Global architecture to reduce risk and mitigate next global health crisis Before the outbreak occurs we need to identify leaders and roles resources appropriate times for responding Successful containment of future outbreaks requires ID: 691772
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Slide1Slide2
Need for a Global Health Risk Framework
Global architecture to reduce risk and mitigate next global health crisis
Before the outbreak occurs, we need to identify leaders and roles, resources, appropriate times for responding.
Successful containment of future outbreaks requires
timeliness.
Coordinated response informed by good planning and evidence, not fear or politics.
Responders need to move as one to avoid mistrust, stigma, or miseducation of communities.Need to learn now, before memories fade.Slide3
U.S. National Academy of Sciences Charter (1863)
“
The academy shall, whenever called upon by any department of the government, investigate, examine… and report upon any subject of science.
”
The New York Times describes the IOM as “the most esteemed and authoritative adviser on issues of health and medicine, and its reports can transform medical thinking around the world.” Slide4
Global Health Risk Framework Initiative
What?
A plan for a global architecture for preparedness and response mitigating the threat of epidemic infectious
diseases
How?
Fall 2014
: A concerned conversation between Jim Kim, World Bank, and Victor Dzau about the Ebola outbreak;Support from Judith Rodin ( Rockefeller), and initial planning with World Bank, WHO, Rockefeller
December 2014
: “Getting to Zero Ebola Cases in West Africa: A Convening of Leaders” chaired by Margaret Chan
March 2015
: Planning meeting for Global Health Risk Framework
Support
Paul Allen Foundation, Ford Foundation, Gates Foundation, Ming Wai Lau, Moore Foundation, Rockefeller Foundation, USAID,
Wellcome
TrustSlide5
Architecture of Global Health Risk Framework InitiativeSlide6
Commission Roster
Peter Sands
,
MPA
(Chair)
(Former) Standard
Chartered
PLC
Harvard Kennedy School
Oyewale Tomori,
DVM,
PhD
(Vice-Chair)
Nigeria Academy of Sciences
Ximena
Aguilera
, MD
Universidad del
Desarrollo
, Chile
Irene
Akua
Agyepong
,
DrPh
,
MBChB
, FGCPS
Ghana Health Service
Yvette
Chesson-Wureh
,
JD
The University of
Liberia
Paul Farmer
, MD, PhD
Harvard Medical School
Partners in Health
Maria Freire,
PhD
Foundation for the National Institutes
of Health
Julio
Frenk
,
MD, MPH, PhD
University of Miami
Lawrence
Gostin
, JD
Georgetown University
O'Neill Institute on National and Global Law
Gabriel
Leung
,
MD, MPH
University of Hong Kong
Francis
Omaswa
,
MBBCh
,
MMed
, FRCS, FCS
African Center for Global Health and Social Transformation
Melissa Parker,
DPhil
London
School of Hygiene & Tropical Medicine
K. Sujatha Rao
, MA, MPA
(Former) Ministry of Health & Family Welfare of India
Daniel Ryan
, MA
Swiss Re
Jeanette Vega,
MD, MPH, PhD
Chilean National Health Fund
Suwit
Wibulpolprasert
,
MD
Ministry of Public Health, Thailand
Tadataka
Yamada
, MD
Frazier Life SciencesSlide7
International Oversight Group Members
Victor Dzau
(Chair), President, National Academy of Medicine
Judith Rodin
(Vice-Chair), President, The Rockefeller Foundation
Fazle
Hasan Abed
, Founder of BRAC and Chairman of BRAC Bank Limited
Arnaud Bernaert
, Senior Director, Head of Global Health and Healthcare Industries, World Economic Forum
Chris Elias
, President of the Global Development Program, Bill & Melinda Gates Foundation
Jeremy Farrar
, President,
Wellcome
Trust
Shigeru Omi,
President, Japan Community Healthcare Organization
Paul
Polman
, CEO, Unilever
Mirta
Roses
, Former Director-General Pan American Health Organization
Shen
Xiaoming
,
Professor of Pediatrics, Xin Hua Hospital and Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of
Medicine
Tan
Chorh
Chuan
,
President, National University of Singapore
Miriam
Were
,
Chancellor,
Moi
University
Slide8
Architecture of Global Health Risk Framework InitiativeSlide9
Timeline
July
– Commission Meeting
#
1
Aug-Sept
– Four Workshops August 5-7 – Resilient Health Systems
(Ghana)
August
19-21
–
R&D of Medical Products
(Hong Kong)
August
27-28
– Pandemic Financing (Washington,
D.C
.)
