world health report 2007 vi global public health security in the 21st century The world has changed dramatically since 1951, when WHO issued its first set of legally binding regulations aimed at preventing the international spread of disease. At that time, the disease situation was relatively stable Concern focused on only six"quarantinable"diseases: cholera, plague, relapsing fever, smallpox, typhus and yellow fever New diseases were rare and miracle drugs had revolutionized the care of many well-known infections. People travelled internationally by ship, and news travelled by telegram MIESSAGI FROMI THE DIRECTOR-GENERAl Since then, profound changes have occurred in the way humanity inhabits the planet. The disease situation is anything but stable Popula tion growth, incursion into previously uninhabited areas, rapid urbaniza tion, intensive farming practices, environmental degradation, and the misuse of antimicrobials have disrupted the equilibrium of the microbial world. New diseases are emerging at the historically unprecedented rate of one per year. Airlines now carry more than 2 billion passengers annually, vastly increasing opportunities for the rapid international spread of infectious agents and their vectors Dependence on chemicals has increased, as has awareness of the potential hazards for health and the environment. Industrialization of food production and processing and globalization of marketing and ibution mean that a single tainted ingredient can lead to the recall of tons of food items from scores of countries. In a particularly ominous trend, mainstay antimicrobials are failing at a rate that outpaces the development of replacement drugs These threats have become a much larger menace in a world characterized by high mobility, economic interdependence and electronic interconnectedness. Traditional defences at national borders cannot pro- tect against the invasion of a disease or vector. Real time news allows panic to spread with equal ease. Shocks to health reverberate as shocks to economies and business continuity in areas well beyond the affected site vulnerability is universal
The world has changed dramatically since 1951, when WHO issued its first set of legally binding regulations aimed at preventing the international spread of disease. At that time, the disease situation was relatively stable. Concern focused on only six “quarantinable” diseases: cholera, plague, relapsing fever, smallpox, typhus and yellow fever. New diseases were rare, and miracle drugs had revolutionized the care of many well-known infections. People travelled internationally by ship, and news travelled by telegram. Message from the Director-General Since then, profound changes have occurred in the way humanity inhabits the planet. The disease situation is anything but stable. Population growth, incursion into previously uninhabited areas, rapid urbanization, intensive farming practices, environmental degradation, and the misuse of antimicrobials have disrupted the equilibrium of the microbial world. New diseases are emerging at the historically unprecedented rate of one per year. Airlines now carry more than 2 billion passengers annually, vastly increasing opportunities for the rapid international spread of infectious agents and their vectors. Dependence on chemicals has increased, as has awareness of the potential hazards for health and the environment. Industrialization of food production and processing, and globalization of marketing and distribution mean that a single tainted ingredient can lead to the recall of tons of food items from scores of countries. In a particularly ominous trend, mainstay antimicrobials are failing at a rate that outpaces the development of replacement drugs. These threats have become a much larger menace in a world characterized by high mobility, economic interdependence and electronic interconnectedness. Traditional defences at national borders cannot protect against the invasion of a disease or vector. Real time news allows panic to spread with equal ease. Shocks to health reverberate as shocks to economies and business continuity in areas well beyond the affected site. Vulnerability is universal. vi global public health security world health report 2007 in the 21st century
The World Health Report 2007 is dedicated to promoting global public health security- the reduced vulnerability of populations to acute threats to health. This year's World Health Day, celebrated in Apri, launched WHO's discussion on global public health security. Around the world academics, students, health professionals, politicians and the business community are engaged in dialogue on how to protect the world from threats like pandemic influenza, the health consequences of conflict and natural disasters. and bioterrorism The World Health Report 2007 addresses these issues, among others in the context of new tools for collective defence including, most notably the revised International Health Regulations(2005). These Regulations are an international legal instrument designed to achieve maximum security against the international spread of diseases. They also aim to reduce the international impact of public health emergencies The IHR (2005)expand the focus of collective defence from just a few"quarantinable"diseases to include any emergency with interna- tional repercussions for health, including outbreaks of emerging and epidemic-prone diseases, outbreaks of foodborne disease, natural disasters, and chemical or radionuclear events whether accidental or In a significant departure from the past, IHR (2005) move away from a focus on passive barriers at borders, airports and seaports to a strategy of proactive risk management. This strategy aims to detect an event early and stop it at its source -before it has a chance to become an international threat Given today's universal vulnerability to these threats, better security calls for global solidarity Intermational public health security is both a collective aspiration and a mutual responsibility As the determinants and consequences of health emergencies have become broader, so has the range of players with a stake in the security agenda. The new watchwords are diplomacy, cooperation, transparency and prepared ness. Successful implementation of IHR(2005)serves the interests of politicians and business leaders as well as the health, trade and tourism sectors I am pleased to present the World Health Report 2007 to our partners and look forward to the discussions directions and actions that it will 久Ra Dr Margaret Chan Director-General World Health Organization
