THE WORLD HEALTH REPORT 2007 SAFER UTURE GLOBAL PUBLIC HEALTH SECURITY IN THE 2ST CENTURY World Health Organization
The world health report 2007 Global Public Health Security in the 21st Century A safer future
WHO Library Cataloguing-in-Publication Data The world health report 2007: a safer future global public health security in the 21st century. 1. World health-trends. 2. Disease outbreaks- prevention and controL. 3. Legislation, Health. 4. International cooperation. 5.Environmental health. ITitle. ILTItle: A safer future: global public health security in the 21st cer BN978924156344 NLM classification: WA530.1) e World Health Organization 2007 Requests we Appia, 1211 Geneva 27, Switzerland (tel : +41 22 791 3264: fax: +41 22 4857 roduce or translate WHO publications- whether for sale or for be addressed to WHO Press, at the abowe address (fax +41 22 791 4806; e-mail: permi border lines for which there may not full agreement. orld Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions the names of proprietary products are distinguished by initial capital letters All reasonable precautions have been tai al isI the world Health Organization to verify responsibility for the interpretation and use of the material lies wit der. In no event shall the World Health Organia. The able for damages arising from its use Information conceming this publication can be obtained from World Health Organization 1211 Geneva 27. Switzerland mail: whr @ who int Copies of this publication can be ordered from: bookorders@who in his report was produced under the leadership of Director-General, Margaret Chan. David Heymann, Assistant Director-General for Communicable Diseases, was Editor-in-Chief. The main writers were Thomson Prentice and Lina Tucker Reinders of the world Health Report Advice and support were gratefully received from all Assistant Directors-General, Regional Directors, numerous WHO technical units, and many ers who reviewed and cont the text athers, Angela Merianos, Francois-Xavier Meslin, Michael Nathan, Maria Neira, Paul Nunn, Kevin O Reilly, Andree Rodier, Oliver Rosenbauer, Cathy Roth, Mike Ryan, Jorgen Schlundt, George Schmid, lan Smith, Claudia Stein and Leo Vita-Finzi. The report was edited by Diana Hopkins, assisted by Barbara Campanini Figures, tables and other illustrations were d by gael Kernen, who also produced the web site version and other electronic media. Vreni schoenenberger assisted in historical research. Administrative support to the world Health Report team was prowided by Saba Amdeselassie. The index was prepared by June Morrison. 30): United States National Library of Medicine(NLM)(p. 47) WHO/Olivier Asselin (pp wi, 16: WHO/Christopher Black(pp. vi, xiv, xvi, i, Xx, xXii, 1, 16, 34, 44, 56, 64: WHO/Christopher Black, Chris de Bode, Umit Kartoglu, Marko Kokic and Jean Mohr (cover) WHO/Chris de Bode (p. 19 WHO/Marko Kokic (pp 20, 21): WHO/Jean Mohr(pp. vili, 1) ns: The Plague Doctor, unknown artist, Wellcome Library, London(p. 2); Death's Dispensary, George Pinwell, 1866(p. 4); Edward enner Performing the First Vaccination against Smallpox in 1796, Gaston Melingue, 1879, Bibliotheque de l'Ac and Reda sad ki on: Raphael Crettaz
WHO Library Cataloguing-in-Publication Data World Health Organization. The world health report 2007 : a safer future : global public health security in the 21st century. 1.World health – trends. 2.Disease outbreaks – prevention and control. 3.Legislation, Health. 4.International cooperation. 5.Environmental health. I.Title. II.Title: A safer future: global public health security in the 21st century. ISBN 978 92 4 156344 4 (NLM classification: WA 530.1) ISSN 1020-3311 © World Health Organization 2007 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Information concerning this publication can be obtained from: World Health Report World Health Organization 1211 Geneva 27, Switzerland E-mail: whr@who.int Copies of this publication can be ordered from: bookorders@who.int This report was produced under the leadership of Director-General, Margaret Chan. David Heymann, Assistant Director-General for Communicable Diseases, was Editor-in-Chief. The main writers were Thomson Prentice and Lina Tucker Reinders of the World Health Report team. Advice and support were gratefully received from all Assistant Directors-General, Regional Directors, numerous WHO technical units, and many others who reviewed and contributed to the text. Special thanks for their contributions are due to Tomas Allen, Penelope Andrea, Bruce Aylward, Anand Balachandran, Sona Bari, Diarmid Campbell-Lendrum, Amina Chaieb, Claire Lise Chaignat, May