ASEF NETWORK FOR PUBLIC HEALTH Thematic Working Group 1 on Regional - - PowerPoint PPT Presentation

ASEF NETWORK FOR PUBLIC HEALTH

Thematic Working Group 1 on Regional Integration and Infectious Diseases EXPERT MEETING 18-20 May in Luxembourg

Regional Integration and Communicable Diseases in Europe and Asia

M arco Liverani London School of Hygiene and Tropical M edicine

Regional M echanisms: Why?

• Bacteria respect no borders -> hotspots of

epidemic activity encompass more than one country

• Regional organisation of WHO
• Projects of political and economic cooperation

provided institutional bases for the development

• f public health policies at the regional level

Regional Organisations

• European Union (EU)
• the Association of Southeast Asian Nations

(ASEAN)

• the Asia-Pacific Economic Cooperation (APEC)
• the South Asian Association for Regional

Cooperation (SAARC)

• the Caribbean Community (CARICOM )
• the Southern Common M arket (M ERCOSUR)

Outline

• 1. Regional Integration in Europe
• 2. Regional Integration in SE Asia
• 3. Interregional M echanisms across Europe and

Asia

Aims

• Provide examples of good practices in each region
• Provide an overview of achievements, gaps, key issues

and obstacles

• M ap experience/ expertise exchange between Asia and

Europe

• Identify areas for future cooperation

M ethods

Very broad issue: difficult to frame it strategically for analytical purposes Focus on some of the most interesting developments:

• In Europe the EU is becoming an increasingly important

institutional actor in the shaping of regional policies

• In Asia it is more complicated: many different platforms

for regional cooperation -> focus on ASEAN, and examples of regional programmes

• Platforms for cross-regional cooperations

M aterials

• primary sources (e.g. guidelines, conference

proceedings, policy documents, directives, regulations)

• academic articles and reports
• semi-structured interviews with key

informants

• 1. Regional Integration in Europe

Cooperation in Europe: Background

• 1950s – 1980s: national health authorities

established national centres for the collection, analysis, and report of epidemiological information

• > fragmentation
• 1980s: disease-specific surveillance networks at the

European level (e.g. HIV/ AIDS, EUROTB, EWGLI, SALM NET, EUROSENTINEL)

• 1990s: establishment of the “ Charter Group” as an

advisory body to deal with the European Commission and set up a framework for CD surveillance at the European level; EPIET

EU Policies

• Increased mobility of people and traded goods

within the EU, especially after the latest enlargements

• Shift from the single economic market to a

more political union -> legal bases for EU policies have been strenghtened

• Public health crises, such as BSE (“mad cow

disease”), bioterrorism and pandemic threats

Reasons::

Decision 2119/ 98/ EC (1998)

• European policy network for epidemiological

surveillance and control

• Early Warning and Response System (EWRS)

was set up to ensure rapid communication in case of public health emergencies of international concern

The European Centre for Disease Prevention and Control (ECDC)

• Collection and analysis of relevant scientific

data

• M anagement of dedicated surveillance

networks

• M aintenance of databases for epidemiological

surveillance

• Technical and scientific evaluation of

prevention and control measures at the EU level

• Standardization of methods

ECDC

EUROPEAN PROGRAM M E FOR INTERVENTION EPIDEM IOLOGY TRAINING (EPIET) EUROSURVEILLANCE DEDICATED SURVEILLANCE NETWORKS (DNS) The ECDC aims to become “the focal point for communicable disease surveillance in the European Union and the authoritative point of reference for strengthening surveillance systems in the M ember States” (ECDC 2008)

ECDC (Risk Assessment) DG Sanco (Risk M anagement)

M EM BER STATES M EM BER STATES

“The Union shall encourage cooperation between the M ember States… and, if necessary, lend support to their action. It shall in particular encourage cooperation between the M ember States to improve the complementarity of their health services in cross-border areas” (Treaty of Lisbon)

Challenges

• Limited supranational power of EU health (e.g. failed

agreement on a European stockpile of antivirals)

• Important discrepancies in case definitions, laboratory

protocols, reporting practices across M ember States: “ Additional extensive work is needed to improve the quality and comparability of EU-wide disease surveillance data” (ECDC 2008)

