WHO’s role in COVID19

International Health Regulations

Dr. Alexandra Vokaty

Team Leader, Communicable Diseases
WHO Country Office in India
March 2020
 WHO:
Working for better health for everyone
everywhere
• Direct and coordinate international health within
the United Nations system.
• 194 Member States, six regions, > 150 offices,
>7000 people
• HQ: Geneva
• Director General: Dr. Tedros Adhanom
Ghebreyesus
• Program Areas: health systems; health through
the life-course; noncommunicable and
communicable diseases; preparedness,
surveillance and response; and corporate services
 WHO’s role in health emergencies

• Prepare for emergencies by identifying,

mitigating and managing risks
• Prevent emergencies and support
development of tools necessary during
outbreaks
• Detect and respond to acute health
emergencies
• Support delivery of essential health services
in fragile settings.
 International health regulations
• IHR (2005), is an agreement between 196
countries including all WHO Member States
to work together for global health security.
• Countries have agreed to build capacities to
detect, assess and report public health
events. WHO plays the coordinating role &
helps countries to build capacities
• IHR also includes specific measures at ports,
airports and ground crossings to limit the
spread of health risks to neighboring
countries, and to prevent unwarranted
travel and trade restrictions so that traffic
and trade disruption is kept to a minimum.
 Purpose of IHR
“ to prevent protect against,
control and provide a public
health response to the
international spread of disease
in ways that are commensurate
with and restricted to public
health risks, and which avoid
unnecessary interference with
international traffic and trade”
A global system for
alert and response
When a significant
public health event
takes place, WHO’s
comprehensive global
alert and response
system ensures that
information is available
and response
operations are
coordinated effectively.
 Ports of entry
Under the International Health
Regulations (IHR 2005), Member
States are requested to maintain
public health measures and
response capacity at designated
airports, ports and ground
crossings.

WHO produces and disseminates

technical guidance and training
tools to support Member States
in developing competencies to
fulfill their IHR requirements at
points of entry.
 What is a PHEIC?
PHEIC – Public Health Emergency of International Concern

An extraordinary event which is determined, as provided in these

Regulations:
• To constitute a public health risk to other member States through
international spread of disease and
• To potentially required a coordinated international response.
 Event Management Process
Others sources Informal/Unofficial Information
Disseminate Public
IHR Reports
IHR National Focal Health Information
Point(s)
Verification

Public Health
Initial Event Risk Emergency of
International
screen Assessment Concern (PHEIC)
WHO
Assessment

Assistance /
Response
 Declaration of PHEIC

• Only the DG WHO can declare a PHEIC under the

IHR (2005).
• The DG WHO is supported by the IHR Emergency
Committee, who reviews the event to advise the
DG on whether the criteria for PHEIC have been
met
• Since 2009 there have been six PHEIC
declarations: the 2009 H1N1 (or swine flu)
pandemic, the 2014 polio declaration, the 2014
outbreak of Ebola in Western Africa, the 2015–16
Zika virus epidemic, the ongoing 2018–20 Kivu
Ebola epidemic, and the ongoing 2019–20 4 March 2020

coronavirus outbreak.
 WHO support to MS during a PHEIC
• Monitoring for health measures- affected countries
• Readiness, Exercises- based on risk assessment
• Updated scientific information about the event
• Disease outbreak news/EIS websites for NFPs
• Review and follow up on any additional health measures
• Resource mobilization
• Updated scientific advice for countries- therapeutics, tools for
detection, verification, response

4 March 2020 13
Supporting affected countries and ‘at-risk’
countries- during the PHEIC

4 March 2020 14
 Supporting measures for risk reduction

4 March 2020 15
Informing Travelers- based on updated risk assessment

4 March 2020 16
 Continued advocacy for open borders

4 March 2020 17
Corona Virus Disease “COVID-19”

Update March 4, 2020

 Corona
Epidemiology Virus Disease “COVID-19”
Agent
Coronaviruses belonging to the family of Coronaviridae infect both animals and
humans.
Human coronaviruses can cause mild disease similar to a common cold, while
others cause more severe disease (such as MERS - Middle East Respiratory
Syndrome and SARS – Severe Acute Respiratory Syndrome).
Some coronaviruses found in animals can infect humans – zoonotic
Source and mode of transmission
Increasing evidences demonstrate the link between the COVID-19 and other
similar known coronaviruses circulating in bats, and more specifically those of the
Rhinolophus bat sub-species.
Based on current information, an animal source seems the most likely primary
source of this outbreak
Though the route of transmission to humans at the start of this event remains
unclear, it is likely that an intermediate host played a role as well in the
transmission of the disease
From our understanding, thus, there are two types of transmission: zoonotic
transmission (transmission from animals to humans) and human to human
transmission..
Current estimates of the incubation period range from 1-12.5 days with median
estimates of 5-6 days.
Clinical features COVID19COVID 19
• Signs and symptoms
• Are typically respiratory symptoms
• include fever, cough, shortness of breath, and other cold-like symptoms
• Most cases (82%) reported to date have been milder; about 15 %
appear to progress to severe cases, some 3% are critical
• Less than a quarter of cases experienced severe illness.
• Chinese authorities report about 2% of people infected with the
virus have died.
• The exact case-fatality ratio is still difficult to assess as the
denominator (or number of infections including mild) remains
unknown
• This is a new disease and our understanding is changing rapidly.
• Continued analysis of information on both current and any new
cases is critical to enhance understanding of the severity of the
illness.
 March 4, 2020
Global risk –Very High Regional risk –Very High China – Very high risk

Total number of
affected Total number Total number of
countries confirmed of cases deaths
71 90,870
3112
(8 new) (166 outside
(1,922 new) china)

