Announcement of the WHO-NTI Global Emergency Outbreak Response Fund

ANNOUNCEMENT OF THE
WORLD HEALTH ORGANIZATION – NUCLEAR THREAT INITIATIVE
GLOBAL EMERGENCY
OUTBREAK RESPONSE FUND

Former Senator Sam Nunn, Co-Chairman, NTI
Dr. Gro H. Brundtland, Director-General, WHO


SENATOR SAM NUNN: I'm very honored to be here today with a leader that I've known and admired for many years, Dr. Gro Brundtland, Director-General of the World Health Organization. We're here today to announce the formation of The Global Emergency Response Fund to strengthen the global response to infectious disease outbreaks, wherever they occur. NTI, our foundation, standing for the Nuclear Threat Initiative, has given $500,000 to the World Health Organization to establish this new, revolving fund, which will ensure that resources are immediately available to send WHO teams to investigate and respond to disease outbreaks around the globe, whenever and wherever they occur.
Infectious disease outbreaks around the world constitute a major threat to our health and our security, whether they occur naturally or are caused by deliberate bio-terrorist event. The good news in this grim bio-terrorism business, and there's not much good news, is that the steps that we must take to prepare against bioterrorism are the same basic steps that we should already be taking to protect against infectious disease. Enhancing global infectious disease surveillance including rapid detection and response is a fundamental building block of effective preparedness, and I do see it as a very important part of our nation's security.

Every American has a big stake in the work of the World Health Organization. Microbes do not respect borders. Today with the dramatic increase in travel and trade throughout the world, disease anywhere can be a threat to public health everywhere. In the wake of the September 11 attacks and the subsequent use of anthrax as a weapon, the nexus between health and security has become even more clearly defined in our own country. The worldwide emergence of new and infectious diseases and the re-emergence of old ones led a recent national intelligence estimate to conclude, and quoting from that estimate directly, "new and emerging infectious diseases will pose a rising global threat and will complicate U. S. and global security over the next 20 years."

There are two lessons that we need to learn and we need to learn them fast. First, that infectious disease anywhere threatens public health everywhere. And second, that a threat to public health can be a threat to our nation's security. In the event of an attack, lives, and in fact, thousands of lives, will depend on how quickly doctors, nurses, pharmacists and public health officials detect symptoms, diagnose the disease, communicate their findings, and provide the necessary care for those who are sick and also those who are exposed or at risk.

The bottom line, we must recognize disease outbreaks sooner and we must respond faster. To detect an outbreak as rapidly as possible, the World Health Organization’s Global Public Health Intelligence Network continuously scans a stunning amount of electronic news and information from around the world, looking for early signs of disease outbreaks. Until very recently, the computer based tool searched only in two languages -- French and English. In the spring of this year, our foundation provided additional funding to WHO, which in coordination with a grant from the government of Canada, will add Russian, Chinese, Spanish and Arabic to the network's language capabilities, which we believe is a very big step forward.

Yet, detecting the outbreak is only the first step. How many live and how many die will depend on the speed of the response. In the past, WHO member countries have always covered the cost of infectious disease outbreak investigations. But often the money collection effort had to take place before the medical teams could leave for the hot zones. Imagine an alarm sounding at a local fire station, fire fighters jumping on the truck, and the fire chief calling out, "has anybody got any money for gas?" Now that is not too strange of an analogy in where WHO has been.

With this new revolving fund in place, when signs of an outbreak are seen, WHO will use resources from the fund to transport disease experts to the sight of an epidemic immediately. And I emphasize, immediately. The fund will be replenished during and after the investigation to allow WHO to respond quickly to the next outbreak. So it's very important to recognize that additional funding for member nations and other non-governmental organizations will be absolutely critical to the fund's success. Because any funds spent have got to be replenished. We don't know when the next outbreak could occur.

