Perspective Turning commitments into actions: perspectives on emergency preparedness in South-East Asia Roderico H Ofrin, Anil K Bhola, Nilesh Buddha World Health Organization Health Emergencies Programme, World Health Organization Regional Office for South-East Asia, New Delhi, India Correspondence to: Dr Roderico H Ofrin ([email protected]) Abstract Emergency preparedness is a continuous process in which risk and vulnerability assessments, planning and implementation, funding, partnerships and political commitment at all levels must be sustained and acted upon. It relates to health systems strengthening, disaster risk reduction and operational readiness to respond to emergencies. Strategic interventions to strengthen the capacities of countries in the World Health Organization (WHO) South-East Asia Region for emergency preparedness and response began in 2005. Efforts accelerated from 2014 when emergency risk management was identified as one of the regional flagship priority programmes following the pragmatic approach “sustain, accelerate and innovate”. Despite increased attention and some progress on risk management, the existing capacities to respond to health emergencies are inadequate in the face of prevailing and increasing threats posed by multiple hazards, including climate change and emerging and re-emerging diseases. The setting up of a “preparedness stream” under the South-East Asia Regional Health Emergency Fund in July 2016 was an important milestone. The endorsement of the Five-year regional strategic plan to strengthen public health preparedness and response – 2019–2023 by Member States was another step forward. Furthermore, ministerial-level commitment, in the form of the Delhi Declaration on Emergency Preparedness, adopted in September 2019 in the 72nd session of the WHO Regional Committee for South-East Asia, is in place to facilitate Member States to invest resources in the protection and safety of people and systems and in overall emergency risk management through national action plans for health security. It is essential now to turn these commitments into actions to strengthen emergency preparedness in countries of the region. Keywords: Delhi Declaration, emergency preparedness, regional strategies, South-East Asia Background which clearly illustrates the high degree of vulnerability and exposure of people of the region to prevailing risks and The World Health Organization (WHO) South-East Asia Region hazards. Hardly a year passes without an emergency in is vulnerable to a varied range of natural hazards and human- the region. The drivers of risk are growing rapidly in south- induced disasters; it also has a high burden of outbreaks of east Asia. Unplanned urbanization, inequitable and risk- common diseases and emerging and re-emerging diseases, uninformed development planning, close human–animal including zoonoses. People in this region are frequently and wildlife habitations, variations in climatic conditions and exposed to seasonal floods, landslides, tsunamis, droughts, newly emerging environmental health emergencies such as earthquakes, volcanic eruptions and extreme weather air pollution are wake-up calls indicating that urgent corrective conditions.1 As noted in the World disasters report 2018, during measures are required to restore the public health ecology. 2008–2017, 79.8% of people affected by disasters lived in Asia “Emergency preparedness” is defined as the “capability of and 45.4% of estimated damages resulted from disasters in the public health and health-care systems, communities, and Asia.2 individuals, to prevent, protect against, quickly respond to, and Pathogens associated with recent outbreaks in countries recover from health emergencies, particularly those whose of the region include avian influenza A(H5N1) and A(H9N2), scale, timing, or unpredictability threatens to overwhelm influenza A(H1N1)pdm09, Zika virus, Middle East respiratory routine capabilities”.4 Emergency preparedness is a continuous syndrome coronavirus, Nipah virus and Crimean Congo process in which risk and vulnerability assessments, planning haemorrhagic fever virus.1 Hazards, outbreaks and resultant and implementation, funding, partnerships and political health emergencies are frequent,3 as set out in Annex Table 1, commitment at all levels must be sustained. It relies on all WHO South-East Asia Journal of Public Health | April 2020 | 9(1) 5 Ofrin et al.: Turning commitments into actions: emergency preparedness in South-East Asia stakeholders working together effectively to plan, invest in and Fig. 1. Key strategic interventions for emergency preparedness implement priority actions. It bridges the gaps between health in the WHO South-East Asia Region, 2004–2019 systems strengthening, disaster