Examination of Witnesses (Questions 505
- 519)
MONDAY 21 APRIL 2008
Dr David Heymann, Dr Paul Gully, Mr Pat Drury and
Dr Max Hardiman
Q505 Chairman:
Welcome to the Intergovernmental Organisations Select Committee.
We are very pleased to have you here and very grateful for the
written evidence you have already given. The Clerk has already
suggested to you that we are going to split this into two one-hour
sessions. The bad news is that there is not a break in-between!
We will go from organisational structure mode into the local outbreak
alert issues. Perhaps I could start, as someone said to me last
night, by wishing the World Health Organisation a happy birthday
as of a week or two ago. It is a good time to review one's life's
progress so far. I did the same at 60 and I am still here, so
there must be something going for it! The purpose today is to
look at the way in which, from the British perspective, the British
Government uses its funds in intergovernmental organisations,
in this case the World Health Organisation, in order to combat
these diseases. As I indicated, for the first hour I am particularly
interested in looking at the strategy, structure and organisation
of the WHO, and in the second hour some of the application, if
you like, although there will not be an absolute division. I would
very much like to invite any of the witnesses to chip in when
you feel you have something useful to say. At the end of this
session in a few days' time, it might be longer than that, you
will get a transcript of the evidence and will have an opportunity
to look at that and correct it before it is published in its final
form. Again, if you feel there is anything we have not covered
that we should have covered, or anything that needs clarifying,
then do not hesitate to write to the clerk. The whole purpose
of this is to understand rather better than we do at the moment
how the system is functioning, where the problems and the possibilities
are, and to move forward. Perhaps I should start by asking each
of you to very briefly introduce your roles within the organisation.
I think that would help us, if you do not mind.
Dr Heymann: My name is David Heymann. I am the
Assistant Director-General for Health Security in the Environment
and the representative of the Director-General for Polio Eradication.
Dr Gully: My name is Paul Gully. I am a Senior
Adviser to Dr Heymann in his office. I am actually seconded from
the Public Health Agency of Canada and have been in WHO for the
last two years.
Mr Drury: My name is Pat Drury. I work in the
Department of Epidemic and Pandemic Alert Response, which is under
David's chapeau. The Department is responsible for managing
epidemic risks across the spectrum of all diseases, except for
the big three. I work in a team called Alert and Response Operations,
in which I manage the Global Outbreak Alert and Response Network.
Dr Hardiman: My name is Max Hardiman. I work
in the programme on the International Health Regulations, which
is under David Heymann. My role is Coordinator of the International
Health Regulations Secretariat, which is one of the teams within
that programme.
Q506 Chairman:
Thank you very much indeed. Perhaps I could start the questions
with this overall strategy one and on the organisation of the
WHO. I think everyone accepts that the diseases we face now are
particularly serious, particularly difficult and on a global scale
because of other changes that have happened in the world generally.
I particularly want to know how you see your strategy. One of
the areas of interest to us is this problem of our health structure
within nations and within areas of the world, and it is often
lacking particularly in areas of Africa, say, and the issue of
vertical treatment of diseases. We are conscious that you have
many organisations putting a lot of money into these diseases
but often there are not the health structures within the country.
My first question is very much on your strategy. What strategy
do you have in view of the conflicting interests of these various
groups, and there are a lot of them in our understanding?
Dr Heymann: Thank you. If I might start off
by just thanking the United Kingdom for the strong support that
it has given to WHO. We are all very grateful for that support
in many different areas. To address what many people like to talk
about as the vertical and the horizontal programmes, the strengthening
of health systems versus the vertical programmes which concentrate
on a specific disease, the easiest answer to give is that if a
vertical programme is functioning properly, it will be horizontal
in its nature and will permit other programmes to follow on. I
will give you a good example: tuberculosis. Tuberculosis requires
community action to provide supervised treatment to patients.
If that can be accomplished for tuberculosis, that same system
can be used for HIV treatment and a whole series of other interventions.
