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Is region ready for a new pandemic?

Ten years after South-east Asia’s experience with Severe Acute Respiratory Syndrome (SARS), the region’s capacity to respond must be re-assessed.

Ten years after South-east Asia’s experience with Severe Acute Respiratory Syndrome (SARS), the region’s capacity to respond must be re-assessed.

With increasing global travel, rapid urbanisation and the world’s growing population, the threat of re-emerging infectious diseases looms large.

In Asia, in particular, the health crises brought on by SARS in 2003 and bird flu in 2005 are reminders that infectious diseases have grave impacts that extend to the economy and political stability.

The recent outbreak of H7N9 flu in China — first reported on March 31 — has again heightened global concern over pandemic risks. This is compounded by the novel SARS-related coronavirus that emerged in the Middle East last year. As new uncertainties unfold, there is no room for complacency, nor can “pandemic fatigue” be allowed to set in.

INCREASING VIRULENCE

The virulence of SARS-related virus and H7N9 is certainly worrying, given that these new iterations are more often than not resistant to current vaccines.

In this regard, the efforts by China to deal with H7N9 have been encouraging. Despite initial complaints about delays in notifying the public when the first cases were diagnosed, the World Health Organization (WHO) has praised China for its cooperation in sending virus samples to laboratories worldwide for identification and the development of new vaccines. WHO experts were also invited to visit H7N9-affected areas to provide guidance on disease prevention and control.

The Chinese authorities have also moved fast to prevent the virus from spreading: They ordered the mass culling of thousands of birds and livestock, banned live poultry trade and shut down wholesale markets for live poultry.

Despite these efforts, the spectre of a pandemic hovers. In the Middle East, the new SARS-related coronavirus has been responsible for 18 deaths out of the 30 cases reported since April last year.

With new cases still being reported, the risk of virus spread warrants increased surveillance.

While the WHO has yet to issue travel advisories, the virulence of the new viruses has already prompted warnings of a possible pandemic from the US Centers for Disease Control and Prevention.

HOW READY IS ASEAN?

Efforts by the Association of South-east Asian Nations (ASEAN) to strengthen the Regional Multi-sectoral Pandemic Preparedness Strategic Framework are, thus, timely.

This follows on from collaborative regional arrangements — which included information sharing, situation updates and national disease control activities — that were put in place by the ASEAN Highly Pathogenic Avian Influenza Taskforce (2004–2010).

The task force brought together animal and health authorities in the region, providing them with a platform to develop a multi-sectoral, multi-agency approach to pandemic preparedness. This is particularly important given that the new flu strains are known to be transmitted from animals to humans.

The framework developed by ASEAN takes a distinctive approach: It combines collaborative pandemic preparedness with multilevel disaster management. Compulsory reporting of disease outbreaks is integrated with a virtual, centralised regional health emergency infrastructure.

This approach allows ASEAN to leverage on the disaster and emergency management role of the ASEAN Coordinating Centre for Humanitarian Assistance. More international support and funding, however, are needed to fully operationalise the ASEAN pandemic preparedness and response framework.

Transparency and timely information can go a long way in dealing with uncertainties brought on by disease outbreaks, and the region should take advantage of the established channels available through the ASEAN Risk Communication Resource Centre to strengthen capacity in this area.

ASEAN could also draw on disease surveillance and information-sharing arrangements under the ASEAN Plus 3 Emerging Infectious Diseases Programme, to address the threats that could arise should a new flu strain become capable of human-to-human transmission.

The expertise of the ASEAN Plus 3 Field Epidemiology Training Network in joint disease surveillance and clinical management can also be tapped.

VACCINE STOCKPILE STILL VALID?

In 2006, ASEAN with the help of Japan established a regional stockpile of vaccines aimed at improving access to vaccines in times of pandemic outbreak. The question is whether the stockpile can be utilised to respond to a possible new pandemic.

Because vaccines take time to develop, the utility of the current stockpile may need to be reassessed in light of the emergence of new variants of the influenza virus. At the same time, the ASEAN Minimum Standards on Joint Multi-sectoral Outbreak Investigation and Response needs to be operationalised soon, to enable the sharing of treatment protocols that can adequately respond to global public health emergencies.

International institutions and governments must step up research efforts and funding for the development of new vaccines and to enhance cooperation in disease surveillance. The International Severe Acute Respiratory and Emerging Infection Consortium — which has a regional hub in China — should be utilised to facilitate access and sharing of clinical research protocols to rapidly respond to a pandemic in the making.

At the same time, countries need to think beyond pandemic-specific plans and responses, and focus on strengthening health systems to support pandemic efforts.

ABOUT THE AUTHOR:

Mely Caballero-Anthony is Associate Professor and Head of the Centre for Non-Traditional Security Studies at the S. Rajaratnam School of International Studies. Gianna Gayle Amul is a Research Analyst with the centre

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