September
1-2
–
Governance for Global
Health (London)
Sept-Dec
– Consultations
September 25
– US federal
government
October 9
–
I
nternational and national representatives
November 12
–
Jim Yong Kim, President, World Bank
November 20
– Margaret Chan, Director-General, WHO
December 16
– Japanese government leadership & G7 planning
October
– Commission Meeting #2
November
– Commission Meeting #3
January 2016
– Report releaseSlide10
Four
Key
F
eatures
C
haracterized the Report
Independence. The remit, membership, and processes of the Commission were designed to ensure independence from individual governments, international agencies, and other stakeholders.
Forward-looking
focus.
Devised
recommendations for the future, drawing
on lessons
not just from Ebola, but from previous outbreaks, including SARS, MERS and the H1N1 influenza and HIV/AIDS pandemics
.
Comprehensiveness.
Considered
every aspect of an effective framework
ranging
from models of governance at an international level to the skills and infrastructure requirements at the local level.
Assessed
the implications for scientific research and development and
defined
the financing requirements
.
Timeliness .
The Commission completed
its work within six months to enable
the
recommendations to inform policy initiatives in 2016
.Slide11
Dissemination
Plan to achieve maximum impact via:
Scholarly journals and op-eds
Personal briefings with key leaders
Key international events, e.g.,
World
Economic Forum annual meeting in DavosWorld Health Organization Executive Board meetingAsia Launch in Hong Kong
Africa Launch
World Bank and International Monetary
Fund spring
m
eetings
G7
OthersSlide12Slide13
Outline
Overview of Report Recommendations
The Framework
Rationale for Recommendations
Financing the Framework
Conclusion
2Slide14
Summary
of Recommendations
Source: Sands, Mundaca-Shah, and Dzau. In press. The neglected dimension of global security – a framework to counter infectious disease crises, a perspective.
NEJM.
3
Chapter
2
– The Case for Investing in Pandemic Preparedness
The G7, G20, and UN should commit to:
A.1
: Implementing framework set out in this report and embodied in Rec. B.1–D.3.
A.2
: Mobilizing incremental financial resources required ($4.5
billion/year).
A.3
: Monitoring progress of implementation by an independent assessment in 2017 and every 3
year
thereafter.Slide15
Summary
of
Recommendations
(Cont.)
Source: Sands et al., in press.
4
B.1: WHO and member states should develop an agreed-on, precise definition and benchmarks for national core capabilities, and functioning, based on IHR and other efforts (GHSA and OIE Terrestrial Animal Health Code).
B.2:
WHO should devise a regular, independent, transparent, and objective assessment mechanism to evaluate country performance against benchmarks defined in Rec. B.1.
B.3:
All countries should commit to participate in external assessment process (Rec. B.2), including publication of results.
B.4
:
WB, bilateral, and multilateral donors should declare that related funding will be conditional on a country’s participation in external assessment process (Rec B.2).
B.5:
IMF should include pandemic preparedness in its economic and policy assessments of individual countries, based on outcomes of the external assessment of national core capacities.
B.6:
Countries should develop plans to achieve and maintain benchmark core capacities by mid-2017 (target to achieve full compliance with the benchmarks by 2020).
