High-level debate tackled need for improved international health security

World Health Day 2007: International Health Security
"Invest in health, build a safer future"

Political, business and opinion leaders gathered in Singapore on 2 April for a global debate that focused on the urgent need to improve international health security. The high-level debate, hosted by the World Health Organization (WHO) and the Government of Singapore, launched the World Health Day 2007 theme of international health security and sent a global message to "Invest in health, build a safer future."

The debate focused on threats to our collective health security. These include emerging and rapidly spreading diseases, environmental change, the danger of bioterrorism, sudden and intense humanitarian emergencies caused by natural disasters, chemical spills or radioactive accidents, and the impact of HIV/AIDS, a disease that is threatening the stability of communities in some of the poorest countries in the world.

"The uncertainty and destructive potential of disease outbreaks and acute public health emergencies gives them a high public and political profile," said the WHO Director-General, Dr Margaret Chan. "When the world is collectively at risk, defence becomes a shared responsibility of all nations. WHO continues to track evolving infectious disease situations and acute health threats, sound the alarm if necessary, share expertise with local and national health officials, and mount the kind of response needed to protect people from these dangers to health."

The wide-ranging debate challenged panelists to confront the public health, business and diplomatic obstacles to improved cross-border cooperation, and urged them to find a way forward to more effective collaboration. Participants in the global event included the Prime Minister of Singapore Mr Lee Hsien Loong as the keynote speaker, Dr Margaret Chan, Mr Philip Chen, Chief Executive of Cathay Pacific Airways, Dr Balaji Sadasivan, Senior Minister of State of Foreign Affairs of Singapore, and Mr Jonas Gahr Støre, Minister of Foreign Affairs of Norway. After the initial debate, the event shifted to a "town hall" format to stimulate wider discussion with an audience of more than 200 participants.

Prime Minister Lee Hsien Loong said "The theme of this year's World Health Day, international health security, is apt given the global health landscape today. In a highly interconnected world, diseases spread fast and recognize no boundaries. Cooperation among nations is crucial, for we all have a responsibility to one another. The debate will help build consensus on how we can deal with the challenges together. Singapore is happy to be part of this process as co-host of the World Health Day 2007 event.”

Mr Jonas Gahr Støre , Minister of Foreign Affairs of Norway, began an initiative last summer to establish an informal group of foreign ministers to explore the linkages between foreign policy and global health. He said: “Globalization has increased countries’ vulnerability and interdependence. Health issues are among the major challenges that call for stronger strategic focus and closer international cooperation."

Mr Philip Chen, Chief Executive of Cathay Pacific Airways, steered the airline through the 2003 outbreak of SARS , a highly contagious disease that travelled the globe quickly and inflicted severe economic damage. He said: "The SARS outbreak taught us that organizational competence is essential in meeting the challenges of a crisis but - perhaps more importantly - it is also critical to invest in the time needed to build credibility and win the trust of those people you must rely on for support should a crisis ever happen. This is as true for multinational organizations and governments as it is for commercial enterprises such as Cathay Pacific."

"The transnational nature of impending health threats makes it imperative for all countries to work together to counter them. Our experience in battling SARS has taught us many lessons which we can share with others. As a member of the WHO Executive Board, Singapore will continue to play its part in and contribute to the global health arena," said Dr Balaji Sadasivan, Senior Minister of State of Foreign Affairs of Singapore.

A new sense of urgency following the outbreaks of SARS and avian influenza in the early years of this decade has led the world to adopt an innovative new approach to strengthen global defenses against the spread of disease. The revised International Health Regulations (2005) come into force on 15 June 2007. They represent an unprecedented public health tool that aims to ensure maximum health security and minimum interference with international transport and trade.

The revised Regulations offer new opportunities to strengthen national and international public health capacities and collaboration. They significantly broaden reporting requirements for Member States. The legal framework will require countries to inform WHO of all public health emergencies of international concern. WHO, with its extensive technical and communications capacities, stands ready to work with countries to investigate, verify and respond to threats, and protect people worldwide.

"New outbreaks of avian influenza and the looming danger of an influenza pandemic, together with the severe health impacts of recent flooding in Indonesia and the Horn of Africa, underline the fact that now is the time to focus on international health security. Even with serious challenges in today's world, however, it is my view that these are optimistic times for health," said Dr Chan.

A WHO background document, released just prior to the debate, was used to help guide discussions and stir debate. The paper profiles eight issues linked to international health security, together with key points to focus the debate:

International health security issues

• Emerging diseases: new, highly contagious diseases, such as SARS and avian influenza, know no borders. Their potential to cause international harm means that outbreaks cannot be treated as purely national issues. In the last few decades, new diseases began emerging at an unprecedented rate of one or more per year.
• Economic stability: public heath dangers have economic as well as health consequences. Containing international threats is good for economic well-being. With fewer than 10,000 cases, SARS cost Asian countries US $ 60 billion of gross expenditure and business losses in the second quarter of 2003 alone.
• International crises and humanitarian emergencies: these events kill and maim individuals and severely stress the health systems that people rely on for personal health security. In 2006, 134.6 million people were affected and 21 342 were killed by natural disasters.
• Chemical, radioactive and biological terror threats: whether deliberate or accidental, WHO's global networks are well placed to respond to the health effects of these threats using the same techniques employed in other disasters - rapid assessment and response, triage and treatment, securing water, food and sanitation systems. Anthrax-tainted letters sent through the U.S. postal system in 2001 and the release of sarin on the Tokyo subway in 1995 remind us that although chemical and biological attacks are rare, there are people ready to use this brand of terrorism.
• Environmental change: environmental and climate changes have a growing impact on health, but health policies alone cannot prevent their effects. People are dying- upwards of 60 000 in recent years in climate-related natural disasters, mainly in developing countries.
• HIV/AIDS - a key health and security issue: the devastating impact of HIV/AIDS, demonstrated to international security specialists the potential impact of a public health issue on security. In 2006, an estimated 39.5 million people were living with HIV/AIDS.
• Building health security: national compliance with the revised IHR 2005 will underpin international health security.
• Strengthening health systems: functioning health systems are the bedrock of health security, but the current state of systems worldwide is inadequate. As an example, the world is currently short of more than four million health workers, with the impact most felt in developing countries.