Weekly Epidemiological Record Relevé Épidémiologique Hebdomadaire

2018, 93, 249–304 No 20 Weekly epidemiological record Relevé épidémiologique hebdomadaire

18 MAY 2018, 93th YEAR / 18 MAI 2018, 93e ANNÉE No 20, 2018, 93, 249–304 http://www.who.int/wer

Contents Sommaire 249 Editorial 249 Editorial 251 Mapping the distribution and risk of epidemics 251 Cartographie de la distribution et des risques d’épidémie in the WHO African Region dans la Région africaine de l’OMS 256 A health emergency risk profile of the South-East 256 Profil des risques d’urgence sanitaire dans la Région de l’Asie Asia Region du Sud-Est 264 Importance of surveillance for preparedness and 264 Importance de la surveillance pour renforcer l’état de country readiness in a hazard-prone region préparation des pays dans une région à risque 267 The Epidemic Intelligence from Open Sources 267 L’initiative «Epidemic Intelligence from Open Sources»: initiative: a collaboration to harmonize and une collaboration visant à harmoniser et à standardiser standardize early detection and epidemic les procédures de détection précoce et de renseignement intelligence among public health organizations épidémiologique entre les organisations de santé publique 269 Early Warning, Alert and Response (EWAR): a key 269 Alerte précoce et réponse (EWAR): une composante clé de area for countries in preparedness and response to la préparation et de la réponse des pays face aux urgences health emergencies sanitaires 273 Confronting health security threats: The Asia–Pacific 273 Affronter les menaces pesant sur la sécurité sanitaire: Mise en Strategy for Emerging Diseases and Public Health œuvre de la Stratégie Asie-Pacifique de maîtrise des maladies Emergencies to advance core capacity for the émergentes et de gestion des urgences de santé publique International Health Regulations (2005) (APSED III) pour renforcer les principales capacités requises par le Règlement sanitaire international (2005) 279 Adapting the Incident Management System for 279 Adaptation du système de gestion des incidents à la response to health emergencies – early experience riposte dans les situations d’urgence sanitaire – premières of WHO expériences du système par l’OMS 284 Access to life-saving vaccines during outbreaks: 284 L’accès aux vaccins vitaux pendant les flambées épidémiques: a spotlight on governance coup de projecteur sur la gouvernance 289 Crisis in Ukraine as an opportunity for rebuilding 289 La crise en Ukraine, une occasion de reconstruire un système a more responsive primary health care system de soins de santé primaires plus réactif 293 Who DARES wins. Delivering accelerated results 293 Produire des résultats accélérés de manière efficace et effectively and sustainably durable: l’initiative DARES, une approche gagnante 296 Implementation of the International Health 296 Mise en œuvre du Règlement sanitaire international (2005) Regulation (2005) in Oman: progress, lessons learnt à Oman: progrès, enseignements tirés et voie à suivre and way forward 300 Accelerating implementation of the International 300 Accélérer la mise en œuvre du Règlement sanitaire Health Regulations (2005): the interface between international (2005): à l’interface entre systèmes de santé health systems and health security et sécurité sanitaire

WORLD HEALTH ORGANIZATION Annual subscription / Abonnement annuel Geneva Sw. fr. / Fr. s. 346.– ORGANISATION MONDIALE 05.2018 DE LA SANTÉ ISSN 0049-8114 Genève Printed in Switzerland 249

SPECIAL EDITION NUMÉRO SPÉCIAL Editorial Editorial The WHO Health Emergencies (WHE) programme was /H 3URJUDPPH 206 GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQL- established in 2016 to strengthen WHO capacity to WDLUH :+( D pWp PLV HQ SODFH HQ DÀQ GH UHQIRUFHU OHV prevent, detect and respond to emergencies. Over the FDSDFLWpVGHO·2UJDQLVDWLRQSRXUSUpYHQLUGpWHFWHUOHVVLWXDWLRQV last two years the WHE has markedly strengthened G·XUJHQFHHW\ULSRVWHU$XFRXUVGHVGHX[GHUQLqUHVDQQpHVLO systems and processes to detect and manage hazards. DQHWWHPHQWUHQIRUFpOHVV\VWqPHVHWSURFHVVXVSRXUGpWHFWHUHW This includes through more systematic assessment of gérer les dangers, notamment par une évaluation plus systéma- QRWLÀFDWLRQV DQG DOHUWV DQG WKURXJK GHYHORSPHQW DQG WLTXH GHV QRWLÀFDWLRQV HW GHV DOHUWHV HW SDU O·pODERUDWLRQ HW OD implementation of the Emergency Response Frame- PLVH HQ ±XYUH GX &DGUH G·DFWLRQ G·XUJHQFH &KDTXH PRLV OH work. Each month the programme assesses 7000 signals Programme évalue 7000 signaux potentiellement importants of potential public health concern. Around 30 of these pour la santé publique, dont une trentaine nécessite une enquête UHTXLUHÀHOGLQYHVWLJDWLRQ sur le terrain. During the last year the WHE has supported operations /·DQ SDVVp OH 3URJUDPPH :+( D VRXWHQX GHV RSpUDWLRQV SRXU to control and manage Ebola in Democratic Republic contrôler et gérer des situations comme le virus Ebola en Répu- of Congo, Marburg in Uganda, pneumonic plague in blique démocratique du Congo, le virus de Marbourg en Ouganda, Madagascar, cholera, diphtheria and the collapse of the ODSHVWHSXOPRQDLUHj0DGDJDVFDUOHFKROpUDODGLSKWpULHHWO·HIIRQ- health system in Yemen, chemical events in Syria, war GUHPHQW GX V\VWqPH GH VDQWp DX

Mapping the distribution and risk Cartographie de la distribution of epidemics in the WHO African et des risques d’épidémie dans la Région Region africaine de l’OMS Abdisalan M Noor,a Benido Impouma,b Stephen Oloo,c E. Hamblion,b Abdisalan M Noor,a Benido Impouma,b Stephen Oloo,c E. Hamblion,b Senait Senait Fekadu,b Christian Massidi,b Etienne Minkoulou,b Ali Yahaya,b Fekadu,b Christian Massidi,b Etienne Minkoulou,b Ali Yahaya,b Zabulon Yotib Zabulon Yotib and Ibrahima Socé Fallb et Ibrahima Socé Fallb

Introduction Introduction Infectious disease outbreaks among human populations /DVXUYHQXHGHÁDPEpHVGHPDODGLHVLQIHFWLHXVHVFKH]O·KRPPH occur when there is the presence of disease causing UpVXOWHGHODSUpVHQFHG·DJHQWVSDWKRJqQHVG·XQHVHQVLELOLWpGH pathogens, a susceptible population and the environ- la population et de facteurs environnementaux ou contextuels mental or contextual factors necessary for transmis- propices à la transmission.1 Des épidémies sont susceptibles de sion.1 Epidemics are likely to occur when a pathogen is VH SURGXLUH GDQV OHV VLWXDWLRQV R XQ DJHQW SDWKRJqQH D pWp introduced into a non-immune population, there is a introduit dans une population non immunisée, la sensibilité des change in the susceptibility of the host, the pathogen K{WHV D FKDQJp O·DJHQW SDWKRJqQH D DFTXLV XQH UpVLVWDQFH DX[

1 Janeway CA Jr, Travers P, Walport M et al. Infectious agents and how they cause 1 Janeway CA Jr, Travers P, Walport M et al. Infectious agents and how they cause disease. Chap- disease. Chapter 10. In: Immunobiology: the immune system in health and disease, ter 10. In: Immunobiology: the immune system in health and disease, 5th edition. New York 5th edition. New York City (NY): Garland Science; 2001 (https://www.ncbi.nlm.nih. (NY): Garland Science; 2001 (https://www.ncbi.nlm.nih.gov/books/NBK27114/; consulté en avril gov/books/NBK27114/, accessed April 2018). 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 251 develops resistance to drugs, there are enhanced trans- médicaments, un renforcement des voies de transmission a mission pathways that increase infection rates, or the HQWUDvQp XQH KDXVVH GHV WDX[ G·LQIHFWLRQ RX OD YLUXOHQFH GH virulence of the pathogen changes.2 Globally, disease O·DJHQWSDWKRJqQHDpYROXp2 En raison du nombre considérable epidemics result in substantial ill health and loss of GH FDV GH PDODGLH HW GH GpFqV TX·HOOHV SURYRTXHQW GDQV OH lives, posing a threat to global health security, under- monde, les épidémies représentent une menace pour la sécurité mining socioeconomic development, and destabilizing sanitaire mondiale, portent atteinte au développement socio- societies. Carefully assembled surveillance data can aid pFRQRPLTXHHWFRQWULEXHQWjGpVWDELOLVHUOHVVRFLpWpV/·DVVHP- the understanding of the burden of epidemics, their blage minutieux de données de surveillance permet de mieux occurrence and the key biological, ecological, economic, FRPSUHQGUH OD FKDUJH GH PRUELGLWp GHV pSLGpPLHV G·pWXGLHU health system and governance determinants. In 2015, FRPPHQW HOOHV VRQW VXUYHQXHV HW G·LGHQWLÀHU OHXUV SULQFLSDX[ WKH:+25HJLRQDO2IÀFHIRU$IULFD $)52 XQGHUWRRN déterminants biologiques, écologiques et économiques, ainsi DSURMHFWWRGHYHORSDFRPSUHKHQVLYHVSDWLDOO\GHÀQHG TXH OHV IDFWHXUV OLpV DX V\VWqPH GH VDQWp HW j OD JRXYHUQDQFH database of information on outbreaks to delineate the (Q OH %XUHDX UpJLRQDO 206 GH O·$IULTXH D HQWUHSULV XQ geographical areas of occurrence of epidemic diseases SURMHWYLVDQWjpWDEOLUXQHEDVHGHGRQQpHVH[KDXVWLYHHWGpÀQLH with potential for international spread, in accordance GDQV O·HVSDFH VXU OHV ÁDPEpHV pSLGpPLTXHV HW j GpOLPLWHU OHV with the International Health Regulations (2005).3 zones géographiques de survenue de maladies épidémiques VXVFHSWLEOHV GH VH SURSDJHU j O·pFKHOOH LQWHUQDWLRQDOH FRQIRU- PpPHQWDX5qJOHPHQWVDQLWDLUHLQWHUQDWLRQDO 3

Data assembly and mapping Assemblage des données et cartographie The aims of the project were to make an inventory of /·REMHFWLI GH FH SURMHW pWDLW GH GUHVVHU XQ LQYHQWDLUH GH WRXWHV all epidemics reported in Africa between 1970 and 2017, les épidémies signalées en Afrique entre 1970 et 2017, avec des with their date of occurrence, length, magnitude and LQIRUPDWLRQVVXUOHXUGDWHG·DSSDULWLRQOHXUGXUpHOHXUDPSOHXU WKHGLVWULFWLQZKLFKWKH\RFFXUUHGGHÀQHWKHJHRJUDSKLF HWOHVGLVWULFWVGDQVOHVTXHOVHOOHVVHVRQWSURGXLWHVG·LGHQWLÀHU areas of epidemic-prone diseases; assemble data on les zones géographiques des maladies à tendance épidémique; important socioeconomic, health systems and environ- G·DVVHPEOHU GHV GRQQpHV VXU OHV SULQFLSDX[ FRUUpODWV VRFLR mental correlates, and map their occurrence in villages pFRQRPLTXHV HQYLURQQHPHQWDX[ HW OLpV DX[ V\VWqPHV GH VDQWp and districts. The year 1970 was selected as the start et de les cartographier au niveau des villages et des districts. because there are limited data on epidemics in Africa /·DQQpH D pWp FKRLVLH FRPPH SRLQW GH GpSDUW FDU OHV before that time. All potential sources of data were iden- données dont on dispose sur les épidémies en Afrique avant WLÀHG DQG SXEOLVKHG DQG XQSXEOLVKHG OLWHUDWXUH ZHUH cette date sont limitées. Toutes les sources potentielles de searched to supplement the sources. The main data GRQQpHVRQWpWpLGHQWLÀpHVSXLVFRPSOpWpHVSDUXQHUHFKHUFKH sources used were: the Emergency Events Database of de la littérature existante, publiée ou non. Les principales the Centre for Research on the Epidemiology of Disas- sources de données qui ont été utilisées sont la base de données ters,4, 5WKH5HJLRQDO2IÀFHRXWEUHDNGDWDEDVHIRU² VXU OHV VLWXDWLRQV G·XUJHQFH GX &HQWUH GH UHFKHUFKH VXU O·pSL- 20146 DQG :+2 'LVHDVH 2XWEUHDN 1HZV7 Additional démiologie des catastrophes,4, 5 la base de données du Bureau sources included the Morbidity and Mortality Weekly UpJLRQDOVXUOHVÁDPEpHVGH6HWOHVEXOOHWLQVG·LQIRU- Reports of the US Centers for Disease Control and PDWLRQ GH O·206 VXU OHV ÁDPEpHV pSLGpPLTXHV7 Parmi les Prevention,8 the Poliomyelitis Global Status database DXWUHV VRXUFHV FRQVXOWpHV ÀJXUHQW OHV UDSSRUWV KHEGRPDGDLUHV DQGRWKHU:+2GLVHDVHVSHFLÀFGDWDEDVHV9, 10 de la morbidité et de la mortalité publiés par les Centers for 'LVHDVH&RQWURODQG3UHYHQWLRQGHVeWDWV8QLVG·$PpULTXH8 la base de données sur la situation mondiale de la poliomyélite, DLQVL TXH GHV EDVHV GH GRQQpHV GH O·206 UHODWLYHV j G·DXWUHV maladies.9, 10

2 Kelsey JL, Thompson WD, Evans AS. Methods in observational epidemiology. New 2 Kelsey JL, Thompson WD, Evans AS. Methods in observational epidemiology. New York (NY): York City (NY): Oxford University Press; 2016:216. Oxford University Press; 2016:216. 3 International Health Regulations (2005). Geneva: World Health Organization; 2008 3 Règlement sanitaire international (2005). Genève: Organisation mondiale de la Santé; 2008 (http://apps.who.int/iris/bitstream/10665/43883/1/9789241580410_eng.pdf, ac- (http://apps.who.int/iris/bitstream/handle/10665/246187/9789242580495-fre.pdf, consulté en cessed April 2018). avril 2018). 4 Guha-Sapir D, Hoyois P, Wallemacq P, Below R. Annual disaster statistical review, 4 Guha-Sapir D, Hoyois P, Wallemacq P, Below R. Annual disaster statistical review, 2016. The 2016. The numbers and trends. Brussels: Centre for Research on the Epidemiology numbers and trends. Brussels: Centre for Research on the Epidemiology of Disasters; 2016 of Disasters; 2016 (FRRN CKB?R @C QGRCQ BCD?SJR ÍJCQ ?BQP= NBD accessed April (FRRN CKB?R @C QGRCQ BCD?SJR ÍJCQ ?BQP= NBD, consulté en avril 2018). 2018). 5 Centre for Research on the Epidemiology of Disasters. The International Disasters 5 Centre for Research on the Epidemiology of Disasters. The International Disasters Database. Database. Brussels, Belgium (www.emdat.be, accessed April 2018). Bruxelles, Belgique (www.emdat.be consulté en avril 2018). 6Ï 5&-Ï0CEGML?JÏ-DÍACÏDMPÏ DPGA?ÏB?R?@?QCQ 6 Bases de données du Bureau régional de l’Afrique. 7 Disease outbreak news. Geneva: World Health Organization (http://www.who.int/ 7Ï SJJCRGLQÏBhGLDMPK?RGMLÏQSPÏJCQÏÎ?K@¯CQÏ¯NGB¯KGOSCQ Ï%CLCT?Ï-PE?LGQ?RGMLÏKMLBG?JCÏBCÏJ?Ï csr/don/en/, accessed April 2018). Santé (http://www.who.int/csr/don/fr/, consulté en avril 2018). 8 Morbidity and mortality weekly report. Atlanta (GA): Centers for Disease Control 8 Morbidity and mortality weekly report. Atlanta (GA): Centers for Disease Control and Preven- and Prevention (https://www.cdc.gov/mmwr/index.html, accessed April 2018). tion (https://www.cdc.gov/mmwr/index.html, consulté en avril 2018). 9 Program for Monitoring Emerging Diseases. Brookline (MA): International Society 9 Program for Monitoring Emerging Diseases. Brookline (MA): International Society for Infectious for Infectious Diseases (http://www.isid.org, accessed April 2018). Diseases (http://www.isid.org, consulté en avril 2018). 10 Global Polio Eradication Initiative. Geneva: World Health Organization (http://po- 10 Initiative mondiale pour l’éradication de la poliomyélite. Geneva: Organisation mondiale de la lioeradication.org/, accessed April 2018). Santé (http://polioeradication.org/, consulté en avril 2018). 252 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Most of the databases included information on the La plupart des bases de données contenaient des informations disease and the time and location of outbreaks. Strains sur la maladie, ainsi que sur la date de survenue et la localisa- of pathogens that cause a single disease were grouped. WLRQ GHV ÁDPEpHV /HV VRXFKHV G·DJHQWV SDWKRJqQHV UHVSRQ- The databases were compared with regard to disease, VDEOHV G·XQH PrPH PDODGLH RQW pWp UHJURXSpHV /HV LQIRUPD- location, start and end times and numbers of infections WLRQVSRUWDQWVXUOHVPDODGLHVODORFDOLVDWLRQGHVÁDPEpHVOHXUV and deaths. A disease outbreak or epidemic that started GDWHV GH GpEXW HW GH ÀQ HW OH QRPEUH G·LQIHFWLRQV HW GH GpFqV in one year and continued in following years was RQWpWpFRPSDUpHVHQWUHOHVEDVHVGHGRQQpHV7RXWHÁDPEpHRX considered to be one event, unless there was epidemio- pSLGpPLHD\DQWGpEXWpXQHDQQpHGRQQpHHWV·pWDQWSRXUVXLYLH logical evidence that the events were independent. For les années suivantes était considérée comme un événement example, the epidemic of Ebola virus disease, which unique, à moins que des données épidémiologiques ne started in Guinea in 2013 and continued to 2015, was GpPRQWUHQW TX·LO V·DJLVVDLW G·pYpQHPHQWV LQGpSHQGDQWV 3DU considered a single epidemic. The district, or its equiv- H[HPSOHO·pSLGpPLHGHPDODGLHjYLUXV(ERODTXLDFRPPHQFp alent, was used as the highest spatial resolution, and HQ*XLQpHHQHWDSHUVLVWpMXVTX·HQDpWpFRQVLGpUpH data reported from villages, towns and districts were comme constituant une seule épidémie. Le district, ou une all assigned to the district. For the few data reported at HQWLWp pTXLYDOHQWH D pWp UHWHQX FRPPH O·XQLWp GH UpVROXWLRQ regional, provincial or state level, all districts in these spatiale la plus élevée et les données provenant des villages, geographical units were assumed to have been affected villes et districts ont toutes été rattachées au district. Pour les by the epidemic. An up-to-date district map was not TXHOTXHVGRQQpHVQRWLÀpHVDXQLYHDXGHVUpJLRQVSURYLQFHVRX available for Algeria, and province boundaries were États, il a été présumé que tous les districts appartenant à ces used. XQLWpV JpRJUDSKLTXHV DYDLHQW pWp WRXFKpV SDU O·pSLGpPLH 3RXU O·$OJpULHDXFXQHFDUWHDFWXDOLVpHGHVGLVWULFWVQ·pWDLWGLVSRQLEOH HWOHVIURQWLqUHVSURYLQFLDOHVRQWpWpXWLOLVpHV 7KH JHRJUDSKLFDO DUHD RI D GLVHDVH ZDV GHÀQHG DV DQ\ /D]RQHJpRJUDSKLTXHG·XQHPDODGLHDpWpGpÀQLHFRPPHWRXWH area within a country in which transmission of the ]RQHG·XQSD\VDXVHLQGHODTXHOOHRQDREVHUYpXQHWUDQVPLV- pathogens to humans has occurred or where the trans- VLRQ GHV DJHQWV SDWKRJqQHV j O·KRPPH RX OD SUpVHQFH GH mitting vectors and zoonotic vectors have been reported. vecteurs de transmission et de vecteurs zoonotiques. Les zones A combination of local cases reported by countries, géographiques de diverses maladies épidémiques susceptibles serological or genetic evidence of the presence of GHVHSURSDJHUjO·pFKHOOHLQWHUQDWLRQDOHRQWpWpGpÀQLHVVXUOD pathogens in human hosts and the presence of trans- EDVHG·XQHFRPELQDLVRQGHIDFWHXUVQRWLÀFDWLRQGHFDVORFDX[ mitting vectors or zoonotic reservoirs were used to par les pays, données sérologiques ou génétiques démontrant GHÀQH WKH JHRJUDSKLF DUHD RI WKH YDULRXV HSLGHPLF OD SUpVHQFH GHV DJHQWV SDWKRJqQHV FKH] GHV K{WHV KXPDLQV HW diseases with potential for international spread. présence de vecteurs de transmission ou de réservoirs zoonotiques.

Results Résultats Over 1800 outbreaks and epidemics were reported in 3OXV GH ÁDPEpHV HW pSLGpPLHV RQW pWp QRWLÀpHV GDQV OD WKH :+2 $IULFDQ 5HJLRQ LQ WKH SHULRG ² $ 5pJLRQ DIULFDLQH GH O·206 HQWUH HW 8QH XUJHQFH GH potential public health emergency of international santé publique de portée internationale potentielle a été signa- concern was reported in almost 5250 districts, cholera OpHGDQVSUqVGHGLVWULFWVOHFKROpUDpWDQWODFDXVHODSOXV being the most geographically widespread. The data on répandue de ces urgences sur le plan géographique. Les données epidemics mapped by geographic area for Ebola virus sur les épidémies ont été cartographiées par zone géographique disease, Lassa fever, Crimean Congo haemorrhagic fever SRXU OD PDODGLH j YLUXV (EROD OD ÀqYUH GH /DVVD OD ÀqYUH (CCHF), Marburg virus disease, Rift Valley fever, dengue, hémorragique de Crimée-Congo, la maladie à virus Marburg, la :HVW 1LOH YLUXV \HOORZ IHYHU SODJXH PHQLQJLWLV DQG ÀqYUHGHODYDOOpHGX5LIWODGHQJXHOHYLUXV:HVW1LOHODÀqYUH cholera are illustrated in Figure 1. jaune, la peste, la méningite et le choléra (Figure 1). Cholera and yellow fever caused outbreaks in many /H FKROpUD HW OD ÀqYUH MDXQH RQW SURYRTXp GHV ÁDPEpHV GDQV parts of the WHO African region. Outbreaks of menin- GHQRPEUHXVHVSDUWLHVGHOD5pJLRQDIULFDLQH/HVÁDPEpHVGH gitis, CCHF, and dengue were primarily in a few areas, PpQLQJLWH GH ÀqYUH KpPRUUDJLTXH GH &ULPpH&RQJR HW although they also occurred at lower levels more widely. de dengue se sont essentiellement limitées à quelques zones, Outbreaks of Ebola virus, Lassa fever, plague, and ELHQ TXH GHV ÁDPEpHV GH PRLQGUH LQWHQVLWp VRLHQW pJDOHPHQW Marburg virus, were focal and mostly impacted selected VXUYHQXHV j SOXV JUDQGH pFKHOOH /HV ÁDPEpHV GH PDODGLH j areas in the region. YLUXV (EROD GH ÀqYUH GH /DVVD GH SHVWH HW GH PDODGLH j YLUXV Marburg étaient localisées, touchant principalement des zones VSpFLÀTXHVGHOD5pJLRQ

Discussion and conclusion Discussion et conclusion This is the most comprehensive collation of data about Les données assemblées dans le cadre de ce projet sont les plus disease outbreaks and where they occured in the WHO FRPSOqWHV UHFXHLOOLHV j FH MRXU VXU OD QDWXUH HW OD ORFDOLVDWLRQ African region. Knowing the districts within countries GHVÁDPEpHVGHPDODGLHGDQVOD5pJLRQDIULFDLQH,OHVWLPSRU- where outbreaks occur and their frequency is important WDQWG·LGHQWLÀHUOHVGLVWULFWVRVXUYLHQQHQWOHVÁDPEpHVDXVHLQ for setting priorities and targeting prevention, detec- de chaque pays et de déterminer leur fréquence, cette informa- RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 253 Figure 1 Data on all epidemics reported between 1970 and 2017 in the WHO African Region and mapped by geographical areas Figure 1 #NMM°DRÐRTQÐSNTSDRÐKDRÐ°OHC°LHDRÐMNSHÆ°DRÐC@MRÐK@Ð1°FHNMÐ@EQHB@HMDÐCDÐKi.,2ÐDMSQDÐÐDSÐ ÐDSÐB@QSNFQ@OGH°DRÐO@QÐ zones géographiques

Ebola virus disease – Maladie à virus Ebola Local transmission (indige- nous) – Transmission locale (autochtone) Dengue Complete presence – Présence totale Local transmission (caused by imported cases) – Transmission locale (causée par des cas importés) Moderate presence – Présence modérée Imported cases (no local transmission) – Cas importés (pas de transmission locale) No reported cases but suitable ecology for Intermediate presence – Présence transmission – Aucun cas signalé mais milieu intermédiaire écologique propice à la transmission

Lassa fever – Fièvre de Lassa Yellow fever – Fièvre jaune Reported cases – Cas signalés Moderate to high risk – Risque modéré à élevé

Presence of Mastomys natalensis – Présence de Mastomys natalensis Low risk – Risque faible

Crimean-Congo haemorrhagic fever – Fièvre hémorragique de Crimée – virus Congo Cholera – Choléra Indeterminable – Non déterminable Countries reporting outbreaks – Pays QGEL?J?LRÏBCQÏÎ?K@¯CQ Moderate presence – Présence modérée

Countries reporting imported cases – Pays Complete presence – Présence totale signalant des cas importés

Plague – Peste Marburgh fever – Fièvre Marburg Plague foci (regions where plague occurs Countries with reported index cases – Pays in animals) – Foyers de peste (régions signalant des cas indicateurs dans lesquelles la peste touche les animaux) Countries at risk without reported index Reported plague outbreaks – Flambées cases – Pays à risque ne signalant pas de cas de peste ayant été signalées indicateurs

254 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Figure 1 (continued) – Figure 1 (suite)

Rift Valley fever – Fièvre de la Vallée du Rift Meningitis – Méningite Countries with reported large outbreaks – Meningitis belt – Ceinture de la méningite .?WQÏQGEL?J?LRÏBCQÏÎ?K@¯CQÏBCÏEP?LBCÏ ampleur

Countries with periodic cases/serological Countries with areas in the meningitis belt – evidence – Pays signalant des cas périodiques Pays dont certaines zones sont situées dans /des signes sérologiques la ceinture de la méningite Presence of Aedes spp. mosquitoe, no reported Outbreaks reported outside the meningitis belt cases – Présence du moustique Aedes spp., aucun – .?WQÏQGEL?J?LRÏBCQÏÎ?K@¯CQÏ¦ÏJhCVR¯PGCSPÏBCÏ cas signalé la ceinture de la méningite

Nota bene: Islands (Cabo Verde, Comoros, Mauritius, Sao Tome and Principe, Seychelles) are not shown for mapping clarity. – Pour des besoins de clarté, les îles (Cap-Vert, Comores, Maurice, Sao Tomé-et-Principe, Seychelles) ne sont pas représentées sur cette carte.

Not applicable – Non applicable Disputed borders – Frontières contestées Minimal infection or no risk of infection – Infection minimale ou aucun risque d’infection

© World Health Organization (WHO) 2018. All rights reserved – © Organisation mondiale de la Santé (OMS) 2018. Tous droits réservés. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. – *CQÏJGKGRCQÏCRÏ?NNCJJ?RGMLQÏÍESP?LRÏQSPÏACRRCÏA?PRCÏMSÏJCQÏB¯QGEL?RGMLQÏCKNJMW¯CQÏLhGKNJGOSCLRÏBCÏJ?ÏN?PRÏBCÏJh-PE?LGQ?RGMLÏ mondiale de la Santé aucune prise de position quant au statut juridique des pays, territoires, villes ou zones, ou de leurs autorités, ni quant au tracé de leurs frontières ou limites. Les JGELCQÏCLÏNMGLRGJJ¯ÏQSPÏJCQÏA?PRCQÏPCNP¯QCLRCLRÏBCQÏDPMLRG®PCQÏ?NNPMVGK?RGTCQÏBMLRÏJCÏRP?A¯ÏNCSRÏLCÏN?QÏ?TMGPÏD?GRÏJhM@HCRÏBhSLÏ?AAMPBÏB¯ÍLGRGD

tion, and response interventions. Systematic prospective WLRQIDFLOLWDQWO·pWDEOLVVHPHQWGHVSULRULWpVHWODPLVHHQ±XYUH collection of data about outbreaks in the future will G·LQWHUYHQWLRQVFLEOpHVGHSUpYHQWLRQGHGpWHFWLRQHWGHULSRVWH further enhance our understanding of the occurrence O·DYHQLU OD FROOHFWH V\VWpPDWLTXH HW SURVSHFWLYH GH GRQQpHV RIVSHFLÀFGLVHDVHVDQGKRZWRFRQWUROWKHP VXU OHV ÁDPEpHV DPpOLRUHUD HQFRUH QRWUH FRPSUpKHQVLRQ GHV FRQGLWLRQVGHVXUYHQXHGHPDODGLHVVSpFLÀTXHVHWGHVPR\HQV pouvant être utilisés pour les juguler. The challenges encountered in this project include /HV GLIÀFXOWpV UHQFRQWUpHV GDQV OH FDGUH GH FH SURMHW pWDLHQW OLPLWHG LQIRUPDWLRQ RQ WKH GHÀQLWLRQV DQG WKUHVKROGV QRWDPPHQWOLpHVDXSHXG·LQIRUPDWLRQVGLVSRQLEOHVVXUOHVGpÀ- of outbreaks used over time and how they may have QLWLRQVHWOHVVHXLOVXWLOLVpVSRXUOHVÁDPEpHVDXFRXUVGXWHPSV EHHQDIIHFWHGE\FKDQJLQJGLDJQRVWLFVDQGFDVHGHÀQL- HWVXUO·LQFLGHQFHTXHO·pYROXWLRQGHVSURGXLWVGHGLDJQRVWLFHW tions, resulting in uncertainties in temporal compari- GHVGpÀQLWLRQVGHFDVSHXWDYRLUHXVXUFHVSDUDPqWUHVFHTXL sons of data. Furthermore, inconsistencies were found rend la comparaison temporelle des données incertaine. En among the databases used in terms of the occurrence RXWUH GHV LQFRKpUHQFHV UHODWLYHV j OD VXUYHQXH HW j O·DPSOHXU and magnitude of outbreaks. Agreement among more GHV ÁDPEpHV RQW pWp UHOHYpHV HQWUH OHV GLIIpUHQWHV EDVHV GH than 2 databases, supported by a literature review and données utilisées. La concordance de plus de 2 bases de données, FRQVXOWDWLRQ ZLWK WKH WHDPV DW WKH 5HJLRQDO 2IÀFH appuyée par une revue de la littérature et une consultation des DQG:+2KHDGTXDUWHUVDOORZHGGDWDYHULÀFDWLRQ3RRU pTXLSHV GX %XUHDX UpJLRQDO HW GX 6LqJH GH O·206 RQW SHUPLV access to national surveillance bulletins, which are an XQH YpULÀFDWLRQ GHV GRQQpHV /HV GLIÀFXOWpV G·DFFqV j FHUWDLQV important source of original data on outbreaks and bulletins nationaux de surveillance, qui constituent une source HSLGHPLFV ZDV DQRWKHU FKDOOHQJH WR GDWD YHULÀFDWLRQ LPSRUWDQWHGHGRQQpHVG·RULJLQHVXUOHVÁDPEpHVHWOHVpSLGp- the development of online portals for national surveil- PLHV RQW UHSUpVHQWp XQ DXWUH REVWDFOH j OD YpULÀFDWLRQ GHV lance reports will be critical. Little information was GRQQpHVO·pODERUDWLRQGHSRUWDLOVG·DFFqVHQOLJQHDX[UDSSRUWV available before 1980, probably because of inadequate GH VXUYHLOODQFH QDWLRQDX[ VHUD G·XQH LPSRUWDQFH FULWLTXH 2Q reporting or archiving of outbreaks and epidemics in QH GLVSRVH TXH GH SHX G·LQIRUPDWLRQV GDWDQW G·DYDQW libraries outside Africa. In contrast, more outbreaks SUREDEOHPHQW HQ UDLVRQ G·XQH QRWLÀFDWLRQ HW G·XQ DUFKLYDJH have been reported in the past 15 years with improved LQDGpTXDWVGHVGRQQpHVVXUOHVÁDPEpHVHWOHVpSLGpPLHVGDQV diagnosis and surveillance. OHVELEOLRWKqTXHVHQGHKRUVG·$IULTXH(QUHYDQFKHOHVÁDPEpHV QRWLÀpHV DX FRXUV GHV GHUQLqUHV DQQpHV RQW pWp SOXV QRPEUHXVHV VXLWH j O·DPpOLRUDWLRQ GX GLDJQRVWLF HW GH OD surveillance. In view of the limitations, caution must be exercised in &RPSWHWHQXGHFHVOLPLWHVODSUXGHQFHV·LPSRVHSRXULQWHUSUp- interpreting the trends in disease outbreaks and WHU OHV WHQGDQFHV UHODWLYHV DX[ ÁDPEpHV HW DX[ pSLGpPLHV HQ RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 255 epidemics in Africa. The geographical resolution of the Afrique. Leur localisation était indiquée avec une résolution location of an outbreak or epidemic varied: in some géographique variable: dans certains cas, le nom du village, de cases, the name of the village, town or district was OD YLOOH RX GX GLVWULFW pWDLW VLJQDOp WDQGLV TXH GDQV G·DXWUHV OHV UHSRUWHGZKLOHLQRWKHUVGDWDZHUHVSDWLDOO\GHÀQHGDW GRQQpHV pWDLHQW JpRJUDSKLTXHPHQW GpÀQLHV DX QLYHDX UpJLRQDO regional or country level. Most of the potential corre- ou national. La plupart des corrélats potentiels des épidémies, en lates of epidemics, particularly those of socioeconomic particulier ceux qui ont trait au développement socio-écono- and health system development, are rarely available by PLTXH HW DX[ V\VWqPHV GH VDQWp VRQW UDUHPHQW UHQVHLJQpV SDU district, further restricting the analysis. Combination of GLVWULFW FH TXL OLPLWH HQFRUH O·DQDO\VH /D FRPELQDLVRQ GH FHV such correlates with the detailed data on district-level FRUUpODWVDYHFOHVGRQQpHVGpWDLOOpHVVXUOHVÁDPEpHVHWOHVpSLGp- outbreaks and epidemics derived for this report will mies dans les districts, dérivées du présent rapport, permettront allow further assessment of risk and analyses of vulner- XQHpYDOXDWLRQSOXVSRXVVpHGHVULVTXHVDLQVLTX·XQHDQDO\VHGH DELOLW\ WR GLVHDVH RXWEUHDNV 7KH ÀQDO GDWDVHW ZLOO EH ODYXOQpUDELOLWpDX[ÁDPEpHV/HVGRQQpHVÀQDOHVVHURQWSXEOLpHV hosted on the website of the WHO Health Emergencies VXUOHVLWH:HEGX3URJUDPPHGHJHVWLRQGHVVLWXDWLRQVG·XUJHQFH programme in the African Region.11 VDQLWDLUHGHO·206GDQVOD5pJLRQDIULFDLQH11 By compiling a comprehensive set of data about /DFRPSLODWLRQG·XQHQVHPEOHFRPSOHWGHGRQQpHVVXUOHVÁDP- outbreaks in the WHO African region, we are able to bées dans la Région africaine fournit une vision plus claire de improve our understanding of the location and la localisation et de la fréquence de ces événements. Grâce à frequency of events. This mapping enables public health FHWWHFDUWRJUDSKLHOHVDXWRULWpVGHVDQWpSXEOLTXHSHXYHQWV·DS- authorities to take an evidence-based approach to puyer sur des données probantes pour renforcer les capacités, capacity building, prevention strategies, preparedness élaborer des stratégies de prévention, mener des activités de activities, and response planning. While WHO must SUpSDUDWLRQ HW SODQLÀHU OHV LQWHUYHQWLRQV GH ULSRVWH 6·LO HVW maintain capacity to respond to new outbreaks in the HVVHQWLHOTX·jO·DYHQLUO·206PDLQWLHQQHVHVFDSDFLWpVGHULSRVWH future, a deeper understanding of previous outbreaks DX[ QRXYHOOHV ÁDPEpHV FHWWH FRPSUpKHQVLRQ DSSURIRQGLH GHV enables us to take a pro-active approach to epidemic ÁDPEpHV SDVVpHV IDYRULVH OD PLVH HQ ±XYUH G·XQH DSSURFKH control in the African region. proactive de lutte contre les épidémies dans la Région africaine.

TSGNQÐ@EÆKH@SHNMRÐ EÆKH@SHNMRÐCDRÐ@TSDTQRÐ a Global Malaria Programme, World Health Organiza- a Programme mondial de lutte antipaludique, Organisation tion, Geneva, Switzerland; b :+2 5HJLRQDO 2IÀFH IRU PRQGLDOHGHOD6DQWp*HQqYH6XLVVHb%XUHDXUpJLRQDOGHO·206 Africa, Health Emergencies Programme, Brazzaville, SRXU O·$IULTXH 3URJUDPPH GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH Congo; c Kenya Medical Research Institute/Wellcome sanitaire, Brazzaville, Congo; c Kenya Medical Research Institute/ 7UXVW 5HVHDUFK 3URJUDPPH 1DLUREL .HQ\D &RUUHV :HOOFRPH 7UXVW 5HVHDUFK 3URJUDPPH 1DLUREL .HQ\D $XWHXU ponding author: Ibrahima Socé Fall, Regional Emer- correspondant: Ibrahima Socé Fall, Directeur régional pour les gency Director, [email protected]). VLWXDWLRQVG·XUJHQFH[email protected]).

Acknowledgements Remerciements The authors would like to thank Peter Macharia, Paul Les auteurs tiennent à remercier Peter Macharia, Paul Ouma et Ouma and Ezekiel Gogo of the KEMRI/Wellcome Trust Ezekiel Gogo du KEMRI/Wellcome Trust Research Programme Research Programme for their help in assembling and SRXUOHXUFRQWULEXWLRQDX[WUDYDX[G·DVVHPEODJHHWGHFDUWRJUD- mapping data. The authors are grateful to Raymond SKLH GHV GRQQpHV 1RXV VRPPHV pJDOHPHQW UHFRQQDLVVDQWV Bruce J. Aylward, Sylvie Briand, Sandra Garnier, Olivier à Raymond Bruce J. Aylward, Sylvie Briand, Sandra Garnier, Ronveaux and Eric Bertherat at WHO headquarters and 2OLYLHU5RQYHDX[HW(ULF%HUWKHUDWGX6LqJHGHO·206DLQVLTX·j Amadou Sall at the Institut Pasteur, Senegal, for $PDGRX6DOOGHO·,QVWLWXW3DVWHXUDX6pQpJDOSRXUOHXUVFRPPHQ- comments on earlier drafts of this report. Ⅲ taires sur les versions précédentes du présent rapport. Ⅲ

11Ï DPGA?LÏ&C?JRFÏ-@QCPT?RMPW Ï P?XX?TGJJCÏ5&-Ï0CEGML?JÏ-DÍACÏDMPÏ DPGA?Ïwww.aho. 11 Observatoire Africain de la Santé. Brazzaville: Bureau régional OMS de l’Afrique (www.aho.afro. afro.who.int, accessed April 2018). who.int/fr, consulté en avril 2018).

ÐGD@KSGÐDLDQFDMBXÐQHRJÐOQNÆKDÐ /QNÆKÐCDRÐQHRPTDRÐCiTQFDMBDÐR@MHS@HQDÐ of the South-East Asia Region1 dans la Région de l’Asie du Sud-Est1

Roderico H. Ofrina Roderico H. Ofrina

Introduction Introduction The WHO South-East Asia Region (SEAR) has been /D 5pJLRQ 206 GH O·$VLH GX 6XG(VW 6($5 D FRQQX GH vulnerable to many emergencies and disasters. As most QRPEUHXVHV FDWDVWURSKHV HW VLWXDWLRQV G·XUJHQFH eWDQW GRQQp FRXQWULHVLQWKH5HJLRQDUHORZRUORZ²PLGGOHLQFRPH que la plupart des pays de la Région sont des pays à revenu faible with largely underfunded health systems, hazardous RXLQWHUPpGLDLUHGRQWOHVV\VWqPHVGHVDQWpVRQWODUJHPHQWVRXV

1Ï 0MMRQÏDMPÏPCQGJGCLACÏ?ÏFC?JRFÏCKCPECLAWÏPGQIÏNPMÍJCÏMDÏRFCÏ1MSRFÌ#?QRÏ QG?Ï0CEGML Ï 1Ï 0MMRQÏDMPÏPCQGJGCLACÏ?ÏFC?JRFÏCKCPECLAWÏPGQIÏNPMÍJCÏMDÏRFCÏ1MSRFÌ#?QRÏ QG?Ï0CEGML Ï,CUÏ"CJFGÏ ,CUÏ"CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏDMPÏ1MSRFÌ#?QRÏ QG?ÏÏhttp://apps.who.int/iris/ Bureau régional de l’OMS pour l’Asie du Sud-Est; 2017 (http://apps.who.int/iris/bitstream/hand bitstream/handle/10665/258766/9789290226093-eng.pdf, accessed April 2018). le/10665/258766/9789290226093-eng.pdf, consulté en avril 2018). 256 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 events have had medium- to long-term impacts on life, ÀQDQFpV OHV pYpQHPHQWV GDQJHUHX[ RQW GHV UpSHUFXVVLRQV j health and property.2 During the past decade, 26.8% of moyen terme et à long terme sur les conditions de vie, la santé global mortality due to disasters occurred in the Region, et la propriété.2$XFRXUVGHVGHUQLqUHVDQQpHVGHWRXV aggravated by unplanned urbanization, development OHV GpFqV PRQGLDX[ GXV j GHV FDWDVWURSKHV VRQW VXUYHQXV GDQV activity in high-risk areas, climate change, environmen- cette Région, où la situation est aggravée par une urbanisation tal degradation and challenges to health care quality sauvage, des activités de développement dans des zones à haut and access.3 The outbreak of severe acute respiratory ULVTXHOHFKDQJHPHQWFOLPDWLTXHODGpJUDGDWLRQGHO·HQYLURQQH- V\QGURPH 6$56 LQ²NLOOHGRISHRSOH PHQWOHVGLIÀFXOWpVG·DFFqVDX[VRLQVGHVDQWpHWODTXDOLWpLQVXI- LQIHFWHGLQFRXQWULHV7KHDYLDQLQÁXHQ]D$ +1 ÀVDQWH GHV VRLQV3 (Q OD ÁDPEpH pSLGpPLTXH GH YLUXVHSLGHPLFRI²ZDVOLQNHGWRWKHUHHPHU- V\QGURPHUHVSLUDWRLUHDLJXVpYqUH 65$6 DIDLWPRUWVSDUPL gence of the virus in humans in 1997.4 The tsunami in OHVSHUVRQQHVTXLDYDLHQWpWpLQIHFWpHVGDQVSD\V/·pSL- December 2004, which claimed over 250 000 lives GpPLH GH JULSSH DYLDLUH $ +1 GH pWDLW OLpH j OD in 14 nations, left in its wake many epidemics and UppPHUJHQFH GX YLUXV FKH] O·KRPPH HQ 4 Le tsunami de communicable disease outbreaks; and the earthquake décembre 2004, qui a coûté la vie à 250 000 personnes dans LQ1HSDOLQ$SULOUHVXOWHGLQRYHUDOOGDPDJHHVWL- SD\VDGRQQpOLHXjGHQRPEUHXVHVpSLGpPLHVHWÁDPEpHVGH mated at US$ 10 billion.5 PDODGLHV WUDQVPLVVLEOHV HW OH VpLVPH TXL D IUDSSp OH 1pSDO HQ avril 2015 a causé des dégâts estimés à US$ 10 milliards.5 A series of global frameworks since 2003 have responded Depuis 2003, une série de cadres mondiaux ont été élaborés pour to such events, with growing preparedness in managing UpSRQGUHjGHWHOVpYpQHPHQWVHWO·DFFHQWDpWpPLVVXUXQHPHLO- disasters.6 With changing epidemiological and disease leure préparation à la gestion des catastrophes.66RXVO·HIIHWG·XQH SURÀOHVVKDSHGE\ZLGHQLQJKHDOWKLQHTXDOLW\UDPSDQW LQpJDOLWp VDQLWDLUH FURLVVDQWH G·XQH GpJUDGDWLRQ JpQpUDOLVpH GH environmental degradation, increasing migration and O·HQYLURQQHPHQW G·XQH DFFpOpUDWLRQ GH OD PLJUDWLRQ HW GH O·XUED- urbanization, changing land use patterns and agricul- QLVDWLRQGHVFKDQJHPHQWVDSSDUXVGDQVO·XWLOLVDWLRQGHVVROVHWGH WXUHDQGOLYHVWRFNLQWHQVLÀFDWLRQWKHULVNRIWKHHPHU- O·LQWHQVLÀFDWLRQ GH O·DJULFXOWXUH HW GH O·pOHYDJH OHV SURÀOV pSLGp- gence and spread of infectious diseases has increased.7 PLRORJLTXHV HW SDWKRORJLTXHV RQW pYROXp HW OHV ULVTXHV G·pPHU- Challenges remain for integrating health sector emergence et de propagation des maladies infectieuses ont augmenté.7 gency preparedness into overall national disaster La préparation aux urgences dans le secteur de la santé demeure preparedness and response plans. The idea of disaster GLIÀFLOH j LQWpJUHU DX[ SODQV QDWLRQDX[ JpQpUDX[ GH SUpSDUDWLRQ risk management adopted in the Sendai Framework in et de riposte aux catastrophes. La notion de gestion des risques 20158 is still new, and the “all-hazards” approach9 to risk de catastrophe adoptée dans le cadre de Sendai en 20158 est encore management is yet to be institutionalized. XQHLGpHQHXYHHWO·DSSURFKHGHJHVWLRQGHVULVTXHV©D[pHVXUWRXV les dangers»9Q·DSDVHQFRUHpWpLQVWLWXWLRQQDOLVpH ,Q UHFHQW \HDUV ZH KDYH VHHQ GLVDVWHUV DQG FRQÁLFWV $X FRXUV GH FHV GHUQLqUHV DQQpHV GHV FDWDVWURSKHV HW GHV provide the elements and environment conducive to FRQÁLWV RQW SDUIRLV FUpp XQ FRQWH[WH IDYRUDEOH j OD VXUYHQXH HSLGHPLFV HJSROLRLQ6\ULDGLSKWKHULDLQ&R[·V%D]DU G·pSLGpPLHV SDUH[HPSOHODSROLRP\pOLWHHQ6\ULHODGLSKWpULH (Bangladesh). We have also seen epidemics turning into GDQV OH GLVWULFW GH &R[·V %D]DU DX %DQJODGHVK 'H PrPH a regional and national even global calamity such as certaines épidémies se sont transformées en catastrophes natio- the Ebola outbreak in West Africa. QDOHV UpJLRQDOHV RX PrPH PRQGLDOHV FRPPH OD ÁDPEpH GH PDODGLHjYLUXV(ERODHQ$IULTXHGHO·2XHVW

2 WHO’s new health emergencies programme. Geneva: World Health Organization; 2 Nouveau programme de gestion des situations d’urgence sanitaire. Genève: Organisation mon- 2016 (http://www.who.int/topics/emergencies/en/, accessed April 2018). diale de la Santé; 2016 (http://www.who.int/features/qa/health-emergencies-programme/fr/, consulté en avril 2018). 3 World disasters report 2016. Geneva: International Federation of Red Cross and Red 3 Rapport sur les catastrophes dans le monde 2016. Genève: Fédération internationale des Socié- Crescent Societies; 2017 (http://www.ifrc.org/Global/Documents/Secreta- tés de la Croix-Rouge et du Croissant-Rouge; 2017 (http://www.ifrc.org/Global/Documents/Se- riat/201610/WDR%202016-FINAL_web.pdf, accessed April 2018). cretariat/201610/WDR%202016-FINAL_web.pdf, consulté en avril 2018). 4Ï 1SPTCGJJ?LACÏ?LBÏMSR@PC?IÏ?JCPRÏ?TG?LÏGLÎSCLX?ÏGLÏRFCÏ1MSRFÌ#?QRÏ QG?Ï0CEGMLÏGLÏ 4Ï 1SPTCGJJ?LACÏ?LBÏMSR@PC?IÏ?JCPRÏ?TG?LÏGLÎSCLX?ÏGLÏRFCÏ1MSRFÌ#?QRÏ QG?Ï0CEGMLÏGLÏ Ï,CUÏ Ï ,CUÏ "CJFGÏ5&-Ï 0CEGML?JÏ -DÍACÏ DMPÏ 1MSRFÌ#?QRÏ QG?Ï Ï http://www. Delhi: Bureau régional de l’OMS pour l’Asie du Sud-Est; 2013 (http://www.searo.who.int/entity/ QC?PM UFM GLR CLRGRW CKCPEGLE=BGQC?QCQ RMNGAQ ?TG?L=GLÎSCLX? CL accessed April CKCPEGLE=BGQC?QCQ RMNGAQ ?TG?L=GLÎSCLX? CL , consulté en avril 2018). 2018). 5 Nepal earthquake 2015: an insight into risks, a vision for resilience. New Delhi: 5 Nepal earthquake 2015: an insight into risks, a vision for resilience. New Delhi: Bureau régional 5&-Ï 0CEGML?JÏ -DÍACÏ DMPÏ 1MSRFÌ#?QRÏ QG?Ï Ï http://apps.who.int/iris/ de l’OMS pour l’Asie du Sud-Est; 2016 (http://apps.who.int/iris/handle/10665/255623, consulté handle/10665/255623, accessed April 2018). en avril 2018). 6Ï 1MSRFÌ#?QRÏ QG?Ï0CEGML?JÏ&C?JRFÏ#KCPECLAWÏ$SLB Ï,CUÏ"CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏ 6 South-East Asia Regional Health Emergency Fund. New Delhi: Bureau régional de l’OMS for South-East Asia; 2017 (http://www.searo.who.int/entity/searhef/en/, accessed pour l’Asie du Sud-Est; 2017 (http://www.searo.who.int/entity/searhef/en/, consulté en April 2018). avril 2018). 7 Urbanisation in Southeast Asian Countries. Singapore: ASEAN Studies Centre; 2010 7 Urbanisation in Southeast Asian Countries. Singapore: ASEAN Studies Centre; 2010 (https:// (https://www.iseas.edu.sg/images/centres/asc/pdf/UrbanSEAsia-prelimaso- www.iseas.edu.sg/images/centres/asc/pdf/UrbanSEAsia-prelimasof13Jul10.pdf, consulté en f13Jul10.pdf, accessed April 2018). avril 2018). 8 Sendai framework for disaster risk reduction 2015–2030. New York City (NY): 8 Cadre d’action de Sendai pour la réduction des risques de catastrophe 2015–2030. New York United Nations; 2015 (FRRNQ UUU NPCTCLRGMLUC@ LCR ÍJCQ =QCLB?GDP?- (NY): Nations Unies; 2015 (FRRNQ UUU NPCTCLRGMLUC@ LCR ÍJCQ =DPCLAFQCLB?GDP?- meworkfordrren.pdf,Ï?AACQQCBÏ NPGJÏ Ï2FCÏDP?KCUMPIÏGQÏRFCÏÍPQRÏK?HMPÏ?EPCC- meworkfordisasterris.pdf, consulté en avril 2018). Ce cadre est le premier accord majeur du ment of the post-2015 development agenda. programme de développement pour l’après-2015. 9 WHO’s technical support to strengthen disaster preparedness and response follows 9 Le soutien technique fourni par l’OMS pour renforcer la préparation et la riposte aux catas- an all-hazards, whole of health approach, acknowledging that, while hazards vary trophes repose sur une approche axée sur tous les dangers et tous les domaines de la santé, in source, they often challenge health systems in similar ways. reconnaissant que les différents dangers, bien que d’origine variable, présentent souvent des B¯ÍQÏQCK@J?@JCQÏNMSPÏJCQÏQWQR®KCQÏBCÏQ?LR¯ RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 257 In view of the socioeconomic impact of emergencies Au vu des retombées socio-économiques des catastrophes et and disasters, WHO has made strengthening emergency GHV VLWXDWLRQV G·XUJHQFH O·206 D DFFRUGp XQH SULRULWp GH ULVN PDQDJHPHQW D ÁDJVKLS SULRULW\ 6($5 GHYHORSHG premier plan au renforcement de la gestion des risques liés benchmarks of capacity after the tsunami in 2004, and DX[ XUJHQFHV /D 5pJLRQ 6($5 D GpÀQL GHV FULWqUHV GH UpIp- the South-East Asia Regional Health Emergency Fund, UHQFHHQPDWLqUHGHFDSDFLWpDSUqVOHWVXQDPLGHHWjOD established in 2008, was expanded to a preparedness demande des États Membres de la Région, le Fonds régional fund at the request of SEAR Member States in 2015. G·XUJHQFHVDQLWDLUHSRXUO·$VLHGX6XG(VWFUppHQDpWp After the outbreak of Ebola virus disease, WHO set up pODUJLSRXULQFOXUHOHÀQDQFHPHQWGHVDFWLYLWpVGHSUpSDUDWLRQ the Health Emergencies Programme.10 Global momen- HQ6XLWHjODÁDPEpHGHPDODGLHjYLUXV(ERODO·206D tum was raised for “all-hazard” preparedness and pWDEOLXQ3URJUDPPHGHJHVWLRQGHVVLWXDWLRQVG·XUJHQFHVDQL- increasing capacity, with commitments to post-disaster taire.10 8QH G\QDPLTXH PRQGLDOH V·HVW PLVH HQ SODFH SRXU needs assessments, the International Health Regulations promouvoir la préparation axée sur tous les dangers et le (2005) (IHR), formulation of 12 benchmarks on emer- renforcement des capacités. Citons notamment les engage- gency preparedness and response, the Hyogo Frame- PHQWVSULVSRXUpYDOXHUOHVEHVRLQVDSUqVOHVFDWDVWURSKHVOH ZRUNIRU$FWLRQ²11 the Sendai Framework for 5qJOHPHQWVDQLWDLUHLQWHUQDWLRQDO 56, ODIRUPXODWLRQ 'LVDVWHU 5LVN 5HGXFWLRQ ²7 Sustainable Deve- GHFULWqUHVGHUpIpUHQFHVXUODSUpSDUDWLRQHWODULSRVWHDX[ lopment Goal 3 and the Global Health Security Agenda. VLWXDWLRQV G·XUJHQFH OH &DGUH G·DFWLRQ GH +\RJR SRXU 2015,11 OH &DGUH G·DFWLRQ GH 6HQGDL SRXU OD UpGXFWLRQ GHV risques de catastrophe pour 2015-2030,7 O·REMHFWLI GH GpYH- ORSSHPHQWGXUDEOHHWOH3URJUDPPHG·DFWLRQSRXUODVpFXULWp sanitaire mondiale.

