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2008/SOM1/HWG/017

Agenda Item: VI

Private Sector Engagement in the Implementation of the WHO’s International Health Regulations

Purpose: Consideration

Submitted by: USA

/ First Health Working Group Meeting Lima, Peru
21 - 22 February 2008

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Private Sector Engagement in the Implementation of

World Health Organization’s International Health Regulations (WHO IHR)

The United States seeks discussion and approval of this umbrella initiative by the APEC Health Working Group (HWG) so that the HWG can exercise its leadership role in coordinating health issues across APEC and to raise awareness of this issue in other relevant APEC fora for the development of specific projects to engage the private sector in the implementation of WHO IHRs.

APEC Leaders’ and Ministers’ Instructions:

{Note: Sections in underlined italics are for emphasis only.}

In the September 2007 APEC Ministerial Statement, Ministers said that “Strengthening emergency preparedness is an abiding priority for APEC and promoting the economic benefits of investing in risk reduction is an important means to achieve this. We agreed on the importance of strengthening our capacity to build community resilience and preparedness for emergencies and natural disasters. In this regard, we welcomed new initiatives to further cooperation between our senior emergency and disaster management officials, business and international partners to ensure we are able to respond in a timely and effective manner. We agreed on the importance of further building public-private partnerships in this area.”

In 2007 APEC Ministers also “discussed the importance of robust preparedness plans to mitigate the social and economic impact of a possible influenza pandemic. We reaffirmed our support for the World Health Organisation process of fully implementing the revised International Health Regulations (2005) to prevent, protect against, control and provide a public health response to the international spread of disease.”

In the November 2006 Ha Noi Declaration, APEC Leaders “… commended the collaboration in APEC on health and emergency preparedness and urged continued multi-sectoral, regional and international cooperation on policies and infrastructure to mitigate pandemic influenza. We called on expanded capacity building and technical collaboration between economies, and urged deepened engagement of the private sector to ensure continuity of business, trade and essential services in the event of a pandemic outbreak.”

In the November 2006 APEC Ministerial Statement, “Ministers reiterated the importance of cooperation and coordination on health security issues in the APEC region, and renewed their commitment to the … priority areas of the APEC Health Task Force” including “Enhancing avian and human pandemic influenza preparedness and response.”

In the November 2005 Busan Declaration, APEC Leaders “… committed to multi-sectoral preparedness planning, timely data and sample sharing, science-based decision-making regarding trade and travel, and early implementation, where appropriate, of the relevant International Health Regulations.” Leaders “agreed on collective, practical measures, including: strengthening cooperation and technical assistance among APEC economies to limit avian influenza at the source and prevent human outbreaks;” and “…enhancing public and business outreach and risk communication.”

In the November 2005 APEC Ministerial Statement, “Ministers committed to accelerating APEC’s ongoing work on infectious disease threats such as avian influenza ….. They agreed it was critical to ensure that APEC was prepared for and had the capacity to effectively respond to infectious diseases at the individual, regional and international levels, in cooperation with specialized international organizations, in particular the World Health Organization….”

Initiative Description

The International Health Regulations (IHR) were recently revised by the World Health Organization to promote early detection and containment of “public health emergencies of international concern” [PHEICs] (e.g. emerging and pandemic diseases, toxic spills, etc.) that endanger public health and disrupt trade and travel, while simultaneously avoiding unjustified trade and travel restrictions disproportionate to a health threat. Challenges to IHR implementation exist at technical and political levels. The main technical challenge is inadequate public health infrastructure, especially in developing economies. Political challenges include coordination among multiple government ministries, addressing economic disincentives to transparency and disease control measures, and possible reluctance of economies to seek international assistance. This initiative is a multi-faceted approach to promote collaboration between public health and global trade and tourism government officials and interested private sector stakeholders to raise the profile and optimize the implementation of the IHR, thus protecting public health, trade, and tourism from emerging infectious disease threats (e.g., SARS and pandemic influenza) as well as other PHEICs.