Vertical programmes, if they are implemented properly, will end
up in a strengthening of the health system to get the goods to
the people. Vertical programmes can also strengthen disease surveillance
or detection systems. The example of that is the Polio Eradication
Initiative, which has a surveillance system which comprises over
3,000 health officers throughout the world who have real-time
communications and at the same time have transport and fuel. They
are constantly identifying foci of polio and reporting. This network
is a vertical network supported by the Polio Eradication Initiative,
but we have now begun to broaden it to include Yellow Fever in
Africa, the haemorrhagic fevers in Africa, and to include measles,
other immunisable diseases worldwide and a whole series of other
interventions to make this vertical programme more horizontal.
Both in surveillance and response, vertical programmes can lead
to a horizontal strengthening of the infrastructure. In order
that these systems can work properly there must be the correct
health system environment in a country that develops the funding
and other policies which will permit sustainability of that health
system, and a whole series of other policies to make sure that
what is occurring occurs in an integrated matter. No matter how
vertical a programme is, either from the centre, the government,
or from a region, when it gets to the peripheral areas it must
be horizontal by necessity because there are only one or two people
who can implement those programmes there. I will call on my colleagues
if there are any other comments.
Mr Drury: In terms of explaining a bit of the
operational glue that we are putting in place as well, the Alert
Response Operations Team in Geneva runs a series of activities
which are about using all sources of information to identify what
we call "events", that is a spike, and some news story
or some incident of interest to us, and then puts that through
a process of risk assessment, and out of that risk assessment
we make recommendations for the country to take action and for
WHO and its partners to take action. That is a system and a process
which has been in place for ten or 15 years since David took over
what was then the new Department of Emerging Diseases in WHO.
It is now governed legally by the International Health Regulations
and it is a major challenge for us to take it forward to the next
step. We hook in on a daily basis to the Global Polio Network.
So, if there is an incident in Angola, where we know there are
polio people on the ground, we will be in touch with them for
information about what is happening so that we can inform the
risk assessment.
Q507 Chairman:
The answers you have given suggest a slight blurring of the line
between vertical and horizontal in a way that we have not quite
heard from other people. What strikes me is that, in order to
pull that together, you need a very strong central body. Is WHO
that strong central body given that you are dealing with groups
that are profoundly well-funded, better funded than you are in
a sense? I am not quite sure that you are going to be able to
manage this. Can you tell me a bit more about what you think about
that?
Dr Heymann: Let me just give a brief reply and
then I will call on Paul Gully. WHO is many times at the whim
of its investors and funders, and many countries prefer to fund
vertical programmes, others prefer horizontal programmes. We must
do what those countries request us to do because they are our
Member Countries and they decide how we will function. With a
very small budget that comes in from our assessed contributions
to countries we are required to take extra budgetary resources.
For example, from the United States it is very seldom that they
will invest in infrastructure or a system. What they will invest
in is diseases because that is what their Congress is used to
funding in a vertical manner. Paul may want to say something about
this as well.
Dr Gully: What I was going to say in reference
to your point was that there has now been reference to diagonal
processes, a combination of vertical and horizontal. The promotion
of health system strengthening, vertical, as opposed to polio,
HIV, TB programmes, horizontal, and primary healthcare could be
used as an example. The health system strengthening is there to
ensure that, if there are vertical programmes and you want to
promote them horizontally, then you have got an infrastructure
in the health system which can then carry out those programmes
and not just those vertical programmes. It has been described
as something which pulls them together. The G8 meeting this year
under the chair of Japan is promoting that concept of health system
strengthening, and now in WHO there is an Assistant Director General
with responsibility for health system strengthening to try and
pull them both together. In terms of the other players, WHO is
often on the frontline, and I will use the recent example of H5N1
in Pakistan, where we used the infrastructure which is in Pakistan
for polio eradication in order to be able to investigate and respond
there. The other main players, the funders and so on, are not
there to do that, they are not there at the frontline and, in
fact, I do not think they would regard it as being their responsibility.
In order for those kinds of interventions to take place, which
are going to be an inevitable reflection of new and emerging diseases,
WHO has to be there, but that strengthened health system has to
be there as well in order to be able to make it better, improve
it and then make those responses more rapid on the ground.