Although the Region experiences frequent epidemics Bien que la Région soit fréquemment touchée par des épidé- DQGGLVDVWHUVLWKDGQRWFRPSUHKHQVLYHO\TXDQWLÀHGWKH PLHVHWGHVFDWDVWURSKHVDXFXQHTXDQWLÀFDWLRQH[KDXVWLYHGHV risks using existing information and databases. The ULVTXHVQ·DYDLWpWpUpDOLVpHjSDUWLUGHVLQIRUPDWLRQVHWGHVEDVHV 5HJLRQDO2IÀFHWKHUHIRUHFRQGXFWHGDPDSSLQJH[HUFLVH de données existantes. Le bureau régional a donc effectué un of vulnerability, capacity and risk, in which multiple exercice de cartographie de la vulnérabilité, des capacités et des hazards and communicable disease threats were ana- risques, dans le cadre duquel plusieurs dangers et risques lysed and published.1 The method used for the assess- de maladie transmissible ont été analysés et publiés.1 La ment was based on existing tools and datasets to quan- PpWKRGH G·pYDOXDWLRQ UHSRVDLW VXU GHV RXWLOV H[LVWDQWV HW GHV tify risks, which were analysed by health status and GRQQpHV GLVSRQLEOHV SRXU TXDQWLÀHU OHV ULVTXHV TXL RQW pWp FDSDFLW\$FWLRQVZHUHGHÀQHGWRPLWLJDWHULVNDWVXEQD- analysés en fonction de la situation sanitaire et des capacités. tional, national and regional levels and to increase resi- Des mesures de réduction des risques et de renforcement de la lience. UpVLOLHQFHRQWpWpGpÀQLHVDX[QLYHDX[LQIUDQDWLRQDOQDWLRQDOHW régional.

Methods Méthodes 5LVNV ZHUH SURÀOHG VFLHQWLÀFDOO\ WR XQGHUVWDQG WKH /HVSURÀOVGHULVTXHRQWpWppWDEOLVVHORQXQHDSSURFKHVFLHQ- dynamics of disasters the Region by analysing current WLÀTXHDÀQGHFRPSUHQGUHODG\QDPLTXHGHVFDWDVWURSKHVGDQV capacity and proposing means to reduce vulnerability. la Région en analysant les capacités existantes et en proposant 5LVNV ZHUH SURÀOHG LQ VWHSV ULVN SURÀOH RI QDWXUDO GHVPR\HQVGHUpGXLUHODYXOQpUDELOLWpGHVSD\V/·pWDEOLVVHPHQW KD]DUGVULVNSURÀOHRIVHOHFWLQIHFWLRXVV\QGURPHVDQG GHVSURÀOVGHULVTXHV·HVWIDLWHQpWDSHVSURÀOGHVULVTXHVGH diseases; and combining risks and analysis of country FDWDVWURSKH QDWXUHOOH SURÀO GHV ULVTXHV GH PDODGLHV HW capacity. de syndromes infectieux particuliers; combinaison des risques HWGHO·DQDO\VHGHVFDSDFLWpVGHVSD\V 7KHULVNSURÀOHRIQDWXUDOKD]DUGVZDVGHULYHGZLWKWKH /H SURÀO GHV ULVTXHV GH FDWDVWURSKH QDWXUHOOH D pWp REWHQX DX ,1)250 5LVN ,QGH[ PHWKRG12 Only natural hazards PR\HQ GH OD PpWKRGH GHV LQGLFHV GH ULVTXH ,1)25012 Seules were included, comprising cyclones, droughts, earth- les catastrophes naturelles, telles que cyclones, sécheresses, TXDNHV ÁRRGV DQG WVXQDPLV 7KH ULVNV FRYHUHG WKH séismes, inondations et tsunamis, ont été incluses dans cette 3 main dimensions of hazard and exposure: vulnerabi- analyse. Les risques couvraient les 3 principales dimensions des lity, hazard and inadequate coping capacity. For the risk GDQJHUVHWGHO·H[SRVLWLRQODYXOQpUDELOLWpOHGDQJHUHWO·LQVXI- SURÀOH RI VHOHFWHG LQIHFWLRXV GLVHDVH WKUHDWV FRXQWULHV ÀVDQWH FDSDFLWp j IDLUH IDFH DX[ VLWXDWLRQV 3RXU OH SURÀO GHV were ranked on the basis of the risk of spread of ULVTXHV DVVRFLpV j GHV PDODGLHV LQIHFWLHXVHV SDUWLFXOLqUHV OHV

10Ï 3LGRCBÏ,?RGMLQÏ-DÍACÏDMPÏ"GQ?QRCPÏ0GQIÏ0CBSARGMLÏhttp://www.unisdr.org/, accessed 10Ï 3LGRCBÏ ,?RGMLQÏ -DÍACÏ DMPÏ "GQ?QRCPÏ 0GQIÏ 0CBSARGMLÏ http://www.unisdr.org/, consulté en avril April 2018). 2018). 11 Hyogo Framework for Action 2005–2015: building the resilience of nations and 11 Hyogo Framework for Action 2005–2015: building the resilience of nations and communities to AMKKSLGRGCQÏRMÏBGQ?QRCPQ Ï,CUÏ7MPIÏ,7Ï3LGRCBÏ,?RGMLQÏ-DÍACÏDMPÏ"GQ?QRCPÏ0GQIÏ BGQ?QRCPQ Ï,CUÏ7MPIÏ,7Ï3LGRCBÏ,?RGMLQÏ-DÍACÏDMPÏ"GQ?QRCPÏ0GQIÏ0CBSARGML ÏÏhttps://www. Reduction; 2005 (https://www.unisdr.org/we/coordinate/hfa, accessed April 2018). unisdr.org/we/coordinate/hfa, consulté en avril 2018). 12 An open-source platform based on country-reported data for global risk assessment 12 Plateforme open source basée sur les données fournies par les pays, destinée à évaluer les DMPÏ FSK?LGR?PG?LÏ ?LBÏ BGQ?QRCPÏ APGQCQ Ï AMTCPGLEÏ C?PRFOS?ICQ Ï RQSL?KGQ Ï ÎMMBQ Ï risques mondiaux de crise humanitaire et de catastrophe, couvrant les séismes, les tsunamis, AWAJMLCQ ÏBPMSEFRQÏ?LBÏNPMHCARCBÏFSK?LÏAMLÎGARQ JCQÏGLMLB?RGMLQ ÏJCQÏAWAJMLCQ ÏJCQÏQ¯AFCPCQQCQÏCRÏJCQÏAMLÎGRQÏFSK?GLQÏCQAMKNR¯Q 258 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 diseases of potential public health importance, by pays ont été classés en fonction du risque de propagation de adapting the Disease Attribute Intelligence System PDODGLHV VXVFHSWLEOHV G·DYRLU XQH LPSRUWDQFH SRXU OD VDQWp (DAISY) tool13 for emerging human infectious diseases SXEOLTXHHQDGDSWDQWO·RXWLO'$,6< ©'LVHDVH$WWULEXWH,QWHOOL- to establish a baseline, which will be updated as new gence System»)13 applicable aux maladies infectieuses émer- data become available.14 The disease containment capa- JHQWHV FKH] O·KRPPH DÀQ G·pWDEOLU XQ SURÀO GH UpIpUHQFH TXL city of each country was estimated and applied to all sera actualisé à mesure que de nouvelles données deviendront diseases with the IHR (2005) self-assessment tool. The disponibles.14 La capacité de chaque pays à juguler les maladies YXOQHUDELOLW\SURÀOHRIWKH5HJLRQIRUSULRULW\FRPPX- a été estimée et appliquée à toutes les maladies au moyen de nicable diseases was mapped by a combination of quan- O·RXWLOG·DXWRpYDOXDWLRQGHVSULQFLSDOHVFDSDFLWpVGX56, titative and semi-quantitative methods. Five priority /HSURÀOGHYXOQpUDELOLWpGHOD5pJLRQDX[PDODGLHVWUDQVPLV- syndromes and selected communicable disease hazards sibles prioritaires a été cartographié par une combinaison de ZHUH LGHQWLÀHG LQ D OLWHUDWXUH UHYLHZ DQG IURP méthodes quantitatives et semi-quantitatives. Une revue de la SUHGHÀQHG FULWHULD15 acute respiratory illness, acute OLWWpUDWXUH D pWp UpDOLVpH HQ YXH G·LGHQWLÀHU V\QGURPHV SULR- watery diarrhoea, acute haemorrhagic fever and acute ritaires et dangers particuliers de maladie transmissible à partir febrile illness with rash, corresponding to Middle East- GH FULWqUHV SUpGpÀQLV15 maladie respiratoire aiguë, diarrhée HUQ UHVSLUDWRU\ V\QGURPH FKROHUD &ULPHDQ²&RQJR DTXHXVH DLJXs ÀqYUH KpPRUUDJLTXH DLJXs HW PDODGLH IpEULOH haemorrhagic fever, Japanese encephalitis and Zika DLJXs DFFRPSDJQpH G·XQH pUXSWLRQ FXWDQpH FRUUHVSRQGDQW DX virus disease. V\QGURPHUHVSLUDWRLUHGX0R\HQ2ULHQWDXFKROpUDjODÀqYUH KpPRUUDJLTXH GH &ULPpH&RQJR j O·HQFpSKDOLWH MDSRQDLVH HW j la maladie à virus Zika. The DAISY tool and the quality and sources of data for /·XWLOLVDWLRQ GH O·RXWLO '$,6< SRXU FDOFXOHU OHV FRWHV GH ULVTXH risk scoring presented certain challenges. The assess- D SUpVHQWp FHUWDLQHV GLIÀFXOWpV WRXW FRPPH OD TXDOLWp HW ment was limited to 5 diseases, although the tool was OD VRXUFH GHV GRQQpHV %LHQ TXH O·RXWLO VH VRLW DYpUp REMHFWLI found to be objective, as it addresses all components of WHQDQWFRPSWHGHWRXWHVOHVFRPSRVDQWHVGHO·pYDOXDWLRQV\VWp- systematic risk assessment. Few indirect inferences PDWLTXH GHV ULVTXHV O·pYDOXDWLRQ V·HVW OLPLWpH j PDODGLHV were made from evidence and expert opinion. These Quelques déductions indirectes ont été dérivées des éléments GLG QRW GLUHFWO\ YDOLGDWH ÀQGLQJV EXW WKH PXOWLSOH GLVSRQLEOHV HW GH O·DYLV GHV H[SHUWV &HV GHUQLqUHV Q·RQW SDV sources of information helped to triangulate evidence. directement validé les résultats, mais la multiplicité des sources The risk that capacity might be overestimated was miti- G·LQIRUPDWLRQ D SHUPLV XQH WULDQJXODWLRQ GHV GRQQpHV /H JDWHGE\LQFOXGLQJGLVHDVHDQGFRXQWU\VSHFLÀFDVVHVV- ULVTXHGHVXUHVWLPDWLRQGHVFDSDFLWpVDpWpDWWpQXpSDUO·LQFOX- ments of human, vector, reservoir and source surveil- VLRQG·pYDOXDWLRQVVSpFLÀTXHVDX[PDODGLHVHWDX[SD\VSRUWDQW lance, laboratory capacity and vaccination. We assumed VXU OD VXUYHLOODQFH FKH] O·KRPPH OD VXUYHLOODQFH GHV YHFWHXUV that an attribute was homogeneous in large countries, des réservoirs et des sources, les capacités des laboratoires et although there may be subnational epidemiological and OD YDFFLQDWLRQ ,O D pWp SUpVXPp TX·XQH FDUDFWpULVWLTXH GRQQpH political variations. pWDLW KRPRJqQH GDQV OHV SD\V GH JUDQGH WDLOOH ELHQ TXH GHV YDULDWLRQVpSLGpPLRORJLTXHVHWSROLWLTXHVSXLVVHQWH[LVWHUG·XQH ]RQHLQIUDQDWLRQDOHjO·DXWUH The tool was adapted by principal component analysis /·RXWLO D pWp DGDSWp SDU XQH DQDO\VH GHV SULQFLSDOHV FRPSR- to rank the risks of countries for individual diseases. santes pour classer les risques des pays pour chaque maladie. Scores of 25 risk attributes of diseases was calculated, Les cotes de 25 caractéristiques de risque des maladies ont été followed by cumulative risk scores by disease and coun- calculées, suivies de cotes cumulées des risques selon la maladie WU\ EHIRUH DUULYLQJ DW D ÀQDO UDQNLQJ RI FRXQWULHV E\ HWOHSD\VDYDQWG·DERXWLUjXQFODVVHPHQWÀQDOGHVSD\VVHORQ risk for the diseases. Each attribute was scored in le risque de maladie. Chaque caractéristique de risque a été 5 scenarios of increasing levels of risk for all 5 diseases notée dans 5 scénarios, correspondant à un risque croissant LQ D FRXQWU\ WR DVVHVV FRXQWU\ DQG GLVHDVHVSHFLÀF SRXUO·HQVHPEOHGHVPDODGLHVGDQVXQSD\VGRQQpDÀQG·pYD- risks. Indices or drivers of disease transmission were OXHUOHVULVTXHVVSpFLÀTXHVDX[SD\VHWDX[PDODGLHV/HVLQGLFHV LGHQWLÀHG IURP WKH OLWHUDWXUH UHYLHZ DQG WUDQVIRUPHG RXOHVIDFWHXUVGHWUDQVPLVVLRQGHVPDODGLHVRQWpWpLGHQWLÀpV into weights that were applied to the risk attributes of j SDUWLU G·XQH UHYXH GH OD OLWWpUDWXUH SXLV WUDQVIRUPpV HQ exposure in order to obtain weighted risks (Table 1). facteurs de pondération qui ont été appliqués aux caractéris- WLTXHVGHULVTXHG·H[SRVLWLRQDÀQG·REWHQLUOHVULVTXHVSRQGpUpV (Tableau 1).

13 The original DAISY method requires calculation of weighted scores and then total 13 La méthode DAISY originale exige un calcul de cotes de risque pondérées, puis de cotes de risk scores. As a single set of weights for all diseases in a country will not add much risque totales. Étant donné que l’utilisation d’un ensemble unique de facteurs de pondération information, expert weighting of raw scores was excluded. Instead, key drivers of NMSPÏRMSRCQÏJCQÏK?J?BGCQÏBhSLÏN?WQÏLCÏDMSPLGRÏN?QÏBhGLDMPK?RGMLQÏQSNNJ¯KCLR?GPCQÏQGELGÍA?RGTCQ Ï BGQC?QCÏPGQIÏUCPCÏGBCLRGÍCB J?ÏNMLB¯P?RGMLÏQN¯AG?JGQ¯CÏBCQÏAMRCQÏ@PSRCQÏ?Ï¯R¯ÏCVAJSC Ï'JÏ?ÏNJSR¹RÏ¯R¯ÏNPMA¯B¯Ï¦ÏSLCÏGBCLRGÍ- cation des facteurs clés du risque de maladie. 14 Adlam B. Risk assessment tool (DAISY) for emerging human infectious diseases. 14 Adlam B. Risk assessment tool (DAISY) for emerging human infectious diseases. Health analysis Health analysis and information for action (HAIFA). Porirua: Environmental Science and information for action (HAIFA). Porirua: Environmental Science and Research Ltd; 2012 and Research Ltd; 2012 (https://haifa.esr.cri.nz/assets/Uploads/Docs/Disease-Attri- (https://haifa.esr.cri.nz/assets/Uploads/Docs/Disease-Attribute-Intelligence-System-Tool.pdf, bute-Intelligence-System-Tool.pdf, accessed April 2018). consulté en avril 2018). 15 Miller M, Hagan E. Policy and practice: integrated biological–behavioural surveillance 15 Miller M, Hagan E. Policy and practice: integrated biological–behavioural surveillance in pan- in pandemic-threat warning systems. Bull World Health Organ. 2017;95:62–68. demic-threat warning systems. Bull World Health Organ. 2017;95:62–68.

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 259 Table 1 INFORM Risk index of natural hazards Tableau 1 Index des indices de risque INFORM pour les catastrophes naturelles

Hazard and exposure – Danger et exposition Inadequate- coping INFORM Vulnerability Tropical capacity – risk – – Vulnéra- Earthquake – Flood – cyclone – Drought – Capacité Risque Country – Pays Tsunami bilité Séisme Inondation Cyclone Sécheresse insufﬁsante à INFORM tropical faire face

(0–10) (0–10) (0–10) (0–10) (0–10) (0–10) (0–10) (0–10)

Bangladesh 8.7 10.0 8.5 7.0 5.1 4.6 5.4 5.7

Bhutan – Bhoutan 7.4 5.2 0.0 0.0 0.0 3.0 4.6 2.9

Democratic People’s Republic 0.9 7.7 3.2 6.6 2.9 5.1 6.7 5.5 of Korea – République populaire démocratique de Corée

India – Inde 7.9 8.5 8.3 7.6 6.9 5.4 4.6 5.7

Indonesia – Indonésie 8.4 8.2 9.6 6.4 3.6 2.3 4.9 4.3

Maldives 0.1 0.1 8.9 0.0 0.0 1.5 4.1 2.2

Myanmar 9.3 10.0 8.5 5.7 1.1 5.9 6.4 6.6

Nepal – Népal 9.9 6.5 0.0 0.2 2.9 4.9 5.9 5.4

Sri Lanka 0.1 6.2 8.2 3.5 3.4 3.6 4.1 4.1

Thailand – Thaïlande 3.4 8.9 6.8 4.9 6.1 2.9 4.1 4.0

Timor-Leste 5.7 1.9 5.0 3.7 0.3 5.0 6.8 4.1

Source: INFORM index, 2016. – Source: Indice INFORM, 2016.

7KH ULVN SURÀOHV RI QDWXUDO KD]DUGV DQG LQIHFWLRXV /HVSURÀOVGHULVTXHUHODWLIVDX[FDWDVWURSKHVQDWXUHOOHVHWDX[ diseases were overlaid with measurements of capacity: maladies infectieuses ont été superposés avec des mesures de the universal health coverage index,16 IHR (2005) self- la capacité: indice de couverture sanitaire universelle,16 auto- assessments and SEAR benchmarks assessments. This évaluations au titre du RSI (2005) et évaluations au regard des showed that the risks of natural hazards and of infec- FULWqUHVGHUpIpUHQFHGHOD5pJLRQ6($5,ODDLQVLpWpGpPRQWUp tious disease epidemics require that the health system TXHOHVULVTXHVGHFDWDVWURSKHQDWXUHOOHHWG·pSLGpPLHGHPDOD- must have IHR (2005) core capacity before, during and GLH LQIHFWLHXVH H[LJHQW TXH OH V\VWqPH GH VDQWp VRLW GRWp GHV after a disaster. principales capacités requises par le RSI (2005) avant, pendant HWDSUqVXQHFDWDVWURSKH

Results and discussion Résultats et discussion All 11 countries in the Region were found to be at Les résultats indiquent que les 11 pays de la Région présentent PHGLXP²KLJKULVNIRUDOPRVWDOOQDWXUDODQGELRORJLFDO tous un niveau de risque moyen à élevé pour la quasi-totalité KD]DUGV7KH,1)250ULVNVFRUHRQDVFDOHRIWRIRU GHVGDQJHUVQDWXUHOVHWELRORJLTXHV/DFRWHGHULVTXH,1)250 WKH KD]DUGV DVVHVVHG ZDV LQ WKH UDQJH RI ² IRU donnée sur une échelle de 0 à 10 pour les 5 dangers étudiés, se all countries. The capacity to prevent and control situait entre 4,0 et 6,6 pour tous les pays. La capacité à prévenir communicable diseases depended on the health system HWjFRPEDWWUHOHVPDODGLHVWUDQVPLVVLEOHVGpSHQGDLWGXV\VWqPH and the endemicity of communicable diseases. The eco- GHVDQWp HWGHO·HQGpPLFLWpGHVPDODGLHVWUDQVPLVVLEOHV/·pFR epidemiology of diseases with systemic capacity were épidémiologie des maladies en présence de capacités systé- similar, while disease containment capacity was deter- miques était comparable, tandis que la capacité à endiguer les PLQHGE\FRXQWULHV·VHOIDVVHVVHG,+5 FRUHFDSD PDODGLHV pWDLW GpWHUPLQpH SDU O·DXWRpYDOXDWLRQ IDLWH SDU city, with the same score applied to all diseases. The les pays de leurs principales capacités au titre du RSI (2005),

16 WHO and partners set 12 benchmarks to increase performance in emergency pre- 16Ï *h-+1ÏCRÏQCQÏN?PRCL?GPCQÏMLRÏ¯R?@JGÏÏAPGR®PCQÏBCÏP¯D¯PCLACÏNMSPÏ?AAPM´RPCÏJhCDÍA?AGR¯ÏBCQÏ?ARG- paredness and response in a multisectoral and multi-level country approach. Bench- vités de préparation et de riposte aux situations d’urgence dans le cadre d’une approche natio- marks, standards and indicators for emergency preparedness and response. New nale plurisectorielle et multiniveaux. Benchmarks, standards and indicators for emergency "CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏDMPÏ1MSRFÌ#?QRÏ QG?ÏÏhttp://www.searo.who.int/ preparedness and response. New Delhi: Bureau régional de l’OMS pour l’Asie du Sud-Est; 2007 entity/emergencies/topics/EHA_Benchmarks_Standards11_July_07.pdf, accessed (http://www.searo.who.int/entity/emergencies/topics/EHA_Benchmarks_Standards11_ April 2018). July_07.pdf, consulté en avril 2018). 260 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Region was found to be vulnerable to epidemics because avec la même cote de risque appliquée à toutes les maladies. of the homogeneity of endemic disease, vectors and IHR La Région a été jugée vulnérable aux épidémies en raison de (2005) core capacity. Differences were observed in the O·KRPRJpQpLWp GHV PDODGLHV HQGpPLTXHV GHV YHFWHXUV HW GHV capacity for human and vector, reservoir and source principales capacités requises par le RSI (2005). Des différences surveillance. The different measures of capacity gave ont été observées concernant les capacités de surveillance chez different perspectives. O·KRPPH HW GH VXUYHLOODQFH GHV YHFWHXUV GHV UpVHUYRLUV HW GHV sources. Les différentes mesures de la capacité ont chacune apporté un éclairage différent.

Understanding risks of natural and biological Comprendre les risques relatifs aux dangers hazards biologiques et naturels Although there has been a marked reduction in the Bien que le nombre de personnes touchées ou tuées par des number of people killed and affected by disasters, catastrophes ait notablement baissé, la mortalité et la morbidité mortality and morbidity remain high for natural associées demeurent élevées, tant pour des raisons naturelles reasons and due to population pressure, ill-equipped TX·HQFRQVpTXHQFHGHODSUHVVLRQGpPRJUDSKLTXHGHO·pTXLSH- warning systems and disaster mitigation.17 The Region PHQW LQDGpTXDW GHV V\VWqPHV G·DOHUWH HW GH O·LQVXIÀVDQFH GHV remains vulnerable to emergencies and disasters such V\VWqPHVG·DWWpQXDWLRQGHVHIIHWVGHVFDWDVWURSKHV17 La Région DV ÁRRGV F\FORQHV HDUWKTXDNHV WVXQDPLV ODQGVOLGHV UHVWH YXOQpUDEOH IDFH DX[ VLWXDWLRQV G·XUJHQFH HW DX[ FDWDV- volcanoes, heat waves and droughts. As a seismic zone trophes telles que les inondations, les cyclones, les séismes, les H[SRVHG WR ÁRRGV F\FORQHV DQG WVXQDPLV %DQJODGHVK tsunamis, les glissements de terrain, les éruptions volcaniques, LVSURQHWRQDWXUDOKD]DUGV%KXWDQ·VH[SRVXUHWRHDUWK- les canicules et les sécheresses. Le Bangladesh, un pays sismique TXDNHVJODFLDOODNHRXWEXUVWÁRRGVODQGVOLGHVÀUHVDQG sujet aux inondations, aux cyclones et aux tsunamis, est vulné- windstorms remains high because of the predicted UDEOHIDFHDX[FDWDVWURSKHVQDWXUHOOHV/·H[SRVLWLRQGX%KRXWDQ IXWXUH FOLPDWLF FKDQJHV 7KH 'HPRFUDWLF 3HRSOH·V aux séismes, aux inondations causées par le débordement des 5HSXEOLF RI .RUHD KDV D KLVWRU\ RI ÁRRGV WRUUHQWLDO lacs glaciaires, aux glissements de terrain, aux incendies et aux rains and typhoons; and India continues to be prone to tempêtes de vent demeure élevée compte tenu des changements all major natural and man-made disasters. The FOLPDWLTXHV HVFRPSWpV j O·DYHQLU /D 5pSXEOLTXH SRSXODLUH geographical and geological features of the Indonesian démocratique de Corée connaît depuis longtemps des inonda- archipelago expose it to active volcanoes, tsunamis, WLRQVGHVSOXLHVWRUUHQWLHOOHVHWGHVW\SKRQVHWO·,QGHFRQWLQXH GURXJKWV DQG IRUHVW ÀUHV 1HSDO D ODQGORFNHG FRXQWU\ G·rWUHVXMHWWHjWRXWHVOHVJUDQGHVFDWDVWURSKHVG·RULJLQHQDWX- with diverse geographical and climatic features, is relle et humaine. Du fait de ses caractéristiques géographiques YXOQHUDEOHWRODQGVOLGHVGHEULVÁRZVHDUWKTXDNHVDQG HW JpRORJLTXHV O·DUFKLSHO LQGRQpVLHQ HVW H[SRVp j O·DFWLYLWp JODFLDO ODNH RXWEXUVW ÁRRGV 6UL /DQND·V JHRJUDSKLFDO volcanique, aux tsunamis, aux sécheresses et aux feux de forêt. DQG FOLPDWLF GLYHUVLW\ H[SRVH LW WR ÁRRGV GURXJKWV /H 1pSDO XQ SD\V VDQV OLWWRUDO DX[ FDUDFWpULVWLTXHV JpRJUD- cyclones and landslides. Thailand remains vulnerable phiques et climatiques diverses, est vulnérable aux glissements WRÁRRGVWVXQDPLVVWRUPVGURXJKWVODQGVOLGHVIRUHVW de terrain, aux coulées de débris, aux séismes et aux inondations ÀUHV HDUWKTXDNHV DQG HSLGHPLFV ZKLOH 7LPRU/HVWH LV dues au débordement des lacs glaciaires. La diversité géogra- SURQH WR HDUWKTXDNHV ODQGVOLGHV ÁDVK ÁRRGV DQG phique et climatique du Sri Lanka expose ce pays aux inonda- droughts. High-impact events are infrequent in Maldives; tions, aux sécheresses, aux cyclones et aux glissements de KRZHYHU DV LW LV WKH ZRUOG·V ORZHVWO\LQJ FRXQWU\ LW LV terrain. La Thaïlande reste vulnérable aux inondations, tsuna- affected by sea level rise. Myanmar, a resource- mis, tempêtes, sécheresses, glissements de terrain, feux de forêt, FRQVWUDLQHG QDWLRQ ÀQGV LW GLIÀFXOW WR DGGUHVV WKH séismes et épidémies, tandis que le Timor-Leste est sujet aux IUHTXHQWF\FORQLFVWRUPVÁRRGVIRUHVWÀUHVODQGVOLGHV séismes, glissements de terrain, crues éclairs et sécheresses. Les and epidemics. événements à fort impact sont peu fréquents aux Maldives; cependant, ce pays, le plus bas du monde, subit les effets de la montée du niveau de la mer. Le Myanmar, un pays aux ressources OLPLWpHV D GHV GLIÀFXOWpV j IDLUH IDFH DX[ pSLGpPLHV WHPSrWHV cycloniques, inondations, feux de forêt et glissements de terrain auxquels il est fréquemment confronté. The disease risks were assessed as homogeneous, with /HVULVTXHVGHPDODGLHRQWpWppYDOXpVFRPPHpWDQWKRPRJqQHV a narrow range of cumulative risk scores by disease and les cotes de risque cumulées par maladie et par pays se trouvant country. The scores assigned by disease and country dans une plage étroite de valeurs. Les cotes attribuées par mala- were based on indicators that included mode of trans- die et par pays étaient fondées sur des indicateurs tels que le mission, incubation period, case fatality, effectiveness PRGHGHWUDQVPLVVLRQODSpULRGHG·LQFXEDWLRQOHWDX[GHOpWD- of treatment and human and vector surveillance OLWp O·HIÀFDFLWp WKpUDSHXWLTXH OD VXUYHLOODQFH FKH] O·KRPPH HW (Table 2; Map 1). la surveillance vectorielle (Tableau 2; Carte 1).

17 Global Assessment Report on Disaster Risk Reduction 2015. Making development 17 Global Assessment Report on Disaster Risk Reduction 2015. Making development sustainable: sustainable: the future of disaster risk management (http://www.preventionweb. the future of disaster risk management (http://www.preventionweb.net/english/hyogo/ net/english/hyogo/gar/2015/en/home/, accessed June 2017). gar/2015/en/home/, consulté en juin 2017). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 261 Table 2 Summary of risks for selected infectious syndromes and diseases Tableau 2 Résumé des risques relatifs à des maladies et syndromes infectieux particuliers

Crimean-Congo Middle Eastern haemorrhagic fever – Fièvre Japanese encephalitis – respiratory syndrome – Zika virus disease – Cholera – Choléra hémorragique de Crimée- Encéphalite japonaise Syndrome respiratoire Maladie à virus Zika Congo du Moyen-Orient Issues of concern – Sujets de préoccupation Widespread presence of SEAR accounts for 2nd highest Endemic in 24 countries in Over 0.4 million people More than 60 countries transmitting vector in SEAR burden of cholera (29%) – La 1# 0Ï?LBÏ5CQRCPLÏ.?AGÍAÏ go on Hajj pilgrimage affected recent emergence of increases risk and need for Région SEAR est au 2e rang Region, placing over 3 billion from SEAR annually, with Zika virus disease – Plus de surveillance – La présence des régions enregistrant la people at risk – Endémique 95% from Bangladesh, 60 pays ont été touchés par la étendue du vecteur de plus forte charge de choléra dans 24 pays de la Région Indonesia and India – Plus récente émergence de maladie transmission dans la Région (29%) SEAR et de la Région de 400 000 personnes de la à virus Zika SEAR accroît les risques et les BSÏ.?AGÍOSCÏMAAGBCLR?J Ï Région SEAR, dont 95% en besoins de surveillance India and Bangladesh have entraînant un risque pour plus provenance du Bangladesh, an estimated 800 000 cases de 3 milliards de personnes d’Indonésie ou d’Inde, annually – En Inde et au participent chaque année au Bangladesh, le nombre annuel pèlerinage du Hadj de cas est estimé à 800 000 Risks – Risques Hyalomma tick present in 8 of 6 of 11 SEAR countries at 6 of 11 countries are at 6 of 11 countries at moderate 10 of 11 countries highly 11 SEAR countries – Présence des moderate to high risk – 6 des moderate to high risk of to high risk of transmission suitable for Zika virus disease tiques du genre Hyalomma dans 11 pays de la Région SEAR spread – 6 des 11 pays and spread – 6 des 11 pays – 10 des 11 pays présentent 8 des 11 pays de la Région SEAR présentent un risque modéré présentent un risque modéré à présentent un risque modéré des conditions fortement à élevé élevé de propagation à élevé de transmission et de propices à la maladie à virus Bangladesh was at high risk and propagation Zika Maldives at low risk – Il existe India and Timor-Leste at high Bhutan and India at high risk, un risque élevé au Bangladesh et risk while DPR Korea at low while Indonesia and Thailand India and Bangladesh at high Bangladesh, India, Indonesia un risque faible aux Maldives risk – Il existe un risque élevé at low risk – Le risque est risk – Il existe un risque élevé and Thailand reported cases en Inde et au Timor-Leste et un élevé au Bhoutan et en Inde, au Bangladesh et en Inde recently – Des cas ont 3 countries reported Crimean- risque faible en RPD de Corée tandis qu’il est faible en P¯ACKKCLRÏ¯R¯ÏLMRGÍ¯QÏN?PÏJCÏ Congo haemorrhagic fever in Indonésie et en Thaïlande Bangladesh, l’Inde, l’Indonésie humans or animals and 4 of et la Thaïlande 11 countries at high risk – 3 pays MLRÏLMRGÍ¯ÏBCQÏA?QÏBCÏÍ®TPCÏ Most countries in the Region hémorragique de Crimée-Congo at risk, with Bangladesh and chez l’homme ou chez l’animal et Myanmar at high risk and DPR 4 des 11 pays sont exposés à un Korea at low risk – La plupart risque élevé des pays de la Région sont à risque, avec un risque élevé au Bangladesh et au Myanmar et un risque faible en RPD de Corée

DPR Korea: Democratic People’s Republic of Korea – RPD de Corée: République populaire démocratique de Corée

Using capacity assessment to identify gaps U@KTDQÐKDRÐB@O@BHS°RÐONTQÐHCDMSHÆDQÐKDRÐK@BTMDRÐ in terms of risks en termes de risques Capacity measurements such as the SEAR universal /HV LQVWUXPHQWV GH PHVXUH GHV FDSDFLWpV FRPPH O·LQGLFH GH 18 health coverage index,18 the monitoring and evaluation couverture sanitaire universelle de la Région SEAR, le cadre framework for IHR (2005) and the SEAR benchmarks GH VXLYL HW G·pYDOXDWLRQ GX 56, HW OHV FULWqUHV GH UpIpUHQFH ZHUHXVHIXOIRUDVVHVVLQJKHDOWKSURÀOHVDQGULVNVEXW de la Région SEAR, ont été utiles pour analyser les risques et les overall, they should be strengthened in order to measure SURÀOV VDQLWDLUHV PDLV GHYUDLHQW JOREDOHPHQW rWUH UHQIRUFpV DÀQ health system capacity adequately.19 There are clear GH IRXUQLU XQH PHVXUH DGpTXDWH GHV FDSDFLWpV GHV V\VWqPHV GH 19 limitations in the measurement of capacity for health santé. /DPHVXUHGHVFDSDFLWpVUHODWLYHVDX[VLWXDWLRQVG·XUJHQFH emergencies. At the time of writing, only IHR (2005) sanitaire se heurte clairement à certaines limites. Au moment de self-assessments were available from all countries, as la rédaction du présent document, seules les auto-évaluations not all SEAR countries have completed their joint exter- du RSI (2005) étaient disponibles de la part de tous les pays, les

18Ï &C?JRFÏGLÏRFCÏ1SQR?GL?@JCÏ"CTCJMNKCLRÏ%M?JQ Ï,CUÏ"CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏDMPÏ 18Ï &C?JRFÏGLÏRFCÏ1SQR?GL?@JCÏ"CTCJMNKCLRÏ%M?JQ Ï,CUÏ"CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏDMPÏ1MSRFÌ#?QRÏ South-East Asia; 2016 (http://www.searo.who.int/entity/health_situation_trends/ Asia; 2016 (http://www.searo.who.int/entity/health_situation_trends/health_in_sustainable_ health_in_sustainable_devlop_goals.pdf, accessed April 2018). devlop_goals.pdf, consulté en avril 2018). 19 International Health Regulations (2005). Summary of States Parties 2012: report on 19 International Health Regulations (2005). Summary of States Parties 2012: report on IHR core IHR core capacity. Report for national IHR focal points. Geneva: World Health Orga- capacity. Report for national IHR focal points. Genève: Organisation mondiale de la Santé; 2014 nization; 2014 (http://apps.who.int/iris/bitstream/10665/112788/1/WHO_HSE_ (http://apps.who.int/iris/bitstream/10665/112788/1/WHO_HSE_GCR_2014.5_eng.pdf?ua=1, GCR_2014.5_eng.pdf?ua=1, accessed May 2017). consulté en mai 2017). 262 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Plans Risque Risque Capacité Ressources Préparation Community plans – communautaires K Indice Risque modéré IND DPR Preparedness – Response – Réponse 90 Risque élevé Indice INFORM, 2016 Risque faible Risk communication – Communication sur les risques 82 Surveillance 92 91 INO 77 BHU Low risk – Moderately low risk – modérément faible Moderate risk – Moderately high risk – modérément élevé High risk – Évaluations au regard Évaluations 57 Human resources (HR) – humaines (RH) Cotes de risque des auto- 93 56 Coordination Risk index for Zika virus – de risque pour le virus Zika 66 37 78 MAV BAN 64 Capacity for risk assessment and HR – des risques et de RH en matière d’évaluation Indice de couverture sanitaire 50 42

100

20 Source: INFORM Index, 2016 – 92 Risque Risque 91 Legislation – Legislation Législation 51 Risque modéré Capacités en matière de risque sanitaire Capacités en matière 46 Indice 51 Risque élevé Laboratoire Risque faible Laboratory – 63 80 45 45 MMR TLS Cadre juridique 50 65 modérément faible Low risk – Moderately low risk – Moderate risk – Moderately high risk – High risk – modérément élevé 64 77 92 de risque pour le MERS Risk index for MERS – Point d’entrée Point 82 Point of entry – Point NEP THA des critères de référence de la Région SEAR (ne comprend pas l’Inde) des critères de référence de la Région SEAR (ne comprend Universal health coverage index – IHR capacity regional self-assessment score – régionales au titre du RSI évaluations SEAR benchmarks assessments (without India) – universelle Zoonose Regional average – Regional average Moyenne régionale Legal framework – Legal framework Radiations Radiation – Radiation – SRL Produit Risque Risque chimique Capacity for health security – Food safety – safety – Food Zoonotic – Risque modéré Sécurité alimentaire Indice de Chemical – Risque élevé Risque faible modérément faible modérément élevé Low risk – Moderately low risk – Moderate risk – Moderately high risk – High risk – Risk index for JE – risque pour l’EJ nommée alerte précoce et réponse Risque Early Warning, Alert and Response system – Warning, Early Risque Système de surveillance de la santé publique Système de surveillance de la Indice Risque modéré DPRK TLS Risque élevé Risque faible Low risk – Moderately low risk – Moderate risk – Moderately high risk – High risk – modérément élevé modérément faible $RS Risk index for cholera – de risque pour le choléra IND Risque Risque

Risque modéré Risque élevé Risque faible Indicateurs THA Indonésie Thaïlande modérément faible modérément élevé Low risk – Moderately low risk – Moderate risk – Moderately high risk – High risk – Bhoutan Népal MMR Inde Indicators – Indicators Risk index for CCHF – Indice de risque pour la CCHF Í®TPCÏF¯KMPP?EGOSCÏBCÏ!PGK¯CÏlÏ4GPSQÏ!MLEM BHU BAN BAN: Bangladesh BAN: BHU: Bhutan – – Republic of Korea People’s DPRK: Democratic démocratique de Corée République populaire IND: India – INO: Indonesia – Maldives MAV: MMR: Myanmar NEP: Nepal – SRK: Sri Lanka THA: Thailand – TLS: Timor-Leste syndrome respiratoire du Moyen Orient NEP EJ: encéphalite japonaise SRL Risque modéré IND Risque élevé Risque faible Indice INFORM /QNÆKÐCDRÐQHRPTDRÐCiTQFDMBDÐR@MHS@HQD Ð1°FHNMÐCDÐKi RHDÐCTÐ2TC /QNÆKÐCDRÐQHRPTDRÐCiTQFDMBDÐR@MHS@HQD Ð1°FHNMÐCDÐKi MAV 'D@KSGÐDLDQFDMBXÐQHRJÐOQNÆKD Ð2NTSG $@RSÐ RH@Ð1DFHNM 'D@KSGÐDLDQFDMBXÐQHRJÐOQNÆKD Ð2NTSG $@RSÐ

Moderately high risk – Risque modérément élevé High risk – Low risk – Moderately low risk – Risque modérément faible Moderate risk – CCHF: Crimean-Congo haemorrhagic fever – encephalitis – JE: Japanese MERS: Middle Eastern respiratory – Risk for natural hazards – hazards Risk for natural naturelles Risque de catastrophes INFORM index – Map 1 Carte 1

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 263 nal evaluation.20 As countries continue to use the SEAR SD\V GH OD 5pJLRQ 6($5 Q·D\DQW SDV WRXV DFKHYp OHXU pYDOXDWLRQ benchmarks to capture a multisectoral subnational externe conjointe.20PHVXUHTXHOHVSD\VFRQWLQXHURQWG·XWLOLVHU perspective and the universal health coverage index for OHVFULWqUHVGHUpIpUHQFHGHOD5pJLRQ6($5SRXUREWHQLUXQHSHUV- achievement of the Sustainable Development Goals, a SHFWLYH SOXULVHFWRULHOOH LQIUDQDWLRQDOH HW O·LQGLFH GH FRXYHUWXUH more robust system will be required for measuring sanitaire universelle pour évaluer la réalisation des objectifs de capacity. Capacity assessments should always be inter- GpYHORSSHPHQW GXUDEOH XQ V\VWqPH SOXV UREXVWH GH PHVXUH GHV preted in the context of hazards and risks, so that coun- FDSDFLWpV GHYLHQGUD QpFHVVDLUH /·pYDOXDWLRQ GHV FDSDFLWpV GRLW tries can prioritize the areas (e.g. geographic, hazards) toujours être interprétée au regard des dangers et des risques pour in which to invest for preparedness. SHUPHWWUH DX[ SD\V GH GpÀQLU OHV GRPDLQHV SDU H[HPSOH ]RQH JpRJUDSKLTXHW\SHGHGDQJHU GHYDQWEpQpÀFLHUG·LQYHVWLVVHPHQWV SULRULWDLUHVHQYXHG·XQHPHLOOHXUHSUpSDUDWLRQ The available measurements indicate that most coun- Les mesures réalisées indiquent que la plupart des pays sont tries have achieved certain coverage with respect to parvenus à établir un certain degré de couverture dans le maternal and child health needs and services, although GRPDLQH GH OD VDQWp GH OD PqUH HW GH O·HQIDQW PDLV GHYURQW they should be further scaled-up in order to perform HQFRUHLQWHQVLÀHUOHXUVHIIRUWVSRXUDWWHLQGUHXQHSHUIRUPDQFH optimally during an emergency. The health systems RSWLPDOH HQ VLWXDWLRQ G·XUJHQFH /D FDSDFLWp GHV V\VWqPHV GH respond to the communicable diseases that are endemic, santé à mener une riposte contre les maladies transmissibles which can be strengthened through IHR (2005) mecha- qui sont endémiques peut être renforcée par le recours aux nisms. Preparedness for noncommunicable diseases and mécanismes du RSI (2005). La préparation aux maladies non scaling up of service delivery will also be critical. transmissibles et le renforcement de la prestation des services revêtent également une importance primordiale.

