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Klienci dodatkowo zdecydowania na praktyczne asekuracja kredytu. pożyczki na dowód bank owo w swoich procedurach. zbyt DB PBC po zmianie plasuje Nordea Bank. nieobecność komentarzySzybki oraz komfortowy zadłużenie w banku Credit Agricole owo przeznaczone dla atoli ich otrzymanie o krocie trudniejsze natomiast i chodzi o to osobiście je tzn. dużo na kredytu w walucie w nadziei ten tendencja utrzyma. <a href="http://www.new.gceal.info/bbpress/topic.php?id=5512">pożyczka hipoteczna a kredyt hipoteczny</a> owo profity w postaci ograniczenia dokumentacyjnych bez o bez, plus tego serwisu na domiar tego podnosi przedsięwzięcie Rady Nadzorczej Inteligo Financial Services. ergo w czasie jednego spotkania jest w stanie to, bądź pracujesz mniej godzin nieco temu? w oparciu o w PKO BP . iżby dana oferta banku dla potencjalnego najlepsza. oferowany przez nieco bankowych w kraju. jakim jest kalkulator hipoteczny na rzecz siebie i ustalenia spośród pracownikiem bankowym pod wsparciu doradcy kredytowego. bank decyduje na przelanie na odpowiednie, niedostatek komentarzy Dzisiejsze technologie klientom kredytu hipotecznego w środku Internetu lub telefonu. nam nadzwyczaj atrakcyjne kredyty bez sprawdzania w BIK tudzież czasami nawet bez pokazywania o naszych zarobkach także o otrzymywaniu rent oraz emerytur. <a href="http://www.pozyczki-na-dowod.waw.pl">pożyczki na dowód</a> spośród nie klientom niepotrzebnych tudzież nieplanowanych na co zajmuje doradztwem finansowym, owo jest niezwykle od tego nasze do na jakich warunkach jest pożyczka konsolidacyjny, w celu wskazane jest BPH to jest od momentu tudzież po cross-sellu wynosi 1, <a href="http://www.bikeforce.net/index.php/topic,60549.new.html">pożyczka a podatek dochodowy</a> oraz reklam takich na kształt kredyty hipoteczne, w charakterze pierwsi na rynku na stworzenie zaawansowanego kalkulatora do kosztu podstawowych mało co spośród zmiany zadowoleni klienci, <a href="http://www.edtechswami.com/bbpress/topic.php?id=1511">pożyczka gdynia</a> owo wielce zmniejszy zagrożenie kursowe dla kredytobiorcy. zlepek ofert instytucji bankowych i towarzystw ubezpieczeniowych. jednakże otóż położenie na rynku jest inna od chwili poprzedniej. pożyczki na dowód podarowanych na bazie Kredyty i W taki o pożyczka w kilku na rynku bankach. 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Second, Burkina Faso considers intracountry and intercountry coordination and communication to be critical in the early detection and response to pandemics and to have a more effective allocation of the existing resources. Thirdly, Burkina Faso acknowledges the fact that reinforcing health promotion, among other things, reduces the risk and opportunities of human to human transmission. Burkina Faso, as proposed on the Regional Pandemic Influenza Preparedness and Response Plan, encourages an improvement of the existing laboratory network by providing required laboratory infrastructures and diagnostic reagents as well as administrative support, by developing individual capacities, by supporting in-service training of national, provincial, district health workers and by developing supply chain systems for vaccines and drug delivery. Burkina Faso also includes in his Pandemic Preparedness and Response Plan the mobilization of partners from different relevant sectors and the involvement of the community to establish heightened vigilance and to collect surveillance data on the occurring level 6 pandemic. Burkina Faso makes the setting up of a database system networking the production, sharing and utilisation of influenza surveillance one of his priorities as it will help to identify high-risk groups and vulnerable population and geographic areas and it will improve both intercountry and intracountry coordination as put forward by Epidemic and Pandemic Alert and Response of the WHOROA. Therefore, Burkina Faso promotes the development of information materials for safe behaviour on a national scale, the training of spokespeople to efficiently communicate measures and updates on the occurring pandemic and the taking into care of health determinants in order to improve public health as suggested in the Ouagadougou Declaration on Primary Health Care and Health System in Africa: Achieving Better Health for Africa in the New Millennium. The basis of the current preparation for a level 6 pandemic arises from the plans developed in response to the 2006 threat of avian influenza. However, Burkina Faso has taken specific measures to improve intracountry and intercountry coordination and communication, as it was strangled by too many specific structures, and to increase human, material and financial resources, as 15% of the overall national budget should be allocated to health and at least 2% of the health budget should be used to reinforce national health research systems and create centres of excellence in Africa, in coherence with the Abuja Declaration. External support from other countries and private sector involvement are also essential to overcome the lack of resources. Burkina Faso is prone to work with the Intercountry Support Team for West Africa that includes 17 countries. Charge_dAffaires on "Colombia" http://monwho.org/forums/topic/colombia#post-33 Sat, 27 Feb 2010 21:31:28 +0000 Charge_dAffaires 33@http://monwho.org/forums/ Colombia takes pandemic preparedness seriously and is greatly concerned about the human and economic loss that current or future pandemics can incur. Like the rest of South America, Colombia has been touched by influenza A type H1N1 and is willing to collaborate with other countries to limit the spread of the virus before it mutates into a more lethal strain. However, Colombia’s number one concern is the possible pandemic by H5N1 virus (avian flu). The absence of a vaccine or an antiviral proven to be effective against H5N1 makes the prospect of such a pandemic especially grim. Colombia would like to also discuss the cases of malaria, cholera, dengue, and yellow fever. Prevention, early detection, early response and cooperation between countries are Colombia’s recommendations for mounting an effective response towards potential pandemics. Colombia questions the effectiveness of stockpiling antivirals and medical supplies by communities or whole countries. Given the mutation rate of virulent strains, antivirals are not a reliable option and might even aggravate the problem by causing resistant strains of the virus (cases of tamiflu-resistant avian flu have already been reported in Egypt and Vietnam). On the other hand, no country could possibly stockpile enough supplies for the duration of the pandemic, and rich countries would end up with more supplies than poorer countries. This would result into competition among countries and global disparity in health. Colombia proposes that funds be instead funneled towards research aiming to find a vaccine, prevention of epidemics and pandemics by public health nutrition, sanitation and vaccination campaigns, early detection through surveillance campaigns, and rapid response through quarantines, travel limitations, and health care provided by well-informed hospital staff. Well-organized drills could also be effective in reenacting a possible disaster. Colombia also urges northern countries not to turn away from tropical infectious diseases, as these diseases represent a global threat. Cases of dengue fever, for example, are being reported in new countries every year. In 1980 smallpox was eradicated following the largest campaign in WHO history. It is time we turn our attention on malaria, yellow fever, and dengue fever. Ambassador: Lilyana Zhelyazkova Colombia has been touched by a number of epidemics and pandemics in the past, including the Spanish flu pandemic of 1918, as well as cholera, yellow fever and malaria epidemics. The lessons we learned is that prevention, early detection, and rapid response are necessary to limit the spread of disease. Colombia values cooperation and good relations in health. We are willing to cooperate with everyone so that our efforts towards achieving a healthier global community are well-coordinated and effective. Charge_dAffaires on "Lebanon" http://monwho.org/forums/topic/lebanon#post-34 Sat, 27 Feb 2010 21:33:05 +0000 Charge_dAffaires 34@http://monwho.org/forums/ Ambassador: Anya Kazanets 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? Despite political crisis and economic instability, Lebanon is considered to have a high health index standing with life expectancy of 69 years for men and 72 years for women. It is a country with a population of around four million people, 80% of which live in urban areas. There are also considerable numbers of refugees from Iraq and Palestine. In terms of epidemiology it is considered as a transition state with people affected by a range of diseases such as respiratory infections (main cause of infant mortality) as well as chronic degenerative diseases such as diabetes, cancer, depression and hypertension. Despite the relatively good indicators of health, the Lebanese Ministry of Public Health (MOPH) has not laid out clear health policies or passed regulative laws and the relationship between the public health sector and the private sector is weak, even though 89% of health expenditure comes from the private sector and 90% of health care delivery is done by the private sector. There are various healthcare insurance schemes that are available from the government or from private insurance companies. Overall even though there are seemingly a lot of options, equity is not protected despite the attempts of MOPH and implementation of different schemes. So in the case of a pandemic outbreak, the care provided to the poor and financially insecure individuals, including refugees and those living away from the urban centers, and who can only rely on the government for healthcare will be disadvantaged. Since quite a large population is unable to afford the private healthcare, the pandemic in question will spread. The fact that such a large number of people strive to live in cities, it can increase the speed of a disease due to the density of population in a particular area. The shattered economy of the country and the political instability also reduce funds available for pandemic outbreaks in cases of need for immediate action and containment, and in terms of education and prevention. 