Communication and Coordination

International Global Health Frameworks

 

Topics:

·         IHR

·         PHEIC

·         GHSA

·         JEE

·         Emergency Operations Centers

Welcome back. Today, we’re going to talk about international global health frameworks in place to support preparedness and response for a public health emergency. We’re also going to talk about public health emergency operations centers – or EOCs.

 

The objective of this module is to give you a foundational knowledge of the international health frameworks in place to support public health preparedness and response – including targets for EOC country capacity.

 

By the end of this module, you should be able to:

 

·         Define a ‘public health emergency’;

·         Explain the goals of a Joint External Evaluation;

·         Describe the functions of an Emergency Operations Center; and

·         Create an operational plan for an EOC during an outbreak. 

 

Let’s go.

 

First off, how do we define a ‘public health emergency’?

 

WHO defines a public health emergency as an occurrence or imminent threat of an illness or health condition caused by:

 

·         Bioterrorism;

·         Epidemic or pandemic disease; or

·         A novel and highly fatal infectious agent or biological toxin that poses a substantial risk of a significant number of human fatalities or incidents or permanent or long-term disability.

 (WHO Emergency Response Framework, 2017)

 

The declaration of a state of public health emergency permits government authorities to suspend certain regulations and/or change the functions of state agencies.

 

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How are decisions made about what constitutes the designation of a public health emergency?

 

The International Health Regulations – or IHR – drive those decisions. The IHR is an agreement between all WHO Member States to work together for global health security.

 

PHEIC

 

Serious public health events that endanger international public health may be designated by WHO as Public Health Emergencies of International Concern -- also known by the acronym PHEIC (Pronounced P-Heck).

 

This designation is defined as "an extraordinary event, which is determined by IHR regulations” to meet this criteria:

 

·         It constitutes a public health risk to other states through the international spread of disease; and

·         Potentially requires a coordinated international response.

 

This designation carries implications for public health across borders, and it may require immediate international action.

 

The identification and grading of health emergencies triggers WHO’s Incident Management System.

 

For WHO, the primary IMS functions are:

 

·         Leadership;

·         Partner Coordination;

·         Information and planning;

·         Health operations and technical expertise;

·         Operations support and logistics; and

·         Finance and administration

 

Essentially, this boils down to three things:

 

·         Staff;

·         Stuff; and

·         Systems.

 

 

 

Through International Health Regulations, countries have agreed to build their capacities to detect, assess and respond to public health events. (Source: IHR 2015)

 

The International Health Regulations are also part of larger global health security frameworks – including the Global Health Security Agenda. Or GHSA.

 

GHSA

 

The GHSA is an effort by nations, international organizations, and civil society to accelerate progress toward a world safe and secure from infectious disease threats.

 

The GHSA brings together the private sector and public health organizations – including WHO and the World Organization for Animal Health (OIE) – to promote global health security as an international priority. ("Global Health Security Agenda: Action Packages," 2016)

 

To help achieve this goal, GHSA developed ‘Action Packages’ to help countries reach certain benchmarks. The information and guidance in the “Action Packages’ are divided into categories of: Prevent – Detect – and Respond.

 

The “Prevention” packages include:

 

·         Targets for action against Antimicrobial resistance – or AMR;

·         Targets for action against zoonotic disease;

·         Targets for Biosafety and biosecurity action; and

·         Targets for immunization activities.

 

The ‘Detect’ packages include:

 

·         Targets for national laboratory systems;

·         Benchmarks for real-time surveillance action;

·         Targets for disease reporting according to WHO requirements; and

·         Targets for workforce development.

 

The ‘Respond’ packages include:

 

·         Targets for linking public heath with law and multisectoral rapid response;

·         Targets for medical countermeasures and personnel deployment; and

·         Targets for establishing and operating an ‘Emergency Operations Center.’

 

Emergency Operations Center

 

Let’s talk about the Emergency Operations Center:

 

Where do the staff, stuff and systems come together in a response?

 

The Public Health Emergency Operations Center – also known as the EOC – is a physical location or virtual space where emergency management personnel assemble to coordinate operational information and resources. (Brooks et al., 2016)

 

The EOC provides a space for the strategic management of events and emergencies.

 

EOCs are one of four Incident Management System Command and Coordination structures. ("Emergency Operations Centers (EOC),")

 

The Incident Command System is used to manage on-site, tactical level responses.

 

EOCs are off-site locations where staff from multiple agencies comes together to:

 

·         Address imminent threats and hazards

·         Provide coordinated support to Incident Command and on-scene personnel

 

Or course, a public health emergency and response require that a variety of actors work together in close collaboration.

 

It’s important for emergency management personnel to be in a central location away from the actual emergency to coordinate the staff, stuff and systems. 

 

That’s the EOC.

 

***

 

The purposes, authorities and compositions of EOCs depend on the nature of an emergency. But EOCs generally perform these functions:

 

·         Collecting, analyzing and sharing data;

·         Supporting resource needs and requests; and

·         Coordinating plans and determining future needs.