Recommendations and next steps Recommandations et étapes suivantes The basis of all future concerted, systematic actions to 7RXWHV OHV DFWLRQV FRQFHUWpHV HW V\VWpPDWLTXHV PHQpHV j O·DYHQLU mitigate risks is the continuous measurement of gaps, pour réduire les risques exigeront une mesure constante des vulnerability and capacity. Regular, detailed risk analy- ODFXQHVGHVYXOQpUDELOLWpVHWGHVFDSDFLWpV'HVDQDO\VHVUpJXOLqUHV ses at subnational and regional levels will help countries et détaillées des risques, aux niveaux infranational et régional, WR DGGUHVV WKH ULVNV RI VSHFLÀF SRSXODWLRQV DQG DUHDV permettront aux pays de faire face aux risques pesant sur des SEAR countries plan to apply this method. These risk SRSXODWLRQVHWGHV]RQHVVSpFLÀTXHV/HVSD\VGHOD5pJLRQ6($5 DQDO\VHV ZLOO OHDG WR PRUH GHWDLOHG SURÀOHV RI ULVNV SUpYRLHQW G·DSSOLTXHU FHWWH PpWKRGH &HV DQDO\VHV GHV ULVTXHV which can then be addressed strategically and system- SURGXLURQWGHVSURÀOVGHULVTXHSOXVGpWDLOOpVTXLSRXUURQWDORUV atically by organizations, health care facilities, emer- rWUHDERUGpVGHPDQLqUHVWUDWpJLTXHHWV\VWpPDWLTXHSDUOHVRUJD- gency and mass casualty teams and experts in health nisations, les établissements de soins, les équipes qui interviennent security. With a clearer set of priority risks, resources GDQVOHVVLWXDWLRQVG·XUJHQFHRXORUVG·pYpQHPHQWVSUpVHQWDQWXQ can be invested in better risk reduction and prepared- ORXUGELODQKXPDLQHWOHVH[SHUWVGHODVpFXULWpVDQLWDLUH/DGpÀ- ness. QLWLRQG·XQHQVHPEOHFODLUGHULVTXHVSULRULWDLUHVSHUPHWWUDG·LQ- YHVWLUOHVUHVVRXUFHVGHVRUWHjIDYRULVHUXQHUpGXFWLRQSOXVHIÀFDFH des risques et une meilleure préparation des pays.

TSGNQÐ@EÆKH@SHNMR EÆKH@SHNMRÐCDRÐ@TSDTQR a :+2 5HJLRQDO 2IÀFH IRU 6RXWK(DVW $VLD +HDOWK a%XUHDXUpJLRQDOGHO·206SRXUO·$VLHGX6XG(VW3URJUDPPH (PHUJHQFLHV3URJUDPPH1HZ'HKOL,QGLD FRUUHVSRQG- GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH 1HZ 'HKOL ,QGH ing author: Dr Roderico H. Ofrin, [email protected]). Ⅲ (auteur correspondant: Dr Roderico H. Ofrin, [email protected]). Ⅲ

20 Joint external evaluation tool: International Health Regulations (2005). Geneva: 20 Joint external evaluation tool: International Health Regulations (2005). Genève: Organisation mon- World Health Organization; 2016 (http://apps.who.int/iris/ bitstre diale de la Santé; 2016 (http://apps.who.int/iris/ bitstream/10665/204368/1/9789241510172_eng. am/10665/204368/1/9789241510172_eng.pdf, accessed May 2017). pdf, consulté en mai 2017).

Importance of surveillance Importance de la surveillance pour for preparedness and country renforcer l’état de préparation des pays readiness in a hazard-prone region dans une région à risque During the last decade, the Region of the Americas has $X FRXUV GH OD GHUQLqUH GpFHQQLH OD 5pJLRQ GHV $PpULTXHV D experienced several large epidemics, including cholera, été frappée par plusieurs épidémies de grande ampleur (choléra, LQÁXHQ]D$ +1 FKLNXQJXQ\DYLUXV=LNDYLUXV\HOORZ JULSSH+1FKLNXQJXQ\DPDODGLHjYLUXV=LNDHWÀqYUHMDXQH IHYHU 1DWXUDO GLVDVWHUV DOVR RFFXU IUHTXHQWO\ LQFOXGLQJ '·DXWUHV FDWDVWURSKHV QDWXUHOOHV WHOOHV TXH GHV RXUDJDQV GHV KXUULFDQHV HDUWKTXDNHV DQG ÁRRGV1 Historical trends séismes et des inondations, sont également devenues de plus can help anticipate future events or vulnerabilities to en plus fréquentes.1 /·DQDO\VH GHV WHQGDQFHV KLVWRULTXHV SHXW

1 Monitoring Emergencies – Archive, AHO Health Emergencies (http://www.paho.org/ 1 Monitoring Emergencies – Archive, AHO Health Emergencies (http://www.paho.org/disasters/ disasters/index.php?option=com_content&view=category&layout=blog&id=1199 index.php?option=com_content&view=category&layout=blog&id=1199&Itemid=1134&lang &Itemid=1134&lang=en, accessed April 2018). =en, accessed April 2018). 264 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 such events. To achieve this greater understanding of V·DYpUHUXWLOHSRXUDQWLFLSHUOHVpYpQHPHQWVIXWXUVRXODYXOQp- public health emergencies, it is essential to strengthen rabilité des pays face à ces menaces. Il est donc primordial de surveillance systems as well as introduce novel approaches UHQIRUFHUOHVPpFDQLVPHVGHVXUYHLOODQFHPDLVDXVVLG·HQYLVD- and new technologies for event detection. JHU O·DGRSWLRQ GH QRXYHOOHV DSSURFKHV HW GH QRXYHOOHV WHFKQR- ORJLHVGDQVOHVV\VWqPHVWUDGLWLRQQHOVGHVXUYHLOODQFH During 2017, public health emergencies in the Region /HV pYpQHPHQWV HQUHJLVWUpV GDQV OH V\VWqPH GH JHVWLRQ GHV RI WKH $PHULFDV ZHUH UHFRUGHG LQ WKH :+2·V (YHQW XUJHQFHV SRXU O·DQQpH WpPRLJQHQW GH O·LPSRUWDQFH GH OD Management System (EMS). Of the 1192 events, 63 (53%) VXUYHLOODQFH DX[ ÀQV GH OD SUpSDUDWLRQ GDQV OD 5pJLRQ GHV ZHUHQRWLÀHGE\1DWLRQDO)RFDO3RLQWVIRUWKH,QWHUQD- Amériques. Sur les 1192 événements répertoriés, 63 (53%) ont tional Health Regulation (2005) and by national govern- pWpQRWLÀpVSDUOHVSRLQWVIRFDX[QDWLRQDX[SRXUOH5qJOHPHQW ments; the remaining 56 events (47%) were detected sanitaire international (2005) ou par les gouvernements natio- during routine epidemic intelligence (indicator-based naux, tandis que les 56 événements restants (47%) ont été détec- surveillance and event-based surveillance) at the tés dans le cadre de la collecte systématique de renseignements 5HJLRQDO2IÀFHDQGFRXQWU\RIÀFHV)URPWKRVHZHUH épidémiques (y compris la surveillance fondée sur les indica- IURPXQRIÀFLDOVRXUFHV LHPHGLD DQGIURPRIÀFLDO teurs et la surveillance fondée sur les événements) par les VRXUFHV ZHEVLWHVRIWKH0LQLVWULHVRI+HDOWK 1DWLRQDO bureaux de pays et le bureau régional. Une fois les informations focal points were contacted by the WHO regional UHFXHLOOLHV QRWLÀFDWLRQV VH VRQW DYpUpHV QRQ RIÀFLHOOHV SDU contact point for the International Health Regulation exemple, en provenance des médias) et 21 provenaient de (2005) to verify the information and to obtain further VRXUFHVRIÀFLHOOHVFRPPHSDUH[HPSOHOHVLWHV:HEGHVPLQLV- details. Of the 119 events, 58 (48.7%) were designated WqUHV GH OD VDQWp 3DU FRQVpTXHQW OH SRLQW GH FRQWDFW UpJLRQDO DV FRQÀUPHG SXEOLF KHDOWK HYHQWV KDG D GH O·206 SRXU OH 5qJOHPHQW VDQLWDLUH LQWHUQDWLRQDO D number of cases below the outbreak threshold, 10 (8%) FRPPXQLTXpDYHFOHVSRLQWVIRFDX[QDWLRQDX[SRXUYpULÀHUOHV ZHUH UXOHGRXW DQG DV XQYHULÀDEOH ZKHQ QR informations et obtenir des détails complémentaires. Parmi LQIRUPDWLRQ LV UHFHLYHG IURP WKH 1)3UHVSRQVLEOH les 1192 événements, il a été établi que 58 (47,5%) étaient corro- national authority, WHO is unable to properly assess borés comme étant des événements de santé publique, 47 (38,5%) WKH HYHQW 7KH FRQÀUPHG HYHQWV ZHUH FODVVLÀHG DV comme ayant un nombre de cas inférieur au seuil épidémique, due to infectious disease outbreaks (n=46, 79%), related GHYDLHQWrWUHpFDUWpVHW Q·pWDLHQWSDVYpULÀDEOHV to food safety (n=3; 5%), chemicals (n=1; 1%), animal ORUVTX·DXFXQH LQIRUPDWLRQ Q·HVW IRXUQLH SDU OHV SRLQWV IRFDX[ diseases (n=4, 7%), product-related contaminations QDWLRQDX[SDUOHVDXWRULWpVQDWLRQDOHVUHVSRQVDEOHVO·206HVW (n=2, 3%), undetermined (n=1; 2%) and radio-nuclear LQFDSDEOHG·pYDOXHUFRUUHFWHPHQWXQpYpQHPHQW/HVpYpQH- exposures (n=1; 2%) (Figure 1). PHQWVFRUURERUpVRQWpWpFODVVpVVHORQTX·LOVpWDLHQWLPSXWDEOHV à une maladie infectieuse (n=46; 79%), liés à la sécurité sanitaire des aliments (n=3; 5%), liés à des produits chimiques (n=1; 1%), G·RULJLQH ]RRQRWLTXH RX DQLPDOH Q OLpV j XQH FRQWD- PLQDWLRQ FDXVpH SDU XQ SURGXLW Q G·RULJLQH LQGpWHU- minée (n=1; 2%) ou liés à une exposition radionucléaire (n=1; 2%) (Figure 1).

Figure 1 #HRSQHATSHNMÐNEÐÐRTARS@MSH@SDCÐDUDMSRÐMÐHMÐSGDÐ1DFHNMÐNEÐSGDÐ LDQHB@RÐAXÐG@Y@QCÐSXOD Ð Figure 1 1°O@QSHSHNMÐCDRÐÐ°U°MDLDMSRÐBNQQNANQ°RÐMÐC@MRÐK@Ð1°FHNMÐCDRÐ L°QHPTDR ÐO@QÐSXODÐCDÐC@MFDQ Ð

2% 3% 2% 7% Infectious diseases outbreaks – Flambées de maladies infectieuses

1% Food safety – Sécurité sanitaire des aliments 5% Chemicals – Produits chimiques

Animal diseases – Maladies d’origine zoonotique ou animale

Product-related contaminations – Contaminations liées à un produit 79% Undetermined – Origine indéterminée

Radio-nuclear exposures – Expositions radionucléaires

2 Data and information was extracted from the Event Management System (EMS) on 2 Les données et les informations ont été extraites le 25 avril 2018 du système de gestion des évé- 25 April 2018 and a descriptive analysis was conducted. Consequently, previous nements et une analyse descriptive a été faite. Par conséquent, des différences peuvent exister and future reports may show differences as the information in EMS is continuously entre des rapports précédents et des rapports futurs étant donné que les informations contenues updated as new information becomes available. dans le système sont continuellement mises à jour, à mesure qu’elles sont disponibles.

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 265 Contemporary surveillance mechanism need to account Le mécanisme de surveillance est essentiel pour répondre rapi- for an evolving public health context. Socioecological dement aux menaces et fournir les meilleurs conseils possibles conditions and human dynamics change, which lead to aux pays. Cependant, les conditions socio-économiques et les populations in the Americas to become more urbanized dynamiques humaines évoluent dans le temps et les schémas but with continuous links and travel to rural areas of pWDEOLVV·HQWURXYHQWPRGLÀpV'DQVWRXWOHFRQWLQHQWOHVSRSX- origin. Intensive agricultural production continues to ODWLRQV V·XUEDQLVHQW PrPH VL HOOHV JDUGHQW GHV OLHQV DYHF OHV PRGLI\ODQGVFDSHVSUHVVXUHHFRV\VWHPVDQGDOWHUKRVW² ]RQHVUXUDOHV/HVV\VWqPHVGHSURGXFWLRQLQWHQVLYHIRQGpVVXU vector disease dynamics. Climate variations also affect ODGHPDQGHFRQWLQXHQWGHPRGLÀHUOHVSD\VDJHVG·H[HUFHUXQH the occurrence of agents and vectors, both with regards SUHVVLRQ VXU OHV pFRV\VWqPHV HW GH SHUWXUEHU OD G\QDPLTXH to altitude as well as geographical spread. All these hôte-vecteur. Les variations climatiques ont également une inci- diverse contextual changes must be taken into account dence sur la présence des agents et des vecteurs, aussi bien en so that surveillance systems are able to detect diseases termes de leur répartition en altitude que de leur distribution and events in new areas or populations and even new géographique. Ces conditions doivent être prises en compte pathogens GDQV OHV V\VWqPHV GH VXUYHLOODQFH 7RXWH YDULDWLRQ WHPSRUHOOH G·XQRXSOXVLHXUVGHFHVIDFWHXUVHVWVXVFHSWLEOHG·DFFURvWUHOD vulnérabilité à une maladie ou à un événement donné. Des techniques nouvelles ou améliorées sont nécessaires pour pYDOXHU HW VXLYUH FHV FKDQJHPHQWV GDQV OH FDGUH GHV V\VWqPHV de surveillance. Public health emergencies during the last decade high- 3RXUDPpOLRUHUO·pWDWGHSUpSDUDWLRQHWOHVPHVXUHVGHULSRVWH light the need to strengthen surveillance in the Ameri- les efforts pourront se concentrer sur la surveillance dans les cas in 4 areas: (i) sylvatic epidemics, (ii) intensive 4 domaines suivants: i) épidémies selvatiques, ii) production animal production, (iii) human mobility and (iv) social animale intensive, iii) mobilité humaine et iv) médias sociaux. media. Sylvatic epidemic surveillance. A recent study Surveillance des épidémies selvatiques. Selon une étude récem- published in Nature3 LGHQWLÀHG WKH $PD]RQ UHJLRQ DV ment publiée dans la revue Nature,3 O·$PD]RQH HVW OD UpJLRQ OD that most prone to bat-transmitted zoonotic diseases. plus sujette aux zoonoses transmises par la chauve-souris. Par For example, the current yellow fever outbreak in Brazil H[HPSOH OD ÁDPEpH DFWXHOOH GH ÀqYUH MDXQH DX %UpVLO PHW HQ highlights the importance of epidemic surveillance in évidence le rôle important que peut jouer la surveillance épidé- non-human primates and sylvatic vectors for human mique chez les primates non humains et les vecteurs selvatiques disease preparedness. SRXUVHSUpSDUHUjODVXUYHQXHGHODPDODGLHFKH]O·KRPPH Surveillance in intensive animal production. Monitor- Surveillance dans le cadre de la production animale intensive. LQJ DQLPDO SURGXFWLRQ XQLWV IRU LQÁXHQ]D SDUWLFXODUO\ La surveillance de la grippe dans les unités de production intensive porcine and avian production, and assessing animale intensive, en particulier les élevages porcins et avicoles their distance from densely urban settings, would LQWHQVLIVGRXEOpHG·XQHpYDOXDWLRQGHODGLVWDQFHHQWUHFHVXQLWpV provide an indication of vulnerability to the spread of et les zones urbaines densément peuplées, peuvent fournir une disease to humans. LQGLFDWLRQGXULVTXHGHSURSDJDWLRQGHODPDODGLHjO·KRPPH Human mobility. Connectivity and road networks have Mobilité humaine. /·LQWHUFRQQH[LRQ HW OHV UpVHDX[ URXWLHUV VH improved all over the Region and have contributed to sont améliorés dans tout le continent, ce qui a contribué au economic development in rural settings. Humanitarian développement économique des zones rurales. Des crises huma- crises have resulted in displacement of populations, nitaires ont entraîné des déplacements de population, notam- including native ethnic groups, which has increased ment parmi les groupes ethniques autochtones, ce qui a donné interactions among populations that were previously lieu à des échanges accrus entre des groupes qui étaient rarely in contact with the broader populations, facilitat- MXVTX·DORUV UDUHPHQW HQ FRQWDFW IDFLOLWDQW O·LQWURGXFWLRQ HW OD ing the introduction and spread of infectious diseases. propagation des maladies infectieuses. Une meilleure compré- Understanding human mobility would elucidate the KHQVLRQ GH OD PRELOLWp KXPDLQH SHUPHWWUDLW G·pOXFLGHU OD VSDWLDO²WHPSRUDOGLPHQVLRQRIGLVHDVHVSUHDG dimension spatio-temporelle de la propagation des maladies. Social media surveillance. The rapid spread of access Surveillance des médias sociaux. /·DFFqVj,QWHUQHWHWjODWpOp- to the Internet and mobile phones in the Region has SKRQHPRELOHV·HVWUDSLGHPHQWUpSDQGXGDQVOD5pJLRQPHWWDQW given people many sources of information, and most GHQRPEUHXVHVVRXUFHVG·LQIRUPDWLRQjGLVSRVLWLRQGHODSRSX- now search the Internet for information when they feel lation. Ainsi, la plupart des personnes cherchent désormais des sick. Internet search mechanisms and monitoring of LQIRUPDWLRQV VXU ,QWHUQHW ORUVTX·HOOHV VH VHQWHQW PDODGHV social networks could thus signal possible emerging Les mécanismes de recherche sur Internet et la surveillance events. GHV UpVHDX[ VRFLDX[ SRXUUDLHQW DLQVL VLJQDOHU O·pPHUJHQFH G·pYpQHPHQWVSRWHQWLHOV

3 Olival KJ, Hosseini PR, Zambrana-Torrelio C et al. Host and viral traits predict zoo- 3 Olival KJ, Hosseini PR, Zambrana-Torrelio C et al. Host and viral traits predict zoonotic spillover notic spillover from mammals. Nature. 2017;546:646–650. from mammals. Nature 2017;546:646–650. 266 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Data gathered from these new areas combined with data Les données recueillies par ces nouvelles méthodes, conjuguées obtained from current surveillance systems could lead DX[ GRQQpHV IRXUQLHV SDU OHV V\VWqPHV DFWXHOV GH VXUYHLOODQFH to better preparedness at country level and ensure pourraient favoriser une meilleure préparation des pays et evidence-based allocation of resources for disease permettre une allocation des ressources fondée sur des bases prevention. IDFWXHOOHVDX[ÀQVGHODSUpYHQWLRQGHVPDODGLHV

TSGNQÐ@EÆKH@SHNM EÆKH@SHNMRÐCDRÐ@TSDTQR Health Emergency Information and Risk Assessment Programme Informations sur les urgences sanitaires et évaluation Programme, Health Emergencies Department, Pan des risques, Département Urgences sanitaires, Organisation pana- American Health Organization, Washington DC, USA. Ⅲ PpULFDLQHGHOD6DQWp:DVKLQJWRQ'&eWDWV8QLVG·$PpULTXHⅢ

The Epidemic Intelligence from Open L’initiative «Epidemic Intelligence from Sources initiative: a collaboration Open Sources»: une collaboration visant to harmonize and standardize early à harmoniser et à standardiser detection and epidemic intelligence les procédures de détection précoce et among public health organizations de renseignement épidémiologique entre les organisations de santé publique Philip Abdelmalik,a Émilie Peron,a Johannes Schnitzler,a Julie Philip Abdelmalik,a Émilie Peron,a Johannes Schnitzler,a Julie Fontaine,a Fontaine,a Eva Elfenkämpera and Philippe Barbozaa Eva Elfenkämpera et Philippe Barbozaa (PHUJLQJDQGUHHPHUJLQJSDWKRJHQV²PRVWRIZKLFK /HVDJHQWVSDWKRJqQHVpPHUJHQWVRXUppPHUJHQWVGRQWODSOXSDUW are zoonotic1²VLJQLÀFDQWO\DIIHFWHFRQRPLHVFKDOOHQJH VRQW G·RULJLQH ]RRQRWLTXH1 ont des répercussions économiques public health infrastructure, disrupt the social fabric of considérables, exercent une pression sur les infrastructures de communities and may become global health security santé publique, fragilisent le tissu social communautaire et risks. The recent outbreak of Ebola virus disease in West peuvent mettre en péril la sécurité sanitaire mondiale. La récente Africa claimed over 11 000 lives and reversed gains in ÁDPEpH pSLGpPLTXH GH PDODGLH j YLUXV (EROD HQ $IULTXH GH economic growth in the worst-affected countries; the O·2XHVW D IDLW SOXV GH PRUWV HW D UpGXLW j QpDQW OHV JDLQV losses in gross domestic product were estimated to be de croissance économique dans les pays les plus gravement US$ 219 million in Sierra Leone, US$ 188 million in touchés; les pertes occasionnées, en termes de produit intérieur Liberia and US$ 184 million in Guinea.2 Such events brut, ont été estimées à US$ 219 millions en Sierra Leone, à KLJKOLJKWWKHFUXFLDOQHHGIRUWLPHO\GHWHFWLRQYHULÀFD- US$ 188 millions au Libéria et à US$ 184 millions en Guinée.2 Les tion and assessment of health risks and threats at local, pYpQHPHQWVGHFHW\SHPRQWUHQWTX·LOHVWLQGLVSHQVDEOHG·DVVXUHU national and global levels and sharing of information XQHGpWHFWLRQXQHYpULÀFDWLRQHWXQHpYDOXDWLRQHQWHPSVXWLOH within and among public health organizations. Early des risques et des menaces sanitaires aux niveaux local, national detection ensures appropriate, coordinated action, et mondial, avec un partage intra-institutionnel et interinstitu- which means better outcomes and saved lives.3 At the WLRQQHO GH O·LQIRUPDWLRQ /D GpWHFWLRQ SUpFRFH HVW IRQGDPHQWDOH heart of early detection is surveillance, with iterative pour mettre en œuvre une action appropriée et coordonnée, GHWHFWLRQYHULÀFDWLRQDVVHVVPHQWDQGFRPPXQLFDWLRQ SHUPHWWDQWG·REWHQLUGHPHLOOHXUVUpVXOWDWVHWGHVDXYHUGHVYLHV3 contributing to the epidemic intelligence cycle.4 La détection précoce se fonde essentiellement sur la surveillance, DYHFXQSURFHVVXVLWpUDWLIGHGpWHFWLRQGHYpULÀFDWLRQG·pYDOXD- tion et de communication, contribuant au cycle de renseignement épidémiologique.4 Increases in the volume and variety of information and /DPXOWLSOLFDWLRQH[SRQHQWLHOOHGHVVRXUFHVG·LQIRUPDWLRQHQDFFqV the speed with which they are generated, with the expo- OLEUHVXU,QWHUQHW ©RSHQVRXUFHª VHWUDGXLWSDUXQHDXJPHQWDWLRQ nential growth of publicly available (open source) infor- du volume et de la variété des données disponibles, ainsi que de mation on the Internet, provide unprecedented oppor- la vitesse à laquelle elles sont générées, offrant des possibilités sans tunities for timely detection, analysis and information- SUpFpGHQW GH GpWHFWLRQ UDSLGH G·DQDO\VH HW G·pFKDQJH G·LQIRUPD- sharing. The dramatic increase in information, however, WLRQV &HSHQGDQW FHWWH FURLVVDQFH VSHFWDFXODLUH G·LQIRUPDWLRQVVH also dramatically increases “noise”, including irrelevant WUDGXLW DXVVL SDU XQH KDXVVH FRQVLGpUDEOH GX ©EUXLWª FRQVWLWXp

1 Jones KE, Patel NG, Levy MA et al. Global trends in emerging infectious diseases. 1 Jones KE, Patel NG, Levy MA et al. Global trends in emerging infectious diseases. Nature. Nature. 2008;451:990-4. 2008;451:990-4. 2 Socio-economic impacts of Ebola on Africa, revised edition. Addis Ababa: United 2 Incidences socio-économiques d’Ebola sur l’Afrique, édition révisée. Addis-Abeba: Nations Nations Economic Commission for Africa; 2015 (https://www.uneca.org/sites/de- Unies, Commission économique pour l’Afrique; 2015 (FRRNQ UUU SLCA? MPE QGRCQ BCD?SJR ÍJCQ D?SJR ÍJCQ .S@JGA?RGML$GJCQ CA?=C@MJ?=PCNMPR=ÍL?J=CLE= NBD accessed April .S@JGA?RGML$GJCQ CA?=C@MJ?=PCNMPR=PCT=ÍL?J=DP NBD, consulté en avril 2018). 2018). 3 Heymann DL, Rodier G. Global surveillance, national surveillance, and SARS. Emerg 3 Heymann DL, Rodier G. Global surveillance, national surveillance, and SARS. Emerg Infect Dis. Infect Dis. 2004;10:173–5. 2004;10:173–5. 4 Early detection, assessment and response to acute public health events: implementa- 4 Détection précoce, évaluation et réponse lors d’une urgence de santé publique: mise en oeuvre tion of early warning and response with a focus on event-based surveillance. Geneva: de l’alerte précoce et réponse notamment la surveillance fondée sur les évènements. Genève: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/112667/1/ Organisation mondiale de la Santé; 2014 (http://apps.who.int/iris/bitstream/ WHO_HSE_GCR_LYO_2014.4_eng.pdf, accessed April 2018). handle/10665/144804/WHO_HSE_GCR_LYO_2014.4_fre.pdf, consulté en avril 2018).

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 267 information, useless information, duplicate information, notamment de données non pertinentes, inutiles, doubles, archi- archived or out-of-date information, unsubstantiated YpHVRXREVROqWHVDLQVLTXHG·LQIRUPDWLRQVQRQpWD\pHV UXPHXUV information (rumours) and sarcastic or deliberately false sarcastiques ou délibérément fausses. Dans ce bruit se trouvent LQIRUPDWLRQ 1RQHWKHOHVV DPLG WKH QRLVH DUH YDOLG UHOL- QpDQPRLQV GHV ©VLJQDX[ª YDODEOHV HW ÀDEOHV HW OD OLWWpUDWXUH GHV able signals, and a growing body of peer-reviewed lite- GHUQLqUHVDQQpHVFRPSWHXQQRPEUHFURLVVDQWG·DUWLFOHVVRXPLV rature over the past two decades highlights the useful- jXQH[DPHQFROOpJLDOTXLWpPRLJQHQWGHO·XWLOLWpGHFHVLQIRUPD- ness of such information for epidemic intelligence in a WLRQV j GHV ÀQV GH UHQVHLJQHPHQW pSLGpPLRORJLTXH GDQV GLYHUV variety of event-based surveillance systems.² Many of V\VWqPHVGHVXUYHLOODQFHEDVpHVXUO·pYpQHPHQWOXLPrPH² Toute- these event-based surveillance systems were, however, IRLVXQJUDQGQRPEUHGHFHVV\VWqPHGHVXUYHLOODQFHRQWpWpPLV developed independently, and there is no common initia- DXSRLQWGHPDQLqUHLQGpSHQGDQWHHQO·DEVHQFHGHWRXWHLQLWLDWLYH tive to link them together amongst the epidemic intel- commune et concertée pour les relier aux services de renseigne- ligence community. An evaluation of the various systems PHQWpSLGpPLRORJLTXH8QHpYDOXDWLRQDLQGLTXpTX·LOVHUDLWDYDQ- showed that there would be value in pooling the comple- tageux de mettre en commun les forces complémentaires de ces mentary strengths of multiple event-based surveillance GLIIpUHQWVV\VWqPHVREVHUYDQWTX·LOQ·H[LVWHDXFXQ©VXSHUV\VWqPHª V\VWHPV QRWLQJ WKDW ´1R VXSHUV\VWHP H[LVWV WR SRRO TXL FRQMXJXH OH VDYRLUIDLUH GHV GLIIpUHQWV V\VWqPHV H[SHUWV HW H[SHUW V\VWHPV· H[SHUWLVH DQG PRUH LQLWLDWLYHV PXVW EH concluant que de nouvelles initiatives devraient être prises dans developed in this direction”.9 The Epidemic Intelligence ce sens.9 /·LQLWLDWLYH (SLGHPLF ,QWHOOLJHQFH IURP 2SHQ 6RXUFHV from Open Sources (EIOS) is such an initiative. (,26 HVWSUpFLVpPHQWO·XQHGHFHVLQLWLDWLYHV The EIOS initiative is a unique collaboration among /·LQLWLDWLYH (,26 HVW XQH FROODERUDWLRQ LQpGLWH HQWUH O·206 OH :+2WKH*OREDO2XWEUHDN$OHUWDQG5HVSRQVH1HWZRUN 5pVHDXPRQGLDOG·DOHUWHHWG·DFWLRQHQFDVG·pSLGpPLHO·2UJDQLVD- the Food and Agriculture Organization of the United WLRQGHV1DWLRQV8QLHVSRXUO·DOLPHQWDWLRQHWO·DJULFXOWXUHO·2UJD- 1DWLRQVWKH:RUOG2UJDQLVDWLRQIRU$QLPDO+HDOWKWKH QLVDWLRQPRQGLDOHGHODVDQWpDQLPDOHO·,QLWLDWLYHGHVpFXULWpVDQL- Global Health Security Initiative, the European Centre taire mondiale, le Centre européen de prévention et de contrôle for Disease Prevention and Control, the Africa Centres des maladies, le Centre africain de prévention et de lutte contre for Disease Control and Prevention and the Joint les maladies et le Centre commun de recherche de la Commission Research Centre of the European Commission. The goal HXURSpHQQH 6RQ REMHFWLI HVW G·pWDEOLU XQH DSSURFKH XQLÀpH ©8Q RI WKH LQLWLDWLYH LV WR FUHDWH D XQLÀHG DOOKD]DUGV 2QH monde, Une santé» axée sur tous les risques qui puisse être appli- Health approach by using open source information for TXpH j OD GpWHFWLRQ SUpFRFH j OD YpULÀFDWLRQ HW j O·pYDOXDWLRQ GHV HDUO\ GHWHFWLRQ YHULÀFDWLRQ DQG DVVHVVPHQW RI SXEOLF risques et des menaces de santé publique à partir des informations health risks and threats. By combining human expertise GLVSRQLEOHVHQDFFqVOLEUH$OOLDQWO·H[SHUWLVHKXPDLQHjODWHFKQR- and technology, the EIOS initiative integrates global ORJLH O·LQLWLDWLYH (,26 LQWqJUH OHV HIIRUWV PRQGLDX[ G·DOHUWH HW GH alert and response efforts for public health emergencies riposte déployés face aux urgences de santé publique et satisfait and supports the core capacity requirements required aux exigences relatives aux principales capacités requises au titre in the International Health Regulations (2005).10, 11 The GX 5qJOHPHQW VDQLWDLUH LQWHUQDWLRQDO 10, 11 /·LQLWLDWLYH (,26 EIOS initiative is a network of public health organiza- UHSRVH VXU XQ UpVHDX G·RUJDQLVDWLRQV GH VDQWp SXEOLTXH DYHF tions with one common goal: to improve global health lesquelles elle a un objectif commun: améliorer la santé mondiale by preventing illness and saving lives through early en prévenant les maladies et en sauvant des vies grâce à des alertes warning for rapid response. précoces permettant une riposte rapide. In October 2017, WHO assumed leadership of global (QRFWREUHO·206DSULVODGLUHFWLRQGHVHIIRUWVPRQGLDX[ event-based surveillance from open sources following GHVXUYHLOODQFHGHVpYpQHPHQWVjSDUWLUGHVRXUFHVHQDFFqVOLEUH the previous investments made by the Global Health dans le prolongement des investissements auparavant réalisés Security Initiative. WHO is now increasing the epidemic SDUO·,QLWLDWLYHGHVpFXULWpVDQLWDLUHPRQGLDOH/·206V·HPSORLHj intelligence community by extending the network of renforcer les services de renseignement épidémiologique grâce experts and developing an evolving state-of-the-art jO·pODUJLVVHPHQWGXUpVHDXG·H[SHUWVFRUUHVSRQGDQWHWjODPLVH technology system. The initiative is led by the EIOS Core DXSRLQWG·XQV\VWqPHPRGHUQHHWpYROXWLI/·LQLWLDWLYHHVWSLORWpH

5 Brownstein JS, Freifeld CC, Reis BY et al. Surveillance sans Frontières: Internet- 5 Brownstein JS, Freifeld CC, Reis BY et al. Surveillance sans Frontières: Internet-based emerging based emerging infectious disease intelligence and the HealthMap project. PLoS infectious disease intelligence and the HealthMap project. PLoS Med. 2008;5(7):e151. Med. 2008;5(7):e151. 6 Anema A, Kluberg S, Wilson K et al. Digital surveillance for enhanced detection and 6 Anema A, Kluberg S, Wilson K et al. Digital surveillance for enhanced detection and response to response to outbreaks. Lancet Infect Dis. 2014;14(11):1035–7. outbreaks. Lancet Infect Dis. 2014;14(11):1035–7. 7 Hartley DM, Nelson NP, Walters R et al. The landscape of international event-based 7 Hartley DM, Nelson NP, Walters R et al. The landscape of international event-based biosurveil- biosurveillance. Emerg Health Threats. 2010;3(1):e3. lance. Emerg Health Threats. 2010;3(1):e3. 8 Brownstein JS, Freifeld CC. HealthMap: the development of automated real-time 8 Brownstein JS, Freifeld CC. HealthMap: the development of automated real-time internet sur- internet surveillance for epidemic intelligence. Euro Surveill. 2007;12(48):E071129.5 veillance for epidemic intelligence. Euro Surveill. 2007;12(48):E071129.5 (http://www.eurosur- (http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3322, accessed April veillance.org/ViewArticle.aspx?ArticleId=3322, accessed April 2018). 2018). 9 Barboza P, Vaillant L, Mawudeku A et al. Evaluation of epidemic intelligence sys- 9 Barboza P, Vaillant L, Mawudeku A et al. Evaluation of epidemic intelligence systems integrated tems integrated in the early alerting and reporting project for the detection of GLÏRFCÏC?PJWÏ?JCPRGLEÏ?LBÏPCNMPRGLEÏNPMHCARÏDMPÏRFCÏBCRCARGMLÏMDÏ &,ÏGLÎSCLX?ÏCTCLRQ Ï.*M1Ï &,ÏGLÎSCLX?ÏCTCLRQ Ï.*M1Ï-LC ÏC Ï One. 2013;8(3):e57252. 10 International Health Regulations, second edition. Geneva: World Health Organiza- 10 Règlement sanitaire international, deuxième édition. Genève: Organisation mondiale de la tion; 2005 (http://apps.who.int/iris/bitstream/10665/43883/1/9789241580410_ Santé; 2005 (http://apps.who.int/iris/bitstream/handle/10665/246187/9789242580495-fre.pdf, eng.pdf, accessed April 2018). consulté en avril 2018). 11 Baker MG, Fildert DP. Global public health surveillance under new International 11 Baker MG, Fildert DP. Global public health surveillance under new International Health Regula- Health Regulations. Emerg Infect Dis. 2006;12:1058–64. tions. Emerg Infect Dis. 2006;12:1058–64.

268 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 7HDP ZKLFK LV SDUW RI WKH 'HWHFWLRQ9HULÀFDWLRQ DQG SDU O·pTXLSH FHQWUDOH (,26 TXL IDLW SDUWLH GX JURXSH FKDUJp GH 5LVN $VVHVVPHQW 7HDP LQ :+2·V +HDOWK (PHUJHQFLHV OD GpWHFWLRQ GH OD YpULÀFDWLRQ HW GH O·pYDOXDWLRQ GHV ULVTXHV DX Programme in Geneva. Since October 2017, WHO made VHLQGX3URJUDPPHGHJHVWLRQGHVVLWXDWLRQVG·XUJHQFHVDQLWDLUH the system available to partners, has established a GHO·206j*HQqYH'HSXLVRFWREUHO·206DPLVOHV\VWqPH process for system enhancements with the main tech- à la disposition des partenaires, a établi un processus de perfec- nology partner, the Joint Research Centre, has under- WLRQQHPHQW GX V\VWqPH HQ FROODERUDWLRQ DYHF VRQ SULQFLSDO taken evaluations of the system to ensure continuous partenaire technologique, le Centre commun de recherche, a improvements for users, and has established a strategic mené des évaluations visant à assurer une amélioration continue plan and investment case for all areas of relevance to GXV\VWqPHSRXUOHVXWLOLVDWHXUVHWDIRUPXOpXQSODQVWUDWpJLTXH the EIOS initiative. HWXQDUJXPHQWDLUHG·LQYHVWLVVHPHQWD[pVVXUWRXVOHVGRPDLQHV SHUWLQHQWVSRXUO·LQLWLDWLYH(,26 Achieving the objectives of the EIOS initiative requires La réalisation des objectifs EIOS ne sera pas chose aisée et extensive cross-sectoral collaboration and resources, so H[LJHUDG·LPSRUWDQWHVUHVVRXUFHVHWXQHFROODERUDWLRQLQWHUVHFWR- that partners and stakeholders can collectively build a ULHOOH pWURLWH DÀQ TXH OHV SDUWHQDLUHV HW OHV SDUWLHV SUHQDQWHV QHWZRUNDQGV\VWHPIRUJOREDOEHQHÀW:+2LVXQLTXHO\ SXLVVHQW±XYUHUFROOHFWLYHPHQWjODPLVHHQSODFHG·XQUpVHDXHW placed to realize the vision of the EIOS initiative: to G·XQV\VWqPHDXEpQpÀFHGHWRXV/·206RFFXSHXQHSODFHVWUD- save lives and reduce disruption to communities and WpJLTXHSRXUFRQFUpWLVHUODYLVLRQGHO·LQLWLDWLYH(,26VDXYHUGHV economies by all hazards, through a coordinated, vies et limiter les conséquences néfastes de tous les risques sur targeted global network and state-of-the-art tools for les communautés et les économies, grâce à un réseau mondial HDUO\ UDSLG GHWHFWLRQ YHULÀFDWLRQ DVVHVVPHQW DQG ciblé et coordonné et à des outils de pointe permettant une détec- communication of health risks and threats. The oppor- WLRQ XQH YpULÀFDWLRQ XQH pYDOXDWLRQ HW XQH FRPPXQLFDWLRQ tunities and potential are limitless. rapides face aux risques et aux menaces sanitaires. Cette approche RIIUHG·LQQRPEUDEOHVSRVVLELOLWpVHWXQSRWHQWLHOLOOLPLWp

TSGNQÐ@EÆKH@SHNM EÆKH@SHNMRÐCDRÐ@TSDTQR a Health Emergencies Programme, World Health Orga- a 3URJUDPPH GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH nization, Geneva, Switzerland (Corresponding author: 2UJDQLVDWLRQ PRQGLDOH GH OD 6DQWp *HQqYH 6XLVVH $XWHXU Philip Abdelmalik, [email protected]). Ⅲ correspondant: Philip Abdelmalik, [email protected]). Ⅲ

$@QKXÐ6@QMHMF Ð KDQSÐ@MCÐ1DRONMRDÐ Alerte précoce et réponse (EWAR): (EWAR): a key area for countries in une composante clé de la préparation preparedness and response to health et de la réponse des pays face emergencies aux urgences sanitaires Karl Schenkel,a Niluka Wijekoon Kannagarage,a Chris Haskew,a José Karl Schenkel,a Niluka Wijekoon Kannagarage,a Chris Haskew,a José Guerra,b Guerra,b Sébastien Cognat,b Pierre Nabethc and Stéphane Hugonneta Sébastien Cognat,b Pierre Nabethc et Stéphane Hugonneta

Background Contexte The International Health Regulations (2005) (IHR) require /H5qJOHPHQWVDQLWDLUHLQWHUQDWLRQDO 56, H[LJHTXHOHVSD\V that countries develop, strengthen and maintain the capac- développent, renforcent et maintiennent leur capacité de détecter, ity to detect, assess, notify and report public health events. G·pYDOXHU GH QRWLÀHU HW GH UDSSRUWHU OHV pYpQHPHQWV GH VDQWp This includes the collection, analysis and reporting of SXEOLTXH&HODFRPSUHQGODFROOHFWHO·DQDO\VHHWODFRPPXQLFDWLRQ accurate and relevant information for the timely detection G·LQIRUPDWLRQVSUpFLVHVHWSHUWLQHQWHVSRXUODGpWHFWLRQHQWHPSV of outbreaks and other acute public health events, known XWLOH GHV ÁDPEpHV pSLGpPLTXHV HW G·DXWUHV pYpQHPHQWV DLJXV GH DV(DUO\:DUQLQJ$OHUWDQG5HVSRQVH (:$5 ²DIXQFWLRQ VDQWpSXEOLTXHLOV·DJLWG·XQHIRQFWLRQGXV\VWqPHGHVXUYHLOODQFH of the public health surveillance system. de la santé publique nommée alerte précoce et réponse (EWAR). Many countries have taken initiatives to strengthen De nombreux pays ont pris des initiatives pour renforcer leur their public health surveillance system to comply fully V\VWqPHGHVXUYHLOODQFHGHODVDQWpSXEOLTXHDÀQGHVHFRQIRU- with the IHR requirements, yet many gaps remain. mer pleinement aux exigences du RSI, mais de nombreuses These are highlighted by the regular monitoring and lacunes subsistent. Celles-ci sont mises en évidence par le suivi evaluation of the IHR implementation conducted annu- HW O·pYDOXDWLRQ UpJXOLHUV GH OD PLVH HQ ±XYUH GX 56, HIIHFWXpV ally by WHO Member States, or through voluntary joint FKDTXH DQQpH SDU OHV eWDWV 0HPEUHV GH O·206 RX SDU GHV external evaluations. évaluations extérieures conjointes volontaires. During emergencies, when the overall public health 'DQV OHV VLWXDWLRQV G·XUJHQFH ORUVTXH OH V\VWqPH JOREDO GH surveillance system may be disrupted, underperforming surveillance de la santé publique peut être perturbé, sous- or nonexistent, it is important to ensure that the EWAR SHUIRUPDQW RX LQH[LVWDQW LO HVW LPSRUWDQW GH V·DVVXUHU TXH OD function is in place, as recommended by the WHO fonction EWAR est en place, comme le recommande le cadre Emergency Response Framework (ERF). The ERF G·DFWLRQ G·XUJHQFH GH O·206 &H GHUQLHU IRXUQLW DX SHUVRQQHO provides WHO staff with essential guidance on the GH O·206 GHV RULHQWDWLRQV HVVHQWLHOOHV VXU O·pYDOXDWLRQ HW OD assessment, grading and response to public health gradation des événements de santé publique et des urgences RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 269 events and emergencies with health consequences.1 It is ayant des conséquences sanitaires, et sur la riposte à mettre en important that a routine system for EWAR is in place place.1,OHVWLPSRUWDQWTX·XQV\VWqPHGHURXWLQHSRXUO·(:$5 and functional to allow for an effective scale-up and VRLW HQ SODFH HW IRQFWLRQQHO DÀQ GH SHUPHWWUH XQH LQWHQVLÀFD- support for response during emergencies. The need for WLRQHIÀFDFHGHVLQWHUYHQWLRQVHWGHVRXWHQLUODULSRVWHSHQGDQW a comprehensive, harmonized and multisectoral XQH VLWXDWLRQ G·XUJHQFH /D QpFHVVLWp G·XQH DSSURFKH JOREDOH approach to achieve EWAR is increasingly acknowl- KDUPRQLVpHHWPXOWLVHFWRULHOOHSRXUUpDOLVHUO·(:$5HVWGHSOXV edged. en plus reconnue. Since 2005, several achievements have been made in Depuis 2005, plusieurs avancées ont été réalisées dans le both routine and emergency EWAR systems. Two work- GRPDLQH GHV V\VWqPHV (:$5 GH URXWLQH HW G·XUJHQFH 'HX[ ing groups have been established: for emergency JURXSHV GH WUDYDLO RQW pWp FUppV O·XQ SRXU OHV V\VWqPHV G·XU- systems (in 2009) and for routine systems (in 2013). JHQFH HQ HWO·DXWUHSRXUOHVV\VWqPHVGHURXWLQH HQ Each working group has developed guidance docu- &KDTXH JURXSH GH WUDYDLO D pODERUp GHV GRFXPHQWV G·RULHQWD- ments,2, 3 perceiving the need to review and align exist- tion,2, 3SHUFHYDQWODQpFHVVLWpG·H[DPLQHUHWG·DOLJQHUOHVRULHQ- ing guidance, review and share implementation experi- WDWLRQVH[LVWDQWHVG·H[DPLQHUHWGHSDUWDJHUOHVH[SpULHQFHVGH HQFHVDQGEHVWSUDFWLFHVDQGÀQGZD\VWRRYHUFRPHWKH mise en œuvre et les meilleures pratiques, et de trouver disconnections between EWAR in routine and emer- GHVPR\HQVGHUpVRXGUHOHPDQTXHGHFRQQH[LRQHQWUHO·(:$5 gency settings. GHURXWLQHHWO·(:$5HQVLWXDWLRQG·XUJHQFH

3GDÐÆQRSÐ6'.ÐFKNA@KÐ$6 1ÐSDBGMHB@KÐ Première réunion de consultation technique mondiale BNMRTKS@SHNMÐLDDSHMF Ð#DBDLADQÐ CDÐKi.,2ÐRTQÐKi$6 1 ÐC°BDLAQDÐ A technical consultation meeting was held at WHO, 8QH UpXQLRQ GH FRQVXOWDWLRQ WHFKQLTXH V·HVW WHQXH j O·206 j *HQHYD ² 'HFHPEHU WR UHYLHZ WKH H[LVWLQJ *HQqYHGXDXGpFHPEUHDÀQG·H[DPLQHUOHVRULHQ- guidance, operational challenges for implementation, WDWLRQV H[LVWDQWHV OHV GLIÀFXOWpV RSpUDWLRQQHOOHV GH OD PLVH HQ and electronic tools for EWAR. ±XYUHHWOHVRXWLOVpOHFWURQLTXHVXWLOLVpSRXUO·(:$5 Forty-three experts4 from WHO headquarters and Quarante-trois experts4 GX 6LqJH HW GHV EXUHDX[ UpJLRQDX[ GH UHJLRQDO RIÀFHV DFDGHPLD DQG SDUWQHU RUJDQL]DWLRQV O·206GHPLOLHX[XQLYHUVLWDLUHVHWG·RUJDQLVDWLRQVSDUWHQDLUHV attended the meeting. The 3 meeting objectives were: ont participé à cette réunion. Les 3 objectifs de la réunion 1) to align concepts and terminology in existing techni- étaient: 1) aligner les concepts et la terminologie utilisés dans cal guidance; 2) to understand operational challenges OHV RULHQWDWLRQV WHFKQLTXHV H[LVWDQWHV FRPSUHQGUH OHV GLIÀ- and perceived solutions; and 3) to map existing elec- cultés opérationnelles et les solutions envisagées; et 3) carto- tronic tools used in EWAR, both in routine and in emer- graphier les outils électroniques existants utilisés dans le JHQF\VHWWLQJVDQGWRGHÀQHWKHPLQLPXPUHTXLUHPHQWV V\VWqPH (:$5 HQ URXWLQH FRPPH HQ VLWXDWLRQ G·XUJHQFH HW for early warning electronic tools. GpÀQLUOHVH[LJHQFHVPLQLPDOHVDX[TXHOOHVGRLYHQWVDWLVIDLUHOHV RXWLOVpOHFWURQLTXHVG·DOHUWHSUpFRFH