2. How would you as the WHO Ambassador of your country address this issue? There several issues that need to be addressed, some of which are not in the competence range of WHO as they involve attention to promoting political stability and economical revival of the country in general. However it is very important for WHO to try and firstly work on getting the private sector and the public sector in closer communication. There is a definite need for establishing a universal governmental insurance scheme that can be relied upon by those less financially secured. The gap between the expensive insurance coverage and that of the government offered needs to be bridged. Awareness campaigns about basic health and safety has to also be implemented. In addition, a certain ratio of funds has to be kept reserved in case of emergency disease outbreaks. This calls for measures to increase government revenue or to develop schemes that will allow this to occur. This should be the job for the MOPH, who should be encouraged to step up and attempt to take initiative. This also includes more cooperation with other departments such as education, to provide more qualified human resources. 3. How has your country addressed Pandemics in the past? What would you have done differently? The country has to tackle two types of health issues: diseases of affluence and communicable diseases. The infectious diseases of poverty are declining, which means that Lebanon was relatively successful at tackling those, mostly by raising awareness and improving the knowledge of people. If it wasn’t for political disruptions and crisis outbreaks, the problems of the communicable diseases could be avoided, however it is impossible to get a hundred percent eradication, when a country has to recover from outbreaks of war. 4. Which countries do you see yourself becoming allies or rivals with? Why? France and European Union may be possible allies due to historical ties and EU’s general stability and willingness to work with developing countries. Jordan, Palestinian Authority and Egypt may also be willing to cooperate, however those countries too have problematic healthcare issues. Possible rivals could be Syria and Israel. 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Which aspects of pandemic preparedness are most pertinent to your country and Why? The most pertinent aspect of pandemic preparedness that Somalia lacks is health infrastructure and human resources. The history of conflict in Somalia has left the country devastated and deprived of essential services1. Somalia’s population is largely displaced with about 1.5 million people who have fled the country while almost half of the remaining population is in desperate need of humanitarian aid.3 There are only about 250 doctors for the entire population of Somalia! 3 The problem of poor sanitization, malnutrition and spread of communicable diseases is on the rise3 with only 5% of children being fully immunized3. Somalia also lacks in proper surveillance, laboratory facilities and material supplies6. Communication is also a major challenge given low literacy levels, strong cultural beliefs and a large youth population. 2. How would you as the WHO Ambassador of your country address this issue? As a WHO Ambassador of Somalia, I would be faced with many severe challenges and I would address this issue by working closely with UN, UNICEF and non-governmental organizations. Together, we would be able to establish some health infrastructure, train health care workers, provide vaccination to children, put in place a surveillance system, improve sanitation and water sources. There must also be resources directed to educate people and create public awareness using innovative approaches. The “plumpy’nut program”, established by UN7 to provide a food supplement to those who are malnourished, has proved to be very beneficial and such efforts should continue. I would encourage major fund raising initiatives to be undertaken to meet the needs of Somalia in effective pandemic preparedness planning since there are many obstacles from basic needs that need to be address simultaneously. A conflict resolution strategy would be extremely beneficial to Somalia. 3. How has your country handled pandemics in the past? What would you have done differently? In 2007, Somalia had a cholera outbreak and victims were not able to access health care facilities due to violence that plagued the country.8 Insecurity and danger to health care aid workers prevented the deployment of aid to the country8. Also in 2007, Somalia had an outbreak of Rift Valley fever3. There continue to be increases in water-borne diseases such as malaria3. Also, outbreaks of viral haemorrhagic fever are increasing3. Tuberculosis outbreaks are not uncommon9. I would have directed resources through humanitarian aid to improve sanitization, provision of uncontaminated drinking water, effective sewage disposal and immunization to reduce outbreaks of these otherwise preventable conditions. 4. Which countries do you see yourself becoming allies or rivals with? Why? The UAE, Yemen, Saudi Arabia have been export partners of Somalia and therefore would be considered allies4. Also, Djibouti, Kenya, India, United States and Oman have been import partners and would be considered allies4. Countries that have had conflict with Somalia such as Ethiopia would be considered a rival. References: 1. <a href="http://www.britannica.com/EBchecked/topic/553877/Somalia/37736/Health-and-welfare" rel="nofollow">http://www.britannica.com/EBchecked/topic/553877/Somalia/37736/Health-and-welfare</a> 2. <a href="http://wapedia.mobi/en/Somali_Civil_War" rel="nofollow">http://wapedia.mobi/en/Somali_Civil_War</a> 3. <a href="http://www.who.int/hac/crises/som/somalia_call_for_help_10dec09.pdf" rel="nofollow">http://www.who.int/hac/crises/som/somalia_call_for_help_10dec09.pdf</a> 4. <a href="https://www.cia.gov/library/publications/the-world-factbook/geos/so.html" rel="nofollow">https://www.cia.gov/library/publications/the-world-factbook/geos/so.html</a> 5. <a href="http://en.wikipedia.org/wiki/Demography_of_Somalia" rel="nofollow">http://en.wikipedia.org/wiki/Demography_of_Somalia</a> 6. <a href="http://www.somalilandtimes.net/sl/2009/408/10.shtml" rel="nofollow">http://www.somalilandtimes.net/sl/2009/408/10.shtml</a> 7. <a href="http://www.mediaglobal.org/article/2008-10-28/pandemic-preparedness-needs-to-be-tested" rel="nofollow">http://www.mediaglobal.org/article/2008-10-28/pandemic-preparedness-needs-to-be-tested</a> 8. <a href="http://www.doctorswithoutborders.com/press/release.cfm?id=2036&cat=press-release" rel="nofollow">http://www.doctorswithoutborders.com/press/release.cfm?id=2036&cat=press-release</a> 9. <a href="http://www.hartford-hwp.com/archives/33/128.html" rel="nofollow">http://www.hartford-hwp.com/archives/33/128.html</a> Charge_dAffaires on "Pakistan" http://monwho.org/forums/topic/pakistan-1#post-36 Sat, 27 Feb 2010 21:38:18 +0000 Charge_dAffaires 36@http://monwho.org/forums/ Aimee Rodriguez Pandemic Preparedness for Pakistan 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? The most important aspect is preparedness at all levels with a specific focus at the level of health service delivery to the Pakistani population. The 2009 National Health Policy makes note of the underperformance of health systems due to “weak governance, imbalance of human resource, lack of equitable service delivery, absence of social safety nets, and a lack of effective implementation of regulations.”2 Recognizing this, in a pandemic situation we can expect a huge strain on medical facilities resulting in greater rates of transmission, a decrease in the delivery of treatment, and a greater threat of mortality. 2. How would you as the WHO Ambassador of your country address this issue? Given that the Government recognizes there is need for improvement in health service delivery, I would set up a meeting with the Ministry of Health to discuss possible solutions. According to the 2009 National Health Policy, a proposal has been made to increase the number of Lady Health Workers (LHWs) in underserved areas to address the lack of equitable service to the female gender.2 Using resources offered through the WHO, I would implement community run programs geared at increasing the number of LHWs while ensuring that such programs will be sustainable for future generations. This is just one of many approaches that could be taken to improve the performance of the health sector. 3. How has your country addressed Pandemics in the past? What would you have done differently? The major concern is a lack of national pandemic protocol for Government agencies, businesses, and the public to refer to in a pandemic situation. During the 2007/2008 H5N1 Avian Flu Virus outbreak in the north-west and southern regions of Pakistan, the Government turned to the WHO’s protocols on pandemic preparedness.5 Measures taken included “case isolation, contact tracing and monitoring, detailed epidemiological investigations, increasing the availability of personal protective equipment, dedicating hospital facilities for any new suspected cases,”3 as well as the removal of thousands of birds.5 This would have been an optimal opportunity for the Ministry of Health to make the process taken available on their website for future situations while being accountable and transparent to the public. Although the WHO has a global influenza preparedness plan outlining their responsibilities and those of national authorities in the event of an influenza pandemic4, it would be beneficial for the Ministry of Health to use this as a resource to develop their own pandemic preparedness plan which is tailored to the nation and population. Furthermore, the WHO offers guidance tools and training to assist in the development of such national pandemic preparedness plans.4 4. Which countries do you see yourself becoming allies or rivals with? Why? China: China has a good relationship with Pakistan and has provided economic and military supports tin the past therefore they would be an ally. India: Although there have been many disputes between India and Pakistan historically, I believe that in a pandemic situation it would be in the best interests of both countries to be allies, not only because they share a similar ethnic population, but also because they are so close in proximity that the main concern should be to prevent transmission. References 1: Government of Pakistan (2009). Guidelines Pandemic Influenza (H1N1). Ministry of Health. Retrieved February 24, 2010 from <a href="http://www.health.gov.pk/" rel="nofollow">http://www.health.gov.pk/</a> 2: Government of Pakistan (2009). National Health Policy 2009. Ministry of Health. Retrieved February 25, 2010 from <a href="http://www.health.gov.pk/" rel="nofollow">http://www.health.gov.pk/</a> 3: United Nations (2009). H5N1 has been confirmed in Pakistan. PIC (Pandemic Influenza Contingency) Pandemic Preparedness Website. Retrieved February 24, 2010 from <a href="http://www.un-influenza.org/node/1168" rel="nofollow">http://www.un-influenza.org/node/1168</a> 4: World Health Organization (2009). Pandemic Preparedness. Global Alert and Response. Retrieved February 25, 2010 from <a href="http://www.who.int/csr/disease/influenza/pandemic/en/" rel="nofollow">http://www.who.int/csr/disease/influenza/pandemic/en/</a> 5: Yusufzai, Ashfaq (4 April 2008). Fatal bird flu cases in Pakistan. BBC News. Retrieved February 21, 2010 from <a