The World Health Report 2007 is dedicated to promoting global public health security – the reduced vulnerability of populations to acute threats to health. This year’s World Health Day, celebrated in April, launched WHO’s discussion on global public health security. Around the world, academics, students, health professionals, politicians and the business community are engaged in dialogue on how to protect the world from threats like pandemic influenza, the health consequences of conflict and natural disasters, and bioterrorism. The World Health Report 2007 addresses these issues, among others, in the context of new tools for collective defence, including, most notably, the revised International Health Regulations (2005). These Regulations are an international legal instrument designed to achieve maximum security against the international spread of diseases. They also aim to reduce the international impact of public health emergencies. The IHR (2005) expand the focus of collective defence from just a few “quarantinable” diseases to include any emergency with international repercussions for health, including outbreaks of emerging and epidemic-prone diseases, outbreaks of foodborne disease, natural disasters, and chemical or radionuclear events, whether accidental or caused deliberately. In a significant departure from the past, IHR (2005) move away from a focus on passive barriers at borders, airports and seaports to a strategy of proactive risk management. This strategy aims to detect an event early and stop it at its source – before it has a chance to become an international threat. Given today’s universal vulnerability to these threats, better security calls for global solidarity. International public health security is both a collective aspiration and a mutual responsibility. As the determinants and consequences of health emergencies have become broader, so has the range of players with a stake in the security agenda. The new watchwords are diplomacy, cooperation, transparency and preparedness. Successful implementation of IHR (2005) serves the interests of politicians and business leaders as well as the health, trade and tourism sectors. I am pleased to present the World Health Report 2007 to our partners and look forward to the discussions, directions and actions that it will inspire. Dr Margaret Chan Director-General World Health Organization vii
world health report 2007 vii global public health security in the 21st century zoG OVERVIEW
Overview viii global public health security world health report 2007 in the 21st century
overview ix At a time when the world faces many new and recurring threats, the ambi tious aim of this years World Health Report is to show how collective international public health action can build a safer future for humanity This is the overall goal of global public health security. For the purposes of this report, global public health security is defined as the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries As the events illustrated in this report show, global health security, or the lack of it, may also have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability. It embraces a wide range of complex and daunting issues, from the international stage to the individual household, including the health consequences of poverty, wars and conflicts, climate change, natural catastrophes and man-made disasters All of these are areas of continuing WHO work and will be the topics of forthcoming publications. The 2008 World Health Report, for example, will be concerned with individual health security, concentrating on the role of primary health care and humanitarian action in providing access to the essential prerequisites for health This report, however, focuses on specific issues that threaten the collective health of people internationally: infectious disease epidemics, pandemics and other acute health events as defined by the revised International Health Regulations, known as HR(2005), which came into force in June of this year. The purpose of these Regulations is to prevent the spread of disease across international borders. They are a vital legislative instrument of global public health security, providing the necessary global framework to prevent, detect, assess and, if necessary, provide a coordinated response to events that may constitute a public health emergency of international concern Meeting the requirements in the revised IHR (2005)is a challenge that requires time, com mitment and the willingness to change. The Regulations are broader and more demanding than those they replace, with a much greater emphasis on the responsibility of all countries to have in place effective systems for detection and control of public health risks-and to accomplish this by 2012. a strategic plan has been developed by WHo to guide countries in the implementation of the obligations in the Regulations and to help them overcome the inherent challenges