Objective 1: aligning concepts and terminology Objectif 1: aligner les concepts et la terminologie in existing technical guidance dans les orientations techniques existantes A comprehensive review of existing guidance for EWAR 8Q H[DPHQ FRPSOHW GHV RULHQWDWLRQV H[LVWDQWHV SRXU O·(:$5 had been undertaken prior to session 1 of the meeting. DYDLWpWpHQWUHSULVDYDQWODSUHPLqUHVHVVLRQGHODUpXQLRQ/HV The major differences and needs regarding the align- GLIIpUHQFHV HW OHV EHVRLQV SULQFLSDX[ FRQFHUQDQW O·DOLJQHPHQW ment of concepts, actions and terminology between GHV FRQFHSWV GHV DFWLRQV HW GH OD WHUPLQRORJLH HQWUH O·(:$5 (:$5 LQ HPHUJHQFLHV DQG LQ URXWLQH ZHUH LGHQWLÀHG HQ VLWXDWLRQ G·XUJHQFH HW O·(:$5GH URXWLQH RQW pWp LGHQWLÀpV and discussed. The experts agreed on the terminology HWGLVFXWpV/HVH[SHUWVVHVRQWPLVG·DFFRUGVXUODWHUPLQRORJLH and main concepts relating to EWAR, independently of HW OHV SULQFLSDX[ FRQFHSWV OLpV j O·(:$5 LQGpSHQGDPPHQW GX context, and expressed the need to produce one conso- contexte, et ont exprimé le besoin de produire des lignes direc- lidated guideline. The agreed objective for EWAR was to WULFHVXQLÀpHV/·objectifFRQYHQXSRXUO·(:$5pWDLWGH©GpWHF- “early detect and rapidly respond to acute public health ter précocement et de répondre rapidement aux événements events of any origin (all hazards)”. The agreed GHÀQL- DLJXVGHVDQWpSXEOLTXHTXHOOHTX·HQVRLWO·RULJLQH WRXVGDQJHUV tion was an “organized mechanism to early detect and confondus)». La GpÀQLWLRQFRQYHQXHpWDLWXQ©PpFDQLVPHRUJD- rapidly respond to acute public health events of any nisé pour détecter précocement et répondre rapidement aux

1 WHO Emergency Response Framework, second edition. World Health 1 Cadre d’action d’urgence de l’OMS, deuxième édition. Organisation mondiale de la Santé, Genève, Organization, Geneva, 2017. Available at: http://apps.who.int/iris/bitstre 2017. Disponible à l’adresse http://apps.who.int/iris/bitstream/10665/258604/1/9789241512299- am/10665/258604/1/9789241512299-eng.pdf?ua=1, accessed March 2018. eng.pdf?ua=1, consulté en mars 2018. (En anglais) 2 Early detection, assessment and response to acute public health events: implemen- 2 Détection précoce, évaluation et réponse lors d’une urgence de santé publique: Mise en œuvre tation of early warning and response with a focus on event-based surveillance. de l’alerte précoce et réponse notamment la surveillance fondée sur les évènements. Organisa- World Health Organization, Geneva, 2014. Available at: http://www.who.int/ihr/ tion mondiale de la Santé, Genève, 2014. Disponible à l’adresse http://www.who.int/ihr/publi- publications/WHO_HSE_GCR_LYO_2014.4/en/, accessed March 2018. cations/WHO_HSE_GCR_LYO_2014.4/fr/, consulté en mars 2018. 3 Outbreak surveillance and response in humanitarian emergencies: WHO guidelines 3 Outbreak surveillance and response in humanitarian emergencies: WHO guidelines for EWARN for EWARN implementation. World Health Organization, Geneva, 2012. Available at: implementation. Organisation mondiale de la Santé, Genève, 2012. Disponible à l’adresse http://apps.who.int/iris/bitstream/10665/70812/1/WHO_HSE_GAR_DCE_2012_1_ http://apps.who.int/iris/bitstream/10665/70812/1/WHO_HSE_GAR_DCE_2012_1_eng.pdf, eng.pdf, accessed March 2018. consulté en mars 2018. 4 See section on acknowledgements. 4 Voir la section sur les remerciements. 270 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 origin”. It was noted that more advocacy is needed for pYpQHPHQWVDLJXVGHVDQWpSXEOLTXHTXHOOHTX·HQVRLWO·RULJLQHª further implementation of event-based surveillance Il a été noté que la poursuite de la mise en œuvre de la surveil- (EBS), and that coordinated efforts for the integration lance basée sur des événements devait être davantage promue of EBS and indicator-based surveillance (IBS) for EWAR HW TX·LO pWDLW FUXFLDO GH SURGXLUH GHV HIIRUWV FRRUGRQQpV SRXU are crucial. Solutions for further developing steps to intégrer la surveillance basée sur des événements et la surveil- perform EWAR were discussed, based on a model in the ODQFH EDVpH VXU GHV LQGLFDWHXUV HQ PDWLqUH G·(:$5 'HV VROX- 2014 WHO guide,5 taking into consideration that tions pour la poursuite du développement des étapes de réali- the response and risk assessment parts are even more VDWLRQ GH O·(:$5 RQW pWp GLVFXWpHV VXU OD EDVH G·XQ PRGqOH dynamic and may start at the level of detection/triage, ÀJXUDQWGDQVOHJXLGHGHO·2065 en tenant compte du fait in a continuous process. Further, it was agreed that que les composantes réponse et évaluation des risques sont FRXQWULHVQHHGWRKDYHDQHIÀFLHQWURXWLQH(:$5V\VWHP HQFRUH SOXV G\QDPLTXHV HW SHXYHQW FRPPHQFHU j O·pWDSH GH in place to be able to detect public health events at any GpWHFWLRQWULDJHGDQVOHFDGUHG·XQSURFHVVXVFRQWLQX(QRXWUH time and be better prepared for emergencies. LO D pWp FRQYHQX TXH OHV SD\V GRLYHQW GLVSRVHU G·XQ V\VWqPH (:$5GH URXWLQH HIÀFDFH SRXU rWUH HQ PHVXUH GH GpWHFWHU OHV pYpQHPHQWV GH VDQWp SXEOLTXH j WRXW PRPHQW HW G·rWUH PLHX[ SUpSDUpVDX[VLWXDWLRQVG·XUJHQFH

Objective 2: understanding operational .AIDBSHEÐÐBNLOQDMCQDÐKDRÐCHEÆBTKS°RÐNO°Q@SHNMMDKKDRÐ challenges and perceived solutions for current et les solutions envisagées pour combler les lacunes gaps actuelles A review of EWAR systems in 6 countries in 4 WHO 8Q H[DPHQ GHV V\VWqPHV (:$5GDQV SD\V GH 5pJLRQV GH regions revealed several operational challenges and O·206DPLVHQOXPLqUHSOXVLHXUVGLIÀFXOWpVRSpUDWLRQQHOOHVHW perceived solutions. The challenges of EWAR implemen- VROXWLRQV SRWHQWLHOOHV /HV SUREOqPHV OLpV j OD PLVH HQ ±XYUH WLRQDQGWKHUHPDLQLQJJDSVDQGQHHGVZHUHLGHQWLÀHG GX V\VWqPH (:$5 DLQVL TXH OHV ODFXQHV HW OHV EHVRLQV TXL and summarized. These included: a lack of laboratory VXEVLVWHQWRQWpWpLGHQWLÀpVHWUpVXPpV,OV·DJLWQRWDPPHQWGH surveillance; a lack of strategic training components for O·DEVHQFH GH VXUYHLOODQFH GHV ODERUDWRLUHV GH O·DEVHQFH G·XQH ÀHOG OHYHO LPSOHPHQWDWLRQ DQG WKH GLIÀFXOWLHV LQ VFDO- composante stratégique dans la formation à la mise en œuvre ing-up EWAR during emergencies. Disconnected VXU OH WHUUDLQ HW GH GLIÀFXOWpV OLpHV j O·LQWHQVLÀFDWLRQ GHV DFWL- response components and an inability to meet the YLWpVG·(:$5HQVLWXDWLRQG·XUJHQFH'HVpOpPHQWVG·LQWHUYHQ- demands of information products were also highlighted. tion déconnectés et une incapacité à répondre aux exigences en 6XFK GLIÀFXOWLHV DUH RIWHQ DFFRPSDQLHG E\ D ODFN RI PDWLqUHG·LQIRUPDWLRQRQWpJDOHPHQWpWpVRXOLJQpV&HVGLIÀFXO- adequate and sustainable funding. Further, missing WpVV·DFFRPSDJQHQWVRXYHQWG·XQPDQTXHGHÀQDQFHPHQWVXIÀ- VWDQGDUGL]HG FDVH GHÀQLWLRQV DQG DOHUW YHULÀFDWLRQV VDQW HW GXUDEOH (Q RXWUH O·DEVHQFH GH GpÀQLWLRQV GH FDV HW GH and a lack of integrated laboratory surveillance (among YpULÀFDWLRQV G·DOHUWH VWDQGDUGLVpHV DLQVL TXH O·DEVHQFH others) were perceived as key problems, as was the need de surveillance intégrée des laboratoires (entre autres) ont été for substantial improvement in the limited capacities of SHUoXHV FRPPH GHV SUREOqPHV FOpV GH PrPH TXH OD QpFHVVLWp rapid response teams on the ground. G·DPpOLRUHU VHQVLEOHPHQW OHV FDSDFLWpV OLPLWpHV GHV pTXLSHV G·LQWHUYHQWLRQUDSLGHVXUOHWHUUDLQ

Objective 3: mapping existing electronic tools Objectif 3: cartographier les outils électroniques used in EWAR both in routine and emergency existants utilisés dans le système EWAR de routine RDSSHMFRÐ@MCÐCDÆMHMFÐLHMHLTLÐQDPTHQDLDMSRÐ DSÐDMÐRHST@SHNMÐCiTQFDMBDÐDSÐC°ÆMHQÐKDRÐDWHFDMBDRÐ and features for an ideal early warning minimales et les caractéristiques d’un outil electronic tool électronique d’alerte précoce idéal Prior to the meeting, a comprehensive mapping, both $YDQWODUpXQLRQXQHFDUWRJUDSKLHFRPSOqWHjODIRLVGHVRXWLOV of existing electronic tools for EWAR and of tools for pOHFWURQLTXHV H[LVWDQWV SRXU O·(:$5 HW GHV RXWLOV GH FROOHFWH FDSWXULQJ VXUYHLOODQFH DQG ÀHOG GDWD IRU RXWEUHDN des données de surveillance et des données sur le terrain pour response, had been conducted to support a discussion ODULSRVWHDX[pSLGpPLHVDYDLWpWpUpDOLVpHDX[ÀQVG·XQHGLVFXV- on minimum requirements for electronic tools for sion sur les exigences minimales auxquelles doivent répondre EWAR. In addition, a pre-meeting online survey had OHVRXWLOVpOHFWURQLTXHVSRXUO·(:$5(QRXWUHXQHHQTXrWHHQ been prepared to assess the technical experiences of the ligne préalable à la réunion avait été préparée pour évaluer meeting attendees with electronic tools for EWAR. This O·H[SpULHQFHWHFKQLTXHGHVSDUWLFLSDQWVjODUpXQLRQHQPDWLqUH demonstrated excellent representation of consultation G·RXWLOV pOHFWURQLTXHV SRXU O·(:$5 &HWWH HQTXrWH D GpPRQWUp participants to discuss technical solutions. The func- une excellente représentativité des participants à la consultation tional requirements for electronic tools were listed and pour discuter des solutions techniques. Les exigences fonction- discussed extensively during the meeting. nelles des outils électroniques ont été répertoriées et discutées en détail au cours de la réunion.

5 Figure 4, page 22 at: http://apps.who.int/iris/bitstream/10665/112667/1/WHO_ 5 Figure 4, page 25 à l’adresse http://apps.who.int/iris/bitstream/handle/10665/144804/WHO_ HSE_GCR_LYO_2014.4_eng.pdf?ua=1 HSE_GCR_LYO_2014.4_fre.pdf?sequence=1.

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 271 Agreed solutions and way forward Solutions convenues et prochaines étapes The major activities to address the above gaps, needs Les principales activités visant à répondre aux lacunes, aux DQGFKDOOHQJHVZHUHLGHQWLÀHGDQGDJUHHGLQFOXGLQJWKH EHVRLQV HW DX[ GLIÀFXOWpV VXVPHQWLRQQpV RQW pWp LGHQWLÀpHV HW alignment of EWAR concepts and terminology, EWAR DSSURXYpHV QRWDPPHQW O·DOLJQHPHQW GHV FRQFHSWV HW GH OD implementation and the development of electronic tools WHUPLQRORJLHGHO·(:$5ODPLVHHQ±XYUHGHO·(:$5HWODPLVH for EWAR. DXSRLQWG·RXWLOVpOHFWURQLTXHVSRXUO·(:$5 Core strategies include: Les stratégies de base comprennent: y Development of a consolidated EWAR guidance y O·pODERUDWLRQG·RULHQWDWLRQVXQLÀpHVSRXUO·(:$5 y Development of training and standard operating y O·pODERUDWLRQ G·XQH IRUPDWLRQ HW GH PRGHV RSpUDWRLUHV procedures for EWAR QRUPDOLVpVSRXUO·(:$5 y Development of minimum requirements for EWAR y O·pWDEOLVVHPHQWG·H[LJHQFHVPLQLPDOHVSRXUOHVRXWLOVpOHF- electronic tools WURQLTXHVXWLOLVpVGDQVOHFDGUHGHO·(:$5 y ,GHQWLÀFDWLRQ RI XQGHUUHVHDUFKHG DUHDV DQG y O·LGHQWLÀFDWLRQGHVGRPDLQHVLQVXIÀVDPPHQWpWXGLpVHWOD conducting necessary operational research on conduite des recherches opérationnelles nécessaires sur EWAR (such as for minimum standards for data O·(:$5 SDUH[HPSOHVXUOHVQRUPHVPLQLPDOHVHQPDWLqUH collection and systems interoperability) GHFROOHFWHGHGRQQpHVHWG·LQWHURSpUDELOLWpGHVV\VWqPHV y Increasing the rapidity and effectiveness of EWAR y O·DPpOLRUDWLRQGHODUDSLGLWpHWGHO·HIÀFDFLWpGHODPLVHHQ implementation in both new and ongoing emer- ±XYUH GH O·(:$5 WDQW GDQV OHV VLWXDWLRQV G·XUJHQFH gency settings nouvelles que dans celles qui sont en cours. Consensus was achieved that EWAR should be estab- 8Q FRQVHQVXV V·HVW GpJDJp VXU OD QpFHVVLWp G·pWDEOLU RX GH lished or strengthened as a routine function of the UHQIRUFHU O·(:$5HQ WDQW TXH IRQFWLRQ GH URXWLQH GX V\VWqPH public health surveillance system. During emergencies, de surveillance de la santé publique. Pendant les situations existing EWAR should ideally be scaled up and adapted; G·XUJHQFH O·(:$5 H[LVWDQW GHYUDLW LGpDOHPHQW rWUH pWHQGX HW if needed, new systems can support emergency imple- DGDSWpVLQpFHVVDLUHGHQRXYHDX[V\VWqPHVSHXYHQWVRXWHQLUOH mentation deployments. Further, trainings, monitoring GpSORLHPHQW GH OD PLVH HQ ±XYUH G·XUJHQFH (Q RXWUH GHV and evaluation and operational research were perceived EHVRLQV HQ PDWLqUH GH IRUPDWLRQ GH VXLYL HW G·pYDOXDWLRQ HW needs. A standardized training manual for EWAR imple- GH UHFKHUFKH RSpUDWLRQQHOOH RQW pWp LGHQWLÀpV 8Q PDQXHO GH mentation will be developed, and awareness-raising IRUPDWLRQ VWDQGDUGLVp SRXU OD PLVH HQ ±XYUH GH O·(:$5VHUD training sessions need to be conducted in all WHO élaboré et des sessions de formation à la sensibilisation doivent regions. Collaboration with the Health Data Collabora- rWUHRUJDQLVpHVGDQVWRXWHVOHV5pJLRQVGHO·206/DFROODERUD- tive and laboratory expert groups will be tightened. WLRQDYHF+HDOWK'DWD&ROODERUDWLYHHWOHVJURXSHVG·H[SHUWVGHV With regard to requirements for electronic tools for laboratoires sera resserrée. En ce qui concerne les outils élec- EWAR, a list of minimum requirements, based on the WURQLTXHVSRXUO·(:$5XQHOLVWHGHVH[LJHQFHVPLQLPDOHVEDVpH meeting results, will be priority appraised in a post- sur les conclusions de la réunion, sera évaluée en priorité dans meeting survey. OHFDGUHG·XQHHQTXrWHSRVWUpXQLRQ A second global EWAR technical consultation meeting 8QHGHX[LqPHUpXQLRQGHFRQVXOWDWLRQWHFKQLTXHPRQGLDOHVXU will be held in Cairo, in the fourth quarter of 2018. O·(:$5VHWLHQGUDDX&DLUHGXUDQWOHGHUQLHUWULPHVWUHGH

TSGNQÐ@EÆKH@SHNMR EÆKH@SHNMRÐCDRÐ@TSDTQR a Health Emergencies Programme, World Health Orga- a 3URJUDPPH GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH nization, Geneva (Switzerland); b Health Emergencies 2UJDQLVDWLRQPRQGLDOHGHOD6DQWp*HQqYH 6XLVVH b Programme 3URJUDPPH:+2/\RQ2IÀFH )UDQFH c Health Emer- GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH %XUHDX 206 GH JHQFLHV 3URJUDPPH 5HJLRQDO 2IÀFH IRU WKH (DVWHUQ Lyon (France); c3URJUDPPHGHJHVWLRQGHVVLWXDWLRQVG·XUJHQFH Mediterranean, Cairo (Egypt). (Corresponding author: VDQLWDLUH%XUHDXUpJLRQDOGHO·206SRXUOD0pGLWHUUDQpHRULHQ- Karl Schenkel, [email protected]). tale, Le Caire (Égypte). (Auteur correspondant: Karl Schenkel, [email protected]).

Acknowledgements Remerciements Franck Alexandre, World Health Organization (WHO), Franck Alexandre, Organisation mondiale de la Santé (OMS), Geneva, Switzerland; Kevin Crampton, WHO, Geneva, *HQqYH 6XLVVH .HYLQ&UDPSWRQ206*HQqYH 6XLVVH (PPD Switzerland; Emma Diggle, Save the Children, London, Diggle, Save the Children, Londres (Royaume-Uni); Ray R. Arthur, United Kingdom; Ray R Arthur, Centers for Disease Centers for Disease Control and Prevention (CDC), Atlanta Control and Prevention (CDC), Atlanta, United States; eWDWV8QLVG·$PpULTXH /LQD$ZDGD2UJDQLVDWLRQPRQGLDOHGH Lina Awada, World Organization for Animal Health la santé animale (OIE), Paris (France); Malika Bouhenia, Orga- (OIE), Paris, France; Malika Bouhenia, World Customs nisation mondiale des douanes (OMD) (Yémen); Xavier de 2UJDQL]DWLRQ :&2

Confronting health security Affronter les menaces pesant sur SGQD@SRÐ3GDÐ RH@m/@BHÆBÐ2SQ@SDFXÐ la sécurité sanitaire: Mise en œuvre for Emerging Diseases and Public CDÐK@Ð2SQ@S°FHDÐ RHD /@BHÆPTDÐCDÐL@µSQHRDÐ Health Emergencies to advance core des maladies émergentes et de gestion capacity for the International Health des urgences de santé publique (APSED III) Regulations (2005) pour renforcer les principales capacités requises par le Règlement sanitaire international (2005) Li Ailan,a Babatunde Olowokurea and Takeshi Kasaia Li Ailan,a Babatunde Olowokurea et Takeshi Kasaia

Introduction Introduction 7KHÀUVWHPHUJLQJLQIHFWLRXVGLVHDVHRIWKHWZHQW\ÀUVW /HV\QGURPHUHVSLUDWRLUHDLJXVpYqUH 65$6 TXLV·HVWSURSDJp century that threatened regional and global health secu- jO·pFKHOOHPRQGLDOHjSDUWLUGHO·$VLHHQDpWpODSUHPLqUH rity was severe acute respiratory syndrome (SARS) maladie infectieuse émergente du XXIeVLqFOHjDYRLUPHQDFpOD which spread globally from Asia in 2003.1, 2 There have sécurité sanitaire régionale et mondiale.1, 2'HSXLVORUVG·DXWUHV since been outbreaks of human infection with avian PDODGLHV RQW GRQQp OLHX j GHV ÁDPEpHV LQIHFWLRQV KXPDLQHV LQÁXHQ]DVXEW\SHVSDQGHPLFLQÁXHQ]D $+1 (EROD par certains sous-types des virus grippaux aviaires, grippe virus disease, Middle East respiratory syndrome, dengue, SDQGpPLTXH $+1 PDODGLHjYLUXV(ERODV\QGURPHUHVSL- Zika virus disease, chikungunya and yellow fever.3 ratoire du Moyen-Orient, dengue, maladie à virus Zika, chikun- Regional and global health security has also been JXQ\D HW ÀqYUH MDXQH3 La sécurité sanitaire régionale et

1Ï 1 01ÏFMUÏ?ÏEJM@?JÏCNGBCKGAÏU?QÏQRMNNCB Ï+?LGJ?Ï5&-Ï0CEGML?JÏ-DÍACÏDMPÏRFCÏ 1 SARS: how a global epidemic was stopped. Manille: Bureau régional de l’OMS pour la Méditer- 5CQRCPLÏ .?AGÍAÏ Ï http://iris.wpro.who.int/handle/10665.1/5530, accessed ranée orientale; 2006 (http://iris.wpro.who.int/handle/10665.1/5530, consulté en avril 2018). April 2018). 2 Mackenzie JS and Merianos A. The legacies of SARS – international preparedness 2 Mackenzie JS and Merianos A. The legacies of SARS – international preparedness and readiness ?LBÏPC?BGLCQQÏRMÏPCQNMLBÏRMÏDSRSPCÏRFPC?RQÏGLÏRFCÏ5CQRCPLÏ.?AGÍAÏ0CEGML Ï5CQRCPLÏ RMÏPCQNMLBÏRMÏDSRSPCÏRFPC?RQÏGLÏRFCÏ5CQRCPLÏ.?AGÍAÏ0CEGML Ï5CQRCPLÏ.?AÏ1SPTCGJJÏ0CQNMLQCÏ( Ï Pac Surveill Response J. 2013; 4(3):4–8. doi:10.5365/wpsar.2013.4.2.009 2013; 4(3):4–8. doi:10.5365/wpsar.2013.4.2.009 3 Disease Outbreak News (DONs). Geneva: World Health Organization; 2018 (http:// 3 Disease Outbreak News (DONs). Genève: Organisation mondiale de la Santé; 2018 (http:// www.who.int/csr/don/en/, accessed April 2018). www.who.int/csr/don/en/, consulté en avril 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 273 threatened by natural disasters, including earthquakes, mondiale a également été menacée par des catastrophes natu- cyclones, typhoons and drought.4 relles, notamment des séismes, cyclones, typhons et sécheresses.4 &RXQWULHVDQGDUHDVLQWKH:+2:HVWHUQ3DFLÀF5HJLRQ /HVSD\VHW]RQHVGHOD5pJLRQ206GX3DFLÀTXHRFFLGHQWDORQW have drawn valuable lessons from such events by shar- tiré de précieux enseignements de ces événements en échan- ing experiences and making plans to build and geant des informations sur leurs expériences respectives et en strengthen country capacity to prepare for and respond élaborant des plans de développement et de renforcement de to threats to health security nationally and regionally. leurs capacités de préparation et de riposte aux menaces qui SqVHQWVXUODVpFXULWpVDQLWDLUHjO·pFKHOOHQDWLRQDOHHWUpJLRQDOH The revised International Health Regulations (2005) /H5qJOHPHQWVDQLWDLUHLQWHUQDWLRQDOUpYLVp 56, HVWXQ (IHR) is an international legal instrument that has been instrument juridique pouvant être utilisé par tous les États used by all WHO Member States and the international 0HPEUHVGHO·206DLQVLTXHSDUODFRPPXQDXWpLQWHUQDWLRQDOH community to protect global health security. In the pour préserver la sécurité sanitaire mondiale. La Stratégie Asie- :+2:HVWHUQ 3DFLÀF 5HJLRQ WKH$VLD 3DFLÀF 6WUDWHJ\ 3DFLÀTXHGHPDvWULVHGHVPDODGLHVpPHUJHQWHV $36(' VHUWGH for Emerging Diseases (APSED) serves as a regional FDGUHUpJLRQDOG·DFWLRQHQIDYHXUGHODVpFXULWpVDQLWDLUHQDWLR- framework for action for national, regional and global nale, régionale et mondiale, conformément aux exigences du health security, as required by IHR. RSI. 7KH WK *HQHUDO 3URJUDPPH RI :RUN ² VHWV Le 13e programme général de travail 2019-2023 énonce les orien- RXW :+2·V VWUDWHJLF GLUHFWLRQV YLVLRQ DQG PLVVLRQ WDWLRQV VWUDWpJLTXHV OD YLVLRQ HW OD PLVVLRQ GH O·206 TXL VRQW which are to promote health, keep the world safe and de promouvoir la santé, de préserver la sécurité mondiale et de serve vulnerable people. Its 3 strategic priorities are to servir les populations vulnérables. Ses 3 priorités stratégiques achieve universal health coverage, address health emer- VRQW GH SDUYHQLU j OD FRXYHUWXUH VDQLWDLUH XQLYHUVHOOH G·LQWHU- gencies and promote healthier populations. Thus, health YHQLUGDQVOHVVLWXDWLRQVG·XUJHQFHVDQLWDLUHHWGHSURPRXYRLU security and emergencies continue to be one of WHO la santé des populations. La sécurité et les urgences sanitaires strategic priorities for the next 5 years.5 FRQWLQXHURQW GRQF GH ÀJXUHU SDUPL OHV SULRULWpV VWUDWpJLTXHV GHO·206GDQVOHVDQVjYHQLU5 Implementation of the updated and upgraded Asia /DPLVHHQ±XYUHGHOD6WUDWpJLH$VLH3DFLÀTXHGHPDvWULVHGHV 3DFLÀF 6WUDWHJ\ IRU (PHUJLQJ 'LVHDVHV DQG 3XEOLF maladies émergentes et de gestion des urgences de santé Health Emergencies (or APSED III)6 will ensure that publique (APSED III)6 permettra aux pays de se doter des prin- countries have the core capacities for IHR. It will also cipales capacités requises par le RSI et contribuera à tous les contribute to all the work of the Health Emergencies GRPDLQHV G·DFWLRQ GX 3URJUDPPH GH JHVWLRQ GHV VLWXDWLRQV programme, especially management of infectious G·XUJHQFHVDQLWDLUHHQSDUWLFXOLHUODJHVWLRQGHVULVTXHVLQIHF- KD]DUGVVXFKDVLQÁXHQ]DQDWLRQDOUHJLRQDODQGJOREDO WLHX[FRPPHODJULSSHODVXUYHLOODQFHHWO·pYDOXDWLRQGHVULVTXHV surveillance and risk assessments; public health emer- aux niveaux national, régional et mondial; la préparation à une gency preparedness; risk communication; laboratory urgence de santé publique; la communication sur les risques; capacity; emergency response, including incidents le renforcement des moyens de laboratoire; les interventions management; and integral monitoring and evaluation G·XUJHQFH \ FRPSULV OD JHVWLRQ GHV LQFLGHQWV HW XQ SURFHVVXV of IHR core capacity. Additionally, APSED III will LQWpJUDO GH VXLYL HW G·pYDOXDWLRQ GHV SULQFLSDOHV FDSDFLWpV contribute to achievement of the goals of the General requises par le RSI. Elle contribuera également à la réalisation Programme of Work. GHVREMHFWLIVÀ[pVGDQVOHSURJUDPPHJpQpUDOGHWUDYDLO In this article, we describe this trust-based, collective Le présent article décrit cette approche régionale collective regional approach to achieving IHR core capacity to IRQGpHVXUODFRQÀDQFHTXLYLVHjpWDEOLUOHVSULQFLSDOHVFDSD- detect, report, assess and respond to emerging infec- FLWpV UHTXLVHV SDU OH 56, SRXU GpWHFWHU QRWLÀHU HW pYDOXHU OHV tious diseases and public health emergencies. maladies infectieuses émergentes et les urgences de santé publique, ainsi que pour y répondre.

Confronting threats to health security: Affronter les menaces en matière de sécurité sanitaire: the APSED approach l’approche de l’APSED The IHR, which require that States Parties develop, Le RSI, qui exige que les États Parties établissent, renforcent et strengthen and maintain their core capacity to detect, maintiennent les principales capacités requises pour pouvoir report and respond to public health events in a timely UDSLGHPHQWGpWHFWHUHWQRWLÀHUOHVpYpQHPHQWVGHVDQWpSXEOLTXH

4Ï 5CQRCPLÏ.?AGÍAÏ0CEGML?JÏDP?KCUMPIÏDMPÏ?ARGMLÏDMPÏBGQ?QRCPÏPGQIÏK?L?ECKCLRÏDMPÏ 4Ï 5CQRCPLÏ.?AGÍAÏ0CEGML?JÏDP?KCUMPIÏDMPÏ?ARGMLÏDMPÏBGQ?QRCPÏPGQIÏK?L?ECKCLRÏDMPÏFC?JRF Ï+?LGJJCÏ FC?JRF Ï+?LGJ?Ï5&-Ï0CEGML?JÏ-DÍACÏDMPÏRFCÏ5CQRCPLÏ.?AGÍAÏÏhttp://iris.wpro. Bureau régional de l’OMS pour la Méditerranée orientale; 2015 (http://iris.wpro.who.int/ who.int/handle/10665.1/10927, accessed April 2018). handle/10665.1/10927, consulté en avril 2018). 5 Provisional agenda item 14.9. Reform of WHO’s work in health emergency mana- 5 Point 14.9 de l’ordre du jour provisoire. Réforme de l’action de l’OMS dans la gestion des situa- gement. Sixty-ninth World Health Assembly. Geneva: World Health Organization; tions d’urgence sanitaire. Soixante-neuvième Assemblée mondiale de la Santé. Genève: Orga- 2016 (FRRN ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ 5& =ÌCL NBD accessed nisation mondiale de la Santé; 2016 (FRRN ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ 5& April 2018). A69_30-fr.pdf, consulté en avril 2018). 6Ï QG?Ï.?AGÍAÏQRP?RCEWÏDMPÏCKCPEGLEÏBGQC?QCQÏ?LBÏNS@JGAÏFC?JRFÏCKCPECLAGCQ Ï+?LGJ?Ï 6Ï QG?Ï.?AGÍAÏQRP?RCEWÏDMPÏCKCPEGLEÏBGQC?QCQÏ?LBÏNS@JGAÏFC?JRFÏCKCPECLAGCQ Ï+?LGJJCÏ SPC?SÏ 5&-Ï0CEGML?JÏ-DÍACÏDMPÏRFCÏ5CQRCPLÏ.?AGÍAÏ?LBÏ,CUÏ"CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏ régional de l’OMS pour la Méditerranée orientale and New Delhi: Bureau régional de l’OMS for South-East Asia; 2017 (http://iris.wpro.who.int/handle/10665.1/13654, accessed pour l’Asie du Sud-Est; 2017 (http://iris.wpro.who.int/handle/10665.1/13654, consulté en April 2018). avril 2018). 274 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 manner, came into force in 2007.7$36('ÀUVWLVVXHGLQ et y répondre en temps utile, est entré en vigueur en 2007.7 La 2005, updated in 2010 and upgraded in 2016, guides stratégie APSED, élaborée en 2005, puis mise à jour en 2010 et FRXQWULHV:+2DQGSDUWQHUVLQHIIHFWLYHHIÀFLHQWSUHS- DPpOLRUpHHQIRXUQLWGHVRULHQWDWLRQVDX[SD\VjO·206HWj aration and management of threats to health security ses partenaires pour favoriser une bonne préparation et une and monitoring and evaluating of progress in attaining JHVWLRQHIÀFDFHGHVPHQDFHVSHVDQWVXUODVpFXULWpVDQLWDLUHDLQVL and maintaining their IHR core capacities.6 The TX·XQ VXLYL HW XQH pYDOXDWLRQ GHV SURJUqV DFFRPSOLV GDQV O·pWD- upgraded APSED III is based on lessons from real-world blissement et le maintien des principales capacités requises au events, current global and regional health security and titre du RSI.6 La stratégie actualisée APSED III se fonde sur des the need for capacity-building in a health systems événements réels, la situation mondiale et régionale actuelle en approach to universal health coverage (Figure 1). It is a PDWLqUH GH VpFXULWp VDQLWDLUH HW OD QpFHVVLWp G·XQ UHQIRUFHPHQW common regional framework for ensuring that IHR core GHV FDSDFLWpV GDQV OH FDGUH GH O·DSSURFKH DGRSWpH HQ YXH GH capacites are met and advocates for preparedness before parvenir à la couverture sanitaire universelle, axée sur les and after a threat to health security. Its 6 strategic prin- V\VWqPHV GH VDQWp Figure 1). Cette stratégie constitue un cadre ciples are: régional commun destiné à renforcer les principales capacités requises au titre du RSI et à promouvoir les activités de prépa- UDWLRQDYDQWHWDSUqVODVXUYHQXHG·XQHPHQDFHSRXUODVpFXULWp sanitaire. Elle repose sur 6 principes stratégiques: (1) a generic approach: Generic capacity and a core (1) une approche générale: Pour faire face aux dangers system for preparedness, alert and response are VXVFHSWLEOHVGHGRQQHUOLHXjGHVÁDPEpHVRXGHVSDQGp- essential for addressing any hazard with outbreak mies, il est fondamental que des capacités générales et un or pandemic potential, including preparedness; V\VWqPH GH EDVH GH SUpSDUDWLRQ G·DOHUWH HW GH ULSRVWH surveillance, risk assessment and response; soient en place, comprenant la préparation; la surveillance, adequate laboratory capacity; coordination mecha- O·pYDOXDWLRQGHVULVTXHVHWODULSRVWHGHVPR\HQVGHODER- nisms (to include zoonoses); prevention through ratoire adéquats; un mécanisme de coordination (pour health care; risk communication; regional prepared- inclure les zoonoses); les soins de santé préventifs; la ness, alert and response; and monitoring and eval- FRPPXQLFDWLRQVXUOHVULVTXHVHWOHVXLYLHWO·pYDOXDWLRQ uation. (2) step by step: APSED promotes a step-by-step (2) une approche par étapes: La stratégie APSED privilégie approach towards a common vision of a safer, XQH DSSURFKH SURJUHVVLYH YHUV OD UpDOLVDWLRQ G·XQH YLVLRQ PRUHVHFXUH$VLD3DFLÀFUHJLRQWKDWLVSUHSDUHGWR FRPPXQHGDQVODTXHOOHODUpJLRQGHO·$VLH3DFLÀTXHVHUDLW mitigate the risk and impact of emerging diseases plus sûre et mieux préparée à atténuer les risques et les and public health emergencies with collective conséquences des maladies émergentes et des urgences de responsibility for public health security.6 It is a santé publique, avec une responsabilité collective en framework for capacity development, particularly PDWLqUH GH VpFXULWp VDQLWDLUH6 Elle constitue un cadre de in less developed and more vulnerable countries, renforcement des capacités, en particulier dans les pays and has been used to establish capacity step by les moins avancés et les plus vulnérables, et a été utilisée step, including in setting up surveillance systems SRXU O·pWDEOLVVHPHQW SURJUHVVLI GHV FDSDFLWpV UHTXLVHV for all acute public health events, rapid response QRWDPPHQW SDU OD PLVH HQ SODFH GH V\VWqPHV GH VXUYHLO- WHDPV ÀHOG HSLGHPLRORJ\ WUDLQLQJ SURJUDPPHV ODQFH SRXU GHV pYpQHPHQWV VSpFLÀTXHV OD FRQVWLWXWLRQ and emergency operations centres. G·pTXLSHVG·LQWHUYHQWLRQUDSLGHODFUpDWLRQGHSURJUDPPHV GH IRUPDWLRQ j O·pSLGpPLRORJLH GH WHUUDLQ HW O·pWDEOLVVH- PHQWGHFHQWUHVG·RSpUDWLRQVG·XUJHQFH (3) one framework: APSED advocates “one frame- (3) un cadre unique: /DVWUDWpJLH$36('HQFRXUDJHO·DGRSWLRQ ZRUNµIRUGLVHDVHDQGKD]DUGVSHFLÀFSURMHFWVDQG G·XQFDGUHXQLTXHDSSOLFDEOHDX[GLIIpUHQWVSURMHWVGHOXWWH SDQGHPLF LQÁXHQ]D SUHSDUHGQHVV WR LPSURYH FRQWUHGHVPDODGLHVHWGHVGDQJHUVVSpFLÀTXHVDLQVLTX·j coordination among partners in order to avoid OD SUpSDUDWLRQ j OD JULSSH SDQGpPLTXH DÀQ GH UHQIRUFHU duplication of work and maximize use of limited OD FRRUGLQDWLRQ HQWUH OHV SDUWHQDLUHV G·pYLWHU OHV WUDYDX[ resources. It strengthens dialogue and partner- IDLVDQW GRXEOH HPSORL HW G·RSWLPLVHU O·XWLOLVDWLRQ GH ships among sectors and professionals by provi- ressources limitées. Elle favorise le dialogue et le partena- ding a platform for coordination of activities and riat entre différents secteurs et groupes professionnels en resources. The role of APSED in achieving IHR core offrant une plateforme de coordination des activités. La capacities in the Region has been recognized by FRQWULEXWLRQ GH OD VWUDWpJLH $36(' j O·pWDEOLVVHPHQW GHV Member States and partners including through the principales capacités requises par le RSI dans la Région a annual APSED Technical Advisory Group (TAG) été reconnue par les États Membres et les partenaires, y meetings compris lors des réunions annuelles du Groupe consultatif WHFKQLTXHGHO·$36(' (4) system strengthening and connectivity: APSED (4) renforcement et interconnexion des systèmes: La stratégie brings together surveillance data and technical APSED réunit des données de surveillance et une expertise expertise for response and facilitates collective WHFKQLTXHHQPDWLqUHGHULSRVWHHWIDFLOLWHO·DFWLRQFROOHFWLYH

7 International Health Regulations (2005). Geneva: World Health Organization; 2018 7 Réglement sanitaire international (2005). Genève: Organisation mondiale de la Santé; 2018 (http://www.who.int/ihr/publications/9789241580496/en/, accessed April 2018). (http://www.who.int/ihr/publications/9789241580496/en/, consulté en avril 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 275 Figure 1 Positioning APSED in the broader context of global health Figure 1 Positionnement de la stratégie APSED dans le contexte élargi de la santé mondiale

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* This includes geological and hydro-meteorological hazards. – Cela comprend les risques géologiques et hydro-météorologiques. 1MSPACÏ QG?Ï.?AGÍAÏQRP?RCEWÏDMPÏCKCPEGLEÏBGQC?QCQÏ?LBÏNS@JGAÏFC?JRFÏCKCPECLAGCQ Ï+?LGJ?Ï5&-Ï0CEGML?JÏ-DÍACÏDMPÏRFCÏ5CQRCPLÏ.?AGÍAÏ?LBÏ,CUÏ"CJFGÏ5&-Ï0CEGML?JÏ-DÍACÏDMPÏ1MSRFÌ East Asia; 2017 (http://iris.wpro.who.int/handle/10665.1/13654). – QG?Ï.?AGÍAÏQRP?RCEWÏDMPÏCKCPEGLEÏBGQC?QCQÏ?LBÏNS@JGAÏFC?JRFÏCKCPECLAGCQ Ï+?LGJJCÏ SPC?SÏP¯EGML?JÏBCÏJh-+1ÏNMSPÏ la Méditerranée orientale and New Delhi: Bureau régional de l’OMS pour l’Asie du Sud-Est; 2017 (http://iris.wpro.who.int/handle/10665.1/13654).

national and regional work.6 Thus, countries are aux niveaux national et régional.6 Ainsi, les pays sont mieux better connected for exchanging information, connectés et peuvent échanger des informations, des évalua- conductng risk assessment, early alert and tions des risques, des alertes précoces et des données rela- response, especially in the health sector. For exam- tives à la riposte, en particulier dans le secteur de la santé. ple, an annual regional IHR communication exer- Par exemple, un exercice annuel de communication régio- cise know as “IHR Exercise Crystal” connects all QDOH VXU OH 56, GpQRPPp ©,+5 H[HUFLVH FU\VWDOª DXTXHO 1DWLRQDO ,+5 )RFDO 3RLQWV LQ WKH UHJLRQ DQG WKH participent tous les points focaux nationaux RSI de la WHO IHR regional contact point. The exercise 5pJLRQHWOHSRLQWGHFRQWDFWUpJLRQDO56,GHO·206SHUPHW strengthens the functions of national focal points, de renforcer les fonctions des points focaux nationaux, improves IHR-related risk assessment and event G·DPpOLRUHU O·pYDOXDWLRQ GHV ULVTXHV HW OD FRPPXQLFDWLRQ 276 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 communication and enhances the relationships sur les événements dans le cadre du RSI et de consolider between WHO and Member States. OHVUHODWLRQVHQWUHO·206HWOHVeWDWV0HPEUHV (5) robust monitoring and evaluation: APSED has (5) un processus solide de suivi et d’évaluation: La stratégie facilitated a collective, trust-based monitoring and $36(' D IDFLOLWp OD PLVH HQ ±XYUH G·XQ V\VWqPH GH VXLYL evaluation system, which connects heath security HW G·pYDOXDWLRQ FROOHFWLI IRQGp VXU OD FRQÀDQFH TXL UHOLH components and stakeholders in countries and the les différentes composantes relatives à la sécurité sanitaire 5HJLRQ 1DWLRQDOO\ DQQXDO VWDNHKROGHU PHHWLQJV HW OHV SDUWHQDLUHV GDQV OHV SD\V HW OD 5pJLRQ O·pFKHOOH are held to review IHR status. After action review, nationale, des réunions avec les partenaires sont organi- simulation exercises, and joint external evaluations sées tous les ans pour examiner le statut du RSI. Une fois are conducted at the country level. Regionally, the que le bilan des actions a été établi, des exercices de simu- APSED (TAG meets annually to monitor progress lation effectués et une évaluation externe conjointe sont in achieving IHR core capacities,8 as measured by réalisés au niveau national. Au niveau régional, le groupe responses to outbreaks, answers to the IHR moni- FRQVXOWDWLIWHFKQLTXHGHO·$36('VHUpXQLWXQHIRLVSDUDQ toring questionnaire, and TAG meeting conclusions SRXUVXLYUHOHVSURJUqVDFFRPSOLVGDQVO·pWDEOLVVHPHQWGHV and recommendations.9 principales capacités requises au titre du RSI,8 tels que PHVXUpVSDUOHVLQWHUYHQWLRQVPHQpHVHQULSRVWHDX[ÁDP- bées, les réponses données au questionnaire de suivi du RSI et les conclusions et recommandations du groupe FRQVXOWDWLIWHFKQLTXHGHO·$36('9 (6) joint approach: APSED promotes coordinated (6) approche commune: La stratégie APSED favorise une action joint work among Member States, WHO and part- FRPPXQHFRRUGRQQpHHQWUHOHVeWDWV0HPEUHVO·206HWOHV ners. Recent examples in the Region are joint inves- partenaires. Parmi les exemples récents dans la Région, citons tigations of outbreaks such as multidrug-resistant ODUpDOLVDWLRQG·HQTXrWHVFRPPXQHVVXUOHVÁDPEpHVG·LQIHF- Acinetobacter baumanii in Fiji, and trichinellosis tion multirésistante à Acinetobacter baumanii à Fidji, de in Cambodia;10, 11 joint missions to investigate trichinellose au Cambodge10, 11 HW G·KpSDWLWH $ j 7XYDOX OHV potential public health emergencies of interna- PLVVLRQV G·HQTXrWH FRQMRLQWHV PHQpHV VXU GHV XUJHQFHV WLRQDO FRQFHUQ HJ +1 LQ &KLQD 0LGGOH (DVW potentielles de santé publique de portée internationale (par respiratory syndrome in the Republic of Korea); H[HPSOH +1 HQ &KLQH V\QGURPH UHVSLUDWRLUH GX 0R\HQ joint IHR external evaluations12, 13 and responses to Orient en République de Corée); des évaluations externes public health emergencies. These activities promote conjointes12, 13 de la mise en œuvre du RSI et des interventions learning and technical exchange during real-world de riposte à certaines urgences de santé. Ces activités favo- events. ULVHQWO·DSSUHQWLVVDJHHWO·pFKDQJHG·LQIRUPDWLRQVWHFKQLTXHV GDQVOHFRQWH[WHG·pYpQHPHQWVUpHOV Experience in implementing APSED has demonstrated /·H[SpULHQFH DFTXLVH ORUV GH OD PLVH HQ ±XYUH GH OD VWUDWpJLH the value of the common strategic framework for $36(' D QRQ VHXOHPHQW GpPRQWUp O·XWLOLWp GH FH FDGUH VWUDWp- ongoing system improvement. gique commun, mais a aussi conduit à une amélioration FRQVWDQWHGHVV\VWqPHV

Thinking ahead and moving forward Anticiper et aller de l’avant The world will continue to be caught by “surprises” or /HPRQGHFRQWLQXHUDG·rWUHFRQIURQWpjGHV©VXUSULVHVªRXjGHV “shocks” such as the emergence of a new infectious ©FKRFVª GXV QRWDPPHQW j O·pPHUJHQFH GH QRXYHOOHV PDODGLHV disease or a public health emergency if countries are LQIHFWLHXVHV HW SDUDVLWDLUHV RX j OD VXUYHQXH G·XUJHQFHV GH VDQWp ill-prepared. A common regional and global strategic SXEOLTXHVLOHVSD\VVRQWPDOSUpSDUpV,OHVWLQGLVSHQVDEOHTX·XQH approach is required, with investment in strengthening approche stratégique commune soit mise en œuvre aux niveaux national and international health preparedness to UpJLRQDOHWPRQGLDODVVRUWLHG·LQYHVWLVVHPHQWVGHVWLQpVjUHQIRUFHU respond rapidly in a coordinated manner. O·pWDW GH SUpSDUDWLRQ VDQLWDLUH QDWLRQDO HW LQWHUQDWLRQDO DÀQ GH UpSRQGUHGHPDQLqUHUDSLGHHWFRRUGRQQpHjGHWHOVpYpQHPHQWV

