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It\222s a privilege and a pleasure t\ o welcome you here, first to )Tj 0.105 Tw 0 -1.72 TD (Canada and sec)Tj (ond to the International Development Research Centre... Council, sorry, \ and to )Tj 0 Tw T* (this meeting.)Tj ( )Tj 0.225 Tw 3 -1.72 Td (I\222d like to first of all introduce our Deputy Chief Public Health Off\ icer of Canada, )Tj 0 Tw -3 -1.74 Td (Dr.)Tj ( )Tj (Bob Clarke, who will say a few words as well.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Bob Clarke)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thanks, Ron.)Tj ( )Tj 0.103 Tw T* (Again I\222d like to just welcome you all here on behalf of the Canadian\ government and )Tj 0.204 Tw -3 -1.72 Td (also the Public Health Agency of Canada, IDRC and all those who helped p\ repare for this )Tj 0.047 Tw T* (meeting. This is a very important meeting for us, and I think just from \ the intere)Tj 32.722 0 Td (st that has been )Tj 0.064 Tw -32.722 -1.72 Td (generated in this meeting. The International Health Regulations are cert\ ainly something that we )Tj 0.411 Tw 0 -1.74 TD (need to learn more about, and the issues around governance and applicati\ on of these )Tj 0 Tw 0 -1.72 TD (International Health Regulations will be a very interesting)Tj 23.243 0 Td ( )Tj (discussion.)Tj ( )Tj 0.251 Tw -20.243 -1.72 Td (So I really welcome you here and look forward to hearing the proceedings\ of this )Tj 0 Tw -3 -1.72 Td (meeting. Thank)Tj (-)Tj (you.)Tj ( )Tj 3 -1.74 Td ( )Tj /TT1 1 Tf -3 -1.72 Td (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj (you. Dr.)Tj ( )Tj (Lazar?)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf -3 -1.72 Td (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.065 Tw 3 -1.64 Td (I\222m Harvey Lazar. I\222m not on the agenda, but I\222d just like to t\ ell you in 15 seconds)Tj 0 Tw 34.185 0 Td ( )Tj 0.315 0 Td (that )Tj 0.133 Tw -37.5 -1.74 Td (the boardroom you\222re in is the boardroom of the International Develop\ ment Research Centre, )Tj 0.167 Tw 0 -1.72 TD (which is an NGO, a Canadian NGO with sponsorship from the Canadian gover\ nment which )Tj 0.112 Tw T* (works at arm\222s length, and it\222s one of the... The pictures you see\ on the w)Tj 31.029 0 Td (alls around you are )Tj 0.065 Tw -31.029 -1.72 Td (former members of the board of IDRC and I would just say, in Canada we t\ hink it\222s one of the )Tj ET endstream endobj 3 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 4 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (3)Tj ( )Tj ET Q BT 0.068 Tw 12 0 0 12 71.88 709.08 Tm (most effective NGO\222s around the world, and I just thought you might w\ ant to know where you )Tj 0.004 Tw 0 -1.72 TD [(are. )0.5(If )0.5(there\222s )0.5(anyone )0.5(from )0.5(IDRC )0.5(who )0.5(would )0.5(like )0.5(to )0.5(a)]TJ [(dd )0.5(a )0.5(word )0.5(about )0.5(just )0.5(the )0.5(nature )0.5(of )0.5(what )0.5(you )]TJ 0 Tw T* (do...? No? Okay, so thank)Tj (-)Tj (you for that.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 0.064 Tw 3 -1.64 Td (I thought we\222d begin with just a round of introductions. My name\222s\ Kumanan Wilson. I )Tj 0 Tw -3 -1.74 Td (again would like to thank everybody for participating in this event)Tj 26.493 0 Td (.)Tj ( )Tj 0.046 Tw -23.493 -1.72 Td (I\222m a physician at the Toronto General Hospital, I\222m with the Univ\ ersity of Toronto and )Tj 0.164 Tw -3 -1.72 Td [(Queen\222s University, and I\222ll be making a few more comments later a\ bout how )0.5(we )0.5(hope this )]TJ 0 Tw T* (workshop unfolds.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (David Fidler)Tj ( )Tj /TT0 1 Tf 0.257 Tw 3 -1.64 Td [(I\222m )0.5(David )0.5(Fidler. )0.5(I\222m )0.5(a )0.5(Professor )0.5(of )0.5(Law )0.5(a)]TJ [(t )0.5(Indiana )0.5(University )0.5(School )0.5(of )0.5(Law )0.5(in )]TJ 0 Tw -3 -1.74 Td (Bloomington, Indiana.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Jeffrey Scott)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (I\222m Jeff Scott, I\222m Chief Medical Officer of Health, Province of N\ ova Scotia, in Canada.)Tj 35.655 0 Td ( )Tj -38.655 -1.72 Td ( )Tj /TT1 1 Tf T* ([Several speakers inaudible])Tj ( )Tj /TT0 1 Tf 0 -1.66 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Jianzhong Zhang)Tj ( )Tj /TT0 1 Tf 0.114 Tw 3 -1.64 Td (I\222m Zhang Jianzong from the National )Tj 16.349 0 Td (Institute of Communicable Disease Control and )Tj 0 Tw -19.349 -1.74 Td (Prevention, China\222s CDC.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Sampath K. Krishnan)Tj ( )Tj /TT0 1 Tf 0.044 Tw 3 -1.66 Td (I\222m Dr.)Tj 0 Tw ( )Tj 0.044 Tw (Sampath Krishnan, I\222m the Coordinator of Communicable Diseases Survei\ llance )Tj 0 Tw -3 -1.72 Td (at the country office of the WHO in India.)Tj 16.855 0 Td ( )Tj -16.855 -1.72 Td ( )Tj /TT1 1 Tf T* ([Several speakers inaudible])Tj ( )Tj /TT0 1 Tf 0 -1.66 TD ( )Tj ET endstream endobj 5 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 6 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (4)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Mr)Tj (.)Tj ( )Tj (Andr\351 Basse)Tj ( )Tj /TT2 1 Tf 0.114 Tw 3 -1.64 Td (Je suis Andr\351 Basse. Je suis diplomate de formation et j\222ai n\351g\ oci\351 donc le R\350glement )Tj 0 Tw -3 -1.74 Td (sanitaire international pour le compte du S\351n\351gal et pour le compt\ e du Groupe africain. )Tj 35.634 0 Td (Merci.)Tj ( )Tj /TT0 1 Tf -32.634 -1.72 Td ([inaudible])Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Expedito Luna)Tj ( )Tj /TT0 1 Tf 0.021 Tw 3 -1.66 Td (I\222m Expedito Luna, I come from)Tj 0 Tw ( )Tj 0.021 Tw 13.428 0 Td (the Ministry of Health of Brazil, where I\222m the Director )Tj 0 Tw -16.428 -1.72 Td (of Communicable Disease Surveillance and Control.)Tj 21.05 0 Td ( )Tj -21.05 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Anthony A. Marfin)Tj ( )Tj /TT0 1 Tf 0.315 Tw 3 -1.64 Td (Hi, I\222m Anthony Marfin, and I\222m the Deputy Director of the Divisio\ n of Global )Tj 0.073 Tw -3 -1.72 Td (Migration and Quarantine at the United States C)Tj 19.87 0 Td (enters for Disease Control and Prevention, and )Tj 0 Tw -19.87 -1.74 Td (I\222m here representing the Department of Health and Human Services.)Tj 27.823 0 Td ( )Tj -24.823 -1.72 Td ([inaudible])Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Mr.)Tj ( )Tj (Bruce Plotkin)Tj ( )Tj /TT0 1 Tf 0.03 Tw 3 -1.66 Td (Good morning. Very glad to be here. My name is Bruce Plotkin. I am the l\ egal expert on )Tj 0.065 Tw -3 -1.72 Td (the International Health)Tj 0 Tw ( )Tj 0.065 Tw 9.941 0 Td (Regulations implementation team, so I work at WHO together with the )Tj 0 Tw -9.941 -1.72 Td (rest of the team that is implementing the IHR.)Tj 18.357 0 Td ( )Tj -18.357 -1.74 Td ( )Tj /TT1 1 Tf T* ([Two speakers inaudible])Tj ( )Tj /TT0 1 Tf 0 -1.64 TD ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.094 Tw 3 -1.64 Td (Thanks very much. I would ask please that you remember to use the microp\ hone when )Tj 0.027 Tw -3 -1.72 Td (you speak beca)Tj (use we do have translation and we are trying to record the proceedings, \ so they\222ll )Tj 0.074 Tw T* [(miss )0.5(it )0.5(if )0.5(we )0.5(don\222t )0.5(use )0.5(the )0.5(microphone, )0.5(so )0.5(I )0.6(would )0.6(appreciate )0.5(it )0.5(if )0.5(you )0.5(would )0.5(just )0.5(press )0.5(the )0.5(red )]TJ 0 Tw 0 -1.72 TD (button when you speak. Thank)Tj (-)Tj (you.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 0.005 Tw 3 -1.66 Td (Once again I\222d like to)Tj 0 Tw ( )Tj 0.005 Tw 8.994 0 Td (thank everybody on behalf of the conference organizers for making )Tj 0.242 Tw -11.994 -1.72 Td (it to this workshop, and in particular I would like to thank those that \ have travelled long )Tj ET endstream endobj 7 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 8 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (5)Tj ( )Tj ET Q BT 0.063 Tw 12 0 0 12 71.88 709.08 Tm (distances to make it here. I know many of you were on flights most of th\ e day yesterday, and I )Tj 0 Tw 0 -1.72 TD (ap)Tj (ologize for any inconvenience you may have experienced.)Tj 24.211 0 Td ( )Tj -21.211 -1.72 Td (Up)Tj (-)Tj 0.221 Tw (front, is there any logistical issues or concerns? I think we can direct\ people to )Tj 0 Tw -3 -1.74 Td (Christopher, myself or Patty and we\222ll try to help with any of those \ issues.)Tj 29.746 0 Td ( )Tj 0.153 Tw -26.746 -1.72 Td (Most of you have received some of the)Tj 0 Tw ( )Tj 0.153 Tw 17.055 0 Td (information leading up to this workshop, and )Tj 0.093 Tw -20.055 -1.72 Td (again the very broad objective is to understand the governance challenge\ s to implementing the )Tj 0.121 Tw T* (International Health Regulation, focusing specifically on how these gove\ rnance challenges are )Tj 0 Tw 0 -1.74 TD (unique to federal nati)Tj (ons or non)Tj (-)Tj (federal nations that have decentralized systems of government.)Tj 38.237 0 Td ( )Tj 0.075 Tw -35.237 -1.72 Td [(And )0.5(in )0.5(essence )0.5(there\222ll )0.5(be )0.5(two )0.5(major )0.5(points )0.5(of )0.5(emphasis )0.5(during )0.5(this )0.5(workshop. )0.5(One )0.5(is )0.5(I )]TJ 0.041 Tw -3 -1.72 Td [(think obviously everybody here recognizes the importance of the IHR and \ )0.5(the )0.5(importance )0.5(of )0.5(the )]TJ 0 Tw 0 -1.72 TD (w)Tj 0.055 Tw (ork a lot of people are doing around the table here, and the necessity t\ o effectively implement )Tj 0.132 Tw 0 -1.74 TD (the International Health Regulations. And then the International Health \ Regulations also offer )Tj 0.023 Tw 0 -1.72 TD (several unique challenges, it\222s in many ways a revolutionary new )Tj (approach to managing some of )Tj 0.001 Tw T* [(the problems in a globalized world, and )0.5(because of its uniqueness )0.5(countries with older systems of )]TJ 0 Tw T* (government )Tj 5.069 0 Td (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (such as federal states and unitary states )Tj 0 Tw 16.207 0 Td (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (may have difficulties in adapting to this )Tj 0 Tw -22.861 -1.74 Td (new approach.)Tj ( )Tj 0.167 Tw 3 -1.72 Td (The overall goal)Tj 0 Tw ( )Tj 0.167 Tw 7.305 0 Td (is to hopefully have a relatively frank and open discussion on these )Tj 0.055 Tw -10.305 -1.72 Td (governance challenges, but most importantly it\222ll be for each of us t\ o learn from each other and )Tj 0.082 Tw T* (learn from each other\222s experiences, and then from the synthesis of t\ he information that )Tj 0 Tw 36.445 0 Td (comes )Tj 0.028 Tw -36.445 -1.74 Td (out of this workshop we hope to provide some key messages and learning m\ aterials for others to )Tj 0 Tw T* (benefit from as well.)Tj ( )Tj 0.064 Tw 3 -1.72 Td (The general approach is this will be a two)Tj 0 Tw 17.227 0 Td (-)Tj 0.064 Tw (day workshop. We are fortunate to have nine )Tj 0.132 Tw -20.227 -1.72 Td (country presentations )Tj 0 Tw (\226)Tj ( )Tj 0.132 Tw 9.978 0 Td (these will be approxim)Tj (ately one hour each )Tj 0 Tw 18.114 0 Td (\226)Tj ( )Tj 0.132 Tw 0.882 0 Td (and we\222ll also have two )Tj 0 Tw -28.974 -1.74 Td (presentations representing more regional perspectives.)Tj 21.742 0 Td ( )Tj 0.02 Tw -18.742 -1.72 Td (In general these presentations will be approximately 20 to 30 minutes )Tj 0 Tw (\226)Tj ( )Tj 0.02 Tw 29.065 0 Td (there\222s obviously )Tj 0.114 Tw -32.065 -1.72 Td [(flexibility )0.5(depending )0.5(on )0.5(the )0.5(amount )0.5(of )0.5(content )]TJ 0 Tw 19.652 0 Td (\226)Tj ( )Tj 0.114 Tw 0.864 0 Td [(and )0.5(then )0.5(I )0.5(think)]TJ 0 Tw ( )Tj 0.114 Tw 7.008 0 Td [(the )0.5(most )0.5(critical )0.5(component )]TJ 0.139 Tw -27.524 -1.72 Td (will be a discussion where each of you will have an opportunity to ask q\ uestions )Tj 0 Tw 34.501 0 Td (\226)Tj ( )Tj 0.139 Tw 0.889 0 Td (and very )Tj 0 Tw -35.39 -1.74 Td (specific questions if you wish )Tj (\226)Tj ( )Tj (about some of the challenges countries may be experiencing.)Tj 37.24 0 Td ( )Tj 0.116 Tw -34.24 -1.72 Td (Just a point of clarification, people were)Tj 0 Tw ( )Tj 0.116 Tw 17.137 0 Td (invited here as experts in public health in the )Tj 0.103 Tw -20.137 -1.72 Td (IHR from a specific country, not necessarily as representing that countr\ y. If they wish to state )Tj 0.024 Tw T* [(that )0.5(they )0.5(would )0.5(be )0.5(representing )0.5(the )0.5(position )0.5(of )0.5(their )0.5(country )0.5(they )0.5(are free )0.5(to )0.5(do )0.5(so, )0.5(but )0.5(otherwise )]TJ ET endstream endobj 9 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 10 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (6)Tj ( )Tj ET Q BT 0.016 Tw 12 0 0 12 71.88 709.08 Tm (we will no)Tj (t take the comments as being representative of the country from which th\ ey came. Not )Tj 0 Tw 0 -1.72 TD (an official statement.)Tj ( )Tj 0.141 Tw 3 -1.72 Td (Again, just another point of clarification. This again is not in a... th\ e objective of this )Tj 0.071 Tw -3 -1.74 Td (workshop will not be to identify past problems or any ch)Tj (allenges people have had in the past )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw T* (unless that\222s an essential part of the background )Tj 0 Tw 20.416 0 Td (\226)Tj ( )Tj 0.122 Tw 0.872 0 Td (but primarily to look forward and again to )Tj 0.234 Tw -21.288 -1.72 Td (describe strategies countries may be working on or beginning to examine \ to overcome the )Tj 0 Tw T* (potential governance obstacles to )Tj 13.551 0 Td (implementing the International Health Regulations.)Tj 20.578 0 Td ( )Tj 0.125 Tw -31.129 -1.74 Td (And finally )Tj 0 Tw (\226)Tj ( )Tj 0.125 Tw 5.956 0 Td (and we\222ll discuss it a bit more at the end of the workshop )Tj 0 Tw (\226)Tj ( )Tj 0.125 Tw 25.629 0 Td (we will be )Tj 0.272 Tw -34.585 -1.72 Td (providing edited transcripts to all participants for their comments and \ feedback. From the )Tj 0.115 Tw T* (information we obtain from t)Tj (his workshop we hope to develop a list of key messages and the )Tj 0.036 Tw T* (suggested strategies to assist federal nations and decentralized states \ to assist them with some of )Tj 0.146 Tw 0 -1.74 TD (the governance challenges that will be discussed, and then ideally we co\ uld develop learning )Tj 0 Tw 0 -1.72 TD (materials to more concretely assist countries in the WHO in this very im\ portant process.)Tj 35.269 0 Td ( )Tj 0.179 Tw -32.269 -1.72 Td (Perhaps we can take a few quick questions on any points here that were p\ articularly )Tj 0.052 Tw -3 -1.72 Td (unexpected or require clarification...? No? Okay, thank)Tj 0 Tw 22.36 0 Td (-)Tj 0.052 Tw (you very much. I think we\222l)Tj (l begin with )Tj 0.057 Tw -22.36 -1.74 Td [(our )0.5(first )0.5(presentation. )0.5(Does )0.5(anybody )0.5(on )0.5(the )0.5(conference )0.5(organizing )0.5(committee )0.5(want )0.5(to )0.5(make )0.5(any )]TJ 0 Tw T* (comments? No?)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.072 Tw 3 -1.66 Td (The first speaker I believe is Bruce. You\222re going to speak first, is\ that correct? Tony, I )Tj 0.108 Tw -3 -1.72 Td (mean. Sorry, beg your pard)Tj (on. Sorry, Bruce is WHO. No, I\222m sorry, is David Fidler speaking )Tj 0 Tw T* (now? Yes, you put me off)Tj (-)Tj (track, Kumanan.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (I apologize.)Tj ( )Tj -3 -1.74 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.042 Tw 3 -1.64 Td (Sorry, I apologize. I got off)Tj 0 Tw (-)Tj 0.042 Tw (track. David, you\222re going to go first. Sorry about that. I got )Tj 0 Tw -3 -1.74 Td (off)Tj (-)Tj (t)Tj (rack.)Tj ( )Tj T* ( )Tj ET endstream endobj 11 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 12 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (7)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (David Fidler )Tj (\226)Tj ( )Tj (Overview of the New IHR)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj 0.214 Tw [(you. )0.5(Just )0.5(let )0.5(me )0.5(first )0.5(personally )0.5(thank )0.5(Kumanan, )0.5(Chris, )0.5(Harvey, )0.5(and )0.6(Ron )0.5(for )]TJ 0.221 Tw -3 -1.74 Td (inviting me to participate in this event. It\222s those gentlemen that r\ eally had the vision, the )Tj 0.131 Tw 0 -1.72 TD (perseverance and the patience)Tj 0 Tw ( )Tj 0.131 Tw 12.737 0 Td (to see this gathering come together, and I just wanted to thank )Tj 0.035 Tw -12.737 -1.72 Td (them personally for including me in this. I\222d also like to thank all \ of you for coming to be a part )Tj 0.082 Tw T* (of this. I know many of you have busy and probably impossibly busy sched\ ules but you found )Tj 0 Tw 0 -1.74 TD (time to join us on this effort.)Tj ( )Tj 0.001 Tw 3 -1.72 Td [(I )0.5(say )0.5(these )0.5(thank)]TJ 0 Tw (-)Tj 0.001 Tw [(you\222s )0.6(not )0.6(just )0.5(a )0.5(matter )0.5(of )0.5(etiquette )0.5(but )0.5(I )0.5(think )0.5(that )0.5(it )0.6(also reflects )0.6(well )0.5(on )]TJ 0.065 Tw -3 -1.72 Td (all the time and effort that you and the organizers of this effort have \ put together, and it sort of )Tj 0.025 Tw 0 -1.72 TD (underscores for me, I thin)Tj (k, the two themes of what I want to talk about in my brief remarks this \ )Tj 0 Tw 0 -1.74 TD (morning, and I promise I\222m going to be brief.)Tj 18.218 0 Td ( )Tj 0.243 Tw -15.218 -1.72 Td (I think this event and your participation in it highlights the importanc\ e of the new )Tj 0.084 Tw -3 -1.72 Td (International Health Regulations in two contexts. Fir)Tj 21.582 0 Td (st, I think us getting together to talk about )Tj 0.01 Tw -21.582 -1.72 Td (this signals appreciation of the new International Health Regulations as\ a governance mechanism )Tj 0.114 Tw T* (in global health, and second it also signals appreciation that this impo\ rtant innovation that the )Tj 0.204 Tw 0 -1.72 TD (new IHR represen)Tj (ts in terms of global health governance depends critically on its effect\ ive )Tj 0.022 Tw T* (implementation in countries throughout the world, and I just want to bri\ efly share some thoughts )Tj 0.029 Tw T* [(on the themes of innovation and )0.5(implementation )0.6(that )0.6(I )0.5(think )0.5(are )0.5(really )0.5(at )0.5(the )0.5(heart)]TJ 0 Tw 33.112 0 Td ( )Tj 0.029 Tw 0.279 0 Td [(of )0.5(what )0.5(we\222re )]TJ 0 Tw -33.39 -1.74 Td (going to be doing today and tomorrow.)Tj ( )Tj 0.249 Tw 3 -1.72 Td (Now, a major theme of the writing and the scholarship that I\222ve done \ on the new )Tj 0.001 Tw -3 -1.72 Td (International Health Regulations has attempted to convey both conceptual\ ly as well as practically )Tj 0.042 Tw T* (how radically different t)Tj (he new International Health Regulations are from the approach that was )Tj 0.287 Tw 0 -1.74 TD (taken in the past with the IHR and the predecessor international legal r\ egimes that were )Tj 0 Tw 0 -1.72 TD (established, and I call that older approach the classical regime.)Tj 25.018 0 Td ( )Tj 0.059 Tw -22.018 -1.72 Td (My talk is billed as an overvi)Tj (ew of the new IHR but I just want to make sure that... you )Tj 0.13 Tw -3 -1.72 Td [(should )0.5(rest )0.5(assured )0.5(I\222m )0.5(not )0.5(going )0.5(to )0.5(go )0.5(through )0.5(all )0.6(the )0.5(different )0.5(ways )0.5(in )0.5(which )0.5(the )0.5(new )0.5(IHR )]TJ 0.027 Tw 0 -1.74 TD (differ from the old classical approach, which is actually a relief for m\ e because most audiences I )Tj 0.334 Tw 0 -1.72 TD (talk t)Tj (o about this have absolutely no idea about the details. I think this gro\ up actually )Tj 0 Tw T* (understands the way in which it\222s different so I\222m not going to go\ into those details.)Tj 33.55 0 Td ( )Tj 0.037 Tw -30.55 -1.72 Td (But what I do want to talk about is to focus a little bit on these theme\ s of innovati)Tj (on and )Tj 0.071 Tw -3 -1.74 Td (implementation, because I think it\222s important. And as I started thin\ king about making remarks )Tj ET endstream endobj 13 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 14 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (8)Tj ( )Tj ET Q BT 0.042 Tw 12 0 0 12 71.88 709.08 Tm (to this group I began to sort of have flashbacks, memories of the years \ that I\222d been working on )Tj 0.045 Tw 0 -1.72 TD (the IHR, and I can still vividly recall some of my first )Tj 22.288 0 Td (forays into the world of international law )Tj 0.105 Tw -22.288 -1.72 Td (and public health, which would be just about over ten years ago now. I n\ aively assumed, as a )Tj 0.411 Tw 0 -1.74 TD [(rather )0.5(ill)]TJ 0 Tw (-)Tj 0.411 Tw [(informed international )0.6(lawyer on )0.5(issues )0.5(of )0.5(public )0.5(health, )0.5(that )0.5(people )0.5(in )0.5(both )]TJ 0.241 Tw 0 -1.72 TD (international and public health)Tj 0 Tw 12.913 0 Td ( )Tj 0.241 Tw 0.491 0 Td (would know about the International Health Regulations and )Tj 0.006 Tw -13.404 -1.72 Td (would also be interested in them. The most typical response I received t\ o my early inquiries were )Tj 0.004 Tw T* (either blank stares of total incomprehension )Tj 0 Tw 17.797 0 Td (\226)Tj ( )Tj 0.004 Tw 0.754 0 Td (which is indicating that people I was talking to had)Tj 0 Tw 20.449 0 Td ( )Tj 0.169 Tw -39 -1.74 Td (absolutely no idea that the IHR existed )Tj 0 Tw (\226)Tj ( )Tj 0.169 Tw 17.904 0 Td (or laughter, which indicated that the people I was )Tj 0.39 Tw -17.904 -1.72 Td [(talking )0.5(to )0.5(thought )0.5(that )0.5(my )0.5(interest )0.5(in )0.5(the )0.5(International )0.5(Health )0.5(Regulations, )0.6(or )0.6(that )0.6(the )]TJ 0 Tw T* (International Health Regulations themselves, were something of a joke.)Tj 28.603 0 Td ( )Tj -25.603 -1.72 Td (It)Tj 0.104 Tw (\222s very different today. Today I get inquiries from people about the \ new IHR. People )Tj 0.228 Tw -3 -1.74 Td (are interested in how the new International Health Regulations relate to\ security objectives )Tj 0.184 Tw T* (concerning biological weapons. They want to know about how the new Inter\ nation)Tj (al Health )Tj 0.306 Tw T* (Regulations fit with the rules of international trade law that operate a\ t the World Trade )Tj 0.165 Tw T* (Organization. They want to know how the International Health Regulations\ contribute to the )Tj 0 Tw 0 -1.74 TD (health)Tj (-)Tj 0.077 Tw (related millennium development goals that the United Natio)Tj 27.334 0 Td (ns has established. And they )Tj 0 Tw -27.334 -1.72 Td (want to know how the new International Health Regulations incorporate hu\ man rights principles.)Tj 38.852 0 Td ( )Tj 0.122 Tw -35.852 -1.72 Td (Now, often these questions )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw 12.44 0 Td (and others which I haven\222t mentioned )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw 16.986 0 Td (they come from )Tj 0.073 Tw -32.426 -1.72 Td (people who are not experts in public health, they)Tj 20.051 0 Td (\222re not experts in international law, they come )Tj 0.049 Tw -20.051 -1.74 Td (from people working on national security, development policy, the protec\ tion of human dignity, )Tj 0.123 Tw 0 -1.72 TD (or issues related to the liberalization of international trade, and this\ indicates just an extent to )Tj 0.025 Tw T* (which the ne)Tj (w International Health Regulations has impacted across such a wide range\ of policy )Tj 0 Tw T* (areas.)Tj ( )Tj 0.393 Tw 3 -1.74 Td (I\222ve also been asked why has the UN Secretary)Tj 0 Tw 22.023 0 Td (-)Tj 0.393 Tw (General stressed repeatedly the )Tj 0.148 Tw -25.023 -1.72 Td (importance of the new International Health Regulations with respect to s\ trategies that h)Tj 36.714 0 Td (e and )Tj 0.145 Tw -36.714 -1.72 Td (others are devising for reform of the entire United Nations. Why, I\222v\ e also been asked, have )Tj 0 Tw T* (high)Tj (-)Tj 0.105 Tw [(level )0.5(panels and )0.5(experts )0.5(linked )0.5(the )0.5(new )0.5(International )0.5(Health )0.5(Regulations )0.5(with )0.5(developing )]TJ 0 Tw 0 -1.74 TD (new forms of governance, not only globally but also at the nati)Tj 25.105 0 Td (onal level.)Tj ( )Tj 0.062 Tw -22.105 -1.72 Td (Now, the nature and frequency of these questions have of course been sti\ mulated by the )Tj 0.184 Tw -3 -1.72 Td (impact of events that have taken place in the world, particularly the ou\ tbreak of SARS, the )Tj ET endstream endobj 15 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 16 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (9)Tj ( )Tj ET Q BT 0.128 Tw 12 0 0 12 71.88 709.08 Tm (concerns that exist about bioterrorism, the issues related to avi)Tj (an influenza, and of course the )Tj 0 Tw 0 -1.72 TD (fear about pandemic influenza.)Tj 12.383 0 Td ( )Tj 0.42 Tw -9.383 -1.72 Td (Now, recognition of the importance of the governance innovation that the\ new )Tj 0.043 Tw -3 -1.74 Td (International Health Regulations represents comes, I think, tempered wit\ h an appreciation of the )Tj 0.191 Tw T* (seriousness of the )Tj (challenges that the new International Health Regulations and I explain t\ o )Tj 0.157 Tw T* (people how radically different and historic the new International Health\ Regulations are as a )Tj 0.146 Tw T* (matter of international law and international governance, people don\222\ t stare at me with )Tj 0 Tw 36.778 0 Td (blank )Tj 0.015 Tw -36.778 -1.74 Td [(faces )0.5(and )]TJ 0 Tw (\226)Tj ( )Tj 0.015 Tw 4.791 0 Td [(at )0.5(least )0.5(not )0.5(to )0.5(my )0.5(face, )0.5(anyway )]TJ 0 Tw (\226)Tj ( )Tj 0.015 Tw 13.528 0 Td [(they\222re )0.5(not )0.5(laughing )0.5(at )0.5(what )0.5(I\222m )0.5(saying. )0.5(But )0.5(what )0.5(I )]TJ 0.032 Tw -18.319 -1.72 Td [(do )0.5(tend )0.5(to )0.5(get )0.5(is )0.5(the )0.5(raising )0.5(of )0.5(the )0.5(skeptical )0.5(eyebrow )0.5(when )0.5(I )0.5(describe )0.5(how )0.5(new )0.5(and )0.5(different )0.5(this )]TJ 0.142 Tw T* [(is. )0.5(They )0.5(understand )0.5(conceptually )0.5(what )0.5(I\222m )0.5(talking )0.5(abou)]TJ 23.318 0 Td [(t )0.5(in )0.5(terms )0.5(of )0.5(how )0.5(innovative )0.5(the )0.5(new )]TJ 0.054 Tw -23.318 -1.72 Td (International Health Regulations are, but I think they\222re wondering a\ bout the implementation of )Tj 0.162 Tw 0 -1.74 TD (this new innovation, and you sort of see them thinking, \223If it sounds\ too good to be true, it )Tj 0 Tw 0 -1.72 TD (probably is.\224)Tj ( )Tj 0.135 Tw 3 -1.72 Td (Now, internatio)Tj (nal lawyers are accustomed, they\222re very used to this kind of skeptic\ al )Tj 0.102 Tw -3 -1.72 Td (reactions because we have to live with them all the time. States\222 int\ ernational organizations in )Tj 0.01 Tw 0 -1.74 TD (many different realms of international relations create new, innovative \ schemes, new tr)Tj 34.955 0 Td (eaties , all )Tj 0.055 Tw -34.955 -1.72 Td (the time, and these often raise hopes that we\222re finally going to tur\ n the corner. Of course often )Tj 0.049 Tw 0 -1.72 TD (those hopes are never achieved because those innovations are never imple\ mented to the point at )Tj 0 Tw T* (which the promise becomes reality.)Tj ( )Tj 0.025 Tw 3 -1.74 Td (And we\222ve actu)Tj (ally seen this pattern in global health on a number of occasions. After \ all, )Tj 0.231 Tw -3 -1.72 Td (once upon a time the classical regime in the old international health re\ gulations were also )Tj 0.121 Tw T* (considered innovative and progressive, and of course that image no longe\ r exists becaus)Tj 36.686 0 Td (e that )Tj 0.04 Tw -36.686 -1.72 Td (image has been tarnished by the failure of states to implement the innov\ ations effectively and to )Tj 0 Tw 0 -1.74 TD (comply with those regimes.)Tj ( )Tj 0.001 Tw 3 -1.72 Td [(So implementation is really )0.5(what )0.5(this )0.5(meeting )0.5(is )0.6(all )0.6(about. )0.5(The )0.5(scope )0.5(and )0.5(substance )0.5(of )0.5(the )]TJ 0.375 Tw -3 -1.72 Td (new International Health Regulati)Tj (ons are innovative but they\222re also much, much more )Tj 0.071 Tw 0 -1.72 TD (demanding of countries and of the World Health Organization than any pre\ vious incarnation of )Tj 0.068 Tw 0 -1.74 TD (these set of rules. In addition, the harmonization of a global strategy \ )Tj 0 Tw (\226)Tj ( )Tj 0.068 Tw 29.122 0 Td (which is achieved at the )Tj 0.067 Tw -29.122 -1.72 Td (level of the)Tj 0 Tw ( )Tj 0.067 Tw 4.949 0 Td (International Health Regulations )Tj 0 Tw (\226)Tj ( )Tj 0.067 Tw 14.32 0 Td (meets in this implementation phase the diversity )Tj 0 Tw -19.269 -1.72 Td (of governmental systems and public health realities that exist around th\ e world.)Tj 31.77 0 Td ( )Tj ET endstream endobj 17 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 18 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (10)Tj ( )Tj ET Q BT 0.213 Tw 12 0 0 12 107.88 709.08 Tm [(We )0.5(are )0.5(essentially )0.5(facing )0.5(today )0.5(a )0.5(challenge )]TJ 0 Tw 19.062 0 Td (\226)Tj ( )Tj 0.213 Tw 0.962 0 Td [(and )0.5(I\222m )0.5(going )0.5(to )0.5(paraphrase )0.5(Edmund )]TJ 0.02 Tw -23.025 -1.72 Td (Burke, he)Tj 0 Tw (re )Tj 4.954 0 Td (\226)Tj ( )Tj 0.02 Tw 0.77 0 Td (and that challenge is achieving a unity of purpose globally through the \ diversity of )Tj 0 Tw -5.724 -1.72 Td (operations locally.)Tj ( )Tj 0.077 Tw 3 -1.74 Td (This is why I personally think that this meeting )Tj 0 Tw (\226)Tj ( )Tj 0.077 Tw 20.654 0 Td (as well as WHO\222s ongoing efforts on )Tj 0 Tw -23.654 -1.72 Td (implementation )Tj 6.754 0 Td (\226)Tj ( )Tj 0.228 Tw 0.978 0 Td (is so critical, and I do really look forwa)Tj (rd to hearing the views and the )Tj 0 Tw -7.732 -1.72 Td (opinions of the people that are gathered around here today.)Tj 23.547 0 Td ( )Tj 0.035 Tw -20.547 -1.72 Td (And I really can\222t think of any better way to close my brief remarks \ this morning than to )Tj 0.223 Tw -3 -1.74 Td (yield the floor to our colleagues at the World Health Organization who I\ t)Tj (hink shouldered )Tj 0.043 Tw 0 -1.72 TD [(successfully )0.5(the )0.5(need )0.5(to )0.5(achieve )0.5(innovation )0.5(in )0.5(global )0.5(health )0.5(governance, )0.5(but )0.5(who )0.5(also )0.5(now )0.5(have )]TJ 0.067 Tw T* (to face, shoulder to shoulder with the rest of us, the challenge of impl\ ementation, the challenge )Tj 0 Tw T* (of turning that remarkable vision into a sustai)Tj (nable governance framework for the 21st century.)Tj 38.154 0 Td ( )Tj -35.154 -1.74 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj T* ( )Tj /TT1 1 Tf -3 -1.72 Td (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj 0.15 Tw [(you )0.5(very )0.5(much, )0.5(Dr.)]TJ 0 Tw ( )Tj 0.15 Tw [(Fidler. )0.5(We\222ll )0.5(now )0.5(turn )0.5(the )0.5(floor )0.5(over )0.5(to )]TJ 0 Tw (\226)Tj ( )Tj 0.15 Tw 29.453 0 Td [(in )0.5(proper )0.5(order, )]TJ 0 Tw -32.453 -1.72 Td (Stefano, you go first )Tj (\226)Tj ( )Tj (Stefano Lazzari from the Lyon Office of WHO.)Tj 28.269 0 Td ( )Tj -28.269 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Stefano Lazzari )Tj (\226)Tj ( )Tj (C)Tj (urrent WHO Approaches to Implementation Activities)Tj ( )Tj /TT0 1 Tf 0.049 Tw 3 -1.66 Td (Yes, good morning everybody. We decided to switch presentations simply b\ ecause mine )Tj 0.005 Tw -3 -1.72 Td (will be a bit more informative in providing you with an update of where \ we are in terms of WHO )Tj 0.072 Tw T* (activities towards the imp)Tj (lementation of IHR, and Bruce will go there a bit more into the more )Tj 0.106 Tw 0 -1.74 TD (key topics for discussion for this meeting which is the governance and t\ he issue of federalism )Tj 0 Tw 0 -1.72 TD (and how this can be addressed.)Tj ( )Tj 0.084 Tw 3 -1.72 Td (I have a short presentation. I\222m going to try to keep it just)Tj 0 Tw 24.083 0 Td ( )Tj 0.084 Tw 0.334 0 Td (to the main points, the main )Tj 0 Tw -27.416 -1.72 Td (concept, and provide you really with some useful information on that.)Tj 27.937 0 Td ( )Tj 0.017 Tw -24.937 -1.74 Td (Perhaps while the presentation is coming up let me just say that WHO is \ organizing itself )Tj 0.052 Tw -3 -1.72 Td (in terms of IHR implementation re. IHR secretary to the group that)Tj 0 Tw 27.347 0 Td ( )Tj 0.052 Tw 0.302 0 Td (followed discussion the text )Tj 0.058 Tw -27.65 -1.72 Td (of the regulations is now being restructured under the leadership of Dr.\ )Tj 0 Tw 29.019 0 Td ( )Tj 0.058 Tw (Rodier that most of you )Tj 0.404 Tw -29.019 -1.72 Td (know, and is organizing itself around a number of areas that I will illu\ strate you in )Tj 0.319 Tw 0 -1.74 TD (implementation, recognizing that so many di)Tj 19.481 0 Td (fferent partners and peoples and expertise is )Tj 0 Tw -19.481 -1.72 Td (required.)Tj ( )Tj ET endstream endobj 19 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 20 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (11)Tj ( )Tj ET Q BT 0.106 Tw 12 0 0 12 107.88 709.08 Tm (This is very much construction and work in progress, and I\222m just goi\ ng to try to give )Tj 0 Tw -3 -1.72 Td (you an update of where we are with some of these aspects.)Tj 23.436 0 Td ( )Tj 0.276 Tw -20.436 -1.72 Td (Of course a major step in the implementation strategy h)Tj 24.732 0 Td (as been the World Health )Tj 0.118 Tw -27.732 -1.74 Td (Assembly resolution on early IHR implementation last May that sort of ac\ celerated the whole )Tj 0.165 Tw 0 -1.72 TD (process of implementation based on the agreement among WHO member states\ to apply the )Tj 0.027 Tw T* (early implementation of some aspects of the IHR on a )Tj (voluntary basis, and this very much in the )Tj 0.121 Tw T* (context of pandemic influenza, so there are a number of elements that ar\ e under the IHR that )Tj 0.025 Tw 0 -1.74 TD (now member states and state parties have committed to implement voluntar\ y earlier on from this )Tj 0.012 Tw 0 -1.72 TD (initial directional focal)Tj 0 Tw ( )Tj 0.012 Tw 9.393 0 Td (point to some of the specific work related to pandemic influenza. And I\222\ ll )Tj 0.03 Tw -9.393 -1.72 Td (come back later to this, but definitely this resolution has sort of acce\ lerated the whole process of )Tj 0.122 Tw T* (implementation and put also some pressure on WHO and I think all member \ states )Tj 34.979 0 Td (to start to )Tj 0 Tw -34.979 -1.74 Td (becoming more active in addressing the issue of implementation.)Tj 26.021 0 Td ( )Tj 0.176 Tw -23.021 -1.72 Td (WHO is defining a WHO strategy as such )Tj 0 Tw (\226)Tj ( )Tj 0.176 Tw 19.385 0 Td (again, as I said under the leadership of )Tj 0 Tw -22.385 -1.72 Td (Dr.)Tj ( )Tj (Rodier )Tj 4.602 0 Td (\226)Tj ( )Tj 0.075 Tw 0.825 0 Td (that is built around three different domains and seven specific areas of\ work. And )Tj 0 Tw -5.427 -1.72 Td (th)Tj 0.107 Tw (is is all done building on existing, we\222re not really starting from s\ cratch in IHR. \(There is a )Tj 0.007 Tw 0 -1.74 TD (whole?\) background of work done first of all \(by the various?\) IHR im\ plementation teams. Many )Tj 0.204 Tw 0 -1.72 TD (of the background consultation and documents prepared will be also)Tj 0 Tw 29.132 0 Td ( )Tj 0.204 Tw 0.454 0 Td (very useful during the )Tj 0 Tw -29.586 -1.72 Td (whole implementation phase.)Tj ( )Tj 0.052 Tw 3 -1.72 Td (The whole structure of WHO alert and response operation is very much imp\ ortant in the )Tj 0.02 Tw -3 -1.74 Td (context of the implementation strategy. Other ongoing efforts in terms o\ f disease surveillance, of )Tj 0.086 Tw T* (disease response an)Tj (d other WHO relevant control programs also come into the picture, and we\ )Tj 0.036 Tw T* (have a number of regional strategies for surveillance and response that \ very much meet many of )Tj 0.193 Tw T* (the elements and the requirements of IHR implementation. So there are a \ number of things)Tj 0 Tw 39 0 Td ( )Tj -39 -1.74 Td (already in place that we have to keep into consideration in developing t\ he strategy.)Tj 33.1 0 Td ( )Tj 0.134 Tw -30.1 -1.72 Td (The three areas, the three domains we find are the very management of th\ e project as )Tj 0.089 Tw -3 -1.72 Td [(such and the way WHO organizes itself. The whole alert, )0.5(preparedness )0.5(and response ope)]TJ 0 Tw 36.667 0 Td (ration )Tj 0.023 Tw -36.667 -1.72 Td (side, and the national core capacity )Tj 0 Tw 14.438 0 Td (\226)Tj ( )Tj 0.023 Tw 0.773 0 Td (what member states and countries with WHO support have )Tj 0.105 Tw -15.211 -1.74 Td (to put in place )Tj 0 Tw (\226)Tj ( )Tj 0.105 Tw 7.216 0 Td (and we have identified these different seven areas. Going anti)Tj 0 Tw 25.598 0 Td (-)Tj 0.105 Tw (clockwise you )Tj 0.114 Tw -32.814 -1.72 Td (have the overall coordination of this IHR implementation pro)Tj 25.462 0 Td (ject or effort; some specific IHR )Tj 0.099 Tw -25.462 -1.72 Td (bodies and procedures that need to be put in place, the IHR focal points\ , the roster expert, the )Tj 0.048 Tw T* (emergency committee, review committees and all that are these other requ\ irements which are in )Tj ET endstream endobj 21 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 22 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (12)Tj ( )Tj ET Q BT 0.017 Tw 12 0 0 12 71.88 709.08 Tm (the IHR. Some IHR communication)Tj 0 Tw ( )Tj 0.017 Tw 14.751 0 Td (strategies are required, that is very much to build \(that focus )Tj 0.031 Tw -14.751 -1.72 Td (in?\), interest and knowledge about International Health Regulations mor\ e broadly than what it is )Tj 0.09 Tw 0 -1.72 TD (nowadays. In terms of national core capacity we have of course the count\ ry alert and response )Tj 0.095 Tw 0 -1.74 TD (operations as well as the whole issue of points of entry and what needs \ to be built in terms of )Tj 0.023 Tw 0 -1.72 TD (point of entry. And then for alert and response operation there\222s a n\ umber of elements already in )Tj 0.293 Tw T* (place, the whole process of intelligent information collection)Tj 26.375 0 Td (, verification, assessment and )Tj 0.032 Tw -26.375 -1.72 Td [(response to global threat, as well as some work that is ongoing on speci\ fic threats, )0.5(and of course )]TJ 0.177 Tw 0 -1.74 TD (pandemic influenza\222s the first one that come that comes into the pict\ ure but there are many )Tj 0 Tw 0 -1.72 TD (others the WHO programs are alread)Tj (y involved with.)Tj ( )Tj 0.179 Tw 3 -1.72 Td (So we feel that our efforts in IHR implementation will have to revolve a\ round these )Tj 0 Tw -3 -1.72 Td (seven areas, and specific strategies are being developed for each and ev\ ery one of them.)Tj 35.15 0 Td ( )Tj 0.161 Tw -32.15 -1.74 Td (I will use this framework just to update you on where we are, star)Tj 28.303 0 Td (ting a bit with the )Tj 0.107 Tw -31.303 -1.72 Td (project management side, the coordination, the bodies and procedures, an\ d the communication )Tj 0 Tw T* (side.)Tj ( )Tj 0.102 Tw 3 -1.72 Td (And coordination is going to be an issue here. IHR touches so many diffe\ rent domains )Tj 0.051 Tw -3 -1.74 Td (and areas and expertise that many players have to be )Tj 21.781 0 Td (brought on board, they have to understand )Tj 0.055 Tw -21.781 -1.72 Td (and they have to in a sense speak the same language and work together if\ we are to achieve the )Tj 0.064 Tw T* (results. And this is a challenge in itself, I think )Tj 0 Tw (\226)Tj ( )Tj 0.064 Tw 20.336 0 Td (within the organization, but also globally )Tj 0 Tw (\226)Tj ( )Tj 17.887 0 Td (to )Tj 0.102 Tw -38.222 -1.72 Td (achieve this coor)Tj (dination of many different players, institutions, agencies, both at inte\ rnational )Tj 0.076 Tw 0 -1.74 TD (but also at regional level. And of course the issue of federal states it\ \222s part of this coordination )Tj 0 Tw 0 -1.72 TD (challenge.)Tj ( )Tj 0.073 Tw 3 -1.72 Td (We have decided to build, in the WHO in Geneva, a WHO taskforc)Tj 27.866 0 Td (e that will comprise )Tj 0.102 Tw -30.866 -1.72 Td (many of the players within the organization has the tools to ensuring th\ is coordination at least )Tj 0.085 Tw 0 -1.74 TD (within the organization. And this taskforce is not found yet but it\222s\ going to be that people are )Tj 0.108 Tw 0 -1.72 TD (going to be identified and put together )Tj 16.339 0 Td (within the next few weeks, so it\222s a process already in )Tj 0 Tw -16.339 -1.72 Td (motion.)Tj ( )Tj 0.328 Tw 3 -1.72 Td [(In terms of bodies and procedures the resolution of )0.5(the Assembly has called for )]TJ 0.03 Tw -3 -1.74 Td (identification of national focal points, and of course this is the defin\ ition that we have in the text )Tj 0.048 Tw T* (of the re)Tj (gulation. I would like to stress here that the regulations talk about a \ national centre, not )Tj 0.142 Tw T* (an individual, whereas many state parties in fact have come back appoint\ ing an individual to )Tj 0 Tw T* (that, and this is still an ongoing discussion that we have with each o)Tj 27.107 0 Td (f the state parties.)Tj ( )Tj ET endstream endobj 23 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 24 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (13)Tj ( )Tj ET Q BT 0.112 Tw 12 0 0 12 107.88 709.08 Tm (This is the situation as of mid)Tj 0 Tw (-)Tj 0.112 Tw (September, 60 national focal points have been officially )Tj 0.09 Tw -3 -1.72 Td (designated and WHO has been informed of their details and contact detail\ s, and you have also )Tj 0.094 Tw 0 -1.72 TD (distribution by regions, which for some regions I mus)Tj (t say it\222s still a bit disappointing, but we )Tj 0 Tw 0 -1.74 TD (hope as we keep negotiating with them the procedure will accelerate.)Tj 27.627 0 Td ( )Tj -24.627 -1.72 Td (If your country\222s not on the list, of course, the message is clear. [\ laughter])Tj 29.602 0 Td ( )Tj 0.081 Tw -29.602 -1.72 Td [(The )0.5(information )0.5(on )0.5(each )0.5(national )0.5(focal )0.5(point )0.5(is )0.5(put )0.5(in )0.5(a )0.5(databa)]TJ 0 Tw 25.795 0 Td (se )Tj 1.164 0 Td (\226)Tj ( )Tj 0.081 Tw 0.831 0 Td [(and )0.5(this )0.5(an )0.5(example )]TJ 0 Tw -30.789 -1.72 Td (database )Tj 3.781 0 Td (\226)Tj ( )Tj 0.089 Tw 0.839 0 Td (with all the contact details and how they can be reached by e)Tj 0 Tw 25.337 0 Td (-)Tj 0.089 Tw (mail, phone, fax, and )Tj 0.023 Tw -29.958 -1.74 Td (every other means, and this database will be continuously updated as we \ get new nominations or )Tj 0.046 Tw 0 -1.72 TD (as, perhaps, member states or state parti)Tj (es decide to change the definition of the focal point. So, )Tj 0 Tw T* (60 out of 192 member states still is a bit of a way to go.)Tj 22.247 0 Td ( )Tj 0.11 Tw -19.247 -1.72 Td (Also, the roster of experts is being put together. These are experts in \ relevant fields of )Tj 0.022 Tw -3 -1.74 Td (expertise that can be utilized in terms of a re)Tj 17.938 0 Td (sponse to a public health emergency of international )Tj 0.001 Tw -17.938 -1.72 Td (concern, and it\222s also the source of members for the emergency commit\ tee or review committees, )Tj 0.032 Tw T* (and it\222s appointed by the DG. As of today 45 states have proposed exp\ erts for membership. And )Tj 0.069 Tw T* (once again, if)Tj 0 Tw ( )Tj 0.069 Tw 5.872 0 Td (you haven\222t done it yet I think we would very much encourage your cou\ ntries to )Tj 0.094 Tw -5.872 -1.74 Td (come forward and propose experts because we want the roster to be of cou\ rse as broad and as )Tj 0.017 Tw T* (rich as it can possibly be. All this will go, again, into a public datab\ ase, an IHR )Tj (expert roster that )Tj 0 Tw T* (is being put together.)Tj ( )Tj 0.127 Tw 3 -1.72 Td (On the alert response operations side, many of the elements in relation \ to the IHR are )Tj 0.035 Tw -3 -1.74 Td (actually already in place in the overall ___ \(and goals and actors?\) b\ ut there\222s a couple of things )Tj 0.028 Tw T* (that have been done. One is)Tj 0 Tw ( )Tj 0.028 Tw 11.471 0 Td (in trying to apply the concept of the IHR to the existing system, and )Tj 0.08 Tw -11.471 -1.72 Td (you see here a bit of a summary of how an event will have to go a differ\ ent... a series of steps )Tj 0.101 Tw T* (during the notification and determination process starting from, of cour\ se, the detectio)Tj 35.576 0 Td (n by the )Tj 0.102 Tw -35.576 -1.74 Td (disease surveillance system in the country, through the national IHR foc\ al point that will have )Tj 0.068 Tw T* (the responsibility to communicate with WHO contact points )Tj 0 Tw (\226)Tj ( )Tj 0.068 Tw 25.691 0 Td (usually at regional level but also )Tj 0.046 Tw -25.691 -1.72 Td (in Geneva )Tj 0 Tw (\226)Tj ( )Tj 0.046 Tw 5.219 0 Td (and then it will go to the WHO director)Tj 0 Tw 16.14 0 Td (-)Tj (gene)Tj 0.046 Tw (ral who actually has the responsibility )Tj 0.178 Tw -21.359 -1.72 Td (to determine whether the event constitutes or not a public health emerge\ ncy of international )Tj 0.115 Tw 0 -1.74 TD [(concern )0.5(and )0.5(recommend )0.5(appropriate )0.6(members, )0.6(of )0.5(course )0.5(in )0.5(consultation )0.5(with )0.5(state )0.5(parties )0.5(and )]TJ 0 Tw 0 -1.72 TD (with the advice if required, of)Tj ( )Tj (the emergency committee.)Tj 22.713 0 Td ( )Tj 0.022 Tw -19.713 -1.72 Td (So all these elements and the notification system is now being revised a\ nd discussed, and )Tj 0.017 Tw -3 -1.72 Td (let\222s say in a sense re)Tj 0 Tw (-)Tj 0.017 Tw (adapted to the requirement of the IHR, and in particular we have identif\ ied )Tj ET endstream endobj 25 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 26 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (14)Tj ( )Tj ET Q BT 0.279 Tw 12 0 0 12 71.88 709.08 Tm (IHR counterpoints in every regional offi)Tj 17.528 0 Td (ce which will have a dedicated phone number, a )Tj 0.039 Tw -17.528 -1.72 Td (dedicated fax number and e)Tj 0 Tw (-)Tj 0.039 Tw (mail, and also will be provided where feasible with BlackBerries so )Tj 0.079 Tw 0 -1.72 TD (they can be reached any time, and a roster of duty offices being organiz\ ed so that the presence )Tj 0.235 Tw 0 -1.74 TD (and the contents w)Tj 8.175 0 Td (ill be available 24 hours a day 7 days a week. And standard operating )Tj 0 Tw -8.175 -1.72 Td (procedures are being developed for each region on how this whole system \ should work.)Tj 35.102 0 Td ( )Tj 0.022 Tw -32.102 -1.72 Td (And some of the work will have to also filter down to our country office\ s that as well are )Tj 0.132 Tw -3 -1.72 Td (going to h)Tj (ave to organize themselves in terms of facilitating the contact between \ the national )Tj 0.013 Tw T* (focal point and our IHR counterpoints. This is a work in progress and I \ think in a matter of a few )Tj 0 Tw 0 -1.72 TD (weeks the system will be in place in every region.)Tj 19.938 0 Td ( )Tj 0.057 Tw -16.938 -1.72 Td [(Also )0.5(in )0.5(terms )0.5(of )0.5(spec)]TJ [(ific threats )0.6(the )0.5(influenza )0.5(pandemic )0.5(taskforce )0.5(has )0.5(been )0.5(put )0.5(together. )]TJ 0.073 Tw -3 -1.72 Td (It functions similar to the emergency committee but it will basically en\ d its functions when the )Tj 0.051 Tw 0 -1.74 TD (emergency committee of the IHR will come into place ___ \(to force of?\)\ the IHR. The mandat)Tj 0 Tw 38.556 0 Td (e )Tj 0.093 Tw -38.556 -1.72 Td (is to provide technical advice to the DG on all issues related to pandem\ ic and avian influenza, )Tj 0.225 Tw 0 -1.72 TD (and there is a meeting of the influenza pandemic taskforce already plann\ ed for the end of )Tj 0.031 Tw T* [(September. )0.5(It\222s )0.5(the )0.5(first )0.5(organizational )0.6(meeting )0.5(to )0.5(really )0.5(see )0.5(how, )]TJ [(again, )0.5(they )0.5(can )0.5(function )0.5(in )0.5(the )]TJ 0 Tw 0 -1.74 TD (interim and how then their functions can be transferred to the emergency\ committee.)Tj 33.849 0 Td ( )Tj 0.036 Tw -30.849 -1.72 Td (I will then go into things that are more close to the work we\222re doin\ g in Lyon, and that\222s )Tj 0.001 Tw -3 -1.72 Td (the development of national core capacity. That, )Tj (in some ways, is going to probably be one of the )Tj 0.008 Tw 0 -1.72 TD (most challenging aspects of IHR implementation. We have organized in Lyo\ n )Tj 0 Tw 31.524 0 Td (\226)Tj ( )Tj 0.008 Tw 0.758 0 Td (and I think some )Tj 0.068 Tw -32.282 -1.74 Td (of you might have attended or seen the results on international consulta\ tions specifically on the )Tj 0.251 Tw T* (topic national c)Tj 0 Tw (apacities )Tj 10.665 0 Td (\226)Tj ( )Tj 0.251 Tw 1.001 0 Td (with the objective no identify how to translate Annex 1 in the )Tj 0.262 Tw -11.665 -1.72 Td [(requirements )0.5(of )0.5(the )0.5(IHR )0.5(into )0.5(operational )0.5(guidance, )0.5(and )0.5(develop )0.5(out )0.5(of )0.5(that )0.5(strategies )0.5(and )]TJ 0 Tw T* (mechanisms to develop this capacity within the time)Tj 20.967 0 Td (-)Tj (frame of the IHR.)Tj ( )Tj 0.064 Tw -17.967 -1.74 Td (We focus there on thr)Tj (ee or four areas of functions: the early warning system; laboratory )Tj 0.007 Tw -3 -1.72 Td (support; response capacities required at country level; and the whole is\ sue of communication and )Tj 0.062 Tw T* [(coordination, always at the national level. The report is )0.5(available, )0.5(and )0.5(out )0.5(of )0.5(that )0.5(report)]TJ 0 Tw 35.711 0 Td ( )Tj 0.062 Tw 0.312 0 Td [(now )0.5(an )]TJ 0 Tw -36.022 -1.72 Td (advanced draft is being developed on what we interpret as national core \ capacity for IHR.)Tj 35.902 0 Td ( )Tj 0.053 Tw -32.902 -1.74 Td (It is quite a difficult issue. Defining what we mean by core or minimum \ as opposed to a )Tj 0.061 Tw -3 -1.72 Td (perfect system is quite challenging, and defining it in a sense that i)Tj 27.369 0 Td (s universal and applicable to )Tj 0.195 Tw -27.369 -1.72 Td (countries as different as maybe China and Tonga, or Burkina Faso and Bel\ gium. It\222s really )Tj ET endstream endobj 27 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 28 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (15)Tj ( )Tj ET Q BT 0.018 Tw 12 0 0 12 71.88 709.08 Tm (challenging, and we\222re trying to address this is very many different \ ways. This work will have to )Tj 0 Tw 0 -1.72 TD (be done, brought up to more global and)Tj ( )Tj (international discussion.)Tj ( )Tj 0.148 Tw 3 -1.72 Td (Also an issue is at what level this capacity will actually be required, \ and the issue of )Tj 0.121 Tw -3 -1.74 Td (federalism here is very important because of course some of these functi\ ons may be a central )Tj 0.017 Tw T* [(level )0.5(but )0.5(it )0.5(could )0.5(very )0.5(well )0.5(be )0.5(delegated )0.5(in )0.5(so)]TJ 18.337 0 Td [(me )0.5(countries )0.5(at )0.5(the )0.5(more )0.5(peripheral )0.5(level, )0.5(requiring )]TJ 0 Tw -18.337 -1.72 Td (a whole different set of implementation.)Tj 16.05 0 Td ( )Tj 0.084 Tw -13.05 -1.72 Td (A special point is also how can we then assess this core capacity within\ the time)Tj 0 Tw 33.335 0 Td (-)Tj (frame )Tj 0.035 Tw -36.335 -1.74 Td (required by the IHR )Tj 0 Tw (\226)Tj ( )Tj 0.035 Tw 9.199 0 Td (which is two years )Tj 0 Tw (\226)Tj ( )Tj 0.035 Tw 8.645 0 Td (and we\222re looking at what exist)Tj (ing guidelines, tools, )Tj 0.002 Tw -17.844 -1.72 Td (training materials, can actually be used or adapted to the IHR requireme\ nt. All of this will be part )Tj 0 Tw T* (of a strategy as well of the definition of this core capacity.)Tj 23.27 0 Td ( )Tj 0.105 Tw -20.27 -1.72 Td (I will touch very briefly on two concepts. One is how can we develop )Tj (a system that is )Tj 0.025 Tw -3 -1.74 Td (universal, and one idea is to have maybe IHR Level A, Level B, Level C, \ according to the status )Tj 0.036 Tw T* (of development of the country, which is a possibility but it will make i\ t difficult to define which )Tj 0.032 Tw T* [(countries )0.5(go )0.5(in )0.5(A, )0.5(B, )0.5(C )0.5(or )0.5(D )0.5(or )0.5(so )0.5(on. )0.5(I )0.5(pr)]TJ 0 Tw (efer )Tj 18.906 0 Td (\226)Tj ( )Tj 0.032 Tw 0.781 0 Td [(and )0.5(I )0.5(put )0.5(this )0.5(together )0.5(for )0.5(you )0.5(this )0.5(morning )0.5(so )0.5(I )]TJ 0 Tw -19.687 -1.72 Td (apologize )Tj 4.244 0 Td (\226)Tj ( )Tj 0.107 Tw 0.857 0 Td (a concept car. What does this mean? It means car some in all sorts of sh\ apes and )Tj 0.093 Tw -5.102 -1.74 Td (flavours all around the world and in history, right? And you have some e\ xamples here of very )Tj 0.278 Tw T* (different car)Tj (s. But if you look into it, in fact cars have some key components that e\ xist )Tj 0.11 Tw T* (everywhere. They have a steering wheel for the direction, they have an e\ ngine for propulsion, )Tj 0 Tw T* (they have a fuel tank to get fuel to the engine, they have lights, they \ have wheels.)Tj 32.517 0 Td ( )Tj 0.072 Tw -29.517 -1.74 Td (So when we talk about core function and core requirements, in a sense )Tj 0 Tw 29.377 0 Td (\226)Tj ( )Tj 0.072 Tw 0.822 0 Td (and this is my )Tj 0.066 Tw -33.199 -1.72 Td (view at least )Tj 0 Tw (\226)Tj ( )Tj 0.066 Tw 6.26 0 Td [(we are trying )0.5(to )0.5(identify )0.5(these )0.5(elements, )0.5(key )0.5(elements )0.6(that make )0.5(up )0.5(an )0.5(IHR )0.5(car. )]TJ 0.084 Tw -6.26 -1.72 Td (And then it will be up to the country, to the state party, depending on \ t)Tj (heir resources and their )Tj 0.191 Tw T* (willingness to invest to decide how complex, how elaborate, how performi\ ng they want the )Tj 0.007 Tw 0 -1.74 TD (system to be, but in terms of IHR I think we need to make sure that thes\ e key elements that make )Tj 0.106 Tw 0 -1.72 TD (the IHR car are all there. And the effort we\222)Tj 18.5 0 Td (re trying to do is to identify these key things that )Tj 0 Tw -18.5 -1.72 Td (have to be there to make the IHR car come together.)Tj 20.908 0 Td ( )Tj 0.148 Tw -17.908 -1.72 Td (In general terms we\222ve talked about the capability of detecting an ev\ ent coming from )Tj 0.021 Tw -3 -1.74 Td (very many different sources, the capability to verify, assess and )Tj 25.866 0 Td (investigate and confirm an event )Tj 0.087 Tw -25.866 -1.72 Td [(with )0.5(a )0.5(major )0.5(epidemiological )0.5(but )0.5(also )0.5(laboratory )0.6(support )0.5(component )0.5(required, )0.5(the )0.5(capability )0.5(to )]TJ 0.267 Tw T* (respond in the most appropriate way at national level to this event, and\ the capability to )Tj 0.098 Tw T* (communicate it properly, both to WHO )Tj (on an international level but also nationally within the )Tj ET endstream endobj 29 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 30 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (16)Tj ( )Tj ET Q BT 0.041 Tw 12 0 0 12 71.88 709.08 Tm (country and particularly with the media and the general public because w\ e know sometimes bad )Tj 0 Tw 0 -1.72 TD (communication can cause more damage than the event itself.)Tj 24.352 0 Td ( )Tj 0.012 Tw -21.352 -1.72 Td (We have tried to redevelop all this in the sens)Tj 18.35 0 Td (e of IHR monitoring and evaluation system, )Tj 0.113 Tw -21.35 -1.74 Td (trying to identify the key indicators that will tell us that the car is \ there, and we have divided )Tj 0.132 Tw T* (these indicators in five broad areas. One is policy, planning and financ\ ing and it includes the )Tj 0.059 Tw T* (existence of some )Tj (legal framework; a national plan for responding to public health emergen\ cies )Tj 0.168 Tw T* [(of )0.5(international )0.5(concern; )0.5(a )0.5(budget )0.5(allocation )0.5(for )0.5(this; )0.5(some )0.5(on )0.5(infrastructure )0.5(and )0.5(institutions; )]TJ 0.136 Tw 0 -1.74 TD (others on the availability of human resources and skills and knowledge r\ equired fo)Tj 34.674 0 Td (r IHR; the )Tj 0.199 Tw -34.674 -1.72 Td (specific technical resources, and something on the IHR system and servic\ es, and the list of )Tj 0.003 Tw 0 -1.72 TD (indicators is there. It\222s still on discussion but I just wanted to gi\ ve you an idea of the direction we )Tj 0.047 Tw T* (are taking. And it\222s important that we can come t)Tj 20.031 0 Td (o a consensus on this because in a way it\222s the )Tj 0.05 Tw -20.031 -1.74 Td [(only way we can eventually say a country is complying with the requireme\ nt of )0.5(the )0.5(IHR or not, )]TJ 0.119 Tw T* (we have to be able to have some sort of a universal understanding of wha\ t we have to put in )Tj 0 Tw T* (place.)Tj ( )Tj 0.087 Tw 3 -1.72 Td (A document with)Tj 0 Tw ( )Tj 0.087 Tw 7.455 0 Td (more details of this is on an advanced draft and I think will be going )Tj 0 Tw -10.455 -1.74 Td (out for discussion soon, but I just wanted to give you basically \(the c\ oncept?\).)Tj 31.188 0 Td ( )Tj 0.118 Tw -28.188 -1.72 Td (And finally another major challenge is points of entry. There\222s been \ a meeting held in )Tj 0 Tw -3 -1.72 Td (Montr\351al )Tj 3.918 0 Td (\226)Tj ( )Tj 0.752 0 Td (again)Tj ( )Tj 0.002 Tw 2.418 0 Td (around May, if I\222m not mistaken )Tj 0 Tw 13.317 0 Td (\226)Tj ( )Tj 0.002 Tw 0.752 0 Td (and various working groups have worked on )Tj 0.166 Tw -21.157 -1.72 Td [(standard )0.5(operating )0.5(procedures )0.5(on )0.5(the )0.5(various )0.5(aspects )0.5(in )0.5(terms )0.5(of )0.5(points )0.5(of )0.5(entry )0.6(that )0.6(will )0.6(be )]TJ 0.091 Tw 0 -1.74 TD (required, and the expectation is that the work will advance on all the S\ OP\222s fairly r)Tj 34.522 0 Td (apidly. We )Tj 0.115 Tw -34.522 -1.72 Td (might be able to produce some draft by the end of the year. The list of \ SOP\222s that have been )Tj 0.195 Tw 0 -1.72 TD (identified is here and will go from inspection standard operating proced\ ure to hospitals and )Tj 0.065 Tw T* (clinics and transport and many different aspects, and I thi)Tj 23.52 0 Td (nk the work is definitely going in this )Tj 0 Tw -23.52 -1.74 Td (area.)Tj ( )Tj 0.237 Tw 3 -1.72 Td (And finally there are two guides which are planned for publication, one \ is on ship )Tj 0.092 Tw -3 -1.72 Td (sanitation and the other one is on hygiene and sanitation in aviation, a\ nd both of them are due )Tj 0 Tw T* (some time in 2007.)Tj ( )Tj 0.353 Tw 3 -1.74 Td (Okay, I\222ll s)Tj (top here. Thank)Tj 0 Tw (-)Tj 0.353 Tw (you very much, and )Tj /TT1 1 Tf (merci beaucoup)Tj /TT0 1 Tf (. I hope it was )Tj 0.051 Tw -3 -1.72 Td (informative even if quick, and of course I\222m very much interested in \ the discussion and if some )Tj 0.11 Tw T* (of these points might )Tj 0 Tw (\226)Tj ( )Tj 0.11 Tw 9.966 0 Td (or will )Tj 0 Tw (\226)Tj ( )Tj 0.11 Tw 3.969 0 Td (come up again during the rest of today. And thank)Tj 0 Tw (-)Tj 0.11 Tw (you very )Tj ET endstream endobj 31 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 32 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (17)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (mu)Tj 0.063 Tw [(ch again to Ron and the organizers for giving me the opportunity to be h\ ere )0.5(with )0.5(you today. )]TJ 0 Tw 0 -1.72 TD (Thanks.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.19 Tw 3 -1.64 Td (Thanks very much, Stefano. Bruce? I think we\222ll hold questions and co\ mments until )Tj 0 Tw -3 -1.72 Td (Bruce makes his presentation.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.72 TD (Mr.)Tj ( )Tj (Bruce Plotkin )Tj (\226)Tj ( )Tj (A WHO)Tj ( )Tj (Perspective on Legal Challenges and Frameworks)Tj ( )Tj /TT0 1 Tf 0.08 Tw 3 -1.64 Td (While that\222s coming up let me introduce myself again. I\222m Bruce Pl\ otkin, I\222m the legal )Tj 0.084 Tw -3 -1.74 Td (expert on the IHR implementation team, and I work with the technical per\ sonnel in Geneva. I )Tj 0.025 Tw T* (can tell you from my own per)Tj (sonal experience that there are enormous activities going on all the )Tj 0.086 Tw T* (way across the organization as the programs that deal with specific dise\ ases, the programs that )Tj 0.015 Tw T* (deal with outbreak alert and response, and the programs that deal with a\ lmost any communica)Tj 0 Tw (ble )Tj 0.101 Tw 0 -1.74 TD (and other disease problems are all working to revise their SOP\222s, to \ revise their procedures so )Tj 0.025 Tw 0 -1.72 TD (that everybody is applying the same basic rules and so that everyone wil\ l be ready to go forward )Tj 0 Tw T* (under the new IHR when the new IHR come into force.)Tj ( )Tj 3 -1.72 Td (This is)Tj ( )Tj (a massive undertaking...)Tj ( )Tj -3 -1.74 Td ([Start of Side 2])Tj ( )Tj 0.097 Tw 3 -1.14 Td (... At the headquarters the IHR are coming up already in a number of way\ s, not just in )Tj 0.012 Tw -3 -1.72 Td (terms of preparation. As you can imagine, there are outbreaks of all kin\ ds of diseases all over the )Tj 0.079 Tw 0 -1.74 TD (world, and now when major)Tj 0 Tw ( )Tj 0.079 Tw 11.892 0 Td (outbreaks come up we are using them as sort of an opportunity to )Tj 0.164 Tw -11.892 -1.72 Td (test the new International Health Regulations so that when there is an o\ utbreak of polio, for )Tj 0.06 Tw 0 -1.72 TD [(example, )0.5(questions )0.5(are )0.5(raised )0.5(about )0.5(how )0.5(would )0.5(this )0.5(be )0.5(handled )0.5(under )0.5(the )0.5(IHR, )0.5(how )0.5(might it )0.5(be )]TJ 0 Tw T* (han)Tj (dled differently, how would it be handled the same. These are all very i\ mportant questions.)Tj 37.85 0 Td ( )Tj 0.058 Tw -34.85 -1.74 Td (In this context, while there are a lot of important and serious outbreak\ s that happen, one )Tj 0.122 Tw -3 -1.72 Td (thing that needs to be kept in mind is that the IHR public health emerge\ n)Tj 30.814 0 Td (cies of international )Tj 0.072 Tw -30.814 -1.72 Td [(concern, which is one of the )0.5(aspects of )0.5(the new IHR that everybody seems to focus on, are not )]TJ 0.044 Tw T* (likely to happen very often. Again, it is an aspect that that tends to g\ et so much of the attention, )Tj 0.004 Tw 0 -1.74 TD (but as a practical matter, true public )Tj (health emergencies of international concern)Tj 0 Tw 32.137 0 Td (--)Tj 0.004 Tw (with convening )Tj 0.23 Tw -32.137 -1.72 Td (of the IHR Emergency Committee and formal declaration of a public health\ emergency of )Tj 0.049 Tw 0 -1.72 TD (international concern)Tj 0 Tw (--)Tj 0.049 Tw (at least in terms of the immediate future it appears likely that there w\ on\222t )Tj 0.058 Tw T* (be a lot o)Tj (f them. We\222ll have to see what the future holds, but my current expec\ tation is not that )Tj ET endstream endobj 33 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 34 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (18)Tj ( )Tj ET Q BT 0.042 Tw 12 0 0 12 71.88 709.08 Tm (you will having three or four public health emergencies of international\ concern a year, I expect )Tj 0 Tw 0 -1.72 TD (it be a fairly rare phenomenon.)Tj ( )Tj 0.055 Tw 3 -1.72 Td (One area where the IHR are already aff)Tj 16.124 0 Td (ecting the global scenario is with regard to avian )Tj 0.163 Tw -19.124 -1.74 Td (influenza. Stefano touched briefly on the resolution passed by the Healt\ h Assembly on early )Tj 0.017 Tw T* (voluntary compliance with a number of the requirements in the Internatio\ nal Health Regulations. )Tj 0.041 Tw T* (And I can tell yo)Tj (u that as events of various kinds having to do with influenza are arisin\ g around )Tj 0.161 Tw T* (the world, they are being measured against the International Health Regu\ lations even though )Tj 0.279 Tw 0 -1.74 TD [(they\222re )0.5(not )0.5(binding )0.5(yet, )0.6(in )0.6(the )0.6(context )0.5(of )0.5(the )0.5(early )0.5(compliance )0.5(resolution. )0.5(with )0.5(re)]TJ 35.917 0 Td [(gard )0.5(to )]TJ 0 Tw -35.917 -1.72 Td (information or specimens or whatever having to do with influenza.)Tj 26.715 0 Td ( )Tj 0.062 Tw -23.715 -1.72 Td (So on the one hand it\222s very easy to say this is happening in about e\ ight or nine months )Tj 0.101 Tw -3 -1.72 Td (from now, and it\222s not really happening now, but it\222s already comi\ ng forward, we can already )Tj 0.014 Tw T* (see it in the way that we are looking at things, the way that we\222re a\ nalyzing things, and of course )Tj 0 Tw 0 -1.72 TD (the way that Stefano\222s people out in Lyon are trying to prepare to fi\ ll all those requirements.)Tj 36.906 0 Td ( )Tj 0.015 Tw -33.906 -1.72 Td (One of the things that\222s also important to keep in mind as w)Tj (e go forward is the incredibly )Tj 0.14 Tw -3 -1.72 Td (tortuous, satisfying, frustrating negotiations that went on with the Int\ ergovernmental Working )Tj 0.19 Tw 0 -1.74 TD (Group for the revised IHR. You had vast numbers of people all trapped wi\ th each other in )Tj 0.245 Tw 0 -1.72 TD (various kinds of rooms, forced to negotia)Tj (te things that were often very complex and very )Tj 0.131 Tw T* (difficult. This was done in face)Tj 0 Tw (-)Tj (to)Tj (-)Tj 0.131 Tw (face negotiations by the delegates from the member states. )Tj 0.11 Tw T* (And one of the important things to remember about this is not only that \ it went on for a long )Tj 0.191 Tw 0 -1.74 TD (time, that it was f)Tj (ace to face, that these were hard decisions, that a lot of issues had to\ be )Tj 0.147 Tw 0 -1.72 TD (compromised, was that this happened in the shadow of SARS. So it\222s no\ t like this happened )Tj 0.067 Tw T* (without any particular emergency or without any particular experience ha\ ving happened. SAR)Tj 0 Tw 38.444 0 Td (S )Tj 0.025 Tw -38.444 -1.72 Td (happened in the middle of 2003, our negotiations didn\222t start until t\ he end of 2004, and I can tell )Tj 0.063 Tw 0 -1.74 TD (you that for countries that were involved in SARS and the experience of \ SARS )Tj 0 Tw 32.765 0 Td (\226)Tj ( )Tj 0.063 Tw 0.813 0 Td (and countries )Tj 0.061 Tw -33.578 -1.72 Td (that weren\222t )Tj 0 Tw 5.176 0 Td (\226)Tj ( )Tj 0.061 Tw 0.811 0 Td (it was on everybody\222s mind. People were talkin)Tj (g about the issues that had arisen )Tj 0.011 Tw -5.987 -1.72 Td (and what should be in the new IHR to address those concerns, what should\ the IHR have in them )Tj 0 Tw 0 -1.72 TD (because we\222ve had this experience.)Tj 14.076 0 Td ( )Tj 0.37 Tw -11.076 -1.74 Td (Very quickly )Tj 0 Tw (\226)Tj ( )Tj 0.37 Tw 7.357 0 Td [(this is the legal portion of )0.5(the )0.5(show )]TJ 0 Tw (\226)Tj ( )Tj 0.37 Tw 18.408 0 Td [(the )0.5(International )0.5(Health )]TJ 0 Tw -28.765 -1.72 Td (Regulations,)Tj ( )Tj 0.032 Tw 5.309 0 Td (while on the one hand they are very new and really unprecedented in a lo\ t of ways, )Tj 0.101 Tw -5.309 -1.72 Td (in one way they\222re very old, and that is the International Health Reg\ ulations are an agreement )Tj 0.073 Tw T* (between states. Under the WHO constitution for the international health \ regul)Tj 31.802 0 Td (ations and certain )Tj ET endstream endobj 35 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 36 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (19)Tj ( )Tj ET Q BT 0.031 Tw 12 0 0 12 71.88 709.08 Tm [(other regulations, once they\222re adopted )0.5(by the Health Assembly )]TJ 0 Tw (\226)Tj ( )Tj 0.031 Tw 26.826 0 Td [(which )0.5(happened )0.5(in )0.5(the )0.5(middle )]TJ 0.018 Tw -26.826 -1.72 Td (of last year )Tj 0 Tw (\226)Tj ( )Tj 0.018 Tw 5.513 0 Td (once they were adopted by the Health Assembly all WHO member states are \ in, all )Tj 0.076 Tw -5.513 -1.72 Td (WHO member states are automatically bound by the)Tj (m unless within a limited time period they )Tj 0.255 Tw 0 -1.74 TD (affirmatively take a step either to make certain kinds of reservations o\ r to reject the new )Tj 0 Tw 0 -1.72 TD (regulations in their entirety.)Tj ( )Tj 0.053 Tw 3 -1.72 Td (So, for those of you who may not be watching your calendar every day, th\ e deadline for )Tj 0 Tw -3 -1.72 Td (rej)Tj (ection )Tj 3.844 0 Td (\226)Tj ( )Tj 0.096 Tw 0.846 0 Td (or making a reservation, of course )Tj 0 Tw 14.49 0 Td (\226)Tj ( )Tj 0.096 Tw 0.846 0 Td (is December 15th. I can tell you that we have )Tj 0.138 Tw -20.028 -1.74 Td (received no official notifications of reservations by anybody. The only \ one that I\222m aware of )Tj 0.062 Tw T* (that\222s even been announced is one reservation by one country that was\ )Tj 29.179 0 Td (announced a while back )Tj 0.192 Tw -29.179 -1.72 Td (and there has been no further official activity. But in any event, it is\ )Tj 0 Tw 30.015 0 Td (\226)Tj ( )Tj 0.192 Tw 0.942 0 Td (as I indicated )Tj 0 Tw (\226)Tj ( )Tj 7.1 0 Td (an )Tj -38.056 -1.72 Td (agreement among member states of WHO.)Tj 17.105 0 Td ( )Tj 0.04 Tw -14.105 -1.74 Td (So what does this mean? I have other interesting bits to say but most of\ the presentation, )Tj 0.151 Tw -3 -1.72 Td (for our p)Tj (urposes, as we look forward now, can be summed up right here. Because th\ is is an )Tj 0.163 Tw T* (agreement among WHO member states, no matter what subdivisions are invol\ ved, no matter )Tj 0.134 Tw T* (how states may be aggregated for some purposes or divided up for other p\ urposes, like ot)Tj 0 Tw (her )Tj 0.059 Tw 0 -1.74 TD [(international )0.5(agreements )0.5(the )0.5(overall )0.5(rights )0.5(and )0.5(responsibilities )0.5(that )0.6(come )0.5(with )0.6(the )0.5(IHR )0.5(2005 )0.5(are )]TJ 0.13 Tw 0 -1.72 TD [(the focus of states\222 parties. It is the states\222 parties that have \ these )0.5(obligations, )0.5(it is )0.5(the states\222 )]TJ 0.105 Tw T* (parties that have these rights. And one of the oblig)Tj 21.108 0 Td (ations that states\222 parties have )Tj 0 Tw 12.772 0 Td (\226)Tj ( )Tj 0.105 Tw 0.855 0 Td (and this is )Tj 0.119 Tw -34.734 -1.72 Td (traditional under international law )Tj 0 Tw (\226)Tj ( )Tj 0.119 Tw 15.228 0 Td (is that the states\222 parties are the ones who decide how to )Tj 0.063 Tw -15.228 -1.74 Td (implement their international legal obligations within their own politic\ al and legal context. And )Tj 0.068 Tw T* (if you think a)Tj (bout it, this is logical. I mean, it\222s a fundamental sovereignty issu\ e. If you go and )Tj 0.006 Tw T* (you try and tell a state, \223Well, you have to do this, and you have to\ do it that way, you have to do )Tj 0.01 Tw T* (it that way,\224 these things are seen as being the fundamental prerogat\ )Tj 27.379 0 Td (ives of the states themselves. )Tj 0.067 Tw -27.379 -1.74 Td (And it also makes sense from a logical perspective because how a state w\ ill need to implement )Tj 0.155 Tw T* (its obligations under the IHR is going to depend on a large number of wh\ at are going to be )Tj 0.2 Tw T* (essentially unique characteristics. What)Tj 0 Tw 16.426 0 Td ( )Tj 0.2 Tw 0.45 0 Td (is the state\222s legal system? They vary. How are the )Tj 0.054 Tw -16.876 -1.72 Td (relevant obligations broken up horizontally among different ministries? \ How are the obligations )Tj 0.156 Tw 0 -1.74 TD (broken up vertically among the different governmental units? How do they\ all relate to each )Tj 0.138 Tw 0 -1.72 TD [(other? )0.5(Who )0.5(is )0.5(r)]TJ [(esponsible )0.5(for )0.5(what? )0.5(Who\222s )0.5(responsible )0.5(for )0.5(the )0.5(money, )0.5(who\222s )0.5(responsible )0.5(for )]TJ 0 Tw T* (enforcement?)Tj ( )Tj ET endstream endobj 37 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 38 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (20)Tj ( )Tj ET Q BT 0.264 Tw 12 0 0 12 107.88 709.08 Tm (On the one hand you can speak of them generally in terms of listing all \ of these )Tj 0.039 Tw -3 -1.72 Td (requirements. At the same time, how they appear in any particular countr\ y is going to )Tj 35.046 0 Td (be unique )Tj 0 Tw -35.046 -1.72 Td (because it\222s going to depend on the history and the relations within \ the country.)Tj 31.826 0 Td ( )Tj 0.082 Tw -28.826 -1.74 Td (That\222s the first key point to sort of keep in mind. The second one is\ obvious and rather )Tj 0 Tw -3 -1.72 Td (self)Tj 1.444 0 Td (-)Tj 0.01 Tw [(evidence )0.5(but )0.5(I )0.5(wanted )0.5(to )0.5(make )0.5(it )0.5(anyway, )0.5(and that )0.5(is )0.5(broad )0.5(participati)]TJ 28.298 0 Td [(on )0.5(by )0.5(all )0.5(states\222 )0.5(parties )]TJ 0.024 Tw -29.742 -1.72 Td (is the key to benefits for all of us, and this is true whether you have \ an event which is happening )Tj 0.164 Tw 0 -1.72 TD (in the capital, whether you have an event that is happening in the perip\ hery of a country or )Tj 0.082 Tw 0 -1.74 TD (anywhere in between, whether it\222s dea)Tj (lt with by a local or intermediate governmental unit or a )Tj 0.065 Tw 0 -1.72 TD (national unit. The point is that what happens in that state is going to \ affect other states, and the )Tj 0.047 Tw T* (other states... for the other states it\222s not going to make a big dif\ ference if the issue arose a)Tj 36.981 0 Td (t one )Tj 0.035 Tw -36.981 -1.72 Td (level or another level, it can still very much affect every other state.\ And when I say every other )Tj 0.103 Tw 0 -1.74 TD (state, I mean all of us. And this is the key to this kind of agreement, \ this is an interdependent )Tj 0.027 Tw 0 -1.72 TD (world, and because it\222s an interdependent world we n)Tj 21.569 0 Td (eed as many of us and as much of us in the )Tj 0.025 Tw -21.569 -1.72 Td [(picture for it to work. If you have a hole in the net )0.5(the )0.5(net )0.5(doesn\222t )0.5(work )0.5(nearly )0.5(as well )0.5(for )0.5(any )0.5(of )]TJ 0 Tw T* (us.)Tj ( )Tj 0.172 Tw 3 -1.74 Td [(Federalism. It\222s an interesting issue. It is, as some of the backgrou\ nd materials )0.5(make )]TJ 0.258 Tw -3 -1.72 Td (clear, it\222s not an un)Tj (usual issue, it comes up all the time in agreements because there are )Tj 0.044 Tw T* (agreements in all kinds of areas that require some sort of action or oth\ er activities on the part of )Tj 0.127 Tw T* (units other than the federal government or the national government that\222\ s actually si)Tj 35.124 0 Td (gning the )Tj 0.025 Tw -35.124 -1.74 Td (treaty. This is part of the international legal process, the lawyers, th\ e diplomats, they know all of )Tj 0.027 Tw T* (this going in, and so the question then becomes how best to address thes\ e in order to achieve the )Tj 0 Tw T* (objectives of the agreement.)Tj 11.273 0 Td ( )Tj 0.048 Tw -8.273 -1.72 Td (I can also tell y)Tj (ou from having been through the negotiations )Tj 0 Tw (\226)Tj ( )Tj 0.048 Tw 25.957 0 Td (and I know many of you )Tj 0.001 Tw -28.957 -1.74 Td (were in the negotiations there too )Tj 0 Tw (\226)Tj ( )Tj 0.001 Tw 14.363 0 Td (that participation of multiple governmental levels and entities )Tj 0 Tw -14.363 -1.72 Td (\226)Tj ( )Tj 0.243 Tw 0.993 0 Td (whether they\222re ports, whether they\222re local health districts, as \ well as the heads)Tj 0 Tw 34.965 0 Td ( )Tj 0.243 Tw 0.493 0 Td (of the )Tj 0 Tw -36.452 -1.72 Td (ministries )Tj 4.423 0 Td (\226)Tj ( )Tj 0.229 Tw 0.979 0 Td (the activities of all of these levels were self)Tj 0 Tw 19.1 0 Td (-)Tj 0.229 Tw (evidence all the way through the )Tj 0.003 Tw -24.501 -1.72 Td (negotiations. Everybody knew it, everybody knew that that was going to h\ ave to happen, because )Tj 0.251 Tw 0 -1.74 TD (otherwise you couldn\222t put together a system that would mak)Tj 26.724 0 Td (e any difference in terms of )Tj 0.002 Tw -26.724 -1.72 Td (combating these problems on a global level. These were discussed on a ro\ utine basis. You should )Tj 0.051 Tw 0 -1.72 TD [(have )0.5(heard )0.5(the )0.5(negotiations )0.5(about )0.5(how )0.5(detailed )0.5(they )0.5(were, )0.5(and )0.5(how )0.6(intense )0.5(various )0.5(people )0.5(were )]TJ 0.149 Tw T* (about the national capacity)Tj 0 Tw 11.192 0 Td (-)Tj (building )Tj 0.149 Tw 4.065 0 Td (requirements, how should those be seen, how should the )Tj ET endstream endobj 39 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 40 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (21)Tj ( )Tj ET Q BT 0.026 Tw 12 0 0 12 71.88 709.08 Tm [(requirements )0.5(be )0.5(seen )0.5(for )0.5(ports )0.5(and )0.5(airport )0.5(area )0.5(and issues )0.5(like )0.5(that. )0.5(So )0.5(all )0.5(of )0.5(this, )0.5(the )0.5(fact )0.5(that )0.5(all )]TJ 0.021 Tw 0 -1.72 TD (of these local areas would be involved, all these different governmental\ units would be involved,)Tj 0 Tw 39 0 Td ( )Tj 0.126 Tw -39 -1.72 Td [(was very much a subject of awareness and discussion by the )0.5(delegates as it )0.5(went through the )]TJ 0.149 Tw 0 -1.74 TD (process. And again, feel free to go and talk to some of the people who w\ ere there and were )Tj 0 Tw 0 -1.72 TD (involved in it, and some of them are in the room.)Tj 19.551 0 Td ( )Tj 0.059 Tw -16.551 -1.72 Td (In addition )Tj 0 Tw (\226)Tj ( )Tj 0.059 Tw 5.537 0 Td (and I ha)Tj (ve a slide on this in just a couple of minutes )Tj 0 Tw 21.787 0 Td (\226)Tj ( )Tj 0.059 Tw 0.809 0 Td (the delegates in the )Tj 0.011 Tw -31.132 -1.72 Td (negotiations also reflected the fact that there might be a need for lega\ l or legislative or regulatory )Tj 0.038 Tw 0 -1.74 TD (revision of the legal systems among various countries and various places\ around the)Tj 0 Tw 34.063 0 Td ( )Tj 0.038 Tw 0.288 0 Td (world. This )Tj 0.081 Tw -34.351 -1.72 Td [(is )0.5(inevitable. )0.5(Again )0.5(the )0.5(country )0.5(saw this )0.6(as )0.5(this )0.5(was )0.5(being )0.5(negotiated, )0.5(saw )0.5(that )0.5(this )0.5(was )0.5(one )0.5(of )]TJ 0.069 Tw 0 -1.72 TD (the things that was going to have to be dealt with, and there are provis\ ions on it. I\222ll talk about )Tj 0.011 Tw T* (them in a moment. The very first resolution th)Tj 18.557 0 Td (at adopted the IHR addressed these and said, \223This )Tj 0.119 Tw -18.557 -1.74 Td (is coming, we need to...\224 Well, actually it\222s the Health Assembly \ )Tj 0 Tw 27.527 0 Td (\226)Tj ( )Tj 0.119 Tw 0.869 0 Td (which means the member )Tj 0 Tw -28.396 -1.72 Td (states )Tj 2.543 0 Td (\226)Tj ( )Tj 0.072 Tw 0.822 0 Td [(urged )0.5(the )0.5(other )0.5(member )0.5(states )]TJ 0 Tw (\226)Tj ( )Tj 0.072 Tw 13.48 0 Td [(which )0.5(was )0.5(the )0.5(same )0.5(group )0.5(of )0.5(them )]TJ 0 Tw (\226)Tj ( )Tj 0.072 Tw 15.513 0 Td [(to )0.5(start )0.5(thanking )]TJ 0 Tw -32.358 -1.72 Td (about this because t)Tj (his is part of the process.)Tj ( )Tj 0.071 Tw 3 -1.72 Td (The last bullet isn\222t actually on there, and that is the specific str\ ategies. I think, because )Tj 0.027 Tw -3 -1.74 Td (so many countries\222 situations are necessarily going to be unique in t\ he specifics, I think it makes )Tj 0.034 Tw T* [(sense )0.5(to )0.5(discuss them )0.5(most )0.5(in )0.5(ter)]TJ [(ms )0.5(of )0.5(the )0.5(specific )0.5(countries, )0.5(but )0.5(in )0.5(general )0.5(terms )0.5(you\222re )0.5(talking )]TJ 0.016 Tw T* (about the same kinds of considerations in all of them. Prioritization: i\ n the context of the country )Tj 0.072 Tw T* (what are the legal arrangements or the changes or whatever that have to \ be made that go a)Tj 37.179 0 Td (t the )Tj 0.219 Tw -37.179 -1.74 Td (most important aspects of the IHR? What are the specific key points with\ in that particular )Tj 0 Tw T* (country, within those particular units? We can talk about more of that s\ pecifically.)Tj 32.934 0 Td ( )Tj 0.047 Tw -29.934 -1.72 Td [(Just )0.5(a )0.5(little )0.5(bit )0.5(more )0.5(of )0.5(the )0.5(legal )0.5(part. )0.5(The )0.5(IHR )0.5(generally )0.5(take )0.5(a )0.5(unitary)]TJ 0 Tw 28.836 0 Td ( )Tj 0.047 Tw 0.296 0 Td [(approach )0.5(to )0.5(state )]TJ 0.107 Tw -32.132 -1.72 Td (party obligations. The vast majority of them are in state and in terms o\ f states\222 parties. At the )Tj 0.185 Tw 0 -1.74 TD (same time they do recognize that for some purposes you really do have to\ talk about some )Tj 0.066 Tw 0 -1.72 TD (subnational unit, and there were a lot of discussi)Tj (ons during the negotiations because you would )Tj 0.059 Tw T* (talk about, \223Well, the state party shall take the following measures \ at the port to kill the rats on )Tj 0.127 Tw T* (ships,\224 or things like this, and it would be obvious that it sounded \ funny to say that the state )Tj 0.167 Tw 0 -1.74 TD (party would )Tj (do it, so there was a lot of discussion about what term would you use. A\ nd so )Tj 0.152 Tw 0 -1.72 TD (ultimately, after a lot of discussion, we wound up with \223competent au\ thority\224, and it was an )Tj 0.086 Tw T* (accommodation of a number of concerns that were raised by a number of co\ untries. That)Tj 36.72 0 Td (\222s the )Tj 0 Tw -36.72 -1.72 Td (primary subnational unit that is discussed.)Tj ( )Tj ET endstream endobj 41 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 42 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (22)Tj ( )Tj ET Q BT 0.025 Tw 12 0 0 12 107.88 709.08 Tm (At the same time, of course, what the competent authority does, in whate\ ver context, it is )Tj 0.289 Tw -3 -1.72 Td (still the state party of course which is the party to the agreement whic\ h has the overall )Tj 0 Tw 0 -1.72 TD (responsibilities and rig)Tj (hts under the regulations.)Tj ( )Tj 0.14 Tw 3 -1.74 Td (There are surprisingly few points in the regulations that actually addre\ ss legislative or )Tj 0.129 Tw -3 -1.72 Td (legal or administrative revision. These are the two main ones. You may h\ ave seen this in the )Tj 0.046 Tw T* (background materials. The first one is a part )Tj 18.278 0 Td (toward the very end of the regulations, tacked onto )Tj 0.035 Tw -18.278 -1.72 Td (another article that deals mostly with other things, and it provides exa\ ctly as it says there. It was )Tj 0.002 Tw 0 -1.74 TD (put there in recognition that countries will need to address some revisi\ ons )Tj 0 Tw 29.741 0 Td (\226)Tj ( )Tj 0.002 Tw 0.752 0 Td (and it depends on the )Tj 0 Tw -30.493 -1.72 Td (co)Tj (untry )Tj (\226)Tj ( )Tj (in their legal or legislative systems, and it provides for this mechanis\ m right here.)Tj 36.686 0 Td ( )Tj 0.145 Tw -33.686 -1.72 Td (I put the little note there that says \223notes and questions\224, and t\ he notes and questions )Tj 0.008 Tw -3 -1.72 Td (really come down to this. First of all, if a country is going to invoke \ t)Tj 27.749 0 Td (his provision the deadline is )Tj 0.1 Tw -27.749 -1.74 Td (December 15th, just like it is for reservations. So, know that the deadl\ ine is out there. But the )Tj 0.097 Tw 0 -1.72 TD (second one is this was a provision that was drafted very quickly at the \ end of the negotiations )Tj 0.052 Tw T* (when a lot of things were being )Tj (done at once, and frankly it\222s not entirely clear exactly what its )Tj 0.081 Tw T* (effect may be. We can talk about this in more detail, it\222s just that \ this is the one provision that )Tj 0.014 Tw 0 -1.74 TD (actually talks reasonably specifically about some of the issues that we\222\ re talking about )Tj 34.975 0 Td (here and I )Tj 0 Tw -34.975 -1.72 Td (wanted to make sure that it was out there so you all know that it\222s t\ here.)Tj 28.771 0 Td ( )Tj 0.059 Tw -25.771 -1.72 Td (The other provision is the one on collaboration, which specifically cont\ emplates that the )Tj 0 Tw -3 -1.72 Td (States Parties would assist each other in this area.)Tj 19.801 0 Td ( )Tj 0.076 Tw -16.801 -1.74 Td (The other items we can disc)Tj (uss as they come up in the course of our discussions, and )Tj 0 Tw (\226)Tj ( )Tj 0.108 Tw -3 -1.72 Td (like Stefano )Tj 0 Tw (\226)Tj ( )Tj 0.108 Tw 6.129 0 Td (if you have questions we are here to provide information and to discuss \ what\222s )Tj 0.132 Tw -6.129 -1.72 Td (happening at WHO and what we\222re doing to help support the States Part\ ies in going forward )Tj 0 Tw 0 -1.72 TD (with the Reg)Tj (ulations.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj 0.117 Tw (you very much, Bruce. We\222ll entertain some comments and questions for\ a few )Tj 0 Tw -3 -1.74 Td (minutes from the floor, if people have comments or questions for our col\ leagues from WHO.)Tj 37.212 0 Td ( )Tj -37.212 -1.72 Td ( )Tj /TT1 1 Tf T* (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.66 TD (RS:)Tj ( )Tj 3 0 Td (Yes, France?)Tj ( )Tj ET endstream endobj 43 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 44 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (23)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (SV:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.05 Tw (you fo)Tj (r those two presentations. My question is to Stefano Lazzari. Perhaps I \ can )Tj 0 Tw 0 -1.72 TD (ask him in French? I don\222t know if people...)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 0.227 Tw 3 0 Td (I\222m sorry, there are translation headphones here for those who would \ like them for )Tj 0 Tw 0 -1.74 TD (French. )Tj (Please, )Tj /TT1 1 Tf (un petit peu)Tj /TT0 1 Tf (.)Tj ( )Tj -3 -1.72 Td (SV:)Tj ( )Tj 3 0 Td (Technical paus)Tj (e.)Tj ( )Tj -3 -1.72 Td (SP:)Tj ( )Tj 3 0 Td (Bien s\373r. Pas de probl\350me. Je crois que nous sommes pr\352ts. )Tj ( )Tj -3 -1.72 Td (SV:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. )Tj 0.011 Tw 4.899 0 Td (Ma question est la suivante, j\222ai vu dans la pr\351sentation que l\222\ OMS travaillait )Tj 0.468 Tw -4.899 -1.74 Td (\340 identifier des contacts points r\351gionaux et donc dans le R\350gl\ ement sanitaire )Tj 0.183 Tw 0 -1.72 TD [(international )0.5(o)]TJ [(n )0.5(a )0.5(vu )0.5(que )0.5(les )0.5(contacts )0.5(points )0.5(n\222\351taient )0.5(pas )0.5(pr\351cis\351s )0.5(s\222ils )0.5(devaient )0.5(\352tre )]TJ 0.234 Tw T* (r\351gionaux ou au niveau du si\350ge. Donc je voulais savoir s\222il y \ avait eu depuis des )Tj 0.294 Tw T* (\351volutions et si on partait plut\364t sur des points de contact de l\222\ OMS qui seraient )Tj 0.156 Tw 0 -1.74 TD (r\351gionaux ou si )Tj (on restait sur quelque chose de centraliser au niveau du si\350ge. Et ma\ )Tj 0.134 Tw 0 -1.72 TD (question est double \340 la fois pour le probl\350me de la consultation \ \(article)Tj 0 Tw 30.21 0 Td ( )Tj 0.134 Tw (6\) ou pour le )Tj 0.145 Tw -30.21 -1.72 Td (probl\350me de la notification \(article)Tj 0 Tw ( )Tj 0.145 Tw (12\). Donc est)Tj 0 Tw (-)Tj 0.145 Tw (ce qu\222un utilisera les m\352mes circuits )Tj 0.298 Tw T* (pour les)Tj 0 Tw ( )Tj 0.298 Tw 4.04 0 Td (deux? Est)Tj 0 Tw (-)Tj 0.298 Tw (ce qu\222on aura des contacts avec la r\351gion pour uniquement la )Tj 0.457 Tw -4.04 -1.74 Td (consultation, une sorte de pr\351notification bilat\351rale et d\222\351\ change ou est)Tj 0 Tw 32.379 0 Td (-)Tj 0.457 Tw (ce que, )Tj 0 Tw -32.379 -1.72 Td (effectivement, les deux voies seront les m\352mes ou distinctes? Voil\340\ ma question.)Tj 32.353 0 Td ( )Tj -35.353 -1.72 Td (SP:)Tj ( )Tj 0.065 Tw 3 0 Td (Oui, effectivemen)Tj (t il y a eu une discussion sur \340 quel niveau le contact point devait \ \352tre )Tj 0.014 Tw T* (\351tabli et comme c\222est pas bien sp\351cifi\351 comme vous l\222avez\ dit dans le texte de R\350glement )Tj 0.071 Tw 0 -1.74 TD (sanitaire international et je crois que la d\351cision serait effectivem\ ent d\222\351tablir des points)Tj 0 Tw 36 0 Td ( )Tj 0.01 Tw -36 -1.72 Td [(de )0.5(contact )0.5(au )0.5(niveau )0.5(r\351gional. )0.5(Et )0.5(pour )0.5(la )0.5(raison )0.5(justement )0.5(de )0.5(rapport )0.5(avec )0.5(le )0.5(pays )0.5(de )0.5(suivi )]TJ 0.043 Tw 0 -1.72 TD (et de la fa\347on que l\222OMS est organis\351e. Ce qui n\222emp\352che \ que le syst\350me va \352tre mis en )Tj 0.073 Tw T* (place d\222une fa\347on que le transfert d\222une formation et la discus\ sion avec les)Tj 0 Tw 30.755 0 Td ( )Tj 0.073 Tw 0.323 0 Td (pays va \352tre )Tj 0.095 Tw -31.078 -1.74 Td (faite assez rapidement avec l\222engagement du si\350ge, mais le premier\ point de contact en )Tj 0.175 Tw T* (principe ce sera pour la notification des \351v\351nements potentiels au\ niveau r\351gional. Et )Tj 0.047 Tw T* (justement l\222\351quipe \340 ____ on a travaill\351 de fa\347on tr\350s\ \351troite et co)Tj 26.723 0 Td (ntinue avec les r\351gions )Tj 0.103 Tw -26.723 -1.72 Td (pour \351tablir des m\351canismes de syst\350me de communication et de s\ yst\350me op\351ratif pour )Tj 0.149 Tw 0 -1.74 TD [(s\222assurer que \347a puisse marcher d\222une fa\347on correcte. )0.5(Mais oui, je crois que )0.5(peut)]TJ 0 Tw 34.168 0 Td (-)Tj (\352tre )Tj 0.032 Tw -34.168 -1.72 Td (Bruce \351tait aussi parti de la discussion qui a eu lieu d\222aill)Tj (eurs \340 Lyon apr\350s la conf\351rence )Tj 0.027 Tw 0 -1.72 TD (de mai et o\371 effectivement on a estim\351 qu\222au niveau r\351gional\ c\222est le bon niveau. )Tj 0 Tw 33.112 0 Td (Thank)Tj (-)Tj -33.112 -1.72 Td (you.)Tj ( )Tj ET endstream endobj 45 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 46 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (24)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (RS:)Tj ( )Tj 3 0 Td (Comments, questions? Additional...?)Tj ( )Tj -3 -1.72 Td (?:)Tj ( )Tj 0.056 Tw 3 0 Td (Une question. )Tj (Quand vous parlez de points de contact r\351gional, vous voulez dire dan\ s le )Tj 0.108 Tw 0 -1.72 TD (contexte global? Pas \340 l\222int\351rieur du pays, mais r\351gional au\ plan du monde c\222est)Tj 0 Tw 33.335 0 Td (-)Tj (\340)Tj (-)Tj (dire )Tj 0.134 Tw -33.335 -1.74 Td [(les\205 Vous pouvez pas dire le niveau r\351gional \340 l\222int\351rieu\ r )0.5(du pays, mais vous voulez )]TJ 0 Tw T* (dire\205 le niveau r\351gional \340 l\222int\351rieur du pays, mais vous\ voulez dire\205 global?)Tj 31.685 0 Td ( )Tj -34.685 -1.72 Td (SP:)Tj ( )Tj 0.048 Tw 3 0 Td (Non, non, non, non. Comme j\222ai montr\351, l\222\351v\351nement potent\ iel va \352tre d\351tect\351 au niveau )Tj 0.315 Tw T* (pays. Le focal point au niveau national, la responsabilit\351 de notifie\ r l\222OMS et la )Tj 0.194 Tw 0 -1.74 TD (notification sera \340 travers le point de contact r\351gional, et \340 \ travers ce syst\350me \347a v)Tj 0 Tw 35.556 0 Td (a )Tj 0.258 Tw -35.556 -1.72 Td (arriver \340 Gen\350ve et \347a va activer le syst\350me de l\222OMS. Vo\ il\340. Et l\222OMS c\222est un )Tj 0.027 Tw 0 -1.72 TD [(organisme )0.5(r\351gionalis\351, )0.5(comme )0.5(vous )0.5(le savez )0.5(bien. C\222est )0.5(normal )0.5(que )0.5(\347a )0.5(suive )0.5(la )0.5(structure, )]TJ 0 Tw T* (si vous voulez, de l\222organisation. )Tj ( )Tj -3 -1.74 Td (RS:)Tj ( )Tj 0.028 Tw 3 0 Td (The lady in the back from Foreign Affairs. Ju)Tj 18.417 0 Td (st a moment, Dr.)Tj 0 Tw ( )Tj 0.028 Tw (Fedorov, you\222re next. The )Tj 0 Tw -18.417 -1.72 Td (lady in the back? Would you please...?)