Opening Ceremony of the Global Outbreak Alert and Response Network Steering Committee Meeting

07 Dec 2005

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: Sheraton Towers

Distinguished guests, ladies and gentlemen

Preamble

1  It is my pleasure to be here with you this morning at the opening of the Global Outbreak Alert and Response Network (GOARN) Steering Committee Meeting of the World Health Organization's Communicable Disease Surveillance and Response Office for Alert and Response Operations.  The hosting of this important event in Singapore reflects our strong desire to contribute to the network.

Public health emergencies

2  Outbreaks pose a health threat not just locally but also to other countries through spread of disease. Those that constitute public health emergencies of international concern require a coordinated international response. The distinguishing features of such events are a potential for mass casualties and a short window period for effective response.

3  Despite many advances made in disease prevention and control, the threat of an international public health emergency from outbreaks today is more imminent than ever. The reasons have to do with expanding international trade and travel, the rise of exotic new infections, spread of existing diseases to new areas, antimicrobial resistance, and bioterrorism. A public health emergency of international concern is expected to occur somewhere in the world from time to time..

4  In such an emergency, our preparedness contributes to both primary and secondary prevention. Primary prevention takes place when a local emergency that is detected early and responded to effectively never spreads beyond the borders. Secondary prevention takes place when, even if we cannot prevent the cross-border spread, systems of alert and response at both national and international levels mitigate the worst damage measurable in terms of reduced morbidity and mortality and in economic consequences. 

Lessons from SARS

5  Singapore was not spared when in 2003, SARS moved from southern China across several countries and threatened to establish itself endemically in the city state. While no two public health emergencies of international concern can ever be identical, we have drawn some key lessons from this outbreak as a concrete example.

6  The first lesson is the importance of surveillance and response measures to reduce opportunities for the agent to spread from the reservoirs of infection. We found that contact tracing, with or without quarantine, was an important measure in both the assessment and control of the emergency. It should be clear that while quarantine was effective in the control of SARS, it cannot be universally effective in all other emergencies. Response preparedness must include plans for instituting mass chemoprophylaxis, vaccination and other interventions.

7  The second lesson is the critical value of community mobilisation through health education and health promotion activities. People are keen to do their part but need to understand the way the specific disease was transmitted, the measures for prevention and control, and the obligations to observe if quarantined.

8  The third lesson is the need for the public health authority to stay flexible and be prepared to use extraordinary measures and adjust its strategies as new challenges emerge. Needless to say, we uncovered many legal, operational and financial challenges when mounting new and large scale public health operations.

9  Extrapolating these three lessons to a wider public health context, our rapidly changing global infectious diseases situation mandates that we evaluate all available tools and build institutional capacity to effectively manage a public health emergency. For urban centres with high population density and global connectivity, this is all the more important because of greater transmission potential.

International Health Regulations (2005)

10  The rise of public health emergencies of international concern has prompted WHO to revise the International Health Regulations which had stood little changed since 1969. In May this year, the 58th World Health Assembly endorsed the new International Health Regulations (2005) and called on member states to implement the regulations to the full when they enter into force in 2007. They are binding on every member state that has not rejected or reserved against them.

11  The purpose and scope of the new regulations are to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which would avoid unnecessary interference with international traffic and trade. These revisions are timely because in the modern-day evolution of infectious diseases, microbial agents are taking full advantage of the growing economic and environmental activities that allow them to thrive, prosper and propagate.

Conclusion

12  In conclusion, with emerging diseases as a real threat, we have to recognise the collective need for heightened levels of vigilance, commitment, and resources to safeguard public health against outbreaks. The key elements in global outbreak management involve effective cooperation at the national and international levels. You, as the steering committee, have an important role to play here and I wish you a fruitful meeting in Singapore.