Giuseppe
Emeritus
[PANDEMIC PREPAREDNESS, WHO, UPDATES] WHO Public Health Security Exercise (PHSX) - FAQs
6 June 2008
1. What is the Public Health Security Exercise (PHSX)?
PHSX is a preparedness exercise which has been designed to test specific aspects of WHO's response to a potential PHEIC (public health emergency of international concern) and the procedures, protocols and communications methods that would be used when notified of such a threat. PHSX is part of a series of exercises begun in June 2007 to test International Health Regulations (IHR) event management mechanisms.
2. What are the International Health Regulations?
The International Health Regulations (IHR) are an international legal instrument that is binding on 194 State Parties (193 WHO Member States plus the Holy See) across the globe. Their aim is to help the international community prevent and respond to acute public health risks, such as communicable diseases, that have the potential to cross borders and threaten people worldwide. The IHR can also apply to public health emergencies such as chemical spills, leaks and dumping, or nuclear melt-downs. The IHR aim to limit interference with international traffic and trade while safeguarding public health through the prevention of disease spread. The IHR, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO. Building on WHO?s unique experience in global disease surveillance, alert and response, the IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security.
3. Which IHR mechanisms will be tested during PHSX?
The exercise will be based on a simulated public health event where the nature and potential magnitude of the event needs to be investigated and determined. Consultation and consequent collaboration will occur between the Ministries of Health of the countries concerned and WHO at all its levels - Country, Regional and Headquarters Offices - and will culminate in a declaration of a PHEIC.
4. Why is it important to test IHR mechanisms now?
The IHR have been in force for less than a year, and, as opposed to the previous version of the International Health Regulations, which dated from 1969, the onus is now on countries to report events of potential international health concern to WHO. Moreover, WHO now has the ability to follow up on potential events from sources other than Ministries of Health or other government entities. Therefore, it is both much more likely that potential events will get reported, and that more involvement from WHO will be needed to track these events, assess the actual risk from them, and organize responses. As with any policy or procedure, exercising is a critical part of the training and improvement process. Many of the procedures mandated by the IHR are new and have not been implemented in an actual public health emergency. WHO is undertaking a series of exercises to ensure that in the case of an actual PHEIC, the processes which the IHR stipulate, and which WHO has constructed in order to protect global public health, will function to provide a rapid, efficient, and predictable response from the organization.
5. Who is participating in PHSX?
PHSX takes place on 11 and 12 June. WHO and several of its Member States,, as well as some WHO country offices, will join WHO Headquarters during this exercise.
6. What will take place during the exercise?
Through a series of simulated events, a pathogen will emerge whose symptoms mimic many possible aetiologies, making it hard, at first, to understand the nature and gravity of the disease outbreak. The pathogen is first discovered in Country A, which responds rapidly and reports the outbreak to WHO, as per its IHR obligations. With this notification, WHO forms an event management group, spanning the Country and Regional Offices and Headquarters, to assess the pathogen and the public health threat it might pose Subsequently, cases are discovered in Countries B and C.
7. What kinds of capabilities will be tested in PHSX?
? The processes for the identification, notification and alert of potential international public health events;
? The procedures for processing and communication of critical event information;
? The arrangements for risk assessment of potential international public health events;
? Planning and coordination arrangements, including the convening of an Emergency Committee;
? The ability of WHO staff across the Organization to work collectively, across time zones and administrative entities, on assessing and responding to threats involving international health security.
8. What assumptions/artificialities must be incorporated into the exercise?
Given the fact that events which might normally take weeks to unfold are being compressed into two days, certain assumptions and limits to the exercise are being imposed:
? It is being assumed that people know their IHR event management roles and responsibilities
? Processes--not people--are being exercised (as opposed to practised)
? The exercise is totally self contained. All resource deployments are simulated. No staff or material will be deployed to the field during the exercise.
9. What will be learned from PHSX?
Evaluators drawn from Asia, North America and Europe will be watching how WHO performs in real time, measuring performance against what is expected from existing procedures. PHSX is expected to yield practical information about the efficiency of procedures, discover gaps in planning and operational responses, build on strengths and identify opportunities for the improvement of the way in which an Emergency Committee is convened and operated. The exercise offers participants a way to test their plans and capabilities in a realistic environment and to gain an in-depth experience that can be achieved only by practice. The lessons learnt from PHSX will be shared with WHO Offices across the world, and with the Ministries of Health and the National IHR Focal Points, with whom WHO will be working closely during any public health emergency with the potential to become a PHEIC.
10. How was PHSX developed?
A team of experts in emergency management, infectious disease surveillance, control and response, and international goods-and-services procurement developed a plausible scenario. While the exercise is ?in play?, the team will continue to add ?surprises/yellow cards? that WHO and Ministry of Health staff may face in an actual PHEIC.
11. How much will PHSX cost?
Given that no personnel or material will be deployed during the course of the exercise, the cost of PHSX is minimal as most personnel and exercise-related resources are already in place.
12. What happens if there is a real PHEIC while the exercise is taking place?
The exercise will be halted immediately. No essential personnel will be diverted from any emergency response effort.