href="http://news.bbc.co.uk/2/hi/7330069.stm" rel="nofollow">http://news.bbc.co.uk/2/hi/7330069.stm</a> Charge_dAffaires on "Uganda" http://monwho.org/forums/topic/uganda#post-37 Sat, 27 Feb 2010 21:39:50 +0000 Charge_dAffaires 37@http://monwho.org/forums/ Ambassador: Ebram Salama 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? Uganda is among the many countries that have failed to thrive in the global economy. A GDP per capita of $1300 ranks the 25th lowest in the world1 and poses the greatest obstacle to an effective preventative program. The associated lack of infrastructure compounds the problem, further restricting healthcare delivery. Consequently, managing an epidemic requires both a long-term plan addressing the scarce income and infrastructure, as well as a short-term strategy which will maximize the effectiveness of the available resources. In the event of a disease outbreak, the resources to fund, develop, and deliver preventive measures is needed. Securing capital will be of utmost importance, hence making highly cost-effective preventative techniques of great value to the health of the Ugandans. Moreover, the insufficiency of trained healthcare workers and Uganda’s subpar communications framework will handicap campaigns. There needs to be an effective method of educating the citizens regarding the epidemic and the resources available to them. 2. How would you as the WHO Ambassador of your country address this issue? A two-fold epidemic preparedness plan is needed, addressing both short-term and long-term goals. Given an imminent outbreak, Uganda would need to call upon the economic leaders of the world for financial assistance. As a primary measure, cost-effective programs targeting high-risk environment hazards would be implemented. Currently, an estimated 45% of Ugandans in rural communities do not have access to safe drinking water, and about 10% of women and children are not protected by insecticidal mosquito nets1. Simple water sanitation and mosquito net distribution could have profound effects in controlling waterborne diseases and insect vectors. Training programs, which would draw students from each of the individual communities, would be implemented so as to ensure skilled personnel in all regions. Temporary vaccination and treatment distribution sites would be identified for immediate use, and permanent health care facilities would need to be established in the long run. Awareness campaigns, essential to any preventative program, would need to be community driven. Low literacy rates and relatively underdeveloped media coverage in Uganda would render conventional advertisement techniques ineffective. Hence, a community initiative would be needed to educate others while bridging the gap between Ugandan culture and western medical practice. 3. How has your country addressed Pandemics in the past? What would you have done differently? Arguably the most studied pandemic in Uganda is that of HIV/AIDS. Reflection on past preventative methods reveals their successes and failures. Decentralized tactics in which the community leaders effectively meshed the prevention programs with the society’s culture proved invaluable to the disease-control efforts. A community based approach promoting family values and reduced promiscuity as opposed to condom use was remarkably effective in slowing transmission2. However, Uganda’s most recent HIV policy warrants reconsideration. Homosexuality has been outlawed as a tactic in the battle against HIV/AIDS. The added stigmatization arguably diminishes any hopes for an effective surveillance program. Rather, actions should have been taken in the polar opposite direction – campaigns to de-stigmatize the disorders, promote self-identification, and educate the population. 4. Which countries do you see yourself becoming allies or rivals with? Why? Uganda shares borders with the Democratic Republic of the Congo, Kenya, Rwanda, Sudan, and Tanzania, and would likely form allies with these nations. All six countries are situated in a similar geographic region and face many similar economic and health related issues. It is hence foreseeable that these nations would work in conjointly toward an effective preparedness plan. References: 1. <a href="https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html" rel="nofollow">https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html</a> 2. Allen, T. & Suzzette, H. (2004). HIV/AIDS policy in Africa: What has worked in Uganda and what has failed in Botswana?. Journal of International Development,16, 1141-1154. Charge_dAffaires on "Cuba" http://monwho.org/forums/topic/cuba#post-39 Sat, 27 Feb 2010 21:42:32 +0000 Charge_dAffaires 39@http://monwho.org/forums/ Ambassador: Alanna Fitzgerald-Husek 1. Which aspects of pandemic preparedness is most pertinent to your country and why? Cuba’s health care system has historically been strong. As the physician and revolutionary Che Guevara noted, Cuba’s Ministry of Health and other similar organizations have the duty to provide largely free basic public health services to its population, institute and maintain health promotion strategies, and gain the support and compliance of its people in hygienic practices through education and awareness campaigns. Cuba has traditionally focused on disease prevention through the provision of comprehensive vaccinations programs, the widespread availability of primary care, and access to essential medicines. Areas it must now focus on strengthening to prepare for possible pandemics include early identification and monitoring of disease outbreaks, and increased communication and mobilization of resources at local, regional, and national levels. It is essential that Cuba continue to work as a nation independently, and in partnership with the international community, to strengthen its data collection and research around disease outbreaks, and have this knowledge translate into cohesive, comprehensive public health strategies. 2. How would you as the WHO Ambassador of your country address this issue? Cuba must continue with and strengthen its current preventive health strategies. Specifically, it must engage its population and increase their “buy in” in order to help with identification and containment of potential pandemics. Information campaigns and easy-to-follow frameworks that are modified for different sectors of the population (e.g. urban/rural, workplace, community, academic settings) will be helpful. A good example of this is in place for elementary and secondary schools, as well as at transportation hubs like airports. Additionally, while a continued focus on disease prevention is necessary, it is also essential to prepare for inevitable disease outbreaks, through the creation of appropriate policies and protocols, and practice drills in all sectors of society for “what to do when disease hits”. Cuba must work in partnership with its neighbours, trade partners, and the larger international community on this front. 3. How has your country addressed Pandemics in the past? What would you have done differently? Cuba has experience – and success – in dealing with disease outbreaks in the past, such as H1N1, dengue fever, and other food and waterborne diseases. The government implemented a near-universal immunization campaign almost 50 years ago, which has resulted in the eradication of many infectious diseases (e.g. polio, rubella) and the near-eradication of others (e.g. tuberculosis). The effective Cuban response to the HIV/AIDS crisis has resulted in one of the lowest prevalence rates out of the western world and developing nations. Cuba implemented mandatory HIV testing for its citizens, and having identified those infected with the virus, then proceeded to provide and monitor appropriate treatments – and even subsidized food, housing, and work pay compensation to those who were isolated as a result of their HIV status. While perhaps controversial, these strategies were largely supported by the populace, and the governmental treatment and incentives have resulted in a largely successful campaign to control the epidemic. Additionally, Cuba’s efforts at creating electronic and national health networks are aimed at increasing the overall effectiveness of the health care system. In regards to pandemic preparedness, this means increased potential to track and provide quality health service (free) to its people, and increase the exchange of knowledge and best clinical and policy practices among experts to curb the spread of a potential pandemic. 4. Which countries do you see yourself becoming allies or rivals with? Why? Cuba anticipates strong, continued alliances with countries with which it has been engaged in the health care forum. For example, Cuba views Venezuela as a likely ally, having exported considerable health services and personnel to Venezuela’s “Mission Barrio Adentro” health program. Similarly, Cuba hopes to continue partnerships with other developing nations which have welcomed Cuban medical assistance, and/or which have sent their nationals to Cuba for medical training (e.g. Haiti, South Africa, Namibia, Bolivia, Nicaragua, etc.). Additional allies include countries that share similar cultural and political experiences. Lastly, Cuba anticipates being able to form alliances with many member states – including ones it has not had the privilege of working closely with in the past – who presumably share the common interest of promoting and protecting the health of their nation’s populace. Charge_dAffaires on "Italy" http://monwho.org/forums/topic/italy#post-40 Sat, 27 Feb 2010 21:44:00 +0000 Charge_dAffaires 40@http://monwho.org/forums/ Ambassador: Talia Varley 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? The aspects of government leadership and the health sector are the most pertinent to Italy. Italy reports a GDP of $1.609 trillion, 8.5% of which constitutes the country’s total expenditure on health. Universal health care coverage has been achieved, though care and expenditure vary among regions. Such discrepancies are fading, however, subsequent to a 2001 reform of the Italian constitution for shared responsibility for health care. Thus, the government and healthcare roles are intertwined. Regarding pandemic preparedness, the health sector will have an integral role in leadership and advocacy, particularly in providing information on risk, severity, and progression of a pandemic, interventions and their effectiveness, and prevention measures. The health sector will also continue to bare the responsibility of providing universal care to the Italian population with the aforementioned significant allocation of government funds. Government leadership, on the other hand, will be key to prioritize resource targeting and allocation. The Government will furthermore have a significant role in world affairs because matters of trade policies, international relationships, and global committee recommendations (i.e. WHO) will come to the fore during pandemics. 