We, in the United States, have a large stake in global health. Fifty million people visit the United States from other nations each year and I've seen figures far higher than that, but at least 50 million. Billions of dollars in food enter the United States from other nations every year. It is impossible to stop disease at our borders. We have to stop it when it starts and wherever it starts. If the threat of biological terrorism encourages us to lead the way in defeating infectious disease around the globe, then it may serve to awaken us and make us stronger than we are today.

That is NTI's aim in making this grant. And that's why we are honored to participate. The fight against infectious disease, whenever and wherever it occurs around the world, has always been a moral imperative. I believe it is now also a security imperative.

I would now like to turn the podium over to Dr. Gro Brundtland, Director-General of the World Health Organization. Most of you know her background; I won't go into great detail today. She has done so many things and been such a leader in so many endeavors, that it would take forever to go through them. Suffice it to say that she chaired the World Commission on Environment and Development, she is a distinguished physician and leader, she served ten years as the Prime Minister of Norway, among many other leadership roles. Gro, we are delighted to have you here today and I'm honored to be at this podium with you. Thank you for your leadership. Gro Brundtland.

DR. GRO BRUNDTLAND: Thank you very much, indeed. And I am really happy to be here today with Sam Nunn and with Peggy Hamburg who came here with the two of us to present this agreement on the Nuclear Threat Initiative, which has an importance of course far beyond momentary turns. It is an important principle and last year, we all can think back to how the United States felt the horror of having a deadly disease striking randomly within the population. We all saw it. We watched it from our TV screens as the anthrax incidents were teaching us how vulnerable even the most sophisticated societies are to the deliberate use of chemical and biological agents to cause harm.

But through the impressive efforts by the U. S. Centers for Disease Control and of the U. S. and national agencies, we have also seen the wake up call has been heeded. WHO is working globally and we were before, but it has been scaled up to improve awareness and assist other countries in building up their preparedness. Unlike most (UNINTELLIGIBLE) investments, however, we see surveillance and control has immediate civilian benefits. Since it includes protection against all kinds of disease outbreaks, whatever the cost.

Thanks to the experiences of last year, health authorities here in the U. S., were better prepared to detect and deal with the West Nile Virus as it appeared in states where no previous experience of the disease.

We should remember that almost every month somewhere around the world, a deadly disease strikes a community creating much of the same fear and uncertainty that the anthrax incident did here a year ago. Ebola, Congo Hemorrhagic Fever, Yellow Fever, even measles outbreaks, often kill dozens or hundreds of people before they are contained. The speed with which these outbreaks are detected and contained makes the difference between a few dead and perhaps hundreds or thousands.

Take Ebola, so far it has been contained because it has been confined to small villages. So far, far away from big cities. Health systems, like that of Uganda, have done a fine job in isolating patients and restricting spread. They could do it with the help of international specialists from WHO and CDC because the security situation in the country was good. And we were prepared to help them take that effort.

Now, what if an outbreak occurs and takes place in a devastated central African country, where there is no local health care? What if the security situation was so bad that we could not send any international experts to advise and assist in containing the outbreak? What if infected people started fleeing into cities, to neighboring countries, and eventually out of the region? These, unfortunately, are not hypothetical questions. They are issues WHO surveillance experts are already grappling with.

So what is emerging today more and more is a new and wider notion of national security. That is, human security. The levels of ill health in countries constituting a majority of the world's population, pose a direct threat to their own national economies, their political stability and therefore, to the global economic and political interests of all countries.

Now, I'm putting this into an even wider perspective than what Sam Nunn just did, because it is important to see it in the broad context of what importance there is to look at what happens in the international community on so many aspects which are linked to health, poverty, disease, and where, as you said, unless we look at them and deal with them where they happen, to a greater extent than what is the case today, we will all directly and indirectly be affected.

