HKMUN
14’ World Health Organization
08 Fall
Topic 2: Protocol for Response to Pandemic Disease Note from the Chair: This document serves as an introductory study guide on the topic above for HKMUN 2014. While this document outlines the framework and the scope for this topic, further reading and extra research of current affairs and your country’s domestic/foreign policies are highly recommended.
Hong Kong Model United Nations 2014
Overview Pandemics are the greatest threat to global public health. As history shows, some pandemic diseases have caused high mortality rates and devastated continents repeatedly. The World Health Organization categorizes diseases based on their infectious rates. A disease is categorized as endemic if it spreads to many people in a particular area in a short period of time. The disease becomes pandemic once it spreads to different continents. The term also applies to diseases that have reemerged after disappearance for a certain time. Historically, pandemics occurred during war or through intercontinental routes of trade in which the distant civilians were significantly less prone to them. However, this era of globalization and advanced transportation methods make the international community vulnerable to infectious diseases. While modern medicine and health services could suppress the outbreaks of various diseases to minimize health threats, distribution of these pharmaceutical products and services also depend on their status of approval, availability and cost; this puts low-income countries and vulnerable groups into a damaging disadvantage. Furthermore, there can be situations where the pandemic disease does not have a treatable drug that the international community must be equipped to face. In this conference, it is the duty and responsibility of delegates to examine the past and current situations of pandemic diseases, and come up with a practical protocol in response to pandemics. This committee is expected to address various types of pandemic diseases, such as but not limited to subtypes of influenza, HIV/AIDS and cholera - it is possible and recommended to categorize pandemic diseases into separate resolutions.
Key Terms While delegates are expected to know the following terms as general knowledge, it is important to refer to the definition imposed by the World Health Organization to avoid any ambiguity. Key Term
Definition
Explanation/Notes
Disease outbreak
“A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. An outbreak may occur in a restricted geographical area, or may extend over several countries. It may last for a few days or weeks, or for several years.”
“A single case of a communicable disease long absent from a population, or caused by an agent (e.g. bacterium or virus) not previously recognized in that community or area, or the emergence of a previously unknown disease, may also constitute an outbreak and should be reported and investigated.”
HIV/AIDS
“The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). “
“It can take 10-15 years for an HIVinfected person to develop AIDS; antiretroviral drugs can slow down the process even further… HIV is transmitted through unprotected sexual intercourse, transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth and breastfeeding.”
Influenza
“Influenza is a viral infection that affects mainly the nose, throat, bronchi and, occasionally, lungs. Infection usually lasts for about a week, and is characterized by sudden onset of high fever, aching muscles, headache and severe malaise, non-productive cough, sore throat and rhinitis.”
Cholera
“Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients.”
Smallpox
“Smallpox is an acute contagious disease, caused by the variola virus.”
“It is transmitted from person to person via infected aerosols and droplets from infected symptomatic people…Following a global WHO-led immunization campaign, smallpox was declared eradicated in 1980. It no longer occurs naturally, but stocks of the virus are still kept in two highcontainment laboratories.”
Measles
“Measles is a highly contagious viral disease, which affects mostly children.”
“It is transmitted via droplets from the nose, mouth or throat of infected persons…There is no specific treatment for measles and most people recover within 2–3 weeks. However, particularly in malnourished children and people with reduced immunity, measles can cause serious complications, including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia. Measles can be prevented by immunization.”
Tuberculosis
“Tuberculosis, or TB, is an infectious
“It is transmitted via droplets from the
“The virus is transmitted easily from person to person via droplets and small particles produced when infected people cough or sneeze. Influenza tends to spread rapidly in seasonal epidemics. Most infected people recover within one to two weeks without requiring medical treatment. However, in the very young, the elderly, and those with other serious medical conditions, infection can lead to severe complications of the underlying condition, pneumonia and death.”