Basis for Involvement of Trade and Tourism Sectors in IHR Implementation

The IHRs help to safeguard trade and tourism from disruptions caused by PHEICs, thus promoting safe and unhindered travel, stability of supply and distribution chains, continuity of production, and safety of imports and exports. Business, trade, and tourism stakeholders as well asglobal and regional trade and tourism organizations can potentially offer venues, mechanisms, and resources to help support the IHR.Promoting IHR implementation is enlightened self-interest and good risk management, since business risk is reduced in countries where the IHR are implemented. Membership in global and regional trading systems implies a shared interest in protecting the systems from disruption by emerging and pandemic infectious disease threats.

Purpose of this Initiative:

  1. To develop public-private collaborations to raise the profile and optimize implementation of the IHRs, specifically by engaging business, trade, and tourism stakeholders to collaborate with public health. Several categories of interested parties could be included, each acting through its own networks and according to its own abilities, e.g.,
  2. Governments (including Ministries of Health, Trade/Economics/Commerce, and Foreign Affairs)
  3. Business sector associations and trade groups (e.g., Chambers of Commerce)
  4. Multilateral bodies (e.g., WHO, UN World Tourism Organization, Organization for Economic Cooperation and Development, World Animal Health Organization, Food and Agriculture Organization, G-8)
  5. Non-governmental organizations (e.g., World Economic Forum, World Bank, International Association of Public Health Institutes, charitable foundations)
  6. Regional organizations (e.g., Asia-Pacific Economic Cooperation, European Union, African Union, the Security and Prosperity Partnership of North America)
  1. To increase IHR visibility outside the health sector and develop innovative approaches to promote IHR implementation, including:
  2. Measures to help address technical and resource barriers to implementation, especially in developing economies that lack public health infrastructure.
  3. Examples might include funds to help build IHR-required public health capacity; help with training and/or the dissemination of new technology
  4. Measures to support occasionally difficult political decisions by governments to fully implement the IHR when a possible disease outbreak occurs in their territory. Since these decisions may be complicated by fears of economic loss, engagement of global business, trade, and tourism stakeholders would be helpful.
  5. Examples might include model industry policies, codes of best practice, and/or insurance products or other funds to help compensate for economic loss incurred by compliance with the IHR

Decision Points for HWG

  1. Approval of this umbrella initiative by the HWG, as the responsible body for coordinating health issues across APEC.
  2. HWG agreement to encourage members to consider engagingthe private sector to raise the profile and promote implementation of the IHRs. This engagement may include the formation of public-private partnerships, a focus of the APEC 2008 Chair Peru. Engagement may also include public-private sector collaboration on a more informal basis, if deemed appropriate by the member in a given situation.
  3. HWG agreement to raise awareness of this issue in other relevant APEC fora for the development of specific projects to engage the private sector to raise the profile and promote implementation of the IHRs. For example, the United States proposes to draft a similar concept paper for HWG approval for presentation at the APEC Tourism Working Group meeting in April in Cusco, Peru.
  4. HWG approval for members to collaborate intersessionallyto plan a workshop in 2009 for stakeholders in private and public sectors with the following objectives:

a.To providean update on the revised IHR, including their important role in facilitating the detection, prevention, and controlof emerging and pandemic disease threats toAPECeconomies.

b.Toassess potentialvulnerabilities of specific industries to emerging and pandemic disease threats and highlight ways in which IHR implementation would benefit those industries.

c.To exploreopportunities for public-private sector engagement in raising the profile and promotingimplementation of the IHR.