• Good cooperation with WHO/ Europe in some areas (e.g.

pandemic preparedness), but less coordination in others (e.g. surveillance networks); also very different framing of ‘Europe’ (27 M S vs 53 M S), with important implications on priorities and policy strategies

• 2. Regional Cooperation in Southeast Asia

Communicable Diseases in SEAsia

• SEAsia still suffers from many public health

burdens

• Emerging and re-emerging communicable

diseases such as dengue, chikungunya fever, and cholera, as well as the lingering burden of human immunodeficiency virus (HIV)

• Epicentre of public health crises such as severe

acute respiratory syndrome (SARS) and highly pathogenic avian influenza

CD Control in SE Asia

• Foundations, national programmes, NGOs,

donors, government agencies

• SARS and avian influenza
• Projects for political and economic cooperation:
• Association of Southeast Asia Nations (ASEAN)
• the Ayeyawady-Chao Phraya-M ekong Economic

Cooperation Strategy (ACM ECS)

• the Asia-Pacific Economic Cooperation (APEC)

Regional Cooperation in SEAsia: Case Studies

1) The role of ASEAN and its Emerging Infectious Disease Programme (EID) 2) Three regional programmes, driven by a pledge to strengthen capacities at the regional level; almost finished Examples, not comprehensive analysis…

The Association of Southeast Asian Nations (ASEAN)

• Established in 1967 by the prime ministers of

five countries (Indonesia, M alaysia, the Philippines, Singapore, and Thailand)

• It has enlarged to include ten states, as well as

China, J apan, Korea in bilateral agreements known as the ASEAN +3 process

• Beyond core economic and political issues, also

cooperation in other areas such as the environment, education, security, and migration

ASEAN and SARS

• After the SARS outbreak in 2003, PUBLIC HEALTH has become

more prominent in ASEAN regional policies

• April 2003: the Health M inisters of ASEAN countries agreed on a

J

• int Statement “to foster the sharing of experience and best

practices between countries”

• Regional division of labour: Indonesia (information exchange

through website); Thailand (epidemiological surveillance); M alaysia (laboratory capacity and quality ensurance)

• Harmonisation of travel procedures

In J une 2003, SE Asia was declared SARS-free; however, capacities, expertise and an information-sharing network remained

ASEAN +3 Emerging Infectious Disease (EID) Programme

Set up in 2004 to provide an additional instrument in support of regional cooperation and coordination

• It has become a reference point for regional coordination
• It has organised many training programmes, seminars and

workshops

• It has monitored the level of response plans in member countries
• Its website has become a central hub for the sharing of

epidemiological data and surveillance information The programme is concluding its second phase. Aims and structures

• f a third multi-annual programme are being discussed

Examples of projects under the EID

• Healthy Tourism
• Animal Health and Human Health
• Gender Issues
• Dengue Control
• Laboratory Capacities

Other activities at ASEANSec:

• Working group on Pandemic Preparedness
• ASEAN Stockpile
• PANSTOP Exercises

1) Greater M ekong Subregion Communicable Disease Control Project (GM S-CDC)

• Four-year scheme, launched in 2005 as a joint

initiative of WHO and ADB

• Involves Cambodia, Lao PDR and Vietnam
• Aims: strengthen national capacities; develop

integrated systems of surveillance, response and preparedness; establish the foundation for sustainable transnational cooperation

1) Greater M ekong Subregion Communicable Disease Control Project (GM S-CDC) Achievements:

• Linked research institutions and laboratories

in the three countries

• Organised workshops and various events
• Project website is a hub for information at

the regional level (e.g. scientific events and meetings, outbreak notification, scientific articles

2) The M ekong Basin Diseases Surveillance Project (M BDS)

• Visionary project (started in 2001 -> will end

2010), supported by the Rockefeller Foundation

• Initiative of national health ministers of

Cambodia, China, Laos, M yanmar, Thailand and Vietnam

• Aims: (1) strengthen regional surveillance and

information exchange; (2) strengthen human resources in field epidemiology; (3) establish sustainable national capacities; (4) provide information for health and social policy to reduce burden arising from priority diseases

2) The M ekong Basin Diseases Surveillance Project (M BDS) Achievements:

