Global & Disaster Medicine

Archive for February, 2019

WHO’s Health Emergencies Programme


What is WHO’s role in emergencies?

WHO is committed to saving lives and reducing suffering during times of crisis – whether caused by conflict, disease outbreak or a disaster. The new WHO Health Emergencies Programme addresses the full risk management cycle, meaning it works with countries to address emergencies before they happen by working on prevention and preparedness, helps in the response to the emergency, and also, once the initial event has passed, on recovery. The new Programme builds on WHO’s years of experience working with countries in emergencies.

What is the new WHO Health Emergencies Programme?

Requested and approved by Member States, the new WHO Health Emergencies Programme is a profound change for WHO, adding operational capabilities to our traditional technical and normative roles. The Programme works with countries and partners to prepare for, prevent, respond to and recover from all hazards that create health emergencies, including disasters, disease outbreaks and conflicts. The Programme will also lead and coordinate the international health response to contain disease outbreaks and provide effective relief and recovery to affected people.

Why is the WHO Health Emergencies Programme needed?

Worldwide, a record 130 million people are in need of humanitarian assistance, and disease outbreaks are a constant global threat.

To meet the immediate health needs of crisis-affected populations at the same time as addressing the underlying causes of their vulnerability, WHO must be part of a broader change in the way the international community prevents, prepares for, and responds to crises.

What are some of the key changes and achievements within the Programme so far?

Since 1 August 2016, WHO has operated under new emergency-management processes for risk assessment, grading of emergencies and incident management. Recent emergency responses have seen the Programme continually tested and adjusted. Significant progress has been made in areas such as risk assessment and grading, coordination of WHO’s response at headquarters, regional offices and country offices through an Incident Management System, and the rapid release of funds from the WHO Contingency Fund for Emergencies. Lessons are being applied to adapt and improve the processes.

Hurricane Matthew in Haiti

In response to Hurricane Matthew in Haiti, WHO/PAHO quickly established 2 new field offices, deployed multinational teams of experts to support the government’s efforts to provide health services to affected areas, and sent essential supplies and medicines. Anticipating increased numbers of cholera outbreaks, WHO/PAHO prepositioned cholera supplies in at-risk areas. WHO/PAHO also evaluated health structures and services in Haiti to prioritize needs.

Yellow fever outbreak in Africa

WHO and partners supported the vaccination of at least 17 million people this year in response to the yellow fever outbreak in Angola and the Democratic Republic of the Congo, in complex campaigns that came together in a matter of weeks.

Response to Zika virus

Within 10 days of the declaration of Zika and its associated complications being declared a Public Health Emergency of International Concern, WHO worked with 23 agencies to develop a common strategic and operational plan. WHO’s Contingency Fund for Emergencies was used for rapid initial cash disbursement. WHO developed and rapidly distributed guidance to help countries in all aspects of the Zika response, from caring for affected infants, to eliminating mosquitoes, to strengthening health services for pregnant women living in affected areas.

Conflict in north eastern Nigeria

In north eastern Nigeria, within 6 weeks of scaling up its emergency operations, WHO supported setting up a disease alert system in 160 health facilities which serve 85% of the 1.6 million displaced people in Borno state.

How does WHO work with partners in emergencies?

The Health Emergencies Programme works with its partners to protect and save people’s lives in all health emergencies. During a crisis, WHO works with the local ministry of health and partners to identify where health needs are greatest and to coordinate the efforts of partner organizations to ensure that these areas are covered by both medical supplies and personnel.