Q508 Chairman:
Before I bring my colleagues in, it is an interventionist role
that you are describing in what we might call the horizontal health
system. That requires funding and also raises questions about
what happens to the government in the country that is also trying
to structure it and presumably not always welcomes this intervention.
What is your response to that?
Dr Gully: WHO does not enter into a country
without being invited by the government of that Member State.
I think one could draw parallels to that in the way that an operation
such as the Health Protection Agency in the UK or CDC in the US
or the Public Health Agency in Canada work internally, that you
do not go into a jurisdiction that has responsibility for health
without being invited. However, having said that, the country
representatives in those countries, such as Pakistan for example,
will be there promoting working together with the government of
the Member State to try and sell the advantages of that intervention.
Often where it becomes difficult is if we want to encourage intervention
not just in the health sector but perhaps in the agricultural
sector and other sectors as well. Often that is not helped by
a lack of intersectoral collaboration within the country itself.
We do not go in without being invited but we can be there promoting
that. Often health is more likely to be invited than perhaps other
sectors, such as agriculture. On numerous occasions there have
been illustrations of where those invitations have been extended.
For example, the Government of Madagascar on Rift Valley fever,
both from the health and agricultural side, has extended an invitation
to investigate that as of Wednesday this week.
Q509 Lord Avebury:
I was interested to hear what you said about the Assistant Director
being responsible for health system strengthening, particularly
in the light of what Dr Chan said about countries needing a primary
healthcare basis to deliver relevant services. You said earlier
that the organisation was constrained to a large extent by the
voluntary funding. But would there not be very strong support
in developing countries for assistance with the financing of their
health services if that was something that WHO was prepared to
provide?
Dr Gully: I think that is correct. The challenge
is that countries often do not come forward and say generically,
"We wish to support health system strengthening". This
goes to the collaboration within countries too, because often
there you have a development agency, a department of health, a
department of foreign affairs or equivalent, and they do not necessarily
reflect a unified policy within a country. So, whereas one might
be in favour of that, another might not be. This comes down to
how individual government policy is manifest. Often there is a
wish to be much more precise and say health system strengthening.
I think you are right, countries would welcome it, but it is not
necessarily there. The other point I might make is that often
countries do offer support in areas in which they are strong and
often developed countries are strong in healthcare delivery as
opposed to public health per se and, therefore, what they might
offer specifically might be less enabling for that health system
strengthening across the board than perhaps might be needed.
Q510 Lord Howarth of Newport:
I would like to ask you to talk about questions of synergy. If
you look at an organogram of the different international intergovernmental
organisations in the health field, you see a mass of organisations
interlocking, overlapping, independent, and the world looks, fairly
or unfairly, to the WHO to achieve a strategic vision to bring
in some coherence, some coordination. It would be interesting
to us if you could talk a little bit about how this works, where
your successes are achieved, what the key has been to achieving
success, and equally where the deficiencies are. You say in your
excellent evidence to us that there is a strong level of synergy
between the various organisations concerned with disease control
but you also acknowledge that the synergy is not complete. Where
it works well, why does it work well? Where it does not work well,
why does it not work well?
Dr Heymann: I will start with that and pass
it to others. The Polio Eradication Partnership is a very good
example of a partnership that brings together four principal actors
in polio eradication and it succeeds because each of those actors
has found and adheres to its comparative advantage. In the Polio
Eradication Initiative, the World Health Organisation is responsible
for setting the norms and standards in global policy and providing
technical support to governments to develop the appropriate responses
to polio. UNICEF provides all the vaccines necessary and at the
same time works on social mobilisation in countries and with countries.
Rotary International advocates internationally, and if any of
you are Rotarians you will know that it is a very important role.
Not only do they advocate internationally, but they advocate in
countries like the United States, where they ensure each year
that there is a significant contribution to the Polio Eradication
Initiative, as they do in the United Kingdom, in Sweden and in
many other countries. The Polio Eradication partners are WHO,
UNICEF and Rotary, they have each found their comparative advantage
and stick to it, and CDC, the Center for Disease Control in Atlanta,
where I come from, is a technical partner that provides technical
support to countries through provision of staff to work on certain
issues mainly involved in surveillance, monitoring and evaluation.