• Links and information exchange
• Trust building among stakeholders
• Supports the implementation of the IHR 2005
• Reported and addressed epidemic outbreaks

3) Surveillance and Investigation of Epidemic Situations in SE Asia (SISEA)

• Started in 2006, supported by the French

Development Agency

• Relies on the International Pasteur Network in SE

Asia (Cambodia, China, Laos, and Vietnam)

• Three strategies: (a) improving the diagnostic

capabilities of the national referential laboratories and integrating them into a network; (b) strengthening national epidemiological surveillance systems; (c) strengthening coordination at the national and regional levels, especially with the WHO, the OIE and the FAO

• Rigorous scientific approach (surveillance + research)

3) Surveillance and Investigation of Epidemic Situations in SE Asia (SISEA) Achievements:

• Scientific output
• Development of technical capacities (e.g.

standardization, diagnostic tests)

• Laboratory training & workshops
• Fostered exchanges across the region
• Reported epidemic outbreaks

Challenges in SE Asia

• Patchwork of overlapping initiatives -> duplication of

efforts, lack of coordination - > work against the harmonisation of procedures (but good informal communication between GM S-CDC, M SDN, SISEA)

• In this context, ASEAN can play a crucial role, but has very

limited supra-national powers; health has still a low profile within the wider ASEAN agenda

• As in the EU, there are different political and economic

needs in the region, as well as imbalances between the capacities of national health systems. These remain crucial issues to be addressed by any plans for further integration

• 3. Interregional Cooperation

EU-ASEAN Dialogue

• Started in 1978, when ASEAN Foreign M inisters

agreed to initiate a formal process of cooperation with the EEC

• Today, it is pursued through interregional ministerial

meetings and individual cooperation agreements

• Public health has become an important area for

cooperation (see Nuremberg Declaration, 2007)

• OUTCOM ES: joint research projects within the EU

Framework Programmes, joint workshops and seminars

EU-Asia International Development

• “Regional Strategy for EU-Asia Cooperation (2007-

2013) included plans to strengthen public health capacities in SEAsia -> followed by the decision to support a regional cooperation programme on highly pathogenic and re-emerging diseases in Asia, with a budget of 5 million euros

• Strong emphasis on the promotion of regional

integration, and it includes specific actions to assist the ASEAN and SAARC secretariats to strengthen health infrastructures at the regional level

Also: “Better Training for Safer Food” (DG Sanco) -> training on RASFF

ASIA-EUROPE M eeting (ASEM )

• Established in 1996; expanded to involve all EU countries,

the ASEAN +3 countries, as well as India, Pakistan and M ongolia (Australia, New Zeland and Russia)

• Biannual meetings of the heads of state, as well as various

ministerial meetings

• Public health identified as a key sector for cooperation in

2008

• ASEM stockpile of antivirals and personal protection

equipment in Singapore

• ASEF network for public health (enhanced cooperation on

public health issues, regional mechanisms of pandemic preparedness, public awareness programmes, exchanges and knowledge sharing)

ASIA EUROPE Patchwork of different initiatives,

• ften underpinned by different

approaches and agenda Process of rationalization, driven by the patronage and leading role of the European Union -> harmonization and coordination No legal framework at the regional level; informal agreements Legal framework; increasing formalization Temporary arrangements -> problem

• f capitalisation

Permanent institutions -> continuity, but also ‘path dependency’ Regional division of labour; decentralized structure Increasing centralization; Emphasis on the initiative and expertise of member states Emphasis on the central agency

Recommendations

Need for closer cooperation between European and Asian partners, also due to increasing cross-regional mobility and resulting spread of diseases.

• Asian experience on communicable diseases can be very valuable to

European partners, especially after SARS and avian flu

• EU experience in supranational integration, including public health, can

be very valuable to ASEAN, especially in consideration of the roadmap to the ASEAN Community

• Exchanges tend to be short-termed -> need for long-term inter-regional

exchanges (e.g. postdoctoral fellowships; professional positions)

• Need for more exchanges not only of technical experts, but also policy
• makers. So far there are no ASEM meetings of public health ministers

but this might be crucial, as well as the ‘institutionalization’ of events like this one.

Thank you!

marco.liverani@lshtm.ac.uk