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (If you could just everybody state their name, just for the transcription\ process.)Tj 31.27 0 Td ( )Tj -34.27 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Yeah, say your name.)Tj ( )Tj -3 -1.74 Td (VP:)Tj ( )Tj 0.212 Tw 3 0 Td (Hi, I\222m Val Percival from Foreign Affairs, and this questio)Tj (n may be self)Tj 0 Tw (-)Tj 0.212 Tw (evident to )Tj 0.08 Tw T* (people who are more familiar with the IHR than I am, but I was wondering\ what... you )Tj 0.026 Tw T* (talked about the obligations that the IHR put on state parties. What add\ itional obligations )Tj 0.049 Tw T* [(does it put on the WHO and what does it mean )0.5(in terms )]TJ (of the evolution of the WHO as )Tj 0 Tw 0 -1.74 TD (we move forward?)Tj ( )Tj -3 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.092 Tw (you, Bruce. In the interests of time I\222m afraid we\222re going to hav\ e entertain one )Tj 0 Tw 0 -1.72 TD (more comment, and Dr.)Tj ( )Tj (Fedorov you were the next to ask. I\222m sorry. Dr.)Tj ( )Tj (Fedorov?)Tj ( )Tj -3 -1.74 Td (YF:)Tj ( )Tj 0.022 Tw 3 0 Td [(I )0.5(have )0.5(a )0.5(question )0.5(to )0.5(Dr.)]TJ 0 Tw ( )Tj (La)Tj 0.022 Tw [(zzari. )0.5(May )0.5(I )0.5(ask )0.5(you, )0.5(when )0.5(you\222re )0.5(coming )0.5(back )0.5(to )0.5(the )0.5(original )]TJ 0.043 Tw T* (focal points, when we discuss this matter, do you mean that the original\ offices of WHO )Tj 0 Tw T* (will serve as regional focal points?)Tj ( )Tj -3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 1.555 0 Td (They are contact points, they are not focal points.)Tj 19.771 0 Td ( )Tj -22.771 -1.74 Td (YF:)Tj ( )Tj 3 0 Td (For organ)Tj (izations, I mean.)Tj ( )Tj -3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 0.271 Tw 1.555 0 Td [(What )0.5(it )0.5(means )0.5(is )0.5(that )0.5(we\222re )0.5(organizing )0.5(contact )0.5(points )0.5(in )0.5(each )0.5(region )0.5(who )0.5(will )0.5(be )]TJ 0 Tw T* (accessible by the national focal points at any time in order to notify p\ otential...)Tj 31.436 0 Td ( )Tj -34.436 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (So you will not produce any other new structures or...? The origi)Tj (nal offer will serve.)Tj ( )Tj ET endstream endobj 47 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 48 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (25)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (SL:)Tj 1.445 0 Td ( )Tj 0.094 Tw 1.555 0 Td (It will be within the regional office and it\222s going to be most likel\ y the existing people )Tj 0 Tw 0 -1.72 TD (involved in epidemic alert or response already.)Tj 18.743 0 Td ( )Tj -21.743 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. Yeah, that\222s clear.)Tj ( )Tj -3 -1.74 Td (SL:)Tj 1.445 0 Td ( )Tj 0.14 Tw 1.555 0 Td (But they\222re going to organized themselves in order t)Tj (o be available and contactable 24 )Tj 0 Tw T* (hours seven days a week.)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. One more comment from Senegal. )Tj (Please state your name.)Tj ( )Tj -3 -1.74 Td (AB:)Tj ( )Tj 0.084 Tw 3 0 Td (Andr\351 Basse, )Tj /TT1 1 Tf (du S\351n\351gal)Tj /TT0 1 Tf (. Je voudrais revenir \340 cette question de point de contact parce )Tj 0.068 Tw T* (que je crois que c\222e)Tj (st important, parce qu\222il se situe donc dans ma compr\351hension, dan\ s )Tj 0.083 Tw T* (le cas de l\222article)Tj 0 Tw ( )Tj 0.083 Tw (6 de Stefano Lazzari. Et le concept de l\222article)Tj 0 Tw 26.479 0 Td ( )Tj 0.083 Tw (6 c\222est d\222aller tr\350s vite )Tj 0.213 Tw -26.479 -1.72 Td (dans la notification et \340 m\352me d\222aider les ____ qui sont pr\351\ vus l\340)Tj 0 Tw 28.604 0 Td (-)Tj 0.213 Tw (bas de 24)Tj 0 Tw ( )Tj (heures )Tj -28.604 -1.74 Td (notamment)Tj 0.11 Tw (. Est)Tj 0 Tw (-)Tj 0.11 Tw (ce qu\222en introduisant la notion de points de contact au niveau r\351g\ ional )Tj 0.035 Tw T* [(c\222est pas une lourdeur qu\222on va ajouter au )0.5(dispositif de notification, et d\222autre part est)]TJ 0 Tw 34.779 0 Td (-)Tj (ce )Tj 0.102 Tw -34.779 -1.72 Td [(que )0.5(le )0.5(point )0.5(de )0.5(contact )0.5(r\351gional )0.5(sera )0.6(une )0.5(option )0.5(\340 )0.5(c\364t\351 )0.5(de )0.5(la )0.5(possibilit\351 )0.5(qui )0.5(sera )0.5(o)]TJ 0 Tw 33.835 0 Td (fferte )Tj 0.198 Tw -33.835 -1.72 Td (aux points focals nationaux de communiquer directement avec le si\350ge,\ parce que le )Tj 0.008 Tw 0 -1.74 TD (concept de l\222article)Tj 0 Tw ( )Tj 0.008 Tw (6 c\222est la consultation. En cr\351ant une \351tape interm\351diaire e\ ntre le pays )Tj 0.157 Tw 0 -1.72 TD (et l\222OMS si\350ge on peut aller lentement. Donc c\222est pourquoi cet\ te notion)Tj 0 Tw 30.834 0 Td ( )Tj 0.157 Tw 0.407 0 Td (de point de )Tj 0 Tw -31.242 -1.72 Td (contact r\351gional cause probl\350me par rapport au concept de l\222art\ icle)Tj 26.681 0 Td ( )Tj (6. Je vous remercie.)Tj ( )Tj -29.681 -1.72 Td (SL?:)Tj 1.889 0 Td ( )Tj 0.108 Tw 1.111 0 Td (Merci pour la question. Effectivement je crois qu\222on ne peut pas emp\352\ cher un national )Tj 0.074 Tw 0 -1.74 TD (focal point ou un gouvernement de contacter directement le si\350g)Tj 26.348 0 Td (e. Mais \340 ce moment)Tj 0 Tw (-)Tj (l\340 )Tj 0.239 Tw -26.348 -1.72 Td (ce qui se passe c\222est que le point de contact du volet national sera \ imm\351diatement )Tj 0.104 Tw 0 -1.72 TD (inform\351 par le si\350ge. Bon, aujourd\222hui les syst\350mes de commu\ nication nous permettent )Tj 0.029 Tw T* [(de faire \347a dans un temps tr\350s )0.5(rapide. C\222est pas vraiment un prob)]TJ 26.252 0 Td (l\350me. Le probl\350me c\222est )Tj 0.051 Tw -26.252 -1.74 Td (d\222avoir des m\351canismes de syst\350mes en place qui marchent et qui\ marchent bien; et \340 ce )Tj 0 Tw T* (moment)Tj (-)Tj 0.047 Tw (l\340 tout le monde va \352tre mis au jour de la situation dans un d\351\ lai minimal. Mais )Tj 0.055 Tw T* [(je )0.5(ne )0.5(crois )0.5(pas )0.5(qu\222on )0.5(peut )0.5(effectivement )0.5(emp\352cher )0.5(un )0.5(gouv)]TJ 24.12 0 Td [(ernement )0.5(au )0.5(point )0.5(focal )0.6(de\205 )]TJ 0.065 Tw -24.12 -1.72 Td [(par exemple s\222ils n\222arrivent pas \340 contacter au niveau r\351gio\ nal tout de suite )0.5(de )0.5(contacter )]TJ 0.266 Tw 0 -1.74 TD [(le si\350ge. Je crois que c\222est quelque chose qui restera possible. E\ t apr\350s ce )0.5(sera le )]TJ 0 Tw 0 -1.72 TD (m\351canisme diff\351rent qui entrera en place. )Tj 16.797 0 Td ( )Tj -19.797 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.009 Tw (you very much. I believe in the interests of time now we\222ll move into\ the next part )Tj 0 Tw T* (of our agenda. Dr.)Tj ( )Tj (Wilson will introduce the country presentations.)Tj 26.826 0 Td ( )Tj ET endstream endobj 49 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 50 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (26)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.019 Tw 3 0 Td (If I could add, to avoid confusion, some of you picked up the agenda out\ side. The )Tj 0.201 Tw -3 -1.72 Td (agenda outside does)Tj 0 Tw ( )Tj 0.201 Tw 8.906 0 Td (not reflect a change )Tj 0 Tw (\226)Tj ( )Tj 0.201 Tw 9.861 0 Td (a last)Tj 0 Tw (-)Tj 0.201 Tw (minute change )Tj 0 Tw (\226)Tj ( )Tj 0.201 Tw 10.078 0 Td (we had to make. )Tj 0 Tw -28.844 -1.72 Td (Dr.)Tj ( )Tj 0.028 Tw (Howard Njoo, who was going to start off with the Canada presentation, wa\ s called to )Tj 0.075 Tw 0 -1.74 TD (the Minister\222s office. We didn\222t feel we should say we\222re busy \ and so he is currently at )Tj 0.172 Tw 0 -1.72 TD (the Minister\222s o)Tj (ffice and we\222ve switched the Canada presentation to right after lunch\ )Tj 0 Tw T* (today. Sorry for any confusion.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0.004 Tc -0.003 Tw 13.92 0 0 13.92 71.88 562.2 Tm [(COUNT)0.7(RY P)0.7(RE)0.7(S)0.7(E)0.7(NT)0.7(AT)0.7(I)1.7(ONS)]TJ 0 Tc 0 Tw 13.831 0 Td ( )Tj 12 0 0 12 71.88 542.04 Tm (Chair: Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj 0.26 Tw (you. We\222re a little behind schedule but we\222re doing okay. The firs\ t country )Tj 0.268 Tw -3 -1.74 Td (presentation will be fr)Tj (om the United States, Dr.)Tj 0 Tw ( )Tj 0.268 Tw (Marfin, and then there will be comments )Tj 0 Tw T* (afterwards by Dr.)Tj ( )Tj (Hathaway.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (COUNTRY 1: USA)Tj ( )Tj 0 -1.66 TD (Dr.)Tj ( )Tj (Anthony Marfin)Tj ( )Tj /TT0 1 Tf 0.04 Tw 3 -1.64 Td (First let me think the organizers at this meeting for inviting me. It\222\ s a real opportunity to )Tj 0.022 Tw -3 -1.72 Td (see some people that I\222ve worked )Tj (with in the past already with regards to security and prosperity )Tj 0.071 Tw 0 -1.74 TD (partnerships and to move into some of the new things that we\222re going\ to be involved in in the )Tj 0 Tw 0 -1.72 TD (coming years.)Tj ( )Tj 0.177 Tw 3 -1.72 Td (Let me also say that my background is actually arbovirology, and I say t\ hat becaus)Tj 0 Tw 35.556 0 Td (e )Tj 0.039 Tw -38.556 -1.72 Td (everyone here seems to be very familiar with the International Health Re\ gulations. My role here )Tj 0.196 Tw 0 -1.74 TD (has only started perhaps six to eight months ago, so I will make the bet\ that I\222m the most )Tj 0.021 Tw 0 -1.72 TD (inexperienced person in the room on this. But I do listen well and )Tj 26.716 0 Td (I know that I will learn quite a )Tj 0 Tw -26.716 -1.72 Td (bit.)Tj ( )Tj 0.028 Tw 3 -1.72 Td (I will tell you that this talk has been cleared with the United States D\ epartment of Health )Tj 0.021 Tw -3 -1.74 Td (and Human Services. Despite that, I do bring a certain amount of bias. I\ am a former state health )Tj 0.074 Tw T* (officer with the State of Or)Tj (egon and a former county health officer with Santa Clara County in )Tj 0 Tw T* (California, so I think sometimes that\222s going to show in some of my d\ iscussion.)Tj ( )Tj 0.048 Tw 3 -1.72 Td (As has already been talked about, we are here to describe the extent to \ which the United )Tj 0.23 Tw -3 -1.74 Td (States has a system )Tj (of governance that will enable effective implementation of the revised )Tj 0.164 Tw T* [(International )0.5(Health )0.5(Regulations, )0.5(and )0.5(so )0.5(I\222m )0.5(going )0.5(to )0.5(address )0.5(this )0.5(over )0.5(about )0.5(the )0.5(next )0.5(15 )0.5(to )]TJ ET endstream endobj 51 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 52 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (27)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (20)Tj ( )Tj 0.16 Tw (minutes. Although I will be speaking for about 15 to 20 minutes and show\ you about 15 )Tj 0 Tw 0 -1.72 TD (sli)Tj 0.043 Tw 0.945 0 Td (des, this is actually the very key slide. Many of you may already know t\ hat the United States, )Tj 0.021 Tw -0.945 -1.72 Td (of course, has a deeply rich colonial background. Back in the mid)Tj 0 Tw (-)Tj 0.021 Tw (17th century we had influence )Tj 0.018 Tw 0 -1.74 TD (from the French, the British and the Dutch in our north)Tj 0 Tw 22.148 0 Td (-)Tj 0.018 Tw (east area)Tj (s, influence from the British and )Tj 0.112 Tw -22.148 -1.72 Td (the Spanish in the south)Tj 0 Tw (-)Tj 0.112 Tw (east, influence from the Spanish and later the Mexicans in the south)Tj 0 Tw 38.667 0 Td (-)Tj -38.667 -1.72 Td (west, and then quite a bit of influence from the Russians, the Spanish a\ nd the British in the north)Tj 38.667 0 Td (-)Tj 0.05 Tw -38.667 -1.72 Td (west. As a result we have a )Tj (very, very rich and flavourful regional concept in the United States, )Tj 0.061 Tw T* (and in many places it has continued on and we take a great deal of pride\ in our regionalization. )Tj 0.087 Tw 0 -1.72 TD (And let me tell you not only with regard to the International Health Reg\ ulations but on a)Tj 0 Tw 36.777 0 Td (lmost )Tj 0.163 Tw -36.777 -1.72 Td [(everything )0.5(that )0.5(we )0.5(do )0.5(in )0.5(public )0.5(health )0.5(this )0.5(has a )0.5(great )0.5(influence on )0.5(the )0.5(way )0.5(that )0.5(the )0.5(federal )]TJ 0 Tw T* (government and the state governments interact.)Tj 18.938 0 Td ( )Tj 0.112 Tw -15.938 -1.74 Td (So, in terms of the background for our political structure the United St\ ates is a federal )Tj 0.138 Tw -3 -1.72 Td (system of governmen)Tj (t, but let me emphasize the fact that it\222s a federation of states tha\ t have )Tj 0.007 Tw T* (independent and sovereign governments of their own, that these states do\ retain powers that were )Tj 0.061 Tw T* (not expressly given to us )Tj 0 Tw (\226)Tj ( )Tj 0.061 Tw 11.308 0 Td (to the federal government )Tj 0 Tw (\226)Tj ( )Tj 0.061 Tw 11.605 0 Td (in our U.S. Constitution ov)Tj (er 200 years )Tj 0 Tw -22.914 -1.74 Td (ago )Tj 1.804 0 Td (\226)Tj ( )Tj 0.11 Tw 0.86 0 Td (with the subsequent amendments, of course )Tj 0 Tw 18.351 0 Td (\226)Tj ( )Tj 0.11 Tw 0.86 0 Td (and that we are a full presidential system )Tj 0.015 Tw -21.874 -1.72 Td (with a bicameral legislation of senators and congresspersons that repres\ ent their constituencies at )Tj 0.086 Tw T* (the state and local level, and this gives a great )Tj (deal of flavour to, again, any discussion around )Tj 0 Tw T* (public health, or practically anything else in the United States.)Tj 24.91 0 Td ( )Tj 0.08 Tw -21.91 -1.74 Td (But the basic questions are, \223Well, who really does public health in \ the United States?\224 )Tj 0.138 Tw -3 -1.72 Td [(and )0.5(I )0.5(would )0.5(contend )0.5(that )0.5(it )0.5(is )0.5(really )0.5(a )0.5(concurrent )0.5(j)]TJ [(urisdiction. )0.5(The )0.5(United )0.5(States )0.5(Constitution )]TJ 0.263 Tw T* (does describe a division of the jurisdiction. This is )Tj 0 Tw 22.757 0 Td (\226)Tj ( )Tj 0.263 Tw 1.013 0 Td (in the third bullet, here )Tj 0 Tw 10.703 0 Td (\226)Tj ( )Tj 0.263 Tw 1.013 0 Td (the 10th )Tj 0.047 Tw -35.487 -1.72 Td (Amendment to our Constitution that states that the powers not delegated \ to the United States by )Tj 0.022 Tw 0 -1.74 TD (the Constitution, nor p)Tj (rohibited by it to the states, are reserved to the states respectively o\ r to the )Tj 0 Tw 0 -1.72 TD (people.)Tj ( )Tj 0.158 Tw 3 -1.72 Td (Now, that\222s very confusing for me not being a lawyer, but what that m\ eans is public )Tj 0.014 Tw -3 -1.72 Td [(health )0.5(was )0.5(not )0.5(expressly )0.5(given )0.5(to )0.5(the )0.5(United )0.5(States )0.5(in )0.5(the )0.5(Constitution, )0.6(and )0.6(as )0.5(a )0.5(r)]TJ 32.586 0 Td [(esult )0.5(that )0.5(power )]TJ 0 Tw -32.586 -1.74 Td (resides within the states.)Tj ( )Tj 0.063 Tw 3 -1.72 Td (Well, then, how does the federal government exert any power in public he\ alth? Because )Tj 0.048 Tw -3 -1.72 Td (I\222m going to describe that we have lots of roles, we do lots of thing\ s, and where we get into the )Tj 0.006 Tw T* (business is really in the fa)Tj (ct that we are able to regulate commerce with foreign nations and those \ )Tj ET endstream endobj 53 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 54 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (28)Tj ( )Tj ET Q BT 0.072 Tw 12 0 0 12 71.88 709.08 Tm [(factors that are related to )0.5(commerce. And we can also regulate commerce between )0.5(the )0.5(states )0.5(in )]TJ 0 Tw 0 -1.72 TD (terms of interstate commerce.)Tj 11.884 0 Td ( )Tj 0.004 Tw -8.884 -1.72 Td (And the way that this has been interpreted, the way that we )Tj 23.954 0 Td (would reach in, is that we feel )Tj 0.082 Tw -26.954 -1.74 Td (that disease, the movement of disease, outbreaks, epidemics, all affect \ commerce, and we have )Tj 0 Tw T* (used this in many situations to say that we do have a role here.)Tj 24.994 0 Td ( )Tj 0.067 Tw -21.994 -1.72 Td (Continuing, then, who does public health? What I\222m saying is that)Tj 0 Tw 27.218 0 Td ( )Tj 0.067 Tw 0.317 0 Td (the responsibility for )Tj 0.058 Tw -30.535 -1.72 Td (public health is shared, and most of the functions are decentralized as \ I will show you here in a )Tj 0.13 Tw 0 -1.74 TD [(table in just a bit. But within a state all aspects of surveillance, rep\ orting )0.5(and public health )]TJ 0 Tw 38.5 0 Td (\226)Tj ( )Tj 0.095 Tw -38.5 -1.72 Td (including the laboratory )Tj 0 Tw (\226)Tj ( )Tj 10.988 0 Td (clearly )Tj 0.095 Tw 3.065 0 Td (belong to state and local health departments. In international )Tj 0.133 Tw -14.054 -1.72 Td (settings, in inter)Tj 0 Tw (-)Tj 0.133 Tw (state settings, the jurisdiction belongs to the federal government. The \ federal )Tj 0.184 Tw 0 -1.72 TD (public health entities do not have any direct authority over the state a\ nd local public health)Tj 0 Tw 39 0 Td ( )Tj -39 -1.74 Td (entities. Despite that we have an amazing record for cooperation.)Tj 26.017 0 Td ( )Tj 0.198 Tw -23.017 -1.72 Td (These are our national core capacities, again talking about who is perfo\ rming public )Tj 0.036 Tw -3 -1.72 Td [(health )0.5(in )0.5(the )0.5(United )0.5(States. )0.5(As )0.5(you )0.5(can )0.5(see )]TJ 0 Tw (\226)Tj ( )Tj 0.036 Tw 18.434 0 Td [(and )0.5(we\222ll )0.5(start )0.5(with )0.5(the )0.5(right)]TJ 0 Tw (-)Tj 0.036 Tw [(hand )0.5(column )]TJ 0 Tw (\226)Tj ( )Tj 0.036 Tw 18.169 0 Td [(this )0.5(is )]TJ 0.101 Tw -36.603 -1.72 Td (the l)Tj (ocal health department, these are the counties and the parishes that... \ I think there\222s 3,118 )Tj 0.138 Tw 0 -1.74 TD (counties or parishes in the United States, and they are responsible for \ all aspects. Ultimately, )Tj 0.064 Tw 0 -1.72 TD (when somebody has a problem they\222re going to call a local county )Tj 27.591 0 Td (or parish health department. )Tj 0.375 Tw -27.591 -1.72 Td (They\222re responsible or case detection, notification, collection of ca\ se data, analysis and )Tj 0.19 Tw T* (interpretation of that data, the investigations, dissemination of any pu\ blic health information )Tj 0.095 Tw 0 -1.74 TD (ultimately comes down to the local level)Tj 16.787 0 Td (, and then response and intervention ultimately comes )Tj 0 Tw -16.787 -1.72 Td (down to the local level as well.)Tj ( )Tj 0.027 Tw 3 -1.72 Td (The states actually have a very close relationship with the local health\ departments, and I )Tj 0.092 Tw -3 -1.72 Td [(think )0.5(that )0.5(that )0.5(is )0.5(one )0.5(thing )0.5(that )0.5(is somewhat )0.5(different )0.5(than )0.5(the relationship)]TJ 0 Tw 30.647 0 Td ( )Tj 0.092 Tw 0.341 0 Td [(between )0.5(the )0.5(federal )]TJ 0.154 Tw -30.988 -1.74 Td [(and the state public health departments, that you will see )0.5(states and local health departments )]TJ 0.147 Tw 0 -1.72 TD [(often blurring the hard edges between a county )0.5(and )0.5(between a )0.5(state. )0.5(And )0.5(the )0.5(states, in some )]TJ 0.149 Tw T* (states there are no county health departments, i)Tj 19.813 0 Td (n some states the state is responsible for case )Tj 0.101 Tw -19.813 -1.72 Td (detection and notification, but in all states you\222ll see that the sta\ te is frequently supporting the )Tj 0.087 Tw 0 -1.74 TD [(local )0.5(health )0.5(departments. )0.5(States )0.5(are )0.5(frequently )0.5(involved )0.6(in )0.5(the )0.6(collection )0.5(of )0.5(case )0.5(data, )0.5(analysis, )]TJ 0 Tw 0 -1.72 TD (interpre)Tj (tation.)Tj ( )Tj ET endstream endobj 55 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 56 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (29)Tj ( )Tj ET Q BT 0.078 Tw 12 0 0 12 107.88 709.08 Tm (With regard to the investigation and confirmation of diagnoses, the stat\ es all maintain a )Tj 0.001 Tw -3 -1.72 Td (cadre of epidemiologists that are working very, very closely, either wit\ h regions within their state )Tj 0 Tw 0 -1.72 TD (\226)Tj ( )Tj (meaning groups of counties or parishes )Tj (\226)Tj ( )Tj (or with indivi)Tj (dual counties and parishes.)Tj ( )Tj 0.06 Tw 3 -1.74 Td (With regard to the clinicians and the laboratory, in some states this wo\ uld be done upon )Tj 0.279 Tw -3 -1.72 Td (request, the county or a parish would request assistance with either cli\ nical or laboratory )Tj 0.464 Tw T* (assistance. In many states, the states do have )Tj (some primary public health laboratory )Tj 0.153 Tw T* (responsibilities, and then there are other functions that may be availab\ le upon request. States )Tj 0.06 Tw 0 -1.74 TD (again are involved in the dissemination of public health information and\ are often partners with )Tj 0 Tw 0 -1.72 TD (the counties in terms of )Tj (the response and intervention.)Tj ( )Tj 0.017 Tw 3 -1.72 Td (The national level, this is where we sit in the ivory tower and are ofte\ n able to pontificate )Tj 0.003 Tw -3 -1.72 Td (about what is going on, but every once in a while )Tj 0 Tw (\226)Tj ( )Tj 0.003 Tw 20.726 0 Td (as you\222ll see here )Tj 0 Tw (\226)Tj ( )Tj 0.003 Tw 7.984 0 Td (we do roll up our sleeves, )Tj 0.082 Tw -28.71 -1.74 Td (but it\222s usually upon the reque)Tj (st of a state, and that is usually transmitted from a county to the )Tj T* (state and then to the federal public health entities. And primarily we a\ re talking about the U.S. )Tj 0 Tw T* (Centers for Disease Control and Prevention when we talk about the federa\ l public health en)Tj 36.6 0 Td (tity.)Tj ( )Tj 0.054 Tw -33.6 -1.72 Td (But you will not see very many situations where the CDC )Tj 0 Tw (\226)Tj ( )Tj 0.054 Tw 24.757 0 Td (the U.S. CDC )Tj 0 Tw (\226)Tj ( )Tj 0.054 Tw 6.772 0 Td (is involved )Tj 0.131 Tw -34.529 -1.74 Td (in case detection or notification and the collection of case data. We of\ ten will be involved in )Tj 0 Tw T* (investigations with state and local health departments upon their req)Tj 27.243 0 Td (uest.)Tj ( )Tj 0.02 Tw -24.243 -1.72 Td (We\222re frequently involved in the analysis and interpretation of publi\ c health data because )Tj 0.025 Tw -3 -1.72 Td (despite this division the cooperation that we have with state and local \ health departments has led )Tj 0 Tw 0 -1.74 TD (to some incredibly rich databases that we are frequently usi)Tj 23.742 0 Td (ng.)Tj ( )Tj 0.026 Tw -20.742 -1.72 Td (With regard to the investigation of cases and confirmation and diagnosis\ , although we do )Tj 0.215 Tw -3 -1.72 Td (provide epidemiologists and laboratory support upon request from the sta\ tes, primarily, this )Tj 0.173 Tw 0 -1.72 TD (usually does not happen, and there\222s almost no situations in which ou\ r)Tj 0 Tw 30.012 0 Td ( )Tj 0.173 Tw 0.423 0 Td (federal public health )Tj 0 Tw -30.435 -1.74 Td (agency )Tj 3.121 0 Td (\226)Tj ( )Tj 0.04 Tw 0.79 0 Td (the U.S. Centre for Disease Control and Prevention )Tj 0 Tw (\226)Tj ( )Tj 0.04 Tw 21.881 0 Td (actually provides clinical care or )Tj 0.048 Tw -25.792 -1.72 Td (clinical... I won\222t say clinical consultation because we will frequen\ tly give consultation in terms )Tj 0 Tw T* (of guidelines or guidance, but we ve)Tj (ry rarely would be involved in clinical care.)Tj 32.017 0 Td ( )Tj 0.115 Tw -29.017 -1.72 Td (As many of your know when you peruse our Web site at the U.S. Centers fo\ r Disease )Tj 0.31 Tw -3 -1.74 Td (Control, dissemination of information is one of our key functions, and i\ t\222s becoming an )Tj 0 Tw T* (increasingly important part of all of ou)Tj 15.496 0 Td (r functions.)Tj ( )Tj 0.073 Tw -12.496 -1.72 Td (With regards to the response and intervention, again this is primarily u\ pon request from )Tj 0.163 Tw -3 -1.72 Td (state health departments. There\222s very, very few situations )Tj 0 Tw 24.91 0 Td (\226)Tj ( )Tj 0.163 Tw 0.913 0 Td (there\222s almost no situation )Tj 0 Tw 11.485 0 Td (\226)Tj ( )Tj 0.913 0 Td (in )Tj ET endstream endobj 57 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 58 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (30)Tj ( )Tj ET Q BT 0.149 Tw 12 0 0 12 71.88 709.08 Tm (which the federal government, the United States Centers for)Tj 0 Tw 25.212 0 Td ( )Tj 0.149 Tw 0.399 0 Td (Disease Control and Prevention, )Tj 0.261 Tw -25.611 -1.72 Td (would intercede and put in an intervention unless it were at the request\ of a state health )Tj 0 Tw 0 -1.72 TD (department. Now, sometimes that may come after many, many...)Tj 25.881 0 Td ( )Tj -25.881 -1.74 Td ([Start of Side 3])Tj ( )Tj 0.008 Tw T* (...spinach in E. coli 0157, we\222ve had a bioterrorism )Tj (attack with anthrax five years ago, we\222ve had )Tj 0 Tw T* (a large mumps outbreak, and it\222s a recurring problem with measles.)Tj 26.992 0 Td ( )Tj 0.007 Tw -23.992 -1.72 Td (And so despite the fact... most of those, if I\222m not mistaken, are no\ t on our nine notifiable )Tj 0.204 Tw -3 -1.74 Td (diseases, yet we\222ve done a very good job in terms)Tj 0 Tw ( )Tj 0.204 Tw 22.17 0 Td (of supporting our states and getting the )Tj 0.002 Tw -22.17 -1.72 Td (information out to others. Sometimes it\222s through CNN a little bit ea\ rlier than us, but our intent is )Tj 0 Tw T* (there and it is always moving out, we are always moving that information\ out in general.)Tj 35.463 0 Td ( )Tj 0.125 Tw -32.463 -1.72 Td (And so people say, \223Wel)Tj (l, how do you that? You don\222t have any jurisdiction over the )Tj 0.074 Tw -3 -1.74 Td [(states.\224 The way that we work now is that we work )0.5(through harmonization. We are working to )]TJ 0.019 Tw T* [(establish )0.5(consensus )0.5(with )0.5(professional groups )0.6(of state )0.5(and )0.5(local )0.5(public )0.5(health )0.5(officers. )0.5(And )0.5(what )0.5(I )]TJ 0 Tw T* (have )Tj 0.205 Tw 2.343 0 Td (here in the fourth bullet is an example of the by)Tj 0 Tw (-)Tj 0.205 Tw (laws from our Council of State and )Tj 0.108 Tw -2.343 -1.72 Td (Territorial Epidemiologists, and this is just an excerpt of it, but high\ lighted in yellow is a key )Tj 0.157 Tw 0 -1.74 TD (phrase here. The CSTE, one of their main functions is to support the use\ )Tj 0 Tw ( )Tj 0.157 Tw 31.357 0 Td (of effective public )Tj 0.017 Tw -31.357 -1.72 Td (health surveillance and good epidemiologic practice through training, ca\ pacity)Tj 0 Tw 31.541 0 Td (-)Tj 0.017 Tw (development, and )Tj 0.06 Tw -31.541 -1.72 Td (peer consultation. Peer consultation goes both ways. It moves up: they w\ ill consult with federal )Tj 0.133 Tw 0 -1.72 TD (entities. They will go down: there\222s some )Tj 17.762 0 Td (incredibly talented public health people working in )Tj 0.153 Tw -17.762 -1.74 Td [(counties )0.5(and )0.5(parishes )0.5(of )0.5(the )0.5(United )0.5(States. )0.5(The )0.5(federal )0.5(government )0.5(will )0.5(often )0.5(consult )0.5(others. )]TJ 0 Tw T* (When you look at our advisory groups it is very full of state and local \ public health officials.)Tj 37.046 0 Td ( )Tj 0.229 Tw -34.046 -1.72 Td (But the key p)Tj (iece here is developing standards for practice. We\222ll often bring up \ a )Tj 0.001 Tw -3 -1.72 Td (change, we will say, \223This is the standard practice based on the foll\ owing scientific reasons,\224 and )Tj 0.249 Tw 0 -1.74 TD (then we undergo a discussion. And this is a regular annual event, actual\ ly, in which )Tj 0 Tw (new )Tj 0.091 Tw 0 -1.72 TD (standards of practice, new ways of approaching certain diseases of publi\ c health importance in )Tj 0 Tw T* (the United States are addressed.)Tj ( )Tj 0.439 Tw 3 -1.72 Td (And so again, I just want to emphasize that although we do not have dire\ ct )Tj 0.214 Tw -3 -1.74 Td (power/jurisdiction over the state health departme)Tj 20.649 0 Td (nts, that for the past 40 years it\222s working )Tj 0.123 Tw -20.649 -1.72 Td (through this harmonization by developing standards of practice that are \ similar that has really )Tj 0 Tw T* (carried us through some tough times and some tough outbreaks.)Tj 25.551 0 Td ( )Tj ET endstream endobj 59 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 60 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (31)Tj ( )Tj ET Q BT 0.03 Tw 12 0 0 12 107.88 709.08 Tm (So, getting to IHR negotiation and approval, carrying)Tj 0 Tw 21.569 0 Td ( )Tj 0.03 Tw 0.28 0 Td (on from all that I\222ve already said, I )Tj 0.145 Tw -24.849 -1.72 Td (think you would have probably expected this slide, and that is that the \ U.S. government will )Tj 0.371 Tw 0 -1.72 TD (implement the International Health Regulations in a manner that is consi\ stent with our )Tj 0.365 Tw 0 -1.74 TD (fundamental principles of federalism,)Tj 0 Tw 16.09 0 Td ( )Tj 0.365 Tw 0.615 0 Td (that these International Health Regulations will be )Tj 0.042 Tw -16.705 -1.72 Td [(implemented )0.5(by )0.5(the )0.5(federal )0.6(government )0.5(to )0.5(the )0.5(extent )0.5(that )0.5(their )0.5(implementation )0.5(comes )0.5(under )0.5(our )]TJ 0.051 Tw 0 -1.72 TD [(jurisdiction. )0.5(This )0.5(is )0.5(something )0.5(that )0.5(is )0.5(going to... )0.5(we )0.5(discuss )0.5(very )0.5(often, )0.5(but )0.5(ultimately )0.5(this )0.5(is )0.5(the )]TJ 0 Tw T* (bottom )Tj 0.108 Tw 3.191 0 Td (line. To the extent that the International Health Regulation obligations\ come under the )Tj 0.165 Tw -3.191 -1.74 Td (jurisdiction of state and local governments we will bring these obligati\ ons with a favourable )Tj 0.179 Tw T* (recommendation, we will help state and local health departments accept t\ he)Tj 0 Tw 32.031 0 Td ( )Tj 0.179 Tw 0.429 0 Td (new obligations )Tj 0 Tw -32.46 -1.72 Td (under the IHR.)Tj ( )Tj 0.143 Tw 3 -1.72 Td (People may not know it but in each state a significant proportion of the\ public health )Tj 0.056 Tw -3 -1.74 Td (budget is actually given to the states by the federal government, and th\ at is pretty)Tj 0 Tw 33.25 0 Td (-)Tj 0.056 Tw (much usually )Tj 0.055 Tw -33.25 -1.72 Td [(without )0.5(strings )0.5(attached, )0.5(or )0.5(not )0.5(a )0.5(whol)]TJ [(e )0.5(lot of strings )0.5([laughter] but )0.5(it )0.5(is )0.5(given )0.5(there )0.5(so )0.5(they )0.5(can )]TJ 0.197 Tw T* (minister as they see fit. These are ways that we will work with them, th\ ese are things, the )Tj 0.074 Tw T* (financing of new ways accommodate the IHR obligations, or things that we\ will approach very )Tj 0 Tw 0 -1.74 TD (favourably)Tj 0.084 Tw (, and that we will work though consensus again, and assistance )Tj 0 Tw (\226)Tj ( )Tj 0.084 Tw 31.501 0 Td (both technical and )Tj 0 Tw -31.501 -1.72 Td (financial assistance )Tj (\226)Tj ( )Tj (with our states.)Tj ( )Tj 0.11 Tw 3 -1.72 Td (Actually, this is just restating all of that, and that is that we\222re \ going to work with our )Tj 0.165 Tw -3 -1.72 Td (professional groups, the professional gr)Tj (oups that represent state and local health officers and )Tj 0.001 Tw T* [(epidemiologists, to adopt the IHR 2005 requirements )0.5(as )0.5(a standard )0.5(for public health in the United )]TJ 0.04 Tw 0 -1.72 TD [(States, )0.5(and )0.5(that )0.5(as necessary )0.5(the )0.5(federal government )0.5(will )0.5(provide financial )0.6(and )0.5(technical )0.5(support )]TJ 0 Tw T* (to t)Tj (he states to adopt this new standard.)Tj ( )Tj 0.004 Tw 3 -1.72 Td (Because of the time and because we are getting a little behind I am goin\ g to skip over this )Tj 0.275 Tw -3 -1.74 Td (slide. It is again just restating where authority sits, and the fact tha\ t the public health is )Tj 0.166 Tw T* [(performed )0.5(by )0.5(state )0.5(and )0.5(local )0.5(he)]TJ [(alth )0.5(governments )0.5(but )0.5(that )0.5(technical )0.5(lab )0.5(assistance )0.5(does )0.5(come )]TJ 0 Tw T* (from the federal government.)Tj ( )Tj 0.086 Tw 3 -1.72 Td (Communication is actually one of our biggest and most important pieces. \ It\222s also been )Tj 0.037 Tw -3 -1.74 Td (one of our best technological advances over the last five years. CDC and\ the st)Tj (ates have worked )Tj 0.282 Tw T* (hard to put in place something called FEX. This is a rapid firewall prot\ ected site where )Tj 0.038 Tw T* [(privileged )0.5(information )0.5(can )0.5(move )0.5(between )0.5(federal, )0.5(state )0.5(and )0.5(local )0.5(health )0.5(officers. )0.5(This )0.5(is )0.5(become )]TJ 0.156 Tw T* [(an )0.5(incredibly )0.5(important )0.5(tool )0.5(for )0.6(us. )0.5(We )0.5(get )0.5(regular )0.5(n)]TJ 22.337 0 Td [(otifications )0.5(on )0.5(our )0.5(BlackBerries, )0.5(on )0.5(our )]TJ ET endstream endobj 61 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 62 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (32)Tj ( )Tj ET Q BT 0.032 Tw 12 0 0 12 71.88 709.08 Tm (cellphones, that we have to check in with out FEX mailbox. It\222s just \ been an incredibly valuable )Tj 0.111 Tw 0 -1.72 TD (tool. Right now, during spinach and our discussions about 0157 and spina\ ch, this thing is just )Tj 0.146 Tw T* (constantly going, it\222s )Tj (just constantly notifying people so there\222s constant updates. It\222s\ been, I )Tj 0.079 Tw 0 -1.74 TD (think, one of the real steps forward that we\222ve made in terms of the \ relationship between CDC )Tj 0 Tw 0 -1.72 TD (and local health departments.)Tj 11.718 0 Td ( )Tj 0.255 Tw -8.718 -1.72 Td (We still have health alert networks where we get out elec)Tj 25.432 0 Td (tronically or through fax )Tj 0.089 Tw -28.432 -1.72 Td (information to state health officers. And now we have a third piece out \ there and we have just )Tj 0.142 Tw 0 -1.74 TD (expanded the number of forward)Tj 0 Tw (-)Tj 0.142 Tw (deployed field stations that are maintained by the CDC. Up )Tj 0.048 Tw 0 -1.72 TD [(until )0.5(two )0.5(years )0.5(ago )0.5(there )0.5(were )0.5(only )0.6(eight qua)]TJ 18.43 0 Td [(rantine )0.5(stations )0.5(in )0.5(the )0.5(United )0.5(States. )0.5(We )0.5(have )0.5(now )]TJ 0.081 Tw -18.43 -1.72 Td (increased that to 18. By the end of the next fiscal year we will have in\ creased that to 20. Each )Tj 0.045 Tw T* (one of those quarantine stations has a jurisdiction, and each one of tho\ se quarantine stations can )Tj 0.074 Tw 0 -1.74 TD (serve as )Tj (a forward)Tj 0 Tw (-)Tj 0.074 Tw (deployed CDC resource for states that are within that jurisdiction. So w\ e\222ve )Tj 0.002 Tw 0 -1.72 TD (done a lot in terms of communication, and these things are probably the \ most valuable things that )Tj 0 Tw T* (we have done.)Tj ( )Tj 0.136 Tw 3 -1.72 Td (We will )Tj 0 Tw (\226)Tj ( )Tj 0.136 Tw 4.6 0 Td (the U.S. federal government )Tj 0 Tw (\226)Tj ( )Tj 0.136 Tw 12.98 0 Td (will express auth)Tj [(ority over )0.5(the public health )]TJ 0.044 Tw -20.58 -1.74 Td (emergencies within specific settings )Tj 0 Tw 14.895 0 Td (\226)Tj ( )Tj 0.044 Tw 0.794 0 Td (that should say \223settings\224 not \223jurisdictions\224 )Tj 0 Tw 18.318 0 Td (\226)Tj ( )Tj 0.044 Tw 0.794 0 Td (and that is )Tj 0.189 Tw -34.801 -1.72 Td (the settings where there\222s an international event or an interstate ev\ ent. Otherwise the public )Tj 0.215 Tw T* (health emergencies will be under)Tj 0 Tw ( )Tj 0.215 Tw 14.54 0 Td (the jurisdiction of state and local governments, and these )Tj 0.045 Tw -14.54 -1.72 Td (settings are those interstate events that involve non)Tj 0 Tw 20.672 0 Td (-)Tj 0.045 Tw (federal assets or non)Tj 0 Tw (-)Tj 0.045 Tw (federal resources. Why )Tj 0 Tw -20.672 -1.74 Td (non)Tj (-)Tj 0.013 Tw (federal? The best example would be a nuclear problem, a nuclear event. B\ ecause the nuclear )Tj 0 Tw T* (in)Tj 0.12 Tw (dustry is under the regulation of the United States government that woul\ d rapidly become a )Tj 0.044 Tw T* (federal event. That is something that cannot stay within the jurisdictio\ n of a state or local health )Tj 0 Tw T* (department.)Tj ( )Tj 0.09 Tw 3 -1.74 Td (Are there events that can say within a state and loc)Tj 21.169 0 Td (al health department? Yes, there are )Tj 0.056 Tw -24.169 -1.72 Td (many. But is it likely? No. And that is because of the... again getting \ back to the harmonization )Tj 0 Tw T* (and the cooperation and the voluntary nature of the systems that we have\ established.)Tj 34.101 0 Td ( )Tj 0.117 Tw -31.101 -1.72 Td [(With )0.5(regards )0.5(to )0.5(public )0.5(health )0.5(emerg)]TJ 14.994 0 Td [(encies )0.5(in )0.5(interstate )0.5(settings )0.5(the )0.5(U.S. )0.5(government )0.5(is )]TJ 0.041 Tw -17.994 -1.74 Td (committed to take all appropriate measures to facilitate the implementat\ ion of IHR\222s at the local )Tj 0 Tw T* (level.)Tj ( )Tj 0.352 Tw 3 -1.72 Td (What are the potential obstacles? They really come down to communication\ and )Tj 0.311 Tw -3 -1.72 Td (collaboration, just l)Tj (ike anything else. The states don\222t want a system where there\222s du\ al )Tj ET endstream endobj 63 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 64 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (33)Tj ( )Tj ET Q BT 0.058 Tw 12 0 0 12 71.88 709.08 Tm (reporting, they have to turn from one computer here and turn over to ano\ ther computer here for )Tj 0.151 Tw 0 -1.72 TD (dual reporting. We are working at that. There\222s a great deal of varia\ tion in the technologic)Tj 0 Tw 38.278 0 Td (al )Tj 0.275 Tw -38.278 -1.72 Td [(capacity )0.5(between )0.5(our )0.5(states )0.5(and )0.5(counties. )0.5(We )0.5(have )0.5(world )0.5(leaders )0.5(in )0.5(terms )0.5(of )0.5(technologic )]TJ 0.131 Tw 0 -1.74 TD (capacity, and we have other states that )Tj 0 Tw 16.522 0 Td (\226)Tj ( )Tj 0.131 Tw 0.881 0 Td (for either financial reasons or other resources )Tj 0 Tw 19.271 0 Td (\226)Tj ( )Tj 0.881 0 Td (just )Tj 0.136 Tw -37.555 -1.72 Td (simply do not, cannot come up to a given standard. So even within ou)Tj 29.679 0 Td (r country the variation )Tj 0 Tw -29.679 -1.72 Td (creates new challenges for us. There\222s always a need for more rapid m\ ovement of information.)Tj 37.93 0 Td ( )Tj 0.03 Tw -34.93 -1.72 Td (And actually I don\222t think that one of the obstacles is establishing \ our focal point, I think )Tj 0.08 Tw -3 -1.74 Td (that is moving along rapidly. Yeah, we\222ve ide)Tj (ntified the Office of the Secretary of HHS, and... )Tj 0.081 Tw 0 -1.72 TD (well, it\222s done from that point but now how do we get information to \ that person? Well, we\222re )Tj 0 Tw T* (working on that on a weekly basis.)Tj ( )Tj 0.153 Tw 3 -1.72 Td (How do we overcome these obstacles? I actually created one of CDC\222s f\ ew real)Tj 0 Tw (-)Tj (time )Tj 0.023 Tw -3 -1.74 Td [(ongoing )0.5(surveillance )0.5(networks, )0.5(and )0.5(that\222s )0.5(ArboNet )0.5(which )0.5(has )0.5(been used )0.5(to )0.5(monitor )0.5(to )0.5(West )0.5(Nile )]TJ 0.101 Tw T* (Virus, and these are actually the principles that we use to standardize \ data collection based on )Tj 0.018 Tw T* (scientific principles, to simplify data transfer that would)Tj 0 Tw 22.565 0 Td ( )Tj 0.018 Tw 0.268 0 Td (move necessary data, not desirable data. )Tj 0.185 Tw -22.833 -1.72 Td (You know, sitting in Fort Collins it\222s always desirable to know about\ the potassium in that )Tj 0 Tw 0 -1.74 TD (person on the third day of illness, but is it really necessary? We alway\ s come back to that.)Tj 35.961 0 Td ( )Tj -32.961 -1.72 Td (Web)Tj (-)Tj 0.256 Tw (based data systems: we\222re)Tj 0 Tw ( )Tj 0.256 Tw 13.908 0 Td (just starting this exploration where we have shared )Tj 0.108 Tw -16.908 -1.72 Td (workspaces that are jointly accessible and maintained by all three level\ s of government. XML )Tj 0.033 Tw 0 -1.72 TD (file transfer between data systems has been a godsend to us, dedicated c\ ommunications systems, )Tj 0 -1.74 TD (and then the pr)Tj (otocols. It\222s one thing to establish something but we need protocols \ on how these )Tj 0 Tw 0 -1.72 TD (things are done.)Tj ( )Tj 0.115 Tw 3 -1.72 Td (To overcome these obstacles we\222re going to require agreements on data\ sharing, we\222re )Tj 0 Tw -3 -1.72 Td (going to require ongoing development and access to secured electronic co\ )Tj 29.545 0 Td (mmunications systems.)Tj ( )Tj 0.136 Tw -26.545 -1.74 Td (So in summary )Tj 0 Tw (\226)Tj ( )Tj 0.136 Tw 7.599 0 Td (and this is my last slide )Tj 0 Tw (\226)Tj ( )Tj 0.136 Tw 11.311 0 Td (the obstacles to implementation remain a )Tj 0.04 Tw -21.91 -1.72 Td (decentralized public health system that anything that is implemented has\ to be done in a manner )Tj 0.039 Tw T* (that is consistent with our fundamental U.S. principl)Tj (es of federalism, and full implementation of )Tj 0.213 Tw T* (the new IHR\222s will rely on cooperation from state and local health de\ partments. The rapid )Tj 0.008 Tw 0 -1.74 TD (communication is always an important point, and then of course the need \ for technical support of )Tj 0.02 Tw 0 -1.72 TD (state and local health d)Tj (epartments. And then I think the last question that was on that format w\ as )Tj 0.064 Tw T* (do you expect the need for any assistance with the implementation. I don\ \222t think we do, I think )Tj 0 Tw T* (we\222ve got it pretty)Tj (-)Tj (well covered.)Tj ( )Tj ET endstream endobj 65 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 66 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (34)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (So with that I\222ll turn it over to Becky and then qu)Tj 19.747 0 Td (estions.)Tj ( )Tj -22.747 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Ms Rebecca Hathaway)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj (you, and good morning. Thank)Tj (-)Tj (you, Dr.)Tj ( )Tj (Marfin.)Tj ( )Tj 0.061 Tw T* (Let me be brief since I know we\222re running a little late this morning\ , but I want to echo )Tj 0 Tw -3 -1.72 Td (Dr.)Tj ( )Tj 0.042 Tw [(Marfin\222s )0.5(statement )0.5(about )0.5(the )0.6(fact )0.5(that )0.5(we )0.5(have )0.5(a )0.5(long )0.5(history )0.5(of )0.5(working )0.5(among o)]TJ 34.85 0 Td [(ur )0.5(federal, )]TJ 0.069 Tw -34.85 -1.74 Td (state and local public health entities in the U.S., cooperatively and co\ llaboratively if sometimes )Tj 0 Tw T* (informally, to share information and to address any issues of public hea\ lth emergencies.)Tj 35.157 0 Td ( )Tj 0.368 Tw -32.157 -1.72 Td (I think for us we are very fortunate, and Dr.)Tj 0 Tw 20.782 0 Td ( )Tj 0.368 Tw (Marfin men)Tj (tioned that the federal )Tj 0.03 Tw -23.782 -1.72 Td (government has funded the states to really, in this case, support, devel\ op and enhance some core )Tj 0.012 Tw 0 -1.74 TD (public health functions that are necessary for implementation of the IHR\ , and they do include the )Tj 0.217 Tw 0 -1.72 TD (improvement of epidemiology and surve)Tj (illance systems, laboratory capacity, communication )Tj 0.015 Tw T* (systems, and in this case I\222m talking about some of the secure electr\ onic communication systems )Tj 0.008 Tw T* (that we now have in place which Dr.)Tj 0 Tw 14.719 0 Td ( )Tj 0.008 Tw (Marfin pointed out in some of his slides. We also talk about )Tj 0.018 Tw -14.719 -1.74 Td [(risk )0.5(commun)]TJ [(ication )0.5(for )0.5(all )0.5(of )0.5(our )0.5(public )0.5(so that )0.5(we )0.5(speak )0.5(with )0.5(one )0.5(voice, )0.5(and )0.5(there )0.5(is )0.5(in )0.5(addition )]TJ 0.006 Tw T* (funding for training so that we can assure an effective public health wo\ rkforce )Tj 0 Tw 31.646 0 Td (\226)Tj ( )Tj 0.006 Tw 0.756 0 Td (whether that is a )Tj 0 Tw -32.402 -1.72 Td (local, state or federal workforce )Tj 12.993 0 Td (\226)Tj ( )Tj (to address any issues.)Tj ( )Tj 0.059 Tw -9.993 -1.72 Td (I think I)Tj 0 Tw ( )Tj 0.059 Tw 3.649 0 Td (would like to say as a representative of the states )Tj 0 Tw 20.363 0 Td (\226)Tj ( )Tj 0.059 Tw 0.809 0 Td (all the individual states this )Tj 0 Tw -27.821 -1.74 Td (morning )Tj 3.684 0 Td (\226)Tj ( )Tj 0.046 Tw 0.796 0 Td (that we concur with Dr.)Tj 0 Tw ( )Tj 0.046 Tw (Marfin that we should look at some of our current capacities )Tj 0.001 Tw -4.48 -1.72 Td (and systems to identify standards of practice and leverage those systems\ an)Tj 30.084 0 Td (d mechanisms that are )Tj 0.151 Tw -30.084 -1.72 Td (currently in place to ensure efficient and effective use of our assets a\ nd resources to support )Tj 0 Tw T* (implementation of the IHR.)Tj ( )Tj 3 -1.74 Td (And that\222s all I have this morning. Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.14 TD (Dr. Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj 0.08 Tw (you very much. I think we have a fair )Tj (bit of time now for some discussion. Any )Tj 0 Tw -3 -1.72 Td (questions? Dr.)Tj ( )Tj (Federov?)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf 0 -1.74 TD (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (YF:)Tj ( )Tj 0.088 Tw 3 0 Td (I have a question for Anthony. You mentioned you have a quarantine stati\ on. What are )Tj 0.098 Tw 0 -1.72 TD (their responsibilities, and where are they situated? At the cross points\ , front)Tj 31.264 0 Td (ier crossing )Tj 0 Tw -31.264 -1.74 Td (points, or somewhere else?)Tj ( )Tj ET endstream endobj 67 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 68 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (35)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (AM:)Tj ( )Tj 0.204 Tw 3 0 Td (Yes. Well, there have been quarantine stations )Tj 0 Tw 20.226 0 Td (\226)Tj ( )Tj 0.204 Tw 0.954 0 Td (federal quarantine stations )Tj 0 Tw (\226)Tj ( )Tj 0.204 Tw 12.367 0 Td (in the )Tj 0.074 Tw -33.547 -1.72 Td (United States for probably about 120 years now. They were first establis\ hed on the east )Tj 0.163 Tw 0 -1.72 TD (coast, again in response to commerce p)Tj 16.667 0 Td (rimarily. The yellow fever and smallpox were )Tj 0.043 Tw -16.667 -1.74 Td (problems and so there were quarantine stations primarily directed at mar\ itime health that )Tj 0 Tw T* (were established in the late 19th century.)Tj 16.355 0 Td ( )Tj -19.355 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.037 Tw 3 0 Td [(Following )0.5(World )0.5(War )0.5(II )0.5(there )0.6(were )0.6(many )0.5(changes. )0.5(As )0.5(increased )0.5(aviation )0.5(became)]TJ 0 Tw 33 0 Td ( )Tj 0.157 Tw -36 -1.72 Td (an entity there were quarantine stations that were set up primarily at t\ he international )Tj 0.328 Tw 0 -1.74 TD (airports as well as the maritime. In the early 1960s there were, I think\ , roughly )Tj 0 Tw 0 -1.72 TD (80)Tj ( )Tj 0.14 Tw [(quarantine )0.5(stations )0.5(in )0.5(the )0.5(United )0.5(States. )0.5(We )0.5(probably )0.5(had )0.5(the )0.5(third)]TJ 0 Tw 29.278 0 Td (-)Tj 0.14 Tw [(biggest )0.5(navy )]TJ 0 Tw (in )Tj 0.152 Tw -29.278 -1.72 Td (North America )Tj 0 Tw (\226)Tj ( )Tj 0.152 Tw 7.481 0 Td (it was a very large, large operation )Tj 0 Tw (\226)Tj ( )Tj 0.152 Tw 16.07 0 Td (and they had been reduced in )Tj 0 Tw -23.551 -1.72 Td (number after we won the war against infectious diseases in 1968 I think \ that was.)Tj 32.519 0 Td ( )Tj -35.519 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.027 Tw 3 0 Td (And then we started to expand them again. As I said, in 2004 there were \ eight, an )Tj 0 Tw -3 -1.72 Td (the)Tj 0.133 Tw (y were at the places that you would have expected, the big ports of entr\ y, and that )Tj 0.202 Tw T* [(would have been New York, Los Angeles, Chicago and Miami, )0.5(those are really our )]TJ 0.133 Tw T* (biggest four ports. In addition there were quarantine stations in Seattl\ e, Honolulu, San )Tj 0 Tw 0 -1.74 TD (Fran)Tj (cisco, Atlanta, and I think that\222s it.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.077 Tw 3 0 Td (And since that time we have put quarantine medical officers at all of th\ e ports )Tj 0 Tw (\226)Tj ( )Tj 0.022 Tw -3 -1.72 Td (that is a new thing )Tj 0 Tw (\226)Tj ( )Tj 0.022 Tw 8.462 0 Td [(and we\222ve increased the staff, and we\222ve increased )0.5(the )0.5(stations. And )]TJ 0.034 Tw -8.462 -1.72 Td (now there are quarantine stations at, well)Tj 16.617 0 Td (, essentially our 18 biggest cities in the country, )Tj 0.013 Tw -16.617 -1.74 Td [(so )0.5(we )0.5(now )0.5(have )0.5(quarantine )0.5(stations )0.5(in )0.5(Detroit, )0.5(we )0.5(have )0.5(quarantine )0.5(stations )0.5(in )0.5(Houston, )0.5(in )]TJ 0.205 Tw 0 -1.72 TD [(Dallas, )0.5(Forth )0.5(Worth. )0.5(We )0.5(have )0.5(two )0.5(quarantine )0.5(stations )0.5(that )0.5(are )0.5(primarily )0.5(involved )0.5(in )]TJ 0.209 Tw T* (border health issues, so we ha)Tj (ve one is San Diego and one in El Paso, and they\222re )Tj 0.018 Tw T* (working along the land border. We have stations in Boston and in Dulles,\ and so we\222ll be )Tj 0 Tw 0 -1.74 TD (adding others.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.215 Tw 3 0 Td (The function has changed somewhat. Our quarantine medical officers are n\ ot )Tj 0.108 Tw -3 -1.72 Td (there to really look an)Tj (d wait for ill passengers to come through, they\222re intended to be )Tj 0.047 Tw 0 -1.72 TD (there to be a CDC resource for disease control in the community, a regio\ nal resource, so )Tj 0.064 Tw 0 -1.74 TD (that for instance if the State of New York had to rapidly communicate so\ mething where )Tj 0.242 Tw 0 -1.72 TD (they wanted CDC)Tj 0 Tw ( )Tj 0.242 Tw 8.142 0 Td (assistance and they were not getting the response out of Atlanta )Tj 0.044 Tw -8.142 -1.72 Td (directly they could go directly to the New York City quarantine station.\ We are a part of )Tj 0.056 Tw T* (the CDC, we see ourselves as part of the CDC, and we see one of our main\ functions to )Tj ET endstream endobj 69 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 70 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (36)Tj ( )Tj ET Q BT 0.066 Tw 12 0 0 12 107.88 709.08 Tm (be communicati)Tj (on with headquarters, but mostly we are there to put in place systems to\ )Tj 0.036 Tw 0 -1.72 TD [(identify ill passengers with diseases )0.5(of public health significance, and that\222s really where )]TJ 0 Tw T* (we spent a lot of our time over the past year trying to define just what\ those are.)Tj 31.935 0 Td ( )Tj -34.935 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.26 Tw 3 0 Td (In t)Tj (hat way we\222re very different than quarantine medical officers that si\ t in )Tj 0.08 Tw -3 -1.72 Td (quarantine stations say in Germany or Japan where they may have a comple\ te intensive )Tj 0.086 Tw T* (care unit, they may have multiple surgical suites, they may have a nursi\ ng staff of 300. )Tj 0.108 Tw T* (We do no)Tj (t have that. In fact... and this is actually directly relevant to the IH\ R because )Tj 0.065 Tw 0 -1.74 TD (you say, \223Well, where are your resources, then? How are you going to \ meet the need to )Tj 0.052 Tw 0 -1.72 TD (intervene?\224 Again, we work with state and local health departments, a\ nd we have many, )Tj 0 Tw T* (ma)Tj 0.09 Tw (ny fine intensive care units within miles of an airport, and we have agr\ eements with )Tj 0.003 Tw T* [(them )0.5(with )0.5(regards )0.5(to )0.5(the )0.5(transport )0.5(and )0.5(care )0.5(of )0.5(ill )0.5(passengers )0.5(with )0.5(diseases )0.5(of )0.5(public )0.5(health )]TJ 0.082 Tw 0 -1.74 TD (significance. We transport other people too, but we are working very, ve\ ry clo)Tj 32.279 0 Td (sely with )Tj 0.172 Tw -32.279 -1.72 Td (specific hospitals that are in the proximity of large maritime ports, la\ rge airports and )Tj 0 Tw 0 -1.72 TD (large land border crossings to accommodate our nine quarantinable diseas\ es.)Tj 30.656 0 Td ( )Tj -33.656 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.237 Tw 3 0 Td (This underscores our need to define a public health emergency a little m\ ore )Tj 0 Tw -3 -1.74 Td (bro)Tj 0.137 Tw (adly than those nine diseases, and we are constantly pushing people to b\ e thinking )Tj 0 Tw T* (about other things other than those nine entities.)Tj 19.218 0 Td ( )Tj -22.218 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (I think Dr. St.)Tj ( )Tj (John wanted to make a comment.)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 0.152 Tw 3 0 Td (Just to add a quick comment, Canada found itself in exactly the sam)Tj (e position as the )Tj 0.143 Tw 0 -1.74 TD (Unit.ted States because we had effectively disbanded our quarantine prog\ ram over the )Tj 0.131 Tw 0 -1.72 TD (years. Following SARS it was a government decision to rebuild, but to re\ build almost )Tj 0.078 Tw T* (identically along the same lines that the United States has rebuilt )Tj 26.987 0 Td (is quarantine services, )Tj 0.046 Tw -26.987 -1.72 Td (with almost the identical mission and the same objectives, so we have a \ very compatible )Tj 0 Tw 0 -1.74 TD (system between Canada and the United States for quarantine. Thank)Tj 27.325 0 Td (-)Tj (you.)Tj ( )Tj -30.325 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Next we have questions from first Dr.)Tj ( )Tj (Lazar and then Dr.)Tj ( )Tj (von Tigerstr)Tj (om.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Thanks for the presentation, Dr.)Tj ( )Tj (Marfin. That was really excellent, so I thank you for that.)Tj 35.933 0 Td ( )Tj -38.933 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.195 Tw 3 0 Td (You emphasized, I think as forcefully as you could, the federal nature o\ f the )Tj 0.114 Tw -3 -1.74 Td (public health system in the United States, and if I understood you corre\ ctl)Tj (y the United )Tj 0.007 Tw 0 -1.72 TD (States government )Tj 0 Tw (\226)Tj ( )Tj 0.007 Tw 8.436 0 Td (the federal government )Tj 0 Tw 9.545 0 Td (\226)Tj ( )Tj 0.007 Tw 0.757 0 Td (accepts the IHR obligations insofar as U.S. )Tj 0.012 Tw -18.738 -1.72 Td (government has authority and capacity, but for things where it doesn\222\ t it\222s recommending )Tj 0.052 Tw T* (that the state and local authorities assume the responsibilities,)Tj 0 Tw 25.052 0 Td ( )Tj 0.052 Tw 0.302 0 Td (but it\222s up to the state and )Tj ET endstream endobj 71 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 72 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (37)Tj ( )Tj ET Q BT 0.056 Tw 12 0 0 12 107.88 709.08 Tm (local authorities to do so of their own volition. You also then talk abo\ ut the fact that the )Tj 0.164 Tw 0 -1.72 TD [(U.S. )0.5(government )0.5(transfers )0.5(some )0.5(money )0.5(I )0.5(think )0.5(to )0.5(state )0.5(and )0.6(local. )0.6(Is )0.6(it )0.6(both )0.6(state )0.6(and )]TJ 0 Tw T* (local?)Tj ( )Tj -3 -1.74 Td (AM:)Tj ( )Tj 0.114 Tw 3 0 Td (Yes, there are several... we give mo)Tj [(ney to almost all states with regards to STD, )0.5(HIV, )]TJ 0.006 Tw T* (TB. There are several emerging infections, we do give a great deal of mo\ ney to the states. )Tj 0.013 Tw T* (But in addition there are some very large metropolitan areas that will g\ ive money directly )Tj 0.112 Tw T* (to. New York City is an)Tj 0 Tw ( )Tj 0.112 Tw 10.474 0 Td (example of that, Los Angeles is an example of that, Chicago, )Tj 0.193 Tw -10.474 -1.74 Td (Philadelphia is an example of that, so there\222s roughly about 62 entit\ ies that we give )Tj 0 Tw T* (money to.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.006 Tw 1.389 0 Td (I guess my question is, you made a comment about it was unconditional bu\ t then you said )Tj 0.118 Tw T* (some o)Tj [(f it is conditional, and then )0.5(the )0.5(two )0.5(of )0.5(you )0.5(laughed, )0.5(so )0.5(my )0.5(guess )0.5(is )0.5(that )0.5(in )0.5(that )]TJ 0.041 Tw 0 -1.74 TD (laugher there\222s a story. Could you elaborate a little bit on the exte\ nt of the conditionality )Tj 0.101 Tw 0 -1.72 TD (or non)Tj 0 Tw (-)Tj 0.101 Tw (conditionality associated? I guess what I\222m really ultimately driving\ at )Tj 32.52 0 Td (is if you )Tj 0.229 Tw -32.52 -1.72 Td (had some state and local governments that were less enthusiastic than ot\ hers in the )Tj 0.048 Tw T* (implementation of the IHR, to what extend does U.S. government practice \ enable you to )Tj 0 Tw 0 -1.74 TD (use conditional grants to move these folks along?)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.23 Tw 3 0 Td (I can give you an exam)Tj (ple of something that we did with regards to ArboNet, our )Tj 0.077 Tw 0 -1.72 TD (arbovirus surveillance system, in that there were a significant proporti\ on of surveillance )Tj 0.463 Tw T* (and public health dollars given out through one of our cooperative agree\ ment )Tj 0.084 Tw 0 -1.74 TD (mechanisms, and it very specif)Tj (ically said that you will cooperate with ArboNet. That is )Tj 0 Tw 0 -1.72 TD (about as direct as I have ever seen it written.)Tj 17.771 0 Td ( )Tj -20.771 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.095 Tw 3 0 Td (Now, we had a responsibility to make ArboNet an accessible system to the\ m as )Tj 0.041 Tw -3 -1.72 Td (well, and we worked very hard. Becky and I just actually just met today)Tj 0 Tw 29.281 0 Td ( )Tj 0.041 Tw 0.291 0 Td (so I\222ve not seen )Tj 0.107 Tw -29.572 -1.74 Td [(her )0.5(at )0.5(the )0.5(West )0.5(Nile )0.5(meetings, )0.5(but )0.5(all )0.6(our )0.5(annual )0.5(meetings )0.5(we )0.5(spend )0.5(a )0.5(full )0.5(day )0.5(talking )]TJ 0.023 Tw T* (with our partners, \223How do we need to change this?\224 And so we went\ from a system that )Tj 0.128 Tw T* (took probably about 20 minutes to enter every infected bird in th)Tj 27.267 0 Td (e country to one that )Tj 0 Tw -27.267 -1.72 Td (comes up with a location, a tag, a species, and that\222s it.)Tj 21.966 0 Td ( )Tj -24.966 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.114 Tw 3 0 Td [(And )0.5(so )0.5(we )0.5(have )0.5(worked )0.5(with )0.5(them )0.5(to )0.5(modify )0.6(that )0.6(system, )0.6(but )0.6(ultimately )]TJ 0 Tw (\226)Tj ( )Tj 31.556 0 Td (and )Tj 0.159 Tw -34.556 -1.72 Td [(this )0.5(is )0.5(where )0.5(the )0.5(laughter )0.5(comes )0.5(from )]TJ 0 Tw (\226)Tj ( )Tj 0.159 Tw 17.319 0 Td [(we )0.5(said, )0.5(\223If )0.5(you )0.5(want )0.5(these )0.5(dollars )0.5(you )0.5(will )]TJ 0 Tw -17.319 -1.72 Td (partake in t)Tj (his system,\224 and so we would do that.)Tj ( )Tj ET endstream endobj 73 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 74 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (38)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.034 Tw 3 0 Td (Is there )Tj 0 Tw (\226)Tj ( )Tj 0.034 Tw 4.074 0 Td (and I guess this is a market)Tj 0 Tw (-)Tj 0.034 Tw (driven kind of thing )Tj 0 Tw 19.729 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (is there a set number )Tj 0.056 Tw -27.588 -1.72 Td (of dollars where somebody would say, \223We don\222t want to report to A\ rboNet. Keep your )Tj 0.114 Tw 0 -1.72 TD (money.\224 We have not run into that yet. [laughte)Tj 20.014 0 Td (r] Public health dollars are tight in the )Tj 0.021 Tw -20.014 -1.74 Td (United States right now, and in fact the federal government is probably.\ .. I\222m going to let )Tj 0 Tw T* (Becky get into trouble saying how big our proportion is.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.153 Tw 1.389 0 Td (That was actually going to be my next question, what proporti)Tj 26.389 0 Td (on of the public health )Tj 0 Tw -26.389 -1.72 Td (dollars do come from Washington... or, Atlanta?)Tj ( )Tj -3 -1.74 Td (RH:)Tj ( )Tj 0.008 Tw 3 0 Td (I think it differs state by state. In some states almost 100% of local p\ rogrammatic funding )Tj 0.088 Tw T* (comes from federal dollars. And I will use an example of New York specif\ ically, and I )Tj 0 Tw T* (ca)Tj 0.163 Tw (n speak to STD and TB because Dr.)Tj 0 Tw ( )Tj 0.163 Tw (Marfin\222s already mentioned them, but in New )Tj 0.04 Tw T* (York to run that program and to sustain it the state looks at federal do\ llars, which can be )Tj 0.067 Tw 0 -1.74 TD (problematic at times if you\222re hoping that your state government will\ also support som)Tj 0 Tw 35.556 0 Td (e )Tj -35.556 -1.72 Td (of the activities for disease intervention and control.)Tj 20.827 0 Td ( )Tj -23.827 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.056 Tw 3 0 Td (In other states it\222s very different, so again that\222s our independe\ nce. I can say this )Tj 0.309 Tw -3 -1.72 Td (about the dollars. The dollars are usually granted under what we call co\ operative )Tj 0.07 Tw T* (agreements, and there is usu)Tj (ally a spirit of cooperation about how do we hold ourselves )Tj 0.012 Tw 0 -1.72 TD (accountable and what is built into those systems so that we can say ther\ e are deliverables, )Tj 0.069 Tw T* (there are outcomes that all of us are expected to achieve. And we do usu\ ally have to do )Tj 0.056 Tw T* (some kind of rep)Tj (orting to show that we are progressing in a manner that will achieve an \ )Tj 0.197 Tw 0 -1.74 TD (overall goal, both programmatically and we have to show that we were als\ o fiscally )Tj 0 Tw 0 -1.72 TD (responsible.)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (I think next Dr.)Tj ( )Tj (von Tigerstrom, then Dr.)Tj ( )Tj (Krishnan.)Tj ( )Tj -3 -1.72 Td (BT:)Tj ( )Tj 0.001 Tw 3 0 Td (Hi. Dr.)Tj 0 Tw ( )Tj 0.001 Tw (Marfin, you mentione)Tj [(d )0.5(a )0.5(couple )0.5(of )0.5(issues, )0.5(first )0.5(of )0.5(all )0.6(the )0.5(variation )0.5(in )0.5(the )0.5(definition )]TJ 0.063 Tw 0 -1.74 TD (of notifiable disease from state to state )Tj 0 Tw (\226)Tj ( )Tj 0.063 Tw 16.941 0 Td (which is also an issue here in Canada, I would )Tj 0.081 Tw -16.941 -1.72 Td [(imagine )0.5(most )0.5(federal )0.5(states )]TJ 0 Tw (\226)Tj ( )Tj 0.081 Tw 12.315 0 Td [(and )0.5(also )0.5(the )0.5(efforts )0.5(at )0.5(the )0.5(federal )0.5(level )0.5(to )0.5(start )0.5(integrating )]TJ 0 Tw -12.315 -1.72 Td (this )Tj 0.241 Tw 1.936 0 Td (concept of public health emergency of international concern or potential\ public )Tj 0.116 Tw -1.936 -1.72 Td (health emergency of international concern to your definition. And so I\222\ m curious as to )Tj 0.052 Tw T* (whether you can share any knowledge about efforts that are going on, esp\ ecially dealing )Tj 0 Tw 0 -1.72 TD (w)Tj 0.086 Tw (ith harmonization between the states, specifically on that issue of the \ list of notifiable )Tj 0.264 Tw T* [(disease but also in terms of public health )0.5(capacities )0.5(as )0.5(well, in )0.5(terms of the legal )]TJ 0.304 Tw T* (framework, and also to the extent that that\222s happening whether it\222\ s incorporati)Tj 0 Tw 35 0 Td (ng )Tj ET endstream endobj 75 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 76 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (39)Tj ( )Tj ET Q BT 0.06 Tw 12 0 0 12 107.88 709.08 Tm (concepts from the IHR and speaking to core capacities and that concept o\ f public health )Tj 0 Tw 0 -1.72 TD (emergency.)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.121 Tw 3 0 Td (That is actually one of those questions where I am going to have to say \ this truly is a )Tj 0.069 Tw 0 -1.74 TD (work in progress. We are now putting together our strategy )Tj 0 Tw (\226)Tj ( )Tj 25.421 0 Td (w)Tj 0.069 Tw (ith state partners, by the )Tj 0 Tw -25.421 -1.72 Td (way )Tj 1.944 0 Td (\226)Tj ( )Tj 0.028 Tw 0.778 0 Td (to come up with the mechanism, the strategy, for incorporating this into\ the nature )Tj 0 Tw -2.723 -1.72 Td (of reportable diseases )Tj (\226)Tj ( )Tj (or notifiable diseases )Tj (\226)Tj ( )Tj (for all states.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.1 Tw 3 0 Td (Some of the things that we talk about are introducing this concept of t)Tj (he public )Tj 0.107 Tw -3 -1.74 Td [(health )0.5(emergency )0.5(with )0.5(potential )0.5(international )0.5(consequences )0.5(is )0.5(through )0.5(Council )0.5(of )0.5(State )]TJ 0.086 Tw 0 -1.72 TD (and Territorial Epidemiologists, introducing it as a proposal that all s\ tates would accept )Tj 0 Tw T* (and then integrate into their state public health department.)Tj 23.575 0 Td ( )Tj -26.575 -1.72 Td ( )Tj 3 0 Td ( )Tj 3 0 Td (Ther)Tj 0.12 Tw (e would be a second piece to that where we would have very little contro\ l )Tj 0.051 Tw -3 -1.74 Td [(and )0.5(that )0.5(is )0.5(then )0.5(the )0.5(states )0.5(themselves )0.5(would )0.5(have )0.5(to )0.5(work )0.5(with )0.5(their )0.5(counties )0.5(or )0.5(parishes )]TJ 0.072 Tw T* (to get that involved. In Oregon we had a county council of local health \ officers that got )Tj 0 Tw T* (to)Tj 0.073 Tw (gether and in a very analogous system would look at a proposal )Tj 0 Tw (\226)Tj ( )Tj 0.073 Tw 28.133 0 Td (something that was )Tj 0.016 Tw -28.133 -1.72 Td [(brought )0.5(in )0.5(my )0.5(the )0.5(State )0.5(of )0.6(Oregon )]TJ 0 Tw (\226)Tj ( )Tj 0.016 Tw 14.844 0 Td [(and )0.5(then )0.5(look )0.5(for )0.5(general discussion )0.5(and )0.5(acceptance, )]TJ 0.125 Tw -14.844 -1.74 Td (revision in all of these things, and then acceptance, and then... I mean\ , very simi)Tj 33.793 0 Td (lar to )Tj 0.105 Tw -33.793 -1.72 Td (what we\222re doing here, because those counties are signatories or they\ \222re participants in )Tj 0.015 Tw T* [(that )0.5(particular )0.5(council, )0.5(they )0.5(would )0.5(say, )0.5(\223Yes, )0.5(this )0.5(is )0.5(now )0.5(something )0.5(that )0.5(we )0.5(will )0.5(integrate )]TJ 0 Tw T* (into our county.\224)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.085 Tw 3 0 Td (So it\222s a long process. One of the good points a)Tj (bout it is that it is scientifically)Tj 0 Tw 32.667 0 Td (-)Tj 0.054 Tw -35.667 -1.72 Td (based, for the most part, that we bring in scientifically)Tj 0 Tw (-)Tj 0.054 Tw (based case definitions, laboratory )Tj 0.284 Tw T* [(methods and those things, so it\222s very responsive to that. )0.5(But )0.5(it )0.5(is )0.5(a )0.5(method )0.5(that )]TJ 0.152 Tw T* (sometimes may take a year to several years )Tj (to put in place, to craft that resolution at )Tj 0 Tw 0 -1.74 TD (CSTE.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.137 Tw 3 0 Td (I\222m not as familiar with ASTHOR, so if there are similar processes th\ at go on )Tj 0 Tw -3 -1.72 Td (there.)Tj ( )Tj -3 -1.72 Td (RH:)Tj ( )Tj 0.064 Tw 3 0 Td (There are similar processes, and currently the states that... this is ki\ nd of a little sidebar, )Tj 0.119 Tw T* (and this is why we)Tj 0 Tw ( )Tj 0.119 Tw 8.29 0 Td (have to integrate what we\222re doing. Some states that share borders )Tj 0.094 Tw -8.29 -1.72 Td (with Canada and Mexico have received funding for an early warning infect\ ious disease )Tj 0.049 Tw 0 -1.72 TD (surveillance project, and not only are we working with our sister states\ on the borders to )Tj 0.282 Tw T* (work on some)Tj 0 Tw ( )Tj 0.282 Tw 6.763 0 Td (issues about what diseases do we all consider to be notifiable and )Tj ET endstream endobj 77 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 78 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (40)Tj ( )Tj ET Q BT 0.01 Tw 12 0 0 12 107.88 709.08 Tm (reportable and we will share... we\222re working through data sharing ag\ reements, and that\222s )Tj 0.086 Tw 0 -1.72 TD (a legal issue that I cannot address, but we\222re also working with the \ Canadian provinces )Tj 0.038 Tw T* (and with M)Tj (exico now, so that we not only do this on a regional basis but we also d\ o this )Tj 0 Tw 0 -1.74 TD (with these two countries.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.078 Tw 3 0 Td (And when we look at certain notifiable conditions and what we all can ag\ ree to, )Tj 0.014 Tw -3 -1.72 Td [(we )0.5(also )0.5(within )0.5(the )0.5(state )]TJ 0 Tw (\226)Tj ( )Tj 0.014 Tw 10.468 0 Td [(and )0.5(I )0.5(will )0.5(speak )0.5(for )0.6(New )0.5(York )0.5(but )0.5(some )0.5(oth)]TJ [(er )0.5(states )0.5(do )0.5(this )0.5(too )]TJ 0 Tw -10.468 -1.72 Td (\226)Tj ( )Tj 0.036 Tw 0.786 0 Td [(we legislate which diseases )-0.6(and conditions will be reported from the local health entity )]TJ 0 Tw -0.786 -1.74 Td (\226)Tj ( )Tj 0.06 Tw 0.81 0 Td (and some states have them, and Dr.)Tj 0 Tw ( )Tj 0.06 Tw (Marfin mentioned that some states don\222t, the state )Tj 0.126 Tw -0.81 -1.72 Td (is the local health entity\(?\) )Tj 0 Tw (\226)Tj ( )Tj 0.126 Tw 12.417 0 Td (but we legislate what w)Tj (ill be reported to the state health )Tj 0.133 Tw -12.417 -1.72 Td (department, and when it\222s reported, and how it\222s reported, and exa\ ctly what necessary )Tj 0 Tw 0 -1.72 TD (information should be reported. And that does take time.)Tj 22.661 0 Td ( )Tj -25.661 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.024 Tw 3 0 Td (So there\222s two things going on between states and locals because New \ York S)Tj 0 Tw 31.557 0 Td (tate )Tj 0.328 Tw -34.557 -1.72 Td (added \222flu as one of their reportable diseases and legislated that th\ e local health )Tj 0.154 Tw T* (departments will now report certain cases )Tj 0 Tw 17.808 0 Td (\226)Tj ( )Tj 0.154 Tw 0.904 0 Td (I\222m not going to go into too much detail )Tj 0.089 Tw -18.712 -1.72 Td (about that )Tj 0 Tw (\226)Tj ( )Tj 0.089 Tw 5.237 0 Td (up to the state. And the states are working among one another, too, t)Tj 28.424 0 Td (o talk )Tj 0.115 Tw -33.662 -1.74 Td (about what can we all agree to share with data about notifiable diseases\ that may be a )Tj 0.1 Tw T* (concern to all of us. There are no boundaries when it comes to land, air\ or sea borders )Tj 0 Tw T* (because infectious diseases aren\222t noted for stopping there.)Tj 23.547 0 Td ( )Tj -26.547 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.082 Tw 1.056 0 Td (Just a po)Tj (int of clarification. We were normally scheduled for a coffee break now \ but in )Tj 0.019 Tw 0 -1.74 TD (the interests of time what I\222m going to suggest is people can very qu\ ietly go in and out to )Tj 0.182 Tw 0 -1.72 TD (get refreshments. I think I want to continue with this discussion and I \ don\222t want to)Tj 0 Tw ( )Tj 0.07 Tw T* (interrupt it, so if that\222s okay with people there should be refreshme\ nt available and then )Tj 0 Tw T* (we\222ll continue with questions.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 3 0 Td (Next is Dr.)Tj ( )Tj (Krishnan.)Tj ( )Tj -6 -1.72 Td (SK:)Tj ( )Tj 0.022 Tw 3 0 Td (My question to Dr.)Tj 0 Tw ( )Tj 0.022 Tw (Marfin is how much dependence are the states as far as on the federal )Tj 0 Tw T* (laboratories are)Tj ( )Tj (concerned?)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.097 Tw 3 0 Td (I think that that, too, is very similar to the rest of our operations. T\ here are... matter of )Tj 0.075 Tw 0 -1.74 TD (fact it may be even moreso just simply because of the nature of reagents\ . Here the U.S. )Tj 0.161 Tw 0 -1.72 TD (Centers for Disease Control has a large infrastructure bac)Tj (k in Atlanta where we have )Tj 0.23 Tw T* (laboratorians that are not involved with a particular state, they\222re \ not involved with )Tj 0.005 Tw T* (running a particular public health program, but they\222re researchers a\ nd they are doing one )Tj ET endstream endobj 79 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 80 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (41)Tj ( )Tj ET Q BT 0.027 Tw 12 0 0 12 107.88 709.08 Tm [(thing )0.5(and )0.5(that )0.5(is )0.5(developing )0.5(laboratory )0.5(tests. This)]TJ 0 Tw 19.96 0 Td ( )Tj 0.027 Tw 0.277 0 Td [(kind )0.5(of )0.5(goes )0.5(back )0.5(in )0.5(the )0.5(history of )]TJ 0 Tw (\226)Tj ( )Tj 14.93 0 Td (as )Tj 0.079 Tw -35.167 -1.72 Td (you can see, I\222m a historian at heart )Tj 0 Tw 15.157 0 Td (\226)Tj ( )Tj 0.079 Tw 0.829 0 Td (it kind of goes back to the history of CDC when )Tj 0.03 Tw -15.986 -1.72 Td (there was the Bureau of Epidemiology and the Bureau of Labs, and then th\ ey kind of got )Tj 0 Tw 0 -1.74 TD (merged together and forced to work toge)Tj (ther.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.174 Tw 3 0 Td (Those laboratorians, that\222s all they did, they just made tests, they \ made better )Tj 0.086 Tw -3 -1.72 Td (tests, they made better reagents. Monoclonals came on the scene, all the\ tests had to be )Tj 0.063 Tw 0 -1.72 TD (revised. Nucleic acid amplification comes on the scene, how are we going\ to im)Tj 0 Tw 32.779 0 Td (plement )Tj -32.779 -1.74 Td (those? And that\222s what those people do.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.052 Tw 3 0 Td (That is an expensive undertaking, and there are very, very few labs in t\ he United )Tj 0 Tw -3 -1.72 Td (States )Tj 2.673 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (on the state level )Tj 0 Tw 7.135 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (that would do that. One of them is Wadsworth in New York, )Tj 0.012 Tw -11.377 -1.72 Td (that they will develop new tests for)Tj 0 Tw ( )Tj 0.012 Tw 14.384 0 Td (deployment across the United States. The other one is )Tj 0.046 Tw -14.384 -1.74 Td (the California Public Health Laboratory in Richmond that will do the sam\ e thing, and so )Tj 0.093 Tw T* (they\222re deployed... and Texas, to some extent, and Michigan. These ar\ e the ones where )Tj 0 Tw T* (they may make some and depl)Tj (oy them very, very widely.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.074 Tw 3 0 Td (So ultimately new tests, most of them are coming out of the Centers for \ Disease )Tj 0.114 Tw -3 -1.74 Td (Control, and then they\222re being shared. The reagents )Tj 0 Tw 22.185 0 Td (\226)Tj ( )Tj 0.114 Tw 0.864 0 Td (new reagents )Tj 0 Tw (\226)Tj ( )Tj 0.114 Tw 6.59 0 Td (because they\222re )Tj 0.065 Tw -29.64 -1.72 Td (limited, sometimes the distribution has to be limited, and th)Tj 24.39 0 Td (at has been a problem in the )Tj 0 Tw -24.39 -1.72 Td (past, it\222s been a problem with the pan \222flu reagents in terms of g\ etting wide distribution.)Tj 35.187 0 Td ( )Tj -38.187 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.125 Tw 3 0 Td (But the financial underpinnings for those laboratories are also coming f\ rom the )Tj 0.014 Tw -3 -1.74 Td (federal government. There are cooperative agreements )Tj 22.156 0 Td (with regards to the laboratory, and )Tj 0 Tw -22.156 -1.72 Td (money is going, and it funds a lot of what they do at the state laborato\ ries.)Tj 29.632 0 Td ( )Tj -32.632 -1.72 Td (SK:)Tj ( )Tj 0.036 Tw 3 0 Td (Clarify a little. The states are dependent on the lab confirmation from \ the federal side, or )Tj 0 Tw T* (are the states committed enough to do the lab)Tj 18.106 0 Td ( )Tj (confirmation at a state level?)Tj ( )Tj -21.106 -1.74 Td (AM:)Tj ( )Tj 0.058 Tw 3 0 Td (It depends on the states. There are many states that do not want to conf\ irm, they will do )Tj 0.037 Tw T* (all of the preliminary stuff, because the cost of confirming the one or \ two cases that may )Tj 0.158 Tw T* [(occur within their border )0.5(over a )0.5(ten)]TJ 0 Tw (-)Tj (ye)Tj 0.158 Tw (ar time period, the machinery alone is just too )Tj 0.146 Tw T* (expensive, so they\222ll very often be involved in the high)Tj 0 Tw 23.365 0 Td (-)Tj 0.146 Tw (level screening tests and then )Tj 0 Tw -23.365 -1.74 Td (move it to Atlanta very, very quickly for a confirmatory test.)Tj 24.271 0 Td ( )Tj -27.271 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.124 Tw 3 0 Td (Again, there are some laboratories where that is not ne)Tj 0 Tw (cessary )Tj 26.255 0 Td (\226)Tj ( )Tj 0.124 Tw 0.874 0 Td (California and )Tj 0.16 Tw -30.128 -1.72 Td (New York being two of the best examples of that. We are involved in a ce\ rtification )Tj 0.06 Tw T* (program looking at laboratories and asking them, \223Do you have the abi\ lity, do you have )Tj ET endstream endobj 81 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 82 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (42)Tj ( )Tj ET Q BT 0.188 Tw 12 0 0 12 107.88 709.08 Tm (the core capacity to be part of a laboratory response networ)Tj 25.592 0 Td (k?\224 and so there will be )Tj 0 Tw -25.592 -1.72 Td (certain labs that will be identified as being capable of doing the final\ confirmatory test.)Tj 34.794 0 Td ( )Tj -37.794 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.074 Tw 1.056 0 Td [(I )0.5(think )0.5(Dr.)]TJ 0 Tw ( )Tj 0.074 Tw [(Lazzari )0.5(is )0.5(next. )0.5(If )0.5(I )0.5(could )0.5(just )0.5(ask )0.5(a )0.5(quick )0.5(question )0.5(before )0.6(that. )0.5(The )0.5(wording )]TJ 0.101 Tw 0 -1.74 TD (you had up there on the issue of complying w)Tj (ith the IHR as committed under the U.S. )Tj 0.071 Tw 0 -1.72 TD (system of government, it seems familiar, it was taken from the announcem\ ent that there )Tj 0.066 Tw T* (may be an intent to issue a reservation on this issue. I was wondering i\ f you\222re aware if )Tj 0.088 Tw T* (that intent to issue a narrowly tailore)Tj (d reservation around the federal issue is still being )Tj 0 Tw 0 -1.74 TD (considered.)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.043 Tw 3 0 Td (I think that within HHS and Department of State that people continue to \ discuss how we )Tj 0.059 Tw 0 -1.72 TD [(can )0.5(best )0.5(accommodate )0.5(the )0.5(needs )0.5(for )0.5(the )0.5(IHR\222s, )0.6(to get )0.5(state )0.6(and )0.5(local )0.5(health )0.5(departments )]TJ 0.011 Tw T* (to cooperat)Tj (e, as well as still to meet our needs around federalism, so the discussi\ on is still )Tj 0 Tw 0 -1.74 TD (ongoing and I can\222t comment on whether there\222s a formal one coming\ down.)Tj 30.741 0 Td ( )Tj -33.741 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Dr.)Tj ( )Tj (Lazzari?)Tj ( )Tj -3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 0.137 Tw 1.555 0 Td (Yes. Dr.)Tj 0 Tw ( )Tj 0.137 Tw (Marfin, thank)Tj 0 Tw (-)Tj 0.137 Tw (you very much for your presentation. I particularly app)Tj 0 Tw 32.836 0 Td (reciated )Tj 0.049 Tw -32.836 -1.72 Td (the table on the core function at the different levels within the federa\ l government, and I )Tj 0.173 Tw T* (think it highlight very well a problem we\222re trying to deal with in l\ ooking how core )Tj 0.221 Tw 0 -1.72 TD (capacity can be implemented, and that is that the way you illustrated )Tj 30.283 0 Td (it, in fact the )Tj 0.21 Tw -30.283 -1.72 Td (functions within the IHR Annex 1 at central level, many of these functio\ ns actually )Tj 0.021 Tw T* (within the U.S. system are not at central level )Tj 0 Tw 18.658 0 Td (\226)Tj ( )Tj 0.021 Tw 0.771 0 Td (federal level )Tj 0 Tw (\226)Tj ( )Tj 0.021 Tw 6.032 0 Td (at all, they are at state and )Tj 0.112 Tw -25.461 -1.74 Td (even county level. And this is not just because the capaciti)Tj 24.474 0 Td (es are there but because the )Tj 0.253 Tw -24.474 -1.72 Td (mandate is there, right? At the federal level you don\222t really have t\ he mandate by )Tj 0 Tw T* (constitution to do that.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.011 Tw 3 0 Td [(And this of course is a challenge if you try to look at it in terms of )0.5(a universal sort )]TJ 0.114 Tw -3 -1.74 Td (of system applicable to all l)Tj (evels, but the IHR deals with public health emergencies of )Tj 0.007 Tw T* [(international )0.5(concern, )0.5(serious )0.5(stuff, )0.5(it\222s )0.5(not )0.5(really )0.6(the routine )0.5(work, )0.5(so )0.5(my )0.5(question )0.5(to )0.5(you )]TJ 0.01 Tw T* [(is in the case of a truly public health emergency )0.5(of )0.5(international concern, )0.5(or )0.5(even )0.5(a )0.5(public )]TJ 0.09 Tw T* (health eme)Tj (rgency of national concern that covers many different states, potentiall\ y, and )Tj 0.114 Tw 0 -1.74 TD (could quickly damage the health of many people, would that role change o\ r could that )Tj 0.187 Tw 0 -1.72 TD (role change? Could then the federal level take on more responsibility be\ cause of the )Tj 0 Tw T* (nature )Tj 0.122 Tw 2.87 0 Td (of the danger )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw 6.763 0 Td (which is a specific of the IHR )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw 13.915 0 Td (or would still be some sort of )Tj 0 Tw -23.548 -1.72 Td (upon)Tj (-)Tj 0.192 Tw (request sort of role? And really just trying to be practical and see us \ in a true )Tj ET endstream endobj 83 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 84 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (43)Tj ( )Tj ET Q BT 0.087 Tw 12 0 0 12 107.88 709.08 Tm (situation, because this is what really IHR is about, it\222s not the 99%\ of the routine work)Tj 0 Tw 36 0 Td ( )Tj 0.119 Tw -36 -1.72 Td (that might happen, epidemics or outbreaks in the country is the true eve\ nt that has the )Tj 0 Tw 0 -1.72 TD (potential for being a major public health problem at national or interna\ tional level.)Tj 32.961 0 Td ( )Tj -35.961 -1.74 Td (RS:)Tj ( )Tj 0.032 Tw 3 0 Td (I wonder, before you answer that question if I could ask my question, be\ cause)Tj 0 Tw ( )Tj 0.032 Tw 31.884 0 Td (you might )Tj 0.082 Tw -31.884 -1.72 Td (answer them both at the same time because it\222s an overlapping questio\ n. At the time of )Tj 0.029 Tw T* [(Katrina, as seen from outside the United )0.5(States, )0.5(there appeared to be imperfections in the )]TJ 0.025 Tw T* [(communication )0.5(between )0.5(local, )0.5(state )0.5(and )0.5(federal )0.5(level, )0.5(not )0.5(just )0.6(rela)]TJ 0.024 Tw 26.682 0 Td (ted to public health but )Tj 0.06 Tw -26.682 -1.74 Td (more broadly related to be dealing with that emergency. And this is just\ an impression I )Tj 0.105 Tw T* (had. The impression I had is at the level of politics and society rather\ than at the legal )Tj 0.001 Tw T* (level there was a sense that the federal government)Tj 0 Tw 20.388 0 Td ( )Tj 0.001 Tw 0.251 0 Td (\223should have done more faster\224. Now, )Tj 0.105 Tw -20.639 -1.72 Td (how much of that was public health related and how much of that was rela\ ted to other )Tj 0.086 Tw 0 -1.74 TD [(things? )0.5(I )0.5(don\222t )0.5(know, )0.5(but )0.5(I )0.5(guess )0.5(what )0.5(I )0.5(wonder )0.5(about )0.5(is )0.5(whether )0.5(there\222s )0.5(a )0.5(sense )0.5(at )0.5(the )]TJ 0.1 Tw 0 -1.72 TD (level of the federal government that they sho)Tj 18.611 0 Td (uld have had more legal powers than they )Tj 0 Tw -18.611 -1.72 Td (did have to deal with that particular issue?)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.135 Tw 3 0 Td (So I raise the question now because Dr.)Tj 0 Tw ( )Tj 0.135 Tw (Lazzari asked his question and I think )Tj 0.176 Tw -3 -1.74 Td (they\222re overlapping sorts of questions. I ask it because when I wonde\ red about these )Tj 0 Tw T* (ques)Tj 0.243 Tw (tions in a Canadian context )Tj 0 Tw (\226)Tj ( )Tj 0.243 Tw 15.175 0 Td (and I think probably the Canadian story will be )Tj 0.11 Tw -15.175 -1.72 Td (somewhat analogous to your story )Tj 0 Tw (\226)Tj ( )Tj 0.11 Tw 15.38 0 Td (I wondered if there was a true large public health )Tj 0.009 Tw -15.38 -1.72 Td (emergency in Canada whether the Canadian public would tolerate the feder\ al government )Tj 0 Tw 0 -1.74 TD (saying)Tj 0.015 Tw [(, )0.5(\223We )0.5(have )0.5(limited )0.5(authority )0.5(to )0.5(do )0.5(with )0.5(this. )0.5(We )0.6(need )0.5(the request )0.5(to )0.6(come )0.5(from )0.5(the )]TJ 0.101 Tw 0 -1.72 TD (provinces before we can do whatever it is \(we resolve?\).\224 It\222s a\ n overlapping question, )Tj 0 Tw T* (that\222s why I wanted to do it.)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.09 Tw 3 0 Td (And a difficult question, by the way. [laughter] An)Tj (d it is going to require both of us to )Tj 0 Tw 0 -1.74 TD (answer it.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.114 Tw 3 0 Td (The concept of federalism is not one that is restricted to public health\ or to the )Tj 0.46 Tw -3 -1.72 Td (Department of Health and Human Services. Federalism goes across all of o\ ur )Tj 0.209 Tw 0 -1.72 TD (departments and it goes into all of these thin)Tj 19.387 0 Td (gs. So I think it is fair to say that the )Tj 0.265 Tw -19.387 -1.74 Td (Department of Homeland Security )Tj 0 Tw (\226)Tj ( )Tj 0.265 Tw 16.125 0 Td (which was the primary driver with regards to )Tj 0 Tw -16.125 -1.72 Td (Katrina )Tj 3.32 0 Td (\226)Tj ( )Tj 0.072 Tw 0.822 0 Td (also operates in a system of federalism, and that requests would go up f\ rom a )Tj 0 Tw -4.142 -1.72 Td (local or state to the U.S. government federal l)Tj (evel for assistance.)Tj ( )Tj ET endstream endobj 85 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 86 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (44)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.007 Tw 3 0 Td (I\222m not going to comment on whether it moved through adequately or fa\ st enough )Tj 0.089 Tw -3 -1.72 Td (or things like that, but I can tell you that the Department of Homeland \ Security is a lot )Tj 0.075 Tw 0 -1.72 TD (newer at communication problems than CDC and the state and local)Tj 0 Tw ( )Tj 0.075 Tw 28.344 0 Td (health departments )Tj 0.047 Tw -28.344 -1.74 Td (are. We\222ve been doing this for many, many years just because of the n\ ature of notifiable )Tj 0.128 Tw T* (diseases. And so we are coming from a spirit... we have that spirit of c\ ooperation and )Tj 0 Tw T* (communication that is a little more developed because of tim)Tj 24.409 0 Td (e, I think.)Tj ( )Tj -27.409 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.116 Tw 3 0 Td (We are interdependent. One of the things that was on that table, we don\222\ t have )Tj 0.04 Tw -3 -1.74 Td (people in every city in the United States, so we are dependent on people\ to work with us )Tj 0.062 Tw T* (to let us know. They are dependent upon us for some financial obligation\ s,)Tj 0 Tw 30.628 0 Td ( )Tj 0.062 Tw 0.312 0 Td (for reagents, )Tj 0.14 Tw -30.94 -1.72 Td (for laboratories, for the infrastructure about the communication, which \ is again a very )Tj 0.023 Tw T* (expensive operation and so we maintain that for all of us. So it is beca\ use of mutual need )Tj 0 Tw 0 -1.74 TD (that we keep each other in the loop.)Tj 14.217 0 Td ( )Tj -17.217 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.038 Tw 3 0 Td (With regard to public h)Tj 9.483 0 Td (ealth emergencies where we would change that method of )Tj 0.084 Tw -12.483 -1.72 Td (functioning, we\222ve had some big ones... and I\222m glad you expanded \ it to be of national )Tj 0.105 Tw 0 -1.72 TD (consequence because then I could turn it to anthrax and speak to that be\ cause I was in )Tj 0 Tw 0 -1.74 TD (New York City as a team lea)Tj (der, and everything there was a partner...)Tj 27.878 0 Td ( )Tj -30.878 -1.72 Td ([Start of Side 4])Tj ( )Tj 0 -1.72 TD ( )Tj 0.057 Tw 3 0 Td [(...we did not federalize the )0.5(public )0.5(health aspect of that. \(Marcia Leighton?\) and I )0.5(argued )]TJ 0.077 Tw T* (every day about at least one thing, and that\222s just the way it was, a\ nd we discussed lots )Tj 0.133 Tw 0 -1.74 TD (and lots of s)Tj (tuff, and so we never changed that. And that probably is one of the most\ )Tj 0 Tw 0 -1.72 TD (important national events that we have had.)Tj 17.411 0 Td ( )Tj -20.411 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.108 Tw 3 0 Td (I think that in all situations we would prefer to keep the method or the\ form of )Tj 0.011 Tw -3 -1.72 Td (communication our current methods, I think we would pref)Tj 23.777 0 Td (er to keep it like that. And at a )Tj 0.082 Tw -23.777 -1.74 Td (time of stress, whether it\222s spinach yesterday or monkeypox or anthra\ x we have always )Tj 0.006 Tw T* (maintained that we have yet to run up against that event where, from a p\ ublic health point )Tj 0 Tw T* (of view, that we would have changed that.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 3 0 Td (N)Tj 0.095 Tw (ow, I was not around at Three Mile Island. Could that have been one? I d\ on\222t )Tj 0.104 Tw -3 -1.74 Td (know. But it\222s within my knowledge, and within our recent exercises, \ I do not see one )Tj 0 Tw T* (where we would change that system.)