 

In some cases, EOCs provide coordination and policy direction.

 

Like the Incident Command System, EOCs are also characterized by their modular organization.

 

The modular nature of the ICS allows EOCs to combine functions based on need.

 

In the auto accident scenario we discussed in an earlier module – in which you were the Incident Commander – the objective was achieved – the car was off the road. So both Operations and Logistics functional areas could be deactivated.

 

The Incident Commander could then go home for a relaxing evening with family.

 

SFX: Woman’s voice: Welcome home! We’re having barbeque for dinner!

 

***

 

For planning purposes, decisions must be made about where locate an EOC in the event of an emergency.  And who should be included in the EOC?

 

The decisions can be effectively organized within the ICS structure.

 

·         Command;

·         Operations;

·         Planning;

·         Logistics; and

·         Administration and finance.

 

 The modular design of ICS allows for the adaptation of roles based on the objective of the response.

 

The EOC is rarely just a support mechanism. It deals with all levels of response:

·         Continuity of government,

·         Continuity of operations,

·         Providing emergency services to unaffected areas in an otherwise affected community,

·         Road closures and diversions,

·         Public warnings,

·         Legal declarations,

·         Care of evacuees and recovery efforts, and

·         Information and dissemination.

 

…. among many other activities.

 

GHSA EOC

 

The Global Health Security Agenda “Emergency Operations Center Action Package’ sets a five-year target for every country to have a public health EOC functioning according to minimum common standards.

 

Under these GHSA standards, and EOC is expected to maintain:

 

·         Trained, functioning, rapid response teams – or RRTs;

·         Real-time bio-surveillance laboratory networks;

·         Real-time information systems; and

·         Trained EOC staff, capable of activating a coordinated emergency response within 120 minutes of the identification of a public health emergency.

 

“Activating a coordinated response” is defined as conducting a first conference call or meeting that includes all relevant emergency management sectors and functions.

 

These functions are again organized around the five ICS functions:

 

·         Command;

·         Operations;

·         Planning;

·         Logistics; and

·         Administration and finance.

 

So the question is: Could your jurisdiction or country reach this goal? Could you have a functional EOC in place and ready to go within 120 minutes of the identification of a public health emergency?

 

If not, what would it take for you to get there?

 

Joint External Evaluations

 

Joint External Evaluations – or JEEs – are voluntary, external assessments of a country’s capacity to prevent, detect, and respond to infectious diseases and other public health threats. ("Advancing the Global Health Security Agenda: Joint External Evaluations," 2018)

 

The JEE process brings together experts from around the world to help a country assess its strength and weaknesses in health security, and identify priority actions to improve its health capacity.

 

A Joint External Evaluation will help you understand – among many other things – what you need to get a functional EOC in place and ready to go within 120 minutes of the identification of a public health emergency.

 

After a JEE is conducted, countries develop National Action Plans to identify resources and actions needed to identify and address areas that need improvement.

 

There are 19 areas of epidemic preparedness and response capacity that are scored as part of a Joint External Evaluation. They are arranged into these categories:

 

·         Prevent – How prepared is a country to PREVENT an outbreak; and

·         Detect – how prepared is a country to FIND an outbreak?

·         Respond – how prepared is a country to RESPOND to an outbreak?

 

A JEE assessment is voluntary, conducted every five years, and the results are reported by WHO.

 

The JEE Tool can be found here:

https://www.who.int/ihr/publications/WHO_HSE_GCR_2018_2/en/

 

 

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Preventedpidemics.org

 

The website Prevent Epidemics dot com collects the data reported to WHO as part of Joint External Evaluations and organizes the information by country in an easy-to-read and understand format.

 

On the Prevent Epidemics website, you can see the strengths and weaknesses of preparedness and response capacity in every country that reports results to WHO. You can also find information about current outbreaks listed by country.

 

Prevent Epidemics dot org a great place to see where your country and others are in terms of their ability to find, stop, and prevent epidemics.

 

https://preventepidemics.org/

 Thank you for joining us.

References:

Advancing the Global Health Security Agenda: Joint External Evaluations. (2018).   Retrieved from https://www.cdc.gov/globalhealth/security/ghsareport/jee.html

Brooks, J. C., Pinto, M., Gill, A., Hills, K. E., Murthy, S., Podgornik, M. N., . . . Rzeszotarski, P. (2016). Incident Management Systems and Building Emergency Management Capacity during the 2014-2016 Ebola Epidemic - Liberia, Sierra Leone, and Guinea. MMWR Suppl, 65(3), 28-34. doi:10.15585/mmwr.su6503a5

Emergency Operations Centers (EOC).   Retrieved from https://emilms.fema.gov/IS700b/groups/338.html

Global Health Security Agenda: Action Packages. (2016).   Retrieved from https://www.cdc.gov/globalhealth/security/actionpackages/default.htm

WHO Emergency Response Framework. (2017). Geneva: World Health Organization.