At a time when the world faces many new and recurring threats, the ambitious aim of this year’s World Health Report is to show how collective international public health action can build a safer future for humanity. This is the overall goal of global public health security. For the purposes of this report, global public health security is defined as the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries. As the events illustrated in this report show, global health security, or the lack of it, may also have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability. It embraces a wide range of complex and daunting issues, from the international stage to the individual household, including the health consequences of poverty, wars and conflicts, climate change, natural catastrophes and man-made disasters. All of these are areas of continuing WHO work and will be the topics of forthcoming publications. The 2008 World Health Report, for example, will be concerned with individual health security, concentrating on the role of primary health care and humanitarian action in providing access to the essential prerequisites for health. This report, however, focuses on specific issues that threaten the collective health of people internationally: infectious disease epidemics, pandemics and other acute health events as defined by the revised International Health Regulations, known as IHR (2005), which came into force in June of this year. The purpose of these Regulations is to prevent the spread of disease across international borders. They are a vital legislative instrument of global public health security, providing the necessary global framework to prevent, detect, assess and, if necessary, provide a coordinated response to events that may constitute a public health emergency of international concern. Meeting the requirements in the revised IHR (2005) is a challenge that requires time, commitment and the willingness to change. The Regulations are broader and more demanding than those they replace, with a much greater emphasis on the responsibility of all countries to have in place effective systems for detection and control of public health risks – and to accomplish this by 2012. A strategic plan has been developed by WHO to guide countries in the implementation of the obligations in the Regulations and to help them overcome the inherent challenges. Overview overview ix
world health report 2007 X global public health security in the 21st century GLOBAL PUBLIC HEALTH THREATS IN THE 21ST CENTURY oday' s highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases, and radionuclear and toxic threats, which is why updated and expanded Regulations are necessary. Infectious eases are now spreading geographically much faster than at any time in history. It is estimated that 2.1 billion airline passengers travelled in 2006; an outbreak or epidemic in any one part of the world is only a few hours away from becoming an imminent threat somewhere else(see Figure 1) Infectious diseases are not only spreading faster, they appear to be emerging more quickly than ever before. Since the 1970s, newly emerging diseases have beer identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago. In addition, during the last five years, WHO has verified more than 1100 epidemic events worldwide The categories and examples given below illustrate the variety and breadth of public health threats confronting people today Epidemic-prone diseases Cholera, yellow fever and epidemic meningococcal diseases made a comeback in the last quarter of the 20th century and call for renewed efforts in surveillance, prevention and control. Severe Acute Respiratory Syndrome(SARS)and avian influenza in humans have triggered major intemational concern, raised new scientific challenges, caused major human suffering and imposed enormous economic damage. Other emerging viral diseases such as Ebola, Marburg haemorrhagic fever and Nipah virus pose threats to lobal public health security and also require containment at their source due to thei acute nature and resulting illness and mortality During outbreaks of these diseases, rapid assessment and response, often needing international assistance, has been required to limit local spread. Strengthening of capacity is imperative in the future to assess such new threats Figure 1 Verified events of potential international public health concem by WHO region, September 2003-September Westem South-East Americas Pacific Mediterranean WHO regions
Global public health threats in the 21st century Today’s highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases, and radionuclear and toxic threats, which is why updated and expanded Regulations are necessary. Infectious diseases are now spreading geographically much faster than at any time in history. It is estimated that 2.1 billion airline passengers travelled in 2006; an outbreak or epidemic in any one part of the world is only a few hours away from becoming an imminent threat somewhere else (see Figure 1). Infectious diseases are not only spreading faster, they appear to be emerging more quickly than ever before. Since the 1970s, newly emerging diseases have been identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago. In addition, during the last five years, WHO has verified more than 1100 epidemic events worldwide. The categories and examples given below illustrate the variety and breadth of public health threats confronting people today. Epidemic-prone diseases Cholera, yellow fever and epidemic meningococcal diseases made a comeback in the last quarter of the 20th century and call for renewed efforts in surveillance, prevention and control. Severe Acute Respiratory Syndrome (SARS) and avian influenza in humans have triggered major international concern, raised new scientific challenges, caused major human suffering and imposed enormous economic damage. Other emerging viral diseases such as Ebola, Marburg haemorrhagic fever and Nipah virus pose threats to global public health security and also require containment at their source due to their acute nature and resulting illness and mortality. During outbreaks of these diseases, rapid assessment and response, often needing international assistance, has been required to limit local spread. Strengthening of capacity is imperative in the future to assess such new threats. 350 0 Numbers Africa WHO regions Figure 1 Verified events of potential international public health concern, by WHO region, September 2003–September 2006 300 250 200 150 100 50 Western Pacific Eastern Mediterranean South-East Asia Europe Americas Total number of cases = 685 288 41 81 78 89 108 x global public health security world health report 2007 in the 21st century