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Next Dr.)Tj ( )Tj (Veyrat and then Mr.)Tj ( )Tj (Basse.)Tj ( )Tj -3 -1.72 Td (SV:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. Can)Tj ( )Tj (I ask you a question in French too?)Tj ( )Tj ET endstream endobj 87 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 88 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (45)Tj ( )Tj ET Q BT 0.159 Tw 12 0 0 12 143.88 709.08 Tm (J\222ai en fait deux questions. La premi\350re c\222est est)Tj 0 Tw 20.571 0 Td (-)Tj 0.159 Tw (ce que j\222ai bien compris que )Tj 0.136 Tw -23.571 -1.72 Td (donc on serait sur autant de points focaux nationaux qu\222il y a d\222\351\ toiles sur le drapeau )Tj 0.031 Tw 0 -1.72 TD (am\351ricain? Donc c\222est juste une confirmation. Ou es)Tj 0 Tw 21.207 0 Td (t)Tj (-)Tj 0.031 Tw (ce qu\222il va y avoir en plus\205 est)Tj 0 Tw (-)Tj (ce )Tj 0.124 Tw -21.207 -1.74 Td (qu\222il va y avoir en plus un super point focal donc qui serait au nive\ au du CDC ou du )Tj 0.001 Tw T* (DHHS? \307a c\222\351tait la premi\350re question. La deuxi\350me questi\ on c\222est en termes d\222action de )Tj 0.227 Tw T* (sant\351 publique qui est un des \351l\351ments et un )Tj (des articles pr\351vus dans le R\350glement )Tj 0.037 Tw T* (sanitaire international, prenons l\222exemple d\222une n\351cessit\351 d\ e mettre sous quarantaine soit )Tj 0 -1.74 TD (des avions arrivants, soit des navires, parce qu\222on a d\351tect\351 e\ ffectivement un cas import\351 )Tj 0.017 Tw 0 -1.72 TD (ou des choses comme \347a. Est)Tj 0 Tw (-)Tj 0.017 Tw (ce que \347)Tj (a va \352tre une comp\351tence partag\351e entre la ville qui )Tj 0.227 Tw T* (re\347oit l\222avion ou les avions en cons\351quence? Est)Tj 0 Tw (-)Tj 0.227 Tw (ce que dans un cas d\222une alerte \340 )Tj 0.1 Tw T* [(transmission interhumaines on peut prendre l\222exemple de )0.5(la pand\351mie grippale )0.5(avec )0.5(un )]TJ 0.348 Tw 0 -1.74 TD (virus qui mute et qui est identifi\351)Tj 0 Tw ( )Tj 0.348 Tw 15.906 0 Td (comme recombinant? Est)Tj 0 Tw (-)Tj 0.348 Tw (ce qu\222on va d\351cider )Tj 0.072 Tw -15.906 -1.72 Td (simultan\351ment et \340 quel niveau donc la d\351cision sera)Tj 0 Tw 21.627 0 Td (-)Tj (t)Tj (-)Tj 0.072 Tw (elle prise? Est)Tj 0 Tw (-)Tj 0.072 Tw (ce que le CDC va )Tj 0.021 Tw -21.627 -1.72 Td (donner ordre en quelque sorte aux diff\351rents \311tats bien que souver\ ains de mettre en place )Tj 0.019 Tw 0 -1.72 TD [(de )0.5(dispositif )0.5(de )0.5(screening )0.5(pour )0.5(l\222)]TJ [(entr\351e )0.5(comme )0.5(pour )0.5(les )0.5(sorties )0.5(et )0.5(puis )0.5(de )]TJ /TT1 1 Tf [(contact )0.5(tracing)]TJ /TT0 1 Tf 0 Tw (, )Tj 0.11 Tw 0 -1.74 TD (de tra\347abilit\351 des passagers? Ou est)Tj 0 Tw (-)Tj 0.11 Tw (ce que \347a va \352tre aussi la libert\351 encore de chaque )Tj 0.122 Tw 0 -1.72 TD (\351tat, chaque responsable de grandes villes ou de comt\351s de mettre \ en place son propre )Tj 0.01 Tw T* (dispositif \340 son gr\351 et)Tj 0 Tw ( )Tj 0.01 Tw 8.856 0 Td (\340 son rythme? Et enfin donc effectivement sur ces deux points l\340, \ si )Tj 0 Tw -8.856 -1.72 Td (vous pouvez nous apporter les pr\351cisions.)Tj ( )Tj -3 -1.74 Td (AM:)Tj ( )Tj 0.144 Tw 3 0 Td (If I suggested that there were going to be 50 focal points that is not c\ orrect. There is )Tj 0.045 Tw T* (going to be one national focal point for the United)Tj 0 Tw 20.486 0 Td ( )Tj 0.045 Tw 0.295 0 Td (States, and that is in the Office of the )Tj 0.042 Tw -20.781 -1.72 Td (Secretary of the Department of Health and Human Services )Tj 0 Tw 24.455 0 Td (\226)Tj ( )Tj 0.792 0 Td (DHHS )Tj 3.015 0 Td (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (and it will not be )Tj 0 Tw -29.054 -1.72 Td (at CDC.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.094 Tw 3 0 Td (Our discussion with Mr.)Tj 0 Tw ( )Tj 0.094 Tw (Plotkin was that even though we\222ve designated that we )Tj 0.008 Tw -3 -1.72 Td (have a lot of work to do to make that rig)Tj (ht, now, because up until just recently in terms of )Tj 0.037 Tw T* (sending cables back and forth to Geneva and things like that it has been\ our division, the )Tj 0.309 Tw T* [(Division )0.5(of )0.5(Global )0.5(Migration )0.5(and )0.5(Quarantine, )0.5(or )0.6(the )0.5(director )0.5(of )0.5(CDC )0.5(that\222s )0.5(been )]TJ 0.037 Tw 0 -1.74 TD (responsible, so this is a major s)Tj (hift for us, and now we have to think of how we\222re going )Tj 0.03 Tw 0 -1.72 TD (to be funnelling information in to them. But no, there are not going to \ be 50 focal points, )Tj 0 Tw T* (there will be only one national focal point.)Tj 16.995 0 Td ( )Tj ET endstream endobj 89 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 90 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (46)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.084 Tw 3 0 Td (Your question regarding quarantine is an interesting one. An)Tj (d again, a historical )Tj 0.348 Tw -3 -1.72 Td (piece, in fact the very first quarantine stations in the United States i\ n the early )Tj 0 Tw 0 -1.72 TD (18)Tj 0.003 Tc -0.003 Tw 7.92 0 0 7.92 119.88 673.32 Tm (th)Tj 0 Tc 0 Tw 12 0 0 12 126.1027 667.8 Tm ( )Tj 0.012 Tw (century, there were two, one was in New York City and one was in Philade\ lphia, and )Tj 0.002 Tw -1.519 -1.74 Td (they were established by the municipality, they were not run b)Tj 24.933 0 Td (y the states of New York or )Tj 0.201 Tw -24.933 -1.72 Td (Pennsylvania respectively, they were not run by the federal government. \ The federal )Tj 0.008 Tw T* (government did not really get into the business of quarantine until afte\ r the Civil War, the )Tj 0.212 Tw T* (late 19th)Tj 0 Tw ( )Tj 0.212 Tw (century, and then there were just a few o)Tj (vertures. It wasn\222t \222til we hit the )Tj 0 Tw 0 -1.74 TD (20th)Tj ( )Tj (century that the federal government got into that.)Tj 21.632 0 Td ( )Tj -24.632 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.001 Tw 3 0 Td (Now we\222ve gone completely the other way. There are no local quarantin\ e stations, )Tj 0.078 Tw -3 -1.72 Td (all quarantine stations in the United States are operated by federal par\ tners. Th)Tj 32.341 0 Td (ey\222re not )Tj 0.203 Tw -32.341 -1.72 Td (known as the Federal Inspection Services, of which CDC is one of them. T\ here are )Tj 0.126 Tw T* (roughly 425 ports of entry into the United States )Tj 0 Tw 20.773 0 Td (\226)Tj ( )Tj 0.126 Tw 0.876 0 Td (that includes our land borders, our )Tj 0.049 Tw -21.65 -1.72 Td [(maritime )0.5(ports )0.5(of )0.5(entry )0.5(and )0.5(our )0.5(airports )0.5(that )0.5(are )0.5(receiving )0.5(international )0.5(fli)]TJ 0 Tw 29.995 0 Td (ghts )Tj 1.965 0 Td (\226)Tj ( )Tj 0.049 Tw 0.798 0 Td [(at )0.5(every )]TJ 0.102 Tw -32.759 -1.72 Td (single one of those there will be a federal presence at the border. All \ of them have the )Tj 0.007 Tw 0 -1.72 TD (ability to contact one of the 20 CDC quarantine stations if there is a q\ uestion about public )Tj 0.348 Tw 0 -1.74 TD (health or about quarantine, and so that is the way that we)Tj 0 Tw 26.597 0 Td ( )Tj 0.348 Tw 0.598 0 Td (are supporting those )Tj 0 Tw -27.195 -1.72 Td (individuals.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.298 Tw 3 0 Td (There may be some situations where we would ask a state or local health \ )Tj 0.068 Tw -3 -1.72 Td [(department )0.5(to )0.5(act )0.5(on )0.5(our )0.5(behalf, )0.5(for )0.5(example )0.5(one )0.5(of )0.5(the )0.5(remote )0.5(land )0.5(border )0.5(crossings )0.5(of )]TJ 0.043 Tw T* (Montana where there is not... it would take us I don\222t know)Tj 0 Tw 24.189 0 Td ( )Tj 0.043 Tw 0.293 0 Td (how many hours to fly there )Tj 0.138 Tw -24.482 -1.72 Td (from Seattle, but in fact we would ask the state or local health departm\ ent to actually )Tj 0.106 Tw 0 -1.72 TD (visually inspect someone for that rash illness or that consideration of \ pan \222flu. And we )Tj 0.145 Tw T* (have done that several times already within the pa)Tj 21.15 0 Td (st year, but it is again that spirit of )Tj 0 Tw -21.15 -1.74 Td (cooperation.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.078 Tw 3 0 Td (With regards to the screening operations, at the larger ports of entry w\ e do have )Tj 0.124 Tw -3 -1.72 Td (CDC personnel that are capable of screening those folks. With regards to\ pan \222flu, we )Tj 0.019 Tw T* (anticipate that there may be some)Tj 0 Tw ( )Tj 0.019 Tw 13.776 0 Td (situations... we can all envision a situation in which we )Tj 0.077 Tw -13.776 -1.74 Td (put in place a very large screening program for one to three weeks, for \ example, and in )Tj 0.121 Tw T* (that case we would keep that as a federal operation as well. And you may\ say, \223Well, )Tj 0.025 Tw T* (doesn\222t that violate the)Tj 0 Tw ( )Tj 0.025 Tw 9.485 0 Td (whole spirit of what you\222ve been talking about?\224 Within a port of \ )Tj 0.082 Tw -9.485 -1.72 Td (entry a person isn\222t in the United States until they cross a certain \ line, so when you get )Tj ET endstream endobj 91 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 92 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (47)Tj ( )Tj ET Q BT 0.221 Tw 12 0 0 12 107.88 709.08 Tm (off that airplane, before you walk through those white doors that say, \223\ Now you\222re )Tj 0.21 Tw 0 -1.72 TD (entering the Un)Tj (ited States,\224 that is federal land, and the screeners, the public hea\ lth )Tj 0.174 Tw T* (authority on that piece of land is the United States government, federal\ people. With )Tj 0.187 Tw 0 -1.74 TD (regards to health they\222re CDC, U.S. CDC, and the Public Health Servic\ e )Tj 0 Tw (\226)Tj ( )Tj 0.187 Tw 32.452 0 Td (which is )Tj 0.064 Tw -32.452 -1.72 Td (closely entwine)Tj (d with the Department of Health and Human Services and CDC )Tj 0 Tw 32.761 0 Td (\226)Tj ( )Tj 0.064 Tw 0.814 0 Td (has in )Tj 0.118 Tw -33.575 -1.72 Td (place... we are now putting together plans to think about how they would\ augment the )Tj 0 Tw 0 -1.72 TD (screening at these ports of entry.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.078 Tw 3 0 Td (Now, again, I want to emphasize that these are plans. Although we )Tj 27.896 0 Td (can envision )Tj 0.047 Tw -30.896 -1.72 Td (scenarios where we would do this, that is not... I\222m looking at Ron b\ ecause I\222m thinking )Tj 0.122 Tw T* (about SBP issues as we move down the line here! These are not... you kno\ w, our line )Tj 0.086 Tw T* [(continues to be that these ports should be as )0.5(open )0.5(as possible, )0.5(and )0.5(we)]TJ 0 Tw ( )Tj 0.086 Tw 29.164 0 Td [(do )0.5(not )0.5(anticipate )]TJ 0.061 Tw -29.164 -1.74 Td (that large screening operations that interfere with commerce and movemen\ t are going to )Tj 0.035 Tw T* (be a part of that, but we still had the plans in place that we would not\ call upon state and )Tj 0 Tw T* (local resources at that time.)Tj 10.968 0 Td ( )Tj -13.968 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.211 Tw 3 0 Td (Now, we do ask... we are )Tj (setting up situations where we would ask them to )Tj 0.334 Tw -3 -1.74 Td (receive ill folks for quarantine or isolation, we rely heavily upon them\ for local )Tj 0.213 Tw T* (laboratory support. When the federal government puts out an isolation or\ quarantine )Tj 0.03 Tw T* (order U.S. Centers for Disease Control d)Tj (oesn\222t have any police to enforce that, so we are )Tj 0.166 Tw T* [(dependent )0.5(upon )0.5(state )0.5(and )0.5(local )0.5(authorities )0.5(to )0.5(help )0.5(us )0.5(do )0.5(that. )0.5(We )0.5(are )0.5(in )0.5(the )0.5(midst )0.5(of )]TJ 0.169 Tw 0 -1.74 TD (negotiating on almost a case by case basis with the cities and states th\ at house these )Tj 0.197 Tw 0 -1.72 TD (major ports of entry how we are g)Tj (oing to accomplish that. In some states will have )Tj 0.002 Tw T* (memoranda of agreement, in some states it will be a little less formal t\ han that, but we are )Tj 0 Tw T* (negotiating on an ongoing basis for them to operate on our behalf.)Tj 26.438 0 Td ( )Tj -29.438 -1.74 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Next is Mr.)Tj ( )Tj (Basse.)Tj ( )Tj -3 -1.72 Td (AB:)Tj ( )Tj 0.191 Tw 3 0 Td (Merci beaucoup. Jus)Tj (te une question sur le f\351d\351ralisme. Nous savons que pendant les )Tj 0.057 Tw T* (n\351gociations donc des RSI les \311tats)Tj 0 Tw (-)Tj 0.057 Tw (Unis avec d\222autres pays certainement \351taient tr\350s en )Tj 0.053 Tw T* (pointe sur la question donc la clause f\351d\351rale. Comme l\222a dit c\ e matin le repr\351sentant de )Tj 0.079 Tw 0 -1.74 TD (l\222OMS Bruce, )Tj (cette question\205 cette clause n\222a pas \351t\351 retenue mais il y a\ quand m\352me )Tj 0.003 Tw 0 -1.72 TD (une option qui figure dans le texte du RSI c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.003 Tw (dire l\222article)Tj 0 Tw ( )Tj 0.003 Tw (593 donc qui offre l\222option )Tj 0.14 Tw T* (d\222une d\351claration qui pourrait \352tre faite par les \311tats qui \ le souhaitent ou d\351clarent au )Tj 0.451 Tw T* (directeur g\351n\351ral de l\222OMS pour proc\351der \340 un certain nom\ bre d\222arrangements )Tj ET endstream endobj 93 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 94 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (48)Tj ( )Tj ET Q BT 0.18 Tw 12 0 0 12 107.88 709.08 Tm (administratifs. \300 partir de ce moment donc je crois que les \311tats \ f\351d\351raux concern\351s )Tj 0.055 Tw 0 -1.72 TD [(avaient )0.5(deux )0.5(options )0.5(en )0.5(termes de )0.6(mise en )0.5(oeuvre )0.5(du )0.5(RSI, )0.5(la )0.5(premi\350re )0.5(option )0.5(\351tant )0.5(de )0.5(le )]TJ 0.029 Tw T* (faire d)Tj (ans le cadre actuel de leurs arrangements administratifs c\222est)Tj 0 Tw 27.111 0 Td (-)Tj (\340)Tj (-)Tj 0.029 Tw (dire donc en optant )Tj 0.004 Tw -27.111 -1.74 Td (pour le status quo; la deuxi\350me option \351tant n\222est)Tj 0 Tw (-)Tj 0.004 Tw (ce pas de proc\351der \340 la r\351vision de leurs )Tj 0.095 Tw T* (arrangements administratifs auquel cas ils auraient besoin de faire une \ d\351clar)Tj 31.712 0 Td (ation donc )Tj 0.126 Tw -31.712 -1.72 Td (au directeur g\351n\351ral de l\222OMS. Est)Tj 0 Tw (-)Tj 0.126 Tw (ce que je peux d\351duire de votre pr\351sentation de ce )Tj 0.1 Tw T* (matin et de vos diff\351rentes r\351ponses aux questions que votre inten\ tion en tant que pays )Tj 0.07 Tw 0 -1.74 TD (parti \340 RSI est de le mettre en oeuvre dans le cadre de vos arrangeme\ nt)Tj 29.362 0 Td (s actuels? )Tj 0 Tw (Merci )Tj -29.362 -1.72 Td (beaucoup.)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.126 Tw 3 0 Td (I think the most honest and direct way to answer that would be that at p\ resent we are )Tj 0.132 Tw 0 -1.72 TD (using the established arrangements that we have. Those established arran\ gements have )Tj 0.258 Tw 0 -1.74 TD (helped us in many, many situations, and again )Tj 0 Tw 20.785 0 Td (\226)Tj ( )Tj 1.008 0 Td (whethe)Tj 0.258 Tw (r it\222s anthrax or SARS or )Tj 0 Tw -21.794 -1.72 Td (spinach)Tj ( )Tj (\226)Tj ( )Tj (that has kept us in good stead. And it has been tested numerous times.)Tj 32.022 0 Td ( )Tj -35.022 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.029 Tw 3 0 Td (Will that stop us from seeking, in a cooperative nature, a different arr\ angement? I )Tj 0.251 Tw -3 -1.72 Td [(don\222t think it will. I )0.5(think that we will try to define a diffe)]TJ 26.364 0 Td (rent arrangement. That )Tj 0.268 Tw -26.364 -1.74 Td (arrangement may be something as simple as defining for all states a publ\ ic health )Tj 0.188 Tw 0 -1.72 TD (emergency of international consequence, and putting in a case definition\ through our )Tj 0.165 Tw T* (Council of State and Territorial Epidemiologists and putting that )Tj 27.563 0 Td (in place and saying, )Tj 0.077 Tw -27.563 -1.72 Td (\223Now every state has this, we all know what this is, and even though \ we have different )Tj 0.146 Tw 0 -1.74 TD (notifiable diseases and everything, now we\222re going to define it in a\ slightly different )Tj 0.053 Tw 0 -1.72 TD (way.\224 And so will we pursue that? We\222re discussing that. So)Tj 0 Tw ( )Tj 0.053 Tw 25.101 0 Td (I think if we\222re using what )Tj 0.009 Tw -25.101 -1.72 Td (we have, we are doing that now, we will continue to do that. Are we open\ to new ways of )Tj 0 Tw T* (doing it in a way that does not violate the state sovereignty? We\222re \ open to that as well.)Tj 34.99 0 Td ( )Tj -37.99 -1.74 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (One last question from Dr.)Tj ( )Tj (McGeer.)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 3 0 Td (It\222s )Tj 0.174 Tw 1.757 0 Td (actually a two)Tj 0 Tw (-)Tj 0.174 Tw (part question. The first piece of it, what I think I heard about the )Tj 0.022 Tw -1.757 -1.72 Td (influence of the federal government over what happens in public health i\ s three)Tj 0 Tw 31.979 0 Td (-)Tj 0.022 Tw (fold. The )Tj 0.171 Tw -31.979 -1.72 Td (first is the ability to control funding, and at least from my perspectiv\ e as a for)Tj 0 Tw 33.557 0 Td (tunate )Tj 0.034 Tw -33.557 -1.74 Td (Canadian holder of cooperative agreement money when people aren\222t pay\ ing attention to )Tj 0.157 Tw T* (international borders, that\222s a very substantial and highly organized\ amount of money )Tj 0.151 Tw T* (that I think has a large influence on that. But there are also two other\ clea)Tj 31.587 0 Td (r points of )Tj 0.295 Tw -31.587 -1.72 Td (influence. The first is the technical expertise that resides in epidemio\ logy and the )Tj ET endstream endobj 95 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 96 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (49)Tj ( )Tj ET Q BT 0.06 Tw 12 0 0 12 107.88 709.08 Tm (laboratory at the CDC that mean that if you... and I think a very well)Tj 0 Tw 28.248 0 Td (-)Tj 0.06 Tw (developed support )Tj 0.121 Tw -28.248 -1.72 Td (system that goes with it that leaves people in local and state health )Tj 28.371 0 Td (departments in the )Tj 0.027 Tw -28.371 -1.72 Td [(position of wanting to talk to the federal government when they )0.5(have a problem. And the )]TJ 0.132 Tw 0 -1.74 TD (second is that there\222s a very clear system of federal employees embed\ ded in state and )Tj 0.095 Tw 0 -1.72 TD (local health departments whose )Tj 0 Tw 13.209 0 Td (\226)Tj ( )Tj 0.095 Tw 0.845 0 Td (this is a bit of an overstatem)Tj 0 Tw (ent )Tj 13.412 0 Td (\226)Tj ( )Tj 0.095 Tw 0.845 0 Td (but whose primary )Tj 0.143 Tw -28.311 -1.72 Td (allegiance, if you like, is to the United States and to the federal gove\ rnment and who )Tj 0.125 Tw T* (must be a phenomenal source of information transfer that some of the res\ t of us don\222t )Tj 0 Tw 0 -1.74 TD (have.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.028 Tw 3 0 Td (Can you talk a little bit about a\) whether I\222ve mis)Tj 20 0 Td (sed things about other ways that )Tj 0.042 Tw -23 -1.72 Td [(the )0.5(federal )0.5(government )0.5(influences )0.6(the )0.6(rest )0.5(of )0.5(the )0.5(world )0.5(in )0.5(public )0.5(health, )0.5(and )0.5(b\) )0.5(what )0.5(you )]TJ 0.097 Tw 0 -1.72 TD (think those relative weights are, how important they are, whether there \ are other things )Tj 0 Tw 0 -1.74 TD (that might work?)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.094 Tw 3 0 Td (Although we\222ve talked a)Tj 0 Tw ( )Tj 0.094 Tw 10.484 0 Td (lot about funding and financing, being an idealist at heart I\222m )Tj 0 Tw -10.484 -1.72 Td (going to say I don\222t think that\222s the biggest, most important driv\ er for these things, I think )Tj 0.153 Tw 0 -1.72 TD [(it\222s )0.5(your )0.5(second )0.5(one, )0.5(and )0.5(that )0.5(is )0.5(the )0.5(technical )0.5(advisors. )0.5(We )0.5(maintain )0.5(a )0.5(good )0.5(group, )0.5(a )]TJ 0.123 Tw 0 -1.74 TD (quality gr)Tj (oup, a group that is... you know, although sometimes we\222re ponderous \ we\222re )Tj 0.089 Tw 0 -1.72 TD (usually right, and trying to move out in terms of some of these new test\ s and new case )Tj 0.088 Tw T* (definitions that... you know, again, we are ponderous, but because we ha\ ve that time to )Tj 0 Tw T* (think )Tj 0.084 Tw 2.39 0 Td (about these things rather than running public health programs on a state\ and local )Tj 0.096 Tw -2.39 -1.74 Td (level we\222re able to think about some of these different things, so we\ are sought out for )Tj 0 Tw T* (our opinion by our state and local partners.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.068 Tw 3 0 Td (We are actually in a very interesting)Tj 0 Tw 14.903 0 Td ( )Tj 0.068 Tw 0.318 0 Td (time right now because we have some state )Tj 0.134 Tw -18.222 -1.72 Td [(and local people who are incredible public health experts right )0.5(now too. I don\222t know )]TJ 0.11 Tw 0 -1.74 TD (where they\222re finding the time to think about these things because th\ ey do have to run )Tj 0.045 Tw 0 -1.72 TD (local programs and things like that, so )Tj (we\222re also at a time where it\222s a two)Tj 0 Tw (-)Tj 0.045 Tw (way street. I )Tj 0.002 Tw T* (think maybe in \22246 when CDC established, in the early \22250s, it mig\ ht have been more of a )Tj 0 Tw T* (one)Tj (-)Tj 0.095 Tw (way street, but now it\222s a two)Tj 0 Tw (-)Tj 0.095 Tw (way street and there\222s information moving back and )Tj 0 Tw 0 -1.74 TD (forth.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.094 Tw 3 0 Td (The embedding, I wou)Tj (ld say that embedding )Tj 0 Tw (\226)Tj ( )Tj 0.094 Tw 19.609 0 Td (and Becky can correct me if she )Tj 0.016 Tw -22.609 -1.72 Td (thinks it\222s different )Tj 0 Tw (\226)Tj ( )Tj 0.016 Tw 8.73 0 Td (although it is big a lot of it is... you know, most of the vast majority\ )Tj 0.078 Tw -8.73 -1.72 Td (of these people are the people that are actually making the programs hap\ pen, the public )Tj ET endstream endobj 97 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 98 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (50)Tj ( )Tj ET Q BT 0.159 Tw 12 0 0 12 107.88 709.08 Tm (health advisors)Tj 0 Tw ( )Tj 0.159 Tw 6.594 0 Td (in STD\222s, TB, in immunization. We have hundreds of people that are )Tj 0.281 Tw -6.594 -1.72 Td (working in the States. Surprisingly, these people often identify themsel\ ves as state )Tj 0.074 Tw 0 -1.72 TD (people, and they very, very much identify themselves as working on behal\ f of the state. )Tj 0.141 Tw 0 -1.74 TD (So I don\222t thin)Tj 0 Tw (k )Tj 7.118 0 Td (\226)Tj ( )Tj 0.141 Tw 0.891 0 Td (and this is opinion, now )Tj 0 Tw (\226)Tj ( )Tj 0.141 Tw 11.427 0 Td [(I don\222t think that they are )0.5(really on the )]TJ 0.1 Tw -19.436 -1.72 Td (watchout for CDC specifically, I think that they are usually looking for\ a nice balance. )Tj 0.041 Tw 0 -1.72 TD (And the example I would use, of someone that I have worked with an awful\ lot lately, is )Tj 0.047 Tw T* (Gil Ch)Tj (avez who\222s the state epidemiologist to California . He is in fact a C\ DC employee. )Tj 0.223 Tw 0 -1.74 TD (But Gil really goes out of his way to give a very balanced and equitable\ image of )Tj 0.104 Tw 0 -1.72 TD (working on behalf of the state, and if anything I think that he would er\ r on the side of )Tj 0 Tw T* (sta)Tj 1.111 0 Td (nding up for the states because he knows he has to overcome that other p\ iece.)Tj 31.018 0 Td ( )Tj -35.128 -1.72 Td (RH:)Tj ( )Tj 0.221 Tw 3 0 Td (I think also what we find is that laboratorians want to speak to other l\ aboratorians, )Tj 0.063 Tw 0 -1.74 TD (epidemiologists want to speak to other epidemiologists. What you will fi\ nd between our )Tj 0 Tw 0 -1.72 TD (f)Tj 0.138 Tw (ederal level and our state level is, aside from who\222s embedded where \ in the states to )Tj 0.158 Tw T* (carry out some programmatic functions is fairly often the feds capture s\ omebody that )Tj 0.186 Tw T* (used to work at a state level, or the states captured... you know, now h\ ave someone )Tj 0 Tw 0 -1.74 TD (e)Tj 0.062 Tw (mployed for them that used to work on a federal level. So, once those re\ lationships are )Tj 0.335 Tw 0 -1.72 TD [(established, whether they\222re formal )0.5(or whether they\222re standardized in some way, )]TJ 0.135 Tw T* (whether there\222s some standard operating procedures, they take place, \ and I think what )Tj 0 Tw T* (y)Tj 0.053 Tw (ou find for public health is people are more liable to pick up the phone\ ad say, \223We\222ve )Tj 0.016 Tw 0 -1.74 TD (got to have emergency phone call for CSTE,\224 for the state and territo\ rial epidemiologists, )Tj 0.05 Tw 0 -1.72 TD (\223because this is what\222s going on,\224 and we need as a group to de\ cide how we\222re)Tj 0 Tw 32.345 0 Td ( )Tj 0.05 Tw 0.3 0 Td (going to )Tj 0 Tw -32.645 -1.72 Td (handle it, and we need... so I think that\222s what happens more often t\ han not.)Tj 30.298 0 Td ( )Tj -33.298 -1.72 Td (AM:)Tj ( )Tj 0.021 Tw 3 0 Td (And that would be a new mechanism, it\222s that movement back and forth,\ \223I am no longer )Tj 0.055 Tw 0 -1.74 TD (an employee of the State of Oregon, I'm CDC.\224 When Dave Fleming went \ from Oreg)Tj 0 Tw 35 0 Td (on )Tj 0.073 Tw -35 -1.72 Td (to the federal government to be the Deputy Director of CDC he\222s no lo\ nger Oregon but )Tj 0.091 Tw 0 -1.72 TD [(he )0.5(brings )0.5(that )0.5(perspective, )0.5(and )0.5(it\222s )0.5(the )0.5(perspective )0.5(that )0.5(is )0.5(more )0.5(important )0.5(than )0.5(anything )]TJ 0 Tw T* (else.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.112 Tw 3 0 Td (Accessibility is the other one that Becky was just mentioning there, a)Tj 28.889 0 Td (nd for the )Tj 0.216 Tw -31.889 -1.72 Td [(most part... it may have decreased over the past few years just because \ of )0.5(the time )]TJ 0.09 Tw T* (demands, but our folks )Tj 0 Tw (\226)Tj ( )Tj 0.09 Tw 10.615 0 Td (relatively highly placed within our organization at CDC )Tj 0 Tw 23.324 0 Td (\226)Tj ( )Tj 0.84 0 Td (are )Tj 0.142 Tw -34.779 -1.72 Td (still very accessible to state epidemiologist or a program director, and\ t)Tj 29.939 0 Td (hat has been a )Tj ET endstream endobj 99 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 100 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (51)Tj ( )Tj ET Q BT 0.082 Tw 12 0 0 12 107.88 709.08 Tm (very valuable piece as well, they know that they\222re not going to get \ the run)Tj 0 Tw 31.114 0 Td (-)Tj 0.082 Tw (around and )Tj 0 Tw -31.114 -1.72 Td (that they\222re very often going to get an answer that they would like t\ o have.)Tj 29.852 0 Td ( )Tj -32.852 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.181 Tw 3 0 Td (So I think those are two other pieces that go in there with the three th\ at)Tj 0 Tw ( )Tj 31.5 0 Td (you )Tj -34.5 -1.74 Td (identified.)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.105 Tw 1.056 0 Td [(This )0.5(is )0.5(the )0.5(last )0.5(question, )0.5(so )0.5(Mr.)]TJ 0 Tw ( )Tj 0.105 Tw [(Plotkin, )0.5(and )0.5(then we\222re )0.5(actually )]TJ 0 Tw (\226)Tj ( )Tj 0.105 Tw 27.805 0 Td [(as )0.5(you )0.5(may )0.5(know )]TJ 0 Tw 7.695 0 Td (\226)Tj ( )Tj 0.176 Tw -35.5 -1.72 Td (one presentation behind, but we\222ll move to Dr.)Tj 0 Tw ( )Tj 0.176 Tw (Luna\222s presentation to the first in the )Tj 0 Tw 0 -1.72 TD (afternoon, but I\222ll describe the logistics after Mr.)Tj 19.521 0 Td ( )Tj (Plotkin\222)Tj (s question.)Tj ( )Tj -22.521 -1.74 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.012 Tw 3 0 Td (That is correct. And because they are coming into international ports of\ entry they are not )Tj 0.062 Tw T* (technically in that state until they cross some point so they\222ve gone\ from federal land to )Tj 0.45 Tw T* (state land, and so within those jurisdictions we sti)Tj (ll retain very, very specific )Tj 0.173 Tw 0 -1.74 TD (requirements for determining what documents, what vaccination. That goes\ through a )Tj 0.123 Tw 0 -1.72 TD (series of rule changes, and in fact we are in a whole series of rule cha\ nges right now. )Tj 0.193 Tw T* (Rule changes are not constitutional amendments, they\222re)Tj 0 Tw ( )Tj 0.193 Tw 24.288 0 Td (not laws that are passed by )Tj 0.009 Tw -24.288 -1.72 Td (Congress, but it is our operational guide. These operational guides get \ changed very, very )Tj 0.064 Tw 0 -1.74 TD (rarely simply because it\222s expensive to do and it has an incredible r\ ipple effect. And we )Tj 0.112 Tw 0 -1.72 TD (would approach many of these things through a )Tj (rule change, and it would be a federal )Tj 0.264 Tw T* (change. There are numerous opportunities for state and local health depa\ rtments to )Tj 0.017 Tw T* (comment on rule changes, there\222s numerous opportunities for the indiv\ idual citizen in the )Tj 0.004 Tw 0 -1.74 TD (United States or a corporation to comment on)Tj 0 Tw ( )Tj 0.004 Tw 18.526 0 Td (those, and so that would be the way that we )Tj 0.302 Tw -18.526 -1.72 Td (would tweak that rule change to accommodate some of the needs that have \ been )Tj 0.047 Tw 0 -1.72 TD (identified by the state local health departments, the professional board\ s, Council of State )Tj 0.009 Tw T* (and Territorial Epidemiologists, the assoc)Tj [(iations for state and territorial health officers, )0.5(or )]TJ 0 Tw 0 -1.74 TD (the individual citizens and corporations.)Tj 16.023 0 Td ( )Tj -19.023 -1.72 Td (BP:)Tj ( )Tj 3 0 Td (AM:)Tj ( )Tj 3 0 Td (Yes.)Tj ( )Tj -6 -1.72 Td (BP:)Tj ( )Tj 3 0 Td (AM:)Tj ( )Tj 0.068 Tw 3 0 Td (Yes, they are federal decisions. My hesitancy here is we\222ve come into\ a new era )Tj 0.011 Tw -3 -1.72 Td (in that there is more cooperation between the various depar)Tj 23.782 0 Td (tments of the United States. In )Tj 0.006 Tw -23.782 -1.74 Td (some of these cases it\222s not just a Department of Health and Human Se\ rvices decision but )Tj 0.191 Tw 0 -1.72 TD (in fact homeland security, commerce, agriculture very much so that it is\ cooperation )Tj 0 Tw T* (across multiple departments, but yes it would stil)Tj (l remain federal.)Tj ( )Tj -3 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj ET endstream endobj 101 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 102 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (52)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (AM:)Tj ( )Tj 0.188 Tw 3 0 Td (Outside of the situation where we\222re talking about border measures, o\ utside of those )Tj 0.07 Tw 0 -1.72 TD (situations where we\222re talking about federal reservations )Tj 0 Tw 23.401 0 Td (\226)Tj ( )Tj 0.07 Tw 0.82 0 Td (meaning the land around our )Tj 0.123 Tw -24.222 -1.72 Td (international ports of entry, or federal areas that are )Tj 21.931 0 Td (in states such as military bases or )Tj 0.067 Tw -21.931 -1.74 Td (bureau of land management or things like that )Tj 0 Tw (\226)Tj ( )Tj 0.067 Tw 20.01 0 Td (I do not know of a specific mechanism )Tj 0 Tw -20.01 -1.72 Td (or proposed mechanism where we would do that.)Tj ( )Tj -3 -1.72 Td (BP:)Tj ( )Tj 3 0 Td (.)Tj ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 0.129 Tw 3 0 Td (Where we would federalize. I think, yeah, independent of the cooperation\ of st)Tj 33.011 0 Td (ate and )Tj 0.243 Tw -33.011 -1.74 Td (local health departments. We could, at a time come to an agreement that \ a federal )Tj 0.031 Tw T* [(resource )0.5(would )0.5(be )0.5(mobilized )0.5(and )0.5(used )0.5(within )0.5(that )0.6(investigation, and )0.6(what )0.6(comes )0.5(to )0.6(mind )]TJ 0.157 Tw T* (is the Department of Defence laboratories that we moved into New York Ci\ ty duri)Tj 0 Tw 35 0 Td (ng )Tj 0.09 Tw -35 -1.72 Td [(anthrax )0.5(to )0.5(do )0.5(testing )0.5(for )0.5(us. )0.5(We )0.5(had )0.5(DoD )0.5(personnel )0.5(that )0.5(were )0.5(working )0.6(with )0.6(New )0.6(York )]TJ 0.019 Tw 0 -1.74 TD (City\222s Department of Health laboratory, we had a laboratory that was \ moved out onto the )Tj 0.053 Tw 0 -1.72 TD [(street )0.5(just )0.5(in )0.5(front )0.5(of )0.5(those )0.5(laboratories, )0.5(so )0.5(we )0.5(did )0.5(move those )0.5(federal resources)]TJ 0 Tw 32.396 0 Td ( )Tj 0.053 Tw 0.302 0 Td [(but )0.5(they )]TJ 0.286 Tw -32.698 -1.72 Td (were under guidance from )Tj 0 Tw 11.918 0 Td (\226)Tj ( )Tj 0.286 Tw 1.036 0 Td (at least jointly )Tj 0 Tw 6.774 0 Td (\226)Tj ( )Tj 0.286 Tw 1.036 0 Td (for somebody from CDC who was )Tj 0.312 Tw -20.765 -1.72 Td (overseeing a lot of those DoD resources, and a person from the New York \ City )Tj 0 Tw 0 -1.74 TD (Department of Health, so we did not federalize in that situation, no.)Tj 26.992 0 Td ( )Tj -29.992 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (AM:)Tj ( )Tj 3 0 Td (I think that\222s)Tj ( )Tj (true, yes.)Tj ( )Tj -3 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.74 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Thank)Tj (-)Tj 0.027 Tw (you very much. I think we\222re off to a good start. I think it\222s tim\ e for lunch. Lunch )Tj 0.295 Tw 0 -1.72 TD (should be served at five after 12:00. There\222ll be a noon)Tj 0 Tw 24.915 0 Td (-)Tj 0.295 Tw (time talk at 12:35, so if )Tj 0.116 Tw -24.915 -1.72 Td (everybody could be back here at 12:35 you can bring your lunc)Tj (h and Dr.)Tj 0 Tw ( )Tj 0.116 Tw (McGeer will )Tj 0.082 Tw T* (give us some perspectives on SARS and avian \222flu, and then we\222ll b\ egin after that with )Tj 0 Tw 0 -1.74 TD (Dr.)Tj ( )Tj (Luna in the afternoon.)Tj ( )Tj -3 -1.72 Td ( )Tj 0 -1.14 TD ( )Tj /TT1 1 Tf 0 -1.16 TD (LUNCHEON SPEAKER)Tj ( )Tj 0 -1.64 TD (Dr.)Tj ( )Tj (Allison McGeer)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Dr.)Tj ( )Tj 0.116 Tw (Marfin was wrong. There is absolutely no doubt that I am the least knowl\ edgeab)Tj 0 Tw 35.278 0 Td (le )Tj -38.278 -1.72 Td (person in the room about the IHR!)Tj ( )Tj ET endstream endobj 103 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 104 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (53)Tj ( )Tj ET Q BT 0.14 Tw 12 0 0 12 107.88 709.08 Tm (This of course is the other way of identifying an academic in medicine i\ s that we are )Tj 0.065 Tw -3 -1.72 Td (incapable of talking without having PowerPoint slides up at the same tim\ e, so you need to bear )Tj 0 Tw 0 -1.72 TD (with me on that aspect.)Tj ( )Tj 0.173 Tw 3 -1.74 Td (Kumanan asked )Tj (me if I would talk a little bit about the perspective from the ground )Tj 0.103 Tw -3 -1.72 Td [(outside )0.5(of )0.5(public )0.5(health )0.5(on )0.5(issues )0.5(surrounding )0.5(the )0.5(management )0.5(of )0.5(outbreaks )0.5(with )0.5(international )]TJ 0.002 Tw T* (consequences, and I'm expecting to have some experience in pan \222flu i\ n the near future, but )Tj 36.805 0 Td (at the )Tj 0.037 Tw -36.805 -1.72 Td (moment the sum total of my experience is SARS, so SARS is what you get t\ o hear about, and if )Tj 0 Tw 0 -1.74 TD (I'm too medical please just stop me.)Tj ( )Tj 0.018 Tw 3 -1.72 Td [(The first thing that I )0.5(need to say is )0.5(that first of all it is wonderful to be here today )0.5(and )0.5(it\222s )]TJ 0.179 Tw -3 -1.72 Td (great to see the IHR )Tj 9.144 0 Td (moving forward, because for all the people who worked on the SARS )Tj 0 Tw -9.144 -1.72 Td (outbreak )Tj 3.819 0 Td (\226)Tj ( )Tj 0.07 Tw 0.82 0 Td (and I can only speak to the local people in Toronto, essentially, though\ I'm sure it\222s )Tj 0.023 Tw -4.639 -1.74 Td (true of outbreaks elsewhere in the world )Tj 0 Tw (\226)Tj ( )Tj 0.023 Tw 17.287 0 Td (that to see people move as a consequence )Tj 0 Tw (\226)Tj ( )Tj 0.023 Tw 17.781 0 Td (or at )Tj 0 Tw (least )Tj 0.105 Tw -35.067 -1.72 Td [(in )0.5(part )0.5(as )0.5(a )0.5(consequence )0.5(of )0.5(this )0.5(outbreak )]TJ 0 Tw (\226)Tj ( )Tj 0.105 Tw 18.185 0 Td [(and )0.5(to )0.5(see )0.5(the )0.5(progress )0.5(that )0.5(we )0.5(can )0.5(make )0.5(is )0.6(really )]TJ 0.082 Tw -18.185 -1.72 Td (heartening, and for the families that lost multiple relatives during the\ outbreak I think it means )Tj 0.025 Tw 0 -1.72 TD (that we actually are doing something to honour their mem)Tj (ory. So, none of what we learned from )Tj 0.195 Tw 0 -1.74 TD (SARS in Toronto would have been possible without the assistance of the p\ atients and their )Tj 0.018 Tw 0 -1.72 TD (families and a huge number of people from many sources who\222ve worked \ on control of SARS in )Tj 0 Tw T* (Toronto.)Tj ( )Tj 0.217 Tw 3 -1.72 Td (Here\222s the summary. It\222s, on)Tj 0 Tw ( )Tj 0.217 Tw 12.776 0 Td (the scale of things, a fairly small outbreak )Tj 0 Tw 18.758 0 Td (\226)Tj ( )Tj 0.967 0 Td (although )Tj -35.5 -1.74 Td (widespread )Tj 4.842 0 Td (\226)Tj ( )Tj 0.038 Tw 0.788 0 Td (26 countries, 8,000 cases, 774 deaths in about a two and a half month pe\ riod. And )Tj 0.13 Tw -5.63 -1.72 Td (this is the beginning of it. As everyone knows the initial discussion oc\ curred in December of )Tj 0.056 Tw T* (2002 about)Tj 0 Tw ( )Tj 0.056 Tw 4.834 0 Td (a cluster of cases )Tj 0 Tw (\226)Tj ( )Tj 0.056 Tw 8.084 0 Td (a fairly small cluster of cases )Tj 0 Tw (\226)Tj ( )Tj 0.056 Tw 13.028 0 Td (that was eventually reported out )Tj 0.027 Tw -25.946 -1.72 Td (as probably due to Influenza B that we know fairly little about, and the\ n at the end of January as )Tj 0.008 Tw 0 -1.74 TD (the SARS virus evolved a very large cluster of hospitalized cases in)Tj 0 Tw 27.165 0 Td ( )Tj 0.008 Tw 0.258 0 Td (Guangzhou. The little purple )Tj 0.13 Tw -27.423 -1.72 Td (line on the left side here is where exportation of disease )Tj 0 Tw 23.952 0 Td (\226)Tj ( )Tj 0.13 Tw 0.88 0 Td (at last outside of China and Hong )Tj 0 Tw -24.832 -1.72 Td (Kong )Tj 2.527 0 Td (\226)Tj ( )Tj 0.055 Tw 0.805 0 Td (occurred, and you can see that that occurred by the end of the Guangzhou\ outbreak. By )Tj 0.198 Tw -3.332 -1.72 Td (the time we were dealing with it elsew)Tj 16.8 0 Td (here in the world a number of Chinese had about a )Tj 0.086 Tw -16.8 -1.74 Td (month\222s experience with us and were substantially ahead of it, and it\ is one of the tragedies of )Tj 0 Tw 0 -1.72 TD (the SARS outbreak that we weren\222t able to capitalize on that experien\ ce in the rest of the world.)Tj 38.375 0 Td ( )Tj 0.009 Tw -35.375 -1.72 Td (Having said)Tj 0 Tw ( )Tj 5.072 0 Td (that )Tj 1.758 0 Td (\226)Tj ( )Tj 0.009 Tw 0.759 0 Td (and I\222ll come back to this when I talk about reporting and limitation\ s )Tj 0 Tw 27.911 0 Td (\226)Tj ( )Tj 0.072 Tw -38.5 -1.72 Td (if you had told anybody before the 15th of March of 2003 that what appea\ red to be a localized )Tj ET endstream endobj 105 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 106 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (54)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (hospital)Tj (-)Tj 0.007 Tw (based cluster in Guangzhou would be exported to 26 countries in four wee\ )Tj (ks, you would )Tj 0.099 Tw 0 -1.72 TD (have been told to go away and work somewhere else. And I think the prima\ ry answer that we )Tj 0.048 Tw T* [(didn\222t )0.5(hear )0.5(about )0.5(this )0.5(was )0.5(because )0.5(nobody )0.5(really )0.5(believed )0.5(that )0.5(it )0.6(was )0.5(going )0.5(to )0.6(be )0.5(exported. )0.5(And )]TJ 0.066 Tw 0 -1.74 TD (looking at it retrospectively, none of us, I don\222t think)Tj 21.783 0 Td (, would have believed that it was going to )Tj 0.147 Tw -21.783 -1.72 Td (be exported, and so I think it\222s very important to recognize, when we\ talk about recognizing )Tj 0.066 Tw 0 -1.72 TD (events of international importance, that those events do not come with c\ lear labels, and that the )Tj 0.003 Tw T* (fact that we wish to d)Tj (iscuss them and we wish to know about them means we need to have a very \ )Tj 0.131 Tw 0 -1.74 TD (clear understanding about knowing about things that may not be internati\ onal events but may )Tj 0 Tw 0 -1.72 TD (become international events.)Tj 11.468 0 Td ( )Tj 0.016 Tw -8.468 -1.72 Td (And the exportation to the rest of the world )Tj 0 Tw 17.727 0 Td (\226)Tj ( )Tj 0.016 Tw 0.766 0 Td (this is not quit)Tj (e true for Hong Kong but it\222s )Tj 0.009 Tw -21.493 -1.72 Td (very clearly true for the outbreaks outside of Hong Kong )Tj 0 Tw (\226)Tj ( )Tj 0.009 Tw 23.841 0 Td (were associated with a single event in )Tj 0.138 Tw -23.841 -1.74 Td [(a single hotel room in Hong Kong on the )0.5(evening )0.5(of )0.5(February )0.5(21st. )0.5(A )0.5(physician )0.5(from )0.5(China )]TJ 0.119 Tw T* (stayed in the Metropark Hotel in Kowloo)Tj (n overnight. He was ill when he came. He stayed in )Tj 0.039 Tw T* (Room 911 in the hotel overnight, and the little red room notices on this\ floor plan are the rooms )Tj 0.019 Tw T* (of other hotel visitors or rooms in which people came who were infected \ as a consequence of his )Tj 0.098 Tw 0 -1.74 TD (stay there.)Tj 0 Tw ( )Tj 0.098 Tw 4.555 0 Td (He was hospitalized on February 22nd in Hong Kong. At least anecdotally \ I'm told )Tj 0.022 Tw -4.555 -1.72 Td (that he went into the hospital and said, \223I have a highly infectious \ disease, you need to put me in )Tj 0 Tw 0 -1.72 TD (isolation now.\224 He subsequently died in the hospital in Hong Kong.)Tj ( )Tj 0.047 Tw 3 -1.72 Td (From th)Tj (at one night there was one infected traveller who travelled to Ireland a\ nd did not )Tj 0.142 Tw -3 -1.74 Td (transmit disease, an American businessman who went to Vietnam and starte\ d the outbreak in )Tj 0.325 Tw T* (Vietnam, three travellers from Singapore who took the outbreak back to S\ ingapore, t)Tj 0 Tw 37.778 0 Td (wo )Tj 0.168 Tw -37.778 -1.72 Td [(travellers )0.5(in )0.5(the )0.5(index )0.5(case )0.5(who )0.5(furthered )0.5(the )0.5(spread )0.5(of )0.5(disease )0.5(in )0.5(Hong )0.5(Kong, )0.5(one )0.5(infected )]TJ 0.031 Tw T* (traveller to the United States )Tj 0 Tw 11.847 0 Td (\226)Tj ( )Tj 0.031 Tw 0.781 0 Td (we had originally called it two but I think it\222s fairly clear that th\ e )Tj 0.05 Tw -12.629 -1.74 Td (second case was in fact household transmission in the Uni)Tj (ted States, although it\222s an interesting )Tj 0.072 Tw T* (fact that we chose to call it a travel)Tj 0 Tw 14.517 0 Td (-)Tj 0.072 Tw (related case for a long time after SARS )Tj 0 Tw 16.851 0 Td (\226)Tj ( )Tj 0.072 Tw 0.822 0 Td (and two infected )Tj 0.038 Tw -32.191 -1.72 Td (travellers who came back to Toronto, one who travelled to British Columb\ ia and transmitted the )Tj 0.171 Tw T* (disease to a single he)Tj (althcare worker in Vancouver, and a second person who came back to )Tj 0 Tw 0 -1.74 TD (Toronto.)Tj ( )Tj 0.036 Tw 3 -1.72 Td (Index case in the Toronto outbreak was a 78 year)Tj 0 Tw (-)Tj 0.036 Tw (old woman who came back to Toronto )Tj 0.077 Tw -3 -1.72 Td (on February the 23rd, their last night in the hotel room. They\222d actu\ ally gotten free coupons to)Tj 0 Tw 39 0 Td ( )Tj 0.118 Tw -39 -1.72 Td [(stay )0.5(in )0.5(the )0.5(hotel )0.5(so )0.5(it )0.5(was )0.5(a )0.5(treat )0.5(staying in )0.5(the )0.5(hotel, )0.6(and )0.6(it\222s )0.6(a )0.6(message )0.6(about )0.6(travelling )0.6(and )]TJ ET endstream endobj 107 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 108 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (55)Tj ( )Tj ET Q BT 0.067 Tw 12 0 0 12 71.88 709.08 Tm (staying in hotel rooms. She was not ill when she returned to Toronto, sh\ e became ill about tow )Tj 0.056 Tw 0 -1.72 TD (days later with what we now of as the prodrome of SARS. She wa)Tj 27.222 0 Td (s given a diagnosis of a viral )Tj 0.037 Tw -27.222 -1.72 Td (illness and died at home about eight days after her initial onset of sym\ ptoms. She was presumed )Tj 0.098 Tw 0 -1.74 TD (to have died of a heart attack because she had some underlying heart dis\ ease and there wasn\222t )Tj 0 Tw 0 -1.72 TD (another obvious cause of death, I t)Tj (hink fairly typical for what you would expect to happen.)Tj 36.295 0 Td ( )Tj 0.062 Tw -33.295 -1.72 Td (Before she died she transmitted the disease to her son who was her prima\ ry caregiver at )Tj 0.03 Tw -3 -1.72 Td (home. He was admitted to hospital on March the 7th with what was presume\ d to be community)Tj 0 Tw 38.667 0 Td (-)Tj 0.035 Tw -38.667 -1.74 Td (acquired pneumonia an)Tj (d developed progressive disease and died on the 13th of March. Between )Tj 0.074 Tw T* (March 3rd and March 12th all of his household contacts developed illness\ . Obviously not clear )Tj 0.009 Tw T* (whether it was his mother or himself who was the index, but his wife, hi\ s son, his brother )Tj (and his )Tj 0 Tw T* (father all developed symptoms of illness.)Tj ( )Tj 0.056 Tw 3 -1.74 Td (Now, remember when you\222re talking about SARS in retrospect that there\ \222s on average a )Tj 0 Tw -3 -1.72 Td (five)Tj (-)Tj 0.129 Tw (day incubation period from exposure to the development of disease, there\ \222s on average a )Tj 0 Tw T* (seven)Tj (-)Tj 0.006 Tw (day period from the ti)Tj [(me you develop disease until )0.6(the )0.6(time you )0.5(are )0.5(sick )0.5(enough )0.5(to )0.5(need )0.5(to )]TJ 0.065 Tw T* (be admitted to a hospital or see a physician, so that the total gap from\ illness onset to when we )Tj 0.172 Tw 0 -1.74 TD [(would recognize you as diseased in a setting where we\222re not actively\ screening )0.5(people an)]TJ 0 Tw 38.5 0 Td (d )Tj 0.113 Tw -38.5 -1.72 Td (looking for people is nearly two weeks. I would point out to you that th\ e gap for influenza is )Tj 0.114 Tw 0 -1.72 TD (actually very similar. The difference between SARS and influenza is that\ because you are not )Tj 0.162 Tw T* (infectious with SARS until you are generally at least three or fou)Tj 27.747 0 Td (r days into illness, the gap )Tj 0.047 Tw -27.747 -1.74 Td (between when you become infectious and when we know about you even when \ not expecting it )Tj 0.013 Tw T* (is generally only three or four days. Influenza is of course completely \ different, you\222re infectious )Tj 0.159 Tw T* (at the beginning of influenza, you pr)Tj 15.531 0 Td (esent usually with a complication at day eight to ten of )Tj 0.103 Tw -15.531 -1.72 Td (illness, and by the time we see you in the healthcare system with influe\ nza we\222re already five )Tj 0.007 Tw 0 -1.74 TD (generations in. And that of course is why pan \222flu and SARS are unrel\ ated diseases from a public )Tj 0 Tw 0 -1.72 TD (health )Tj 0.048 Tw 2.741 0 Td (perspective. They may look clinically the same but they bear no relation\ in terms of their )Tj 0 Tw -2.741 -1.72 Td (management and control.)Tj ( )Tj 0.034 Tw 3 -1.72 Td (Shortly after that initial spread had the onset of illness that was outs\ ide of the household, )Tj 0.061 Tw -3 -1.74 Td [(initially to the daughter of the index case )0.5(who)]TJ 0 Tw 18.813 0 Td ( )Tj 0.061 Tw 0.311 0 Td (had been in visiting her mother while ill, did not )Tj 0.039 Tw -19.124 -1.72 Td (live in the same household, and then to the family physician of the fami\ ly who saw a number of )Tj 0.105 Tw T* (ill family members on March the 6th and became ill three days later. And\ on March 10th and )Tj ET endstream endobj 109 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 110 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (56)Tj ( )Tj ET Q BT 0.044 Tw 12 0 0 12 71.88 709.08 Tm (13th two patients )Tj (who had been in the emergency department at the same time as the son on \ his )Tj 0 Tw 0 -1.72 TD (admission on the 7th developed illness.)Tj ( )Tj 0.074 Tw 3 -1.72 Td (This is all, of course, completely under the radar. There was no notific\ ation of anything )Tj 0 Tw -3 -1.74 Td (until )Tj 2.268 0 Td (\226)Tj ( )Tj 0.185 Tw 0.935 0 Td [(in )0.5(Toronto )]TJ 0 Tw (\226)Tj ( )Tj 0.185 Tw 5.803 0 Td [(on )0.5(March )0.5(the )0.5(10th )0.5(a )0.5(public )0.5(he)]TJ [(alth )0.5(notification )0.6(about )0.6(a potential )0.5(H5N1 )]TJ 0.008 Tw -9.006 -1.72 Td (influenza came to people\222s attention and the family was considered fo\ r that. I truth, the history of )Tj 0.011 Tw T* [(travel )0.5(in )0.5(the )0.5(family )0.5(was )0.5(not )0.5(clear )0.5(for )0.5(a )0.5(very )0.6(long )0.5(time, )0.5(another )0.5(message )0.5(about )0.5(the )0.6(transmission )0.5(of )]TJ 0.01 Tw T* (information. It)Tj (\222s nice to say you transmit information but you have to have it to tr\ ansmit it, and it )Tj 0.044 Tw 0 -1.74 TD (was not easy to obtain information about the family, and it became progr\ essively more difficult. )Tj 0.405 Tw 0 -1.72 TD [(On )0.5(the )0.5(13th, )0.5(when )0.5(the )0.5(ProMED )0.5(message )0.5(came )0.5(out... )0.5(another )0.5(message )0.5(about )0.5(h)]TJ 35.957 0 Td [(ow )0.5(we )]TJ 0.018 Tw -35.957 -1.72 Td [(communicate effectively at a clinical level: the most )0.5(reliable source of information that any of us )]TJ 0.132 Tw T* (have outside the public health system is ProMED and it\222s now become a\ critical function for )Tj 0 Tw 0 -1.74 TD (transmitting information outside of public health.)Tj 19.719 0 Td ( )Tj 0.07 Tw -16.719 -1.72 Td (And I t)Tj (hink it\222s something we need to think about between public health and \ the rest of )Tj 0.162 Tw -3 -1.72 Td (us in the world that simply having public health know about things is no\ t adequate, and the )Tj 0.106 Tw 0 -1.72 TD (communication to the healthcare system )Tj 0 Tw 16.887 0 Td (\226)Tj ( )Tj 0.106 Tw 0.856 0 Td (as opposed to the communication to the pub)Tj 0 Tw 18.379 0 Td (lic )Tj 1.356 0 Td (\226)Tj ( )Tj 0.856 0 Td (is )Tj 0.228 Tw -38.333 -1.74 Td (something that I think we need to think about in the process of asking h\ ow we make the )Tj 0 Tw T* (notification of important events work rapidly and efficiently.)Tj 24.326 0 Td ( )Tj 0.034 Tw -21.326 -1.72 Td (So here\222s the initial case family. By the time the ProMED alert came \ out and we became )Tj 0.1 Tw -3 -1.72 Td [(in )0.5(Toronto)]TJ 0 Tw ( )Tj 0.1 Tw 4.699 0 Td [(of )0.5(the )0.5(cluster )0.5(of )0.5(illness )0.5(in )0.5(the )0.5(family, )0.6(all )0.5(members )0.5(of )0.5(the )0.5(family )0.5(were )0.5(symptomatic )]TJ 0.094 Tw -4.699 -1.74 Td (except the seven month)Tj 0 Tw (-)Tj 0.094 Tw (old grandchild who was infected but not symptomatic at the time, and )Tj 0.04 Tw T* (two of them had died and it therefore became increasingly difficult to g\ et any )Tj 31.767 0 Td (information about )Tj 0 Tw -31.767 -1.72 Td (what had happened to them.)Tj ( )Tj 0.044 Tw 3 -1.72 Td (Now, we\222re still before the 12th of March when we knew what was happe\ ning. Between )Tj 0.046 Tw -3 -1.74 Td (March 9th and 11th the family had a number of chest x)Tj 0 Tw 22.525 0 Td (-)Tj 0.046 Tw (rays and investigation from their family )Tj 0.086 Tw -22.525 -1.72 Td (physician\222s office and transmitte)Tj (d it to five staff at the hospital. Between March 11th and 14th )Tj 0.001 Tw T* (one of the people )Tj 0 Tw (\226)Tj ( )Tj 0.001 Tw 7.918 0 Td (now we\222re starting to talk chains, okay? )Tj 0 Tw (\226)Tj ( )Tj 0.001 Tw 16.973 0 Td (second index case, the index case\222s )Tj 0.022 Tw -24.891 -1.72 Td [(son, )0.5(the )0.5(son )0.5(of )0.5(the )0.5(index )0.5(case )0.5(comes )0.5(to )0.5(the )0.5(emergency )0.5(department, )0.5(transmits )0.5(it )0.5(to )0.5(another )0.5(pat)]TJ 0 Tw 37.5 0 Td (ient )Tj 0.292 Tw -37.5 -1.74 Td (in the emergency department, that patient returns to the hospital with d\ isease that is not )Tj 0.093 Tw T* (recognized as SARS, and before we knew what was happening had in fact tr\ ansmitted it to 36 )Tj 0.21 Tw T* (hospital staff members, students, patients, and visitors at two hospi)Tj (tals because of an inter)Tj 0 Tw (-)Tj T* (hospital transfer that occurred because of his need for renal dialysis.)Tj 27.24 0 Td ( )Tj ET endstream endobj 111 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 112 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (57)Tj ( )Tj ET Q BT 0.03 Tw 12 0 0 12 107.88 709.08 Tm (On March the 16th, now about 48 hours after the investigation had starte\ d and just as the )Tj 0.072 Tw -3 -1.72 Td (patient was being called to notify him his exposure, the second patie)Tj 28.116 0 Td (nt who was infected in the )Tj 0.112 Tw -28.116 -1.72 Td (emergency department on March the 7th came back into the hospital, and i\ n the roughly hour )Tj 0.244 Tw 0 -1.74 TD (and a half before he and his wife were recognized as ill and put into is\ olation there was )Tj 0.225 Tw 0 -1.72 TD (transmission from the case to three of the emerg)Tj 21.071 0 Td (ency personnel who picked them up, four )Tj 0.066 Tw -21.071 -1.72 Td (emergency department staff, and from the case\222s ill wife )Tj 0 Tw 23.419 0 Td (\226)Tj ( )Tj 0.066 Tw 0.816 0 Td (who was merely a visitor )Tj 0 Tw (\226)Tj ( )Tj 0.066 Tw 11.45 0 Td (to about )Tj 0.04 Tw -35.684 -1.72 Td (22 people who had had the misfortune to pass through the emergency depar\ tment while she was )Tj 0 Tw 0 -1.74 TD (waiting for her husband to be)Tj ( )Tj (registered and admitted.)Tj ( )Tj 0.022 Tw 3 -1.72 Td (So here\222s our status about 48 hours into the outbreak. Not all of the\ se people were ill yet, )Tj 0 Tw -3 -1.72 Td (but all of them had been exposed and their illness could not have been p\ revented.)Tj 32.518 0 Td ( )Tj 0.153 Tw -32.518 -1.72 Td (By March the 16th, if you think about this has occurred)Tj 0 Tw 23.723 0 Td ( )Tj 0.153 Tw 0.403 0 Td (in an urban centre, the jurisdictions )Tj 0 Tw -21.126 -1.74 Td (involved now included four local public health units...)Tj 21.662 0 Td ( )Tj -24.662 -1.72 Td ([Start of Side 5])Tj ( )Tj 0.057 Tw 0 -1.72 TD [(...where )0.5(people )0.5(lived, )0.5(where )0.5(people )0.5(worked, )0.5(where )0.5(people )0.5(went )0.5(to )0.5(the )0.5(hospital )]TJ 0 Tw (\226)Tj ( )Tj 0.057 Tw 33.168 0 Td [(these )0.5(were )0.5(the )]TJ 0.046 Tw -33.168 -1.72 Td (people we knew about: there were in fact two oth)Tj 20.156 0 Td (er local public health units who were involved )Tj 0.048 Tw -20.156 -1.74 Td [(that )0.5(we )0.5(didn\222t )0.5(know )0.5(about )0.5(yet )]TJ 0 Tw (\226)Tj ( )Tj 0.048 Tw 13.302 0 Td [(the )0.5(province, )0.5(the )0.5(provincial )0.5(public )0.5(health )0.5(laboratory )]TJ 0 Tw (\226)Tj ( )Tj 0.048 Tw 22.178 0 Td [(which )0.5(in )]TJ 0.341 Tw -35.481 -1.72 Td [(our area is a separate jurisdiction from the )0.5(province\222s epidemiology unit )]TJ 0 Tw (\226)Tj ( )Tj 0.341 Tw 33.967 0 Td (the national )Tj 0.105 Tw -33.967 -1.72 Td (microbiology lab who wa)Tj (s also processing specimens, and the federal government because we )Tj 0.147 Tw T* (had March the 16th recognized two travel)Tj 0 Tw (-)Tj 0.147 Tw (related cases )Tj 0 Tw (\226)Tj ( )Tj 0.147 Tw 24.453 0 Td (potential cases )Tj 0 Tw (\226)Tj ( )Tj 0.147 Tw 7.3 0 Td (in addition to the )Tj 0.01 Tw -31.754 -1.74 Td [(index case, and because one of the infected family )0.5(members )0.5(had )0.5(travelled )0.5(to )0.5(the United )0.5(States )0.5(o)]TJ 0 Tw 38.5 0 Td (n )Tj 0.088 Tw -38.5 -1.72 Td (a business trip on the day she became ill. So with a new disease, in a v\ ery short time)Tj 0 Tw (-)Tj 0.088 Tw (frame, a )Tj 0.184 Tw T* (hugely complex process for trying to manage what was already going to be\ a very difficult )Tj 0 Tw T* (outbreak.)Tj ( )Tj 0.093 Tw 3 -1.74 Td (We then got about a week of relative peace because of the )Tj 24.609 0 Td (incubation period of SARS. )Tj 0.045 Tw -27.609 -1.72 Td (There was a period of time when we\222d had a relatively small number of\ people exposed and the )Tj 0.105 Tw T* (gap between exposure on the 14th and 16th and recognition of disease too\ k us about seven or )Tj 0.216 Tw T* (eight days, so between the 15th and the 21st)Tj 0 Tw ( )Tj 0.216 Tw 19.833 0 Td (there were only three or four new cases and )Tj 0.113 Tw -19.833 -1.74 Td (everybody kind of thought it was going to be okay, and people I think le\ t down their guard a )Tj 0.214 Tw T* (little bit and did not panic as extensively and effectively as we might \ have done, with the )Tj 0.097 Tw T* (consequence that on March )Tj 11.607 0 Td (the 21st )Tj 0 Tw (\226)Tj ( )Tj 0.097 Tw 4.43 0 Td (on the afternoon of March the 21st )Tj 0 Tw 14.815 0 Td (\226)Tj ( )Tj 0.097 Tw 0.847 0 Td (we became aware )Tj 0.107 Tw -31.7 -1.72 Td (that seven members of staff that we had not recognized as exposed had a \ febrile illness at the )Tj ET endstream endobj 113 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 114 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (58)Tj ( )Tj ET Q BT 0.016 Tw 12 0 0 12 71.88 709.08 Tm (hospital, and we started a fan)Tj 0 Tw (-)Tj 0.016 Tw (out procedure whose goal was to contact every member of hospital )Tj 0 Tw 0 -1.72 TD (s)Tj (taff to ask about illness.)Tj ( )Tj 0.011 Tw 3 -1.72 Td (ֱ 18 hours later we had seen 35 healthcare workers in the emergency \ department, all )Tj 0.087 Tw -3 -1.74 Td (of whom... it was actually not an experience I\222d care to repeat but i\ t was interesting. It was an )Tj T* (opportunity to read a next textbook. They h)Tj 17.994 0 Td (ad the same disease, and it was not a disease I had )Tj 0.002 Tw -17.994 -1.72 Td (ever seen before, but I could tell they all had it. Clinically, of the 3\ 5 people we saw there were 30 )Tj 0.122 Tw T* [(cases who we were sure had SARS and four people we )0.5(were )0.5(sure )0.5(about, )0.5(and )0.5(one )0.5(we )0.5(thought )]TJ 0.191 Tw 0 -1.74 TD (didn\222t. The one)Tj 0 Tw ( )Tj 0.191 Tw 6.961 0 Td (we thought didn\222t have Influenza B. All of the other 34 were subseque\ ntly )Tj 0 Tw -6.961 -1.72 Td (proven to have SARS.)Tj ( )Tj 0.134 Tw 3 -1.72 Td (And over the next two days the number of... there were household contact\ cases from )Tj 0.062 Tw -3 -1.72 Td (those healthcare workers who presented. There were additional healthcare\ wor)Tj 31.989 0 Td (kers and contacts )Tj 0.059 Tw -31.989 -1.74 Td (who presented, and consequently on the 25th of March we had run out of i\ solation beds to care )Tj 0.007 Tw 0 -1.72 TD (for these patients in Toronto. We knew that there was going to be transm\ ission in other hospitals, )Tj 0.06 Tw T* (but we had no concept of... we knew that ther)Tj (e were exposures that we didn\222t understand at the )Tj 0.101 Tw T* (index hospital, that we had no idea what they were. We didn\222t know wh\ ether we were talking )Tj 0.199 Tw 0 -1.74 TD (asymptomatic staff, we didn\222t know whether we were missing the diagno\ sis in patients, we )Tj 0.007 Tw 0 -1.72 TD [(didn\222t )0.5(know )0.5(whether )0.5(the )0.5(tr)]TJ [(ansmission )0.5(was )0.5(airborne, )0.5(and )0.5(we )0.5(just... )0.5(you )0.5(know, )0.5(it )0.5(didn\222t )0.5(necessarily )]TJ 0.041 Tw T* (make sense but all we knew was that something serious had gone wrong in \ that hospital that we )Tj 0.047 Tw T* (were not in control of, and we also knew )Tj 0 Tw (\226)Tj ( )Tj 0.047 Tw 17.766 0 Td [(because )0.5(of )0.5(our )0.5(regionalized )0.5(healthcare )0.5(system )]TJ 0 Tw 18.937 0 Td (\226)Tj ( )Tj 0.797 0 Td (that )Tj 0.025 Tw -37.5 -1.74 Td (we had to have had transferred enough patients and staff to other hospit\ als that other hospitals in )Tj 0.01 Tw T* (the system were not safe, but we had no date to tell us which of those h\ ospitals were not going to )Tj 0 Tw T* (be safe.)Tj ( )Tj 0.033 Tw 3 -1.72 Td (Consequently there was a meeting that Ron )Tj 0 Tw (St.)Tj ( )Tj 0.033 Tw (John probably remembers very clearly on )Tj 0.088 Tw -3 -1.74 Td [(the )0.5(afternoon )0.5(of )0.5(the )0.5(25th, )0.5(as )0.5(I )0.5(understand, )0.5(to )0.5(discuss )0.5(whether )0.5(we )0.5(were )0.5(talking )0.5(about )0.5(a )0.5(national )]TJ 0.051 Tw T* (emergency or provincial emergency and try to define responsibilities. I \ would put it to you that, )Tj 0.003 Tw T* [(in the )0.5(wisdom )0.5(of )0.5(h)]TJ [(indsight, )0.5(this )0.5(was )0.5(way )0.5(too )0.5(late )]TJ 0 Tw (\226)Tj ( )Tj 0.003 Tw 20.637 0 Td [(but )0.5(I )0.5(think )0.5(it\222s )0.5(a )0.5(predictable )0.5(evolution )0.5(and )0.5(I'm )]TJ 0.025 Tw -20.637 -1.72 Td (not sure how much better we can do )Tj 0 Tw 14.921 0 Td (\226)Tj ( )Tj 0.025 Tw 0.775 0 Td (and on the evening of March 21st a provincial emergency )Tj 0.144 Tw -15.696 -1.74 Td (was declared and we closed the hospitals and we quarantined anybody who \ might ha)Tj 35.775 0 Td (ve been )Tj 0 Tw -35.775 -1.72 Td (exposed.)Tj ( )Tj 0.085 Tw 3 -1.72 Td (So here\222s the shape of the SARS outbreak in Toronto. This tall peak i\ s the day that the )Tj 0.153 Tw -3 -1.72 Td (emergency was declared, and it\222s important to recognize that this was\ the stage at which we )Tj ET endstream endobj 115 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 116 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (59)Tj ( )Tj ET Q BT 0.009 Tw 12 0 0 12 71.88 709.08 Tm (actually put into place measures to control transmission. T)Tj (he incubation period is ten days. Move )Tj 0.04 Tw 0 -1.72 TD (out ten days and you get those cases that we could not have prevented ba\ sed on those measures, )Tj 0.05 Tw T* (and you can see that once you decided to take it far enough that SARS wa\ s actually a relatively )Tj 0.015 Tw 0 -1.74 TD (easy disease to control. A)Tj 10.306 0 Td (nd retrospectively, of course, when you know what you\222re dealing with\ )Tj 0.261 Tw -10.306 -1.72 Td (there isn\222t actually much challenge to controlling the transmission o\ f SARS, it\222s not very )Tj 0 Tw 0 -1.72 TD (difficult if you know what you\222re doing. It\222s knowing what you\222\ re doing that\222s hard.)Tj 33.799 0 Td ( )Tj 0.165 Tw -30.799 -1.72 Td (Here\222s our)Tj 0 Tw ( )Tj 0.165 Tw 4.829 0 Td (sum total of cases, a total of 358 cases in Toronto, 44 patients who die\ d, )Tj 0.251 Tw -7.829 -1.74 Td [(23,000 patients quarantined, 316,000 calls to the hotline )0.5(at )0.5(Toronto Public Health, and an )]TJ 0 Tw T* (estimated $1.13)Tj ( )Tj (billion in economic losses.)Tj ( )Tj 0.037 Tw 3 -1.72 Td (As somebody who dealt with this issue in hosp)Tj (itals, I don\222t have a lot of apologies about )Tj 0.125 Tw -3 -1.72 Td (the draconian measures that were taken to control transmission in hospit\ als )Tj 0 Tw 31.613 0 Td (\226)Tj ( )Tj 0.125 Tw 0.875 0 Td (I still think that )Tj 0.071 Tw -32.488 -1.74 Td (there wasn\222t a lot of choice about taking those)Tj 0 Tw 19.007 0 Td (-)Tj ( )Tj 0.071 Tw 0.654 0 Td (but I absolutely agree that the damage that was )Tj 0.05 Tw -19.661 -1.72 Td (done to people ot)Tj [(her than the people who had SARS, and the damage that )0.5(was done to people\222s )]TJ 0.02 Tw T* (health as a result of the economic loss, was almost certainly orders of \ magnitude greater than the )Tj 0.184 Tw T* (illness associated with SARS. It\222s unrecognized but the economic loss\ es to Toronto)Tj 0 Tw ( )Tj 0.184 Tw 35.9 0 Td (and the )Tj 0.084 Tw -35.9 -1.74 Td (mortgages that went unpaid and the depression and suicide associated wit\ h those losses I think )Tj 0 Tw T* (were probably more substantial than the illness we saw.)Tj 22.3 0 Td ( )Tj 0.131 Tw -19.3 -1.72 Td (One cannot, of course, talk about what happened in Toronto without talki\ ng about the )Tj 0.213 Tw -3 -1.72 Td (travel advi)Tj (sory, and what I want to point out to you is that the travel advisory in\ Toronto )Tj 0.063 Tw 0 -1.74 TD (occurred here. It actually was declared the day after I decided that we \ might be okay. I was the )Tj 0.126 Tw 0 -1.72 TD (last person in the group. By the time the travel advisory was declared i\ n Toro)Tj 32.666 0 Td (nto... we didn\222t )Tj 0.03 Tw -32.666 -1.72 Td (know we had it under control in hospitals, and there was some discussion\ about the fact that this )Tj 0.025 Tw T* (second wave in Toronto was entirely hospital)Tj 0 Tw 18.311 0 Td (-)Tj 0.025 Tw (based, and it was a hospital catastrophe, but it was )Tj 0.197 Tw -18.311 -1.74 Td [(not )0.5(a )0.5(public )0.5(health )0.5(threat )0.5(outside )0.5(of )0.6(the )0.5(h)]TJ 17.956 0 Td [(ospitals, )0.5(and )0.5(I )0.5(was )0.5(I )0.5(think )0.5(the )0.5(last )0.5(person )0.5(to )0.5(feel )]TJ 0.037 Tw -17.956 -1.72 Td (comfortable. I don\222t have any doubt that if people at the World Healt\ h Organization had had the )Tj 0.034 Tw T* (data that we had on the ground in Toronto on April 23rd that the travel \ advisory would not have )Tj 0.037 Tw T* (been issued,)Tj 0 Tw ( )Tj 0.037 Tw 5.212 0 Td (but we were completely unable to transmit that data to anybody who knew \ to make )Tj 0 Tw -5.212 -1.74 Td (those decisions effectively.)Tj ( )Tj 0.091 Tw 3 -1.72 Td (I would point out to you that after the travel advisory was declared sud\ denly it became )Tj 0.046 Tw -3 -1.72 Td (much easier to do so, which is a message about science and)Tj 0 Tw 24.274 0 Td ( )Tj 0.046 Tw 0.296 0 Td (politics in the world, but I think we )Tj 0.131 Tw -24.57 -1.72 Td (put... it is unforgivable, I think, that we put the World Health Organiz\ ation in the position of )Tj ET endstream endobj 117 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 118 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (60)Tj ( )Tj ET Q BT 0.002 Tw 12 0 0 12 71.88 709.08 Tm (having to make critical decisions without being able to supply them with\ the information to make )Tj 0.05 Tw 0 -1.72 TD (those decisions, and fo)Tj (r us in Canada I think it\222s... I believe the word that David Naylor u\ sed in )Tj 0.03 Tw T* (his commission report was \223shameful\224. It is not something that cou\ ntries in the developed world )Tj 0 Tw 0 -1.74 TD (should be doing.)Tj ( )Tj 0.075 Tw 3 -1.72 Td (So a couple more minutes on my perspective on learnings of the stor)Tj (y. I wanted to first )Tj 0.152 Tw -3 -1.72 Td [(provide )0.5(you )0.5(with )0.5(two )0.5(quotes )0.5(from )0.5(people )0.5(other )0.5(than )0.5(me and )0.5(David )0.5(Naylor. )0.5(This )0.5(is )0.5(from )0.5(the )]TJ 0.021 Tw 0 -1.72 TD (Campbell Commission report. \223Despite the eventual success in containi\ ng SARS so many things )Tj 0.249 Tw 0 -1.74 TD (went wrong in the public health response it is difficu)Tj 23.318 0 Td (lt to know where to start.\224 There is )Tj 0.02 Tw -23.318 -1.72 Td (subsequently a list of 27 headings of areas for improvement and changes,\ and I take this meeting )Tj 0 Tw 0 -1.72 TD (as the promise that we are moving in Canada, although we can talk about \ fast enough.)Tj 34.407 0 Td ( )Tj 0.004 Tw -31.407 -1.72 Td (This second slide is a slide from one)Tj 0 Tw ( )Tj 0.004 Tw 14.861 0 Td (of the hospital epidemiologists who came to assist in )Tj 0.128 Tw -17.861 -1.74 Td (the management of the second phase of the SARS outbreak in hospitals, an\ d I gave it to you )Tj 0 Tw T* (verbatim )Tj 3.854 0 Td (\226)Tj ( )Tj 0.05 Tw 0.8 0 Td [(I'm not awfully fond of )0.5(looking at it myself )]TJ 0 Tw (\226)Tj ( )Tj 0.05 Tw 18.84 0 Td (but I think the issues on the ground in )Tj 0.053 Tw -23.493 -1.72 Td (Toronto were)Tj 0 Tw ( )Tj 0.053 Tw 5.771 0 Td (first of all that we did not have the local expertise in public health t\ o manage this )Tj 0.115 Tw -5.771 -1.72 Td (outbreak and we were willing to ask. There are, I think, two issues with\ our culture of public )Tj 0.047 Tw 0 -1.74 TD (health that we need to think seriously about. The first is that all of u\ s )Tj 28.425 0 Td (have limits when we need )Tj 0.046 Tw -28.425 -1.72 Td (help, and when eventually we had three precautions transmission in our h\ ospitals and were very )Tj 0.106 Tw 0 -1.72 TD (worried about our healthcare workers, and the teaching hospitals in Toro\ nto asked if the CDC )Tj 0.04 Tw T* (would come, we were at a state in the outbr)Tj (eak where most people working on the outbreak had )Tj 0.084 Tw 0 -1.74 TD (worked 31 days out of the last 31 with an average of four or five hours\222\ sleep )Tj 0 Tw (\226)Tj ( )Tj 0.084 Tw 33.387 0 Td (this is not the )Tj 0.087 Tw -33.387 -1.72 Td (way you should be functioning )Tj 0 Tw (\226)Tj ( )Tj 0.087 Tw 13.908 0 Td (and one of her other slides was to point out that nobody was )Tj 0 Tw -13.908 -1.72 Td (capable of decis)Tj (ion)Tj (-)Tj (making in hospitals adequately at that time.)Tj 25.464 0 Td ( )Tj 0.107 Tw -22.464 -1.72 Td [(When )0.5(we )0.5(asked )0.5(for )0.5(the )0.5(CDC )0.5(to come )0.5(in )]TJ 0 Tw (\226)Tj ( )Tj 0.107 Tw 18.06 0 Td [(this )0.5(another )0.5(marker )0.5(about )0.5(asking, )0.5(about )0.5(the )]TJ 0.025 Tw -21.06 -1.74 Td (CDC\222s reputation and about meeting that reputation of being willing t\ o help )Tj 0 Tw 30.959 0 Td (\226)Tj ( )Tj 0.025 Tw 0.775 0 Td (the response at all )Tj 0.031 Tw -31.734 -1.72 Td (levels of our public healt)Tj (h system was that they didn\222t want to do it because it was an admissi\ on )Tj 0.061 Tw 0 -1.72 TD [(that we couldn\222t cope with it. I didn\222t )0.5(have any trouble, at that time, with it being an admission )]TJ 0.11 Tw T* (that I couldn\222t cope with, and I think we all need to be able to reco\ gnize that some )Tj 0 Tw 35.112 0 Td (outbreaks )Tj -35.112 -1.74 Td (need to be managed with every resource that can be applied.)Tj 24.128 0 Td ( )Tj 0.09 Tw -21.128 -1.72 Td [(The )0.5(second )0.5(level )0.5(of )0.5(culture )0.5(within )0.5(this )0.5(setting )0.5(is )0.5(that we )0.5(don\222t )0.5(have )0.6(a )0.7(solid )0.7(connection, )]TJ 0.045 Tw -3 -1.72 Td (particularly in larger centres, between clinicians on the ground and pub\ lic health, and that nee)Tj 0 Tw 38.111 0 Td (ds )Tj 0.003 Tw -38.111 -1.72 Td (to be... I'm not sure that even through the many layers of the public he\ alth system and federations )Tj ET endstream endobj 119 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 120 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (61)Tj ( )Tj ET Q BT 0.044 Tw 12 0 0 12 71.88 709.08 Tm [(that )0.5(we )0.5(are )0.5(free )0.6(of )0.5(problems, )0.5(but )0.5(it\222s )0.5(very )0.5(clear )0.5(that )0.5(there\222s )0.5(a )0.5(major )0.5(gap )0.6(between )0.6(clinical )0.6(sectors )]TJ 0.003 Tw 0 -1.72 TD [(and )0.5(public )0.5(health, )0.5(and )0.5(if )0.5(we )0.6(expect )0.6(to...the )0.6(people )0.5(w)]TJ 20.876 0 Td [(ho )0.5(know )0.5(something\222s )0.5(wrong )0.5(at )0.5(the )0.5(beginning )]TJ 0.06 Tw -20.876 -1.72 Td (of a public health emergency are the family physicians and nurses on the\ ground, and if we fail )Tj 0.056 Tw 0 -1.74 TD (to engage them in this process ultimately then we will be slower and les\ s effective in managing )Tj 0 Tw 0 -1.72 TD (it.)Tj ( )Tj 0.053 Tw 3 -1.72 Td (We also have a cu)Tj (lture within the public health system in Canada, I think )Tj 0 Tw (\226)Tj ( )Tj 0.053 Tw 31.063 0 Td (and you can )Tj 0.09 Tw -34.063 -1.72 Td (shoot me for this later )Tj 0 Tw 9.478 0 Td (\226)Tj ( )Tj 0.09 Tw 0.84 0 Td (in which we find ourselves bound by the regulations and policies and )Tj 0.084 Tw -10.318 -1.74 Td (what we believe we can do. The response when we look at trying to do thi\ ngs tends not to b)Tj 0 Tw 38.306 0 Td (e, )Tj 0.023 Tw -38.306 -1.72 Td (\223How do we do this? It needs to be done,\224 but, \223What are the li\ mitations on what I can do?\224 and )Tj 0.094 Tw T* (I think that\222s a function of, in part, a very layered system of respo\ nsibility for public health in )Tj 0.12 Tw T* (which it is easy to lose sight of the ultimate goal, and )Tj 22.968 0 Td (I think that parcel of delivering on the )Tj 0.11 Tw -22.968 -1.74 Td (International Health Regulation needs to take into account how we try to\ break that cycle and )Tj 0 Tw T* (more effectively get people collaborating.)Tj 16.743 0 Td ( )Tj 0.209 Tw -13.743 -1.72 Td (The last three slides, quickly, these are obvious statements. I have to \ say my)Tj 0 Tw 33.208 0 Td ( )Tj 0.459 0 Td (initial )Tj 0.258 Tw -36.667 -1.72 Td (reaction to the concept of international health regulation is that I thi\ nk we have failed to )Tj 0.393 Tw 0 -1.74 TD (demonstrate, repeatedly, that you can control human movement, that contr\ olling human )Tj 0.158 Tw 0 -1.72 TD (movement is an effective way of controlling disease. And I\222ve been ve\ )Tj 30.003 0 Td (ry appreciative of the )Tj 0.122 Tw -30.003 -1.72 Td (World Health Organization move to support local control and to try to ma\ ke sure that we are )Tj 0.056 Tw T* (focused on pathogens as opposed to people. It seems to me the only way f\ or long)Tj 0 Tw 33.279 0 Td (-)Tj 0.056 Tw (term success, )Tj 0.044 Tw -33.279 -1.74 Td (and so to the extent that this is about informa)Tj (tion and support for local control of things that are )Tj 0.064 Tw T* (potential global problems, it\222s a good thing. To the extent that we t\ hink it\222s about being able to )Tj 0 Tw T* (control human movement I think it will fail badly.)Tj 20.08 0 Td ( )Tj 0.058 Tw -17.08 -1.72 Td (I think I\222ve talked about many of these things, and )Tj 20.99 0 Td (you heard my question this morning. )Tj 0.03 Tw -23.99 -1.74 Td (If you want people to report at any level to a level that is larger/high\ er)Tj 0 Tw 28.469 0 Td (-)Tj 0.03 Tw (up/different, they need to )Tj 0.071 Tw -28.469 -1.72 Td (understand what it is they have to report and they need to understand wh\ y )Tj 0 Tw 30.761 0 Td (\226)Tj ( )Tj 0.071 Tw 0.821 0 Td (otherwise it won\222t )Tj 0 Tw -31.582 -1.72 Td (happen )Tj 3.168 0 Td (\226)Tj ( )Tj 0.03 Tw 0.78 0 Td (and it needs t)Tj (o be accompanied with sufficient incentives. Those incentives can just b\ e )Tj 0.058 Tw -3.949 -1.72 Td (feeling good and knowing that you\222re doing your job, but they have to\ be clear. The system we )Tj 0.025 Tw 0 -1.74 TD (have currently for reporting, at most levels, are active disincentives: \ travel advisorie)Tj 33.899 0 Td (s at the most )Tj 0.132 Tw -33.899 -1.72 Td (senior levels, demands for detailed information at lesser levels. I thin\ k we need to think very )Tj 0.073 Tw 0 -1.72 TD (carefully through the federal systems about how to make it a positive th\ ing to feed information )Tj 0 Tw T* (up the chain as opposed to a negative thing.)Tj 17.468 0 Td ( )Tj ET endstream endobj 121 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 122 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (62)Tj ( )Tj ET Q BT 0.225 Tw 12 0 0 12 107.88 709.08 Tm (And a)Tj (bout the collaborative process, I think the CDC\222s success in their co\ operative )Tj 0.105 Tw -3 -1.72 Td (agreements has a lot to do with ongoing discussions about what data is c\ ollected and why it\222s )Tj 0 Tw 0 -1.72 TD (collected so that people on the ground doing it see the need for it and \ are willing)Tj 32.157 0 Td ( )Tj (to do it.)Tj ( )Tj 0.063 Tw -29.157 -1.74 Td (And lastly )Tj 0 Tw (\226)Tj ( )Tj 0.063 Tw 5.327 0 Td (this is another obvious statement about the interaction between science \ and )Tj 0 Tw -8.327 -1.72 Td (politics )Tj 3.226 0 Td (\226)Tj ( )Tj 0.032 Tw 0.782 0 Td (we had a great deal of difficulty during the SARS outbreak being able to\ use scientific )Tj 0.272 Tw -4.008 -1.72 Td (evidence effectively, being able to translate what people)Tj 0 Tw 24.392 0 Td ( )Tj 0.272 Tw 0.522 0 Td (at the SARS Scientific Advisory )Tj 0.159 Tw -24.914 -1.72 Td (Committee thought should happen to the political levels that were making\ decisions, and we )Tj 0.115 Tw 0 -1.74 TD (failed very badly in accumulating the evidence about what was going on s\ o as to make better )Tj 0.249 Tw 0 -1.72 TD (decisions, and I would hope that in the )Tj (translation of the notification and the policies for )Tj 0.045 Tw T* (notification and management of new diseases that we\222re paying very ca\ reful attention to both of )Tj 0 Tw T* (those issues.)Tj ( )Tj 3 -1.74 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf T* (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.66 TD (KW:)Tj 1.944 0 Td ( )Tj 0.034 Tw 1.056 0 Td (Maybe we can take two quick questions. Does anybody hav)Tj (e any questions? And if not I )Tj 0.086 Tw 0 -1.72 TD (might ask one myself. The issue of travel advisories obviously has been \ a controversial )Tj 0.193 Tw T* (one, and I think of the recent article just published in )Tj /TT2 1 Tf 23.506 0 Td (PLoS Medicine)Tj /TT0 1 Tf 0 Tw ( )Tj 6.773 0 Td (demonstrating )Tj 0.402 Tw -30.279 -1.72 Td (perhaps the efficacy of travel advisories in delaying)Tj 0 Tw 23.502 0 Td ( )Tj 0.402 Tw 0.652 0 Td (transmission and using the )Tj 0.058 Tw -24.155 -1.74 Td (September 11th reduction in air travel and the delaying of the \222flu s\ eason. I don\222t know, )Tj 0.298 Tw T* (given the controversies of the travel advisory in Toronto and its useful\ ness as an )Tj 0 Tw T* (instrument, if you had any thoughts on that specific is)Tj 21.497 0 Td (sue.)Tj ( )Tj -24.497 -1.72 Td (AMc:)Tj 2.333 0 Td ( )Tj 0.073 Tw 0.667 0 Td (The problem with travel advisories is that they make a certain amount of\ sense some of )Tj 0.041 Tw 0 -1.74 TD (the time. The difficulty, to my mind, is that they are a very blunt inst\ rument, and it\222s not )Tj 0.238 Tw 0 -1.72 TD (clear that the benefits are greater than the risks. I also... you )Tj 26.956 0 Td (know, the data about )Tj 0.172 Tw -26.956 -1.72 Td (reducing air travel and the transmission of influenza is cool and intere\ sting academic )Tj 0.075 Tw T* (data, but I think any influenza expert and any public health person will\ tell you that the )Tj 0.105 Tw 0 -1.74 TD [(extent )0.5(to )0.5(which )0.5(you )0.5(have )0.5(to )0.5(reduce )]TJ 0 Tw (\226)Tj ( )Tj 0.105 Tw 15.831 0 Td [(for )0.5(influenza )0.5(specif)]TJ [(ically, )0.5(than )0.6(other )0.5(things )]TJ 0 Tw (\226)Tj ( )Tj 18.947 0 Td (the )Tj 0.036 Tw -34.778 -1.72 Td [(extent )0.5(to )0.5(which )0.5(you )0.5(have )0.5(to )0.5(reduce )0.5(travel )0.5(and )0.5(the )0.5(benefit )0.5(you )0.5(get )0.5(from )0.5(reducing )0.5(travel )0.5(in )]TJ 0.027 Tw 0 -1.72 TD (influenza is a\) limited )Tj 0 Tw (\226)Tj ( )Tj 0.027 Tw 9.88 0 Td (we were talking about an extension of ten days, which gives you )Tj 0.053 Tw -9.88 -1.72 Td (time to panic but it doesn\222t give you time t)Tj (o prepare )Tj 0 Tw (\226)Tj ( )Tj 0.053 Tw 22.408 0 Td (and b\) that the second problem is )Tj 0.114 Tw -22.408 -1.74 Td (that restriction of movement works if it\222s very extensive and if it o\ ccurs early enough. )Tj ET endstream endobj 123 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 124 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (63)Tj ( )Tj ET Q BT 0.049 Tw 12 0 0 12 107.88 709.08 Tm (You will notice in the data about pan \222flu that we were talking about\ restricting travel in )Tj 0.012 Tw 0 -1.72 TD (September and October to crea)Tj (te an eight)Tj 0 Tw (-)Tj 0.012 Tw (day delay in \222flu transmission in December and )Tj 0.045 Tw T* (January. I can\222t imagine that when we get to Phase 5 in pan \222flu a\ nd we don\222t know that )Tj 0.005 Tw 0 -1.74 TD (there\222s going to be a pandemic )Tj 0 Tw 12.583 0 Td (\226)Tj ( )Tj 0.005 Tw 0.755 0 Td (we\222re going to be still uncertain )Tj 0 Tw 13.027 0 Td (\226)Tj ( )Tj 0.005 Tw 0.755 0 Td (and the time at which, )Tj 0.127 Tw -27.121 -1.72 Td (in my view, we\222re)Tj 0 Tw ( )Tj 0.127 Tw 8.032 0 Td [(going to have to make the decision about stopping )0.5(travel )0.5(to )0.5(reduce )]TJ 0.1 Tw -8.032 -1.72 Td (transmission is at that level, when we\222re uncertain. There\222s no wa\ y that we\222re going to )Tj 0 Tw 0 -1.72 TD (make the decision to reduce travel enough to delay the onset.)Tj 24.408 0 Td ( )Tj -27.408 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.073 Tw 3 0 Td (And so I think because the impact of)Tj 0 Tw ( )Tj 0.073 Tw 15.524 0 Td (travel advisories are so great that they will )Tj 0.197 Tw -18.524 -1.72 Td (almost be invariably initiated too late, and probably not broadly enough\ to be really )Tj 0.048 Tw T* (effective. And I'm empathetic with the fact that they\222re such a draco\ nian thing to do that )Tj 0.004 Tw T* (people don\222t like doing them unt)Tj (il they\222re really sure, but the price of waiting until you\222re )Tj 0 Tw 0 -1.74 TD (really sure is that it\222s, I think, almost always going to be too late\ .)Tj 25.939 0 Td ( )Tj -28.939 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.127 Tw 1.056 0 Td (I\222d like to thank you on behalf of all of us, Dr.)Tj 0 Tw ( )Tj 0.127 Tw (McGeer. I hope you never have to go )Tj 0 Tw 0 -1.72 TD (through that experience again! [a)Tj (pplause])Tj ( )Tj -3 -1.72 Td ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Afternoon, September 20, 2006)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD ( )Tj /TT1 1 Tf 0 -1.74 TD (COUNTRY 3: CANADA)Tj ( )Tj 0 -1.64 TD (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.017 Tw 3 -1.66 Td (I\222d like to introduce Dr.)Tj 0 Tw ( )Tj 0.017 Tw (Howard Njoo. Dr.)Tj 0 Tw ( )Tj 0.017 Tw (Njoo is the Associate Director)Tj 0 Tw (-)Tj 0.017 Tw (General for the )Tj 0.128 Tw -3 -1.72 Td (Centre for Emergency Preparedness and Response of the Public Health Agen\ cy. Dr.)Tj 0 Tw 35.039 0 Td ( )Tj 0.128 Tw (Njoo has )Tj 0.042 Tw -35.039 -1.72 Td (quite a bit of experience with IHR )Tj 0 Tw (\226)Tj ( )Tj 0.042 Tw 14.995 0 Td [(he was an active member of the Canadian )0.5(negotiating team )]TJ 0 Tw -14.995 -1.72 Td (at the IHR sessions at WHO )Tj (\226)Tj ( )Tj (and is going to give a Canadian perspective on the IHR.)Tj 34.659 0 Td ( )Tj 0.031 Tw -31.659 -1.74 Td (Just also by way of introduction I was impressed so much with how what w\ e hav)Tj (e to say )Tj 0.044 Tw -3 -1.72 Td (in Canada parallels and duplicates what Dr.)Tj 0 Tw 17.675 0 Td ( )Tj 0.044 Tw (Marfin had to say about the United States, so if you )Tj 0.121 Tw -17.675 -1.72 Td (ask us the same questions about how things work in Canada we\222ll say s\ ame as U.S., same as )Tj 0 Tw 0 -1.72 TD (U.S., same as U.S. So, without introduction, Howard, please )Tj (go ahead.)Tj ( )Tj 0 -1.74 TD ( )Tj ET endstream endobj 125 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 126 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (64)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Howard Njoo)Tj ( )Tj /TT0 1 Tf 0.104 Tw 3 -1.64 Td (I thank you very much, Ron. It\222s a pleasure for me to be here today t\ o be able to give )Tj 0.034 Tw -3 -1.74 Td (you, I guess, my own personal reflections and perspective on the IHR\222\ s. I apologize, though, for )Tj 0.039 Tw 0 -1.72 TD [(not )0.5(being )0.5(here )0.5(this )0.5(morning )0.5(and )0.5(missing )0.5(the )0.5(d)]TJ 18.639 0 Td [(iscussion )0.5(because )0.5(I'm )0.5(sure )0.5(that )0.5(would )0.5(have )0.5(helped )]TJ 0.077 Tw -18.639 -1.72 Td (tweak what I want to say, so if I say anything which is out of context a\ nd so on I apologize in )Tj 0 Tw T* (advance.)Tj ( )Tj 0.078 Tw 3 -1.74 Td (Basically, I guess, my personal reflections on the IHR\222s come from tw\ o points of view. )Tj 0.076 Tw -3 -1.72 Td (First of all i)Tj (s that I do have experience in both clinical medicine and public health,\ and when I )Tj 0.021 Tw T* (say \223public health\224 at all three levels of government, so in a sen\ se I\222ve seen it from both sides of )Tj 0.067 Tw T* (the fence in Canada, I\222ve seen it from the local Toronto and Ontario \ pe)Tj 29.246 0 Td (rspective, and now with )Tj 0.08 Tw -29.246 -1.74 Td [(the feds I have obviously a different hat on, so I think that was )0.5(quite useful )0.5(for me in terms )0.5(of )]TJ 0 Tw T* (formulating my perspective.)Tj ( )Tj 0.105 Tw 3 -1.72 Td (The second point is that, as Ron said, I was the federal technical lead \ on the Canadian )Tj 0.102 Tw -3 -1.72 Td (delegation for the)Tj 0 Tw ( )Tj 0.102 Tw 7.608 0 Td (negotiations IHR, so having seen how things developed and unfolded in th\ e )Tj 0.162 Tw -7.608 -1.74 Td (actual negotiations in Geneva it was certainly an eye)Tj 0 Tw 22.346 0 Td (-)Tj 0.162 Tw (opener for me, and I think I see many )Tj 0.089 Tw -22.346 -1.72 Td (familiar faces who were with me in Geneva at 2:00, 3:00 in the morning w\ hen we\222re trying )Tj 0 Tw 38.222 0 Td (to )Tj 0.084 Tw -38.222 -1.72 Td (hammer out a deal, and the challenges and how we overcame them, so it\222\ s good to see you all )Tj 0.064 Tw T* [(again and hopefully I think all of us are part of, now, a bigger picture\ and )0.5(a )0.5(bigger )0.5(approach )0.5(to )]TJ 0 Tw 0 -1.74 TD (try and implement them world)Tj (-)Tj (wide, so I think that that\222s very )Tj (good.)Tj ( )Tj 0.013 Tw 3 -1.72 Td (In terms of the actual revision of the IHR\222s, my personal observation\ )Tj 0 Tw 27.951 0 Td (\226)Tj ( )Tj 0.013 Tw 0.763 0 Td (I think it\222s echoed )Tj 0.016 Tw -31.714 -1.72 Td (by many in the international community )Tj 0 Tw 16.426 0 Td (\226)Tj ( )Tj 0.016 Tw 0.766 0 Td (is that it\222s an amazing success story for what I call the )Tj 0.233 Tw -17.192 -1.72 Td [(international public health community. If you look at, I )0.5(gu)]TJ 25.393 0 Td [(ess, how thinks function )0.5(in )0.5(UN )]TJ 0 Tw -25.393 -1.74 Td (agencies )Tj 3.835 0 Td (\226)Tj ( )Tj 0.143 Tw 0.893 0 Td (from what I\222ve been told )Tj 0 Tw (\226)Tj ( )Tj 0.143 Tw 11.798 0 Td (to actually get the revisions of the IHR\222s done barely )Tj 0.053 Tw -16.526 -1.72 Td (about two years after the SARS crisis occurred world)Tj 0 Tw 21.749 0 Td (-)Tj (wide )Tj 2.579 0 Td (\226)Tj ( )Tj 0.053 Tw 0.803 0 Td (and obviously in Canada )Tj 0 Tw (\226)Tj ( )Tj 0.053 Tw 11.178 0 Td (I think )Tj 0.054 Tw -36.309 -1.72 Td (is almost unbelievable, so it just sho)Tj (wed the level of commitment and work which was done by )Tj 0.049 Tw 0 -1.72 TD (all countries involved, and in the public health community in particular\ , to actually get it to that )Tj 0 Tw 0 -1.74 TD (point.)Tj ( )Tj 0.063 Tw 3 -1.72 Td [(The )0.5(other )0.5(part )0.5(also )0.5(is )0.5(that )0.5(in )0.5(terms )0.5(of )0.6(this )0.6(specific )0.6(workshop, )0.5(I\222ll )0.5(just )0.5(mention )0.5(just )0.5(as )0.5(an )]TJ 0.051 Tw -3 -1.72 Td (observation, is that the issue of the challenges for federal states did \ actually come up during the )Tj 0.014 Tw 0 -1.72 TD [(actual negotiations in Geneva, and I think it was one country in particu\ lar the U.S. had brought )0.5(it )]TJ 0.192 Tw 0 -1.74 TD (up as a potential obstacle or challenge in terms of the )Tj (federal government being in a sense )Tj ET endstream endobj 127 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 128 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (65)Tj ( )Tj ET Q BT 0.006 Tw 12 0 0 12 71.88 709.08 Tm [(present )0.5(at )0.5(the )0.5(negotiations )0.5(and )0.5(speaking )0.5(on )0.5(behalf )0.5(of )0.5(the )0.5(U.S. )0.5(but )0.5(in )0.6(essence )0.5(not )0.5(really )0.5(having )0.5(the )]TJ 0.014 Tw 0 -1.72 TD [(authority )0.5(or )0.5(power )0.5(to )0.6(compel )0.6(their )0.5(states )]TJ 0 Tw (\226)Tj ( )Tj 0.014 Tw 17.326 0 Td [(which )0.5(would )0.5(have )0.5(obviously )0.5(a )0.5(large )0.6(responsibility )0.6(for )]TJ 0.09 Tw -17.326 -1.72 Td (the implementation of )Tj (the IHR\222s )Tj 0 Tw (\226)Tj ( )Tj 0.09 Tw 14.537 0 Td (comply. What was interesting is that, Canada included, and )Tj 0.056 Tw -14.537 -1.74 Td (the many other federal states present at that time in terms of their con\ sideration, for them at the )Tj 0.043 Tw T* (end of the day it wasn\222t what they saw as an insurmountable issue or \ challenge, and t)Tj 34.71 0 Td (here really )Tj 0.207 Tw -34.71 -1.72 Td [(was )0.5(no )0.5(support )0.5(for )0.5(any )0.5(specific )0.5(article )0.5(in )0.5(the )0.5(IHR\222s )0.5(making )0.5(reference )0.5(to )0.6(federal )0.5(states )0.5(and )]TJ 0.02 Tw T* (possible challenges and so on in terms of implementation. So I just want\ ed to put that forward in )Tj 0.06 Tw 0 -1.74 TD (terms of the fact that it was recognized at the actual)Tj 0 Tw 21.198 0 Td ( )Tj 0.06 Tw 0.31 0 Td (negotiations, and most federal states saw it )Tj 0 Tw -21.508 -1.72 Td (in a particular light.)Tj ( )Tj 0.195 Tw 3 -1.72 Td (Having said that, I just now want to, I guess, dive into a Canadian pers\ pective, and )Tj 0.059 Tw -3 -1.72 Td (basically what I think from Canada )Tj 0 Tw 14.684 0 Td (\226)Tj ( )Tj 0.059 Tw 0.809 0 Td (or at least my own personal viewpoint )Tj 0 Tw (\226)Tj ( )Tj 0.059 Tw 16.747 0 Td (is that the IHR\222s )Tj 0.027 Tw -32.24 -1.74 Td (an exce)Tj (llent tool, and certainly a framework which will allow us collectively i\ n the public health )Tj 0 Tw 0 -1.72 TD (community )Tj 4.868 0 Td (\226)Tj ( )Tj 0.063 Tw 0.813 0 Td (and also in the medical community )Tj 0 Tw (\226)Tj ( )Tj 0.063 Tw 15.463 0 Td (to systematically examine our infrastructure )Tj 0.023 Tw -21.144 -1.72 Td (and practices and subsequently enhance the areas in which we can improv)Tj 29.885 0 Td (e. I think we would all )Tj 0.1 Tw -29.885 -1.72 Td (acknowledge that we don\222t have any perfect system anywhere in the wor\ ld and there\222s always )Tj 0 Tw 0 -1.74 TD (room for improvement, and Canada\222s no exception.)Tj 20.661 0 Td ( )Tj 0.084 Tw -17.661 -1.72 Td (One thing I will say )Tj 0 Tw (\226)Tj ( )Tj 0.084 Tw 9.445 0 Td (and I think this is also alludes to what Dr.)Tj 0 Tw ( )Tj 0.084 Tw (McGeer said )Tj 0 Tw (\226)Tj ( )Tj 0.084 Tw 24.055 0 Td (is that )Tj 0 Tw -36.5 -1.72 Td (Ca)Tj 0.066 Tw (nada in many ways had a leading role in the development of the revision \ of the IHR\222s. With )Tj 0.023 Tw 0 -1.72 TD (the Toronto experience we were certainly looked upon as leaders because \ of our lessons learned, )Tj 0.081 Tw 0 -1.74 TD (and we still are looked upon as leaders in terms of the implementatio)Tj 28.516 0 Td (n based on what we went )Tj 0.049 Tw -28.516 -1.72 Td (through in Toronto. It certainly brings back memories for me when Alliso\ n showed some of the )Tj 0 -1.72 TD (presentation because I was also technically involved at a very practical\ level, both at the federal )Tj 0.108 Tw T* (level but then )Tj 0 Tw (\226)Tj ( )Tj 0.108 Tw 6.874 0 Td (I'm not sure if you re)Tj 0 Tw (call )Tj 10.713 0 Td (\226)Tj ( )Tj 0.108 Tw 0.858 0 Td (when some members of the committee in Ontario )Tj 0.027 Tw -18.445 -1.74 Td (actually came down ill they had to sort of co)Tj 0 Tw 18.041 0 Td (-)Tj 0.027 Tw (opt people from throughout Canada, and especially )Tj 0.115 Tw -18.041 -1.72 Td (those who had an Ontario license in the public health and medical system\ in Ontario to come )Tj 0.011 Tw T* (down, and so I )Tj (was actually part of that committee for a while, spent a few weeks in To\ ronto and )Tj 0 Tw T* (then obviously came back to Ottawa. I have very fond memories of that ti\ me, by the way.)Tj 35.851 0 Td ( )Tj 0.15 Tw -32.851 -1.74 Td (Anyway, in terms of my perspective as far as how the IHR\222s play in Ca\ nada, I think )Tj 0 Tw -3 -1.72 Td (ove)Tj 0.166 Tw (rall I would say that we have an excellent and history of collaboration \ between, I guess, )Tj 0.015 Tw T* (federal and provincial and territorial levels in terms of how we work wi\ thin the public health and )Tj 0.031 Tw T* (medical communities. If something were to happen tomorrow, an emerg)Tj 29.188 0 Td (ency, regardless of what )Tj ET endstream endobj 129 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 130 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (66)Tj ( )Tj ET Q BT 0.056 Tw 12 0 0 12 71.88 709.08 Tm (legal frameworks or whatever we have in place, people would just want to\ get it done right and )Tj 0.048 Tw 0 -1.72 TD (we would cooperate. Obviously things may not be smooth and there are alw\ ays lessons learned, )Tj 0.091 Tw T* (but by and large we have the history and hi)Tj (story, so I think that\222s stood us in good stead even )Tj 0 Tw 0 -1.74 TD (during the SARS crisis.)Tj ( )Tj 0.153 Tw 3 -1.72 Td [(Many )0.5(of )0.5(the )0.5(elements, )0.5(I )0.5(think, )0.5(of )0.5(the )0.5(IHR )0.5(regarding )0.5(surveillance )0.5(and )0.5(notification )0.5(and )]TJ 0.034 Tw -3 -1.72 Td (control measures and so on are actually essentially already in place in \ Canada. We could alwa)Tj 0 Tw 38.111 0 Td (ys )Tj 0.042 Tw -38.111 -1.72 Td [(do better, but we have established working )0.5(relationships, )0.5(certainly between the federal level and )]TJ 0.171 Tw T* (our counterparts in terms of public health in the provinces and territor\ ies, and that has been )Tj 0.006 Tw 0 -1.72 TD (ongoing and continues to be very strong. We now have additio)Tj 25.136 0 Td (nal structures )Tj 0 Tw (\226)Tj ( )Tj 0.006 Tw 6.377 0 Td (which I\222ll speak to )Tj 0 Tw -31.512 -1.72 Td (\226)Tj ( )Tj 0.001 Tw 0.751 0 Td (such as the Pan)Tj 0 Tw (-)Tj 0.001 Tw [(Canadian Public )0.5(Health Network, but by and large it builds on what we already )]TJ 0 Tw -0.751 -1.72 Td (have.)Tj ( )Tj 0.024 Tw 3 -1.74 Td (Just another point )Tj 0 Tw (\226)Tj ( )Tj 0.024 Tw 8.208 0 Td (which I'm not sure if Allison may agree or disagree with me )Tj 0 Tw 24.577 0 Td (\226)Tj ( )Tj 0.024 Tw 0.774 0 Td (is that )Tj 0.124 Tw -36.559 -1.72 Td (even if you use the SARS e)Tj (xample in terms of an actual practice it worked quite well in one )Tj 0.24 Tw T* (respect. If you look at sort of this whole cycle of information, startin\ g at the WHO level )Tj 0.11 Tw T* (internationally, the WHO did report to us at the federal level that ther\ e were cases of atypical )Tj 0 Tw 0 -1.74 TD (pn)Tj 0.014 Tw [(eumonia happening in Hong Kong and so on )0.5(and something to be on the alert for, especially if )]TJ 0.484 Tw 0 -1.72 TD (people were coming out of Hong Kong. Through our established networks we\ then )Tj 0.097 Tw T* (communicated that message, that alert, that advisory, to our provincial \ counterparts.)Tj 0 Tw 34.571 0 Td ( )Tj 0.097 Tw 0.347 0 Td (So I can\222t )Tj 0.001 Tw -34.918 -1.72 Td (speak for the public health system within the provincial jurisdiction bu\ t certainly from the federal )Tj 0 Tw 0 -1.74 TD (level it went down to the provincial level.)Tj 16.662 0 Td ( )Tj 0.035 Tw -13.662 -1.72 Td (And my understanding )Tj 0 Tw (\226)Tj ( )Tj 0.035 Tw 10.306 0 Td (and I'm also a clinical physician )Tj 0 Tw 13.276 0 Td (\226)Tj ( )Tj 0.035 Tw 0.785 0 Td (is that depending, obviously, )Tj 0.171 Tw -27.368 -1.72 Td (on the var)Tj (ious jurisdictions, I think then the local medical offices of health, th\ rough various )Tj 0.017 Tw 0 -1.72 TD (mechanisms, I think made their health professionals aware of the situati\ on, so it might have been )Tj 0.174 Tw 0 -1.74 TD [(a )0.5(notice )0.5(posted )0.5(in )0.5(the )0.5(emergency )0.5(room )0.5(or )0.5(doctors\222 )0.5(offices. )0.5(I'm )0.5(not )0.5(quite)]TJ 0 Tw 30.726 0 Td ( )Tj 0.174 Tw 0.424 0 Td [(sure, )0.5(I )0.5(don\222t )0.5(recall )]TJ 0.099 Tw -31.149 -1.72 Td (exactly if I got a notice in the mail, but certainly it was made clear t\ o the clinical docs on the )Tj 0.123 Tw 0 -1.72 TD (ground from the provincial public authority to be on the lookout for the\ se types of situations. )Tj 0.138 Tw T* (And lo and behold, barely a couple of d)Tj (ays after this notice came out coming from WHO to )Tj 0 Tw 0 -1.74 TD (federal level to province we actually got a call.)Tj 18.741 0 Td ( )Tj 0.023 Tw -15.741 -1.72 Td (And interestingly, I actually got a personal phone call from the then ch\ ief medical officer )Tj 0.006 Tw -3 -1.72 Td (of health at the time, Dr.)Tj 0 Tw ( )Tj 0.006 Tw (Colin D\222Cunha, that there were a coup)Tj (le of cases which met this criteria )Tj ET endstream endobj 131 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 132 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (67)Tj ( )Tj ET Q BT 0.041 Tw 12 0 0 12 71.88 709.08 Tm [(in )0.5(terms )0.5(of )0.5(atypical )0.5(pneumonia )0.5(having )0.5(recently )0.5(come )0.5(back )0.6(from )0.6(Hong )0.6(Kong )0.6(in )0.6(the )0.6(Scarborough )]TJ 0 Tw 0 -1.72 TD (Hospital.)Tj ( )Tj 0.078 Tw 3 -1.72 Td (The rest is history, and obviously there are many things that we could c\ ollectively have )Tj 0.021 Tw -3 -1.74 Td (done better, but in terms of t)Tj (hat initial notification from sort of the local level to the federal lev\ el )Tj 0.01 Tw T* (to then start managing the situation, that was there. So I think that\222\ s maybe a small success but at )Tj 0 Tw T* (least was something that was there, and I think was something we can cer\ tainly b)Tj 32.463 0 Td (uild on.)Tj ( )Tj 0.3 Tw -29.463 -1.72 Td (As far as FPT collaboration, I think Dr.)Tj 0 Tw ( )Tj 0.3 Tw (Jeff Scott will speak from the provincial )Tj 0.178 Tw -3 -1.74 Td (perspective, but certainly I think that spirit has always been there, an\ d even in terms of the )Tj 0.199 Tw T* (negotiating team that went to Geneva from Canada we made sure that we)Tj 0 Tw 31.711 0 Td ( )Tj 0.199 Tw 0.449 0 Td (had a provincial )Tj 0.055 Tw -32.16 -1.72 Td [(perspective, )0.5(and )0.5(Dr.)]TJ 0 Tw ( )Tj 0.055 Tw [(Jeff )0.5(Scott )0.5(and )0.5(also )0.5(Dr.)]TJ 0 Tw ( )Tj 0.055 Tw [(Joel Kitner )0.5(from )0.6(Manitoba )0.5(were )0.5(actually )0.5(part )0.5(of )0.5(our )]TJ 0.124 Tw T* (delegation that went over to negotiate in Geneva, so to me it\222s anoth\ er example of good FPT )Tj 0 Tw 0 -1.74 TD (collaboration in Canada.)Tj ( )Tj 0.035 Tw 3 -1.72 Td (As far as the IHR implem)Tj (entation, I'm going to go through a template afterwards. 