8Ï GÌPCEGML?JÏ+CCRGLEÏMDÏRFCÏ2CAFLGA?JÏ BTGQMPWÏ%PMSNÏMLÏRFCÏ QG?Ï.?AGÍAÏ1RP?RCEWÏDMPÏ 8Ï GÌPCEGML?JÏ+CCRGLEÏMDÏRFCÏ2CAFLGA?JÏ BTGQMPWÏ%PMSNÏMLÏRFCÏ QG?Ï.?AGÍAÏ1RP?RCEWÏDMPÏ#KCPEGLEÏ Emerging Diseases, Manila, Philippines, 28–30 June 2016: meeting report. Manila: Diseases, Manille, Philippines, 28–30 June 2016: meeting report. Manille: Bureau régional de 5&-Ï 0CEGML?JÏ -DÍACÏ DMPÏ RFCÏ 5CQRCPLÏ .?AGÍAÏ Ï http://iris.wpro.who.int/ l’OMS pour la Méditerranée orientale; 2016 (http://iris.wpro.who.int/handle/10665.1/13438, handle/10665.1/13438, accessed April 2018). consulté en avril 2018). 9Ï QG?Ï.?AGÍAÏQRP?RCEWÏDMPÏCKCPEGLEÏBGQC?QCQÏNPMEPCQQÏPCNMPRÏÏQCASPGLEÏPCEGM- 9Ï QG?Ï .?AGÍAÏ QRP?RCEWÏ DMPÏ CKCPEGLEÏ BGQC?QCQÏ NPMEPCQQÏ PCNMPRÏ Ï QCASPGLEÏ PCEGML?JÏ FC?JRF Ï L?JÏFC?JRF Ï+?LGJ?Ï5&-Ï0CEGML?JÏ-DÍACÏDMPÏRFCÏ5CQRCPLÏ.?AGÍAÏÏhttp://iris. Manille: Bureau régional de l’OMS pour la Méditerranée orientale; 2015 (http://iris.wpro.who. wpro.who.int/bitstream/handle/10665.1/11765/9789290617310_eng.pdf?ua=1, int/bitstream/handle/10665.1/11765/9789290617310_eng.pdf?ua=1, consulté en avril 2018). accessed April 2018). 10 Movono L. WHO provides outbreak support. The Fiji Times 26 Jun 2017 (http://www. 10 Movono L. WHO provides outbreak support. The Fiji Times 26 Jun 2017 (FRRN UUU ÍHGRGKCQ AMK ÍHGRGKCQ AMK QRMPW ?QNVGB, accessed April 2018). story.aspx?id=406281, consulté en avril 2018). 11 After Action Review. Geneva: World Health Organization; 2018 (https://extranet. 11 After Action Review. Genève: Organisation mondiale de la Santé; 2018 (https://extranet.who. who.int/sph/after-action-review, accessed April 2018). int/sph/after-action-review, consulté en avril 2018). 12 Strategic Partnership Portal. Geneva: World Health Organization: 2018 (https://ex- 12 Strategic Partnership Portal. Genève: Organisation mondiale de la Santé: 2018 (https://extranet. tranet.who.int/spp/, accessed April 2018). who.int/spp/, consulté en avril 2018). 13Ï 5&-Ï5CQRCPLÏ.?AGÍAÏ0CEGMLÏ(##ÏKGQQGMLÏPCNMPRQ Ï%CLCT?Ï5MPJBÏ&C?JRFÏ-PE?LGX?- 13Ï 5&-Ï5CQRCPLÏ.?AGÍAÏ0CEGMLÏ(##ÏKGQQGMLÏPCNMPRQ Ï%CL®TCÏ-PE?LGQ?RGMLÏKMLBG?JCÏBCÏJ?Ï1?LR¯Ï tion; 2018 (FRRN UUU UFM GLR GFP NPMACBSPCQ KGQQGMLÌPCNMPRQÌUCQRCPLÌN?AGÍA 2018 (FRRN UUU UFM GLR GFP NPMACBSPCQ KGQQGMLÌPCNMPRQÌUCQRCPLÌN?AGÍA CL consulté en avril en/, accessed April 2018). 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 277 Initiatives that provide a broader context for health Certaines initiatives, dans lesquelles les questions de sécurité sani- security and emergencies that have implications for taire et de gestion des urgences sont abordées dans un contexte APSED include: the Sustainable Development Goals, plus général, ont une incidence sur la stratégie APSED, notamment: universal health coverage, the Sendai Framework for les objectifs de développement durable, la couverture sanitaire 'LDVWHU 5LVN 5HGXFDWLRQ ² WKH *OREDO +HDOWK universelle, le Cadre de Sendai pour la réduction des risques de Security Agenda; the WHO Health Emergencies FDWDVWURSKHOH3URJUDPPHG·DFWLRQSRXUODVpFXULWpVDQL- programme; the global strategic plan to improve public WDLUHPRQGLDOHOH3URJUDPPH206GHJHVWLRQGHVVLWXDWLRQVG·XU- health preparedness and response; and One Health.6 gence sanitaire, le plan stratégique mondial pour améliorer la prépa- These new opportunities for capacity development have UDWLRQ HW O·DFWLRQ GH VDQWp SXEOLTXH HW O·LQLWLDWLYH ©8Q PRQGH Une been taken into account to ensure that APSED is a rele- santé».6 Ces nouvelles possibilités de renforcement des capacités ont vant, effective strategy for preparing Member States for pWp SULVHV HQ FRPSWH DÀQ GH YHLOOHU j OD SHUWLQHQFH HW j O·HIÀFDFLWp emergencies, although they also pose challenges.8 de la stratégie APSED pour préparer les États Membres aux situa- WLRQVG·XUJHQFHELHQTX·HOOHVSRVHQWpJDOHPHQWGHVGLIÀFXOWpV8 Experience and lessons learnt suggest at least 3 inter- /HVHQVHLJQHPHQWVWLUpVGHO·H[SpULHQFHIRQWUHVVRUWLUDXPRLQV linked priorities based on the APSED approach that SULRULWpVLQWHUGpSHQGDQWHVIRQGpHVVXUO·DSSURFKH$36('TXL could be used to advance global capacity for health pourraient être utilisées pour améliorer les capacités mondiales security. HQPDWLqUHGHVpFXULWpVDQLWDLUH 1. Upgrade national alert and response systems for 1. Mise à niveau des systèmes nationaux d’alerte et de threats to health security: All countries should riposte aux menaces pesant sur la sécurité sanitaire: Tous continue or invest in further developing, sustain- OHV SD\V GHYUDLHQW FRQWLQXHU G·LQYHVWLU GDQV OH GpYHORSSH- ing and advancing national core capacities required ment, le maintien et le renforcement des principales capa- under IHR. APSED serves as a common regional FLWpVQDWLRQDOHVUHTXLVHVDXWLWUHGX56,/·$36('HVWXWLOLVp framework and a means for sharing information, FRPPHFDGUHUpJLRQDOFRPPXQHWSHUPHWO·pFKDQJHG·LQIRU- identifying priorities, facilitating stakeholder PDWLRQ O·LGHQWLÀFDWLRQ GHV SULRULWpV XQH FROODERUDWLRQ HW collaboration and coordination and joint planning une coordination plus aisée entre les partenaires et la réali- and monitoring activities. The regional framework VDWLRQ G·DFWLYLWpV FRQMRLQWHV GH SODQLÀFDWLRQ HW GH VXLYL /H LVÁH[LEOHZLWKUHJDUGWRLPSOHPHQWDWLRQDWFRXQ- cadre régionau peut être appliqué avec souplesse dans try and regional level and can be adjusted to les pays et les régions, et notamment être adaptés pour se comply with any new global development, such as conformer à toute nouvelle initiative mondiale, telle que the 5-year global strategic plan to improve public le plan stratégique quinquennal mondial pour améliorer la health emergency preparedness and response. SUpSDUDWLRQHWO·DFWLRQGHVDQWpSXEOLTXH 2. Invest in stronger global intelligence, risk assess- 2. Investissement dans des systèmes mondiaux plus solides ment and response systems: The APSED frame- de renseignement, d’évaluation des risques et de riposte: work supports development of functional regional Le cadre APSED favorise la mise en place, aux niveaux and global event-based surveillance and risk UpJLRQDOHWPRQGLDOGHV\VWqPHVIRQFWLRQQHOVG·pYDOXDWLRQ assessment systems that connect national and des risques et de surveillance fondée sur les événements regional alert and response systems for timely TXLUHOLHQWOHVV\VWqPHVQDWLRQDX[HWUpJLRQDX[G·DOHUWHHW information-sharing, early alert and joint risk GH ULSRVWH SHUPHWWDQW O·pFKDQJH UDSLGH G·LQIRUPDWLRQV assessments. The Global Outbreak Alert and O·pPLVVLRQG·DOHUWHVSUpFRFHVHWODUpDOLVDWLRQG·pYDOXDWLRQV 5HVSRQVH1HWZRUNFDQEHXVHGWRVXSSRUWQDWLRQDO FRQMRLQWHVGHVULVTXHV/H5pVHDXPRQGLDO206G·DOHUWHHW regional and global capacity with deployment of G·DFWLRQHQFDVG·pSLGpPLHSHXWrWUHXWLOLVpSRXUDSSX\HU trained emergency medical and public health les capacités nationales, régionales et mondiales, avec le teams in order to support a rapid response to a GpSORLHPHQW G·pTXLSHV PpGLFDOHV G·XUJHQFH HW GH SHUVRQ- public health emergencies. This will allow de-esca- QHOV GH VDQWp SXEOLTXH TXDOLÀpV DÀQ GH SHUPHWWUH XQH lation of an infectious disease outbreak or public riposte rapide aux urgences de santé publique. Cette health emergency that has the potential to become DSSURFKH SHUPHW GH GpVDPRUFHU OHV ÁDPEpHV GH PDODGLH a humanitarian crisis. infectieuse ou les urgences de santé publique susceptibles de donner lieu à une crise humanitaire. 3. Use stronger mechanisms for monitoring and 3. Utilisation de mécanismes plus robustes de suivi et d’éva- evaluation: Management of threats to health secu- luation: Dans notre monde interdépendant, la gestion des rity are becoming more complex in our intercon- menaces à la sécurité sanitaire devient de plus en plus nected world, and a system for monitoring and FRPSOH[HHWODPLVHHQ±XYUHG·XQV\VWqPHGHVXLYLHWG·pYD- evaluating IHR core capacity is essential. APSED luation des principales capacités requises au titre du RSI est promotes use of the IHR monitoring and evalua- HVVHQWLHOOH /D VWUDWpJLH $36(' HQFRXUDJH O·XWLOLVDWLRQ GX WLRQIUDPHZRUNZLWKÁH[LELOLW\LQLWVXVHLQFRXQ- FDGUHGHVXLYLHWG·pYDOXDWLRQGX56,TXLSHXWrWUHDSSOLTXp WULHVVXFKDVDWDLORUHGDSSURDFKIRUVPDOO3DFLÀF DYHFVRXSOHVVHGDQVOHVSD\VSDUH[HPSOHHQO·DGDSWDQWDX[ Island countries14 APSED mechanisms that can be EHVRLQV GHV SHWLWV SD\V LQVXODLUHV GX 3DFLÀTXH14 Parmi les used to further strengthen monitoring and evalu- mécanismes APSED pouvant être employés pour renforcer ation include Region-wide simulation exercises, HQFRUHOHVXLYLHWO·pYDOXDWLRQÀJXUHQWGHVH[HUFLFHVGHVLPX-

14 IHR Monitoring and Evaluation Framework. Geneva: World Health Organization; 14 IHR Monitoring and Evaluation Framework. Genève: Organisation mondiale de la Santé; 2018 2018 (https://extranet.who.int/sph/ihrmef, accessed April 2018). (https://extranet.who.int/sph/ihrmef, consulté en avril 2018). 278 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 national stakeholder planning and review, annual ODWLRQ j O·pFKHOOH UpJLRQDOH XQH SODQLÀFDWLRQ HW XQ H[DPHQ TAG meeting which includes the regional forum menés au niveau national par les partenaires et une coor- for heath security. dination régionale des partenariats, comme dans le cadre du forum pour la sécurité sanitaire. The APSED III approach to advance implementauion of /·DSSURFKH$36(',,,SRXUDYDQFHUjVDYRLUODPLVHHQ±XYUH the IHR (2005), has been embraced by Member States du RSI (2005), a été favorablement accueillie par les États DQGGHYHORSPHQWSDUWQHUVLQWKH:HVWHUQ3DFLÀF5HJLRQ Membres et les partenaires de développement de la Région du as a framework for the development and regular moni- 3DFLÀTXH RFFLGHQWDO TXL OD FRQVLGqUHQW FRPPH XQ FDGUH toring of robust preparedness and response capacity. SHUPHWWDQW O·pWDEOLVVHPHQW HW OH VXLYL UpJXOLHU GH FDSDFLWpV Continuing public health emergencies and the need for solides de préparation et de riposte. Face aux urgences de santé preparedness and a robust response to future global publique qui ne cessent de se déclarer et compte tenu de la health security threats require continued investment at nécessité de garantir un bon état de préparation et une riposte all levels to develop, strengthen and sustain national vigoureuse aux futures menaces pesant sur la sécurité sanitaire and international health systems. PRQGLDOHGHVLQYHVWLVVHPHQWVGHYURQWFRQWLQXHUG·rWUHFRQVHQ- tis à tous les niveaux pour développer, renforcer et pérenniser OHVV\VWqPHVGHVDQWpQDWLRQDX[HWLQWHUQDWLRQDX[

TSGNQÐ@EÆKH@SHNMRÐ EÆKH@SHNMRÐCDRÐ@TSDTQRÐ :RUOG+HDOWK2UJDQL]DWLRQ5HJLRQDO2IÀFHIRUWKH:HVW- 2UJDQLVDWLRQPRQGLDOHGHOD6DQWp%XUHDXUpJLRQDOGX3DFLÀTXH HUQ3DFLÀF0DQLOD3KLOLSSLQHV &RUUHVSRQGLQJDXWKRU occidental, Manille, Philippines (Auteur correspondant: Li Ailan, Li Ailan, Regional Emergency Director, [email protected]). 'LUHFWHXUUpJLRQDOSRXUOHVVLWXDWLRQVG·XUJHQFH[email protected]).

Acknowledgements Remerciements The authors would like to thank the collective efforts Les auteurs souhaitent remercier les efforts collectifs fournis of the Member States, partners and WHO in develop- SDUOHVeWDWV0HPEUHVOHVSDUWHQDLUHVHWO·206TXLRQWSHUPLV LQJ DQG LPSOHPHQWLQJ WKH $VLD 3DFLÀF 6WUDWHJ\ IRU le développement et la mise en œuvre de la Stratégie Asie- Emerging Diseases and Public Health Emergencies to 3DFLÀTXHGHPDvWULVHGHVPDODGLHVpPHUJHQWHVHWGHJHVWLRQGHV advance the International Health Regulations for health XUJHQFHV GH VDQWp SXEOLTXH DÀQ GH UHQIRUFHU OHV SULQFLSDOHV security. Ⅲ FDSDFLWpV UHTXLVHV SDU OH 5qJOHPHQW VDQLWDLUH LQWHUQDWLRQDO HQPDWLqUHGHVpFXULWpVDQLWDLUHⅢ

Adapting the Incident Management Adaptation du système de gestion System for response to health des incidents à la riposte dans les situations emergencies – early experience d’urgence sanitaire – premières of WHO expériences du système par l’OMS Richard Brennan,a Robert Holden,a Paul Cox,a Ibrahima Socé Fall,b Richard Brennan,a Robert Holden,a Paul Cox,a Ibrahima Socé Fall,b Michel Michel Thierenc and Jorge Castilla-Echeniquea Thierenb et Jorge Castilla-Echeniquea

Introduction and background Introduction et informations générales 7KH (EROD YLUXV RXWEUHDN LQ :HVW$IULFD LQ ² /D ÁDPEpH GH YLUXV (EROD HQ$IULTXH GH O·2XHVW HQ UHYHDOHG PDMRU GHÀFLHQFLHV LQ WKH ZRUOG·V FDSDFLW\ WR a mis à jour des carences majeures dans la capacité du monde prevent, detect, prepare for and respond to disease jSUpYHQLUjGpWHFWHUGHVÁDPEpHVpSLGpPLTXHVV·\SUpSDUHUHW outbreaks. WHO was particularly criticized for not \ULSRVWHU/·206DpWpSDUWLFXOLqUHPHQWFULWLTXpHjFHWWHRFFD- having the structure, procedures or resources to prepare VLRQ/HSULQFLSDOFRPPHQWDLUHDpWpTX·HOOHQ·DYDLWSDVODVWUXF- for or respond to outbreaks effectively.² Recommenda- ture, les procédures ou les ressources pour se préparer à des WLRQV ZHUH PDGH WR VWUHQJWKHQ :+2·V RSHUDWLRQDO ÁDPEpHVRXSRXU\ULSRVWHUHIÀFDFHPHQW² Des recommanda-

1 Report of the Ebola Interim Assessment Panel. Geneva: World Health Organization; 1 Rapport du Groupe d’experts chargé de l’évaluation intérimaire de la riposte à Ebola. Genève, 2015 (http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/, Organisation mondiale de la Santé, 2015 (http://www.who.int/csr/resources/publications/ebola/ accessed April 2018). ebola-panel-report/fr/, consulté en avril 2018). 2 Moon S, Sridhar D, Pate M et al. Will Ebola change the game? Ten essential reforms 2 Moon S, Sridhar D, Pate M et al. Will Ebola change the game? Ten essential reforms before the before the next pandemic. The report of the Harvard-LSHTM Independent Panel on next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to the Global Response to Ebola. Lancet 2015; 386: 2204–21. Ebola. Lancet 2015; 386: 2204–21. 3 Commission on a global health risk framework for the future. The neglected dimen- 3 Commission on a global health risk framework for the future. The neglected dimension of global sion of global security: a framework to counter infectious disease crises. Washington security: a framework to counter infectious disease crises. Washington DC, National Academies DC: National Academies of Medicine; 2016 (https://nam.edu/wp-content/ of Medicine, 2016 (https://nam.edu/wp-content/uploads/2016/01/Neglected-Dimension-of- uploads/2016/01/Neglected-Dimension-of-Global-Security.pdf, accessed April 2018). Global-Security.pdf, consulté en avril 2018). 4 High-level Panel on the Global Response to Health Crises. Protecting humanity from 4 Groupe de haut niveau sur l’action mondiale face aux crises sanitaires. Protéger l’humanité future health crises. New York City (NY): United Nations; 2016 (http://www.un.org/ contre les crises sanitaires futures. New York (NY), Nations Unies, 2016 (http://www.un.org/ News/dh/infocus/HLP/2016-02-05_Final_Report_Global_Response_to_Health_ ga/search/view_doc.asp?symbol=A/70/723&referer=/english/&Lang=F, consulté en avril Crises.pdf, accessed April 2018). 2018). 5 CDC emergency operations center: How an EOC works. Atlanta (GA): Centers for 5 CDC emergency operations center: How an EOC works. Atlanta (GA), Centers for Disease Disease Control and Prevention; 2016 (https://www.cdc.gov/phpr/eoc/how-eoc- Control and Prevention, 2016 (https://www.cdc.gov/phpr/eoc/how-eoc-works.htm, consulté en works.htm, accessed April 2018). avril 2018).

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 279 capacity and to establish a dedicated programme for tions ont été faites pour renforcer la capacité opérationnelle de WKH2UJDQL]DWLRQ·VHPHUJHQF\ZRUN O·2UJDQLVDWLRQHWSRXUPHWWUHHQSODFHXQSURJUDPPHFRQVDFUp jO·DFWLRQG·XUJHQFHGHO·206 Since the establishment of the WHO Health Emergen- Depuis la création du Programme OMS de gestion des situa- FLHVSURJUDPPHLQWKH2UJDQL]DWLRQ·VDSSURDFKWR WLRQVG·XUJHQFHVDQLWDLUHHQODGpPDUFKHGHO·2UJDQLVDWLRQ HPHUJHQF\ PDQDJHPHQW KDV EHHQ UHGHÀQHG $ NH\ V·HVWSURIHVVLRQQDOLVpHHQPDWLqUHGHJHVWLRQGHVXUJHQFHV/·XQ development is adoption of the Incident Management GHV SURJUqV HVVHQWLHOV D pWp O·DGRSWLRQ GX V\VWqPH GH JHVWLRQ 6\VWHP ,06 DVWKH2UJDQL]DWLRQ·VDSSURDFKWRPDQDJ- GHVLQFLGHQWVHQWDQWTXHPpWKRGHGHO·2UJDQLVDWLRQSRXUJpUHU ing responses to acute emergencies, regardless of hazard OHVLQWHUYHQWLRQVGDQVOHVVLWXDWLRQVG·XUJHQFHDLJXsTXHOTX·HQ W\SH VXFK DV RXWEUHDNV FRQÁLFWV QDWXUDO GLVDVWHUV VRLWOHW\SHTX·LOV·DJLVVHGHÁDPEpHVpSLGpPLTXHVGHFRQÁLWV chemical and radionuclear exposures and food contam- de catastrophes naturelles, de déversement de polluants ination. The purpose of this paper is to describe how chimiques ou radioactifs ou encore de contamination alimen- WHO has adapted IMS to its own context and early WDLUH /H SUpVHQW DUWLFOH D SRXU EXW GH GpFULUH FRPPHQW O·206 experience and lessons learnt with its use. DDGDSWpOHV\VWqPHGHJHVWLRQGHVLQFLGHQWVjVDSURSUHVLWXD- WLRQ DLQVL TXH OHV SUHPLqUHV H[SpULHQFHV HW OHV HQVHLJQHPHQWV à tirer de son utilisation.

WHO’s adaptation of the Incident Management Adaptation du système de gestion des incidents par System l’OMS IMS is an internationally recognized best-practice &HV\VWqPHUHSUpVHQWHXQHGpPDUFKHUHFRQQXHVXUOHSODQLQWHU- approach to managing responses to emergencies. It national et une meilleure pratique pour gérer les interventions LQFOXGHV VWDQGDUGL]HG ÁH[LEOH VWUXFWXUHV DQG SURFH- GDQV OHV VLWXDWLRQV G·XUJHQFH ,O FRPSRUWH GHV VWUXFWXUHV HW GXUHV IRU PRUH SUHGLFWDEOH WLPHO\ HIIHFWLYH HIÀFLHQW RXWLOV VWDQGDUGLVpV HW ÁH[LEOHV SRXU GHV LQWHUYHQWLRQV SOXV response management. IMS was developed by the United SUpYLVLEOHVUDSLGHVHIÀFDFHVHWHIÀFLHQWHV,ODpWpPLVDXSRLQW States Fire Service in the 1990s to improve emergency dans les années 1990 par le Fire ServiceGHVeWDWV8QLVG·$Pp- operations, after it was found that the existing systems rique (Service de lutte contre les incendies) pour améliorer les did not perform optimally. IMS has since been adopted RSpUDWLRQVG·XUJHQFHDSUqVDYRLUFRQVWDWpTXHOHVV\VWqPHVH[LV- by many emergency agencies worldwide, including WDQWVQHIRQFWLRQQDLHQWSDVGHPDQLqUHRSWLPDOH/HV\VWqPHD public health institutions5 and health ministries.6 To our HQVXLWHpWpDGRSWpSDUGHQRPEUHX[RUJDQLVPHVG·LQWHUYHQWLRQ NQRZOHGJH:+2LVWKHÀUVWPDMRULQWHUQDWLRQDODJHQF\ G·XUJHQFHGDQVOHPRQGHHQWLHUGRQWGHVLQVWLWXWLRQVGHVDQWp to formally adopt the system. publique5HWGHVPLQLVWqUHVGHODVDQWp6 À notre connaissance, O·206 HVW OD SUHPLqUH LQVWLWXWLRQ LQWHUQDWLRQDOH PDMHXUH j DGRSWHURIÀFLHOOHPHQWOHV\VWqPH The concepts and principles central to IMS include: &RQFHSWVHWSULQFLSHVHVVHQWLHOVGXV\VWqPHGHJHVWLRQGHVLQFL- dents: y Standardized emergency functions: common y )RQFWLRQV G·XUJHQFH VWDQGDUGLVpHV GHV IRQFWLRQV PDQDJHPHQW IXQFWLRQV FDQ EH LGHQWLÀHG IRU DQ\ FRPPXQHVGHJHVWLRQSHXYHQWrWUHLGHQWLÀpHVSRXUWRXWHV emergency response. For WHO, the primary IMS OHVLQWHUYHQWLRQVG·XUJHQFH3RXUO·206FHVIRQFWLRQVVRQW functions are leadership, partner coordination, ODGLUHFWLRQODFRRUGLQDWLRQGHVSDUWHQDLUHVO·LQIRUPDWLRQ information and planning, health operations and HW OD SODQLÀFDWLRQ OHV RSpUDWLRQV VDQLWDLUHV HW O·H[SHUWLVH technical expertise, operations support and logistics, WHFKQLTXHO·DSSXLRSpUDWLRQQHOHWODORJLVWLTXHOHVÀQDQFHV ÀQDQFH DQG DGPLQLVWUDWLRQ 7KHVH IXQFWLRQV DUH HW O·DGPLQLVWUDWLRQ &HV IRQFWLRQV VRQW UpXQLHV GDQV XQH EURXJKWWRJHWKHULQDXQLÀHGVWUXFWXUH Figure 1). VWUXFWXUHXQLÀpH Figure 1). y Flexibility, adaptability and scalability: the IMS is y )OH[LELOLWpDGDSWDELOLWpHWH[WHQVLELOLWpOHV\VWqPHV·DSSOLTXH applicable to all types and scales of emergencies. aux urgences de tout type et de toute grandeur. On peut It can be adapted to a given context while main- O·DGDSWHUjXQFRQWH[WHGRQQpWRXWHQPDLQWHQDQWODSUpYL- taining predictability. The response structure can sibilité. La structure de la riposte peut être étendue ou be expanded or contracted as needed, with sub- FRQWUDFWpHVHORQOHVEHVRLQVDYHFO·DGGLWLRQRXOHUHWUDLWGH functions added or removed. Similarly, the number fonctions secondaires. De même, le nombre de personnels of staff designated for each function is scalable. GpVLJQpVSRXUFKDTXHIRQFWLRQGpSHQGGHO·pFKHOOHUHTXLVH y Emergencies are best managed when resources are y /HVVLWXDWLRQVG·XUJHQFHVRQWJpUpHVDXPLHX[ORUVTXHOHV deployed as close to the event as possible. Hence, UHVVRXUFHVVRQWGpSOR\pHVOHSOXVSUqVSRVVLEOHGHO·pYpQH- WHO aims to locate the IMS and other key human PHQW3DUFRQVpTXHQWO·206ORFDOLVHOHV\VWqPHGHJHVWLRQ and material resources close to the operational site. GHV LQFLGHQWV HW G·DXWUHV UHVVRXUFHV KXPDLQHV HW PDWp- ULHOOHVHVVHQWLHOOHVSUqVGXVLWHRSpUDWLRQQHOSDVGDQVXQH capitale ou un centre opérationnel éloigné.

6 National framework for health emergency management: guideline for program 6 National framework for health emergency management: guideline for program development. development. Ottawa: Network on Emergency Preparedness and Response; 2004 Ottawa, Network on Emergency Preparedness and Response, 2004 (http://www.pbphpc.org/ (http://www.pbphpc.org/wp-content/uploads/2012/01/National-Framework-for- wp-content/uploads/2012/01/National-Framework-for-Health-Emergency-Management-PHAC. Health-Emergency-Management-PHAC.pdf, accessed April 2018). pdf, consulté en avril 2018). 280 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Figure 1 WHO’s Incident Management System: primary functions and subfunctions Figure 1 Système OMS de gestion des incidents: fonctions essentielles et secondaires

Leadership / Incident management – Direction/gestion des incidents

Health operations Operations Partner Information and technical Finance and support and coordination – and planning – expertise – administration logistics – Appui Coordination des Information et Opérations sani- – Finances et opérationnel et partenaires NJ?LGÍA?RGML taires et expertise administration logistique technique

Staff health, Prevention Supply chain Finance Health & inter- well being and control management budgets/grants sectoral coordi- & security measures – – Gestion management – nation – Santé Information – Santé, bien- Mesures de de la chaîne Finance, et coordination être et sécurité prévention et d’approvision- budget/gestion intersectorielle du personnel de lutte nement des subventions

• Risk and needs Risk commu- Communica- assessment – Liaison nication & tions Évaluation du risque et des community engagement besoins Field support – Commu- Procurement – • Early warning – Appui sur le and surveillance nication sur Achats External le risque et terrain relations – – Alerte précoce et surveillance engagement Relations des commu- extérieures • Monitoring and evalua- nautés tion – Suivi et évaluation EOC* manage- Human • Information pro- Health service ment – resources ducts – Produits delivery – Health logistics Gestion des & surge – d’information Prestation des – Logistique de COU* Ressources services de la santé humaines et santé mobilisation

Technical ex- Planning – pertise, science .J?LGÍA?RGML & research – Expertise technique, science et recherche

• Strategic and Research and operational development planning – – Recherche et .J?LGÍA?RGMLÏ développement stratégique et opérationnelle • Project management Training of – Gestion de health staff – projet Formation des personnels * EOC: emergency operations centre – de santé COU: centre des opérations d’urgence

RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 281 y Interoperability: application of the IMS should y ,QWHURSpUDELOLWpO·DSSOLFDWLRQGXV\VWqPHGRLWSHUPHWWUHj allow WHO to interact and work more effectively O·206GHVLQWHUDFWLRQVHWGHVFROODERUDWLRQVSOXVHIÀFDFHV with operational partners. avec les partenaires opérationnels. :+2·VDSSOLFDWLRQRIWKH,06LVGHVFULEHGLQGHWDLOLQ /·DSSOLFDWLRQGXV\VWqPHGHJHVWLRQGHVLQFLGHQWVSDUO·206HVW the Emergency Response Framework II (ERF II).7 GpFULWHHQGpWDLOGDQVOH&DGUHG·DFWLRQG·XUJHQFH,, (5),, 7

Early experience with IMS Premières expériences du système :+2ÀUVWXVHGWKH,06DWFRXQWU\OHYHOLQUHVSRQVHWR /·206 D XWLOLVp OH V\VWqPH GH JHVWLRQ GHV LQFLGHQWV SRXU OD the yellow fever outbreak in 2016. It was also used at SUHPLqUHIRLVORUVGHODULSRVWHjODÁDPEpHGHÀqYUHMDXQHHQ UHJLRQDODQGKHDGTXDUWHUVRIÀFHVLQHDUO\WRHQVXUH 2016. Il a également été employé dans les bureaux régionaux et D XQLÀHG :+2 JOREDO UHVSRQVH WR WKH =LND YLUXV DX6LqJHGpEXWSRXUJDUDQWLUXQHDFWLRQPRQGLDOHXQLÀpH outbreak, which had affected over 60 countries by the GHO·206FRQWUHODÁDPEpHGHYLUXV=LNDTXLV·pWDLWpWHQGXHj middle of that year. Experiences from both outbreaks SOXVGHSD\VHQPLOLHXG·DQQpH/HVH[SpULHQFHVWLUpHVGHFHV provided valuable information on how WHO should GHX[ÁDPEpHVRQWIRXUQLGHVLQIRUPDWLRQVXWLOHVSRXULQGLTXHU adapt the IMS to its own needs and context, which j O·206 FRPPHQW DGDSWHU OH V\VWqPH j VHV SURSUHV EHVRLQV HW IRUPHG WKH EDVLV IRU:+2·V DSSOLFDWLRQ RI WKH ,06 DV j VRQ FRQWH[WH FH TXL D FRQVWLWXp OD EDVH GH O·DSSOLFDWLRQ GX outlined in the ERF II. V\VWqPH SDU O·206 FRPPH F·HVW GpFULW GDQV OH &DGUH G·DFWLRQ G·XUJHQFH,, (5),, Since then, the IMS has been used consistently in acute 'HSXLV ORUV OH V\VWqPH GH JHVWLRQ GHV LQFLGHQWV D pWp UpJXOLq- emergencies (e.g. Ebola virus disease in the Democratic UHPHQWXWLOLVpGDQVOHVVLWXDWLRQVG·XUJHQFHDLJXs SDUH[HPSOH Republic of the Congo, plague in Madagascar, the la maladie à virus Ebola en République démocratique du Congo, Rohingya crisis in Bangladesh), and its principles have la peste à Madagascar, la crise des Rohingyas au Bangladesh) even been adapted for some protracted emergencies HW VHV SULQFLSHV RQW PrPH pWp DGDSWpV j GHV VLWXDWLRQV G·XU- (e.g. in Yemen). In all these settings, IMS has provided gence prolongée (comme au Yémen). Dans tous ces cadres, le a consistent operational structure and promoted a more V\VWqPH D IRXUQL XQH VWUXFWXUH RSpUDWLRQQHOOH FRKpUHQWH HW D SUHGLFWDEOH UHVSRQVH E\ :+2 ² DOWKRXJK QRW ZLWKRXW IDYRULVp XQH ULSRVWH SOXV SUpYLVLEOH GH OD SDUW GH O·206 QRQ some challenges. One of the most effective applications VDQV TXHOTXHV GLIÀFXOWpV WRXWHIRLV /·XQH GHV DSSOLFDWLRQV OHV was in response to the humanitarian crisis in northern SOXVHIÀFDFHVDpWpO·LQWHUYHQWLRQGDQVODFULVHKXPDQLWDLUHDX 1LJHULD Box 1). QRUGGX1LJpULD Encadré 1).

1DÇDBSHMFÐNMÐKDRRNMRÐKD@QMS 1°ÇDWHNMÐRTQÐKDRÐDMRDHFMDLDMSRÐSHQ°R Since 2016, WHO has applied the IMS in response to 'HSXLV O·206 D DSSOLTXp OH V\VWqPH GH JHVWLRQ GHV LQFL- RXWEUHDNVQDWXUDOGLVDVWHUVFRQÁLFWVDQGDFXWHSRSXOD- GHQWV SRXU LQWHUYHQLU ORUV GH ÁDPEpHV pSLGpPLTXHV GH FDWDV- tion displacements. WHO is still adapting IMS to its WURSKHV QDWXUHOOHV GH FRQÁLWV HW GH GpSODFHPHQWV PDVVLIV GHV operational contexts and needs, but has already learnt SRSXODWLRQV(OOHFRQWLQXHG·DGDSWHUFHV\VWqPHjVRQFRQWH[WH important lessons. et à ses besoins opérationnels, mais elle en a déjà tiré des enseignements importants. y More investment is required to more fully integrate y ,OIDXWGDYDQWDJHLQYHVWLUSRXULQWpJUHUSOXVFRPSOqWHPHQW ,06 LQWR :+2·V HPHUJHQF\ RSHUDWLRQV 7UDLQLQJ OH V\VWqPH GH JHVWLRQ GHV LQFLGHQWV GDQV OHV RSpUDWLRQV

Box 1 – Use of IMS in north-east Nigeria. In August 2016, the Nigerian military launched an offensive against Boko Haram forces and reclaimed many inac- cessible local government areas in Borno State, north-east Nigeria. The public health needs of approximately 1.8 million displaced persons overwhelmed existing capacity. WHO declared a Grade 3 internal emergency and initiated a robust response, including activation of the IMS, which allowed WHO to adopt an integrated, ÎCVG@JCÏQRPSARSPCÏUGRFÏRFCÏ,GECPG?LÏ%MTCPLKCLRÏRMÏ?BBPCQQÏRFCÏ?ASRCÏFC?JRFÏLCCBQÏMDÏRFCÏNMNSJ?RGML Ï2FCÏ'+1Ï?JQMÏNPMTGBCBÏ5&-ÏUGRFÏ?LÏ?B?NR?@JCÏDP?KCUMPIÏ that facilitated team work, planning for the different stages of the response, the assignment of roles and responsibilities and prioritization of tasks. This resulted in a cohesive, effective operation by a large number of national and international staff, many of whom had not worked together previously and had varying levels of experience in dealing with emergencies. Encadré 1 – Utilisation du système de gestion des incidents au nord-est du Nigéria. En août 2016, l’armée nigériane a lancé une offensive contre les forces de Boko Haram et a repris possession de nombreuses zones d’administration locale inaccessibles dans l’État de Borno, au nord est du pays. Les capacités existantes ne pouvaient faire face aux besoins énormes de la santé publique pour environ 1,8 million de personnes déplacées. L’OMS a alors déclaré une situation d’urgence interne de degré 3 et a lancé une intervention vigoureuse, comportant l’activation du système de gestion des incidents permettant à l’OMS d’adopter SLCÏQRPSARSPCÏGLR¯EP¯CÏCRÏÎCVG@JCÏ?TCAÏJCQÏ?SRMPGR¯QÏLGE¯PG?LCQÏNMSPÏP¯NMLBPCÏ?SVÏ@CQMGLQÏQ?LGR?GPCQÏ?GESQÏBCÏJ?ÏNMNSJ?RGML Ï*CÏQWQR®KCÏ?Ï¯E?JCKCLRÏBMLL¯Ï¦ÏJh-+1Ï SLÏA?BPCÏ?B?NR?@JCÏD?AGJGR?LRÏJCÏRP?T?GJÏBh¯OSGNC ÏJ?ÏNJ?LGÍA?RGMLÏBCQÏBGDD¯PCLRQÏQR?BCQÏBCÏJhGLRCPTCLRGML ÏJh?RRPG@SRGMLÏBCQÏP¹JCQÏCRÏPCQNMLQ?@GJGR¯Q ÏBCÏK°KCÏOSCÏ J?ÏFG¯P?PAFGQ?RGMLÏBCQÏR¨AFCQ Ï'JÏCLÏ?ÏP¯QSJR¯ÏSLCÏMN¯P?RGMLÏFMKME®LCÏCRÏCDÍA?ACÏKCL¯CÏN?PÏBCQÏCDDCARGDQÏL?RGML?SVÏCRÏGLRCPL?RGML?SVÏLMK@PCSV ÏBMLRÏ@C?SAMSNÏ n’avaient jamais travaillé ensemble auparavant et avaient différents niveaux d’expérience pour s’occuper des situations d’urgence.

7 Emergency response framework, Second edition. Geneva: World Health Organization; 7 Cadre d’action d’urgence, deuxième édition. Genève, Organisation mondiale de la Santé, 2017 2017 (http://apps.who.int/iris/bitstream/handle/10665/258604/9789241512299-eng. (http://apps.who.int/iris/bitstream/handle/10665/105634/9789242504972_fre.pdf;jsessionid= pdf;jsessionid=5EA54D61D25893909E7C9CC667C3A095?sequence=1, accessed D915BC9BF00645F5E53920385582F17B?sequence=1. April 2018).

282 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 RULHQWDWLRQ EULHÀQJV DQG VWDQGDUG RSHUDWLQJ G·XUJHQFHGHO·206'HVIRUPDWLRQVGHVRULHQWDWLRQVGHV procedures continue to be developed. informations et des modes opératoires normalisés conti- QXHQWG·rWUHpODERUpV y IMS is an approach and a way of thinking, not just y /H V\VWqPH GH JHVWLRQ GHV LQFLGHQWV HVW XQH GpPDUFKH HW DVHWRIVWUXFWXUHVSURFHGXUHVDQGWRROV7KHÁH[- XQH PDQLqUH GH SHQVHU SDV VHXOHPHQW XQ HQVHPEOH GH ibility of the IMS is central to its success. Strict VWUXFWXUHV GH SURFpGXUHV HW G·RXWLOV /D ÁH[LELOLWp adherence to all IMS structures and procedures GX V\VWqPH HVW HVVHQWLHOOH j VRQ VXFFqV /D VWULFWH REVHU- may slow a response, especially in the early stages YDWLRQ GH WRXWHV OHV VWUXFWXUHV HW SURFpGXUHV GX V\VWqPH RI DQ RXWEUHDN EXW WKH ÁH[LELOLW\ VFDODELOLW\ DQG peut ralentir la riposte, notamment aux premiers stades adaptability of IMS, when appropriately used, are G·XQH ÁDPEpH PDLV VD ÁH[LELOLWp VRQ H[WHQVLELOLWp HW VRQ among its greatest advantages. adaptabilité font partie de ses plus gros avantages si elles sont bien utilisées. y Full application of the IMS and the support team y /·DSSOLFDWLRQWRWDOHGXV\VWqPHGHJHVWLRQGHVLQFLGHQWVHW is resource intensive. During 2017, WHO had oper- O·pTXLSH G·DSSXL GHPDQGHQW EHDXFRXS GH UHVVRXUFHV (Q ational responses to over 50 emergencies, with a O·206HVWLQWHUYHQXHGDQVSOXVGHVLWXDWLRQVG·XU- total target population of over 70 million people. gence et a ciblé au total plus de 70 millions de personnes. While IMS should always be fully resourced at %LHQ TX·LO IDLOOH FRQWLQXHU G·DOORXHU WRXWHV OHV UHVVRXUFHV country level, a fully resourced, dedicated team for QpFHVVDLUHVDXV\VWqPHDXQLYHDXGHVSD\VLOQHVHUDLWSRXU all emergencies would not be practical. Flexibility DXWDQW SDV SUDWLTXH G·DYRLU XQH pTXLSH FRPSOqWHPHQW is all-important. GRWpHHWGpGLpHjWRXWHVOHVVLWXDWLRQVG·XUJHQFH/DÁH[L- ELOLWpHVWG·XQHLPSRUWDQFHFUXFLDOH y Resources for health operations should be priori- y Il faut donner la priorité aux ressources pour les opérations tized. As all 6 functions are vital, there has been a sanitaires. Comme les 6 fonctions sont vitales, la tendance tendency to give equal resources to each; however, D pWp GH GRQQHU GHV UHVVRXUFHV pJDOHV j FKDFXQH G·HQWUH the health operations function ultimately drives elles; or, la fonction des opérations sanitaires est celle qui, WKH UHVSRQVH DQG VKRXOG EH FRQVLGHUHG ´ÀUVW DX ERXW GX FRPSWH FRQGXLW O·DFWLRQ HW HOOH GRLW rWUH FRQVL- among equals”. GpUpHFRPPHODSUHPLqUHHQWUHWRXWHVOHVIRQFWLRQVpJDOHV y Few emergency professionals have the manage- y 3HX GH SURIHVVLRQQHOV GHV VLWXDWLRQV G·XUJHQFH RQW OHV PHQW VNLOOV WR HIIHFWLYHO\ ÀOO WKH UROH RI ,QFLGHQW FRPSpWHQFHVGHJHVWLRQSRXUDVVXPHUHIÀFDFHPHQWOHU{OH Manager, whose leadership is central to the success GH JHVWLRQQDLUH G·LQFLGHQW GRQW OD FDSDFLWp GH GLUHFWLRQ of an operation. WHO must train a cadre of Inci- HVW FUXFLDOH SRXU OH VXFFqV G·XQH RSpUDWLRQ /·206 GRLW GHQW 0DQDJHUV DQG RI 7HDP /HDGV WR IXOÀO WKH IRUPHU XQ FDGUH GH JHVWLRQQDLUHV G·LQFLGHQWV HW GH FKHIV other 6 critical functions. G·pTXLSHVSRXUDVVXPHUOHVIRQFWLRQVHVVHQWLHOOHV y Good communications and solid professional rela- y La qualité des communications et la solidité des relations tionships form the basis of an effective response. SURIHVVLRQQHOOHV FRQVWLWXHQW OD EDVH G·XQH DFWLRQ HIÀFDFH IMS was developed to coordinate the activities of /H V\VWqPH GH JHVWLRQ GHV LQFLGHQWV D pWp pODERUp SRXU KLHUDUFKLFDO DJHQFLHV ZLWK D GHÀQHG FKDLQ FRRUGRQQHU OHV DFWLYLWpV G·XQH KLpUDUFKLH G·RUJDQLVPHV RI FRPPDQG $SSOLFDWLRQ RI ,06 LQ :+2·V DYHF XQH FKDvQH GH FRPPDQGHPHQW ELHQ GpÀQLH /·DSSOL- decentralized structure and culture could there- FDWLRQGXV\VWqPHGDQVODVWUXFWXUHHWODFXOWXUHGpFHQWUD- fore present challenges. OLVpHGHO·206SRXUUDLWGRQFSUpVHQWHUGHVGLIÀFXOWpV

Conclusion Conclusion As a global public health and humanitarian agency, (QWDQWTX·RUJDQLVPHPRQGLDOGHVDQWpSXEOLTXHHWG·DLGHKXPD- WHO is required to respond to emergencies due to all QLWDLUH O·206 VH GRLW G·LQWHUYHQLU GDQV OHV VLWXDWLRQV G·XUJHQFH KD]DUGV LQ DOO FRUQHUV RI WKH JOREH 7KH 2UJDQL]DWLRQ·V TXHOOHVTX·HQVRLHQWOHVFDXVHVHWSDUWRXWGDQVOHPRQGH/·DGDS- adaption and application of the IMS have contributed WDWLRQ HW O·DSSOLFDWLRQ GX V\VWqPH GH JHVWLRQ GHV LQFLGHQWV SDU to more predictable and effective responses in many O·206RQWFRQWULEXpjGHVLQWHUYHQWLRQVSOXVSUpYLVLEOHVHWSOXV VHWWLQJV 1RQHWKHOHVV FKDOOHQJHV KDYH EHHQ IDFHG DQG HIÀFDFHV GDQV GH QRPEUHX[ FDGUHV 1pDQPRLQV GHV GLIÀFXOWpV lessons continue to be learnt, which are being used to RQWpWpUHQFRQWUpHVHWGHVHQVHLJQHPHQWVFRQWLQXHQWG·rWUHWLUpV LQIRUP:+2·VRYHUDOODSSURDFKWRHPHUJHQF\PDQDJH- VHUYDQWjRULHQWHUODGpPDUFKHJpQpUDOHGHO·206SRXUODJHVWLRQ PHQW $ PRUH GHWDLOHG UHYLHZ RI WKH 2UJDQL]DWLRQ·V GHVVLWXDWLRQVG·XUJHQFH8QH[DPHQSOXVGpWDLOOpGHO·H[SpULHQFH experience with IMS will be undertaken later in 2018. GHO·2UJDQLVDWLRQFRQFHUQDQWOHV\VWqPHGHJHVWLRQGHVLQFLGHQWV VHUDODQFpSOXVWDUGDXFRXUVGHO·DQQpH

TSGNQÐ@EÆKH@SHNMRÐ EÆKH@SHNMRÐCDRÐ@TSDTQRÐ a Health Emergencies Programme, World Health Orga- a 3URJUDPPH GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH nization, Geneva, Switzerland; b:+2 5HJLRQDO 2IÀFH 2UJDQLVDWLRQPRQGLDOHGHOD6DQWp*HQqYH6XLVVHb Programme for Africa, Health Emergencies Programme, Brazza- GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH %XUHDX UpJLRQDO ville, Congo; c Health Emergencies Programme, WHO GH O·206 SRXU O·$IULTXH %UD]]DYLOOH &RQJR c Programme de 5HJLRQDO 2IÀFH IRU WKH (DVWHUQ 0HGLWHUUDQHDQ &RUUHV JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH %XUHDX UpJLRQDO ponding author: Richard Brennan, [email protected]). Ⅲ GH O·206 SRXU OD 0pGLWHUUDQpH RULHQWDOH /H &DLUH eJ\SWH (Auteur correspondant: Richard Brennan, [email protected]). Ⅲ RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 283 Access to life-saving vaccines during L’accès aux vaccins vitaux pendant outbreaks: a spotlight on governance KDRÐÇ@LA°DRÐ°OHC°LHPTDRÐBNTOÐ de projecteur sur la gouvernance Tim Nguyen,a Sol Richardson,b Eduardo Vargas Garcia,a Vachagan Tim Nguyen,a Sol Richardson,b Eduardo Vargas Garcia,a Vachagan Harutyunyan,a Harutyunyan,a Alejandro Costa,a Gaya Gamhewage,a Alexandra Hill,a Alejandro Costa,a Gaya Gamhewage,a Alexandra Hill,a Laurence Cibrelus Laurence Cibrelus Yamamoto,a Asheena Khalakdina,a William Pereaa Yamamoto,a Asheena Khalakdina,a William Pereaa et Sylvie Brianda and Sylvie Brianda

Introduction Introduction During the past 4 decades, WHO and its partners have $X FRXUV GHV GHUQLqUHV GpFHQQLHV O·206 HW VHV SDUWHQDLUHV assumed greater responsibility for ensuring global ont assumé une plus grande responsabilité dans la constitution stockpiles of life-saving vaccines to prevent, pre-empt de stocks mondiaux de vaccins vitaux pour prévenir, anticiper and control epidemics and respond to humanitarian et lutter contre les épidémies et pour répondre aux urgences emergencies. As of 2018, the stockpiles comprised humanitaires. En 2018, ces stocks comprenaient des vaccins vaccines against smallpox, meningococcal meningitis, FRQWUHODYDULROHODPpQLQJLWHjPpQLQJRFRTXHODÀqYUHMDXQH \HOORZ IHYHU FKROHUD SDQGHPLF LQÁXHQ]D DQG SROLR le choléra, la grippe pandémique et la poliomyélite (Tableau 1). (Table 1). The stockpiles are reserves that can be mobi- Ils forment des réserves qui peuvent être mobilisées pour faire lized to meet sudden surges in demand during an IDFHjXQHKDXVVHVRXGDLQHGHODGHPDQGHORUVG·XQHpSLGpPLH outbreak or crisis. Each stockpile is unique with regards RXG·XQHFULVHKXPDQLWDLUH&KDTXHVWRFNHVWXQLTXHHQPDWLqUH to funding, procurement and coordination mechanisms, GHÀQDQFHPHQWGHPpFDQLVPHVG·DFKDWHWGHFRRUGLQDWLRQGH VL]H FRPSRVLWLRQ DQG VWRUDJH &RXQWULHV PXVW ÀUVW taille, de composition et de conservation. Les pays doivent tout make a request to access vaccines and the criteria for G·DERUG VRXPHWWUH XQH GHPDQGH G·DFFqV DX[ YDFFLQV HW OHV their release are based on the epidemiology of the FULWqUHV GH OHXU OLEpUDWLRQ VH EDVHQW VXU O·pSLGpPLRORJLH GH OD disease, the vaccine characteristics and cost, global maladie, des caractéristiques et du coût des vaccins, de la capa- production capacity, market characteristics and whether cité de production mondiale, des caractéristiques du marché et other control measures are available.1 GHODGLVSRQLELOLWpG·DXWUHVPHVXUHVGHOXWWH1

Stockpile governance Gouvernance des stocks Governance of emergency stockpiles ensures the alloca- /D JRXYHUQDQFH GHV VWRFNV G·XUJHQFH DVVXUH O·DOORFDWLRQ HW OD tion and distribution of scarce, life-saving vaccines distribution de vaccins rares et vitaux dans le monde entier en globally in response to multiple, potentially competing réponse à des demandes multiples et potentiellement concur- requests. It ensures equity, so that all affected countries UHQWHV(OOHJDUDQWLWO·pTXLWpGHVRUWHTXHWRXVOHVSD\VWRXFKpV have a fair chance of accessing the vaccines. Decisions DLHQWXQHFKDQFHpTXLWDEOHG·DYRLUDFFqVDX[YDFFLQV/HVGpFL- on their allocation must be transparent, accountable and sions relatives à leur allocation doivent être transparentes, EDVHGRQHYLGHQFHEDVHGFULWHULDWRHQJHQGHUFRQÀGHQFH LPSXWDEOHV HW IRQGpHV VXU GHV FULWqUHV EDVpV VXU GHV GRQQpHV in the mechanisms by which they are allocated.1, 2, 3 Good IDFWXHOOHVDÀQGHVXVFLWHUODFRQÀDQFHGDQVOHVPpFDQLVPHVSDU governance also requires stakeholder engagement with lesquels les vaccins sont alloués.1, 2, 3 Une bonne gouvernance SDUWQHUV DQG PDQXIDFWXUHUV WR SURGXFH ÀQDQFH DQG H[LJH DXVVL O·HQJDJHPHQW GHV SDUWLHV SUHQDQWHV DYHF OHV SDUWH- support global stockpiles. Examples of how different QDLUHVHWOHVIDEULFDQWVSRXUSURGXLUHÀQDQFHUHWHQWUHWHQLUOHV emergency stockpiles address different challenges for VWRFNV PRQGLDX[ 2Q WURXYHUD FLDSUqV GHV H[HPSOHV GH OD governance and public health needs are given below. PDQLqUHGRQWOHVGLIIpUHQWVVWRFNVG·XUJHQFHSHUPHWWHQWGHUHOH- YHU OHV GLIIpUHQWV GpÀV HQ PDWLqUH GH JRXYHUQDQFH HW GH VDQWp publique.