No organization can act alone in emergencies. WHO regularly collaborates with partner networks to leverage and coordinate the expertise of hundreds of partner agencies:

  • Global Health Cluster: More than 300 partners responding in 24 crisis-affected countries.
  • Emergency Medical Teams: More than 60 teams from 25 countries classified by WHO to provide clinical care in wake of emergencies, with the number expected to rise to 200 soon.
  • Global Outbreak Alert and Response Network (GOARN): Since 2000, approximately 2 500 health personnel in response to over 130 public health emergencies in 80 countries.
  • Standby partners: In 2015, WHO’s Standby Partners deployed 207 months of personnel support to 18 countries.
  • Inter-Agency Standing Committee (IASC): WHO is an active member of IASC, the primary mechanism for inter-agency coordination relating to humanitarian assistance in response to complex and major emergencies under the leadership of the Emergency Relief Coordinator.

How does WHO’s Health Emergencies Programme support countries?

WHO’s Health Emergencies Programme provides the following services to countries:

  • support of the assessment of country health emergency preparedness and development of national plans to address critical capacity gaps;
  • development of strategies and capacities to prevent and control high-threat infectious hazards; and
  • monitoring of new and ongoing public health events to assess, communicate and recommend action for public health risks.

In addition, WHO will work with countries and partners to:

  • ensure readiness to diminish public health risks in countries with high vulnerability; and
  • provide life-saving health services to affected populations in countries with ongoing emergencies.

What is the structure of the new Programme?

The Programme has a common structure across the organization, in country offices, regional offices and headquarters. This is 1 Emergencies Programme, with

  • 1 workforce
  • 1 budget
  • 1 line of accountability
  • 1 set of processes/systems
  • 1 set of benchmarks.

The Programme’s structure reflects WHO’s major functions and responsibilities in health emergency risk assessment and management. This structure and related results expected are the same in headquarters and in regional offices and country offices.

The Programme is made up of 5 technical and operational departments. Their titles and specific outcomes are:

  • Infectious hazards management: ensure strategies and capacities are established for priority high-threat infectious hazards.
  • Country health emergency preparedness and the International Health Regulations (2005): ensure country capacities are established for all-hazards emergency risk management.
  • Health emergency information and risk assessments: provide timely and authoritative situation analysis, risk assessment and response monitoring for all major health threats and events.
  • Emergency operations: ensure emergency-affected populations have access to an essential package of life-saving health services.
  • Emergency core services: ensure WHO emergency operations are rapidly and sustainably financed and staffed.

The Programme will dedicate more than 1000 core WHO staff to work on emergencies. It will harness WHO’s experience and technical expertise on all health hazards at all levels of the Organization to coordinate the international responses to health emergencies worldwide.

How much funding is required for the new Programme?

Financing the work of the new WHO Health Emergencies Programme will require a combination of core financing for baseline staff and activities at the 3 levels of the Programme, financing of the WHO Contingency Fund for Emergencies, and financing for ongoing activities in acute and protracted emergencies through appeals guided by humanitarian response plans.

The core budget is the funding WHO needs to implement the normative, technical, and operations-management capacities and activities reflected in the new results framework for the Health Emergencies Programme. To implement the core activities of the new Health Emergencies Programme WHO must raise US$ 485 million in 2016–2017: at present a gap of 44% remains.

Funding for the core budget comes from 3 sources:

  • Assessed contributions: The annual quotas paid by Member States to support the work of the Organization.
  • Core voluntary contributions: Flexible contributions made by Member States and other donors that the Director-General may allocate at her discretion and according to need.
  • Earmarked contributions: Voluntary contributions earmarked for the core budget of the WHO Health Emergencies Programme or specific activities within it.

Appeals linked to Humanitarian Response Plans (HRPs) currently have a funding gap of 66% of the total requirement of US$ 656 million.

The third basket of funding, the WHO Contingency Fund for Emergencies (CFE), a replenishable fund which facilitates cash flow in the initial 3 months of response to an emergency (before donor funding arrives), has raised US$ 31.5 million of its US$ 100 million target.

What is the Joint External Evaluation?

The Joint External Evaluation (JEE) was developed to assist in evaluating a country’s capacity under International Health Regulations (2005) to prevent, detect, and respond to high-threat infectious hazards. The tool is arranged according to the following core elements:

  • preventing and reducing the likelihood of outbreaks and other public health hazards and events defined by International Health Regulations (2005) is essential;
  • detecting threats early can save lives; and
  • rapid, effective response requires multi-sectoral, national and international coordination and communication.

