Global Health Risk Framework
August 19, 2015
Victor J Dzau, MD
U.S. National Academy of Sciences Charter
(1863)
“The academy shall, whenever called upon by any department of the government, investigate, examine… and report upon any subject of science or art,… but the Academy
shall receive no compensation whatsoever for any services to the government of the United States.”
Mission
The Institute of Medicine serves as adviser to the nation
to improve health.
The Institute of Medicine (IOM) is an independent, nonprofit
organization that works outside of government to provide
unbiased and authoritative advice to decision makers and the
public.
The mission of Institute of Medicine embraces the health of
people everywhere.
The New York Times describes the IOM as
“
the most esteemed
and authoritative adviser on issues of health and medicine, and
its reports can transform medical thinking around the world
.”
What We Are Known For
Convening the best
minds in health and
science
Providing high-quality reports and
recommendations to inform
Residents react as volunteers take away the body of a woman who died of Ebola in Waterloo, Sierra Leone.
Photo: Getty Images
8 Surveillance Alert Generation Alert Verification Response
International
level
Country
level
• Reluctance to recognize severity of outbreak • Obstruction to early notification • Limited sharing of information with other countries• Limited trained workforce • Limited infrastructure • Limited supplies and
medicine
• Lack of coordination mechanisms
• Poor understanding of community culture and traditions
• Delay to recognize magnitude of outbreak
• Limited financial resources
• Lack of coordination mechanisms between public and private
organizations
• Absence of an easily mobilized reserve of pooled funds
Community
level
• Mistrust of the government
• Slow uptake of disease control measures (unsafe burial practices)
Inadequate Response to
Ebola Outbreak
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• Global architecture to reduce risk and mitigate next global
health crisis
• Before the outbreak occurs, we need to identify leaders and
roles, resources, appropriate times for responding.
• Successful containment of future outbreaks requires timely
response.
• Coordinated response informed by good planning and
evidence, not fear or politics.
o Responders need to move as one to avoid mistrust, stigma, or miseducation of communities.
• Need to learn now, before memories fade.
10
•
Fall 2014
: A conversation between Jim Kim, World Bank, and
Victor Dzau led to the idea that the IOM should evaluate the
global Ebola response, and convene experts to develop a plan
for future pandemic response.
•
Fall 2014
: Support from Judith Rodin, Rockefeller Foundation,
and initial planning with World Bank, WHO, Rockefeller
•
December 2014
: “Getting to Zero Ebola Cases in West Africa:
A Convening of Leaders” chaired by Margaret Chan
•
March 2015
: Planning meeting for Global Health Risk
Framework
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What?
• A plan for a new global architecture for mitigating the threat of epidemic infectious diseases.
• Evidence provided by four work streams hosted by the Institute of Medicine (IOM) that converge in a synthesis and deliberations by the independent commission.
Why IOM?
• Wide reach into many disciplines
• Recommendations based on available evidence • Independent
• Long history of global health
• Able to pull many pieces together to look at the comprehensive picture
Support
Paul Allen Foundation, Ford Foundation, Gates Foundation, Ming Wai Lau, Moore Foundation, Rockefeller Foundation, USAID, Wellcome Trust
=====================================================================================
Notes:
1. The Host Group has been composed of the IOM, the Rockefeller Foundation and the World Bank, with input from WHO. It has convened multiple experts and invited input on the design and initial draft architecture of the initiative drafted by IOM (time bound initiation phase).
2. Following the initiation phase, the Host Group will cease and be replaced by an International Oversight Group, made up of several sponsors of the initiative and others relevant stakeholders. This group will nominate commissioners for the Independent Commission and will finalize the statement of task for the Commission. The IOM will function as the Secretariat and provide project management throughout the whole of the initiative.
3. The Independent Commission will be geographically/demographically diverse and include needed expertise. Many of the commissioners would be “dual-hatted” as members of the workstream teams.