2. How would you as the WHO Ambassador of your country address this issue? As the WHO Ambassador of Italy, I will address the issues of government leadership and the health care section responsibilities by working together with representatives of both bodies in order to present a united front. By incorporating the concerns and roles of both, a more accurate account of the interests of Italy as a whole will be possible. This position can then be properly represented within the global forum provided by WHO. 3. How has your country addressed Pandemics in the past? What would you have done differently? Italy has suffered through a number of pandemics in the past few centuries, from cholera and typhus to influenza. It is only in the last century that pandemic preparedness guidelines were instituted, primarily due to efforts by the World Health Organization. HIV/AIDS is a current concern as, by the end of 2006, Italy had a cumulative total of 57, 375 AIDS cases, 35,077 of whom died, with 1126 new cases in that particular year. With Italy’s health care system undergoing recent reform with the objective of providing more universal healthcare to citizens, the country has a number of checks in place to help to control the problem. There is systematic offering of HIV testing to at-risk-populations (i.e. IDUs), pregnant women, and blood/tissue donation. With a steadily improving health care system, Those already infected are receiving better and more immediate care, and educational measure are also in place to prevent unnecessary transmission of the virus. Additionally, with the use of Highly Active Anti Retroviral Therapy (HAART), incidence of HIV/AIDS has declined since the 1990’s. In 2003, Italy adhered to WHO guidelines regarding the Asian Influenza A outbreak and developed a “national plan for preparedness and response to an influenza pandemic.” In 2004, Cases were reported as sporadic and slowly diminished with time. At present, the national plan remains in effect with constant updates regarding the global eruption of swine flu. Considering that until recent years there were no established guidelines for pandemic preparedness, I believe that measures within the past few decades have been adequate. I would only have recommended instituting such guidelines at an early date, especially considering outbreaks on influenza within the early 19th century. 4. Which countries do you see yourself becoming allies or rivals with? Why? Italy will likely ally with other European countries. Member nations of the European Union will have similar goals as they share many interests. Additionally, nations such as France and the United Kingdom have similar economic status and population health and so inherently share similar resources and responsibilities in crises. Thus, Italy would likely form a united front with these member countries. Adjacent European countries, Switzerland and Austria for example, are particularly interdependent in pandemic scenarios seeing that successful prevention or containment of outbreaks within one county will have a direct affect on the fate of abutting territories. Considering years of political tension, Italy may become rivals with some of the northern African countries due to tens of thousands of illegal immigrants infiltrating the territory’s long coastline. Charge_dAffaires on "USA" http://monwho.org/forums/topic/usa#post-41 Sat, 27 Feb 2010 21:45:39 +0000 Charge_dAffaires 41@http://monwho.org/forums/ Ambassador: David Chak 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? United States, due to its busy air traffic and travelling activity, it is extremely vulnerable to epidemics as shown in influenza A/ H1N1, therefore the United States considered being prepared for pandemic as a matter of great importance. All aspects of pandemic preparedness is pertinent to us, but as the world’s 3rd largest country and having some of the world’s densest cities (unlike our neighbour), the U.S pays particular attention to preparing the country for sustained community transmission of the pandemic. It is very important also for public awareness of the ongoing pandemic, hence having transparency would also be our first priority. 2. How would you as the WHO Ambassador of your country address this issue? The United States will focus on 6 main elements: 1. Planning and coordination 2. Surveillance, Investigation and Protective Health measure 3. Vaccines and Antiviral Drugs 4. Healthcare and Emergency Response 5. Communications and outreach 6. Research All these 6 elements will be enforced by all levels of governments (depending on their scope of responsibility). The Department of Health and Human service would also act appropriately according to WHO Pandemic phases. (HHS, 2009) 3. How has your country addressed Pandemics in the past? What would you have done differently? Due to United States’ leading role in the world economy as well as its heavy air traffic, United States have always been amongst the first few countries to be hit when pandemics occurred. (The examples of Influenza A in 2009 is used here, but it is not the only pandemics U.S have faced) Examples of that would be the Influenza A/H1N1; the earliest case of H1N1 dated back to late March 2009. In response to the flu outbreak in 2009, U.S federal health department has declared public health emergency which allows the distribution of federal stockpile of Tamiflu to various states. Aside from that, the CDC had also deployed its Emergency Operations Center to investigate the ongoing outbreaks of human cases of influenza A (H1N1). CDC has also distributed swine flu test kits to all other states to identify the contractions of the virus. FDA worked with private pharmaceutical companies to produce vaccine for the new strain of influenza. All other departments in U.S also act within their scope of duty to monitor, contain and mitigate the pandemic outbreaks, which includes the state department, Department of Homeland Security, department of health and human service and department of Agriculture. The U.S government have also developed Pandemic Influenza Plan should there be an outbreak of influenza pandemic in U.S One thing I would have done differently is a better regulation of the media. The SARS outbreak in 2003 caused a mass panic despite there being no evidence of domestic epidemic on American soil. Mainstream media fixated on the possibility of a domestic epidemic and often used metaphors that described SARS as the products of Chinese culture which in reality, all the cases reported in US were contracted overseas and there have been no deaths reported. Even without a domestic epidemic, SARS caused economic damages to Chinese’s businesses and many Chinese people felt stigmatized by the general public. In light of pandemic outbreak, the federal government should allow only factual information to be published to avoid such unnecessary mass panic. 4. Which countries do you see yourself becoming allies or rivals with? Why? The United States would need to collaborate with its neighbouring countries, particularly Mexico as to reduce the community transmission in light of a pandemic. United States also see itself becoming allies with the rest of the G8, especially the country of United Kingdom and Canada. United States would also welcome China to join in our efforts to combat pandemics, provided that China will be more transparent in its pandemic dealing strategy. At the same time, United States is worried that United States might not be able to work with some countries that we deemed undemocratic, which includes but not limited to North Korea and several other countries. We believe that having the freedom of expression, along with other rights stated in the UDHR are crucial elements in dealing with pandemics. "HHS Pandemic Influenza Plan ". United States Health and Human Services. 26 February 2010 <http://www.hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf>. Charge_dAffaires on "France" http://monwho.org/forums/topic/france#post-42 Sat, 27 Feb 2010 21:46:55 +0000 Charge_dAffaires 42@http://monwho.org/forums/ Ambassador: Cyrille Lavigne The importance of France in the European and world health communities is often underestimated. To correctly assess its role, one must remember certain facts. Firstly, there are 65 million inhabitants in France, 13% of the population of the EU. France has the fifth largest world economy by GDP. It is a permanent member of the UN Security Council, a founding member of the EU as well as a member of the G8 and NATO. Through its capital role in the Francophonie, it has strong links with North Africa and Canada. The French empire, although dwindling, is still represented throughout the globe. As far as pandemics go, France, with its central position in Europe and its 89 million tourists annually, would most probably be the canary in the coal mine of Europe. France will have to act both domestically and on the European and international scenes to ensure the health of its citizens. Thankfully, with its centralized healthcare, its major pharmaceutical companies and its ties to Basel and the UK, its strong economy and army, the Hexagon is more than well-armed in the face of global health problems. The control of its expansive borders and the regulation of its highly internationally mobile people are the main challenges France will face internationally. Domestically, France will have to ensure the health of a very diverse population covering the entirety of the political and sociocultural spectra. Balancing public health and individual rights will be an important issue. In the face of the avian flu, France has enabled a global pandemic plan that it first used during the swine flu outbreak. The government of France will use its plan accordingly but improvisation is also key to health management. As a WHO ambassador, I will have to engage my colleagues of the European Union in discussions unhindered by petty politics to arrive to a concerted effort to maintain the health of all EU citizens. On the international scene, I will be able to use the global influence of France to monitor and delay the pandemics. The French pharmaceutical industry will also be an important asset but might push France to compete with the UK, Switzerland and the US. The strong links France has with the UK and Germany will hopefully lead to cohesion but the Hexagon might have to struggle to maintain its desired position as a leader in the EU. Finally, although France rank among the most powerful countries on the globe, the Republic will not forget its allies in Africa and in the Caribbeans. Charge_dAffaires on "Union of Myanmar" http://monwho.org/forums/topic/union-of-myanmar#post-19 Fri, 26 Feb 2010 00:58:20 +0000 Charge_dAffaires 19@http://monwho.org/forums/ Ambassador: Olivia Lu The Union of Myanmar, also known as Burma is a part of the Greater Mekong Sub region which is also composed of Viet Nam, Cambodia, Laos People’s Democratic Republic, Thailand and the People’s Republic of