B.7:
WHO should provide technical support to fill countries’ gaps in core capacities and achieve benchmark performance.
B.8:
National governments should develop domestic resourcing plans to finance improvement and maintenance of core capacities as set out in plans (Rec. B.6).
B.9:
WB should convene other multilateral donors to secure financial support for lower-middle-income and low-income countries in delivering plans (Rec. B.6).
B.10:
UNSG should work with the WHO and other parts of the UN system to develop strategies for sustaining health system capabilities and infrastructure in fragile and failed states and in war zones, to the extent possible.
Chapter 3 – Strengthening Public Health as the Foundation of the Health System and First Line of DefenseSlide16
5
C.1:
WHO should create a Center for Health Emergency Preparedness and Response (CHEPR) to lead the global effort toward outbreak preparedness and response. This center should be governed by an independent Technical Governing Board.
C.2
: WHA should agree to an appropriate increase in WHO member states’ core contributions to provide sustainable financing for the CHEPR.
C.3:
WHO should create and fund a
sustainable contingency fund of $100 million through one-off contributions or commitments proportional to assessed contributions from member states.
C.4:
UN and WHO should establish clear mechanisms for coordination and escalation in health crises.
C.5:
WHO should work with existing formal and informal regional and
sub-regional
networks to strengthen linkages and coordination among neighboring countries.
C.6:
WHO and national governments should enhance means of cooperation with
nonstate
actors.
C.7:
WHO should establish a mechanism to generate a daily high-priority “watch list” of outbreaks with potential to become a PHEIC. List to be communicated to NFPs daily and to the public weekly.
C.8:
WHA should agree on new mechanisms for holding governments publicly accountable for performance under the IHR and broader GHRF, including protocols for avoiding delays in data and alerts and unnecessary restrictions on trade or travel.
C.9:
WB should establish the PEF as a rapidly deployable source of funds to support pandemic response.
C.10:
IMF should ensure capability to provide budgetary support to governments raising alerts of outbreaks.
Source: Sands et al., in press.
Summary
of
Recommendations
(Cont.)
Chapter
4 – Strengthening the Global and Regional System for Outbreak Preparedness, Alert, and ResponseSlide17
6
Source: Sands et al., in press.
Summary
of
Recommendations
(Cont.)
D.1: WHO should establish an independent PPDC
, accountable to TGB, to galvanize acceleration of relevant R&D, define priorities, and mobilize and allocate resources.
D.2:
WHO should work with global R&D stakeholders to catalyze the commitment of $1
billion/year
to maintain a portfolio of projects coordinated by the PPDC.
D.3:
PPDC should convene regulatory agencies, industry stakeholders, and research organizations to commit to:
Adopting R&D approaches during crises that maintain consistently high scientific standards.
Defining protocols and approaches to engage local scientists and community members in the conduct of research.
Agreeing on ways to expedite medical product approval, manufacture, and distribution.
Chapter 5 – Accelerating Research and Development to Counter the Threat of Infectious DiseaseSlide18
The Framework
Stronger
national public health capabilities, infrastructure, and processes
built to a common standard and regularly assessed through an objective, transparent process fully consistent with international legal obligations under the IHR.
More effective global and regional capabilities,
led by a reenergized WHO, through a dedicated
Center
for Health Emergency Preparedness and Response, coordinated effectively with the rest of the UN system, and supported by the World Bank and IMF.