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One)Tj 0 Tw ( )Tj 0.043 Tw 34.915 0 Td (of the key )Tj 0.094 Tw -34.915 -1.72 Td (parts, as others have mentioned, is the actual notification protocol, an\ d in Canada although we )Tj 0.015 Tw T* (have a long)Tj 0 Tw (-)Tj 0.015 Tw (standing tradition of good notification communication channels from loca\ l to federal )Tj 0.177 Tw 0 -1.74 TD (levels, it\222s actually never been formalized in law.)Tj 0 Tw 20.924 0 Td ( )Tj 0.177 Tw 0.427 0 Td (So that\222s one of the things we\222re actually )Tj 0 Tw -21.351 -1.72 Td (looking at to in a sense formalize what is already)Tj 19.577 0 Td (-)Tj (existing practice.)Tj ( )Tj 0.143 Tw -16.577 -1.72 Td (And then finally, I think, which is obviously the biggest for us but als\ o for any other )Tj 0.058 Tw -3 -1.72 Td (state, I think, is to actually look at our gaps, our w)Tj 20.688 0 Td (eaknesses, and certainly in Canada we\222re not )Tj 0.105 Tw -20.688 -1.74 Td (alone. We\222re going to look at specific things such as how we use this\ new algorithm, because )Tj 0.049 Tw 0 -1.72 TD (that certainly is a departure from the traditional practice of having a \ list of defined diseases. So, )Tj 0.054 Tw T* (for something li)Tj (ke the new virus x which may appear tomorrow, how do we actually work wi\ th )Tj ET endstream endobj 133 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 134 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (68)Tj ( )Tj ET Q BT 0.016 Tw 12 0 0 12 71.88 709.08 Tm (the provinces and territories to actually develop a consistent approach \ to actually determine what )Tj 0 Tw 0 -1.72 TD (would constitute a public health emergency of international concern.)Tj 27.462 0 Td ( )Tj 0.034 Tw -24.462 -1.72 Td (And then of c)Tj (ourse one thing that we\222ve very cognizant about )Tj 0 Tw 25.339 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (and myself in particular, )Tj 0.093 Tw -29.123 -1.74 Td (wearing my other hat as a clinician )Tj 0 Tw 14.898 0 Td (\226)Tj ( )Tj 0.093 Tw 0.843 0 Td (is that we need to make that connection to the front)Tj 0 Tw (-)Tj (line )Tj 0.128 Tw -15.741 -1.72 Td (folks which Dr.)Tj 0 Tw ( )Tj 0.128 Tw (McGeer alluded to, the actual front)Tj 0 Tw (-)Tj 0.128 Tw (line health professionals who ac)Tj (tually are )Tj 0.184 Tw T* [(really )0.5(the )0.5(first )0.5(line )0.5(of )0.6(defence )0.5(and )0.5(the )0.5(first )0.5(people )0.5(who )0.5(would )0.5(actually )0.5(recognize )0.5(something )]TJ 0.079 Tw T* (which may become a so)Tj 0 Tw (-)Tj 0.079 Tw (called PHEIC, if you use the acronym. So, in terms of tools for front)Tj 0 Tw (-)Tj 0.018 Tw 0 -1.74 TD (line physicians, nurses and so on, doctors\222 offices and hosp)Tj (itals, that\222s certainly something we\222re )Tj 0 Tw 0 -1.72 TD (going to have to work forward in that regard.)Tj ( )Tj 0.082 Tw 3 -1.72 Td (But having said all that, I think overall )Tj 0 Tw 16.35 0 Td (\226)Tj ( )Tj 0.082 Tw 0.832 0 Td (before I go to this template )Tj 0 Tw 11.546 0 Td (\226)Tj ( )Tj 0.082 Tw 0.832 0 Td (I think we have )Tj 0.086 Tw -32.561 -1.72 Td (been and continued to be viewed as a leader because of our experience, a\ nd I th)Tj 33.109 0 Td (ink sometimes )Tj 0.033 Tw -33.109 -1.74 Td (there\222s always a silver lining in sort of the bad times we go through\ , and I think we\222re hopefully )Tj 0 Tw T* (now on sort of the upward curve having lived through SARS.)Tj ( )Tj 0.021 Tw 3 -1.72 Td (And I don\222t think we have enough time but I certainly have my own vie\ wpoints on trav)Tj 0 Tw (el )Tj -3 -1.72 Td (advisories, and the one thing I will say is that yes, I don\222t think t\ hey work, and even if you have a )Tj 0.124 Tw 0 -1.74 TD (very carefully)Tj 0 Tw (-)Tj 0.124 Tw (worded travel advisory that says, you know, \223No essential travel to t\ he City of )Tj 0.067 Tw 0 -1.72 TD (Toronto,\224 or whatever, be it warranted or not, what I sa)Tj 22.802 0 Td (w at the federal level is that people just )Tj 0.038 Tw -22.802 -1.72 Td (look at political boundaries and so they see all of Canada as tainted. Y\ ou know, we have a large )Tj 0.225 Tw T* (countries, it\222s a couple thousand kilometres from sea to sea, but for\ people in Europe and )Tj 0 -1.74 TD (elsewhere as soon as you )Tj (saw the word \223Canada\224 they wouldn\222t be able to recognize that )Tj 0.034 Tw 0 -1.72 TD [(someone )0.5(actually )0.5(came )0.5(from )0.5(Vancouver )0.5(or )0.5(Halifax, )0.5(a )0.5(couple )0.5(thousand )0.5(kilometres )0.5(from )0.5(Toronto, )]TJ 0.008 Tw T* (and so there were sort of horror stories that I had to deal with in term\ s of Canadians being denied )Tj 0 Tw T* (ho)Tj 0.009 Tw (tel accommodation in Paris, or being denied entry on a cruise ship in th\ e Mediterranean and so )Tj 0.13 Tw 0 -1.74 TD (on. So there is a lot of fall)Tj 0 Tw (-)Tj 0.13 Tw (out which we have to obviously expect, and of course there\222s the )Tj 0 Tw 0 -1.72 TD (economic losses and so on which go without saying.)Tj ( )Tj 0.162 Tw 3 -1.72 Td (One thing I'm g)Tj (oing to slip into )Tj 0 Tw (\226)Tj ( )Tj 0.162 Tw 14.863 0 Td (I know we\222re stuck for time )Tj 0 Tw (\226)Tj ( )Tj 0.162 Tw 13.268 0 Td (is I was given this )Tj 0 Tw -31.131 -1.72 Td (template )Tj 3.791 0 Td (\226)Tj ( )Tj 0.098 Tw 0.848 0 Td (which I'm not sure if the other speakers are following )Tj 0 Tw 22.596 0 Td (\226)Tj ( )Tj 0.098 Tw 0.848 0 Td (in terms of consistency, in )Tj 0.034 Tw -28.083 -1.74 Td (terms of how Canada )Tj 0 Tw 8.913 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (at least my opinion )Tj 0 Tw 8.025 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (how we shape up against the various questions )Tj 0 Tw 19.216 0 Td (put )Tj 0.136 Tw -37.722 -1.72 Td (forward by the organizing committee. So, here goes. Pretty straightforwa\ rd. If we look at the )Tj 0.086 Tw T* (political structure in a public health governance, Canada is a federal s\ tate with a parliamentary )Tj 0.295 Tw T* (confederation of provinces and territories. All clinical and)Tj 0 Tw 25.279 0 Td ( )Tj 0.295 Tw 0.545 0 Td (public health activities are the )Tj ET endstream endobj 135 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 136 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (69)Tj ( )Tj ET Q BT 0.044 Tw 12 0 0 12 71.88 709.08 Tm [(responsibility of the province, and that\222s )0.5(something that\222s )0.5(very well)]TJ 0 Tw 27.442 0 Td (-)Tj 0.044 Tw (recognized in Canada and a )Tj 0.146 Tw -27.442 -1.72 Td (very strong responsibility of the provinces and territories, the only ex\ ception really being the )Tj /TT1 1 Tf 0.01 Tw 0 -1.72 TD (Quarantine Act )Tj /TT0 1 Tf (which the fed)Tj (eral government is responsible for which in a sense gives us certain )Tj 0.138 Tw 0 -1.74 TD (powers at our ports of entry in terms of the international boundary, bor\ der with the U.S. and )Tj 0 Tw 0 -1.72 TD (other countries.)Tj ( )Tj 0.005 Tw 3 -1.72 Td [(If )0.5(you )0.5(look )0.5(at )0.5(the )0.5(major )0.6(public )0.6(health )0.5(institutions, )0.6(certainly )0.5(where )0.5(I )0.5(work )]TJ [(the )0.5(federal )0.5(focal )]TJ 0.03 Tw -3 -1.72 Td (point would be the Public Health Agency of Canada, and we have now creat\ ed something called )Tj 0.048 Tw 0 -1.74 TD (a Pan)Tj 0 Tw 2.242 0 Td (-)Tj 0.048 Tw (Canadian Public Health Network, which we see as an integration mechanism\ between the )Tj 0.015 Tw -2.242 -1.72 Td (federal level and the provinces and territories. I thin)Tj 20.859 0 Td (k it\222s a good mechanism, and it\222s certainly in )Tj 0.068 Tw -20.859 -1.72 Td (the early phases of using it but I think so far it\222s proven to be qui\ te useful in terms of having a )Tj 0 Tw 0 -1.72 TD (good dialogue.)Tj ( )Tj 0.072 Tw 3 -1.74 Td (The provincial/territorial counterparts are obviously the ministries of \ health, and then as )Tj 0 Tw -3 -1.72 Td (we)Tj 0.046 Tw (ll as the local level, which my understanding in terms of a legal interp\ retation it really is part )Tj 0.02 Tw T* (of the province, because municipalities in Canada )Tj 0 Tw 20.3 0 Td (\226)Tj ( )Tj 0.77 0 Td (cities )Tj 2.38 0 Td (\226)Tj ( )Tj 0.02 Tw 0.77 0 Td (are really by legislation a creation of )Tj 0 Tw -24.22 -1.72 Td (the province, so that\222s just a minor technical point to )Tj 21.301 0 Td (note.)Tj ( )Tj 0.019 Tw -18.301 -1.74 Td (In terms of national core capacities, I don\222t think we\222re much dif\ ferent from other federal )Tj 0.036 Tw -3 -1.72 Td (states, so I won\222t really comment on this. As you can see, if you loo\ k at it at a broad level, what )Tj 0.027 Tw T* (is most important and has the most access obviously is the)Tj 0 Tw 23.598 0 Td ( )Tj 0.027 Tw 0.277 0 Td (local level. You can see it in terms of )Tj 0.067 Tw -23.875 -1.72 Td (actual detection and management and so on, so that\222s something all of\ us you collectively keep )Tj 0.005 Tw 0 -1.74 TD (in mind, is that we need to support the local level and make sure that t\ hey\222re engaged and they\222re )Tj 0 Tw 0 -1.72 TD (part of the solution )Tj (implementation of the ideal IHR\222s in every federal state.)Tj 30.407 0 Td ( )Tj 0.095 Tw -27.407 -1.72 Td (What are we doing in terms of negotiation approval? As I mentioned befor\ e we have a )Tj 0.032 Tw -3 -1.72 Td (good tradition of information sharing but I think it\222s certainly been\ a wake)Tj 0 Tw 30.153 0 Td (-)Tj 0.032 Tw (up call for Canada to )Tj 0.003 Tw -30.153 -1.74 Td (actually try an)Tj [(d formalize some of )0.5(these things )0.5(in legislation, so that\222s what we\222re actually doing. )]TJ 0 Tw T* (So that\222s all I\222ll say on that one.)Tj ( )Tj 0.086 Tw 3 -1.72 Td (Does the federal national government have the authority to mandate? No, \ but I think in )Tj 0.056 Tw -3 -1.72 Td (terms of the spirit of how we\222ve always worked )Tj 19.861 0 Td (within the public health community I don\222t see )Tj 0.041 Tw -19.861 -1.74 Td (that personally as a major obstacle or challenge, it\222s something that\ we\222re just going to continue )Tj 0 Tw T* (business as usual and make sure that we do the right thing collectively.\ )Tj 28.354 0 Td ( )Tj 0.15 Tw -25.354 -1.72 Td (And in terms of mechanisms, like I sa)Tj (y we\222re relying obviously on our long)Tj 0 Tw 32.278 0 Td (-)Tj (standing )Tj 0.086 Tw -35.278 -1.72 Td (good working relationships, but the one thing I\222ll put down here )Tj 0 Tw (\226)Tj ( )Tj 0.086 Tw 27.663 0 Td (and maybe other Canadians )Tj ET endstream endobj 137 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 138 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (70)Tj ( )Tj ET Q BT 0.101 Tw 12 0 0 12 71.88 709.08 Tm (will want to comment )Tj 0 Tw (\226)Tj ( )Tj 0.101 Tw 10.255 0 Td (is that the federal government as a mechanism could use its spending )Tj 0.015 Tw -10.255 -1.72 Td (power in much the same w)Tj (ay that the federal government has played on in terms of ensuring that )Tj 0.091 Tw 0 -1.72 TD (there is in a sense a national sort of medicare system in terms of publi\ cly)Tj 0 Tw 30.377 0 Td (-)Tj 0.091 Tw (funded they\222ve used )Tj 0.219 Tw -30.377 -1.74 Td (their spending power in the past to have the individual provinces and te\ rritories have th)Tj 0 Tw 37.945 0 Td (eir )Tj -37.945 -1.72 Td (publicly)Tj (-)Tj 0.153 Tw [(funded healthcare systems more )0.5(or less be compatible and have portability so that a )]TJ 0.046 Tw T* (Canadian citizen, if they are a resident of one province and then become\ ill in another province, )Tj 0.087 Tw T* (would also have access to healthcare and so on. So, in much t)Tj (hat same way I think the federal )Tj 0.005 Tw 0 -1.74 TD (government could use )Tj 0 Tw (\226)Tj ( )Tj 0.005 Tw 9.85 0 Td (or at least it\222s one tool we could access )Tj 0 Tw 15.899 0 Td (\226)Tj ( )Tj 0.005 Tw 0.755 0 Td (its spending power to assist the )Tj 0.191 Tw -26.505 -1.72 Td (provinces and territories in some fashion in terms of surveillance syste\ ms and other aspects )Tj 0 Tw 0 -1.72 TD (necessary for the IHR\222s.)Tj ( )Tj 3 -1.72 Td (Respo)Tj 0.177 Tw (nse to a public health emergency of international concern, I think all o\ f us are )Tj 0.277 Tw -3 -1.74 Td (aware or very keenly recognize that there are always local events first.\ As they say, it\222s )Tj 0.237 Tw T* (something that happens to be handled at the local level, and because of \ our long)Tj 0 Tw 35.278 0 Td (-)Tj (sta)Tj 1.444 0 Td (nding )Tj 0.144 Tw -36.722 -1.72 Td (collaborative environment it\222s certainly something that I think we\222\ ll just continue in terms of )Tj 0.37 Tw T* (making sure that all the stakeholders are engaged and involved in findin\ g solutions to )Tj 0 Tw 0 -1.74 TD (weaknesses.)Tj ( )Tj 0.027 Tw 3 -1.72 Td (The one thing where we do have the federal responsibili)Tj 22.705 0 Td (ty is from a WHO perspective. It )Tj 0.033 Tw -25.705 -1.72 Td (has to be at the federal level, and the Public Health Agency of Canada h\ as been identified as the )Tj 0.005 Tw 0 -1.72 TD (national focal point, so we are that point of contact with the WHO in te\ rms of notifying them and )Tj 0 Tw 0 -1.74 TD (also having notification ba)Tj (ck of situations happening elsewhere in the world.)Tj 30.742 0 Td ( )Tj 0.03 Tw -27.742 -1.72 Td (Here I think we\222re just saying the same thing again. We\222re obvious\ ly involved in various )Tj 0.179 Tw -3 -1.72 Td (process underway working with our colleagues at the provincial/territori\ al levels, and at this )Tj 0 Tw 0 -1.72 TD (point I don\222t think t)Tj (here\222s anything further I need to say, it\222s sort of the same thing\ s.)Tj 33.66 0 Td ( )Tj 0.156 Tw -30.66 -1.74 Td (In terms of costs )Tj 0 Tw (\226)Tj ( )Tj 0.156 Tw 8.416 0 Td [(this is always a sticky area when you talk about FPT )0.5(relations )0.5(in )]TJ 0 Tw -11.416 -1.72 Td (Canada )Tj 3.271 0 Td (\226)Tj ( )Tj 0.023 Tw 0.773 0 Td (I think it\222s recognized that most jurisdictions would be responsible \ for their own costs. )Tj 0 Tw -4.044 -1.72 Td (Of)Tj ( )Tj 0.267 Tw 1.572 0 Td (course there are certain areas in which there might be overlap, or an ar\ ea for further )Tj 0.046 Tw -1.572 -1.72 Td (discussion, but I think it\222s recognized that based on the responsibil\ ities for the jurisdictions they )Tj 0 Tw 0 -1.74 TD (would be responsible for, obviously, taking care of their own area)Tj (s.)Tj ( )Tj 0.015 Tw 3 -1.72 Td [(Finally, )0.5(comparing )0.5(strategies, )0.5(my )0.5(own )0.5(personal )0.5(viewpoint )0.5(in )0.5(terms )0.5(of )0.5(challenges )0.5(in )0.5(terms )]TJ 0.066 Tw -3 -1.72 Td (of communication/collaboration, no major challenges. I think the most im\ portant thing we need )Tj ET endstream endobj 139 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 140 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (71)Tj ( )Tj ET Q BT 0.035 Tw 12 0 0 12 71.88 709.08 Tm (is goodwill, which I think we have in Canada. It\222s obviously just wor\ k)Tj (ing with the goodwill and )Tj 0 Tw 0 -1.72 TD (moving forward.)Tj ( )Tj 0.223 Tw 3 -1.72 Td (Strategies: the Public Health Network is one mechanism. I don\222t think\ it\222s the only )Tj 0.041 Tw -3 -1.74 Td (mechanism but it\222s certainly a key mechanism that we\222re currently \ using. And does it serve as a )Tj 0.056 Tw T* (useful framework? Yes, I think the)Tj 0 Tw ( )Tj 0.056 Tw 14.527 0 Td (IHR\222s have been something that all of us in Canada can use )Tj 0.156 Tw -14.527 -1.72 Td [(to )0.5(our )0.5(mutual )0.5(benefit )0.5(to )0.5(actually )0.6(improve, )0.5(enhance )0.5(our )0.6(public )0.6(health, )0.6(and )0.6(obviously )0.6(also )0.6(our )]TJ 0 Tw T* (medical care system in Canada.)Tj 12.634 0 Td ( )Tj 0.053 Tw -9.634 -1.74 Td (And it\222s all a matter of degree, because in Canada I think we wanted \ the)Tj 0 Tw 29.591 0 Td ( )Tj 0.053 Tw 0.303 0 Td (perfect system, )Tj 0.067 Tw -32.894 -1.72 Td (and where we\222re going to use the IHR\222s in one way. When I was at t\ he negotiations in Geneva )Tj 0.008 Tw T* (some countries, to me it was quite striking, they\222re so happy they ca\ n use the IHR\222s to go to their )Tj 0.088 Tw T* (government and be able to advocate for a nation)Tj 19.975 0 Td (al microbiology laboratory )Tj 0 Tw (\226)Tj ( )Tj 0.088 Tw 12.072 0 Td (which they don\222t )Tj 0.167 Tw -32.047 -1.74 Td (even have )Tj 0 Tw (\226)Tj ( )Tj 0.167 Tw 5.527 0 Td (to be able to make diagnoses for various diseases, so you can see how va\ rious )Tj 0.212 Tw -5.527 -1.72 Td (countries need to use it for different purposes and obviously our level,\ in a sense, is quite )Tj 0 Tw T* (different from some other )Tj (countries.)Tj ( )Tj 0.023 Tw 3 -1.72 Td (Three governance challenges that I would put forward, I think )Tj 0 Tw (\226)Tj ( )Tj 0.023 Tw 26.073 0 Td (obviously I\222ve had some )Tj 0.097 Tw -29.073 -1.74 Td (discussion with some colleagues )Tj 0 Tw (\226)Tj ( )Tj 0.097 Tw 14.511 0 Td (surveillance capacity at all levels is certainly something we )Tj 0.023 Tw -14.511 -1.72 Td [(need )0.5(to )0.5(look )0.5(at, )0.5(and )0.5(part )0.5(and )0.5(parcel )0.5(of )0.5(that )0.5(is )0.5(obviously a )0.5(r)]TJ 23.564 0 Td [(esponse )0.5(part )0.5(as )0.5(well. )0.5(Capacity )0.5(at )0.6(ports )]TJ 0.108 Tw -23.564 -1.72 Td (of entry, so this is a strictly federal responsibility in terms of the )Tj /TT1 1 Tf 27.291 0 Td (Quarantine Act )Tj /TT0 1 Tf (and how we )Tj 0.035 Tw -27.291 -1.72 Td (keep the diseases out if that\222s at all possible, or at least what we \ could do in terms of that aspect )Tj 0.043 Tw 0 -1.74 TD [(of )0.5(disease )0.5(contro)]TJ [(l. )0.5(And )0.6(of )0.5(course )0.5(FPT )0.5(cooperation/collaboration. )0.5(You )0.5(know, )0.5(I'm )0.5(sure )0.5(there\222ll )0.5(be )]TJ 0.02 Tw 0 -1.72 TD (little glitches that come up and we just need to be able to have the goo\ d spirit to keep moving on )Tj 0 Tw T* (in that direction.)Tj ( )Tj 0.058 Tw 3 -1.72 Td (What expectations when you look at WHO donors and so on, ob)Tj 26.411 0 Td (viously Canada )Tj 0 Tw (\226)Tj ( )Tj 7.367 0 Td (being )Tj 0.123 Tw -36.778 -1.74 Td (one of the, I guess, richer countries )Tj 0 Tw (\226)Tj ( )Tj 0.123 Tw 16.037 0 Td (would really not have any expectations for that type of )Tj 0 Tw -16.037 -1.72 Td (assistance.)Tj ( )Tj 0.004 Tw 3 -1.72 Td (And then finally in terms of technical assistance and so on, not importa\ nt. In many ways I )Tj 0.025 Tw -3 -1.72 Td (think it\222s quite gratifying to Can)Tj (ada that we\222ve been called upon to participate and provide some )Tj 0 Tw 0 -1.74 TD (technical expertise in different processes related to the IHR\222s.)Tj 24.685 0 Td ( )Tj -21.685 -1.72 Td (Any human rights challenges? I don\222t think so in Canada at this point\ .)Tj 28.023 0 Td ( )Tj -28.023 -1.72 Td (Governance obstacles? No.)Tj ( )Tj 0 -1.72 TD (And formally/informally linked)Tj ( )Tj (with those of other countries...)Tj ( )Tj ET endstream endobj 141 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 142 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (72)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ([Start of Side 6])Tj ( )Tj 0.183 Tw 0 -1.72 TD (...as far as implementation strategy, I think we\222ve got natural linka\ ges with lots of different )Tj 0.059 Tw T* (groups, be it in the Commonwealth or others, but obviously I think the c\ losest country we have )Tj 0.125 Tw 0 -1.74 TD [(linkages )0.5(with)]TJ 0 Tw ( )Tj 0.125 Tw 5.859 0 Td [(are )0.5(obviously )0.5(our )0.5(neighbours )0.5(to )0.5(the )0.5(south, )0.5(because )0.5(we )0.5(obviously )0.5(have )0.5(common )]TJ 0 Tw -5.859 -1.72 Td (issues and a common border as well.)Tj ( )Tj 3 -1.72 Td (So with that I\222ll end my presentation, and any questions...)Tj 23.08 0 Td ( )Tj -26.08 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj 0.088 Tw (you, Howard. I\222d ask the delegates please just hold their q)Tj 26.987 0 Td (uestions until we hear )Tj 0 Tw -29.987 -1.72 Td (Dr.)Tj ( )Tj 0.123 Tw (Jeff Scott who is the Chief Medical Officer for the Government of Nova S\ cotia, will also )Tj 0 Tw T* (provide some comments from the provincial perspective.)Tj 22.799 0 Td ( )Tj -22.799 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Jeffrey Scott.)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj 0.017 Tw (you very much. I\222ve taken the liberty of putting a few slid)Tj 26.239 0 Td (es together. I have some )Tj 0 Tw -29.239 -1.72 Td (disagreements with the federal perspective but on the whole I think we a\ re moving towards this.)Tj 38.434 0 Td ( )Tj 0.058 Tw -35.434 -1.72 Td (I did have the opportunity to attend in a couple of the negotiation sess\ ions, and that was )Tj 0.108 Tw -3 -1.72 Td (really important because it really brought t)Tj (o me the link between activities at the international )Tj 0.124 Tw 0 -1.74 TD (level and activities at the local level. This is my perspective as an At\ lantic medical officer of )Tj 0.22 Tw 0 -1.72 TD (health. And so just to give you a sense, I'm from Nova Scotia, which is \ one of the small )Tj 0.039 Tw T* (provinces over )Tj (here, and as you can see we\222re a coastal province. There\222s a few s\ mall provinces )Tj 0.005 Tw T* (around us which means that we\222re faced with the situation of we\222re\ a port of entry, we have ____ )Tj 0.118 Tw 0 -1.74 TD (airport, we have the sea routes, we\222ve got the cruise ships. And we h\ ave the c)Tj 32.764 0 Td (ruise ships that )Tj 0.073 Tw -32.764 -1.72 Td [(actually go back and forward between the four other Atlantic provinces, \ )0.5(so )0.5(we )0.5(face )0.5(challenges, )]TJ 0.225 Tw 0 -1.72 TD (and we\222ve seen those challenges during exercises and when we actually\ have outbreaks of )Tj 0.059 Tw T* (diseases on ships, which are very relevant, I think. So )Tj (I'm trying to give a perspective from this )Tj 0 Tw 0 -1.74 TD (point of view.)Tj ( )Tj 0.09 Tw 3 -1.72 Td (I thought I\222d talk about what I see as some of the building blocks th\ at are in place that )Tj 0.155 Tw -3 -1.72 Td (will aid implementation, and then talk about some of what are the obstac\ les that we need to )Tj 0.235 Tw 0 -1.72 TD (really deal with)Tj 0 Tw ( )Tj 0.235 Tw 7.175 0 Td (in order to make these work. First of all, as Dr.)Tj 0 Tw ( )Tj 0.235 Tw (McGeer said, we\222ve had )Tj 0.044 Tw -7.175 -1.74 Td (experience in Canada with SARS, and even though in Nova Scotia we didn\222\ t have SARS we all )Tj 0.028 Tw T* (had experience with it, and it really got attention, it got political at\ tention, that\222s the )Tj 34.139 0 Td (bottom line. )Tj ET endstream endobj 143 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 144 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (73)Tj ( )Tj ET Q BT 0.042 Tw 12 0 0 12 71.88 709.08 Tm (And then we had the Naylor Report, the national report, which had really\ said, \223Look, you need )Tj 0.125 Tw 0 -1.72 TD (a robust public health system, you need to have good infrastructure, you\ \222ve got to have well)Tj 0 Tw 38.667 0 Td (-)Tj 0.098 Tw -38.667 -1.72 Td (trained individuals, you\222ve got to deal with all aspect)Tj (s of public health, and that gives you the )Tj 0.114 Tw 0 -1.74 TD (search capacity to deal with these major incidents. You\222ve got to be \ able to do epidemiology, )Tj 0.008 Tw 0 -1.72 TD (you\222ve got to coordinate, you\222ve got to communicate, and you\222ve\ got to manage. And the Naylor )Tj 0.04 Tw T* (Report has really been on)Tj (e of the blueprints that\222s been moving through the FPT system. FPT is\ )Tj 1.37 Tw T* (the Federal/Provincial/Territorial system, FPT, because we think togethe\ r )Tj 0 Tw 0 -1.74 TD (federal/provincial/territorial system.)Tj 14.439 0 Td ( )Tj 0.053 Tw -11.439 -1.72 Td (We\222ve got a chief public health office now, and a public health agenc\ y, a)Tj 29.926 0 Td (nd we\222ve got a )Tj 0.233 Tw -32.926 -1.72 Td (centre for emergency preparedness and response. That\222s important. We \ didn\222t have a chief )Tj 0.231 Tw 0 -1.72 TD (medical officer of health. The issue of what is the true, national indep\ endent leadership is )Tj 0.251 Tw 0 -1.74 TD (critical. We\222ve got that, that\222s very important. We have ne)Tj 25.584 0 Td (w quarantine legislation. That\222s )Tj 0.079 Tw -25.584 -1.72 Td (moving through, the regulations are coming )Tj 0 Tw (\226)Tj ( )Tj 0.079 Tw 19.102 0 Td (and Howard and Ron can speak about that )Tj 0 Tw (\226)Tj ( )Tj 18.62 0 Td (but )Tj -37.722 -1.72 Td (that\222s important. We had old legislation.)Tj 16.135 0 Td ( )Tj 0.019 Tw -13.135 -1.72 Td [(And we have this concept which is called the Public )0.5(Health Network, and what )0.5(happened )]TJ 0 Tw -3 -1.74 Td (was )Tj 0.153 Tw 1.958 0 Td (the federal/provincial/territorial ministers said we really want to star\ t looking at how we )Tj 0.265 Tw -1.958 -1.72 Td (coordinate our public health activities across the provinces and territo\ ries with the federal )Tj 0 Tw 0 -1.72 TD (government.)Tj ( )Tj 0.265 Tw 3 -1.72 Td (Now, this might look like a very complex structure, but in)Tj 0 Tw 25.871 0 Td ( )Tj 0.265 Tw 0.515 0 Td (fact it is an important )Tj 0.013 Tw -29.386 -1.74 Td (structure. This replaces 76 committees that were place and were not real\ ly well coordinated. And )Tj 0.083 Tw T* [(really )0.5(the )0.5(intent, )0.5(as )0.5(you )0.5(can )0.5(see, )0.5(there )0.5(are )0.5(various )0.5(areas )0.5(such )0.5(as )0.5(communicable )0.5(disease )0.5(control, )]TJ 0.375 Tw T* (emergency preparedness and response, )Tj (public health laboratory process, surveillance and )Tj 0.014 Tw T* [(information. )0.5(And )0.5(I\222ll )0.5(be )0.6(also )0.5(dealing )0.5(with )0.5(the )0.5(other )0.5(very )0.5(important )0.5(public )0.5(health )0.5(issues, )0.5(but )0.5(these )]TJ 0.101 Tw 0 -1.74 TD (are the ones that are focused on how we\222re going to deal with some of\ these IHR issues, how )Tj 0 Tw 0 -1.72 TD (we\222re going t)Tj (o coordinate our activities.)Tj ( )Tj 0.099 Tw 3 -1.72 Td (And the important thing is that these go through a council who report ul\ timately to the )Tj 0.274 Tw -3 -1.72 Td (Conference of Deputy Ministers. That means it\222s reporting to the depu\ ty ministers of the )Tj 0.154 Tw 0 -1.74 TD (provinces and territories and the federal governme)Tj 21.081 0 Td (nt. And we really didn\222t have a very good )Tj 0.138 Tw -21.081 -1.72 Td (mechanism for the coordination or actions going to that group, and that\222\ s important if you\222re )Tj 0.048 Tw 0 -1.72 TD (going to get political decisions to make recommendations, decisions at t\ he practical policy level )Tj 0.027 Tw T* [(to )0.5(get )0.5(recommendations)]TJ 0 Tw 9.661 0 Td ( )Tj 0.027 Tw 0.277 0 Td [(to )0.5(the )0.5(ministers )0.5(who )0.5(cover )0.5(the )0.5(various )0.5(jurisdictions. )0.5(And )0.5(there\222s )0.5(a )0.5(lot )0.5(of )]TJ ET endstream endobj 145 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 146 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (74)Tj ( )Tj ET Q BT 0.151 Tw 12 0 0 12 71.88 709.08 Tm [(outcomes )0.5(that )0.5(are )0.5(coming )0.5(from )0.5(this )0.5(group, )0.5(deliverables )0.5(which )0.5(are )0.5(expectations )0.5(of )0.5(the )0.5(deputy )]TJ 0 Tw 0 -1.72 TD (ministers which are going to the ministers of health for endorsement.)Tj 27.577 0 Td ( )Tj 0.199 Tw -24.577 -1.72 Td (The other thing th)Tj (at was really important was that after the Naylor report there was )Tj 0.214 Tw -3 -1.74 Td (funding that came from the federal government towards public health. The\ re was $100,000 )Tj 0.037 Tw T* [(allocated in a trust fund to provinces and territories, and )0.5(that was to be )0.5(used in )0.5(a )0.5(way... it was to)]TJ 0 Tw 39 0 Td ( )Tj 0.034 Tw -39 -1.72 Td (be used in fact to help with some of your ability for emergency prepared\ ness, your public health )Tj 0.208 Tw T* (laboratory functions. It was directed towards that. The problem was it w\ as a trust fund, so )Tj 0.278 Tw 0 -1.74 TD (basically a province and territory could do anything it liked with)Tj 0 Tw 28.555 0 Td ( )Tj 0.278 Tw 0.528 0 Td (it. Now, provinces and )Tj 0.013 Tw -29.083 -1.72 Td (territories have chosen to use that, but I can tell you it was a struggl\ e at times to keep that money )Tj 0.226 Tw 0 -1.72 TD (within the public health system. But that was a one)Tj 0 Tw (-)Tj 0.226 Tw (off grant to be used over three years. )Tj 0 Tw T* (Basically it\222s the end of the time, and)Tj 14.94 0 Td ( )Tj (that\222s going to be an important issue.)Tj ( )Tj 0.058 Tw -11.94 -1.74 Td (There was money for health, fully\(?\) $100 million to help towards the \ development of a )Tj 0.039 Tw -3 -1.72 Td (Canadian integrated public health surveillance system, and what that has\ meant is there\222s been a )Tj 0.06 Tw T* [(lot )0.5(of )0.5(work )0.5(because )0.5(the )0.5(IT )]TJ 0 Tw (\226)Tj ( )Tj 11.941 0 Td (the)Tj ( )Tj 0.06 Tw 1.531 0 Td [(information )0.5(technology )0.5(specialists )]TJ 0 Tw (\226)Tj ( )Tj 0.06 Tw 15.013 0 Td [(were )0.5(at )0.5(one )0.5(level, )0.5(and )0.5(the )]TJ 0.092 Tw -28.485 -1.72 Td (public health people were at another level. And we were in the stone age\ , quite frankly, and it )Tj 0.015 Tw 0 -1.74 TD (varied across the country. We\222re now starting to talk, to work togeth\ er. But this is moving, an)Tj 37.679 0 Td (d it )Tj 0.115 Tw -37.679 -1.72 Td (is important and it\222s going to take a while, but basically we need to\ have good, computerized )Tj 0 Tw 0 -1.72 TD (data sets that work, that communicate.)Tj 15.356 0 Td ( )Tj 0.091 Tw -12.356 -1.72 Td (We\222ve had some issue, we\222ve got some good flows like EPIX, we\222v\ e got the CIOSC )Tj 0 Tw (\226)Tj ( )Tj 0.216 Tw -3 -1.74 Td (the Canadian Integrated Outbreak Surv)Tj (eillance Centre )Tj 0 Tw (\226)Tj ( )Tj 0.216 Tw 24.196 0 Td (so people can transmit information )Tj 0.068 Tw -24.196 -1.72 Td (about outbreaks from a local public health level, can go to a provincial\ level, and go across the )Tj 0.173 Tw T* (country. So we\222re starting to use computer technology in a much bette\ r way, but we\222re still )Tj 0 Tw T* (learning how )Tj (to use this.)Tj ( )Tj 0.069 Tw 3 -1.74 Td (And there\222s been the development of several memorandums of understand\ ing which are )Tj 0 Tw -3 -1.72 Td (really practical and important, but we\222ve got to operationalize them.\ )Tj 27.24 0 Td ( )Tj 0.112 Tw -24.24 -1.72 Td (We had a food)Tj 0 Tw (-)Tj 0.112 Tw (borne illness outbreak protocol, because what we were finding is when )Tj 0.091 Tw -3 -1.72 Td (you ha)Tj (d an outbreak that crossed jurisdictions between different provinces, an\ d where you had )Tj 0.01 Tw 0 -1.74 TD (federal agencies such as the Canadian Food Inspection Agency, the issue \ is who\222s on first, who\222s )Tj 0 Tw 0 -1.72 TD (going to coordinate, how do you deal with these multi)Tj (-)Tj (jurisdictional ou)Tj (tbreaks.)Tj ( )Tj 0.112 Tw 3 -1.72 Td (We also now have a respiratory illness outbreak protocol, and that in fa\ ct is just being )Tj 0.023 Tw -3 -1.72 Td (disseminated and has just literally gone out to the provinces and territ\ ories, and that clarifies in a )Tj ET endstream endobj 147 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 148 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (75)Tj ( )Tj ET Q BT 0.01 Tw 12 0 0 12 71.88 709.08 Tm (way the roles and responsibilities of the jurisdictions)Tj 0 Tw 21.15 0 Td ( )Tj 0.01 Tw 0.26 0 Td (and how the federal agencies will engage in )Tj 0.004 Tw -21.41 -1.72 Td (action when we have an outbreak that takes place that cross jurisdiction\ s, and our role in that was )Tj 0.026 Tw 0 -1.72 TD (to take that protocol and to really see how we can make it work and to a\ pply it and to evaluate it )Tj 0 Tw 0 -1.74 TD (and to use i)Tj (t.)Tj ( )Tj 0.078 Tw 3 -1.72 Td (The other thing that\222s really important and I\222ve found in public h\ ealth as time\222s passed, )Tj 0.02 Tw -3 -1.72 Td (we\222re getting more and more involved with other things apart from hum\ an health, so the issue of )Tj 0.105 Tw 0 -1.72 TD [(avian )0.5(influenza, )0.5(we )0.5(have )0.5(to )0.5(look )0.5(at )0.5(things )0.5(such )0.5(as )0.6(a formal )0.5(animal )]TJ 28.017 0 Td [(disease )0.5(emergency )0.5(support )]TJ 0.07 Tw -28.017 -1.74 Td (plan. So what do you do when you have an animal disease that could or co\ uld not have human )Tj 0.057 Tw T* [(health potential? The number of )0.5(agencies )0.5(that )0.5(get involved )0.5(at )0.5(the )0.5(federal )0.5(level )0.5(or )0.5(the )0.5(local )0.5(level )]TJ 0.073 Tw T* (are increasing, and it\222s really critical)Tj 0 Tw 14.971 0 Td ( )Tj 0.073 Tw 0.323 0 Td (that we have the ability to get \222round the table in order to )Tj 0.008 Tw -15.294 -1.72 Td [(say, )0.5(\223What )0.5(do )0.5(you )0.5(do, )0.5(how )0.5(do )0.5(you do )0.6(it, )0.5(and )0.5(how )0.5(do )0.5(we )0.5(work )0.5(together )0.5(before )0.5(we\222re )0.5(faced )0.5(with )0.5(a )]TJ 0 Tw 0 -1.74 TD (situation of dealing with a public health issue that requires that coord\ inated response?\224)Tj 34.712 0 Td ( )Tj 0.127 Tw -31.712 -1.72 Td (We have a )Tj (memorandum of provision of mutual aid during a public health emergency )Tj 0 Tw -3 -1.72 Td (about to be agreed to and signed off in fact by the deputy ministers and\ the ministers of health.)Tj 37.851 0 Td ( )Tj 0.084 Tw -34.851 -1.72 Td (The other thing that\222s going to be important is that there\222s a pro\ cess now to look at t)Tj 0 Tw 35.056 0 Td (he )Tj 0.057 Tw -38.056 -1.74 Td [(federal/provincial/territorial roles and )0.5(responsibilities )0.5(during a pandemic. In a way, the intent of )]TJ 0.067 Tw 0 -1.72 TD (that, in fact )Tj 0 Tw (\226)Tj ( )Tj 0.067 Tw 5.792 0 Td (and the network is doing a piece of this )Tj 0 Tw (\226)Tj ( )Tj 0.067 Tw 17.384 0 Td (is to scope out all of these memoranda )Tj 0.035 Tw -23.177 -1.72 Td (that we have and see, during a pandemic, how would we )Tj (actually... what will we do, how would )Tj 0.105 Tw T* (we really effectively operationalize this at that senior level. And ther\ e\222s been a lot of pressure )Tj 0.033 Tw 0 -1.74 TD (from the provinces to get this done. And these are all benefits indeed t\ o the bigger picture of the )Tj 0 Tw 0 -1.72 TD (national health re)Tj (gulations.)Tj ( )Tj 0.154 Tw 3 -1.72 Td (And the other thing that\222s about to be signed off is a process for in\ formation sharing )Tj 0.107 Tw -3 -1.72 Td (during a public health emergency. Now, this is not quite the latest road\ chart )Tj 0 Tw (\226)Tj ( )Tj 0.107 Tw 33.177 0 Td (the latest road )Tj 0.136 Tw -33.177 -1.74 Td (chart was developed last week )Tj 0 Tw 13.092 0 Td (\226)Tj ( )Tj 0.136 Tw 0.886 0 Td (but basically one of the issu)Tj (es is this concern about sharing )Tj 0.058 Tw -13.978 -1.72 Td (information between jurisdictions. And in fact many of us have the legis\ lation that would allow )Tj 0.041 Tw T* [(us to do it, and many of us believe that we should just do it anyway. Bu\ t this is a process that )0.5(is )]TJ 0.06 Tw T* (being put into place to all)Tj (ow us to basically advise the Chief Medical Officer of Health Canada )Tj 0.045 Tw 0 -1.74 TD (to pull together the Council of Chief Medical Officers of Health to deci\ de that we believe )Tj 0 Tw 36.761 0 Td (\226)Tj ( )Tj 0.795 0 Td (and )Tj 0.011 Tw -37.556 -1.72 Td (using the same decision tree that is used by the International Health Re\ gulations )Tj 0 Tw 32.442 0 Td (\226)Tj ( )Tj 0.761 0 Td (decide)Tj ( )Tj 0.011 Tw 2.87 0 Td (that we )Tj 0.005 Tw -36.073 -1.72 Td (think there may be a public health risk that is of concern across Canada\ , and allow us basically to )Tj 0 Tw 0 -1.72 TD (share whatever information is necessary in order that we can effectively\ control that risk.)Tj 35.597 0 Td ( )Tj ET endstream endobj 149 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 150 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (76)Tj ( )Tj ET Q BT 0.05 Tw 12 0 0 12 107.88 709.08 Tm (So this process is just about to be signed off. Again w)Tj (hat we have to do now is take this )Tj 0.034 Tw -3 -1.72 Td [(and )0.5(make )0.5(it )0.5(work )0.5(within )0.5(our )0.5(jurisdictions. )0.5(And )0.5(there\222s )0.5(a )0.5(longer )0.5(process, )0.5(as )0.5(Howard )0.5(said, )0.6(to )0.5(look )]TJ 0.226 Tw 0 -1.72 TD (at how can effectively in the long term share information respecting pri\ vacy/confidentiality )Tj 0.283 Tw 0 -1.74 TD [(information. )0.5(These )0.5(are )0.5(all )0.5(thin)]TJ 13.265 0 Td [(gs )0.5(that )0.5(are )0.5(important, )0.5(that )0.5(are )0.6(building )0.6(blocks )0.6(that )0.5(are )0.5(not )]TJ 0.207 Tw -13.265 -1.72 Td (necessarily targeted to International Health regulations )Tj 0 Tw 23.402 0 Td (\226)Tj ( )Tj 0.207 Tw 0.957 0 Td (our target is to make sure we can )Tj 0 Tw -24.359 -1.72 Td (respond internally in Canada )Tj (\226)Tj ( )Tj (but are useful to them.)Tj ( )Tj 0.082 Tw 3 -1.72 Td (The other thing are exercises, and in the Atlan)Tj 19.123 0 Td (tic provinces we\222ve gone through several )Tj 0.1 Tw -22.123 -1.74 Td (exercises where usually there\222s a scenario of an infectious disease o\ r a bioterrorist type threat: )Tj 0.19 Tw 0 -1.72 TD (Atlantic Guard, Atlantic Shield, collaboration and coordination between \ jurisdictions )Tj 0 Tw 36.005 0 Td (\226)Tj ( )Tj 0.94 0 Td (more )Tj 0.123 Tw -36.945 -1.72 Td (than one province and t)Tj (he federal government )Tj 0 Tw (\226)Tj ( )Tj 0.123 Tw 20.365 0 Td (and we\222re planning avian influenza exercises )Tj 0.234 Tw -20.365 -1.72 Td (and pandemic influenza exercises. These I believe are critical, because \ it\222s only when you )Tj 0.053 Tw 0 -1.74 TD (actually stress that and take the scenarios and take the protocols and s\ ee that they actually wo)Tj 0 Tw 38.167 0 Td (rk )Tj 0.024 Tw -38.167 -1.72 Td (and then really find out where the grey areas are, because there are sti\ ll grey areas and they keep )Tj 0 Tw 0 -1.72 TD (coming up.)Tj ( )Tj 0.062 Tw 3 -1.72 Td (So I think they\222re obstacles, and I call them obstacles. Funding is c\ ritical. Naylor, in his )Tj 0.005 Tw -3 -1.74 Td (recommendation, said really that the federal gove)Tj 19.828 0 Td (rnment should be providing $300 million a year )Tj 0.054 Tw -19.828 -1.72 Td (which flows through to local public health units in order that they can \ continue to do programs, )Tj 0.124 Tw T* (strengthen infrastructure, and that in turn will aid in the ability to d\ eal with another SARS or )Tj 0 Tw T* (something like )Tj (that if it comes along.)Tj ( )Tj 0.034 Tw 3 -1.74 Td (And to date what has happened is we\222ve not got consistency of approac\ h, and that\222s why )Tj 0.01 Tw -3 -1.72 Td (it really has to be at the political level to ensure that funding flows,\ and that funding is dedicated, )Tj 0.237 Tw T* (and that there\222s a reporting mechanism ba)Tj (ck to say, \223What have you effectively used that )Tj 0 Tw T* (funding for?\224)Tj ( )Tj 0.055 Tw 3 -1.74 Td [(There\222s a lack of an awareness of the International Health Regulation\ s )0.5(at the local level, )]TJ 0.235 Tw -3 -1.72 Td (and what I mean by the local level is the regional medical officer of he\ alth, who\222s really )Tj 0.138 Tw T* (important in)Tj 0 Tw ( )Tj 0.138 Tw 5.442 0 Td (the coordination at that level. And I talked to some of my colleagues an\ d asked )Tj 0.139 Tw -5.442 -1.72 Td (them what they know at it, and not many do. So we failed, I think, to co\ mmunicate national )Tj 0.177 Tw 0 -1.74 TD (health regulations and really what are the true perspectives and the tru\ e issues tha)Tj 34.87 0 Td (t relate to )Tj 0 Tw -34.87 -1.72 Td (public health at the front line.)Tj 11.83 0 Td ( )Tj 0.233 Tw -8.83 -1.72 Td (There is differing provincial legislation, and many jurisdictions have u\ pdated or are )Tj 0.108 Tw -3 -1.72 Td (updating their public health acts. We have done that in Nova Scotia, and\ SARS allowed us to )Tj ET endstream endobj 151 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 152 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (77)Tj ( )Tj ET Q BT 0.146 Tw 12 0 0 12 71.88 709.08 Tm (actually get that through and all)Tj (owed us to put in the possibility of declaring a public health )Tj 0 Tw 0 -1.72 TD (emergency which may be necessary to operationalize any response.)Tj 27.017 0 Td ( )Tj 0.022 Tw -24.017 -1.72 Td (There needs to be clarification of the role of the chief public health o\ fficer )Tj 0 Tw 30.234 0 Td (\226)Tj ( )Tj 0.022 Tw 0.772 0 Td (that position )Tj 0.101 Tw -34.006 -1.74 Td (is there but there needs to be le)Tj 0 Tw (gislation )Tj 16.914 0 Td (\226)Tj ( )Tj 0.101 Tw 0.851 0 Td (and I really think that\222s very important, we need to )Tj 0 Tw -17.765 -1.72 Td (have that national leadership role which will be critical.)Tj 22.242 0 Td ( )Tj 0.145 Tw -19.242 -1.72 Td (There is the issue of multiple players, and as I say we\222re communicat\ ing I think well )Tj 0.096 Tw -3 -1.72 Td (between our health partners at the federal/pro)Tj 18.736 0 Td (vincial/territorial level, but at the provincial level )Tj 0.105 Tw -18.736 -1.74 Td (there\222s so many agencies to communicate and so many agencies at the f\ ederal level it is quite )Tj 0 Tw T* (complicated.)Tj ( )Tj 0.116 Tw 3 -1.72 Td (There are what I call the grey border areas, and we\222ve found during o\ ur exercises that )Tj 0.019 Tw -3 -1.72 Td (when yo)Tj (u have situations where you have a passenger arriving, clearing customs \ in one province )Tj 0.148 Tw 0 -1.74 TD (and then moving between provinces, a cruise ship, then whose jurisdictio\ n? And what we\222ve )Tj 0.235 Tw 0 -1.72 TD (done in Nova Scotia, in fact, we sat \222round the table and we sat down\ with som)Tj 35.42 0 Td (e of our )Tj 0.115 Tw -35.42 -1.72 Td [(quarantine officers, the quarantine )0.5(nurses, )0.5(we\222ve sat down with Workplace Health and Safety, )]TJ 0.196 Tw T* (we haven\222t had DND )Tj 0 Tw 9.557 0 Td (\226)Tj ( )Tj 0.196 Tw 0.946 0 Td [(the )0.5(Department )0.5(of )0.5(National )0.5(Defence )]TJ 0 Tw (\226)Tj ( )Tj 0.196 Tw 16.722 0 Td [(because )0.5(they )0.5(have )0.5(a )0.5(federal )]TJ 0.096 Tw -27.225 -1.74 Td (responsibility, we\222ve had First Nations Inuit Health Branch because )Tj (we have the responsibility )Tj 0.199 Tw T* (there, we\222ve had our provincial partners, and we\222ve basically trie\ d to say, \223If this happens, )Tj 0.155 Tw T* (what\222s your job?\224 And that\222s really important that we take thes\ e issues at the local level, so )Tj 0.138 Tw T* (we\222ve developed a draft what we think ou)Tj 17.766 0 Td (r jobs are and how we collaborate, but we have to )Tj 0 Tw -17.766 -1.74 Td (verify that and make sure that works in advance.)Tj 19.41 0 Td ( )Tj 0.195 Tw -16.41 -1.72 Td (Now, the other thing that\222s really important is changes. We have the \ changes in the )Tj 0.256 Tw -3 -1.72 Td (deputy minister and the minister. We\222ve just been asked to sign off i\ n th)Tj 32.212 0 Td (e provinces and )Tj 0.076 Tw -32.212 -1.72 Td (territories, do we all agree to Canada endorsing the International Healt\ h Regulations. The good )Tj 0.162 Tw 0 -1.74 TD (news is Nova Scotia signed )Tj 0 Tw (\226)Tj ( )Tj 0.162 Tw 12.969 0 Td (the two ministers signed )Tj 0 Tw (\226)Tj ( )Tj 0.162 Tw 11.557 0 Td (yesterday, but these were changes. )Tj 0.119 Tw -24.526 -1.72 Td (These were new ministers and I had to do briefings of)Tj 0 Tw ( )Tj 0.119 Tw 23.104 0 Td (the ministers of something which they )Tj 0.157 Tw -23.104 -1.72 Td [(were not involved in. If this had happened a little bit earlier it )0.5(would )0.5(have )0.5(been )0.5(a )0.5(lot )0.5(easier )]TJ 0.018 Tw 0 -1.72 TD (because the other ministers lived through the SARS scenario. So there\222\ s a timeliness issue which )Tj 0.069 Tw 0 -1.74 TD (I think is important, an)Tj (d I think we\222re moving in the right direction but we\222ve got to acc\ elerate )Tj 0 Tw 0 -1.72 TD (that because there\222s only a window of opportunity before the next iss\ ue comes up.)Tj 32.88 0 Td ( )Tj 0.119 Tw -29.88 -1.72 Td (So on the whole I think we can, but we still have these issues, and the \ key issue is to )Tj 0.035 Tw -3 -1.72 Td (make sure we)Tj 0 Tw ( )Tj 0.035 Tw 5.853 0 Td (get the funding that\222s dedicated to help us enhance the public health\ system at the )Tj ET endstream endobj 153 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 154 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (78)Tj ( )Tj ET Q BT 0.021 Tw 12 0 0 12 71.88 709.08 Tm (local level, because unless we do that then you will have significant va\ riation across the country, )Tj 0 Tw 0 -1.72 TD (and the variation is that Canada will only be as strong as its weakest )Tj 27.494 0 Td (link.)Tj ( )Tj -24.494 -1.72 Td (That\222s it.)Tj ( )Tj -3 -1.74 Td ( )Tj /TT1 1 Tf T* (Dr. Ron St. John)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj (you very much, Jeff. The floor is open for questions and/or comments.)Tj 31.104 0 Td ( )Tj -34.104 -1.74 Td ( )Tj /TT1 1 Tf T* (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (CH?:)Tj ( )Tj 0.11 Tw 3 0 Td (I had a question for Howard. For Canada, Australia and the U.S. the key \ public health )Tj 0.08 Tw 0 -1.74 TD (power is the powers under the )Tj /TT2 1 Tf 0 Tw (Q)Tj 0.08 Tw (uarantine Act )Tj /TT0 1 Tf (which serve for communicable disease )Tj 0 Tw (\226)Tj ( )Tj 0.011 Tw 0 -1.72 TD [(and )0.5(I )0.5(was )0.5(going )0.5(to )0.5(ask )0.5(you )0.5(this )0.5(morning )0.5(as )0.5(well )]TJ 0 Tw (\226)Tj ( )Tj 0.011 Tw 20.235 0 Td [(have )0.5(you )0.5(got )0.5(any )0.5(views )0.5(on )0.5(whether )0.5(it\222s )]TJ 0.126 Tw -20.235 -1.72 Td (desirable or necessary for the federal government to get powers in relat\ ion to... I keep )Tj 0.163 Tw T* (saying non)Tj 0 Tw (-)Tj 0.163 Tw (communicable d)Tj (isease but I don\222t mean that, I mean diseases that are not )Tj 0.039 Tw 0 -1.74 TD [(communicable, or health threats that )0.5(are )0.5(not )0.5(communicable )0.5(such )0.5(as... )0.5(I )0.5(mean, )0.5(it\222s )0.5(hard )0.5(to )]TJ 0.307 Tw 0 -1.72 TD (picture but deliberate international event or an accident or contaminati\ on event or )Tj 0.304 Tw T* (something like that. Sh)Tj (ould the federal government have powers to act and make )Tj 0 Tw T* (decisions in those cases?)Tj ( )Tj -3 -1.74 Td (HN:)Tj ( )Tj 0.011 Tw 3 0 Td (I'm sorry, I may not be getting your question. Are you talking about a h\ ealth threat of any )Tj 0 Tw T* (source that may cross international borders?)Tj ( )Tj -3 -1.72 Td (CH?:)Tj ( )Tj 0.007 Tw 3 0 Td (Well, a public health event )Tj 11.033 0 Td (of international concern that\222s not a communicable disease, so )Tj 0.086 Tw -11.033 -1.72 Td (therefore you can\222t use your powers under the )Tj /TT2 1 Tf 19.349 0 Td (Quarantine Act)Tj /TT0 1 Tf (, or the powers under the )Tj /TT2 1 Tf 0 Tw -19.349 -1.74 Td (Quarantine Act )Tj /TT0 1 Tf (are irrelevant in that situation.)Tj 18.467 0 Td ( )Tj -21.467 -1.72 Td (HN:)Tj ( )Tj 0.041 Tw 3 0 Td (My own personal viewpoint is that yes, because as part)Tj 0 Tw ( )Tj 0.041 Tw 22.713 0 Td (of the discussion for the revision )Tj 0.116 Tw -22.713 -1.72 Td (of the IHR\222s they made the explicit point that it would be expanded b\ eyond infectious )Tj 0.008 Tw T* [(diseases, it really was a public health )0.5(threat of any source and any type, which would also )]TJ 0.012 Tw 0 -1.74 TD (include chemical and radionuclear, and the)Tj 17.217 0 Td (y also said irregardless of origin, which I think )Tj 0.208 Tw -17.217 -1.72 Td (is a fuzzy way of saying either accidental or intentional. So, certainly\ for infectious )Tj 0.051 Tw 0 -1.72 TD (diseases at the federal level we\222ve got the )Tj /TT2 1 Tf 17.292 0 Td (Quarantine Act )Tj /TT0 1 Tf 6.546 0 Td (in terms of what we can do at )Tj 0.03 Tw -23.839 -1.72 Td (our ports of entry, but withi)Tj (n our jurisdiction if there was something to happen, an event, )Tj 0.062 Tw 0 -1.74 TD (a terrorist event involving, I guess, let\222s say a radionuclear device\ or so, our perspective )Tj 0.01 Tw 0 -1.72 TD [(is that we always use an )0.5(all)]TJ 0 Tw (-)Tj 0.01 Tw [(hazards approach. So )0.5(we )0.5(have )0.5(a )0.5(framework )0.5(in )0.5(Canada )0.5(to )0.5(deal )]TJ ET endstream endobj 155 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 156 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (79)Tj ( )Tj ET Q BT 0.369 Tw 12 0 0 12 107.88 709.08 Tm (with those t)Tj (ypes of emergencies, we have our Department of Public Safety and )Tj 0.161 Tw 0 -1.72 TD (Emergency Preparedness and so on, and the other departments play into th\ at, and we )Tj 0.244 Tw T* (come in from a public health point of view to cover off the public healt\ h and the )Tj 0 Tw 0 -1.74 TD (healthcare)Tj (-)Tj (related aspects)Tj ( )Tj (of that emergency.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.007 Tw 3 0 Td (So I don\222t think we\222re relying any specific piece of legislation l\ ike the )Tj /TT1 1 Tf 0 Tw 28.389 0 Td (Quarantine )Tj -31.389 -1.72 Td (Act )Tj /TT0 1 Tf 0.048 Tw 1.63 0 Td [(to deal with other types of threats, just recognizing )0.5(that we have an approach to deal )]TJ 0 Tw -1.63 -1.72 Td (with all threats.)Tj ( )Tj -3 -1.74 Td (CH?:)Tj ( )Tj 0.058 Tw 3 0 Td (I suppose we have been considering )Tj 15.012 0 Td (in Australia whether or not we need a healthcare as )Tj 0 Tw -15.012 -1.72 Td (well as the security)Tj (-)Tj (related powers for that sort of incident.)Tj ( )Tj -3 -1.72 Td (HN:)Tj ( )Tj 0.019 Tw 3 0 Td [(There )0.5(is )0.5(an )0.5(all)]TJ 0 Tw (-)Tj 0.019 Tw [(encompassing )0.5(act, )0.5(which )0.5(it )0.5(doesn\222t )0.5(belong )0.5(to )0.5(us )0.5(specifically )0.5(but )0.5(it )0.5(belongs )]TJ 0.022 Tw 0 -1.72 TD (to another department, the Department of Publ)Tj 18.767 0 Td (ic Safety, the )Tj /TT1 1 Tf (Emergencies Act)Tj /TT0 1 Tf (, and I think )Tj 0.056 Tw -18.767 -1.74 Td (some of the legal folks here may want to delve into that, but that power\ is sort of a last)Tj 0 Tw 35.667 0 Td (-)Tj 0.001 Tw -35.667 -1.72 Td (resort piece of legislation in which the federal government specifically\ could almost order )Tj 0.1 Tw T* (anyone to do anything )Tj 0 Tw 9.566 0 Td (\226)Tj ( )Tj 0.1 Tw 0.85 0 Td (if yo)Tj (u want to put it in sort of familiar terms )Tj 0 Tw 19.017 0 Td (\226)Tj ( )Tj 0.1 Tw 0.85 0 Td (to deal with a )Tj 0.277 Tw -30.284 -1.72 Td [(threat )0.5(to )0.5(the )0.5(public, )0.5(so )0.5(that )0.5(is )0.5(one )0.5(tool )0.5(that )0.5(is )0.5(already )0.5(available, )0.5(but )0.5(it\222s )0.5(certainly )]TJ 0.019 Tw 0 -1.74 TD (something that we\222ve been all told not to use, that there\222s so man\ y other mechanisms and )Tj 0.086 Tw 0 -1.72 TD (tools we could be u)Tj (sing before that, but certainly that\222s something that is available as\ a )Tj 0 Tw T* (last resort.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 3 0 Td (I\222ll leave it open to other colleagues to chip in.)Tj 18.661 0 Td ( )Tj -24.661 -1.74 Td (RS:)Tj ( )Tj 0.004 Tw 3 0 Td (If I could just add a comment to that, if I understood your question, th\ e London bombings )Tj 0 Tw T* (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (the unfortunate London)Tj 0 Tw ( )Tj 9.819 0 Td (bombings )Tj 4.237 0 Td (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (were obviously no health threat to Canada, yet we )Tj 0.118 Tw -15.64 -1.72 Td (had an intense interest in that event, certainly because our colleagues \ in London had a )Tj 0.052 Tw T* (remarkable survival rate for people trapped in what\222s called an enclo\ sed space explosive )Tj 0.258 Tw 0 -1.74 TD (event, so we were)Tj 0 Tw ( )Tj 0.258 Tw 8.445 0 Td (very interested in the medical management of those unfortunate )Tj 0.093 Tw -8.445 -1.72 Td (casualties. But we did not feel we needed to seek any authority, for exa\ mple, to talk to )Tj 0.048 Tw 0 -1.72 TD [(our colleagues in the UK and to urge them )0.5(to )0.5(share their experiences with us, and we\222ve )]TJ 0.209 Tw T* (had meetings an)Tj (d visits to talk about those kinds of events, although they posed no )Tj 0 Tw 0 -1.74 TD (immediate public health threat to Canada.)Tj 16.716 0 Td ( )Tj -19.716 -1.72 Td (CH?:)Tj ( )Tj 0.056 Tw 3 0 Td (Perhaps if I gave an example, which is a risky one, but there\222s certa\ in events which will )Tj 0.049 Tw 0 -1.72 TD (threaten trade, commerce, etc. At the moment it\222s )Tj 20.467 0 Td (quite a debate as to which powers and )Tj 0.276 Tw -20.467 -1.72 Td (what authority you would act under to take actions that would interrupt \ trade and )Tj ET endstream endobj 157 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 158 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (80)Tj ( )Tj ET Q BT 0.067 Tw 12 0 0 12 107.88 709.08 Tm [(commerce, )0.5(etc. )0.5(We )0.5(all )0.5(know )0.5(that )0.5(we )0.5(have )0.5(various )0.5(powers, )0.5(our )0.5(external )0.5(powers )0.5(covers )0.5(a )]TJ 0.054 Tw 0 -1.72 TD (lot of things. I suppose some of our _____ governme)Tj (nt colleagues have looked to health )Tj 0.12 Tw T* (to provide very definitive advice that certain health actions need to be\ taken in certain )Tj 0.491 Tw 0 -1.74 TD (circumstances. I understand from what you\222re saying that Canada has a\ n all)Tj 0 Tw 35.667 0 Td (-)Tj 0.358 Tw -35.667 -1.72 Td (encompassing power to take those decisions. I'm sure Au)Tj (stralia could take those )Tj 0.067 Tw 0 -1.72 TD (decisions under some power or other, but the question for us is whether \ it\222s desirable to )Tj 0.006 Tw T* (have a public health power to take actions that would sort of override o\ thers. I don\222t think )Tj 0.077 Tw 0 -1.74 TD (we\222ve got close to the answer to that, because t)Tj (hat\222s very complex and difficult, but we )Tj 0.075 Tw 0 -1.72 TD (certainly have that power in relation to quarantine, in relation to comm\ unicable disease, )Tj 0 Tw T* (and we don\222t really debate that.)Tj 12.606 0 Td ( )Tj -15.606 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Yes, Dr.)Tj ( )Tj (Lazar?)Tj ( )Tj -3 -1.74 Td (JS:)Tj ( )Tj 3 0 Td (Was there another question first?)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Was there another one I missed)Tj (?)Tj ( )Tj -3 -1.72 Td (HL?:)Tj 2.055 0 Td ( )Tj 0.198 Tw 0.945 0 Td [(I had a series of questions, but just one )0.5(remark )0.5(on )0.5(the )0.5(last )0.5(comment. )0.5(I'm )0.5(subject )0.5(to )]TJ 0.145 Tw T* (correction, but it\222s not my understanding Canada has an overriding em\ ergency power. )Tj 0 Tw 0 -1.74 TD (The )Tj /TT1 1 Tf 0.255 Tw 2.06 0 Td (Emergencies Act )Tj /TT0 1 Tf (in Canada, as I understand it, could only be implemented or )Tj 0.019 Tw -2.06 -1.72 Td (invoked or promulgated )Tj 0 Tw (\226)Tj ( )Tj 0.019 Tw 10.685 0 Td (whatever the right word is )Tj 0 Tw (\226)Tj ( )Tj 0.019 Tw 11.612 0 Td (under certain conditions, and so if )Tj 0.203 Tw -22.297 -1.72 Td (there\222s an outbreak of infectious disease in one province which is of\ concern to the )Tj 0.015 Tw 0 -1.72 TD (federal government, it cannot... that in and of itself is not a sufficie\ nt trigge)Tj 30.264 0 Td (r to enable the )Tj 0.068 Tw -30.264 -1.74 Td (federal government to use all of its powers. Now, I'm subject to correct\ ion but I believe )Tj 0 Tw T* (that\222s correct.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.014 Tw 3 0 Td (I had two questions for Dr.)Tj 0 Tw ( )Tj 0.014 Tw (Njoo. The first one may be a little bit nasty, so forgive )Tj 0.139 Tw -3 -1.72 Td (me. It\222s actually posed in a spirit of nastine)Tj (ss, so not only is it nasty but it\222s nasty in )Tj 0.108 Tw 0 -1.74 TD (spirit, so I ask you in advance to... anyhow, you alluded on numerous oc\ casions to the )Tj 0.107 Tw 0 -1.72 TD [(spirit )0.5(of )0.5(intergovernmental )0.5(cooperation )0.5(that )0.5(apparently )0.5(infuses )0.5(your )0.5(relationships )0.5(to )0.5(the )]TJ 0.119 Tw T* (different orders or levels of gov)Tj (ernment. My understanding of the level of cooperation )Tj 0.015 Tw T* (that went on during the SARS episode is that it fell short of that high \ level of cooperation )Tj 0.02 Tw 0 -1.74 TD (that you alluded to, that there were in fact some real impediments. I me\ an, first of all you )Tj 0.038 Tw 0 -1.72 TD (may think I'm wr)Tj (ong on that statement in which case you can just tell me I'm wrong, but \ )Tj 0.007 Tw T* [(if I'm not wrong then )0.5(can you )0.5(sort of help me understated what has happened since SARS )]TJ 0 Tw T* (that gives you this confidence? That\222s question number one.)Tj 24.077 0 Td ( )Tj ET endstream endobj 159 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 160 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (81)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.131 Tw 3 0 Td (Question number two, I think in dea)Tj (ling with the template... this is not a nasty )Tj 0.087 Tw -3 -1.72 Td (question, the first one was. You can answer both of them nastily if you \ want, though, I )Tj 0.134 Tw 0 -1.72 TD (mean I probably deserve it. On the question of funding I think you basic\ ally said that )Tj 0.044 Tw 0 -1.74 TD [(provinces )0.5(will )0.5(fund )0.5(what )0.5(they\222re )0.5(re)]TJ [(sponsible )0.5(for )0.5(funding, )0.5(the )0.5(feds )0.5(will )0.5(fund )0.5(what )0.5(they\222re )]TJ 0.286 Tw 0 -1.72 TD [(responsible )0.5(for )0.5(funding, )0.5(and )0.5(there\222s )0.5(no )0.5(real )0.5(issue )0.5(of )0.5(re)]TJ 0 Tw (-)Tj 0.286 Tw [(allocating )0.5(the )0.6(public )0.5(funds )]TJ 0.036 Tw T* (associated with public health emergency. I think that\222s what you said\ . If that\222s the case )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj 0.215 Tw -35.5 -1.72 Td (and I may have got you w)Tj 0 Tw (rong )Tj 13.972 0 Td (\226)Tj ( )Tj 0.215 Tw 0.965 0 Td (if that\222s the case let me encourage you and your )Tj 0 Tw -14.937 -1.74 Td (colleagues to rethink that issue.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.169 Tw 3 0 Td (It seems to me that if you were in the planning stages and you were to g\ et a )Tj 0.163 Tw -3 -1.72 Td (serious outbreak in one of two provinces, and the federal government wou\ ld take the )Tj 0 Tw T* (vie)Tj 0.271 Tw (w, \223Well, there\222s an outbreak in Saskatchewan and Manitoba of what\ ever)Tj 0 Tw 33.417 0 Td (-)Tj (it)Tj (-)Tj (is,\224 )Tj 0.016 Tw -33.417 -1.74 Td (healthcare is a responsibility of the Manitoba and Saskatchewan governme\ nts, the federal )Tj 0.075 Tw T* [(government )0.5(already )0.5(transferred )0.5(some )0.5(money )0.5(under )0.5(the )0.5(Canada )0.5(health )0.5(transfer )0.5(and )0.5(some )]TJ 0 Tw T* (othe)Tj 0.054 Tw (r intergovernmental transfers, but those transfers are really not intend\ ed to deal with )Tj 0.063 Tw T* (an emergency situation. It seems to me that it would be unfortunate if i\ t was only in the )Tj 0.001 Tw 0 -1.74 TD (middle of an emergency where the physical limitations )Tj 0 Tw 22.221 0 Td (\226)Tj ( )Tj 0.001 Tw 0.751 0 Td (and the financial limi)Tj 0 Tw (tations )Tj 11.444 0 Td (\226)Tj ( )Tj 0.751 0 Td (of )Tj 0.088 Tw -35.167 -1.72 Td (my two hypothetical provinces were being tested that you then got down t\ o negotiating )Tj 0.153 Tw 0 -1.72 TD (fiscal arrangements that were going to help those provinces cope with a \ truly horrific )Tj 0 Tw T* (situation. That would be unfortunate.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.171 Tw 3 0 Td (I don\222t expect a definitive an)Tj 12.38 0 Td (swer from you, obviously, on this point, but any )Tj 0 Tw -15.38 -1.72 Td (comments you might be able to make on either of those two points I would\ welcome.)Tj 34.104 0 Td ( )Tj -37.104 -1.72 Td (HN:)Tj ( )Tj 0.125 Tw 3 0 Td (Sure, I\222ll take the second one )Tj 0 Tw (\226)Tj ( )Tj 0.125 Tw 13.536 0 Td (I think it\222s the easier one )Tj 0 Tw (\226)Tj ( )Tj 0.125 Tw 11.787 0 Td (then I\222ll go with the first, )Tj 0 Tw -25.323 -1.72 Td (which I also think is not tha)Tj (t nasty. You could be nastier, I guess.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.179 Tw 3 0 Td [(The )0.5(second )0.5(one )0.5(I )0.5(think )0.5(in )0.5(terms )0.5(of )]TJ 0 Tw (\226)Tj ( )Tj 0.179 Tw 16.353 0 Td [(maybe )0.5(I )0.5(didn\222t )0.5(present )0.5(it )0.5(well )]TJ 0 Tw (\226)Tj ( )Tj 0.179 Tw 14.052 0 Td [(is )0.5(that )]TJ 0.054 Tw -33.405 -1.72 Td (certainly there are sort of the very clear jurisdictional responsibiliti\ es, federal, provincial )Tj 0.042 Tw T* (and so on, but I think there\222s a lot of )Tj (the areas in which obviously there\222s areas in which )Tj 0.072 Tw T* (we could further collaborate, and I think one of the points I made was a\ bout the federal )Tj 0.007 Tw 0 -1.74 TD [(government using its spending power. Certainly in many areas we are look\ ing )0.5(at )0.5(ways )0.5(we )]TJ 0.129 Tw 0 -1.72 TD (could bolster provincial cap)Tj (acity in terms of an emergency. In others we\222re looking at )Tj 0.024 Tw T* (mechanisms where we can facilitate cooperation not just between the fede\ ral government )Tj 0.047 Tw T* (and a province but even between provinces as far as mutual assistance. W\ e\222re looking at )Tj ET endstream endobj 161 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 162 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (82)Tj ( )Tj ET Q BT 0.045 Tw 12 0 0 12 107.88 709.08 Tm (things such as health )Tj (emergency response teams, sort of a multi)Tj 0 Tw (-)Tj 0.045 Tw (jurisdiction which could )Tj 0.119 Tw 0 -1.72 TD (be used in case of a true emergency. And so I think through a variety of\ mechanisms, )Tj 0.39 Tw T* [(both )0.5(funding, )0.5(maybe )0.5(even )0.5(things )0.5(like )0.5(what )0.5(we\222re )0.5(doing )0.5(in )0.5(other )0.5(areas )0.5(such )0.5(as )]TJ 0.191 Tw 0 -1.74 TD (surveillance, giving tools,)Tj 0 Tw ( )Tj 0.191 Tw 11.154 0 Td (I think Dr.)Tj 0 Tw ( )Tj 0.191 Tw (Jeff Scott alluded to some of the moneys were )Tj 0.286 Tw -11.154 -1.72 Td (pouring into certain networks and so on, to me that\222s all part of how\ the federal )Tj 0 Tw 0 -1.72 TD (government can be part of the solution.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.045 Tw 3 0 Td (So I think that\222s answering your second question, so the federal gove\ rnme)Tj (nt only )Tj 0.035 Tw -3 -1.74 Td [(gets )0.5(into )0.5(a )0.5(discussion )0.5(on )0.5(financial )0.5(arrangements )0.5(when )0.5(there\222s )0.5(a )0.5(crisis. )0.5(We\222re )0.5(trying )0.5(to )0.5(do )]TJ 0 Tw T* (a lot of things up front collaboratively with the provinces and territor\ ies.)Tj 28.937 0 Td ( )Tj -31.937 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.133 Tw 3 0 Td (My personal perspective on the first one is that it\222s quite interesti\ ng, becau)Tj 31.451 0 Td (se I )Tj 0.052 Tw -34.451 -1.72 Td (think based partly on my own personal experience and knowing the players\ in Ontario )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj 0.05 Tw -35.5 -1.74 Td (because I was a medical officer of health with the City of Toronto befor\ e, I knew all the )Tj 0.118 Tw T* (public health folks and so on )Tj 0 Tw 12.486 0 Td (\226)Tj ( )Tj 0.118 Tw 0.868 0 Td (I think there were obviously issues, I thin)Tj (k, within the )Tj 0.028 Tw -13.355 -1.72 Td (Ontario public health system between the City of Toronto and the provinc\ ial level and so )Tj 0 Tw T* (on.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.003 Tw 3 0 Td [(Of )0.5(course )0.5(we )0.5(can )0.5(get )0.5(into )0.6(a )0.5(big )0.6(discussion )0.5(in )0.5(terms )0.6(of )0.5(healthcare )0.5(and )0.5(public )0.5(health )]TJ 0.039 Tw -3 -1.72 Td (and so on. What I saw is something that\222s a very important less)Tj 25.766 0 Td (on learned, is that there\222s )Tj 0.241 Tw -25.766 -1.72 Td (now a recognition I think in Canada )Tj 0 Tw (\226)Tj ( )Tj 0.241 Tw 17.311 0 Td (and I think abroad as well )Tj 0 Tw (\226)Tj ( )Tj 0.241 Tw 13.043 0 Td (that there\222s a )Tj 0.053 Tw -30.354 -1.72 Td (difference between what we consider sort of a single mandate or a very c\ lear what I call )Tj 0.052 Tw 0 -1.74 TD [(simple )0.5(emergency )0.5(and )0.5(something )0.5(I )0.5(might )0.5(euphemistically )0.5(ca)]TJ 0.051 Tw (ll a complex emergency. So )Tj 0.04 Tw 0 -1.72 TD (a simple emergency, in my view, looking at the public health sector woul\ d be something )Tj 0.068 Tw T* (like a waterborne illness outbreak where it\222s pretty straightforward,\ there\222s a source and )Tj 0.067 Tw T* (people are ill and the local public health authorit)Tj 19.921 0 Td (ies and physicians can deal with it, and )Tj 0 Tw -19.921 -1.74 Td (there might be some spillover in terms of other consequences.)Tj 24.771 0 Td ( )Tj -27.771 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.022 Tw 3 0 Td (Where I think we recognize there\222s a broader issue is that if there i\ s a certain type )Tj 0.119 Tw -3 -1.72 Td (of emergency )Tj 0 Tw (\226)Tj ( )Tj 0.119 Tw 6.827 0 Td (and it doesn\222t necessarily have to be an infectiou)Tj 20.448 0 Td (s disease, it could be )Tj 0.082 Tw -27.275 -1.72 Td (from other sources )Tj 0 Tw (\226)Tj ( )Tj 0.082 Tw 8.826 0 Td (but in this case it was SARS and now we\222re looking at pandemic, )Tj 0.161 Tw -8.826 -1.74 Td (where it happened in SARS and we anticipate for pandemic it\222ll be com\ plex because )Tj 0.094 Tw T* (there won\222t just be the medical and public health aspects in terms)Tj 0 Tw 27.169 0 Td ( )Tj 0.094 Tw 0.344 0 Td (of the virus and sick )Tj 0.012 Tw -27.513 -1.72 Td (patients and treatment and research and vaccines and so on, but the othe\ r impacts in other )Tj 0.079 Tw T* (society in terms of other sectors affected in terms of transportation, b\ usiness continuity, )Tj ET endstream endobj 163 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 164 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (83)Tj ( )Tj ET Q BT 0.139 Tw 12 0 0 12 107.88 709.08 Tm (the impact on a country )Tj 0 Tw 10.388 0 Td (\226)Tj ( )Tj 0.139 Tw 0.889 0 Td (the tourism and so on )Tj 0 Tw (\226)Tj ( )Tj 0.139 Tw 10.447 0 Td (and those were things which were )Tj 0.105 Tw -21.724 -1.72 Td (unanticipated before SARS but came to the forefront as the SARS situatio\ n developed, )Tj 0 Tw 0 -1.72 TD (and to me that\222s the biggest lesson learned.)Tj 17.218 0 Td ( )Tj -20.218 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.048 Tw 3 0 Td (And so there\222s nothing wrong in terms of the various sectors didn\222\ t know how to )Tj 0.177 Tw -3 -1.72 Td (play with e)Tj (ach other because they never had to do it before, but certainly somethin\ g )Tj 0.061 Tw T* (we\222re now recognizing as important to deal with up front. At the fede\ ral level )Tj 0 Tw 32.144 0 Td (\226)Tj ( )Tj 0.061 Tw 0.811 0 Td (and I'm )Tj 0.029 Tw -32.955 -1.72 Td [(sure )0.5(it\222s )0.5(happened )0.5(at )0.5(our )0.5(provincial )0.5(level )]TJ 0 Tw (\226)Tj ( )Tj 0.029 Tw 17.556 0 Td [(we )0.5(now )0.5(have )0.5(a )0.5(framework in )0.5(which )0.5(there )0.5(is )0.5(a )]TJ 0 Tw -17.556 -1.74 Td (desi)Tj 0.08 Tw (gnated federal department that\222s the lead. In this case it\222s Publi\ c Safety, so they are )Tj 0.322 Tw T* (sort of the hub of the wheel, and depending on the type of emergency if \ it\222s a )Tj 0.054 Tw T* (straightforward one it might just be a single department dealing with it\ and it would jus)Tj 0 Tw 35.722 0 Td (t )Tj 0.039 Tw -35.722 -1.72 Td (help coordinate in a very low)Tj 0 Tw 11.887 0 Td (-)Tj 0.039 Tw (key fashion, but if something ever developed which would )Tj 0.011 Tw -11.887 -1.74 Td (be recognized to be complex and involve multiple sectors and jurisdictio\ ns they would be )Tj 0 Tw T* (the coordinating force.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.05 Tw 3 0 Td (Let\222s say for example in Toronto in SARS or a pandem)Tj 22.663 0 Td (ic, the public health folks )Tj 0.156 Tw -25.663 -1.72 Td [(could deal with really the public )0.5(health medical )0.5(aspects )0.5(and not )0.5(be )0.5(bombarded )0.5(by )0.5(all )]TJ 0.221 Tw 0 -1.74 TD (these other issues such as what happened during SARS such as airports an\ d airport )Tj 0.283 Tw 0 -1.72 TD (authorities and dealing with other sectors and the impacts on)Tj 0 Tw 26.787 0 Td ( )Tj 0.283 Tw 0.533 0 Td (them, which I think )Tj 0.046 Tw -27.32 -1.72 Td [(overloaded and burdened the folks trying to )0.5(then deal with actually dealing with patients )]TJ 0 Tw T* (and the virus and so on.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.004 Tw 3 0 Td [(So )0.5(that\222s )0.5(sort )0.5(of )0.5(a )0.5(long )0.5(of )0.5(way )0.5(I )0.5(saying )0.5(that )0.5(I )0.5(think )0.5(that\222s )0.5(one )0.5(thing )0.5(we )0.5(learned )0.5(and )]TJ 0.075 Tw -3 -1.72 Td (hopefully we can deal with bette)Tj (r in the future. I'm not sure if Ron or others have other )Tj 0 Tw T* (comments...?)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 0.017 Tw 3 0 Td (Just a very brief comment, just to illustrate that we don\222t argue dur\ ing crises. We manage )Tj 0.415 Tw 0 -1.74 TD (the National Emergency Stockpile System in Canada. It\222s $300 million \ plus of )Tj 0.039 Tw 0 -1.72 TD (emergency sup)Tj (plies located in nine strategic warehouses and 1300 other smaller deposi\ ts )Tj 0.07 Tw T* (of supplies and materials. This is instantly available to all the provin\ ces with one phone )Tj 0.054 Tw T* (call, and the authority to deploy those resources does not require my ap\ proval, there is a)Tj 0 Tw 36 0 Td ( )Tj 0.243 Tw -36 -1.74 Td (director of the system that has the authority to deploy on one phone cal\ l from the )Tj 0.253 Tw T* (province, and our standard is that those supplies will be available anyw\ here in the )Tj 0 Tw T* (country within 24 hours of receipt of a request.)Tj ( )Tj ET endstream endobj 165 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 166 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (84)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.042 Tw 3 0 Td (So I just use that as an example of m)Tj (any areas where when the crisis happens we )Tj 0 Tw -3 -1.72 Td (don\222t argue a lot in Canada, we just do things.)Tj ( )Tj -3 -1.72 Td (HN:)Tj ( )Tj 0.099 Tw 3 0 Td [(Just to finish your )0.5(thought, )0.5(you )0.5(were )0.5(referring )0.5(to )0.5(the )0.5(Toronto )0.5(situation. )0.5(I )0.5(don\222t )0.5(want )0.5(to )]TJ 0.066 Tw 0 -1.74 TD (attribute this to anyone, this is my own personal observation. During t)Tj 28.691 0 Td (he SARS crisis, it )Tj 0.014 Tw -28.691 -1.72 Td (became aware that it had expanded beyond a simple emergency, because at \ the beginning )Tj 0.006 Tw 0 -1.72 TD (if it was strictly in medical public health it was Ontario\222s Chief Me\ dical Officer of Health )Tj 0 Tw T* (\226)Tj ( )Tj 0.958 0 Td (Dr.)Tj ( )Tj 0.208 Tw (Colin D\222Cunha at the time )Tj 0 Tw (\226)Tj ( )Tj 0.208 Tw 14.412 0 Td (who was responsible, but)Tj 0 Tw ( )Tj 0.208 Tw 11.191 0 Td (as it spread it became )Tj 0.129 Tw -26.561 -1.74 Td (essentially a true emergency in the general sense for the population of \ Ontario. That\222s )Tj 0.086 Tw T* (when you had another I think commissioner )Tj 0 Tw 18.462 0 Td (\226)Tj ( )Tj 0.086 Tw 0.836 0 Td (I'm not sure what the title was )Tj 0 Tw (\226)Tj ( )Tj 13.702 0 Td (Dr.)Tj ( )Tj (Jim )Tj 0.17 Tw -33 -1.72 Td (Young, Emergency Preparedness, also coming in to help mana)Tj (ge that. And of course )Tj 0.049 Tw T* (these were two, in a sense, two different areas of the Ontario system ha\ ving to deal with )Tj 0.018 Tw 0 -1.74 TD [(it. )0.5(And )0.5(of )0.5(course )0.5(in )0.5(terms )0.5(of )0.6(a )0.5(first )0.5(time )0.5(it\222s )0.5(always )0.5(more )0.5(complex )0.5(and )0.5(difficult )0.5(to )0.5(try )0.5(and )]TJ 0 Tw 0 -1.72 TD (figure out who does what and who\222s responsible.)Tj ( )Tj -3 -1.72 Td (RS)Tj (:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Scott?)Tj ( )Tj -3 -1.72 Td (JS:)Tj ( )Tj 0.086 Tw 3 0 Td (Yeah, maybe I can comment on the funding. I think there are two challeng\ es. It\222s good )Tj 0.231 Tw 0 -1.74 TD (because what we have seen for the first time in preparation we\222ve see\ n the federal )Tj 0.241 Tw 0 -1.72 TD (government provide money for a national immunization strategy. I mean,)Tj 0 Tw 31.519 0 Td ( )Tj 0.241 Tw 0.491 0 Td (money to )Tj 0.265 Tw -32.01 -1.72 Td (prepare Public Health. We\222ve seen them pay 60% of the cost of the ant\ ivirals for )Tj 0.086 Tw T* (pandemic preparedness, but to get to that process it really had to be a \ consensus on the )Tj 0.244 Tw 0 -1.74 TD (total amount and it was a mixture of political, public and professional \ orga)Tj 0 Tw 32.779 0 Td (nization )Tj -32.779 -1.72 Td (advocacy to get there.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.065 Tw 3 0 Td [(So I think you need to keep that going )0.5(to )0.5(get )0.5(money )0.5(flowing, )0.6(but )0.5(the )0.6(other )0.5(thing )]TJ 0.015 Tw -3 -1.72 Td (that you have to be very careful about is even if you get money the prov\ inces within your )Tj 0.022 Tw T* (own jurisdiction will sometimes say wait times or o)Tj (ur hospital sector are more important, )Tj 0.134 Tw 0 -1.72 TD [(and )0.5(so )0.5(it\222s )0.5(siphoned )0.5(sideways. )0.5(So )0.5(you )0.5(need )0.5(to )0.5(have )0.5(the )0.5(arrangements )0.5(that )0.5(provide )0.5(the )]TJ 0.039 Tw T* (funding and the accountability that the funding is used for the purpose \ it was intended to )Tj 0 Tw T* (be used for.)Tj ( )Tj -3 -1.74 Td (RS:)Tj ( )Tj 3 0 Td (One... two more question)Tj (s or comments, then we\222ll have to move on.)Tj ( )Tj -3 -1.72 Td (AMc:)Tj 2.333 0 Td ( )Tj 0.203 Tw 0.667 0 Td (I guess a federal... maybe a personal opinion on how we cope )Tj 0 Tw 27.29 0 Td (\226)Tj ( )Tj 0.203 Tw 0.953 0 Td (and I think this is )Tj 0.106 Tw -28.243 -1.72 Td (probably broader than just Canada )Tj 0 Tw 14.554 0 Td (\226)Tj ( )Tj 0.106 Tw 0.856 0 Td (with what I think is the public expectation that in )Tj 0.016 Tw -15.41 -1.72 Td (emergency setting that the feds are i)Tj 14.532 0 Td [(n charge, that the buck stops in terms of )0.5(management )]TJ ET endstream endobj 167 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 168 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (85)Tj ( )Tj ET Q BT 0.112 Tw 12 0 0 12 107.88 709.08 Tm (with the government of Canada, but in fact functionally that\222s not at\ all what happens, )Tj 0.091 Tw 0 -1.72 TD (that the buck stops for public health, for most things )Tj 0 Tw (\226)Tj ( )Tj 0.091 Tw 22.883 0 Td (not, I understand at borders and )Tj 0.169 Tw -22.883 -1.72 Td (other things )Tj 0 Tw (\226)Tj ( )Tj 0.169 Tw 6.255 0 Td (but the bu)Tj (ck stops at the provinces, and I think the... my sense of the )Tj 0.04 Tw -6.255 -1.74 Td (Canadian public is that that\222s not the way they see the world, and I \ don\222t think they\222d be )Tj 0.002 Tw T* (very happy if they knew that that was what the function was. How do we m\ anage... is that )Tj 0.132 Tw T* [(a )0.5(reasonable )0.5(e)]TJ 0.131 Tw (xpectation? If it\222s not a reasonable expectation then how do we manag\ e )Tj 0.012 Tw T* (that process )Tj 0 Tw (\226)Tj ( )Tj 0.012 Tw 5.784 0 Td (we get people to understand that our functioning is okay )Tj 0 Tw 22.892 0 Td (\226)Tj ( )Tj 0.012 Tw 0.762 0 Td (when I think the )Tj 0.107 Tw -29.438 -1.74 Td [(external )0.5(review )0.5(of )0.5(our )0.5(management )0.5(of )0.5(SARS )]TJ 0 Tw (\226)Tj ( )Tj 0.107 Tw 19.902 0 Td [(and )0.5(yeah, )0.5(I )0.5(apply )0.5(it )0.5(as )0.5(much )0.5(to )0.5(myself )]TJ 0 Tw -19.902 -1.72 Td (as... more )Tj (to myself than anybody else )Tj (\226)Tj ( )Tj (was very negative, and with justification?)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 0.089 Tw 3 0 Td (That\222s a similar question that I asked our U.S. colleagues this morni\ ng, which was in a )Tj 0.138 Tw T* [(sense )0.5([10 )0.5(sec. )0.5(blank] )0.5(federal )0.5(government )0.5(that )0.5(has )0.5(to )0.5(be )0.5(there, )0.5(not )0.5(constitutionally, )0.5(not )]TJ 0 Tw 0 -1.74 TD (le)Tj 0.1 Tw (gally, and maybe functionally it\222s impossible because you don\222t ha\ ve the doctors and )Tj 0.021 Tw 0 -1.72 TD (nurses, but the sense that they\222ve got to be in charge because they\222\ re the big government. )Tj 0 Tw T* (Same sort of question.)Tj ( )Tj -3 -1.72 Td (HN:)Tj ( )Tj 0.118 Tw 3 0 Td (It\222s interesting. I agree with Allison\222s comment that)Tj 0 Tw ( )Tj 0.118 Tw 21.909 0 Td (the buck stops, really, at the front )Tj 0.303 Tw -21.909 -1.74 Td (line. And I'm not sure, maybe somewhere people have a different percepti\ on, but )Tj 0.053 Tw T* (certainly the way we\222ve worked )Tj 0 Tw (\226)Tj ( )Tj 0.053 Tw 14.145 0 Td (or I\222ve perceived it )Tj 0 Tw (\226)Tj ( )Tj 0.053 Tw 8.9 0 Td (is that any emergency is always )Tj 0 Tw -23.045 -1.72 Td (bottom)Tj (-)Tj 0.042 Tw [(up, it\222s always a local event first )0.5(and we )]TJ [(always, at the federal level, prescribe )0.5(to )]TJ T* (this principle of what we call YOYO 24. In English yo)Tj 0 Tw (-)Tj 0.042 Tw (yo is the little toy that you go up )Tj 0.089 Tw 0 -1.74 TD (and down with, but YOYO can also stand an acronym for You\222re on Your \ Own for 24 )Tj 0.087 Tw 0 -1.72 TD (Hours, so that\222s the way we\222ve always worke)Tj (d, and it\222s always been sort of a going up )Tj 0.182 Tw T* (the pyramid in the sense that it\222s not the feds in charge but the loc\ al folks have the )Tj 0.048 Tw T* (responsibility, first responders. If it\222s a city it\222s fire and so \ on, paramedics, hospitals and )Tj 0.079 Tw 0 -1.74 TD (so on. If they\222re overwhelmed )Tj (by the event, be it... not a car crash because that\222s pretty )Tj 0.13 Tw 0 -1.72 TD [(constrained, but let\222s say an earthquake or something then it goes up\ )0.5(to the provincial )]TJ 0.02 Tw T* (level to try and pull resources as appropriate to assist with the local \ event, and then at the )Tj 0.112 Tw T* (final level )Tj (if there is further assistance to support them it would be at the federa\ l level )Tj 0.066 Tw 0 -1.74 TD (where Ron talked about the nest, let\222s say emergency stockpile, but w\ e never come at it )Tj 0.088 Tw 0 -1.72 TD (that the feds are in charge, we\222re taking over, that certainly hasn\222\ t been my perspectiv)Tj 0 Tw 35.556 0 Td (e )Tj -35.556 -1.72 Td (and approach.)Tj ( )Tj ET endstream endobj 169 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 170 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (86)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (AMc:)Tj 2.333 0 Td ( )Tj 0.119 Tw 0.667 0 Td (I don\222t think it\222s a \223taking over\224 question, I think it\222s\ some level of responsibility and )Tj 0.038 Tw 0 -1.72 TD (accountability, you know, it becomes a team. It\222s just that I think w\ hat Canadians expect )Tj 0.041 Tw T* [(is )0.5(that )0.5(the )0.5(federal )0.5(government )0.5(carries )0.5(the )0.5(ultimate )0.5(re)]TJ 21.204 0 Td [(sponsibility )0.5(and )0.5(the )0.5(goal )0.5(for )0.5(the )0.5(best )]TJ 0.046 Tw -21.204 -1.74 Td (we can do for all Canadians all the time. What I perceive is exactly as \ you\222ve described, )Tj 0.094 Tw T* (in general the can is actually carried at the local level where there\222\ s not a great deal of )Tj 0.144 Tw T* (expertise sometimes, and that may n)Tj 15.273 0 Td (ot be a bad thing but I think if we expect that to )Tj 0.102 Tw -15.273 -1.72 Td (continue then we need to work at the understanding that that\222s how th\ e system... that\222s )Tj 0.096 Tw 0 -1.74 TD (what the system actually is, and I'm not sure that Canadians will tolera\ te that system if )Tj 0 Tw 0 -1.72 TD (they know it exists.)