Select Committee on Science and Technology Written Evidence

Memorandum by the World Health Organization (WHO)



  1.  Following the recognition of the threat of new and emerging infectious diseases, and serious global crises associated with epidemics such as plague in India (1994) and Ebola haemorrhagic fever in former Zaire (1995), the World Health Organization (WHO) created a specific department (now known as the Department of Communicable Disease Surveillance and Response, CSR) and new activities dedicated to surveillance, alert and response to epidemic-prone and emerging infectious diseases. The UK has been a strong supporter of this department from its initiation.

  2.  The work of CSR and the vital part played by the United Kingdom (UK) in this work is outlined below.


  3.  Throughout history, human populations have experienced major epidemics, often resulting in panic, political instability, disruption of trade and large numbers of deaths. While all communicable diseases have the potential to spread, it is the rapidity of spread of epidemic-prone diseases, the emergence of previously unknown pathogens and the high mortality rates in newly affected populations which have marked the human psyche and determined many of our social and political responses.

  4.  Global health security is threatened by the emergence of new or newly recognised pathogens, the resurgence of known infectious threats, and the possible intentional use of either of these in acts of terrorism. There is weak and patchy capacity to respond to these threats in a timely manner. The epidemiology and geographical distribution of infectious diseases, once thought to be relatively stable, have become subject to rapid, significant, and often unexpected changes. No country is safe. An outbreak anywhere in the world poses a threat to health security everywhere. This new reality has global implications which go well beyond matters of health and disease and underscores the vital need for nations to be more alert to the emergence of new diseases, and to be more proactive in containing them at an early stage, before a local epidemic becomes a global pandemic.

  5.  Over two-thirds of the emerging infections identified during the 1990s are thought to have originated in animals, both domestic and wild species. Some are believed to have emerged from animals living in tropical rainforests or elsewhere in close proximity to humans. Though intensive research has failed to disclose the origins of Marburg and Ebola haemorrhagic fever outbreaks, both are thought to have animal sources somewhere in the transmission cycle. Increased human mobility has also resulted in incursions into new or unfamiliar ecological zones, for economic reasons, research, or adventure. These activities contribute to the frequency with which diseases, previously confined to animals, can "jump the species barrier" to man. Man-made changes, such as deforestation, disrupt natural habitats and can force animals searching for food into closer contact with humans. For example, in 2000, the EcoChallenge sports event in the jungles and rivers of Malaysia, which drew over 300 athletes from 27 countries, resulted in the importation of leptospirosis to cities in three continents. Less exotic but more alarming are cases where diseases of domestic animals have entered human populations, with major implications for the food supply and huge costs for agriculture and trade.

  6.  One of the obvious consequences of globalisation of travel and trade is the creation of opportunities for the rapid international spread of epidemics. Transmission from continent to continent is no longer limited to ships, and the insects, animals, birds, and humans that travel on them. The number of international airline passengers has risen from two million in 1950 to over 1.4 billion a year today. This increase in mobility means that infectious agents can now travel during their incubation period in unsuspecting travellers and spread from continent to continent in a matter of hours.


  7.  Today, there is insufficient capacity in many countries to recognise disease events in a timely manner and to contain them. Even in developed countries, funding for the maintenance of systems of surveillance, alert and response is often challenged. Furthermore, there is the fear of costly repercussions for countries (such as trade or travel restrictions) if disease events are notified. WHO data show that new diseases emerge most frequently, and outbreaks occur most often, in poor nations or belts of poverty in industrialised nations, where prompt reporting is often impeded by lack of communications capacity. In some of these countries, expertise is weak, laboratories are poorly equipped for epidemiological studies and clinical diagnoses, and systems for the collection and analysis of epidemiological data are insufficient. Moreover, some epidemic-prone infectious agents are extremely difficult to handle; for example, of the haemorrhagic fever viruses currently identified, virtually all are classified as biosafety level four pathogens.


  8.  A strategic framework to address the threats posed by epidemics and emerging infections and to improve global health security was approved by the World Health Assembly in May 2001. The framework comprises three key objectives:

    —  containing known risks (eg influenza, meningitis, haemorrhagic fevers, smallpox, cholera);

    —  responding to the unexpected (eg outbreaks of natural or intentional origin, emerging infections); and

    —  improving both global and national preparedness (eg laboratory capacity strengthening, epidemiology training, improved communications systems).

  9.  The strategy builds on WHO's global public health mandate, under the umbrella of the International Health Regulations (currently under revision), exploiting WHO's political neutrality, public health focus and privileged access to Member States. It is supported by global partnerships. For example. over the past five years, WHO has worked with many partners including the UK and other countries in the G7 and the European Union, taking advantage of the technical excellence and unique experience of their institutions, to implement a series of essential activities aimed at ensuring global health security against epidemics and emerging diseases. A brief review of the WHO activities in the domain of global health security, and the critical role played by the UK follows.

