Archived: WMA Statement on Health Emergencies Communication and Coordination

Approved by the 55^th WMA General Assembly, Tokyo, Japan, October 2004
and rescinded by the 65^th WMA General Assembly, Durban, South Africa, October 2014

A.  INTRODUCTION

1. 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.
2. 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.
3. 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.
4. 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.…”

B.  BASIC PRINCIPLES

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

C.  RECOMMENDATIONS

1. 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.
2. 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.
3. 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.
4. That the WMA call on NMAs to promote and support WHO’s GOARN as a control coordinating entity in combating global health security threats.
5. 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.
6. 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.
7. 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.
8. That international agreements should be proactively explored to facilitate the movement of health professionals who are involved in the management of epidemics.
9. 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.
10. 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.
11. That physicians everywhere in the world, including those in Taiwan, have unlimited access to WHO programs and information concerning health emergencies.