Initiated February 2004
Approved by the WMA General Assembly, Tokyo 2004
- INTRODUCTION
- In late 2002, an outbreak of a new severe acute respiratory
syndrome (SARS) began in southern China. The disease, which
was caused by the SARS coronavirus, spread internationally
in late February 2003. The most severely affected countries
were China, Canada, Singapore and Vietnam, all of which
experienced outbreaks before the issue of global alerts
by the World Health Organization (WHO). According to WHO
data, altogether 8422 cases occurred in 29 countries; in
the four afore-mentioned countries, 908 cases were fatal.
- SARS was an especially difficult new disease to diagnose
and treat - it passed readily from person to person, required
no vector, had no particular geographic affinity, mimicked
the symptoms of many other diseases, took its heaviest toll
on hospital staff, and spread internationally with alarming
ease. The spread of SARS along the routes of international
air travel emphasizes the fact that pathogens know no boundaries
and reinforces the critical need for global public health
strategies.
- The main outbreaks of SARS occurred in areas with well-developed
health systems. If SARS had become established in areas
with weak health infrastructure, it is unlikely that containment
would have been achieved so quickly. But even in well-developed
health care systems, certain very significant flaws were
demonstrated during this epidemic:
- Lack of effective real-time, two-way communication channels
to front-line physicians;
- Lack of adequate resources, stockpiles of medication
and supplies to deal with this type of catastrophe;
- Lack of surge capacity within acute care and public
health systems.
- A gap between public health authorities (national and
international) and clinical medicine was demonstrated during
this episode. At its September 2003 General Assembly, the
WMA adopted a Resolution on SARS that: "strongly encouraged
the World Health Organization to enhance its emergency response
protocol to provide for the early, ongoing and meaningful
engagement and involvement of the medical community globally.…"
- BASIC PRINCIPLES
- The international community must be constantly alert to
the threat of emerging disease outbreaks and ready to respond
with a global strategy. The Global Outbreak Alert and Response
Network (GOARN) of WHO has a significant role to play in
global health security by:
- combating the international spread of outbreaks;
- ensuring that appropriate technical assistance reaches
affected states rapidly; and
- contributing to long-term epidemic preparedness and
capacity-building.
The WMA has been actively involved in GOARN, where appropriate.
The role of GOARN must, however, be acknowledged and
actively promoted within the medical profession.
- Sovereign states have a responsibility to address the
health needs within their borders. Today, however, many
urgent health security risks are not confined by national
boundaries. Early detection, through effective national
surveillance systems, of unusual disease events that threaten
public health, and international cooperation between WHO,
its member states, and non-governmental partners like the
WMA, are required to effectively respond to public health
emergencies of international concern. A strengthening of
the International Health Regulations to broaden their scope
to include new and future health emergencies and enable
WHO to actively assist States in responding to international
health security threats will provide additional tools for
global epidemic control.
- Effective communication between WHO and the WMA, the WMA
and its member National Medical Associations (NMAs), and
NMAs and physicians can strengthen the information exchange
between WHO and its Member States during public health emergencies.
- Physicians are often the first point of contact with the
emergence of new diseases; therefore they are in a position
to aid in all elements of diagnosis, treatment and reporting
of affected patients and prevention of disease. Physicians
with key expertise must be incorporated into the health
emergency decision-making process so that the impact of
national and international directives on clinical settings
and patient care is understood.
- WHO and its Member States must work with the WMA and
NMAs to proactively address the safety of patients and of
health professionals involved in caring for the sick during
outbreaks of new diseases. Delays in identifying and distributing
supplies of protective equipment to health professionals
and their patients exacerbate anxiety and risk of spread
of infectious disease. National and international systems
that stockpile relevant and adequate supplies and rapidly
move them to affected areas should be created or enhanced.
All the principles employed in the safeguarding of patient
safety should be respected and followed in emergencies such
as SARS.
- RECOMMENDATIONS
- That the WMA and member NMAs should work closely with
WHO, national governments, and other professional groups
to jointly promote the elements of this Statement.
- That the WMA urge physicians to a) be alert to the occurrence
of unexplained illnesses and deaths in the community, b)
be knowledgeable of disease surveillance and control capabilities
for responding to unusual clusters of diseases, symptoms
and presentations, and assiduous in the timely reporting
of suspicious cases of illness to appropriate authorities;
c) utilize appropriate procedures to prevent exposure of
infectious pathogens to themselves and others; d) understand
the principles of risk communication so that they can communicate
clearly and non-threateningly with patients, their families,
and the media about issues such as exposure risks and potential
preventive measures (e.g., vaccinations); and e) understand
the roles of the public health, emergency medical services,
emergency management, and incident management systems in
response to a health crisis and the individual health professional's
role in these systems.
- That the WMA encourage physicians, NMAs, and other medical
societies to participate with local, national, and international
health authorities in developing and implementing disaster
preparedness and response protocols for natural infectious
disease outbreaks. These protocols should be used as the
basis for physician and public education.
- That the WMA call on NMAs to promote and support WHO's
GOARN as a control coordinating entity in combating global
health security threats.
- That the WMA call for the establishment of a strategic
partnership agreement with WHO, so that in case of epidemics,
health communication can be stepped up considerably and
two-way flow of information ensured.
- That WHO should coordinate the development of an inventory
based on existing stockpiles of supplies, so that such supplies
can be rapidly deployed and accessed by physicians involved
in the care of victims.
- That WHO should strengthen the International Health Regulations
to broaden their scope to include reporting of new and future
health emergencies, and to enable WHO to actively assist
States in responding to international health security threats.
- That international agreements should be proactively explored
to facilitate the movement of health professionals who are
involved in the management of epidemics.
- That research in the field of emergency preparedness should
be enhanced by national governments and NMAs where appropriate,
to better understand current flaws in the system and how
to improve preparedness in the future.
- That education and training of physicians should be modified
to take into account the realities and specific needs required
in the event of emergencies, and to ensure that due diligence
is paid to patient and health care worker safety when managing
patients with acute infectious diseases.
- That physicians everywhere in the world, including those
in Taiwan, have unlimited access to WHO programs and information
concerning health emergencies.
9.10.2004
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