Each partner sticks to its specific role and all four partners
together mobilise resources, and to date have mobilised over US$5.5
billion for polio eradication. The United Kingdom has been one
of the very important partners in that financial partnership.
Another partnership that has begun is the—
Q511 Lord Howarth of Newport:
Just before you move on to that, can I ask you how is that excellent
orchestration achieved? And is the WHO the leader in coordination?
Dr Heymann: Yes, the WHO is the leader in that.
This is achieved by weekly telephone calls with the four partners.
There has never been a formal governance mechanism set up, it
has been purely by the will of these four partners to talk together
once a week or once every two weeks if it involves a specific
area of work, and, in addition, working in concert at country
level. For example, if I want to go and see a Head of State in
a country, it is usually Rotary that is the most rapid in getting
that visit, it is not the health sector, it is Rotary International.
When the meeting occurs, it is Rotary, UNICEF and WHO who attend
that meeting. CDC usually does not attend because they prefer
to stay in the background. It works very well that each member
uses its own comparative advantage, but it is a mechanism which
is informally run, it is not formal governance. The other partnerships
are partnerships that have formed around avian influenza. There
are two major ones. There is GLEWS, which is a surveillance network,
and Paul will speak more about that, which works with FAO, WHO
and the OIE in Paris to be sure that we understand where avian
influenza is occurring in animals and where the risk is greatest
to humans. This is a partnership which is run with no formal governance,
but it is run because one of our financial partners, Canada, insisted
that we work together and provide the resources in such a way
that it forces us to work together. Another initiative is the
Tripartite Agreement of WHO, FAO and the World Organisation for
Animals Health (OIE) in Paris: and UNICEF that has just begun
to work with the partnership as well. Together we are working
to set up a one health/one world programme, which will be a programme
that operates at the country level and which provides programme
capacity in both veterinary and human health making sure that
together we are working to not let humans be the indicator of
animal disease but animals themselves be the indicator. Today,
in countries zoonotic infection, or an infection that comes from
an animal to a human, is mostly found first in humans and then
the infected animals are found and dealt with, but it needs to
be the other way around, so that when BSE or other zoonotic diseases
occur, the disease is dealt with so that the barrier that protects
humans from being infected is strengthened early on.
Dr Gully: If I could just add a couple more
examples. One is in relation to Yellow Fever, where there have
been recent outbreaks in South America, particularly of note in
Paraguay, where there had not been an outbreak for decades. Rapidly
WHO, together with private industry, a vaccine manufacturer in
Brazil but also one from the US and France, Sanofi, and UNICEF,
that has the logistics capability for delivery, worked together
to deliver 1.6 million doses of vaccine to Paraguay in a very
short space of time. That was also helped by a broader agreement
about Yellow Fever vaccine, which was in collaboration with GAVI,
the Global Alliance for Vaccines and Immunisation. That is one
which does work between other UN countries but also with the private
sector as well. The other relates to other intergovernmental organisations,
such as the International Federation of the Red Cross, where WHO
is working together with IFRC and the UN agencies involved in
humanitarian response, and this relates to pandemic preparedness.
IFRC has received a large amount of money from USAID to work on
what they describe as Level Six pandemic preparedness. It has
meant that the UN agencies, plus and including ones such as the
World Food Programme, for example, which did provide a logistic
response in the recent Ebola outbreak in Democratic Republic of
Congo, together with other organisations do respond. They do relate
to specific needs, specific initiatives, so there is not one big
organisational structure that meets to say how they work together,
but when it is necessary we believe that synergy does exist and
I am sure it can be proved.
Q512 Lord Howarth of Newport:
Those instances are admirable and encouraging but, on the less
cheerful side, the world is an imperfect place; and, if we look
at the tragic predicament of Africa, for example, you must be
concerned at WHO that there are important problems where we are
failing to get the coherence of effort that is needed to be properly
effective. Will you talk to us about some of those as well?
Dr Heymann: An example in Africa is very important.