International Oversight Group (Collective Charging Authority)
Independent Synthetic & Deliberative Global Commission
18 Commissioners Governance Workstream Finance Workstream Health Systems Workstream 2-Day Workshop Planning Committee (Mix of Several Commissioners and other Experts) 3-Day Workshop Planning Committee (Mix of Several Commissioners and other Experts) Evidence Supplied by Workstreams/Workshops Independently Published Consensus Commission report Host Group
(Initiation & Convening Phase – time bound)
Medical Products R&D Workstream 3-Day Workshop Planning Committee (Mix of Several Commissioners and other Experts)
Four workshop summaries published by the National Academies Press 2-day Workshop
Planning Committee (Mix of Several Commissioners and
other Experts)
International Oversight Group
A diverse group of experts from different disciplines whose main goal is to offer independent, evidence-based advice for the prosperity of the global community.
To ensure the independence and objectivity of this technical group, and protect the integrity and maintain public confidence in this process, the IOG is tasked to:
• Determine the Scope of the Study • Approve the Commission Slate
• Approve the Commission Process for Meetings, Information Gathering, Deliberations and Report Drafting
• Provide Guidelines for the Report Review Process • Assist with Developing a Dissemination Strategy
International Oversight Group Members
Victor Dzau (Chair), President, Institute of MedicineJudith Rodin (Vice-Chair), President, Rockefeller Foundation
Fazle Hasan Abed, Founder of BRAC and Chairman of BRAC Bank Limited
Arnaud Bernaert, Senior Director, Head of Global Health and Healthcare Industries, World Economic Forum
Chris Elias, President of the Global Development Program, Bill & Melinda Gates Foundation
Jeremy Farrar, President, Wellcome Trust
Shigeru Omi, President, Japan Community Healthcare Organization
Paul Polman, CEO, Unilever
Tan Chorh Chuan, President, National University of Singapore
Miriam Were, Chair of the Board of the Africa Medical and Research Foundation
Mirta Roses, Former Director-General, Pan American Health Organization
Shen Xiaoming, Professor of Pediatrics, Xin Hua Hospital and Shanghai Children’s Medical Center,
Shanghai Jiao Tong University School of Medicine
Independent Commission
• Governance for Global Health • International Health Law
• Epidemic Disease Control • Disease Surveillance
• Finance and Economics for Global Health
• Public-Private Partnerships
• NGOs and Civil Society Perspectives
• Global Workforce Mobilization • Global Health Systems
• Humanitarian Assistance • Systems for Medical Product
Research and Development
The commission includes 18 experts drawn from diverse disciplines:
The commission will attend three 2- to 3-day in-person meetings (in late
July, October, and November) and participate in a collective process to
produce options, conclusions, and recommendations for the final report.
Each commissioner will attend and assist with the planning of one
workstream workshops and will report back to the commission.
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Commission Roster
Peter Sands, MPA (Chair)
(Former) Standard Chartered PLC
Oyewale Tomori, DVM, PhD (Vice-Chair)
Nigeria Academy of Sciences
Ximena Aguilera, MD
Universidad del Desarrollo, Chile
Irene Akua Agyepong, DrPh, MBChB, FGCPS Ghana Health Service
Paul Farmer, MD, PhD
Harvard Medical School, Partners in Health
Maria Freire, PhD
Foundation for the National Institutes of Health
Julio Frenk, MD, MPH, PhD University of Miami
Yvette Chesson-Wureh, Esq Angie Brooks International Centre
Lawrence Gostin, JD Georgetown University
O'Neill Institute on National and Global Law
Alan Knight, PhD, OBE ArcelorMittal
Gabriel Leung, MD, MPH University of Hong Kong
Francis Omaswa, MBBCh, MMed, FRCS, FCS African Center for Global Health and Social Transformation
Melissa Parker, DPhil
London School of Hygiene & Tropical Medicine
K. Sujatha Rao, MA, MPA
(Former) Ministry of Health & Family Welfare of India
Daniel Ryan, MA Swiss Re
Jeanette Vega, MD, MPH, PhD Chilean National Health Fund
Suwit Wibulpolprasert, MD Ministry of Public Health, Thailand
Tachi Yamada, MD Frazier Life Sciences
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Workstreams
Governance• Review current responsibilities and constraints of countries, regional (non-UN)
institutions, WHO, other relevant UN agencies, and International Health Regulations. • Assess options for changes to international governance frameworks.
