19th Brunei Darussalam – Indonesia – Malaysia – Singapore – Thailand
(BIMST) Public Health Conference
10 - 11September 2015
Kuantan Pahang,MALAYSIA
Opening session
Welcome and opening address by the Host of the meeting [Malaysia]
YBhg. Datuk Dr. Lokman Hakim bin Sulaiman, Deputy Director General of Health (Public Health) of Ministry of Health Malaysiadelivered the opening address. He stated that Malaysia is delighted to Host the 19th BIMST International Public Health Meetingwhich comprised of 21 BIMST Member State delegates and 32 observers who were senior officers from Ministry of Health Malaysia. He highlighted the importance of the theme “Global Health Security”emphasizingtoday’s increasingly mobile world where there has beena paradigm shift whereby communicable diseases have no borders. He looked forward to having an open and frank discussion as many of our healthcare issues are indeed common between the neighbouring countries.
Remarks by Outgoing Chair(Indonesia)
Dr Wiendra Waworuntu, Director of Surveillance, Immunization and Health Quarantine of Ministry of Health Indonesia, as outgoing chair, thanked Malaysia for hosting this meeting. She realizedthat the meeting had inspired members to further strengthen coordination of border agencies among BIMST member states. She encouraged building strong multi-sectoral cooperation and national capacities in addressing EIDs. She emphasized onthe global and regional commitments which are based onthe International Health Regulation(IHR, 2005) framework.She also highlighted the importance of border health cooperation in combating the spread of communicable diseases. She then handed over the chairmanship of BIMST to Malaysia.
Election of Chairperson, Vice Chairperson and Rapporteur
As per the alphabetical chronology for the BIMST Member States which is the yearly practice, Malaysia was elected as Chair of the meeting along with Singapore as ViceChair. Subsequently, Brunei wasthen elected as the Rapporteur.
Adoption of Agenda
The agenda of the 19th BIMST Public Health Conference was adopted and conducted as scheduled.
Review of Recommendations from the 18th BIMST Public Health Conference Meeting in Province of Bangka, Belitung Indonesia [Indonesia]
Indonesia shared the recommendations from the 18th BIMST meeting which was held in Indonesia in October 2014.BIMST member states had agreed to strengthen the mechanismsto accelerate cooperation in the prevention and control of EIDs. This includes regular bilateral border meetings and continuous ongoing simulation exercises on EID between member states that have and will be conducted to achieve the agreed recommendations from the previous meeting.
Briefing on the theme “Global Health Security” by the Secretariat
“Global Health Security” was adopted as the theme for this meeting. This theme is very timely as currently there is a concerted international collaborative drive in the form of the Global Health Security Agenda (GHSA). Rapid globalization and industrialization have led to a phenomenal rise in travel and trade. These inevitable developments have in turn caused an increase in universal challenges to health security. Public health logistics and laboratory services were emphasized as essential parts of technical assistance in managing Public Health Emergencies of International Concern (PHEIC).
Country Presentation on the theme “Global Health Security (GHS)”
- Brunei Darussalam
Currently, Brunei has not formally signed on to the GHSA. Nevertheless, Brunei is committed to global health security which is operationalised in 4 key areas namely; strengthening disease surveillance activities for communicable disease; laboratory strengthening and biosafety; enhancing health system preparedness for EIDs; and Public Health Workforce Development. Brunei noted that theIHR (2005) lays the foundation for global health security. Sharing of information and best practices would assist member states to work synergistically.
- Indonesia
Indonesia emphasized the followingpriority areas in the implementation of IHR (2005)which includesregulations, policies and strategies; readiness of healthcare facilities and surveillance; and coordination and communication.Regulations related to IHR include laws on sea and air quarantine and communicable diseases. The primary health care system will be strengthened by increasing access, improving quality of health care and referral system regionally. Surveillance activities are continuously carried out by active and passive surveillance. Current core capacities at designated ports of entry were reviewed to identify gaps and challenges. Capacity building and multi-sectoral engagement were carried out by disseminating information on IHR (2005) to improve collaboration between multi-sectoral institutions, universities and private sectors.