Now rapid detection, identification and response are key to saving lives and controlling infectious disease, whether caused by an incident or bioterrorism or by a naturally occurring infection. And a rapid response may also make the difference with regard to identifying the source of the outbreak. And, of course, that is essential in the context of what we are trying to achieve. And to better be able to identify whether the outbreak was intentional or naturally occurring.

So strategies to enhance preparedness against both of these threats depends on the same systems of public health and medical care and the fact that we are prepared and, as you said, able to go immediately. Not to have to wait, to have too much of practical things, funding and a safety that in fact we can do this, which is why the fund supplements a global alert and response network with all the institutions that are now making it possible for WHO to look at the world, whether there are rumors or concrete observations, it is shared via the Internet in a systematic way.

And there's a 24-hour presence in WHO headquarters, looking at all these information sources and putting a sensible picture together. The moment there is anything that looks serious, we now not only identify it, but we can even work quickly and directly beyond the ground, within 24-hours from an outbreak being detected, and I think this is a greater reassurance for public health efforts and for the millions of people who are dependent on this capacity. That all of us can (UNINTELLIGIBLE) have together to control outbreaks, whatever the reason for those outbreaks. Thank you very much.

SAM NUNN: Why don't we stay up together and answer questions and let me ask Dr. Peggy Hamburg to come up too -- in case they ask me a hard question. Peggy and Asha George are basically our biological experts at the Foundation and Peggy has been New York City Public Health Commissioner and held a very high position in HHS in the previous administration so we're proud to have Peggy. So why don't we have questions for (UNINTELLIGIBLE).

(UNINTELLIGIBLE) FROM VOICE OF AMERICA: (INAUDIBLE)

SAM NUNN: No, it's our understanding that the WHO will conduct fundraising to replenish the fund, but let me ask Gro to speak directly to that.

GRO BRUNDTLAND: Well, I think some of the countries that have been involved in the aftermath of September 11, the G-8 and Mexico meetings, is one example, countries who are already involved in looking at also the public health perspectives and looking at it from a security perspective, that some of those countries I think will be willing to come forward. But we generally do fundraising, not only with the G-8 countries, but also with others, like the Scandinavian countries; Netherlands, those who are, and Japan, so I believe it is possible that the principle has been established, people will see the importance, that it is possible to keep a revolving fund working.

(UNINTELLIGIBLE QUESTIONER):

GRO BRUNDTLAND: Yeah, so this, of course, depends where it's happening. And we have a WHO office in all developing countries and in fact, in about 140 countries, worldwide. They have collaborating centers and the link with those offices from the WHO headquarters and our regional offices is there. So the moment somebody questions in a country what's happening, there is a communication system that starts giving advice even before any expert is on the ground. So we have to see it in several stages, but obviously, if we know that immediately we can push a button and know who is available to go directly, it is a slight time more or less, and to be able to find out the quickest way to get to some African village, it can take, I mean we have seen examples where we have been on the spot after 15 hours. Even in far away African countries. However, in other cases where the need is not as quickly as obvious, you can have some time, you know, assessing whether it's necessary or not and I think sometimes that barrier can be too high. That in fact, in cases, because we don't have the funding, but that it would be helpful to have real experts supporting what the government can do on the ground, which is often not very much. As you can imagine, in some of the poorest countries. It would really be helpful that we don't have to have that high a barrier to really call the alarm immediately. We do that if we think it's an Ebola outbreak, then, directly of course, we have to use whatever funding we have. But we cannot develop a system in such a way that we can be better at identifying some of the others if we don't have a more secure funding system.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: It may be potentially very dangerous.

(UNINTELLIGIBLE QUESTIONER:)

SAM NUNN: Peggy can answer that probably with more expertise than I can, but I would say that we are working very carefully with WHO. We are also working with CDC. We are working on a project in India with CDC. There are a lot of other areas we are involved in, in bioterrorism, and we will continue to work very closely with WHO. I don't have a specific program in mind, now, but we are involved in probably 15 to 20 different biological projects, including the all important area of protecting our food supply, which is just beginning to get the focus that it has needed for a long time. Peggy, you want to speak about this?