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Dr)Tj (.)Tj ( )Tj (Scott, 30 seconds, and then we\222ll go to Dr.)Tj ( )Tj (Krishnan.)Tj ( )Tj -3 -1.72 Td (JS:)Tj ( )Tj 0.093 Tw 3 0 Td [(I )0.5(think )0.5(on )0.5(of )0.5(the )0.5(clear )0.5(things )0.5(there, )0.5(the )0.5(issue, )0.5(it\222s )0.5(the )0.5(risk )0.5(communication )0.5(to )0.5(the )0.5(public. )]TJ 0.139 Tw 0 -1.74 TD (During SARS one of the problems we had was who issues an advisory for Ca\ nadians )Tj 0.082 Tw 0 -1.72 TD (within Canada, and reall)Tj (y it was very difficult, between the provinces and territories, to )Tj 0.099 Tw T* (see who did it. To me that is a role of the chief public health officer,\ and that\222s a very )Tj 0.082 Tw T* (strong role of the public face )Tj 0 Tw 12.267 0 Td (\226)Tj ( )Tj 0.082 Tw 0.832 0 Td (not necessarily managing it, because I think it will be )Tj 0 Tw 22.4 0 Td (\226)Tj ( )Tj 0.031 Tw -35.5 -1.74 Td (but it\222)Tj (s a public face coordinating and collaborating with the agency, because \ that should )Tj 0 Tw T* (be seen as very important from the Canadian perspective.)Tj 22.964 0 Td ( )Tj -25.964 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. Dr.)Tj ( )Tj (Krishnan, last comment please.)Tj ( )Tj -3 -1.72 Td (SK:)Tj ( )Tj 0.106 Tw 3 0 Td (I want to know what is the role of the political leadership a)Tj (nd commitment during this )Tj 0.153 Tw 0 -1.74 TD (type of episode, because in India for example when we had SARS we never \ had any )Tj 0.042 Tw 0 -1.72 TD [(cases except for two suspect cases. The health minister )0.5(of the federal system calls all the )]TJ 0.001 Tw T* (health ministers of the states and we have an emergency ty)Tj 23.499 0 Td (pe of a meeting and discuss the )Tj 0.011 Tw -23.499 -1.72 Td (issues, and similarly at the administrative level we have the health sec\ retaries who are the )Tj 0.057 Tw 0 -1.74 TD [(bureaucrats )0.5(who )0.5(the )0.5(executive )0.5(power )0.5(is )0.6(with )0.6(them, )0.5(they )0.5(are )0.5(also )0.5(called )0.5(to )0.5(the )0.5(centre )0.5(and )]TJ 0.047 Tw 0 -1.72 TD (you have a meeting and it is discussed. Si)Tj (milarly, during the avian \222flu outbreak also the )Tj 0.055 Tw T* (affected state health ministers are called and briefed about it, so how \ does it work in the )Tj 0 Tw T* (Canada or U.S. system?)Tj ( )Tj -3 -1.74 Td (RS:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Njoo, you\222re on the hotseat, here!)Tj ( )Tj -3 -1.72 Td (HN:)Tj ( )Tj 0.122 Tw 3 0 Td (Again, one of the many, many legacies or less)Tj 19.415 0 Td (ons from SARS was the need to have a )Tj 0.13 Tw -19.415 -1.72 Td (coordinated communications and messaging )Tj 0 Tw (\226)Tj ( )Tj 0.13 Tw 19.394 0 Td (both political and technical )Tj 0 Tw (\226)Tj ( )Tj 0.13 Tw 12.506 0 Td (across the )Tj ET endstream endobj 171 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 172 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (87)Tj ( )Tj ET Q BT 0.129 Tw 12 0 0 12 107.88 709.08 Tm (country, so that the federal and the provincial territorial levels are n\ ot saying different )Tj 0 Tw 0 -1.72 TD (things at different times to the populatio)Tj 16.052 0 Td (n.)Tj ( )Tj -19.052 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.576 Tw 3 0 Td (So there has been a lot of work on communications network, crisis )Tj 0.137 Tw -3 -1.74 Td (communications network across the entire country, so that there is stron\ g linkages not )Tj 0.043 Tw T* (only across the federal government between departments but also with the\ provinces and )Tj 0 Tw T* (territories)Tj (. I trust, Dr.)Tj ( )Tj (Scott, you would agree with that?)Tj ( )Tj -3 -1.72 Td (JS:)Tj ( )Tj 0.079 Tw 3 0 Td (Yeah. In the process, I think one of the key things, part of the roles a\ nd responsibilities )Tj 0.035 Tw 0 -1.74 TD (during a pandemic was really try and articulate, as well, not just that \ but how you set the )Tj 0.023 Tw 0 -1.72 TD (system in place, be)Tj (cause when a pandemic comes you want to have a process that there\222s )Tj 0.056 Tw T* (a national response, and how do you communicate that between the various\ policies and )Tj 0 Tw T* (political levels? It\222s there but it needs to be put in place. That\222\ ll take place.)Tj 29.878 0 Td ( )Tj -32.878 -1.74 Td (RS:)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (COUNTRY 2: BRAZ)Tj (IL)Tj ( )Tj 0 -1.66 TD (Dr.)Tj ( )Tj (Expedito Luna)Tj ( )Tj /TT0 1 Tf 0.276 Tw 3 -1.64 Td (First of all I would like to thank the organizers for inviting Brazil to\ present our )Tj 0.1 Tw -3 -1.72 Td (experience and to share the experiences of the countries, and also I wou\ ld like to apologize in )Tj 0.083 Tw 0 -1.74 TD (advance for my mistakes because I'm not a native Engli)Tj 23.005 0 Td (sh speaker so I\222ll probably make many )Tj 0 Tw -23.005 -1.72 Td (mistakes in language.)Tj ( )Tj 0.084 Tw 3 -1.72 Td (As most countries represented here, Brazil is a very large country. Popu\ lation estimates )Tj 0.152 Tw -3 -1.72 Td (for 2006 is 186 million population. It\222s a federal state with 26 stat\ es and one federal district )Tj 0.143 Tw T* (which is t)Tj (he national capital and in practice functions as the 27th state, and mor\ e than 5,500 )Tj 0 Tw 0 -1.72 TD (municipalities.)Tj ( )Tj 0.117 Tw 3 -1.72 Td (As you can see in this map it shows the demographic distribution of the \ population of )Tj 0.074 Tw -3 -1.72 Td (Brazil, and most of the population is located in the south)Tj 0 Tw 23.378 0 Td (-)Tj 0.074 Tw (eastern co)Tj (astal area and north)Tj 0 Tw (-)Tj (eastern )Tj 0.03 Tw -23.378 -1.74 Td (coastal area, and there is a huge almost empty space in the northern reg\ ion which is the Amazon )Tj 0.051 Tw T* [(forest. )0.5(And )0.5(these )0.5(differences )0.5(are )0.5(not )0.5(only )0.5(geographical )0.5(and )0.5(also )0.5(populational )0.5(but )0.5(also )0.5(ethnical )]TJ 0 Tw 38.5 0 Td (\226)Tj ( )Tj 0.036 Tw -38.5 -1.72 Td [(being )0.5(the )0.5(southern )0.5(population )0.5(of )]TJ [(Brazil )0.5(mostly )0.5(descended )0.5(from )0.5(European )0.5(immigrants, )0.5(the )0.5(north)]TJ 0 Tw 38.667 0 Td (-)Tj 0.112 Tw -38.667 -1.72 Td (eastern population mostly descended from Africans, and the northern stat\ es mostly indigenous )Tj 0.047 Tw 0 -1.74 TD (native South Americans )Tj 0 Tw (\226)Tj ( )Tj 0.047 Tw 10.796 0 Td (and also of income distributions with the most developed areas in the )Tj 0 Tw -10.796 -1.72 Td (southern)Tj ( )Tj 0.009 Tw 3.703 0 Td (areas, and also the largest state of Brazil, which is the State of Sao P\ aolo )Tj 0 Tw 29.429 0 Td (\226)Tj ( )Tj 0.009 Tw 0.759 0 Td (I\222ll point it )Tj 0 Tw (\226)Tj ( )Tj ET endstream endobj 173 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 174 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (88)Tj ( )Tj ET Q BT 0.038 Tw 12 0 0 12 71.88 709.08 Tm (the state with 43 million population is the largest and it\222s responsi\ ble for half of the economy of )Tj 0 Tw 0 -1.72 TD (the country.)Tj ( )Tj 0.076 Tw 3 -1.72 Td (And so these differences are key to the process)Tj 19.378 0 Td (es of Brazil. On the one hand we have a )Tj 0.011 Tw -22.378 -1.74 Td [(very )0.5(populous, )0.5(very )0.5(large )0.5(state. )0.5(On )0.5(the )0.5(other )0.5(hand )0.5(we )0.5(have )0.5(a )0.5(state )0.5(like )0.5(that )0.5(one, )0.5(the )0.5(northernmost )]TJ 0.093 Tw T* (state, with a population of 300,00 only, and half of the are or half of \ the surface, belonging to )Tj 0.038 Tw T* (one of the indigeno)Tj (us groups, the Yanomami nation. These differences, they account for a lo\ t of )Tj 0 Tw T* (our difficulties in implementing not only the IHR but all healthcare and\ public health.)Tj 34.269 0 Td ( )Tj 0.128 Tw -31.269 -1.74 Td (And another key thing to understand our process is to understand that we\ are in Latin )Tj 0 Tw -3 -1.72 Td (Ameri)Tj 0.115 Tw (ca and with the strong authoritarian politics that go in the subcontinen\ t, and in the 20th )Tj 0.11 Tw T* (century Brazil has had two dictatorships, and the last one that ended on\ ly in 1985, and so it\222s )Tj 0.001 Tw T* [(only )0.5(21 )0.5(years )0.5(of )0.5(democratic )0.6(government, )0.5(and )0.5(so )0.5(our )0.5(institutions )0.5(are )0.5(i)]TJ [(n )0.5(the )0.5(building )]TJ 0 Tw (\226)Tj ( )Tj 0.001 Tw [(it )0.5(takes )0.5(time )]TJ 0.179 Tw 0 -1.74 TD (to build democratic institutions )Tj 0 Tw (\226)Tj ( )Tj 0.179 Tw 14.365 0 Td (and so is our national health system. The constitution, the )Tj 0.135 Tw -14.365 -1.72 Td (national constitution, the democratic constitution was established in 19\ 88, and the new health )Tj 0 Tw 0 -1.72 TD (system )Tj 3.086 0 Td (\226)Tj ( )Tj 0.058 Tw 0.808 0 Td (which is designed to be a )Tj (universal healthcare system )Tj 0 Tw (\226)Tj ( )Tj 0.058 Tw 22.962 0 Td (was begun its implementation )Tj 0.102 Tw -26.856 -1.72 Td (in 1999. And it\222s a decentralized system involving the three levels o\ f government, the federal, )Tj 0.027 Tw 0 -1.74 TD (state and municipalities, and the municipalities are the ones responsibl\ e for delivering healthcare )Tj 0 Tw 0 -1.72 TD (t)Tj (o the population.)Tj ( )Tj 0.133 Tw 3 -1.72 Td (The Ministry of Health coordinates the national health system and also f\ unds it. Two)Tj 0 Tw 35.667 0 Td (-)Tj 0.134 Tw -38.667 -1.72 Td (thirds of the funds of the national healthcare system come from the fede\ ral government. This )Tj 0.092 Tw 0 -1.74 TD (money is routinely decentralized to the states and municipal)Tj 24.728 0 Td (ities on the basis of the population )Tj 0 Tw -24.728 -1.72 Td (and...)Tj ( )Tj 0 -1.72 TD ([Start of Side 7])Tj ( )Tj 0.289 Tw T* [(...the degree of development and income, so that the northern, which are\ )0.5(larger and less )]TJ 0.05 Tw 0 -1.74 TD [(populated, )0.5(they )0.5(get )0.5(more )0.5(money )0.5(per )0.5(capita )0.5(than )0.5(the )0.6(southern, )0.5(which )0.6(are )0.5(richer )0.5(and )0.5(with )0.5(a )0.5(larger )]TJ 0 Tw 0 -1.72 TD (populatio)Tj (n.)Tj ( )Tj 0.135 Tw 3 -1.72 Td (And the public health surveillance system, it was established in 1975. O\ f course there )Tj 0.07 Tw -3 -1.72 Td [(were public health activities before )0.5(that, )0.5(but there was a major meningococcal disease outbreak )]TJ 0.047 Tw 0 -1.74 TD (in the \22270s in Brazil, and it was a time of the military government. \ A)Tj 28.094 0 Td (t first the government tried )Tj 0.028 Tw -28.094 -1.72 Td (to hide, to say that nothing was happening, and then later on they came \ to accept and to publicly )Tj 0.053 Tw 0 -1.72 TD (acknowledge there was an outbreak, a huge epidemic, and as a response to\ that they created the )Tj 0.167 Tw T* (first national public health surve)Tj (illance system in 1975. At that time it was mostly a federal )Tj ET endstream endobj 175 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 176 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (89)Tj ( )Tj ET Q BT 0.09 Tw 12 0 0 12 71.88 709.08 Tm [(system with a small participation of the states. )0.5(From 1999 )0.5(on )0.5(we began the )0.5(decentralization )0.5(of )]TJ 0 Tw 0 -1.72 TD (the national public health surveillance system.)Tj 18.495 0 Td ( )Tj 0.015 Tw -15.495 -1.72 Td [(This )0.5(is )0.5(the )0.5(flow )0.5(chart )0.5(of )0.5(the )0.5(Ministry )0.5(of )0.5(Health, )0.5(an)]TJ 0.014 Tw (d I\222ll point out where we are located in )Tj 0.221 Tw -3 -1.74 Td (one of the secretariats of the ministry which is the focal point for the\ International Health )Tj 0.183 Tw T* (Regulations. Then here it\222s called the \(Secretariat de Vigilance y S\ alud?\), the Public Health )Tj 0.077 Tw T* (Surveillance Secretariat, a)Tj (nd it\222s one of the five secretariats of the ministry. The other ones \ are )Tj 0.352 Tw T* (healthcare, human resources, of the democratic governance, and science, \ technology and )Tj 0 Tw 0 -1.74 TD (strategic supplies.)Tj ( )Tj 0.088 Tw 3 -1.72 Td (And then within the secretariat we have three departments. This one is w\ here)Tj 0 Tw 31.904 0 Td ( )Tj 0.088 Tw 0.338 0 Td (I am, it\222s )Tj 0.362 Tw -35.242 -1.72 Td (the Communicable Disease, then Health Situation and Analysis, and Non)Tj 0 Tw 32.557 0 Td (-)Tj (Communicable )Tj 0.182 Tw -32.557 -1.72 Td (Disease, the STD/AIDS Department, and also an environmental health )Tj 0 Tw 30.162 0 Td (\226)Tj ( )Tj 0.182 Tw 0.932 0 Td (it doesn\222t have the )Tj 0.001 Tw -31.094 -1.74 Td (status of a department )Tj 0 Tw (\226)Tj ( )Tj 0.001 Tw 9.807 0 Td (and we also have the four decentralized service)Tj 18.913 0 Td (s. Two of them are public )Tj 0.078 Tw -28.721 -1.72 Td (health laboratories, one located in the Amazon, which specializes in arb\ oviral diseases, and the )Tj 0 Tw 0 -1.72 TD (other one in Rio De Janeiro specializes in tuberculosis.)Tj 21.966 0 Td ( )Tj 0.054 Tw -18.966 -1.72 Td (What\222s the mandate of the Ministry of Health in public health surveil\ lance? )Tj 31.142 0 Td (Well, it sets )Tj 0.173 Tw -34.142 -1.74 Td (the standards, case definitions, guidelines, and coordinates the public \ health surveillance and )Tj 0.012 Tw T* (disease prevention and control programs, like STD/AIDS, tuberculosis, le\ prosy, malaria, dengue, )Tj 0.272 Tw T* (viral hepatitis, and also the national immunizatio)Tj 21.153 0 Td (n program and the national public health )Tj 0 Tw -21.153 -1.72 Td (laboratories network.)Tj ( )Tj 0.072 Tw 3 -1.74 Td [(We )0.5(share )0.5(the )0.5(role )0.5(of )0.5(protection )0.5(and )0.5(response )0.5(to )0.5(national )0.5(public )0.5(health )0.5(emergencies )0.5(with )]TJ 0.369 Tw -3 -1.72 Td (states and municipalities, and also the Ministry of Health is responsibl\ e for centralized )Tj 0.258 Tw T* (procurement of )Tj (strategic supplies like drugs for special programs, like \222flu, HIV va\ ccines, )Tj 0 Tw T* (insecticides and lab reagents, and also to deliver those goods to the st\ ates.)Tj 29.492 0 Td ( )Tj 0.276 Tw -26.492 -1.74 Td (There\222s an annual planning of activities which is made jointly with t\ he states and )Tj 0.076 Tw -3 -1.72 Td (municipalities, an)Tj (d the ministry conducts the assessment of that planning. We set goals an\ d we )Tj 0.036 Tw T* (set targets to be achieved, and that\222s continuously monitored. And we\ have a specific budget for )Tj 0.031 Tw T* [(disease )0.5(surveillance )0.5(and )0.5(control )0.5(programs )0.5(which )0.5(in )0.5(2006 )0.6(was )0.5(equivalent )0.6(to )0.5(US$250 )0.6(m)]TJ 34.914 0 Td [(illion, )0.5(and )]TJ 0 Tw -34.914 -1.74 Td (we in the Public Health Surveillance Secretariat are the national coordi\ nators of all that.)Tj 35.154 0 Td ( )Tj 0.117 Tw -32.154 -1.72 Td (As in Canada, in the U.S., it\222s quite difficult to really separate pr\ ecisely which are the )Tj 0.003 Tw -3 -1.72 Td (roles of states, national and local. I put it in red the ones)Tj 0 Tw 22.424 0 Td ( )Tj 0.003 Tw 0.253 0 Td (which are more likely to be developed at )Tj 0.12 Tw -22.677 -1.72 Td (a national or state or local, and in green which is more from the other \ ones. See, most of the )Tj ET endstream endobj 177 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 178 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (90)Tj ( )Tj ET Q BT 0.108 Tw 12 0 0 12 71.88 709.08 Tm (capacities are shared amongst the three levels of government, being the \ detection mostly local )Tj 0 Tw 0 -1.72 TD (and the dissemination of)Tj ( )Tj (information of information mostly federal, mostly central.)Tj 33.27 0 Td ( )Tj 0.063 Tw -30.27 -1.72 Td (Concerning the approval of IHR, our president, the president of the repu\ blic will submit )Tj 0.108 Tw -3 -1.74 Td (the IHR for the National Congress approval. As we\222re going to have na\ tional elections in two )Tj 0 Tw T* (weeks we under)Tj (stand that that will only happen after the elections.)Tj 26.63 0 Td ( )Tj 0.145 Tw -23.63 -1.72 Td (In Brazil the national law is over any state or local laws and regulatio\ ns, so once it\222s )Tj 0.063 Tw -3 -1.72 Td (approved conflicting legislation of state and municipalities, they no lo\ nger are valid. And states )Tj 0.064 Tw 0 -1.74 TD (and municipali)Tj (ties, they can add more things to the legislation but they cannot confli\ ct with the )Tj 0.006 Tw 0 -1.72 TD (federal. Amongst the key changes are the requirements of isolation, quar\ antine, social distancing, )Tj 0 Tw T* (because these things have never been clearly regulated in our country.)Tj 28.016 0 Td ( )Tj -25.016 -1.72 Td (An)Tj 0.056 Tw (d how is the negotiation process within the health system? There is a co\ mmittee with )Tj 0.186 Tw -3 -1.74 Td [(eight )0.5(representatives )0.5(from )0.5(each )0.5(one )0.5(of )0.5(the levels, )0.6(so )0.6(the )0.6(council )0.5(of )0.5(state )0.5(health )0.5(departments )]TJ 0.046 Tw T* [(appoints eight people, the council of municipal health authorities )0.5(appoints e)]TJ 30.753 0 Td (ight people, and this )Tj 0.041 Tw -30.753 -1.72 Td [(committee decides which things are going to be followed )0.5(by )0.5(the )0.5(health )0.5(system )0.5(as )0.5(a )0.5(whole. )0.5(They )]TJ 0.117 Tw T* (are particularly concerned in costs and more money, so things that do no\ t imply new costs or )Tj 0.048 Tw 0 -1.74 TD (new money they tend to approve without much dis)Tj (cussion. [laughter] And besides financing the )Tj 0.153 Tw 0 -1.72 TD (regular transfer of money, we may )Tj 0 Tw (\226)Tj ( )Tj 0.153 Tw 15.898 0 Td (we as the federal government )Tj 0 Tw (\226)Tj ( )Tj 0.153 Tw 13.69 0 Td (may decentralize more )Tj 0 Tw -29.588 -1.72 Td (money for specific projects. I\222ll discuss that later on.)Tj 21.049 0 Td ( )Tj 0.017 Tw -18.049 -1.72 Td (One other change to comply with the IHR is the revision of the p)Tj 26.191 0 Td (ublic health surveillance )Tj 0.143 Tw -29.191 -1.74 Td (system law of 1975, and then we hired one of the universities of our cou\ ntry, the Centre for )Tj 0.133 Tw T* [(Health Law at the Public Health School at the University of Sao Paulo wh\ ich has prepared )0.5(a )]TJ 0.019 Tw T* (draft for us )Tj 0 Tw (\226)Tj ( )Tj 0.019 Tw 5.519 0 Td (currently the second draft )Tj 0 Tw (\226)Tj ( )Tj 11.341 0 Td (an)Tj 0.019 Tw (d as we finish the discussion within the health sector )Tj 0.113 Tw -16.86 -1.72 Td (that will include the state and municipalities. For now it\222s only wit\ hin the Ministry of Health. )Tj 0.025 Tw 0 -1.74 TD (After that process we\222ll present to the office of the president that \ will submit that to the National )Tj 0 Tw 0 -1.72 TD (Co)Tj (ngress.)Tj ( )Tj 0.193 Tw 3 -1.72 Td (And among the key changes is the establishing of the roles of the federa\ l, state and )Tj 0.165 Tw -3 -1.72 Td (municipal governments, because at that time )Tj 0 Tw 19.07 0 Td (\226)Tj ( )Tj 0.165 Tw 0.915 0 Td (in 1975 )Tj 0 Tw (\226)Tj ( )Tj 0.165 Tw 4.524 0 Td (the municipal governments had no )Tj 0.168 Tw -24.509 -1.74 Td [(participation )0.5(in )0.5(surveillance )0.5(and )0.5(disease )0.5(control, )0.5(and )0.5(also )0.5(those )0.5(things )0.5(I)]TJ 30.195 0 Td [(\222ve )0.5(spoken )0.5(already )]TJ 0 Tw (\226)Tj ( )Tj 0.16 Tw -30.195 -1.72 Td (isolation, quarantine, social distancing )Tj 0 Tw 16.249 0 Td (\226)Tj ( )Tj 0.16 Tw 0.91 0 Td (their applicability, and also the definitions of public )Tj 0.051 Tw -17.16 -1.72 Td [(health )0.5(emergencies )0.5(of )0.5(national )0.5(concern, )0.5(and )0.5(penalties )0.5(for )0.5(not )0.5(complying )0.5(with )0.5(that )0.6(law which )0.5(do )]TJ ET endstream endobj 179 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 180 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (91)Tj ( )Tj ET Q BT 0.176 Tw 12 0 0 12 71.88 709.08 Tm (not exist presently )Tj 0 Tw (\226)Tj ( )Tj 0.176 Tw 9.037 0 Td (the present law doe)Tj (s not define any penalty )Tj 0 Tw (\226)Tj ( )Tj 0.176 Tw 19.887 0 Td (so the ones who do not )Tj 0 Tw -28.924 -1.72 Td (comply are not punished.)Tj ( )Tj 0.183 Tw 3 -1.72 Td [(And )0.5(we )0.5(have )0.5(already )0.5(established, )0.5(as )0.5(a )0.5(ministerial )0.5(act, )0.5(a )0.5(list )0.5(of )0.5(immediate )0.5(mandatory )]TJ 0.013 Tw -3 -1.74 Td (reporting diseases. What does that mean? That means the diseases which a\ re of national concern. )Tj 0.124 Tw 0 -1.72 TD [(In )0.5(the )0.5(regulations )0.5(concerning )0.5(their )0.5(detection, )0.5(notification, )0.5(verification, )0.5(reporting )0.5(and )0.5(response, )]TJ 0.114 Tw T* (that was done in February. And also the establishment of the Strategic I\ nformation Centre for )Tj 0 Tw T* (Public Health Surveillance.)Tj ( )Tj 0.101 Tw 3 -1.74 Td (And the next step was a funding mec)Tj (hanism to support the establishment of equivalent )Tj 0 Tw -3 -1.72 Td (centres in the states and the capital cities\222 health secretariats.)Tj 24.267 0 Td ( )Tj 0.007 Tw -21.267 -1.72 Td (Another initiative is the FETP training which was established in 2000 in\ cooperation with )Tj 0.027 Tw -3 -1.72 Td [(the )0.5(CDC )0.5(of )0.5(the )0.5(United States, and )0.5(at )0.5(the )0.5(same )0.5(tim)]TJ 20.234 0 Td [(e )0.5(the )0.5(short )0.5(courses )0.5(on )0.5(outbreaks )0.5(investigations )]TJ 0 Tw -20.234 -1.74 Td (for a large audience, and Internet)Tj (-)Tj (based epidemiology courses.)Tj ( )Tj 3 -1.72 Td (And there was a huge investment in public health laboratories network.)Tj 28.52 0 Td ( )Tj 0.032 Tw -28.52 -1.72 Td (Here we have the disease list which is of national interest. Then we hav\ e.)Tj 29.711 0 Td (.. some of them )Tj 0.049 Tw -32.711 -1.72 Td (are related to the bioterrorisms and do not happen, in Brazil have never\ happened. And some of )Tj 0.006 Tw 0 -1.74 TD (the old IHR and some of the new, complying with the new IHR. Then botuli\ sm, anthrax, cholera, )Tj 0 Tw 0 -1.72 TD (yellow fever, West Nile and so on.)Tj ( )Tj 0.174 Tw 3 -1.72 Td [(And )0.5(also )0.5(unusual)]TJ 0 Tw ( )Tj 0.174 Tw 7.714 0 Td [(and )0.5(unexpected )0.5(events, )0.5(which )0.5(are )0.5(the )0.5(cases )0.5(or )0.5(deaths )0.5(related )0.5(to )0.5(an )]TJ 0 Tw -10.714 -1.72 Td (unknown disease or modified pattern of a known disease.)Tj ( )Tj 0.179 Tw 3 -1.74 Td [(And )0.5(the )0.5(ways )0.5(how )0.5(to )0.5(notify, )0.5(how )0.5(to )0.5(report )0.5(those, )0.5(which )0.5(is )0.5(a )0.5(0)]TJ 0 Tw (-)Tj (800 )Tj 29.273 0 Td (\226)Tj ( )Tj 0.179 Tw 0.928 0 Td [(it\222s )0.5(a )0.5(toll)]TJ 0 Tw (-)Tj (free )Tj -33.201 -1.72 Td (telephone )Tj (\226)Tj ( )Tj (and by e)Tj (-)Tj (mail, and also a search in)Tj ( )Tj (the press and Internet.)Tj ( )Tj 0.277 Tw 3 -1.72 Td (And some of the diseases are here because of national policies, like mea\ sles. The )Tj 0.045 Tw -3 -1.72 Td (transmission of measles has been interrupted in Brazil since 2000, and t\ hen we have the interest )Tj 0.39 Tw 0 -1.74 TD (of keeping that achievement. And Chagas Disease, tha)Tj 24.526 0 Td (t as well their transmission was )Tj 0.138 Tw -24.526 -1.72 Td [(interrupted, )0.5(the )0.5(bacterial )0.5(transmission )0.5(was )0.5(interrupted, )0.5(and )0.5(we )0.5(now )0.5(only )0.5(have )0.5(acute )0.5(episodes, )]TJ 0 Tw 0 -1.72 TD (mostly related to food)Tj (-)Tj (borne Chagas Disease, something that was unknown before.)Tj ( )Tj 0.122 Tw 3 -1.72 Td (This is a data flow. It usually starts in the hea)Tj (lth units and ends up in our Ministry of )Tj 0 Tw -3 -1.74 Td (Health, the Public Health Surveillance Secretariat.)Tj 20.131 0 Td ( )Tj 0.059 Tw -17.131 -1.72 Td (And as the Annex 2 of the IHR we have set an algorithm for notification \ of diseases, so )Tj 0.136 Tw -3 -1.72 Td (we\222re trying to follow that for every event to classify if it\222s of\ national)Tj 0 Tw 29.903 0 Td ( )Tj 0.136 Tw 0.386 0 Td (interest and also if it )Tj ET endstream endobj 181 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 182 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (92)Tj ( )Tj ET Q BT 0.046 Tw 12 0 0 12 71.88 709.08 Tm (would be of international interest. That\222s our Strategic Information \ Centre, which is the 24)Tj 0 Tw 36.834 0 Td (-)Tj (hour )Tj -36.834 -1.72 Td (functioning for reporting of diseases.)Tj ( )Tj 0.259 Tw 3 -1.72 Td [(And )0.5(in )0.5(the )0.5(past )0.5(six )0.5(years )0.5(the )0.5(number )0.5(of )0.5(outbreaks )0.5(that )0.5(were )0.5(investigated )0.5(with )0.5(the )]TJ 0 Tw -3 -1.74 Td (participatio)Tj 0.016 Tw [(n )0.5(of )0.5(people )0.5(from )0.5(the )0.5(Ministry )0.6(of )0.6(Health, )0.5(and )0.5(that )0.5(until )0.5(2005 )0.5(there )0.5(were )0.5(114 )0.5(outbreaks )]TJ 0 Tw 0 -1.72 TD (in 83 municipalities, and it\222s things very diverse, food)Tj 21.607 0 Td (-)Tj (borne diseases to yet)Tj (-)Tj (unknown problems.)Tj ( )Tj 0.098 Tw -18.607 -1.72 Td (As I told you there\222s been a huge investment in our national public h\ ealt)Tj 30.182 0 Td (h laboratories. )Tj 0.311 Tw -33.182 -1.72 Td (These laboratories are mostly state public health laboratories and we ar\ e upgrading their )Tj 0.086 Tw 0 -1.74 TD (biosafety capabilities, and then you\222ll see in a triangle 12 laborato\ ries that received a biosafety )Tj 0.131 Tw 0 -1.72 TD (laboratory, and the red spots are the border labor)Tj (atories which were built in order to increase )Tj 0.106 Tw T* (sensitivity and specificity of surveillance in all national borders. And\ these are also not linked )Tj 0.1 Tw T* (directly to the federal level, we have financed them but they usually be\ long to the state health )Tj 0 Tw 0 -1.74 TD (departments or)Tj ( )Tj (to the municipal health departments.)Tj 20.799 0 Td ( )Tj 0.154 Tw -17.799 -1.72 Td [(These )0.5(new )0.5(regulations )0.5(from )0.5(March )0.5(this )0.6(year )0.6(establishes )0.6(the )0.6(diseases )0.5(and )0.6(situations )0.5(of )]TJ 0.118 Tw -3 -1.72 Td (national and international... mostly national but the ones that are nati\ onal are submitted to the )Tj 0 Tw 0 -1.72 TD (algorithm to see if they\222re intern)Tj 12.968 0 Td (ational or not, of international concern.)Tj 15.633 0 Td ( )Tj 0.234 Tw -25.601 -1.74 Td (The direct intervention of the federal government is to be decided accor\ ding to the )Tj 0.039 Tw -3 -1.72 Td (request of the state )Tj 0 Tw 7.932 0 Td (\226)Tj ( )Tj 0.039 Tw 0.789 0 Td (of the state governments )Tj 0 Tw 10.21 0 Td (\226)Tj ( )Tj 0.039 Tw 0.789 0 Td (insufficient capacity of state and local, or a risk )Tj 0 Tw -19.721 -1.72 Td (of national spread, or if th)Tj (ey are problems that occur simultaneously in two or more states.)Tj 36.185 0 Td ( )Tj 0.082 Tw -33.185 -1.72 Td (The Public Health Surveillance Secretariat was formally designated as th\ e focal point. I )Tj 0.035 Tw -3 -1.74 Td (saw it was on the WHO slide this morning, and I\222ll ask the diplomats,\ the foreign relations what )Tj 0 Tw T* (happe)Tj 0.168 Tw (ned, because there was a presidential act nominating the secretariat, an\ d I don\222t know, )Tj 0 Tw T* (maybe the foreign ministry has not informed yet WHO.)Tj 22.245 0 Td ( )Tj 0.033 Tw -19.245 -1.72 Td (Internally it was established a committee for the coordination of the IH\ R implementation )Tj 0.415 Tw -3 -1.74 Td (in August, last month, and)Tj 0 Tw ( )Tj 0.415 Tw 12.881 0 Td (with also the participation of federal, state and municipal )Tj 0.021 Tw -12.881 -1.72 Td (representatives. And this committee has the mandate to invite, to call o\ ther ministries if there are )Tj 0 Tw T* (issues which relate to agriculture or trade and other areas.)Tj 23.046 0 Td ( )Tj 0.129 Tw -20.046 -1.72 Td (How our system works, the states )Tj (and municipalities they must formally adhere to the )Tj 0.059 Tw -3 -1.74 Td [(decentralized )0.5(public )0.5(health )0.5(surveillance )0.5(system, )0.5(and )0.5(once )0.5(they )0.5(do )0.5(that )0.6(they agree )0.5(with )0.5(the )0.5(goals )]TJ 0.065 Tw T* (and the targets that are set up annually and they begin to receive the m\ oney. And if they fail to )Tj 0.114 Tw T* [(comply )0.5(wi)]TJ [(th )0.5(the )0.5(targets )0.5(they )0.5(may )0.5(have )0.5(restrictions )0.5(in )0.5(the )0.5(money )0.5(they )0.5(keep )0.5(on )0.5(receiving. )0.5(As )0.5(I )]TJ ET endstream endobj 183 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 184 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (93)Tj ( )Tj ET Q BT 0.073 Tw 12 0 0 12 71.88 709.08 Tm (said, it\222s around $350 million )Tj 0 Tw (\226)Tj ( )Tj 0.073 Tw 13.242 0 Td (it was in 2006 )Tj 0 Tw (\226)Tj ( )Tj 0.073 Tw 7.003 0 Td (and that corresponds to two)Tj 0 Tw (-)Tj 0.073 Tw (thirds of the total )Tj 0 Tw -20.244 -1.72 Td (budget.)Tj ( )Tj 0.08 Tw 3 -1.72 Td (And also we sometimes finance direct investment for different prog)Tj 27.791 0 Td (rams besides of that )Tj 0.067 Tw -30.791 -1.74 Td (regular money transfer, like the laboratories for building and remodelli\ ng, for equipment )Tj 0 Tw 36.517 0 Td (\226)Tj ( )Tj 0.817 0 Td (new )Tj -37.334 -1.72 Td (equipment )Tj (\226)Tj ( )Tj (vehicles and so on.)Tj ( )Tj 0.039 Tw 3 -1.72 Td (The potential obstacles, one of them I\222ve spoken already is the diffe\ rent capacity of state )Tj 0.076 Tw -3 -1.72 Td (and municipal g)Tj (overnments. Some of the state governments are very weak, they\222re smal\ l states )Tj 0.216 Tw 0 -1.74 TD (and they have difficulty in performing routine activities of public heal\ th. The decentralized )Tj 0.255 Tw 0 -1.72 TD (process sometimes may delay the decision)Tj 0 Tw 18.245 0 Td (-)Tj 0.255 Tw (making process because we need to consult a)Tj 0 Tw 20.199 0 Td (ll )Tj 0.242 Tw -38.444 -1.72 Td (different levels, and sometimes there are logistics difficulties. Brasil\ ia is the capital of the )Tj 0.063 Tw T* (country. It\222s located very centrally of the country. We are not more \ than two hours\222 flight from )Tj 0.1 Tw 0 -1.74 TD (any of the states, but sometimes it\222s quite difficult to ge)Tj (t to places. I remember last year there )Tj 0.066 Tw 0 -1.72 TD (was a huge rotavirus epidemic in the Amazon region. 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So, sometimes it\222s very difficult logist\ ics to get to places.)Tj 34.41 0 Td ( )Tj 0.037 Tw -31.41 -1.74 Td (And then we see that the 27 )Tj 0 Tw (\226)Tj ( )Tj 0.037 Tw 12.401 0 Td (the 26 states and the federal district )Tj 0 Tw (\226)Tj ( )Tj 0.037 Tw 15.455 0 Td (now take part of the )Tj 0.389 Tw -30.856 -1.72 Td (public health of the s)Tj 9.944 0 Td (ystem, and of the municipalities 93%. As you see, most of the )Tj 0.266 Tw -9.944 -1.72 Td (municipalities are very small, are under 20,000 population, and that als\ o means that their )Tj 0.021 Tw T* [(capacities )0.5(are )0.5(quite )0.5(different )0.5(or )0.5(quite )0.5(weak, )0.5(and )0.5(of )0.5(the )0.5(large )0.5(cities )0.5(of )0.5(the )0.5(14 )0.5(municipalities )0.5(over )0.5(1 )]TJ 0 Tw 0 -1.74 TD (m)Tj 0.235 Tw (illion, only one has not formally adhered to the national health system,\ because of local )Tj 0 Tw 0 -1.72 TD (political struggles between the state and the municipality of the capita\ l.)Tj 28.463 0 Td ( )Tj 0.173 Tw -25.463 -1.72 Td (The Ministry of Health, concerning the public health surveillance and di\ sease control )Tj 0 Tw -3 -1.72 Td (activ)Tj 0.434 Tw (ities, there is a mechanism of direct monitoring, of assessment if the s\ tates and )Tj 0.022 Tw 0 -1.74 TD (municipalities are complying with the established targets, and that\222s\ made not only by looking at )Tj 0.127 Tw 0 -1.72 TD (the data but also actively visiting the places, and then we have a targe\ t to)Tj 0 Tw 30.909 0 Td ( )Tj 0.127 Tw 0.377 0 Td (meet of visits, and )Tj 0.074 Tw -31.286 -1.72 Td [(that\222s )0.5(how )0.5(we )0.5(are )0.5(performing. )0.5(The )0.5(numbers )0.5(for )0.5(2006 )0.5(are )0.5(only )0.5(until )0.5(March, )0.5(and )0.5(then )0.5(you )0.5(know )]TJ 0.025 Tw T* (that January and February is the summer)Tj 0 Tw 16.423 0 Td (-)Tj 0.025 Tw (time there and most things are on vacation and will not )Tj ET endstream endobj 185 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 186 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (94)Tj ( )Tj ET Q BT 0.075 Tw 12 0 0 12 71.88 709.08 Tm [(work, )0.5(so )0.5(2006 )0.5(will )0.5(probably )0.5(change )0.5(a )0.5(lot. )0.5(But )0.5(mo)]TJ 20.529 0 Td [(stly )0.5(we\222ve )0.5(been )0.5(able )0.5(to )0.5(comply )0.5(or )0.5(to )0.5(be )0.5(very )]TJ 0.069 Tw -20.529 -1.72 Td (close to our target of visiting and assessing the performance of most st\ ates, state capitals, cities )Tj 0.16 Tw 0 -1.72 TD (with over 100,000 inhabitants. For the small areas, that process has not\ been for the smaller )Tj 0 Tw 0 -1.74 TD (municipalities, )Tj (this process has not been established.)Tj ( )Tj 0.274 Tw 3 -1.72 Td (The key obstacles, I think it\222s the differences and the inequities am\ ong states and )Tj 0.09 Tw -3 -1.72 Td [(municipalities, )0.5(also )0.5(the )0.5(scope )0.5(of )0.5(the )0.5(IHR )0.5(with )0.5(the )0.5(need to )0.5(involve )0.5(other )0.5(sectors )0.5(of )0.5(government )]TJ 0.055 Tw 0 -1.72 TD (like agriculture, like defence, this w)Tj 14.628 0 Td (ill pose an extra problem, and the problem of federalism, of )Tj 0 Tw -14.628 -1.74 Td (the need to... the agreement of all levels. )Tj 16.438 0 Td ( )Tj 0.062 Tw -13.438 -1.72 Td (Is there a problem with human rights issues? Yes, there is, because as a\ new democracy )Tj 0.05 Tw -3 -1.72 Td (any restriction in human rights tends to be seen as undesirable)Tj 25.323 0 Td (, so the lawyers and the people in )Tj 0.024 Tw -25.323 -1.72 Td (that area they tend to say no, even the ones who when we asked them to p\ repare the draft for the )Tj 0.044 Tw 0 -1.74 TD (new law when we started talking about the new IHR isolation quarantine t\ hey said, \223No, no, we )Tj 0 Tw 0 -1.72 TD (don\222t want to do that.\224 Then w)Tj (e discussed it and they were convinced that it was necessary.)Tj 36.6 0 Td ( )Tj 0.068 Tw -33.6 -1.72 Td (I don\222t think in the IHR... I think it will be easy to be approved by\ our congress but the )Tj 0 Tw -3 -1.72 Td (new law will not be so easy because it\222s more specific to our situati\ on.)Tj 28.215 0 Td ( )Tj 0.217 Tw -25.215 -1.74 Td (Well, concerning international)Tj 0 Tw ( )Tj 0.217 Tw 13.09 0 Td (cooperation, we\222re having very successful cooperation )Tj 0.313 Tw -16.09 -1.72 Td [(with our neighbours, and that reflected in our )0.5(interventions during the whole process of )]TJ 0.041 Tw T* (discussion and approval of the IHR, so the Mercosur countries )Tj 0 Tw 25.658 0 Td (\226)Tj ( )Tj 0.041 Tw 0.791 0 Td (Paraguay, Argentina, Uruguay, )Tj 0.084 Tw -26.449 -1.72 Td (and more recently )Tj 0 Tw 7.722 0 Td (Venezuela )Tj 4.554 0 Td (\226)Tj ( )Tj 0.084 Tw 0.834 0 Td (they had very active participation, with common positions, and )Tj 0.123 Tw -13.109 -1.74 Td (since 2000 we meet regularly at least twice every semester. There is a s\ pecific committee for )Tj 0.37 Tw T* (public health surveillance and control. So, we have advanced a lot infor\ mation)Tj 0 Tw 35.473 0 Td (-)Tj (sharing,)Tj ( )Tj 0.075 Tw -35.473 -1.72 Td (harmonization of programs and protocols, and it has been a very positive\ experience for all the )Tj 0 Tw T* (countries.)Tj ( )Tj 0.098 Tw 3 -1.74 Td (At the same time we feel the need of technical and scientific cooperatio\ n, especially in )Tj 0.135 Tw -3 -1.72 Td (the assessment of core capacities. We need to define what\222s)Tj 0 Tw 25.091 0 Td ( )Tj 0.135 Tw 0.385 0 Td (that and how is that going to be )Tj 0.098 Tw -25.476 -1.72 Td (among the states and municipalities. Also in training and the process of\ implementation of the )Tj 0.204 Tw T* (national public health laboratory. We do not have a national public heal\ th laboratory. Most )Tj 0.003 Tw 0 -1.74 TD (laboratories are at the state level)Tj (s and act as references for the national level, and we now feel the )Tj 0.098 Tw 0 -1.72 TD (need to have a reference centre which works closely)Tj 0 Tw 21.665 0 Td (-)Tj 0.098 Tw (coordinated with the epidemiologists. So, )Tj 0.005 Tw -21.665 -1.72 Td (we have reserved money in our budget to build a national laboratory. Our\ target to the end of )Tj 0 Tw 37.555 0 Td (this )Tj 0.018 Tw -37.555 -1.72 Td (year is to have the terms of reference published so that companies )Tj 0 Tw 26.814 0 Td (\226)Tj ( )Tj 0.018 Tw 0.768 0 Td (engineering and architecture )Tj ET endstream endobj 187 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 188 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (95)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (companies )Tj 4.625 0 Td (\226)Tj ( )Tj 0.099 Tw 0.849 0 Td (can come and participate in the bid to build the laboratory, and we inte\ nd that in )Tj 0 Tw -5.474 -1.72 Td (2007 will start the construction of the national laborator)Tj 22.328 0 Td (y in Brasilia.)Tj ( )Tj 0.065 Tw -19.328 -1.72 Td (We do not intend to issue any reservations. We understand the new Intern\ ational Health )Tj 0.288 Tw -3 -1.74 Td (Regulations reinforces a current movement in the country to strengthen o\ ur public health )Tj 0 Tw 0 -1.72 TD (surveillance system.)Tj ( )Tj 3 -1.72 Td (I think that\222s it, and we\222ll end with a view)Tj 16.774 0 Td ( )Tj (of Brasilia.)Tj ( )Tj -16.774 -1.72 Td ( )Tj /TT1 1 Tf -3 -1.74 Td (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you very much, Dr.)Tj ( )Tj (Luna, and no need to apologize for English, it was well done.)Tj 35.491 0 Td ( )Tj -38.491 -1.72 Td (EL:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.74 Td (RS:)Tj ( )Tj 3 0 Td (Comments and questions from the floor for Dr.)Tj ( )Tj (Luna? Yes, Dr.)Tj ( )Tj (Kumanan?)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Thank)Tj (-)Tj 0.219 Tw (you, that was a very helpful )Tj (presentation. I\222ll just make sure I understand, it )Tj 0.154 Tw 0 -1.72 TD (appears from what I\222ve taken in from your presentation that the feder\ al government\222s )Tj 0.291 Tw T* (taking a fairly aggressive role on these issues. You mentioned the idea \ of having )Tj 0.147 Tw 0 -1.74 TD (penalties and having conditional fundi)Tj 15.916 0 Td (ng and auditing at the local and regional levels. )Tj 0.063 Tw -15.916 -1.72 Td (And we\222ve heard from the previous two presentations there\222s perhap\ s a reluctance to do )Tj 0.396 Tw 0 -1.72 TD (such an aggressive approach because it may damage the necessary collabor\ ative )Tj 0.069 Tw T* (relationships that are important in comba)Tj (tting these types of problems. Has there been a )Tj 0.002 Tw 0 -1.74 TD (lot of objection from the other levels of government about this type of \ an approach, and is )Tj 0 Tw 0 -1.72 TD (there a perception that it may be damaging to these collaborative relati\ onships?)Tj 31.683 0 Td ( )Tj -34.683 -1.72 Td (EL:)Tj ( )Tj 0.143 Tw 3 0 Td (I think one thing is )Tj 0 Tw (\226)Tj ( )Tj 0.143 Tw 9.411 0 Td (it relat)Tj (es to what I\222ve said )Tj 0 Tw (\226)Tj ( )Tj 0.143 Tw 12.356 0 Td (the authoritarian tradition of Latin )Tj 0.536 Tw -21.767 -1.72 Td (America, and the two dictatorships that we\222ve had were also movements\ of )Tj 0.024 Tw 0 -1.74 TD (centralization, that they took away powers from the states, and within t\ he democracy that )Tj 0 -1.72 TD (shifted, and sometimes shifted to)Tj (o much. Like, the health system it\222s not even the state\222s, )Tj 0.321 Tw T* (it\222s the local authority, which receives most of the money and is res\ ponsible for )Tj 0.227 Tw T* (delivering care and also public health. And the new law, we are trying t\ o establish )Tj 0.036 Tw 0 -1.74 TD (punishments but we don\222t know i)Tj (f it\222s going to pass, and we don\222t know who is going to )Tj 0.01 Tw 0 -1.72 TD (punish who! Maybe that will be shared, a shared responsibility. That\222\ s what we think, it\222s )Tj 0 Tw T* (a shared responsibility.)Tj ( )Tj ET endstream endobj 189 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 190 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (96)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.125 Tw 3 0 Td [(And )-0.6(also, )-0.6(as )-0.6(I )-0.6(said, )-0.6(most )-0.6(of the money comes from the federal government, so )]TJ 0 Tw -3 -1.72 Td (there)Tj 0.115 Tw (\222s a natural leverage for us to assess and to monitor what they are d\ oing with the )Tj 0 Tw 0 -1.72 TD (money.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.199 Tw 3 0 Td (But that has come out of common agreement. As I said, in the public heal\ th )Tj 0.276 Tw -3 -1.72 Td (system there is the three)Tj 0 Tw (-)Tj 0.276 Tw (level committee and everything\222s decided, everything that )Tj 0 Tw T* (espec)Tj 0.039 Tw (ially involves money is decided jointly by the three levels. And sometim\ es they are )Tj 0.127 Tw T* (interested that the others got punished, that they got less money, becau\ se more money )Tj 0 Tw 0 -1.74 TD (will be available for the others.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.004 Tw 3 0 Td (And there are also very strong states, like the St)Tj (ate of Sao Paolo, very strong, very )Tj 0 Tw -3 -1.72 Td (powerful )Tj (\226)Tj ( )Tj (including public health )Tj (\226)Tj ( )Tj (that continuously challenges.)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. Dr.)Tj ( )Tj (Lazzari?)Tj ( )Tj -3 -1.74 Td (SL:)Tj 1.445 0 Td ( )Tj /TT1 1 Tf 1.555 0 Td (Obrigado)Tj /TT0 1 Tf 0.146 Tw (, Dr.)Tj 0 Tw ( )Tj 0.146 Tw (Luna. Thank)Tj 0 Tw (-)Tj 0.146 Tw (you very much for your presentation, and I think it\222s also )Tj 0.167 Tw 0 -1.72 TD (nice to see how Brazil is moving rap)Tj (idly implementing the public health surveillance )Tj 0 Tw T* (system.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.158 Tw 3 0 Td (I really have just a small question, more for clarification or more info\ rmation. )Tj 0.025 Tw -3 -1.74 Td (You talked a lot about the funding available for disease surveillance an\ d control and how )Tj 0.061 Tw T* (this is distributed with t)Tj (he states and the federal level. I was wondering if you also have )Tj 0.042 Tw T* (provision of some emergency funding, funding that can be used in emergen\ cy situations, )Tj 0.048 Tw T* (and if you have also stockpile capacity of equipment or material that ca\ n be used, and at )Tj 0.064 Tw 0 -1.74 TD (what level wo)Tj (uld this funding or resources be kept and utilized? Is this something ag\ ain )Tj 0 Tw 0 -1.72 TD (that is transferred as a responsibility to the state level, or it remain\ s at the federal level?)Tj 34.904 0 Td ( )Tj -37.904 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.048 Tw 3 0 Td [(And )0.5(a )0.5(second )0.5(question )0.5(is )0.5(on )0.5(your )0.5(disease )0.5(reporting )0.5(list, )0.5(which )0.5(very )0.5(interesting )0.5(as)]TJ 0 Tw 33 0 Td ( )Tj 0.011 Tw -36 -1.72 Td (proposed. Would the reporting be based only on confirmed cases of the di\ sease which are )Tj 0.14 Tw 0 -1.74 TD [(on )0.5(the )0.5(list, )0.5(with )0.5(a )0.5(laboratory )0.5(confirmation, )0.5(or )0.5(would )0.5(they )0.5(go )0.5(also )0.5(on )0.5(suspected )0.5(cases? )]TJ 0.163 Tw 0 -1.72 TD (And in cases it\222s suspected then how would the system go about the ve\ rification )Tj 0 Tw 34.556 0 Td (and )Tj -34.556 -1.72 Td (confirmation?)Tj ( )Tj -3 -1.72 Td (EL:)Tj ( )Tj 0.021 Tw 3 0 Td (There\222s only one for confirmed cases, it\222s neonatal tetanus, becau\ se we are in the process )Tj 0.086 Tw 0 -1.74 TD (of eliminating tetanus, so that\222s the only confirmed case part of the\ list )Tj 0 Tw 29.607 0 Td (\226)Tj ( )Tj 0.086 Tw 0.836 0 Td (the others are )Tj 0.017 Tw -30.442 -1.72 Td (suspect cases )Tj 0 Tw (\226)Tj ( )Tj 0.017 Tw 6.354 0 Td (and we expect that our network of l)Tj (aboratories functions and provides the )Tj 0.024 Tw -6.354 -1.72 Td (confirmation of cases. Although it\222s difficult, when you see new sub)Tj 0 Tw (-)Tj 0.024 Tw (types of influenza it )Tj 0 Tw 0 -1.72 TD (implies laboratory, but that\222s the same with the IHR.)Tj 21.051 0 Td ( )Tj ET endstream endobj 191 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 192 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (97)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (SL:)Tj 1.445 0 Td ( )Tj 0.027 Tw 1.555 0 Td [(But )0.5(if )0.5(I )0.5(may, )0.5(this )0.5(role )0.5(of )0.5(confirming )0.5(the )0.5(suspected cases )0.5(is )0.5(somethi)]TJ [(ng )0.5(that )0.5(would )0.5(go )0.5(back )]TJ 0 Tw 0 -1.72 TD (to the state level, or would be done at local level?)Tj 19.798 0 Td ( )Tj -22.798 -1.72 Td (EL:)Tj ( )Tj 0.182 Tw 3 0 Td (Yes, mostly at local level, and sometimes if you are in those northern)Tj 0 Tw 29.902 0 Td (-)Tj 0.182 Tw (most Amazon )Tj 0.112 Tw -29.902 -1.74 Td (states we take that responsibility, to take samples to a reference labor\ atory. We have a )Tj 0 Tw T* (contr)Tj 0.153 Tw (act with an airliner that carries biological material all over the count\ ry when it\222s )Tj 0 Tw T* (necessary.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.052 Tw 3 0 Td (And concerning the funding of emergency activities, yes, there is curren\ tly at the )Tj 0.471 Tw -3 -1.74 Td (federal level funding for emergencies, which may be distributed to state\ s a)Tj 0 Tw 35 0 Td (nd )Tj -35 -1.72 Td (municipalities but it\222s managed centrally.)Tj 16.579 0 Td ( )Tj -19.579 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.106 Tw 3 0 Td (And supplies, we have a chain of warehouses from the federal level in Br\ azil )Tj 0 Tw (\226)Tj ( )Tj 0.092 Tw -3 -1.72 Td (they\222re in Rio )Tj 0 Tw (\226)Tj ( )Tj 0.092 Tw 6.922 0 Td (and each state has its own warehouses. But for new things we are still )Tj 0.091 Tw -6.922 -1.74 Td (debating, like the osoclamivir\(?\), it\222s s)Tj 15.866 0 Td [(till held by the federal government. We have )0.5(not )]TJ 0.015 Tw -15.866 -1.72 Td [(come )0.5(to )0.5(an )0.5(agreement )0.5(where )0.5(it\222s )0.5(supposed )0.5(to )0.5(be, )0.5(and )0.5(if )0.5(all )0.5(states )0.5(need )0.5(to )0.5(have )0.5(a )0.5(supply )0.5(or )]TJ 0 Tw T* (not. It\222s still being debated.)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. Other questions or comments?)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.241 Tw 3 0 Td (Okay, we do have provisions for a break)Tj (. I think everybody could probably )Tj 0 Tw -3 -1.72 Td (benefit from a stretch, so let\222s take a ten)Tj 16.021 0 Td (-)Tj (minute break at this time. Thank)Tj 13.33 0 Td (-)Tj (you.)Tj ( )Tj -32.351 -1.72 Td ([break])Tj ( )Tj T* (RS:)Tj ( )Tj 3 0 Td (We\222d like to invite our experts from China to please make their prese\ ntation at this time.)Tj 35.434 0 Td ( )Tj -38.434 -1.74 Td ( )Tj /TT1 1 Tf T* (COUNTRY 4: CHINA)Tj ( )Tj 0 -1.64 TD (Drs. Jian Guo Li a)Tj (nd Jianzhong Zhang)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thanks, Mr.)Tj ( )Tj (Chairman.)Tj ( )Tj 0.251 Tw 0 -1.72 TD (Ladies and gentlemen, good afternoon. I really want to say sorry here be\ cause my )Tj 0.127 Tw -3 -1.72 Td (English is very poor, so I can\222t make a good communication with each \ other. So sorry. Even )Tj 0 Tw 0 -1.74 TD (though that, I still want to report my pres)Tj 16.414 0 Td (entation in English. Let me try.)Tj ( )Tj 0.398 Tw -13.414 -1.72 Td (My topic is that perfecting the development of emergency response mechan\ ism, )Tj 0.318 Tw -3 -1.72 Td (improving health emergency response capacity, and implementing effective\ ly International )Tj 0 Tw 0 -1.72 TD (Health Regulations, 2004.)Tj ( )Tj 0 -1.74 TD ( )Tj ET endstream endobj 193 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 194 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (98)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (Part I:)Tj ( )Tj ET 71.88 706.92 29.759 0.48 re f BT 0.066 Tw 12 0 0 12 107.88 689.4 Tm [(As )0.5(we )0.5(know, )0.5(the )0.5(newly)]TJ 0 Tw (-)Tj 0.066 Tw [(revised )0.5(International )0.5(Health Regulations, )0.5(2004 )0.5(is )0.5(a )0.5(milestone )0.5(in )]TJ 0.078 Tw -3 -1.74 Td [(preventing )0.5(the )0.5(spread )0.5(of )0.5(a )0.5(disease )0.5(on )0.5(global )0.5(scale )0.5(and )0.5(will )0.5(come )0.5(into )0.5(effect )0.5(in )0.5(June, )0.6(2007. )0.5(The )]TJ 0.041 Tw 0 -1.72 TD [(implementation )0.5(of )0.5(IHR )0.5(will )0.5(play )0.5(an )0.5(important )0.5(role )0.5(in )0.5(improving )0.5(each )0.5(country\222s )0.5(core )0.5(capacity )0.5(of )]TJ 0.341 Tw T* (surveilling and the reporting to a public health emergency of internatio\ nal concern, and )Tj 0.292 Tw T* (strengthening the relations between WHO and its member countries to join\ tly respond to )Tj 0 Tw 0 -1.74 TD (possible international public health risks.)Tj 16.414 0 Td ( )Tj 0.093 Tw -13.414 -1.72 Td (The Chinese government was actively )Tj 15.989 0 Td (involved in the revision of IHR. Furthermore, as )Tj 0.271 Tw -18.989 -1.72 Td (the revised IHR came out, the Chinese government has made a lot of prepa\ ration for its )Tj 0.276 Tw 0 -1.72 TD (implementation. In accordance with these regulations, WHA)Tj 0 Tw 25.925 0 Td ( )Tj 0.276 Tw (59.2, the Chinese Ministry of )Tj 0.037 Tw -25.925 -1.74 Td [(Health )0.5(has )0.5(voluntarily )0.5(commenced)]TJ 0 Tw ( )Tj 0.037 Tw 14.364 0 Td [(to )0.5(observe )0.5(the )0.5(provisions )0.5(related )0.5(to )0.5(the )0.5(risks )0.5(caused )0.5(by )0.5(avian )]TJ 0.198 Tw -14.364 -1.72 Td (influenza and the pandemic influenza. Today\222s conference is of great \ significance as it will )Tj 0.441 Tw T* (provide opportunity for every country to share experiences in the prepar\ ation for the )Tj 0 Tw T* (implementatio)Tj (n of IHR.)Tj ( )Tj 0.112 Tw 3 -1.74 Td (Now I would like to introduce Chinese preparation for the implementation\ of IHR, the )Tj 0 Tw -3 -1.72 Td (\(four)Tj (-)Tj 0.496 Tw (step plan?\). China\222s health undertaking has formed the layout, chara\ cterized by )Tj 0.299 Tw T* (government leadership, coordination of sectors, and enrollment of the wh\ ole)Tj 0 Tw ( )Tj 0.299 Tw 33.814 0 Td (society. The )Tj 0.082 Tw -33.814 -1.72 Td (Chinese government has attached great importance to the building of a pu\ blic health system. It )Tj 0.12 Tw 0 -1.74 TD (has set up institutions of disease control, health supervision, women an\ d child healthcare, and )Tj 0.031 Tw 0 -1.72 TD (specialized in disease prevention and treatment at )Tj (a national, province, city and county levels, as )Tj 0 Tw T* (well as a community health surveillance network.)Tj 19.855 0 Td ( )Tj 0.183 Tw -16.855 -1.72 Td (A multi)Tj 0 Tw (-)Tj 0.183 Tw (sector cooperation mechanism, including sectors of health, planning, fin\ ance, )Tj 0.151 Tw -3 -1.74 Td (foreign relations, border control, agriculture, transportation, educatio\ )Tj 28.453 0 Td (n, tourism, etc., has been )Tj 0 Tw -28.453 -1.72 Td (established and therefore a framework of health work involving the whole\ society was set up.)Tj 37.405 0 Td ( )Tj 0.402 Tw -34.405 -1.72 Td (In terms of emergency response management, the Chinese government gradua\ lly )Tj 0.173 Tw -3 -1.72 Td (develops a management system which is administrated by categ)Tj 26.934 0 Td (ories, graded responsibilities, )Tj 0.248 Tw -26.934 -1.74 Td (combined ____, and the priority responsibility areas besides its buildin\ g of the emergency )Tj 0.356 Tw T* (response mechanism with unified command, sensitive response, smooth coor\ dination and )Tj 0 Tw T* (efficient operation.)Tj ( )Tj ET endstream endobj 195 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 196 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (99)Tj ( )Tj ET Q BT 0.199 Tw 12 0 0 12 107.88 709.08 Tm (Emergency response manageme)Tj (nt institutions and \(assistance teams?\) are developing, )Tj 0.078 Tw -3 -1.72 Td (and the layout of government leadership, coordination of sectors and inv\ olvement of the whole )Tj 0 Tw 0 -1.72 TD (society have been formed.)Tj ( )Tj 3 -1.74 Td ( )Tj -3 -1.72 Td (Part II:)Tj ( )Tj ET 71.88 624.12 33.6 0.48 re f BT 0.043 Tw 12 0 0 12 107.88 606.6 Tm (Public health emergency response system and the mechanism have been pr)Tj 30.416 0 Td (imarily set up )Tj 0 Tw -33.416 -1.74 Td (which lay the foundation for the implementation of IHR.)Tj 22.689 0 Td ( )Tj 0.057 Tw -19.689 -1.72 Td [(1\) )0.5(Establishing )0.5(the )0.5(organization )0.5(and )0.5(the )0.5(coordination )0.5(mechanism )0.5(for )0.5(the )0.5(implementation )]TJ 0.029 Tw -3 -1.72 Td [(of IHR; to make full preparations )0.5(for the implementation of IHR; a preparation and coordination )]TJ 0 Tw T* (le)Tj 0.074 Tw (ader team for the implementation of IHR was established by the Ministry \ of Health, Ministry )Tj 0 Tw 0 -1.74 TD (of Foreign Affairs, state administration of quality\(?\) supervision, in\ spection and quarantine.)Tj 36.741 0 Td ( )Tj 0.068 Tw -33.741 -1.72 Td (In order to present the response to public health emergencies effecti)Tj 27.784 0 Td (vely and in a timely )Tj 0.034 Tw -30.784 -1.72 Td (manner, the Ministry of Health of China initiated and set up a public he\ alth emergency response )Tj 0.304 Tw 0 -1.72 TD (coordination mechanism with 31 government departments. The mechanism has\ effectively )Tj 0 Tw 0 -1.74 TD (strengthened the exchange of information and the joint)Tj 21.91 0 Td ( )Tj (action taken.)Tj ( )Tj 0.357 Tw -18.91 -1.72 Td (2\) Maturing emergency response legislation and a plan to standardize em\ ergency )Tj 0.093 Tw -3 -1.72 Td (response by)Tj 0 Tw (-)Tj 0.093 Tw (laws and regulations: the constitution of the People\222s Republic of Ch\ ina stipulates )Tj 0.042 Tw 0 -1.72 TD [(that )0.5(the )0.5(state )0.5(should )0.5(develop )0.5(health )0.5(and )0.5(medicine )0.6(including )0.6(modern)]TJ 0 Tw 27.394 0 Td ( )Tj 0.042 Tw 0.291 0 Td [(medicine )0.5(and )0.5(the )0.5(traditional )]TJ 0.198 Tw -27.685 -1.74 Td (Chinese medicine, encourage and support establishment of various medical\ facilities by ___ )Tj 0.101 Tw T* (collective organizations, enterprises, public sector, as well as communi\ ty organization. People)Tj 0 Tw 38.667 0 Td (-)Tj 0.29 Tw -38.667 -1.72 Td (oriented health activities should be ca)Tj (rried out to safeguard people\222s health. The Chinese )Tj 0.135 Tw T* (government insists on responding to public health emergencies according \ to the laws and has )Tj 0 Tw 0 -1.74 TD (perfected the laws, regulations and health emergency response plans of d\ ifferent kinds.)Tj 34.793 0 Td ( )Tj 0.013 Tw -31.793 -1.72 Td (In 2003 China issued pub)Tj (lic health emergency response regulations through _____ public )Tj 0.074 Tw -3 -1.72 Td (health emergency response mechanism. In 2004 the Chinese government revi\ sed the law of the )Tj 0.027 Tw 0 -1.72 TD [(People\222s Republic of China on the )0.5(prevention and treatment )0.5(of communicable disease. In 2005 a )]TJ 0 Tw 0 -1.74 TD (national)Tj ( )Tj 0.079 Tw 3.55 0 Td (plan for public emergency response in general was drawn up by the state \ council. The )Tj 0.038 Tw -3.55 -1.72 Td (general plan defined the objective of the emergency response system whic\ h prioritizes classified )Tj 0.631 Tw 0 -1.72 TD (management, graded responsibilities, combination of ____, and the manage\ m)Tj 36.065 0 Td (ent of )Tj 0.14 Tw -36.065 -1.72 Td [(responsibility )0.5(areas )0.5(in )0.5(line )0.5(with )0.5(the )0.5(three )0.5(laws )0.5(or )0.5(regulations )0.5(and )0.5(based )0.5(on )0.5(assignment )0.5(of )0.5(the )]TJ 0.046 Tw 0 -1.74 TD (State Council, Ministry of Health of China, formulate national plan for \ public health emergency )Tj ET endstream endobj 197 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 198 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (100)Tj ( )Tj ET Q BT 0.4 Tw 12 0 0 12 71.88 709.08 Tm (response and a national plan for medical assistance and th)Tj 26.735 0 Td (e response to public health )Tj 0 Tw -26.735 -1.72 Td (emergencies which were promulgated by the General Office of the State Co\ uncil.)Tj 32.599 0 Td ( )Tj 0.026 Tw -29.599 -1.72 Td (Targeting prominent public health emergencies, Ministry of Health of Chi\ na also worked )Tj 0.183 Tw -3 -1.74 Td [(out )0.5(such )0.5(plans )0.5(as )0.5(emergency )0.5(response )0.5(plan )0.5(for )0.5(highly )0.5(pathogeni)]TJ [(c )0.5(human )0.5(avian )0.5(influenza )0.5(by )]TJ 0.003 Tw 0 -1.72 TD (Ministry of Health, response plan for nuclear accidents and radiation ac\ cidents by the Ministry of )Tj 0 Tw T* (Health.)Tj ( )Tj 0.02 Tw 3 -1.72 Td (Local governments have drawn up a local health emergency response plan b\ ased on local )Tj 0.035 Tw -3 -1.74 Td (realities, and a system of national )Tj (plans for public health emergency response has been basically )Tj 0 Tw T* (set up.)Tj ( )Tj 0.069 Tw 3 -1.72 Td (Currently China is working on state laws on public emergency response. A\ s the frontier )Tj 0.23 Tw -3 -1.72 Td (health and the quarantine law of the People\222s Republic of China, and \ in specific rules for )Tj 0 Tw 0 -1.74 TD (enforcin)Tj 0.06 Tw (g issued in 1988, targeted only at the plague and the cholera, China is \ now revising the )Tj 0 Tw 0 -1.72 TD (law to meet the requirements of implementing...)Tj 19.245 0 Td ( )Tj -19.245 -1.72 Td ([Start of Side 8])Tj ( )Tj 0.008 Tw T* (...enhancing core capacity to meet the requirements of IHR, in line with\ the provision in Annex 1 )Tj 0 Tw 0 -1.74 TD (of )Tj 0.206 Tw 1.289 0 Td (IHR, and with the joint efforts of the Ministry of Health, state adminis\ tration of quality )Tj 0.115 Tw -1.289 -1.72 Td (supervision, inspection and quarantine, the core capacity)Tj 0 Tw 23.347 0 Td (-)Tj 0.115 Tw (building of state surveillance and the )Tj 0.01 Tw -23.347 -1.72 Td (public health emergency response has been included in public health )Tj 27.816 0 Td (emergency response system )Tj 0 Tw -27.816 -1.72 Td (plan during eleven five)Tj (-)Tj (year periods which is still in the process of formulation.)Tj 31.908 0 Td ( )Tj 0.052 Tw -28.908 -1.74 Td (Two other documents on the way, core capacity)Tj 0 Tw (-)Tj 0.052 Tw [(building standards )0.5(for health quarantine )]TJ 0.152 Tw -3 -1.72 Td (on borders and guidelines for the formulation of a national )Tj (plan for public health emergency )Tj 0 Tw 0 -1.72 TD (response in communities and to improve health emergency response on bord\ ers and crossroads.)Tj 38.24 0 Td ( )Tj 0.214 Tw -35.24 -1.72 Td (Based on Annex 2 of IHR, regarding portable public health emergencies, C\ hina has )Tj 0.548 Tw -3 -1.74 Td (begun to formulate regulations on evaluation and a)Tj 24.191 0 Td (ssessment to standards, domestic )Tj 0 Tw -24.191 -1.72 Td (identification and international report.)Tj 15.217 0 Td ( )Tj 0.017 Tw -12.217 -1.72 Td (The Ministry of Health of China has drawn up a plan for dissemination of\ information on )Tj 0.212 Tw -3 -1.72 Td (public emergency and epidemic of communicable diseases required to repor\ t, which aim to )Tj 0 Tw 0 -1.74 TD (inform)Tj ( )Tj 0.103 Tw 3.075 0 Td (the public of information on public health emergencies and epidemic of c\ ommunicable )Tj 0.155 Tw -3.075 -1.72 Td [(diseases )0.5(required )0.5(to )0.5(report, )0.5(as )0.5(well )0.5(as )0.5(the )0.5(measures )0.5(taken. )0.5(This )0.5(information )0.5(will )0.5(appear )0.5(on )0.5(a )]TJ 0 Tw 0 -1.72 TD (government Web site and government communiqu\351s at the same time.)Tj 28.159 0 Td ( )Tj ET endstream endobj 199 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 200 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (101)Tj ( )Tj ET Q BT 0.131 Tw 12 0 0 12 107.88 709.08 Tm (4\) Identify )Tj 4.761 0 Td (national focal point, strengthening coordination: the Chinese government\ is )Tj 0.103 Tw -7.761 -1.72 Td (making great efforts on work relative to national focal point for IHR an\ d keeps improving the )Tj 0 Tw 0 -1.72 TD (multi)Tj (-)Tj 0.251 Tw (sector and inter)Tj 0 Tw (-)Tj 0.251 Tw (regional communication and coordination system so as to effecti)Tj 0 Tw 37.278 0 Td (vely )Tj -37.278 -1.74 Td (implement IHR by joint efforts.)Tj ( )Tj 0.47 Tw 3 -1.72 Td (5\) Effectively carrying out prevention and controlling measures, respec\ ting and )Tj 0.134 Tw -3 -1.72 Td (protecting individual rights: IHR states that its implementation should \ fully respect individual )Tj 0.009 Tw T* [(dignity, )0.5(human )0.5(rights )0.5(and )0.5(basic )0.5(freedom. )0.5(T)]TJ [(he )0.5(constitution )0.5(of )0.5(the )0.5(People\222s )0.5(Republic )0.5(of )0.5(China )0.5(also )]TJ 0.016 Tw 0 -1.74 TD (stipulates that nationality should respect and protect human rights. Eve\ ry citizen enjoys the right, )Tj 0.041 Tw 0 -1.72 TD (entitled by the constitution and the laws, and they \(must obey?\) the o\ bligations stipulated by the )Tj 0 Tw T* (c)Tj (onstitution and the laws too.)Tj ( )Tj 0.165 Tw 3 -1.72 Td (The Chinese government holds that measures taken by the government shoul\ d accord )Tj 0.211 Tw -3 -1.74 Td (with the possible characteristics, extent and the scale of the social ri\ sk of the emergencies. )Tj 0.29 Tw T* (Alternative measures must protect citizens\222 rights)Tj 0 Tw 21.306 0 Td ( )Tj 0.29 Tw 0.54 0 Td (to the maximum. Every citizen has the )Tj 0 Tw -21.846 -1.72 Td (responsibility to participate in emergency response.)Tj 20.605 0 Td ( )Tj 0.127 Tw -17.605 -1.72 Td (6\) Strengthening the construction of the public health system to lay th\ e foundation for )Tj 0.11 Tw -3 -1.74 Td (implementation of IHR: the Chinese government pays much attention to the\ dev)Tj 33.283 0 Td (elopment of a )Tj 0.309 Tw -33.283 -1.72 Td [(public )0.5(health )0.5(system. )0.5(In )0.5(the )0.5(last )0.5(three )0.5(years )0.5(the )0.5(government\222s )0.6(expenditure )0.5(in )0.5(this )0.5(regard )]TJ 0.082 Tw T* (amounted to RMB30)Tj 0 Tw ( )Tj 0.082 Tw (billion and over 5,000 construction programs have been started. All thes\ e )Tj 0.124 Tw T* (efforts aim to strengthen the mechanism of disease control a)Tj 25.189 0 Td (nd prevention, medical assistance )Tj 0.089 Tw -25.189 -1.74 Td (and treatment, health supervision, as well as construction of public hea\ lth emergency reporting )Tj 0.355 Tw T* (systems. All these measures have improved the capacity of responding to \ public health )Tj 0 Tw T* (emergencies.)Tj ( )Tj 0.13 Tw 3 -1.72 Td [(In )0.5(January, )0.5(2004, )0.5(China )0.5(stu)]TJ [(died )0.5(the )0.5(information )0.5(reporting )0.5(and )0.5(management )0.5(system )0.5(for )]TJ 0.188 Tw -3 -1.74 Td (public health emergencies in communicable diseases on the basis of indiv\ idual case reports. )Tj 0 Tw T* (Thirty)Tj (-)Tj 0.269 Tw (one provinces in China can directly report related information through t\ he Internet. )Tj 0.075 Tw T* (Currently the r)Tj (eport rate among medical institutions above county level reaches 93%; to\ wnship )Tj 0 Tw T* (hospitals, 66%; and the CDCS at various levels, 100%.)Tj ( )Tj 0.151 Tw 3 -1.74 Td (The establishment of the vertical reporting system is useful to set up a\ mechanism of )Tj 0.124 Tw -3 -1.72 Td (surveillance, evaluation, early warni)Tj (ng and the response which has built a sound basis for the )Tj 0 Tw T* (effective response to public health emergencies.)Tj 19.214 0 Td ( )Tj ET endstream endobj 201 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 202 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (102)Tj ( )Tj ET Q BT 0.142 Tw 12 0 0 12 107.88 709.08 Tm (In addition, China has set a surveillance network on food pollutants and\ food)Tj 0 Tw 32.501 0 Td (-)Tj (induced )Tj 0.082 Tw -35.501 -1.72 Td (diseases which cover 16 provinces and 830 million people. Since)Tj 0 Tw 26.788 0 Td ( )Tj 0.082 Tw 0.332 0 Td (2004 China has renewed and )Tj 0.101 Tw -27.12 -1.72 Td (constructed surveillance points at the national level for key 20 communi\ cable diseases and the )Tj 0.092 Tw 0 -1.74 TD [(vector )0.5(borne )0.5(by )0.5(origin. )0.5(To )0.5(date )0.5(762 )0.5(surveillance )0.5(points )0.5(are )0.5(in )0.5(use, )0.5(which )0.5(has )0.5(provided )0.5(reliable )]TJ 0 Tw 0 -1.72 TD (information for the control of epidem)Tj (ics.)Tj ( )Tj 0.019 Tw 3 -1.72 Td (7\) Investigating on potential risk and evaluation capacities to issue q\ uick response: China )Tj 0.274 Tw -3 -1.72 Td (will investigate on potential risks and make registry, develop and impro\ ve a database for )Tj 0.082 Tw 0 -1.74 TD (potential risks so that basically information can be provided for the)Tj 0 Tw 27.647 0 Td ( )Tj 0.082 Tw 0.332 0 Td (surveillance, early warning )Tj 0 Tw -27.979 -1.72 Td (and handling of public health emergencies.)Tj 17.216 0 Td ( )Tj 0.123 Tw -14.216 -1.72 Td (A survey on the emergency response resources should be conducted and a d\ atabase of )Tj 0.173 Tw -3 -1.72 Td (material reserved, as well as an evacuation plan must be initiated. A st\ udy on big resources )Tj 0 Tw T* (demanded)Tj ( )Tj 0.116 Tw 4.475 0 Td (in times of public health emergency should be strengthened to meet the d\ emand of )Tj 0 Tw -4.475 -1.72 Td (emergency relief.)Tj ( )Tj 0.047 Tw 3 -1.72 Td (8\) Strengthening the supporting system of science and technology to pre\ vent and control )Tj 0 Tw -3 -1.72 Td (in a scientific way: emergency response supporting systems should be)Tj ( )Tj (strengthened.)Tj ( )Tj 0.337 Tw 3 -1.74 Td (An emergency response laboratory network made of laboratories of four le\ vels )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj 0.28 Tw -38.5 -1.72 Td (national, province, prefecture and the county levels )Tj 0 Tw 22.704 0 Td (\226)Tj ( )Tj 0.28 Tw 1.03 0 Td (should be built up. Studies on key )Tj 0.477 Tw -23.735 -1.72 Td (emergency response technologies should be strengthened, and the emergenc\ )Tj 34.274 0 Td (y response )Tj 0.237 Tw -34.274 -1.72 Td (standardized system should be established. Evaluation on emergency respo\ nse capacity and )Tj 0.013 Tw T* (emergency relief performance should be perfected so that managing standa\ rds on quality control, )Tj 0 Tw 0 -1.72 TD (training and evaluation of emergency works.)Tj 17.883 0 Td ( )Tj 0.19 Tw -14.883 -1.72 Td (Surveillance on )Tj 6.879 0 Td (diseases of unknown causes and emerging infectious disease and the )Tj 0.092 Tw -9.879 -1.72 Td (capacities of scientific research such as testing should be improved to \ respond to public health )Tj 0 Tw 0 -1.74 TD (emergencies effectively.)Tj 9.772 0 Td ( )Tj 0.129 Tw -6.772 -1.72 Td (9\) Strengthening financial input on emergency response management: )Tj 29.3 0 Td (according to the )Tj 0.001 Tw -32.3 -1.72 Td (national plan for public emergency response in general, and based on the\ principle of the division )Tj 0.152 Tw 0 -1.72 TD [(of )0.5(executive )0.5(and )0.5(financial )0.5(powers, )0.5(financial )0.5(departments )0.5(at )0.5(various )0.5(levels \(should )0.5(build?\) )0.5(the )]TJ 0.179 Tw 0 -1.74 TD (expenses concerning public security, public e)Tj (mergency prevention and response, which must )Tj 0 Tw 0 -1.72 TD (also be included in annual budgets.)Tj ( )Tj 0.094 Tw 3 -1.72 Td (10\) Strengthening international exchange and cooperation: Resolution WH\ A 58.3 states )Tj 0.064 Tw -3 -1.72 Td (that based on the related provisions in IHR member countries are encoura\ ged to cooperate w)Tj 0 Tw 37.944 0 Td (ith )Tj ET endstream endobj 203 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 204 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (103)Tj ( )Tj ET Q BT 0.264 Tw 12 0 0 12 71.88 709.08 Tm (each other and with WHO to ensure the effective implementation of the pr\ ovisions about )Tj 0.091 Tw 0 -1.72 TD (prevention and control of public health emergencies such as human avian \ influenza. China has )Tj 0 Tw T* (had extensive communication and cooperation with WHO and the countries r\ )Tj 30.935 0 Td (elated.)Tj ( )Tj -30.935 -1.74 Td ( )Tj T* (Part III )Tj (\226)Tj ( )Tj (Weakness in Implementing IHR)Tj ( )Tj ET 71.88 624.12 201.36 0.48 re f BT 0.078 Tw 12 0 0 12 107.88 606.6 Tm (1\) __ of promotion among the public in health education is not enough. \ The public still )Tj 0.009 Tw -3 -1.74 Td (lacks common sense about response to public emergencies, self)Tj 0 Tw 25.479 0 Td (-)Tj 0.009 Tw (protection, awareness and ability )Tj 0 Tw -25.479 -1.72 Td (to save themselves or o)Tj (thers.)Tj ( )Tj 0.415 Tw 3 -1.72 Td (2\) Emergency response capacity and infrastructure are relatively laggin\ g behind. )Tj 0.086 Tw -3 -1.72 Td (Emergency relief teams at the community level are poorly equipped, and t\ he lack of flexibility )Tj 0 Tw 0 -1.74 TD (and training, and their training cannot be conducted effectively and sys\ t)Tj 28.685 0 Td (ematically.)Tj ( )Tj 0.459 Tw -25.685 -1.72 Td (3\) Supporting systems for emergency testing techniques is not perfect. \ Testing )Tj 0.099 Tw -3 -1.72 Td (laboratories of different kinds at various levels are poorly equipped, a\ nd rapid testing methods )Tj 0 Tw 0 -1.72 TD (and capacity need improving.)Tj ( )Tj 0 -1.74 TD ( )Tj 0 -1.72 TD (Part IV )Tj (\226)Tj ( )Tj (Suggestions:)Tj ( )Tj ET 71.88 397.32 108.239 0.48 re f BT 0.193 Tw 12 0 0 12 107.88 379.8 Tm (1\) IHR has made)Tj 0 Tw ( )Tj 0.193 Tw 7.826 0 Td (requirements for the capacities of national surveillance, emergency )Tj 0.228 Tw -10.826 -1.74 Td (relieving action, and border control. WHO should strengthen guidance and\ support in each )Tj 0.232 Tw T* (regard, especially support on meeting developing countries\222 needs on \ capacity)Tj 0 Tw 33.408 0 Td (-)Tj 0.232 Tw (building and )Tj 0 Tw -33.408 -1.72 Td (resourc)Tj (es.)Tj ( )Tj 0.122 Tw 3 -1.72 Td (2\) Strengthen technical assistance, guidance and training in terms of n\ ational capacity)Tj 0 Tw 35.667 0 Td (-)Tj 0.223 Tw -38.667 -1.74 Td (building, such as prevention guidelines for systems surveillance, early \ warning, methods of )Tj 0 Tw T* (evaluation, regular and emergency measures.)Tj 18.047 0 Td ( )Tj 0.069 Tw -15.047 -1.72 Td (3\) Strengthen exchanges of e)Tj (xperience about preparation for the implementation of IHR )Tj 0.132 Tw -3 -1.72 Td (among member countries, setting up frequent communication mechanisms in \ order to achieve )Tj 0.204 Tw 0 -1.74 TD (information exchange, technical cooperation, resource sharing, preventio\ n and the control to )Tj 0 Tw 0 -1.72 TD (prevent outbreak)Tj (s or threats of public health emergencies in a joint manner.)Tj 30.211 0 Td ( )Tj 0.103 Tw -27.211 -1.72 Td (China will closely communicate and cooperate with WHO and its member cou\ ntries to )Tj 0 Tw -3 -1.72 Td (improve the capacity of implementing IHR and push forward its implementa\ tion.)Tj 32.464 0 Td ( )Tj -29.464 -1.74 Td (Thanks for your attention. I would )Tj (like to answer some questions. Maybe in Chinese!)Tj ( )Tj -3 -1.72 Td ( )Tj ET endstream endobj 205 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 206 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (104)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.161 Tw (you very much. Excellent. An excellent presentation. May I open the floo\ r for )Tj 0 Tw 0 -1.74 TD (questions and comments? Go ahead, Dr.)Tj ( )Tj (Lazarri. You have the floor.)Tj ( )Tj -3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 0.217 Tw 1.555 0 Td (I agree with you. I\222d lik)Tj (e to thank our Chinese colleagues for their very interesting )Tj 0 Tw 0 -1.72 TD (presentation.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.279 Tw 3 0 Td (At one point in the presentation your colleague made reference to nation\ al, )Tj 0.258 Tw -3 -1.74 Td (provincial, prefecture and county levels, four different levels. I wonde\ r if he could )Tj 0.038 Tw T* (elaborate a littl)Tj (e bit on the different roles in implementing the IHR for the national le\ vel, )Tj 0 Tw T* (for the provincial level, for the prefecture level, and for the county l\ evel.)Tj 29.015 0 Td ( )Tj -32.015 -1.72 Td (JL:)Tj 1.278 0 Td ( )Tj 0.065 Tw 1.722 0 Td ([via translator] I would like to answer this question. This is a very in\ teresting topic, and )Tj 0 Tw 0 -1.74 TD (actu)Tj 0.106 Tw (ally after the SARS crisis in 2003 all levels of the Chinese government \ )Tj 0 Tw 31.622 0 Td (\226)Tj ( )Tj 0.106 Tw 0.856 0 Td (from the )Tj 0.177 Tw -32.478 -1.72 Td (central government, provincial government, prefecture governments as wel\ l as county )Tj 0 Tw 0 -1.72 TD (governments )Tj 5.547 0 Td (\226)Tj ( )Tj 0.131 Tw 0.881 0 Td (all of them have put \(special and enough?\) attention to this emergency\ )Tj 0 Tw -6.428 -1.72 Td (resp)Tj (onding system.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.243 Tw 3 0 Td (First of all, I have to say that the Chinese government, we have a trend\ of )Tj 0 Tw -3 -1.72 Td (improving gradually to the system management based on the law and regula\ tions.)Tj 32.659 0 Td ( )Tj -35.659 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.018 Tw 3 0 Td (In 2003 the Chinese government has published of national regulations in \ response )Tj 0 Tw -3 -1.72 Td (t)Tj (o the emergency disease responding regulation.)Tj 19.271 0 Td ( )Tj -22.271 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.263 Tw 3 0 Td (In 2005 we have implementing and improving that regulation, and we have \ )Tj 0.301 Tw -3 -1.72 Td (globalized policy with regards to the emergency and infectious disease r\ esponding )Tj 0 Tw T* (system.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.157 Tw 3 0 Td (After that each of the departments, on the )Tj (direction of the State Council, each )Tj 0.205 Tw -3 -1.74 Td (ministry and department individually they have respectively published a \ total of 105 )Tj 0 Tw T* (individual regulations with each of the departments and ministries.)Tj 26.688 0 Td ( )Tj -29.688 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.09 Tw 3 0 Td (In terms of procedure for the legislature purpose, in the second)Tj 0 Tw 26.031 0 Td ( )Tj 0.09 Tw 0.34 0 Td (half of 2006 the )Tj 0.11 Tw -29.371 -1.72 Td [(Chinese )0.5(emergency )0.5(infectious )0.5(disease )0.5(responding )0.5(system )0.5(law )0.5(has )0.6(been )0.5(approved )0.5(in )0.5(the )]TJ 0.155 Tw 0 -1.74 TD [(level )0.5(of )0.5(the )0.5(State )0.5(Council. )0.5(This )0.5(legislation )0.5(proposition )0.5(has )0.5(already )0.5(been )0.5(tabled )0.5(on )0.5(the )]TJ 0 Tw 0 -1.72 TD (Chinese National Assembly.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.071 Tw 3 0 Td (This legislation proposition is alrea)Tj (dy in the National Assembly of China, which )Tj 0.07 Tw -3 -1.72 Td (\(Pudong Fu?\) analyzed in the different levels )Tj 0 Tw 18.791 0 Td (\226)Tj ( )Tj 0.07 Tw 0.82 0 Td (on the provincial level and the counties, )Tj 0 Tw -19.611 -1.74 Td (and the individual organizations )Tj (\226)Tj ( )Tj (to have the feedback of this regulation and law.)Tj 32.823 0 Td ( )Tj ET endstream endobj 207 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 208 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (105)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.079 Tw 3 0 Td (I think, from my perspective, this p)Tj (roposition will be passed after three readings )Tj 0.027 Tw -3 -1.72 Td (in the first half of next year. In that way, after the approval by the A\ ssembly, this kind of )Tj 0.266 Tw 0 -1.72 TD (emergency response for infectious disease system and public health syste\ m will be )Tj 0 Tw 0 -1.74 TD (legalized in terms of legislature)Tj (, in terms of the local by)Tj (-)Tj (law and so on.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.101 Tw 3 0 Td (So in terms of implementing of IHR, after this proposition has become th\ e law, )Tj 0.038 Tw -3 -1.72 Td (the four levels of the Chinese governments will act according to the law\ , they have more )Tj 0 Tw 0 -1.72 TD (power.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.185 Tw 3 0 Td (Otherwise, remember in 2003, in the)Tj 0 Tw ( )Tj 0.185 Tw 16.05 0 Td (case of the SARS in 2003, some of the )Tj 0.121 Tw -19.05 -1.72 Td (officials which showed incompetence in the response for this kind of eme\ rgency crisis )Tj 0 Tw T* (has been ____ and punished. It\222s because of the law support.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.112 Tw 3 0 Td (With regards to the management of the system and the leadership mana)Tj 0 Tw 29.807 0 Td (gement, )Tj 0.112 Tw -32.807 -1.74 Td (there\222s kind of established\(?\) ___ in the China State Council a kin\ d of specific agency )Tj 0.07 Tw T* (which is named National Council\222s Emergency Responding Office. Partic\ ularly in some )Tj 0.034 Tw T* (of the State Council\222s ministries, for example in the Ministry of Pub\ lic Hea)Tj (lth in which I )Tj 0.188 Tw T* (worked, there was establishment of the Office of Health Emergency and Re\ sponding )Tj 0 Tw 0 -1.74 TD (Centre.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.033 Tw 3 0 Td (Even if in some of the ministries in which there is not this kind of spe\ cific office, )Tj 0.032 Tw -3 -1.72 Td (however, we do have some people responsible for this purpose. In)Tj 0 Tw 26.756 0 Td ( )Tj 0.032 Tw 0.282 0 Td (the May of this year )Tj 0 Tw (\226)Tj ( )Tj 0.295 Tw -27.038 -1.72 Td (which is 2006 )Tj 0 Tw (\226)Tj ( )Tj 0.295 Tw 7.791 0 Td (there was a meeting held in Beijing with regard to the national )Tj 0.127 Tw -7.791 -1.74 Td (management on the health emergency and response system. In that meeting \ something )Tj 0 Tw 0 -1.72 TD (has already clarified.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.261 Tw 3 0 Td (So in each level of the government it must )Tj 0 Tw 19.543 0 Td (\226)Tj ( )Tj 0.261 Tw 1.011 0 Td (this is kind of a compulsory )Tj 0 Tw -23.555 -1.72 Td (requirement )Tj 5.191 0 Td (\226)Tj ( )Tj 0.11 Tw 0.86 0 Td (in each of the levels of government, for example in province, prefecture\ )Tj 0.076 Tw -6.051 -1.74 Td (and as well as the county levels, each of the governments must have a ki\ nd of office or )Tj 0 Tw T* (the centre for this kind of public emergency and res)Tj 20.631 0 Td (ponding system.)Tj ( )Tj -23.631 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.05 Tw 3 0 Td (So I\222m personally very confident with the support of law and legislat\ ure with the )Tj 0.357 Tw -3 -1.72 Td [(improvement )0.5(of )0.5(the )0.5(management )0.5(system )0.5(so )0.5(the )0.5(Chinese )0.5(public )0.5(health )0.5(emergency )]TJ 0 Tw 0 -1.74 TD (responding would cause... will be improved and go forwards for the bette\ r, effic)Tj 31.99 0 Td (ient way.)Tj ( )Tj -34.99 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.04 Tw 3 0 Td (Of course we have to be facing kind of weakness, as I mentioned, because\ due to )Tj 0.256 Tw -3 -1.72 Td (this emergency health centre and office has newly established we have tr\ emendous )Tj 0 Tw 0 -1.72 TD (problems and issues to be overcome.)Tj ( )Tj ET endstream endobj 209 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 210 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (106)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.08 Tw 3 0 Td (Let me raise the example to further explain t)Tj 18.408 0 Td (he situation currently. For example, )Tj 0.035 Tw -21.408 -1.72 Td (in terms of the domain of the public health system, if something happene\ d, even if in the )Tj 0.128 Tw 0 -1.72 TD (rural level, so the report for this kind of event can go over the differ\ ent levels and go )Tj 0.019 Tw 0 -1.74 TD (reported directly to the central, becau)Tj 15.034 0 Td (se this kind of report will be carried out through our )Tj 0 Tw -15.034 -1.72 Td (electronic reporting system.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.172 Tw 3 0 Td (In comparison with this we did have, previously, using this kind of elec\ tronic )Tj 0.399 Tw -3 -1.72 Td (reporting system allowed us to jump over so many inconveniences in terms\ of )Tj 0 Tw T* (administration )Tj 0.08 Tw 6.107 0 Td (or the bureaucracy. In that way, once the central government is aware of\ )Tj 0.061 Tw -6.107 -1.72 Td (this event they will make the quick and direct intervention from the cen\ tral government. )Tj 0.186 Tw 0 -1.72 TD (If necessary the central government\222s central office will sent direct\ ly some experts )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj -35.5 -1.72 Td (specifi)Tj 0.022 Tw [(c )0.5(experts )0.5(and )0.5(officials )]TJ 0 Tw (\226)Tj ( )Tj 0.021 Tw 12.575 0 Td (to go to the site inspection and visit and give the guidance )Tj 0 Tw -12.575 -1.74 Td (and help and support right away at that place.)Tj 18.188 0 Td ( )Tj -21.188 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.082 Tw 3 0 Td (So, after evaluation made by the experts we should have kind of differen\ t levels )Tj 0.029 Tw -3 -1.72 Td (evaluation reports. Currently we do hav)Tj (e a four)Tj 0 Tw (-)Tj 0.029 Tw (level evaluation system. For the ordinary )Tj 0.187 Tw T* [(events )0.5(we )0.5(will )0.5(let )0.5(the )0.5(county )0.5(level\222s )0.5(governments )0.5(deal )0.5(with )0.5(it. Meanwhile, )0.5(they )0.5(will )]TJ 0.276 Tw 0 -1.74 TD (receive the support from the prefecture level governments, of course. If\ something )Tj 0.016 Tw 0 -1.72 TD (relatively serious )Tj 0 Tw (\226)Tj ( )Tj 0.016 Tw 7.906 0 Td (more important, )Tj (more serious )Tj 0 Tw (\226)Tj ( )Tj 0.016 Tw 12.909 0 Td (in that way we let the prefecture level )Tj 0.148 Tw -20.814 -1.72 Td [(to )0.5(deal, )0.5(with )0.5(the )0.5(support )0.5(of )0.5(the )0.5(provincial )0.5(government, )0.5(where )0.5(the )0.5(major )0.5(crisis )0.5(will )0.5(be )]TJ 0.082 Tw T* (dealt by the provincial level government with support of central governm\ ent. In case of )Tj 0 Tw 0 -1.74 TD (extremely serious crises, )Tj (we do have the central government\222s direct intervention.)Tj 32.71 0 Td ( )Tj -35.71 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.292 Tw 3 0 Td (In that way, as we have not only a networked electronic reporting system\ , )Tj 0.066 Tw -3 -1.72 Td (however we have kind of a grassroots level reporting, ordinary people re\ porting system. )Tj 0 Tw 0 -1.72 TD (Also we have a supervision made by )Tj (the mass media.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.018 Tw 3 0 Td (So, particularly which is more important than that, of the SARS crisis, \ each of the )Tj 0.2 Tw -3 -1.72 Td (government officials have much more conscious intention toward this kind\ of public )Tj 0.205 Tw T* (health crisis. So, by my personal perspective, the Chinese in the whole)Tj 0 Tw 30.47 0 Td ( )Tj 0.455 0 Td (\226)Tj ( )Tj 0.205 Tw 0.955 0 Td (all levels\222 )Tj 0.078 Tw -31.88 -1.72 Td (government officials )Tj 0 Tw (\226)Tj ( )Tj 0.078 Tw 9.536 0 Td (particularly in regards to the response of the public health crisis, )Tj 0.128 Tw -9.536 -1.74 Td (so the ability to deal with this kind of crisis and the people\222s cons\ ciousness has much )Tj 0 Tw T* (more improved.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.125 Tw 3 0 Td (Of course we do not forget that we have the )Tj (support international, for example )Tj 0 Tw -3 -1.72 Td (WHO, and for the international societies as well.)Tj 19.521 0 Td ( )Tj ET endstream endobj 211 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 212 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (107)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 3 0 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -6 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you. Other questions? One more question. Dr.)Tj ( )Tj (Luna, from Brazil?)Tj ( )Tj -3 -1.72 Td (EL:)Tj ( )Tj 0.118 Tw 3 0 Td (China is currently facing the H5N1 influenza virus in domestic birds and\ some hu)Tj 0 Tw 34.278 0 Td (man )Tj 0.108 Tw -34.278 -1.74 Td (cases, and I wonder if you could exemplify how it really works, the surv\ eillance chain )Tj 0.056 Tw 0 -1.72 TD (really works, how the detection happens, who is responsible for detectio\ n, where are the )Tj 0.154 Tw T* (laboratories? Because for every confirmed episode probably there are ten\ s or)Tj 0 Tw 32.304 0 Td ( )Tj 0.154 Tw 0.404 0 Td (more of )Tj 0.004 Tw -32.708 -1.72 Td (suspect cases. And then in which level that decision is made, which is i\ mportant, which is )Tj 0.072 Tw 0 -1.74 TD (not important, which is strongly suspected, and who takes action, specif\ ically in H5N1? )Tj 0 Tw 0 -1.72 TD (Is it the provinces, is it the federal? And who notifies to WHO?)Tj ( )Tj -3 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Brief answer, please, so we can have France\222s presentation next. Than\ k)Tj 28.572 0 Td (-)Tj (you.)Tj ( )Tj -31.572 -1.72 Td (JL:)Tj 1.278 0 Td ( )Tj 0.178 Tw 1.722 0 Td ([via translator] Also I would like to answer this question. According to\ my memory, )Tj 0.167 Tw 0 -1.74 TD (based on China\222s national statistics in terms of influenza H51, not i\ ncluding the case )Tj 0 Tw 0 -1.72 TD (whic)Tj 0.229 Tw (h happened in September, 1997 and beginning of 1998 in Hong Kong area, i\ n )Tj 0 Tw T* (mainland China totally so far now we have reported and confirmed a total\ of 21 cases.)Tj 34.489 0 Td ( )Tj -37.489 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.114 Tw 3 0 Td [(Actually )0.5(so )0.5(far )]TJ 0 Tw (\226)Tj ( )Tj 0.114 Tw 7.396 0 Td [(as )0.5(I )0.5(mentioned )]TJ 0 Tw (\226)Tj ( )Tj 0.114 Tw 7.341 0 Td [(totally )0.5(we )0.5(have )0.5(21 )0.5(cases, )0.5(and )0.5(only )0.5(one )0.5(case )]TJ 0.066 Tw -17.737 -1.74 Td (which happened )Tj (in the end of year 2003 which has been detected and conformed by the )Tj 0.007 Tw T* (scientific experts and recognized by the WHO, and other 20 cases have be\ en reported and )Tj 0 Tw T* (detected in our different levels of laboratories in the second half of l\ ast year.)Tj 30.543 0 Td ( )Tj -33.543 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.216 Tw 3 0 Td (Actually I woul)Tj (d like to say that in terms of influenza transmitted to human )Tj 0.09 Tw -3 -1.74 Td (beings, among those cases I know that for in terms of surveillance repor\ ting and action )Tj 0.086 Tw T* (taken, all those kind of responding measures belong to the Ministry of P\ ublic Health in )Tj 0.14 Tw T* [(the )0.5(national )0.5(level)]TJ [(. )0.5(So )0.5(in )0.5(terms )0.5(of )0.5(the )0.5(human )0.5(being )0.5(transmitted )0.5(by )0.5(the )0.5(avian )0.5(influenza, )]TJ 0.048 Tw T* (particularly we detected and reported according to the standard made by \ the WHO, once )Tj 0.037 Tw 0 -1.74 TD (recognized diagnosis and confirmed by both governments and WHO we have t\ o report it )Tj 0.148 Tw 0 -1.72 TD [(confirmed. )0.5(So, )0.5(we)]TJ 0 Tw ( )Tj 0.148 Tw 8.024 0 Td [(have )0.5(intentions )0.5(in )0.5(that )0.5(to )0.5(have )0.5(shortened the )0.5(time )0.5(of detection )0.5(and )]TJ 0 Tw -8.024 -1.72 Td (confirmation.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.143 Tw 3 0 Td (I\222ll give you an example. For example, in 2006 in the month of June w\ e have )Tj 0.17 Tw -3 -1.74 Td (reported one human being transmitted this kind of influenza. From the di\ scovery and )Tj 0.315 Tw T* (detecting t)Tj (o send the confirmed patient to the hospital for treatment until for the\ )Tj 0.136 Tw T* (confirmation reporting at the national level for all this three matters \ were taken in the )Tj 0.019 Tw T* (process, the whole process takes less than two days. Even if for the con\ firmation by the... )Tj ET endstream endobj 213 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 214 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (108)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (i)Tj 0.042 Tw (t takes us totally less than 50 hours. Once this suspicion happens we im\ mediately report )Tj 0.093 Tw 0 -1.72 TD (it to both the Hong Kong and Macau public health authorities, because it\ \222s close to the )Tj 0 Tw T* (case discovery places. It was in June, 2006.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.176 Tw 3 0 Td (We have also discovered another )Tj (patient in the Xinjiang Autonomous Region. )Tj 0.181 Tw -3 -1.72 Td (Those kinds of patients have been diagnosed and detected by our SARS sur\ veillance )Tj 0.034 Tw T* (detecting system. For example, in the case in Xinjiang Province, once we\ got this patient )Tj 0.246 Tw T* (which is suspicious we take from his resp)Tj (iratory system some sample and detected )Tj 0 Tw 0 -1.74 TD (negative.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.067 Tw 3 0 Td [(Based )0.5(on )0.5(the )0.5(standard )0.5(made )0.5(by )0.5(WHO )0.5(we )0.5(would )0.5(like )0.5(to )0.5(think )0.5(that )0.5(we )0.5(can )0.5(give )0.5(it )]TJ 0.05 Tw -3 -1.72 Td (up this kind of suspicious patients because it does not meet for the sta\ ndard of suspicion )Tj 0.11 Tw 0 -1.72 TD (made by the WHO. However, our system)Tj 0 Tw ( )Tj 0.11 Tw 17.57 0 Td (did not let him go. Instead, we made further )Tj 0.058 Tw -17.57 -1.74 Td (detecting based on the sample taken from the patient and we just capture\ d germs off the )Tj 0.234 Tw T* (sample for three generations. Finally after three generations\222 detect\ ing we make the )Tj 0 Tw T* (confirmation, we can make the final d)Tj 15.188 0 Td (iagnosis.)Tj ( )Tj -18.188 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.101 Tw 3 0 Td (I would like here to take only one minute to explain a little bit for th\ e situation )Tj 0 Tw -3 -1.74 Td (made ____ in the Agricultural Ministry of China.)Tj 19.719 0 Td ( )Tj -22.719 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (If we could just make it very short, please.)Tj ( )Tj -3 -1.72 Td (JL:)Tj 1.278 0 Td ( )Tj 0.058 Tw 1.722 0 Td (You know, in terms of surveillance for the poultry and bir)Tj (ds, this kind of surveillance is )Tj 0.12 Tw T* [(made normally by the system of ____ in the )0.5(Ministry of Agriculture. )0.5(However, )0.5(we )0.5(do )]TJ 0.26 Tw 0 -1.74 TD (have, in terms of officials from public health ministries, we have very \ cooperation )Tj 0 Tw 0 -1.72 TD (between the two ministries.