Implementing the Almaty Declaration: Experiences and Future Opportunities”

Home , Almaty

Countries and areas of the WHO Eastern Mediterranean and European regions that participated in Operation MECACAR “Implementing the Almaty Declaration: Experiences and Future Opportunities” – Harbin, PR China

26 September 2007 Geneva, 7-9 Nov. 2005 (UN system)

Local Regional Global

1 5 9 Development of ‘Rapid response’ Expanded global integrated teams of experts anti-viral stockpile national plans

2 Aggressive control of 6 10 Global strategy Avian Influenza in birds Stronger country and for vaccine research and human pandemic regional capacity and development preparedness

3 7 11 Assess needs of Costing of country Expanded network of veterinary plans and regional and influenza laboratories infrastructures global requirements

4 8 12 Voluntary compliance Finalize coordination Multi-country technical of International Health framework building on networks Regulations existing mechanisms Influenza Regional Meeting (12-13 June 2006) Principles: Joint funding and planning of agencies & donors Move towards performance-based mechanism towards regional collaboration to fight influenza threats

Sponsors: WHO, UNICEF, UNDP, FAO, USAID, US-CDC, European Commission, World Bank, ADB (contributions: $ 7,000 - $ 25,000) Extra speakers: UNSIC & OiE Central Asia Roundtable

Participating (=CAREC): Invited: • Kazakhstan, Kyrgyz • International Republic, Tajikistan, organizations Turkmenistan, Uzbekistan • Greater Mekong • Russian Federation Sub-Region • XUAR, PR China (e.g. Thailand) • Afghanistan, Mongolia

Experts (human & animal health sector, coordination & communication) & Senior officials Institutional framework • Intersectoral government co-ordination (agriculture, health, emergencies/ KAZ) -> endorsed 7 April

• Interagency co-ordination (ADB, EC, UNSIC & 3 UN agencies [FAO, UNICEF, WHO], USAID, World Bank) -> weekly teleconference meetings (27 March, 3 & 10 April) • Conference Secretariat linked with technical working group & administrative support -> established 29 March Country needs (next 2-3 yrs) 1. Coordination & communication 2. Surveillance & early warning (animal & human influenza) 3. Response capacity to handle local outbreaks 4. National health system strengthening, including surge capacity to address generalized epidemics (a.o: lab equipment, protective clothing, overtime payment for staff, etc…) Central Asian & Caucausus: $ 45 million (including $10 to $ 15 million self-funded) other Asian developing countries: $ 711 (incl. $240- $380) Regional needs (next 2-3 yrs) 1. Stockpiles of drugs & medical equipment -> economies of scale 2. Exchange of information (transparent & immediate reporting) through: a) Regional training of animal and health workers b) Regional networking (workshops, communication system) Animal (FAO): $ 10 to 20 million for CAREC-countries Human (WHO): $ 11 million for CAREC countries Influenza Almaty Declaration (13 June 2006) 18.Create 3 working groups who draft plans: (a) Disease surveillance & response (b) Laboratory capacity building (c) Public communication, governance

17.Coordination committee with first priority:

Establish mechanism for regular exchange of information, including early-warning system. Influenza Committee of donors & technical agencies – (Tele)conference Meetings in Almaty

1. 27 March 2006 (European Commission) 2. 12 June 2006 (ADB & Eur. Commission) 3. 6 December 2006 (USAID & US-CDC) 4. 18 May 2007 (ADB & US-CDC & WB)

Burning questions: • Joint planning for capacity building (human/ animal health) • Common technical guidance on diagnostics Immunization: MECACAR

< 80% 1993

80-89%

>89%

No report

1999

Routine immunization coverage (OPV3 in children < 1 year old) Immunization MECACAR Meetings:

