ASEAN Association of Southeast Asian Nations 2010 Thailand

������� (������������ ) ASEAN : Association of Southeast Asian Nations ประเทศสมาชกกอ ตง ป พ. ศ. 2010 • Thailand • Malaysia • Indonesia • Philippines • Singapore ประเทศสมาชก • Brunei Darussalam ป พ. ศ. 2527 • Viet Nam ป พ. ศ. 2538 • Lao PDR ป พ. ศ. 2540 • Myanmar ป พ. ศ. 2540 • Cambodia ป พ. ศ. 2542 “ปฏญญากรงเทพฯ ” ) Bangkok Declaration 8สงหาคม 2510 (

ASEAN “One” community comes with opportunities and threats Opportunities • Larger markets, higher economic growth • More work opportunities • Better IT network • More exchange and collaborations • etc. 7 Threats • Easier and more cross-border movements of people, workforce; hence, the source of infections • Influx of poor quality foods, drugs, chemicals, alcohol & tobacco • More accidents • Overload of health service • Drainage of HCW • etc.

Health Collaborative Networks Global health APEC ASEAN ACMEC S MBDS Regional & Trans-regional – APEC, ASEAN, …… Sub-regional - GMS, LMI, ACMECS, …… Bilateral - TUC, JICA, TICA, China, UK HPA, ……… - Neighboring countries : Cambodia, Lao PDR, Myanmar, Malaysia UN Agencies - WHO, UNICEF, FAO, OIE, …. . NGOs - MBDS, KENAN, …………. ……

ASEAN Socio-cultural Community - ASCC Action lines under ASEAN Socio-Cultural Community Blueprint สาธารณสข A. Human Development A. 1. Advancing and prioritising education A. 2. Investing in human resource development A. 3. Promotion of decent work A. 4. Promoting Information and Communication Technology (ICT) A. 5. Facilitating access to applied Science and Technology (S&T) A. 6. Strengthening entrepreneurship skills for women, youth, elderly and persons with Disabilities B. Social Welfare and Protection B. 1. Poverty Alleviation B. 2. Social safety net and protection from the negative impacts of integration and globalization B. 3. Enhancing food security and safety B. 4. Access to healthcare and promotion of healthy lifestyles B. 5. Improving capability to control communicable diseases B. 6. Ensuring a drug-free ASEAN B. 7. Building disaster-resilient nations and safer communities C. Social Justice and Rights C. 1 Promotion and protection of the rights and welfare of women, children, the elderly, and persons with disabilities C. 2. Protection and promotion of the rights of migrant workers C. 3 Promoting Corporate Social Responsibility (CSR)

ASEAN Health Ministerial Meeting (AHMM) Senior Officials Meeting on Health Development (SOMHD) ASEAN Expert Group on Communicable Diseases (AEGCD) ASEAN Working Group on Pandemic Preparedness and Responses (AWGPPR) • ASEAN+3 FETN ASEAN Technical Focal Point on AIDS (ATFOA) ASEAN Focal Point on Tobacco Control (AFPTC) ASEAN Task ASEAN Working Force on Expert Group on Non Group Communi on Food Pharmaceutical cable Safety Develop. Disease (AEGFS) (AWGPD) (ATFNCD ) ASEAN Task Force on Mental Health Traditional Maternal Task Medicine and Child Force (ATFTM) Health (AMT) (ATFMCH) • APL • Risk Communication Health & Communicable Diseases, ASEAN Secretariat, Provide coordinating support to AMS, 4 staff, project based staff

Main Land ASEAN �������� CLMV Cambodia, Lao PDR, Myanmar, Vietnam

��������� Forum GMS - Greater Mekong Sub-region (China ��������� 2535) LMI - Lower Mekong Initiative (USA ��������� 2553) Member Countries Areas of Cooperation (Lead Countries) Cambodia, ��������� Loa PDR, ��������� Myanmar Vietnam HIV/AIDS Thailand ���������� China (������ ) EIDs ���������� Cambodia Loa PDR, Myanmar (���� 2555) Vietnam Thailand ������������������ Health (Cambodia) Education (Thailand)

��������� Forum ACMECS - Member Countries Cambodia, Loa PDR Myanmar Vietnam Thailand Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy (Thailand ��������� Areas of Cooperation (Lead Countries) ��������� -������ Health : Avian Influenza and other emerging infectious diseases (Thailand) 2549) Cambodia, MBDS Loa PDR Mekong Basin Myanmar Disease Vietnam Surveillance Thailand (������� ) -������������������ -������� MBDS

Globalization, Global Warming, Ageing Society AC and ASEAN Connectivity, …. “Nothing on earth is more International than Disease” Keerti Bhusan Pradhan, WHO

Distribution of migrants in Bangkok

��������� ? Ever-Ready for emerging Infectious Diseases

Preparedness for Public Health Crisis is paid off ��������������� “If we want peace, King Rama VI we need Preparedness” Preparedness

“พระราชดำรสพระบาทสมเดจพระเจาอยหว ” ���������������������� ��������� ��� 2 ���� �. �. 2540. ทรงแปลดวยพระองคเอง : “…. . If we look at some faces in Bangkok we can surmise that they came from foreign countries illegally. We do not know what diseases they carried, there must be some. We have to seek out those who carry a disease to provide them with some medical treatment. Whether they came in illegally or not, the diseases they carry have also entered the country illegally. Nevertheless, we must fight the diseases regardless of whether it came legally or illegally. We must help, otherwise the disease will surge up and spread out again. This is the duty or it could be called the future mission that we have to do in the future. We cannot rest on our laurels after our victory, we cannot stop working. ”

Plague Outbreaks India, 1994 Economic Loss: 1, 700 Mil. USD Between 1348 and 1359 the Black Death wiped out an estimated 30 percent of the population in Europe and Asia.