PEGGY HAMBURG: Well, I think, as Senator Nunn said, we are trying through different avenues and with different organizations and entities to try to build, to strengthen and extend the public health infrastructure for early recognition and response. This is, I think, a very important activity. We also are funding WHO, as Senator Nunn mentioned, to expand the language capabilities for the Global Public Health Information Network, which feeds directly into this Outbreak Response Fund in terms of early recognition through the Global Public Health Information Network and then the Rapid Outbreak Response Fund and will be continuing to work closely with WHO in trying to identify areas of mutual concern and opportunity to improve public health, globally and improve the fight against infectious disease.

SAM NUNN: One of the areas that we're working in, I'll take advantage of this group here, does not directly relate to WHO, but I think that this is certainly something that they would be very interested in. We're trying to get the pharmaceutical community in this country and around the globe, as well as the biotechnology community, to recognize their responsibility over protecting dangerous pathogens -- not only those private industries, but also government laboratories and also university laboratories. Where they may have their own safety mechanisms, but there is no coordination. It has no best practices. No peer reviews. So we are saying to our pharmaceutical friends and our biotechnology friends, as well as many laboratories, it's time to have your own voluntary efforts and if you do that and you get in front of a regulatory system, you can probably be much more effective without diminishing the good work that is going on, on behalf of people on health issues. The nuclear industry found out the hard way, after Three Mile Island and after Chernobyl, that they needed to organize. They are organized now, both in this country and around the globe, and the global effort is called The World Association of Nuclear Operators. One of the things that we really hope is that we can stimulate a similar response by the biological community, because most of the dangerous pathogens are not controlled by government. They are not controlled necessarily by big industries, as is the case with the nuclear. But rather by thousands of laboratories that are handling all sorts of dangerous material, but also have a very noble purpose on behalf of mankind. So the key here is to improve security without stifling the kind of research we need to improve global health, and that is a very difficult balance.

(UNINTELLIGIBLE QUESTIONER):

SAM NUNN: Well, we would like for a perfect world to exist where the governments actually funded all the international organizations. We know that doesn't happen. We watch with much frustration in this country when Ted Turner basically had to come up with some $35 million to make sure that the U.N. dues were paid and he stimulated the activity on the part of our own government to pay up back dues. So international organizations don't have the kind of appeal in this country that they should have. And that's one of the things we're trying to do -- is increase educational awareness about how every American has a stake in the work that Gro Brundtland and her team, World Health Organization, are doing. They have a real stake in it. It involves the security of our families. The security of our friends and the protection of our own well being. So this is what we are trying to do. We're trying to get the ball rolling in a lot of different directions including this one here today, which we believe is very important.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: Well, I mean generally, the public health capacity on the ground in African countries as well as in other developing countries, has to be scaled up. Laboratories, they have to have reference centers so that they can identify at least a number of the most important pathogens and chemicals. And so that's a challenge to those countries, but also to all of us to be supporting them in increasing their capacity. So that is part of a broader plan to scale up the whole public health system. Which is necessary for so many reasons as we have seen demonstrated here during this press conference.

SAM NUNN: I just want to emphasize one other point. In many cases, the health experts tell me that you're not going to know until you've had several weeks of investigation, what the source of the infectious disease may be and whether it's deliberate or whether it's naturally occurring. So in terms of, as Gro informed me a few minutes ago in our preliminary conversation, in terms of determining if it was a bioterrorist attack, where it came from and how you stop it and how you prevent it from being perpetuated in other regions and other countries, getting on the ground very quickly is very important. Whether it's WHO or whether they take along CDC and NIH experts. And the broadening of the languages goes to that question in many countries. Right now, it's my understanding, it's only French and English and this will expand it to include Chinese and Russian and Arabic, as well as Spanish. So you're tripling the number of languages and so all of that has got to be beefed up and strengthened. There's no question about it.