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 3 0 Td (I\222m sorry that I\222ve taken )Tj (long speaking.)Tj ( )Tj -6 -1.72 Td (RS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.113 Tw (you very much. I think in the interests of time we\222re going to have t\ o move on )Tj 0.119 Tw 0 -1.74 TD (because we do have to vacate the room precisely at 5 o\222clock, no exce\ ptions. I do not )Tj 0.043 Tw 0 -1.72 TD (wish to cut our colleague from France short but is it possible to )Tj 26.084 0 Td (make your presentation? )Tj 0 Tw -26.084 -1.72 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td ( )Tj ET endstream endobj 215 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 216 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (109)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (COUNTRY 5: FRANCE)Tj ( )Tj 0 -1.64 TD (Dr.)Tj ( )Tj (St\351phane Veyrat)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj 0.191 Tw (you to welcome a little country like France [laughter] because there is \ so big )Tj 0.114 Tw -3 -1.72 Td [(countries )0.5(all )0.5(around. )0.5(I\222ll )0.5(try )0.5(to )0.5(make )0.5(my )0.5(presentation )0.5(as )0.5(short )0.5(as )0.5(possible )0.5(and )0.5(perhaps )0.5(we )0.5(can )]TJ 0 Tw 0 -1.72 TD (ha)Tj (ve questions tomorrow if there is some. I\222ll present in French. I apo\ logize for that.)Tj 33.796 0 Td ( )Tj -33.796 -1.74 Td ([Start Side 9])Tj ( )Tj 0.139 Tw 3 -1.72 Td (Donc la France est un pays de 60)Tj 0 Tw ( )Tj 0.139 Tw (millions d\222habitants. Nous avons un minist\350re de la )Tj 0.188 Tw -3 -1.72 Td (Sant\351 et des solidarit\351s et c\222est au sein de ce minist\350re qu\ e je trava)Tj 28.967 0 Td (ille au D\351partement des )Tj 0.163 Tw -28.967 -1.72 Td (situations d\222urgence sanitaire. Donc on a des lois de d\351centralisa\ tion qui sont intervenues en )Tj 0.026 Tw 0 -1.74 TD (1983 en France et une autre loi aussi qui a confort\351 le r\364le local\ des pr\351fets qui est intervenue en )Tj 0 Tw 0 -1.72 TD (2004.)Tj ( )Tj 0.088 Tw 3 -1.72 Td (Donc on a un \311tat qu\222on peut q)Tj (ualifier de semi)Tj 0 Tw (-)Tj 0.088 Tw (centralis\351 \340 la diff\351rence des nombreux )Tj 0.313 Tw -3 -1.72 Td (\311tats f\351d\351raux auxquels vous \352tes habitu\351s ici avec un pr\ \351sident, un premier ministre et )Tj 0.023 Tw 0 -1.74 TD (\351videmment des ministres, un gouvernement et puis au sein de cet \311\ tat nous avons sept zones de )Tj 0.348 Tw 0 -1.72 TD (d\351fense qui ont)Tj 0 Tw ( )Tj 0.348 Tw 7.404 0 Td (d\351j\340 une connotation tr\350s crise puisque c\222est vraiment des c\ omp\351tences )Tj 0.183 Tw -7.404 -1.72 Td (sp\351cifiques autour d\222un pr\351fet de zone pour coordonner l\222act\ ion quand il y a des probl\350mes )Tj 0.137 Tw T* (d\222ordre public. Vingt)Tj 0 Tw (-)Tj 0.137 Tw (deux r\351gions en France, 95)Tj 0 Tw ( )Tj 0.137 Tw (d\351partements sans compter les d\351partements )Tj 0 Tw 0 -1.74 TD (d)Tj (\222outremer et 36)Tj ( )Tj (000)Tj ( )Tj (communes donc beaucoup, beaucoup de petites communes aussi. )Tj 34.99 0 Td ( )Tj 0.012 Tw -31.99 -1.72 Td (On a donc des pr\351fets en r\351gion et dans les d\351partements qui on\ t des pouvoirs importants. )Tj 0.04 Tw -3 -1.72 Td (Ils d\351tiennent des pouvoirs ex\351cutifs de faire appliquer les lois \ vot\351es au niveau na)Tj 33.589 0 Td (tional et pour )Tj 0.27 Tw -33.589 -1.72 Td (cela ils s\222appuient sur les services d\351concentr\351s donc les serv\ ices d\351concentr\351s de chaque )Tj 0.205 Tw T* (minist\350re, chaque minist\350re ayant des agents dans chaque d\351part\ ement. On a \351galement des )Tj 0.182 Tw 0 -1.72 TD (maires qui ont un certain pouvoir, des pouvoirs notamment de )Tj 26.902 0 Td (police sanitaire et d\222hygi\350ne. )Tj 0.034 Tw -26.902 -1.72 Td (Quand il y a des probl\350mes d\222habitats insalubres, des probl\350mes\ d\222insalubrit\351 aussi parce qu\222il y )Tj 0.01 Tw T* (a une pollution de l\222eau etc. C\222est un pouvoir de police du maire.\ Et le pr\351fet n\222intervient que par )Tj 0 Tw 0 -1.74 TD (subsidiarit\351 c\222est)Tj (-)Tj (\340)Tj (-)Tj (dire )Tj (quand le maire fait d\351faut et n\222intervient pas. )Tj 27.905 0 Td ( )Tj 0.082 Tw -24.905 -1.72 Td (L\222ensemble des budgets de veille et de s\351curit\351 sanitaire depui\ s tr\350s peu, depuis une loi )Tj 0.104 Tw -3 -1.72 Td (de 2004 est vot\351 chaque ann\351e annuellement devant le Parlement ce \ qui nous donne d\222ailleurs )Tj 0.156 Tw 0 -1.72 TD (beaucoup de travail puisq)Tj (u\222on doit pr\351parer une \351valuation des actions et de comment on \ va )Tj 0.195 Tw 0 -1.74 TD (consacrer et utiliser le budget vot\351. On a \351galement une loi tr\350\ s, tr\350s importante mais on y )Tj 0.039 Tw 0 -1.72 TD (reviendra tout \340 l\222heure qui est la Loi de sant\351 publique. La p\ r\351c\351dente loi \351tait de 1901 donc \347)Tj 0 Tw 38.556 0 Td (a )Tj ET endstream endobj 217 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 218 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (110)Tj ( )Tj ET Q BT 0.033 Tw 12 0 0 12 71.88 709.08 Tm (faisait plus de 100)Tj 0 Tw ( )Tj 0.033 Tw (ans et c\222est une loi majeure pour nous puisque pour la premi\350re fo\ is on a fix\351 )Tj 0.029 Tw 0 -1.72 TD [(plus )0.5(d\222une )0.5(centaine )0.5(d\222objectifs )0.5(de )0.5(sant\351 )0.5(publique )0.6(et )0.5(on )0.5(a )0.5(confi\351 )0.5(des )0.5(missions )0.5(tr\350s )0.5(claires )0.5(\340 )0.5(la )0.5(fois )]TJ 0.219 Tw T* (\340 l\222Institut de veille sanitaire qui au niveau nationa)Tj 22.025 0 Td (l est charg\351 de collecter l\222ensemble des )Tj 0.129 Tw -22.025 -1.74 Td (donn\351es sanitaires et qui fixe des missions aussi aux r\351gions pour\ organiser tout ce qui est la )Tj 0 Tw T* (pr\351vention, les politiques de sant\351 publique et la veille et l\222\ alerte.)Tj 26.047 0 Td ( )Tj 0.074 Tw -23.047 -1.72 Td [(Tr\350s, tr\350s rapidement et juste pour vous )0.5(donner )]TJ (une id\351e on a cinq niveaux. Ici on parle )Tj 0.022 Tw -3 -1.72 Td (du niveau du bas c\222est le niveau local avec des \351metteurs du signa\ l sanitaire donc que ce soit des )Tj 0.056 Tw 0 -1.74 TD (professionnels de sant\351 qui travaillent dans les \351tablissements de\ sant\351 ou dans le monde lib\351ral )Tj 0.165 Tw 0 -1.72 TD (en ville, que ce s)Tj 7.353 0 Td (oient les professionnels des maisons de retraite, d\222\351tablissements\ m\351dicaux, )Tj 0.484 Tw -7.353 -1.72 Td (sociaux, que ce soient les exploitants qui sont dans les r\351seaux d\222\ eau potable pour )Tj 0.304 Tw T* (l\222approvisionnement d\222eau potable des villes, les exploitations ag\ ricoles avec les \351levages )Tj 0 Tw 0 -1.74 TD (not)Tj 0.14 Tw [(amment, les usines et )0.5(notamment on )0.5(pense aux installations class\351es. On a eu un accident )]TJ 0.112 Tw 0 -1.72 TD [(2003 )0.5(qui )0.5(\351tait... )0.5(en )0.5(2001 )0.5(pardon, )0.5(qui )0.5(\351tait )0.5(juste )0.5(apr\350s )0.5(les )]TJ /TT1 1 Tf [(Twin )0.5(Towers)]TJ /TT0 1 Tf [(, )0.5(beaucoup )0.5(moins )0.5(grand )]TJ 0.051 Tw T* (mais quand m\352me important \340 notre niveau qui \351tait un accident \ \340 Toulouse)Tj 0 Tw 30.934 0 Td ( )Tj 0.051 Tw 0.301 0 Td (avec une explosion )Tj 0.07 Tw -31.234 -1.72 Td (dans une usine chimique qui a fait beaucoup de victimes et qui a beaucou\ p traumatis\351 la classe )Tj 0 Tw 0 -1.74 TD (politique fran\347aise et par rapport justement \340 l\222organisation d\ es secours.)Tj 28.768 0 Td ( )Tj 0.025 Tw -25.768 -1.72 Td (On a ici effectivement sur le terrain aussi des v\351t\351rinaires et be\ )Tj 25.402 0 Td (aucoup de v\351t\351rinaires ont )Tj 0.05 Tw -28.402 -1.72 Td (des mandats sanitaires et donc peuvent faire des interventions et peuven\ t signaler aux directions )Tj 0.033 Tw 0 -1.72 TD (dans les d\351partements, les directions charg\351es justement du contr\364\ le en sant\351 animale. Quand on )Tj 0.037 Tw 0 -1.74 TD (remonte d\222un cran on arrive au nive)Tj (au d\351partemental et au niveau d\351partemental on a \351galement )Tj 0.036 Tw 0 -1.72 TD (un niveau qui est centr\351 sur les pr\351fets. J\222ai mis ici tout le \ niveau vertical en rouge puisque c\222est )Tj 0.194 Tw T* (la crise. Quand il y a la crise c\222est les pr\351fets donc pr\351fets \ et \347a remonte jusqu\222au premier )Tj 0 Tw T* (m)Tj 0.23 Tw (inistre en g\351n\351ral par le biais du minist\350re de l\222Int\351rie\ ur qui prend la main sur tous nos )Tj 0 Tw 0 -1.74 TD (probl\350mes. )Tj ( )Tj 0.199 Tw 3 -1.72 Td (Quand c\222est des alertes les pr\351fets savent g\351rer tr\350s bien a\ u niveau local et on a ici )Tj 0.178 Tw -3 -1.72 Td (l\222ensemble des services d\351concentr\351s. Il s\222agit de l\222\351\ quipement, q)Tj 27.635 0 Td (u\222il s\222agisse des transports, )Tj 0.067 Tw -27.635 -1.72 Td (qu\222il s\222agisse de services v\351t\351rinaires, qu\222il s\222agiss\ e de l\222action sanitaire et sociale, des services )Tj 0.178 Tw T* (d\351concentr\351s du minist\350re de la Sant\351. Donc la DDASS ici, la\ Direction d\351partementale des )Tj 0.113 Tw 0 -1.72 TD (affaires sanitaires et sociales e)Tj (st une des structures. Et on a \340 c\364t\351 de \347a des services qui\ sont )Tj 0.277 Tw T* (d\351partementaux, le SAMU qui est le Service d\222aide m\351dicale urge\ nte qui chez nous \340 la )Tj 0.011 Tw T* (diff\351rence de, je pense au Canada, des \311tats)Tj 0 Tw 17.598 0 Td (-)Tj 0.011 Tw (Unis, le SAMU est m\351dicalis\351 chez nous. Donc on a )Tj ET endstream endobj 219 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 220 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (111)Tj ( )Tj ET Q BT 0.014 Tw 12 0 0 12 71.88 709.08 Tm (un m\351deci)Tj (n \340 bord dans les camions. Et on a aussi des pompiers avec certains m\ \351decins mais pas )Tj 0.123 Tw 0 -1.72 TD (toujours. On a la police et la gendarmerie ici et donc ces structures)Tj 0 Tw 28.102 0 Td (-)Tj 0.123 Tw (l\340 quand il y a une alerte )Tj 0.083 Tw -28.102 -1.72 Td (particuli\350re sur le territoire du d\351partement ils vont pr\351venir\ le pr\351fet)Tj 28.37 0 Td (. 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On n\222en a )Tj 0.145 Tw T* (pas dans toutes les r\351gions mais on en a 16 sur 22)Tj 0 Tw ( )Tj 0.145 Tw (r\351gions. \300 c\364t\351 de \347a le CCLIN c\222est les )Tj 0.061 Tw T* (Centres de coordination pour la lutte contre les infections nosocomiales\ puisque comme partout )Tj 0.212 Tw 0 -1.74 TD (dans le monde les infections no)Tj (socomiales c\222est un vrai probl\350me et probablement une des )Tj 0.013 Tw 0 -1.72 TD (\351mergences qu\222on aura... sur lesquelles le RSI devra intervenir. O\ n en parlait tout \340 l\222heure. On a )Tj 0.223 Tw T* (effectivement des structures r\351gionales d\222appui \340 chaque fois q\ u\222il y a des alertes dans les )Tj 0 Tw T* (\351tabl)Tj (issements. )Tj ( )Tj 0.027 Tw 3 -1.74 Td (Et puis au niveau national, ici on a un point focal national qui est pos\ itionn\351 au minist\350re )Tj 0.041 Tw -3 -1.72 Td (de la Sant\351 et dans notre d\351partement. Et puis on a \340 c\364t\351\ de ce point focal national qui est juste )Tj 0.027 Tw T* (l\340 pour faire le lien finalement surtout ici vertic)Tj (al mais aussi ici horizontalement, on a \351galement )Tj 0.003 Tw T* (\351videmment une tr\350s grande importance pour \340 la fois l\222Insti\ tut de veille sanitaire qui va collecter )Tj 0.07 Tw 0 -1.74 TD [(les donn\351es analys\351es remont\351es du terrain et pouvoir )0.5(d\351tecter une alerte et puis les agences de )]TJ 0 Tw 0 -1.72 TD (s\351curit\351)Tj ( )Tj 0.143 Tw 3.503 0 Td (sanitaire. Donc on voit qu\222elles ont \351t\351 cr\351\351es par la Lo\ i de 1998. 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L\222environnement et le travail )Tj 0 Tw T* (c\222est l\222[AFSET] et on a une agence de biom\351decine qui vient d\222\ \352tre constitu\351e.)Tj 31.571 0 Td ( )Tj 0.056 Tw -28.571 -1.72 Td (Donc \340 c\364t\351 de \347a vous voyez que dans cet organigramme sur)Tj 0 Tw 25.25 0 Td ( )Tj 0.056 Tw 0.306 0 Td (la veille et le signalement )Tj 0.161 Tw -28.556 -1.72 Td (on a effectivement l\222Institut de veille sanitaire et on a l\222admini\ stration de la sant\351. Il y a un )Tj 0.025 Tw 0 -1.74 TD (partage des t\342ches qui est assez pr\351cis entre les missions de veil\ le, de surveillance, d\222expertise et )Tj 0.032 Tw 0 -1.72 TD (d\222alerte et les missions de)Tj 0 Tw ( )Tj 0.032 Tw 10.743 0 Td (l\222administration qui sont d\222\351laborer les politiques de sant\351\ publique et )Tj 0.209 Tw -10.743 -1.72 Td (les mesures de gestion, et l\222administration de la sant\351 avec \340 \ c\364t\351 aussi l\222administration de )Tj 0 Tw T* (l\222agriculture qui est charg\351e de la m\352me chose mais pour son ch\ amp de comp\351tence.)Tj 33.82 0 Td ( )Tj ET endstream endobj 221 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 222 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (112)Tj ( )Tj ET Q BT 0.104 Tw 12 0 0 12 107.88 709.08 Tm (Donc l)Tj (e r\351sum\351 des diapos pr\351c\351dentes se retrouve ici avec la m\352\ me difficult\351 qu\222on a )Tj 0.053 Tw -3 -1.72 Td (d\351j\340 vue chez les coll\350gues pour arriver \340 positionner les t\ rois puisque effectivement des choses )Tj 0.029 Tw 0 -1.72 TD [(sont )0.5(faites )0.5(au )0.5(niveau )0.5(local. )0.5(\307a )0.5(d\351pend )0.5(de )0.6(quoi )0.5(on )0.5(parle. )0.5(La )0.5(d\351tection )0.5(des )0.5(cas )]TJ 31.111 0 Td [(et )0.5(la )0.5(notification )0.5(on )]TJ 0.074 Tw -31.111 -1.74 Td (la met au niveau local mais c\222est \351vident que pour des ph\351nom\350\ nes rares et des \351mergences on )Tj 0.105 Tw T* (pourra avoir en fait une pertinence simplement et une d\351tection qui n\ e pourra se faire qu\222\340 un )Tj 0.399 Tw T* (niveau r\351gional de ____ ou \340 un niveau nationa)Tj 22.13 0 Td (l puisque \347a peut \352tre r\351parti et pris )Tj 0 Tw -22.13 -1.72 Td (individuellement au niveau local o\371 un peut tr\350s bien ne pas avoir\ de d\351tection particuli\350re. )Tj 36.709 0 Td ( )Tj 0.148 Tw -33.709 -1.74 Td [(La )0.5(collecte )0.5(et )0.5(l\222uniformisation )0.5(des )0.5(donn\351es )0.5(l\340 )0.5(aussi )0.5(se )0.5(fait )0.5(dans )0.5(les )0.5(trois )0.5(niveaux )0.5(plus )]TJ 0.016 Tw -3 -1.72 Td (particuli\350rement aux r\351gions nati)Tj (onales mais le niveau local aussi a son r\364le \340 jouer. L\222analyse\ et )Tj 0.074 Tw T* [(interpr\351tation )0.5(de )0.5(la )0.5(m\352me )0.5(fa\347on. )0.5(Les )0.5(confirmations )0.5(diagnostiques )0.5(ben )0.5(c\222est )0.5(plut\364t )0.5(du )0.5(ressort )0.5(du )]TJ 0.239 Tw T* (niveau local et donc on avait vu tout \340 l\222heure les Directions d\351\ partementales des affaires )Tj 0 Tw 0 -1.74 TD (s)Tj 0.04 Tw (anitaires et sociales, les Directions des affaires v\351t\351rinaires. E\ lles vont voir sur place quand il y )Tj 0.114 Tw 0 -1.72 TD [(a )0.5(des )0.5(\351pid\351mies )0.5(et )0.5(des )]TJ /TT1 1 Tf 0 Tw (outbreaks)Tj /TT0 1 Tf 0.114 Tw [(. )0.5(Ensuite )0.5(la )0.5(diffusion )0.5(de )0.5(l\222alerte )0.5(elle )0.5(est )0.5(plut\364t )0.5(soit )0.5(du )0.5(niveau )]TJ 0.267 Tw T* (local, soit du niveau national, rarement du niveau r\351gio)Tj 24.182 0 Td (nal mais on a vu quelques alertes )Tj 0.078 Tw -24.182 -1.72 Td (coordonn\351es par un niveau r\351gional. Et puis l\222intervention elle\ est aussi soit du niveau national )Tj 0.029 Tw 0 -1.74 TD [(quand il )0.5(s\222agit )0.5(de )0.5(communications )0.5(principalement )0.5(et )0.6(les )0.5(niveaux )0.5(locals )0.5(quand )0.5(il )0.5(s\222agit )0.5(d\222imposer )]TJ 0 Tw 0 -1.72 TD (des mesures de correction l)Tj (ocalement.)Tj ( )Tj 0.025 Tw 3 -1.72 Td (Alors si on passe \340 la n\351gociation et \340 l\222approbation du nou\ veau r\351cit on a eu un r\351cit qui )Tj 0.11 Tw -3 -1.72 Td (a \351t\351 adopt\351 sans r\351serve par le gouvernement fran\347ais. L\ e minist\350re des Affaires \351trang\350res a )Tj 0.113 Tw 0 -1.74 TD (transmis l\222information \340 l\222OMS. Il s\222impose pour nous sans)Tj 0 Tw 24.766 0 Td ( )Tj 0.113 Tw 0.363 0 Td (aucune... il n\222a pas besoin que \347a )Tj 0.124 Tw -25.13 -1.72 Td (passe au Parlement. Il n\222a pas besoin que \347a soit vot\351. 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De la m\352me fa\347on on a un cer\ tain nombre d\222\351l\351ments dans le )Tj 0.098 Tw T* (code de sant\351 publique qu\222il faut ajuster pour r\351pondre \340 to\ ut ce qui est)Tj 0 Tw 29.679 0 Td ( )Tj 0.348 0 Td (USPPI )Tj 0.098 Tw 3.071 0 Td (\(Public Health )Tj ET endstream endobj 223 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 224 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (113)Tj ( )Tj ET Q BT 0.116 Tw 12 0 0 12 71.88 709.08 Tm (and Emergency International Concern\))Tj 15.924 0 Td (. 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Alors \340 d\351faut s\222il n\222y avait pas de d\351cision au ni\ veau d\222OMS, pas de)Tj 0 Tw 33.399 0 Td ( )Tj 0.023 Tw 0.273 0 Td (possibilit\351 de )Tj 0.242 Tw -33.672 -1.72 Td (faire \351voluer les choses avec des syst\350mes de r\351servation en li\ gne comme AMADEUS ou )Tj 0.207 Tw T* (d\222autres choses comme \347a il faudra que nous on prenne des d\351cis\ ions et probablement une )Tj 0.166 Tw 0 -1.74 TD (r\351glementation sp\351cifique obligeant les tour op\351rators en Franc\ e et )Tj 28.398 0 Td (les agences de voyages \340 )Tj 0 Tw -28.398 -1.72 Td (signaler les choses.)Tj ( )Tj 0.032 Tw 3 -1.72 Td (Alors je ne vous apprends rien en vous disant qu\222on s\222est pench\351\ tout d\222abord sur tout ce )Tj 0.035 Tw -3 -1.72 Td [(qui \351tait contenu dans la d\351cision de voter par l\222assembl\351e \ l\222OMS, par l\222assembl\351e )0.5(mondiale )0.5(sur )]TJ 0.095 Tw T* (l\222application anticip\351e )Tj (de certaines mesures pour la mise en oeuvre du RSI dans le cadre de la )Tj 0.073 Tw 0 -1.72 TD (pr\351vention de la pand\351mie grippale et donc on avait identifi\351 e\ ffectivement ces cinq points \340 la )Tj 0.055 Tw T* [(fois la mise en place de )0.5(l\222algorithme, annexe)]TJ 0 Tw 18.264 0 Td ( )Tj 0.055 Tw (2, \340 la fois le point focal national, la d)Tj 0 Tw (\351signation)Tj ( )Tj (\226)Tj ( )Tj 0.058 Tw -18.264 -1.72 Td (donc je vous dis qu\222on vient de le d\351signer)Tj 0 Tw ( )Tj (\226)Tj ( )Tj 0.058 Tw 18.629 0 Td (le dispositif de surveillance et de notification bien )Tj 0.021 Tw -18.629 -1.74 Td (on a d\351j\340 vu une partie et on pourra peut)Tj 0 Tw (-)Tj 0.021 Tw (\352tre \351ventuellement d\351velopper si on en a le temps. Les )Tj 0.02 Tw T* (mesures de sant\351 publique pour les voyageurs )Tj (on va y revenir. Elles posent un certain nombre de )Tj 0.055 Tw T* (probl\350mes. J\222ai \351voqu\351 le probl\350me des agences de voyages\ , de la connaissance, de l\222action des )Tj 0.213 Tw T* (compagnies mais il y a d\222autres sujets aussi. Et puis \351videmment l\ e probl\350me des donn\351es )Tj 0 Tw 0 -1.74 TD (personnelles et les t)Tj (ransports des mat\351riels biologiques. )Tj ( )Tj 0.002 Tw 3 -1.72 Td (Donc sur ces cinq actions on s\222est pench\351 et on a essay\351 d\222\351\ valuer ce qui \351tait d\351j\340 fait, ce )Tj 0.082 Tw -3 -1.72 Td (qui nous posait probl\350me et l\340 o\371 on a laiss\351. Sur le syst\350\ me de surveillance la France est d\351j\340 )Tj 0.057 Tw 0 -1.72 TD (relativement structur\351e en )Tj [(termes de r\351seaux de surveillance \340 )0.5(la )0.5(fois sur le volet sant\351 animale. )]TJ 0.157 Tw 0 -1.74 TD [(Je )0.5(vous )0.5(ai )0.5(parl\351 )0.5(des )0.5(v\351t\351rinaires. )0.5(Donc )0.5(il )0.5(y )0.5(a )0.5(les )0.5(v\351t\351rinaires )0.5(sur )0.5(le )0.5(terrain )0.5(qui )0.5(vont )0.5(dans )0.5(les )]TJ 0.1 Tw 0 -1.72 TD (fermes et il y a les v\351t\351rinaires qui travaillent dans les directi\ ons d\351partementales d)Tj 34.485 0 Td (ans chaque )Tj 0.058 Tw -34.485 -1.72 Td (d\351partement, et puis il y a des v\351t\351rinaires au niveau national\ . Et puis la m\352me chose au niveau )Tj 0.066 Tw T* (sant\351 humaine, on a des m\351decins g\351n\351ralistes donc qui sont \ lib\351raux ou p\351diatres ou m\351decins )Tj ET endstream endobj 225 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 226 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (114)Tj ( )Tj ET Q BT 0.12 Tw 12 0 0 12 71.88 709.08 Tm (g\351n\351ralistes qui travaillent et qui participent \340 un r)Tj 21.065 0 Td (\351seau qu\222on appelle un r\351seau de m\351decins )Tj 0 Tw -21.065 -1.72 Td (sentinelles)Tj ( )Tj (\226)Tj ( )Tj 0.134 Tw 5.356 0 Td (donc il y a deux cat\351gories)Tj 0 Tw 11.362 0 Td ( )Tj (\226)Tj ( )Tj 0.134 Tw 1.134 0 Td (et ces m\351decins se sont engag\351s, enfin ce sont des )Tj 0.09 Tw -17.852 -1.72 Td (m\351decins assez volontaires qui s\222engagent \340 faire \340 la fois \ des pr\351l\350vements)Tj 0 Tw 31.287 0 Td ( )Tj (\226)Tj ( )Tj 0.09 Tw 1.09 0 Td (ils peuvent faire )Tj 0.042 Tw -32.378 -1.74 Td (des pr\351l\350vements \340 la )Tj (recherche de virus de la grippe)Tj 0 Tw ( )Tj (\226)Tj ( )Tj 0.042 Tw 22.545 0 Td [(et puis ils signalent, ils )0.5(renseignent )0.5(et )0.5(ils )]TJ 0 Tw -22.545 -1.72 Td (remontent leurs informations de mani\350re hebdomadaire au niveau nation\ al.)Tj 30.017 0 Td ( )Tj 0.177 Tw -27.017 -1.72 Td (Il y a certains laboratoires aussi qui agissent de la m\352me fa\347on e\ t qui remontent des )Tj 0.411 Tw -3 -1.72 Td (souches pour cara)Tj (ct\351risation aux laboratoires nationaux de r\351f\351rence, et donc on\ a les )Tj 0.079 Tw 0 -1.74 TD (laboratoires nationaux de r\351f\351rence qui suivent tout \347a. Et pui\ s en parall\350le de \347a on a un autre )Tj 0.004 Tw 0 -1.72 TD (r\351seau que je n\222ai pas mentionn\351 ici qui est un r\351seau de ve\ ille entomologique. Vous sav)Tj 35.439 0 Td (ez que la )Tj 0.102 Tw -35.439 -1.72 Td (France a \351t\351 quand m\352me tr\350s touch\351e par effectivement de\ s alertes )Tj /TT1 1 Tf 0 Tw 28.356 0 Td (vector)Tj (-)Tj 0.102 Tw (borne disease)Tj /TT0 1 Tf 0 Tw ( )Tj 8.812 0 Td (avec )Tj 0.019 Tw -37.168 -1.72 Td (notamment le )Tj /TT1 1 Tf 0 Tw 5.759 0 Td (Chikungunya)Tj /TT0 1 Tf 0.019 Tw (, une \351pid\351mie de dengue qui a touch\351 aussi les Antilles et la \ Guyane )Tj 0 Tw -5.759 -1.74 Td (et )Tj /TT1 1 Tf 1.182 0 Td (Chikungunya)Tj /TT0 1 Tf ( )Tj 0.211 Tw 5.793 0 Td (\340 la R\351union et \340 la Mayotte. Donc on est tr)Tj (\350s sensibilis\351 et on s\222aper\347oit )Tj 0.099 Tw -6.976 -1.72 Td (qu\222effectivement on a des nouveaux vecteurs en France qui apparaissen\ t. On a notamment des )Tj 0.18 Tw T* (familles d\222[AIDS] qui semblent remonter d\222Italie pour s\222implant\ er dans le sud de la France. )Tj 0.247 Tw T* (Donc cette surveillance mise en place aus)Tj 18.14 0 Td (si pour le West Nile virus puisque comme pour )Tj 0.003 Tw -18.14 -1.74 Td [(l\222Am\351rique on a \351galement du West Nile virus )0.5(de temps )0.5(en temps sur l\222arc m\351diterran\351en, sur les )]TJ 0.157 Tw T* [(d\351partements )0.5(du )0.5(bord )0.5(de )0.5(la )0.5(M\351diterran\351e. )0.5(On )0.5(a )0.5(aussi )0.5(une )0.6(surveillance )0.6(sur )0.6(tous )0.6(ces )0.7(arbres )0.6(de )]TJ 0 Tw T* (virus.)Tj ( )Tj 0.02 Tw 3 -1.72 Td (Sur la deuxi\350me)Tj 0 Tw ( )Tj 0.02 Tw 6.809 0 Td (\351tape dont j\222ai parl\351 tout alors c\222est la Loi de la sant\351\ publique du 9)Tj 0 Tw 27.219 0 Td ( )Tj (ao\373t )Tj 0.169 Tw -37.028 -1.74 Td (2004. On voit bien qu\222on a un Institut de veille sanitaire qui doit m\ onter en puissance mais )Tj 0.178 Tw T* [(compar\351 au CDC d\222Atlanta l\222Institut de veille sanitaire est enc\ ore )0.5(tr\350s, tr\350s faible )]TJ (en termes )Tj 0.282 Tw T* (d\222effectifs. C\222est tout petit mais c\222est... la France est aussi\ plus petite que les \311tats)Tj 0 Tw 36.778 0 Td (-)Tj (Unis )Tj 0.146 Tw -36.778 -1.72 Td [(d\222Am\351rique. )0.5(Donc )0.5(c\222est )0.5(une )0.5(petite )0.5(structure )0.5(mais )0.5(qui )0.5(monte )0.5(en )0.5(puissance )0.5(et )0.5(qui )0.5(doit )0.5(pouvoir )]TJ 0.183 Tw 0 -1.74 TD (s\222appuyer sur un r\351seau de correspondants qu\222il soit au niv)Tj 25.172 0 Td (eau local, au niveau r\351gional, au )Tj 0.01 Tw -25.172 -1.72 Td (niveau national avec des laboratoires et des partenaires. Donc tout ph\351\ nom\350ne mena\347ant en sant\351 )Tj 0.169 Tw 0 -1.72 TD (publique doit pouvoir en plus lui conf\351rer... la loi lui conf\350re u\ ne possibilit\351 d\222investigation, )Tj 0.068 Tw T* (d\222aller voir exactement ce q)Tj 11.432 0 Td (ui se passe et de demander \340 des entreprises, \340 des structures, \340\ des )Tj 0.114 Tw -11.432 -1.74 Td (compagnies a\351riennes ou \340 d\222autres compagnies des donn\351es m\352\ mes nominatives quand il y a )Tj 0 Tw T* (une menace pour la sant\351 publique avec un ph\351nom\350ne \351mergent\ .)Tj 26.267 0 Td ( )Tj 0.051 Tw -23.267 -1.72 Td [(Pour )0.5(nous )0.5(on )0.5(a )0.5(un )0.5(gros )0.5(travail )0.5(qui )]TJ [(est )0.5(de )0.5(diffuser )0.5(l\222information )0.5(aux )0.5(autres )0.5(minist\350res )0.5(qui )]TJ 0.23 Tw -3 -1.72 Td (n\222est pas encore fait aujourd\222hui, diffuser l\222information sur c\ e qui entra\356ne l\222application de )Tj ET endstream endobj 227 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 228 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (115)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (l\222annexe)Tj ( )Tj 0.102 Tw (1 et l\222annexe)Tj 0 Tw ( )Tj 0.102 Tw (2 du r\350glement sanitaire international et \347a c\222est un gros trav\ ail \340 venir. )Tj 0.055 Tw 0 -1.72 TD (Sur la)Tj 0 Tw ( )Tj 0.055 Tw 2.72 0 Td (d\351tection, notification, v\351rification, d\351claration je ne revien\ s pas. On a vu avec le tableau )Tj 0.001 Tw -2.72 -1.72 Td (la pr\351sentation simplement deux accents et deux focus, l\222un sur le\ fait que la France vous avez vu )Tj 0.04 Tw 0 -1.74 TD (est un syst\350me avec plusieurs minist\350res donc on a un fonction)Tj 25.508 0 Td (nement historiquement qui est un )Tj 0.018 Tw -25.508 -1.72 Td (peu en tuyaux d\222orgue vertical et la difficult\351 c\222est que selon\ la nature du risque les comp\351tences )Tj 0 Tw 0 -1.72 TD (ne sont pas forc\351ment \340 la sant\351. )Tj ( )Tj 0.31 Tw 3 -1.72 Td (C\222est par exemple pour la radiologique et le nucl\351aire o\371 on a \ une structure qui )Tj 0 Tw -3 -1.74 Td (mainten)Tj 0.014 Tw (ant ne d\351pend plus directement de la sant\351 m\352me si on y est plu\ s ou moins rattach\351, mais )Tj 0.145 Tw T* (qui g\350re tous les ph\351nom\350nes d\222alertes nucl\351aires, donc a\ lertes m\351t\351orologiques, accidents de )Tj 0.473 Tw T* (radioth\351rapie importants mais aussi \351ventuellement probl\350mes de\ diffusion)Tj 0 Tw 33.333 0 Td ( )Tj 0.473 Tw 0.723 0 Td (d\222un nuage )Tj 0.073 Tw -34.056 -1.72 Td (radioactif. Et donc tout le travail va \352tre de remettre de l\222horiz\ ontalit\351, de la transversalit\351 dans )Tj 0.144 Tw 0 -1.74 TD (des remont\351es qui se font plut\364t verticalement jusqu\222au premier\ ministre pour revenir ensuite )Tj 0.069 Tw 0 -1.72 TD [(vers )0.5(nous )0.5(\351ventuellement )0.5(avec )0.5(retard. )0.5(Et )0.5(puis )0.5(po)]TJ 19.862 0 Td [(ur )0.5(rappeler )0.5(qu\222en )0.5(France )0.5(on )0.5(a )0.5(un )0.5(\311tat )0.5(qui )0.5(s\222est )]TJ 0.02 Tw -19.862 -1.72 Td [(pr\351sent\351 )0.5(pendant )0.5(longtemps )0.5(comme )0.5(un )0.5(peu )0.5(providence )0.5(et )0.5(garant )0.6(de )0.5(la )0.6(s\351curit\351, )0.5(on )0.5(a )0.5(eu )0.5(beaucoup )]TJ 0.009 Tw T* (d\222implication d\222hommes politiques, de ministres de la Sant\351 sur\ des alertes. Le plus r\351cent c\222\351tait )Tj 0.055 Tw 0 -1.74 TD (2003. Vous sav)Tj (ez qu\222on a eu une canicule et que notre ministre de la Sant\351 de l\222\ \351poque n\222a pas )Tj 0 Tw 0 -1.72 TD (r\351sist\351 \340 la canicule non plus. )Tj ( )Tj 0.23 Tw 3 -1.72 Td (Donc on a cette obligation de d\351tection des ph\351nom\350nes, obligat\ ion d\222alerte et puis )Tj 0.06 Tw -3 -1.72 Td (obligation de gestion, et le probl\350me \347a va \352tre justement)Tj 0 Tw 23.367 0 Td ( )Tj 0.06 Tw 0.31 0 Td (de travailler sur qui valide finalement )Tj 0.125 Tw -23.677 -1.74 Td (la communication \340 l\222OMS quand on fait soit une consultation \(art\ icle)Tj 0 Tw 29.295 0 Td ( )Tj 0.125 Tw (6\) soit une notification )Tj 0 Tw -29.295 -1.72 Td (\(article)Tj ( )Tj 0.037 Tw (12\). \307a va \352tre \340 quel niveau est)Tj 0 Tw (-)Tj 0.037 Tw (ce que cela va \352tre arr\352t\351. Est)Tj 0 Tw (-)Tj 0.037 Tw (ce que \347a va d\351pendre du )Tj 0.003 Tw T* (directeur g\351n\351ral de)Tj 0 Tw ( )Tj 0.003 Tw 8.197 0 Td (la sant\351, mon sup\351rieur direct, ou est)Tj 0 Tw (-)Tj 0.003 Tw (ce que \347a va d\351pendre du ministre de la )Tj 0.152 Tw -8.197 -1.72 Td (Sant\351 ou est)Tj 0 Tw (-)Tj 0.152 Tw (ce que \347a va remonter jusqu\222au premier ministre avant de vous \352\ tre retransmis? )Tj 0.088 Tw 0 -1.74 TD (C\222est une des questions qui est encore un peu ouverte \340 vrai dire.\ Et en plus de \347a )Tj 34.381 0 Td (il va falloir )Tj 0.062 Tw -34.381 -1.72 Td (qu\222on ait la validation avant de communiquer des autres directeurs d\222\ administration, agriculture )Tj 0.105 Tw 0 -1.72 TD (ou fraude ou douanes ou que sais)Tj 0 Tw 13.902 0 Td (-)Tj 0.105 Tw (je encore... m\352me int\351rieur peut)Tj 0 Tw 13.44 0 Td (-)Tj 0.105 Tw (\352tre. Donc voil\340, donc on a )Tj 0 Tw -27.342 -1.72 Td (encore des sujets.)Tj ( )Tj 0.011 Tw 3 -1.74 Td [(\307a je viens )0.5(de )0.5(vous )0.5(le )0.5(dire )0.5(de )0.5(t)]TJ [(oute )0.5(fa\347on. )0.6(Un )0.5(autre )0.5(point )0.5(peut)]TJ 0 Tw (-)Tj 0.011 Tw [(\352tre )0.5(important )0.5(c\222est )0.5(de )0.5(dire )]TJ 0.006 Tw -3 -1.72 Td [(que )0.5(la )0.5(Direction )0.5(g\351n\351rale )0.5(de )0.5(la )0.5(sant\351 )0.5(donc )0.5(ma )0.5(structure )0.5(\340 )0.5(moi )0.5(n\222a )0.5(pas )0.5(d\222armes )0.5(directes, )0.5(on )0.5(va )0.5(dire )]TJ 0.058 Tw T* (pour imposer les choses au niveau local. On n\222a pas d\222agents de po\ lice. On n\222a pas de structure )Tj 0.182 Tw T* [(comme )0.5(\347a. )0.5(On )0.5(a )0.5(bien )0.5(des )0.5(m\351decins )0.5(inspecteurs )0.5(dans )0.5(les )0.5(d\351partements )0.5(qui )0.5(peuvent )0.5(faire )0.5(des )]TJ ET endstream endobj 229 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 230 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (116)Tj ( )Tj ET Q BT 0.15 Tw 12 0 0 12 71.88 709.08 Tm (missions d\222inspection et de contr\364le, mais bien souvent pour faire\ appliquer une politique on )Tj 0.008 Tw 0 -1.72 TD (passe aussi avec d\222autres intervenants, d\222autres minist\350res. Do\ nc je vous)Tj 0 Tw 29.037 0 Td ( )Tj 0.008 Tw 0.258 0 Td (ai parl\351 des deux lois, je )Tj 0.118 Tw -29.295 -1.72 Td [(ne )0.5(reviens )0.5(pas )0.5(dessus )0.5(mais )0.5(elles )0.5(sont )0.5(fondamentales. )0.5(Pour )0.5(nous )0.5(elles )0.5(nous )0.5(donnent )0.5(surtout )0.5(les )]TJ 0 Tw 0 -1.74 TD (outils pour faire appliquer le RSI et pour intervenir.)Tj 20.633 0 Td ( )Tj 0.071 Tw -17.633 -1.72 Td (Sur le sujet qui \351tait une des pr\351occupations sur comment faire po\ ur travailler)Tj 0 Tw 31.902 0 Td ( )Tj 0.321 0 Td (ensemble )Tj 0.251 Tw -35.224 -1.72 Td (ben je vous ai expliqu\351 qu\222on avait ces structures. On a \340 trav\ ailler sur l\222horizontalit\351, la )Tj 0.008 Tw 0 -1.72 TD (transversalit\351, travailler sur ce qui se fait d\351j\340 au niveau lo\ cal avec la Loi de la d\351centralisation et )Tj 0.264 Tw 0 -1.74 TD [(puis )0.5(surtout )0.5(les )0.5(avanc\351es )0.5(d\222une )0.5(loi )0.5(de )0.5(2004 )0.5(aut)]TJ [(our )0.5(des )0.5(pr\351fets. )0.5(On )0.5(a )0.5(une )0.5(Constitution )0.5(de )]TJ 0.063 Tw 0 -1.72 TD [(d\351l\351gation interservices. Par exemple on a un pool de s\351curit\351\ )0.5(alimentaire au niveau des pr\351fets )]TJ 0.02 Tw T* (de d\351partement constitu\351 \340 la fois par les Directions des affai\ res sanitaires et sociales de la sant\351, )Tj 0.172 Tw T* (des Directions)Tj 0 Tw ( )Tj 0.172 Tw 6.342 0 Td (des services v\351t\351rinaires et les Directions des fraudes et de la c\ onsommation. )Tj 0.053 Tw -6.342 -1.74 Td (Donc tout \347a travaille autour du pr\351fet pour essayer d\222agir \340\ la source quand on d\351tecte quelque )Tj 0 Tw T* (chose. C\222est ce que j\222appelle les pools de s\351curit\351 sanitair\ e.)Tj 23.686 0 Td ( )Tj 0.279 Tw -20.686 -1.72 Td (On a aussi un r\364)Tj (le de coordination au niveau national c\222est le Service g\351n\351ral \ du )Tj 0.08 Tw -3 -1.72 Td (gouvernement qui d\351pend du premier ministre, le SGDN. Le SGDN \351tan\ t donc la structure qui )Tj 0.013 Tw 0 -1.74 TD (quand on est en situation de crise... vous vous souvenez du tableau de t\ out \340 l\222heure, et bien c\222est)Tj 0 Tw ( )Tj 0.065 Tw 0 -1.72 TD [(la structure tout en haut ici qui est charg\351e de coordonner )0.5(et pis finalement de mettre de l\222huile )]TJ 0.104 Tw T* [(entre les diff\351rents minist\350res. Et puis on a un )0.5(certain nombre de plans de pr\351vention. On a le )]TJ 0.049 Tw T* (plan de pr\351vention pour le SRAS, pour la grippe aviaire pand)Tj 25.009 0 Td (\351mique et puis pour d\222autres plans )Tj 0.227 Tw -25.009 -1.74 Td (qui sont d\222autres plans de type variole, peste, charbon, tular\351mie\ ou d\222autres maladies non )Tj 0.154 Tw T* (infectieuses comme par exemple la canicule qui int\350grent un certain n\ ombre de logigrammes )Tj 0.027 Tw T* (organisationnels et d\351cisionnels qui pe)Tj (rmettent de pr\351ciser qui fait quoi \340 quel moment, et \340 quel )Tj 0.173 Tw T* (moment la sant\351 par exemple va passer la main au minist\350re de l\222\ Int\351rieur voire au premier )Tj 0 Tw 0 -1.74 TD (ministre.)Tj ( )Tj 0.033 Tw 3 -1.72 Td (Quelles sont rapidement les difficult\351s identifi\351es? Je vais vous \ parler tout \340 l\222heure pour )Tj 0 Tw -3 -1.72 Td (le)Tj 0.367 Tw (s mesures de sant\351 publique aux voyageurs. On a \340 la fois la probl\ \351matique de ces )Tj 0.415 Tw 0 -1.72 TD (interconnexions internationales en Europe. On a cinq )Tj /TT1 1 Tf 0 Tw 24.398 0 Td (hubs)Tj /TT0 1 Tf ( )Tj 0.415 Tw 2.554 0 Td (internationaux qui sont des )Tj 0.192 Tw -26.952 -1.74 Td (plateformes a\351roportuaires de transit majeurs. Il y en a d\222autres \ bien s\373r en Asie. Il y)Tj 0 Tw 36.728 0 Td ( )Tj 0.192 Tw 0.442 0 Td (en a )Tj 0.019 Tw -37.17 -1.72 Td (d\222autres partout mais pour l\222Europe on en a cinq principales avec \ Heathrow \340 Londres, Francfort )Tj 0.026 Tw T* (en Allemagne, Zurich en Suisse et puis aussi Schiphol \340 Amsterdam et \ puis Roissy chez nous en )Tj ET endstream endobj 231 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 232 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (117)Tj ( )Tj ET Q BT 0.027 Tw 12 0 0 12 71.88 709.08 Tm (France, Roissy)Tj 0 Tw (-)Tj 0.027 Tw (Charle de Gaulle. Et donc c\222est des probl\350mes)Tj 0 Tw 24.983 0 Td ( )Tj 0.027 Tw 0.277 0 Td (majeurs pour tracer les personnes, )Tj 0 Tw -25.26 -1.72 Td (pour identifier les personnes. )Tj ( )Tj 0.078 Tw 3 -1.72 Td (Cinquante pour cent des voyageurs de Roissy il y a 30)Tj 0 Tw ( )Tj 0.078 Tw (millions de passagers \340 peu pr\350s )Tj 0.007 Tw -3 -1.74 Td (par an et 50)Tj 0 Tw ( )Tj 0.007 Tw (pour cent des voyageurs sont en transit quand ils sont \340 Roissy c\222\ est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.007 Tw (dire qu\222en fait )Tj 0.05 Tw 0 -1.72 TD [(ils vont passer par Roissy mais )0.5(ils )0.5(arriveront )0.5(dans )0.5(un )0.5(a\351roport, )0.5(un )0.5(petit )0.5(a\351roport )0.5(en )0.5(France )0.5(X )0.5(ou )]TJ 0.231 Tw T* [(Y et il va falloir... \351videmment c\222est beaucoup plus difficile de \ )0.5(tracer \340 ce moment)]TJ 0 Tw 36.188 0 Td (-)Tj 0.231 Tw (l\340 ces )Tj 0.112 Tw -36.188 -1.72 Td (passagers, de les identifier pour les informer ou pour simplement )Tj 27.363 0 Td (les prendre en charge. Donc )Tj 0.045 Tw -27.363 -1.74 Td (c\222est le probl\350me du )Tj /TT1 1 Tf 0 Tw (screening)Tj /TT0 1 Tf 0.045 Tw (, c\222est le probl\350me d\222avoir des moyens adapt\351s, c\222est le \ probl\350me )Tj 0.06 Tw T* (d\222avoir dans les a\351roports des locaux parce que j\222ai visit\351 \ m\352me le local \340 Dallas \340 Washington )Tj 0.066 Tw T* (au mois de mai et c\222est pareil. Il y)Tj 0 Tw ( )Tj 0.066 Tw 14.422 0 Td (a le m\352me probl\350me c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.066 Tw (dire qu\222il y a des agents mais il )Tj 0.048 Tw -14.422 -1.72 Td (n\222y a pas de local pr\351cis pour isoler les personnes en quarantaine\ et au moins pour les examiner )Tj 0.07 Tw 0 -1.74 TD (de mani\350re approfondie. Enfin il y a une petite salle mais en tout ca\ s qui ne peut pas permettre )Tj 0 Tw 0 -1.72 TD (d\222accueillir tout un avion entier.)Tj 12.856 0 Td ( )Tj 0.082 Tw -9.856 -1.72 Td (Donc on a le m\352me probl\350me en France. On a le probl\350me aussi d\222\ identifier autour des )Tj 0.169 Tw -3 -1.72 Td (a\351roports des lieux o\371 on pourrait avoir \351ventuellement une qua\ rantaine quand il y a un cas )Tj 0.048 Tw 0 -1.74 TD (d\351clar\351 \340 bord puisque le principe c\222est que)Tj 0 Tw ( )Tj 0.048 Tw 17.989 0 Td (quand le cas n\222est que suspect on prenait plut\364t une )Tj 0.107 Tw -17.989 -1.72 Td [(quarantaine )0.5(\340 )0.5(domicile )0.5(sur )0.5(la )0.5(base )0.5(du )0.5(volontariat. )0.5(Bon il )0.5(y a )0.5(tout )0.5(le )0.5(probl\350me )0.5(des )0.5(conventions )]TJ 0.039 Tw 0 -1.72 TD (avec les m\351decins, avec les h\364pitaux pour les prises en charge. On\ a le probl\350me tr\350s clairement )Tj 0.036 Tw T* (pos\351 par a)Tj (ussi le R\350glement sanitaire international qui est)Tj 0 Tw 23.282 0 Td (-)Tj 0.036 Tw (ce qu\222on peut faire ou est)Tj 0 Tw (-)Tj 0.036 Tw (ce qu\222on ne )Tj 0.017 Tw -23.282 -1.74 Td (peut pas faire un examen invasif et notamment un pr\351l\350vement oroph\ aryng\351 puisque dans la liste )Tj 0.013 Tw T* (des choses qu\222on peut faire pour lesquelles le RSI nous dit qu\222eff\ ective)Tj (ment qu\222on consid\350re que )Tj 0.14 Tw T* (cet examen n\222est pas invasif, il n\222y a pas de pr\351l\350vement or\ opharyng\351. Donc il y a l\222examen )Tj 0.318 Tw T* (buccal oui. Il y a les examens des urines, des selles, mais il n\222y a \ pas le pr\351l\350vement )Tj 0.09 Tw 0 -1.74 TD (oropharyng\351. Donc l\340 une des questions c\222est est)Tj 0 Tw (-)Tj (ce)Tj ( )Tj 0.09 Tw 21.684 0 Td (qu\222on pourra le faire quand m\352me dans le )Tj 0.004 Tw -21.684 -1.72 Td (cas du RSI ou est)Tj 0 Tw (-)Tj 0.004 Tw (ce qu\222il faut une disposition particuli\350re qu\222on pourrait prend\ re nous au titre de )Tj 0.032 Tw 0 -1.72 TD (la loi du 9)Tj 0 Tw ( )Tj 0.032 Tw (ao\373t 2004 si la personne refusait comme menace grave \340 la sant\351\ publique, mais c\222est )Tj 0 Tw T* (encore une quest)Tj (ion ouverte aujourd\222hui.)Tj ( )Tj 0.013 Tw 3 -1.74 Td (On a tout le probl\350me de la tra\347abilit\351 des voyageurs \340 post\ eriori. On a l\222exemple tous les )Tj 0.088 Tw -3 -1.72 Td (jours avec la tuberculose quand on a eu r\351cemment un probl\350me en F\ inlande avec un passager )Tj 0.023 Tw T* [(qui )0.5(revenait )0.5(et )0.5(qu\222on )0.5(a )0.5(d\351couvert )0.5(avec )0.5(une )0.5(tuber)]TJ 19.449 0 Td [(culose )0.5(multir\351sistante )0.5(et )0.5(bacillifaire. )0.5(La )0.5(question )]TJ 0.11 Tw -19.449 -1.72 Td (derri\350re c\222est effectivement comment identifier \340 posteriori no\ s deux rangs devant, deux rangs )Tj ET endstream endobj 233 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 234 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (118)Tj ( )Tj ET Q BT 0.125 Tw 12 0 0 12 71.88 709.08 Tm (derri\350re si on a des passagers. On a des listes mais les listes des c\ ompagnies ne sont pas tr\350s )Tj 0.337 Tw 0 -1.72 TD (fiables et le)Tj (s coordonn\351es qu\222on peut r\351cup\351rer comme \347a nous permette\ nt difficilement )Tj 0 Tw T* (d\222identifier les personnes.)Tj ( )Tj 0.007 Tw 3 -1.74 Td (L\222information des touristes j\222en parlais. Quel est le r\364le des \ agences de voyages? Quel est )Tj 0.155 Tw -3 -1.72 Td (le r\364le qu\222on peut aussi donner comme obligation d\222information)Tj 0 Tw 26.904 0 Td ( )Tj 0.155 Tw 0.405 0 Td (pour les ventes en ligne sur )Tj 0.001 Tw -27.309 -1.72 Td [(Internet )0.5(qui )0.5(seront )0.5(de )0.5(plus )0.6(en )0.6(plus )0.6(fr\351quentes. )0.5(Et )0.5(puis )0.5(enfin )0.5(le )0.5(passager )0.5(en )0.5(transit. )0.5(Le )0.5(RSI )0.5(nous )0.5(dit )]TJ 0.08 Tw T* (qu\222il va voyager et qu\222il peut poursuivre son voyage, qu\222il n\222\ y a pas de probl\350mes particuliers. )Tj 0.021 Tw 0 -1.74 TD (Effectivement c\222est un cas )Tj (suspect. M\352me s\222il est suspect \340 priori dans le temps du voyage\ il a le )Tj 0.068 Tw 0 -1.72 TD (temps d\222arriver avant d\222\352tre infectieux. Ceci dit il faut encor\ e convaincre \340 la fois l\222a\351roport de )Tj 0.025 Tw T* (destination, le toucher, et surtout le commandant de bord puisque le com\ mandant de b)Tj 34.786 0 Td (ord a cette )Tj 0.031 Tw -34.786 -1.72 Td [(capacit\351 )0.5(de )0.5(garantir... )0.5(a )0.5(cette )0.5(obligation )0.6(de )0.5(garantir )0.5(la )0.5(s\351curit\351 )0.5(des )0.5(gens )0.5(qui )0.5(seront )0.5(dans )0.5(sa )0.5(cabine )]TJ 0 Tw 0 -1.74 TD (pendant le temps du voyage. Donc il pourrait tr\350s bien refuser de pre\ ndre le passager.)Tj 34.154 0 Td ( )Tj 0.134 Tw -31.154 -1.72 Td (Pour les biens je serai plus bref. Notre principale dif)Tj 22.086 0 Td (ficult\351 c\222est que pour l\222instant on )Tj 0.065 Tw -25.086 -1.72 Td (\351tait concentr\351. Nos actions de contr\364le sanitaire en fronti\350\ re, d\351moustification, d\351sinsectisation )Tj 0.164 Tw 0 -1.72 TD (sont des actions qui sont men\351es en routine soit par la Direction d\351\ partementale des affaires )Tj 0.174 Tw 0 -1.74 TD (sanitaires et sociales dan)Tj (s les d\351partements mais uniquement pour les gros a\351roports \340 tr\ afic )Tj 0.065 Tw 0 -1.72 TD (international et donc principalement Roissy actuellement et Orly pour no\ us. Et maintenant il va )Tj 0.181 Tw T* (falloir \351tendre ces mesures)Tj 0 Tw 11.231 0 Td (-)Tj 0.181 Tw (l\340 a beaucoup d\222autres a\351roports du fait d\222une part qu\222il\ y a de)Tj 0 Tw 27.379 0 Td (s )Tj 0.249 Tw -38.611 -1.72 Td (liaisons indirectes avec des transits, mais d\222autre part parce qu\222\ on doit mettre \347a au point )Tj 0.199 Tw 0 -1.74 TD (d\222entr\351e de tout ce qui peut rentrer m\352me indirectement mais av\ ec un point d\222entr\351e sur le )Tj 0 Tw 0 -1.72 TD (territoire et de la m\352me fa\347on sur les points de sortie. )Tj 21.493 0 Td ( )Tj 0.036 Tw -18.493 -1.72 Td (Et puis on a)Tj 0 Tw ( )Tj 0.036 Tw 5.143 0 Td (encore plus difficile pour l\222instant comme )Tj /TT1 1 Tf 0 Tw (challenge)Tj /TT0 1 Tf ( )Tj 0.036 Tw 21.439 0 Td (c\222est de mettre \347a aussi )Tj 0.153 Tw -29.583 -1.72 Td [(sur )0.5(l\222ensemble )0.5(des )0.5(ports )0.5(\340 )0.5(trafic )0.5(international )0.5(puisque )0.5(jusqu\222\340 )0.5(maintenant )0.5(on )0.5(estimait )0.5(que )0.5(les )]TJ 0.195 Tw 0 -1.74 TD (d\351lais nous permettaient quand m\352me en g\351n\351ral d\222avoir un\ e application plus strict)Tj 35.332 0 Td (e sur les )Tj 0.236 Tw -35.332 -1.72 Td (a\351roports mais c\222est vrai que sur les ports on avait moins d\222ac\ tion muscl\351e, d\222intervention )Tj 0 Tw 0 -1.72 TD (muscl\351e pour garantir le c\364t\351 exempt de germes, exempt d\222ins\ ectes. )Tj 27.323 0 Td ( )Tj 0.112 Tw -24.323 -1.72 Td (Donc pour \347a on doit faire \351videmment tout un tas d\222\351volutio\ n et de concertation avec )Tj 0.033 Tw -3 -1.74 Td (nos partenaires. Sur le mat\351riel biologique j\222ai parl\351. Et les \ donn\351es personnelles le probl\350me on )Tj 0.054 Tw T* (a aussi chez nous une Commission nationale informatique et libert\351 et\ effectivement \347a pourrait )Tj 0.134 Tw T* (poser probl\350me si on levait les secrets avec des listes nomin)Tj (atives. Ceci dit dans un cadre de )Tj 0.002 Tw T* (menaces sanitaires et dans le cadre de la Loi de 2004 il est possible \340\ l\222InVS d\222obtenir ces listes \340 )Tj ET endstream endobj 235 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 236 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (119)Tj ( )Tj ET Q BT 0.225 Tw 12 0 0 12 71.88 709.08 Tm (des fins d\222investigation de sant\351 publique avec bien s\373r une co\ nsigne pour une destruction )Tj 0 Tw 0 -1.72 TD (ult\351rieure.)Tj ( )Tj 0.037 Tw 3 -1.72 Td (Donc sur le finan)Tj (cement, le partage des frais, l\340 aussi on a un vote annuel. Je vous d\ isais )Tj 0.063 Tw -3 -1.74 Td (tout \340 l\222heure chaque ann\351e on doit travailler \340 pr\351sente\ r ce rapport. On a des objectifs qui sont )Tj 0.089 Tw T* (d\351finis et donc chaque ann\351e aussi on doit dire comment on a attei\ nt, \340 quel degr\351)Tj 0 Tw 34.041 0 Td ( )Tj 0.089 Tw 0.339 0 Td (on a atteint )Tj 0.136 Tw -34.38 -1.72 Td (nos objectifs et puis on doit enfin d\222essayer de travailler en amont \ puisqu\222il y a une sorte de )Tj 0.291 Tw T* (mission veille et s\351curit\351 sanitaires qui d\351passe le minist\350\ re de la Sant\351 et donc on doit )Tj 0.17 Tw 0 -1.74 TD [(\351videmment )0.5(int\351grer )0.5(les )0.5(contributions )0.5(des )0.5(uns )0.5(et )0.5(les )0.5(au)]TJ 23.295 0 Td [(tres )0.5(\340 )0.5(l\222am\351lioration. )0.5(Donc )0.5(la )0.5(part )0.5(de )]TJ -23.295 -1.72 Td (l\222agriculture par exemple qui a travaill\351 \340 son plan d\222urgen\ ce pour la pr\351vention d\222influenza )Tj 0.044 Tw 0 -1.72 TD (aviaire en France, on a eu cette alerte au mois de mars de l\222ann\351e\ derni\350re et donc on a bien s\373r )Tj 0.006 Tw T* (tout int\351r\352t \340 travailler)Tj 0 Tw 8.929 0 Td ( )Tj 0.006 Tw 0.256 0 Td (ensemble pour voir qui contribue \340 quoi et dans quel domaine et pour \ quel )Tj 0 Tw -9.185 -1.74 Td (montant.)Tj ( )Tj 0.122 Tw 3 -1.72 Td (C\222est un peu le r\351sum\351 de ce qu\222on est en train d\222essayer\ de mettre en place. Donc la )Tj 0.119 Tw -3 -1.72 Td (transversalit\351 bien s\373r, le travail en interminist\351rialit\351 q\ uelque chose d\222assez nouve)Tj 34.374 0 Td (au aussi en )Tj 0.116 Tw -34.374 -1.72 Td (France, le travail p\351dagogique, d\222explication des enjeux du RSI, d\ u r\350glement pour \351viter que )Tj 0.067 Tw 0 -1.74 TD (chaque administration aille jusqu\222\340 la validation compl\350te de t\ out le signal avant de transmettre )Tj 0.036 Tw 0 -1.72 TD (au point focal national et \347a c\222est \351videmment quelq)Tj 21.166 0 Td (ue chose de tr\350s d\351licat puisque derri\350re il y )Tj 0.029 Tw -21.166 -1.72 Td (a des engagements. Il y a des cons\351quences financi\350res. Il y a \351\ ventuellement si on communique )Tj 0.019 Tw T* (trop t\364t, on a jou\351 la transparence pour donner un exemple avec le\ cas de Versailleux dans l\222Ain. )Tj 0.061 Tw 0 -1.74 TD (Vous savez qu\222on)Tj 0 Tw ( )Tj 0.061 Tw 7.598 0 Td (l\222a tout de suite transmis en disant qu\222on avait un \351levage de \ dindes qui \351tait )Tj 0.012 Tw -7.598 -1.72 Td (contamin\351es. \311videmment derri\350re il y a des r\351percussions en\ termes d\222arr\352t des importations, de )Tj 0.005 Tw 0 -1.72 TD (tas de pays qui se sont aussit\364t positionn\351s en disant ben nous on\ mangera plu)Tj 31.237 0 Td (s de poulet fran\347ais )Tj 0.11 Tw -31.237 -1.72 Td (alors que c\222\351tait un \351levage de dindes ponctuel dans l\222Ain d\ onc qui est un d\351partement quand )Tj 0.023 Tw 0 -1.74 TD (m\352me relativement circonscrit. Et l\340 c\222\351tait l\222ensemble d\ u poulet de la fili\350re de production et de )Tj 0.11 Tw 0 -1.72 TD (l\222exportation du poulet fran\347ais qui \351tait)Tj 0 Tw 16.629 0 Td ( )Tj 0.11 Tw 0.36 0 Td (vis\351. Donc on voit bien que c\222est tr\350s difficile et que )Tj 0 Tw -16.989 -1.72 Td (c\222est pas simple de prendre une d\351cision de communication d\222inf\ ormation.)Tj 29.88 0 Td ( )Tj 0.075 Tw -26.88 -1.72 Td (On a effectivement une toute nouvelle structure aussi qu\222il faudra co\ nsulter puisqu\222on a )Tj 0.056 Tw -3 -1.74 Td (la Haute autorit\351 de sant\351 qui doit \352)Tj 14.584 0 Td (tre consult\351e quand on prend des mesures de sant\351 publique )Tj 0.112 Tw -14.584 -1.72 Td (notamment une urgence et donc il faudra voir comment on l\222associe aus\ si \340 cette consultation )Tj 0.043 Tw T* (avant transmission, ou avant ou apr\350s transmission. Et donc ces nivea\ ux de validation je vous ai )Tj 0 Tw T* (dit tou)Tj (t \340 l\222heure qu\222ils sont fondamentaux.)Tj ( )Tj ET endstream endobj 237 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 238 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (120)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (Peut)Tj (-)Tj 0.052 Tw (\352tre trois propositions \340 l\222OMS puisqu\222on a la chance qu\222\ ils soient avec nous, donc )Tj 0.013 Tw -3 -1.72 Td (travailler sur effectivement cette harmonisation europ\351enne aux point\ s d\222entr\351e/sortie par rapport )Tj 0.025 Tw 0 -1.72 TD (au probl\350me du trafic internat)Tj (ional. C\222est vrai que c\222est assez peu pour nous... moi je suis le \ seul )Tj 0.134 Tw 0 -1.74 TD (repr\351sentant ici de la Vieille Europe et c\222est une petite structur\ e avec beaucoup, beaucoup de )Tj 0.013 Tw 0 -1.72 TD (pays et de liaisons donc les liaisons sont \351normes entre les pays et \ la France a des front)Tj 35.018 0 Td (i\350res avec )Tj 0.21 Tw -35.018 -1.72 Td (plus de six pays diff\351rents. Donc bien \351videmment on va pas fermer\ les fronti\350res, et bien )Tj 0.089 Tw T* (\351videmment on ne peut pas prendre des mesures comme \347a, mais il va\ falloir qu\222on travaille \340 )Tj 0 Tw 0 -1.74 TD (harmoniser pour qu\222aux points d\222entr\351e... )Tj ( )Tj 0.157 Tw 3 -1.72 Td (Je vous ai parl\351 d)Tj (\222Amsterdam, je vous ai parl\351 de Francfort, de Zurich. Il y a Rome,\ )Tj 0.035 Tw -3 -1.72 Td (pareil Barcelone ou d\222autres. Il va falloir qu\222on travaille ensemb\ le pour qu\222on prenne les m\352mes )Tj 0.006 Tw 0 -1.72 TD (dispositions \340 tous les points d\222entr\351e par exemple il ne s\222\ agirait pas que les Anglais lais)Tj 35.383 0 Td (sent... on )Tj 0.036 Tw -35.383 -1.74 Td (va dire Neuchatel pour le trafic trans)Tj 0 Tw 14.875 0 Td (-)Tj 0.036 Tw (Manche ouvert et pis que la France d\351cide de fermer parce )Tj 0.003 Tw -14.875 -1.72 Td (qu\222\340 ce moment)Tj 0 Tw (-)Tj 0.003 Tw (l\340 il y aurait comme un probl\350me diplomatique. Donc on doit vraime\ nt travailler )Tj 0 Tw T* (l\340)Tj (-)Tj (dessus.)Tj ( )Tj 0.058 Tw 3 -1.72 Td (Le deuxi\350me point c\222est... Alors \340 la fois)Tj 0 Tw 16.679 0 Td ( )Tj 0.058 Tw 0.308 0 Td (on va travailler au niveau entre nous, je pense, )Tj 0.102 Tw -19.987 -1.74 Td (mais je pense qu\222il y a un r\364le important pour au moins l\222OMS E\ urope \340 jouer l\340)Tj 0 Tw 33.908 0 Td (-)Tj 0.102 Tw (dessus et le )Tj 0.105 Tw -33.908 -1.72 Td (CDC et je pense que de c\364t\351)Tj 0 Tw (-)Tj 0.105 Tw (l\340 on doit travailler ensemble puisqu\222on a un centre europ\351en d\ e )Tj 0.091 Tw T* (contr\364le des maladie)Tj (s maintenant. Le deuxi\350me point c\222est le renforcement des obligati\ ons des )Tj 0.202 Tw T* (compagnies de transport et de voyages. Je ne reviens pas dessus. Je vous\ ai dit que c\222\351tait )Tj 0.002 Tw 0 -1.74 TD (important pour nous pour assurer \340 la fois l\222information aux voyag\ eurs et la tra\347abilit\351 s)Tj 35.189 0 Td (i on a des )Tj 0 Tw -35.189 -1.72 Td (cas suspects.)Tj ( )Tj 0.126 Tw 3 -1.72 Td (Et le troisi\350me point important pour nous c\222est le centre RSI de l\ \222OMS. Pour nous on )Tj 0.004 Tw -3 -1.72 Td (pousse effectivement pour qu\222il y ait une implantation sur le pool de\ Lyons d\222un centre qui aurait )Tj 0.114 Tw T* [(pour )0.5(mission )0.5(d\222aider )0.5(les )0.5(maillons )0.5(faibles )0.5(puisq)]TJ 19.345 0 Td [(u\222on )0.5(n\222est )0.5(jamais )0.5(aussi )0.5(fort )0.5(qu\222on )0.5(a )0.5(la )0.5(force )0.5(du )]TJ 0.036 Tw -19.345 -1.72 Td (maillon le plus faible en termes de vigilance pour aider les maillons fa\ ibles justement \340 )Tj /TT1 1 Tf 0 Tw 35.613 0 Td (capacity )Tj -35.613 -1.72 Td (building)Tj /TT0 1 Tf ( )Tj 0.08 Tw 3.664 0 Td (et surtout en termes de surveillance, d\351tection, signalement et gesti\ on \340 la fois pour la )Tj 0 Tw -3.664 -1.72 Td (formation)Tj (, la coop\351ration technique ou l\222aide financi\350re.)Tj 22.546 0 Td ( )Tj 0.259 Tw -19.546 -1.74 Td (Voil\340. Donc c\222est un peu les points importants. Le dernier point q\ ue je rajouterais )Tj 0.036 Tw -3 -1.72 Td (effectivement c\222est que vu ce qui a \351t\351 dit ce matin par St\351\ fano, si on a une r\351gion OMS Europe )Tj 0.004 Tw 0 -1.72 TD (comme une r\351gion OMS ailleu)Tj (rs qui est le point focal... le point de contact pour les points focaux \ )Tj 0.162 Tw T* [(nationaux, il faut absolument qu\222on ait un syst\350me concert\351 )0.5(et )0.5(coh\351rent )0.5(avec )0.5(le )0.5(dispositif )0.5(de )]TJ ET endstream endobj 239 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 240 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (121)Tj ( )Tj ET Q BT 0.152 Tw 12 0 0 12 71.88 709.08 Tm [(signalement qu\222on a au sein de )0.5(l\222Union europ\351enne puisqu\222on a effectivement tout un tas de)]TJ 0 Tw 39 0 Td ( )Tj -39 -1.72 Td (dispositifs et de r\351seaux d\222information. )Tj (Voil\340. Je vous remercie.)Tj ( )Tj 3 -1.72 Td ( )Tj 0 -1.74 TD (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj 0.075 Tw 0 -1.72 TD (Thank you very much. I\222ve been informed by Dr.)Tj 0 Tw 20.372 0 Td ( )Tj 0.075 Tw (Lazzari we do have a little extra time )Tj 0.053 Tw -23.372 -1.72 Td (so if we have some time for questions and comments. Thank you very much.\ It was a ver)Tj 36.531 0 Td (y nice )Tj 0 Tw -36.531 -1.72 Td (presentation. Dr.)Tj ( )Tj (Lazzari.)Tj ( )Tj 3 -1.74 Td ( )Tj T* (Questions and Answers)Tj ( )Tj T* (SL:)Tj 1.445 0 Td ( )Tj 0.007 Tw 7.555 0 Td (I\222m going to ask the question in English if you allow so that people \ )Tj 0.084 Tw -12 -1.72 Td (can take... It\222s actually a very simple question. If I understood cor\ rectly then the national focal )Tj 0.027 Tw 0 -1.74 TD (point in France is the Dep)Tj (artment of General Health. But information in terms of events is likely \ )Tj 0.145 Tw 0 -1.72 TD [(to )0.5(come )0.5(to )0.5(the )0.5(InVS )0.5(or )0.5(go )0.5(through )0.6(other )0.5(surveillance )0.5(and )0.5(reporting )0.5(systems. )0.5(So )0.5(how )0.5(do )0.5(you )]TJ 0.092 Tw T* (envisage to articulate the communication between InVS or other systems a\ t local level and the )Tj 0.081 Tw T* [(Director )0.5(General )0.5(in )0.5(order )0.5(to )0.5(acquire )0.5(all )0.5(the )0.5(information )0.5(required? )0.5(Is )0.5(this )0.5(going )0.5(to )0.5(request )0.5(some )]TJ 0.21 Tw 0 -1.74 TD [(change )0.5(in )0.5(mechanism )0.5(or )0.5(some )0.5(better )0.5(articulation )0.6(of )0.5(exchange )0.5(of )0.5(information )0.5(between )0.5(these )]TJ 0.044 Tw 0 -1.72 TD (different institutions? And you\222ve mentioned other institutions as we\ l)Tj 28.181 0 Td (l would be [__] but I think )Tj 0.004 Tw -28.181 -1.72 Td (that transmission is crucial. And it might apply other countries as well\ that decide to put the focal )Tj 0 Tw T* (point not in a technical unit but in a more senior level managerial unit\ in the Ministry of Health.)Tj 38.352 0 Td ( )Tj -35.352 -1.74 Td (SV:)Tj ( )Tj 0.019 Tw 9 0 Td (Yes. That was a big de)Tj (bate, a big discussion between the InVS and )Tj 0.01 Tw -12 -1.72 Td (us and in fact in this, about 90% of signals and alerts are transmitted \ to European Commission or )Tj 0.143 Tw T* (European Union, and we only make about 10% of the French transmission. I\ t\222s about all the )Tj 0.077 Tw T* (management and the manag)Tj (ement measure. So I think we have a big discussion, but the fact is )Tj 0.037 Tw 0 -1.74 TD (the International Health Regulation does not only concern some infectiou\ s disease and that\222s the )Tj 0.031 Tw 0 -1.72 TD (main point. It can concern other administrations and nobody can understa\ nd or could underst)Tj 0 Tw 37.556 0 Td (and )Tj 0.124 Tw -37.556 -1.72 Td (why InVS can transmit some information from the directory of agriculture\ or the directory of )Tj 0.054 Tw T* (fraud, you know, customers or things like that. So it\222s not for radio\ logical and nuclear accident. )Tj 0.09 Tw 0 -1.74 TD (InVS is not competent to transmit to an authority about that)Tj 0 Tw 24.733 0 Td ( )Tj 0.09 Tw 0.34 0 Td (type of incident or event so that\222s )Tj 0.085 Tw -25.073 -1.72 Td (why the choice is to put the focal point on the Ministry of Health and n\ ot on the Institute. But )Tj 0.129 Tw 0 -1.72 TD (you\222re right. If have to move some... and to get better for transmiss\ ion and the reciprocity of )Tj ET endstream endobj 241 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 242 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (122)Tj ( )Tj ET Q BT 0.038 Tw 12 0 0 12 71.88 709.08 Tm (signals. But we have also )Tj 10.579 0 Td (some signals that we are used to give to [__] so we must improve that )Tj 0 Tw -10.579 -1.72 Td (but it\222s already possible.)Tj ( )Tj 3 -1.72 Td (RS:)Tj ( )Tj 9 0 Td (Thank you. Other comments, questions? Dr.)Tj ( )Tj ([__].)Tj ( )Tj -9 -1.74 Td (Dr.?:)Tj ( )Tj 0.077 Tw 9 0 Td (Yes. Without going into any detail I can tell you that some of the )Tj 0.035 Tw -12 -1.72 Td (questions you asked do have answer)Tj (s, some specific, some very indirect in the IHR and we\222d be )Tj 0.046 Tw 0 -1.72 TD (happy to discuss it with you specifically and some of them only have ver\ y, very vague answers, )Tj 0.105 Tw T* (and some of them actually say consult your national law which may or may\ not help, I\222m not )Tj 0.121 Tw 0 -1.74 TD (sure. It d)Tj (epends on the issue. I can tell you that under the IHR, and this was a s\ ubject of big )Tj 0.036 Tw 0 -1.72 TD (debate, they are actually listed what is invasive and what is non invasi\ ve and it was a big debate )Tj 0.014 Tw T* (because you can imagine how many doctors were involved in this and ever)Tj 30.154 0 Td (ybody, you know, has )Tj 0.015 Tw -30.154 -1.72 Td (a different view, you know, is it x)Tj 0 Tw (-)Tj 0.015 Tw (ray invasive is it not invasive? But external collection of urine )Tj 0.03 Tw 0 -1.74 TD (sample: non invasive. That much we answered specifically. But as to the \ other ones, if you want )Tj 0.084 Tw 0 -1.72 TD (to follow up later of course we can g)Tj 15.332 0 Td (o through some of the provisions and see how much help )Tj 0 Tw -15.332 -1.72 Td (they make. )Tj ( )Tj 3 -1.72 Td (SV:)Tj ( )Tj 0.011 Tw 9 0 Td (... prelevement but for old prelevement for [H_1] is not recorded in )Tj 0 Tw -12 -1.74 Td (the list of non)Tj (-)Tj (invasive examination. )Tj ( )Tj 3 -1.72 Td (Dr.?:)Tj ( )Tj 0.148 Tw 9 0 Td (These [__] swabs would be... Is that invasive or non)Tj 0 Tw 22.16 0 Td (-)Tj 0.148 Tw (invasive? I )Tj 0 Tw -34.16 -1.72 Td (rememb)Tj 0.061 Tw (er the debate really well. I was there. I think it may be bad news. If i\ nvasive means the )Tj 0.032 Tw T* (puncture or incision of the skin or insertion of an instrument or foreig\ n material into the body or )Tj 0.002 Tw 0 -1.74 TD (the examination of a body cavity, so if that involves going into s)Tj (omething like that then it may be )Tj 0.122 Tw 0 -1.72 TD (invasive. And I just want to make sure it\222s not covered in one of the\ specifics. You can do a )Tj 0.063 Tw T* (temperature assessment in somebody\222s ear but I think that\222s... wai\ t, wait... medical examination )Tj 0.128 Tw T* (of the nose. Medical examinatio)Tj 13.369 0 Td (n of the nose. Then you may have a problem. I should say it )Tj 0.012 Tw -13.369 -1.74 Td (doesn\222t mean you can\222t do it. It just means that you can\222t do i\ t on a routine basis. There has to be )Tj 0 Tw T* (a specific justification for it. That\222s the difference.)Tj 20.13 0 Td ( )Tj -17.13 -1.72 Td (Dr.?:)Tj ( )Tj 0.074 Tw 9 0 Td (Right. That was the sort of the w)Tj (ay out of the dilemma since as a )Tj 0.143 Tw -12 -1.72 Td (physician we know that a lot of our diagnostic testing depends on the ve\ na puncture and the )Tj 0.144 Tw 0 -1.74 TD (extraction of a blood sample. And technically speaking that is invasive.\ You do puncture the )Tj 0.162 Tw 0 -1.72 TD (skin. You do select blood. But again t)Tj (hat was the caveat that opened the door for a broader )Tj 0 Tw T* (interpretation. )Tj ( )Tj 3 -1.72 Td (RS:)Tj ( )Tj 9 0 Td (Other comments? )Tj ( )Tj ET endstream endobj 243 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 244 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (123)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (Dr.?:)Tj ( )Tj 0.075 Tw 9 0 Td (Thank you and I apologize if you have addressed this topic in the )Tj 0.058 Tw -12 -1.72 Td (presentation. Maybe for a point of clarification. It seems like a lot of\ this ought to be ad)Tj 0 Tw 36.001 0 Td (dressed )Tj 0.097 Tw -36.001 -1.72 Td (legislatively. I\222m just wondering how... are there any mechanisms to \ ensure that local officials )Tj 0.014 Tw 0 -1.74 TD (are able to comply with the legislation or have the capacity to comply, \ and are there any ongoing )Tj 0 Tw 0 -1.72 TD (mechanisms to ensure ongoing compliance?)Tj ( )Tj 3 -1.72 Td (SV:)Tj ( )Tj 9 0 Td (Peut)Tj (-)Tj (\352tr)Tj 0.098 Tw (e je vais r\351pondre en fran\347ais si c\222est possible. En France )Tj 0.065 Tw -12 -1.72 Td (nous avons effectivement des Directions d\351partementales des affaires \ sanitaires et sociales avec )Tj 0.092 Tw 0 -1.74 TD (des ing\351nieurs d\222\351tude et du g\351nie sanitaire, des m\351decin\ s inspecteurs de sant\351 publique. Et au )Tj 0 Tw 0 -1.72 TD (niv)Tj 0.146 Tw (eau r\351gional nous avons en plus des pharmaciens inspecteurs de sant\351\ publique. Donc ces )Tj 0.004 Tw T* (personnes qui sont des agents du minist\350re de la Sant\351 plac\351es \ au niveau local ont d\351j\340 l\222habitude )Tj 0.296 Tw T* (de travailler sur des sujets d\222infectieux. C\222est eux qui g\350rent\ la pl)Tj 29.308 0 Td (upart des )Tj /TT1 1 Tf 0 Tw (outbreaks)Tj /TT0 1 Tf ( )Tj 8.971 0 Td (et )Tj 0.07 Tw -38.278 -1.74 Td (\351pid\351mies localement soit seuls soit en lien avec l\222\311ducatio\ n nationale pour le... quand c\222est en )Tj 0.063 Tw T* (milieu scolaire ou avec la Direction des services v\351t\351rinaires qua\ nd c\222est un )Tj /TT1 1 Tf 0 Tw 31.299 0 Td (food)Tj (-)Tj 0.063 Tw (borne disease)Tj /TT0 1 Tf 0 Tw ( )Tj 0.153 Tw -31.299 -1.72 Td (et des choses comme \347a. Maintenant plu)Tj (s sp\351cifiquement par rapport \340 la mise en oeuvre de )Tj 0.097 Tw T* (l\222application du RSI aux points d\222entr\351e si les multiplie effec\ tivement sur le territoire, on a un )Tj 0.033 Tw 0 -1.74 TD (probl\350me de ressources c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.033 Tw (dire qu\222aujourd\222hui on a... C\222est pas des grosses structures. I\ l y a )Tj 0.179 Tw 0 -1.72 TD (peu d)Tj (e techniciens sur ces d\351partements)Tj 0 Tw 16.863 0 Td (-)Tj 0.179 Tw (l\340 donc c\222est s\373r qu\222ils ne pourront pas assurer des )Tj 0.185 Tw -16.863 -1.72 Td (veilles 24/24 si on ne les renforce pas. Donc il y a tout un travail pou\ r voir si on renforce )Tj 0.142 Tw T* (sp\351cifiquement ces structures lorsqu\222elles ont un a\351roport ou u\ n port \340 tr)Tj 30.525 0 Td (afic international. Et )Tj 0 Tw -30.525 -1.74 Td (c\222est en cours de d\351bat. Est)Tj (-)Tj (ce que j\222ai r\351pondu \340 la question?)Tj ( )Tj 3 -1.72 Td (Dr.?)Tj (:)Tj ( )Tj 9 0 Td (Yes, thank you very much.)Tj ( )Tj -9 -1.72 Td (RS:)Tj ( )Tj 9 0 Td (Other questions? I\222m sorry, I missed... oh yes Dr. Lazarri.)Tj ( )Tj -9 -1.72 Td ([Start of Side 10])Tj ( )Tj 0 -1.74 TD (SL:)Tj 1.445 0 Td ( )Tj 0.051 Tw 7.555 0 Td [(J\222aimerais )0.5(clarifier )0.5(quelque )0.5(chose. )0.5(Si )0.5(je )0.5(comprend)]TJ 20.323 0 Td [(s )0.5(bien )0.5(en )0.5(France )]TJ 0.24 Tw -32.323 -1.72 Td (on fait une distinction entre la d\351concentration et la d\351centralis\ ation, parce que dans votre )Tj 0.064 Tw 0 -1.72 TD [(pr\351sentation )0.5(vous )0.5(avez )0.5(utilis\351 )0.5(l\222expression )0.5(\253)]TJ 0 Tw 18.008 0 Td ( )Tj (d\351concentration)Tj ( )Tj 0.064 Tw [(\273. )0.5(Et )0.5(pour )0.5(moi )0.5(cela )0.5(sugg\350re que )0.5(le )]TJ 0.147 Tw -18.008 -1.72 Td (pouvoir ultime reste \340 Paris. Il y a des pouvoir)Tj (s qui sont exerc\351s pas \340 Paris mais au niveau )Tj 0.128 Tw 0 -1.74 TD (r\351gional ou local, mais c\222est quelque chose\205 ce pouvoir n\222es\ t pas d\351centralis\351 \340 des r\351gions. )Tj 0 Tw 0 -1.72 TD (C\222est d\351concentr\351, \347a veut dire quelque diff\351rent? Est)Tj 21.435 0 Td (-)Tj (ce que je\205)Tj ( )Tj -18.435 -1.72 Td (SV:)Tj ( )Tj 9 0 Td (Je crois que vous avez bien compris, oui, c\222es)Tj 18.272 0 Td (t)Tj (-)Tj (\340)Tj (-)Tj (dire qu\222on a\205)Tj ( )Tj ET endstream endobj 245 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 246 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (124)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (SL:)Tj 1.445 0 Td ( )Tj 0.882 Tw 7.555 0 Td (Dans ce contexte c\222est une d\351concentration, pas une )Tj 0 Tw -12 -1.72 Td (d\351centralisation?)Tj ( )Tj 3 -1.72 Td (SV:)Tj ( )Tj 9 0 Td (C\222est)Tj (-)Tj (\340)Tj (-)Tj 0.179 Tw [(dire )0.5(qu\222on )0.5(a )0.5(des )0.5(lois )0.5(de )0.5(d\351centralisation )0.5(en )0.5(83 )0.5(mais )0.5(qui )]TJ 0.314 Tw -12 -1.74 Td [(aboutissent )0.5(dans )0.5(les )0.5(faits )0.5(\340 un )0.5(\351tat )0.5(semi )0.5(d\351concentr\351 )0.5(effectivement. )0.5(Mais )0.5(l\222ensemble )0.5(des )]TJ 0 Tw 0 -1.72 TD (minist)Tj 0.046 Tw (\350res, le gouvernement, le premier ministre restent \340 Paris et on a\ des pr\351fets de r\351gion qui )Tj 0.322 Tw T* (ont de plus en plus de pouvoir mais plut\364t des pouvoirs d\222organisa\ tion par exemple de )Tj 0.022 Tw T* (l\222\351ducation, des infrastructures routi\350res, des choses comme \347\ a, mais ils n\222o)Tj 30.574 0 Td (nt pas vraiment\205 ils )Tj 0.173 Tw -30.574 -1.74 Td [(n\222ont pas pour l\222instant le pouvoir sur )0.5(tout ce qui est les choses sensibles comme justement )]TJ 0.276 Tw T* (l\222organisation des secours, l\222organisation de la sant\351, l\222or\ ganisation de tous ces dispositifs )Tj 0 Tw T* (sensibles.)Tj ( )Tj 3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 7.555 0 Td (Merci.)Tj ( )Tj -9 -1.74 Td ( )Tj T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj T* (Apologi)Tj 0.229 Tw (es to our colleague from Senegal. We will open the place first thing in \ the )Tj 0.051 Tw -3 -1.72 Td (morning for your presentation. We did build in some flexibility into the\ program so we do have )Tj 0.243 Tw 0 -1.74 TD (room to make up some of the time that we did lose today. Would you like \ to make any )Tj 0 Tw 0 -1.72 TD (c)Tj (oncluding remarks on today?)Tj ( )Tj 3 -1.72 Td ( )Tj T* (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj 0.103 Tw 0 -1.74 TD (No, I was scheduled to say a few things but I think it\222s too late to \ do that. I think you )Tj 0 Tw -3 -1.72 Td (should just focus on logistics for this evening, Kumanan.)Tj ( )Tj 3 -1.72 Td ( )Tj 0 -1.72 TD (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj 0.105 Tw 0 -1.74 TD (I hope you all received the invitation for)Tj 0 Tw 16.869 0 Td ( )Tj 0.105 Tw 0.355 0 Td (dinner to tonight at the Westin, I think it\222s at )Tj 0 Tw -20.224 -1.72 Td (7)Tj ( )Tj 0.033 Tw (o\222clock, and there\222s a map in your program... no, Chris is handing\ out the map right now. And )Tj 0.079 Tw 0 -1.72 TD (I believe all hotel issues have been resolved, is that correct? I think \ it is. Chris, all hotel issues )Tj 0.048 Tw T* (are res)Tj [(olved? I\222m asking. Yes, okay! So al hotel issues have been resolved. \ I )0.5(don\222t think there\222s )]TJ 0.215 Tw 0 -1.74 TD (anything else to discuss, so we\222ll be starting I guess breakfast agai\ n at 8:30 and hopefully )Tj 0.234 Tw 0 -1.72 TD (starting sharp at 9:00 tomorrow. And again, thank)Tj 0 Tw (-)Tj 0.234 Tw (you very much. A long )Tj (day but a very )Tj 0 Tw T* (informative day, and very useful presentations.)Tj 18.8 0 Td ( )Tj -15.8 -1.72 Td ( )Tj ET endstream endobj 247 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 248 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 296.76 36.12 18.24 13.68 re W n BT 12 0 0 12 296.76 38.76 Tm (125)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj 0 -1.72 TD (Thank)Tj (-)Tj (you. 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At least that's the feeling I ha\ ve.)Tj 28.477 0 Td ( )Tj -28.477 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.212 Tw 3 -1.72 Td (We were committed to ending by 4:00. I imagine that some of the members \ of the )Tj 0.048 Tw -3 -1.72 Td (organizing committee may want to make s)Tj 17.284 0 Td (ome final remarks, but before we do that, can I ask if )Tj 0.02 Tw -17.284 -1.72 Td (any of you want to make any final remarks on any aspect at all of the la\ st two days? This is your )Tj 0 Tw T* (last chance. Going, going, gone. Okay.)Tj ( )Tj 3 -1.72 Td (Ron, did you want to say anything final? David?)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (David Fidle)Tj (r)Tj ( )Tj /TT0 1 Tf 3 -1.74 Td (Two words. Thank you.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 3 -1.72 Td (Dr.)Tj ( )Tj 0.304 Tw (Wilson will make the last few remarks. Let me just say that I appreciate\ the )Tj 0.151 Tw -3 -1.74 Td (cooperation of the Public Health agency of Canada, and David, for your s\ upport as we were )Tj 0.183 Tw T* (developing this. This project originated wi)Tj (th Kumanan and myself. But let me also say that )Tj 0.031 Tw T* [(Kumanan )0.5(and )0.5(I )0.5(have )0.5(done )0.5(almost )0.5(no )0.5(work. )0.6(Chris, )0.5(over )0.6(here, )0.5(has )0.5(turned )0.5(out )0.5(to )0.5(be )0.5(the )0.5(doer, )0.5(so )0.5(I'd )]TJ 0.027 Tw T* [(like )0.5(to )0.5(make )0.5(special )0.5(thanks to )0.5(you )0.5(Chris )0.5(for )0.5(your )0.5(prodigious )0.5(efforts )0.5(in )0.5(helping )0.5(us )0.5(to )0.5(pull )0.5(this )0.5(off. )]TJ 0.046 Tw 0 -1.74 TD [(I'd )0.5(like )0.5(to)]TJ 0 Tw ( )Tj 0.046 Tw 4.177 0 Td [(thank )0.5(all )0.5(of )0.5(you )0.5(for )0.6(coming. )0.5(I )0.5(look )0.5(forward )0.5(to )0.5(working )0.5(with )0.5(you )0.5(as )0.5(we )0.5(move )0.5(some )0.5(of )]TJ 0.041 Tw -4.177 -1.72 Td (the products from this process to market, so to speak. Have a safe trip \ home. Again, if you have )Tj 0.011 Tw 0 -1.72 TD (any logistical questions, or questions about other things, please let us\ kn)Tj 28.978 0 Td (ow and I'll turn it over to )Tj 0 Tw -28.978 -1.72 Td (Kumanan for the final remarks.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 0.134 Tw 3 -1.64 Td (Thank you. A few final thank you's on behalf of the organizing committee\ . I'd like to )Tj 0.147 Tw -3 -1.74 Td (thank all of our funders. We had several different sources off support, \ and the Public Heal)Tj 0 Tw 38.222 0 Td (th )Tj -38.222 -1.72 Td (Agency has provided us with support, IDRC for providing the room...)Tj ( )Tj T* (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (And some money!)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.026 Tw 1.056 0 Td (And some money. ...The Canadian International Development Agency, Canadi\ an Service )Tj 0 Tw -3 -1.74 Td (for Health Research also provided support.)Tj ( )Tj ET endstream endobj 326 0 obj <> endobj 327 0 obj <>stream HV PVν?"QT6;fܗDQ .5UԆTCjDkShݵ.Q+Z&v{澹s=wy3~:x9Q=Y~UiWs߽ۉSLU$724;+cՁ3#d͍j|gή~@ue9kǴwꃶߜ[gd/({ԁM2f秡h{& vxyvjy#g=>^ h&h@4Cs=Ah 'BWn C8Z!BkAC{t@ :}ΈEtE7tGWGܿG_F}D:Wha@u󾫏œkuS1Xճf` w81Bi$K !no+邾KߛM:iFܕ(7, Fb㔀IzYdvvgy)@4,ZlaT29fV:#:3.~ 5/cG{Tb}7&"{MI1RNS|)>V L,M-Ty|b%Nx RZ 98k8LMK@'z$).4}J|HL*NY{<TPQF6X8gbJ-# !3-˗crK5SN5\ӥJkLdd,RYCTJ8IUTg0=ZF8n0]]7uO K_'TSRCIce̓"y_6+>Ϸ4.78đx*1Ӧܴ$%)岖A#Ҟ&*2"B&QԱܰ=׾ԡóٲBզwE#H0))<-O5{cLsb7?7+L˶mɞfl_n #SV/U2ʈVEb_5bhRyEީ v<{(7/}RM u*@:nRUgܢn(*%CFc,Hc|k cYHC}ɗQa6!K:S؃xOh%OU*l]2:ZYd)P ؆;Eh|ͱ;v1?7Ap@`q1+Ջ;p6Tj]G}PJ$x2!NKKz ][ҟ7u?:)Pb()1=W %Lf?q2IV5Zo֙#H~⏣^bYUIëHc+"퉦J3,2?6wGӶvͬ(Sv d_{b=IaS}= n'#əŖ!gD|e423<{QN_ agbbŝ󈠟Ī\箳ŬǨ5c&Ʋ:.5?x\e%"$pN]n{VȧE L܎e`#64QP 7eCDϨ4,-O2˹9+y^Q?$T}<0زJ_9°މg+0ٳ'%ia-;Ȃ8՛aĤ2'<6N R_̻}?T.͂ a26`3>(1T%ހɾ[<*ֻJm1ONjv+V{n#W*U5Q({Id: 3q|23ˉm,ΡO6zmx⬒Z)R!:(_%d[mfros! 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H-E&\u;t@A',.zVjX෬u0al 8o0)pym2 J-2($,Q6pzI ;'gծ.x-+smdݓV0f k;&3-ށcT]OfŁNwj-v/Tb;Aك:-#ށsIY^oyPNrխRKqDֿ] cٮئ3|>?Z96ܐĽ!esW!Pi[GRԙՒa4UaImҍ V[i4k7jRBp61dlmUZʞsd=s|sspy*^pyU&ɓ3YA>oHWhEyV㝀 '\_8ׂ(+43d?h)+i0QG~U~dp5+%y,dߒȰͳ!<˹bt>PQ0q%Qa&}:!6V?N*$I`X밮 5mLak-=4k_%9` !IymDcy}~+Qt|*ZPx }1m>Ȟa=s_'+}_z%_D@wWZ6{G46a8;_ӝ-bo7 u.*4RXrfeo7'r"Wuj|^MRDJղ~mҹZULj $79m׳mQoކkִ9iћa9*'gdn`.w {lI]+1ݕ+ W tG׀I`"6@7Q`1ވqgwi3w ;p\^~ArA?쟓w/'39nw;ιnitxlk&]Ţ#YpN[A2 9] VWAp\WP ]Q;ʂP((GGl4&trBg9z ąD߸_]7W[6S[p\Yl\FyDEfpУKBy6w.>xGB%+B- d@DСJFY\|%io)&/R#gKe"(ܡ3'Y9V/x~]>Xm?#VU*W*Q`XD*IV375hhQ]81e싸tF?4+ߣQD85u ^666΅ѰX6 P1"[n׼О2>   oBWCF{6O sjn=+E+WL2@|ÌeLiaej dL%!2@TQeE :UZ.Ch+9(O|,Ӌ wdL7I3cOo K%4 S>WBt %n}7Dr4cҌB~Ud rLB~!7 2Gb:sQWjL2 鑩V%7Tםtd41u˴ى|tcUG~HԒWA]7;ttHG[BK+n11mcX,SsF i8 ^uZIUώZE:Ji*4C"XFiYqq?N藥cTcVjgGYQL/1o Vi6ذpRub;ęr=Iq*V`ӏl}AS8?@C8 IH5v;/v[ŷ0NyTtꌷģzzF'tÆVC5 \Z:75% 4 `#rL)1oa4f !xiV%CېzJʫ>0`#U2' F Vzc DƼl,_-JK#,1cD!wʺSҝ28mT4~7(jv*EC/PSQ9Yݎwxse[6uo3;^o2C;2U k(Ы^5* ݰƣQbb71x[JJL3嫳8%/zNƙ/x rz%xQz '}I;ZI^4I" °w]k2G0 e clX̒yyo'ob02FN- ,'^|~x?=#+.;Pwv̮3Վz^uzWj'MBhSSgAӌsF`0S@ 8/2XLgAu9%0|XgG?[$ endstream endobj 328 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (93)Tj ( )Tj ET Q BT 0.028 Tw 12 0 0 12 71.88 709.08 Tm (over 20,000 doses, but that was)Tj 0 Tw ( )Tj 0.028 Tw 13.001 0 Td (inadequate because used almost 100,000 to 200,000 doses in the )Tj 0.053 Tw -13.001 -1.72 Td (field. If at that time it had happened, then it would have become endemi\ c in that area in respect )Tj 0 Tw 0 -1.72 TD (to many more statistics, and probably we'd be still fighting it.)Tj 24.51 0 Td ( )Tj 0.235 Tw -21.51 -1.74 Td (I think a similar thing has h)Tj (appened in Indonesia where initially they did not have )Tj 0.037 Tw -3 -1.72 Td (Tamiflu, and they did not have any protection for the healthcare workers\ to go into the field and )Tj 0.063 Tw T* (do stamping\(?\) out of patients. I think later on Australia did help a \ lot in doing that, but I think )Tj 0 Tw T* (th)Tj (at delay of an initial few months has made it endemic in that area.)Tj 27.102 0 Td ( )Tj -24.102 -1.74 Td (I think we have to look at it in those areas also.)Tj 18.829 0 Td ( )Tj -21.829 -1.72 Td ( )Tj /TT1 1 Tf T* (Ms Cath Halbert)Tj /TT0 1 Tf (\(?\))Tj ( )Tj 0.07 Tw 3 -1.72 Td (It may also be useful, while we need to identify the resources available\ , would it not be )Tj 0.028 Tw -3 -1.74 Td (useful to look at where it )Tj 10.39 0 Td (may be happening already, and look at what is working, where there is )Tj 0 Tw -10.39 -1.72 Td (good capacity building that's working across the world?)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Sampath K. Krishnan)Tj ( )Tj /TT0 1 Tf 0.084 Tw 3 -1.66 Td (Okay. Of course we thought about this a bit in _____ with ___, and the l\ ogical process )Tj 0.089 Tw -3 -1.72 Td (would be to identi)Tj [(fy what actually the requirements are in more operational and )0.5(organizational )]TJ 0.117 Tw T* (terms in countries. Then, as you know, the IHR calls for assessments to \ be conducted in ever )Tj 0.242 Tw 0 -1.74 TD (country to see if this capacity is there at present or not. It's only af\ ter you conduc)Tj (t these )Tj 0.108 Tw 0 -1.72 TD (assessments based on theses sorts of requirements that we have to still \ clearly refine, that you )Tj 0.119 Tw T* (could do some costing. No country's starting from scratch. Many of these\ things already exist )Tj 0 Tw T* (and might not require a major investment.)Tj 16.801 0 Td ( )Tj 0.03 Tw -13.801 -1.74 Td (Some might requ)Tj (ire a major investment, you know, labs and things like that. And only at\ )Tj 0.053 Tw -3 -1.72 Td (that point, really, you could make a cost for implementing the IHR. How \ this could be covered, )Tj 0.091 Tw T* (that's also been the object of a lot of discussion. There were talks abo\ ut a global fund)Tj 0 Tw 35.43 0 Td ( )Tj 0.091 Tw 0.341 0 Td (for IHR )Tj 0.016 Tw -35.771 -1.72 Td (implementation. But global funds are not really popular nowadays with ma\ jor donor agencies, so )Tj 0.026 Tw 0 -1.74 TD (there might be other mechanisms and such. There's been quite a lot of ta\ lk also about mobilizing )Tj 0 Tw 0 -1.72 TD (resources for avian flu that has led to some sort of un)Tj (ique system.)Tj ( )Tj 0.065 Tw 3 -1.72 Td (But in defence, I think it will be very difficult, if not even impossibl\ e, to estimate today )Tj 0.03 Tw -3 -1.72 Td (what will be the cost of implementing the IHR based on the tests and the\ requirements. I think it )Tj ET endstream endobj 329 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (92)Tj ( )Tj ET Q BT 0.165 Tw 12 0 0 12 71.88 709.08 Tm (not just a problem with donor countries like the United States with rega\ rds to these specific )Tj 0 Tw 0 -1.72 TD (issues.)Tj ( )Tj 0.019 Tw 3 -1.72 Td (One of the )Tj (problems that I have encountered at virtually every meeting that I go to\ on the )Tj 0.018 Tw -3 -1.74 Td [(IHR )0.5(with )0.5(regards )0.5(to )0.5(building )0.5(core )0.5(surveillance )0.6(and )0.6(response )0.5(capacity )0.5(is )0.6(the )0.5(need )0.5(for )0.5(a )0.5(significant )]TJ 0.062 Tw T* (amount of resources to help developing countries engage in this. Even wi\ th th)Tj 31.878 0 Td (e recognition that )Tj 0.073 Tw -31.878 -1.72 Td (the primary financial responsibility lies with each individual state, it\ 's been clear since the very )Tj 0.058 Tw T* (beginning of this revision process that there is a need for significant \ financial assistance to help )Tj 0 Tw 0 -1.74 TD (developing countries do that.)Tj ( )Tj 0.142 Tw 3 -1.72 Td [(The )0.5(p)]TJ [(roblem )0.5(is )0.5(identifying )0.5(where )0.5(that )0.5(money )0.5(is )0.5(going )0.5(to )0.5(come )0.5(from, )0.5(particularly )0.5(in )0.5(a )]TJ 0.243 Tw -3 -1.72 Td (global health context in which you have had enormous increases in the am\ ount of money )Tj 0.007 Tw 0 -1.72 TD (available for global health projects, both from governments and non)Tj 0 Tw 27.275 0 Td (-)Tj 0.007 Tw (governmental organizat)Tj 0 Tw (ions, )Tj 0.079 Tw -27.275 -1.74 Td (very little of which, I'm told by Public Health experts who work on this\ , contribute to building )Tj 0.007 Tw T* [(core )0.5(capacities )0.5(for )0.5(surveillance )0.5(and )0.5(response. )0.5(It's )0.5(either )0.7(for )0.6(purposes )0.6(of )0.6(buying )0.6(anti)]TJ 0 Tw 33.218 0 Td (-)Tj 0.006 Tw (retrovirals, or )Tj 0 Tw -33.218 -1.72 Td (it's a vertical, disease)Tj (-)Tj (specific project.)Tj ( )Tj 0.08 Tw 3 -1.72 Td (Even in)Tj 0 Tw ( )Tj 0.08 Tw 3.492 0 Td (a context where you have enormous amount of new money flowing into globa\ l )Tj 0.058 Tw -6.492 -1.74 Td [(health, very little of it )0.5(seems )0.5(to )0.5(be )0.5(addressing )0.5(the )0.5(needs )0.5(identified )0.5(by )0.5(the )0.5(IHR. )0.5(I )0.5(think )0.5(there )0.5(is )0.5(a )]TJ 0.313 Tw T* (significant and urgent need to identify those resources, calculating rou\ ghly how)Tj 0 Tw 34.985 0 Td ( )Tj 0.313 Tw 0.563 0 Td (much is )Tj 0.05 Tw -35.548 -1.72 Td [(required, )0.5(and )0.5(then )0.5(thinking )0.5(about )0.5(creating )0.6(some )0.5(types )0.5(of )0.6(financing )0.5(mechanisms. )0.5(Otherwise, )0.6(that )]TJ 0.047 Tw T* [(aspect of the IHR will go unanswered. I think that's one of the biggest \ achilles heels of )0.5(this )0.5(as )0.5(a )]TJ 0 Tw 0 -1.74 TD (sustainable matter.)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Sampath K. Krishnan)Tj ( )Tj /TT0 1 Tf 0.076 Tw 3 -1.72 Td (I agree)Tj 0 Tw ( )Tj 0.076 Tw 3.15 0 Td (with what David says. What are the examples in India to be faced? A lot \ of our )Tj 0.216 Tw -6.15 -1.74 Td [(external funding has been for capacity building, so that definitely )0.5(is )0.5(an area which is very )]TJ 0 Tw T* (important.)Tj ( )Tj 0.031 Tw 3 -1.72 Td [(Regarding the avian influenza, the country was )0.5(going through a transitio)]TJ 29.271 0 Td (n and luckily we )Tj 0.134 Tw -32.271 -1.72 Td (were pushing for the ______ plans, both from the animal husbandry side a\ s well as from the )Tj 0.065 Tw 0 -1.74 TD (health side. These were already... well in time. Suppose the outbreak ha\ d hit is in, say, October )Tj 0.096 Tw 0 -1.72 TD (or November. We finalized it around December. Indi)Tj (a would not have been prepared to tackle )Tj 0.005 Tw T* (that avian influenza outbreak. We did not have _PP. We did not _____ ___\ __ forever\(?\), because )Tj 0.123 Tw T* (it would have wandered the field. We did not have Tamiflu. Now, the ____\ _ _____ provided )Tj ET endstream endobj 330 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (91)Tj ( )Tj ET Q BT 0.017 Tw 12 0 0 12 107.88 709.08 Tm (I have three points for follow up which are more related to WHO, what I \ think we should )Tj 0.012 Tw -3 -1.72 Td (do. One is that we will have, even if the text of the IHR does not addre\ ss Fede)Tj 31.449 0 Td (ral States, thinking )Tj 0.227 Tw -31.449 -1.72 Td (about implementation we will have to consider how this applies to the sp\ ecial situation of )Tj 0.061 Tw 0 -1.74 TD [(Federal )0.5(States )0.5(and )0.5(maybe )0.5(get )0.5(some )0.5(guidance )0.5(there )0.5(as )0.5(well. )0.6(I )0.5(think )0.5(if )0.5(we )0.5(try )0.5(to )0.5(do )0.5(that, )0.5(many )0.5(of )]TJ 0.072 Tw 0 -1.72 TD (you might be involved in reviewing this, and we )Tj (will try to use your experience, expertise, and )Tj 0.04 Tw T* (knowledge of the situation, and also how you are involved in the thinkin\ g about your country to )Tj 0 Tw T* (provide some guidance about this.)Tj ( )Tj 0.022 Tw 3 -1.74 Td (I think we do need an advocacy strategy for IHR that, as I said before, \ has to)Tj 0 Tw 31.012 0 Td ( )Tj 0.022 Tw 0.272 0 Td (be touching )Tj 0.025 Tw -34.284 -1.72 Td [(on different sectors, but also different levels in government and instit\ utions. This )0.5(may go in very )]TJ 0.105 Tw T* [(many )0.5(different )0.5(ways. )0.5(I )0.5(think )0.5(we )0.5(have )0.5(to )0.5(think )0.5(as )0.5(an )0.5(organization )0.5(with )0.5(colleagues )0.5(and )0.5(partners )]TJ 0 Tw T* (how best to do that.)Tj ( )Tj 0.009 Tw 3 -1.74 Td (I think what definitely came)Tj 0 Tw ( )Tj 0.009 Tw 11.57 0 Td (out of the discussion is that we have this important dual role. )Tj 0.065 Tw -14.57 -1.72 Td (One is the technical guidance I mentioned, but the other one )Tj 0 Tw 25.038 0 Td (\226)Tj ( )Tj 0.065 Tw 0.815 0 Td (and it was strong, I think, in the )Tj 0.231 Tw -25.853 -1.72 Td (presentation made by the colleague from S\351n\351gal )Tj 0 Tw 21.581 0 Td (\226)Tj ( )Tj 0.231 Tw 0.981 0 Td (in the support to capacity building in)Tj 0 Tw (-)Tj -22.562 -1.72 Td (coun)Tj 0.494 Tw (try, as well as in the development of human resources for implementation\ and )Tj 0.156 Tw 0 -1.74 TD [(________tion, )0.5(including )0.5(perhaps )0.5(looking )0.5(at )0.5(new )0.5(profiles )0.6(that )0.5(might )0.5(be )0.5(required )0.5(for )0.5(IHR. )0.5(I'm )]TJ 0.021 Tw 0 -1.72 TD (thinking particularly of a file of managers for Public Health emergencie\ s of people who)Tj 0 Tw 35.348 0 Td ( )Tj 0.021 Tw 0.271 0 Td (have the )Tj 0.095 Tw -35.619 -1.72 Td (broad expertise and knowledge to be able to tackle all the different asp\ ects that dealing with a )Tj 0 Tw T* (Public Health emergency is a ______ of concern involved.)Tj 23.465 0 Td ( )Tj 0.063 Tw -20.465 -1.74 Td (This, and I think Bruce has other points, but these are some of the take\ )Tj 0 Tw 29.098 0 Td (-)Tj 0.063 Tw (home message I )Tj 0 Tw -32.098 -1.72 Td (got )Tj 0.067 Tw 1.595 0 Td (from this meeting, and I think it's been very interesting, for me at lea\ st, to listen to all your )Tj 0 Tw -1.595 -1.72 Td (experiences and the way you're trying to adapt the IHR to your local rea\ lities.)Tj 31.003 0 Td ( )Tj -31.003 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.155 Tw 3 -1.72 Td (Thank you. If there's no one else who wants to comment on th)Tj (e follow up, we'll just )Tj 0 Tw -3 -1.72 Td (continue the conversation. David, you were going to make some remarks.)Tj 29.464 0 Td ( )Tj -26.464 -1.72 Td ( )Tj /TT1 1 Tf -3 -1.74 Td (Dr.)Tj ( )Tj (David Fidler)Tj ( )Tj /TT0 1 Tf 0.049 Tw 3 -1.64 Td (This is continuing the conversation about resources and financial assist\ ance with regards )Tj 0.036 Tw -3 -1.72 Td (to, particularly core capacity building and the IHR. )Tj 20.949 0 Td (Some of my earlier remarks were an attempt )Tj 0.07 Tw -20.949 -1.74 Td (to explain foreign policy thinking in the United States about the alloca\ tion of resources, but it's )Tj ET endstream endobj 331 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 332 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 333 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 334 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 335 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 336 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (90)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Stefano Lazzari)Tj ( )Tj /TT0 1 Tf 0.033 Tw 3 -1.64 Td (I just perhaps wanted to add a few points from the WHO point of view, at\ least my point )Tj 0.158 Tw -3 -1.74 Td (of view, because we're going to have to take this discussion back to Gen\ eva and have some )Tj 0 Tw 0 -1.72 TD (reflection on it with the rest of the group. I'll try to make)Tj 22.591 0 Td ( )Tj (it very quick.)Tj ( )Tj 0.04 Tw -19.591 -1.72 Td (The feeling I have is that the discussion, clearly I liked some essentia\ l points in trying to )Tj 0.102 Tw -3 -1.72 Td (implement IHR. One is that IHR challenges everybody )Tj 0 Tw (\226)Tj ( )Tj 0.102 Tw 23.91 0 Td (it's not just developing countries, it's )Tj 0.009 Tw -23.91 -1.74 Td (not just rich countries )Tj 0 Tw (\226)Tj ( )Tj 0.009 Tw 9.737 0 Td (in very different ways. I)Tj (t might be different. Some places might not have )Tj 0.027 Tw -9.737 -1.72 Td (the resources. Others might have more problems of too many resources and\ how to organize and )Tj 0.008 Tw T* (coordinate them, but it does challenge everyone. As has been already sai\ d, the solutions might be )Tj 0 Tw T* (different from p)Tj (lace to place.)Tj ( )Tj 0.155 Tw 3 -1.74 Td (I think the final interpretation would be a mixture of the universal IHR\ requirements, )Tj 0.003 Tw -3 -1.72 Td (which are the same for everyone, the local realities, the resources, the\ capacity, the governance at )Tj 0.043 Tw T* (local level, but also the experiences of countries. I)Tj 0 Tw 20.392 0 Td ( )Tj 0.043 Tw 0.293 0 Td (think SARS in Canada, I think anthrax in the )Tj 0 Tw -20.685 -1.72 Td (US, I think perhaps plague in India will very much dictate how IHR is go\ ing to be implemented.)Tj 38.576 0 Td ( )Tj 0.042 Tw -35.576 -1.74 Td (This might lead to tension, discussion, and maybe changes. For example, \ what happened )Tj 0.079 Tw -3 -1.72 Td (in France that has been prese)Tj (nted in the discussion of where the focal point should be, it could )Tj 0.05 Tw T* (lead to important changes in the way governments will be structured, and\ mechanisms might be )Tj 0 Tw T* (revised and established. All this is progress. All this is positive.)Tj ( )Tj 0.144 Tw 3 -1.74 Td (I think we also need to ex)Tj 0 Tw (pand )Tj 13.479 0 Td (\226)Tj ( )Tj 0.144 Tw 0.894 0 Td (and that goes back to the suggestion you made, the )Tj 0.001 Tw -17.373 -1.72 Td (whole knowledge base about IHR )Tj 0 Tw (\226)Tj ( )Tj 0.001 Tw 14.556 0 Td (beyond the usual suspects, beyond the people who have been )Tj 0.02 Tw -14.556 -1.72 Td (involved in the process, or have to be involved in IHR because of their \ profession. Particularly, I )Tj 0 Tw T* (think )Tj 0.02 Tw 2.326 0 Td (we need to filter the IHR concepts and requirements down to the peripher\ al level. We have )Tj 0.088 Tw -2.326 -1.74 Td (involved in every country the people who are going to become the actual \ real implementers of )Tj 0 Tw T* (the IHR.)Tj ( )Tj 0.063 Tw 3 -1.72 Td (I think )Tj 0 Tw (\226)Tj ( )Tj 0.063 Tw 3.828 0 Td (and it came out from many of your suggestions )Tj 0 Tw 19.704 0 Td (\226)Tj ( )Tj 0.063 Tw 0.813 0 Td (WHO ha)Tj (s to play the role to )Tj 0 Tw -27.346 -1.72 Td (provide...)Tj ( )Tj 0 -1.74 TD ([Start of Side 7])Tj ( )Tj 0 -1.72 TD (...so there is a lot of work that is required.)Tj ( )Tj 0.019 Tw 3 -1.72 Td [(I )0.5(also )0.5(think )]TJ 0 Tw (\226)Tj ( )Tj 0.019 Tw 5.574 0 Td [(and )0.5(it )0.5(came )0.5(out )0.5(of )0.5(many )0.5(of )0.5(the )0.5(presentations )]TJ 0 Tw (\226)Tj ( )Tj 0.019 Tw 18.958 0 Td [(that )0.5(everything )0.5(that )0.5(revolves )]TJ 0.077 Tw -27.531 -1.72 Td (around travels, travellers, borders, points of entry, goods, is go)Tj (ing to be a major challenge, and )Tj 0 Tw 0 -1.74 TD (it's something that really would require a lot of work.)Tj 21.287 0 Td ( )Tj ET endstream endobj 337 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (89)Tj ( )Tj ET Q BT 0.196 Tw 12 0 0 12 71.88 709.08 Tm (publication out hopefully before the end of the years that covers the pr\ oceedings. I)Tj 35.539 0 Td (t's not a )Tj 0 Tw -35.539 -1.72 Td (promise, but the quicker you can respond, the quicker we can get that do\ ne.)Tj 30.212 0 Td ( )Tj 0.125 Tw -27.212 -1.72 Td (The second thing we hope to do as a follow up to this activity is to hav\ e some of the )Tj 0.015 Tw -3 -1.74 Td (researchers and academic people who are associated with this process, we\ will be wri)Tj 34.347 0 Td (ting journal )Tj 0.061 Tw -34.347 -1.72 Td (articles for medical journals, for international law journals, for feder\ alism journals and so forth, )Tj 0.176 Tw 0 -1.72 TD (reflecting our particular interests and expertise. On that, there's prob\ ably a somewhat slower )Tj 0.039 Tw T* (timeline. I don't think we'll all be in referee)Tj 0 Tw ( )Tj 0.039 Tw 17.869 0 Td (journals by the end of the year, unless we happen to )Tj 0 Tw -17.869 -1.74 Td (own the journals as well.)Tj ( )Tj 0.119 Tw 3 -1.72 Td (The third thing is more of a question mark. What we have wondered about \ is whether )Tj 0.095 Tw -3 -1.72 Td (coming out of this overall process we could develop learning materials t\ hat might be useful t)Tj 0 Tw 38.5 0 Td (o )Tj 0.235 Tw -38.5 -1.72 Td (you and your colleagues at home, but also to government, Public Health o\ fficials in other )Tj 0.094 Tw 0 -1.74 TD (countries, in other parts of the world. We have asked our colleagues in \ the WHO to reflect on )Tj 0.123 Tw 0 -1.72 TD (whether they think there are ways we can be useful in that respect. We)Tj 0 Tw 29.806 0 Td ( )Tj 0.123 Tw 0.373 0 Td (are not sure what the )Tj 0.02 Tw -30.179 -1.72 Td (answer is. We're not sure what answer they will give us, or what we migh\ t conclude on our own, )Tj 0.033 Tw T* (but we would welcome advice from any or all of you. If you have ideas th\ at you think we might )Tj 0.055 Tw 0 -1.74 TD (pursue based on the collective work that all)Tj 0 Tw ( )Tj 0.055 Tw 18.043 0 Td (of us have put in the last couple of days, and in the )Tj 0 Tw -18.043 -1.72 Td (run up and the preparations for this event, they would be very welcome.)Tj 28.769 0 Td ( )Tj 0.006 Tw -25.769 -1.72 Td (That, at least for the moment, is the follow up: the proceedings, some j\ ournal articles, and )Tj 0.026 Tw -3 -1.72 Td (then possibly some learning material)Tj (s. I'll ask Kumanan and David or Ron if they want to add to )Tj 0 Tw T* (that.)