Country participation in the JEE process is voluntary, and it takes into account a multisectoral approach by both the external teams and the host countries, with an emphasis on transparency and openness of data, information sharing, and the public release of reports.

The JEE incorporates the targets and indicators of the “Global Health Security Agenda” and additional elements needed to fully cover the International Health Regulations (2005) core capacities. Countries are supported in measuring their progress in achieving the targets of the International Health Regulations (2005), ensuring any improvements can be sustained, and identifying the most urgent needs within their health security system, to prioritize opportunities for enhanced preparedness, response and action. The JEE also provides a basis for countries to engage with current and prospective donors and partners, to target resources effectively.

Who will monitor the success of the Programme?

On 29 March 2016, the Director-General established the Independent Oversight and Advisory Committee to provide oversight and monitoring of the development and performance of the WHO Health Emergencies Programme, guide the Programme’s activities, and report findings through the Executive Board to the Health Assembly. Reports of the Committee will be shared with the United Nations Secretary-General and the Inter-Agency Standing Committee.

These are the main functions of the Independent Oversight and Advisory Committee:

  • Assess the performance of the Programme’s key functions in health emergencies (including all 5 pillars of the work of the Programme, for example, including both emergency operations and core services).
  • Determine the appropriateness and adequacy of the Programme’s financing and resourcing.
  • Provide advice to the Director-General.
  • Review the Programme’s reports on WHO’s actions in health emergencies.
  • Review reports on the state of health security developed by the Director-General for submission to the World Health Assembly through the Executive Board and to the United Nations General Assembly.
  • Prepare an annual report on its activities, conclusions, recommendations, and, where necessary, interim reports, for submission by the Chair of the Committee to the World Health Assembly through the WHO Executive Board.

The Committee consists of 8 members drawn from national governments, nongovernmental organizations, and the UN system, with extensive experience in broad range of disciplines, including public health, infectious disease, humanitarian crises, public administration, emergency management, community engagement, partnerships and development. Members serve in their personal capacity and will exercise their responsibilities with full regard for the paramount importance of independence.

The Committee will regularly meet and engage with the Programme management team to help guide its work. They will also assess and influence the work of the programme through engagement with member states.

Madagascar: “…Since the outbreak began in September, the country in East Africa has seen more than 68,000 cases of the highly infectious disease…The organization says 553 people have died and an additional 373 are suspected to have died because of the measles…..”

USA Today


2/25/1984: A huge gas leak explosion destroys a shantytown in Brazil, killing at least 500 people, mostly young children.


“….When workers opened the wrong pipeline on February 24, highly combustible octane gas poured into the ditches of Vila Soco. Soon after midnight, an explosion was sparked, and a fireball ripped through the favela. Some homes were literally thrown hundreds of feet into the air; others were instantly incinerated. The temperature at the heart of the fireball was estimated at 1,800 degrees Fahrenheit…..”



CDC: How to prepare for and respond to a smallpox emergency with smallpox vaccination how-to videos.


Millions of Indians face eviction after the country’s supreme court ruled that indigenous people illegally living on forest land should move.

The Guardian

“……The conservation groups said state governments should see if families could prove their claim under the act and, if they could, they should be allowed to live and work on the land. If they failed to prove their claim, they should be evicted by the state government.

The supreme court has ordered the 20 state governments – where claims were considered by special committees – to act on about 1.1m claims now rejected as bogus and evict the families. Depending on the size of the families, more than 1m claims could translate to about 5-7 million people being evicted by 27 July…..”


A Plethora Of Impacts To The Central And Eastern U.S. This Weekend


National Weather Outlook


Although antibiotic reserves are part of pandemic preparedness plans, experts may not have fully explored the value of stockpiling or conserving the effectiveness of antibiotics, despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics because of emerging antibiotic-resistant organisms.

