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 of 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 Reasons : : • 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
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
EUROPEAN PROGRAM M E FOR INTERVENTION EPIDEM IOLOGY TRAINING (EPIET) ECDC DEDICATED SURVEILLANCE EUROSURVEILLANCE 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) M EM BER STATES M EM BER STATES DG Sanco (Risk M anagement) “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 oint 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 of 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
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