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Kumanan Wilson)Tj /TT0 1 Tf ( )Tj 0.098 Tw 3 -1.72 Td (Also about the presentations, we will ask each of you individually wheth\ er it would be )Tj 0 Tw -3 -1.74 Td (okay for us to put those on the Website.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (I've said that. At least)Tj (, if I haven't, I think it was implicit. But that's fine.)Tj 28.868 0 Td ( )Tj 0.052 Tw -28.868 -1.72 Td (Does anyone have any questions about this particular aspect so we can le\ t our American )Tj 0.12 Tw -3 -1.72 Td (colleagues make their airplanes and so forth? You're better off walking \ home! [laughter] Yes, )Tj 0 Tw T* (Dr.)Tj ( )Tj (Lazzari?)Tj ( )Tj 0 -1.74 TD ( )Tj ET endstream endobj 338 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (88)Tj ( )Tj ET Q BT 0.086 Tw 12 0 0 12 107.88 709.08 Tm (The problem with the IHR is that we have a short timeframe. We have some\ things we )Tj 0.198 Tw -3 -1.72 Td [(want )0.5(national )0.5(systems )0.5(to )0.5(develop)]TJ [(. )0.5(We )0.5(are )0.5(not )0.5(going )0.5(to... )0.5(there's )0.5(no )0.5(way )0.5(we )0.5(can )0.5(be )0.5(able )0.5(to )]TJ 0.019 Tw 0 -1.72 TD (improve the overall system by 2012 so that it can deliver this everywher\ e. That's why the idea of )Tj 0 Tw 0 -1.74 TD (focusing on core function, on key elements that should be everywhere com\ es about.)Tj 33.545 0 Td ( )Tj 0.006 Tw -30.545 -1.72 Td (There is a discuss)Tj (ion on this. Many people feel nervous about the idea that you only work \ )Tj 0.107 Tw -3 -1.72 Td [(on )0.5(part )0.5(of )0.5(the )0.5(system, )0.5(that )0.5(you )0.5(don\222t )0.5(see this )0.5(as )0.5(developing )0.5(an )0.5(overall )0.5(laboratory )0.5(network )0.5(and )]TJ 0.021 Tw 0 -1.72 TD (surveillance capacity and response capacity in the whole Public Health s\ ystem, and if you)Tj 0 Tw 36.208 0 Td ( )Tj 0.021 Tw 0.271 0 Td (go on, )Tj 0.036 Tw -36.479 -1.74 Td (it's the whole health system. There is a reluctance to do that. But I th\ ink it's not possible. It's not )Tj 0.102 Tw T* (possible in the timeframe of the IHR. It's not possible given the fact t\ hat many countries have )Tj 0.068 Tw T* (serious important structural weaknesses. It's no)Tj (t possible because I don\222t think we can mobilize )Tj 0 Tw T* (the resources required to actually do that.)Tj 16.521 0 Td ( )Tj 0.038 Tw -13.521 -1.74 Td (The trade)Tj 0 Tw (-)Tj 0.038 Tw (off could be that you focus on some specific elements, make sure that th\ ey are )Tj 0.117 Tw -3 -1.72 Td (there and they are working, because there is a commitment to do that. Bu\ t )Tj (at least WHO will )Tj 0.146 Tw T* [(continue )0.5(anyway )0.5(to )0.5(work )0.5(on )0.5(the )0.5(overall )0.5(development )0.5(of )0.5(a )0.5(national )0.5(system )0.5(for )0.5(Public )0.5(Health, )]TJ 0.054 Tw T* (because that\222s our mandate. There's no way we can avoid that. It migh\ t be a two)Tj 0 Tw 32.837 0 Td (-)Tj 0.054 Tw (speed process, )Tj 0 Tw -32.837 -1.74 Td (but it has to be ____ at.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.008 Tw 3 -1.66 Td (Just bef)Tj (ore we continue, just to remind you, we're scheduled to end at 4:00. How\ many of )Tj 0.042 Tw -3 -1.72 Td (you have to leave before then for airports and so forth? What I'd like t\ o do is just... I'm going to )Tj 0.076 Tw T* [(bring )0.5(the )0.5(conversation )0.5(back )0.5(to )0.5(where )0.5(we )0.5(were, )0.6(but )0.5(I'd )0.5(like )0.5(to )0.5(say )0.5(a )0.5(couple)]TJ 0 Tw 30.477 0 Td ( )Tj 0.076 Tw 0.325 0 Td [(of )0.5(things )0.5(about )0.5(next )]TJ 0 Tw -30.802 -1.72 Td (steps just before we... Have you got about two or three minutes? Okay.)Tj 28.382 0 Td ( )Tj 0.335 Tw -25.382 -1.74 Td (It's the intention of the Organizing Committee to attempt to put togethe\ r a Web )Tj 0.075 Tw -3 -1.72 Td (publication quickly which reflects the proceedings of this workshop. To \ do that, we)Tj ('re going to )Tj 0.078 Tw T* (be sending to each of the national presenters a version of what we think\ you said based on our )Tj 0.008 Tw T* (recordings and interpretations and so forth. We will send your text only\ to you. We won't end the )Tj 0.087 Tw 0 -1.74 TD (US text to China and the Chinese text to the Unite)Tj (d States initially, so you can verify the text, )Tj 0.136 Tw 0 -1.72 TD (add, elaborate, correct. If there are points of special sensitivity in y\ our country, then you can )Tj 0.068 Tw T* (adjust as appropriate, so you're not caught out with your political mast\ ers or whatever. We will )Tj 0.135 Tw T* (attempt to ge)Tj (t those out quickly. The people who are going to do this, as you do, hav\ e other )Tj 0.219 Tw 0 -1.74 TD (responsibilities as well, but we will try to do this quickly with the vi\ ew to getting a Web )Tj ET endstream endobj 339 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (87)Tj ( )Tj ET Q BT 0.068 Tw 12 0 0 12 71.88 709.08 Tm (offer up people, resources, mobile laboratories... whatever it takes to \ accumulate rapid resour)Tj 0 Tw 38.112 0 Td (ce )Tj -38.112 -1.72 Td (for WHO deployment.)Tj ( )Tj 0.01 Tw 3 -1.72 Td (The GOARN team is deployed under the WHO nice blue flag, the umbrella, t\ he nice blue )Tj 0 Tw -3 -1.74 Td (flag, but it is not a WHO program)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Yuri Fedorov)Tj 10.8 0 0 10.8 161.5284 605.64 Tm ( )Tj /TT0 1 Tf 0.207 Tw 12 0 0 12 107.88 585.72 Tm (The WHO strategy to deal with epidemic events, or epidemic and pandemic \ disease )Tj 0.135 Tw -3 -1.72 Td (actually involve)Tj (s both approaches. One side, we want to strengthen and improve mechanism\ s )Tj 0.243 Tw T* (like GOARN, like the old detection or verification system, and the old a\ lert and response )Tj 0.065 Tw T* [(operation )0.5(platform )0.5(to )0.5(enable )0.5(the )0.5(organization )0.5(to )0.6(respond )0.6(even better )0.5(and )0.5(quicker )0.5(to )0.5(requests)]TJ 0 Tw 37.52 0 Td ( )Tj 0.314 0 Td (for )Tj 0.253 Tw -37.834 -1.74 Td (assistance in dealing with outbreaks. In that, GOARN has proven over the\ years, really a )Tj 0 Tw T* (wonderful tool, so there's no question about it.)Tj ( )Tj 0.077 Tw 3 -1.72 Td (At the same time, we recognize that there is a need to develop local cap\ acities, because )Tj 0.026 Tw -3 -1.72 Td (that\222s' where the detect)Tj (ion takes place first of all, but also because SWAT teams coming into th\ e )Tj 0.016 Tw 0 -1.74 TD (country sometimes face some more difficulties: language, culture, differ\ ent foods and this sort of )Tj 0.108 Tw 0 -1.72 TD (thing. Having local capacity there can facilitate even external teams qu\ ite a bit. )Tj 33.248 0 Td (It's one or the )Tj 0.056 Tw -33.248 -1.72 Td (other. Anyway, WHO is committed to work with member States to improve th\ eir Public Health )Tj 0 Tw T* (structure and systems. It's part of the mandate. There is no question.)Tj 27.173 0 Td ( )Tj 0.018 Tw -24.173 -1.74 Td (By the way, there is a third strategy, which is to deal with specific th\ reats, )Tj 30.094 0 Td (known threats. )Tj 0.286 Tw -33.094 -1.72 Td (That involves also preparedness and prevention and maybe risk reduction \ or vulnerability )Tj 0.152 Tw T* [(reduction )0.5(to )0.5(some )0.5(of )0.5(this. )0.5(That's )0.5(where )0.5(you )0.5(would )0.5(put influenza, )0.5(or viral )0.6(_______ fevers, )0.5(or )]TJ 0 Tw T* (meningitis, or cholera, or other specific problems.)Tj 19.966 0 Td ( )Tj 0.127 Tw -16.966 -1.74 Td (These a)Tj (re the three strategic approaches to the problem. The issue is, with IHR\ , is we )Tj 0.14 Tw -3 -1.72 Td (have worked globally, member States, WHO, the international community, i\ n developing this )Tj 0.069 Tw T* [(capacity )0.5(for )0.5(many )0.5(years. )0.5(Lots )0.5(of )0.5(money )0.5(has )0.5(been )0.5(invested, )0.5(and )0.5(I )0.5(think )0.5(a )0.5(lot )0.5(will )0.5(conti)]TJ 35.198 0 Td [(nue )0.5(to )0.5(be )]TJ 0 Tw -35.198 -1.72 Td (invested in future before we get good systems everywhere.)Tj 23.52 0 Td ( )Tj 0.065 Tw -20.52 -1.74 Td (Getting good systems is not in just investing in Public Health structure\ or part of Public )Tj 0.011 Tw -3 -1.72 Td (Health structure. It's broader than that. It only evolves with the overa\ ll development of a count)Tj 0 Tw 37.917 0 Td (ry. )Tj 0.109 Tw -37.917 -1.72 Td (There is only so much you can do to external investment. It's the reason\ , at the same time, of )Tj 0 Tw T* (development of the whole national system.)Tj 17.163 0 Td ( )Tj ET endstream endobj 340 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (86)Tj ( )Tj ET Q BT 0.014 Tw 12 0 0 12 71.88 709.08 Tm (hope that we would be able to contain and squelch a localized outbreak t\ hat occurred somewhere )Tj 0.052 Tw 0 -1.72 TD (else. If)Tj 0 Tw ( )Tj 0.052 Tw 3.074 0 Td (we were able to successfully do that, we were able to successful recover\ that isolate and )Tj 0.025 Tw -3.074 -1.72 Td (now vaccine production starts, it is to our advantage to keep it squelch\ ed. We recognize that that )Tj 0 Tw 0 -1.74 TD (may not happen. This is actually a big part of the discussion abou)Tj 26.189 0 Td (t the stockpile.)Tj ( )Tj 0.143 Tw -23.189 -1.72 Td (If, in fact, it escapes that containment, do you then bring back the sto\ ckpile drug, the )Tj 0.039 Tw -3 -1.72 Td (international stockpile drug to the United States? I'm glad to say that \ more sane minds prevailed )Tj 0.003 Tw 0 -1.72 TD [(here. It's not worth it at )0.5(that point. There's just )]TJ (not that many doses there. Not only that, that's just )Tj 0 Tw 0 -1.74 TD (not the way that we would do it.)Tj ( )Tj 0.01 Tw 3 -1.72 Td (But there is the thought out there, at what point do we now switch to )Tj 0 Tw (\226)Tj ( )Tj 0.01 Tw 28.573 0 Td (for your use of the )Tj 0.09 Tw -31.573 -1.72 Td (term "Fortress." We know that it's coming. The clock has started. How ma\ ny re)Tj 32.935 0 Td (sources are we )Tj 0.058 Tw -32.935 -1.72 Td (going to put in there? It's a difficult decision, and it's an ongoing de\ cision. In the United States, )Tj 0 Tw T* (whether it's at a State level or a national level, the discussions are t\ he same.)Tj 30.17 0 Td ( )Tj 0.048 Tw -27.17 -1.72 Td (It's the same when we're talking about Alaska and Florida.)Tj 0 Tw 23.785 0 Td ( )Tj 0.048 Tw 0.298 0 Td (Those same, exact arguments )Tj 0 Tw -27.083 -1.72 Td (are going to come up again and again and again.)Tj 19.326 0 Td ( )Tj -19.326 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj /TT0 1 Tf ( )Tj 0.035 Tw 3 -1.72 Td (I'm sorry. Just to add one more comment about GOARN. While the teams wer\ e intended )Tj 0.118 Tw -3 -1.72 Td (to be sort of like SWAT teams: you know, you go in, stamp out the diseas\ e, and)Tj 0 Tw 33.851 0 Td ( )Tj 0.118 Tw 0.368 0 Td (leave. They )Tj 0.002 Tw -34.218 -1.72 Td (have, in essence, operated that way. However, much to the surprise, I th\ ink, of the people that are )Tj 0.298 Tw T* [(closely involved in the )0.5(GOARN )0.5(was )0.5(the )0.5(realization )0.5(that )0.5(by )0.5(employing )0.5(or )0.5(using )0.5(national )]TJ 0.037 Tw 0 -1.72 TD (counterparts as part of the GOARN team, there were actual)Tj 24.048 0 Td (ly unintended, almost indirect results )Tj 0.154 Tw -24.048 -1.72 Td [(and )0.5(some )0.5(capacities )0.5(were )0.5(left )0.5(behind )]TJ 0 Tw (\226)Tj ( )Tj 0.154 Tw 16.818 0 Td [(not )0.5(in )0.5(all )0.5(cases )]TJ 0 Tw (\226)Tj ( )Tj 0.153 Tw 7.682 0 Td (but there have been... much to my )Tj 0.11 Tw -24.5 -1.72 Td [(surprise, )0.5(there )0.5(have )0.5(been )0.5(improvements )0.5(in )0.5(epidemiological )0.5(outbreak, )0.5(investigation )0.5(capacity, )0.5(in )]TJ 0.134 Tw 0 -1.74 TD (the sociological dimensions of)Tj 0 Tw ( )Tj 0.134 Tw 12.978 0 Td (an outbreak... a whole bunch of little sorts of things that were )Tj 0.037 Tw -12.978 -1.72 Td (spread out by the GOARN teams in these epidemics. Not all of them. But i\ t's kind of interesting )Tj 0 Tw 0 -1.72 TD (to see that it was an unintended but real result of a SWAT team approach\ to things.)Tj 33.241 0 Td ( )Tj -33.241 -1.72 Td (HR:)Tj ( )Tj 3 0 Td (Ron, j)Tj (ust for the record, it's just being recorded, what is GOARN?)Tj ( )Tj -3 -1.74 Td (RS:)Tj ( )Tj 3 0 Td (I'm sorry. GOARN: G)Tj (-)Tj (O)Tj (-)Tj (A)Tj (-)Tj (R)Tj (-)Tj (N. The Global Outbreak Alert and Response Network.)Tj ( )Tj 0.042 Tw T* (Just a brief word, the WHO is the secretariat, but is not a WHO program.\ It is a network )Tj 0.017 Tw -3 -1.72 Td (of 130 institutions )Tj 0 Tw (\226)Tj ( )Tj 8.348 0 Td (CDC)Tj ( )Tj 0.017 Tw 2.323 0 Td (is a member )Tj 0 Tw (\226)Tj ( )Tj 0.017 Tw 5.956 0 Td (and they're non)Tj 0 Tw (-)Tj (governmental. )Tj /TT2 1 Tf 0.017 Tw 12.505 0 Td (M\351dicins Sans Fronti\350rs)Tj /TT0 1 Tf 0 Tw ( )Tj 0.151 Tw -29.133 -1.72 Td (is a member, as well as governmental, some academic institutions around \ the world that just )Tj ET endstream endobj 341 0 obj <> endobj 342 0 obj <> endobj 343 0 obj <>stream HV T}? *+D  n k( z$qiUĨ1Ĥ6M4aPqkS1hXh[hNO9]=|)yiN.b!s\h/gneK28ef-̟>/p(@ꍂ\s)"4@Z3d +(*)moe9M;e?U~f,iYbg.ig,(~)U>k}ۣgB=w`e,{ֺן" /p>r{h_Y?N] | CaGzʮzO[F$O'GJfv0ʼhQQ`M%2± eX 'w8i(XT#wFhg cFtTY$/e:sDAeD"0ƛXԇd"\8@@t|[,LMWq'(&p_h PG<~a#uѢwb/'I=Q:Ew}@"q 0 b0WQ.yq#ȋ:an3a.'bx˰\|)٩ :Ǿܞ+\ߪrU}m&O7%B'Q-G~7' jr'gF^kn6%o<F?<#Fg8Kxԝ+V*ZGK_VCV4hz~22*_$sowan ~khRZ@h5.p*L.VCT˵`J;]Fi7ނawЋȓW UQAMA4k,qB=)4QAETFQ];]8W_Y IVg>@h)V--֧S[>ol:thkt6z_73̹sӬ63U v]jKɜ1xEi%\5x]hذ{pDw_2[6=@ԅ_Gh Q1oŴ6&r!tS=]#ܗ8S99*MDkl@S_yjڢ^]U7(DshP-_[]{B->Beղeѵ?)X+!۹R'ޠ;8:ܱ贳ʥԱ5I\hx#(![53lsaxNwWGG wf8dD))/ƫ56 ;};ξ왹k1ƃ݀1$$ C`6A@Bפ)RQCjZHc\&!B&Q5TU)4F)[øa?Tݝs9s9OGUw#͜FtޜFgHcәSYUnN&9Tw-KՖ85Hg}!f2'$VhIKE;ҙXKYXT?i74n%d ? 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CϓXadE"u|Uk /CH5!; iF俞 y;tRa.ĺhz#ޤW8F%rx S%#@a1\/w1_CPd>h$DJd%Ysm#8*\6\%0Q7NaZLχIJ^Fƽ\&lM-Gqyk\|O\^iY$V&\~Z.*5Eȯ)E~JVaE*rZ}ɨn.ۘ7N5iD BQhqZ!͎G4xQP`^1AI+CJ,fO yPwJ|r|8vp{A[$OѺ݉& r2VdMuG܎ )mͨHء+ w`{ӡQiMe332QlOh]OuEqD|B4Ŕ#%.Cb,%4Gj$IJHHjfGim^I&=,3I|NfE]o]2ƯXش?~(/ymk &27d@K6 V,8jWy[Z[;HgAlJV o6u3?homL{u^9'{ssdk'LM>AQsiEd4" 4 @`hrexe˔rg8u93NpL)0PaF)@(CܼYuye6\q|#7`s`YB put@yH]fz5I8ߍ# t"tF_zރ`rմ44LP4ԍUS`vH2Q5@IPrv5k@n$ * X-oڽ6 5-g/ؒ\`$_LIsv {mTn1[`Qt KZdpuOF@Ӎsׄ~-\`͍Qq  { endstream endobj 344 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 345 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 346 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 347 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 348 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 349 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (85)Tj ( )Tj ET Q BT 0.099 Tw 12 0 0 12 71.88 709.08 Tm (hits I'm in the best position possible." It's not the ideal situat)Tj 25.138 0 Td (ion, but the other option is not as )Tj 0 Tw -25.138 -1.72 Td (easy as it might at first appear.)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (David Fidler)Tj /TT0 1 Tf ( )Tj 0.085 Tw 3 -1.72 Td (Just another quick comment. There's kind of a counter... I wouldn\222t c\ all it a movement, )Tj 0.036 Tw -3 -1.72 Td (but it's sort of a counter... well, another way of looking at that, and \ that has)Tj 0 Tw 30.494 0 Td ( )Tj 0.036 Tw 0.286 0 Td (to do with GOARN, )Tj 0 Tw -30.78 -1.72 Td (the Global Outbreak Alert and Response Network of WHO.)Tj ( )Tj 0.059 Tw 3 -1.74 Td (I know that Canada's been a very active member of GOARN, and our thinkin\ g is, "Let's )Tj 0.085 Tw -3 -1.72 Td [(stop )0.5(the )0.5(disease )0.5(over )0.5(there )0.5(before )0.5(it )0.5(gets )0.6(here." )0.6(The )0.5(idea )0.5(of )0.5(having )0.5(a )0.5(network )0.5(of )0.6(almost )0.5(120 )0.5(or )]TJ 0 Tw 0 -1.72 TD (1)Tj 0.021 Tw (30 institutions that volunteer their resources on very short notice to s\ end teams at the request of )Tj 0.153 Tw T* (countries to stop outbreaks )Tj 0 Tw (\226)Tj ( )Tj 0.153 Tw 12.515 0 Td (of course, once we know the outbreak is there )Tj 0 Tw 19.985 0 Td (\226)Tj ( )Tj 0.153 Tw 0.903 0 Td (but there is a )Tj 0.09 Tw -33.403 -1.74 Td (response mechanism now that has proven itself, at least the las)Tj 25.925 0 Td (t time I looked, 57 times for 57 )Tj 0 Tw -25.925 -1.72 Td (outbreaks in other countries over the last three years.)Tj 21.131 0 Td ( )Tj 0.001 Tw -18.131 -1.72 Td (It is fast. It is rapid. Teams are assembled and placed for infection, o\ utbreak control, in 24 )Tj 0.115 Tw -3 -1.72 Td (to 72 hours. There is a sense that it's not just, "Let's create Fortress\ )Tj 0 Tw 28.122 0 Td ( )Tj 0.115 Tw 0.365 0 Td (Canada here and stop the )Tj 0.025 Tw -28.487 -1.74 Td (disease from coming." It's more, "Let's get out there and stop the disea\ se before it becomes a big )Tj 0 Tw T* (problem for all of us.")Tj ( )Tj 3 -1.72 Td ( )Tj /TT1 1 Tf -3 -1.72 Td (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.226 Tw 3 -1.74 Td (Just to carry on with that message, I think that is what has dominated a\ lot of the )Tj 0 Tw -3 -1.72 Td (pandemic )Tj 0.064 Tw 4.201 0 Td (influenza planning in the United States. We see that there is an advanta\ ge to creating )Tj 0.041 Tw -4.201 -1.72 Td [(some )0.5(infrastructure. )0.5(David's )0.5(point )0.5(is )0.5(a )0.5(good )0.5(one: )0.5(how )0.5(far )0.5(you )0.5(go, )0.5(what )0.5(is )0.5(the )0.5(investment? )0.5(Is )0.5(this )]TJ 0.016 Tw T* (going to be an infrastructure that is going to last 100 years, or is it)Tj 0 Tw ( )Tj 0.016 Tw 26.849 0 Td (going to be one that lasts until )Tj 0 Tw -26.849 -1.74 Td (we identify the virus and then we're out of there?)Tj ( )Tj 0.11 Tw 3 -1.72 Td (I think right now it tends to be the latter, that we are creating a sepa\ rate system in the )Tj 0.009 Tw -3 -1.72 Td (United States in which we will have surveillance that is out there. We w\ ill hope)Tj 31.983 0 Td (fully identify that )Tj 0.117 Tw -31.983 -1.72 Td (the human)Tj 0 Tw (-)Tj (to)Tj (-)Tj (human)Tj (-)Tj (to)Tj (-)Tj 0.117 Tw (human sustained isolate, and then that clock starts for development of )Tj 0.002 Tw 0 -1.74 TD (the vaccine. The longer that we can put between that virus coming to the\ United States, there will )Tj 0 Tw 0 -1.72 TD (be a shift.)Tj ( )Tj 0.156 Tw 3 -1.72 Td (You see this in the argument abo)Tj (ut the use of stockpile drugs. We have committed a )Tj 0.03 Tw -3 -1.72 Td (certain portion of our national stockpile to an international stockpile.\ That is because there is the )Tj ET endstream endobj 350 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (84)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Anthony Marfin)Tj /TT0 1 Tf 0.006 Tc -0.006 Tw 10.8 0 0 10.8 176.212 709.08 Tm [(\(?)-2.2(\))]TJ 0 Tc 0 Tw ( )Tj 0.096 Tw 12 0 0 12 107.88 688.44 Tm (I'll sort of lay out where I see thinking on t)Tj (his going. I think I'm going to be reflecting )Tj 0.25 Tw -3 -1.72 Td (here a US)Tj 0 Tw (-)Tj 0.25 Tw (centric position rather than one that fits into the analytical framework\ that I've )Tj 0 Tw 0 -1.74 TD (presented.)Tj ( )Tj 0.086 Tw 3 -1.72 Td (I think there is recognition on the part of the United States and other \ governments that, )Tj 0.119 Tw -3 -1.72 Td (first, they do n)Tj (eed to spend a lot of resources getting their own house in order, so the\ re is an )Tj 0.114 Tw 0 -1.72 TD (intense amount of effort focused domestically and locally. That does mea\ n that some of those )Tj 0 Tw 0 -1.74 TD (resources will not be available for global efforts.)Tj 19.437 0 Td ( )Tj 0.026 Tw -16.437 -1.72 Td (There is, I think, also recogn)Tj (ition of the problem that US Public Health, US National Sec )Tj 0.218 Tw -3 -1.72 Td (with regards to these issues is in fact threatened if you do not have a \ basic Public Health )Tj 0 Tw 0 -1.72 TD (infrastructure in developing countries. I think there is a conceptual re\ cognition of that.)Tj 34.489 0 Td ( )Tj 0.064 Tw -31.489 -1.74 Td (Here's the pr)Tj (oblem I think that I sense amongst people that I talk to about this. If \ you're )Tj 0.128 Tw -3 -1.72 Td [(going )0.5(to )0.5(spend )0.5(large )0.5(sums )0.5(of )0.5(money )0.5(to )0.5(build )0.5(basic )0.5(Public )0.5(Health )0.5(infrastructure )0.5(in )0.5(developing )]TJ 0.02 Tw T* (countries and you want that to be sustainable, you have to have some lev\ el of confid)Tj 34.017 0 Td (ence or trust )Tj 0.008 Tw -34.017 -1.72 Td [(in the existing governance systems that are )0.5(in those countries. If you don\222t, because of your other )]TJ 0.06 Tw 0 -1.74 TD (bilateral and develop aid that you've tried because governments are corr\ upt, or governments are )Tj 0.195 Tw 0 -1.72 TD (weak and there isn't really an infrastructure )Tj 18.901 0 Td (there, you aren't going to spend that money on )Tj 0.094 Tw -18.901 -1.72 Td (building a basic Public Health infrastructure in that developing country\ . You're going to spend )Tj 0.114 Tw T* (that money on making sure that you're as strong and ready as possible fo\ r the moment comes )Tj 0 Tw 0 -1.74 TD (when the pathogens hit)Tj ( )Tj (your shores.)Tj ( )Tj 0.404 Tw 3 -1.72 Td (Your interest there is to get as much information as early as possible t\ hrough )Tj 0.219 Tw -3 -1.72 Td (surveillance, and then you spend your response and intervention money at\ home to protect )Tj 0.136 Tw 0 -1.72 TD (yourself. Because if you want to fix the basic Public Health infrastruct\ ur)Tj 30.484 0 Td (e in many countries, )Tj 0.26 Tw -30.484 -1.74 Td (you're essentially talking about building the entire governance... that'\ s not on. It's just not )Tj 0.112 Tw T* (realistic to expect even in the United States to do... assuming your cou\ ntry wanted the United )Tj 0 Tw T* (States to do that.)Tj ( )Tj 0.082 Tw 3 -1.72 Td (Because you're essentiall)Tj (y saying, that's regime change for Public Health. It gets to that )Tj 0.124 Tw -3 -1.74 Td (level of seriousness in many parts of the world. If you're not willing t\ o recognize then that if )Tj 0.093 Tw T* (Public Health is an important part of good governance, you have to tackl\ e the other aspects o)Tj 0 Tw 38.667 0 Td (f )Tj 0.015 Tw -38.667 -1.72 Td [(good )0.5(governance )0.5(and )0.5(then )0.5(your )0.5(agenda )0.5(just )0.5(got )0.5(so )0.5(enormous )0.5(and )0.5(so )0.5(expensive )0.5(that )0.5(you )0.5(then )0.5(start )]TJ 0.063 Tw T* (to pull back and say, "Now I'm going to spend that money on myself to ma\ ke sure that when it )Tj ET endstream endobj 351 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (83)Tj ( )Tj ET Q BT 0.029 Tw 12 0 0 12 71.88 709.08 Tm [(un )0.5(autre )0.5(dans )0.5(l\222ensemble )0.5(des )0.5(\351tats )0.5(ne )0.5(sera )0.5(pas )0.5(ma\356tris\351e )0.6(du )0.5(tout )0.5(de )0.5(la )0.5(m\352me )0.5(fa\347on )0.5(d\222un )0.5(\311tat )0.5(\340 )0.5(un )]TJ 0 Tw 0 -1.72 TD (autre. )Tj ( )Tj 0.274 Tw 3 -1.72 Td (Donc effectivement sans vouloir du tout me donner de piste ou d\222orien\ tation)Tj 0 Tw 33.587 0 Td ( )Tj 0.524 0 Td (mais )Tj 0.117 Tw -37.111 -1.74 Td (spontan\351ment en tout cas l\222analyse que j\222en fais sur ce type de\ pathologie qui est, encore une )Tj 0.21 Tw T* (fois, particuli\350re au sein des maladies infectieuses, je pense qu\222\ effectivement le fait d\222avoir )Tj 0.131 Tw T* (quelque chose de centraliser pour donner une esp\350ce d\222instr)Tj 24.927 0 Td (uction g\351n\351rale avec les meilleurs )Tj 0 Tw -24.927 -1.72 Td (experts nationaux, f\351d\351raux chez vous etc. peut avoir une l\351git\ imit\351. )Tj 27.518 0 Td ( )Tj -27.518 -1.74 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Jeffrey Scott)Tj /TT0 1 Tf ( )Tj 0.098 Tw 3 -1.72 Td (One of the issues, when I think about it, my sense from many of the pres\ entations was )Tj 0.185 Tw -3 -1.72 Td (that what countries were trying to do was bas)Tj (ically get their system in order to prevent the )Tj 0.125 Tw 0 -1.74 TD (national spread of disease. That's what you're doing because you really \ had to make sure that )Tj 0.08 Tw 0 -1.72 TD (your own house was in order, because you didn\222t want that, and you di\ dn\222t want the economic )Tj 0.129 Tw T* [(affects )0.5(of )0.5(that. )0.5(By )0.5(do)]TJ [(ing )0.6(that, )0.6(you were already )0.6(starting )0.6(to )0.5(get towards )0.5(implementation )0.5(of )0.5(the )]TJ 0 Tw T* (IHRs with a few additions on top of that. But basically you needed to do\ that.)Tj 30.967 0 Td ( )Tj 0.109 Tw -27.967 -1.74 Td [(Then )0.5(when )0.5(you )0.5(look )0.5(at )0.5(the )0.5(issue )]TJ 0 Tw (\226)Tj ( )Tj 0.108 Tw 14.81 0 Td (and it raises the issue to me of the globalization of )Tj 0.115 Tw -17.81 -1.72 Td (Public Health in)Tj 0 Tw ( )Tj 0.115 Tw 7.095 0 Td (new world order )Tj 0 Tw (\226)Tj ( )Tj 0.115 Tw 8.07 0 Td (then when we get the presentation from a colleague from )Tj 0.109 Tw -15.165 -1.72 Td (Africa, and then we hear about the stresses and strains there, to what e\ xtent do you get to the )Tj 0.073 Tw T* (level of recognizing that in order to really protect your own nation, yo\ u have to ens)Tj 34.357 0 Td (ure that the )Tj 0.007 Tw -34.357 -1.74 Td (weaker parts of the world system are able to protect their own nations f\ rom the spread of disease, )Tj 0.117 Tw T* [(which )0.5(in )0.5(turn )0.5(means )0.5(that )0.5(IHRs )0.5(can )0.5(better )0.5(implemented )0.5(which )0.5(in )0.5(turn )0.5(means )0.6(that you're )0.5(better )]TJ 0 Tw T* (protected, and that means that world economy and you)Tj 21.91 0 Td (r economy's protected.)Tj ( )Tj 0.061 Tw -18.91 -1.72 Td [(One of the key issues at some stage needs to be, how do you divert the a\ ttention )0.5(to deal )]TJ 0.012 Tw -3 -1.74 Td (with that? Because we're all moving towards getting our own house in ord\ er better, but it reaches )Tj 0.148 Tw T* (a stage where you can only do so much, and you)Tj 0 Tw ( )Tj 0.148 Tw 21.291 0 Td (get better investment from that investment )Tj 0 Tw -21.291 -1.72 Td (globally with the resources that you'd be using, and we've not discussed\ that at all)Tj 32.659 0 Td ( )Tj -32.659 -1.72 Td (SP:)Tj ( )Tj 0.005 Tw 3 0 Td (Actually, if I could interject, I think it might be worth spending a bit\ of time on that issue, )Tj 0.099 Tw -3 -1.74 Td (because that is something t)Tj (hat is fundamentally related to governance at an international level, )Tj 0.109 Tw T* (and we haven't, perhaps, discussed as much with the attention it deserve\ s. Any perspective on )Tj 0 Tw T* (that would be welcome.)Tj ( )Tj T* ( )Tj ET endstream endobj 352 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (82)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Stephane Veyrat)Tj ( )Tj /TT0 1 Tf 0.156 Tw 3 -1.72 Td [(Je )0.5(voudrais )0.5(rebondir )0.5(justement )0.5(sur )0.5(l\222exemple )0.5(et )0.5(les )0.6(mod\350les )0.5(qu\222on )0.5(a )0.5(pu )0.5(avoir )0.5(avec )0.5(la )]TJ 0.1 Tw -3 -1.72 Td (pand\351mie grippale. C\222\351tait il y a trois mois donc \340 Washingt\ on et \340 )Tj 28.289 0 Td (Atlanta avec la d\351l\351gation )Tj 0.199 Tw -28.289 -1.74 Td (interminist\351rielle de lutte contre la grippe aviaire puisque vous sav\ ez qu\222on a en France un )Tj 0.105 Tw 0 -1.72 TD [(syst\350me\205 un plan )0.5(interminist\351riel )0.5(justement )0.5(pour )0.5(travailler )0.5(avec )0.5(les )0.5(diff\351rents )0.5(minist\350res )0.5(pour )]TJ 0 Tw T* (essayer d\222\351laborer l\222ensemble des mesure)Tj (s et des pr\351parations pour faire face \340 une pand\351mie. )Tj 37.899 0 Td ( )Tj 0.275 Tw -34.899 -1.72 Td (Dans ce cadre)Tj 0 Tw (-)Tj 0.275 Tw (l\340 donc on avait \351t\351 aux \311tats)Tj 0 Tw 19.857 0 Td (-)Tj 0.275 Tw (Unis et ce qui est int\351ressant c\222\351tait )Tj 0.067 Tw -22.857 -1.74 Td (justement cette pr\351sentation qui avait \351t\351 faite dans le servic\ e du CDC d\222Atlanta o\371 on avait eu )Tj 0.208 Tw T* (cette pr\351sentation s)Tj 8.08 0 Td (ur les diff\351rents r\351sultats des actions tr\350s pr\351coces de cer\ tains maires de )Tj 0.096 Tw -8.08 -1.72 Td [(grandes )0.5(villes )0.5(pour )0.5(faire )0.5(face )0.5(\340 )0.5(l\222arriv\351e )0.5(de )0.5(l\222\351pid\351mie )0.5(avec )0.5(des )0.5(d\351cisions )0.5(qui \351taient )0.5(de )]TJ /TT2 1 Tf 0 Tw 36.611 0 Td (social )Tj -36.611 -1.72 Td (mitigation)Tj /TT0 1 Tf ( )Tj 0.071 Tw 4.432 0 Td (et de )Tj /TT2 1 Tf (social distancing)Tj /TT0 1 Tf (. Donc on voyait tr\350s bien qu\222il y avait des \351ca)Tj 28.47 0 Td (rts fantastiques )Tj 0 Tw -32.903 -1.74 Td (effectivement dans la propagation de l\222\351pid\351mie d\222une ville \ \340 l\222autre. )Tj 27.905 0 Td ( )Tj 0.023 Tw -24.905 -1.72 Td (Donc \347a, \347a m\222am\350ne effectivement \340 la r\351flexion suiva\ nte: dans le cas du SARS dont on )Tj 0.01 Tw -3 -1.72 Td (parle tous depuis deux jours on avait quand m\352me un virus qui a un te\ mps d\222incub)Tj 33.112 0 Td (ation de cinq \340 )Tj 0.014 Tw -33.112 -1.72 Td (sept jours. On a un temps effectivement de r\351apparition qui est quasi\ ment d\222une dizaine de jours, )Tj 0.261 Tw 0 -1.74 TD (donc on a un certain temps devant nous pour arriver \340 confiner, \340 \ contr\364ler, \340 mettre en )Tj 0.097 Tw 0 -1.72 TD (quarantaine, \340 isoler. Dans le cas d\222une pand\351mie gri)Tj 21.936 0 Td (ppale on n\222est pas du tout dans ce cas de )Tj 0.243 Tw -21.936 -1.72 Td (figure sauf changement de la dur\351e d\222incubation du virus mais on e\ st dans quelque chose )Tj 0.363 Tw T* [(d\222extr\352mement )0.5(rapide )0.5(qui )0.5(nous )0.5(laissera )0.5(extr\352mement )0.6(d\351sarm\351s )0.6(tr\350s )0.5(rapidement )0.5(avec )0.5(une )]TJ 0 Tw 0 -1.74 TD (propagation assez exponentielle du nombre)Tj ( )Tj (de cas territorialement et en nombre cumul\351. )Tj 35.681 0 Td ( )Tj 0.174 Tw -32.681 -1.72 Td (Donc je pense qu\222il est fondamental \340 ce moment)Tj 0 Tw 21.164 0 Td (-)Tj 0.174 Tw (l\340 d\222avoir une capacit\351 de pouvoir )Tj 0.012 Tw -24.164 -1.72 Td (avoir une concertation tr\350s pr\351coce au sein d\222une structure d\351\ cisionnelle et que cette concertation )Tj 0.044 Tw 0 -1.72 TD (doit s\222appuyer sur un cert)Tj (ain nombre de r\351flexes travailler ensemble, de propositions qu\222on \ peut )Tj 0.031 Tw 0 -1.74 TD (passer en revue. C\222est ce que je vous disais tout \340 l\222heure qua\ nd on disait les d\351cisions, on passe )Tj 0 Tw 0 -1.72 TD (en revue les d\351cisions possibles et on en choisit celles qui nous par\ aissent les plus)Tj 32.716 0 Td ( )Tj (pertinentes. )Tj ( )Tj 0.136 Tw -29.716 -1.72 Td (Si dans votre exemple avec les \311tats f\351d\351r\351s cette organisat\ ion est confi\351e \340 des \311tats )Tj 0.225 Tw -3 -1.72 Td (f\351d\351r\351s souverains vous allez avoir une multiplication de r\351\ unions comme \347a au niveau de )Tj 0.033 Tw 0 -1.74 TD (diff\351rents minist\350res de la Sant\351 avec l\222Agriculture, avec l\ es D)Tj 25.346 0 Td (ouanes, avec l\222Int\351rieur au niveau )Tj 0.014 Tw -25.346 -1.72 Td (de tous les \311tats aboutissant \340 des d\351cisions qui probablement \ seront variables d\222un \311tat \340 l\222autre )Tj 0.006 Tw 0 -1.72 TD (avec donc une possibilit\351 que les mesures prises et d\351cid\351es ne\ soient pas les m\352mes et le r\351sultat )Tj 0.001 Tw T* (au bout du compte c\222e)Tj (st qu\222effectivement votre maladie virale qui aura diss\351min\351 d\222\ un a\351roport \340 )Tj ET endstream endobj 353 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (81)Tj ( )Tj ET Q BT 0.34 Tw 12 0 0 12 71.88 709.08 Tm (In fact, many, many parts of t)Tj (he world by a governing process, which entails multiple )Tj 0.19 Tw 0 -1.72 TD (governments vertically and horizontally, non)Tj 0 Tw 18.728 0 Td (-)Tj 0.19 Tw (governmental players, private sector, in a very, )Tj 0.111 Tw -18.728 -1.72 Td (very complex networked interaction. And what you're describing now in th\ e context of Public )Tj 0.158 Tw 0 -1.74 TD [(Health )0.5(could )0.5(b)]TJ [(e )0.5(described )0.5(as )0.5(environmental )0.5(issues, )0.5(economic )0.5(development )0.5(issues, )0.5(and )0.5(many, )]TJ 0 Tw 0 -1.72 TD (many others.)Tj ( )Tj 0.142 Tw 3 -1.72 Td (Several of you have used the right words, I think, which ism "It has to \ be managed." )Tj 0 Tw -3 -1.72 Td (Dr.)Tj ( )Tj (Lazarri used this, where "managing" is the right word.)Tj 23.254 0 Td ( )Tj -20.254 -1.74 Td (Ron, you wanted to comm)Tj (ent?)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.004 Tw 3 -1.66 Td [(Just )0.5(to )0.5(echo )0.5(a )0.5(little )0.5(bit )0.5(about )0.5(what )0.5(Dr.)]TJ 0 Tw 15.053 0 Td ( )Tj 0.004 Tw [(Marfin )0.5(was )0.5(just )0.5(saying. )0.5(SARS )0.5(in )0.5(Toronto )0.5(was )0.5(a )0.5(big )]TJ 0.219 Tw -18.053 -1.72 Td (wake up call for Canada. Now, there is a chapter in our National Securit\ y Policy that has )Tj 0.106 Tw T* ("Health:" first time in the history of the country t)Tj (hat I know of that Health is part of National )Tj 0 Tw T* (Security Policy.)Tj ( )Tj 0.011 Tw 3 -1.74 Td (SARS, while it was a virus, it also was an airport problem, a travel pro\ blem, an economic )Tj 0.129 Tw -3 -1.72 Td (problem, a restaurant problem in Toronto. People wouldn\222t go to Chine\ se restaurants. Then it )Tj 0.04 Tw T* (became eve)Tj (n bigger, because when Toronto officials began to isolate people, and th\ ey had up to )Tj 0.005 Tw T* [(8,000 people )0.5(isolated )0.5(every )0.5(day, )0.5(then )0.5(the )0.5(questions )0.5(became, )0.5("I )0.5(have )0.5(a )0.5(small )0.5(child. )0.5(Where )0.5(do )0.6(I )0.5(get )]TJ 0.028 Tw 0 -1.74 TD (my baby food? Where do I get my diapers?" And the elderly person saying,\ )Tj ("Can I just go down )Tj 0 Tw 0 -1.72 TD (to the cash machine and get $10?" "Well, no. You're supposed to be in is\ olation.)Tj 32.128 0 Td ( )Tj 0.072 Tw -29.128 -1.72 Td (There were a huge bunch of issues not anticipated by the Public Health c\ ommunity that )Tj 0.041 Tw -3 -1.72 Td (had to be dealt with, and are now recognized as part of what we now c)Tj 28.766 0 Td (all in Canada "a complex )Tj 0 Tw -28.766 -1.74 Td (medical emergency.")Tj 8.459 0 Td ( )Tj 0.146 Tw -5.459 -1.72 Td [(I say, "Yes, it has to be managed, and it's not in the )0.5(isolation )0.5(of )0.5(the )0.5(doctors..." I )0.5(still )]TJ 0.087 Tw -3 -1.72 Td (maintain and say, whenever I have a chance, "SARS is not over in Toronto\ . "There are people )Tj 0.035 Tw T* (there that still remain ter)Tj 9.969 0 Td (ribly affected by the SARS experience of watching their colleagues die, \ )Tj 0.054 Tw -9.969 -1.74 Td [(and in modern times, doctors and nurses aren't used )0.5(to )0.5(watching )0.5(doctors )0.5(and )0.5(nurses )0.5(die )0.5(from )0.5(an )]TJ 0.302 Tw T* (infectious disease. Maybe in the 1920s and '30s, yes. But not today. The\ re are a lot of )Tj 0 Tw T* (t)Tj (raumatized people still in Toronto, so I don\222t consider SARS over yet\ in Toronto.)Tj 32.855 0 Td ( )Tj -32.855 -1.72 Td ( )Tj ET endstream endobj 354 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 355 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 356 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 357 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 358 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 359 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (80)Tj ( )Tj ET Q BT 0.216 Tw 12 0 0 12 71.88 709.08 Tm (that statement. Everything has become multisectoral, and I was trying to\ think of why. It's )Tj 0.135 Tw 0 -1.72 TD (getting back to what David was j)Tj (ust talking about here. I think I trace it more to SARS than )Tj 0 Tw T* (anything else when you see a tremendous economic impact.)Tj 23.965 0 Td ( )Tj 0.067 Tw -20.965 -1.74 Td [(I think that anthrax, I think security, I think )0.5(the )0.5(World )0.5(Trade )0.5(Centre, )0.5(9/11, )0.5(all )0.5(had )0.5(some )]TJ 0.043 Tw -3 -1.72 Td (role, and we're only starting to appreciate som)Tj 18.755 0 Td (e of the Public Health aspects that have rolled out )Tj 0.027 Tw -18.755 -1.72 Td (of that. But SARS did something. It affected many, many countries; it af\ fected a huge portion of )Tj 0.187 Tw T* (our industry. It was at that point, I think we did undergo a change, and\ now Public Health )Tj 0 Tw 0 -1.74 TD (problems were se)Tj (en as multisectoral problems.)Tj ( )Tj 0.053 Tw 3 -1.72 Td [(In the United States, we now see )0.5(this playing out in terms of our pandemic influenza. In )]TJ 0.007 Tw -3 -1.72 Td (the United States, pan flu is a multisectoral problem, and it has been l\ ike that since we started the )Tj 0.282 Tw 0 -1.72 TD [(planning. )0.5(We've )0.5(run )0.5(into )0.5(other )0.5(gove)]TJ [(rnments )0.5(where )0.5(that )0.5(has )0.5(not )0.5(been )0.5(so. )0.5(They\222ve )0.5(kept )0.5(it )]TJ 0.214 Tw 0 -1.74 TD [(primarily in the Public Health realm, )0.5(and as )0.5(a result we sometimes )0.5(view )0.5(things )0.5(very, very )]TJ 0 Tw 0 -1.72 TD (differently.)Tj ( )Tj 0.197 Tw 3 -1.72 Td (I agree with you. It has been very difficult for some of the Public Heal\ th people to )Tj 0.163 Tw -3 -1.72 Td (understand. Ther)Tj (e's numerous epidemiologists, State epidemiologists in our country who s\ ay, )Tj 0.023 Tw 0 -1.74 TD [("This is a Public Health problem. This is influenza. Let's not blow it w\ ay out of proportion." )-0.7(But )]TJ 0 Tw 0 -1.72 TD (it's not an option that they're given any longer.)Tj 18.551 0 Td ( )Tj 0.037 Tw -15.551 -1.72 Td (I don't think some of them have)Tj 0 Tw ( )Tj 0.037 Tw 13.188 0 Td (not thought it all the way through. When pan flu begins, )Tj 0.082 Tw -16.188 -1.72 Td (the economy around several large international airports in the United St\ ates are going to crash, )Tj 0.095 Tw 0 -1.74 TD (and they haven't thought all this through, that they will be impacted by\ these things. It's a real )Tj 0 Tw 0 -1.72 TD (tw)Tj (ist for a lot of traditional Public Health people.)Tj 19.69 0 Td ( )Tj 0.007 Tw -16.69 -1.72 Td (Newer people in the game, they kind of see this and they're a little mor\ e politically savvy, )Tj 0 Tw -3 -1.72 Td (and they have a greater appreciation for it.)Tj 16.936 0 Td ( )Tj -13.936 -1.74 Td ( )Tj /TT1 1 Tf -3 -1.72 Td (Dr.)Tj ( )Tj (Anthony Marfin)Tj ( )Tj /TT0 1 Tf 0.07 Tw 3 -1.64 Td (I have Dr. St.)Tj 0 Tw ( )Tj 0.07 Tw (John and Dr.)Tj 0 Tw ( )Tj 0.07 Tw (Njoo, and I think J)Tj (eff also, but just before that, I'm going to )Tj 0 Tw -3 -1.74 Td (direct my comments at all you Public Health officials.)Tj 21.633 0 Td ( )Tj 0.003 Tw -18.633 -1.72 Td (Just in the context of this last part of the conversation, it may or may\ not surprise you, but )Tj 0.111 Tw -3 -1.72 Td (Public Health is not particularly unique in what you're descr)Tj 25.03 0 Td (ibing. Political Scientists now use )Tj 0.1 Tw -25.03 -1.72 Td (the expression of "network governance" to describe the world in which we\ 've moved. By that, )Tj 0.004 Tw 0 -1.74 TD (they mean that the old role of government is being gradually replaced in\ many parts of the world. )Tj ET endstream endobj 360 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (79)Tj ( )Tj ET Q BT 0.295 Tw 12 0 0 12 107.88 709.08 Tm (It's got major)Tj 0 Tw ( )Tj 0.295 Tw 6.426 0 Td (positive results, for example, more resources, more global attention. )Tj 0.082 Tw -9.426 -1.72 Td (Probably 15)Tj 0 Tw ( )Tj 0.082 Tw (years ago, if you tried to generate a discussion on these issues, nobody\ would pay )Tj 0 Tw 0 -1.72 TD (attention. Now they do.)Tj ( )Tj 0.084 Tw 3 -1.74 Td (It also generates interference and less flexibility and freedom to)Tj 0 Tw 26.22 0 Td ( )Tj 0.084 Tw 0.334 0 Td (act in what we thought )Tj 0.261 Tw -29.554 -1.72 Td (was our safe ground, because many other considerations come in that are \ not the usually )Tj 0.095 Tw T* (considerations we make. I think this is a major shift also in the role a\ nd purpose of the World )Tj 0.059 Tw T* (Health Organization and the role we have to play)Tj 0 Tw 20.133 0 Td ( )Tj 0.059 Tw 0.309 0 Td (in the world. We really have to open to all of )Tj 0 Tw -20.442 -1.74 Td (this.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (David Fidler\(?\))Tj ( )Tj /TT0 1 Tf 0.026 Tw 3 -1.66 Td (I think that's an excellent point, speaking as an international lawyer w\ ho has no scientific )Tj 0.085 Tw -3 -1.72 Td (background or Public Health training. One of the things that's been clea\ r to me is the exten)Tj 37.61 0 Td (t to )Tj 0.125 Tw -37.61 -1.72 Td (which other disciplines have become interested in Public Health. This is\ where these tensions )Tj 0.02 Tw T* [(between )0.5(the )0.5(traditional )0.5(role, )0.5(the )0.5(traditional )0.5(practice, )0.5(traditional )0.5(ethos )0.5(of )0.5(Public )0.5(Health )0.5(sometimes )]TJ 0.211 Tw 0 -1.74 TD (clashes directly with the practice and ethos of other ar)Tj 23.473 0 Td (eas. The best example of that is the )Tj 0 Tw -23.473 -1.72 Td (security framework.)Tj ( )Tj 0.074 Tw 3 -1.72 Td (This is something I think, of the disciplines that have come to Public H\ ealth and Public )Tj 0.035 Tw -3 -1.72 Td (Health itself, I think the biggest transformation has had to be on the P\ ublic Health side. They\222ve )Tj 0 Tw T* (had to sort)Tj ( )Tj (of rethink how they approach things.)Tj ( )Tj 0.012 Tw 3 -1.72 Td (If you begin to argue )Tj 0 Tw (\226)Tj ( )Tj 0.012 Tw 9.458 0 Td (as WHO has and other Public Health advocates have )Tj 0 Tw 21.462 0 Td (\226)Tj ( )Tj 0.012 Tw 0.762 0 Td (that Public )Tj 0.087 Tw -34.683 -1.72 Td [(Health ought to be considered a security concern. )0.5(And )0.5(if you're serious about that, you put the )]TJ 0.105 Tw 0 -1.72 TD (Security Council on the table and )Tj 14.24 0 Td (sort of say, "The Security Council doesn\222t have any role on )Tj 0.02 Tw -14.24 -1.74 Td (this security issue, but on all other security issues," doesn\222t under\ stand the way security works at )Tj 0 Tw T* (the United Nations level, nor in the Foreign Policy of States.)Tj 24.218 0 Td ( )Tj 0.078 Tw -21.218 -1.72 Td (I think that's hard for Public H)Tj (ealth people to adjust to that sort of thinking, but again I )Tj 0.135 Tw -3 -1.72 Td (think it's illustrative of the extent to which the governance context of\ Public Health has been )Tj 0 Tw 0 -1.74 TD (radically transformed.)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Harvey Lazar\(?\))Tj ( )Tj /TT0 1 Tf 0.087 Tw 3 -1.66 Td (Since Dr.)Tj 0 Tw ( )Tj 0.087 Tw (Wilson has mentioned that a lot of the things)Tj 0 Tw 22.754 0 Td ( )Tj 0.087 Tw 0.337 0 Td (that we deal with are no longer )Tj 0.006 Tw -26.092 -1.72 Td (dealing with a Ministry of Health, but in fact multiple Ministries withi\ n government, I agree with )Tj ET endstream endobj 361 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (78)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Har)Tj (vey Lazar)Tj ( )Tj /TT0 1 Tf 0.018 Tw 3 -1.64 Td (I'd just like to add, this is why I think Harvey's model and my approach\ actually give you )Tj 0.217 Tw -3 -1.74 Td (good things to compare: He uses hierarchical and non)Tj 0 Tw 23.228 0 Td (-)Tj 0.217 Tw (hierarchical as sort of an organizing )Tj 0.144 Tw -23.228 -1.72 Td (framework. When I talk about the trend towards centralized gover)Tj 27.728 0 Td (nance, that is not the same )Tj 0.185 Tw -27.728 -1.72 Td (thing as a hierarchical government. It may be a situation )Tj 0 Tw 24.592 0 Td (\226)Tj ( )Tj 0.185 Tw 0.935 0 Td (I'm thinking specifically the US )Tj 0.008 Tw -25.527 -1.72 Td (Constitution. We don\222t have to amend the constitution. But clearly th\ ere's some... the governance )Tj 0.036 Tw 0 -1.74 TD (of Public Health has clearly been tra)Tj (nsformed by a number of different things where the Federal )Tj 0.144 Tw 0 -1.72 TD (Government now plays a role which has centralized how we approach specif\ ic Public Health )Tj 0 Tw T* (problems.)Tj ( )Tj 0.114 Tw 3 -1.72 Td (That doesn\222t create a hierarchical form of government in the formal s\ ense, but there is )Tj 0 Tw -3 -1.74 Td (centralize)Tj 0.067 Tw [(d )0.5(governance )0.5(taking )0.5(form )0.5(within )0.5(that )0.5(country, )0.5(which )0.5(has )0.5(a )0.5(deep )0.5(tradition )0.5(of )0.5(a )0.5(Federal )]TJ 0 Tw T* (approach.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Sampath Krishnan)Tj ( )Tj /TT0 1 Tf 0.037 Tw 3 -1.66 Td (Still looking at this )Tj 0 Tw (\226)Tj ( )Tj 0.037 Tw 8.825 0 Td (and I like to put what we've been discussing, IHR, and the changes )Tj 0 Tw -11.825 -1.72 Td (that it might introduce in a broader context of)Tj 18.217 0 Td ( )Tj (evolution of governance and Public Health.)Tj 17.634 0 Td ( )Tj 0.203 Tw -32.851 -1.72 Td (I don't know if I can agree on all four shifts or evolutions you have pr\ esented, and )Tj 0.094 Tw -3 -1.74 Td [(particularly )0.5(I )0.5(think )0.5(there )0.5(might )0.5(be )0.5(different )0.5(stages )0.5(in )0.5(different )0.5(areas )0.5(of )0.5(the )0.5(world. )0.5(Some )0.5(places )]TJ 0.112 Tw T* (might now be going towards a )Tj (more centralized sort of government, others might be trying to )Tj 0 Tw T* (decentralize and swing back and forth as they might see fit.)Tj 23.742 0 Td ( )Tj 0.028 Tw -20.742 -1.72 Td (But I do feel there is another trend we are in, which is important and s\ ignificant, and that )Tj 0.003 Tw -3 -1.74 Td (is that Public Health is becoming more )Tj 15.826 0 Td (and more the domain of non)Tj 0 Tw (-)Tj 0.003 Tw (Public Health specialists. It's )Tj 0.118 Tw -15.826 -1.72 Td (becoming more and more an area where the involvement of other levels in \ government, other )Tj 0 Tw T* (institutions, other sectors becomes more and more prominent.)Tj 24.689 0 Td ( )Tj 0.084 Tw -21.689 -1.72 Td (I think IHR... well, just the whole issue of s)Tj (ecurity, for example, and how it sometimes )Tj 0.067 Tw -3 -1.74 Td [(interferes )0.5(with )0.5(Public )0.5(Health. )0.5(I )0.5(think )0.5(this )0.5(is )0.5(a )0.5(trend )0.5(that )0.5(will )0.5(continue. )0.5(Some )0.5(of )0.5(the )0.6(decisions\(?\) )]TJ 0.079 Tw T* [(will )0.5(become )0.5(much )0.5(bigger )0.5(than )0.5(they )0.5(were )0.5(thought )0.5(to )0.5(be )0.5(in )0.5(the )0.5(past. They )0.5(have )0.5(implementations )]TJ 0.054 Tw T* (that go, as we said, )Tj 8.131 0 Td (on economy, on commerce, on security, and that becomes something that is\ )Tj 0.059 Tw -8.131 -1.72 Td (way out of what used be the normal domain of medicine or Public Health. \ This is a trend that I )Tj 0 Tw 0 -1.74 TD (don't think we can stop. We just have to manage in the best possible way\ .)Tj 29.396 0 Td ( )Tj ET endstream endobj 362 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (77)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (What )Tj 0.088 Tw 2.503 0 Td (I would say in the context that you're posing the question is that in th\ e short run, )Tj 0.044 Tw -5.503 -1.72 Td [(centralized )0.5(systems )0.5(may )0.5(be )0.5(very )0.5(effective, )0.6(and )0.6(may )0.6(be )0.5(necessary. )0.5(But )0.5(if )0.5(you )0.5(can )0.5(develop )0.5(strong )]TJ 0.106 Tw 0 -1.72 TD (local capacity, then over time a system that integrates well. A strong l\ ocal)Tj 0 Tw 30.822 0 Td ( )Tj 0.106 Tw 0.356 0 Td (capacity with good )Tj 0.14 Tw -31.178 -1.74 Td [(communications )0.5(to )0.5(the )0.5(top )0.5(might )0.5(turn )0.5(out )0.5(to )0.5(more )0.5(efficient )0.5(than )0.5(a )0.5(highly )0.5(centralized )0.5(systems )]TJ 0.052 Tw T* (have all of the )Tj 0 Tw (\226)Tj ( )Tj 0.052 Tw 6.952 0 Td (in anything in the world )Tj 0 Tw (\226)Tj ( )Tj 0.052 Tw 10.922 0 Td (have all of the benefits and all of the dis)Tj 0 Tw 16.491 0 Td (-)Tj 0.052 Tw (benefits of )Tj 0 Tw -34.366 -1.72 Td (being highly centralized.)Tj ( )Tj 0.02 Tw 3 -1.72 Td (They can be too )Tj (rigid. They can try to fit everything into one particular formula when t\ he )Tj 0.024 Tw -3 -1.74 Td (situation at the local level may not accommodate that. I would say, if y\ ou tried to decentralize it, )Tj 0.292 Tw T* [(and it was not working, and you )0.5(were forced to centralize, there might be advant)]TJ (age in )Tj 0.18 Tw T* [(centralizing )0.5(for )0.5(a )0.5(period )0.5(of )0.5(time, )0.5(even )0.5(while )0.5(trying )0.5(to )0.5(correct )0.5(what )0.5(was )0.5(going )0.5(wrong )0.5(in )0.5(the )]TJ 0 Tw T* (decentralized model.)Tj ( )Tj 0.058 Tw 3 -1.74 Td (If you subscribe to Professor Fidler's view, there's a kind of inexorabl\ e pressure towards )Tj 0.074 Tw -3 -1.72 Td [(centralization, )0.5(which )0.5(is )0.5(being )0.5(just )0.5(created )0.5(b)]TJ 17.796 0 Td [(y )0.5(a )0.5(changing )0.5(world, )0.5(changing )0.5(technology... )0.5(a )0.6(whole )]TJ 0.308 Tw -17.796 -1.72 Td (bunch of other forces that are forcing globalization. I think we also kn\ ow that as these )Tj 0.178 Tw T* (globalization forces proceed, they also create their own reaction. There\ is, in Marxist terms, )Tj 0 Tw 0 -1.74 TD (there's an antithesis)Tj (, and there's a pressure for a local reaction.)Tj 24.85 0 Td ( )Tj 0.068 Tw -21.85 -1.72 Td (I think I'm doing a good job of weaselling on this, I have to say! But w\ hat I would say, )Tj 0.142 Tw -3 -1.72 Td (just given the risks associated with local failures, with decentralized \ failures )Tj 0 Tw 32.272 0 Td (\226)Tj ( )Tj 0.142 Tw 0.892 0 Td (my advice for )Tj 0.164 Tw -33.163 -1.72 Td (Canada, which has so fa)Tj (r been ignored )Tj 0 Tw (\226)Tj ( )Tj 0.164 Tw 17.78 0 Td (we have a very decentralized system with a lot of )Tj 0 Tw -17.78 -1.74 Td (potential cooperation between governments to cope with that decentraliza\ tion.)Tj 31.294 0 Td ( )Tj 0.03 Tw -28.294 -1.72 Td (My view is that should remain. But my view also is our Federal governmen\ t should have )Tj 0.097 Tw -3 -1.72 Td (an ultimate power that, i)Tj (n the event that the intergovernmental relationship does not work in a )Tj 0.064 Tw 0 -1.72 TD (crisis, we don\222t have to wait six months while new legislation is pas\ sed, that there is a fail)Tj 0 Tw 37.057 0 Td (-)Tj (safe )Tj -37.057 -1.74 Td (mechanism in place that can exploited very quickly.)Tj 20.826 0 Td ( )Tj 0.143 Tw -17.826 -1.72 Td (I hear you to be saying that when)Tj 0 Tw ( )Tj 0.143 Tw 14.697 0 Td (your decentralized model was not giving you good )Tj 0.125 Tw -17.697 -1.72 Td (enough results quickly enough, you had the option in a non)Tj 0 Tw (-)Tj 0.125 Tw (crisis situation to compensate for )Tj 0.046 Tw T* (that. As with many things with government and governance, systems of che\ cks and balances... I )Tj 0 -1.74 TD (can't tell you wha)Tj (t right for India. I can't tell you what's right for any country. What I\ can say is )Tj 0.086 Tw 0 -1.72 TD (you know the risks associated with a centralized system. You know the ri\ sks associated with a )Tj 0 Tw T* (decentralized system. I think you have to plan to mitigate the risks.)Tj 26.799 0 Td ( )Tj -26.799 -1.72 Td ( )Tj ET endstream endobj 363 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (76)Tj ( )Tj ET Q BT 0.1 Tw 12 0 0 12 71.88 709.08 Tm (maternelles. Il y aura des ordres \340 ce moment)Tj 0 Tw 18.929 0 Td (-)Tj 0.1 Tw (l\340 pour que le personnel qui n\222est plus e)Tj 0 Tw (mploy\351 )Tj 0.234 Tw -18.929 -1.72 Td (puisse vaquer \340 d\222autres t\342ches etc. Mais tout \347a est assez \ centralis\351 quand m\352me dans la )Tj 0 Tw 0 -1.72 TD (d\351cision.)Tj ( )Tj 0 -1.74 TD (YF:)Tj ( )Tj 3 0 Td (Merci.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Sampath Krishnan)Tj ( )Tj /TT0 1 Tf 0.011 Tw 3 -1.66 Td (From the squares which we have put the countries in, I would like to ask\ in the context of )Tj 0.119 Tw -3 -1.72 Td (IHR, which square would y)Tj (ou consider to be ideal square to be in? Because, I'll give you the )Tj 0.019 Tw T* (reason! [laughter] Which square would you consider a country, which woul\ d be in the context of )Tj 0 Tw T* (IHR ideal?)Tj ( )Tj 0.018 Tw 3 -1.74 Td (The reason I will say is when we had the Disease Surveillance System whe\ re we hire)Tj (d he )Tj 0.265 Tw -3 -1.72 Td (National Surveillance Program for communicable diseases was a totally ve\ rtical, centrally)Tj 0 Tw 38.667 0 Td (-)Tj 0.271 Tw -38.667 -1.72 Td (controlled system. It worked well, but we wanted to decentralize it, so \ we shifted to the )Tj 0.112 Tw T* (Integrated Disease Surveillance Project, which is a decentralized syste)Tj 29.025 0 Td (m. It was meant to be a )Tj 0.04 Tw -29.025 -1.74 Td [(decentralized )0.5(system. )0.5(But )0.5(we )0.5(didn\222t )0.5(find )0.5(that )0.5(the )0.5(information )0.5(was )0.5(coming )0.5(in )0.5(that )0.5(quickly. )0.5(It )0.5(was )]TJ 0 Tw T* (taking its time. It was going from the state to the state.)Tj 21.746 0 Td ( )Tj 0.058 Tw -18.746 -1.72 Td (Do we have that response being done at the local level? Fine. But the in\ form)Tj (ation is not )Tj 0.037 Tw -3 -1.72 Td [(being )0.5(received )0.5(at )0.5(the )0.5(Centre. )0.5(That's )0.5(why )0.5(we )0.5(find )0.5(we )0.6(find )0.5(we )0.5(are )0.5(now )0.5(encouraging )0.5(more )0.5(towards )]TJ 0 Tw 0 -1.74 TD (the vertical system for information as far as the context of IHR is conc\ erned.)Tj 30.656 0 Td ( )Tj 0.152 Tw -27.656 -1.72 Td (I would like to ask, which square would you feel that a country should )Tj 30.544 0 Td (be in, in that )Tj 0 Tw -33.544 -1.72 Td (square? For ideally organizing\(?\) or implementing the IHR?)Tj 24.076 0 Td ( )Tj -24.076 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.101 Tw 3 -1.64 Td (Let me weasel on a question. I don't know if you can translate "weasel" \ into Mandarin )Tj 0.052 Tw -3 -1.72 Td (very easily, but in contexts outside of public health, I've used this pa\ rticul)Tj (ar device for trying to )Tj 0.019 Tw T* (understand the character of Federal systems in different parts of the wo\ rld, and even non)Tj 0 Tw 35.668 0 Td (-)Tj (Federal )Tj 0.1 Tw -35.668 -1.72 Td (systems. I've often said to people that there isn't a best or worst quad\ rant. There are trade)Tj 0 Tw 37.112 0 Td (-)Tj (offs )Tj 0.12 Tw -37.112 -1.72 Td [(associated )0.5(with )0.5(the )0.5(different )0.5(quadr)]TJ 14.306 0 Td [(ants, )0.5(and )0.5(if )0.5(you )0.5(are )0.5(in )0.5(a )0.5(particular )0.5(quadrant )0.5(you )0.5(get )0.5(certain )]TJ 0.008 Tw -14.306 -1.72 Td (advantages and certain disadvantages. If you understand the characterist\ ics of the advantages and )Tj 0 Tw T* (disadvantages, you can then plan to exploit the advantages and mitigate \ the disadvantages.)Tj 36.211 0 Td ( )Tj ET endstream endobj 364 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 365 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 366 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 367 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 368 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 369 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (75)Tj ( )Tj ET Q BT 12 0 0 12 107.88 709.08 Tm (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td ( )Tj 0 -1.72 TD ([Side 6])Tj ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (St\351phane Veyrat)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (May I speak in French?)Tj ( )Tj -3 -1.72 Td (SP:)Tj ( )Tj 3 0 Td (No!)Tj ( )Tj -3 -1.74 Td (SV:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you for your authorization.)Tj ( )Tj 0.309 Tw 0 -1.72 TD (En France, par rapport aux deux tableaux qui m\351ritent effectivement d\ \222essayer de )Tj 0.082 Tw -3 -1.72 Td (positionner les diff\351rents pays, sur le premier sur l\222\351)Tj (tablissement des r\350gles on est relativement )Tj 0.054 Tw T* (d\222accord les r\350gles sont impos\351es puisque de toute mani\350re l\ \222accord international qui est conclu )Tj 0.158 Tw 0 -1.74 TD (avec le RSI s\222impose en France et donc chez nous la situation des r\350\ gles et de ce qu\222il faut )Tj 0.154 Tw 0 -1.72 TD (arriver \340 b\342tir et de )Tj (diff\351rentes actions capacit\351, building etc. tout \347a c\222est fi\ x\351 par le niveau )Tj 0 Tw T* (national et le niveau gouvernemental. )Tj 15.272 0 Td ( )Tj 0.281 Tw -12.272 -1.72 Td [(Apr\350s )0.5(je )0.5(pense )0.5(qu\222il )0.5(y )0.5(a )0.5(deux )0.5(choses. )0.5(Dans )0.5(le )0.5(deuxi\350me )0.5(diagramme )0.6(on )0.5(parle )0.5(des )]TJ 0.151 Tw -3 -1.74 Td (op\351rations et l\340 il faut bien distinguer ce qui est de la mise)Tj 0 Tw 25.085 0 Td ( )Tj 0.151 Tw 0.401 0 Td (en oeuvre des d\351cisions et de la )Tj 0.251 Tw -25.486 -1.72 Td (d\351cision des actions qu\222on va mettre en oeuvre. Je m\222explique. \ Quand on va prendre une )Tj 0.453 Tw T* (d\351cision par exemple comme la fermeture temporaire des \351coles ou l\ \222interdiction des )Tj 0 Tw T* (rassemblements c\222est \351vident que c\222est quelque chos)Tj 21.048 0 Td (e qui va \352tre d\351cid\351 en interminist\351riel. )Tj 15.827 0 Td ( )Tj 0.048 Tw -33.875 -1.74 Td (Donc au niveau du gouvernement il va y avoir une r\351union de l\222ense\ mble des minist\350res )Tj 0.185 Tw -3 -1.72 Td (concern\351s et avant de prendre cette d\351cision. Cette d\351cision el\ le figure parmi les diff\351rentes )Tj 0.061 Tw T* (mesures qu\222on peut prendre pour )Tj (lutter contre un ph\351nom\350ne \351mergent, arrivant sur le territoire\ )Tj 0.035 Tw T* (et donc toutes ces mesures)Tj 0 Tw 10.748 0 Td (-)Tj 0.035 Tw (l\340 vont \352tre analys\351es les unes apr\350s les autres et puis on \ regardera si )Tj 0.016 Tw -10.748 -1.74 Td (elle est pertinente\205 pas pertinente, en fonction de sa pertinence et \ du consensus qu\222on arri)Tj 36.57 0 Td (vera \340 )Tj 0.127 Tw -36.57 -1.72 Td (trouver effectivement. La d\351cision sera prise et \340 ce moment)Tj 0 Tw 25.3 0 Td (-)Tj 0.127 Tw (l\340 ordre sera donn\351 au pr\351fet de )Tj 0.053 Tw -25.3 -1.72 Td [(d\351partement )0.5(de )0.5(mettre )0.5(en )0.5(oeuvre )0.5(les )0.5(mesures )0.5(dans )0.5(les )0.5(territoires concern\351s. )0.5(C\222est )0.5(pas )0.5(forc\351ment )]TJ 0.105 Tw T* (la France enti\350re mais \347a peut \352tre une partie. \300 partir de)Tj 0 Tw 23.866 0 Td ( )Tj 0.105 Tw 0.355 0 Td (l\340 il n\222y a pas de latitude laiss\351e au )Tj 0 Tw -24.221 -1.74 Td (d\351partement. )Tj ( )Tj 0.06 Tw 3 -1.72 Td (Il n\222y a pas de d\351centralisation de la d\351cision. La seule chose\ c\222est que effectivement \347a )Tj 0.031 Tw -3 -1.72 Td (va \352tre au niveau du d\351partement que seront mises en oeuvre les me\ sures, les fermetures d\222\351cole )Tj 0.103 Tw T* (et les choses c)Tj (omme \347a, mais l\222ordre sera donn\351 par le pr\351fet, \340 l\222in\ specteur d\222Acad\351mie pour )Tj 0.408 Tw 0 -1.74 TD (l\222\351ducation nationale qui fermera les \351coles ou les coll\350ges\ , les universit\351s, les \351coles )Tj ET endstream endobj 370 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (74)Tj ( )Tj ET Q BT 0.051 Tw 12 0 0 12 71.88 709.08 Tm (same like in Brazil in case of something huge, they need assistance, we\222\ re going to send a team )Tj 0.023 Tw 0 -1.72 TD (of investigators or some operational teams to assist them, because it\222\ s not practical )Tj 0 Tw 33.622 0 Td (\226)Tj ( )Tj 0.023 Tw 0.773 0 Td (my country )Tj 0.049 Tw -34.395 -1.72 Td (is huge )Tj 0 Tw (\226)Tj ( )Tj 0.049 Tw 4.007 0 Td (so it can\222t work for those peo)Tj (ple. At least they have their salary, they should work for )Tj 0 Tw -4.007 -1.74 Td (their salary.)Tj ( )Tj 0.014 Tw 3 -1.72 Td (So, I mean, at the operational level it\222s not such... Russia is not o\ n the top, say. Or maybe )Tj 0 Tw -3 -1.72 Td (I don\222t understand your...)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.118 Tw 3 -1.64 Td (I think that\222s probably correct, and of cour)Tj 17.819 0 Td (se I may be wrong, but I think in all of the )Tj 0.2 Tw -20.819 -1.72 Td (countries the actual practical activity, the public health services, are\ done locally almost by )Tj 0.096 Tw T* (definition. It would be very unusual for a national government to have a\ huge team of doctors )Tj 0.344 Tw 0 -1.72 TD (and laboratories scat)Tj (tered across the country who are directly employed by the national )Tj 0.173 Tw T* (government, that\222s not what I mean. I understood that in Russia, for \ example, that the local )Tj 0 Tw T* (public health officials carry out the first response activities of all s\ orts.)Tj 28.214 0 Td ( )Tj 0.123 Tw -25.214 -1.74 Td (But I also underst)Tj (ood you to say )Tj 0 Tw (\226)Tj ( )Tj 0.123 Tw 14.927 0 Td (and I may have misunderstood you )Tj 0 Tw (\226)Tj ( )Tj 0.123 Tw 15.885 0 Td (that they are )Tj 0.17 Tw -33.812 -1.72 Td [(fully )0.5(funded )0.5(through )0.5(the )0.5(federal )0.5(government )0.5(and )0.5(that... )0.5(and )0.5(I )0.5(was )0.5(judging )0.5(for )0.5(that )0.5(particular )]TJ 0.08 Tw T* (reason that the level of discretion that was available was heavily contr\ olled through the federa)Tj 0 Tw 38.722 0 Td (l )Tj 0.05 Tw -38.722 -1.72 Td (government, that in fact the )Tj 0 Tw 11.525 0 Td (\226)Tj ( )Tj 0.05 Tw 0.8 0 Td (and I may be wrong, of course: you understand this, I don\222t )Tj 0 Tw 24.597 0 Td (\226)Tj ( )Tj 0.8 0 Td (but )Tj 0.306 Tw -37.722 -1.74 Td (that the funding basically meant that the operational activity would fol\ low protocols and )Tj 0.039 Tw T* (procedures that were determined in Moscow. Now, maybe that\222s wrong )Tj 29.324 0 Td (but that is what I had in )Tj 0 Tw -29.324 -1.72 Td (mind.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Yuri Fedorov)Tj ( )Tj /TT0 1 Tf 0.054 Tw 3 -1.64 Td (You\222re right up to a certain extent, you know, but I mean that the fu\ nding is going from )Tj 0.12 Tw -3 -1.72 Td (Moscow, the funding, but they have all a regular budget. In spite of any\ collision, you know, )Tj 0.019 Tw T* (they\222ll get their, say,)Tj 0 Tw ( )Tj 0.019 Tw 8.574 0 Td (one million of rubles. In case of something they will not cope, they can\ add )Tj 0.048 Tw -8.574 -1.72 Td (them, from emergency funds, some more on the funding. But, I mean, this \ is a regular budget, I )Tj 0.158 Tw 0 -1.72 TD (should say. We can add for emergency situations, we can add them... you \ know, they )Tj 0 Tw 36.667 0 Td (spend )Tj 0.081 Tw -36.667 -1.72 Td (more, they need money for transportation, for fuel and \(all of it?\), s\ o it goes in this way. But I )Tj 0.03 Tw 0 -1.74 TD (mean that when you discuss the operational level, the main activities ar\ e at the )Tj 0 Tw 32.048 0 Td (\226)Tj ( )Tj 0.03 Tw 0.78 0 Td (how do we call )Tj 0 Tw -32.828 -1.72 Td (it? )Tj (\226)Tj ( )Tj (grass level, grassroots level. That\222s a nice ex)Tj 19.854 0 Td (pression.)Tj ( )Tj ET endstream endobj 371 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (73)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.279 Tw 3 -1.64 Td (The conversation over the last several minutes has been focused on one p\ articular )Tj 0.353 Tw -3 -1.74 Td (element only of what we\222ve been talking about for the last two days. \ Are there other )Tj 0.324 Tw 0 -1.72 TD (comments/questions that any of you would like to raise, either coming ou\ t of the three )Tj 0.057 Tw T* (presentations which Dr.)Tj 0 Tw ( )Tj 0.057 Tw (Wilson, Dr.)Tj 0 Tw ( )Tj 0.057 Tw (Fidler and I made, or from the earlier conversations? Other )Tj 0 Tw T* (points that you think need to be flagged?)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Expedito Luna)Tj ( )Tj /TT0 1 Tf 0.113 Tw 3 -1.64 Td (I would like)Tj 0 Tw ( )Tj 0.113 Tw 5.422 0 Td (to comment on your presentation. First of all it\222s an opportunity for\ us to )Tj 0.021 Tw -8.422 -1.74 Td (think about ourselves for what we are doing. It\222s very nice. And spec\ ifically on the classification )Tj 0.104 Tw T* [(of the countries, I think you\222re )0.5(right to )0.5(a )0.5(certain )0.5(extent )0.5(on )0.5(the )0.5(rule)]TJ 0 Tw 27.615 0 Td (-)Tj 0.104 Tw [(making )0.5(i)]TJ [(n )0.5(my )0.5(country, )0.5(it\222s )]TJ 0.306 Tw -27.615 -1.72 Td (much centralized, it\222s the ministry who has the active role in propos\ ing new rules, new )Tj 0.155 Tw T* (regulations, new norms. But nowadays with the... as I said in my present\ ation yesterday, the )Tj 0 -1.74 TD (country\222s moving from an authoritarian dictatorship to a)Tj 0 Tw 23.605 0 Td ( )Tj 0.155 Tw 0.405 0 Td (more democratic state, and then the )Tj 0.082 Tw -24.01 -1.72 Td (states at the decentralized levels they have the power to override our g\ roups, to block what we )Tj 0.094 Tw 0 -1.72 TD [(propose, and I have lost several proposals this )-0.6(year, things that we at the central level propose )]TJ 0.034 Tw T* (and they say, \223No, we\222re )Tj (not ready to do that, we do not have the money. That\222s not going to b\ e )Tj 0.028 Tw 0 -1.74 TD (done.\224 So there is a... still it\222s a reactive process. They are no\ t proposing themselves new things, )Tj 0 Tw 0 -1.72 TD (new rules, but they have the power to block the initiatives at the feder\ al level.)Tj 31.045 0 Td ( )Tj -28.045 -1.72 Td (An)Tj 0.253 Tw [(d the operational )0.5(process, )0.6(well, )0.6(I\222m )0.5(sorry )0.5(if )0.5(I )0.5(made )0.5(that )0.5(impression, )0.5(but )0.5(it\222s )0.5(all )]TJ 0.007 Tw -3 -1.72 Td (decentralized. The only operational power we have at the central level i\ s our epidemiologists that )Tj 0.034 Tw 0 -1.74 TD (go and investigate outbreaks. All the control procedures, if you have to\ v)Tj (accinate, if you have to )Tj 0 -1.72 TD (screen people, if you have to control insects, everything\222s done by t\ he local and state levels, and )Tj 0.122 Tw T* (we only have those )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw 9.3 0 Td (how do I say? )Tj 0 Tw 6.318 0 Td (\226)Tj ( )Tj 0.122 Tw 0.872 0 Td [(emergency )0.5(or )0.5(rapid )0.5(response )0.5(teams )0.5(to )0.5(investigate, )0.5(and )]TJ 0 Tw -16.49 -1.72 Td (nothing else.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Yuri Fedorov)Tj ( )Tj /TT0 1 Tf 0.18 Tw 3 -1.64 Td (The same)Tj 0 Tw ( )Tj 0.18 Tw 4.47 0 Td (with me, except the law)Tj 0 Tw 10.245 0 Td (-)Tj 0.18 Tw (making. The law)Tj 0 Tw (-)Tj 0.18 Tw (making is okay also. It\222s highly )Tj 0 Tw -17.715 -1.74 Td (centralized.)Tj ( )Tj 0.019 Tw 3 -1.72 Td (But I\222d also like to make remarks concerning the operational level. T\ he main activities of )Tj 0.11 Tw -3 -1.72 Td (course at the level of the, say, counties... local level, and sometimes \ on the)Tj 0 Tw 31.228 0 Td ( )Tj 0.11 Tw 0.36 0 Td (regional level, the )Tj ET endstream endobj 372 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (72)Tj ( )Tj ET Q BT 0.007 Tw 12 0 0 12 107.88 709.08 Tm (But I think that there is something else that\222s going on, at least wi\ thin the systems that we )Tj 0.152 Tw -3 -1.72 Td (describe. I think there is basically a desire for local and state health\ departments to let other )Tj 0.072 Tw 0 -1.72 TD (people know. That\222s why they\222re there. They want the coun)Tj 24.555 0 Td (ty next to them to know, they want )Tj 0.019 Tw -24.555 -1.74 Td (the state next to them to know, and they would like others to know. And \ that has been as equally )Tj 0.102 Tw T* (important in terms of driving our development of the communication syste\ m, that there is that )Tj 0 Tw T* (desire )Tj 2.656 0 Td (\226)Tj ( )Tj 0.019 Tw 0.768 0 Td [(at )0.5(least )0.5(within )0.5(our )0.5(g)]TJ 0 Tw (overnment )Tj 12.562 0 Td (\226)Tj ( )Tj 0.019 Tw 0.768 0 Td [(to )0.5(share )0.5(this )0.5(information )0.5(and )0.5(to )0.5(rapidly )0.5(move )0.5(it. )0.5(Again, )]TJ 0.198 Tw -16.755 -1.72 Td (I hate to keep coming back to West Nile Virus but in fact I know that th\ e communication )Tj 0.098 Tw 0 -1.74 TD (strategy that we set up around there was driven by that, that we felt th\ at a county in Colorado )Tj 0 Tw 0 -1.72 TD (cou)Tj 0.12 Tw (ld be immediately adjacent to a county in Kansas but they may not talk t\ o each other just )Tj 0.046 Tw T* (because of the nature of reporting, and we sought to break that down wor\ king with EPIX, EPIX )Tj 0.056 Tw T* (Forum, a lot of communication packages, and so it was more I think... I\222\ l)Tj (l give it at least equal. )Tj 0.104 Tw 0 -1.74 TD [(There was at least an equal interest in reporting, )0.5(and reporting to your neighbour. I think it as )]TJ 0 Tw 0 -1.72 TD (Dr.)Tj ( )Tj 0.062 Tw (Lazar who said this... who was it? Anyway, it was about that it\222s ver\ y easy for a country in )Tj 0 Tw T* (sub)Tj (-)Tj 0.13 Tw (Saharan Africa, it\222s easier for)Tj 0 Tw ( )Tj 0.13 Tw 14.424 0 Td (them to communicate with Geneva than it is with our own )Tj 0.105 Tw -14.424 -1.72 Td (neighbour. That\222s true within the United States as well, it\222s easi\ er for a county in Colorado to )Tj 0.011 Tw 0 -1.74 TD (talk to Atlanta or to Fort Collins than it is for a county in Kansas to \ talk to that neighbour, and so)Tj 0 Tw 39 0 Td ( )Tj -39 -1.72 Td (that was as important a driver as anything else.)Tj 18.745 0 Td ( )Tj -18.745 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Jeffrey Scott)Tj ( )Tj /TT0 1 Tf 0.072 Tw 3 -1.66 Td [(The )0.5(other )0.5(thing )0.5(that )0.5(was )0.5(mentioned )0.6(that )0.6(I )0.5(think )0.5(is )]TJ 0 Tw (\226)Tj ( )Tj 0.072 Tw 21.532 0 Td [(I )0.5(know )0.5(we\222re )0.5(seeing )0.5(it )0.5(in )0.6(Canada )]TJ 0 Tw 13.968 0 Td (\226)Tj ( )Tj 0.16 Tw -38.5 -1.72 Td (the issue of, at least North America, the cross)Tj 0 Tw 19.442 0 Td (-)Tj 0.16 Tw (border initiatives. In my sense there are more )Tj 0 Tw -19.442 -1.72 Td (cros)Tj (s)Tj (-)Tj 0.045 Tw (border initiatives around public health preparedness, but even though th\ ose are engaged at )Tj 0.025 Tw 0 -1.74 TD (the national level )Tj 0 Tw (\226)Tj ( )Tj 0.025 Tw 7.986 0 Td (so there has to be some agreement between national governments )Tj 0 Tw 26.685 0 Td (\226)Tj ( )Tj 0.775 0 Td (basically )Tj 0.138 Tw -35.446 -1.72 Td (we have to work on that. And so suddenly )Tj 0 Tw (\226)Tj ( )Tj 0.138 Tw 19.235 0 Td (and we\222ve had some discu)Tj (ssion with the north)Tj 0 Tw (-)Tj 0.175 Tw -19.235 -1.72 Td (eastern states )Tj 0 Tw (\226)Tj ( )Tj 0.175 Tw 6.828 0 Td (you have to... when you\222ve got different levels with a different coun\ try and )Tj 0.051 Tw -6.828 -1.72 Td (you\222re still trying to do that from perhaps a surveillance protection\ , so the more centralized it is )Tj 0.031 Tw T* [(the )0.5(easier )0.5(it )0.5(is )0.5(because )0.5(it\222s )0.5(a )0.5(common )0.5(u)]TJ 0.03 Tw (nderstanding. And sometimes you\222re dealing with what\222s )Tj 0.093 Tw 0 -1.72 TD (happening at a federal level in Canada, what\222s happening with your co\ mpanion provinces, and )Tj 0.095 Tw T* (then what\222s happening with the states in the U.S., and what\222s happ\ ening with the federal. And )Tj 0 Tw T* (we\222d like to ke)Tj (ep it simple, quite frankly, so that harmonization really helps there.)Tj 32.824 0 Td ( )Tj -32.824 -1.74 Td ( )Tj ET endstream endobj 373 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (71)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Stefan)Tj (o Lazzari)Tj ( )Tj /TT0 1 Tf 0.123 Tw 3 -1.64 Td (Scott, I think you hit the nail: timely and accurate, that\222s the issu\ e, because in today\222s )Tj 0.03 Tw -3 -1.74 Td (world if you wait six hours or twelve hours to be accurate you might not\ be timely anymore, it\222s )Tj 0.004 Tw 0 -1.72 TD (already out, and that\222s a big challenge from WHO because w)Tj 24.447 0 Td (e want to be accurate, we want to be )Tj 0.045 Tw -24.447 -1.72 Td (sure, we want the information that is absolutely certain, but if you wai\ t to do that you get CNN, )Tj 0.138 Tw T* (BBC, the local news, all other things coming up that basically put the i\ nformation there, and )Tj 0 Tw 0 -1.74 TD (you\222re behind. And that\222s g)Tj (oing to be the big challenge, I think, for the future.)Tj 31.27 0 Td ( )Tj -31.27 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 0.262 Tw 3 -1.66 Td (In light of this I guess the question then for federal governments is kn\ owing how )Tj 0.104 Tw -3 -1.72 Td (vulnerable they are if reporting does not occur from a regional governme\ nt up because people )Tj 0.045 Tw T* (are go)Tj (ing to find out. Did that perhaps encourage federal governments to be mo\ re aggressive on )Tj 0.103 Tw T* (that specific issue compared to the other capacities? I guess that would\ be the question I\222d... I )Tj 0.014 Tw 0 -1.74 TD (know that reporting, mandatory reporting, has been contentious, and I)Tj 0 Tw 28.06 0 Td ( )Tj 0.014 Tw 0.264 0 Td (would expect that regional )Tj 0.005 Tw -28.324 -1.72 Td (governments would have the same awareness that the federal governments h\ ave that if they don\222t )Tj 0 Tw 0 -1.72 TD (report people will eventually find out.)Tj 15.163 0 Td ( )Tj -15.163 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Anthony Marfin)Tj ( )Tj /TT0 1 Tf 0.179 Tw 3 -1.64 Td (I think that\222s part of it. I think that there has been a real drive )Tj 0 Tw 27.342 0 Td (\226)Tj ( )Tj 0.929 0 Td (at )Tj 0.179 Tw 1.151 0 Td (least within our )Tj 0 Tw -32.421 -1.72 Td (government )Tj 5.064 0 Td (\226)Tj ( )Tj 0.037 Tw 0.787 0 Td (both on the state and federal, and I know this from the local level as w\ ell, that we )Tj 0.132 Tw -5.851 -1.74 Td (want to be the people that control the message, and the six hours makes \ a difference all of a )Tj 0.062 Tw 0 -1.72 TD (sudden. If the news services weren\222t so good we)Tj (\222d have longer to do it, but in fact they\222re very )Tj 0 Tw T* (good at what they do and so we have to get out the message and we have t\ o control it.)Tj 34.324 0 Td ( )Tj 0.103 Tw -31.324 -1.72 Td (That means if you\222re a public health agency and you\222re wanting to \ put out an accurate )Tj 0.077 Tw -3 -1.74 Td (report you have to be able to know)Tj 0 Tw 14.449 0 Td ( )Tj 0.077 Tw 0.327 0 Td (where that test )Tj 0 Tw (\226)Tj ( )Tj 0.077 Tw 7.137 0 Td (the confirmatory test )Tj 0 Tw (\226)Tj ( )Tj 0.077 Tw 9.637 0 Td (was done, when it )Tj 0.012 Tw -31.55 -1.72 Td (was done, which is the sample, what is it, all these things, and so that\ has driven a lot of what we )Tj 0.013 Tw T* [(do )0.5(with )0.5(regards )0.5(to )0.5(EPIX )0.5(and )0.5(our )0.5(communication )0.5(packages. )0.5(Those )0.5(communication )0.5(packages )0.5(have )]TJ 0.09 Tw T* (to w)Tj (ork well, we have to identify cases in other locales as well, very, very\ quickly, so that we )Tj 0.021 Tw 0 -1.74 TD (can give just something that\222s just a little more than a news service\ in that time, because then we )Tj 0 Tw 0 -1.72 TD (appear that we know what we\222re doing and that we control the me)Tj 26.435 0 Td (ssage.)Tj ( )Tj ET endstream endobj 374 0 obj <> endobj 375 0 obj <> endobj 376 0 obj <> endobj 377 0 obj <> endobj 378 0 obj <> endobj 379 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 380 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 381 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 382 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 383 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 384 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (70)Tj ( )Tj ET Q BT 0.314 Tw 12 0 0 12 71.88 709.08 Tm (be developed with some consideration, but there\222s so much ex)Tj 27.71 0 Td (perience nowadays around )Tj 0 Tw -27.71 -1.72 Td (managing this information that I think it\222s going to work out pretty \ fine.)Tj 28.801 0 Td ( )Tj 0.016 Tw -25.801 -1.72 Td (And I like your division of the IHR into different instruments, Ron, but\ actually normally )Tj 0 Tw -3 -1.74 Td (\226)Tj ( )Tj 0.032 Tw 0.782 0 Td (and we discussed it last night )Tj 0 Tw (\226)Tj ( )Tj 0.032 Tw 12.914 0 Td (I proposed three different. Yo)Tj [(u have )0.5(the notification, you have )]TJ 0 Tw -13.696 -1.72 Td (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (and I think it\222s for the first time )Tj 0 Tw 13.224 0 Td (\226)Tj ( )Tj 0.042 Tw 0.792 0 Td (a global response tool. The IHR provides clear mechanisms )Tj 0.04 Tw -14.808 -1.72 Td [(for )0.5(WHO )0.5(and )0.5(state )0.5(parties, )0.5(member )0.5(states, )0.5(to )0.5(manage an )0.5(international )0.5(emergency response. )0.5(And )]TJ 0.136 Tw 0 -1.72 TD (then you have the capacity)Tj 0 Tw (-)Tj (buil)Tj 0.136 Tw (ding part, which for me is perhaps the most difficult, also the )Tj 0 Tw 0 -1.74 TD (most essential.)Tj ( )Tj 0.241 Tw 3 -1.72 Td (Going back to information, I think that if countries don\222t set up the\ ir own internal )Tj 0.022 Tw -3 -1.72 Td (verification system of events or signals, and they will just simply tran\ smit it over to WHO)Tj 36.374 0 Td (, all of )Tj 0.099 Tw -36.374 -1.72 Td [(them, )0.5(we )0.5(will )0.5(be )0.5(flushed )0.5(and )0.5(paralyzed )0.5(within )0.5(a )0.5(day. )0.5(So )0.5(there )0.5(is )0.5(a )0.5(need )0.5(in )0.5(the )0.5(countries )0.5(to )0.5(do )]TJ 0.3 Tw T* (some of this filtering work, and really let only the potential public he\ alth emergency of )Tj 0.202 Tw 0 -1.72 TD (international concern or the potentially serious events filter)Tj 0 Tw 25.042 0 Td ( )Tj 0.202 Tw 0.452 0 Td (up, to avoid just congesting the )Tj 0 Tw -25.494 -1.72 Td (system.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Jeffrey Scott)Tj ( )Tj /TT0 1 Tf 0.002 Tw 3 -1.64 Td (Ron, as a follow)Tj 0 Tw (-)Tj 0.002 Tw (up to that )Tj 0 Tw (\226)Tj ( )Tj 0.002 Tw 11.68 0 Td (and I agree, I appreciate what you said )Tj 0 Tw 15.704 0 Td (\226)Tj ( )Tj 0.002 Tw 0.752 0 Td (the degree to which )Tj 0.009 Tw -31.136 -1.72 Td (the verification process will necessitate enhanced governance, because i\ t\222s really important... and )Tj 0 Tw T* (thi)Tj 0.06 Tw (s relates to the health professionals too, I mean, ProMED is used by the\ health professionals, )Tj 0.084 Tw 0 -1.72 TD (so I\222ve got calls from people I respect saying, \223I\222ve noticed t\ his. What\222s going on?\224 And what )Tj 0.031 Tw T* (we tend to do is to say unless it is officially released by the Pu)Tj 25.32 0 Td (blic Health Agency, or it\222s WHO, )Tj 0.038 Tw -25.32 -1.72 Td (that\222s what we\222re using. But that\222s okay as long as it\222s acc\ urate and it\222s timely, and we will lose )Tj 0.109 Tw 0 -1.74 TD (the credibility in the system unless we know that that is taking place. \ I mean, yes, it can be a )Tj 0.011 Tw 0 -1.72 TD (little bit behind, but it\222)Tj 9.071 0 Td (s got to be right, and it\222s got to be in a reasonable amount of time.\ And I\222d )Tj 0.121 Tw -9.071 -1.72 Td (much rather... it\222s easier for me to defer that to at least the feder\ al level, and if necessary the )Tj 0.041 Tw T* [(world level, rather than do the... because quite frankly we\222re usuall\ y )0.5(dealing)]TJ 0 Tw 30.907 0 Td ( )Tj 0.041 Tw 0.291 0 Td [(with )0.5(some )0.5(problem )]TJ 0.069 Tw -31.198 -1.74 Td [(anyway )0.5(and )0.5(we )0.5(haven\222t )0.5(got )0.5(time )0.5(to )0.5(do )0.5(that )0.5(piece )0.5(of )0.5(work. )0.5(So )0.5(that )0.5(is )0.5(going )0.5(to )0.5(raise )0.5(the )0.5(level )0.5(by )]TJ 0.057 Tw T* [(nature )0.5(of )0.5(being )0.5(able )0.5(to )0.5(respond )0.6(and )0.6(have )0.5(public )0.5(confidence )0.5(you\222re )0.5(responding, )0.5(and )0.5(professional )]TJ 0 Tw T* (confidence that you\222re responding.)Tj ( )Tj T* ( )Tj ET endstream endobj 385 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (69)Tj ( )Tj ET Q BT 0.183 Tw 12 0 0 12 107.88 709.08 Tm (And this information already has been... it was considered already by kn\ owledgeable )Tj 0.027 Tw -3 -1.72 Td (people, experts or something, so I can rely on it. And in this way I pic\ k out the information, say, )Tj 0.115 Tw 0 -1.72 TD (\223Okay, they should not care about somewhere in the corner what\222)Tj 27.449 0 Td (s going on,\224 but in case the )Tj 0.154 Tw -27.449 -1.74 Td (information is nice for my countrymen so I immediately inform those quar\ antine points, you )Tj 0.01 Tw T* (know, \223Be careful. Something\222s going on in that corner. The plane \ will come,\224 or something like )Tj 0 Tw T* (that, \223so you should enforce the surveil)Tj (lance, ask people what\222s going on, so on and so on.\224)Tj ( )Tj 0.078 Tw 3 -1.72 Td (So I prefer not to have a so)Tj 0 Tw (-)Tj 0.078 Tw (called non)Tj 0 Tw (-)Tj 0.078 Tw (governmental source of information, but already )Tj 0.051 Tw -3 -1.74 Td (filtered, I should say. It\222s rather important those who have informat\ ion, those people on the top, )Tj 0 Tw T* (it\222s clear.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Stefano Lazzari)Tj ( )Tj /TT0 1 Tf 0.37 Tw 3 -1.66 Td (I think the expansion of GPHIN to cover more languages and more sources \ of )Tj 0.121 Tw -3 -1.72 Td (information is an interesting one, but it doesn\222t really change the s\ ystem that exists already. I )Tj 0.144 Tw T* (mean, GPHIN, ProMED, the verification list, they\222re already in pla)Tj (ce and they\222re being used )Tj 0 Tw 0 -1.74 TD (widely, so we can improve coverage, we can improve sensitivity of the sy\ stem.)Tj 31.686 0 Td ( )Tj 0.128 Tw -28.686 -1.72 Td (There are a couple of dangers, again, that we have to be careful, and fo\ r me the most )Tj 0.16 Tw -3 -1.72 Td (dangerous thing is over)Tj 0 Tw (-)Tj 0.16 Tw (charging, over)Tj 0 Tw (-)Tj 0.16 Tw (burdening the system by too)Tj 0 Tw ( )Tj 0.16 Tw 28.826 0 Td (much information to the )Tj 0.174 Tw -28.826 -1.72 Td (point that it gets paralyzed. It gets paralyzed for us but also for memb\ er states. They might )Tj 0.117 Tw T* [(receive information of some small outbreak )0.5(on the other side of the world that really is of no )]TJ 0.048 Tw 0 -1.72 TD (relevance, and this sort of background noi)Tj (se sometimes is more of a nuisance, it\222s like all the e)Tj 0 Tw (-)Tj T* (mails you get that are spams and things like that, but not that bad.)Tj 26.245 0 Td ( )Tj 0.004 Tw -23.245 -1.72 Td (So that\222s something that needs to be managed, but in fact it does not\ change the system as )Tj 0.015 Tw -3 -1.74 Td (such. And I think, honestly, in today\222s )Tj (world it becomes more and more difficult to cover up, not )Tj 0.076 Tw T* (to let information out. If it\222s not GPHIN it will be the news, it wil\ l be media, it will be... it\222s a )Tj 0.227 Tw T* (matter of time. It can be two days later, or six hours later, or a few m\ ore days later, but )Tj 0 Tw T* (even)Tj (tually it does get out, and I think that\222s an important aspect of tha\ t.)Tj 28.521 0 Td ( )Tj 0.056 Tw -25.521 -1.74 Td (Now, to what level you will send this information, who will actually go \ to use it, is also )Tj 0.016 Tw -3 -1.72 Td (an important element of the discussion, because if this sort of thing, f\ or example, gets simp)Tj 36.678 0 Td (ly out )Tj 0.095 Tw -36.678 -1.72 Td (to the media without being inserted in a context with more information t\ hen they can generate )Tj 0.048 Tw T* (more problems, we know that, we\222ve seen it, we\222ve experienced that\ over and over. So it has to )Tj ET endstream endobj 386 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (68)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (David Fidler\(?\))Tj ( )Tj /TT0 1 Tf 0.037 Tw 3 -1.66 Td (I just want to step in at this point because I think the example of the \ ubiquity of the non)Tj 0 Tw 35.667 0 Td (-)Tj 0.067 Tw -38.667 -1.72 Td (state actor, non)Tj 0 Tw (-)Tj 0.067 Tw (governmental sources of information, I think that helps illustrate just \ the power )Tj 0.142 Tw T* (and also the interdependency of )Tj (all these particular trends. But specifically I think the use of )Tj 0.057 Tw T* [(information )0.5(technologies )0.5(and )0.5(the )0.5(information )0.5(being )0.5(available )0.5(through )0.5(these )0.5(various )0.5(sources, )0.5(it\222s )]TJ 0.034 Tw 0 -1.74 TD (not just the technological aspect of this, it actually creates in essenc\ e a new governance fun)Tj 0 Tw 37 0 Td (ction )Tj 0.041 Tw -37 -1.72 Td (that really )Tj 0 Tw (\226)Tj ( )Tj 0.041 Tw 5.148 0 Td (and this is the verification and sorting out what\222s rumour and what\222\ s fact )Tj 0 Tw 29.882 0 Td (\226)Tj ( )Tj 0.041 Tw 0.791 0 Td (and this )Tj 0.036 Tw -35.821 -1.72 Td [(is )0.5(where )0.5(again )0.5(I )0.5(think )0.5(that )0.5(governance )0.5(function... )0.5(it\222s )0.5(taken )0.5(up )0.5(the )0.5(chain, )0.5(and )0.5(that\222s )0.5(where )0.5(WHO )]TJ 0.064 Tw 0 -1.72 TD (has that role of acting as that sort of global filter)Tj 0 Tw 19.91 0 Td ( )Tj 0.064 Tw 0.314 0 Td (for purposes of that information. So that\222s not )Tj 0.054 Tw -20.223 -1.74 Td (really... I mean, individual governments will do their own analysis, but\ again in a way in which )Tj 0.017 Tw T* (this tends to operate WHO will be looked for as a credible filter for pu\ rposes of this information, )Tj 0.157 Tw T* (and so tha)Tj (t creates a sort of globalization of governance but also then places... \ you know, if )Tj 0.014 Tw T* [(Google is going to do this, this may increase )0.5(the )0.5(burden on WHO in terms of acting as that filter, )]TJ 0.069 Tw 0 -1.74 TD (so these trends to accelerate each other. And hopefully they can maintai\ )Tj 29.474 0 Td (n a common speed, but )Tj 0.047 Tw -29.474 -1.72 Td (when you start moving down this path it not only intensifies that govern\ ance response for states )Tj 0 Tw 0 -1.72 TD (but I also think for WHO.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.013 Tw 3 -1.64 Td [(Just )0.5(a )0.5(clarification, )0.5(this )0.5(will )0.5(not )0.5(be )0.5(run )0.5(by )0.5(Google. )0.5(Google )0.5(is )0.5(assisting )0.5(in )0.5(the )0.5(expansion. )0.5(I)]TJ 0 Tw 35.722 0 Td (t )Tj -38.722 -1.72 Td (will not be run by Google, it\222ll be totally independent of Google.)Tj 25.912 0 Td ( )Tj -25.912 -1.74 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Yuri Fedorov)Tj ( )Tj /TT0 1 Tf 0.021 Tw 3 -1.64 Td (I\222d like to support the words of Dr.)Tj 0 Tw ( )Tj 0.021 Tw (St. John. It\222s very important to know what\222s going on )Tj 0.158 Tw -3 -1.74 Td (inside the country, but also very important to know what\222s going outs\ ide of th)Tj 33.214 0 Td (e country, the )Tj 0.182 Tw -33.214 -1.72 Td (nearby countries. To my mind, and to my experience, I prefer to use, for\ example )Tj 0 Tw 35.525 0 Td (\226)Tj ( )Tj 0.182 Tw 0.932 0 Td (it was )Tj 0.34 Tw -36.457 -1.72 Td (invented say five, seven years ago )Tj 0 Tw (\226)Tj ( )Tj 17.039 0 Td (so)Tj (-)Tj 0.34 Tw (called verification list of WHO. I rely on this )Tj 0.007 Tw -17.039 -1.72 Td (information. It already has been, let\222s say, looked for. I migh)Tj (t say to somebody from the top, big)Tj 0 Tw (-)Tj 0.105 Tw 0 -1.74 TD (shots, they say, \223What\222s going on somewhere? I heard in Google,\224\ or a rumour, I don\222t know )Tj 0.086 Tw 0 -1.72 TD (where, \223what\222s going on in there?