(TB)
bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs.“
nose, mouth or throat of infected persons…Tuberculosis is treatable with a six-month course of antibiotics. “
Past Actions •
International Health Regulations (2005)
Introduced as an updated set of legally binding agreement among 194 members in 2005, the International Health Regulations (IHR) are intended to assist in prevention and response to unexpected public health threats on a global context. First enforced in 2007, member states are required to report new diseases and outbreaks to WHO. These regulations were shown to be effective in response to the 2009 H1N1 Pandemic. •
Some countries have developed early warning systems for disease outbreaks
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Early Recovery plan assembled by the United Nations Office for the Coordination of Humanitarian Affair (UNOCHA): https://docs.unocha.org/sites/dms/Documents/Guidance %20note%20on%20Early%20Recovery.pdf
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Strategic Early Recovery Action Plan by the United Nations Development Programme (UNDP)
Possible Solutions Some possible solutions - a comprehensive guideline of methodology must be included in the protocol: •
Disease surveillance systems
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Further funds to develop vaccines for evolving viruses
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Policies for faster approval of vaccines in events of pandemics
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Plans for fair distribution of pharmaceutical products and services
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More effective communication between health authorities and the mass media
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Improve the security of health workers & protect them from transmission
Case Studies The Spanish Flu of 1918 •
Flu developed during the First World War – wartime living conditions created stress and malnourishment, and many soldiers lived in unhygienic trenches
•
Healthy adults could die within 24 hours of showing symptoms of the flu
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The virus first emerged in Kansas, affecting 50,000 people in the military camp, before it spread to other parts of the state -> the virus spread to the frontline in Europe -> the flu faded in the United States several weeks after (infected soldiers continued to be sent to Europe from the East Coast of the United States) -> killed over 100,000 civilians and 300,000 soldiers in France
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Human antibodies triggered mutation that the virus spread even further, causing the second wave -> 1.5 million US troops were affected -> the virus spread from Boston to other cities in the United States, pressuring the government to prioritize the flu above the war
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80% of the Spanish population was infected -> the flu was named after high prevalence in Spain
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40-50 million deaths worldwide (double the number of casualties in World War I)
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Approximately 500 million people were infected when world’s population was less than 2 billion
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Mortality was higher in low-income countries such as India due to malnutrition -> 16 million deaths in one year
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Spanish flu was not identified under the microscope until 1933 -> the US Public Health Service’s attempt to develop a vaccine in 1918 was unsuccessful
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Overwhelmed the health infrastructure -> the American Red Cross provided care for the affected in the United States but it was insufficient for the large number of patients, and many eventually died from a lack of care, dehydration and starvation
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Had limited pharmaceutical interventions
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Containment measure was not successful in the United States (ex. closing schools, churches and theaters) - public notices warned civilians to wear masks and cover coughs and sneezes; six million pamphlets warning the public about the flu were disseminated
Avian Influenza: HPAI A (H5N1) •
A subtype of influenza A, commonly known as the “bird flu” or “avian flu”
•
(HPAI) H5N1 is a highly pathogenic and lethal type that concerned health specialists -> birds with this virus were reported in Asia, Middle East and Europe -> the disease may spread across borders through migrating birds, and infected poultry can spread the disease to humans
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Largely endemic among many types of domestic and wild birds since 1997, especially in Southeast Asia where there are large-scale poultry production
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Limited outbreaks of HPAI A (H5N1) suggested a 60% mortality rate for humans – most deaths occurred to children and those who had contact with infected poultry
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Able to prevent transmission through treatment with antiviral medications
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Poultry vaccination campaigns have successfully prevented large numbers of poultry from dying, and it decreased the levels of outbreaks - those after 2008 were less severe than the ones took place between 2003 and 2006
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Many outbreaks have been unreported due to a lack of disease surveillance systems
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Vaccines must be constantly upgraded as the virus is evolving fast
Influenza A (H1N1) 2009
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This novel subtype of influenza A was discovered in 2009, and labeled as the more severe form of seasonal influenza -> the virus did not mutate during the pandemic in 2010 to a more lethal form as widespread resistance to oseltamivir (an antiviral drug to treat influenza) did not develop
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Termed the “swine flu” in the mass media
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Health specialists estimated that it was going to be the largest pandemic since 1918
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Emerged in pigs in Mexico or Asia in 2010, spread worldwide -> officially declared pandemic in June 2010 -> the number of cases began to decline in November 2010
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30,000 to 90,000 deaths were expected as late as August 2010
