Emergencies preparedness, response

WHO SARS Risk Assessment and Preparedness Framework October 2004


Executive Summary

This document sets out a framework of activities, at national and international levels, that can be used to assess the risk that SARS might recur and to prepare appropriate contingency plans. Modelled on WHO’s influenza pandemic preparedness plan, the framework adopts a phased approach in which recommended activities escalate in line with the evolving epidemiological situation. Phases are defined by distinct epidemiological criteria, such as the detection of sporadic cases with no secondary spread, the establishment of human-to-human transmission, and evidence of international spread. The possibility that the SARS coronavirus might behave differently than during the 2002–2003 international outbreak is also taken into account.

WHO strongly recommends that all countries undertake a risk assessment as the basis for contingency plans, as SARS-related risks will vary considerably both within and between countries. In issuing the framework, WHO aims to help countries match the level of risk with appropriate activities and thus avoid introducing costly and demanding measures that are not justified by the epidemiological situation.

The framework is organized according to six phases, moving from the inter-epidemic period, when preparedness planning and routine surveillance for cases are stressed, through the establishment of chains of transmission and subsequent international spread, to global interruption of transmission. For each phase, activities are listed separately for countries/areas reporting SARS cases and countries/areas free of SARS. Examples of activities range from a review of the legal framework to ensure its compatibility with control measures, through an inventory of laboratories working with SARS or storing clinical specimens, to factors to consider when deciding whether to close a health care facility. Also indicated are the activities, at each phase, that will be undertaken by WHO and the types of assistance that WHO can provide to countries. Taken together, these lists of activities should serve as a useful tool for formulating contingency plans that are adequately protective and appropriate to the level of risk.


- Executive summary
- 1. Introduction
- 2. Phases of the SARS preparedness framework
- 3. Phase 0 – Inter-epidemic period: No evidence of SARS - CoV transmission to humans worldwide
- 4. Phase 1 – Inter-epidemic period: Sporadic case(s) of SARS
- 5. Phase 2 – Confirmed human-to-human transmission
- 6. Phase 3 – International spread of SARS
- 7. Phase 4 – Slowing down of the outbreak
- 8. Phase 5 – Global interruption of SARS-CoV transmission (epidemic halted)
- References