Chu, Albert Concha-Eastman, Ottorino Cosivi, Alvaro Cruz, Kevin De Cock,Sophia Desillas, Pat Drury, Pierre Formenty, Keiji Fukuda, Fernando Gonzalez–Martin, Pascal Haefliger, Max Hardiman, Mary Kay Kindhauser, Colin Mathers, Angela Merianos, Francois-Xavier Meslin, Michael Nathan, Maria Neira, Paul Nunn, Kevin O’Reilly, Andrée Pinard-Clark, Guenael Rodier, Oliver Rosenbauer, Cathy Roth, Mike Ryan, Jorgen Schlundt, George Schmid, Ian Smith, Claudia Stein and Leo Vita-Finzi. The report was edited by Diana Hopkins, assisted by Barbara Campanini. Figures, tables and other illustrations were provided by Gael Kernen, who also produced the web site version and other electronic media. Vreni Schoenenberger assisted in historical research. Administrative support to the World Health Report team was provided by Saba Amdeselassie. The index was prepared by June Morrison. Photo credits: Agence France-Presse/Paula Bronstein (pp. viii, 34); International Federation of the Red Cross and Red Crescent Societies (IFRC)/ Christopher Black (p. 25); IFRC/Marko Kokic (p. 22); United Nations Integrated Regional Information Networks (IRIN) (p. 41); Jean-Pierre Revel (p. 30); United States National Library of Medicine (NLM) (p. 47); WHO/Olivier Asselin (pp. viii, 16); WHO/Christopher Black (pp. viii, xiv, xvi, xviii, xx, xxii, 1, 16, 34, 44, 56, 64); WHO/Christopher Black, Chris de Bode, Umit Kartoglu, Marko Kokic and Jean Mohr (cover); WHO/Chris de Bode (p. 19); WHO/Marko Kokic (pp. 20, 21); WHO/Jean Mohr (pp. viii, 1). Illustrations: The Plague Doctor, unknown artist, Wellcome Library, London (p. 2); Death’s Dispensary, George Pinwell, 1866 (p. 4); Edward Jenner Performing the First Vaccination against Smallpox in 1796, Gaston Melingue, 1879, Bibliothèque de l’Académie nationale de Médecine, Paris (p. 5). Design: Reda Sadki Layout: Steve Ewart and Reda Sadki Figures: Christophe Grangier Printing Coordination: Raphaël Crettaz Printed in France
CONTENTS Message from the Director-General Overview Global public health threats in the 21st century Epidemic-prone diseases Foodborne diseases Accidental and deliberate outbreaks Toxic chemical accidents Radionuclear accidents xxxxⅫ Environmental disasters Global collaboration to meet threats to public health security xil Chapter summaries Chapter 1. Evolution of public health security Building on historical landmarks s chapter Plague and quarantine Cholera and sanitation Smallpox and immunization Fostering international cooperation A new code for international health security International preparedness for chemical emergencies 10 New health regulations in a vastly altered world Chapter 2. Threats to public health security 17 Human causes of public health insecurity chapter Inadequate investment 18 Public health consequences of conflict Microbial evolution and antibiotic resistance Animal husbandry and food processing Human bovine spongiform encephalopathy 24 Weather-related events and infectious diseases Other public health emergencie Sudden chemical and radioactive events Industrial accidents Natural phenomena 31
Contents Message from the Director-General vi Overview viii Global public health threats in the 21st century x Epidemic-prone diseases x Foodborne diseases xi Accidental and deliberate outbreaks xi Toxic chemical accidents xi Radionuclear accidents xi Environmental disasters xii Global collaboration to meet threats to public health security xii Chapter summaries xiv Chapter 1. Evolution of public health security 1 Building on historical landmarks 2 Plague and quarantine 2 Cholera and sanitation 4 Smallpox and immunization 5 Fostering international cooperation 6 A new code for international health security 8 International preparedness for chemical emergencies 10 New health regulations in a vastly altered world 11 Chapter 2. Threats to public health security 17 Human causes of public health insecurity 17 Inadequate investment 18 Unexpected policy changes 20 Public health consequences of conflict 21 Microbial evolution and antibiotic resistance 22 Animal husbandry and food processing 24 Human bovine spongiform encephalopathy 24 Nipah virus 24 Weather-related events and infectious diseases 25 Other public health emergencies 26 Sudden chemical and radioactive events 27 Industrial accidents 29 Natural phenomena 31 1 chapter 2 chapter iii
