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Response Team Deployment I: Who decides if external support is needed?

Outbreak responses often require international support. Watch Jon Barden, Tony Stewart and Esther Ngadaya explain how this is decided.
ESTHER NGADAYA: For example, external support from the higher level, comes through two channels. Firstly, the government requests support from the development partners or multilateral agencies such as WHO. Secondly, a development partner volunteer to support the government. This support may be in the form of human and financial resources, laboratory supplies, or vaccines, to mention a few. For example, during a recent outbreak, rabies outbreak, in Kilimanjaro region– the UN Food and Agriculture organisation provided vaccines to control the outbreak. Even during an anthrax outbreak in the country, FAO provided anthrax vaccine to animals. During the last cholera outbreak in Kilimanjaro, a team from WHO joined the regional and district outbreak response teams.
In case the region needs support from the ministry, they just request the support, and normally the units responsible at the ministry act accordingly.
TONY STEWART: So the government in affected countries has the primary responsibility. Under the UN General Assembly Resolution 46/1 Act 2 of 19 December 1991, the affected state– that is, the government and the national actors– retain a primary role in the initiation, organisation, coordination, and implementation of humanitarian assistance within its territory. Furthermore, under the International Health Regulations 2005, countries have the responsibility to detect and respond to public health emergencies. It is up to the government in the affected countries to assess the situation and to coordinate the local response. And if deemed necessary to request international assistance. If the capacity is insufficient to meet the needs of the public health emergency, the government can request international assistance.
This may be bilateral, which are requests directly to other countries and institutions such as emergency medical teams or NGOs, to WHO or other agencies, or more commonly, a mixture of both.
Requests to WHO for support come via the WHO country representative to Regional Offices, and where appropriate to WHO headquarters in Geneva. WHO maintains both internal and external surge capacities at the regional and global level. But in the first instance, staff from WHO, from any part of the organisation, will be deployed to support the government response. The challenge is that no one institution has all the necessary capacities, not even WHO. This situation led to the establishment in 2000 of GOARN– the Global Outbreak Alert and Response Network. The Global Outbreak Alert and Response Network is a global technical partnership coordinated by WHO under its Health Emergencies Programme, WHE. It’s recognised as the operational arm of WHO and the International Health Regulations.
GOARN’s focus and aim is to provide a rapid multidisciplinary technical support for outbreak and other emergency response. Coordinating partners and international teams provides the best expertise and technical assistance to countries. GOARN’S members include technical institutions and other professional networks, which are capable of providing international assistance in areas such as epidemiology, clinical management, infection prevention and control, laboratory, risk communications, logistics, and so on. GOARN is WHO’s deployment mechanism for these experts from external institutions. GOARN also provides a global coordinating role between other response partners, including UNICEF, the International Federation of Red Cross, MSF, and many others.
When an outbreak occurs and there is a need for international assistance, the field response is triggered by a formal request of support from a WHO member state, which is passed by the country office to the regional office and possibly to headquarters. GOARN secretariat will issue an alert to all network partners for early warning, preparedness, and coordinating purposes. The mission is agreed with the country and specific terms of reference for each expert will be developed. These terms of reference for working international outbreak response may apply to an individual or a team. They may be filled by a mix of WHO internal and external experts.
They give the team and the host country officials an opportunity to make sure they have a clear and shared understanding of the mission objectives. Terms of reference should align with country goals. Initially, they might be broad but as an event evolves and more information is available, the terms may change and become more specific. Generally speaking, these terms might be less prescriptive for senior team positions. When external surge is required, GOARN secretariat will issue a request for assistance to all GOARN partners, specifying the expertise and skills required for the outbreak response team. Within hours and over the next few days, offers for assistance are collected and sent to WHO.
Institutions submit their CVs and availability of the staff who fulfil these requirements detailed in their request for assistance. This covers things like qualification, appropriate experience, language skills, and so on. WHO is the primary source of early information about outbreaks. Information is shared with GOARN focal points through the secure GOARN Knowledge Platform and through weekly and ad hoc teleconferences as required.
JON BARDEN: Let’s assume that the UK has been asked for one of its deployable health assets. In this case, the UK’s Public Health Record Support Team. This team will have been monitoring global disease trends for a long time and will therefore have a very good idea of whether or not the UK should respond, whether it will help for them to respond. So they will probably be been going through a lot of disease scenarios in their team meetings. So they will then put together a paper for their government minister in which they’ll put together things like the team size, the length of deployment, the skills needed, the security situation, and most importantly often the cost.
More often than not, a minister will accept the advice of our experts. And if they’ve said that a national response should happen to support a country’s disease outbreak then a whole series of predetermined events will kick in. Some terms of reference will be written, a security plan will be put into place, hotels will be booked, flights will be booked, kit bags will be issued, pre-departure medical checks will be given, and so on. It’s a long list, but it needs to be to give the mission the best possible chance of success.

In this step, Jon Barden (DFID), Tony Stewart (GOARN) and Esther Ngadaya (National Institute for Medical Research, Tanzania) explain how international teams are requested to respond to outbreaks. This video will cover the responsibilities of various actors under the International Health Regulations, and the initial steps undertaken to send teams to help control an outbreak.

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Disease Outbreaks in Low and Middle Income Countries

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