Formålet med det amerikanske initiativet er å styrke kapasiteten til å oppdage og takle utbrot av smittsame sjukdomar, epidemiar og biologisk terrorisme, gjennom meir effektiv implementering av det internasjonale helseregelverket (IHR) og andre rammeverk for global helse.
I denne samanhengen vart det arrangert eit møte i Finland i midten av mai 2014, med representantar frå meir enn 34 land. Norge vart representert av Folkehelseinstituttet, Utanriksdepartementet og Helse- og omsorgsdepartementet.
FHI med liknande initiativ
Folkehelseinstituttet tok i fjor haust initiativet til eit liknande internasjonalt samarbeid i mindre skala, leia av Frode Forland og kjent som The Global Health Preparedness Initiative.
På møtet i Finland heldt Forland innlegg på vegner av Norge. Han la blant anna vekt på verdien av ei horisontal tilnærming som ser på heilskapen i helsevesenet, framfor å fokusere på vertikale enkeltinitiativ, til dømes for å førebygge enkeltsjukdomar. Han understreka at apparatet som vanlegvis handterer helseutfordringar også er best i stand til å handtere kriser.
Dessutan peika Forland på at låginntektsland ofte utgjer det svakaste leddet i kjeda, og at det derfor er viktig at initiativ for å betre den globale helsetryggleiken også har eit utviklingsperspektiv, som tek omsyn til behova desse landa har. Han framheva rolla Verdas helseorganisasjon (WHO) spelar og sa at det er viktig at initiativet frå USA ikkje dupliserer WHO sitt arbeid.
Møtet i Finland var det første av fleire planlagde møte framover. Mellom anna skal det haldast eit høgnivåmøte i Det Kvite Hus i Washington D.C. i september.
Se også: CDC: Global Health Security Agenda
Global Health Preparedness
On behalf of Norway we would like to express our sincere gratitude to the US for taking this initiative, to Finland for hosting this meeting on such a short notice and for WHO and many countries for fully supporting it!
Only a few months before the letter came from the US minister of Health to the Norwegian Minister of Health, inviting Norway to this initiative, Norway had already taken a close to similar initiative, though in a minor scale, called ‘Global Health Preparedness Initiative.’ Based on the role of the Norwegian Institute of Public Health as the Norwegian IHR focal point, and as a response to the call to support LMICs in implementing IHR 2005, (paragraph 44) we called upon Norwegian and international stakeholders (WHO and ECDC) to discuss how Norway best could support the implementation of IHR in LMICs. A kick off meeting was held in Oslo on the 12.12.2013.
The background and the objectives of these initiatives coincide nicely and I am glad to announce Norway’s commitment to take responsibility to support some countries and to follow up in the next five years. We will have to come back to the question of which countries to collaborate with, after having had thorough discussions with the health authorities of relevant countries. One way of support could be to strengthen and support the establishment of national public health institutes, like Norway has been doing in Malawi and Palestine.
As already mentioned, public health events, whether they are of biological, chemical, environmental or radio-nuclear origin, respect no boundaries. The spread of infectious diseases is exacerbated by factors such as international travel, antimicrobial resistance and climate change, as well as an increased threat from non-infectious agents, natural disasters and political instability. There is a pressing need to build strong health preparedness structures that build on evidence based interventions with knowledge about what works as an integrated part of health systems in LMICs. In countries where the disease burden is highest and health systems are weak and the needs are most pressing, good preparedness systems are weak and sometimes even totally lacking.
A health system capable of tackling every day challenges is also a health system that will be best prepared to tackle any extraordinary public health event and to protect its own population as well as the global community. A crisis always poses an extra challenge to the health system. If it doesn’t work well under ordinary conditions, it will usually struggle even more to tackle an extraordinary condition. Building on experiences from Norway, we know that every year we have several public health incidents of national - and sometimes international - concern. If you are not prepared, you are in trouble. These incidents are tackled according to Norwegian Health Preparedness Law, and the four principles of preparedness:
- The responsibility principle: The responsibility for handling a preparedness incident remains the same as under normal conditions
- The proximity principle: An incident should be tackled as close to the source as possible
- The similarity principle: A preparedness incident should as far as possible be dealt with in a way as similar as possible to a normal setting
- The co-ordination principle: All relevant actors and sectors are obliged to share information and work together in a co-ordinated manner.
After having worked several years in Africa, I think these principles are relevant both in an international setting and for most countries, even when resources are scarce. You cannot easily handle a cholera outbreak in Mudzi in Zimbabwe from Geneva, or a measles outbreak in Bulgaria from Stockholm or Brussels. Successful tackling of such incidents are all dependent on local context knowledge and capacities.
Investing in health preparedness is investing in strengthening key functions of health systems. The IHR is just that, a description of a health system with a special design for outbreaks and incidents of public health concern. The role of WHO in implementing the IHR is key to the successful implementation of IHR and to achieving the goals of the Global Health Security Agenda. While vertical programs, such as disease-specific initiatives, can have measurable, short-term results, sustainable solutions to public health problems should be built on a horizontal approach, with local, regional and national commitments and responsibilities. However, this approach should prioritize interventions that can have the greatest positive effects for the countries with the weakest public health systems, rather than prioritizing the needs of the countries with the strongest public health systems.
Public health, animal health and environmental health are closely intertwined. To strengthen co-operation between sectors of public health, animal health, social sciences and environmental health, a ‘One Health Approach’ is needed. Owing to the inter-sectorial nature of the IHR, there is also a need for greater promotion of the regulations beyond the health sector, both nationally and internationally. To avoid a segmented or vertical organization of work, global health security work needs to focus on multi-sectorial collaboration – not becoming a new vertical program.
Research in areas important for preparedness and response also needs strengthening, notably research with a ‘One Health’ perspective. Humans are part of a biological continuum that covers all living species, and most new and emerging infectious diseases are zoonotic – actually 3 out of 4 are emerging in the human – animal interface. We need to stay friends with our hosts, the environment, the biologic diversity which we ourselves are part of, and which generously is giving us our everyday food – and with the microorganisms, without them we would not have been here.
More research is needed to better understand the epidemiology of infectious diseases, how to implement effective evidence based preventive measures and how to make content and context sensitive preparedness plans for public health incidents in all sectors, both of national and international concern. Only with a multi-sectorial approach can we understand better infectious diseases and the inextricable links between human and animal health as well as the health of the ecosystems we all inhabit.
There is a win-win situation of working collaboratively on infectious disease control. One network to work with in this respect is the International Agency for National Public Health Institutes (IANPHI). We need to listen carefully to the needs as expressed by the LMICs before we go into too many details of the actions points of GHSA, we need to agree on the framework before discussing the details.
Norway’s motivation to invest is based on solidarity with the countries in greatest need and with the weakest health systems. Such investments will hopefully have a sustainable impact both for the health of populations on a daily basis and for protection of serious consequences of outbreaks both nationally and globally.