Study weighs value of antibiotics for resistant Staph in pandemic settings

An effective antibiotic that can treat secondary Staphylococcus aureus infections in a pandemic flu outbreak is worth more than $3 billion, according to a new study by researchers from the Center for Disease Dynamics, Economics, and Policy (CDDEP) and their colleagues in Scotland and the Netherlands.

Writing in Health Economics, the authors said though antibiotic reserves are part of pandemic preparedness plans, experts haven’t explores the value of stockpiling or conserving the effectiveness of antibiotics, despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics because of emerging antibiotic-resistant organisms.

Using a mathematical framework based on UK preparedness plan assumptions the scientists estimated the value of investing in developing and conserving an antibiotic to lessen the burden of bacterial infections from resistant S aureus during a pandemic flu outbreak.

The team found that the value of withholding an effective new oral antibiotic can be positive and significant unless the pandemic is mild, with few secondary illnesses involving the resistant strain or if most patients can be treated intravenously.

Ramanan Laxminarayan, PhD, MPH, CDDEP director and the study’s senior author, said in a CDDEP press release that secondary bacterial infections are a major cause of death and disability with flu, and antibiotic resistance is a major barrier to treating those infections. “This study shows that the value of an effective antibiotic against Staph infections, as an insurance policy against future pandemics, is between $3 [billion] and 4 billion at baseline,” he said.
Feb 11 Health Econ abstract
Feb 12 CDDEP press release

Investing in antibiotics critical to saving lives during pandemic influenza outbreaks

CDDEP researchers find that the availability of an effective antibiotic that can treat Staphylococcus aureus infections effectively during a pandemic influenza outbreak is worth over $3 billion.

Center for Disease Dynamics, Economics & Policy

Washington DC – There have been roughly three global pandemic influenza outbreaks each century for the past four hundred years, each of which have resulted in larger numbers of infections and deaths. Secondary bacterial infections have been responsible for a significant proportion of deaths in previous pandemics.

Pandemic preparedness plans call for maintaining stocks of antivirals, antibiotics, and vaccines; however, the value of stockpiling or conserving the effectiveness of antibiotics remains unexplored despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics due to the emerging public health threat of antibiotic-resistant superbugs. In the event of a significant influenza pandemic, secondary infections caused by prevalent pan-drug resistant bacteria could be catastrophic. Effective antibiotics in the future are indispensable in the case of an influenza pandemic.

In a new study published in the journal Health Economics, researchers at CDDEP, the University of Strathclyde in Scotland, and Wageningen University in the Netherlands developed a mathematical framework to estimate the value of investing in developing and conserving an antibiotic to mitigate the burden of bacterial infections caused by resistant Staphylococcus aureus during a pandemic influenza outbreak. The model, which is based on UK preparedness plan assumptions, found that the value of withholding an effective novel oral antibiotic can be positive and significant unless the pandemic is mild and causes few secondary infections with the resistant strain or if most patients can be treated intravenously.

“Although influenza is caused by a virus, which cannot be treated with antibiotics, secondary bacterial infections are a major cause of death and disability and antibiotic resistance is a major barrier to treating these infections,” said Ramanan Laxminarayan, CDDEP director and senior author of the study. “This study shows that the value of an effective antibiotic against Staph infections, as an insurance policy against future pandemics, is between $3 and 4 billion at baseline”.


The study titled, “Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza?” was published on February 11, 2019 in the journal Health Economics and is available online here.

Hezbollah’s Precision Missile Project : February 2019 Document

Precision Missiles : Document

European countries have been critical of Iranian missile tests but a more urgent and alarming regional threat is Iran’s project to upgrade Hezbollah missiles into precision guided missiles. These would enable the Lebanese group to accurately target critical Israeli infrastructure and constitutes a significant threat to Israel’s security.