chapter Chapter 3. New health threats in the 21st century The anthrax letters 3 SARS: vulnerability revealed 5574 Dumping of toxic chemicals chapter chapter 4. Learning lessons, thinking ahead Pandemic influenza: the most feared security threat 4 WHO's strategic action plan for pandemic influenza 5522 Extensively drug-resistant tuberculosis Managing the risks and consequences of the international spread of polio 54 pter Chapter 5. Towards a safer future Helping countries helps the world Global partnerships Strengthening national capacity Legal issues and monitoring 7886366 Preventing and responding to international public health emergencies 63 Conclusions and recommendations Index 69
Chapter 3. New health threats in the 21st century 35 The anthrax letters 35 SARS: vulnerability revealed 37 Dumping of toxic chemicals 40 Chapter 4. Learning lessons, thinking ahead 45 Pandemic influenza: the most feared security threat 45 WHO’s strategic action plan for pandemic influenza 52 Extensively drug-resistant tuberculosis 52 Managing the risks and consequences of the international spread of polio 54 Chapter 5. Towards a safer future 57 Helping countries helps the world 58 Global partnerships 58 Strengthening national capacity 61 Preventing and responding to international public health emergencies 63 Legal issues and monitoring 64 Conclusions and recommendations 66 Index 69 3 chapter 4 chapter 5 chapter iv
Figures- Chapters Figure 1.1 Spread of bubonic plague in Europe Figure 1.2 Examples of international epidemic response missions 1998-1999 Figure 1.3 International public health security: a global network of national health systems and technical partners, coordinated by WHO, founded on four major areas of work 10 Figure 1. 4 Selected emerging and re-emerging infectious diseases 1996-2004 12 Figure 2.1 Twenty-five years of HIV/AIDS Figure 2.2 Global outbreaks, the challenge: late reporting and response 19 Figure 2.3 Evolution of penicillin resistance in Staphylococcus aureus a continuing story Figure 3.1 Probable SARS transmission on flight CA112 in March 2003 Figure 3.2 Direct economic impact of selected infectious disease outbreaks. 1990-2003 Figure 4.1 WHO influenza surveillance network Figure 4.2 Cumulative number of confirmed human cases of avian influenza A/(H5N1)reported to WHO since 200 Figure 4.3 Poliovirus importations, 2003-2006 Figure 5.1 Events that may constitute a public health emergency of international concern the decision instrument Figure 5.2 Verified events of potential international public health concern, by WHO region, September 2003-September 2006 63 Boxes- Chapters Box 1.1 Public health security Box 1.2 International collaboration on infectious disease control Box 2.1 Marburg haemorrhagic fever and health systems in conflict situations Box 2.2 The deliberate use of chemical and biological agents to cause harm ox 3.1 Economic impact of SARS and influenza pandemic Box 3.2 The role of the mass media in risk perceptions Box 4.1 WHO meeting concludes that global stockpiles of H5N1 vaccines are feasible Box 5.1 IHR (2005)-early implementation efforts Tables- Chapters Table 2.1 Examples of major chemical incidents (1974-2006 Table 5.1 Seven strategic actions to guide IHR (2005) implemention 60
Figures – Chapters Figure 1.1 Spread of bubonic plague in Europe 3 Figure 1.2 Examples of international epidemic response missions, 1998–1999 8 Figure 1.3 International public health security: a global network of national health systems and technical partners, coordinated by WHO, founded on four major areas of work 10 Figure 1.4 Selected emerging and re-emerging infectious diseases, 1996–2004 12 Figure 2.1 Twenty-five years of HIV/AIDS 18 Figure 2.2 Global outbreaks, the challenge: late reporting and response 19 Figure 2.3 Evolution of penicillin resistance in Staphylococcus aureus: a continuing story 23 Figure 3.1 Probable SARS transmission on flight CA112 in March 2003 38 Figure 3.2 Direct economic impact of selected infectious disease outbreaks, 1990–2003 40 Figure 4.1 WHO influenza surveillance network 46 Figure 4.2 Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO since 2003 48 Figure 4.3 Poliovirus importations, 2003–2006 54 Figure 5.1 Events that may constitute a public health emergency of international concern: the decision instrument 59 Figure 5.2 Verified events of potential international public health concern, by WHO region, September 2003–September 2006 63 Boxes – Chapters Box 1.1 Public health security 1 Box 1.2 International collaboration on infectious disease control 7 Box 2.1 Marburg haemorrhagic fever and health systems in conflict situations 21 Box 2.2 The deliberate use of chemical and biological agents to cause harm 27 Box 3.1 Economic impact of SARS and influenza pandemics 39 Box 3.2 The role of the mass media in risk perceptions 41 Box 4.1 WHO meeting concludes that global stockpiles of H5N1 vaccines are feasible 50 Box 5.1 IHR (2005) – early implementation efforts 61 Tables – Chapters Table 2.1 Examples of major chemical incidents (1974–2006) 28 Table 5.1 Seven strategic actions to guide IHR (2005) implemention 60 v