PEGGY HAMBURG: In this Global Public Health Information Network that Senator Nunn was just referring to, is just one of the tools that WHO individual countries use in order to identify and track diseases. It has proven very valuable and it really tracks media reports and other Internet communications about these outbreaks that may be occurring. But also, WHO is a central hub in terms of disease reporting through their work with all of the member countries and their national offices. And it is important, what Dr. Brundtland said, that we continue to strengthen on the ground capabilities including trained personnel and laboratory back up so that we can have the kind of day to day disease monitoring that's really going to be necessary to making for a safer world.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: Yeah. So first of all, our networks and generally our role to be a center of knowledge, a center of excellence to be available for the whole of the world, not only the governments, but also civil society and everyone who seeks information. Of course, that knowledge base is available to every country, whether rich or poor. However, when it comes to the kind of support that is necessary for a poor country, the difference is, if an outbreak is in the U. S., the CDC will be there directly in the U. S. You have your institutions in the U. S. But they are in continuous contact with the WHO and we are feeding on each other, the knowledge that is available. And if you have other countries that are smaller, that may be not a developing country, but some middle income, smaller country with less capacity. They will definitely turn to WHO and ask for help in a situation. And we will then be happy to be part of the solution. Often by calling on other collaboration centers like CDC or like teams from Paris, from the French or from U.K. We are not only linked to CDC, but CDC is a major partner because of the size and the experience of CDC. So it's a varied pattern depending on the need of the country. The country may only want advice. They have the team there, and they do it themselves. So there's no, we don't say "no," because a country is over a certain average income.

(OVERLAPPING REMARKS). About how far the money would go? Well, I think the money makes a difference for us in that we can lower the barrier that I said. About being able to identify teams and quickly them on the ground, which will add to the total knowledge base and the ability to deal with more of what's happening around the world then what we are able to do today. So it's a bit in a puzzle that has many different parts and you all have heard about the global fund to fight AIDS, tuberculosis and malaria. There are now $2 billion in that fund and imbursements out to countries is just starting to come. To Haiti, to Tanzania, to a couple of other countries. Given the process and the decision making that is now starting to make it possible to deliver.

Now, because more funding is coming for major infectious diseases like this, there will be higher capacity developed in a number of poor countries to be able to monitor the patients; to be able to deal with the TB and AIDS patients and the malaria treatment; and indirectly, over time, it will help increase the public health capacity on the ground. It illustrates that there are many other things that we are doing, that together lead to an improvement. Where money in one area which affects public health in capacity for poor countries and another one, add up to a greater capacity for, because you need trained people in order to evaluate the situation.

SAM NUNN: The concept also is that $500,000 may have to be replaced many, many times. We're not going to be able to do that as a Foundation. The other donors are going to have to be able to replace that money. This is not the solution to any particular disease problem. This is just making sure there's no resource barrier to early response in any country in the world. Making sure they can go to the country and while they are on the way in the air, perhaps start the fundraising for a much larger sum of money, which may be required, depending on developments. But they'll be on the ground. They will not have to wait. And as Gro said, you will not have the same kind of very high threshold to respond to situations that may end being just as serious as those that are readily identifiable as extremely serious. So you're going to have more ability to go in more directions.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: Well, you know, that's hard to identify really. We see this as a good start and as an important improvement of our total system or response and if we are able to replenish on a regular basis, it may be sufficient. It may prove that we need $1 or $2 million instead of $500,000. Who knows? Because we will see as this goes into function what the needs are, how quickly we get other funding, and so on. Everything will be dependent on how countries are responding in fact.