• The Hezbollah Precision Missile project is a test case that could be replicated. After infrastructure has been put in place, evidence suggests that missiles can be converted into precision guided missiles in just a few hours at a cost of $5,000- $10,000. Iran has already attempted to utilise this technology for its Houthi allies in Yemen, a move which could put US bases in the Gulf under significant risk.

• Iran sought originally to deliver advanced precision missiles to Hezbollah in Lebanon via Syria, with these efforts intensifying during the Syrian civil war. Israel declared that the supply of such weapons was a ‘red-line’ and has carried out air strikes to prevent them reaching Hezbollah by targeting storage facilities, weapons convoys, and research and production facilities in Syria.

• As a result, Iran launched a new initiative to fit GPS guidance packs onto ‘dumb’ medium range Zelzal 2 missiles, of which Hezbollah is thought to possess 14,000 and which are already located in Lebanon. Relevant components are transported from Iran to factories in Syria and Lebanon, either by land, or by air via Damascus, using civilian aircraft.

• Once in the factory, an existing section of the Zelzal 2 is removed and replaced with a new section which includes a GPStype navigation system; a command and guidance system; and a control system (for applying guidance commands and steering the missile). This transforms the Zelzal 2 into something similar to a Fateh 110 missile.

• It is not clear how many precision missiles Hezbollah currently has, with estimates ranging from the low 20 to 200. But even a small number of missiles could do serious damage to Israel – which is a small, densely populated country with all its key industrial and critical infrastructure sites concentrated in a small number of locations. Hezbollah has already threatened to attack power stations, air force bases, the Haifa oil refinery, the nuclear reactor close to Dimona, and the ‘Kirya’ Ministry of Defence and IDF Headquarters in central Tel Aviv.

• Israel has been developing missile defence systems since the 1980s. Yet whilst the country’s capabilities are arguably the most comprehensive and capable in the world, they cannot provide hermetic protection. And with limited batteries available, Israel may be forced to make a choice between protecting critical infrastructure or population centres.

• Israeli decision makers face a dilemma over how best to counter Hezbollah’s Precision Missile project. Israel could launch a preemptive strike inside Lebanon to destroy missile factories, but this could trigger a wider conflagration with Hezbollah. In light of this, Israel is currently focused on issuing public warnings to Hezbollah and the Government of Lebanon including revealing secret intelligence to maximise impact.

• The US and key European states including the UK, France and Germany can play an important role preventing an escalation in Lebanon. One option would be to publicly warn Hezbollah and the Lebanese Government that they are aware of the precision project and to make clear that the project is a direct violation of UN Security Council Resolution 1701. If these warnings fail to make an impact then they should consider initiating tough sanctions against those involved in the project from Hezbollah and the IRGC.

At least 133 people have died and more than 200 others have been hospitalized after consuming tainted alcohol in India


“…..Homemade alcohol is typically brewed in villages before being smuggled into cities, where it sells for about 10 cents a glass — about a third the price of legally brewed liquor…….

Country-made liquor often contains toxic methanol, which can make people feel inebriated. However, even a very small amount can be toxic. Methanol poisoning can cause confusion, dizziness, drowsiness, headaches and the inability to coordinate muscle movements…..”

Human Brucella abortus RB51 Infections and the Consumption of Unpasteurized Domestic Dairy Products — United States, 2017–2019.

Negrón ME, Kharod GA, Bower WA, Walke H. Notes from the Field: Human Brucella abortus RB51 Infections Caused by Consumption of Unpasteurized Domestic Dairy Products — United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2019;68:185. DOI:

“……Since August 2017, CDC has confirmed three cases of brucellosis attributed to Brucella abortus cattle vaccine strain RB51 (RB51). Each case was associated with consumption of domestically acquired unpasteurized (raw) milk products (1). Patient symptoms varied and included fever, headache, overall malaise, and respiratory symptoms. In total, at least eight persons met the probable case definition of a clinically compatible illness epidemiologically linked to a shared contaminated source …..”


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