Work in WHO SEARO on Strengthening Preparedness and Response to Radiological and Chemical Emergencies Thanjira Jiranantakan, M.D., M.P.H.

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1 Work in WHO SEARO on Strengthening Preparedness and Response to Radiological and Chemical Emergencies Thanjira Jiranantakan, M.D., M.P.H. Division of Toxicology, Occupational & Environmental Medicine Department of Preventive and Social Medicine Siriraj Hospital Faculty of Medicine, Mahidol University Siriraj Poison Control Center THAILAND WHO SEARO Poison Centres Network

2 Rad Nuc Risk profile Nuclear weapons (India, DPRK) Nuclear reactors Medical use of radiation radiotherapy machines Radiopharmaceuticals for nuclear apps in medicine Industry (radiography, irradiating facilities) Research labs Radioactive waste (Mayapuri scrapyard accident, 2010) Orphan/uncontrolled sources (Samut accident, 2000) Illicit trafficking of nuclear material Prakarn Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 2

3 Regional Strategy for Public Health Response to Chemical and Radiation Events in the context of IHR (2005) Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 3

4 Specific Objectives 1. To define key strategic actions to strengthen; Policy, coordination and communication, Event detection, verification and risk assessment, Preparedness and emergency response, and Capacity building 2. To assist in the identification of stakeholders in emergency preparedness and response to chemical and radiation events 3. To provide guidance on development of national strategies including implementation, and monitoring and evaluation of implementation Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 4

5 Approach of the Strategy What the strategy aims to do? Fulfill IHR core capacity requirements within defined timeline..! Target audience is the IHR Focal Point in the Ministries of Health, but involvement / endorsement of other stakeholders will be crucial Build on existing capacities Should focus on identified priorities What it should NOT do Build new or parallel structures where capacity already exists Mapping existing conventions/policy/capacity VERY important! Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 5

6 Structure of the Strategy Introduction IHR (Member State and WHO responsibilities) Situation analysis: Chemical and Radiation Preparedness Assessment of needs (IHR monitoring data) The strategy (guiding principles, vision, objectives, expected outcomes) Strategic framework Implementation Resource requirements Monitoring and evaluation Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 6

7 Components of the strategy Policy and legislative support Linkage with IHR NFP; channels of communication Multi sectoral coordination and information exchange Event detection Transport of sample / specimens for event verification Laboratory capacity at country level Access to specialized laboratories Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 7

8 Components of the strategy Risk assessment of detected events; National emergency and response plan; testing and simulation exercise Emergency Operations Centre: command communication and control functions, Emergency response, decontamination facilities Logistics; personal protective equipment, and supplies Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 8

9 Components of the strategy Health care preparedness Risk/crisis communication Points of Entry Training needs Guidelines Human resources Disease Surveillance and Epidemiology (DSE) WHO South-East Asia Regional Office (SEARO) (Richard Brown) 9

10 A South East Asia Region Strategy for Chemical and Radiation Safety in the context of IHR Year Mo. Date City Meeting Colombo An informal consultation on strengthening regional capacity for preparedness, detection and response to chemical and radio nuclear events in the context of IHR Bangkok Regional Workshop on Chemical Safety Bangkok Regional meeting on preparedness, detection and response to chemical and radiation events in the context of IHR Bangkok South East Asia Regional Meeting on implementation of the International Health Regulation (IHR2005) and the Asia Pacific Strategy for Emerging Disease (APSED)

11 Stakeholders & National IHR Focal Points from 11 Member States Representatives from WHO Headquaters, WHO SEARO, WHO WPRO Partner Organizations Temporary Advisors

12 WHO South-East Asian Region 11 Member States: Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste 12 International Health Regulations

13 Annual Questionnaire Questionnaire Submission 20 Indicators (covering 13 capacities) for 2010 (n=126/194, i.e. 65%) for 2011 (n=162/194, i.e. 82%) for 2012 (n=105/194, i.e. 54%) for 2013 (n=158/196, i.e. 81%) for 2014 (n=154/196, i.e. 78%) 192 of the 196 States Parties (98%) have responded to the monitoring questionnaire at least once between International Health Regulations

14 This map will be updated before the WHA Questionnaire 154 Submissions 14 International Health Regulations

15 Achievement of Core Capacities International Health Regulations

16 Achievement Of Core Capacities SEAR 2014 (n=10) 16 International Health Regulations

17 Regional Core Capacity Score RAD (%) 17 International Health Regulations

18 Dr. Florence Fuchs

19 The 2013 IHR Review The world is not well prepared to prevent and mitigate major public health events. It is increasingly evident that multisectoral collaboration is required to combat these threats and that the health sector should play a lead role in this.