Finance
• Focus on specifications for financing mechanisms required to achieve global infectious disease surveillance and to ensure sustainable response capability to emerging
infectious disease events with a minimal amount of transactional cost delays.
Health Systems Strengthening
• Consider the characteristics of and optimum approaches to achieve effective, resilient, and sustainable health systems in countries, with particular attention to the public health functions, infrastructure, human resources, institutions.
Research
• Examine issues related to ensuring the global capacity for relevant research,
development, manufacturing, and deployment of therapeutics, vaccines, diagnostics, and personal protective equipment.
Workstream Workshops
The 4 workshops are designed to:
• gather diverse perspectives of informed stakeholders
• characterize needs and gaps in current approaches
• document key successes and lessons learned
• highlight opportunities and potential approaches to improve
the global system
• consider indicators and metrics that may be used to guide
and assess the resilience of global health infrastructure to
future outbreaks and emergencies
The goal of these workshops is
to go beyond illumination and
offer critical analyses of possible solutions
that the
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Research and Development of Medical
Products Workstream
Workstream may explore:
• Development of a global plan for harmonization and
strengthening of regulatory systems, processes, and standards • Models for public-private partnerships and NGOs that can
support rapid research and development to complement and reinforce private sector mechanisms
• Global financing models that have dedicated mechanisms to incentivize research and development.
• Frameworks for ethical and methodological standards for safety and efficacy of products
• Investments in regulatory science and multi-use platforms to support rapid development and deployment
Examine issues related to ensuring the global capacity for relevant research, development, manufacturing, and deployment of therapeutics, vaccines,
20
Research and Development of Medical
Products Workstream
Objectives of this workshop:
• Review existing incentives, business models and partnership approaches that support the research and development of medical products for emerging infectious diseases.
• Identify shortcomings in existing regulatory and financial
incentives, and highlight promising ideas for improvements that can help advance the development of medical products for
emerging infectious diseases.
• Discuss challenges to building and sustaining more effective business models and public private partnerships; explore
promising approaches and identify key attributes of a well working collaborative approach.
April-May 2015
– International Oversight Group appointed.
May 2015 –
The IOG met via conference call to lay out the ground rules for the
conduct of the work, especially the commission process that will issue conclusions
and recommendations. The oversight group also discussed and approved the
commission membership before invitations were issued.
May-June 2015
– Independent Commission appointed
May-July 2015
– Workshop planning by the coordinated but distinct workshop
planning committees
July 28-29, 2015
– Meeting #1 of the Commission – Washington, D.C.
This meeting will establish a common understanding of the strategic, operational,
and tactical problems raised by the West African Ebola outbreak as well as other
recent major emerging infectious events of global importance
August 5-7, 2015
– Resilient Health Systems workshop – Ghana
August 19-21, 2015
– Research and Development of Medical Products workshop –
Hong Kong
August 27-28, 2015
– Financing for Public Health Emergencies workshop –
Washington D.C.
September 1-2, 2015
– Governance for Global Health workshop – London
October 1-2, 2015
– Meeting #2 of the Commission – London
This will be a writing meeting to outline the sections of the final report.
November 3-5, 2015
– Meeting #3 of the Commission – Bellagio, Italy
Agreement on final conclusions and recommendations.
November 2015
– Completion of report and sign-off by commissioners. The report
will be issued in the name of the commissioners.
Mid-to-late November 2015
– Peer review of final report.
Early December 2015
– Completion of final report before January 2016 World
Health Assembly Executive Board meeting.
July
– Commission Meeting #1
Aug-Sept
– Four Workshops
• August 5-7 – Resilient Health Systems (Ghana)
• August 19-21– R&D of Medical Products (Hong Kong)
• August 27-28 – Pandemic Financing (Washington, D.C.)
• September 1-2 – Governance for Global Health (London)