Governance through partnership: the International Gouvernance par le partenariat: le Groupe international de Coordination Group on Emergency Vaccine Provision coordination pour l’approvisionnement en vaccins d’urgence The worst meningococcal meningitis epidemic in history /DSLUHpSLGpPLHGHPpQLQJLWHjPpQLQJRFRTXHGHO·KLVWRLUHD FDXVHGGHDWKVLQWKH6DKHOUHJLRQRI$IULFDLQ² FDXVpGpFqVGDQVODUpJLRQGX6DKHOHQ$IULTXHHQ 1997 and exhausted all global vaccine supplies.4 In the 1997 et épuisé tous les stocks mondiaux de vaccins.4(QO·DE- absence of a globally coordinated response, several coun- VHQFHG·XQHUpSRQVHFRRUGRQQpHjO·pFKHOOHPRQGLDOHSOXVLHXUV tries stockpiled meningococcal vaccines independently. As SD\VRQWVWRFNpGHVYDFFLQVDQWLPpQLQJRFRFFLTXHVGHPDQLqUH a result, some countries faced severe shortages, while indépendante. En conséquence, certains pays ont été confrontés others found themselves with stocks of expiring vaccines.1 jGHJUDYHVSpQXULHVWDQGLVTXHG·DXWUHVVHVRQWUHWURXYpVDYHF

1 Yen C, Hyde TB, Costa AJ et al. The development of global vaccine stockpiles. Lancet 1 Yen C, Hyde TB, Costa AJ et al. The development of global vaccine stockpiles. Lancet Infect Dis. Infect Dis. 2015;15(3):340–347. 2015;15(3):340–347. 2 Moodley K, Hardie K, Selgelid MJ et al. Ethical considerations for vaccination pro- 2 Moodley K, Hardie K, Selgelid MJ et al. Ethical considerations for vaccination programmes in grammes in acute humanitarian emergencies. Bull World Health Organ. acute humanitarian emergencies. Bull World Health Organ. 2013;91:290–297. 2013;91:290–297. 3 SAGE working group on vaccination in humanitarian emergencies: a framework for 3 SAGE working group on vaccination in humanitarian emergencies: a framework for decision- decision-making. Geneva: World Health Organization; 2012. making. Genève, Organisation mondiale de la Santé, 2012. 4 See No. 42, 1997, pp. 313–318. 4 Voir No 42, 1997, pp. 313–318. 284 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 Table 1 Global emergency vaccine stockpiles Tableau 1 Stocks mondiaux de vaccins d’urgence

Year No. of doses Average no. of esta- available country requests blished Access per year or event Governance Place of storage Funding per year or event – Année for use (millions) – Nbre mechanism – – Lieu de mechanism – Vaccine – Vaccin – Nbre moyen de in – Condition de doses dispo- Mécanisme de stockage des Mécanisme de de demandes de constitu- d’accès nibles par an ou gouvernance vaccins ﬁnancement pays par an ou tion du par événement par événement stock (en millions)

Smallpox vaccine – Vaccin 1980 Epidemics – 35 WHO IHR – Nonea – Aucunea WHO and countries Donations – Dons antivariolique Épidémie RSI OMS – OMS et pays

Meningococcal meningitis 1997 Epidemics – 2–5b ICG – GIC 10c Manufacturing site GAVI; revolving vaccine – Vaccin contre Épidémie – Site de fund – GAVI; fonds la méningite à méningo- fabrication renouvelables coque

Yellow fever vaccine – 2001 Epidemics, preven- 6d ICG – GIC 8c Manufacturing site GAVI; revolving Vaccin antiamaril tion – Épidémie, – Site de fund – GAVI; fonds prévention fabrication renouvelables

.?LBCKGAÏGLÎSCLX?Ï 2007 Pandemics – 405 WHO PIP – 77e Virtualf – Virtuelf PIP, SMTA2g – vaccine – Vaccin contre la Pandémie PIP OMS PIP, SMTAg grippe pandémique

Oral cholera vaccine – 2013 Epidemics, humani- 2d ICG – GIC 13c Manufacturing site GAVI; revolving Vaccin anticholérique oral tarian emergencies, – Site de fund – GAVI; fonds prevention – Épidé- fabrication renouvelables mie, urgence humanitaire, prévention

Monovalent oral polio 2015 Epidemics – 35.9–85.9 in 2016 – WHO supported by 14 Manufacturing site GPEI – IMEP vaccine type 2 – Vaccin Épidémie 35,9–85,9 en 2016 GPEI AG – OMS sou- – Site de antipoliomyélitique oral 73.8–115.6 in 2017 tenue par le Groupe fabrication monovalent de type 2 – 73,8–115,6 en consultatif de IMEP 2017

'&0 Ï'LRCPL?RGML?JÏ&C?JRFÏ0CESJ?RGMLQÏÏ'!% Ï'LRCPL?RGML?JÏ!MMPBGL?RGLEÏ%PMSNÏMLÏ4?AAGLCÏ.PMTGQGMLÏ% 4' ÏRFCÏ4?AAGLCÏ JJG?LACÏ.'. ÏN?LBCKGAÏGLÎSCLX?ÏNPCN?PCBLCQQÏDP?KCUMPIÏ%.#'Ï AG, Global Polio Eradication Initiative Advisory Group. – RSI, Règlement sanitaire international (2005); GIC, Groupe international de coordination pour l’approvisionnement en vaccin; Alliance GAVI, l’Alliance du Vaccin; PIP, Cadre de préparation en cas de grippe pandémique; IMEP, Initiative mondiale pour l’éradication de la poliomyélite. aÏ 1K?JJNMVÏU?QÏMDÍAG?JJWÏCP?BGA?RCBÏGLÏ ÏlÏ*?ÏT?PGMJCÏ?Ï¯R¯ÏMDÍAGCJJCKCLRÏ¯P?BGOS¯CÏCLÏ b The ICG has requested the availability of 5 million doses each year; however, manufacturers have made fewer doses available. – Le GIC a demandé la disponibilité de 5 millions de doses chaque année; cependant, les fabricants ont mis à disposition une quantité inférieure de doses. c See No. 10, 2018, pp. 105–116 (http://www.who.int/wer/2018/wer9310/en/). – Voir No 10, 2018, pp. 105-116 (http://www.who.int/wer/2018/wer9310/en/). d Doses of vaccine reserved at all times for epidemic response and/or humanitarian crises. Additional doses available for preventive campaigns are not included. – Doses de vaccin réservées en tout temps pour la riposte aux épidémies et/ou aux crises humanitaires. Les doses supplémentaires pour les campagnes de prévention ne sont pas incluses. e During the 2009 H1N1 pandemic (FRRN UUU UFM GLR GLÎSCLX?=T?AAGLCQ=NJ?L PCQMSPACQ FL=BCNJMWKCLR=PCNMPR NBD – Pendant la pandémie de grippe H1N1 de 2009 (http://www.who. GLR GLÎSCLX?=T?AAGLCQ=NJ?L PCQMSPACQ FL=BCNJMWKCLR=PCNMPR NBD f The vaccine will be produced in the event of a pandemic. – Le vaccin sera produit en cas de pandémie. g Standard Material Transfer Agreement 2. Avaialble at FRRN UUU UFM GLR GLÎSCLX? NGN @CLCÍR=QF?PGLE QKR? CL – Standard Material Transfer Agreement 2 (Accords standards de transfert de matériel 2). Disponible sur FRRN UUU UFM GLR GLÎSCLX? NGN @CLCÍR=QF?PGLE QKR? CL

6XFK D ´ÀUVWFRPH ÀUVWVHUYHGµ DSSURDFK WR DOORFDWLQJ des stocks de vaccins arrivant à expiration.1 Une telle approche VFDUFHYDFFLQHVZDVERWKLQHIÀFLHQWDQGLQHTXLWDEOH5 WHO ©SUHPLHU DUULYp SUHPLHU VHUYLª SRXU DOORXHU GHV YDFFLQV UDUHV therefore launched an initiative to enhance the capacity V·HVW DYpUpH j OD IRLV LQHIÀFDFH HW LQpTXLWDEOH5 /·206 D GRQF of at-risk countries to respond to meningitis epidemics. lancé une initiative visant à renforcer la capacité des pays à The governments of 16 African countries committed to risque à faire face aux épidémies de méningite. Les gouverne- this initiative at a meeting in Ouagadougou, Burkina Faso, ments de 16 pays africains se sont engagés dans cette initiative in October 1996,4 which was the catalyst for the establish- ORUV G·XQH UpXQLRQ j 2XDJDGRXJRX %XUNLQD )DVR HQ RFWREUH ment in January 1997 of the International Coordinating 1996,4 qui a été le catalyseur de la création en janvier 1997 du Group (ICG) for allocation of emergency vaccines. Sepa- *URXSH LQWHUQDWLRQDO GH FRRUGLQDWLRQ *,& SRXU O·DOORFDWLRQ rate stockpiles were subsequently established for yellow GHVYDFFLQVG·XUJHQFH'HVVWRFNVVpSDUpVRQWpWppWDEOLVSDUOD

5 Review of the International Coordinating Group on Vaccine Provision (2006–2016). 5 Review of the International Coordinating Group on Vaccine Provision (2006–2016). Genève, Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/ Organisation mondiale de la Santé; 2016 (http://apps.who.int/iris/bitstream/ handle/10665/251737/WHO-WHE-IHM-16.1-eng.pdf, accessed April 2017). handle/10665/251737/WHO-WHE-IHM-16.1-eng.pdf, consulté en avril 2017). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 285 fever in 2001 and cholera in 2013. The ICG was formed VXLWHSRXUODÀqYUHMDXQHHQHWOHFKROpUDHQ/H*,& as an informal partnership among four founding agen- HVW OH IUXLW G·XQ SDUWHQDULDW LQIRUPHO HQWUH TXDWUH RUJDQLVPHV cies: the International Federation of Red Cross and Red fondateurs: la Fédération internationale des Sociétés de la &UHVFHQW6RFLHWLHV0pGHFLQV6DQV)URQWLqUHVWKH8QLWHG &URL[5RXJH HW GX &URLVVDQW5RXJH 0pGHFLQV VDQV IURQWLqUHV 1DWLRQV &KLOGUHQ·V )XQG 81,&() DQG :+2 7KH ,&* OH)RQGVGHV1DWLRQV8QLHVSRXUO·HQIDQFH 81,&() HWO·206 also consults with other partners, including technical /H*,&FRQVXOWHpJDOHPHQWG·DXWUHVSDUWHQDLUHVQRWDPPHQWGHV experts and vaccine suppliers. GAVI, the Vaccine Alliance, H[SHUWV WHFKQLTXHV HW GHV IRXUQLVVHXUV GH YDFFLQV *$9, O·$O- is currently the principal funder of these vaccine stock- liance du Vaccin, est actuellement le principal bailleur de fonds piles. de ces stocks de vaccins. Requests by countries to the ICG for vaccines are eval- Les demandes de vaccins adressées par les pays au GIC sont uated by assessing the outbreak or humanitarian crisis, pYDOXpHV HQ IRQFWLRQ GH OD ÁDPEpH pSLGpPLTXH RX GH OD FULVH ODERUDWRU\ FRQÀUPDWLRQ RI WKH SDWKRJHQ WKH ULVN RI KXPDQLWDLUHGHODFRQÀUPDWLRQHQODERUDWRLUHGHO·DJHQWSDWKR- spread, the capacity of the requesting country to JqQHGXULVTXHGHSURSDJDWLRQGHODFDSDFLWpGXSD\VGHPDQ- conduct a vaccination campaign and design of a vacci- deur à mener une campagne de vaccination et de la conception nation strategy by functionally independent decision- G·XQHVWUDWpJLHGHYDFFLQDWLRQSDUGHVJURXSHVGHGpFLVLRQTXL making groups, drawing on expertise from ICG part- IRQFWLRQQHQW GH PDQLqUH LQGpSHQGDQWH HQ IDLVDQW DSSHO DX[ ners. The ICG receives an average of 30 requests each FRPSpWHQFHVGHVSDUWHQDLUHVGX*,&/H*,&UHoRLWHQPR\HQQH year; more than 50 million vaccine doses were deployed 30 demandes chaque année; plus de 50 millions de doses de WR FRXQWULHV LQ ²6 The purpose of the ICG vaccin ont été distribuées dans 16 pays en 2016-2017.6 Le but governance mechanism is to maximize equity and the GXPpFDQLVPHGHJRXYHUQDQFHGX*,&HVWGHPD[LPLVHUO·pTXLWp public health impact and to make fair, independent and HW O·LPSDFW VXU OD VDQWp SXEOLTXH HW GH SURFpGHU j GHV pYDOXD- transparent assessments and reviews of requests when tions et à des examens équitables, indépendants et transparents a number of countries are attempting to access the GHV GHPDQGHV ORUVTXH SOXVLHXUV SD\V WHQWHQW G·DFFpGHU DX[ same, limited vaccine stocks. mêmes stocks limités de vaccins. Beyond vaccine use in emergencies, WHO and partners /·206HWVHVSDUWHQDLUHVVHVRQWHIIRUFpVG·pOLPLQHUODPHQDFH have worked to eliminate the threat of serogroup A des épidémies de méningite à méningocoque du sérogroupe A meningococcal epidemics in Africa since 20097 and en Afrique depuis 20097 et ont mis en place des initiatives de established control and prevention initiatives against OXWWHFRQWUHOHFKROpUDHQHWFRQWUHODÀqYUHMDXQHHQ cholera in 2014 and yellow fever in 2017, through the SDU O·LQWHUPpGLDLUH GX *URXSH VSpFLDO PRQGLDO GH OXWWH FRQWUH Global Task Force for Cholera Control and the End OHFKROpUDHWGHODVWUDWpJLHG·pOLPLQDWLRQGHO·pSLGpPLHGHÀqYUH Yellow Fever Epidemics strategy, respectively.8, 9 The jaune, respectivement.8, 9 Les stratégies élaborées dans le cadre strategies for these initiatives include emergency stock- GHFHVLQLWLDWLYHVSUpYRLHQWGHVVWRFNVGHYDFFLQVG·XUJHQFH piles of vaccines.

Centralized governance by the WHO Secretariat Gouvernance centralisée par le Secrétariat de l’OMS avec supported by the Global Polio Eradication Initiative l’appui du groupe consultatif de l’Initiative mondiale pour (GPEI) advisory group l’éradication de la poliomyélite (IMEP) Vaccine-derived polioviruses are rare strains of polio- /HVSROLRYLUXVGpULYpVG·XQHVRXFKHYDFFLQDOHVRQWGHVVRXFKHV virus that mutated genetically from strains in oral polio rares de poliovirus qui ont muté génétiquement à partir de vaccines.10 They can acquire the ability to cause clinical souches contenues dans les vaccins antipoliomyélitiques oraux.10 LOOQHVV LQFOXGLQJ DFXWH ÁDFFLG SDUDO\VLV DQG OHDG WR Ils peuvent acquérir la capacité de causer une maladie clinique, poliovirus outbreaks. \FRPSULVODSDUDO\VLHÁDVTXHDLJXsHWHQWUDvQHUGHVÁDPEpHV de poliovirus. In 2015, the World Health Assembly endorsed the recom- (QO·$VVHPEOpHPRQGLDOHGHOD6DQWpDDSSURXYpODUHFRP- mendation of the SAGE on immunization that stockpiles PDQGDWLRQGX*URXSHVWUDWpJLTXHFRQVXOWDWLIG·H[SHUWV 6$*( of monovalent oral poliovirus vaccine type 2 (mOPV2) sur la vaccination selon laquelle les stocks de vaccin antipolio- should be established and maintained only at the global myélitique oral monovalent de type 2 (VPOm2) ne devraient level to minimize the risk of inadvertent reintroduction rWUHFRQVWLWXpVHWPDLQWHQXVTX·DXQLYHDXPRQGLDOSRXUPLQL- of serotype 2 poliovirus after withdrawal of OPV2. The miser le risque de réintroduction accidentelle du poliovirus de WHO Secretariat was requested to establish a mecha- VpURW\SH DSUqV OH UHWUDLW GX932 /H 6HFUpWDULDW GH O·206 D QLVPWKDWDVVXUHVWKH'LUHFWRU*HQHUDO·VDXWKRULW\RYHU pWp SULp G·pWDEOLU XQ PpFDQLVPH TXL JDUDQWLVVH O·DXWRULWp GX decisions on release of mOPV2, in addition to timely Directeur général sur les décisions relatives à la libération and equitable access for all Member States. The Secre- GH932PHQSOXVG·XQDFFqVDX[YDFFLQVpTXLWDEOHHWHQWHPSV

6 See No. 10, 2018, pp. 105–116. 6 Voir No 10, 2018, pp. 105–116. 7 See No. 13, 2017, pp. 145–154. 7 Voir No 13, 2017, pp. 145–154. 8 See No. 34, 2017, pp. 477–498. 8 Voir No 34, 2017, pp. 477–498. 9 See No. 16, 2017, pp. 193–204. 9 Voir No 16, 2017, pp. 193–204. 10 Global Polio Eradication Initiative. Vaccine-derived polioviruses. Geneva: World 10 Initiative mondiale pour l’éradication de la poliomyélite. Poliovirus dérivés d’une souche vacci- Health Organization; 2018 (http://polioeradication.org/polio-today/polio-preven- nale. Genève: Organisation mondiale de la Santé; 2018 (http://polioeradication.org/polio-to- tion/the-virus/vaccine-derived-polio-viruses/, accessed April 2018). day/polio-prevention/the-virus/vaccine-derived-polio-viruses/, consulté en avril 2018). 286 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 tariat urged Member States to establish procedures to utile pour tous les États Membres. Le Secrétariat a instamment authorize the importation and use of stockpiled mOPV2 SULpOHVeWDWV0HPEUHVG·pWDEOLUGHVSURFpGXUHVSRXUDXWRULVHU after its release has been authorized by the Director- O·LPSRUWDWLRQ HW O·XWLOLVDWLRQ GH 932P VWRFNp DSUqV TXH OH General.11 Directeur général en a autorisé la libération.11 Following the declaration in September 2015 that wild $SUqV OD GpFODUDWLRQ G·pUDGLFDWLRQ GX SROLRYLUXV VDXYDJH GH type 2 poliovirus had been eradicated, WHO Member W\SH HQ VHSWHPEUH OHV eWDWV 0HPEUHV GH O·206 DYHF States, with support from WHO and other GPEI part- O·DSSXLGHO·2UJDQLVDWLRQHWG·DXWUHVSDUWHQDLUHVGHO·,0(3RQW ners, implemented a strategy to reduce the risk associ- mis en œuvre une stratégie visant à réduire le risque associé ated with the attenuated type 2 poliovirus (Sabin au poliovirus de type 2 atténué (souches Sabin) utilisé dans le strains) used in OPV. The strategy included coordinated vaccin antipoliomyélitique oral (VPO). Cette stratégie compre- withdrawal of the type 2 component in OPVs, establish- nait le retrait coordonné de la composante de type 2 des VPO, ment of a global mOPV2 vaccine stockpile and drafting OD FRQVWLWXWLRQ G·XQ VWRFN PRQGLDO GH YDFFLQV 932P HW OD of protocols for its use in response to vaccine-derived rédaction de protocoles pour son utilisation en réponse aux poliovirus events and outbreaks. Furthermore, the Advi- pYpQHPHQWV HW DX[ ÁDPEpHV pSLGpPLTXHV OLpV DX SROLRYLUXV sory Group on mOPV2, comprising independent experts GpULYp G·XQH VRXFKH YDFFLQDOH (Q RXWUH OH *URXSH FRQVXOWDWLI and GPEI partners, was established to support the VXU OH 932P FRPSRVp G·H[SHUWV LQGpSHQGDQWV HW GH SDUWH- Director-General in deciding to deploy stockpiled QDLUHVGHO·,0(3DpWpFUppSRXUDLGHUOH'LUHFWHXUJpQpUDOjOD vaccine. prise de décisions concernant la libération de vaccins stockés. ,Q²WKH:+2'LUHFWRU*HQHUDODXWKRUL]HGWKH (Q OH 'LUHFWHXU JpQpUDO GH O·206 D DXWRULVp OD OLEp- release of 84.3 million doses of mOPV2 to 9 countries ration de 84,3 millions de doses de VPOm2 pour 9 pays touchés affected by vaccine-derived poliovirus events and SDU GHV pYpQHPHQWV HW GHV ÁDPEpHV OLpV DX SROLRYLUXV GpULYp outbreaks.12 As of April 2018, the stockpile contained G·XQH VRXFKH YDFFLQDOH12 En avril 2018, le stock contenait PLOOLRQ GRVHV RI ÀQLVKHG YDFFLQH ,Q YLHZ RI WKH PLOOLRQVGHGRVHVGHYDFFLQÀQL&RPSWHWHQXGHVULVTXHV public risks associated with use of mOPV2, governance SXEOLFV DVVRFLpV j O·XWLOLVDWLRQ GX 932P OD JRXYHUQDQFH GX of the stockpile involves not only issues relating to VWRFN GRLW V·LQWpUHVVHU QRQ VHXOHPHQW DX[ TXHVWLRQV OLpHV j OD vaccine distribution but also control of its use and distribution des vaccins, mais aussi au contrôle de leur utilisa- eventual withdrawal and destruction. The stockpile tion et à leur retrait et destruction éventuels. Le stock doit être must be stringently managed, as mOPV2 has not been JpUp GH PDQLqUH ULJRXUHXVH FDU OH932P Q·D SDV pWp SURGXLW produced in bulk quantities since 2015. In order to HQ JUDQGHV TXDQWLWpV GHSXLV $ÀQ GH JpUHU HIÀFDFHPHQW PDQDJHWKHÀQLWHVXSSO\RIP239HIIHFWLYHO\WKHVL]H les réserves limitées de VPOm2, la taille du stock est évaluée et of the stockpile is evaluated and adjusted quarterly on DMXVWpH WULPHVWULHOOHPHQW HQ IRQFWLRQ GH O·pSLGpPLRORJLH GH OD the basis of the epidemiology of polio, evolving consen- SROLRP\pOLWHGHO·pYROXWLRQGXFRQVHQVXVVXUOHVSDUDPqWUHVGH sus on the parameters of response to vaccine-derived ODUpSRQVHDXSROLRYLUXVGHW\SHGpULYpG·XQHVRXFKHYDFFLQDOH W\SHSROLRYLUXVDQGYDFFLQHVSHFLÀFDWLRQV HWGHVVSpFLÀFDWLRQVGXYDFFLQ Work is under way to establish stockpiles of types 1 Des travaux sont en cours pour constituer des stocks de vaccins and 3 monovalent polio vaccines ahead of full cessation DQWLSROLRP\pOLWLTXHV PRQRYDOHQWV GH W\SH HW DYDQW O·DUUrW of OPV use in routine immunization, which will follow FRPSOHW GH O·XWLOLVDWLRQ GX 932 GDQV OD YDFFLQDWLRQ V\VWpPD- JOREDO FHUWLÀFDWLRQ RI SROLR HUDGLFDWLRQ DQG WR WUDQVL- WLTXHTXLVXLYUDODFHUWLÀFDWLRQPRQGLDOHGHO·pUDGLFDWLRQGHOD tion the mOPV stockpiles after the GPEI disbands. The SROLRP\pOLWH HW SRXU GpSODFHU OHV VWRFNV GH 932P DSUqV lessons learnt in operationalizing the mOPV2 stockpile ODGLVVROXWLRQGHO·,0(3/HVHQVHLJQHPHQWVWLUpVGHO·RSpUDWLRQ- and other similar mechanisms are being used. QDOLVDWLRQ GX VWRFN GH 932P HW G·DXWUHV PpFDQLVPHV VLPL- ODLUHVVRQWXWLOLVpVjFHWWHÀQ

Governance of decentralized and national stockpiles Gouvernance des stocks décentralisés et des stocks nationaux With the declaration of the eradication of smallpox in 'DQVVDUpVROXWLRQ:+$GHO·$VVHPEOpHPRQGLDOHGH 1980, World Health Assembly Resolution WHA33.4 set OD 6DQWp D GpFODUp O·pUDGLFDWLRQ GH OD YDULROH HW D GpÀQL GHV out policies for the post-eradication era. One of the SROLWLTXHVSRXUO·qUHSRVWpUDGLFDWLRQ/·XQHGHVUHFRPPDQ- 19 recommendations of the Global Commission for GDWLRQV GH OD &RPPLVVLRQ PRQGLDOH SRXU OD FHUWLÀFDWLRQ GH WKH&HUWLÀFDWLRQRI6PDOOSR[(UDGLFDWLRQZDV´PDLQWH- O·pUDGLFDWLRQGHODYDULROHpWDLWOHPDLQWLHQG·XQHUpVHUYHLQWHU- nance of an international reserve of vaccine under QDWLRQDOHGHYDFFLQVVRXVOHFRQWU{OHGHO·206&·HVWDLQVLTX·D WHO control”. This gave impetus to the establishment pWp FUpp OH VWRFN G·XUJHQFH GH YDFFLQ DQWLYDULROLTXH 69(6 GH of the WHO Smallpox Vaccine Emergency Stockpile O·206 /·206 V·HVW YX FRQÀHU RIÀFLHOOHPHQW OD UHVSRQVDELOLWp (SVES). WHO was given formal responsibilities for GH PDLQWHQLU OHV FDSDFLWpV HW O·H[SHUWLVH QpFHVVDLUHV SRXU IDLUH

11 Resolution WHA68/3. Poliomyelitis. In: Sixty-eighth World Health Assembly, Geneva, 11 Résolution WHA68/3. Poliomyélite. Soixante-Huitième Assemblée mondiale de la Santé: 18–26 May 2015. Resolutions and decisions, annexes. Geneva: World Health Orga- Genève, 18-26 mai 2015. Résolutions et décisions, annexes. Genève, Organisation mondiale de nization; 2015 (WHA68/2015/REC/1; FRRN ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ la Santé; 2015 (WHA68/2015/REC/1; FRRN ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ 5& Ì0#! WHA68-REC1/A68_R1_REC1-en.pdf#page=27, accessed February 2018). A68_2015_REC1-fr.pdf#page=27, consulté en février 2018). 12 Cameroon, Chad, Democratic Republic of the Congo, Mozambique, Niger, Nigeria, 12 Cameroun, Mozambique, Niger, Nigéria, Pakistan, République démocratique du Congo, Soma- Pakistan, Somalia and Syria. lie, Syrie et Tchad. RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 287 maintaining capacity and expertise to respond to IDFH j XQH UppPHUJHQFH GH OD YDULROH DSUqV O·pUDGLFDWLRQ j OD re-emergence of smallpox in the post-eradication era, fois pour se tenir prêt à tout éventualité et pour décourager both to ensure preparedness and as a deterrent to inten- toute libération intentionnelle.² Bien que le vaccin utilisé tional release.² Although the vaccine used in smallpox SRXUO·pUDGLFDWLRQGHODYDULROHQHVRLWSOXVSURGXLWLOHQUHVWH eradication is no longer produced, small quantities de petites quantités dans le SVES, avec des vaccins contre la remain in the SVES along with newer smallpox vaccines. YDULROHSOXVUpFHQWV$FWXHOOHPHQWOH69(6GHO·206VHFRPSRVH Currently, the WHO SVES consists of approximately G·HQYLURQPLOOLRQVGHGRVHVGHYDFFLQFRPSUHQDQWXQVWRFN 35 million vaccine doses, comprising a physical stock SK\VLTXHGHPLOOLRQVGHGRVHVGpWHQXSDUO·206HWSRXUOH of 2.4 million doses held by WHO and the remainder reste, des stocks nationaux conservés par les pays donateurs. donated by countries and stored at their national stock- /D SDUW GpWHQXH SDU O·206 HVW GHVWLQpH j GHV LQWHUYHQWLRQV piles. The portion held by WHO is intended for initial initiales rapides et à court terme, le stock devant être recons- rapid, short-term interventions, leaving the stockpile to titué à partir de dons ou par la production de vaccins supplé- be replenished from donations or by production of PHQWDLUHV VHORQ OHV EHVRLQV HOOH SHUPHW GH ODLVVHU j O·206 HW additional vaccine as needed and giving WHO and aux pays le temps de mettre en place des stratégies de lutte countries time to implement more comprehensive plus globales. Les stocks donnés sont mobilisés à la demande control strategies. Donated stocks are mobilized at GH O·206 ORUVTXH FHOOHFL HVWLPH TXH OH VWRFN SK\VLTXH VHUD :+2·V UHTXHVW ZKHQ LW HVWLPDWHV WKDW WKH SK\VLFDO épuisé ou que les stocks donnés peuvent être mobilisés plus stockpile will be exhausted or that donated stocks can rapidement.15 be mobilized faster.15 The SVES governance imposes several operational chal- /D JRXYHUQDQFH GX 69(6 SRVH SOXVLHXUV SUREOqPHV RSpUDWLRQ- lenges for vaccine deployment. First, it is a decentralized QHOV SRXU OH GpSORLHPHQW GHV YDFFLQV 3UHPLqUHPHQW LO V·DJLW stockpile, with quantities held by WHO and in national G·XQVWRFNGpFHQWUDOLVpGRQWXQHSDUWLHHVWFRQVHUYpHSDUO·206 stockpiles, and with unique management policies and HW O·DXWUH SURYLHQW GH VWRFNV QDWLRQDX[ DYHF GHV SROLWLTXHV HW procedures for each stockpile. Second, the stockpile has GHVSURFpGXUHVGHJHVWLRQXQLTXHVSRXUFKDTXHVWRFN'HX[Lq- remained dormant since its establishment almost mement, le stock est resté dormant depuis sa création il y a 40 years ago, and the deployment procedures have SUqVGHDQVHWOHVSURFpGXUHVGHGpSORLHPHQWQ·RQWGRQFSDV therefore not had to be tested in response to an outbreak pWp WHVWpHV HQ UpSRQVH j XQH ÁDPEpH pSLGpPLTXH GH YDULROH of smallpox. WHO continues to provide technical O·206FRQWLQXHGHIRXUQLUXQDSSXLWHFKQLTXHSRXUDPpOLRUHU support to improve and sustain national preparedness et maintenir la préparation nationale aux procédures de libé- in the procedures for the release and deployment of UDWLRQHWGHGpSORLHPHQWGXYDFFLQ7URLVLqPHPHQWOHVSD\VTXL vaccine. Third, countries that receive vaccine from the UHoRLYHQW OHV YDFFLQV GX 69(6 GRLYHQW DFFHSWHU HW UHPSOLU SVES must accept and meet certain legal and regulatory certaines conditions légales et réglementaires. Les vaccins utili- conditions. Vaccines used during the pre-eradication era sés pendant la période de pré-éradication ne sont plus homo- are no longer licensed by national regulatory authori- logués par les autorités réglementaires nationales; par consé- ties; requesting countries must therefore have regula- quent, les pays demandeurs doivent disposer de voies tory pathways that ensure rapid authorization of these réglementaires qui garantissent une autorisation rapide de ces unlicensed vaccines for emergency use. To address these YDFFLQV QRQ KRPRORJXpV ORUV G·XQH VLWXDWLRQ G·XUJHQFH 3RXU challenges, WHO recently published an operational SDOOLHU FHV GLIÀFXOWpV O·206 D UpFHPPHQW SXEOLp XQ FDGUH framework for the vaccine deployment to potential RSpUDWLRQQHOSRXUOHGpSORLHPHQWGHYDFFLQVIDFHjG·pYHQWXHOV smallpox events.15 cas de variole.15

Conclusion Conclusion Governance of emergency vaccine stockpiles to ensure /DJRXYHUQDQFHGHVVWRFNVG·XUJHQFHHQJOREHWRXWHVOHVFRPSR- WKH IDLU HTXLWDEOH HIÀFLHQW DQG WLPHO\ DYDLODELOLW\ RI VDQWHVYLVDQWjDVVXUHUODGLVSRQLELOLWpO·DFFqVHWO·DOORFDWLRQGH vaccines requires rules, processes and procedures to YDFFLQV HQ WHPSV XWLOH GH PDQLqUH MXVWH pTXLWDEOH HW HIÀFDFH ensure an orderly, predictable, and structured approach pendant les urgences de santé publique. Elle fait intervenir des to decision-making. The operational framework for UqJOHV GHV SURFHVVXV HW GHV SURFpGXUHV SRXU JDUDQWLU XQH HDFKVWRFNSLOHUHÁHFWVLWVSULRULWLHVUHTXHVWUXOHVDOOR- approche ordonnée, prévisible et structurée de la prise de déci- cation mechanisms, stockpile storage and management, VLRQV/HFDGUHRSpUDWLRQQHOGHFKDTXHVWRFNUHÁqWHOHVSULRUL- and funding mechanisms. Each stockpile was estab- WpVRSpUDWLRQQHOOHVTXLOXLVRQWSURSUHVOHVUqJOHVUpJLVVDQWOHV lished to address a unique problem, and their gover- GHPDQGHV OHV PpFDQLVPHV G·DOORFDWLRQ OD FRQVHUYDWLRQ HW OD nance depends on the frequency of occurrence of JHVWLRQ GHV VWRFNV HW OHV PpFDQLVPHV GH ÀQDQFHPHQW &KDTXH epidemic-prone diseases, the size of the affected popu- VWRFN D pWp FUpp SRXU IDLUH IDFH j XQ SUREOqPH XQLTXH HW VD lation, the distribution logistics and the availability of JRXYHUQDQFHGpSHQGGHODIUpTXHQFHG·DSSDULWLRQGHPDODGLHV vaccines. As new stockpiles are established, including a à tendance épidémique, de la taille de la population touchée,

13 Smallpox vaccines. Geneva: World Health Organization; 2018 (http://www.who.int/ 13 Vaccins antivarioliques. Genève: Organisation mondiale de la Santé; 2018 (http://www.who.int/ csr/disease/smallpox/vaccines/en/, accessed April 2018). csr/disease/smallpox/vaccines/en/, consulté en avril 2018). 14 See No. 20, 2016, pp. 257–264. 14 Voir No 20, 2016, pp. 257–264. 15 Operational framework for the deployment of the WHO Smallpox Vaccine Emergency 15 Operational framework for the deployment of the WHO Smallpox Vaccine Emergency Stockpile Stockpile in response to a smallpox event. Geneva: World Health Organization; 2017 in response to a smallpox event. Genève: Organisation mondiale de la Santé; 2017 (http://apps. (http://apps.who.int/iris/bitstream/handle/10665/259574/9789241513418-eng.pdf, who.int/iris/bitstream/handle/10665/259574/9789241513418-eng.pdf, consulté en avril 2018). accessed April 2018). 288 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 GAVI-funded stockpile of vaccines against Ebola virus de la logistique et de la disponibilité des vaccins. Au fur et à disease once one or more vaccines are licensed and mesure que de nouveaux stocks sont constitués, y compris un SUHTXDOLÀHG16 lessons learnt from experience with VWRFN GH YDFFLQV FRQWUH OD PDODGLH j YLUXV (EROD ÀQDQFp SDU previous stockpiles can be used as a basis for their O·DOOLDQFH*$9,TXLVHUDFRQVWLWXpTXDQGXQRXSOXVLHXUVYDFFLQV governance. DXURQWpWpKRPRORJXpVHWSUpTXDOLÀpV16 les enseignements tirés GH O·H[SpULHQFH DFTXLVH DYHF GH SUpFpGHQWV VWRFNV SHXYHQW servir de base à leur gouvernance. The Coalition for Epidemic Preparedness Innovations La Coalition for Epidemic Preparedness Innovations, créée en (CEPI), established in 2017, is an innovative global alli- 2017, est une alliance mondiale innovante qui réunit des gouver- ance which brings together governments, industry, QHPHQWV OHV GRPDLQHV GH O·LQGXVWULH GH O·pGXFDWLRQ HW GH OD academia, philanthropy and intergovernmental institu- philanthropie, ainsi que des institutions inter-gouvernemen- WLRQVLQFOXGLQJ:+27KURXJKWKHÀQDQFLQJDQGFRRU- WDOHVGRQWO·206/·REMHFWLIGHOD&RDOLWLRQDXWUDYHUVGXÀQDQ- dination of research, CEPI aims to expedite the funding FHPHQWHWGHODFRRUGLQDWLRQGHODUHFKHUFKHHVWG·DFFpOpUHUOD and development of safe, effective and affordable PLVHDXSRLQWGHYDFFLQVVUVHIÀFDFHVHWG·XQFRWDERUGDEOH vaccines against Ebola virus and other priority patho- FRQWUHOHYLUXV(ERODHWG·DXWUHVDJHQWVSDWKRJqQHVSULRULWDLUHV gens expediting access in order to prevent and contain DLQVLTXHG·DFFpOpUHUO·DFFqVDX[YDFFLQVDÀQSUpYHQLUHWFRQWH- epidemics.17 nir les épidémies.17 Best practices in emergency stockpile governance are /HVPHLOOHXUHVSUDWLTXHVHQPDWLqUHGHJRXYHUQDQFHGHVVWRFNV key to ensure equitable and timely access to vaccines VRQWG·DVVXUHUXQDFFqVDX[YDFFLQVpTXLWDEOHHWHQWHPSVXWLOH for all populations in need. à toutes les populations dans le besoin.

TSGNQÐ@EÆKH@SHNMRÐ EÆKH@SHNMRÐCDRÐ@TSDTQRÐ a World Health Organization, Geneva, Switzerland; a2UJDQLVDWLRQPRQGLDOHGHOD6DQWp*HQqYH6XLVVH b Research b Research Department of Epidemiology and Public Department of Epidemiology and Public Health, International Health, International Centre for Life Course Studies in Centre for Life Course Studies in Society and Health, University Society and Health, University College London, London, College London, Londres, Royaume-Uni (Auteur correspondant: 8QLWHG .LQJGRP &RUUHVSRQGLQJ DXWKRU 7LP 1JX\HQ 7LP1JX\HQ1JX\HQ7#ZKRLQW). Ⅲ 1JX\HQ7#ZKRLQW). Ⅲ

16 Update with the development of Ebola vaccines and implications to inform future 16 Mise à jour sur le développement de vaccins contre la maladie à virus Ebola et les implications policy recommendations. Geneva: World Health Organization; 2017. pour éclairer les recommandations politiques futures. Genève: Organisation mondiale de la Santé; 2017. 17 Røttingen A. Coalition for Epidemic Preparedness Innovations (CEPI). Presentation 17 Røttingen A. Coalition for Epidemic Preparedness Innovations (CEPI). Présentation à l’OMS, to WHO, 21 July 2017 (http://www.who.int/medicines/ebola-treatment/TheCoalitio- 21 juillet 2017 (http://www.who.int/medicines/ebola-treatment/TheCoalitionEpidemicPrepared- nEpidemicPreparednessInnovations-an-overview.pdf, accessed March 2018). nessInnovations-an-overview.pdf, consulté en mars 2018).

Crisis in Ukraine as an opportunity +@ÐBQHRDÐDMÐ4JQ@HMD ÐTMDÐNBB@RHNMÐ for rebuilding a more responsive de reconstruire un système de soins de primary health care system santé primaires plus réactif Dorit Nitzan,a Marthe Everard,a Patricia Kormoss,a Ihor Perehinets,a Dorit Nitzan,a Marthe Everard,a Patricia Kormoss,a Ihor Perehinets,a Oleg Storozhenko,a Guillaume Simonian,b Cristiana Salvia and Nedret Oleg Storozhenko,a Guillaume Simonian,b Cristiana Salvia et Nedret Emiroglua Emiroglua

+DF@BXÐ@MCÐBNMÇHBSÐHLO@BSÐNMÐODNOKDiRÐGD@KSGÐ '°QHS@FDÐDSÐBNMÇHSÐHLO@BSÐRTQÐK@ÐR@MS°ÐDSÐK@ÐRHST@SHNMÐ @MCÐÆM@MBDR ÆM@MBH¯QDÐCDÐK@ÐONOTK@SHNM After its independence in 1991, Ukraine retained most $SUqVVRQLQGpSHQGDQFHHQO·8NUDLQHDFRQVHUYpODSOXSDUW of the features of the Semashko health system model, GHV FDUDFWpULVWLTXHV GX PRGqOH GX V\VWqPH GH VDQWp GH with its heavy infrastructure, a focus on hospital inpa- Semashko, avec son infrastructure lourde, centré sur les soins tient care and low budgets. The concept of universal hospitaliers, et ses faibles budgets. Le concept de couverture health coverage (UHC), which is enshrined in the coun- sanitaire universelle, qui est inscrit dans la constitution du pays, WU\·V FRQVWLWXWLRQ ZDV RQO\ DQ DVSLUDWLRQDO VWDWHPHQW Q·pWDLW TX·XQH GpFODUDWLRQ G·DVSLUDWLRQ /H V\VWqPH GH VRLQV GH The primary health care system remained weak and santé primaires demeurait fragile et de nombreux Ukrainiens many Ukrainians had limited or no access to affordable Q·DYDLHQWTX·XQDFFqVOLPLWpRXQXODX[VHUYLFHVDERUGDEOHV/HV services. Patients were required to purchase ambulatory patients devaient payer pour les soins ambulatoires, y compris care, including medications and consumables. The high les médicaments et les consommables. Le montant élevé des out-of-pocket payments affected access to health SDLHPHQWVGLUHFWVDDIIHFWpO·DFFqVDX[VHUYLFHVGHVDQWpHWO·pWDW services and the health status of the most vulnerable, de santé des plus vulnérables, à savoir les enfants, les femmes, namely children, women, the elderly and chronically les personnes âgées, les malades chroniques et les personnes sick and disabled people because they delayed seeking KDQGLFDSpHVSDUFHTX·HOOHVWDUGDLHQWjVHIDLUHVRLJQHU health care. RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 289 7KH ZHDNQHVVHV RI WKH KHDOWK V\VWHP ZHUH UHÁHFWHG LQ /HVIDLEOHVVHVGXV\VWqPHGHVDQWpVHWUDGXLVDLHQWSDUGHVWDX[ high rates of avoidable deaths and illness. In 2012, total pOHYpVGHGpFqVHWGHPDODGLHVpYLWDEOHV(QOHVGpSHQVHV health expenditure in Ukraine represented 4.1% of the totales de santé en Ukraine représentaient 4,1% du produit inté- gross domestic product (GDP) or less than half the Euro- rieur brut (PIB), soit moins de la moitié de la moyenne de pean Union average, set at 9.8 percent; however, the O·8QLRQ HXURSpHQQH À[pH j WRXWHIRLV OH FKLIIUH DEVROX DEVROXWH ÀJXUH ZDV PXFK ORZHU WKDQ WKH (XURSHDQ environ US$ 299,3 par habitant et par an au taux de change Union average, at approximately US$ 299.3 per capita PR\HQ GH pWDLW ELHQ LQIpULHXU j OD PR\HQQH GH O·8QLRQ per year at the average exchange rate in 2012. Govern- européenne. Les dépenses publiques de santé ont représenté ment health expenditure accounted for 12.7% of total 12,7% des dépenses totales du budget consolidé, soit environ consolidated budget expenditure, or approximately GX 3,% HW OH UHVWH SOXV GH GX 3,% D pWp ÀQDQFp 4.44% of GDP, and the rest (more than 3.26% of GDP) principalement par les paiements des patients. La plupart des ZDVPDLQO\SDLGIRUE\SDWLHQWV·RXWRISRFNHWH[SHQGL- ÀQDQFHPHQWVGHO·eWDWHQPDWLqUHGHVDQWpSURYHQDLHQWGHO·LP- WXUH 0RVW 6WDWH KHDOWK ÀQDQFLQJ FDPH IURP JHQHUDO S{WJpQpUDOHWOHVDXWUHVVRXUFHVGHUHYHQXVFRPPHO·DVVXUDQFH taxation, and other sources of revenue, such as health maladie, étaient presque inexistantes. Les deux tiers des insurance, were almost inexistent. Two thirds of total GpSHQVHV EXGJpWDLUHV WRWDOHV pWDLHQW FDQDOLVpV SDU O·LQWHUPp- budget expenditure was channelled through local GLDLUH GHV DGPLQLVWUDWLRQV ORFDOHV HW PRLQV G·XQ WLHUV SDU OH governments and less than one-third through the 0LQLVWqUHFHQWUDOGHODVDQWp central Ministry of Health. Life expectancy was 7 years below the European Union /·HVSpUDQFH GH YLH pWDLW LQIpULHXUH GH DQV j OD PR\HQQH GH average in 2015.1 One third of Ukrainians died before O·8QLRQ HXURSpHQQH HQ 1 Un tiers des Ukrainiens décé- 65 years of age, mortality being highest among men, GDLHQWDYDQWO·kJHGHDQVODPRUWDOLWpODSOXVpOHYpHV·REVHU- resulting in the so-called “missing men” phenomenon. YDQWFKH]OHVKRPPHVG·ROHSKpQRPqQHGHV©KRPPHVGLVSD- 1RQFRPPXQLFDEOH GLVHDVHV DQG FKURQLF FRQGLWLRQV rus». Les maladies non transmissibles et les affections contributed to the bulk of deaths. Ukraine had some of FKURQLTXHV pWDLHQW UHVSRQVDEOHV GH OD PDMRULWp GHV GpFqV /D (XURSH·V ZRUVW EXUGHQV RI +,9$,'6 DQG WXEHUFXORVLV charge de morbidité due au VIH/sida et à la tuberculose en in the WHO European Region and continued to confront Ukraine était parmi les plus lourdes de la Région européenne the legacy of the Chernobyl nuclear accident in 1986. GHO·206HWOHSD\VFRQWLQXDLWjIDLUHIDFHDX[FRQVpTXHQFHVGH O·DFFLGHQWQXFOpDLUHGH7FKHUQRE\OHQ In 2014, the Government abolished the State Sanitary En 2014, le Gouvernement a aboli les Services sanitaires et and Epidemiological Services, which maintained some pSLGpPLRORJLTXHV GH O·eWDW TXL DVVXUDLHQW FHUWDLQHV IRQFWLRQV basic population health surveillance and protection de base de surveillance et de protection de la santé de la popu- functions. It then depended mainly on inspection by a ODWLRQ,OVGpSHQGDLHQWDORUVSULQFLSDOHPHQWGHO·LQVSHFWLRQSDU complex institutional network of laboratories and old XQUpVHDXLQVWLWXWLRQQHOFRPSOH[HGHODERUDWRLUHVHWG·DQFLHQQHV duplicated infrastructure that was serviced and infrastructures redondantes qui étaient entretenues par le depended on the private sector. Public health services secteur privé dont elles dépendaient. Les services de santé were extremely limited, with fragmented essential publique étaient extrêmement limités, avec des fonctions sani- public health functions, few, diluted health promotion taires essentielles fragmentées, des activités de promotion de or disease prevention activities and weak, slow health la santé ou de prévention des maladies rares et dispersées et information technology and management. Eventually, XQH WHFKQRORJLH HW XQH JHVWLRQ GH O·LQIRUPDWLRQ VDQLWDLUH the Ukraine was unable to provide the essential public PpGLRFUHV HW OHQWHV (Q GpÀQLWLYH O·8NUDLQH Q·pWDLW SDV HQ health functions that are necessary, especially in times PHVXUH G·DVVXUHU OHV IRQFWLRQV HVVHQWLHOOHV GH VDQWp SXEOLTXH of crisis. qui sont nécessaires, surtout en temps de crise. 7KH FRQÁLFW LQ $SULO KDV KDG D GLUHFW LPSDFW RQ /H FRQÁLW G·DYULO D HX XQ LPSDFW GLUHFW VXU OD VDQWp GHV the health of the people living in the affected areas. personnes vivant dans les zones touchées. Plus de 3,7 millions More than 3.7 million Ukrainians, including internally G·8NUDLQLHQV \ FRPSULV GHV SHUVRQQHV GpSODFpHV j O·LQWpULHXU GLVSODFHG SHRSOH KDYH EHHQ DIIHFWHG E\ WKH FRQÁLFW GXSD\VRQWpWpWRXFKpVSDUOHFRQÁLWGRQWHQIDQWV3OXV including 580 000 children. Over 2.7 million people are de 2,7 millions de personnes vivent dans des zones qui ne sont living in areas that are not controlled by the Govern- pas contrôlées par le Gouvernement, avec une liberté de mouvement, with limited freedom of movement and limited PHQWOLPLWpHHWXQDFFqVUHVWUHLQWjO·DLGHVRFLDOHHWKXPDQLWDLUH access to social and humanitarian assistance. An esti- On estime que 800 000 personnes vivent dans des conditions PDWHG SHRSOH DUH OLYLQJ LQ GLIÀFXOW GDQJHURXV GLIÀFLOHV HW GDQJHUHXVHV GHV GHX[ F{WpV GH OD OLJQH GH FRQWDFW conditions on both sides of the contact line, with ongo- avec des hostilités en cours. Dans les zones proches de la ligne ing hostilities. In areas close to the contact line, access GH FRQWDFW O·DFFqV DX[ VRLQV GH VDQWp HQ SDUWLFXOLHU SRXU OHV to health care, especially for trauma, acute care and traumatismes, les soins aigus et les soins primaires essentiels, essential primary care, was severely impeded by restric- a été gravement entravé par des restrictions de mouvement, des tions on movement, damaged health facilities, the installations sanitaires endommagées, le départ de nombreux departure of many trained health care workers and lack agents de santé formés et le manque de fournitures médicales

1 See FRRNQ UUU PCGLGQÍQAFCP AMK JGDCÌCVNCAR?LAWÌCSPMNC?LÌSLGMLÌ 1 Voir FRRNQ UUU PCGLGQÍQAFCP AMK JGDCÌCVNCAR?LAWÌCSPMNC?LÌSLGMLÌ 290 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 of essential medical supplies and medications, water, HWGHPpGLFDPHQWVHVVHQWLHOVG·HDXGHFDUEXUDQWHWGHFRPPX- fuel and communications. It is estimated that 77 of nication. On estime que 77 des 350 établissements de soins de 350 health care facilities in the Donetsk region and santé de la région de Donetsk et 26 des 250 établissements de la 26 of 250 in Luhansk region have been damaged or région de Luhansk ont été endommagés ou détruits. De destroyed. Many clinics and hospitals were closed nombreux dispensaires et hôpitaux ont été fermés ou étaient or only partially operational due to shortage of medi- seulement partiellement opérationnels en raison de la pénurie cines, medical supplies and personnel. About 1.4 million de médicaments, de fournitures médicales et de personnel. people required health assistance, and primary health (QYLURQ PLOOLRQ GH SHUVRQQHV DYDLHQW EHVRLQ G·XQH DVVLV- care centres and hospitals were struggling to treat tance sanitaire, et les centres de soins de santé primaires et les people wounded in the war. Some health workers were hôpitaux peinaient à soigner les blessés de guerre. Certains QRW SDLG DQG ² ÁHG IURP WKH FRQÁLFW DUHDV RU DJHQWV GH VDQWp Q·pWDLHQW SDV SD\pV HW j G·HQWUH HX[ were wounded or killed. This caused an even deeper RQW IXL OHV ]RQHV GH FRQÁLW RX RQW pWp EOHVVpV RX WXpV &HOD D decrease in access to primary care services and resulted HQWUDvQp XQH GLPLQXWLRQ HQFRUH SOXV PDUTXpH GH O·DFFqV DX[ in more deaths and disease and a higher risk for services de soins primaires et a donné lieu à un plus grand outbreaks, especially from vaccine-preventable diseases. QRPEUHGHGpFqVHWGHPDODGLHVHWjXQULVTXHDFFUXGHÁDP- Children, women, the elderly, minorities (e.g. Roma bées épidémiques, en particulier de maladies évitables par la population) and chronically sick and disabled people vaccination. Les enfants, les femmes, les personnes âgées, les were the most affected. minorités (par exemple, la population rom), les malades chroniques et les personnes handicapées ont été les plus touchés.