*China includes Hong Kong SAR, Macau SAR , Taipei

WHO News/ statements

Leading health experts from around the world have been meeting
at the World Health Organization’s Geneva headquarters to assess
World experts the current level of knowledge about the new COVID-19 disease,
identify gaps and work together to accelerate and fund priority
and funders set research needed to help stop this outbreak and prepare for any
future outbreaks.
priorities for The 2-day forum was convened in line with the WHO R&D Blueprint
– a strategy for developing drugs and vaccines before epidemics,
COVID-19 and accelerating research and development while they are
occurring..
research
https://www.who.int/news-room/detail/12-02-2020-world-experts-and-funders-set-priorities-for-covid-
19-research
 e
WHO strategic response plan
c
t • Limit human-to-human transmission including reducing
i secondary infections among close contacts and health care
v workers, preventing transmission amplification events, and
preventing further international spread from China;
e
• Identify, isolate and care for patients early, including
s providing optimized care for infected patients;
o • Identify and reduce transmission from the animal source;
f • Address crucial unknowns regarding clinical severity,
W extent of transmission and infection, treatment options,
H and accelerate the development of diagnostics,
therapeutics and vaccines;
O • Communicate critical risk and event information to all
r communities and counter misinformation;
e • Minimize social and economic impact through
s multisectoral partnerships.
p
o
 Report of the WHO-China Joint Mission
on Coronavirus Disease 2019 (COVID-19)
• WHO sent international team of experts to
China from February 16 to 24. Report
submitted February 28.
• Recommendations for China, for countries
with imported cases or outbreaks, for
uninfected countries, for the public, and for
the international community
• Report available online at
who.int/docs/default-
source/coronavirus/who-china-joint-
mission-on-covid-19-final-report.pdf
For countries with imported cases and/or
outbreaks of COVID-19
Immediately activate the highest level of national Response
Management protocols to ensure the all-of-government and all-of-
society approach needed to contain COVID-19 with non-
pharmaceutical public health measures
Prioritize active, exhaustive case finding and immediate testing and
isolation, painstaking contact tracing and rigorous quarantine of close
contacts
Fully educate the general public on the seriousness of COVID-19 and
their role in preventing its spread
For countries with imported cases and/or
outbreaks of COVID-19
Immediately expand surveillance to detect COVID-19 transmission
chains, by testing all patients with atypical pneumonias, conducting
screening in some patients with upper respiratory illnesses and/or
recent COVID-19 exposure, and adding testing for the COVID-19 virus
to existing surveillance systems (e.g. systems for influenza-like-illness
and SARI)
Conduct multi-sector scenario planning and simulations for the
deployment of even more stringent measures to interrupt transmission
chains as needed (e.g. the suspension of large-scale gatherings and the
closure of schools and workplaces).
Recently drafted guidance and advice
New WHO Guidelines

COMMUNITY QUARANTINE

• Key considerations for repatriation and quarantine of travelers in relation to

the outbreak of novel coronavirus 2019-nCoV

LABORATORY GUIDANCE

• Laboratory biosafety guidance related to the novel coronavirus (2019-nCoV)

• Biosafety presentation and recording

 • Country Readiness assessment completed
• Support for National Incident Management Structures activation
• WCOs activate Incident Management System
• Support for National Preparedness and Response Plans/National
Pandemic Influenza Preparedness Plan activation
WHO Action in • Support for entry screening, strengthening screening at POEs,
screening of returnees from China and large scale quarantine
Countries • Support for POE strengthening, notification by IHR NFPs and
information management
• Facilitate sample testing for MS in WHO identified labs for reference
testing in Thailand and India
• Support for preparation of IEC materials for risk communication
• Rapid Response Teams are alerted and are ready for operations
• Support for assessing hospital preparedness and organizing training
activities
Country situation reports - SEAR
INDIA THAILAND TIMOR LESTE

https://www.who.int/india/emerge https://www.who.int/thailand/em https://www.who.int/timorleste/em

ncies/novel-coronavirus-(2019- ergencies/novel-coronavirus- ergencies/novel-coronavirus-
ncov)-situation-reports 2019/situation-reports 2019/novel-coronavirus-(2019-
ncov)-situation-reports
Key messages (1/2)
WE NEED TO BE VIGILANT AND READY
• The new name for 2019nCoV is COVID-19
• Increasing evidences demonstrate the link between the COVID-19 and other similar known
coronaviruses circulating in bats, and more specifically those of the Rhinolophus bat sub-species.
• However, the route of transmission to humans at the start of this event remains unclear. The current
most likely hypothesis is that an intermediary host animal has played a role in the transmission. Both
Chinese and external expert groups are working in trying to identify the animal source of this new
virus.
• The main driver of transmission, based on currently available data, is symptomatic cases. The
transmission from asymptomatic cases is not likely to be a major driver of transmission.
• WHO is working with networks of researchers and other experts to coordinate global work on
surveillance, epidemiology, modelling, diagnostics, clinical care and treatment and others
Key messages (2/2)

• WHO conducts regular briefings with clinical experts currently treating patients with COVID-19
acute respiratory disease to share case information and standardize data collection;
• WHO is sending 531,000 masks, 350,000 pairs of examination gloves, 40,000 respirators,
18,000 isolation gown and other protection equipment
• Over 400 of the world’s leading experts will gather to set research priorities (2019-nCoV
vaccines, therapeutics and diagnostics, and overall understanding)
• The deliberations will form the basis of a research and innovation roadmap charting all the
research needed and this will be used by researchers and funders to accelerate the research
response
• COVID-19 remains a test of political solidarity – whether the world can come together to fight
a common enemy that does not respect borders or ideologies