You know that in the whole emergency area, more broadly now, when you have earthquakes, floods, other emergencies in poor countries around the world, the system of gathering together funding to deal with that situation is a multi-faceted one. Many donors, countries, foundations, and it illustrates that it is often not one channel or response. It is a sum of things. For here, we are into what we see as a core function or an important function for the network that WHO is. To be more, not only an advisory roll from Geneva, but to be able to see to it that people are also present to help on the ground. Which is a widening of our capacities to improve the mandate or to fulfill a mandate, where we have a comparative advantage, compared to others. Because let me also mention things which may not be so obvious, looking at this from U. S. perspective. It is this.

We are dependent on institutions like the CDC with its big capacity and all its experience. Not in every situation, in every country around the world, if it's as easy to enter an American or in some other cases, a U. K., or a French institution, with their identification, into a situation which may be sensitive for the country, where, you can imagine, that you have people who deal with the tourism industry, who deal with the consequences of transparency and open communication about something that is a potential threat and where even when it's not identified as a big problem, they start trying to protect, to avoid getting into problems which the politicians of that country see as potential downsides of any kind of outbreak.

The WHO with its long-standing experience and the credibility, the feeling that we are a neutral institution which helps every country irrespective of the political situation that may be part of the background in that country, then we are alongside the people we call on. We get access. And we can better deal with the situation. So there is also people don't think always about political sensitivities, which have to do with all the kinds of conflicts and all the difficult situations in so many poor and developing countries in this world. They don't always have even functioning governments of the kind that we expect to have.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: Well, I think in some cases, the purchase of materials is a barrier for us to be able to do the containment. If the government in that situation where we are visiting in order to help them, does not have the capacity, does not have what is needed, somebody has to fund that. And we have to try to do it with our funds or by funding that is being given to us from voluntary sources like this one, in order to be able to do what is necessary in the concrete situation.

And so it's another example of where the barriers need to be lowered in certain cases in order to be able to effective to deal and to contain an outbreak.

SAM NUNN: We certainly would, from the donor point of view, want the funds to be used in whatever way they are needed. To be able to respond immediately and to go back to my own analogy with the fire truck, we want there to be enough gas in the truck to get the fire fighters to the scene of the fire and basically begin the work while they may have to ask for a substantial relief from others, both in terms of resources and personnel. But at least they are there on the scene and they are really working on the problem. And there is no barrier to immediate response. That's what this is all about.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: You mean it's easier to raise funds for AIDS? (OVERLAPPING REMARKS) Well, I think that is an issue because generally people tend to take for granted what I can call public health infrastructure. Although it is non-existent in many poor parts of the world. So for that reason, to be able to deal with an international situation where we are all interdependent and are exchanging our microbes and our problems, in so many different ways, we really sometimes need to build up that capacity. Even if it is not the first thing that some foundation or a government would like to fund, because it seems to be general and not only focused on one specific project and one specific country, where you can count how many children were reached by that vaccine and how can you proudly tell exactly what your money went to. This is a problem, generally, in development work. Whether in the health sector or otherwise.

SAM NUNN: Okay. This is probably the last question here.

(UNINTELLIGIBLE QUESTIONER:)

GRO BRUNDTLAND: Well, I would have to have that data, but, you know, frankly, for the people who are part of the alert team, the unit in my organization, who feel every day responsible to monitor, to be networking, to be knowing exactly what resources we can draw on, will obviously feel that they have one more opportunity to be quick and effective when they have these revolving funds. There's no question that it helps. Because all the different things that you need to deal with, if you also have the money problem on everything, it obviously makes it more difficult to find the best solutions. So, we can always come back to you and answer your question because, you know, as long as we can ask (UNINTELLIGIBLE) to give you a more precise picture of how many times in the last three months, but that will be available, I'm sure.

SAM NUNN: Okay. Thank you very much.

(END OF PRESENTATION)

December 2, 2002
About

Announcement of the WHO-NTI Global Emergency Outbreak Response Fund

Authors
Margaret A. Hamburg, M.D.

Commissioner U.S. Food and Drug Administration

Sam Nunn
Sam Nunn

Co-Chair, NTI