Several years ago, maybe in the early 2000s, I cannot recall exactly
the year, one country in Africa bought all the meningitis vaccine
available on the open market because meningitis vaccine was required
for pilgrims going to the Hajj, but that vaccine is also required
to save the lives of children because each year there are major
epidemics of meningitis. At that time, in order to deal with this
issue, WHO formed a partnership and set up what is called the
International Coordinating Group for Meningitis. We brought together
all those competitors for vaccine internationally—Doctors
without Borders (MSF), the International Federation of
Red Cross and Red Crescent, Societies, UNICEF and WHO, the major
partnerships for countries in meningitis. We got together and
began to make forecasts on needs for meningitis vaccine, worked
with industry to make sure that those needs were met, and mobilised
resources which were made available to purchase vaccine in advance.
That mechanism continues to function and each year provides vaccine
to countries based on criteria that have been pre-established
by the four partners so that when there is an outbreak vaccine
is immediately made available to those countries. Again, it is
an informal mechanism, no formal governance, but there is intensive
work by our staff to make sure that these activities occur. Another
example in Africa is the Polio Surveillance Networks. When Nigeria
developed avian influenza in humans, the only network that was
able to respond was the Polio Eradication Network. That Network
went to communities and began social mobilisation, explaining
to people about influenza and how they should prevent themselves
from becoming infected, a very important tool that we have called
into action. Those are some of the successes in Africa. It is
very difficult to work in Africa and very difficult for countries
to understand all the issues that are going on, but we hope that
with the International Health Regulations, and the requirement
that all countries have accepted to establish core capacities
in surveillance and response, these countries will be able to
establish the capacity if the bilateral donors and international
partnerships occur to deal with that. I could tell you, if you
would like to hear about it, of a partnership that is just forming
with the Commonwealth and Health Protection Agency on strengthening
core capacities in countries.
Q513 Lord Howarth of Newport:
Understandably enough, you are still talking about your successes.
We would like you, if you will, to be candid with us about where
your frustrations are, where your disappointments are, and whether
these are systemic or what the explanation may be for the failures
in progress that occur.
Dr Heymann: I will start just with an honest,
open statement and then I think others will come in. As you know,
our WHO system is such that the Director-General is an elected
official and so are the six Regional Directors of WHO. At times
this causes a great challenge in coordination and in making sure
we work as a corporate World Health Organisation. Dr Brundtland,
when she was here, worked very hard, and now Dr Chan is working
even harder, much, much harder and more intensively, to make sure
that we can work together and understand what each group can offer
best, and promote that in working together. I must admit that
many times there are delays in how WHO Headquarters responds to
a situation and how our African Regional Office responds to that
situation. On the other hand, there are very many successes in
which Directors take the time to work closely with their regional
counterparts at a technical level and succeed in accomplishing
major events. There are some political issues because of the elected
Director General and Regional Directors and responsibilities to
countries that elected them, while at the same time as there are
great successes working at a technical level within the organisation
and sometimes those two areas are not in synch.
Q514 Lord Howarth of Newport:
You said synergy is not complete. Are you also frustrated from
time to time by failure of synergy between the WHO and some of
the other major organisations that have appeared on the scene,
particularly in recent years, which command a lot of funding but
which have their own terms of reference, their own impetus and
may not dance to your tune?
Dr Heymann: We do not want people necessarily
to dance to our tune. Our function for 194 Member Countries, is
to set global policies, norms and standards and hope that others
will work with them. The Global Fund came into Geneva several
years ago and this was encouraged by WHO, WHO advocated with the
G8 for the Global Fund. The Global Fund has come in, and it is
not a technical agency whereas WHO is a technical agency. WHO
has spent much time and energy, as you will hear from the tuberculosis
people when you speak to them later on, in developing national
proposals for the Global Fund so they can be effective in mobilising
the resources from the Global Fund. Early on we approached the
Global Fund for support to WHO in the endeavour to help countries
develop their proposals and we were told that the Fund could not
directly provide resources to WHO, those resources would go to
countries and countries could engage WHO should they wish to have
WHO work with them whilst developing their proposals. Of course,
this is not the way countries work, countries do not pay WHO.
If countries ask WHO for support we provide it to them at no cost.
