WHO s role in strengthening global preparedness to radiological and nuclear emergencies Dr Zhanat CARR Department of Public Health and Environment Joint International KIRAMS-REMPAN Workshop on Medical Response to Radiation Emergencies 10-11 March, 2015 Seoul, Korea
The World Health Organization (WHO) More than 7000 people work for the World Health Organization (WHO) in its 157 country offices, six regional offices and at the Headquarters in Geneva, Switzerland The World Health Assembly (WHA): the WHO's supreme decision making body. Meets once a year, gathering representatives of WHO's 194 Member States Produces WHA Resolutions
WHO's core functions 1. Articulate ethical and evidence-based policy positions 2. Setting norms and standards, and promoting and monitoring their implementation 3. Shaping the research agenda, and stimulating the generation, translation and dissemination of valuable knowledge 4. Providing technical support, catalysing change and developing sustainable institutional capacity 5. Monitoring the health situation and assessing health trends 6. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed 3
Structure of WHO headquarters Director General Office (DGO) General Management (GMG) Health Security and Environment (HSE) PHE/RAD Family, Women's and Children's Health (FWC) Noncommunicable Diseases & Mental Health (NMH) IARC/ Lyon Links to 6 Regional and 147 Country Offices HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM) Health Systems and Innovation (HIS) 4 PAHO Polio, Emergencies and Country Collaboration (PEC)
5 WHO's PROGRAMME 2014-15
WHO and Radiation CLUSTER DEPARTMENT Family, Women's and Children's Health (FWC) Public Health and Environment (PHE) UNIT PROGRAM Interventions for Healthy Environments (IHE) Radiation (RAD) Ionizing Radiation 6
WHO Radiation Program's Partners National Authorities International Organizations Professional Societies Collaborating Centres NGOs Networks, Associations
Key Partnerships for EPR area IACRNE member organizations under Emergency Conven. Inter-Agency Committee for Radiation Safety (IACRS) Relevant IOs, agencies and programs (e.g. UNIDR) ICRP (contributing to C-1, C-3, and C-4 work) Global Health Security Advisory Group (GHSAG), WG on Medical Countermeasures against RN threats NEA's Working Party on Nuclear Emergency Matters HERCA WG on EPR EC projects and platforms (OPERRA, NERIS, RENEB, etc) Professional societies and associations (IRPA, IAR, HP, etc.) 8
Legal Framework for RN Emergency Response The WHO Constitution, 1948 World Health Assembly Resolutions Two Conventions on Early Notification and Assistance (1987) Inter Agency Committee for Radiological and Nuclear Emergencies (IACRNE) Tasks described in the JPlan The International Health Regulations (IHR, 2005)
IHR (2005): a multi hazards overarching scope IHR (2005): Capacity to detect, assess, report and respond to all Public Health Events of International Concern Human infectious pathogens Zoonotic pathogens / Food safety Radio nuclear hazards Chemical hazards Legislation and Policy Coordination Surveillance Response Preparedness Risk Comm. Human Resources Laboratory
A framework for the review of Core Capacities 8 Core Capacities 1. National legislation, policy and financing 2. Coordination and NFP Communications 3. Surveillance 4. Preparedness 5. Response 6. Risk Communications 7. Human Resource Capacity 8. Laboratory 9. Points of Entry 10. Specific Hazards 10.1. Zoonotic 10.2. Food safety 10.3. Chemical emergencies 10.4. Radiological emergencies
4 hazards 8 core capacities 12
IHR National Core Capacities pertaining to radiation emergencies Implementation status, 2013
Follow up actions Member States Identify remaining gaps and carry out national implementation plans Strengthen intersectoral and multisectoral coordination and collaboration among and within States Parties Mobilize technical and financial support for building core public health capacities and ensure full implementation of IHR Set up systems for regional support for strengthening and maintaining the IHR core capacities
Follow up actions WHO Consultation with WHO Regional Offices and countries on the requirements for States Parties for deadline extensions beyond June 2012 and beyond June 2014 Provide tools to support MS' mapping of gaps/needs in IHR implementation (e.g. Costing tool for estimation of costs for IHR core capacity development) Convening of regional or subregional stakeholders workshops to review and match country needs with potential support and interested donors Discussing coordination of IHR assessments with the IAEA's EPREV assessments in order to avoid duplication and to build on each other's work
South East Asian Regional Strategic Framework for Strengthening Chem and RN EPR Informal consultation with technical experts in Colombo, Sri Lanka March 2013 Formal consultation with relevant national counterparts in Bangkok, Thailand Oct 2013 Joint meeting organized by ASPR/HHS and WHO for ASEAN countries to develop an action plan for implementing the Strategic Framework in Bangkok Jan 2014 Proposals developed/submitted to support countries implementation of the strategic framework
WHO's Relevant Emergency Networks Global WHO REMPAN network (since 1987) Radiation Emergency Medical Preparedness and Assistance Network 45 members WHO BioDoseNet (since 2007) Global Network of Biodosimetry Laboratories 90 members WHO/FAO INFOSAN network (since 2004) ternational Food Safety Authorities Network
WHO REMPAN A WHO technical expertise arm for providing to MS assistance on health interventions in radiation emergencies and on strengthening relevant national health sector capacities established in 1987, originally with 4 members today is comprised of 17 CCs, 30 LIs, and dozens of individual experts in 40 countries meets every three years, proceedings published in peer-review journals 2014 directory is available on the web: http://www.who.int/ionizing_radiation/a_e/rempan/en/
Selected REMPAN-14 recommendations: To improve the coordination between all sectors at the both national and international level To develop a conceptual framework which will take into account both the needs of radiological protection and the public health protection aspects in preparedness and response, including ethical, social, and psychological aspects To review current evidence and provide recommendations on the use of potassium iodide in nuclear emergencies (prolonged/repeated exposure, formulation, side-effects, considerations for infants, pregnant and lactating women, etc.) To deliver targeted training programs for relevant health care specialists (joint TP for medical physicistswith IAEA To develop partnerships with non-state actors, outreach to other sectors, professional societies, etc.