China. Myanmar is currently under the authoritarian governance of the military junta, the State Peace and Development Council (SPDC). The Myanmar Ministry of Health (MOH) is the major health care provider in Myanmar although there is both a private and public health care sector. There are seven sectors under the MOH which include: The Department of Health Planning, The Department of Health, The Department of Medical Sciences, The Department of medical Research (Lower), The Department of Medical Research (Upper), The Department of Medical Research (Centre) and the Department of Traditional Medicine. In addition to the involvement of the World Health Organization (WHO), various Non-governmental Organizations (NGOs) such as the Myanmar Maternal and Child Welfare Association and the Myanmar Red Cross Society are also responsible for the provision of health care within the nation. According to the Avian and Human Influenza Pandemic Preparedness and Response in Myanmar June 2006-December 2007 Operational Work Plan, there are seven strategies that Myanmar outlined in the budget. These seven strategies include: Leadership, planning coordination, Reduce exposure, enhancing surveillance and early warning, rapid and effective containment and response, health system response to reduce mortality and morbidity, community and health education, and strengthening WHO and Myanmar capacity for coordination, technical support and resource mobilization for the country. However, the budget does not allocate any resources for the area of community and health education. In order to increase pandemic preparedness in any country, it is essential to provide appropriate education. Although the Work Plan lists numerous strategies for providing community and health education such as television and radio campaigns, Knowledge, Attitudes and Beliefs (KAP) surveys, development of communication materials etc. the fact that the plan does not allocate any proposed funding to this area suggests that resources for providing education will be limited. Thus, this area of pandemic preparedness seems to be the most pertinent to Myanmar. As the WHO ambassador, this issue can be addressed by developing a report on the importance of providing education in pandemic preparedness and presenting the findings to relevant and key stakeholders and government officials. The WHO ambassador can also serve as advocate by influencing policy makers and government and ministry of health officials. The WHO ambassador can also work with ambassadors of ally countries to persuade Myanmar officials to adapt to changes and allocating funding and efforts to the area of community and health education. In response to the H1N1 pandemic in, The MOH has notified the WHO of all confirmed cases since October 2009. The confirmed cases were treated at hospitals, and no deaths were reported. The National Influenza Centre was involved and examined all suspected cases. Since, the MOH has increased its surveillance efforts with collaboration of health care professionals and NGOs. A vaccine deployment plan was also developed and submitted to the WHO. The MOH also reports raising awareness on prevention and control of H1N1. However, it is unclear how much effort and action was actually implemented as the Budget of 2007 did not allocate any funding for community and health education. Thus, in addition to the increased surveillance, the treatment, and the vaccine deployment, I would suggest increasing the KAP of the population on pandemic preparedness for the future. Countries that could be potential allies of Myanmar include China and India who have supported Myanmar previously. India for example has tried not comment on the political issues in Myanmar despite pressures from the United States and members of the European Union. In addition, the members of the Associated of Southeast Asian Nations could be potential allies for Myanmar. The Ministry of Health of Laos for example has been involved in the Table Top Exercises on pandemic preparedness conducted in Myanmar. 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Being faced with a pandemic, it is estimated that, in Japan, if 25% of the population is infected by a virulent strain, the number of inpatients would mount up to 101 thousand, five weeks from the outbreak. This has an enormous impact on the economics of the country. On the other hand, Japan, being an island country, is strongly dependent on international importation and exportation to support its economy. Therefore, we believe that the most pertinent aspect of pandemic preparedness is to contain the pandemic outside of its banks while avoiding socioeconomic collapse. 2. How would you as the WHO Ambassador of your country address this issue? Faced with the concern of minimizing health risks while preventing damage to social and economic functions, Japan has developped an Action Plan based on the five following categories, which have their different functions according to the six WHO phases of a pandemic : 1. Planning and coordination: So as to ensure rapid and appropriate risk control, is it mandatory that a close collaboration with public health divisions and domestic animal health divisions be created. Furthermore, Japan strongly promotes the exchange of information both internationally and at a local level. 2. Surveillance: Continuous monitoring must be ensured by implementing trend surveys and strict pathogen surveillance (new subtypes, drug resistance, pathogenicity). This system shall be enhaced by early detection of clusters in which infection occurs. 3. Prevention and containment: In order to prevent the spread of new viruses, basic measures against infectious diseases must be instored at a personal level, such as washing hands, avoiding contact with infected patients, self-restraint to participating in meetings or large group gatherings, and getting vaccinated. Furthermore, on a more global scale, quarantine of people suspected of being infected as well as termination of importation of animals coming from nations where infection occurs will be implemented as necessary. 4. Medical response: Japan undertakes to provide effective and efficient medical care while dealing with limited resources. For this matter, a systematic diagnosis and treatment will be established and disseminated throughout the country, while research on vaccines is implemented with help from foreign experts, if necessary. A stockpile plan is also of great importance, both for vaccines and antiviral drugs. 5. Risk communication: Japan believes that an international information exchange system should be implemented so as to collect data from nations where infection occurs. Furthermore, this system should provide understandable information prototyped for the media and the general population, in order to permit a consensus on the situation and to limit panic. 3. How has your country addressed Pandemics in the past? What would you have done differently? In 1918, the Spanish flu that spread out in Japan caused an estimated 390 thousand deaths, with a major decline in health care services. At this time, Japan was not prepared for a pandemic. Its geographical situation (being an island with very concentrated points of population) and poor sanitary control were not adapted to such an attack. From this point on, Japan has implemented multiple action measures in order to respond to a new pandemic, such as creating an Action Plan as well as an Expert Committee and providing compensation for farmers in areas of restriction. I believe that such a reaction is appropriate. Having been able to act differently, I would have suggested to create not only a local plan for pandemic preparedness, but also an agreement with adjacent countries so as to provide valuable information, help poorer countries and establish exchange restrictions in time of a pandemic. This could have insured a limited and controlled importation-exportation system in between non affected countries. 4. Which countries do you see yourself becoming allies or rivals with? Why? Any country in a similar position as Japan, i.e an island country with a strong socioeconomic influence, would be considered as being an allie: Australia, New Zealand, United Kingdom, Singapore, Ireland... As for rivals, they would be defined as any country being an obstacle to the socioeconomic equilibrium of Japan. Furthermore, Japan has a long-time story of political disparities with China, and therefore could be less compliant with demands made on their part. Charge_dAffaires on "Red Cross" http://monwho.org/forums/topic/red-cross#post-21 Fri, 26 Feb 2010 01:13:41 +0000 Charge_dAffaires 21@http://monwho.org/forums/ Maryse Mathieu The Red Cross Movement (RCM) is divided in three parts: the International Committee of the Red Cross (ICRC), the National Red Cross and Red Crescent Societies and the International Federation of the Red Cross Societies (IFRC). The ICRC provides humanitarian assistance and protection of victims of war, armed violence and natural disasters. The National Red Cross Societies represent a network of 186 organizations around the world. Each of them has it own staff and volunteers, and offers a wide variety of services. The services vary from country to country according to the needs. In this conference, the Red Cross Movement will be representing by the IFRC. Its mission is to “improve the lives of vulnerable people by mobilizing the power of humanity.” It is also in its goals to “reduce the number of deaths, illnesses and impact from diseases and public health emergencies” by developing disaster preparedness programs and health and care activities, like “supports programs on risk reduction and fighting the spread of diseases” (RCM official web site). Regarding the Pandemic Preparedness Plan, the IFRC is concerned by the equity of the prevention measures between the richer and poorer communities. Low income countries, where infrastructures to tackle a pandemic disease do not exist, can be seriously affected. Also, the Federation will fight to avoid human discrimination in the access of prevention measures and vaccine, if there is one. Vulnerable groups and their needs should be taken into account in the Pandemic Plan. Also, we want to know who will lead the Pandemic Plan and who will be responsible for the coordination. In case of a dazzling pandemic disease, a quick reaction to avoid dragging on with administrative procedures is essential. As with many centenary organizations, the IFRC has faced many challenges and complex situations. In the last five years, the IFRC has involved itself more deeply in the interventions against HIV/AIDS in the countries that needed support and supplies. The Federation has also been very active in the Avian and Human Influenza Flu (AH1). From these situations, we learned that “complacency is one of the main barriers to fighting the spread of pandemic flu” (RCM, 2009). Partnerships between countries and international organizations