world health report 2007 vi global public health security in the 21st century The world has changed dramatically since 1951, when WHO issued its first set of legally binding regulations aimed at preventing the international spread of disease. At that time, the disease situation was relatively stable Concern focused on only six"quarantinable"diseases: cholera, plague, relapsing fever, smallpox, typhus and yellow fever New diseases were rare and miracle drugs had revolutionized the care of many well-known infections. People travelled internationally by ship, and news travelled by telegram MIESSAGI FROMI THE DIRECTOR-GENERAl Since then, profound changes have occurred in the way humanity inhabits the planet. The disease situation is anything but stable Popula tion growth, incursion into previously uninhabited areas, rapid urbaniza tion, intensive farming practices, environmental degradation, and the misuse of antimicrobials have disrupted the equilibrium of the microbial world. New diseases are emerging at the historically unprecedented rate of one per year. Airlines now carry more than 2 billion passengers annually, vastly increasing opportunities for the rapid international spread of infectious agents and their vectors Dependence on chemicals has increased, as has awareness of the potential hazards for health and the environment. Industrialization of food production and processing and globalization of marketing and ibution mean that a single tainted ingredient can lead to the recall of tons of food items from scores of countries. In a particularly ominous trend, mainstay antimicrobials are failing at a rate that outpaces the development of replacement drugs These threats have become a much larger menace in a world characterized by high mobility, economic interdependence and electronic interconnectedness. Traditional defences at national borders cannot pro- tect against the invasion of a disease or vector. Real time news allows panic to spread with equal ease. Shocks to health reverberate as shocks to economies and business continuity in areas well beyond the affected site vulnerability is universal
The world has changed dramatically since 1951, when WHO issued its first set of legally binding regulations aimed at preventing the international spread of disease. At that time, the disease situation was relatively stable. Concern focused on only six “quarantinable” diseases: cholera, plague, relapsing fever, smallpox, typhus and yellow fever. New diseases were rare, and miracle drugs had revolutionized the care of many well-known infections. People travelled internationally by ship, and news travelled by telegram. Message from the Director-General Since then, profound changes have occurred in the way humanity inhabits the planet. The disease situation is anything but stable. Population growth, incursion into previously uninhabited areas, rapid urbanization, intensive farming practices, environmental degradation, and the misuse of antimicrobials have disrupted the equilibrium of the microbial world. New diseases are emerging at the historically unprecedented rate of one per year. Airlines now carry more than 2 billion passengers annually, vastly increasing opportunities for the rapid international spread of infectious agents and their vectors. Dependence on chemicals has increased, as has awareness of the potential hazards for health and the environment. Industrialization of food production and processing, and globalization of marketing and distribution mean that a single tainted ingredient can lead to the recall of tons of food items from scores of countries. In a particularly ominous trend, mainstay antimicrobials are failing at a rate that outpaces the development of replacement drugs. These threats have become a much larger menace in a world characterized by high mobility, economic interdependence and electronic interconnectedness. Traditional defences at national borders cannot protect against the invasion of a disease or vector. Real time news allows panic to spread with equal ease. Shocks to health reverberate as shocks to economies and business continuity in areas well beyond the affected site. Vulnerability is universal. vi global public health security world health report 2007 in the 21st century
