. The World Health Organization had funded
and organised an initiative based in Lyons, which trained fifty
to fifty five people over two years in microbiology methods and
26. The London School of Hygiene and Tropical
Medicine was developing distance learning programmes in field
27. Key threats included effects of globalisation
and deliberate release.
28. It was important to:
(a) develop and sustain national health policies
to underpin international initiatives; and to
(b) strengthen public health, in particular
through surge capacity, and to increase collaborations between
defence and health.
29. The Committee met Mr Brunson McKinley,
Director General, Ms Irena Omelaniuk, Director of Migration Management
Services, Ms Mary Haour-Knipe, Senior Adviser on HIV/AIDS, Ms
Jill Helke, Special Assistant to the Director General.
30. The Committee heard that the International
Organization for Migration (IOM) had been established in 1951
to assure orderly migration of those in need of assistance. It
was an intergovernmental organization with over 150 offices worldwide
and 98 member states.
31. In its work on health and population
mobility, IOM provided pre-departure health assessment of migrants
through immunization, health promotion, counselling and treatment
32. TB needed to be tackled because a third
of the world's population was suffering from it. Migration Health
Services stated that, according to the Centre for Disease Control
and Prevention (CSC), 48 per cent of people with TB in the United
States were foreign born.
33. It was important that public health
programmes recognised the importance of migrants in communicable
disease control and considered them when developing systems and
carrying out forward planning: inclusion not exclusion.
34. In addition, IOM provides migration
health assistance and advice, including physical and mental health
and research and assistance to governments in formulating policies
on migration-related health issues. IOM believed that well-managed
national and community migration health could be a tool to facilitate
integration of migrants (immigrants and refugees) in host communities:
migrants in a state of physical and mental well-being will be
more receptive to education and employment.
35. The Committee heard that UNAIDS was
a joint project between various UN agencies, the International
Labour Organisation (ILO), the World Health Organization (WHO)
and the World Bank. It aimed to prevent transmission of HIV and
to care and support those with HIV/AIDS.
36. AIDS surveillance was not well integrated
into surveillance systems. It was difficult to ascertain what
information was relevant to collect.
37. UK was relatively good at surveillance
and treating HIV/AIDS. However the patient group was changing
which would demand different approaches. There were now more cases
in foreign born individuals rather than in the gay community and
in IV drug users.
38. It was possible to carry out surveillance
on an anonymous basis but this raised the ethical consideration
whereby people could be found to be HIV+ but it would not be possible
to trace them and offer them treatment.
39. In some areas of the world it was common
that the existence of HIV/AIDS was denied. This had prevented
opportunities for developing effective surveillance, prevention
and treatment activity and therefore increased suffering and the