13. Will ordinary citizens be affected by the exercise while it is taking place?
No. This is an exercise where there is no displacement of people or goods. The exercise will not affect public or official activity at all.
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6 June 2008
1. What is the Public Health Security Exercise (PHSX)?
PHSX is a preparedness exercise which has been designed to test specific aspects of WHO's response to a potential PHEIC (public health emergency of international concern) and the procedures, protocols and communications methods that would be used when notified of such a threat. PHSX is part of a series of exercises begun in June 2007 to test International Health Regulations (IHR) event management mechanisms.
2. What are the International Health Regulations?
The International Health Regulations (IHR) are an international legal instrument that is binding on 194 State Parties (193 WHO Member States plus the Holy See) across the globe. Their aim is to help the international community prevent and respond to acute public health risks, such as communicable diseases, that have the potential to cross borders and threaten people worldwide. The IHR can also apply to public health emergencies such as chemical spills, leaks and dumping, or nuclear melt-downs. The IHR aim to limit interference with international traffic and trade while safeguarding public health through the prevention of disease spread. The IHR, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO. Building on WHO?s unique experience in global disease surveillance, alert and response, the IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security.
3. Which IHR mechanisms will be tested during PHSX?
The exercise will be based on a simulated public health event where the nature and potential magnitude of the event needs to be investigated and determined. Consultation and consequent collaboration will occur between the Ministries of Health of the countries concerned and WHO at all its levels - Country, Regional and Headquarters Offices - and will culminate in a declaration of a PHEIC.
4. Why is it important to test IHR mechanisms now?
The IHR have been in force for less than a year, and, as opposed to the previous version of the International Health Regulations, which dated from 1969, the onus is now on countries to report events of potential international health concern to WHO. Moreover, WHO now has the ability to follow up on potential events from sources other than Ministries of Health or other government entities. Therefore, it is both much more likely that potential events will get reported, and that more involvement from WHO will be needed to track these events, assess the actual risk from them, and organize responses. As with any policy or procedure, exercising is a critical part of the training and improvement process. Many of the procedures mandated by the IHR are new and have not been implemented in an actual public health emergency. WHO is undertaking a series of exercises to ensure that in the case of an actual PHEIC, the processes which the IHR stipulate, and which WHO has constructed in order to protect global public health, will function to provide a rapid, efficient, and predictable response from the organization.
5. Who is participating in PHSX?
PHSX takes place on 11 and 12 June. WHO and several of its Member States,, as well as some WHO country offices, will join WHO Headquarters during this exercise.
6. What will take place during the exercise?
Through a series of simulated events, a pathogen will emerge whose symptoms mimic many possible aetiologies, making it hard, at first, to understand the nature and gravity of the disease outbreak. The pathogen is first discovered in Country A, which responds rapidly and reports the outbreak to WHO, as per its IHR obligations. With this notification, WHO forms an event management group, spanning the Country and Regional Offices and Headquarters, to assess the pathogen and the public health threat it might pose Subsequently, cases are discovered in Countries B and C.
7. What kinds of capabilities will be tested in PHSX?
? The processes for the identification, notification and alert of potential international public health events;
? The procedures for processing and communication of critical event information;
? The arrangements for risk assessment of potential international public health events;
? Planning and coordination arrangements, including the convening of an Emergency Committee;
? The ability of WHO staff across the Organization to work collectively, across time zones and administrative entities, on assessing and responding to threats involving international health security.
8. What assumptions/artificialities must be incorporated into the exercise?
Given the fact that events which might normally take weeks to unfold are being compressed into two days, certain assumptions and limits to the exercise are being imposed:
? It is being assumed that people know their IHR event management roles and responsibilities
? Processes--not people--are being exercised (as opposed to practised)
? The exercise is totally self contained. All resource deployments are simulated. No staff or material will be deployed to the field during the exercise.
9. What will be learned from PHSX?
Evaluators drawn from Asia, North America and Europe will be watching how WHO performs in real time, measuring performance against what is expected from existing procedures. PHSX is expected to yield practical information about the efficiency of procedures, discover gaps in planning and operational responses, build on strengths and identify opportunities for the improvement of the way in which an Emergency Committee is convened and operated. The exercise offers participants a way to test their plans and capabilities in a realistic environment and to gain an in-depth experience that can be achieved only by practice. The lessons learnt from PHSX will be shared with WHO Offices across the world, and with the Ministries of Health and the National IHR Focal Points, with whom WHO will be working closely during any public health emergency with the potential to become a PHEIC.
10. How was PHSX developed?
A team of experts in emergency management, infectious disease surveillance, control and response, and international goods-and-services procurement developed a plausible scenario. While the exercise is ?in play?, the team will continue to add ?surprises/yellow cards? that WHO and Ministry of Health staff may face in an actual PHEIC.
11. How much will PHSX cost?
Given that no personnel or material will be deployed during the course of the exercise, the cost of PHSX is minimal as most personnel and exercise-related resources are already in place.
12. What happens if there is a real PHEIC while the exercise is taking place?
The exercise will be halted immediately. No essential personnel will be diverted from any emergency response effort.
13. Will ordinary citizens be affected by the exercise while it is taking place?
No. This is an exercise where there is no displacement of people or goods. The exercise will not affect public or official activity at all.
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