The World Health Report 2007 is dedicated to promoting global public health security- the reduced vulnerability of populations to acute threats to health. This year's World Health Day, celebrated in Apri, launched WHO's discussion on global public health security. Around the world academics, students, health professionals, politicians and the business community are engaged in dialogue on how to protect the world from threats like pandemic influenza, the health consequences of conflict and natural disasters. and bioterrorism The World Health Report 2007 addresses these issues, among others in the context of new tools for collective defence including, most notably the revised International Health Regulations(2005). These Regulations are an international legal instrument designed to achieve maximum security against the international spread of diseases. They also aim to reduce the international impact of public health emergencies The IHR (2005)expand the focus of collective defence from just a few"quarantinable"diseases to include any emergency with interna- tional repercussions for health, including outbreaks of emerging and epidemic-prone diseases, outbreaks of foodborne disease, natural disasters, and chemical or radionuclear events whether accidental or In a significant departure from the past, IHR (2005) move away from a focus on passive barriers at borders, airports and seaports to a strategy of proactive risk management. This strategy aims to detect an event early and stop it at its source -before it has a chance to become an international threat Given today's universal vulnerability to these threats, better security calls for global solidarity Intermational public health security is both a collective aspiration and a mutual responsibility As the determinants and consequences of health emergencies have become broader, so has the range of players with a stake in the security agenda. The new watchwords are diplomacy, cooperation, transparency and prepared ness. Successful implementation of IHR(2005)serves the interests of politicians and business leaders as well as the health, trade and tourism sectors I am pleased to present the World Health Report 2007 to our partners and look forward to the discussions directions and actions that it will 久Ra Dr Margaret Chan Director-General World Health Organization
The World Health Report 2007 is dedicated to promoting global public health security – the reduced vulnerability of populations to acute threats to health. This year’s World Health Day, celebrated in April, launched WHO’s discussion on global public health security. Around the world, academics, students, health professionals, politicians and the business community are engaged in dialogue on how to protect the world from threats like pandemic influenza, the health consequences of conflict and natural disasters, and bioterrorism. The World Health Report 2007 addresses these issues, among others, in the context of new tools for collective defence, including, most notably, the revised International Health Regulations (2005). These Regulations are an international legal instrument designed to achieve maximum security against the international spread of diseases. They also aim to reduce the international impact of public health emergencies. The IHR (2005) expand the focus of collective defence from just a few “quarantinable” diseases to include any emergency with international repercussions for health, including outbreaks of emerging and epidemic-prone diseases, outbreaks of foodborne disease, natural disasters, and chemical or radionuclear events, whether accidental or caused deliberately. In a significant departure from the past, IHR (2005) move away from a focus on passive barriers at borders, airports and seaports to a strategy of proactive risk management. This strategy aims to detect an event early and stop it at its source – before it has a chance to become an international threat. Given today’s universal vulnerability to these threats, better security calls for global solidarity. International public health security is both a collective aspiration and a mutual responsibility. As the determinants and consequences of health emergencies have become broader, so has the range of players with a stake in the security agenda. The new watchwords are diplomacy, cooperation, transparency and preparedness. Successful implementation of IHR (2005) serves the interests of politicians and business leaders as well as the health, trade and tourism sectors. I am pleased to present the World Health Report 2007 to our partners and look forward to the discussions, directions and actions that it will inspire. Dr Margaret Chan Director-General World Health Organization vii
world health report 2007 vii global public health security in the 21st century zoG OVERVIEW
