Pan-American Efforts To Boost Disease Surveillance, Response

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Top international health authorities are urging new efforts to bolster disease surveillance in the Americas, saying that small and poorer countries in the region have limited ability to detect, assess and report on disease outbreaks that could spread beyond their borders.

'Within a day or two, a local event can become an international event, so we need a seamless system,' said Dr. Margaret Chan, Director-General of the World Health Organization (WHO). 'WHO is working closely with its regional offices to make sure there is a seamless connection to address public health emergencies of international concern.'

Chan's comments were made as health leaders from throughout the Americas gathered this week for the 27th Pan American Sanitary Conference at the Pan American Health Organization (PAHO). The conference brings together ministers of health and other high-level health authorities from PAHO's member countries in North, South and Central America and the Caribbean to discuss hemispheric priorities in public health.

On Thursday, delegates called on the countries of the region to identify gaps in their disease surveillance and reporting systems that might impede their full compliance with the International Health Regulations, the WHO framework for international action to prevent or mitigate major international health crises such as SARS or an influenza pandemic. All PAHO/WHO member countries have agreed to abide by the new regulations, which took effect in June.

The delegates also said countries should develop, within two years, national action plans to fill any gaps. They also called on PAHO to provide technical cooperation to the countries in these efforts.

The International Health Regulations require, among other things, that countries report to PAHO/WHO within 24 hours any outbreak or other public health event that could have an international impact. To facilitate this, each country must have a National Focal Point, or designated officials available on a 24-hour, seven-days-a-week basis to communicate with PAHO/WHO and respond to queries.

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Unlike earlier versions of the regulations, the new rules authorize PAHO/WHO to act on health information from nonofficial sources, such as the media and nongovernmental organizations, and require countries to respond to PAHO/WHO queries based on such information within 24 hours of assessing the situation.

PAHO has been working with its member countries to ensure they are able to comply with the new regulations. PAHO Assistant Director Dr. Carissa Etienne noted that all member countries now have designated National Focal Points, and several are currently conducting assessments of their surveillance and response capabilities and preparing action plans for filling in any gaps, as required by the regulations.

'Almost all Member States have successfully participated in simulation tests of communication with PAHO,' Etienne reported. 'The structure and organization of National Focal Points vary considerably among the Member States'.Still, the system of exchange of information related to events of potential international importance between countries and PAHO has been successful during the first semester of 2007.'

WHO Director-General Chan, who was Hong Kong's Public Health Director during the SARS crisis in 2003 and in 1997 during the first major outbreak of H5N1 avian influenza in humans, urged countries to prepare strategies ahead of time for coordinating public health action during public health crises.

'In a major crisis such as SARS or a pandemic, you really require high-level coordination. You need command and control worked out in advance,' she said.

She also urged countries to develop strategies for communicating with the public before a major public health crisis occurs.

'In the 24/7 media world of today, every country'as well as WHO'has less than 24 hours to get their message out. You don't have time to work it out. You need to have messages worked out already that the minister of health or transport, or the prime minister, can deploy to talk to their citizens and to the world,' said Chan.

The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).

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