20 Strengthening chemical& radionuclear capacity through an all-hazards approach All countries reported having national multisectoral emergency or disaster management plans Specific plans do not exist for either chemical or radionuclear events Absence of notification standard operating procedures and clear coordination mechanism in case of an event There is limited human resource capacity Lack of equipment needed for an adequate response [Group Work Outcomes]

21 Support Needed by Countries Training and traning material Lab, radio, poison centre set-up, drill Guidelines and standard operating procedures Network for detection, verification, response Poison centres network, laboratory network Equipment and resources Lab equipment & resources Mapping of hazard sources Mapping of resource for managing a chemical and radionulcear event Mapping of medicine stockpile needs and resources

22 Resources Available Sharing of standard operating procedures and guidelines WHO collaborating centres for training Poison centres for emergency response Thailand: training-chemical and laboratory analysis, hazmat course, technical assistance for establishing poison centre, poison centre to offer advice to other countries Tools: Indonesia: RTC for radionuclear preparedness training(iaea) Thailand: Rapid response teams, WHO collaborating centres, poison centres

23 Request to Member States Accelerate the development of all-hazards preparedness and response plans with the involvement of relevant sectors Document and assess the resource to event/outbreak exercise/simulations to test the function aspect of the IHR Strengthen and establish poison centre networks in order to support the implementation of IHR for chemical and radionuclear hazards Strengthen intercountry collaboaration and regional, bi-regional, and global networking

24 Requests to WHO Develop guidelines and tools for risk mapping and an all-hazards preparedness and response plan Continue to support the establishment and strengthening of emergency operation centres in Member States Support and facilitate the strengthening and establishment of poison centres and poison centre networks in order to support the implementation for chemical and radionuclear hazards

25 Informal Meeting with Directors of Poison Centres in SEARO (New Dehli, 5-6 December 2013)

26 Poisons Centres in SEAR Aspects Number Variation From 0 (Maldives, Bhutan) to 5 (India) Operation NGO (1 MD Nepal) Government Bodies(Sri Lanka) Universities (Thailand) Service Information, Clinical Consultation, Lab Office Hours or 24/7 Local, National, International

27 Poison Centres & the IHR Core capacity Current role Possible future role What is needed Rec /actions National legislation, policy & financing Coordination with IHR FP Surveillance Response Preparedness Risk communication Human resources Laboratory

28 Summary from PCC Directors Meeting, 5-6 Dec 2013: DSE/WHO SEARO Core Capacity National legislation, policy &financing Coordination & National Focal Point communication How might poisons centres help? -Any review of legislation and policy being undertaken? -Linked to the national focal points in some way? -Directory of Experts 4th Asia-Pacific regional meeting on the Strategic Approach to International Chemicals Management (SAICM) and related workshops, Kuala Lumpur, 23 to 27 March 2014

29 Summary from PCC Directors Meeting, 5-6 Dec 2013: DSE/WHO SEARO Core Capacity Surveillance Response How might poisons centres help? Roles in event detection/risk assessment -Provision of advice to first responders & investigation team -Direct participation in outbreak response

30 Free 24/7 service Emergency Preparedness and Responses Monthly Interhosp Tox Case Conf Siriraj Poison Control Center 5 Medical Toxicologist Faculties 21 Specialists in Poison Information Teleconsultation & Bedside Consultation National/International 30

31 Summary from PCC Directors Meeting, 5-6 Dec 2013: DSE/WHO SEARO Core Capacity Preparedness How might poisons centres help? -Assist in risk mapping -Support development of preparedness plans for chemical event -Strategic stockpile of antidotes and personal protective equipment (PPE) Thai NationalAntidote Program - Stockpile of antidote and PPE - Provide consultation - Outreach program to Present - Very cost effective (national cost of antivenom reduced to 25%

32 Summary from PCC Directors Meeting, 5-6 Dec 2013: DSE/WHO SEARO Core Capacity Risk communication Human resources How might poisons centres help? Provision of specialist advice for policy makers and to inform members of the public Support to training on chemical and radionuclear preparedness and responses by verified providers and instructors

33 Siriraj Hospital by Board Certified Medical Toxicologists using advanced educational technologies Course Discipline Duration Language M.D. Physician 6 Years Thai Residency Training Fellowship Training Specialist in Poison Information Visiting Scholars Thai Hazmat Life Support Asia Pacific Edition (THLS- AP) Physician 3 Years Thai/English Physician 2 Years Thai Pharmacists, Nurses Physician, Health Care Personal Physician, Health Care Personal 50 Hours Thai Customized 2 Days (Lectures, Workshop, Hands on Experience) English English (Next = 6-7 Aug 15)

34 Summary from PCC Directors Meeting, 5-6 Dec 2013: DSE/WHO SEARO Core Capacity Laboratory How might poisons centres help? -Diagnostic and environmental sampling -Establish of networks to enhance efficacy Siriraj Toxicology Lab (ISO 15189) 40,000 test/year Screening/Confirmation In-house, domestic, international

35 Poison Centres & the IHR Core capacity National legislation, policy & financing Coordination with IHR FP Surveillance Response Preparedness Risk communication Human resources Laboratory Current role Possible future role

36 Summary There is limited human resource capacity and equipment needed for an adequate chemical and radionuclear preparedness and responses Poison centres are immediate resources available to support the implementation of IHR for chemical and radionuclear hazards preparedness and responses We should strengthen intercountry collaboaration and regional, bi-regional, and global networking in order to implement IHR effectively and in timely fashion