Containing known risks

  10.  Epidemics and emerging infections are caused by a wide range of bacterial, viral and parasitic agents but, despite the emergence of newly recognised pathogens, the majority of epidemics are caused by known pathogens which, after detection, verification and immediate response, require disease-specific control strategies. Detailed and constantly updated understanding of specific disease trends through surveillance and research, and the implementation and evaluation of the control and prevention tools, are critical to detect epidemic "bursts" and build optimum containment strategies. The UK contributes to the work of WHO in containing known risks through specialist advice and facilities provided by the WHO Collaborating Centres based in and supported by the UK, through the participation of individual experts in WHO consultations and through the financial support provided by the UK Department for International Development (DFID).

Responding to the unexpected

  11.  Commencing in 1997, WHO put in place a system for rapid and systematic outbreak alert (intelligence, verification, and dissemination of information) and co-ordinated international response (field investigation, case finding/contact tracing, case management, vaccine supply, logistics and security support). From 1 January 1998 to 31 March 2002, 538 outbreaks of international concern were verified in 132 countries with a median duration to verification of one day. A total of 117 of these events involved Category A biological agents including eight events initially reported as smallpox and all refuted rapidly (eg the most recent rumour of smallpox in Pakistan was investigated and refuted within 24 hours). Other agents revealed through this process included viral haemorrhagic fevers (83), anthrax (13) plague (11), tularaemia (2) and botulism (1).

  12.  In April 2000, WHO established the Global Outbreak Alert and Response Network (GOARN) as a technical partnership of 110 institutions and other relevant networks that have come together to pool resources for epidemic containment. GOARN provides a global mechanism for the international co-ordination of response and has agreed "Guiding principles for International Outbreak Alert and Response" supported by detailed operational protocols under development in technical working groups and the Network Steering Committee. Recent examples of co-ordinated international responses include Ebola in Uganda, Gabon and Congo (550 cases detected and 7,500 contacts traced), urban yellow fever in Cóte d'Ivoire (2.8 million people vaccinated over a 10 day period) and influenza in Madagascar (initially reported as an unknown disease with high case fatality and rapid spread, later confirmed as influenza).

  13.  A number of UK institutions are active in the network including the PHLS Communicable Disease Surveillance Centre (CDSC), PHLS Central Public Health Laboratory (CPHL), Medical Emergency Relief International (MERLIN) and the Infectious Diseases Unit of North Manchester Hospital. UK physicians, epidemiologists and laboratory experts have been involved in supporting international outbreak responses including Ebola in Uganda and Gabon, Lassa fever in Sierra Leone, Congo Crimean Haemorrhagic Fever in Kosovo and most recently influenza in Madagascar. The PHLS is represented on the Steering Committee of the Network by Dr Angus Nicoll, Director of CDSC. Furthermore, DFID has provided significant funding in support of outbreak responses, notably for Ebola in Uganda and Gabon, and for meningitis in Burkina Faso and Ethiopia.

Improving preparedness

  14.  Throughout the development of the WHO strategy for global health security, significant gaps have been identified in global, regional and national infrastructure. Critically, these gaps are most profound in the areas of epidemiology and essential public health laboratory services. These gaps were also identified in the recent reports on global surveillance from the US General Accounting Office.

  15.  WHO's activities in assisting Member States to improve national preparedness for alert and response to epidemic-prone and emerging infections include:

    —  Assessment of national communicable disease surveillance systems (including early warning and response systems) to identify gaps, define priorities, and to identify areas of synergy for integrated disease surveillance;

    —  Assistance to countries to develop national plans of action to strengthen the above systems;

    —  Assistance to countries to implement these plans of action through training in field epidemiology, strengthening laboratory skills and infrastructure, providing specific technical advice, improving information technology skills and electronic communications, and promoting networking both nationally and internationally.

The International Health Regulations (IHR)

  16.  A regulatory framework for global health security activities is provided through the IHR and will be further strengthened by the revision of these regulations currently under way. The revised IHR will be based on the understanding that the best way to prevent international spread of diseases is to detect and contain them rapidly. International co-ordination is necessary since many countries may need assistance during serious disease events. The revised IHR will include a broader scope to include the notification of "public health emergencies of international concern"; a communications mechanism between affected countries and WHO to verify unofficially reported outbreaks; rapid international risk assessment and assistance; and maintenance of national core capacity for early warning and response.

  17.  The revision process involves the nomination of national focal points and a series of consultations with Member States; a process within which the UK has actively participated.


  18.  The globalisation of threats to health security mean that no country can ignore the international perspective. The goal is that the world is alert and ready to respond rapidly, both locally and globally, to epidemic-prone and emerging disease threats as and when they arise, be they natural or intentional in origin, minimising their impact on the health and economy of the world's populations. The UK already assists WHO in working towards this goal and in so doing improves its national health security as well as contributing to the improved surveillance, alert and response capacity in resource-poor countries. WHO would welcome proposals to strengthen the mechanisms by which such contributions can be facilitated.

October 2002

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