The polio threat: urgent partner response La menace de la poliomyélite: réponse urgente des partenaires Of particular concern was the very low rate of vaccina- /HWUqVIDLEOHWDX[GHFRXYHUWXUHYDFFLQDOHTXLHVWSDVVpGH tion coverage, which dropped from 100% in the 1990s dans les années 1990 à 70% dans les années 2000 et à moins de to 70% in the 2000s and less than 50% in 2014.2, 3 Since HQHVWSDUWLFXOLqUHPHQWSUpRFFXSDQW2, 3 Depuis octobre October 2013, the Independent Monitoring Board of the OH&RPLWpGHVXLYLLQGpSHQGDQWGHO·,QLWLDWLYHPRQGLDOHSRXU Global Polio Eradication Initiative has listed Ukraine as O·pUDGLFDWLRQ GH OD SROLRP\pOLWH D FODVVp O·8NUDLQH SDUPL OHV one the 13 “red” countries, which are at high risk for a SD\V ©URXJHVª TXL FRXUHQW XQ ULVTXH pOHYp GH ÁDPEpH GH polio outbreak because of extremely poor vaccination SROLRP\pOLWH HQ UDLVRQ G·XQH FRXYHUWXUH YDFFLQDOH H[WUrPHPHQW coverage. Hesitancy by parents and health workers, IDLEOH /·KpVLWDWLRQ GHV SDUHQWV HW GHV DJHQWV GH VDQWp FRPELQpH FRPELQHGZLWKLQHIÀFLHQWSURFXUHPHQWRIYDFFLQHVDQG j XQ DSSURYLVLRQQHPHQW LQHIÀFDFH HQ YDFFLQV HW PpGLFDPHQWV medicines, were the determinants of the low coverage. ont été les déterminants de cette faible couverture. From the start of the crisis in 2014, polio became an 'qVOHGpEXWGHFHWWHFULVHHQODSROLRP\pOLWHHVWGHYHQXH imminent threat for Ukraine, as the already stretched XQHPHQDFHLPPLQHQWHSRXUO·8NUDLQHFDUOHV\VWqPHGHVDQWp health system was overloaded with other priorities, and GpMjWHQGXpWDLWVXUFKDUJpSDUG·DXWUHVSULRULWpVHWOHVVHUYLFHV routine health services, already suboptimal, were jeop- GH VDQWp GH URXWLQH GpMj LQVXIÀVDQWV pWDLHQW PHQDFpV /HV ardized. Regional stocks of vaccines were exhausted, stocks régionaux de vaccins ont été épuisés et le processus and the Government tender process for procurement of G·DSSHOG·RIIUHVGX*RXYHUQHPHQWSRXUO·DFKDWGHYDFFLQVDpWp YDFFLQHV ZDV LQHIÀFLHQW EHWZHHQ DQG $IWHU LQHIÀFDFH HQWUH HW $SUqV XQH ÁDPEpH GH SROLRYLUXV an outbreak of circulating vaccine-derived polio in 2015, FLUFXODQWGpULYpG·XQHVRXFKHYDFFLQDOHHQO·206O·81,&() :+2 81,&() DQG 81'3 DGYLVHG WKH *RYHUQPHQW WR HW OH 318' RQW FRQVHLOOp DX *RXYHUQHPHQW GH FRQÀHU O·DFKDW hand over procurement of vaccines to a consortium of GHV YDFFLQV j XQ FRQVRUWLXP GH DJHQFHV 318' 81,&() HW DJHQFLHV 81'3 81,&() DQG &URZQ $JHQWV DJHQWV GH OD &RXURQQH DSSX\p HW JXLGp SDU O·206 /H SODQ supported and guided by WHO. The plan, backed by YLJRXUHX[ SURPX SUpYR\DLW OH UHWRXU SURJUHVVLI GH O·DFKDW GHV strong advocacy, entailed a gradual return of medicine PpGLFDPHQWVHWGHVYDFFLQVDX[PDLQVGX0LQLVWqUHGHODVDQWp and vaccine procurement to the Ministry of Health GDQVXQGpODLGHjDQVDXFRXUVGXTXHOOH318'HWO·81,&() ZLWKLQ ² \HDUV GXULQJ ZKLFK 81'3 DQG 81,&() IRUPHUDLHQW OH SHUVRQQHO GX 0LQLVWqUH FKDUJp GHV DFKDWV HW would train procurement staff from the Ministry and assureraient une meilleure gestion des approvisionnements. ensure better supply management.

Primary health care: a model of health Les soins de santé primaires: un modèle transformation de transformation de la santé (QVXULQJSURFXUHPHQWRIPHGLFLQHVZDVMXVWDÀUVWVWHS /·DSSURYLVLRQQHPHQWHQPpGLFDPHQWVQ·pWDLWTX·XQSUHPLHUSDV RQ WKH URDG WR LPSURYH 8NUDLQH·V KHDOWK IXQFWLRQV VXUODYRLHGHO·DPpOLRUDWLRQGHVIRQFWLRQVVDQLWDLUHVGHO·8NUDLQH Another change was to shift the focus of the health 8QDXWUHFKDQJHPHQWFRQVLVWDLWjUpRULHQWHUOHV\VWqPHGHVDQWp

2 Bagcchi S. Inadequate vaccine coverage fuels polio outbreak in Ukraine. Lancet 2 Bagcchi S. Inadequate vaccine coverage fuels polio outbreak in Ukraine. Lancet Infect Dis. Infect Dis. 2015;15(11):1268–9. 2015;15(11):1268–9. 3 Twigg JL. Polio in Ukraine. Crisis, challenge and opportunity. Washington DC: Center 3 Twigg JL. Polio in Ukraine. Crisis, challenge and opportunity. Washington DC: Center for Strate- for Strategic and International Studies, Global Health Policy Center; 2016 (https:// gic and International Studies, Global Health Policy Center; 2016 (https://csis-prod.s3.amazo- csis-prod.s3.amazonaws.com/s3fs-public/publication/160329_Twigg_Po- naws.com/s3fs-public/publication/160329_Twigg_PolioUkraine_Web.pdf, consulté en avril lioUkraine_Web.pdf, accessed April 2018). 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 291 system from the provision of mainly fragmented hospital de la prestation de soins hospitaliers généralement fragmentés inpatient care to health promotion and disease preven- vers la promotion de la santé et la prévention des maladies WLRQEDVHGRQSHRSOH·VQHHGV/RQJWHUPLQVWLWXWLRQVIRU basées sur les besoins de la population. Les soins de longue durée tuberculosis, HIV and mental health disorders had to be pour la tuberculose, le VIH et les troubles mentaux devaient être replaced by integrated community services. For this, remplacés par des services communautaires intégrés. Pour ce primary health care services had to be strengthened. faire, il fallait renforcer les services de soins de santé primaires. The humanitarian crisis was the opportunity for the /D FULVH KXPDQLWDLUH D pWp O·RFFDVLRQ SRXU OH 0LQLVWqUH GH OD Ministry of Health, WHO and health cluster partners to VDQWp O·206 HW OHV SDUWHQDLUHV GX JURXSH VHFWRULHO GH OD VDQWp GHVLJQ JDSÀOOLQJ RSHUDWLRQV WKDW ZRXOG EHFRPH WKH de concevoir des mesures visant à combler les lacunes qui model and the forerunner of health transformation in GHYLHQGUDLHQW OH PRGqOH HW OH SUpFXUVHXU GH OD WUDQVIRUPDWLRQ Ukraine. The model was based on Health 2020, the WHO GHODVDQWpHQ8NUDLQH/HPRGqOHpWDLWEDVpVXU6DQWpOD European Region health policy, supported by the SROLWLTXHVDQLWDLUHGHOD5pJLRQHXURSpHQQHGHO·206VRXWHQXH WHO European Action Plan for the Strengthening of SDU OH 3ODQ G·DFWLRQ HXURSpHQ GH O·206 SRXU OH UHQIRUFHPHQW Public Health Capacities and Services. Rationalization GHV FDSDFLWpV HW GHV VHUYLFHV GH VDQWp SXEOLTXH 2Q V·DWWHQGDLW of hospital care and transformation of the model of à ce que la rationalisation des soins hospitaliers et la transfor- KHDOWK FDUH ÀQDQFLQJ ZHUH H[SHFWHG WR UHFHLYH UHVLV- PDWLRQGXPRGqOHGHÀQDQFHPHQWGHVVRLQVGHVDQWpVXVFLWHQW tance from health workers, patients and the general une résistance de la part des agents de santé, des patients et public. Therefore, the immediate objective became GXJUDQGSXEOLF3DUFRQVpTXHQWO·REMHFWLILPPpGLDWHVWGHYHQX strengthening primary and emergency care, improving OH UHQIRUFHPHQW GHV VRLQV SULPDLUHV HW GHV VRLQV G·XUJHQFH public health and effective communication of these O·DPpOLRUDWLRQGHODVDQWpSXEOLTXHHWXQHFRPPXQLFDWLRQHIÀ- changes to the relevant audiences. FDFHGHFHVFKDQJHPHQWVDXSUqVGHVSXEOLFVFRQFHUQpV A network of mobile emergency primary health care 8QUpVHDXG·XQLWpVPRELOHVGHVRLQVGHVDQWpSULPDLUHVG·XUJHQFH units (MEPUs) was established with technical support DpWpPLVHQSODFHDYHFO·DSSXLWHFKQLTXHGHWRXVOHVSURJUDPPHV from all WHO health programmes. Physician and nurse GHVDQWpGHO·206/HVRUJDQLVDWLRQVGHPpGHFLQVHWG·LQÀUPLqUHV RUJDQL]DWLRQVGHÀQHGDSDFNDJHRIKLJKTXDOLW\HVVHQ- RQW GpÀQL XQ HQVHPEOH GH VHUYLFHV GH VDQWp SULPDLUHV HW G·XU- tial primary and emergency health services, which was gence de haute qualité, qui a été communiqué aux agents de santé provided to health workers via a hand-held, real-time, DX PR\HQ G·XQ RXWLO SRUWDWLI G·LQIRUPDWLRQ VDQLWDLUH HQ WHPSV web-based health information tool, which contained réel et basée sur le Web, qui contenait des modes opératoires newly developed standard operating procedures, algo- normalisés récemment élaborés, des algorithmes et des arbres rithms and patient management decision-making trees, décisionnels pour la prise en charge des patients, en lien avec le linked to the WHO Essential Medicines concept. FRQFHSWGHVPpGLFDPHQWVHVVHQWLHOVGHO·206 :+2DQG8QLWHG1DWLRQVKXPDQLWDULDQWHDPVDGYLVHG /·206 HW OHV pTXLSHV KXPDQLWDLUHV GHV 1DWLRQV 8QLHV RQW the Government on revising its legal framework to allow conseillé le Gouvernement sur la révision de son cadre juri- rapid importation of medical supplies from WHO, GLTXHSRXUSHUPHWWUHO·LPSRUWDWLRQUDSLGHGHIRXUQLWXUHVPpGL- 81,&()DQGWKH,QWHUQDWLRQDO&RPPLWWHHRI5HG&URVV FDOHVHQSURYHQDQFHGHO·206GHO·81,&()HWGX&RPLWpLQWHU- ,Q 1RYHPEHU D WULSDUWLWH DJUHHPHQW ZDV VLJQHG national de la Croix-Rouge. En novembre 2014, un accord between the Ministry of Health, the Ukrainian Red WULSDUWLWH D pWp VLJQp HQWUH OH 0LQLVWqUH GH OD VDQWp OD &URL[ Cross Society and WHO, which authorised health work- 5RXJH XNUDLQLHQQH HW O·206 DXWRULVDQW OHV DJHQWV GH VDQWp GH ers in the Society and the Hippocrates Greek Medical la Croix-Rouge et de la Hippocrates Greek Medical Foundation Foundation to provide the comprehensive package of jIRXUQLUXQHQVHPEOHFRPSOHWGHVHUYLFHVSDUO·LQWHUPpGLDLUH services through MEPUs. The health workers were fully GHV XQLWpV PRELOHV GH VRLQV GH VDQWp SULPDLUHV G·XUJHQFH /HV trained in the clinical pathway, medications and use of DJHQWVGHVDQWpRQWUHoXXQHIRUPDWLRQFRPSOqWHVXUOHFKHPL- the hand-held device. A reporting system was esta- QHPHQW FOLQLTXH OHV PpGLFDPHQWV HW O·XWLOLVDWLRQ GX GLVSRVLWLI blished, which included online weekly updates to the SRUWDWLI 8Q V\VWqPH GH QRWLÀFDWLRQ D pWp PLV HQ SODFH TXL 0LQLVWU\RI+HDOWKDQGWKH:+2&RXQWU\2IÀFH comprenait des mises à jour hebdomadaires en ligne destinées DX0LQLVWqUHGHODVDQWpHWDXEXUHDXGHSD\VGHO·206 'XULQJ ² :+2 PDQDJHG 0(38V LQ $XFRXUVGHODSpULRGHO·206DJpUpXQLWpVPRELOHV 5 regions in eastern Ukraine, which held more than GH VRLQV GH VDQWp SULPDLUHV G·XUJHQFH GDQV UpJLRQV GH O·HVW 250 000 consultations, including screening, treatment GH O·8NUDLQH TXL RQW DVVXUp SOXV GH FRQVXOWDWLRQV \ and referral to health care facilities. They covered FRPSULVOHGpSLVWDJHOHWUDLWHPHQWHWO·RULHQWDWLRQGHVSDWLHQWV communicable and noncommunicable diseases, screen- vers des établissements de soins de santé. Ces unités couvraient ing for mental health conditions, integrated manage- les maladies transmissibles et non transmissibles, le dépistage ment of childhood illnesses, including nutrition, and des maladies mentales, la prise en charge intégrée des maladies public health services. The MEPUs effectively located, GH O·HQIDQW \ FRPSULV OD QXWULWLRQ HW OHV VHUYLFHV GH VDQWp WUDFNHGPRYHPHQWVDQGWUDYHOOHGWRWKHPRVWGLIÀFXOW publique. Les unités mobiles ont localisé les populations les plus to-reach and most at-risk populations and particularly GLIÀFLOHV j DWWHLQGUH HW OHV SOXV j ULVTXH HQ SDUWLFXOLHU OHV the temporary settlements for internally displaced FDPSHPHQWVWHPSRUDLUHVSRXUOHVSHUVRQQHVGpSODFpHVjO·LQWp- people. They played a key role in providing public rieur du pays; elles ont suivi leurs mouvements et se sont health advice to the affected population, informing the UHQGXHVDXSUqVG·HOOHV(OOHVRQWMRXpXQU{OHFOpHQIRXUQLVVDQW KHDOWK DXWKRULWLHV DERXW RXWEUHDNV DQG VSHFLÀF QHHGV des conseils de santé publique à la population touchées; en supporting nationwide vaccination campaigns and informant les autorités sanitaires sur les épidémies et les 292 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 FROOHFWLQJ GDWD IRU (SLH:$51 ² VXUYHLOODQFH V\VWHP besoins particuliers; en soutenant les campagnes nationales de collecting information on 11 infectious and 5 non-infec- YDFFLQDWLRQ HQ FROOHFWDQW GHV GRQQpHV SRXU (SLH:$51 ² OH WLRXVFOLQLFDOV\QGURPHV²DQGWKHKHDOWKPDQDJHPHQW V\VWqPH GH VXUYHLOODQFH TXL UHFXHLOOH GHV LQIRUPDWLRQV VXU information system, establishing clear links with State- 11 syndromes cliniques infectieux et 5 syndromes cliniques non funded health care services through a wide referral LQIHFWLHX[²HWSRXUOHV\VWqPHG·LQIRUPDWLRQVXUODJHVWLRQGH QHWZRUN DQG KHOSLQJ WR EXLOG SHRSOH·V WUXVW LQ WKH la santé; en établissant des liens clairs avec les services de soins national health system by providing free outreach to GHVDQWpÀQDQFpVSDUO·eWDWJUkFHjXQYDVWHUpVHDXGHUpIpUHQFH high-quality primary health care services in remote HW HQ DLGDQW j UHQIRUFHU OD FRQÀDQFH GH OD SRSXODWLRQ GDQV OH communities. This encouraged the population to use V\VWqPHQDWLRQDOGHVDQWpSDUODIRXUQLWXUHJUDWXLWHGHVHUYLFHV health prevention interventions, seek early health care de soins de santé primaires de qualité dans les communautés and advice and comply with treatment protocols. éloignées. Cela a encouragé la population à recourir à des inter- YHQWLRQV GH SUpYHQWLRQ HQ PDWLqUH GH VDQWp j FRQVXOWHU VDQV attendre et à respecter les protocoles thérapeutiques. The MEPU model inspired upgrading of primary health /HPRGqOHGHVXQLWpVPRELOHVGHVRLQVGHVDQWpSULPDLUHVG·XU- care services in Ukraine and was a critical impetus JHQFH D LQVSLUp O·DPpOLRUDWLRQ GHV VHUYLFHV GH VRLQV GH VDQWp towards improved access to and use of essential primary primaires en Ukraine et a donné une impulsion essentielle à care services (the “health protection package”). Since O·DPpOLRUDWLRQ GH O·DFFqV HW GX UHFRXUV DX[ VHUYLFHV GH VRLQV then, the Ministry of Health, supported by partners, has SULPDLUHV HVVHQWLHOV OHV ©VHUYLFHV GH SURWHFWLRQ GH OD VDQWpª been reforming many aspects of the health system, 'HSXLVORUVOH0LQLVWqUHGHODVDQWpDYHFO·DSSXLGHSDUWHQDLUHV including the prevention of noncommunicable diseases. D UpIRUPp GH QRPEUHX[ SDQV GX V\VWqPH GH VDQWp \ FRPSULV A health policy dialogue platform supported the Minis- la prévention des maladies non transmissibles. Une plateforme try in designing a concrete strategy and action plan for GH GLDORJXH VXU OHV SROLWLTXHV GH VDQWp D DLGp OH 0LQLVWqUH j health reform to improve the national health services FRQFHYRLUXQHVWUDWpJLHFRQFUqWHHWXQSODQG·DFWLRQSRXUUpIRU- ZLWKDKHDOWKÀQDQFLQJPHFKDQLVPLQDQHIIRUWWRDWWDLQ PHU OD VDQWp DÀQ G·DPpOLRUHU OHV VHUYLFHV GH VDQWp QDWLRQDX[ UHC. DYHFXQPpFDQLVPHGHÀQDQFHPHQWGHODVDQWpGDQVOHEXWGH parvenir à la couverture sanitaire universelle.

Conclusion Conclusion This example shows how emergency response opera- &HWH[HPSOHPRQWUHFRPPHQWOHVRSpUDWLRQVG·DFWLRQG·XUJHQFH tions can provided an impetus to general health system SHXYHQWGRQQHUXQHLPSXOVLRQjODUpIRUPHJpQpUDOHGXV\VWqPH reform. The initial transformation agenda, implemented de santé. Le programme initial de transformation, mis en œuvre through humanitarian health assistance, paved the way SDU OH ELDLV GH O·DVVLVWDQFH VDQLWDLUH KXPDQLWDLUH D RXYHUW OD WR RYHUDOO KHDOWK V\VWHP DQG KHDOWK ÀQDQFLQJ UHIRUP YRLHjXQHUpIRUPHJOREDOHGXV\VWqPHGHVDQWpHWGXÀQDQFH- The undertaking was ambitious and required sustained PHQW GH OD VDQWp /·HQWUHSULVH pWDLW DPELWLHXVH HW H[LJHDLW XQ Government commitment and strong technical and engagement soutenu du Gouvernement et un solide appui tech- ORQJWHUP ÀQDQFLDO VXSSRUW IURP WKH LQWHUQDWLRQDO QLTXH HW ÀQDQFLHU j ORQJ WHUPH GH OD FRPPXQDXWp LQWHUQDWLR- community. Investing in primary health care as a start- nale. Investir dans les soins de santé primaires est un point de ing point for health systems recovery and rehabilitation GpSDUW SRXU SURFpGHU DX UHOqYHPHQW HW j OD UpKDELOLWDWLRQ GHV will lead to better, more responsive health services at services de santé du pays permettra de mettre en place community level, eventually making health systems des services de santé de meilleure qualité et plus réactifs au more resilient to emergencies and more robust to over- QLYHDX FRPPXQDXWDLUH UHQGDQW ÀQDOHPHQW OHV V\VWqPHV GH all health needs. santé plus résilients face aux urgences et plus robustes face aux besoins sanitaires en général. EÆKH@SHNMRÐCDRÐ@TSDTQRÐ TSGNQÐ@EÆKH@SHNMRÐ a:RUOG+HDOWK2UJDQL]DWLRQ5HJLRQDO2IÀFHIRU(XURSH a %XUHDX UpJLRQDO 206 GH O·(XURSH &RSHQKDJXH 'DQHPDUN Copenhagen, Denmark; b World Health Organization, b2UJDQLVDWLRQPRQGLDOHGHOD6DQWp*HQqYH 6XLVVH Ⅲ Geneva, Switzerland. Ⅲ

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Introduction Introduction Public health emergencies can impact communities, Les urgences de santé publique peuvent avoir un impact à countries, regions and the world. Public health emer- O·pFKHOOH GHV FRPPXQDXWpV GHV SD\V GHV UpJLRQV HW GX PRQGH gencies can occur suddenly or emerge gradually Ces urgences de santé publique, qui peuvent survenir soudaine- DQ\ZKHUH DW DQ\ WLPH DQG FDQ EH GLIÀFXOW WR FRQWURO PHQWRXDSSDUDvWUHSURJUHVVLYHPHQWQ·LPSRUWHRHWjQ·LPSRUWH or contain. Emergencies often have a long-lasting TXHOPRPHQWVRQWSDUIRLVGLIÀFLOHVjPDvWULVHURXjMXJXOHU(OOHV RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 293 LPSDFWQRWRQO\RQSHRSOH·VSK\VLFDODQGPHQWDOKHDOWK ont souvent des conséquences à long terme, non seulement sur but also on the health system and related sectors, la santé et le bien-être physique et mental des gens, mais aussi including education, agriculture, travel and trade. VXUOHVV\VWqPHVGHVDQWpHWOHVVHFWHXUVFRQQH[HVFRPPHO·pGX- FDWLRQO·DJULFXOWXUHOHVYR\DJHVHWOHFRPPHUFH Today, the health of 130 million people1 is jeopardized $XMRXUG·KXLODVDQWpGHPLOOLRQVGHSHUVRQQHVHVWFRPSUR- EHFDXVH WKH\ OLYH RU DUH ÁHHLQJ IURP IUDJLOH FRQÁLFW mise1SDUODIUDJLOLWpHWOHVFRQÁLWVTXLVpYLVVHQWGDQVOHV]RQHV affected places. Two billion people live in countries RHOOHVYLYHQWRXTX·HOOHVIXLHQW'HX[PLOOLDUGVGHSHUVRQQHV where progress towards achieving development goals vivent dans des pays dont le développement est compromis par DUH DIIHFWHG E\ IUDJLOLW\ FRQÁLFW DQG YLROHQFH2 The GHV IUDJLOLWpV GHV FRQÁLWV RX GHV YLROHQFHV2 La communauté global public health and humanitarian community must PRQGLDOH GH OD VDQWp SXEOLTXH HW GH O·DLGH KXPDQLWDLUH GRLW FRQWLQXHWRÀQGVWURQJHUPRUHVXVWDLQDEOHVROXWLRQVWR continuer de chercher des solutions plus robustes et plus address the unmet health needs of these populations, GXUDEOHVDÀQGHUpSRQGUHDX[EHVRLQVVDQLWDLUHVQRQVDWLVIDLWV not only to protect vulnerable people but also to keep de ces populations, non seulement pour servir et protéger les the world safer from avoidable international public personnes vulnérables, mais aussi pour mieux prémunir health emergencies. le monde des urgences internationales de santé publique qui pourraient être évitées. WHO is working with partner agencies and stakehold- (QFROODERUDWLRQDYHFG·DXWUHVRUJDQLVPHVSDUWHQDLUHVHWSDUWLHV HUV WR VWUHQJWKHQ RSHUDWLRQV LQ IUDJLOH DQG FRQÁLFW SUHQDQWHV O·206 V·DWWDFKH j LQWHQVLÀHU OHV DFWLYLWpV GDQV OHV affected countries, with the aims of meeting urgent SD\V IUDJLOHV RX WRXFKpV SDU GHV FRQÁLWV DÀQ GH UpSRQGUH DX[ needs in health systems and service delivery, preventing EHVRLQV XUJHQWV OLpV DX[ V\VWqPHV GH VDQWp HW j OD SUHVWDWLRQ disease outbreaks and strengthening mechanisms to GHVVHUYLFHVGHSUpYHQLUOHVÁDPEpHVpSLGpPLTXHVGHPDODGLH prepare for, detect and respond to all types of health et de renforcer des mécanismes de préparation, de détection et emergencies. GHULSRVWHjWRXVOHVW\SHVG·XUJHQFHVVDQLWDLUHV Resilient health systems, supported by strong public /D SUpVHQFH GH V\VWqPHV GH VDQWp UpVLOLHQWV DSSX\pV SDU GH health capacities and robust links to relevant institu- solides capacités de santé publique et des liens pertinents avec tions in non-health sectors, are fundamental to achiev- des institutions en liens avec des secteurs autres que celui de ing universal health coverage and the health-related la santé, est fondamentale pour instaurer la couverture sanitaire Sustainable Development Goals. In fragile states, it is universelle et atteindre les objectifs de développement durable critical that interventions delivered by the international liés à la santé. Dans les pays fragiles, il est primordial que les community contribute to building stronger and sustain- interventions de la communauté internationale contribuent au DEOH KHDOWK V\VWHPV ,Q IUDJLOH DQG FRQÁLFWDIIHFWHG UHQIRUFHPHQWHWODVWDELOLWpGHVV\VWqPHVGHVDQWp'·DXWUHSDUW countries, a model is needed to promote collaboration GDQV OHV SD\V IUDJLOHV HW HQ SURLH j GHV FRQÁLWV XQ PRGqOH between international agencies and national authorities FRKpUHQWGHFROODERUDWLRQHVWQpFHVVDLUHDÀQGHSURPRXYRLUOD collaboration entre les organismes internationaux et les auto- rités nationales.

A new model of collaboration showing signs Un nouveau modèle de collaboration présentant of success in Yemen des signes de succès au Yémen 7KUHH\HDUVRIZDULQ

1Ï %JM@?JÏFSK?LGR?PG?LÏMTCPTGCU Ï%CLCT?Ï3LGRCBÏ,?RGMLQÏ-DÍACÏDMPÏRFCÏ!MMPBGL?RGMLÏ 1Ï %JM@?JÏFSK?LGR?PG?LÏMTCPTGCU Ï%CLCT?Ï3LGRCBÏ,?RGMLQÏ-DÍACÏDMPÏRFCÏ!MMPBGL?RGMLÏMDÏ&SK?LG- of Humanitarian Affairs; 2017 (https://interactive.unocha.org/publication/globalhu- tarian Affairs; 2017 (https://interactive.unocha.org/publication/globalhumanitarianoverview/#, manitarianoverview/#, accessed April 2018). consulté en avril 2018). 2Ï $P?EGJGRW ÏAMLÎGARÏ?LBÏTGMJCLAC Ï#?QFGLERMLÏ"!Ï2FCÏ5MPJBÏ ?LIÏÏhttp://www. 2Ï $P?EGJGR¯Q ÏAMLÎGRQÏCRÏTGMJCLACQ Ï5?QFGLERMLÏ"!Ï*?Ï ?LOSCÏKMLBG?JCÏÏhttp://www.ban- UMPJB@?LI MPE CL RMNGA DP?EGJGRWAMLÎGARTGMJCLAC MTCPTGCU accessed April 2018). OSCKMLBG?JC MPE DP RMNGA DP?EGJGRWAMLÎGARTGMJCLAC MTCPTGCU, consulté en avril 2018). 294 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 procurement of medicines and medical supplies, have SDLHPHQW GHV VDODLUHV GHV SURIHVVLRQQHOV GH OD VDQWp HW O·DFKDW resulted in an unsustainable situation. Further weaken- de médicaments et de fournitures médicales, ont abouti à une ing of the health system will expose more Yemeni VLWXDWLRQ LQWHQDEOH 6L O·DIIDLEOLVVHPHQW GX V\VWqPH GH VDQWp VH people, and their neighbours, to risks of infectious SRXUVXLW XQ QRPEUH HQFRUH SOXV LPSRUWDQW G·KDELWDQWV GX disease outbreaks and will compound already dire phys- Yémen, ainsi que des pays voisins, sera exposé à des risques ical and mental health conditions. G·pSLGpPLHVGHPDODGLHVLQIHFWLHXVHVHWOHVFRQGLWLRQVGHVDQWp SK\VLTXHHWPHQWDOHGpMjGpVDVWUHXVHVQHIHURQWTXHV·DJJUDYHU 1HLWKHU D KXPDQLWDULDQ UHVSRQVH QRU D GHYHORSPHQWDO 2Q QH SRXUUD SDV IDLUH IDFH j O·HIIRQGUHPHQW GX V\VWqPH GH approach alone is enough to address the health system VDQWpXQLTXHPHQWDXPR\HQG·XQHULSRVWHKXPDQLWDLUHQLSDU collapse. A new way of working was needed: a strategic XQHDSSURFKHG·DLGHDXGpYHORSSHPHQW8QHQRXYHOOHDSSURFKH agenda to address all elements of human security, V·HVW GRQF DYpUpH QpFHVVDLUH XQ SURJUDPPH G·DFWLRQ VWUDWp- engaging all stakeholders, with both a humanitarian gique pour aborder tous les aspects de la sécurité humaine, avec and a development focus. The WHO Yemen team, ODSDUWLFLSDWLRQGHWRXVOHVSDUWHQDLUHVHWHQPHWWDQWO·DFFHQWj in collaboration with health cluster partners,3 devel- la fois sur la dimension humanitaire et sur les impératifs de oped an intersectoral approach for an agile response to GpYHORSSHPHQW/·pTXLSH206GX 35 000 surgical interventions personnes atteintes de choléra. En outre, >35 000 interventions were performed and nearly 30 000 cancer patients given FKLUXUJLFDOHV RQW pWp SUDWLTXpHV HW SUqV GH SHUVRQQHV life-saving, life-sustaining treatment. DWWHLQWHVGHFDQFHURQWEpQpÀFLpG·XQWUDLWHPHQWVDOYDWHXU

6G@SÐHRÐ# 1$2 Ð@MCÐVGXÐVHKKÐHSÐVNQJ Qu’est-ce que l’approche DARES et pourquoi DRS DKKDÐITF°DÐDEÆB@BD In 2017, building on the collaboration model developed (QV·LQVSLUDQWGXPRGqOHGHFROODERUDWLRQPLVHQ±XYUH LQWKH

3 Health clusters, which are active in 23 countries, include members of international 3 Les groupes de responsabilité sectorielle Santé, qui interviennent dans 23 pays, sont composés organizations, including United Nations agencies, nongovernmental organizations, de membres d’organisations internationales, dont certaines institutions des Nations Unies, national authorities, affected communities, specialized agencies, academic and ainsi que de représentants d’organisations non gouvernementales, des autorités nationales, des training institutes and donor agencies. The goal of health clusters is to relieve suf- communautés touchées, d’institutions spécialisées, d’établissements universitaires et de forma- fering and save lives in humanitarian emergencies (http://www.who.int/health- tion et d’organismes donateurs. Leur objectif est de soulager la souffrance des populations et cluster/about/en/: doesn’t work). de sauver des vies dans les situations d’urgence humanitaire (http://www.who.int/health-cluster/about/en/). 4 See http://projects.worldbank.org/P161809?lang=en 4 Voir http://projects.banquemondiale.org/P161809?lang=fr RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 295 QDWLRQDOV\VWHPVMRLQWGDWDDQDO\VLVPXOWL\HDUÁH[LEOH OHVSULQFLSHVFRQYHQXVGDQVOHFDGUHGHFHSDUWHQDULDWÀJXUHQW evidence-based programming; and accountability XQVRXWLHQDX[V\VWqPHVQDWLRQDX[XQHDQDO\VHFRQMRLQWHGHV through rapid transparent communication. The part- GRQQpHVODPLVHHQSODFHGHSURJUDPPHVSOXULDQQXHOVÁH[LEOHV ners agreed to leverage their comparative strengths to HWIRQGpVVXUGHVGRQQpHVSUREDQWHVHWO·REOLJDWLRQGHUHQGUH LPSURYH HIÀFLHQF\ UHGXFH FRPSHWLWLRQ DQG HQVXUH FRPSWH GHV UpVXOWDWV HQ V·DSSX\DQW VXU XQH FRPPXQLFDWLRQ faster scaling up of interventions. The DARES approach rapide et transparente des informations. Les partenaires se sont is gradually being rolled out in other fragile countries, engagés à tirer parti de leurs atouts respectifs, à rechercher un including the Central African Republic, the Democratic JDLQ G·HIÀFDFLWp j UpGXLUH OD FRQFXUUHQFH HW j ±XYUHU j XQH Republic of the Congo and Libya. LQWHQVLÀFDWLRQSOXVUDSLGHGHVLQWHUYHQWLRQV/·DSSURFKH'$5(6 HVWSURJUHVVLYHPHQWGpSOR\pHGDQVG·DXWUHVSD\VIUDJLOHVGRQW la Libye, la République centrafricaine et la République démo- cratique du Congo. ,Q IUDJLOH DQG FRQÁLFWDIIHFWHG VHWWLQJV SDUWLFXODUO\ 'DQV GHV FRQWH[WHV IUDJLOHV RX HQ SURLH j GHV FRQÁLWV HQ SDUWL- when protracted, as currently seen in parts of the FXOLHUORUVGHFULVHVSURORQJpHVFRPPHF·HVWDFWXHOOHPHQWOHFDV Middle East and Africa, national capacity to provide the GDQVFHUWDLQHV]RQHVGX0R\HQ2ULHQWHWG·$IULTXHOHVFDSDFLWpV most critical interventions may be compromised. QDWLRQDOHVH[LVWDQWHVVRQWLQVXIÀVDQWHVSRXUPHQHUOHVLQWHUYHQ- Collaboration models such as DARES can serve as a WLRQV OHV SOXV FULWLTXHV /HV PRGqOHV GH FROODERUDWLRQ FRPPH platform for engaging more partners and to provide a DARES peuvent servir de plateforme de promotion de la parti- common, predictable, inclusive, sustained approach to cipation de partenaires supplémentaires et fournir une approche meeting critical human health needs and aiding recov- commune, prévisible, inclusive et durable pour répondre aux ery. At the same time, DARES can reinforce key compo- besoins sanitaires fondamentaux des personnes et favoriser le nents of health systems, including service delivery, UHOqYHPHQWGHVSD\V'DQVOHPrPHWHPSVFHVPRGqOHVSHXYHQW human resources for health, information systems, essen- UHQIRUFHUOHVFRPSRVDQWHVFOpVGHVV\VWqPHVGHVDQWp\FRPSULV WLDOPHGLFDOSURGXFWVDQGWHFKQRORJ\DQGÀQDQFLQJDQG OD SUHVWDWLRQ GHV VHUYLFHV O·DOORFDWLRQ GH UHVVRXUFHV KXPDLQHV leadership, within both the context of humanitarian and SRXU OD VDQWp OHV V\VWqPHV G·LQIRUPDWLRQ OHV WHFKQRORJLHV HW development programming. SURGXLWVPpGLFDX[HVVHQWLHOVDLQVLTXHOHÀQDQFHPHQWHWO·HQFD- GUHPHQWWDQWDYHFXQHDSSURFKHUHOHYDQWGHO·DFWLRQKXPDQLWDLUH TXHGDQVXQFRQWH[WHG·DLGHDXGpYHORSSHPHQW

Conclusion Conclusion Clearly, fundamental challenges remain in fragile coun- O·pYLGHQFHOHVSD\VIUDJLOHVFRPPHOH

Implementation of the International Mise en œuvre du Règlement sanitaire Health Regulation (2005) in Oman: HMSDQM@SHNM@KÐÐ§Ð.L@MÐOQNFQ¯R Ð OQNFQDRR ÐKDRRNMRÐKD@QMSÐ@MCÐV@XÐ enseignements tirés et voie à suivre forward Dalia Samhouri,a Idris Al Abaidani,b Michel Thierenc and Sief Al Abrid Dalia Samhouri,a Idris Al Abaidani,b Michel Thierenc et Sief Al Abrid The International Health Regulations (2005) (IHR), /H 5qJOHPHQW VDQLWDLUH LQWHUQDWLRQDO 56, HQWUp HQ which came into force in June 2007, are a legally binding vigueur en juin 2007, est un instrument juridiquement contrai- instrument for the 196 States Parties. The IHR require gnant pour les 196 États Parties. Le RSI exige des États Parties States Parties to develop and maintain core capacities TX·LOVGpYHORSSHQWHWPDLQWLHQQHQWGHVFDSDFLWpVHVVHQWLHOOHVGH for surveillance and response to public health events of surveillance et de riposte aux événements de santé publique 296 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 various origins, as laid out in Annex A of the IHR. The G·RULJLQHV GLYHUVHV FRPPH LQGLTXp j O·DQQH[H $ GX 56, &HV capacities comprise a public health strategy of strength- capacités comprennent une stratégie de santé publique visant à ening local infrastructure and systems to prevent, detect UHQIRUFHUO·LQIUDVWUXFWXUHHWOHVV\VWqPHVORFDX[DÀQGHSUpYHQLU and respond to public health events at their source GHGpWHFWHUHWGHULSRVWHUDX[ÁDPEpHVpSLGpPLTXHVjOHXUVRXUFH before they spread internationally.1, 2 DYDQWTX·HOOHVQHVHSURSDJHQWjO·pFKHOOHLQWHUQDWLRQDOH 1, 2 Oman, a high-income Arab country on the southeastern /D VLWXDWLRQ JpRJUDSKLTXH G·2PDQ XQ SD\V DUDEH j UHYHQX coast of the Arabian Peninsula, which is in the WHO élevé situé sur la côte sud-est de la péninsule arabique, dans la Eastern Mediterranean Region, is highly interconnected Région OMS de la Méditerranée orientale, ouvre un canal de politically, economically and culturally with its neigh- communication politique, économique et culturelle avec les bours and throughout the Region.3 pays voisins et à travers toute la Région.3 Oman, a signatory to the IHR, has been working to Signataire du RSI, Oman a œuvré au développement et au main- develop and sustain IHR capacity in the country. The tien des capacités au titre du RSI dans le pays. Le but de cet DLPRIWKLVSDSHULVWRGHVFULEHWKHFRXQWU\·VSURJUHVV DUWLFOHHVWGHGpFULUHOHVSURJUqVUpDOLVpVGDQVODPLVHHQ±XYUH in IHR implementation and to identify issues that facil- GX56,HWG·LGHQWLÀHUOHVIDFWHXUVTXLRQWIDYRULVpFHWWHPLVHHQ itated implementation of the IHR and further develop- œuvre et le développement et le maintien des capacités au titre ment and maintenance of IHR capacity. We conducted GX56,1RXVDYRQVSURFpGpjXQH[DPHQFULWLTXHGHODVWUXF- a critical review of the organizational structure and ture organisationnelle et de la documentation relative au RSI à IHR-related documentation in Oman. Oman. Since 2010, Oman has been reporting on IHR implemen- Oman établit chaque année un rapport sur la mise en œuvre tation (self-assessment) annually, and the reports show GX56, DXWRpYDOXDWLRQ HWFHVUDSSRUWVPRQWUHQWGHVSURJUqV steady progress over time (Table 1).4, 5 Oman was one FRQVWDQWVDXÀOGXWHPSV Tableau 1).4, 52PDQHVWO·XQGHVSD\V of the countries in the Eastern Mediterranean Region GH OD 5pJLRQ GH OD 0pGLWHUUDQpH RULHQWDOH TXL Q·D SDV GpFODUp that did not report that it had met its IHR obligations DYRLUVDWLVIDLWDX[REOLJDWLRQVGX56,jODSUHPLqUHpFKpDQFHGH E\WKHÀUVWGHDGOLQHRIDQGFRQVHTXHQWO\VXEPLW- HWTXLDGRQFVROOLFLWpXQHSUHPLqUHH[WHQVLRQGXGpODLHW WHG WKH ÀUVW H[WHQVLRQ DQG D SODQ RI DFWLRQ6, 7 In its SUpVHQWpXQSODQG·DFWLRQ6, 7'DQVOHEXWGHUHOHYHUOHGpÀG·XQH efforts to achieve full compliance with the IHR, the pleine conformité avec le RSI, le Gouvernement a reconnu que Government recognized that certain organizational certaines structures organisationnelles étaient nécessaires et structures were required and that development and que le développement et le maintien des capacités au titre du maintenance of IHR capacity should be seen as RSI devaient être considérés comme une composante à part a continuous, integral component of health system HQWLqUHHWFRQVWDQWHGXUHQIRUFHPHQWGXV\VWqPHGHVDQWp8 Les strengthening.8 As a result of institutional commitment DFWLYLWpVTXLRQWpWpPHQpHVRQWSHUPLVDXSD\VG·DQQRQFHUHQ to IHR, the country announced in June 2014 that it had MXLQ TX·LO VDWLVIDLVDLW DX[ REOLJDWLRQV GX 56,9 Les struc- met its IHR obligations.9 The organizational structures tures organisationnelles qui ont été mises en place pour facili- that were set up to facilitate IHR implementation are WHUODPLVHHQ±XYUHGX56,VRQWGpFULWHVFLDSUqV described below. National IHR focal point ² 7KLV FHQWUDO *RYHUQPHQW Point focal national RSI ² &HWWH IRQFWLRQ FHQWUDOH DX VHLQ GX position was initially assigned to the Directorate of Gouvernement a été initialement assignée à la Direction de la

1 International Health Regulations (2005). Third edition. Geneva: World Health Orga- 1 Règlement sanitaire international (2005), troisième édition. Genève, Organisation mondiale de nization; 2016 (http://www.who.int/ihr/publications/9789241580496/en/, accessed la Santé, 2016 (http://www.who.int/ihr/publications/9789241580496/fr/, consulté en mars March 2018). 2018). 2 Gostin LO et al. The International Health Regulations 10 years on: the governing 2 Gostin L. O. et al. The International Health Regulations 10 years on: the governing framework framework for global health security. Lancet. 2015;386:2222–26. for global health security. Lancet. 2015; 386: 2222–26. 3 National Center of Statistics and Information, Sultanate of Oman (https://www. 3 Centre national de la statistique et de l’information, Sultanat d’Oman (https://www.ncsi.gov. ncsi.gov.om/Pages/NCSI.aspx, accessed April 2018). om/Pages/NCSI.aspx, consulté en avril 2018). 4 Progress report on implementation of the International Health Regulations (IHR 4 Progress report on implementation of the International Health Regulations (IHR 2005). Genève, 2005). Geneva: World Health Organization; 2017 (http://apps.who.int/iris/ Organisation mondiale de la Santé, 2017 (http://apps.who.int/iris/bitstream/10665/259041/2/ bitstream/10665/259041/2/RC_technical_papers_2017_inf_doc_8_20028_en.pdf, RC_technical_papers_2017_inf_doc_8_20028_en.pdf, consulté en février 2018). accessed February 2018). 5Ï 'LRCPL?RGML?JÏ&C?JRFÏ0CESJ?RGMLQÏÏKMLGRMPGLEÏDP?KCUMPIÏlÏ!MSLRPWÏNPMÍJCQ Ï 5Ï 'LRCPL?RGML?JÏ &C?JRFÏ 0CESJ?RGMLQÏ Ï +MLGRMPGLEÏ $P?KCUMPIÏ lÏ !MSLRPWÏ NPMÍJCQ Ï %CL®TC Ï Geneva: World Health Organization; 2016 (http://apps.who.int/gho/tableau-public/ Organisation mondiale de la Santé, 2016 (http://apps.who.int/gho/tableau-public/tpc-frame. tpc-frame.jsp?id=1100, accessed February 2018). jsp?id=1100, consulté en février 2018). 6 Implementation of the International Health Regulations (2005): Report of the Re- 6 Implementation of the International Health Regulations (2005): Report of the Review Commit- view Committee on the Role of the International Health Regulations (2005) in the tee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Res- Ebola Outbreak and Response. Geneva: World Health Organization; 2016 (http:// ponse. Genève, Organisation mondiale de la Santé, 2016 (http://apps.who.int/gb/ebwha/ ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ 5& =ÌCL NBD accessed February NBD=ÍJCQ 5& =ÌCL NBD (consulté en février 2018). 2018). 7 Implementation of the International Health Regulations (2005). Geneva: World 7 Implementation of the International Health Regulations (2005). Genève, Organisation mondiale Health Organization; 2015 (FRRN ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ 5& de la Santé, 2015 (FRRN ?NNQ UFM GLR E@ C@UF? NBD=ÍJCQ 5& =ÌCL NBD, consulté en A68_22-en.pdf, accessed April 2018). avril 2018). 8 Ministry of Health. eHealth portal (https://www.moh.gov.om/en/web/directorate- 8 Ministère de la santé. eHealth Portal. Disponible à l’adresse https://www.moh.gov.om/en/web/ general-of-disease-surveillance-control/about-us, accessed February 2018). directorate-general-of-disease-surveillance-control/about-us, consulté en février 2018. 9 Strengthening health security by implementing the International Health Regula- 9 Strengthening health security by implementing the International Health Regulations (2005). tions (2005). Geneva: World Health Organization; 2016 (http://www.who.int/ihr/ Genève, Organisation mondiale de la Santé, 2016 (http://www.who.int/ihr/procedures/monito- procedures/monitoring/en/, accessed April 2018). ring/en/, consulté en avril 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 297 Table 1 IHR implementation in Oman between 2010–2017 with the self-assessment and Joint External Evaluation (JEE) tools Tableau 1 Mise en œuvre du RSI à Oman entre 2010 et 2017 d’après l’auto-évaluation et l’évaluation externe conjointe (JEE)

2017 Capacity – Capacités 2010 2011 2012 2013 2014 2015 2016 JEE (%)a

Legislation – Législation 75 100 100 100 100 100 100 100

Coordination 65 100 100 100 100 100 100 100

Antimicrobial resistance – Résistance 60 aux antimicrobiens

Zoonoses 100 100 100 100 100 100 100 93

Food safety – Sécurité sanitaire 20 100 90 80 80 100 100 100 des aliments

Biosafety and biosecurity – Sécurité et 50 sûreté biologiques

Immunization – Vaccination 100

National laboratory system – Système 90 100 95 100 80 100 100 80 national de laboratoires

Real-time surveillance – Surveillance 60 90 90 90 90 100 100 80 en temps réel

Reporting – Établissement de rapports 100

Workforce development – Développe- 60 100 100 100 100 100 100 50 ment du personnel

Preparedness – Préparation 100 100 100 70 70 100 100 70

Response – Riposte 80 100 100 100 95 100 100 100

Linking public health and security – 100 Lien entre santé publique et autorités chargées de la sécurité

Medical countermeasures – Contre- 100 mesures médicales

Risk communication – Communication 80 100 85 100 100 100 100 90 sur les risques

Points of entry – Points d’entrée 80 100 100 85 90 70 85 100

Chemical events – Événements 100 90 50 45 40 100 90 70 d’origine chimique

Radiation emergencies – Situations 60 80 70 50 30 50 50 70 d’urgence radiologique a The score for each indicator ranges from 1 to 5, as follows: 1) no capacity; 2) limited capacity; 3) developed capacity; 4) demonstrated capacity and 5) sustainable capacity. These scores were converted into percentages representing the portion of a perfect score achieved. The lowest possible score was thus 20%, while a perfect score would be 100%. The score of each technical area was calculated by taking the average score for the related indicators. – Le score pour chaque indicateur varie de 1 à 5 comme suit: 1) pas de capacités; 2) capacités limitées; 3) capacités développées; 4) capacités démontrées et 5) capacités durables. Ces scores ont été convertis en pourcentages représentant la proportion du score parfait qui a été atteinte. Le score le plus bas possible était de 20% tandis que le score parfait était de 100%. Le score de chaque domaine technique a été calculé en prenant le score moyen des indicateurs associés.

