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Sustainable Emergency Preparedness - International Perspective

By Alexandra Allen & Rebecca Tomasek, Contributor: Keith Hamilton

There have been numerous devastating disease outbreaks throughout history, highlighted as recently as 2013 by the Ebola outbreaks throughout Western Africa. Ebola virus infection in humans causes a haemorrhagic fever and has a case fatality rate of approximately 50%, meaning half of the people who contract the disease die from it. While Ebola outbreaks have previously occurred in Central Africa, specifically the Democratic Republic of Congo and Uganda, this was the first major outbreak in Western Africa. This outbreak had more cases than all previous outbreaks combined. The disease began in Guinea and spread predominantly to Sierra Leone and Liberia. Transmission was propagated by social, structural, and biological disease factors, and was exacerbated by a lack of timely national and international responses, leading to devastating consequences. In the early stages of outbreak, Ebola virus disease (EVD) was undetected, therefore it was not contained and spread from rural to more urban communities. Traditional burial practices in these cultures include high risk practices for EVD transmission. A single funeral was estimated to be the cause of several hundreds of cases. As the problem went undetected, precautions and preventative measures were not employed early on to mitigate disease spread. Furthermore, the majorly affected countries did not have the infrastructure and healthcare workforce to handle the outbreak.

Photo by http://www.who.int/csr/disease/ebola/en/

The Ebola outbreak is a prime example of an acute international health disaster being exacerbated by a lack of preparedness and containment. From this incident, the significance of developing culturally sensitive and appropriate strategies, strengthening communication and awareness, respecting the existing social structures to engage the community, establishing surveillance and detection, implementing organized contract tracing, and mobilizing a response team of trained healthcare workers have been realized. After the tragedy of the Ebola Outbreak, there was a strong need to put efforts towards strengthening the capacity for emergency response in West Africa. The outbreak of Ebola was complicated due to multifactorial and systematic problems. Rift Valley Fever is a mosquito-borne virus that is zoonotic and has been an important disease throughout several regions of Africa. Like Ebola, it also causes a fatal haemorrhagic fever in humans, however, it is most often contracted from direct or indirect contact with infected livestock animals or animal products at the time of slaughter. This is the basis of the veterinary interface in One Health medicine. It is the responsibility of veterinary professionals to provide proper services for the prevention of animal diseases in order to protect. Farmers, slaughterhouse workers, herders and veterinarians are at the greatest risk for contracting this disease. There are many large festivals that are centered on animal slaughters and pose significant health risks that could result in the rapid spread of disease. Understanding cultures, lifestyles and demographics of countries allows for adequate risk assessment and preparedness planning. These conceptsare important to incorporate into education and outreach to prepare countries for outbreaks of infectious diseases.

These examples highlight the potential impact of disease emergence at the human animal interface and the importance of the One Health concept.

Global emergency preparedness management is an intricate cooperative effort between multiple stakeholders at national, regional and international levels. At international level, the World Health Organization (WHO), Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE) (collectively known as the ‘tripartite’) work closely with their Member Countries and other UN and non UN agencies to build co-operation to manage disease threats at the human animal interface.

Coordination is a critical element in managing national and transboundary threats. By ensuring effective communication between international organisations, national governments, NGOs etc., and facilitating cooperation of multiple organizations, it is possible to limit and even prevent infectious disease outbreaks by enabling the detection of early warnings of health threats as well as a prompt response.

Core capacity is also essential. To prevent isolated infectious disease outbreaks from becoming international crises, national public and veterinary health services must be adequately prepared and resourced.

oiegraphic

Preparedness planning aims to ensure the provision of adequate resources, legislation, laboratory services, and availability of fit for purpose disease outbreak contingency plans which are regularly reviewed and tested. Preparedness planning also avoids serious socio-economic consequences, in addition to health consequences, that result from outbreaks.

At the international level, transparency is another key factor in being able to control infectious diseases. When countries report a disease outbreak to the international community through the relevant international organisation – for high impact animal diseases, the OIE and for public health events of international concern, the WHO - the international community and member countries can take action to protect themselves. This may involve increased surveillance, risk communication, intervention measures (such as vaccination), or in the case of animal diseases, trade restrictions when there is a scientific justification to do so to prevent disease spread (in accordance with the WTO SPS agreement and OIE standards).

These international organisations provide guidance on disease prevention, detection, and control. A member country can also seek help and advice from these international agencies for example, for risk assessment and management, on how to perform necessary epidemiological investigations, confirm disease diagnoses etc. In addition, advice is often provided by centres of expertise which make up a global network of Reference Laboratories and Collaborating Centres.

The international organisations also provide capacity building tools to assist member countries to meet their commitment to managing disease threats in compliance with the WHO’s International Health Regulations and OIE’s International Standards.

In conclusion, two of the greatest feats we face are coordination between the multiple partners involved in emergency management, and support of sustainable national capacity to ensure early detection and rapid response. While plans typically focus on ideal measures to prevent and control disease, practical implications rely on the mobilization of available resources. National governments need to build their capacity to detect and respond to outbreaks to promote global public health, as a weakness in one country may be a threat to all other nations. Because most emerging human diseases are zoonotic, it is crucial for veterinarians to be in the forefront of planning to reduce risks at the human animal interface.

Resources

Research & Development
http://www.who.int/blueprint/en/

Preparedness Planning Resources

Ebola

Rift Valley Fever

Universal Healthcare

http://www.who.int/bulletin/volumes/91/8/13-125450/en/

Authors

Alexandra Allen, MS
DVM Student, Class of 2020
College of Veterinary Medicine
Kansas State University

 

Rebecca Tomasek
DVM/MPH Student, Class of 2021
College of Veterinary Medicine
Kansas State University

Contributor

 

Keith Hamilton
Senior charge de mission
World Organization for Animal Health (OIE)

 

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