Influenza A/H 7 N 9 in China February 2013–January 2014 Summary of confirmed human infections*: • Median age = 58 years (range: 3 -91) • 72% cases male • Apparent case fatality rate = 24% • Cases in clusters (2 or more) = at least 5% • Cases with connections to China = 100% • Cases with likely contact with poultry = at least 34% • Cases involving health workers = 0% • Cases with basic data** = 55% Sources = World Health Organization, Food and Agriculture Organization, OIE, Pro. Med, Flutrackers, and scientific publications through 1/23/14; * may be biased towards more-severe cases that are more-easily recognized. ** includes age, gender, location, clinical outcome, and dates for symptom onset, hospitalization, death (if applicable) in publiclyavailable reports = male; = female ^ Anhui (4), Beijing (2), Fujian (12), Hebei (1), Henan (4), Hunan (2), Jiangxi (6), Shandong (2), Taiwan (2)

Components of Communicable Disease Control Measures Risk Communication Outbreak Communication Social mobilization Co-ordination Logistics & Security Crisis Communication (All Hazards) Case Management Surveillance & Laboratory investigation

Success Stories in Thailand Plague eliminated (1952) Smallpox eradicated (1962) Yaws (no cases since 1966) few cases re-emerged in some years, 22 cases in 2004 Poliomyelitis (no cases since 1997) Vaccine preventable diseases Human diseases (Diphtheria, Pertussis, Tetanus, Mump, JE) Zoonoses (Anthrax, Rabies, …) Filariasis, Leprosy (under controlled) HIV/AIDS (substantially controlled)

Emerging Infectious Diseases (EIDs) • New infectious diseases • New geographical areas • • • Re-emerging infectious diseases Antimicrobial resistant organisms Deliberate use of bio-weapons

EIDs of Major Concerns Avian influenza and Pandemic influenza Re-emerging TB (MDR and XDR) Drug Resistant Malaria, HIV/AIDS (more focus in youths) Severe HFMD (Enterovirus 71, …. ) EIDs and Re-EIDs from abroad e. g. - Plague, SARS - Encephalitis (Nipah, West Nile. . ) - Hemorrhagic Fever (Ebola, Marburg…. ), Yellow Fever - Chikungunya - Vaccine preventable diseases (diptheria, …. ) Antimicrobial resistance pathogens

Risk for areas with recent local transmission of SARS ? ? ������������ ! !! Low (+) ? Medium (++) Case in area of exportation High (+++) Low (+) : Imported probable SARS case(s) have produced only one generation of local probable cases, all of whom are direct personal contacts of the imported case(s) Medium (++) : More than one generation of local probable cases, but only among persons that have been previously identified and followed-up as known contacts of probable SARS cases High (+++) : High transmission pattern other than described above in (+) and (++) Uncertain : Insufficient information available to specify areas or extent of local transmission

����� SARS ! WHO Issues first travel advisory 15 WHO Issues March Global Alert • Global 12 March cooperation • National transparency • National preparedness • Naming diseases carefully

Intregrated management of HPAI at provincial level Provincial Livestock Office District Livestock Officer HPAI Task Force Prov. Gov. (Director) HPAI Task Force District Gov. (Director) Provincial Health Office District Health Office Local municipalities Sub-District Health Unit Chief of village/ Livestock volunteer/ Poultry owner Public Health Volunteer

���������� (���� ) 2009 ���������� Voices of reason quieter than voices of panic Hilary M Babcock, MD, MPH

Response in Public Health Emergency Botulism Outbreak (163 cases) from Canned Bamboo shoot, Nan, 2006

������������ , PHER, Orphan drugs, Risk Communication ผปวยโรคคอตบ Confirm case Carrier 27 11418 20 7 416 525 19 11 2 313 910 24 81517 12 26 2122 3 6

Expected roles of national health authority 1. 2. 3. 4. Policy and strategy development Knowledge management Technology assessment & development Standardization of disease control practices 5. Surveillance 6. Regulatory 7. International cooperation (Medical Hub, ชายแดน, ดาน ( ? 8. monitoring and evaluation 9. Financing 10. Information 11. manpower development

National IHR Core Capacity Requirements • 8 Core capacities –Legislation and Policy ����� �. �. . . . –Coordination –Surveillance –Response –Preparedness –Risk Communications –Human Resources –Laboratory • 3 levels –National –Intermediate –Peripheral/Community n Potential Hazards – Biological Infectious n Zoonoses Food safety n – Chemical – Natural Disaster – Radiological and nuclear – Events at Points of Entry ทกประเทศสมาชก WHO รบหลกการ ทจะตองพฒนาสมรรถนะหลกของประเทศ ในการเฝาระวงและแกไขภาวะฉกเฉนดานสาธารณสขทงภายในและระหวางประเทศ

�������� (District Health System : DHS) ����������� (DCCD) ����������� Health Promotion Hospitals - PCU (Close to client)

����������� (District Health System : DHS) UCARE : Unity - �������� Community - ������� Appreciation - ������� Resource sharing - ����� Essential care - ������

The 4 words starting with co Success in controlling diseases is dependent not only on the authorities’efforts but also on local people's active participation and supports in the efforts. For securing the participation and supports we need the following. » Communication » coordination » collaboration » cooperation Communication is a prerequisite for the rest of the words. Shiro Yoshimura, OIE Coordination, Bangkok Sub-Regional Office for SEA, August, 2007

������� : ������ ������ ? • Networks • Policy, Strategy, System, Mechanism • Action plan • Emergency response plan • Resources • Core capacities ��� IHRs (2005)