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WHO announced on 10 August 2010 that H1N1 ceased to be pandemic – the virus had killed at least 18,000 people (other sources claimed significantly less people had been affected) -> WHO was noted for overestimating the potential effect of the disease; some accused health authorities in the pandemic response due to their ties with the pharmaceutical industry -> WHO Director General responded to the low severity as “pure good luck”
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Media firms have labeled the outbreak a “false pandemic” that spurred the production and sale of a large amount of vaccine units
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Health specialists estimated that it was going to be the largest pandemic since 1918
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WHO alarmed the globe with early observational studies conducted months before the disease became pandemic – published that “young people” were at high risk and that “among those who became critically ill, the morality rate was 41%”
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H1N1 mortality was much lower than expected – WHO predictions of total mortality was five times higher than the actual number of deaths occurred
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WHO helped to alleviate virus spread by supplying 78 million vaccine doses to people in 77 countries -> timely distribution and approval of these vaccines were problematic
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The international community emphasized on the importance of prevention, “the ethos of public health” -> containment was difficult as the virus spread between countries in matter of days
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The International Health Regulations Review Committee of the WHO noted that past planning of pandemic response was more suited for H5N1, and it was more suited to deal with the shortterm outbreaks than an international pandemic lasting several months
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The limited contact between health authorities and the mass media proved to be problematic to the public’s understanding of the disease
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H1N1 has not disappeared since the end of the pandemic -> detected in Ecuador, Mexico, Venezuela as well as in a small number other countries in April 2011
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Scientists have discovered a mutation of the virus that would facilitate person-to-person transmission -> the virus can potentially come back in a more severe form
Relevant Partners The World Health Organization gets information about disease outbreaks by sending teams to affected countries to collect reports and data to monitor the occurrence of communicable diseases on a daily basis. Cooperating partners of WHO are local and provincial health clinics, national ministries of
health, nongovernmental organizations working in the countries, and other individuals involved in the health crisis. Partnerships are vital in the process of data collection - the reports must be rigorously evaluated before publication, and all the surveillance information must be verified in order to issue an early warning of a communicable disease outbreak on time. The reports and data are then assembled, analyzed and assessed by disease specialists in WHO Regional Office for South-East Asia and WHO headquarters in Geneva, Switzerland. The organization disseminates reports compiled based on daily assessments of the outbreak situations throughout the WHO global network and its technical partners, in addition to its official website.
Questions for Resolution 1. How can shortages of pharmaceutical interventions (medicines and health services) be addressed? 2. What roles do WHO partners - health clinics, national ministries of health and NGOs - have in response to pandemics? What obligations do they need to fulfill in order to suppress disease outbreaks? 3. How will the care of vulnerable groups – TCNs, migrants, children, the disabled, elderly and those in zones of high violence and refugee camps – be ensured in case of inadequate health infrastructure? 4. What are possible plans for unknown diseases? 5. How can the WHO and its partners improve in informing the public about disease outbreaks? 6. What special considerations should be made for handling pandemics if they occur in contexts of other ongoing health crisis? 7. How can the WHO work with countries to continue the sustainable recovery of their national health systems after a disease pandemic? 8. How will the WHO and its partners ensure the safety of health workers working in dangerous conditions high at risk of infection and violence? 9. What strategies can be implemented in order to contain disease outbreaks in events of natural disasters? 10. What non-pharmaceutical interventions can be used?
Further Reading Research your national center for disease control and prevention WHO summary and assessment of influenza as of 20 December 2013: http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_20De cember13.pdf More on International Health Regulations (2005): http://www.who.int/ihr/publications/9789241596664/en/index.html More about the nature of seasonal influenza: http://www.who.int/mediacentre/factsheets/fs211/en/index.html
Disease outbreak by year: http://www.who.int/csr/don/archive/year/en/index.html
Bibliography World Health Organization. (2005, January). How does WHO get information about disease outbreaks in the affected countries? [Website]. Retrieved from http://www.who.int/features/qa/05/en/index.html. World Health Organization. (n.d.). Avian influenza [Website]. Retrieved from http://www.who.int/topics/avian_influenza/en/. World Health Organization. (2012, July). Cholera [Website]. Retrieved from http://www.who.int/mediacentre/factsheets/fs107/en/index.html World Health Organization. (n.d.). Disease outbreaks [Website]. Retrieved from http://www.who.int/topics/disease_outbreaks/en/. World Health Organization. (n.d.). HIV/AIDS [Website]. Retrieved from http://www.who.int/topics/hiv_aids/en/. World Health Organization. (2005, January). How does WHO get information about disease outbreaks in the affected countries? [Website]. Retrieved from http://www.who.int/features/qa/05/en/index.html. World Health Organization. (n.d.). Influenza [Website]. Retrieved from http://www.who.int/topics/influenza/en/. World Health Organization. (n.d.). International Health Regulations (2005) [Website]. Retrieved from http://www.who.int/ihr/publications/9789241596664/en/index.html. World Health Organization. (n.d.). Measles [Website]. Retrieved from http://www.who.int/topics/measles/en/. World Health Organization. (n.d.). Smallpox [Website]. Retrieved from http://www.who.int/topics/smallpox/en/. World Health Organization. (n.d.). Tuberculosis (TB) [Website]. Retrieved from http://www.who.int/topics/tuberculosis/en/. Study Guide of Global Health Cluster. Harvard Model United Nations China 2013.