Global Alert and Response (GAR)

Frequently asked questions regarding the deliberate use of biological agents and chemicals as weapons

-Which agents or chemicals are most likely to be used to create a deliberate outbreak?

-How would governments find out that an attack had taken place?

-What kind of monitoring system is in place for infectious disease outbreaks?

-How would a response be coordinated?

-What treatment is available?

-Where is information available about dealing with a deliberate chemical event?

-Would mass vaccination be an option in the case of an outbreak?  

-Should people be vaccinated now as a prevention, and if so against what?

-What should national governments be doing now?
-Should we be producing more vaccine?

-What can be done globally?

Q. Which agents or chemicals are most likely to be used to create a deliberate outbreak?

A. Any infectious agents or toxic chemical could in theory be engineered for deliberate use as a  weapon. Experts in this field believe that smallpox, anthrax, botulism and plague are the pathogens most likely to be used. However, most if not all outbreaks of infectious disease, whether natural or deliberate, would quickly be detected by the Global Outbreak Alert and Response Network, which continually monitors reports and rumours of disease events around the world.

Q. How would governments find out that a deliberate outbreak had taken place?

A. The Global Outbreak Alert and Response Network links more than 70 separate information and diagnostic networks around the world. Formal and informal sources of information are combined to create the best and most up to date information on disease outbreaks around the world. Formal sources of information include the 191 WHO member countries, together with WHO regional and country offices and WHO collaborating laboratories located throughout the world. Informal sources include NGOs, other partners and the Global Public Health Intelligence Network (GPHIN)   Internet-based system that constantly checks for reports and rumours of any outbreak of infectious disease, whether naturally occurring or deliberate. Each report is then thoroughly checked and verified by a team of specialists at WHO headquarters. An appropriate response is then planned and launched in conjunction with national and international partners.

Q. What kind of monitoring system is in place for infectious disease outbreaks?

A. The same Network that recently picked up and verified rumours of the current outbreak of urban yellow fever in Abidjan, Cote d’Ivoire, and that rapidly verified the existence of Ebola in Uganda last year would quickly identify reports of any unusual outbreak of an infectious disease. All reports are thoroughly checked against epidemiological information about background levels of disease in a particular country or region.

Q. How would a response be coordinated?

A. When the Global Outbreak Alert and Response team at WHO verifies an outbreak of infectious disease, Network partners help to provide staff and supplies to work on epidemiological investigation, confirmation of diagnosis and case detection, handling of dangerous pathogens, management of patient care, containment, and provision of logistics support.  Experienced and well equipped teams from WHO are prepared to leave within 24 hours for the site of an outbreak.

Q. What treatment is available?

A. Treatment would depend on the particular pathogen or chemical identified as the source of the outbreak. There are recommended strategies to contain natural or deliberate disease and chemical events. WHO has standard operating procedures for treating and containing outbreaks of all known infectious diseases. In some cases, isolation of patients, containment of infection and the provision of accurate public information is the most effective strategy

Q. Where is information available about dealing with a deliberate chemical event?

A. The WHO/ ILO/UNEP INTOX Programme promotes poison control and chemical safety, minimizing the adverse health effects resulting from toxic exposure. 

Q. Would mass vaccination be an option in the case of a disease outbreak?

A. WHO standard operating protocols indicate when widespread vaccination is appropriate. After any vaccination is given, a certain length of time is required before immunity develops. It may therefore not be effective to vaccinate people who have already been exposed to infection. Containment of infection is therefore extremely important, as is the checking of all contacts an infected person has had with others, in order to ensure they can be treated and the infection contained.

Q. Should people be vaccinated now as a prevention, and if so against what?

A. At the moment, there are naturally occurring infectious diseases – particularly childhood illnesses - which are causing large numbers of death and widespread illness. People should be routinely vaccinated against these diseases. WHO is currently working to confirm where stores of vaccine are held against some of the pathogens that could potentially be released deliberately. WHO is also encouraging both governments and manufacturers to ensure that adequate stocks are available.

Q. What should national governments be doing now?

A. Countries should have contingency plans to cope with any naturally occurring or deliberate outbreak of infectious disease. They should be aware of the international guidance published by WHO. The most important response to any outbreak is a public health response to ensure the safety and treatment of people who could potentially be exposed to a dangerous pathogen. This should include investigating stocks of both drugs and vaccines to ensure that adequate supplies are available to deal with any natural or deliberate outbreak. Countries should also be developing multi-sectoral approaches to dealing with any outbreak of infectious disease. This might include planners from ministries of health, defence, agriculture and the interior.

Q. Should we be producing more vaccine?

A. Pharmaceutical companies and laboratories able to produce vaccine should be contacted by public health authorities and made aware of the potential needs. However, it must be remembered that production on a large scale is usually only possible once a confirmed market is available.

Q. What can be done globally?

A. National and international institutions must work together to strengthen the public health infrastructure, including specialist laboratories and epidemiologists. Investment in the public health system is the best possible defence against any outbreak of infectious disease, whether natural or deliberate.

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