1. 29-30 January 1995 (Ankara, Turkey) 2. 27-28 September 1995 (Tehran, Iran) 3. 14-16 October 1996 (Tashkent, Uzbekistan) 4. 20-22 October 1997 (Rome, Italy) 5. 20-22 October 1998 (Cairo, Egypt) 6. 20-22 October 1999 (Ankara, Turkey) 7. 19-21 March 2001 (Cairo, Egypt) 8. 8-10 September 2003 (Budapest, Hungary) 9. 29-31 August 2006 (Istanbul, Turkey) • 17 May 2007 (Geneva, Switzerland) / MECACAR New Millenium MECACAR: polio eradication & measles elimination Immunization Days in Kyrgyz Republic, Iraq and Afghanistan (1995) Incidence of poliomyelitis

> 10 1994 1 - 10

0 polio

No report

2000 Poliomyelitis & AFP reported cases

EURO (10 countries) EMRO (8 countries) Surveillance quality

Non-polio AFP < 1 AND > 80 % adequate specimen (2 within 14 days)

Non-polio AFP >= 1 OR >= 80 % adequate specimen (2 within 14 days)

Non-polio AFP >= 1 AND >= 80 % adequate specimen (2 within 14 days)

No report MECACAR Meetings

Commitment for:

• common indicators to guide actions • mechanism for timely exchange of information about polio, measles and other outbreaks in our countries; • continued efforts to achieve international partnerships and support. Areas where autochthonous malaria cases reported, Trans–Caucasian countries, 2006

Georgia

Armeni a Azerbaijan Areas with reported autochthonous cases of malaria, Central Asia, 2006

AREAS WHERE AUTOCHTHONOUS CASES ARE REPORTED AREAS WHERE AUTOCHTHONOUS CASES OF P. FALCIPARUM ARE REPORTED Malaria Strata in Central Asia Number of P. falciparum cases and their active foci in Tajikistan, 2000-2006

900 180

800 160

700 140

600 120

500 100 Number of cases Number of foci 400 80

300 60

200 40

100 20

0 0 2000 2001 2002 2003 2004 2005 2006 NUMBER OF FOCI OF P. FALCIPARUM MALARIA IN TAJIKISTAN DISTRICTS FOCI

2002 Darvoz 4 Dushanbe 8 Rudaki 7 Rasht 1 Vahdat 6 Varzob 1 Faizabad 1 Shahrinav 1 Javan 16 Bohtar 7 Nurek 5 Vahsh 5 Kumsangir 1 Sarband 3 Dangara 7 Muminobod 1 Dushanbe Hovaling 1 Baldjuvan 13 Kolhozabad 23 Kurgan- Jilikul 4 Tube Jomi 15 Kurgan-Tube8 Vose 2 158158 Shurobad 2 Huroson 2 Pjanz 6 Kuljab 8 Active foci of P. falciparum malaria (residual & new) NUMBER FOCI OF P. FALCIPARUM MALARIA IN TAJIKISTAN DISTRICTS OF FOCI Horog 1 2004 Dushanbe 1 Rasht 1 Rudaki 3 Vahdat 3 Varzob 1 Javan 5 Bohtar 3 Vahsh 10 Dangara 5 Temurmalik 2 Jomi 23 Kurgan- 2 VoseTube 1 Dushanbe Huroson 2 Pjanz 7

Kurgan- Tube 7070

Active foci of P. falciparum malaria (residual & new) DISTRICT NUMBER FOCI OF P. FALCIPARUM MALARIA IN TAJIKISTAN S OF FOCI Dushanbe 1 2005 Rudaki 2 Vahdat 1 Javan 2 Vahsh 11 Dangara 8 Temurmal ik 2 Jomi 5 Jilikul 1 Nurek 5 Huroson 10 Vose 1

Dushanbe

Kurgan- Tube 4949

Active foci of P. falciparum malaria (residual & new) FOCI OF P. FALCIPARUM MALARIA IN TAJIKISTAN NUMBER DISTRICT S OF FOCI 2006 Dushanbe2 Vakhdat 4 Nurobod 1 Vahsh 3 Temurma lik 1 Jomi 3 Nurek 1

Dushanbe

Kurgan- 1515 Tube

Active foci of P. falciparum malaria (residual & new) Re-emergence of malaria, PR China (2003)