Selected REMPAN-14 recommendations: To improve the coordination between all sectors at the both national and international level To develop a conceptual framework which will take into account both the needs of radiological protection and the public health protection aspects in preparedness and response, including ethical, social, and psychological aspects To review current evidence and provide recommendations on public health interventions in RN emergencies To deliver targeted training programs for relevant health care specialists (e.g. joint TP for medical physicists with IAEA/NAHU) To develop partnerships with non-state actors, outreach to other sectors, professional societies, etc.
Towards development of a new approach to EPR accounting for social dimensions of rad. emergencies Past experience and lessons learnt from Chernobyl and Fukushima UN SG report on humanitarian consequences of nuclear disasters Scope of the problem Social determinants of health Psycho-social aspects Ethical aspects, etc- Stakeholders RP, sociology, and psychology experts, NGOs, affected populations, etc. Solutions Advocacy and awareness of key stakeholders Establishing a dialogue and stakeholders engagement to build a strategy and a road-map towards a stronger system pf emergency preparedness and response 2 1
Development of technical tools Contributing to the IAEA's relevant documents development/revision (GSR Part 7, etc.) WHO technical reports: Fukushima Dose and Health Risk assessment reports WHO Guidelines development PH response to radiation emergencies (2012-2014) delayed till 2015 Revision of 1999 guidelines on KI thyroid blocking (2014-2015) Communications in PH emergency (2014-2015) a guideline and SOPs (DG Comms) Risk communication tool for radioactively contaminated food (Dept of Food safety) GSR PART 7 (2015)
REMPAN e-newsletters http://www.rempan.ukw.de/aktuelles/who-rempan-e-newsletter.html 2 3
WHO BioDoseNet global network for biodosimetry 2006 I 2007 I 2008 I 2009 I 2010 I 2013 I 2015
WHO activities in biodosimetry: BioDoseNet linked with other relevant projects/activities MultiBiodose project was presented at the BioDoseNet meeting in Leiden in 2013 (EC-funded) WHO is a member of EU project RENEB's Adv. Board since 2012 and provides a communication platform to advocate for RENEB's work for BioDoseNet and REMPAN experts communities Conducting a joint RENEB-BioDoseNet exercise in Nov. 2014 Discussing with NAHU/IAEA the possibility to coordinate biodosimetry activities in accordance with the inter-agency cooperation agreement (1959) New WG on internal contamination to develop a research agenda, identify priorities, go after funding eventually, F-2-F meeting in 2015 as a satellite to a conference discussing with EURADOS potential cooperation
REMPAN Internal Contamination WG Established in Sept 2014 including Health Canada, Ottawa, Canada Centers for Disease Control and Prevention, Atlanta, USA Public Health England, Chilton, UK Institute de Radioprotection et de Sûreté Nucléaire, France Federal Medical Biophysical Center, Moscow, Russia National Institute of Radiological Science, Chiba, Japan CIEMAT, Madrid, Spain CEA, Fontenay-aux-Roses, France Institute of Radiation Protection and Dosimetry, Rio de Janeiro, Brazil ARPANSA, Melbourne, Australia NIRP, China CDC, Beijing, China IAEA as an observer The 1 st face-to-face meeting planned for April 2015 2 6
Proposed areas for R&D Children Monitoring and Dose Assessment Medical Management of internal contamination Manuals for Population Monitoring Training Intercomparison exercises
Summary RN emergency preparedness is a high priority issue for IHR implementation RN emergencies require inter-sectoral response and coordination health authorities, + competent authority for radiation safety, environment, transport, Internal coordination within health care providers (doctors, nurses, lab technicians, paramedics, etc.) Engagement and partnerships with key stakeholders Access to technical expertise networks is crucial for timely reaction and advice in emergency also needed for sharing experience, information, and facilitation of international cooperation on harmonizing training programs and building on each other's strength and expertise, which will also allow for most costefficient use of resources WHO provides technical support to regional and national capacity building programs and does this in partnerships with key stakeholdes
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