- Malaysia
Malaysia highlighted on its commitment to accelerate progress towards a world safe and secure from infectious diseases threat and to promote global health security. Global Health Security Agenda (GHSA) is one of the initiatives towards achieving global health security. For the benefit of all delegates, Malaysia highlightedon what GHSA is, the main objective of GHSAwhich is “Towards a World Safe and Secure from Infectious Diseases” and further elaboration was provided on the GHSA action packages. Malaysia is the lead country together with Turkey in enhancing Public Health Emergency Operation Centre (EOC). Malaysia has supported this initiative since its inception in 2013 and details of the minimum common standards for functioning of EOC were explained. Malaysia informed the meeting of the chronology of events in developing GHSA and expanded on the current collaboration with ASEAN member states. The presentation also illustrated the current GHSA-EOC activities amongst ASEAN member states and this includes an exchange of visits to MOH EOCs in the region; explore linking up in communications between existing EOCs in countries such as through tele-conferencing, video-conferencing; identification and sharing of country contact persons; and exploring the provision of technical assistance.Currently there are five other ASEAN member states supporting the GHSA EOC activities namely Brunei Darussalam, Singapore, Indonesia, Thailand and Phillipines. Malaysia emphasized the need for an ASEAN-EOC network as a regional surveillance and response system in addition to the current formal network through National IHR Focal Point. Malaysia alsoseeked support from ASEAN member stateson the establishment of ASEAN-EOC network amongst ASEAN member states to enhance the effectiveness of regional surveillance and response towards EID or public health emergencies.
- Singapore
Singaporeshared their preparedness for emerging infectious diseases and public health threats. The key areas of preparedness include a robust communicabledisease surveillance system; effective outbreak response and investigations; national public health laboratory capacities and capabilities; policies for prevention and control of EIDs; operational readiness; and effective coordination with other government agencies and stakeholders.
- Thailand
Thailand presented the current global health issues on Epidemic and Pandemic Infectious Diseases; EID, Emerging and Re-emerging Diseases; International Trade that affects Health; Access to Essential Drugs and Vaccines; Health Expenditure and Equity to Access to Healthcare; and Natural Disaster and Environmental Health. Thailand is tackling the issues from the perspective of GHSA; Antimicrobial resistance (AMR); international trade and itsimpact on health; sustainability and security in health financing; and public health insecurity from natural disaster.The Cabinet Ministries of Thailand had accepted the Ministry of Public Health, Thailand (MOPH)’s report on GHSA on 28 October 2014. Thailand has contributed towards the Action Packages and has encouraged the border provinces to implement the 12 GHSA targets. Thailand shared the strengths and challenges faced with integrated framework on AMR.
Roundtable Discussion
- Brunei Darussalam[E-cigarettes: Issues and Challenges in Tobacco Control Measures]
Bruneishared findings of a tobacco question survey (TQS) which was conducted in 2014. The survey showed an overall e-cigarette use of 5.6% in 1,294 individuals. E-cigarettes were mainly used by those between15-24 years of age. A WHO report noted that nicotine content in e-cigarettes varies widely between brands and that toxicant levels in 3rd generation e-cigarettes can generate 5-15 times levels of formaldehyde. Evidence for effectiveness of e-cigarettes as a cessation aid is also limited. Current issues faced by Brunei Darussalaminclude the regulation of the use of e-cigarettesas the current generation ofe-cigarettes do not fall strictly under the definition of ‘imitation of tobacco products’ plus presence or absence of nicotine is unknown. Use of e-cigarettes in public places and prohibition of sales are other challenges faced. Singapore has banned the use of e-cigarettes while other member states are currently reviewing the policies and regulations concerning e-cigarettes.
