A whole of society collaboration with detailed tasks attributed to Mongolia’s central and local parliaments and governments, civil society organizations, households and individuals was emphasized in the Recommendations adopted by the two-days long International Conference “Tackling Infectious Diseases: Information for Action” that completed its work in Ulaanbaatar on 21 October. Over 200 participants including prominent national and international public health professionals, representatives from the Mongolian Government, city and aimag health sector managers and civil society organizations have gathered to discuss future directions and joint actions to be undertaken based on a whole array of ground-breaking research and up-to date evidence from surveys, assessments and reviews presented in the area of infectious diseases including tuberculosis, HIV, STIs, viral hepatitis, vaccine-preventable, emerging and re-emerging diseases, zoonotic diseases, WASH, and water safety and quality. The Conference was co-organized by the Ministry of Health of Mongolia, National Centre for Communicable Diseases, National Centre for Zoonotic Disease, Public Health Institute and WHO Representative’s Office in Mongolia. Speakers from Mongolia, Russia, Japan, China, Australia and WHO staff from the Western Pacific Regional Office and WHO Representative’s Office in Mongolia presented scientific papers and the latest findings in the field of communicable diseases.
“It’s notable that this International Conference on Communicable Diseases is taking place in Mongolia as the country still suffers from a raise in infectious diseases. Moreover, Mongolia as any other country faces threats from new and emerging diseases. Unfortunately Mongolia is a leading country in the world by viral hepatitis-induced liver cancer deaths seconded by helicobacter-triggered stomach cancer caused deaths. At the same time sexually transmitted diseases especially among adolescents and young adults as well as high prevalence of tuberculosis have become a matter of a serious concern,” said Dr Soe Nyunt U, WHO Representative in Mongolia.
A number of WHO supported new research was disclosed for the first time at this Conference. Thus, the first ever TB prevalence survey made in Mongolia in 2014-2015 informed of 3 times higher TB prevalence in the country than the National TB Programme and WHO estimated earlier. The ongoing study on introduction of pneumococcal conjugate vaccine (PCV) in Mongolia has already shown its worth in prevention of pneumonia in children.
New data on hepatitis C treatment in Mongolia that started in the beginning of this year with availing new drugs at tired-prices, revealed a very high success rate of cure: the number of patients treated reached 5000 persons in 2016. “It’s a very good news”, said Narantuya Jadambaa, a technical officer at the WHO Representative’s Office in Mongolia. ”However, it is estimated that the rate of new infections come up to 4000 cases a year which is quite discouraging.” Narantuya says that alongside with searching for new ways of making this treatment affordable for most of the HCV patients in Mongolia a focused effort needs to be given to prevention.
WHO-supported series of evaluations on the recent measles outbreak in Mongolia pointed at a number of important lessons learnt from the incident that has been lasting for two years and that took away over 100 babies’ lives in 2016. “This nationwide measles outbreak tested our preparedness and response capacity. It revealed major issues and inefficiencies with surveillance, risk assessment and risk communication. Should the health system response have been adequate and should the health sector haven’t fallen prey to political instability, systemic lack of multi-sectoral and inter-sectoral collaboration and plain managerial irresponsibility these innocent babies would not have died from a vaccine-preventable disease causing deepest pain to their parents and families,” said Dr Soe Nyunt U in his speech at the Opening of the Conference.
The measles outbreak led the Mongolian health managers and practitioners to question the preparedness of the health system for any new and unknown diseases given the challenges the country’s health system has faced during the outbreak of this well-known, vaccine-preventable disease.
“There’ll be new diseases emerging all the time. There is nothing more certain than that. So any country needs to have systems in place that can detect these new diseases quite quickly and respond in a way that reduces risk to people,” said Dr Mark Jacobs, the Director of Communicable Diseases, WHO Western Pacific Regional Office. “Although there has been an incredible success in the world and in Mongolia in tackling infectious diseases this work will never finish. The risks will continue forever and our systems need to continue being strengthened and be very good at picking up cases and stopping people getting infected and suffering from them.”
The Conference participants agreed that to strengthen health systems and ensure its preparedness it’s vital to train multi-sector rapid response teams able to conduct adequate risk assessment of public health events to inform a rapid decision-making. “WHO-developed Field Epidemiology Training Programme is highly valued as a hands-on training that prepares front line response capacity in countries. In Mongolia since 2009 the FETP programme have grown into a network that needs further expansion,” says O. Ariuntuya, the technical officer at the WHO Representative’s Office in Mongolia, adding that the most important conclusion from the Emerging Diseases session of the Conference was “an agreement of all participants that multi-country, multi-sector and multi-level coordination of surveillance and risk assessment in peace time is critical.”
Data on spread of STIs repetitiously suggests that Mongolia is facing a silent epidemic of STIs with increasing number of congenital syphilis cases: 52 cases in 2015 alone. Scientists warn that women who have syphilis, gonorrhoea and human papilloma virus (HPV) today have a higher risk of developing cervical cancer, infertility and pelvic inflammatory diseases in 10-15 years from now. According to the scholars inaction today, when STIs comprise one third of all reported infectious diseases in Mongolia, may translate into an epidemic of cervical cancer in just 10 years.
The importance of water, sanitation and hygiene (WASH) was also underlined at the Conference that split out into three parallel sessions on the second day, one of which was held on WASH. Lack of adequate sanitation and hygiene in Mongolia especially in rural areas including soum hospitals and poorer ger districts of Ulaanbaatar city presents a serious drawback on the country’s efforts to tackle infectious diseases. Regular food-poisonings with bacteria and chemicals especially in schools and kindergartens remind of an insufficient food safety in the country and lack of multisector coordination.
Hence the Conference participants called for a better multisector coordination recognizing that health isn’t the responsibility of health sector alone and “doing business as usual isn’t the way forward”. The Conference emphasized that the issue of human health needs a “dedicated and evidence-based multi-sector cooperation” and is indeed a responsibility of all of the Government and all of the society. Moreover an importance of multi-level and multi-country cooperation was emphasized given the risk of new and emerging infections presenting an ever greater challenge to countries and the international community at large due to globalization, expansion of transnational commerce and intensification of travel.
“This Conference indeed has become a very timely event as the Ministry of Health is currently developing a comprehensive and overarching National Programme on Combatting Communicable Diseases though consolidating the 2016-2020 vertical programmes,” said Mongolia’s Minister of Health Dr A.Togtsetseg. “The Mongolian Government is keenly interested to use the new evidence provided, practices tested in other countries and lessons learnt in Mongolia and elsewhere in strengthening its national and sub-national health systems and multi-sectoral collaboration to ensure an improved health security.”
The State Secretary of the Ministry of Health D.Ochirbat noted that the “Conference was a big success.” He said: “A total of 45 presentations were discussed at this Conference and Recommendations were adopted. We will implement these Recommendations and will work together to tackle the issue of infectious diseases in Mongolia”.
WHO Representative in Mongolia, Dr Soe Nyunt U thanked the Government of Mongolia for the leadership and commitment in improving the country’s health sector and all public health professionals for their dedicated work. He further assured that WHO will always stand by the Government of Mongolia to help the country to tackle the burden of communicable diseases for the benefit of the people of Mongolia.
.jpg?sfvrsn=fabc08c4_2 "20161025-tackling-infectious-diseases (1)")