Rapid action saves lives and reduces morbidity
In emergency clinical care, health workers often use the term “golden hour” as shorthand for the concept that rapid clinical investigation and care within 60 minutes of a traumatic injury is key to a good outcome for the patient. For WHO, the health emergencies are on a larger scale, and the timescales might be slightly different, but the concept is the same: rapid action saves lives and reduces morbidity.
Since the launch of the WHO Health Emergencies programme (WHE) in 2016, WHO has constantly strived to increase the Organization’s health emergency reflexes. In broad terms this means doing three things: increasing WHO’s sensitivity to signals that suggest an emergency might be occurring or about to occur; speeding up the investigation and assessment of these alert signals when they are detected; and rapidly mobilizing the people, supplies and other resources required as soon as a threat to health is confirmed. But as simple as these goals might sound, achieving them is an ever-evolving challenge that relies on WHO’s strong links with thousands of partners around a world in which health emergencies are increasing in both frequency and complexity.
Casting the net wide
Threats to health are continuing to proliferate. In 2022, negative long-term trends included the further acceleration of the emergence and re-emergence of epidemic-prone diseases; increased geopolitical conflict; hunger and shortages of essential goods; the intensification of ecological degradation and climate change; a further weakening of health systems in the wake of COVID-19; and widening economic and social inequalities. The evidence of the past few decades tells us that these trends are increasingly interacting in unpredictable ways to drive health emergencies, and that in turn means WHO must cast its net ever wider to detect emergencies as close as possible to their source.
Leading this effort, WHO’s dedicated teams at headquarters and regional offices already scour the globe for signs of emerging events 24 hours per day, 365 days per year, in close collaboration with WHO country offices, national governments and partners. In 2022, WHO’s global surveillance systems screened about 3500 discrete items of information each day, yielding 498 substantiated new events across 158 countries logged in WHO’s Emergency Management System over the year. The majority (85%) of new events were caused by infectious hazards, but natural and manmade disasters, food contamination and myriad other factors caused incidents throughout 2022.
Finding these signals amidst the noise and chaos of the 21st Century’s information landscape is an increasing challenge, but WHO is fighting back by accelerating the development of new tools for public health intelligence, and expanding and deepening partnerships and collaboration to harness the power of global networks.
WHO’s Hub for Pandemic and Epidemic Intelligence, which was established in September 2021, has already built strategic partnerships with more than 200 global institutions as part of a broad effort to move towards a model of collaborative surveillance. A key tool in this effort, the Epidemic Intelligence from Open Sources (EIOS) initiative, is continuing to expand its reach, with 18 more Member States signing up throughout 2022. The initiative now has a 1400-strong corps of public health professionals trained to use the system to detect emerging acute events, and as the network of EIOS users continues to grow so does its power to find and track threats to health as they emerge. At the same time, the Field Epidemiology Training Programme continues to strengthen the national and global health emergency workforce by training the next generation of epidemiologists.
Starting the clock
As soon as an event is identified, WHO assesses the level of risk and sounds the alarm. But in a subset of cases, particularly those that emerge in vulnerable and conflict-affected contexts, the complex interplay between the risks posed by an event and the pre-existing vulnerabilities of populations and health systems warrants a more detailed risk assessment. It’s at this point that the clock really starts ticking. WHO aims to complete a formal rapid risk assessment within 24 hours of a threat being verified, but in practice getting the requisite expert multidisciplinary team from WHO and partners on site can prove extremely challenging, with access often complicated by the remoteness and isolation of affected communities, insecurity, and other logistical hurdles. Despite these challenges, WHO was able to complete a full and formal rapid risk assessment for a third of the more than 50 country-level events and 14 multi-country events assessed in 2022.
For 90% of all the events assessed, WHO deemed the risk at national level to be high or very high, automatically triggering WHO’s internal grading process to determine the scope of operational response required by the Organization. For acute events and emergencies grading is done within 24 hours of a risk assessment or situation analysis of a sudden-onset emergency such as a natural disaster. Throughout 2022 WHO responded to 70 graded emergencies, of which 42 were classed as acute, and of which nine were Grade 3 emergencies, indicating the greatest threat to health. Of these nine, emergencies in Afghanistan, Ethiopia, Somalia, and Ukraine were covered by scale-up protocols of the United Nations Inter-agency Standing Committee. Given their scale, complexity and inherent operational challenges, these Grade 3 emergencies required the highest level of Organization-wide support, and in line with WHO’s Emergency Response Framework, all graded emergencies were managed through WHO’s incident management system.