An accelerated programme of R&D,
deploying
USD 1
billion
per
year and coordinated by a dedicated
committee
7Slide19
8
Strengthening
public health as the foundation of the health system and first line of defense
Establish clear definition of core capacities and rigorous external assessments to evaluate country performance
Recognize that a fundamental part of the governments’ basic
duty
is to protect its citizens
against infectious disease
threats. Governments should:
Create plans to achieve and maintain benchmark core capacities (including resourcing plans)
Commit
to participate in external assessment process Slide20
9
Strengthening
public health as the foundation of the health system and first line of defense
Galvanize global and regional support for national core capacities:
Development partners’ support
should align
with country plans
World Bank’s support
should be contingent
on country’s participation in external assessment
IMF
should incorporate
results of
these external
assessment
in
its economic evaluations of countries
UNSG should
take the
lead to support
fragile states/failed
states/warzones, working
with the WHO and other parts of the UN
systemSlide21
10
Strengthening
the global and regional system for outbreak preparedness, alert, and response
Create
WHO Center for Health Emergency Preparedness and Response (
CHEPR), overseen by an independent Technical Governing Board (TGB)
Establish clear pathways for multi-sectoral coordination with other UN agencies, regional networks, and non-state actors
Build mechanisms that normalize and incentivize early
reportingSlide22
11
Strengthening
the global and regional system for outbreak preparedness, alert, and response
Create protocols to hold
governments accountable
for performance under IHR
Mobilize financial resources to enable rapid deployment of funds for responseCHEPR should be funded through existing resources plus an appropriate increase (say 5%) in member states’ core contributions
WHO should create and fund the $100
million
contingency
fund
World
Bank should establish
Pandemic
Emergency Finance Facility (PEF)
IMF
should provide
budgetary support
to
governments raising alertsSlide23
Accelerating
R&D to counter
the threat of infectious diseases
Establish an independent Pandemic Product Development Committee
(
PPDC) for coordinating and prioritizing R&D efforts
Chair selected by WHO DG; WHO provides secretarial supportCoordination mechanism needed to pinpoint existing capabilities, identify gaps, and determine priorities for a concerted global effort to develop, test, manufacture, and distribute the relevant medical products in cases of emergency
Commit and mobilize USD 1
billion
per
year to maintain a portfolio of
projects coordinated
by the
PPDC
Portfolio should include drugs
, vaccines, diagnostics, personal protective equipment, and medical
devices to build robust armory
12Slide24
Accelerating
R&D to counter
the threat of infectious diseases
Convene
regulatory agencies, industry stakeholders, and research organizations to commit
to:
High scientific standards to yield interpretable data and strong, valid conclusions
Open information
exchange
with local
communities from the outset
Streamlining
protocols
to
expedite medical product approval, manufacture and distribution
13Slide25
14
Financing
the Framework
Recognize the need
to step up
investment
Scale of threat to human lives and livelihoods is significant (economic expected loss of USD 60 billion
per year
)
Commitment is needed
to
rectify
most important
gaps
in
defenses
Commit to
USD 4.5 billion
per year
to
make humanity much
safer. This includes:
USD 3.4 billion
per year to strengthen public health
systems
USD 130-155
million
per year to reinforce international preparedness and response, including WHO and contingency
funding
USD 1
billion per year to accelerate R&D on infectious
disease threats Slide26
15
Financing
the Framework
Mobilize
different sources of funds for specific
components. This includes:
Domestic government resources for public health upgrading, with international support where required
WHO
capabilities and contingency fund on basis of member state assessed
contributions
World
Bank PEF from innovative insurance/capital market solutions or binding contingent
commitment
Incremental
R&D funding from broad range of sourcesSlide27
Conclusion
16
Infectious disease crises pose a significant threat to global security – to human lives and to economic
well-being
We have neglected this
threat – Ebola
and other outbreaks revealed significant shortcomings in almost every aspects of our defensesThe
case for investing more in pandemic preparedness is compelling
USD 4.5 billion
per year would significantly reduce the risks to human lives and livelihoods
Investing in preparedness and prevention is far more cost-effective than reacting when outbreaks
occur
The Commission's recommendations constitute
a
coherent
framework for countering the threat of infectious disease crises:
Reinforcing the first line of
defense
– public health capabilities and infrastructure at a national level