Initiative Proposers:

David Bell, MD

Senior Medical Officer

Office of Strategy and Innovation

Office of the CDC Director

U.S. Centers for Disease Control and Prevention

1600 Clifton Road (D-28)

Atlanta, GA30333

Phone (404) 639-7662

Email:

Lisa Koonin MN MPH

Senior Advisor for Pandemic Preparedness Partnerships

Influenza Coordination Unit

U.S. Centers for Disease Control and Prevention

1600 Clifton Road (A-20)

Atlanta, GA30329

Phone (404) 921-7955

Email:

Attachment

Additional Background:

An emerging or pandemic disease, such as SARS or pandemic influenza, can cause economic harm by adversely impacting trade and tourism. A distant outbreak, or the perception of an outbreak, can have local impact due to disruption of just-in-time supply and distribution chains caused by illness or public health measures; e.g., travel restrictions imposed by governments or taken voluntarily out of fear. International trade disruption due to disease could force import substitution from alternative sources, jeopardizing import safety. The global economic loss due to the SARS outbreak of 2003 has been estimated at $40 billion USD, including a loss to Hong Kong of 2.63% of GDP, with most of the loss due to changes in people’s behavior (e.g., decreased travel), rather than to illness. (McKibben W., Learning from SARS, Institute of Medicine Workshop, 2004). The World Bank estimates a severe pandemic could cost the global economy up to 4.8 percent of world GDP - $2 trillion of a world GDP of $40 trillion (UNSIC and World Bank Report, 2007). Effects may occur far from the outbreak itself as travel restrictions are applied or supply chains disrupted. During the 2003 SARS outbreak,Hong Kong watch makers were excluded from a trade fair in Switzerland, which the Federation of Hong Kong Watch Trades and Industries estimated cost $1.3 billion in sales (

To promote early detection, reporting, and containment of “public health emergencies of international concern (PHEICs)”, and to discourage trade and travel restrictions disproportionate to the threat, the IHRs were revised by WHO in 2005 and, after approval by the World Health Assembly, entered into force in 2007 ( The algorithm used for assessing whether an event must be notified to WHO as a possible PHEIC includes 4 criteria: whether a) the public health impact is serious, b) event is unusual or unexpected, c) a significant risk of international spread, or d) a significant risk of international travel or trade restrictions. Thus the IHR require notification of possible PHEICs that pose a significant risk of travel or trade restrictions even if their public health impact is not serious.

Challenges to IHR implementation exist at technical and political levels. Many countries, especially in the developing world, lack the necessary infrastructure and resources for timely, effective, and coordinated surveillance and containment of emerging or pandemic diseases or other PHEICs. To guide global capacity-building needs in the next five years, WHO recently published IHR 2005: Areas of work for implementation. ( This ambitious document calls for global partnerships including “ all relevant sectors (e.g., health, agriculture, travel, trade, education, defence)” to provide technical support and mobilize resources for effective implementation of the IHR. Public health capacity goals are addressed in some detail, but possible roles for non-health sectors and the private sector remain to be more fully developed. To date, resources needed to address these capacity-building challenges have not been fully identified and political will may vary among countries in light of competing priorities.

Other political challenges are even more difficult and ways to address them effectively are unclear. Economies may perceive substantial economic disincentives to reporting, acknowledging, and/or effectively investigating and responding to disease outbreaks and other PHEICs as required by the IHR. For various reasons, they may be reluctant to request international assistance promptly. Although the IHR are intended to avoid imposition of excessive, unjustified governmental restrictions on international trade and travel in a PHEIC, the IHR have no enforcement mechanism and in any case do not apply to private entities which may implement such restrictions on their own. IHR implementation is primarily the responsibility of health ministries, yet the trade and tourism sectors have much to lose in a disease outbreak and therefore have a shared interest in optimizing IHR implementation. .

Conversely, risk management strategies of trade and tourism sectors would benefit from better understanding of, alignment with, and support for public health efforts to detect and control emerging infectious diseases. Although these sectors recognize the potential adverse economic impact of an emerging infectious disease, early detection and control are usually considered the responsibilities of public health authorities with little involvement of the business sector outside the immediate containment zone. Since many companies appear to believe that these events are like hurricanes, i.e., unpredictable and unpreventable, their risk management strategy, if any, is limited to minimizing damage if the storm hits them. These companies may not realize the benefits of early detection and containment domestically or in other countries to their own risk management strategy—or the daunting political and technical challenges faced by public health authorities in many countries in implementing effective early detection and containment measures.

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