No regrets policy
For every graded emergency WHO allocates resources according to its policy of “no regrets”. This means ensuring that the staffing and resources requested by the Incident Manager are made available without delay because it is always better to err on the side of over-resourcing critical functions rather than risk failure by under-resourcing.
At this early stage in an emergency cycle, reacting rapidly and at the appropriate scale relies on rapid access to emergency financing. WHO’s Contingency Fund for Emergencies can release funding in 24 hours, and in 2022 released a total of US$ 88 million to support WHO's emergency response operations.
For infectious disease outbreaks alone the fund released US$30 million for response in 22 countries and the global response to mpox (monkeypox). Notably, the CFE released funding to address the unprecedented outbreaks of cholera and measles in 2022, with allocations to 8 countries, including countries already undergoing complex crises such as Afghanistan, Lebanon, Somalia and the Syrian Arab Republic. The CFE also enabled WHO to provide rapid technical support to the governments of the Democratic Republic of the Congo and Uganda to help end Ebola outbreaks. And the CFE was also used in outbreaks that did not make the headlines, including Lassa Fever in Nigeria, dengue in São Tomé and Príncipe, and the Marburg Virus outbreak in Ghana.
The fund was also used to scale up life-saving health operations in protracted crises in response to escalating needs. A total of US$45 million was released to respond to escalations in complex emergencies, including in Ukraine, the greater Horn of Africa and the Sahel, the West Bank and Gaza strip, and northern Ethiopia.
Crucial though it is, financing is only one very important part of the equation.
Getting the people and supplies to where they are needed required more than just funds, and the recent creation of WHO global logistics hubs has helped ensure rapid, efficient delivery of lifesaving supplies to countries.
In Ukraine alone WHO delivered more than 2500 metric tons of emergency medical supplies worth US$ 61 million, including trauma and surgery kits, ambulances, power generators and the installation of two large O2 production plants to improve hospital access to oxygen.
To combat the global cholera outbreak, WHO delivered US$ 14 million of emergency cholera kits, providing treatment to more than 432 000 people, as well as more than 500 000 cholera rapid tests.
The WHO Logistics Hub in Dubai expanded its warehouse capacity to more than 20 000 square meters in late 2021, enabling it to deliver US$38 million in health supplies in 2022 to 90 countries through more than 578 shipments to all WHO regions, representing an annual 341% increase since the Hub was opened in 2019. A new WHO hub established in Nairobi aims to replicate Dubai’s success.
Alongside vital supplies, the technical support and operational capacity provided through surge deployment mechanisms of WHO and its partners continued to save lives in 2022. The Global Outbreak Alert and Response Network, for example, made 111 deployments in support of 11 emergency response operations throughout 2022. Deployed experts covered a broad range of disciplines including coordination, epidemiology and surveillance, laboratory, case management, infection prevention and control, risk communication and community engagement.
To respond effectively to the ever-increasing scale and complexity of health emergencies in the 21st century, however, WHO is working with partners to rethink how the world collectively trains, maintains, equips, coordinates, networks and leads the world’s health emergency workforce. Ultimately every country must be able to respond rapidly and effectively to national health emergencies, and call on regional and global friends and neighbours for rapid, predictable, coordinated support in times of need.
The fundamental building block of a global health emergency workforce is a well-trained national health emergency workforce in every country. In 2022 WHO set out a 5-year roadmap to strengthen the multidisciplinary workforce required to carry out essential public health functions, including emergency preparedness and response, in every Member State. In 2023 WHO aims to work with partners to build on the roadmap by accelerating the development of multidisciplinary national health emergency workforce and leadership capacities at the intersection of health security, primary health care, and health promotion, and continue to strengthen our collective ability to respond rapidly in a world where threats to health continue to multiply.