Strengthening capabilities and coordination at a regional and global level
Accelerating
R&D
We must act with urgency – and we must monitor implementation. We all have a shared interest in making the world safer.Slide28
Contact information
Email Q&A questions to:
GHRFCommission@nas.edu
@
GHRFCommission
#GHRF
Complete report at
nam.edu/GHRF
17Slide29
Appendix
18Slide30
A. Recommendations
Commit to creating and resourcing a comprehensive global framework
The G7
, G20, and United Nations (UN), under the leadership of the UN Secretary General, should reinforce and sustain international focus and actions to protect human lives and livelihoods from the threat of infectious diseases by:
Recommendation A.1: Committing to implementing the framework set out in the report
“The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises” and embodied in Recommendations B.1–D.3. Recommendation A.2: Committing and mobilizing the incremental financial resources required to implement the framework, as set out in the report “The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises,” which amount to about USD 4.5 billion per year.Recommendation A.3: Monitoring progress of implementation by commissioning an independent assessment in 2017 and every 3 years thereafter.19Slide31
B. Recommendations
Reinforcing robust public health infrastructure and capabilities as the first line of
defense
Recommendation B.1: The World Health Organization, in collaboration with member states, should develop an agreed-on, precise definition and benchmarks for national core capabilities and functioning, based on, and implemented through, the International Health Regulations and building on the experiences of other efforts, including the Global Health Security Agenda and the World Organization for Animal Health Terrestrial Animal Health Code by the end of 2016. Benchmarks should be designed to provide metrics against which countries will be independently assessed (see Recommendation B.2).
Recommendation B.2:
The World Health Organization should devise a regular, independent, transparent, and objective assessment mechanism to evaluate country performance against the benchmarks defined in Recommendation B.1, building on current International Health Regulations monitoring tools and Global Health Security Agenda assessment pilots, by the end of 2016.Recommendation B.3: By the end of 2016, all countries should commit to participate in the external assessment process as outlined in Recommendation B.2, including publication of results.20Slide32
B. Recommendations continued
Recommendation B.4: The World Bank, bilateral, and other multilateral donors should declare that funding related to health system strengthening will be conditional upon a country’s participation in the external assessment process.
Recommendation B.5: The International Monetary Fund should include pandemic preparedness in its economic and policy assessments of individual countries, based on outcomes of the external assessment of national core capacities as outlined in Recommendation B.2.
21Slide33
B. Recommendations continued
Recommendation B.6: Countries should develop plans to achieve and maintain benchmark core capacities (as defined in Recommendations B.1). These plans should be published by mid-2017, with a target to achieve full compliance with the benchmarks by 2020. These plans should include sustainable resourcing components, including both financing and skills.
Recommendation B.7: The World Health Organization (WHO) should provide technical support to countries to fill gaps in their core capacities and achieve benchmark performance. (Technical support will be coordinated through a WHO Center for Health Emergency Preparedness and Response; see Recommendation C.1.)
Recommendation B.8: National governments should develop domestic resourcing plans to finance improvement and maintenance of core capacities as set out in the country-specific plans described in Recommendation B.6. For upper- and upper-middle-income countries, these plans should cover all financing requirements. For lower-middle- and low-income countries, these plans should seek to develop a pathway to full domestic resourcing, with a clear timetable for achieving the core capacity benchmarks.
22Slide34
B. Recommendations continued
Recommendation B.9: The World Bank should convene other multilateral donors (including the African Development Bank, Asian Development Bank, New Development Bank, United Nations Development Program, and Asian Infrastructure Investment Bank) and development partners by mid-2017 to secure financial support for lower-middle- and low-income countries in delivering the plans outlined in Recommendation B.6.
Recommendation B.10: The United Nations (UN) Secretary General should work with the World Health Organization and other parts of the UN system to
develop strategies for sustaining health system capabilities and infrastructure in fragile and failed states and in warzones, to the extent possible.
23Slide35
C. Recommendations
Strengthening international coordination and capabilities is the next most vital component of the framework.