Overview viii global public health security world health report 2007 in the 21st century
overview ix At a time when the world faces many new and recurring threats, the ambi tious aim of this years World Health Report is to show how collective international public health action can build a safer future for humanity This is the overall goal of global public health security. For the purposes of this report, global public health security is defined as the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries As the events illustrated in this report show, global health security, or the lack of it, may also have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability. It embraces a wide range of complex and daunting issues, from the international stage to the individual household, including the health consequences of poverty, wars and conflicts, climate change, natural catastrophes and man-made disasters All of these are areas of continuing WHO work and will be the topics of forthcoming publications. The 2008 World Health Report, for example, will be concerned with individual health security, concentrating on the role of primary health care and humanitarian action in providing access to the essential prerequisites for health This report, however, focuses on specific issues that threaten the collective health of people internationally: infectious disease epidemics, pandemics and other acute health events as defined by the revised International Health Regulations, known as HR(2005), which came into force in June of this year. The purpose of these Regulations is to prevent the spread of disease across international borders. They are a vital legislative instrument of global public health security, providing the necessary global framework to prevent, detect, assess and, if necessary, provide a coordinated response to events that may constitute a public health emergency of international concern Meeting the requirements in the revised IHR (2005)is a challenge that requires time, com mitment and the willingness to change. The Regulations are broader and more demanding than those they replace, with a much greater emphasis on the responsibility of all countries to have in place effective systems for detection and control of public health risks-and to accomplish this by 2012. a strategic plan has been developed by WHo to guide countries in the implementation of the obligations in the Regulations and to help them overcome the inherent challenges
At a time when the world faces many new and recurring threats, the ambitious aim of this year’s World Health Report is to show how collective international public health action can build a safer future for humanity. This is the overall goal of global public health security. For the purposes of this report, global public health security is defined as the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries. As the events illustrated in this report show, global health security, or the lack of it, may also have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability. It embraces a wide range of complex and daunting issues, from the international stage to the individual household, including the health consequences of poverty, wars and conflicts, climate change, natural catastrophes and man-made disasters. All of these are areas of continuing WHO work and will be the topics of forthcoming publications. The 2008 World Health Report, for example, will be concerned with individual health security, concentrating on the role of primary health care and humanitarian action in providing access to the essential prerequisites for health. This report, however, focuses on specific issues that threaten the collective health of people internationally: infectious disease epidemics, pandemics and other acute health events as defined by the revised International Health Regulations, known as IHR (2005), which came into force in June of this year. The purpose of these Regulations is to prevent the spread of disease across international borders. They are a vital legislative instrument of global public health security, providing the necessary global framework to prevent, detect, assess and, if necessary, provide a coordinated response to events that may constitute a public health emergency of international concern. Meeting the requirements in the revised IHR (2005) is a challenge that requires time, commitment and the willingness to change. The Regulations are broader and more demanding than those they replace, with a much greater emphasis on the responsibility of all countries to have in place effective systems for detection and control of public health risks – and to accomplish this by 2012. A strategic plan has been developed by WHO to guide countries in the implementation of the obligations in the Regulations and to help them overcome the inherent challenges. Overview overview ix