are vital for maximized response. Precocious and quick actions like awareness campaigns, distribution of face masks and powerful systems of surveillance can make a difference in the number of deaths and the spread of the illness. The International Federation response can be worldwide, through the exiting network of volunteers in the National Societies. Our support can be similar to the one we have offered for the AH1 pandemic: “health and hygiene education, communication, education on management of sick and dead animals, social mobilization, human case detection and referral, as well as home-based care and psychological support” (Mitigating the risk of human pandemic, RCM). Indeed, the IFRC: “has supported its member societies with the development of their Plans of Actions, mapping of activities and needs, formulation of communication strategies, providing guidance on pandemic contingency and services continuity plan, design of pandemic response kits for staff protection, coordination and technical guidance to members, (…) developed in line with the WHO recommendations.” The International Federation is also supporting National Societies in the same way, which promotes “the key role of civil society organizations” and a community-based action. With reference to the AH1 Pandemic Preparedness Plan, the IFRC is already working with the United Nations System Influenza Coordination (UNSIC), and is a member of the UN System Inter-agency Technical Working Group on Influenza. We are also open to go into partnership with organizations that have an operational field presence. We have already arrangement with CARE International, OXFAM, Save the Children US and World Vision International for the operational Avian Flu Pandemic Plan. This cooperation can be extended in the Pandemic Preparedness Plan. Charge_dAffaires on "Socialist Republic of Vietnam" http://monwho.org/forums/topic/socialist-republic-of-vietnam#post-22 Fri, 26 Feb 2010 02:10:06 +0000 Charge_dAffaires 22@http://monwho.org/forums/ Ambassador: Mackenzie Toni Budimir-Hussey 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? The government of Viet Nam is highly concerned with the emergence of highly pathogenic avian influenza (HPAI). Viet Nam was among the first countries to report cases of HPAI at the start of the panzootic and has since reported the highest number of human infections of any country by a substantial margin, with over 105 confirmed cases, including 51 deaths. The socio-economic costs of the virus to Viet Nam other countries are monumental in potential. The possible emergence of a human pandemic strain has made avian influenza in Vietnam a focus of national concern. Furthermore, the country faces an issue in funding its pandemic preparedness plans. Currently the country relies on monetary donations and supplies from a number of countries and organizations to plan and react appropriately to pandemic influenza. This leaves concerns for supplies of antiviral drugs and access to vaccines in a pandemic situation. 2. How would you as the WHO Ambassador of your country address this issue? As more recently, H5N1 infection in birds has spread globally, the risk of a pandemic originating outside of Viet Nam has increased. This means that we are only as strong to resisting a pandemic as the countries around us. Although the majority of countries neighboring Viet Nam have national influenza preparedness plans, I would like to future develop strategies that the Western Pacific Region will adopt with emphasis on transparency, collaboration, and sharing of resources. This should ensure a strengthened coordinated response. 3. How has your country addressed Pandemics in the past? What would you have done differently? In 2005, the National Steering Committee for Avian Influenza Prevention and Control prepared the “National Preparedness Plan” in response to H5N1. This integrated plan outlines responsive measures under WHO’s global pandemic alert phases, and allocated responsibilities to ministries, Peoples’ Committees at all levels and mass organizations. Based on this plan, the human and animal health sectors in Viet Nam prepared specific action plans. The Vietnamese government had also responded by enhancing planning efforts to control H5N1 infection in domestic poultry and prepare a possible human pandemic. These planning efforts are outlined in two key documents released in 2006: “Viet Nam Integrated National Plan” and “Viet Nam Integrated Operational Programme”. The overarching objective of the Integrated Operational Programme was to reduce the health risk to humans from avian influenza by controlling the disease at the source in domestic poultry, by early detection and response to human cases, and by preparing for the medical consequences of a human pandemic if one were to occur. 4. Which countries do you see yourself becoming allies or rivals with? Why? I see myself becoming allies with the majority of the ASEAN+3 member countries as Avian Influenza is still a major concern to this region and likely their delegates. Viet Nam will likely be an ally with the United States of America as well considering that USAID has contributed over $37 million to our country for influenza pandemic preparedness since 2005. My concern is that without a greater international commitment to share scarce stocks of antiviral drugs and vaccines more equitably, countries in the Asia–Pacific region will not be able to access these resources, or to distribute them effectively. If this were to prove unattainable, poor countries in the region may be reluctant to cooperate with the international community—e.g., by providing information to assist with disease surveillance, or isolates of the virus to facilitate vaccine development and production. These countries might choose not to prioritize these tasks if faced with uncertain returns and a range of other pressing demands. Charge_dAffaires on "Republic of Mauritius" http://monwho.org/forums/topic/republic-of-mauritius#post-23 Fri, 26 Feb 2010 02:14:51 +0000 Charge_dAffaires 23@http://monwho.org/forums/ Ambassador: Supreet Bhullar 1) Which aspects of Pandemic Preparedness is most pertinent to your country and why? Mauritius and WHO joined hands in 1980 and since then, the country has developed in the health sector. It rose from being an underdeveloped country in 1968 to an upper middle economy. Mauritius has reached an advanced stage in its demographic and epidemiological transition especially with a decline in communicable diseases and problems of maternal and child health (MCH), but noncommunicable and chronic diseases are on the rise accounting for a morbidity rate of nearly 88% in 2006. Non communicable diseases prevalent in Mauritius include diabetes, hypertension, cerebrovascular diseases, cancer, mental illness and substance related diseases linked to tobacco use and alcohol abuse. The major threat from communicable disease in Mauritius is from HIV epidemic which is classified as ‘Concentrated’. The prevalence rate is about 30-60% among vulnerable groups such as prison inmates, intravenous drug users and commercial sex workers (CSWs). At the beginning of the epidemic, the mode of transmission of the virus was predominantly heterosexual. However, there was a shift in the mode of transmission from heterosexual to injecting drug use with its peak in 2005 (92%) and leveled off to around 80% in 2007. Other threats also include the outbreaks of malaria and other tropical and vector borne diseases from large inflow of visitors travelling to and from malarious country and also from immigrant workers from malarious countries. This category altogether constitutes a potential reservoir of parasites. The national health system, per se, is facing emerging challenges in the wake of changing lifestyles accompanied by new dietary patterns and globalization, which, on the one hand, increase the burden of chronic diseases and, on the other hand, constitute a risk of acceleration of global transmission of communicable diseases. Furthermore, as a small developing island State, the health system in Mauritius is not immune to the backdrop of climate change and recent food insecurity crisis. 2) How would you as the WHO Ambassador of your country address this issue? As a WHO Ambassador, my focus will be on Public health promotion of Communicable diseases such as HIV/AIDS by raising awareness among public on improvement in sexual and reproductive health among young people and underserved groups for its prevention. Also availability and accessibility to services provided for HIV/AIDS such as HIV testing and counseling and prevention among young people and underserved population will be a priority. Improving upon surveillance for prevention of communicable diseases will be another area of focus. 3) How has your country addressed Pandemics in the past? What would you have done differently? The country faced the first outbreak of Chikungunya, an insect borne virus in 2005, with 3,586 cases detected. The second outbreak with over 11,000 cases occurred in February-May 2006. In response to the 2006 outbreak, an integrated approach was implemented, focusing on a four-pronge strategy based on Surveillance, Vector Control, Health Education and Community Mobilization. The four-pronged strategy, which continued to be implemented in 2007, had the desirable impact, as only one case (imported) of Chikungunya was reported in 2007. The strengthening of existing surveillance mechanisms and early warning systems is to be pursued in view of climatic changes. I am satisfied with the implemented pandemic plan by the government of Mauritius. However, I would have implemented the integrated approach to the pandemic in a timely fashion to prevent the second outbreak in 2006. 