Recommendation C.1:
By the end of 2016, the World Health Organization should create a Center for Health Emergency Preparedness and Response
action at headquarters, regional, and country office levels—to lead the global effort toward outbreak preparedness and response. This should be governed by an independent Technical Governing Board.
Recommendation C.2: In May 2016, the World Health Assembly should agree to an appropriate increase in the World Health Organization member states’ core contributions to provide sustainable financing for the Center for Health Emergency Preparedness and Response.Recommendation C.3: By the end of 2016, the World Health Organization should create and fund a sustainable contingency fund of USD 100 million to support rapid deployment of emergency response capabilities through one off contributions or commitments proportional with assessed contributions from member states.24Slide36
C. Recommendations continued
Recommendation C.4: By the end of 2016, the United Nations (UN) and the World Health Organization should establish clear mechanisms for coordination and escalation in health crises, including those that become or are part of broader humanitarian crises requiring mobilization of the entire UN system
.
Recommendation C.5: By the end of 2017, the World Health Organization should work with existing formal and informal regional and sub-regional networks to strengthen linkages and coordination, and thus enhance mutual support and trust, sharing of information and laboratory resources, and joint outbreak investigations amongst neighboring
countries
.
Recommendation C.6: By the end of 2016, the World Health Organization and national governments should enhance means of cooperation with non-state actors, including local and international civil society organizations, the private sector, and the media.25Slide37
C. Recommendations continued
Recommendation C.7: By the end of 2016, the World Health Organization (WHO) should establish a mechanism to generate a daily high-priority “watch list” of outbreaks with potential to become a Public Health Emergency of International Concern to normalize the process of reporting of outbreaks by country and encourage necessary preparedness activities. The WHO should communicate this list to national focal points on a daily basis and provide a public summary on a weekly basis.
Recommendation C.8: By the end of 2016, the World Health Assembly should agree on new mechanisms for holding governments publicly accountable for performance under the International Health Regulations and broader global health risk framework,
as detailed in Recommendation B.2,
including:
protocols for avoiding suppression or delays in data and alerts,
andprotocols for avoiding unnecessary restrictions on trade or travel.26Slide38
C. Recommendations continued
Recommendation C.9: By the end of 2016, the World Bank should establish the Pandemic Emergency Financing Facility as a rapidly deployable source of funds to support pandemic response.
Recommendation
C.10: By the end of 2016, the International Monetary Fund should ensure that it has the demonstrable capability to provide budgetary support to governments raising alerts of outbreaks, perhaps through its existing Rapid Credit Facility.
27Slide39
D. Recommendations
Accelerating R&D in a coordinated manner across the whole range of relevant medical products
to strengthen
scientific and technical
resources against infectious disease threatsRecommendation D.1: By the end of 2016, the World Health Organization should establish an independent
Pandemic Product Development Committee, accountable to the Technical Governing Board, to galvanize acceleration of relevant R&D, define priorities, and mobilize and allocate resources.Recommendation D.2: By the end of 2016, the World Health Organization should work with global R&D stakeholders to catalyze the commitment of USD 1 billion per year to maintain a portfolio of projects in drugs, vaccines, diagnostics, personal protective equipment, and medical devices coordinated by the Pandemic Product Development Committee. 28Slide40
D. Recommendations continued
Recommendation D.3: By the end of 2016, the Pandemic Product Development Committee should convene regulatory agencies, industry stakeholders, and research organizations to:
Commit
to adopting R&D approaches during crises that maintain consistently high scientific
standards.
Define protocols and practical approaches to engage local scientists and community members in the conduct of research.
Agree on ways to expedite medical product approval, manufacture and distribution, including convergence of regulatory processes and standards; pre-approval of clinical trial designs; mechanisms for intellectual property management, data sharing and product liability; and approaches to vaccine manufacture, stockpiling, and distribution. 29