world health report 2007 X global public health security in the 21st century GLOBAL PUBLIC HEALTH THREATS IN THE 21ST CENTURY oday' s highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases, and radionuclear and toxic threats, which is why updated and expanded Regulations are necessary. Infectious eases are now spreading geographically much faster than at any time in history. It is estimated that 2.1 billion airline passengers travelled in 2006; an outbreak or epidemic in any one part of the world is only a few hours away from becoming an imminent threat somewhere else(see Figure 1) Infectious diseases are not only spreading faster, they appear to be emerging more quickly than ever before. Since the 1970s, newly emerging diseases have beer identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago. In addition, during the last five years, WHO has verified more than 1100 epidemic events worldwide The categories and examples given below illustrate the variety and breadth of public health threats confronting people today Epidemic-prone diseases Cholera, yellow fever and epidemic meningococcal diseases made a comeback in the last quarter of the 20th century and call for renewed efforts in surveillance, prevention and control. Severe Acute Respiratory Syndrome(SARS)and avian influenza in humans have triggered major intemational concern, raised new scientific challenges, caused major human suffering and imposed enormous economic damage. Other emerging viral diseases such as Ebola, Marburg haemorrhagic fever and Nipah virus pose threats to lobal public health security and also require containment at their source due to thei acute nature and resulting illness and mortality During outbreaks of these diseases, rapid assessment and response, often needing international assistance, has been required to limit local spread. Strengthening of capacity is imperative in the future to assess such new threats Figure 1 Verified events of potential international public health concem by WHO region, September 2003-September Westem South-East Americas Pacific Mediterranean WHO regions
Global public health threats in the 21st century Today’s highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases, and radionuclear and toxic threats, which is why updated and expanded Regulations are necessary. Infectious diseases are now spreading geographically much faster than at any time in history. It is estimated that 2.1 billion airline passengers travelled in 2006; an outbreak or epidemic in any one part of the world is only a few hours away from becoming an imminent threat somewhere else (see Figure 1). Infectious diseases are not only spreading faster, they appear to be emerging more quickly than ever before. Since the 1970s, newly emerging diseases have been identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago. In addition, during the last five years, WHO has verified more than 1100 epidemic events worldwide. The categories and examples given below illustrate the variety and breadth of public health threats confronting people today. Epidemic-prone diseases Cholera, yellow fever and epidemic meningococcal diseases made a comeback in the last quarter of the 20th century and call for renewed efforts in surveillance, prevention and control. Severe Acute Respiratory Syndrome (SARS) and avian influenza in humans have triggered major international concern, raised new scientific challenges, caused major human suffering and imposed enormous economic damage. Other emerging viral diseases such as Ebola, Marburg haemorrhagic fever and Nipah virus pose threats to global public health security and also require containment at their source due to their acute nature and resulting illness and mortality. During outbreaks of these diseases, rapid assessment and response, often needing international assistance, has been required to limit local spread. Strengthening of capacity is imperative in the future to assess such new threats. 350 0 Numbers Africa WHO regions Figure 1 Verified events of potential international public health concern, by WHO region, September 2003–September 2006 300 250 200 150 100 50 Western Pacific Eastern Mediterranean South-East Asia Europe Americas Total number of cases = 685 288 41 81 78 89 108 x global public health security world health report 2007 in the 21st century