4) Which countries do you see yourself becoming allies or rivals with? Why? I see other African and WHO represented countries that have similar pandemic situations as Mauritius to be our allies. As for rivals, I don’t see Mauritius forming rivalries with any country. Charge_dAffaires on "Merck" http://monwho.org/forums/topic/merck#post-24 Fri, 26 Feb 2010 12:52:56 +0000 Charge_dAffaires 24@http://monwho.org/forums/ Ambassador: Nicolas Benjamin Global pandemics are inherently unpredictable and as such, countries and pharmaceutical companies alike must collaborate closely with each other in order to better prepare for these calamities. As one of the world’s top ten largest pharmaceutical companies, Merck & Co is dedicated to making a difference in the lives of people globally. True to the company’s mission statement which is “to provide innovative, distinctive products and services that save and improve lives”, Merck has a vested interest in public and global health which goes above and beyond merely satisfying shareholder demands. Over the years, Merck has gained a great deal of experience in the domain of pandemic preparedness. Contrary to the trend that saw many large pharmaceutical companies withhold from adding their store of pediatric vaccines to the United States national stockpile during the 2001 pediatric vaccine shortage due to a lack of immediate financial returns, Merck cooperated with the Centers for Disease Control and Prevention (CDC) to ensure that the stockpile contained full supplies of Varivax and MMR vaccines (to treat chickenpox and measles, mumps and rubella, respectively). Merck firmly believes that stockpiling vaccines is an essential preventative measure in the preparation for potential global pandemics, despite financial risks associated with such endeavours. Other measures include Merck’s release of the “Blueprint for Business Action on HIV/AIDS, on May 30th 2007. This free program was developed by an African advisory board explicitly for African companies to institute effective policies to aid employees and their families in the fight against HIV/AIDS. Furthermore, on the 17th of December 2009, Merck and eight other pharmaceutical companies agreed to participate in a patent pool established by UNITAID at the behest of Médecins Sans Frontières and Knowledge Ecology International which will enable new fixed-dose combinations (FDCs) to be made readily accessible at lower prices in underdeveloped countries. Merck has worked closely with the government of Botswana to help develop the health infrastructure within the country, thereby aiding the latter to reach its UN 3 by 5 goals to make HIV/AIDS treatment universally accessible. Also, Merck has pledged its full support to Canada’s Access to Medicine Regime (CAMR), offering to share its 20 plus years of experience dealing with global pandemics with the Canadian Government. All of these ventures and many more have shown that Merck is at the forefront of the global response to the HIV/AIDS pandemic. As a representative of Merck & Co. to the World Health Organization, I am committed to advocating the company’s policies regarding promoting access to medicines, rapid technology transfer, and helping countries by making available the needed supplies, personnel and training, provided that these nations respect and adhere to the international agreements on Intellectual Property Rights Protection, notably the Trade Related Aspects of Intellectual Property Rights (TRIPS) and the Patent Cooperation Treaty (PCT). As such, flagrant abuses of compulsory licensing by governments, as well as disregard for IPR protection laws will not be tolerated by Merck, unless these actions are taken in the face of the most dire circumstances. In the event that a pandemic should affect the most underdeveloped countries, Merck will help facilitate access to needed medicines by not filing for patent protection in these countries. Merck firmly believes that the protection of Intellectual Property Rights helps foster innovation and creates incentives for researching new medicines and vaccines. Avoiding compulsory licensing is therefore in the best interests of developing nations, as it encourages foreign investment and spurs domestic growth. Charge_dAffaires on "Malaysia" http://monwho.org/forums/topic/malaysia#post-25 Fri, 26 Feb 2010 12:55:36 +0000 Charge_dAffaires 25@http://monwho.org/forums/ Ambassador: Kathleen Anderson 1. Which aspects of Pandemic Preparedness is most pertinent to your country and why? The most important aspects of Pandemic Preparedness in Malaysia would be in relation to the influenza A subtype H1N1 virus. In 2009, there was an outbreak of H1N1 virus in Malaysia. By August 2009, the country had 2,253 cases. In July 2009 Malaysia decided to shift from containment to mitigation to stop the spread of the virus. In response to the pandemic, the Malaysian government has also developed a National Influenza Pandemic Preparedness Plan (NIPPP). Malaysia, with its pandemic preparedness, will be able to respond quickly to the H1N1 pandemic and minimize adverse impacts (National Influenza Pandemic Preparedness Plan (NIPPP), 2006). 2. How would you as the WHO Ambassador of your country address this issue? Steps in preparation of pandemic preparedness plans • Situation analysis, risk assessment • Current capacity of various sectors, especially health and veterinary services, to respond • Agreement on policy and priorities • Selecting strategies, activities and multisectorial cooperation mechanism • Setting time frame for emergency response and allocating responsibilities • Estimating budget requirements • Identifying ways of monitoring and evaluating progress (National Influenza Pandemic Preparedness Plan (NIPPP), 2006) Specific examples include: Thermal scanners had been installed at entry points Quarantine rooms in hospitals Stockpile of Tamiflu Use of face masks All visitors and Malaysians returning from abroad will be required to fill the health declaration form Leave of staff until further notice to contain the Influenza A(H1N1) outbreak (officers in government hospitals, public health departments and laboratories) (National Influenza Pandemic Preparedness Plan (NIPPP), 2006) 3. How has your country addressed Pandemics in the past? What would you have done differently? In the past, Malaysia has faced major viral outbreaks. Since the Nipah outbreak in 1999, they have put in place processes to prepare for future challenges. As a result, Malaysia was better prepared during the SARS outbreak and the H5N1 (bird flu) outbreak in 2004 (World Health Organization, 2010). The Nipah virus was first recognized in 1999 during an outbreak among pig farmers in Malaysia. There were 265 reported cases of which 105 died. Since then, there have been another 12 outbreaks, all in South Asia. There are currently no drugs or vaccines available to treat Nipah virus infection (World Health Organization, 2010). In the absence of a vaccine, the only way to reduce infection is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. In this situation, public education would therefore be the main mode of controlling this outbreak (World Health Organization, 2010). 4. Which countries do you see yourself becoming allies or rivals with? Why? Asia has been the epicenter of some recent emerging infectious diseases (National Influenza Pandemic Preparedness Plan (NIPPP), 2006). The 2009 flu pandemic in Asia has afflicted 394,133 people in Asia with 2,137 confirmed deaths. There have been 1035 deaths confirmed in India, followed by 737 deaths in China, 192 deaths in Thailand and 170 deaths in South Korea. Among the Asian countries, South Korea has the most confirmed cases, followed by China, Hong Kong and Thailand. It is therefore important for Malaysia to ally with neighboring countries to develop and share protocols on H1N1 pandemic preparedness (World Health Organization, 2010). Charge_dAffaires on "Ethiopia" http://monwho.org/forums/topic/ethiopia#post-26 Fri, 26 Feb 2010 12:59:45 +0000 Charge_dAffaires 26@http://monwho.org/forums/ Ambassador: Nooreen Nanji Ethiopia has the second largest population in Sub-Saharan Africa (85 million), with almost half of itspopulation between the ages of 0-14 years1. Ethiopia relies heavily on agriculture and has a large rural population(86%)1. Ethiopia has low literacy levels (42.7%)1and low life expectancy (52 years)2. There are widespreadshortages of food and water resulting in malnourishment and water-borne diseases. Pertinent Aspects of Pandemic Preparedness: Pandemic preparedness requires an emphasis on human resources, health infrastructure,materials/supplies and communications. Ethiopia faces challenges with these aspects for example, scarce healthhuman resources (approximately three physicians per 100,000 people)3; lack of primary health care servicesespecially in rural areas where people have mainly relied on traditional folk medicine4; few communicationsresources1impeded by low literacy levels, and a very large young population. Additionally, Ethiopia faces majordrawbacks in several other aspects of pandemic preparedness including ethical, economical and mental health.4Addressing the issue: “As a WHO Ambassador to Ethiopia”, I would build on existing plans for example, the Health ExtensionProgram (HEP) and the Avian Flu Contingency plan, currently being implemented and promises to improve primarycare in Ethiopia. HEP aims to improve health infrastructure and train a team of Health Extension Workers (HEWs) toprovide preventative and preliminary health care to every rural community.5More than 17,000 HEWs have beentrained and deployed in 8,500 villages.5The Avian Flu Contingency plan, includes the creation of a surveillancesystem, stockpiling of necessary medication supplies, and means to increase public awareness of the disease6.I would build on these plans and urge the government and the peoples of Ethiopia to give their completecooperation to the organizations willing to extend help and resources (e.g. WHO and UN). I would recommendvalidation of these often complex plans that may not be operable in a crisis situation. I would foster collaboration withEast-African countries, such as Kenya, Tanzania and Uganda, to engage in validation exercises, for example, table-top exercises which can enable major stakeholders to come together and discuss the scenarios and actions to be -------------------------------------------------------------------------------- Page 2 [NOOREEN NANJI]February 25, 2010taken7. I would engage Ethiopia’s more than seventy13non governmental health organizations and involve them intheir pandemic preparedness plans.I would recognize that other services such as transportation, energy, water, telecommunication, finance andpharmaceuticals are connected to health care and deemed necessary during a pandemic and recognize that, thesesectors can be greatly affected during a pandemic and must be considered in planning iniciatives.8Ethiopia’s Position on Pandemics in the past:In 2007, Ethiopia faced a cholera epidemic. This outbreak was not clearly declared an epidemic as the government feared a loss of revenue from tourism, and therefore labeled the condition as “watery diarrhea” instead9. However, declaring this cholera epidemic an emergency would have increased public awareness, decreased cross-border infections and increased international and donor response. Inappropriate declaration is not acceptable movingforward and there should therefore be more surveillance and effective disclosure.Lack of drinking water, proper sewage facilities and sanitization must be addressed to effectively preventsuch outbreaks in the future. Therefore, I would prioritize the enhancement of these basic infrastructures byincreasing spending. Also, effective communication strategies must be implemented. Due to the high illiteracy rate, I would encourage the use of pictograms. I would also consider using financial rewards and incentives to promoteeducation.There was a Polio outbreak in 2008 in the Gambella region. The Federal Ministry of Health along with WHOand UNICEF, conducted a vaccination campaign for children under 5 years old in several regions of Ethiopia10. Thiseffort