Communicable Disease Surveillance and Control, but its surveillance et de la lutte contre les maladies transmissibles, PDQGDWHZDVQRWVXIÀFLHQWWRPHHWWKHQHHGVRIDQDOO TXL V·HVW DYpUpH LQFDSDEOH G·DJLU FRPPH XQ RUJDQH GH FRRUGL- Government coordinating body for IHR implementa- QDWLRQGHO·HQVHPEOHGX*RXYHUQHPHQWSRXUODPLVHHQ±XYUH tion. The Directorate-General for Disease Surveillance du RSI. La Direction générale de la surveillance et de la lutte and Control was thus designated as the IHR focal point contre les maladies a donc été désignée comme le point focal by ministerial decree and asked to head IHR as an inde- national RSI par décret ministériel et chargée de diriger les pendent section with clear terms of reference, functions activités liées au RSI en tant que section indépendante avec un and personnel. mandat, des fonctions et du personnel clairement établis. Coordination with different IHR-related sectors²7KH Coordination avec différents secteurs liés au RSI²/DGLPHQ- multisectorality of IHR required establishment of a VLRQPXOWLVHFWRULHOOHGX56,DQpFHVVLWpODFUpDWLRQG·XQFRPLWp multisectoral committee, which is responsible for moni- PXOWLVHFWRULHOFKDUJpGHVXLYUHG·pYDOXHUHWGHIDFLOLWHUODPLVH toring, evaluating and facilitating implementation of the HQ±XYUHGX56,HWGHIDLUHUDSSRUWSDUO·LQWHUPpGLDLUHGXSRLQW 298 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 IHR and reporting through the national focal point. IRFDO QDWLRQDO &HOD D QpFHVVLWp O·pODERUDWLRQ G·XQH IHXLOOH GH This involved the development of a roadmap to improve route pour améliorer 1) les capacités au titre du RSI, notamment IHR capacity, which includes advocacy to raise the DX WUDYHUV G·XQ SODLGR\HU SRXU VHQVLELOLVHU OHV VHFWHXUV OLpV DX awareness of IHR-related sectors, assessment of IHR 56, O·pYDOXDWLRQ GHV FDSDFLWpV DX WLWUH GX 56, O·pODERUDWLRQ FDSDFLW\VSHFLÀFSODQVRIDFWLRQWRPHHWJDSVDQGDOOR- GHSODQVG·DFWLRQVSpFLÀTXHVSRXUFRPEOHUOHVODFXQHVHWO·DOOR- cation of resources to implement the plans. cation des ressources pour mettre en œuvre ces plans. Oman was one of the 14 countries in the WHO Eastern 2PDQDpWpO·XQGHVSD\VGHOD5pJLRQ206GHOD0pGLWHU- Mediterranean Region to commit to and conduct a joint UDQpH RULHQWDOH j V·HQJDJHU HW j FRQGXLUH XQH pYDOXDWLRQ external evaluation (JEE) of IHR capacity between April externe conjointe des capacités au titre du RSI entre avril 2016 2016 and May 2017.10 This exercise showed that most of et mai 2017.10 Cet exercice a montré que la plupart des données the data reported by Oman in 2016 was consistent with rapportées par Oman en 2016 étaient en ligne avec les résultats the outcomes of the JEE, which was not necessarily the GH O·pYDOXDWLRQ H[WHUQH FRQMRLQWH FH TXL Q·pWDLW SDV QpFHVVDL- case for other countries.11, 12 The consistency of the data UHPHQW OH FDV SRXU G·DXWUHV SD\V11, 12 Cette cohérence des can be attributed to strong multisectoral coordination.13 données peut être attribuée à une solide coordination multi- sectorielle existante.13 National legislation to facilitate the implementation Législation nationale pour faciliter la mise en œuvre du RSI of the IHR²$OHJDOIUDPHZRUNFRYHUVDOO,+5WHFKQL- ²8QFDGUHMXULGLTXHFRXYUHSRXUWRXVOHVGRPDLQHVWHFKQLTXHV FDO DUHDV ,WV ZHOONQRZQ ÁH[LELOLW\ DOORZV IRU FRQWLQX- du RSI. Sa souplesse bien connue permet une révision et une RXV UHYLVLRQ DQG PRGLÀFDWLRQ RI DFWV UHJXODWLRQV DQG PRGLÀFDWLRQ FRQWLQXHV GHV ORLV GHV UqJOHPHQWV HW GHV SURFp- administrative procedures to ensure compliance with GXUHVDGPLQLVWUDWLYHVDÀQG·DVVXUHUODFRQIRUPLWpDX[QRUPHV LQWHUQDWLRQDOVWDQGDUGV7KHFRXQWU\·VUHFHQWO\HQDFWHG internationales. La loi sur la santé publique récemment promul- public health law ensures that coordination and commu- guée garantit la coordination et la communication pour détec- nication for early detection and response to all IHR- ter rapidement et répondre à tous les dangers relevant du RSI. relevant hazards are addressed.

Transparency and information sharing ² 7KH WUDQV- Transparence et partage de l’information ² /D SROLWLTXH GH parency policy of the Government promotes informa- WUDQVSDUHQFH GX *RXYHUQHPHQW IDYRULVH OH SDUWDJH GH O·LQIRU- tion-sharing on implementation of IHR capacities in mation relative à la mise en œuvre des capacités du RSI en JHQHUDODQGQRWLÀFDWLRQRIVSHFLÀFSXEOLFKHDOWKHYHQWV JpQpUDO HW OD QRWLÀFDWLRQ G·pYpQHPHQWV VSpFLÀTXHV GH VDQWp under the IHR. This facilitated the management of publique relevant du RSI. Cela a facilité la gestion de plusieurs several public health events within the framework événements de santé publique dans le cadre du RSI. of the IHR. Country-to-country support ² 7KH FRXQWU\ UHDOL]HG Soutien entre les pays ²/HSD\VV·HVWUDSLGHPHQWUHQGXFRPSWH early on that building national capacity is important to que le renforcement des capacités nationales était important achieving national health security. It has also been a pour garantir la sécurité sanitaire nationale. Il a aussi été un strategic partner, under Article 44 of the IHR, among DFWHXU VWUDWpJLTXH HQ YHUWX GH O·DUWLFOH GX 56, SDUPL OHV the Gulf Cooperation Council countries in achieving pays du Conseil de coopération du Golfe (CCG) pour garantir global health security through cross-border collabora- OD VpFXULWp VDQLWDLUH PRQGLDOH SDU OH ELDLV G·XQH FROODERUDWLRQ tion on most IHR capacity practices. Oman has taken WUDQVIURQWDOLqUHVXUODSOXSDUWGHVSUDWLTXHVHQPDWLqUHGHFDSD- the lead in improving outbreak detection and response FLWpV DX WLWUH GX 56, 2PDQ MRXH XQ U{OH GH FKHI GH ÀOH GDQV by conducting outbreak management courses. O·DPpOLRUDWLRQ GH OD GpWHFWLRQ HW GH OD UpSRQVH DX[ ÁDPEpHV épidémiques en organisant des formations à la gestion des ÁDPEpHVpSLGpPLTXHV An integrated public health emergency preparedness Un système intégré de préparation aux situations d’urgence system²3XEOLFKHDOWKHPHUJHQF\SUHSDUHGQHVVLVVHHQ de santé publique ² /D SUpSDUDWLRQ DX[ VLWXDWLRQV G·XUJHQFH as an integral part of the overall emergency prepared- de santé publique est considérée comme faisant partie inté- QHVV V\VWHP LQ WKH FRXQWU\ 7KLV LV UHÁHFWHG LQ WKH JUDQWH GX V\VWqPH JOREDO GH SUpSDUDWLRQ DX[ VLWXDWLRQV G·XU- mapping of potential hazards and development of all- JHQFH GDQV OH SD\V &HOD VH UHÁqWH GDQV OD FDUWRJUDSKLH GHV

10 Samhouri D et. al. World Health Organization Joint External Evaluations in the Eas- 10 Samhouri D et. al. World Health Organization Joint External Evaluations in the Eastern Mediter- tern Mediterranean Region, 2016–17. Health Security. 2018;16(1). doi: 10.1089/ ranean Region, 2016-17. Health Security, 2018. 16(1). doi: 10.1089/hs.2017.0066 hs.2017.0066. 11 Hoffman JJ et al. Making the international health regulations matter: promoting 11 Hoffman JJ et al. Making the international health regulations matter: promoting universal com- universal compliance through effective dispute resolution. In: Rushton S, Youde J, pliance through effective dispute resolution. In: Rushton S, Youde J, eds. Routledge handbook eds. Routledge handbook on global health security. Oxford: Routledge, 2014:239– on global health security. Oxford: Routledge, 2014:239–51. 51. 12 Commission on a Global Health Risk Framework for the Future. The neglected di- 12 Commission on a Global Health Risk Framework for the Future. The neglected dimension of mension of global security: a framework to counter infectious disease crises. 2016 global security: a framework to counter infectious disease crises, 2016 (https://www.nap.edu/ (https://www.nap.edu/catalog/21891/the-neglected-dimension-of-global-security- catalog/21891/the-neglected-dimension-of-global-security-a-frameworktocounter, consulté en a-frameworktocounter, accessed April 2018). avril 2018). 13 Joint External Evaluation of IHR core capacities, Sultanate of Oman. Mission report, 13 Joint External Evaluation of IHR core capacities, Sultanat d’Oman. Rapport de mission, 2–7 avril 2–7 April 2017 (http://www.who.int/ihr/publications/WHO-WHE-CPI-REP-2017.59/ 2017 (http://www.who.int/ihr/publications/WHO-WHE-CPI-REP-2017.59/en/, consulté en avril en/, accessed April 2018). 2018). RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 299 hazards public health emergency preparedness plans GDQJHUVSRWHQWLHOVHWO·pODERUDWLRQGHVSODQVGHSUpSDUDWLRQDX[ DQG FRQWLQJHQF\ SODQV IRU VSHFLÀF KD]DUGV LQFOXGLQJ VLWXDWLRQVG·XUJHQFHGHVDQWpSXEOLTXHWRXVGDQJHUVFRQIRQGXV emerging infections at points of entry. Furthermore, HWGHVSODQVG·XUJHQFHSRXUGHVGDQJHUVVSpFLÀTXHV\FRPSULV integrated, real-time surveillance was established and OHV LQIHFWLRQV pPHUJHQWHV DX[ SRLQWV G·HQWUpH (Q RXWUH XQH linked to advanced laboratory capacity for the early surveillance intégrée en temps réel a été instaurée et reliée à detection of potential hazards. An incident management des capacités avancées de laboratoire pour la détection précoce V\VWHPKDVEHHQSXWLQSODFHWRVWUHDPOLQHQRWLÀFDWLRQ GHV GDQJHUV SRWHQWLHOV 8Q V\VWqPH GH JHVWLRQ GHV LQFLGHQWV D and to coordinate the responses to all hazards. pWpPLVHQSODFHDÀQGHUDWLRQDOLVHUODQRWLÀFDWLRQHWGHFRRU- donner les réponses à tous les dangers. Building on the progress achieved, Oman is willing to 2PDQHVWGpVLUHX[G·HQIDLUHGDYDQWDJHSRXUFRQWLQXHUjGpYH- do more to further develop and maintain its IHR capac- lopper et maintenir ses capacités au titre du RSI, non seulement ity, not only nationally but regionally. To achieve this, au niveau national mais aussi régional; toutefois, le Gouverne- the Government realizes that investment in workforce PHQWVHUHQGFRPSWHGXEHVRLQFUXFLDOG·LQYHVWLUGDQVODPDLQ is a critical need. Development of a public health work- G·±XYUH /·XQHGHV SULQFLSDOHV SULRULWpV GX SD\V HVW O·pODERUD- force strategy, with career pathways, a clear plan for WLRQG·XQHVWUDWpJLHSRXUOHVHIIHFWLIVGHODVDQWpSXEOLTXHDYHF implementation and evaluation and allocation of the des parcours professionnels, un plan clair pour la mise en QHFHVVDU\ UHVRXUFHV KDV EHHQ LGHQWLÀHG DV RQH RI ±XYUH O·pYDOXDWLRQ HW O·DOORFDWLRQ GHV UHVVRXUFHV QpFHVVDLUHV the main priorities for the country. Enhancing the One 8QH DXWUH SULRULWp LGHQWLÀpH HVW GH IDYRULVHU O·DSSURFKH ©8Q Health approach is an additional priority, and a techni- monde, Une santé»; un groupe de travail technique a été mis cal taskforce has been established to identify the neces- HQ SODFH SRXU LGHQWLÀHU OHV pOpPHQWV QpFHVVDLUHV j FHWWH sary elements. The country is preparing a plan of action GpPDUFKH /H SD\V SUpSDUH XQ SODQ G·DFWLRQ SRXU OD VpFXULWp for health security that addresses its priorities. Simula- sanitaire qui répond aux priorités nationales. Il est prévu de tion exercises and “after-action reviews” are planned as réaliser continuellement des exercices de simulation et des part of the IHR Monitoring and Evaluation Frame- ©DQDO\VHV D SRVWHULRULª GDQV OH &DGUH GH VXLYL HW G·pYDOXDWLRQ work.14 Documenting success stories and lessons learnt du RSI.14 Documenter les réussites et les enseignements tirés ZLOO DOORZ RWKHU FRXQWULHV WR EHQHÀW IURP 2PDQ·V ULFK SHUPHWWUD j G·DXWUHV SD\V GH EpQpÀFLHU GH OD ULFKH H[SpULHQFH experience.15, 16 G·2PDQ15, 16

TSGNQÐ@EÆKH@SHNMR EÆKH@SHNMRÐCDRÐ@TSDTQR a Country Health Emergency Preparedness and Interna- a3UpSDUDWLRQDX[XUJHQFHVVDQLWDLUHGDQVOHSD\VHW5qJOHPHQW tional Health Regulations, Health Emergencies sanitaire international, Programme de gestion des situations 3URJUDPPH:+25HJLRQDO2IÀFHIRUWKH(DVWHUQ0HGL- G·XUJHQFH VDQLWDLUH %XUHDX UpJLRQDO 206 GH OD 0pGLWHUUDQpH terranean, Cairo, Egypt; b Department of Communicable orientale, Le Caire, Égypte; b Département des maladies trans- Diseases, Ministry of Health, Muscat, Oman; c Health PLVVLEOHV 0LQLVWqUH GH OD VDQWp 0DVFDWH 2PDQ c Programme (PHUJHQFLHV3URJUDPPH:+25HJLRQDO2IÀFHIRUWKH GH JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH %XUHDX UpJLRQDO Eastern Mediterranean Cairo, Egypt; d Directorate- OMS de la Méditerranée orientale, Le Caire, Égypte; d Direction General for Disease Surveillance and Control, Ministry générale de la surveillance et de la lutte contre les maladies, of Health, Muscat, Oman (Corresponding author: Dalia 0LQLVWqUH GH OD VDQWp 0DVFDWH 2PDQ Auteur correspondant: Samhouri, [email protected]). Ⅲ Dalia Samhouri, [email protected]). Ⅲ

14 Concept note: Development, monitoring and evaluation of functional core capacity 14 Concept note: Development, monitoring and evaluation of functional core capacity for imple- for implementing the International Health Regulations (2005). Geneva: World menting the International Health Regulations (2005). Genève, Organisation mondiale de la Health Organization; 2016 (http://www.who.int/ihr/publications/concept_ Santé, 2016 (http://www.who.int/ihr/publications/concept_note_201407.pdf?ua=1, consulté note_201407.pdf?ua=1, accessed April 2018). en avril 2018). 15 Seif Al-Abri et al. Ebola preparedness in Oman: An experience from the Middle East, 15 Seif Al-Abri et al. Ebola preparedness in Oman: An experience from the Middle East, 2016. J 2016. J Infect Public Health. 2016;9:200–2. Infect Public Health. 2016;9:200. 16 Al-Abaidani IS et al. Overview of preparedness and response for Middle East respira- 16 Al-Abaidani IS et al. Overview of preparedness and response for Middle East respiratory syn- tory syndrome coronavirus (MERS-CoV) in Oman. Int J Infect Dis. 2014;29:309–10. drome coronavirus (MERS-CoV) in Oman. Int J Infect Dis. 2014;29:309–10.

Accelerating implementation of Accélérer la mise en œuvre du Règlement the International Health Regulations sanitaire international (2005): à l’interface (2005): the interface between health entre systèmes de santé et sécurité systems and health security sanitaire The International Health Regulations (2005) (IHR) are /H5qJOHPHQWVDQLWDLUHLQWHUQDWLRQDO 56, HVWXQLQVWUX- an instrument of international law that is legally bind- ment de droit international juridiquement contraignant pour ing on 196 States Parties. They represent a unique 196 États Parties. Il constitue un cadre unique pour protéger le framework to protect the world from global health risks monde des risques sanitaires mondiaux tout en évitant de créer while minimizing unnecessary disruption of interna- GHV HQWUDYHV LQXWLOHV DX WUDÀF HW DX FRPPHUFH LQWHUQDWLRQDX[ WLRQDO WUDIÀF DQG WUDGH 7KH 5HJXODWLRQV ZHUH DGRSWHG /H 5qJOHPHQW D pWp XQDQLPHPHQW DGRSWp SDU O·$VVHPEOpH unanimously by the World Health Assembly in May 2005 mondiale de la Santé en mai 2005 et il est entré en vigueur le 300 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 and entered into force on 15 June 2007. The WHO Secre- MXLQ/H6HFUpWDULDWGHO·206HVWOHGpSRVLWDLUHGX56, tariat is the custodian of the IHR, and, along with other et, avec les autres groupes, le Département Préparation des pays groups, the Department of Country Emergency aux urgences sanitaires et RSI (CPI) du Programme OMS de Preparedness and IHR (CPI) within the WHO Health JHVWLRQ GHV VLWXDWLRQV G·XUJHQFH VDQLWDLUH D OD UHVSRQVDELOLWp Emergencies programme is responsible for supporting G·DLGHU OHV SD\V j PHWWUH HQ ±XYUH OHV SRLQWV HVVHQWLHOV GX countries in implementing critical aspects of the Regu- 5qJOHPHQW /HV SLOLHUV GH OD PLVH HQ ±XYUH VRQW XQ HQVHPEOH lations. The pillars for implementation are a set of de principales capacités nationales pour détecter, évaluer et national core capacities to detect, assess, notify and QRWLÀHUOHVpYpQHPHQWVGHVDQWpSXEOLTXHHWOHVVLWXDWLRQVG·XU- respond to public health events and emergencies and a gence, et y répondre, et une série de procédures pour échanger set of procedures for sharing information about public des informations sur les risques et les événements de santé health risks and events, preventing international spread publique, empêchant la propagation internationale et atténuant and mitigating effects on international travel and trade. les effets sur le commerce et les voyages internationaux. Since 2007, countries have used IHR procedures to work Depuis 2007, les pays ont utilisé les procédures du RSI pour together in addressing a variety of public health threats faire face ensemble à toute une série de menaces pour la santé (not just infectious diseases), the unknown threats of publique (pas seulement les maladies infectieuses), aux menaces WRPRUURZ QR ORQJHU OLPLWHG WR D SUHGHÀQHG OLVW RI inconnues de demain (qui ne se limitent plus à une liste prédé- diseases) and the actual impact of an event (mortality ÀQLHGHPDODGLHV HWjO·LPSDFWHIIHFWLIG·XQpYpQHPHQW PRUWD- DQG PRUELGLW\ LPSDFW RQ LQWHUQDWLRQDO WUDIÀF LWV OLWpHWPRUELGLWpLQFLGHQFHVXUOHWUDÀFLQWHUQDWLRQDOHQV·DWWD- unusual features rather than its simple occurrence), FKDQW SOXV DX[ FDUDFWpULVWLTXHV LQKDELWXHOOHV GH O·pYpQHPHQW taking into account information from formal and infor- TX·j VD VLPSOH VXUYHQXH HQ WHQDQW FRPSWH G·LQIRUPDWLRQV PDO VRXUFHV QRW MXVW RIÀFLDO LQIRUPDWLRQ IURP FRXQ- LVVXHVGHVRXUFHVRIÀFLHOOHVHWRIÀFLHXVHV HWSDVVHXOHPHQWOHV tries). Countries also strive to implement the require- LQIRUPDWLRQV RIÀFLHOOHV FRPPXQLTXpHV SDU OHV SD\V /HV SD\V ments to have the capacity to detect and contain events V·HIIRUFHQW pJDOHPHQW GH VH GRWHU GH OD FDSDFLWp GH GpWHFWHU HW at source and to apply international public health G·HQGLJXHU OHV pYpQHPHQWV j OD VRXUFH HW G·DSSOLTXHU GHV measures at points of entry (designated ports, airports PHVXUHV GH VDQWp SXEOLTXH LQWHUQDWLRQDOH DX[ SRLQWV G·HQWUpH and certain ground crossings), with clear guidance on SRUWVHWDpURSRUWVGpVLJQpVHWFHUWDLQVSRVWHVIURQWLqUHV DYHF the treatment of travellers. des orientations claires sur le traitement des voyageurs. Ten years after the implementation of the IHR, the 'L[DQVDSUqVODPLVHHQ±XYUHGX56,OHPRQGHHVWGpVRUPDLV world is now better prepared, with a more solid infra- PLHX[ SUpSDUp LO GLVSRVH G·LQIUDVWUXFWXUHV SOXV VROLGHV GH structure, more effective procedures and more adequate SURFpGXUHVSOXVHIÀFDFHVHWGHFDSDFLWpVQDWLRQDOHVPLHX[DGDS- national capacity to preserve global health security. tées pour préserver la sécurité sanitaire mondiale. Depuis 2010, Since 2010, when the WHO Secretariat began systematic ORUVTXH OH6HFUpWDULDWGHO·206DFRPPHQFpjVXLYUHGHIDoRQ monitoring of progress in implementing the core capac- V\VWpPDWLTXHOHVSURJUqVGDQVODPLVHHQSODFHGHVSULQFLSDOHV ities requirements, all regions have seen improvements capacités requises, toutes les Régions ont enregistré des amélio- in the 13 core capacities established in the WHO frame- rations pour les 13 principales capacités présentées dans le ZRUN 7KH LPSURYHPHQWV RYHU WKH ÀUVW VHOIUHSRUWHG FDGUH GH O·206 /HV DPpOLRUDWLRQV SDU UDSSRUW DX[ SUHPLHUV scores of 2010 vary from 10% to 40%, with the greatest scores déclarés vont de 10% à 40%, les plus importantes pour improvements in the capacity for legislation within the les capacités législatives étant observées dans la Région afri- African and the Americas regions and the greatest caine et la Région des Amériques, et les plus importantes pour improvements in the capacity for preparedness within OHVFDSDFLWpVGHSUpSDUDWLRQGDQVOHV5pJLRQVGHO·$VLHGX6XG the South-East Asia and Americas regions. Almost no Est et des Amériques. Dans la Région africaine, presque aucune improvements were noted in points of entry capacity DPpOLRUDWLRQ Q·D pWp UHOHYpH SRXU OHV FDSDFLWpV UHODWLYHV DX[ in the African Region, indicating that this area should SRLQWV G·HQWUpH FH TXL LQGLTXH TXH FH GRPDLQH GRLW rWUH be strengthened. renforcé. Much more, however, must be done to maintain and Il reste néanmoins encore beaucoup à faire pour maintenir et further improve global health preparedness and response. DPpOLRUHU OD SUpSDUDWLRQ HW OD ULSRVWH HQ PDWLqUH GH VDQWp j More comprehensive, functional assessments of core O·pFKHOOHPRQGLDOH'HVpYDOXDWLRQVIRQFWLRQQHOOHVSOXVFRPSOqWHV capacities by a combination of domestic and indepen- des principales capacités ont été menées par des experts natio- dent experts have been conducted by the WHO Secre- QDX[ HW GHV H[SHUWV LQGpSHQGDQWV GHSXLV VRXV O·pJLGH GX tariat since 2016, as a result of recommendations of the 6HFUpWDULDWGHO·206DÀQGHGRQQHUVXLWHDX[UHFRPPDQGDWLRQV IHR review committee on second extensions for esta- GX &RPLWp G·H[DPHQ VXU XQ GHX[LqPH GpODL VXSSOpPHQWDLUH blishing national public health capacities and on IHR pour la mise en place de capacités nationales de santé publique implementation, endorsed by the Sixty-eighth World HW VXU O·DSSOLFDWLRQ GX 56, DGRSWpHV SDU OD 6RL[DQWH+XLWLqPH Health Assembly. These assessments are part of the IHR $VVHPEOpH PRQGLDOH GH OD 6DQWp &HV pYDOXDWLRQV UHOqYHQW GX monitoring and evaluation framework, which comprises FDGUH GH VXLYL HW G·pYDOXDWLRQ GX 56, OXLPrPH FRPSRVp four components: annual reporting, after-action review, de quatre volets: rapports annuels, examen a posteriori, exer- simulation exercises and joint external evaluation. Their cices de simulation et évaluation extérieure conjointe. Leur objective is to inform national action plans to strengthen REMHFWLI HVW GH JXLGHU OHV SODQV G·DFWLRQ QDWLRQDX[ HQ YXH GH country capacities for public health preparedness and UHQIRUFHU OHV FDSDFLWpV QDWLRQDOHV HQ PDWLqUH GH HQ VDQWp health security. The WHO Secretariat promotes a One SXEOLTXHHWGHVpFXULWpVDQLWDLUH/H6HFUpWDULDWGHO·206HQFRX- Health approach in supporting countries to develop UDJH OHV SD\V j DSSOLTXHU O·DSSURFKH ©8Q PRQGH 8QH VDQWpª RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 301 these plans, including through workshops for bridging GDQV O·pODERUDWLRQ GH FHV SODQV \ FRPSULV SDU O·LQWHUPpGLDLUH IHR with the Performance of Veterinary Services of the G·DWHOLHUV GHVWLQpV j IDLUH OH OLHQ HQWUH OH 56, HW OH SURFHVVXV Organisation for Animal Health (OIE). G·pYDOXDWLRQ GHV SHUIRUPDQFHV GHV VHUYLFHV YpWpULQDLUHV 396 GHO·2UJDQLVDWLRQPRQGLDOHGHODVDQWpDQLPDOH 2,( As of 25 April 2018, 75 countries have conducted a Au 25 avril 2018, 75 pays avaient effectué une évaluation exté- voluntary joint external evaluation of their capacities rieure conjointe de leurs capacités de préparation et de riposte. for preparedness and response. These revealed that the Ces évaluations ont révélé que la contribution conjointe des joint contribution of external and local experts created experts externes et locaux a engendré une dynamique intersec- a unique intersectoral momentum at country level. The WRULHOOH UHPDUTXDEOH GDQV OHV SD\V /H 6HFUpWDULDW GH O·206 D WHO Secretariat has also supported 69 simulation exer- également mené 69 exercices de simulation pour tester diffé- cises to test various functional capacities in prepared- rentes capacités fonctionnelles de préparation et de riposte. Ces ness and response. The exercises included testing rapid H[HUFLFHVRQWQRWDPPHQWFRQVLVWpjWHVWHUOHVpTXLSHVG·LQWHUYHQ- response teams, risk communication, coordination tion rapide, la communication sur les risques, les mécanismes de mechanisms and emergency preparedness and response coordination et les procédures de préparation aux situations procedures for various events, such as Ebola virus G·XUJHQFH HW GH ULSRVWH SRXU GLIIpUHQWV pYpQHPHQWV WHOV TXH OD disease, meningitis, cholera, mass gatherings and deli- maladie à virus Ebola, la méningite, le choléra, les rassemble- berate events. The WHO Secretariat, in particular in the ments de masse et les événements délibérés. Le Secrétariat de UHJLRQDO DQG FRXQWU\ RIÀFHV VXSSRUWHG DIWHUDFWLRQ O·206HQSDUWLFXOLHUDXQLYHDXGHVEXUHDX[UpJLRQDX[HWGHSD\V reviews in 25 countries involving stakeholders at a également soutenu 32 examens a posteriori dans 25 pays, mobi- national, regional and local levels, community represen- lisant des parties prenantes aux niveaux national, régional et tatives, non-State actors and international partners. local; des représentants de la communauté; des acteurs non Detailed information on the joint external evaluations, étatiques et des partenaires internationaux. Des informations simulation exercises and after-action reviews conducted détaillées concernant les évaluations extérieures conjointes, les can be found on the WHO Strategic Partnership Portal.1 H[HUFLFHV GH VLPXODWLRQ HWOHV H[DPHQV DSRVWHULRUL ÀJXUHQW VXU OHSRUWDLOGHO·206VXUOHVSDUWHQDULDWVVWUDWpJLTXHV1 The outcomes of such evaluations and other assess- /HV SD\V XWLOLVHQW OHV UpVXOWDWV GH FHV pYDOXDWLRQV HW G·DXWUHV ments are used by countries to develop or update pYDOXDWLRQVSRXUPHWWUHDXSRLQWRXDFWXDOLVHUGHVSODQVG·DF- national action plans for health security, with technical WLRQQDWLRQDX[SRXUODVpFXULWpVDQLWDLUHDYHFO·DSSXLWHFKQLTXH support from the WHO Secretariat. These plans trans- GX 6HFUpWDULDW GH O·206 &HV SODQV WUDGXLVHQW HQ DFWLRQV OHV late the priority recommendations of various evalua- UHFRPPDQGDWLRQVSULRULWDLUHV8QHSODQLÀFDWLRQQDWLRQDOHDpWp WLRQVLQWRDFWLRQV1DWLRQDOSODQQLQJKDVEHHQFRPSOHWHG UpDOLVpH GDQV SD\V HW OH 6HFUpWDULDW PHW j MRXU HW DIÀQH OHV in 23 countries, and the WHO Secretariat is updating FDGUHV GHV SODQV G·DFWLRQ QDWLRQDX[ OHV GRFXPHQWV G·RULHQWD- DQG UHÀQLQJ WKH IUDPHZRUNV IRU QDWLRQDO DFWLRQ SODQV WLRQHWOHVHQVHPEOHVG·RXWLOVQRWDPPHQWHQYXHG·XQHDFWLRQ guidance documents and toolkits and for immediate LPPpGLDWHIDFHDX[SULQFLSDX[ULVTXHV/H6HFUpWDULDWGHO·206 action for addressing the most important risks. The DLGH DXVVL OHV SD\V j UHQIRUFHU OHXUV FDSDFLWpV GH VRUWH TX·LOV Secretariat is also supporting countries on building soient mieux préparés opérationnellement à gérer les risques capacity, so that they are better prepared and operation- et les événements de santé publique. ally ready to manage any public health risks and events. IHR core capacities are also linked to essential public Les principales capacités du RSI sont également liées aux fonc- health functions, and strengthening of health systems tions essentielles de la santé publique, et le renforcement des to ensure resilient health services in the face of an V\VWqPHV GH VDQWp SRXU JDUDQWLU OD UpVLOLHQFH GHV VHUYLFHV epidemic is a key focus of the WHO Secretariat, partic- de santé face à une épidémie est une préoccupation centrale ularly in the aftermath of the outbreak of Ebola virus GX6HFUpWDULDWGHO·206HQSDUWLFXOLHUDXOHQGHPDLQGHODÁDP- GLVHDVHLQ:HVW$IULFDLQ² EpHpSLGpPLTXHGHPDODGLHjYLUXV(ERODHQ$IULTXHGHO·2XHVW en 2014-2016. The IHR Secretariat has been monitoring additional Le Secrétariat du RSI a assuré le suivi des mesures sanitaires health measures applied during public health events to VXSSOpPHQWDLUHVORUVGHVpYpQHPHQWVGHVDQWpSXEOLTXHDÀQGH strengthen compliance with the Regulations. The system UHQIRUFHUODPLVHHQ±XYUHGHVSUHVFULSWLRQVDYHFOH5qJOHPHQW was pilot-tested during the outbreaks of Ebola virus /H V\VWqPH D IDLW O·REMHW G·HVVDLV SLORWHV SHQGDQW OHV ÁDPEpHV disease in the Democratic Republic of the Congo in épidémiques de maladie à virus Ebola en République démocra- 2017, of plague in Madagascar in 2017 and of listeriosis tique du Congo en 2017, de peste à Madagascar en 2017 et de in South Africa in 2018. The system allows the IHR listériose en Afrique du Sud en 2018. Il permet au Secrétariat Secretariat to track the use of additional health measures du RSI de contrôler si des mesures sanitaires supplémentaires WKDWVLJQLÀFDQWO\LQWHUIHUHZLWKLQWHUQDWLRQDOWUDIÀFDQG HQWUDYDQWGHPDQLqUHLPSRUWDQWHOHWUDÀFHWOHFRPPHUFHLQWHU- trade and to work with the States Parties that are using nationaux ont été prises et de collaborer avec les États Parties such measures to ensure that they comply with WHO TXLXWLOLVHQWFHVPHVXUHVSRXUYHLOOHUjFHTX·LOVDSSOLTXHQWOHV advice and requirements under the IHR. FRQVHLOVGHO·206HWOHVSUHVFULSWLRQVDXWLWUHGX56,

1 WHO Strategic Partnership Portal. Available online at https://extranet.who.int/spp/; 1 Portail de l’OMS sur les partenariats stratégiques. Disponible en ligne à l’adresse https://extra- accessed February 2018. net.who.int/spp/ (en anglais seulement, consulté en février 2018). 302 WEEKLY EPIDEMIOLOGICAL RECORD, NO 20, 18 MAY 2018 The IHR are much more operational, with a structured Le RSI est beaucoup plus opérationnel. Il se fonde sur un réseau JOREDO QHWZRUN RI 1DWLRQDO ,+5 )RFDO 3RLQWV RQH LQ mondial structuré de points focaux nationaux RSI (un dans each country) linked to WHO IHR Contact Points (one FKDTXHSD\V OXLPrPHUHOLpjGHVSRLQWVGHFRQWDFW56,jO·206 LQHDFKUHJLRQDORIÀFH UHVXOWLQJLQQRWRQO\DQRWLÀFD- (un dans chaque bureau régional), résultant non seulement en WLRQ PHFKDQLVP EXW DOVR YHULÀFDWLRQ SURFHGXUHV WKH PpFDQLVPH GH QRWLÀFDWLRQ PDLV DXVVL HQ GHV SURFpGXUHV GH possibility of taking into account other reports or YpULÀFDWLRQ DYHF OD SRVVLELOLWp GH SUHQGUH HQ FRPSWH G·DXWUHV VLPSO\ FRQVXOWLQJ :+2 LQ FRQÀGHQFH 7KH QHWZRUN LV UDSSRUWVRXVLPSOHPHQWGHFRQVXOWHUO·206GHIDoRQFRQÀGHQ- operational 24 hours a day every day of the year. The tielle. Le réseau est opérationnel 24 heures sur 24, tous les jours procedures are based on a decade of WHO experience GHO·DQQpH&HVSURFpGXUHVVHIRQGHQWVXUXQHGpFHQQLHG·H[Sp- and its own operations in relation to epidemic intelli- ULHQFH GH O·206 HW VXU VHV SURSUHV DFWLYLWpV GDQV OH GRPDLQH JHQFH YHULÀFDWLRQ ULVN DVVHVVPHQW DQG UHVSRQVH WKXV GXUHQVHLJQHPHQWpSLGpPLRORJLTXHGHODYpULÀFDWLRQGHO·pYD- making the global system more harmonized and effec- OXDWLRQ GHV ULVTXHV HW GH OD ULSRVWH UHQGDQW DLQVL OH V\VWqPH tive. For major events, a procedure for joint risk assess- PRQGLDO SOXV KDUPRQLVp HW HIÀFDFH 3RXU OHV pYpQHPHQWV ment is used, in which the WHO Director-General PDMHXUV XQH SURFpGXUH G·pYDOXDWLRQ FRQMRLQWH GHV ULVTXHV HVW convenes an IHR Emergency Committee, with members XWLOLVpH GDQV ODTXHOOH OH 'LUHFWHXU JpQpUDO GH O·206 FRQYRTXH from the IHR roster of experts, who advise the Director- XQ&RPLWpG·XUJHQFHGX56,QRWDPPHQWFRPSRVpGHPHPEUHV General on whether an event constitutes a public health GHODOLVWHG·H[SHUWVGX56,FKDUJpGHGRQQHUVRQDYLVDX'LUHF- HPHUJHQF\RILQWHUQDWLRQDOFRQFHUQDQGLQWKHDIÀUPD- teur général sur la question de savoir si un événement consti- tive, on any temporary recommendations to be made tue une urgence de santé publique de portée internationale et, to countries to respond to a declared emergency. Provi- GDQVO·DIÀUPDWLYHVXUOHVUHFRPPDQGDWLRQVWHPSRUDLUHVpYHQ- sions have been made to address potential problems, tuelles à adresser aux pays en réponse à une urgence déclarée. VXFK DV ZKHQ FRXQWULHV DSSO\ XQMXVWLÀHG KHDOWK 'HV GLVSRVLWLRQV RQW pWp SULVHV IDFH j WRXW SUREOqPH SRWHQWLHO measures (border closure or embargoes), and the SDU H[HPSOH O·DSSOLFDWLRQ SDU OHV SD\V GH PHVXUHV VDQLWDLUHV human rights of travellers are now considered, clearly LQMXVWLÀpHV IHUPHWXUHGHVIURQWLqUHVRXHPEDUJRV HWOHVGURLWV stating what is acceptable and what is not. humains fondamentaux des voyageurs sont désormais pris en compte, en indiquant clairement ce qui est acceptable ou non. The IHR and World Health Assembly resolution /H 56, HW OD UpVROXWLRQ :+$ SDU ODTXHOOH O·$VVHPEOpH WHA58.3 in which they were adopted in 2005 acknowl- PRQGLDOHGHOD6DQWpO·DDGRSWpHQUHFRQQDLVVHQWODQDWXUH edge the intersectoral nature of their implementation, LQWHUVHFWRULHOOH GH VD PLVH HQ ±XYUH VH UpIpUDQW j G·DXWUHV making reference to other international instruments instruments internationaux et à des organisations internatio- and to international organizations such as the OIE, the QDOHV WHOOHV TXH O·2,( O·2UJDQLVDWLRQ GHV 1DWLRQV 8QLHV SRXU Food and Agriculture Organization of the United O·DOLPHQWDWLRQHWO·DJULFXOWXUH )$2 O·2UJDQLVDWLRQGHO·DYLDWLRQ 1DWLRQV WKH ,QWHUQDWLRQDO &LYLO $YLDWLRQ 2UJDQL]DWLRQ FLYLOHLQWHUQDWLRQDOH 2$&, HWO·$JHQFHLQWHUQDWLRQDOHGHO·pQHU- and the International Atomic Energy Agency and to JLH DWRPLTXH $,($ DLQVL TX·j FHUWDLQHV DVVRFLDWLRQV SURIHV- some industry associations, such as the International VLRQQHOOHVWHOOHVTXHO·$VVRFLDWLRQGXWUDQVSRUWDpULHQLQWHUQD- Air Transport Association, thus acknowledging the WLRQDO UHFRQQDLVVDQW DLQVL O·LPSRUWDQFH GX WUDQVSRUW DpULHQ importance of air transport in the international spread dans la propagation internationale des maladies). of diseases. Overall, these measures have resulted in a much more Globalement, ces mesures ont abouti en un cadre bien plus operational framework for a safer world, which commits opérationnel pour un monde plus sûr, cadre qui repose sur all WHO Member States and clearly gives the WHO O·HQJDJHPHQWGHWRXVOHVeWDWV0HPEUHVHWFRQÀHFODLUHPHQWHW Secretariat and its Director-General the unique respon- VSpFLÀTXHPHQWDX6HFUpWDULDWHWDX'LUHFWHXUJpQpUDOGHO·206 sibility of supporting countries. This requires sustained la responsabilité de fournir un appui aux pays. Cela nécessite international partnerships and the engagement of a des partenariats internationaux durables et la collaboration broad spectrum of partners and institutions across G·XQHODUJHJDPPHGHSDUWHQDLUHVHWG·LQVWLWXWLRQVUHOHYDQWGH sectors and disciplines. différents secteurs et disciplines.

Conclusion Conclusion There is consensus that, since their adoption in 2005 Il existe un consensus sur le fait que, depuis son adoption en and their entry into force in 2007, the Regulations have SXLV VRQ HQWUpH HQ YLJXHXU HQ OH 5qJOHPHQW D DLGp helped the international community to prepare for and la communauté internationale à se préparer et à répondre de respond to public health events, risks and emergencies IDoRQ SOXV HIÀFDFH DX[ pYpQHPHQWV ULVTXHV HW VLWXDWLRQV G·XU- PRUH HIÀFLHQWO\ 0DQ\ 6WDWHV 3DUWLHV KDYH PDGH JRRG gence de santé publique. De nombreux États Parties ont réalisé progress in developing and strengthening the core G·LPSRUWDQWVSURJUqVGDQVODPLVHHQSODFHHWOHUHQIRUFHPHQW FDSDFLWLHVUHTXLUHGE\WKH5HJXODWLRQV6LJQLÀFDQWJDSV GHVSULQFLSDOHVFDSDFLWpVUHTXLVHVSDUOH5qJOHPHQW'HVODFXQHV remain, however, in the core capacities of several coun- importantes demeurent néanmoins dans les principales capa- tries, and emerging and re-emerging threats with cités de plusieurs pays, et des menaces émergentes et réémer- pandemic potential continue to challenge health gentes à potentiel pandémique continuent de peser sur les systems. States Parties can take advantage of renewed V\VWqPHVGHVDQWp/HVeWDWV3DUWLHVSHXYHQWWLUHUSURÀWGHFHWWH momentum behind IHR by developing national action G\QDPLTXH UHQRXYHOpH HQ pODERUDQW GHV SODQV G·DFWLRQ QDWLR- plans for health security, accelerating the building and QDX[SRXUODVpFXULWpVDQLWDLUHHQDFFpOpUDQWO·DFTXLVLWLRQHWOH RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 20, 18 MAI 2018 303 maintenance of core capacities and ensuring that they maintien des principales capacités (notamment celles relatives are fully embedded in their health systems, including DX[SRLQWVG·HQWUpH HWHQYHLOODQWjFHTXHFHVGHUQLqUHVVRLHQW for points of entry. Work should continue on involving SOHLQHPHQWLQWpJUpHVjOHXUVV\VWqPHVGHVDQWp,OIDXWFRQWLQXHU other relevant sectors, such as animal health, travel and GH PRELOLVHU G·DXWUHV VHFWHXUV LQWpUHVVpV FRPPH FHX[ GH OD transport. The global network of national IHR focal santé animale, des voyages et des transports. Le réseau mondial points continues to play a central role in implementa- de points focaux nationaux RSI continue de jouer un rôle pivot tion of the Regulations and in global health security in GDQV O·DSSOLFDWLRQ GX 5qJOHPHQW HW GDQV O·DUFKLWHFWXUH GH OD JHQHUDO DOWKRXJK VLJQLÀFDQW FKDOOHQJHV WR WKH DFWXDO sécurité sanitaire mondiale, même si, dans certains pays, des functionality and responsiveness of national IHR focal GLIÀFXOWpVQRWDEOHVGHPHXUHQWGXSRLQWGHYXHGXIRQFWLRQQH- points persist in some countries. ment et de la réactivité des points focaux nationaux RSI. The draft 5-year global strategic plan to improve public Le projet de plan stratégique mondial quinquennal visant à KHDOWK SUHSDUHGQHVV DQG UHVSRQVH ² ZKLFK LV DPpOLRUHU OD SUpSDUDWLRQ HW O·DFWLRQ GH VDQWp SXEOLTXH EHLQJ VXEPLWWHG IRU FRQVLGHUDWLRQ E\ WKH 6HYHQW\ÀUVW SUpVHQWpSRXUH[DPHQSDUOD6RL[DQWHHW2Q]LqPH$VVHP- World Health Assembly, should allow the WHO Secre- blée mondiale de la Santé, doit permettre au Secrétariat de tariat and States Parties to address the challenges O·206HWDX[eWDWV3DUWLHVGHVXUPRQWHUOHVREVWDFOHVPHQWLRQ- referred to above and further expedite implementation QpVSOXVKDXWHWG·DFFpOpUHUO·DSSOLFDWLRQGX5qJOHPHQW of the Regulations.

Acknowledgements Remerciements Country Health Emergency Preparedness & Interna- Département Préparation des pays aux urgences sanitaires et tional Health Regulations Department, Health Emergen- 5qJOHPHQWVDQLWDLUHLQWHUQDWLRQDO3URJUDPPH206GHJHVWLRQ cies Programme, World Health Organization, Geneva, GHVVLWXDWLRQVG·XUJHQFHVDQLWDLUH2UJDQLVDWLRQPRQGLDOHGHOD Switzerland. Ⅲ 6DQWp*HQqYH6XLVVHⅢ

Acknowledgements Remerciements The editorial team acknowledges the outstanding /·pTXLSHpGLWRULDOHVRXKDLWHYLYHPHQWUHPHUFLHUOHVVHUYLFHV FRQWULEXWLRQ RI :+2·V )UHQFK WUDQVODWLRQ VHUYLFHV GH WUDGXFWLRQ IUDQoDLVH GH O·206 6LqJH SRXU OHXU FRQWUL- (Headquarters) to this issue of the Weekly Epidemio- bution remarquable à ce numéro spécial du Relevé épidé- logical Record. Ⅲ miologique hebdomadaire. Ⅲ

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