Q515 Lord Jay of Ewelme:
I just wanted to pick up one thing you said in your very interesting
discussion about polio eradication and your handling of that.
I think you said that the CDC's role in Atlanta in all of this,
amongst other things, was that of monitoring and evaluation of
progress on the ground?
Dr Heymann: Yes.
Q516 Lord Jay of Ewelme:
I just wondered if you could enlarge a little bit on that and
talk about how WHO ensures that there is proper monitoring and
evaluation of its programmes more generally. Is that something
which normally, as it were, you would outsource to something like
the CDC? Or is it something you would do in-house? How do you
ensure that there is that constant monitoring and evaluation so
that you can learn the lessons and improve the programmes in the
future?
Dr Heymann: Monitoring and evaluation are not
outsourced, they are done by WHO in the partnership. What is outsourced
is the provision of technical support to countries to do their
national monitoring during campaigns. The monitoring system for
polio eradication is a very strong monitoring system. Wednesday
morning here in Geneva the entire polio team meets and at that
meeting the indicators that have been established for surveillance
are reviewed coming up from countries through Regional Offices
into WHO, all the way from a district level. The indicators that
have been set up concern the number of children with flaccid paralysis
who are identified and the number of those children who are properly
examined and provide the proper specimens of stool in the case
of polio. The indicators have been established at one per 100,000
children under the age of 15 years must have been reported with
flaccid paralysis because flaccid paralysis occurs for diseases
other than polio and there is a background level of paralysis.
This is reported and, if a country falls below that threshold,
the next week the Regional Office, through its Country Office,
contacts the government to find out what has happened and attempts
are made to address the problem. We know, sitting here in Geneva,
in which local government area in Nigeria there is not surveillance
for polio because we receive that information once a week and
we monitor it closely. If there is polio, the indicator goes up
to two cases per 100,000 children required and that is how we
continue to monitor polio surveillance. Polio response is monitored
by the reports of countries of polio and those viruses that are
isolated from countries are genetically sequenced so we can see
where they come from. If a country has polio and it has not had
polio in the last two years, we can see from the genetic sequence
where that virus has come from and most times today it comes from
Nigeria or India.
Q517 Lord Jay of Ewelme:
Thank you very much for that. Just moving for a second on to evaluation,
ex-post evaluation of programmes, is that done centrally, is that
done here? Or would that be built into each programme so that
there is a process for a year or two or three afterwards of checking
how successful the programme has been and learning the lessons
from that?
Dr Heymann: Each programme has a technical advisory
group set up which consists of experts from each of our regions
and headquarters. Through yearly or bi-yearly meetings they monitor
progress and make broad recommendations. In the case of polio,
each country has its own technical advisory group on which WHO
sits and that advises in the countries. Also built into polio
eradication and most other programmes are external assessments
which are done by an external group which comes in and does those
assessments to determine whether or not there is success. Right
now one of those external assessments is being thought about for
the Global Outbreak Alert and Response Network and I wonder, Pat,
if you could say a word about that.
Mr Drury: Maybe if I could take a step back
to some of the earlier stuff and stick my neck out a little bit.