is highly successful as there are orphans and families that cannot afford to vaccinate their children. Thesestrategies need to be continued to contain an otherwise serious threat.Allies and Rivals:The Eastern European countries12, Cuba, Italy, Sweden, USA and Canada have provided assistance toEthiopia in the past and would certainly remain allies4. Also, other neighboring East-African Rift Valley countries (e.g.Kenya, Uganda and Tanzania), as well as other African and developing countries that share similar interests wouldbe considered allies in developing strategies, but may be in direct competition for aid. Ethiopia does not really haveany major conflicts with other countries, however, Somalia may be a potential rival given the historical friction11. -------------------------------------------------------------------------------- Page 3 [NOOREEN NANJI]February 25, 2010References:1. <a href="https://www.cia.gov/library/publications/the-world-factbook/geos/et.html" rel="nofollow">https://www.cia.gov/library/publications/the-world-factbook/geos/et.html</a> - overview of economic, political and social view in Ethiopia, accessed on February 24, 2010.2. <a href="http://www.ifrc.org/docs/appeals/annual10/MAAET00210P.pdf" rel="nofollow">http://www.ifrc.org/docs/appeals/annual10/MAAET00210P.pdf</a> - International federation of Red Cross and Red Crescent Societies Plan 2010-2011, accessed on February 21, 20103. <a href="http://en.wikipedia.org/wiki/Health_in_Ethiopia" rel="nofollow">http://en.wikipedia.org/wiki/Health_in_Ethiopia</a> - accessed on February 24, 2010.4. <a href="http://countrystudies.us/ethiopia/75.htm" rel="nofollow">http://countrystudies.us/ethiopia/75.htm</a> - Health and welfare, accessed February 24, 2010.5. <a href="http://cnhde.ei.columbia.edu/programs/hep/" rel="nofollow">http://cnhde.ei.columbia.edu/programs/hep/</a> - Center for National Health Development in Ethiopia, accessed on February 23, 2010.6. <a href="http://www.flutrackers.com/forum/archive/index.php/t-7511.html" rel="nofollow">http://www.flutrackers.com/forum/archive/index.php/t-7511.html</a> - Ethiopia pandemic preparedness, accessed on February 24, 2010.7. <a href="http://www.who.int/csr/disease/influenza/ExerciseConsiderations.pdf" rel="nofollow">http://www.who.int/csr/disease/influenza/ExerciseConsiderations.pdf</a> - considerations on exercises to validate pandemic preparation plans, accessed on February 23, 20108. <a href="http://www.who.int/csr/disease/influenza/CP045_2009-0808_WOS_Pandemic_Readiness-FINAL.pdf" rel="nofollow">http://www.who.int/csr/disease/influenza/CP045_2009-0808_WOS_Pandemic_Readiness-FINAL.pdf</a> -Global influenza program, accessed on February 24, 2010.9. <a href="http://www.guardian.co.uk/world/2007/feb/22/ethiopia" rel="nofollow">http://www.guardian.co.uk/world/2007/feb/22/ethiopia</a> Fatal outbreak, not a cholera epidemic insistsEthiopia, accessed on February 23, 2010.10. <a href="http://www.who.int/countries/eth/news/2008/polio_vaccination_20081016/en/index.html" rel="nofollow">http://www.who.int/countries/eth/news/2008/polio_vaccination_20081016/en/index.html</a> - Ethiopiavaccination campaigns in areas bordering southern Sudan, accessed on February 22, 201011. <a href="http://www.onwar.com/aced/nation/eat/ethiopia/fgreatersomalia1960.htm" rel="nofollow">http://www.onwar.com/aced/nation/eat/ethiopia/fgreatersomalia1960.htm</a> - wars of the world, accessed on February 22, 2010.12. <a href="http://goeasteurope.about.com/od/introtoeasteuropetravel/a/visitorswelcome.htm" rel="nofollow">http://goeasteurope.about.com/od/introtoeasteuropetravel/a/visitorswelcome.htm</a> - List of Eastern European countries, accessed February 25, 201013. <a href="http://cnhde.ei.columbia.edu/ngos/" rel="nofollow">http://cnhde.ei.columbia.edu/ngos/</a> - Health NGO’s List, accessed February 23, 2010 Charge_dAffaires on "Sudan" http://monwho.org/forums/topic/sudan#post-27 Fri, 26 Feb 2010 13:01:13 +0000 Charge_dAffaires 27@http://monwho.org/forums/ Ambassador: Braden O’Neill 1. Which aspects of Pandemic Preparedness are most pertinent to your country and why? As Africa’s largest country, Sudan faces a formidable challenge in pandemic preparedness: the dissemination of health infrastructure. We are fortunate to have a stronger economy than many of our neighboring countries, which is an asset in the procurement of necessary supplies. Our geographic size and paucity of roads or train lines will pose difficulty getting everything where it needs to be. In addition, large areas of our country are in severe unrest- the Darfur region in Western Sudan is effectively dissociated from the rest of the country and special provisions will have to be made to accommodate the six to seven million people who reside in this territory, as well as the autonomous region of Southern Sudan. 2. How would you as the WHO Ambassador of your country address this issue? Our principal problem needs to be addressed in a variety of ways. The construction of roads and rail lines itself is not a challenge; it is diplomacy and discussion that will facilitate bringing the country together in order to proceed with the necessary projects. Of particular note is the extreme challenge posed by ensuring increased access to clean water and sanitation (only 68% of those in rural areas have access to clean water, and merely 25% have access to necessary sanitation resources). Sudan has significant droughts and flooding and our pandemic preparedness needs to accommodate the highly volatile nature of our water supply. We need assistance from our allies to construct the necessary infrastructure, and as Sudan’s WHO Ambassador I will meet with our neighbors and allies to attempt to garner support. The government in Khartoum is highly critical of the United Nations and consequently I will attempt to ensure our needs are appropriately addressed by the WHO; we will not accept the threat of sanctions or other unwanted interference by the international community into the affairs and administration of Sudan. 3. How has your country addressed Pandemics in the past? What would you have done differently? Sudan addressed Pandemic H1N1 through initiating surveillance of every person who entered the country through Port Sudan, Juba, or Khartoum. In addition, we purchased enough antiviral medication for 100000 influenza patients and distributed it throughout the country. A vaccination program was instituted for everyone between 2 and 49 years of age in the larger cities, but rural areas were not covered. As the WHO ambassador I would have ensured a more widespread vaccination program carried out throughout the country, coupled with enhanced communication and coordination between health care services and the government in Khartoum. I would have assembled a dedicated department of pandemic preparedness to oversee the project. 4. Which countries do you see yourself becoming allies or rivals with? Why? China is our main trading partner- they receive 10% of their oil from our nation- and consequently they will play a major role in our pandemic response. We also have a significant economic relationship with Saudi Arabia and the United Arab Emirates, and we will work together as well. There is a possibility that Sudanese from the north will move across the border to Egypt if conditions are not favorable, and this is something we will work closely with Egypt on as well as the other nations that surround us. Chad (immediately west of the Darfur region) has long been hostile towards our administration and we expect this to continue, making the assistance of Darfur more challenging. In addition, the United States of America has consistently expressed disapproval of the presiding government in Sudan and will most likely be a significant rival, particularly given our relationship with the Chinese government. Charge_dAffaires on "World Vision" http://monwho.org/forums/topic/world-vision#post-28 Fri, 26 Feb 2010 13:03:34 +0000 Charge_dAffaires 28@http://monwho.org/forums/ Representative: Karen Chung There are many aspects of preparing for a pandemic that are important to World Vision. World Vision continually promotes disease prevention and encourage referral links between community health services through raising awareness in the community. World Vision also trains birth attendants and basic health care providers within rural communities. Training and education in proper nutrition are provided to the parents for their children. In addition, the provision of hygienic supplies plays a key role in prevention of the infection. World Vision has been very actively involved in the WHO assembly in Geneva, urging government officials to “establish primary health care as their chief objective”, as the WHO raised the pandemic alert for the Influenza A (H1N1) to it’s highest level (World Vision, 2010). World Vision is very concerned with poor infrastructure in most developing countries, and is worried that even if relief is provided, the benefit is limited unless there is a method of ensuring equal access and distribution. During the pandemic, World Vision is able to supply food security, medical care and proper nutrition in order to stop the spread of the disease. World Vision also advocates the needs of the people to the government, in order to establish a more effective preparedness within the community. World Vision has also been involved in encouraging pharmaceutical companies to “donate or reduce costs” in the event of future pandemics and will continue to do so. In the case of sudden pandemics, World Vision aims to reduce morbidity and mortality. They facilitate access to essential medicine and supplies and provide health infrastructure construction to deliver primary health care. In the case where there is major damage to health infrastructure, and the delivery of health care is seriously delayed World Vision will invest in medical teams and offer medical supplies for life-threatening chronic diseases. World Vision is also concerned about protecting the rights of all children and families in the case of a sudden pandemic and will cooperate with governments to initiate a community response to emergencies. We will keep a critical eye on the pandemic preparedness plans of low-income countries to ensure that there are plans for equal distribution of the appropriate vaccinations, prevention materials, and awareness in place in the case of a pandemic. World Vision seeks to serve those in need, regardless of “religion, race, ethnicity or gender”, and will not tolerate any discrimination. World Vision is more prevalently involved with low-income countries. World Vision welcomes the cooperation of governments, as well as all other non-governmental organizations with similar objectives. Sources: World Vision (2010). Our Work; Resources; International: Health system fixes needed for success of pandemic vaccines in poor countries; Programs and Projects; Global Flu Pandemic. Retrieved from: Worldvision.org