- Indonesia[Preparedness and Response to potential MERS-CoV outbreak in Indonesia]
The risk of importation of MERS-CoV to the region is high asa large population in the region are Moslemswho travel regularly to Middle East for their pilgrimage. The virus continues to evolve and poses potential threats to international travel. The outbreak of Mers-CoV is unpredictable due to lack of epidemiology and scientific evidence regarding source of infection, reservoir, route of infection, communicability and treatment. Indonesia has taken the following preparedness measures as follows: strengthening the existing regulation on laboratory networks; enhancing laboratory capacity; improve readiness respond to MERS-CoV and logistic readiness.
- Malaysia[Cross Border Health Issues]
Cross border health issues remains a serious problem especially with regards to spread of emerging and re-emerging infectious diseases as well as the implications to the healthcare delivery services in Malaysia. The implications include overcrowding at primary care level and hospitals which affects service quality; and overburdening of maternal and child health services. Disease mortality and morbidity statistics in migrant populations would negatively affect the national health statistics. Therefore there is a need to strengthen surveillance and reporting of diseases between border states and to continue bilateral discussion at the border areas.
- Singapore[Hand Foot Mouth Disease (HFMD)– A Significant Public Health Issue?]
HFMD is a common childhood disease that is largely mild and self-limiting. From 2000-2012, over 226,000 cases were notified with eight deaths (case fatality rate of 0.0035%).Local sero-prevalence studies and notification data in Singapore estimated that 75% of HFMD cases were asymptomatic or mild. During an EV71 epidemic in 2006, the need for closure of pre-school centreswas determined based on number of cases in the centre, attack rate and transmission period. However, evaluation of these measures showed that the benefit of mandatory closures was limited. There was no significant difference in the reduction of attack rates and closures did not delay the onset of the next HFMD cases. The mainstay of HFMD control should focus on routine early detection and isolation of cases and maintenance of good personal and environmental hygiene through targeted education. The meeting suggested that a group of experts meet to review the surveillance and control measures for HFMD.
- Thailand[Thailand’s Experiences in Response and Control of MERS-CoV and other EIDs]
Thailand shared their experience in dealing with a MERS-CoV case who had travelled from Oman to Thailand. Subsequently, there were no cases reported after all control measures were conducted. The measures implemented by MOPH Thailand were risk assessment and prevention measures; risk communication measures; advice for travellers visiting affected countries; health system management for Hajj and Umrah pilgrims; and surveillance for MERS-CoV in animal health. Thailand had conducted a VDO conference on MERS-CoV among the Health Ministers in ASEAN plus Three Countries and the two WHO regional offices (SEARO and WPRO). That meeting resulted in recommendations for awareness and cooperation in the region. A National Committee on EIDs was established and a strategic plan was laid out for 2013-2016. Lessons learned were that implementation of National Strategic Plan should be monitored rigorously; an effective operational plan is required to translate policy to real practice; and multi-sectoral collaboration is essential. Thailand is working on strengthening national capacities for EID surveillance, prevention and control and in enhancing regional and international cooperation.
Recommendations from the 19th BIMST Public Health Conference
GHSA is an initiative to help countries achieve core competencies under IHR (2005). In that context, BIMST member states agreed to accelerate cooperation in strengthening mechanisms forGlobal Health Security and to put into action, wherever appropiate, the following activities:
1)Promote the establishment of ASEAN-EOC network through:
a) exchange of visits to share best practices;
b) regular communications between EOCs;
c) identification and sharing of country contact persons; and
d) sharing of technical assistance to strengthen existing EOCs.
2)Establish regular bilateral meetings among countriessharing common borders to
enhance cooperation in infectious disease prevention and control.
3) Enhanceinfection prevention and control in healthcare facilities through
implementation of national standards and accreditation at all levels.
4) Continue to invest and strengthen human resource capacities and capabilities.
5)Explore mechanisms to sharesurveillance data and information onAMR control
measures.
6) Form an expert group to reviewsurveillance and control measures for HFMD.
Date and Venue of the 20th BIMST Public Health Conference
The 20th BIMST Public Health Conference will be held in Singapore in 2016.
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