risk reduction and operational readiness to respond to emergencies. Indian Ocean tsunami (2004) Overview of emergency preparedness in the region Benchmarks, standards and indicators for emergency preparedness and response publishe (200)6 The Indian Ocean tsunami in 2004 alerted the whole world, South-East Asia eional Health Eerenc un and countries in South-East Asia in particular, to the need to establishe (200)7 reassess approaches to planning, designing and delivering Eerenc ris anaeent reconie as a health-care services and public health systems. It was reional flaship priorit prorae (201)1 recognized that the prevailing risks, hazards and vulnerabilities of people and systems could no longer be considered in isolation and only in the aftermath of a disaster but instead WHO Health Emergencies Programme needed to be addressed and integrated into health systems 14,1 and services. Since then, significant work has been done launched (2016) to strengthen emergency preparedness in the region; key strategic interventions are shown in Fig. 1. The WHO Regional Office for South-East Asia began its Prepareness strea of South-East Asia eional efforts to develop comprehensive preparedness plans for each Health Eerenc un launche (201)1 country of the region in 2006, focusing first on public health etor of health eerenc operations centres workforce development.5 Guidance on benchmarks, standards strenthene (201201) and indicators for emergency preparedness and response al eclaration aopte an Framework for action were produced in 2007 to assist countries in assessing their in building health systems resilience to climate change in outh-ast Asia Region, 201–2022 capacities to respond to health emergencies.6 A key milestone publishe (201)11 was the establishment of the South-East Asia Regional Health Roots for resilience: a health emergency regional Emergency Fund through Regional Committee resolution SEA/ risk profile of the outh-ast Asia Region 7 RC/60/R7 in 2007. The fund became effective in January 2008 publishe (201)1 and is designed to provide immediate financial support for the Regional framework on operational partnerships for first 3 months in the aftermath of an emergency in countries emergency response outh-ast Asia Region of the region. Through the WHO country offices, the countries publishe (201)3 can obtain financial support from the fund within 24 hours of hir Asia acific strategy for emerging diseases an emergency. and public health emergencies (APSE ) 19 In 2011, the regional office decided to focus on capacity- publishe (201) building and training; addressing water and sanitation and WHO eional oittee for South-East Asia nutrition in emergencies; vulnerability assessments; and resolution on strenthenin eerenc eical teas (201)20 available technologies. This work synergized efforts on risk uieline on interation of care of people ith identification, mapping of health risks and multi-hazards, use of noncounicable iseases into eerenc information technology and innovations in risk mitigation. The response an prepareness publishe (201)21 focused approach accelerated capacity-building in the health As of 2019 all 11 countries ha coplete State sector and related sectors for strengthening preparedness for Part annual reportin eiht ha coplete oint and response to acute events. ealuation eercises to ha conucte siulation Sound risk management is essential for safeguarding eercises fie ha carrie out after action reies development and implementing local, national, regional and an seen ha ran up national action plans for global strategies in the health sector and other sectors,8 health securit including the Sustainable Development Goals,9 the Sendai Five-year regional strategic plan to strengthen public Framework for Disaster Risk Reduction 2015–2030,10 the health preparedness and response – 2019–2023 22 International Health Regulations 2005 (IHR)11 and the Paris publishe Agreement on climate change.12 The lack of preparedness of Risk communication strategy for public health emergencies in the WHO outh-ast Asia Region: health systems in low- and middle-income countries revealed 2019–2023 publishe (2019)2 in 2014–2015 during the Ebola outbreaks in Guinea, Liberia, South-East Asia eional nolee etor of Nigeria and Sierra Leone led to structural and operational nternational Health eulations ational ocal reform in WHO’s emergency work. Lessons were learnt from Points establishe (2019) these events, and emergency risk management was identified as one of the flagship priority programmes of the WHO South- East Asia Region; these programmes were established in 2014 to sustain, accelerate and innovate approaches to regional Delhi Declaration on Emergency priority areas.13 The overarching strategy has been to sustain Preparedness