Increased tempo in tackling biological threats

"The serious infectious disease epidemics are not only a threat to people's health but also to a country's economy, security and stable development. This new international health agenda aims to improve readiness to halt the spread of such diseases," says MSAH Permanent Secretary Päivi Sillanaukee.

In industrialized countries, the scourge of infectious diseases seemed almost vanquished, but then avian and swine flu and Ebola forced the international community to refocus on the issue.

"One can't totally prevent infectious diseases but one can control them, as the example of Nigeria in halting the spread of Ebola shows. The main assets needed to succeed in this are the ability to detect threats early and to respond to them swiftly," Dr Sillanaukee explains.

The Global Health Security Agenda (GHSA) was launched last year. It aims to create worldwide partnerships to tackle infectious disease threats and to promote global health security as an international security priority.

The GHSA focuses on preventing and reducing the emergence of disease outbreaks, detecting threats timely and using international coordination and communication to create multi-sectoral rapid response.

The partnership currently involves 44 countries, key UN agencies such as WHO, FAO and OIE (the World Organisation for Animal Health), the EU, the World Bank and the Interpol.

Need to improve cooperationThe GHSA is a five year programme, launched in February 2014 in Washington DC and Geneva, and followed by action and strategy-making meetings in Helsinki in May and in Jakarta in August. The Agenda was finalized in a High Level meeting at the White House on September 26th. The initiative does not aim to replicate or compete with the work of UN agencies or other international organisations, but it does seek to influence their work in promoting coordination on biological threats.

"Most recently, the Ebola epidemic has shown that there is a need to improve work between UN agencies. In addition, cooperation on funding needs to be far smoother. The Agenda seeks to ensure that the UN does better in its work and that international financial institutions and foundations are in a position to provide better support for identifying infectious diseases and creating the preparedness for responding rapidly. "

The ownership of the countries themselves lays the groundwork for improved preparedness. Joining the GHSA requires that the partners commit to new and concrete activities. Finland, for instance, is funding a project to reinforce the capacity of laboratory work in Tanzania and train local health and veterinary specialists.

The GHSA also stresses the importance of multi-sectoral activity. "We can't improve the situation purely by health sector activity," says Dr Sillanaukee. "We need a much broader commitment and sufficient political will. Only in this way will we be able to ensure there are the necessary resources, structures and readiness."

In Finland, ministries of social affairs and health, forestry and agriculture, interior, foreign affairs and defence are taking part in the GHSA.

Security perspectiveOne of the programme's key elements is the inclusion of security thinking in the debate on biological threats. The context in part concerns fears of the use of diseases as biological weapons, which is why defence ministries are also involved in GHSA.

"In many countries, defence budgets are much larger than health budgets, so cooperation across these two sectors can help in securing resources for such things as establishing laboratories and training," says Dr Sillanaukee.

Security concerns are not limited only to the possibility of terrorist attacks. Severe epidemics, such as the Ebola outbreak in West Africa, can lead to local or regional system collapse. Because of this, there is a need to include in planning and response the authorities responsible for internal order and crisis management.

Step by stepThe International Health Regulations, a binding international Treaty, was adopted in 2005 in a process convened by WHO. The 196 signatory countries committed to putting it into practice by 2012. However, so far, only a fifth of UN member states have done so.

"The requirements are so demanding that many countries find it hard to implement them and for some it is completely impossible, for example due to lack of laboratory capacity. The implementation of the Treaty has not worked as intended. The world can't simply afford this. . The GHSA intends to support countries in taking a step by step approach to improving health security and prepareness," says Dr Sillanaukee.

In practice, the programme is divided into 11 different ‘ Action Packages' such as antibiotic resistance, biosafety and biosecurity, national laboratory systems, workforce development, and emergency operations centers, to tackle the whole span of disease threats and global health security. Participating countries can then focus on the different issues one at a time.

Each of the 11 Action Packages in the Agenda has indicators to measure that key issues are covered comprehensively. There is also an effort to get those carrying out the GHSA and those providing funding to find one another.

Finnish chairmanshipThe US chaired the work of the GHSA during the first year of its work (2014), handing over the task to Finland for this year. Dr Sillanaukee thinks that Finland's dexterity in cross-sectoral cooperation contributed to its being selected for the role.

"Of course, we're not perfect but we're proficient. The fact that we've been active in international forums in promoting prevention, comprehensive primary health services and health in all policies-thinking must also have had an impact. These are issues that typically require multi-sectoral cooperation."


Teksti: Paula Mannonen & Mark Waller