It is natural for us to blow our own horn and be more comfortable
talking about the successes, not least because any failure is
a failure of a Member State, and as the Secretariat, we are protecting
them. Our real success over the past seven or eight years has
been in responding to events. The process that David spoke about,
about meningitis vaccine, ensuring that the vaccine is there,
is only useful because it can be transferred very rapidly and
these groups come together to review the evidence and make a decision
that the vaccine should be made available cheaply to the country
within a matter of two or three days. The outbreaks in West Africa
of Yellow Fever threatened all the major urban areas. In 2001
and 2002 there were outbreaks which threatened the populations
of Dakar and Senegal, Abidjan and Cote d'Ivoire. Because WHO was
able to deploy teams to investigate these cases, identify the
outbreak and then call in the additional support, that created
a powerful argument for the likes of GAVI and others who now have
taken the example of the meningitis model and cloned it to apply
to Yellow Fever. But we are in a constant struggle, and as soon
as we think we have these two things in place and they are useful,
the outbreaks happen in a different part of the world. This is
to do with the meningitis belt in Africa and West Africa where
the Yellow Fever outbreaks have taken place predominantly. The
mosquitoes did not understand the rules, and this year outbreaks
have taken place in Latin America. Up until the beginning of this
year we felt we were comfortable and any evaluation would have
said a six million dose vaccine stockpile available, support and
money from GAVI and others, UNICEF and WHO and everybody is working
together. But, as soon as one of the factors changes, the outbreaks
happen in Latin America, the stockpile is not enough and what
was an emergency stockpile is now being directed to Latin America
to support a more programmatic approach. That is OK until the
next crisis element comes in, which is that there are now outbreaks
in Liberia and the Liberians should really have first claim on
the emergency stockpile. But the emergency stockpile has been
needed to support a more programmatic approach there. That is
a bit long-winded. Where we have been successful is in our outbreak
response and we measure that in terms of the time we got there,
how many people died in the outbreak and how quickly it was brought
under control. It may be that we are not measuring the right thing
and, although these interventions and international missions are
opportunities and the primary function is on controlling the outbreak,
they should really be measured in terms of how they contribute
to building national capacity and how these events are used to
draw in the more programmatic approach to support the building
of core capacities as envisaged under the IHR. The Global Outbreak
Alert and Response Network is a network of about 140 technical
institutions around the world that WHO coordinates with to ensure
that there are experts available to support these types of activities.
Chairman: We will come back to the global
outbreak a bit later. I am getting a bit worried that we are going
to lose some of our areas. If I could leave it at this stage and
ask Lord Desai to come in.
Lord Desai: My question has more or less
been answered.
Q518 Chairman:
We need to come back on the overlap.
Mr Drury: I was so long-winded I did not get
a chance to answer Lord Jay's question about evaluation. There
are two evaluations just about to kick off. One is the internal
WHO audit group, which looks at performance, which during the
month of April is going to begin an audit of performance in our
group and in influenza and one or two others. That is an internal
audit of performance. The partners in GOARN have asked that we
bring together an external panel of experts to review the activities
of the Network over the first seven or eight years and on the
basis of that external evaluation provide guidance for the future
development of the Network. We hope that will happen within the
next six months with a view to having a meeting of the Network
before the end of the year.
Q519 Lord Avebury:
I was wondering, as you were talking about WHO's success in responding
to outbreaks, whether you had any strategic scenarios over the
years ahead which enable you to plan for the structures that will
be needed to cope with what appear to be an enormous variety of
unpredictable outbreaks occurring in different parts of the world.
How do you develop scenarios within your own organisations to
enable you to develop the structures that will cope with such
a wide variety of possible outcomes?
Dr Heymann: Let me respond to that by giving
you an example of how we cope. When the SARS outbreak was first
identified in 2003, WHO, in order to notify countries about this
disease, was obliged to put it in the press so that every country
could read about it. Today, when an outbreak occurs, such as Rift
Valley Fever in East Africa or many other diseases, we can have
access immediately to an International Health Regulations Focal
Point in each country so that information can be fed immediately
to a country within its own system. These focal points are nominations
made by the country. This helps us greatly in our response to
make sure that countries understand what is going on immediately.
In order to test this new International Health Regulations system
there will be a series of three different tabletop exercises.
The first occurred last year, when the International Health Regulations
came into force and WHO had an internal exercise to see how we
would communicate about an outbreak should it occur. We found
many difficulties, many weaknesses, which we have since remedied.
This year on 11 and 12 June there will be another exercise within
WHO and also involving our country Focal Points. These country
Focal Points and WHO will have an exercise to see how they can
best work together should there be a pandemic that occurs. I think
this scenario will probably be an influenza outbreak. In addition,
at the level of the United Nations we have an exercise coming
up on 19 June, which will be an exercise to see how the United
Nations systems work together in a pandemic; and in September
there will be a further exercise which involves NGOs and the UN
system to see how we can best respond internationally. We are
working on several different scenarios and exercises which we
hope will permit us to identify problems and solve those problems
as we move ahead. This is all possible because we have this coordination
with over 140 different networks and we have the International
Health Regulations which penetrate countries.
|