\224 So I immediately take a perm\ it\(?\) then this verification list )Tj 0 Tw T* (and see what\222s going on in that )Tj (country.)Tj ( )Tj ET endstream endobj 387 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (67)Tj ( )Tj ET Q BT 0.063 Tw 12 0 0 12 71.88 709.08 Tm (going to stay hidden for very long. It may be hidden for a while but it\222\ s not going to be hidden )Tj 0 Tw 0 -1.72 TD (for very long.)Tj ( )Tj 0.054 Tw 3 -1.72 Td (As to the expansion of Google, I mean, the expansion of GPHIN by that la\ rge a margin, )Tj 0.014 Tw -3 -1.74 Td [(that )0.5(could )0.5(be )0.5(huge. )0.5(I )0.5(mean, )0.6(it )0.5(is, )0.5(in )0.5(absolute )0.5(nu)]TJ 18.826 0 Td [(mbers )0.5(it\222s )0.5(huge, )0.5(but )0.5(the )0.5(implications, )0.6(the )0.6(potential )]TJ 0 Tw -18.826 -1.72 Td (implications really boggle the mind. You have to think of where that wil\ l go.)Tj 30.744 0 Td ( )Tj -30.744 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Harvey Lazar\(?\))Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (You meant google the mind?)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.053 Tw 3 -1.66 Td (If I may just respond, our problem so far with the evolutio)Tj 23.853 0 Td (n of GPHIN has been that the )Tj 0.106 Tw -26.853 -1.72 Td (information was only available really to a select few, globally, the Wor\ ld Health Organization )Tj 0.021 Tw T* (and certain countries that were really able to subscribe to the system b\ ecause while the Canadian )Tj 0.015 Tw 0 -1.74 TD (government funded its operation it)Tj 0 Tw ( )Tj 0.015 Tw 14.157 0 Td (did not fund its development, and in the fast)Tj 0 Tw (-)Tj 0.015 Tw (moving world of )Tj 0 Tw -14.157 -1.72 Td (electronic technology we needed developmental funds so we had to ask for\ subscription fees.)Tj 37.266 0 Td ( )Tj 0.041 Tw -34.266 -1.72 Td (What is being taken away, if all these plans work out the way we expect,\ is there will be )Tj 0.081 Tw -3 -1.72 Td (no more sub)Tj [(scription fees, it will be made free, it will be packaged in intelligent\ ways )0.5(because )]TJ 0.068 Tw T* (there\222s a lot of duplication and noise in the system, and try to narr\ ow it down and then make it )Tj 0 Tw 0 -1.72 TD (available to 192 member states, plus WHO, plus FAO, plus UNICEF, plus, p\ l)Tj (us, plus, plus, plus.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Mr. Bruce Plotkin)Tj ( )Tj /TT0 1 Tf 0.039 Tw 3 -1.66 Td (Pardon me, let me just ask one follow)Tj 0 Tw (-)Tj 0.039 Tw [(up question. )0.5(To )0.5(me, )0.5(the )0.5(question )0.5(is, )0.5(is )0.5(there )0.5(going )]TJ 0.036 Tw -3 -1.72 Td (to be any predigestion of it, or is it just going to... I mean, once the\ duplication is worked out is, )Tj 0.063 Tw T* (then, the whole packag)Tj (e going to go out, or is there going to be some analysis that is done fi\ rst )Tj 0 Tw 0 -1.74 TD (and then the results go out, or does the whole thing go out?)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 0.006 Tw 3 -1.66 Td (Tentatively. It can be available in two forms. For those countries that \ want to dedicate the )Tj 0.109 Tw -3 -1.72 Td [(number )0.5(o)]TJ [(f )0.5(personnel )0.5(it )0.5(would )0.6(take to )0.5(look )0.5(at )0.5(this )0.5(system )0.5(every )0.5(day, )0.5(fine, )0.5(they )0.5(can )0.5(look )0.5(at )0.5(the )]TJ 0.025 Tw T* (entire thing. For those countries that want digests there will be digest\ s available, and they can be )Tj 0 Tw T* (daily digests, they can be weekly digests, but there will be digests)Tj 26.3 0 Td ( )Tj (available.)Tj ( )Tj ET endstream endobj 388 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (66)Tj ( )Tj ET Q BT 0.095 Tw 12 0 0 12 71.88 709.08 Tm (Google Foundation approaching us for a huge expansion of GPHIN, not just\ to look at 20,000 )Tj 0.197 Tw 0 -1.72 TD (newspapers but to look at mi)Tj (llions of sources of information, and to make that information )Tj 0 Tw T* (available to every single government world)Tj 17.355 0 Td (-)Tj (wide, in maybe as many as 50 different languages.)Tj 20.549 0 Td ( )Tj 0.041 Tw -34.904 -1.74 Td (So, one of the things that\222s going to happen to us )Tj 0 Tw (\226)Tj ( )Tj 0.041 Tw 21.077 0 Td (and will again, I see, put pressure on )Tj 0 Tw -24.077 -1.72 Td (governme)Tj (nts )Tj 5.505 0 Td (\226)Tj ( )Tj 0.09 Tw 0.84 0 Td (that once all governments know what\222s going on in the neighbouring st\ ate, and )Tj 0.188 Tw -6.345 -1.72 Td (trying to sort out from that mass of information what\222s of internatio\ nal concern is indeed a )Tj 0.034 Tw T* (challenge. I mean, we get the information that three cows have died of a\ nthrax )Tj 32.134 0 Td (in Turkmenistan. )Tj 0.035 Tw -32.134 -1.74 Td (That doesn\222t concern us in Canada, but it might concern Kazakhstan. A\ nd so there\222s going to be )Tj 0.178 Tw T* (a pressure, I think, on all governments to be more reactive, to look at \ this information, and )Tj 0.01 Tw T* (because it\222s the government that\222s going to have t)Tj 19.963 0 Td (o acknowledge )Tj 0 Tw (\226)Tj ( )Tj 0.01 Tw 7.055 0 Td (very quickly )Tj 0 Tw (\226)Tj ( )Tj 0.01 Tw 6.056 0 Td (that something )Tj 0.093 Tw -33.074 -1.72 Td [(is happening, or else the other countries will begin )0.5(to )0.5(worry, )0.5(speculate )0.5(and )0.5(so )0.5(forth )0.6(about )0.6(this. )]TJ 0.068 Tw 0 -1.74 TD (But I see this as a great tsunami sort of washing over the reporting str\ ucture and actually being )Tj 0.072 Tw 0 -1.72 TD (helpful in pus)Tj (hing governments to be more reactive to what\222s going on in their own \ back yard. )Tj 0 Tw T* (Thank)Tj (-)Tj (you.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Jeffrey Scott)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (One other point is I think one of the factors that\222s not just affecti\ ng the IHR\222s but in terms )Tj 0.094 Tw -3 -1.72 Td (of harmonization and working, very simply it\222s the )Tj 21.389 0 Td (Internet. And the bottom line is that I now )Tj 0 Tw -21.389 -1.74 Td (can )Tj 1.685 0 Td (\226)Tj ( )Tj 0.047 Tw 0.797 0 Td (and do )Tj 0 Tw (\226)Tj ( )Tj 0.047 Tw 3.835 0 Td (is if I\222m developing a framework for a public health response plan, f\ or example, )Tj 0.084 Tw -6.317 -1.72 Td (which would be necessary, yes I go to the Public Health Agency of Canada\ , I go to the World )Tj 0.014 Tw 0 -1.72 TD (Health Organization on t)Tj (he \222net, I go to the UK, I probably go to Australia, I go to he U.S. \ I\222d be )Tj 0.042 Tw T* (looking at what\222s in there and what the local ones are. And there\222\ ll be some commonalities, and )Tj 0.062 Tw 0 -1.74 TD (I\222m not going to start afresh, I\222m going to build. And this is hap\ pening all the tim)Tj 33.539 0 Td (e. So, in fact, )Tj 0 Tw -33.539 -1.72 Td (there\222s too much information. But that\222s very critical.)Tj 21.411 0 Td ( )Tj 0.088 Tw -18.411 -1.72 Td (So we\222re basically begging, borrowing and stealing from each other, a\ nd by nature you )Tj 0 Tw -3 -1.72 Td (get commonalities that are occurring because the technology allows you t\ o do that.)Tj 33.129 0 Td ( )Tj -33.129 -1.74 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Mr. Bruce Plot)Tj (kin)Tj ( )Tj /TT0 1 Tf 0.263 Tw 3 -1.64 Td (Personally I agree with the doctor\222s point about while everybody talk\ s a lot about )Tj 0.494 Tw -3 -1.74 Td (notification that far and away the more important part is the authorizat\ ion and the )Tj 0.162 Tw T* [(acknowledgment )0.5(of )0.5(the )0.5(use )0.5(of )0.5(unofficial )0.5(sources, )0.5(because )0.5(it\222s )0.5(the )0.5(simple )0.5(fact )0.5(that )0.5(no)]TJ 35.866 0 Td [(thing )0.5(is )]TJ ET endstream endobj 389 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 390 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 391 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 392 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 393 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 394 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (65)Tj ( )Tj ET Q BT 0.103 Tw 12 0 0 12 71.88 709.08 Tm [(professional, )0.5(that\222s )0.5(part)]TJ 0 Tw ( )Tj 0.103 Tw 9.972 0 Td [(of )0.5(the )0.5(requirements, )0.5(but )0.5(let )0.5(me )0.5(tell )0.5(you )0.5(that )0.5(the )0.5(medical )0.5(association )0.5(is )]TJ 0.118 Tw -9.972 -1.72 Td (very keen to do its own communication and so part of the art is negotiat\ ing with them so the )Tj 0.105 Tw 0 -1.72 TD (same message goes out. It doesn\222t matter if they get the same message\ many times as long )Tj 0 Tw 38.167 0 Td (as )Tj -38.167 -1.74 Td (they get the same message. So, yes, there are tensions in that area.)Tj 26.436 0 Td ( )Tj -23.436 -1.72 Td ( )Tj /TT1 1 Tf -3 -1.72 Td (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Any of you want to react to Dr.)Tj ( )Tj (David Fidler\222s four trends? Ron?)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Ron St. John)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj 0.065 Tw (you. Yes, in a sense I do, because Dr.)Tj 0 Tw ( )Tj 0.065 Tw (Fidler mentioned something sort of alm)Tj 0 Tw (ost )Tj /TT2 1 Tf 0.093 Tw -3 -1.72 Td (en passant)Tj /TT0 1 Tf 0 Tw ( )Tj 0.093 Tw 4.686 0 Td (that I think is an interesting development world)Tj 0 Tw 19.621 0 Td (-)Tj 0.093 Tw (wide. And please bear with me for )Tj 0.031 Tw -24.307 -1.72 Td (just a bit, but I\222ve always seen, personally, I\222ve always seen the\ IHR in kind of two ways. There )Tj 0.268 Tw T* (is certainly an epidemiological kind of component to it whic)Tj 26.543 0 Td (h deals with notification and )Tj 0.082 Tw -26.543 -1.74 Td (identification of events and notification world)Tj 0 Tw 18.767 0 Td (-)Tj 0.082 Tw (wide, and there\222s a long history that goes all the )Tj 0.136 Tw -18.767 -1.72 Td (way back to sanitary conferences at the end of the 1800s and the early 1\ 900s requesting that )Tj 0 Tw T* (governments, nations, make the com)Tj (munity at large aware of what\222s going on.)Tj ( )Tj 0.286 Tw 3 -1.72 Td (Then there\222s another whole piece to the IHR which is kind of... I alw\ ays sort of )Tj 0.096 Tw -3 -1.74 Td (characterize it as rules, capacities, process, emergency committees, wha\ t you have to do at the )Tj 0.071 Tw T* [(airports, )0.5(you )0.5(know, )0.5(it\222s )0.5(kind )0.5(of )0.5(a )0.5(wh)]TJ [(ole )0.5(bunch )0.5(of )0.5(to)]TJ 0 Tw (-)Tj 0.071 Tw [(do\222s. )0.5(I\222d )0.5(just )0.5(like )0.5(to )0.5(focus )0.5(a )0.5(minute )0.5(on )0.5(the )]TJ 0.001 Tw T* (reporting part, because I really think there\222s another sort of thing \ that\222s happening globally that is )Tj 0.079 Tw T* (just going to sort of wash over this like a great tsunami, and this goes\ back to what you ta)Tj 0 Tw 37.278 0 Td (lked )Tj -37.278 -1.74 Td (about or you mentioned as the non)Tj (-)Tj (official sources of information.)Tj ( )Tj 0.005 Tw 3 -1.72 Td (We\222ve witnessed the growth, the creation of ProMED, and Europe we hav\ e MediSys, and )Tj 0.018 Tw -3 -1.72 Td (in Canada we developed several years ago the Global Public Health Intell\ igence Network, which )Tj 0 Tw T* (is )Tj 1.138 0 Td (\226)Tj ( )Tj 0.971 0 Td (a)Tj ( )Tj 0.221 Tw 0.915 0 Td (bit of a commercial here )Tj 0 Tw 11.129 0 Td (\226)Tj ( )Tj 0.221 Tw 0.971 0 Td (it\222s a 24x7 computer)Tj 0 Tw (-)Tj 0.221 Tw (based monitoring of all the global )Tj 0.032 Tw -15.125 -1.74 Td (outbreaks in the world, and we do that in seven languages. The computer \ reads Chinese, Arabic, )Tj 0 Tw T* (Russian )Tj 3.658 0 Td (\226)Tj ( )Tj 0.241 Tw 0.991 0 Td (Cyrillic alphabet )Tj 0 Tw (\226)Tj ( )Tj 0.241 Tw 8.414 0 Td (it reads Spanish, it reads English, French, and)Tj 0 Tw 19.959 0 Td ( )Tj 0.241 Tw 0.491 0 Td (we\222re adding )Tj 0.052 Tw -33.512 -1.72 Td (Portuguese, and it reads Farsi, and it collects... it\222s the equivalen\ t of reading 20,000 newspapers )Tj 0.221 Tw T* (every day and collecting the information, and that information is sent t\ o the World Health )Tj 0.055 Tw 0 -1.74 TD (Organization, and that\222s been going on for several )Tj (years. And now we\222ve been approached, and )Tj 0.161 Tw 0 -1.72 TD (you\222ll see quite coincidentally an article in today\222s Ottawa newsp\ aper, the )Tj /TT2 1 Tf 0 Tw 31.651 0 Td (Citizen)Tj /TT0 1 Tf 0.161 Tw (, about the )Tj ET endstream endobj 395 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (64)Tj ( )Tj ET Q BT 0.002 Tw 12 0 0 12 71.88 709.08 Tm (next layer down of people who\222ll be )Tj 14.761 0 Td (involved in any implementing of the IHR\222s in terms of those )Tj 0.136 Tw -14.761 -1.72 Td (people on the ground, those people who are providing services, we also r\ un into those issues )Tj 0.043 Tw 0 -1.72 TD (around clinical governance and what the professions will say about what \ drives them to do their )Tj 0 Tw 0 -1.74 TD (busines)Tj (s and where their responsibilities to their patients and to their peers \ lie.)Tj 31.298 0 Td ( )Tj 0.247 Tw -28.298 -1.72 Td (So I think as we disseminate these IHR\222s and as we investigate ways t\ o get these )Tj 0.091 Tw -3 -1.72 Td (messages across it\222s really important that we don\222t lose sight of \ that driving force, too, around )Tj 0.089 Tw 0 -1.72 TD [(clinical )0.5(governance )0.5(and )0.5(that )0.5(we )0.5(actually )0.5(look )0.5(at )0.6(how )0.6(the )0.5(corporate )0.5(and )0.5(the )0.5(clinical )0.5(governance )]TJ 0 Tw 0 -1.74 TD (might actually meet somewhere in the middle.)Tj 18.522 0 Td ( )Tj -18.522 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Barbara von Tigerstrom)Tj ( )Tj /TT0 1 Tf 0.011 Tw 3 -1.66 Td (If I could just ask a question following on from that, I\222m curious as\ to the extent to w)Tj 0 Tw 34.278 0 Td (hich )Tj 0.018 Tw -37.278 -1.72 Td [(that )0.5(has )0.5(happened )0.5(in )0.5(various )0.5(countries, )0.5(if )0.5(at )0.5(all, )0.6(because )0.5(it )0.6(seems )0.5(to )0.6(me )0.5(that )0.5(is )0.6(very )0.5(important. )0.5(So )]TJ 0.093 Tw T* (the medical associations, what other professional associations are the I\ HR known by them, are )Tj 0 Tw T* (there activities on that front in Australia, and other c)Tj 20.937 0 Td (ountries as well?)Tj ( )Tj -20.937 -1.74 Td ( )Tj /TT1 1 Tf T* (Ms Cath Halbert)Tj ( )Tj /TT0 1 Tf 0.023 Tw 3 -1.64 Td (My sense in Australia is that it\222s probably very variable, and that\222\ s without wanting to sit )Tj 0.132 Tw -3 -1.74 Td (on the fence but there are people who clearly follow these international\ health sorts of issues )Tj 0.231 Tw T* (more strongly and have more of a)Tj 0 Tw ( )Tj 0.231 Tw 15.362 0 Td (reason to do so. However, I think if you\222re looking at )Tj 0.045 Tw -15.362 -1.72 Td [(implementation )0.5(in )0.5(any )0.5(event )0.5(of )0.5(any )0.5(significance )0.5(we\222ll )0.5(be )0.5(looking )0.5(at )0.5(practitioners )0.5(who )0.5(may )0.5(have )]TJ 0.147 Tw T* [(less interest or less of a need to know about these things, and I think \ in )0.5(terms )0.5(of )0.5(selling )0.5(the )]TJ 0.079 Tw 0 -1.74 TD (impacts a)Tj (nd the requirements under the IHR\222s in Australia I\222d say it\222s f\ airly early days. We\222ve )Tj 0.082 Tw 0 -1.72 TD (got a lot of work to do with the professions, and taking on Bruce\222s p\ oint about the professions )Tj 0.169 Tw T* (setting standards we certainly have done quite a bit of that in Australi\ a)Tj 0 Tw 30.241 0 Td ( )Tj 0.169 Tw 0.419 0 Td (before with a lot of )Tj 0.093 Tw -30.66 -1.72 Td (success in terms of engagement with professions and their acceptance of \ those standards when )Tj 0 Tw 0 -1.74 TD (they\222re established, but I think we\222ve clearly got some way to go \ around the IHR\222s.)Tj 33.38 0 Td ( )Tj -33.38 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.72 TD (Dr.)Tj ( )Tj (Jeffrey Scott)Tj ( )Tj /TT0 1 Tf 0.146 Tw 3 -1.66 Td (No, we\222ve not really approached the pr)Tj 16.51 0 Td (ofessions yet. I mean, the professions are very )Tj 0.056 Tw -19.51 -1.72 Td (sensitized by SARS so some of the... 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Avi)Tj (an influenza has raised issues, and in Canada then you have to look at )Tj 0.075 Tw 0 -1.72 TD (what\222s the governance of the animal health model, and that may not ma\ tch the governance and )Tj 0 Tw T* (the rule)Tj (-)Tj (making of the human health.)Tj ( )Tj 0.027 Tw 3 -1.74 Td (Then let\222s suppose the incident is related to a criminal)Tj 0 Tw 21.872 0 Td ( )Tj 0.027 Tw 0.277 0 Td (activity, and I think we saw issues )Tj 0.327 Tw -25.148 -1.72 Td (where the experience in the other countries related to what had happened\ , so a sort of )Tj 0.012 Tw T* (chemical/biological/radionuclear of a terrorist event, which we\222ve no\ t seen in Canada. If that had )Tj 0.198 Tw T* (been an incident and not SARS the)Tj (n the question in my mind is how might we have been )Tj 0.399 Tw 0 -1.74 TD (responding to the health threats. We\222ve got the issue of it could be \ an exposure, an )Tj 0 Tw 0 -1.72 TD (environmental exposure.)Tj ( )Tj 0.058 Tw 3 -1.72 Td (So one of the complexities is not just this horizontal relationship with\ other departments )Tj 0 Tw -3 -1.72 Td (but )Tj 0.046 Tw 1.574 0 Td (is what is their vertical relationship between the federal and provincia\ l/territorial which may )Tj 0.127 Tw -1.574 -1.74 Td (not match in health, and that makes it much more complicated because you\ \222re having to deal )Tj 0.376 Tw T* (with agencies where sometimes you\222re used to your local authority wor\ )Tj 32.36 0 Td (king with your )Tj 0.116 Tw -32.36 -1.72 Td (counterpart at a local level, another agency relates very much to the fe\ deral level. And so it\222s )Tj 0.101 Tw T* (good to do that, but an analysis of some of the other likely ministries \ of areas where health is )Tj 0.055 Tw 0 -1.74 TD (going to be part of the process and you might s)Tj 19.321 0 Td (ee where it matches and where it doesn\222t match, )Tj 0 Tw -19.321 -1.72 Td (and that would be country by country.)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Sampath K. Krishnan)Tj ( )Tj /TT0 1 Tf 0.076 Tw 3 -1.66 Td (I think, following up from David\222s point on global dominance, I think\ one of the issues )Tj 0.022 Tw -3 -1.72 Td (which IHR is not very clearly addressing which has been b)Tj 23.767 0 Td (rought up by many of the groups here )Tj 0.082 Tw -23.767 -1.72 Td (is the regional forums, like the Asia)Tj 0 Tw (-)Tj 0.082 Tw (Pacific strategy, or the Afro strategy, including within our )Tj 0 Tw 0 -1.74 TD (country )Tj 3.341 0 Td (\226)Tj ( )Tj 0.036 Tw 0.786 0 Td (in India )Tj 0 Tw (\226)Tj ( )Tj 0.036 Tw 4.191 0 Td (also we have ___ countries where IHR has been brought on the map, we\222\ ve )Tj 0.279 Tw -8.318 -1.72 Td [(got )0.5(the... )0.5(during )0.5(the )0.5(avian)]TJ 0 Tw ( )Tj 0.279 Tw 11.89 0 Td [(\222flu )0.5(outbreak )0.5(we )0.5(called )0.6(the )0.6(countries )0.6(of )0.5(the )0.5(region, )0.5(we )0.5(had )0.5(a )]TJ 0.06 Tw -11.89 -1.72 Td [(ministerial )0.5(level )0.5(conference. )0.5(So )0.5(I )0.5(think )0.5(in )0.5(the )0.5(G8 )0.5(and )0.5(any )0.5(of )0.5(these )0.5(other )0.5(global )0.5(alliances )0.5(I )0.5(think )]TJ 0.351 Tw 0 -1.72 TD (IHR should be an important topic brought up in those areas as part of mo\ re effective )Tj 0 Tw 0 -1.74 TD (implement)Tj (ation of the IHR.)Tj ( )Tj 0 -1.72 TD ( )Tj /TT1 1 Tf T* (Ms Cath Halbert)Tj ( )Tj /TT0 1 Tf 0.022 Tw 3 -1.66 Td (I\222d just like to follow on from Jeff\222s point. 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These are also big challenges.)Tj 23.13 0 Td ( )Tj 0.228 Tw -20.13 -1.72 Td (And what, again, is very gratifying to me is that w)Tj 22.391 0 Td (hen I hear the presentations the )Tj 0.023 Tw -25.391 -1.74 Td (countries all recognize this, and virtually all of the plans that we\222\ ve heard about now incorporate )Tj 0.05 Tw T* [(all )0.5(the )0.5(ministries )]TJ 0 Tw (\226)Tj ( )Tj 0.05 Tw 7.864 0 Td [(all )0.5(the )0.5(relevant )0.5(ministries )]TJ 0 Tw (\226)Tj ( )Tj 0.05 Tw 11.383 0 Td [(and )0.5(get )0.5(them )0.5(involved )0.5(in )0.5(the )0.5(process. )0.5(And )0.5(that\222s )]TJ 0.096 Tw -19.247 -1.72 Td (very different from the)Tj 0 Tw ( )Tj 0.096 Tw 9.77 0 Td (way it was back in 2004 when the negotiations started, because then it )Tj 0.025 Tw -9.77 -1.72 Td (was principally Ministry of Health people talking. So that\222s a big di\ fference from back then, that )Tj 0.028 Tw 0 -1.74 TD (all of these ministries are involved. And that\222s critical, because if\ they\222re not it\222)Tj 32.164 0 Td (s not going to go )Tj 0 Tw -32.164 -1.72 Td (forward in the way it really should.)Tj ( )Tj 0.022 Tw 3 -1.72 Td (And this is just me talking, now. There is a tendency to talk about WHO \ has if WHO has )Tj 0.032 Tw -3 -1.72 Td (power, as if WHO is a big box in the middle of the room, and it\222s a b\ ig machine, and you\222re not )Tj 0.042 Tw T* [(really )0.5(sure )0.5(what )0.5(i)]TJ [(t )0.6(is )0.5(and )0.5(where )0.5(it\222s )0.5(going )0.5(and )0.5(all )0.5(of )0.5(this, )0.5(and )0.5(it )0.5(has )0.5(inscrutable )0.5(power )0.5(because )0.5(it )]TJ 0.131 Tw 0 -1.72 TD (has certain things inside of it. Under the IHR the member states got tog\ ether and faced these )Tj 0.025 Tw T* (issues about who does what, who has responsibility for what, and they ca\ me to a)Tj 0 Tw ( )Tj 0.025 Tw 32.84 0 Td (decision that in )Tj 0.057 Tw -32.84 -1.72 Td [(certain )0.5(circumstances, )0.5(in )0.5(order )0.5(for )0.5(the )0.5(benefit )0.5(of )0.5(the )0.5(collective )0.5(whole, )0.5(there )0.5(had )0.5(to )0.5(be )0.5(some )0.6(sort )]TJ 0.06 Tw 0 -1.74 TD (of ability to act in a fairly rapid, organized manner. And once that con\ clusion was reached then )Tj 0.001 Tw 0 -1.72 TD (the question was what kind of procedures, )Tj (what kind of accountability, what kind of transparency )Tj 0 Tw T* (requirements should be imposed.)Tj ( )Tj 0.265 Tw 3 -1.72 Td (And that was, to a great extent, what the negotiations were about, exact\ ly how to )Tj 0.041 Tw -3 -1.74 Td (construct that balance, because at the beginning of the day )Tj 0 Tw 23.984 0 Td (\226)Tj ( )Tj 0.041 Tw 0.791 0 Td (and the end of the day )Tj 0 Tw (\226)Tj ( )Tj 0.041 Tw 10.144 0 Td (WHO is a )Tj 0.146 Tw -34.919 -1.72 Td (constituency organization. I mean, WHO is the member states. Anyway, tha\ t\222s me, that\222s the )Tj 0 Tw T* (way I personally see it.)Tj ( )Tj 0.051 Tw 3 -1.72 Td (The last item is that we are here, Stefano and I, to provide support to \ member states and )Tj 0.005 Tw -3 -1.74 Td (to provide information to the extent we c)Tj 16.392 0 Td (an to help out address these issues and other issues, so if )Tj 0 Tw -16.392 -1.72 Td (you have questions we\222re here. Thank)Tj (-)Tj (you.)Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Dr.)Tj ( )Tj (Jeffrey Scott)Tj ( )Tj /TT0 1 Tf 0.09 Tw 3 -1.66 Td (I just want to follow up that point, because I think avian influenza is \ a good point, and )Tj 0.095 Tw -3 -1.72 Td [(one )0.5(suggestion, )0.5(because )0.5(I )0.5(like )0.5(the )0.5(analysis )0.5(y)]TJ [(ou\222ve )0.5(done, )0.5(I )0.5(like )0.5(the )0.5(static )0.5(analysis )0.5(and )0.5(the )0.5(areas )]TJ 0.186 Tw T* (where you see the rule)Tj 0 Tw (-)Tj 0.186 Tw (making governance, but the IHR\222s are meant to deal with threats to )Tj 0.095 Tw 0 -1.74 TD (human health which are broader, and we\222ve tended to focus, yes, on th\ e SARS, the human)Tj 0 Tw (-)Tj (to)Tj (-)Tj ET endstream endobj 398 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (61)Tj ( )Tj ET Q BT 0.071 Tw 12 0 0 12 107.88 709.08 Tm (And what has been very gratifying is to see)Tj 0 Tw ( )Tj 0.071 Tw 18.217 0 Td (the way that the countries here have sort of )Tj 0.241 Tw -21.217 -1.72 Td (plotted out, \223Okay, this is what we have to do, this is who\222s goin\ g to do this.\224 It\222s very )Tj 0 Tw 0 -1.72 TD (gratifying.)Tj ( )Tj 0.041 Tw 3 -1.74 Td (On this, Dr.)Tj 0 Tw ( )Tj 0.041 Tw (Wilson pointed up a number of strategies that the States had used )Tj 0 Tw 31.932 0 Td (\226)Tj ( )Tj 0.791 0 Td (\223States\224 )Tj 0.043 Tw -35.724 -1.72 Td (with a capital S )Tj 0 Tw (\226)Tj ( )Tj 0.043 Tw 7.408 0 Td (had used, that the various governmental units had employed to deal with \ each )Tj 0.008 Tw -7.408 -1.72 Td (other within the state, but you left out one that I thought was really v\ ery important, and one that I )Tj 0.017 Tw T* (hadn\222t thought of, and that was the one that my colleagues here broug\ ht up,)Tj 0 Tw 30.402 0 Td ( )Tj 0.017 Tw 0.267 0 Td (and that is the use of )Tj 0.191 Tw -30.669 -1.74 Td (professional associations in standard)Tj 0 Tw (-)Tj 0.191 Tw (setting, because... I mean, it has a lot of advantages, it )Tj 0.03 Tw T* (seems to me, if it can be made to work, because legislation takes time, \ legislation takes a certain )Tj 0.034 Tw T* (kind of political work that can cos)Tj (t a lot in terms of investment of time and energy and creates a )Tj 0.069 Tw T* (lot of problems that accommodations among professionals, if standard)Tj 0 Tw 28.686 0 Td (-)Tj 0.069 Tw (setting can be done on a )Tj 0.185 Tw -28.686 -1.74 Td (reasonable consensus basis, it seems like it\222s a much better way to g\ o. It\222s not going to be )Tj 0 Tw T* (avail)Tj (able in all situations but it seems a very good approach to try.)Tj 26.521 0 Td ( )Tj 0.046 Tw -23.521 -1.72 Td (I know I\222ve said it before but the IHR really are, for the most part,\ result)Tj 0 Tw 29.65 0 Td (-)Tj 0.046 Tw (oriented. Now, )Tj 0.051 Tw -32.65 -1.72 Td (the results that are mandated under the IHR do of course have some impac\ t on what states have )Tj 0.077 Tw 0 -1.74 TD (to do)Tj 0 Tw ( )Tj 0.077 Tw 2.431 0 Td (in order to get to those results, but for the most part I know the membe\ r states tried very )Tj 0.053 Tw -2.431 -1.72 Td (hard not to get too specific because the internal situation in Mr.)Tj 0 Tw 25.906 0 Td ( )Tj 0.053 Tw (Basse\222s country is not the same )Tj 0.165 Tw -25.906 -1.72 Td (as the internal situation in Mr.)Tj 0 Tw ( )Tj 0.165 Tw (Marfin\222s country, and yet you h)Tj (ad to come up with Annex 1 )Tj 0.028 Tw 0 -1.72 TD (which had to be one)Tj 0 Tw (-)Tj (size)Tj 10.055 0 Td (-)Tj (fits)Tj (-)Tj 0.028 Tw (all, and the result was that for most of these provisions, even when )Tj 0.041 Tw -10.055 -1.74 Td (there is some detail, the intent was to leave it up to the country to fi\ gure out who does what and )Tj 0 Tw T* (exactly how things are accompli)Tj (shed.)Tj ( )Tj 0.096 Tw 3 -1.72 Td (One issue that was touched on a little bit but I want to emphasize is th\ at when we talk )Tj 0.106 Tw -3 -1.72 Td (about federalism we\222re talking about vertical relationships, and thes\ e are difficulties )Tj 0 Tw 35.04 0 Td (\226)Tj ( )Tj 0.106 Tw 0.856 0 Td (I mean, )Tj 0.186 Tw -35.896 -1.74 Td (let\222s be clear, these have to be accommodated )Tj 0 Tw 20.062 0 Td (\226)Tj ( )Tj 0.186 Tw 0.936 0 Td (but in terms of )Tj (responding to international )Tj 0.072 Tw -20.998 -1.72 Td (disease transmission, for me, and based on what I\222ve heard )Tj 0 Tw (\226)Tj ( )Tj 0.072 Tw 25.365 0 Td (and remember I talked to a lot of )Tj 0.067 Tw -25.365 -1.72 Td (health ministry people )Tj 0 Tw 9.394 0 Td (\226)Tj ( )Tj 0.067 Tw 0.817 0 Td (one of the biggest challenges is the horizontal challenge, is getting th\ e )Tj 0 Tw -10.212 -1.72 Td (ministries )Tj 4.295 0 Td (\226)Tj ( )Tj 0.101 Tw 0.85 0 Td [(all )0.5(ministries )]TJ 0 Tw (\226)Tj ( )Tj 6.495 0 Td (invo)Tj 0.101 Tw [(lved )0.5(in )0.5(the )0.5(process )0.6(of )0.5(understanding )0.5(the )0.5(IHR, )0.5(agreeing )0.5(on )0.5(the )]TJ 0 Tw -11.641 -1.74 Td (IHR and what they mean, and then moving forward to implementation.)Tj 28.437 0 Td ( )Tj 0.094 Tw -25.437 -1.72 Td (The biggest example of this right now is avian influenza. I mean, in man\ y places it\222s a )Tj 0.041 Tw -3 -1.72 Td (big deal just to get the doctors of hum)Tj (an medicine to come to an understanding with the doctors )Tj ET endstream endobj 399 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 400 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 401 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 402 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 403 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 404 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (60)Tj ( )Tj ET Q BT 0.095 Tw 12 0 0 12 71.88 709.08 Tm (think are important that we ignored so far in our comments we\222d be gl\ ad to have them, so the )Tj 0 Tw 0 -1.72 TD (floor is open. Bruce?)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Mr. Bruce Plotkin)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Thank)Tj (-)Tj (you very much.)Tj ( )Tj 0 -1.72 TD (First, )Tj 0.044 Tw 2.378 0 Td (although it\222s way too early to say our final thank)Tj 0 Tw 19.862 0 Td (-)Tj 0.044 Tw (you\222s I do want to say thank)Tj 0 Tw (-)Tj (you )Tj 0.03 Tw -25.24 -1.74 Td (because this has been a very, very informative couple of days. It\222s o\ ur job, together with the rest )Tj 0.053 Tw T* (of WHO and all the member states, to figure out how to get this large ne\ )Tj 29.735 0 Td (w car that Stefano was )Tj 0.005 Tw -29.735 -1.72 Td (building moving, with all of us essentially in the same direction. And t\ here are a lot of issues, it\222s )Tj 0.174 Tw T* (true, and so in this kind of gathering we get a lot of questions but at \ least one of the most )Tj 0.129 Tw 0 -1.74 TD (important aspects for me is we get s)Tj (pecific questions rather than just sort of very generalized )Tj 0.001 Tw 0 -1.72 TD [(concerns, )0.5(questions )0.5(about )0.5(I )0.5(need )0.5(to )0.5(be )0.5(able )0.6(to do )0.6(this, )0.5(and )0.5(in )0.5(order )0.5(to )0.5(do )0.5(this )0.5(I )0.5(need )0.6(x. )0.6(That\222s )0.5(very )]TJ 0.247 Tw T* (helpful. It\222s really critical because otherwise you just have a big, \ undifferentiated mass of )Tj 0 Tw T* (concerns.)Tj ( )Tj 0 -1.74 TD ([Start of Side 5])Tj ( )Tj 0.009 Tw 3 -1.72 Td (I won\222t repeat the points that have been made already about the fact \ that right now we are )Tj 0.052 Tw -3 -1.72 Td [(experiencing )0.5(a )0.5(lot )0.5(of )0.5(globalizing )0.5(trends, )0.5(and )0.5(that )0.5(the )0.5(IHR )0.5(is )0.5(part )0.5(of )0.5(those )0.5(trends )0.6(and )0.6(one )0.6(way )0.5(of )]TJ 0 Tw 0 -1.72 TD (dealing with those trends.)Tj ( )Tj 0.004 Tw 3 -1.74 Td (One thing I )Tj (do want to sort of reinforce is again the uniqueness of each country\222\ s political )Tj 0.212 Tw -3 -1.72 Td (system, because it\222s based on who the country is, where the country c\ omes from, who the )Tj 0.01 Tw T* (country\222s parents are, what the sensitivities of each of the levels i\ s, and for that re)Tj 32.777 0 Td (ason I think the )Tj 0.002 Tw -32.777 -1.72 Td (solutions are going to have to be unique and specific to each country, a\ nd that they\222re going to be )Tj 0.263 Tw 0 -1.74 TD (largely based on negotiations in terms of allocating responsibilities an\ d rights in terms of )Tj 0 Tw 0 -1.72 TD (accommodating the new IHR.)Tj ( )Tj 0.261 Tw 3 -1.72 Td [(Now, )0.5(some )0.5(of )0.5(these.)]TJ [(.. )0.5(like )0.5(any )0.5(family, )0.5(some )0.5(of )0.5(these )0.5(negotiations )0.5(are )0.5(going )0.5(to )0.5(be )]TJ 0.027 Tw -3 -1.72 Td [(weighted in favour of one partner or another, but in this way this )0.5(kind of accommodation among )]TJ 0.117 Tw 0 -1.74 TD [(all of the levels in a government, and )0.5(this sort of agreed resolution, is no different from what )]TJ 0 Tw 0 -1.72 TD (c)Tj 0.038 Tw (ountries have to do under many international agreements, and in fact wha\ t countries have to do )Tj 0.069 Tw T* (in response to any international challenge, is they have to figure out w\ ho\222s going to do what in )Tj 0 Tw T* (order to go forward.)Tj ( )Tj ET endstream endobj 405 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (59)Tj ( )Tj ET Q BT 0.086 Tw 12 0 0 12 71.88 709.08 Tm (that area, and perhaps by using security, which may be considered an iss\ u)Tj 30.525 0 Td (e of federal concern, )Tj 0 Tw -30.525 -1.72 Td (some of the issues in the IHR could be addressed.)Tj ( )Tj 0.326 Tw 3 -1.72 Td (Funding arrangements were also mentioned. There\222s only two broad cate\ gories of )Tj 0.052 Tw -3 -1.74 Td (funding arrangements. One would be non)Tj 0 Tw (-)Tj 0.052 Tw (conditional funding, or the other option is conditional )Tj 0.023 Tw 0 -1.72 TD (funding wh)Tj (ich could be again tied in with legislation, and that seemed to be an ef\ fective strategy )Tj 0.006 Tw T* (that\222s been utilized in several countries. And often, again, the fund\ ing goes hand in hand with the )Tj 0 Tw T* (legislation.)Tj ( )Tj 0.529 Tw 3 -1.74 Td (And finally I also heard about the use of intergovernm)Tj 26.502 0 Td (ental agreements and )Tj 0.148 Tw -29.502 -1.72 Td (memorandums of understanding as perhaps a less aggressive way to achieve\ the same policy )Tj 0 Tw T* (objectives.)Tj ( )Tj 0.064 Tw 3 -1.72 Td (So I think these are some of the questions that it may be worth just spe\ nding some time )Tj 0.081 Tw -3 -1.74 Td (discussing. There are several core capacities )Tj (that are in the IHR. On which core capacities is it )Tj 0.123 Tw T* (worth considering to more centralized approaches? Which ones are so impo\ rtant that is worth )Tj 0.075 Tw T* (willing to accept some of the trade)Tj 0 Tw (-)Tj 0.075 Tw (offs and perhaps damaging these collaborative relationships )Tj 0.375 Tw T* (or perhaps infri)Tj (nging to an extent on local sovereignty? And in moving to centralized )Tj 0.239 Tw 0 -1.74 TD (approaches, how do we manage the impact of these approaches? Obviously s\ imply having )Tj 0.024 Tw 0 -1.72 TD [(legislation )0.5(doesn\222t )0.5(guarantee )0.5(that )0.5(you\222ll )0.5(be )0.5(able )0.5(to )0.5(meet )0.5(the )0.5(requirements )0.5(of )0.5(the )0.6(IHR, )0.5(it )0.6(has )0.5(to )0.6(go )]TJ 0 Tw T* (h)Tj 0.041 Tw (and in hand with developing capacity at the local level, and it also has\ to go hand in hand with )Tj 0 Tw T* (the ability to enforce the legislation.)Tj 14.44 0 Td ( )Tj 0.005 Tw -11.44 -1.74 Td (Finally, in countries that have chosen to explicitly not take aggressive\ or more centralized )Tj 0.099 Tw -3 -1.72 Td (approaches are there mecha)Tj (nisms that they can utilize to ensure that they can comply with the )Tj 0 Tw T* (IHR.)Tj ( )Tj 0.068 Tw 3 -1.72 Td [(So )0.5(I )0.5(thought )0.5(that )0.5(seemed )0.5(to )0.5(be )0.5(the )0.5(fundamental )0.5(issue )0.5(that )0.5(was )0.5(coming )0.5(up )0.5(here )]TJ 0 Tw (\226)Tj ( )Tj 0.068 Tw 33.239 0 Td [(I )0.5(don\222t )]TJ 0.084 Tw -36.239 -1.74 Td (think this will be a surprise to anybody here, this is probably what eve\ rybody\222s been... a lot o)Tj 0 Tw 38.667 0 Td (f )Tj 0.044 Tw -38.667 -1.72 Td (these people have been struggling with, and I guess it would be worth ge\ tting the perspective of )Tj 0 Tw T* (some of the people around here on some of these issues.)Tj ( )Tj T* ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.164 Tw 3 -1.64 Td (David, maybe you should come up to the table. I guess we would open the \ floor for )Tj 0 Tw -3 -1.72 Td (c)Tj 0.126 Tw (omments and reactions, suggestions, criticisms, improvements, or if ther\ e are issues that you )Tj ET endstream endobj 406 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (58)Tj ( )Tj ET Q BT 0.058 Tw 12 0 0 12 107.88 709.08 Tm (I think it also became clear that this is... we\222ve been talking a lot\ about governance here )Tj 0.048 Tw -3 -1.72 Td (but this is really a combination of both governance and capacity and the\ two ne)Tj (ed to work hand )Tj 0 Tw 0 -1.72 TD (in hand. Having one without the other will reduce the effectiveness of a\ ny approach.)Tj 33.794 0 Td ( )Tj 0.394 Tw -30.794 -1.74 Td (And was mentioned by Dr.)Tj 0 Tw ( )Tj 0.394 Tw (Fidler and Mr.)Tj 0 Tw ( )Tj 0.394 Tw (Plotkin, the changes to public health )Tj 0.112 Tw -3 -1.72 Td (governance are influenced by the IHR )Tj 0 Tw (\226)Tj ( )Tj 0.112 Tw 17.025 0 Td (the IHR is obviously, to an extent, pr)Tj 0 Tw (escriptive )Tj 19.835 0 Td (\226)Tj ( )Tj 0.862 0 Td (but )Tj 0.044 Tw -37.722 -1.72 Td (also several other processes occur coincidentally, and the changes had b\ een occurring in nations )Tj 0 Tw T* (prior to this.)Tj ( )Tj 0.188 Tw 3 -1.74 Td (I think it\222s also important to emphasize )Tj 0 Tw 17.232 0 Td (\226)Tj ( )Tj 0.188 Tw 0.938 0 Td (and I think this is a critical issue )Tj 0 Tw 14.671 0 Td (\226)Tj ( )Tj 0.938 0 Td (every )Tj 0.06 Tw -36.779 -1.72 Td (country is unique, every country will h)Tj 15.885 0 Td (ave a unique governance system, and obviously it would )Tj 0.08 Tw -15.885 -1.72 Td (be impossible to have one solution that fits every country, recognizing \ this. Every country also )Tj 0.136 Tw T* (has a different history, a different history of centralization versus de\ centralization, and it also )Tj 0 Tw 0 -1.74 TD (beca)Tj 0.189 Tw (me clear )Tj 0 Tw 5.874 0 Td (\226)Tj ( )Tj 0.189 Tw 0.939 0 Td (we heard about the U.S. talking about anthrax and September 11th, Canada\ )Tj 0.034 Tw -6.814 -1.72 Td (talking about SARS, Australia talking about Bali )Tj 0 Tw 20.072 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (they\222ve all had their own unique experiences )Tj 0 Tw -20.856 -1.72 Td (that have influenced how they\222re approaching these issues.)Tj 23.547 0 Td ( )Tj 0.276 Tw -20.547 -1.72 Td (It was also evide)Tj (nt in several of the presentations that the sovereignty of regional )Tj 0.156 Tw -3 -1.74 Td (governments within countries is critical and must be respected, and that\ has to be taken into )Tj 0 Tw 0 -1.72 TD (consideration when developing these governance strategies.)Tj 23.936 0 Td ( )Tj 0.255 Tw -20.936 -1.72 Td (And it is also clear that public he)Tj (alth responses are fundamentally dependent upon )Tj 0.138 Tw -3 -1.72 Td (effective public health collaboration which goes through all of the orde\ rs of government, and )Tj 0.061 Tw 0 -1.74 TD (strategies that may perhaps on the surface result in a better ability to\ comply with the IHR may )Tj 0 Tw 0 -1.72 TD (impact upon this )Tj (collaborative relationship and may actually ultimately be dysfunctional.\ )Tj 35.629 0 Td ( )Tj 0.115 Tw -32.629 -1.72 Td (This is essentially what I was hoping maybe we could have some discussio\ n on, and I )Tj 0.007 Tw -3 -1.72 Td (open it up to my colleagues here as well to ask questions on these issue\ s. Essentially the question)Tj 0 Tw 39 0 Td ( )Tj 0.134 Tw -39 -1.74 Td (is when do we centralize or when do we rely on a more decentralized syst\ em, and obviously )Tj 0.007 Tw T* (there are tensions between both options and we need to balance these tra\ de)Tj 0 Tw 30.017 0 Td (-)Tj 0.007 Tw (offs. And particularly )Tj 0.05 Tw -30.017 -1.72 Td (with respect to centralization I heard here in several presentation)Tj 26.303 0 Td (s different approaches to trying )Tj 0 Tw -26.303 -1.72 Td (to centralize operations.)Tj ( )Tj 0.301 Tw 3 -1.74 Td (Obviously public health legislation )Tj 0 Tw 15.481 0 Td (\226)Tj ( )Tj 0.301 Tw 1.051 0 Td (or legislation of some sort )Tj 0 Tw 12.2 0 Td (\226)Tj ( )Tj 0.301 Tw 1.051 0 Td (was frequently )Tj 0.124 Tw -32.784 -1.72 Td (mentioned, particularly in more of the centralized federal states or the\ unitary states. In states )Tj 0.006 Tw T* (where that clea)Tj (rly is constitutionally not possible I heard about the policy option of \ using parallel )Tj 0.03 Tw T* (legislation, and security became probably the one that seems to be comin\ g up most frequently in )Tj ET endstream endobj 407 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (57)Tj ( )Tj ET Q BT 0.221 Tw 12 0 0 12 107.88 709.08 Tm (With respect to the United States, I\222d put the United States in the b\ o)Tj 30.086 0 Td (ttom left)Tj 0 Tw (-)Tj (hand )Tj 0.383 Tw -33.086 -1.72 Td (quadrant in rule)Tj 0 Tw (-)Tj 0.383 Tw (making, but my sense is that the central government, that the federal )Tj 0 Tw 0 -1.72 TD (government )Tj 5.048 0 Td (\226)Tj ( )Tj 0.021 Tw 0.771 0 Td (indeed the White House )Tj 0 Tw (\226)Tj ( )Tj 0.021 Tw 10.742 0 Td (has become much more important in driving the federal )Tj 0 Tw -16.56 -1.74 Td (system.)Tj ( )Tj 0.042 Tw 3 -1.72 Td (So what I\222ve really tried to do is play back for you m)Tj (y impressions of how, both in rule)Tj 0 Tw (-)Tj 0.01 Tw -3 -1.72 Td (making and in operations, the different countries gathered around this p\ articular table compare to )Tj 0 Tw T* (one another.)Tj ( )Tj 0.089 Tw 3 -1.74 Td [(Now, )0.5(what )0.5(I )0.5(did )0.5(not )0.5(do )0.5(in )0.5(this, )0.5(and )0.5(what )0.6(David )0.5(did )0.5(in )0.5(his )0.5(presentation, )0.5(is )0.5(David )0.5(talked )]TJ 0.038 Tw -3 -1.72 Td (about trends, the dyn)Tj (amics, the direction in which he sees things going. Whether this is accu\ rate )Tj 0.066 Tw T* (or inaccurate this is static, this is a snapshot of what I heard you to \ be saying to me about your )Tj 0.025 Tw T* (particular countries today. And interesting, even once you\222ve reacted\ to this an)Tj 31.789 0 Td (d I\222ve made some )Tj 0.166 Tw -31.789 -1.74 Td [(adjustments and corrections to take account of how you will correct )0.5(me, )0.5(a )0.5(separate )0.5(question )]TJ 0.007 Tw T* (would be, whatever the correct snapshots may be, is there a trend within\ your country, and is that )Tj 0.272 Tw T* (trend along the lines... remember David made a d)Tj 21.918 0 Td (istinction between international law and )Tj 0.041 Tw -21.918 -1.72 Td (domestic law in his presentation, and when you react to my particular pr\ esentation it would also )Tj 0.001 Tw 0 -1.74 TD [(be helpful to have a )0.5(sense from you whether your domestic law is moving in a direction which \ he )]TJ 0.034 Tw 0 -1.72 TD (talked about, which wa)Tj (s moving towards more centralization )Tj 0 Tw (\226)Tj ( )Tj 0.034 Tw 25.687 0 Td (or not )Tj 0 Tw (\226)Tj ( )Tj 0.034 Tw 3.463 0 Td (and whether it\222s moving )Tj 0 Tw -29.15 -1.72 Td (in some of the other directions.)Tj ( )Tj 0.087 Tw 3 -1.72 Td (I will stop my presentation now )Tj 0 Tw 13.466 0 Td (\226)Tj ( )Tj 0.087 Tw 0.837 0 Td (and we can bring these back later and you can make )Tj 0.076 Tw -17.304 -1.74 Td (comments on it )Tj 0 Tw (\226)Tj ( )Tj 0.076 Tw 7.47 0 Td (and I\222ll turn it over to Dr.)Tj 0 Tw ( )Tj 0.076 Tw (Wilson for the last )Tj (of our quick presentations, and )Tj 0 Tw -7.47 -1.72 Td (then we will open it up to a general conversation.)Tj 19.716 0 Td ( )Tj -16.716 -1.72 Td ( )Tj /TT1 1 Tf -3 -1.72 Td (Dr.)Tj ( )Tj (Kumanan Wilson)Tj ( )Tj /TT0 1 Tf 3 -1.66 Td (Thank)Tj (-)Tj 0.035 Tw [(you. )0.5(My )0.5(presentation )0.5(really )0.5(is )0.5(more )0.5(intended )0.5(to )0.5(be )0.5(a )0.5(lead)]TJ 0 Tw (-)Tj 0.034 Tw (in to a discussion rather )Tj 0.057 Tw -3 -1.72 Td (than a synthesis, but in leading into this discussion I thought)Tj 0 Tw ( )Tj 0.057 Tw 25.019 0 Td (it might be worth discussing some )Tj 0.12 Tw -25.019 -1.72 Td (guiding principles that seem to be overlying the discussion today, so ob\ viously the discussion )Tj 0.163 Tw 0 -1.74 TD (being characterized by the importance of the International Health Regula\ tions, importance of )Tj 0.014 Tw 0 -1.72 TD (countries being able to comply wi)Tj [(th them, )0.5(and )0.5(also )0.5(with )0.5(some )0.5(of )0.6(the )0.5(challenges )0.5(the )0.5(IHR )0.5(poses )0.5(to )]TJ 0 Tw T* (decentralized states.)Tj ( )Tj ET endstream endobj 408 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (56)Tj ( )Tj ET Q BT 0.165 Tw 12 0 0 12 107.88 709.08 Tm (I thought from the U.S. presentation that in a rule)Tj 0 Tw 21.232 0 Td (-)Tj 0.165 Tw (making, rule)Tj 0 Tw (-)Tj 0.165 Tw (setting context where )Tj 0.012 Tw -24.232 -1.72 Td (there was a strong reference to the histo)Tj 15.995 0 Td (ry of the United States and what the constitution said and )Tj 0.13 Tw -15.995 -1.72 Td (so forth, that the framework struck me as being one which depended on co\ operation between )Tj 0 Tw 0 -1.74 TD (governments )Tj 5.527 0 Td (\226)Tj ( )Tj 0.112 Tw 0.862 0 Td [(which )0.5(is )0.5(kind )0.5(of )0.5(my )0.5(horizontal )0.5(axis )]TJ 0 Tw (\226)Tj ( )Tj 0.112 Tw 16.057 0 Td [(but )0.5(that )0.5(it )0.5(was )0.5(done )0.5(in )0.5(a )0.5(relatively )0.5(non)]TJ 0 Tw 16.222 0 Td (-)Tj -38.667 -1.72 Td (hierarchical f)Tj (ashion.)Tj ( )Tj 0.204 Tw 3 -1.72 Td (And with respect to Australia, France and India, you can see that I\222v\ e characterized )Tj 0.12 Tw -3 -1.72 Td (things as a stronger imposition from the centre downward in terms of set\ ting the rules. In the )Tj 0.202 Tw T* (case of France there\222s the history of being a unitary state which is)Tj 0 Tw 28.689 0 Td ( )Tj 0.202 Tw 0.452 0 Td (in the process of being )Tj 0.148 Tw -29.14 -1.72 Td (changed over recent constitutional amendments. It remains a unitary stat\ e, but a unitary state )Tj 0.243 Tw 0 -1.72 TD (which is becoming much more deconcentrated and decentralized )Tj 0 Tw 28.099 0 Td (\226)Tj ( )Tj 0.243 Tw 0.993 0 Td (both of them )Tj 0 Tw (\226)Tj ( )Tj 0.243 Tw 7.082 0 Td (and so )Tj 0.081 Tw -36.174 -1.72 Td (someone who knew France 30 or 40 years ago and knew)Tj 0 Tw 23.467 0 Td ( )Tj 0.081 Tw 0.331 0 Td (its governance and looked at it today )Tj 0.07 Tw -23.798 -1.74 Td (would have a hard time recognizing the old French regime with its relian\ ce on the prefects and )Tj 0.014 Tw T* (so forth compared to the new regime, but I still think the rule)Tj 0 Tw (-)Tj 0.014 Tw (making is significantly centralized. )Tj 0.005 Tw T* [(And )0.5(Australia, )0.5(which )]TJ [(is )0.5(of )0.5(course )0.5(traditionally )0.5(a )0.5(strongly)]TJ 0 Tw (-)Tj 0.005 Tw [(centralized )0.5(federal )0.5(state )0.5(I )0.5(think )0.5(is )0.5(in )0.5(the )]TJ 0.049 Tw T* (same category. And I also had the sense that India, that the rule)Tj 0 Tw (-)Tj 0.049 Tw (making came strongly from the )Tj 0 Tw 0 -1.74 TD (centre.)Tj ( )Tj 0.11 Tw 3 -1.72 Td (I didn\222t reach the same conclusions with respect to operations. In th\ e)Tj 0 Tw 28.699 0 Td ( )Tj 0.11 Tw 0.36 0 Td (operations sense, )Tj 0.012 Tw -32.059 -1.72 Td (again I thought that Russia, Brazil and China, my impression was that it\ wasn\222t just the rules that )Tj 0.086 Tw 0 -1.72 TD (were driven from the centre and quite a large amount of hierarchy, but a\ lso that the operations )Tj 0.068 Tw 0 -1.74 TD (were very similar. Dr.)Tj 0 Tw ( )Tj 0.068 Tw (Fedorov talked abo)Tj (ut the fact that all of the money flows down from the )Tj 0.015 Tw 0 -1.72 TD (centre to the local regions and that in fact they rely almost entirely o\ n central government money )Tj 0 Tw T* (\226)Tj ( )Tj (federal government money )Tj (\226)Tj ( )Tj (to operate at the local level.)Tj 23.574 0 Td ( )Tj 0.184 Tw -20.574 -1.72 Td (I was not sure I interpreted the Chinese si)Tj (tuation correctly so you may well want to )Tj 0.119 Tw -3 -1.74 Td (correct me, but I had the impression that the operations in China, even \ though there was four )Tj 0.055 Tw T* (levels from a central to a regional to prefectural to a county level, I \ had the impression that this )Tj 0 Tw T* (was heavily managed)Tj ( )Tj (from the centre, and so if I\222m wrong you can correct me about that.)Tj 35.765 0 Td ( )Tj -32.765 -1.72 Td (And in the case of Brazil, again I\222m open to corrections.)Tj 22.492 0 Td ( )Tj 0.327 Tw -22.492 -1.74 Td (With respect to France, even though I thought the French rule)Tj 0 Tw 27.958 0 Td (-)Tj 0.327 Tw (making was quite )Tj 0.302 Tw -30.958 -1.72 Td (centralized it was my impression that the operatio)Tj 22.026 0 Td (ns in France have become much more )Tj 0.15 Tw -22.026 -1.72 Td (cooperative, all governments are often at the table and that it\222s bec\ ome a more decentralized )Tj 0 Tw T* (form of operation in France than was the case years ago.)Tj 22.575 0 Td ( )Tj ET endstream endobj 409 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 410 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 411 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 412 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 413 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 414 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (55)Tj ( )Tj ET Q BT 0.223 Tw 12 0 0 12 71.88 709.08 Tm (health field but in other fields)Tj 0 Tw 12.972 0 Td ( )Tj 0.223 Tw 0.473 0 Td (it may be. Of course you could have also a relationship of )Tj 0.207 Tw -13.445 -1.72 Td (interdependence but which is reached on a largely voluntary non)Tj 0 Tw 27.716 0 Td (-)Tj 0.207 Tw (hierarchical basis. And so )Tj 0 Tw -27.716 -1.72 Td (government relationships can be characterized by any of these four quadr\ ants.)Tj 31.182 0 Td ( )Tj 0.047 Tw -28.182 -1.74 Td (Now, what I have done is I )Tj (have decided to try to characterize each of your countries by )Tj 0.065 Tw -3 -1.72 Td (putting you on the map here, somewhere on this particular map, and what \ I expect you to do is )Tj 0.01 Tw 0 -1.72 TD [(when )0.5(you )0.5(see )0.5(the )0.5(way )0.5(in )0.5(which I )0.5(have characterized )0.5(your )0.5(country )0.5(to )0.5(tell )0.5(me )0.6(I have )0.5(it )0.5(wrong. )0.5(And )]TJ 0.057 Tw T* (I do)Tj (n\222t mind that because I probably will have it wrong, but if I can get\ you to tell me I have it )Tj 0 Tw 0 -1.74 TD (wrong then you\222ll be telling me what\222s right and I\222ll be drawin\ g you out.)Tj 29.105 0 Td ( )Tj 0.02 Tw -26.105 -1.72 Td (Now, one of the difficulties when I do such a simplifying exercise is yo\ u may well say )Tj 0 Tw 35.222 0 Td (to )Tj 0.097 Tw -38.222 -1.72 Td (me, \223It\222s impossible to cover all the diverse activities that we\222\ re describing in public health or )Tj 0.082 Tw 0 -1.72 TD (the new International Health Regulations in one simple characterization.\ The world is far more )Tj 0.208 Tw 0 -1.74 TD (complex and far more nuanced,\224 and of course I know that, b)Tj (ut I\222m still looking to try to )Tj 0.053 Tw 0 -1.72 TD (compare and contrast among the different countries, and so what I will d\ o first is show you this )Tj 0 Tw T* (same simple diagram with a focus on rule)Tj (-)Tj (making rather than on operations.)Tj ( )Tj 0.013 Tw 3 -1.72 Td (Now, the impression I got from what was said was that)Tj 0 Tw ( )Tj 0.013 Tw 22.415 0 Td (in three of the countries )Tj 0 Tw (\226)Tj ( )Tj 0.013 Tw 10.574 0 Td (again, I )Tj 0.108 Tw -35.989 -1.74 Td (didn\222t cover Africa here )Tj 0 Tw 10.317 0 Td (\226)Tj ( )Tj 0.108 Tw 0.858 0 Td (that in Russia and Brazil and in China the rule)Tj 0 Tw (-)Tj 0.108 Tw (making was largely )Tj 0.146 Tw -11.176 -1.72 Td [(done )0.5(at )0.5(the )0.5(central )0.5(level, )0.5(that )0.5(the )0.5(central )0.5(government )]TJ 0 Tw 22.578 0 Td (\226)Tj ( )Tj 0.146 Tw 0.896 0 Td [(the )0.5(federal )0.5(government )0.5(or )0.5(the )0.5(central )]TJ 0 Tw -23.474 -1.72 Td (government )Tj 5.044 0 Td (\226)Tj ( )Tj 0.017 Tw 0.767 0 Td (set the rules bo)Tj (th for the central level and for regional and local levels, that there\222\ s )Tj 0.123 Tw -5.811 -1.72 Td (not a lot of interdependence in the making of the rules, that the Russia\ n, the Chinese and the )Tj 0.01 Tw 0 -1.74 TD (Brazilian governments )Tj 0 Tw (\226)Tj ( )Tj 0.01 Tw 10.109 0 Td (if I interpreted you correctly )Tj 0 Tw (\226)Tj ( )Tj 0.01 Tw 12.386 0 Td (basically set the rules at the )Tj (central level, )Tj 0.103 Tw -22.495 -1.72 Td (and that the other levels of government, if you want, are rule)Tj 0 Tw 25.373 0 Td (-)Tj 0.103 Tw (takers, they are not rule)Tj 0 Tw (-)Tj (makers, )Tj 0.023 Tw -25.373 -1.72 Td (there is not a lot of cooperation in how the framework is established, i\ t\222s done hierarchically and )Tj 0 Tw 0 -1.72 TD (it\222s done independently by the central gover)Tj 17.605 0 Td (nment.)Tj ( )Tj 0.004 Tw -14.605 -1.74 Td (At the other extreme )Tj 0 Tw (\226)Tj ( )Tj 0.004 Tw 9.266 0 Td (again this is just my interpretation )Tj 0 Tw 13.91 0 Td (\226)Tj ( )Tj 0.004 Tw 0.754 0 Td (is this lonely northern country )Tj 0.052 Tw -26.931 -1.72 Td (called Canada where the framework, the broad framework for decision)Tj 0 Tw 28.788 0 Td (-)Tj 0.052 Tw (making, the rule)Tj 0 Tw (-)Tj (setting, )Tj 0.138 Tw -28.788 -1.72 Td (is done in some sort of collaborative fashion without a subst)Tj 25.428 0 Td (antial force of... without a lot of )Tj 0.091 Tw -25.428 -1.72 Td (imposition, sort of a cooperative basis, by the federal and provincial g\ overnments )Tj 0 Tw 33.976 0 Td (\226)Tj ( )Tj 0.091 Tw 0.841 0 Td (not by the )Tj 0.138 Tw -34.818 -1.74 Td (local governments, by the federal and provincial governments )Tj 0 Tw 26.121 0 Td (\226)Tj ( )Tj 0.138 Tw 0.888 0 Td (and that it\222s implicit in what )Tj 0.032 Tw -27.008 -1.72 Td (they do that there is going to)Tj 0 Tw ( )Tj 0.032 Tw 11.913 0 Td [(be a lot of interdependence and )0.5(a )0.5(lot )0.5(of )0.5(cooperation )0.5(in )0.5(rule)]TJ 0 Tw 23.754 0 Td (-)Tj (making )Tj -35.667 -1.72 Td (\226)Tj ( )Tj (not operations )Tj (\226)Tj ( )Tj (but that there is no strong imposition.)Tj ( )Tj ET endstream endobj 415 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (54)Tj ( )Tj ET Q BT /TT1 1 Tf 12 0 0 12 71.88 709.08 Tm (Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.151 Tw 3 -1.64 Td (As David mentioned, we were all making notes as the conversations were p\ roceeding )Tj 0.017 Tw -3 -1.74 Td (over the last day and a half, and David has given you som)Tj (e broad trends. My remarks will not be )Tj 0 Tw 0 -1.72 TD (on trends but they will be on a more static analysis of what I interpret\ ed you to be saying.)Tj 35.797 0 Td ( )Tj 0.034 Tw -32.797 -1.72 Td (I have to say my remarks will not focus on the African presentation for \ two reasons. The )Tj 0.095 Tw -3 -1.72 Td (first one is that I was finishing m)Tj (y notes as the African presentation was being made, but also )Tj 0 Tw 0 -1.74 TD (because )Tj 3.511 0 Td (\226)Tj ( )Tj 0.096 Tw 0.846 0 Td (and more importantly, I think )Tj 0 Tw 12.533 0 Td (\226)Tj ( )Tj 0.096 Tw 0.846 0 Td (because the substantive presentation from M. Basse )Tj 0.017 Tw -17.735 -1.72 Td [(highlighted )0.5(for )0.5(me )0.5(the )0.5(differences )0.5(between )0.5(Africa )0.5(and )0.5(other )0.5(parts )0.5(of )0.5(the )0.5(world, )0.5(and )0.6(I )0.5(would )0.5(have )]TJ 0 Tw 0 -1.72 TD (to th)Tj (ink more about whether what I have to say has any relevance for Africa.)Tj 30.683 0 Td ( )Tj 0.048 Tw -27.683 -1.72 Td (When I try to understand what you were saying over the last couple of da\ ys it struck me )Tj 0.187 Tw -3 -1.74 Td [(that )0.5(the )0.5(governance )0.5(that )0.5(was )0.5(being )0.5(talked )0.5(about )0.5(fits )0.5(into )0.5(at )0.5(least two )0.5(categories. )0.5(One )0.5(is )0.5(the )]TJ 0 Tw T* (ar)Tj 0.103 Tw (chitecture or the rules, the broad rules, and who makes the rules, who m\ akes the legislation, )Tj 0.297 Tw T* (who makes the broad framework for your country. When I say \223who\224 i\ s it the national )Tj 0.06 Tw T* (government, is it the regional government, is it the local government, i\ s it s)Tj 30.827 0 Td (ome combination of )Tj 0.054 Tw -30.827 -1.74 Td (governments. So, who makes the rules, and then secondly who operates, wh\ o does things in the )Tj 0 Tw T* (field? So my comments that follow will make a distinction between rule)Tj 28.854 0 Td (-)Tj (making and operations.)Tj ( )Tj 0.36 Tw -25.854 -1.72 Td (When I think about governance I often ask this typ)Tj 23.537 0 Td (e of question. When there\222s )Tj 0.446 Tw -26.537 -1.72 Td (intergovernmental relations involved is the relationship between the dif\ ferent levels of )Tj 0.233 Tw 0 -1.74 TD (government hierarchical or non)Tj 0 Tw (-)Tj 0.233 Tw (hierarchical? And by \223hierarchical\224 I mean is one order of )Tj 0 Tw 0 -1.72 TD (government )Tj 5.095 0 Td (\226)Tj ( )Tj 0.068 Tw 0.818 0 Td (one level of government )Tj 0 Tw 10.27 0 Td (\226)Tj ( )Tj 0.068 Tw 0.818 0 Td (imposing i)Tj (ts will on the other level of government, or )Tj 0.239 Tw -17.001 -1.72 Td (are the different levels of government interacting with one another larg\ ely on the basis of )Tj 0 Tw T* (equality and partnership, so is there hierarchy or is there partnership.\ )Tj 27.491 0 Td ( )Tj 0.319 Tw -24.491 -1.74 Td (The second question I ask myself is whether or)Tj 0 Tw ( )Tj 0.319 Tw 21.95 0 Td (not the relationship between the )Tj 0.125 Tw -24.95 -1.72 Td (governments is one of interdependence or autonomy, and of course in rela\ tion to rule)Tj 0 Tw 35.667 0 Td (-)Tj (making )Tj 0.01 Tw -35.667 -1.72 Td (and in relation to operations you can get different answers to those que\ stions about hierarchy and )Tj 0 Tw T* (non)Tj (-)Tj (hierarchy, and interdepende)Tj (nce or autonomy.)Tj ( )Tj 0.108 Tw 3 -1.74 Td (I usually end up with a diagram that looks something like this, apart fr\ om problems in )Tj 0.013 Tw -3 -1.72 Td (spelling in this. You can have relationships which are hierarchical but \ interdependent, and in that )Tj 0.088 Tw T* (particular case one level of government is the more )Tj 21.537 0 Td (powerful and forceful level of government )Tj 0.231 Tw -21.537 -1.72 Td (but it still is working in a partnership with the other levels of govern\ ment. You can have )Tj 0.086 Tw 0 -1.74 TD (governments acting independently of one another. This may not be very co\ mmon in the public )Tj ET endstream endobj 416 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (53)Tj ( )Tj ET Q BT 0.339 Tw 12 0 0 12 71.88 709.08 Tm [(technologies, )0.5(you\222ve )0.5(got )0.5(to )0.5(have )0.5(standard )0.5(operating )0.5(procedures )0.6(in )0.5(order )0.6(for )0.6(them )0.6(to )0.6(be )]TJ 0.13 Tw 0 -1.72 TD (interoperable. I mean, that by its very nature forces harmonization, and\ it also then facilitates )Tj 0 Tw T* (intensification, etc., etc.)Tj 9.552 0 Td ( )Tj 0.027 Tw -6.552 -1.74 Td (We also see the design)Tj 0 Tw ( )Tj 0.027 Tw 9.491 0 Td [(of new public health strategies for these globalized problems, )0.5(and )]TJ 0.033 Tw -12.491 -1.72 Td (again that\222s where I think the IHR 2005 is important, but we also see\ these changes taking place )Tj 0.029 Tw T* [(at )0.5(the )0.5(national )0.5(and )0.5(the )0.5(subnational )0.5(level )0.5(and )0.6(sort )0.5(of )0.5(rethinking )0.5(how )0.5(we )0.5(approach )0.5(public )0.5(hea)]TJ 36.888 0 Td [(lth )0.5(in )]TJ 0 Tw -36.888 -1.72 Td (a globalized world.)Tj ( )Tj 0.021 Tw 3 -1.74 Td (I also think another driving factor of this is how conceptually we\222ve\ begun to think about )Tj 0.148 Tw -3 -1.72 Td (public health problems differently, and for me one of the best examples \ of that is the use of )Tj 0.219 Tw T* (security as a lens in thinking about public )Tj (health. The International Health Regulations are )Tj 0.07 Tw T* (directly tied, in WHO\222s thinking about this, to the concept of global\ health security )Tj 0 Tw 34.473 0 Td (\226)Tj ( )Tj 0.07 Tw 0.82 0 Td (we heard )Tj 0.114 Tw -35.293 -1.74 Td (the Australian presentation talking about a new national health security\ act )Tj 0 Tw 31.38 0 Td (\226)Tj ( )Tj 0.114 Tw 0.864 0 Td (and so when we )Tj 0.062 Tw -32.244 -1.72 Td (started thinking)Tj 0 Tw ( )Tj 0.062 Tw 6.623 0 Td (about public health differently as well that also, I think, encourages u\ s to move )Tj 0 Tw -6.623 -1.72 Td (in the direction of the four trends that I illustrated earlier.)Tj 22.853 0 Td ( )Tj 0.056 Tw -19.853 -1.72 Td (The involvement of non)Tj 0 Tw (-)Tj 0.056 Tw (governmental actors I think is critical as well as a driving force )Tj 0.274 Tw -3 -1.74 Td (in these situations)Tj (. Again, think of the international health regulations. WHO gets lots of\ )Tj 0.1 Tw T* (information from all different kinds of sources but it has to verify wha\ t is rumour and what is )Tj 0.012 Tw T* (fact, and in order to do that properly you have to have a centralized, h\ armonized appro)Tj 34.81 0 Td (ach to that )Tj 0 Tw -34.81 -1.72 Td (particular problem.)Tj ( )Tj 0.031 Tw 3 -1.74 Td (Then I think we can also see as driving these trends the demand for as w\ ell as the supply )Tj 0.058 Tw -3 -1.72 Td (of either new legislation or new norms or new principles or new standard\ operating procedures, )Tj 0.066 Tw T* [(call it whatever you will we need )0.5(to )0.5(ha)]TJ [(ve )0.5(sort )0.5(of )0.6(a framework )0.5(of )0.5(rules )0.5(and )0.5(principles )0.5(that )0.5(drive )]TJ 0.188 Tw T* (and that move these trends forward in a way that hopefully has an impact\ on public health )Tj 0 Tw 0 -1.74 TD (problems.)Tj ( )Tj 0.046 Tw 3 -1.72 Td (So these trends, I think, are going to be continued in the future, that\222\ s why I said they\222re )Tj 0 Tw -3 -1.72 Td (becom)Tj 0.037 Tw (ing trajectories with regards to how the exercise of sovereignty for pub\ lic health purposes )Tj 0.072 Tw 0 -1.72 TD (in the future is going to unfold. The IHR is an important part of that b\ ut it\222s only one part of a )Tj 0.136 Tw 0 -1.74 TD (much larger transformation of the nature of governance with regar)Tj 27.74 0 Td (ds to the public health that )Tj 0 Tw -27.74 -1.72 Td (we\222re going to be seeing in the near and far future.)Tj 20.242 0 Td ( )Tj -17.242 -1.72 Td (I\222ll stop there.)Tj ( )Tj -3 -1.72 Td ( )Tj ET endstream endobj 417 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (52)Tj ( )Tj ET Q BT 0.012 Tw 12 0 0 12 71.88 709.08 Tm (health, especially in the infectious disease area. I don\222t think it\222\ s, particularly from the U.S. point )Tj 0.134 Tw 0 -1.72 TD (of view and perhaps e)Tj (ven the Canadian point of view, that there\222s no question that today t\ he )Tj 0.234 Tw T* (federal government plays a bigger role in terms of public health. And ag\ ain that\222s part of )Tj 0.054 Tw 0 -1.74 TD (authority moving up to a higher level of political accountability and po\ litical responsibilit)Tj 36.474 0 Td (y than )Tj 0.055 Tw -36.474 -1.72 Td [(we\222ve seen in the past, much )0.5(in the same way that some of that public health sovereignty at the )]TJ 0 Tw 0 -1.72 TD (national level has gone up towards the WHO.)Tj ( )Tj 0.123 Tw 3 -1.72 Td (In terms of intensification of governance we see... and here the example\ s comes from, )Tj 0.421 Tw -3 -1.74 Td (really, non)Tj 0 Tw (-)Tj 0.421 Tw (federal gov)Tj [(ernments, or governments )0.5(with )0.5(a )0.5(stronger history of centralized, )]TJ 0.249 Tw T* (hierarchical government, but even in that context we\222ve seen intensif\ ication of governance )Tj 0.112 Tw T* (activities taking place, and we\222ve heard examples from China, India, \ France and Russia about )Tj 0.104 Tw T* (this in)Tj (tensification process that\222s taking place as countries try to catch u\ p with these problems )Tj 0 Tw 0 -1.74 TD (that we face today with the issues that IHR 2005 are designed to deal wi\ th.)Tj 29.909 0 Td ( )Tj 0.065 Tw -26.909 -1.72 Td (And finally, in terms of the harmonization of governance, again I think \ the IHR 2005 is )Tj 0 Tw -3 -1.72 Td (i)Tj 0.09 Tw [(mportant )0.5(in )0.5(that )0.5(regard. )0.5(And )0.5(you )0.5(can )0.5(think, )0.5(for )0.5(example, )0.5(about )0.5(Annex )0.5(2, )0.5(the )0.6(algorithm, )0.5(about )]TJ 0.058 Tw 0 -1.72 TD (how we\222re going to approach this type of notification is something th\ at\222s sorting of catching on )Tj 0.129 Tw 0 -1.74 TD (from the global level and countries are thinking about using that )Tj 27.331 0 Td (at the national and the local )Tj 0.104 Tw -27.331 -1.72 Td (level. We\222ve even heard the concept of public health emergency of nat\ ional concern, which is )Tj 0.112 Tw 0 -1.72 TD (really based on the algorithm of public health... you can see the harmon\ ization of the strategy )Tj 0.079 Tw T* (taking place here. And I think that a)Tj (lso helps explain why the cooperation between federal and )Tj 0 Tw 0 -1.74 TD (sub)Tj (-)Tj 0.187 Tw (federal levels is both intensifying but that cooperation is also focusin\ g on and trying to )Tj 0.168 Tw 0 -1.72 TD (achieve harmonized strategies. So we\222re not changing the underlying c\ onstitutional structure. )Tj 0.317 Tw T* (The gover)Tj (nmental structure remains the same but the governance is fundamentally b\ eing )Tj 0 Tw T* (changed.)Tj ( )Tj 0.099 Tw 3 -1.74 Td (I think as Bruce Plotkin pointed out earlier many of these changes that \ we\222re seeing in )Tj 0.323 Tw -3 -1.72 Td (terms of globalization, centralization, intensification, harmonization, \ are not ca)Tj 34.187 0 Td (used by or )Tj 0.027 Tw -34.187 -1.72 Td (necessarily even driven by the new international health regulations. Wha\ t\222s fascinating about the )Tj 0.061 Tw T* (new IHR is that they\222re hitting this trend and they\222re sort of cat\ ching the wave and riding these )Tj 0.015 Tw 0 -1.74 TD (forward to create this new regime, but I think th)Tj 19.293 0 Td (ere are other driving factors that we have to keep )Tj 0 Tw -19.293 -1.72 Td (in mind that feed into all four of these trends.)Tj 18.106 0 Td ( )Tj 0.147 Tw -15.106 -1.72 Td (The first I think is the heightened importance of the use of new informa\ tion and new )Tj 0.098 Tw -3 -1.72 Td (communications technologies. For example, in terms of harmonizations yo)Tj 30.721 0 Td (u begin to use these )Tj ET endstream endobj 418 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (51)Tj ( )Tj ET Q BT 0.071 Tw 12 0 0 12 71.88 709.08 Tm (with this issues, and again I think)Tj 0 Tw ( )Tj 0.071 Tw 14.105 0 Td (we see that at all different levels from the global to the local )Tj 0 Tw -14.105 -1.72 Td (level, and I think that\222s an important trend to keep in mind.)Tj 23.633 0 Td ( )Tj 0.378 Tw -20.633 -1.72 Td (As I look at these different trends I think it\222s important to realize\ that they\222re )Tj 0.063 Tw -3 -1.74 Td (interdependent trends. In other words, the tr)Tj (end of the globalization of governance is connected )Tj 0.068 Tw 0 -1.72 TD (to intensification and centralization as dynamics that are also taking p\ lace with regards to these )Tj 0.188 Tw T* [(issues, and I think those are also all feeding into how we are )0.5(in the process )0.5(of slowly )]TJ 0 Tw (\226)Tj ( )Tj 38.389 0 Td (if )Tj -38.389 -1.72 Td (painfully )Tj 3.876 0 Td (\226)Tj ( )Tj 0.016 Tw 0.766 0 Td (harmonizing our approaches to these particular events and problems that \ we\222re trying )Tj 0 Tw -4.642 -1.74 Td (to deal with from the point of view of public health.)Tj 20.745 0 Td ( )Tj 0.018 Tw -17.745 -1.72 Td (And I think it\222s also important to see these trends all converging, I\ think, to really change )Tj 0.056 Tw -3 -1.72 Td (the entire nature of go)Tj (vernance that we\222re thinking about with regards to public health. In \ some )Tj 0.088 Tw T* (of my writings I\222ve tried to communicate this by using this term that\ public health governance )Tj 0.046 Tw 0 -1.74 TD (has sort of moved into a new world order, and these are I think four of \ the trends or f)Tj 34.816 0 Td (actors that )Tj 0.076 Tw -34.816 -1.72 Td (are driving public health governance into this dramatically new environm\ ent that we face. Yes, )Tj 0.077 Tw 0 -1.72 TD (not everything is new but I think even when we talk about the importance\ of collaboration and )Tj 0.029 Tw T* [(voluntary )0.5(compliance )0.5(between )0.5(state )0.5(level )0.5(and )0.5(federal )0.5(le)]TJ 22.44 0 Td [(vel, )0.5(yes )0.5(that )0.5(still )0.5(goes )0.5(on, )0.5(but )0.5(I )0.5(think )0.6(that )]TJ 0.07 Tw -22.44 -1.74 Td (collaboration and coordination is fundamentally different today than it \ was ten years ago, and I )Tj 0 Tw T* (think these trends help explain why that\222s the case.)Tj 20.355 0 Td ( )Tj 0.098 Tw -17.355 -1.72 Td (And just some examples of each of these trends to put a litt)Tj 24.835 0 Td (le more specificity in these )Tj 0.009 Tw -27.835 -1.72 Td (conceptual issues that I\222m talking about )Tj 0 Tw (\226)Tj ( )Tj 0.009 Tw 16.973 0 Td (and this may or may not help you understand what I\222m )Tj 0.053 Tw -16.973 -1.74 Td (trying to communicate )Tj 0 Tw 9.463 0 Td (\226)Tj ( )Tj 0.053 Tw 0.803 0 Td (as I said, I think the IHR 2005 are one of the best examples you could )Tj 0.178 Tw -10.266 -1.72 Td [(find )0.5(of )0.5(the )0.5(globalization )0.5(of )0.5(governa)]TJ [(nce, )0.5(there )0.5(are )0.5(various )0.5(aspects )0.5(of )0.5(this )0.5(which )0.5(indicate )0.5(that )]TJ 0.119 Tw T* (we\222re moving the strategy, we\222re moving authority away from the na\ tion state level up to the )Tj 0.143 Tw T* (global level. For example, WHO has more authority to make decisions and \ to act than it did )Tj 0.323 Tw 0 -1.74 TD (under the old)Tj 0 Tw ( )Tj 0.323 Tw 6.494 0 Td (International Health Regulations. I think that\222s a significant change\ which )Tj 0.244 Tw -6.494 -1.72 Td [(illustrates the globalization of a governance approach. The )0.5(involvement of non)]TJ 0 Tw 33.953 0 Td (-)Tj 0.244 Tw (state actors )Tj 0.124 Tw -33.953 -1.72 Td (through WHO being able to access and act upon information received from \ non)Tj 0 Tw 33.366 0 Td (-)Tj 0.124 Tw (state actor)Tj (s I )Tj 0.084 Tw -33.366 -1.72 Td (think is an example of that. And finally, there are much more demanding \ obligations on WHO )Tj 0.11 Tw T* (member states than we\222ve ever seen in any previous incarnation of the\ IHR or its predecessor )Tj 0 Tw 0 -1.72 TD (regimes.)Tj ( )Tj 0.025 Tw 3 -1.72 Td (In terms of the centralization of governance, I think we\222ve)Tj 0 Tw 23.548 0 Td ( )Tj 0.025 Tw 0.275 0 Td (seen, even in those states with )Tj 0.063 Tw -26.823 -1.72 Td [(a )0.5(deep )0.5(tradition )0.5(of )0.5(centralization, )0.5(a )0.5(growing )0.5(role )0.5(for )0.5(federal )0.5(and )0.5(national )0.5(governments )0.5(in )0.5(public )]TJ ET endstream endobj 419 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 420 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 421 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 422 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 423 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 424 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (50)Tj ( )Tj ET Q BT 0.237 Tw 12 0 0 12 71.88 709.08 Tm [(to identify what I see as some trends, and this is where I )0.5(want )0.5(to )0.5(focus )0.5(my )0.5(remarks )0.5(this )]TJ 0.083 Tw 0 -1.72 TD [(afternoon, because I think I see three basic )0.5(trends as )0.5(I )0.5(listen )0.5(to )0.5(the )0.5(material )0.5(presented )0.5(from )0.5(the )]TJ 0 Tw T* (diffe)Tj 0.119 Tw (rent countries, and also reflecting on the work that I\222d been doing o\ n the IHR myself, as )Tj 0 Tw 0 -1.74 TD (well as issues of global health governance.)Tj ( )Tj 0.141 Tw 3 -1.72 Td (And I\222ll just briefly describe these. Obviously I can\222t go into a \ lot of detail given the )Tj 0.003 Tw -3 -1.72 Td (limited time that I have but I h)Tj 12.215 0 Td (ope I at least can communicate to you in simple terms what I sense )Tj 0 Tw -12.215 -1.72 Td (is our trends.)Tj ( )Tj 0.08 Tw 3 -1.74 Td (The first is I think we\222re moving from a situation of more traditiona\ l intergovernmental )Tj 0.286 Tw -3 -1.72 Td (forms of cooperation )Tj 0 Tw 9.495 0 Td (\226)Tj ( )Tj 0.286 Tw 1.036 0 Td (which we saw, I think, illustrated in the old International He)Tj 0 Tw (alth )Tj -10.532 -1.72 Td (Regulations )Tj 5.11 0 Td (\226)Tj ( )Tj 0.082 Tw 0.832 0 Td (to what I call the globalization of governance. And I think the new Inte\ rnational )Tj 0.175 Tw -5.942 -1.72 Td (Health Regulations are one of the best examples of this type of globaliz\ ation of governance )Tj 0.046 Tw T* (that\222s happening not only in the public health context but in o)Tj 25.138 0 Td (ther areas of international law and )Tj 0 Tw -25.138 -1.72 Td (international relations, and I\222ll come back to that with some example\ s.)Tj 28.158 0 Td ( )Tj 0.019 Tw -25.158 -1.72 Td (The second, particularly in relationship... this trend particularly rela\ tes to those states that )Tj 0.001 Tw -3 -1.72 Td (have a deep tradition of federal government and a d)Tj 20.64 0 Td (ecentralized approach to public health. I think )Tj 0.036 Tw -20.64 -1.74 Td (we\222re seeing a trend away from decentralized government to a centrali\ zation of governance, and )Tj 0.079 Tw 0 -1.72 TD (I want to stress that there is a difference between governance and gover\ nment. We have talked )Tj 0.11 Tw T* (about the challenge)Tj (s that federal states are approaching, and sort of the static constituti\ onal or )Tj 0.166 Tw T* [(domestic )0.5(law )0.5(aspect )0.5(of )0.5(that, )0.5(but )0.5(that )0.5(framework )0.5(doesn\222t )0.5(match )0.5(the )0.5(type )0.5(of )0.5(collaboration )0.5(and )]TJ 0.104 Tw 0 -1.74 TD (coordination and changes that are happening as a matter of governance wi\ thin these c)Tj 0 Tw 35.528 0 Td (ountries, )Tj -35.528 -1.72 Td (and it seems to me that the trend is towards centralization of that proc\ ess.)Tj 29.325 0 Td ( )Tj 0.271 Tw -26.325 -1.72 Td (Third, I think there has been a change from, I think, complacency at the\ level of )Tj 0 Tw -3 -1.72 Td (governments )Tj 5.46 0 Td (\226)Tj ( )Tj 0.045 Tw 0.795 0 Td (this could also be at intergovernmental level as well )Tj 0 Tw 21.424 0 Td (\226)Tj ( )Tj 0.045 Tw 0.795 0 Td (but a shift away )Tj (from sort )Tj 0.207 Tw -28.473 -1.74 Td (of complacency and a go)Tj 0 Tw 10.823 0 Td (-)Tj (along)Tj (-)Tj (get)Tj (-)Tj 0.207 Tw (along attitude towards and intensification of governance )Tj 0.403 Tw -10.823 -1.72 Td (activities. Whether we\222re talking about the global level or the local\ level things have )Tj 0.355 Tw 0 -1.72 TD (dramatically changed. Dr.)Tj 0 Tw ( )Tj 0.355 Tw (Marfin talked about the change at the CDC)Tj 0 Tw 31.077 0 Td ( )Tj 0.355 Tw 0.605 0 Td (where they were )Tj 0.09 Tw -31.682 -1.72 Td (ponderous and slow but they got things right, but that\222s not the real\ ity they work in today, it\222s )Tj 0.056 Tw 0 -1.74 TD (sped up tremendously in terms of the demands on their time and their ene\ rgy, and I think that\222s )Tj 0 Tw 0 -1.72 TD (happening across the board in terms of actors)Tj 18.133 0 Td ( )Tj (that are involved in governance activities.)Tj 16.966 0 Td ( )Tj 0.146 Tw -32.099 -1.72 Td (And fourth, I think we\222ve moving away from a heterogeneity of approac\ hes to public )Tj 0.135 Tw -3 -1.72 Td (health problems towards and a harmonization of strategies and operations\ in terms of dealing )Tj ET endstream endobj 425 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (49)Tj ( )Tj ET Q BT 0.131 Tw 12 0 0 12 71.88 709.08 Tm (of us o)Tj (n sort of the analytical conclusions that we are drawing, and I would ho\ pe you would )Tj 0 Tw 0 -1.72 TD (participate fully in that discussion.)Tj ( )Tj 0.069 Tw 3 -1.72 Td (And then the last part of the afternoon )Tj 0 Tw 16.049 0 Td (\226)Tj ( )Tj 0.069 Tw 0.819 0 Td (and we will be finished by 4 o\222clock )Tj 0 Tw 15.383 0 Td (\226)Tj ( )Tj 0.069 Tw 0.819 0 Td (the last )Tj 0.184 Tw -36.07 -1.74 Td (part of the afternoon will be devoted to ne)Tj 18.301 0 Td (xt steps, where we plan to take the work of this )Tj 0 Tw -18.301 -1.72 Td (workshop over the next couple of months.)Tj ( )Tj 0.001 Tw 3 -1.72 Td [(So, )0.5(first )0.5(part )0.5(of )0.5(the )0.5(afternoon )0.5(will )0.5(be )0.5(on )0.5(sort )0.5(of )0.5(observations, )0.5(analysis )]TJ 0 Tw (\226)Tj ( )Tj 0.001 Tw [(at )0.5(last )0.5(preliminary )]TJ 0 Tw -3 -1.72 Td (analysis )Tj 3.508 0 Td (\226)Tj ( )Tj 0.037 Tw 0.786 0 Td [(and )0.5(some )0.5(evaluation. )0.5(The )0.5(three )0.5(of )0.5(us )0.5(will )0.5(start )0.5(the )0.5(convers)]TJ 23.719 0 Td [(ation )0.5(but )0.5(I )0.5(would )0.5(hope )0.5(you )]TJ 0.102 Tw -28.013 -1.74 Td (would all participate on next steps. And at end the afternoon if any of \ you have any logistical )Tj 0 Tw T* (questions about hotels or airlines or anything else, please do let us kn\ ow.)Tj 29.161 0 Td ( )Tj -26.161 -1.72 Td (We\222ll start off with David Fidler.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.74 TD (Dr.)Tj ( )Tj (David Fidler)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Than)Tj (k)Tj (-)Tj 0.128 Tw (you. All of us, in terms of what we\222re going to present this afternoo\ n from the )Tj 0.165 Tw -3 -1.72 Td (panel organizing committee, we\222ve obviously drawn these thoughts toge\ ther quickly, so they )Tj 0 Tw T* (remain works in progress themselves.)Tj ( )Tj 0.097 Tw 3 -1.72 Td (I want to talk about issues related to what I )Tj (call public health sovereignty, and perhaps )Tj 0.02 Tw -3 -1.72 Td (my comments might be the most conceptual of the responses that we\222re \ going to give, but let me )Tj 0.122 Tw 0 -1.72 TD (try to lay out some of the trends with regards to how countries are exer\ cising sovereignty for )Tj 0.025 Tw 0 -1.74 TD [(public )0.5(health )0.5(purposes)]TJ 0 Tw ( )Tj 0.025 Tw 9.322 0 Td [(that )0.5(we\222ve )0.5(been )0.5(talking )0.5(about )0.5(in )0.5(relationship )0.5(to )0.5(the )0.5(implementation )0.5(of )0.5(the )]TJ 0 Tw -9.322 -1.72 Td (IHR.)Tj ( )Tj 0.07 Tw 3 -1.72 Td (We\222ve been focusing on different country level responses to how the i\ mplementation of )Tj 0.156 Tw -3 -1.72 Td [(the )0.5(IHR )0.5(may )0.5(or )0.5(may )0.5(not )0.6(challenge )0.6(how )0.5(governments )0.5(go )0.5(about )0.5(exercising )0.5(their )0.5(public )0.5(health )]TJ 0.044 Tw T* (sovereignty. And I\222m using \223sovereignty\224 in, really, two legal \ senses. One is in connection with )Tj 0.193 Tw 0 -1.72 TD (the international context or international law, and the International He\ alth Regulations are a )Tj 0.149 Tw T* (Treaty, it\222s international law that relates to issues of soverei)Tj 25.221 0 Td (gnty from a nation state point of )Tj 0.052 Tw -25.221 -1.72 Td (view, but we\222ve also focused quite a bit on issues of constitutional \ or domestic government and )Tj 0.073 Tw 0 -1.74 TD (how governments are organized to deal with things, and how the internati\ onal legal obligations )Tj 0.139 Tw 0 -1.72 TD (may or may not fit into the exi)Tj (sting constitution or domestic legal system that countries may )Tj 0 Tw T* (have, and what may or may not be responses with regards to that issue.)Tj 28.41 0 Td ( )Tj 0.155 Tw -25.41 -1.72 Td (In connection with thinking about what\222s happening to public health s\ overeignty with )Tj 0.001 Tw -3 -1.74 Td (regards to the issues that we\222ve talk)Tj (ed about in terms of the implementation of the IHR, I\222ve tried )Tj ET endstream endobj 426 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (48)Tj ( )Tj ET Q BT 0.211 Tw 12 0 0 12 107.88 709.08 Tm (ensembles, vous avez le sous)Tj 0 Tw (-)Tj 0.211 Tw (ensemble [UEMOI] une organisation \351conomique mais )Tj 0.184 Tw 0 -1.72 TD (\351galement qui s\222affirme de plus en plus n\222est)Tj 0 Tw (-)Tj 0.184 Tw (ce pas sur les questions de sant\351 et \347a )Tj 0.028 Tw T* (regroupe huit pays qui sont tous frontaliers et sont )Tj 20.557 0 Td (un groupe homog\350ne parce qu\222ils sont )Tj 0 Tw -20.557 -1.74 Td (tous francophones \351galement comme vous le savez.)Tj 20.687 0 Td ( )Tj -23.687 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.245 Tw 3 0 Td (Il y a un autre sous)Tj 0 Tw (-)Tj 0.245 Tw [(ensemble qui est plus large donc c\222est la )0.5(CDAO, donc )]TJ 0.073 Tw -3 -1.72 Td (ECOAS en anglais. C\222est \351galement un sous)Tj 0 Tw 18.242 0 Td (-)Tj 0.073 Tw (ensemble qui s\222affirme de plus en plus sur )Tj 0.21 Tw -18.242 -1.72 Td (le plan s)Tj [(anitaire et qui pourrait \352tre )0.6(le )0.5(cadre, )0.5(le )0.5(plateau )0.5(d\222une )0.5(d\351marche )0.5(int\351gr\351e )0.5(de )]TJ 0.099 Tw 0 -1.74 TD (premier niveau avant d\222aller maintenant donc au niveau sup\351rieur. \ Et dans le cas juste)Tj 0 Tw 35.667 0 Td (-)Tj 0.084 Tw -35.667 -1.72 Td (ment de cette CDAO)Tj 0 Tw (-)Tj 0.084 Tw (l\340 le Nigeria qui est d\222ailleurs le plus grand pays de cet ensembl\ e )Tj 0 Tw 0 -1.72 TD (pour)Tj 0.2 Tw (rait naturellement \352tre amen\351 \340 une certaine supranationalit\351\ car il serait un peu )Tj 0.055 Tw T* (difficile de le faire s\222il n\222y a pas un plateau d\351j\340 cr\351\351\ pour cela. Et cette supranationalit\351 )Tj 0.131 Tw 0 -1.74 TD [(prendrait )0.5(la )0.5(forme )0.5(d\222une )0.5(responsabilisation )0.5(de )0.5(ces )0.5(organisations )0.5(dans )0.5(le )0.5(domai)]TJ 32.63 0 Td [(ne )0.5(de )0.5(la )]TJ 0.357 Tw -32.63 -1.72 Td (sant\351 en mati\350re de surveillance mais \351galement en mati\350re d\ \222action quand c\222est )Tj 0.214 Tw 0 -1.72 TD (n\351cessaire et sous l\222umbrella de l\222OMS au niveau r\351gional d\222\ abord et puis peut)Tj 0 Tw 34.168 0 Td (-)Tj (\352tre )Tj -34.168 -1.72 Td (\351ventuellement au nouveau si\350ge.)Tj 13.495 0 Td ( )Tj -16.495 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.204 Tw 3 0 Td (Donc voil\340 les possibilit\351s qu\222on aurait en term)Tj (es d\222action supranationale. En )Tj 0.258 Tw -3 -1.72 Td (dehors de ces plateaux, de ces cadres il serait difficile d\222envisager\ une quelconque )Tj 0.119 Tw T* (supranationalit\351 car ce serait la faire prendre la forme d\222accords\ bilat\351raux et c\222est pas )Tj 0 Tw T* (encore le cas et c\222est pas non plus envisageable )Tj 19.187 0 Td (dans l\222imm\351diat. Merci.)Tj /TT1 1 Tf 10.8 0 0 10.8 453.4191 336.6 Tm ( )Tj /TT0 1 Tf 12 0 0 12 71.88 315.72 Tm (DF:)Tj ( )Tj 0.238 Tw 3 0 Td (D\222autre questions? Other questions, comments? Bon, je rends merci, M.\ Basse, and )Tj 0 Tw T* (thank)Tj (-)Tj 0.007 Tw (you to all of you. I think we\222ll break a little early for lunch. Bon \ appetit. We\222ll start )Tj 0 Tw T* (again at 1:15, une heur et quart.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT2 1 Tf 0.004 Tc -0.003 Tw 13.92 0 0 13.92 71.88 231 Tm [(ANAL)0.7(YS)0.7(I)1.7(S)0.7( AND CON)]TJ 0.003 Tc -0.002 Tw 10.003 0 Td [(C)-1.3(LU)-1.3(SI)0.7(O)-1.3(N)-1.3(S FR)-1.2(O)-1.3(M)-2.3( PR)-1.3(ESEN)]TJ 0.005 Tc -0.005 Tw 12.685 0 Td [(T)1.2(AT)1.2(I)2.2(ONS)]TJ 0 Tc 0 Tw 4.527 0 Td ( )Tj 12 0 0 12 71.88 210.84 Tm (Chair: Dr.)Tj ( )Tj (Harvey Lazar)Tj ( )Tj /TT0 1 Tf 0.066 Tw 3 -1.64 Td (For this last afternoon the procedure we\222re proposing to follow is th\ e following. For the )Tj 0.075 Tw -3 -1.72 Td (next hour or two we will have some substantive discussions. First David \ Fidler then I and then )Tj 0.382 Tw 0 -1.74 TD (Kumanan Wilson will)Tj 0 Tw ( )Tj 0.382 Tw 10.227 0 Td [(convey to you some of the things that we\222ve learned )0.5(from the )]TJ 0.205 Tw -10.227 -1.72 Td (presentations, the country presentations. There will then be some opport\ unity for discussion )Tj 0.039 Tw 0 -1.72 TD (amongst all of us about what we have said, and we look forward to a good\ dialogue amongst all )Tj ET endstream endobj 427 0 obj <> endobj 428 0 obj <> endobj 429 0 obj <>stream HlT}l[?ڵS'I^.VޓD㔰ZnëDͨL4n:36%M)ƺnbC04εCv4iV}h@["{~sާ{&';X4jԤ\ /=xr1ԅ'}, `ɇ^bOJ 4[cU|H$'Ėtu_ȇcUxr--hNLV-tTKE41bdL˱E8C{"p %-gE)ҟϸ<  x ~9X%f ?7V 8 ߇ -QT*-$s 8uEn'rix"܀/NpC366dCV*rs#xºbeg{k UwzO*XD?vKUv[(+ `?gMzM=lkUkfFenjh<-rk!ϩ(m2>灩_O nN[:.(i" ICAA? n`Mvu=}Nӻ=UXw3]*ucuw na7nw2.ʷs.?Tk/=l*w_[klۙb7Q|%tH `o$8dlnzf~3?6 V\[ n]ɤ{ &?Qnq:Av:?t_p܄8"q'FSe9V~ endstream endobj 430 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (47)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ([Start of Side 4])Tj ( )Tj 0 -1.72 TD (SV:)Tj ( )Tj 0.036 Tw 3 0 Td (Donc pour suivre en fran\347ais... Alors en fran\347ais de Paris... La q\ uestion aussi se pose par )Tj 0.218 Tw T* [(rapport \340 l\222exemple r\351cent qu\222on a )0.5(eu )0.5(au Nigeria avec \340 la fois une importation)]TJ 0 Tw 34.589 0 Td ( )Tj 0.468 0 Td (de )Tj 0.005 Tw -35.056 -1.74 Td (volailles clandestines, apparemment, d\222apr\350s ce qu\222on a pu en s\ avoir, qui a contamin\351 pas )Tj 0.245 Tw T* (mal d\222\351levages domestiques et une dispersion ensuite de volailles \ contamin\351es dans )Tj 0.071 Tw T* [(diff\351rents )0.5(march\351s )0.5(du )0.5(Nigeria )0.5(avec )0.5(une )0.5(non)]TJ 0 Tw 17.86 0 Td (-)Tj 0.071 Tw [(d\351cision, )0.5(on )0.5(va )0.5(dire, )0.5(des )0.5(autorit\351s )]TJ 0 Tw (sanitaires )Tj 0.232 Tw -17.86 -1.72 Td (du Nigeria de fermer les march\351s. Et donc on voit bien que \347a r\351\ pond aussi \340 des )Tj 0.082 Tw 0 -1.74 TD (probl\350mes \351conomiques puisque c\222est des \351levages familiaux, \ bon il n\222y a pas vraiment )Tj 0.01 Tw 0 -1.72 TD (de possibilit\351s de compenser les pertes de vente et donc il y a eu un\ libre ma)Tj (rch\351 qui s\222est )Tj 0.103 Tw T* (maintenu m\352me en p\351riode d\222alerte y compris sur des march\351s \ transfrontaliers avec les )Tj 0 Tw T* (pays riverains et donc une grande inqui\351tude de certains pays riverai\ ns du Nigeria.)Tj 33.016 0 Td ( )Tj -36.016 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.049 Tw 3 0 Td (Donc la question qu\222on peut se poser par rapport \340 cette pr\351sen\ tation)Tj 28 0 Td (, si on a une )Tj 0.059 Tw -31 -1.72 Td (d\351marche effectivement int\351gr\351e \340 la fois de surveillance et\ de r\351ponse, quelle va \352tre la )Tj 0.054 Tw T* [(possibilit\351 )0.5(d\222action )0.5(donc )0.5(supranationale )0.5(et )0.5(\351ventuellement )0.5(pour )0.5(pouvoir )0.5(d\222abord )0.5(imposer )]TJ 0.047 Tw T* (certaines mesures sanitaires de base, pouvoir fournir un certai)Tj 25.059 0 Td (n nombre d\222aide financi\350re )Tj 0.226 Tw -25.059 -1.74 Td (pour justement compenser les pertes chez les \351leveurs qui signaleraie\ nt les \351levages )Tj 0.038 Tw T* (contamin\351s, et puis s\222assurer de la tra\347abilit\351 des poulets \ que ce soit en importation donc )Tj 0.033 Tw T* (tout le r\351seau de contr\364le v\351t\351rinaire, de contr\364le )Tj 20.059 0 Td (des fraudes, est)Tj 0 Tw (-)Tj 0.033 Tw (ce qu\222il y aurait moyen )Tj 0.025 Tw -20.059 -1.72 Td (dans ce cadre)Tj 0 Tw (-)Tj 0.025 Tw (l\340 de le renforcer par une action qui serait un peu comme les casques\ bleus )Tj 0 Tw 0 -1.74 TD (sanitaires?)Tj ( )Tj -3 -1.72 Td (AB:)Tj ( )Tj 0.015 Tw 3 0 Td (Merci beaucoup. Je crois que l\222intervention du docteur Lazari c\222es\ t plus une addition \340 ce )Tj 0.088 Tw 0 -1.72 TD (que j\222avais dit do)Tj (nc des commentaires que je trouve d\222ailleurs tr\350s pertinents et c\222\ est la )Tj 0.018 Tw T* [(raison pour laquelle donc que je ne )0.5(suis pas intervenu )0.5(\340 )0.5(sa )0.5(suite. )0.5(Donc )0.5(je crois que c\222est \340 )]TJ 0.051 Tw 0 -1.74 TD (titre de contribution qu\222il a fait \347a et c\222est une contribution\ donc qui va dans exactemen)Tj 0 Tw 35.722 0 Td (t )Tj -35.722 -1.72 Td (le m\352me sens que nous l\222envisagions.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.189 Tw 3 0 Td (Par rapport au docteur V\351grat, le probl\350me de l\222action dans un \ cadre plus ou )Tj 0.042 Tw -3 -1.72 Td [(moins )0.5(supranational. )0.5(D\222abord )0.5(la )0.5(question )0.5(de )0.5(la )0.6(d\351marche )0.5(int\351gr\351e. )0.5(Je )0.5(crois )0.5(que )0.5(quand )0.5(on )]TJ 0.138 Tw T* (parle de d\351marche int\351gr\351e peut)Tj 0 Tw 13.323 0 Td (-)Tj 0.138 Tw (\352tre que j\222aurais )Tj 7.438 0 Td (d\373 pr\351ciser \347a auparavant. La r\351gion )Tj 0.119 Tw -20.761 -1.72 Td (Afro constitue le dernier palier pour ce qui est d\222une d\351marche in\ t\351gr\351e \351ventuelle qui )Tj 0.025 Tw 0 -1.72 TD (serait en tout cas efficace. Au sein de cette r\351gion vous avez des so\ us)Tj 0 Tw 27.98 0 Td (-)Tj 0.025 Tw (ensembles. Et pour )Tj 0.272 Tw -27.98 -1.72 Td (ce qui concerne par exemple l\222Afrique de)Tj 0 Tw 18.236 0 Td ( )Tj 0.272 Tw 0.522 0 Td (l\222Ouest vous avez au moins deux sous)Tj 0 Tw 16.909 0 Td (-)Tj ET endstream endobj 431 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (46)Tj ( )Tj ET Q BT 0.094 Tw 12 0 0 12 107.88 709.08 Tm (ont du mal effectivement \340 g\351rer la crise journali\350re. Alors \340\ ce moment)Tj 0 Tw 29.924 0 Td (-)Tj 0.094 Tw (l\340 investir des )Tj 0.014 Tw -29.924 -1.72 Td [(ressources )0.5(et )0.5(s\222engager )0.5(sur )0.5(des )0.5(risques )0.5(potentiels )0.5(futurs )0.5(deviennent )0.6(une )0.6(d\351cision )0.5(politique )]TJ 0.043 Tw 0 -1.72 TD (difficile. Et moi je crois qu\222il y a deux strat\351gies possibles su)Tj 24.86 0 Td (r \347a. La premi\350re justement )Tj 0.102 Tw -24.86 -1.74 Td (c\222est l\222int\351gration et c\222est \347a qu\222a d\351not\351 le c\ oll\350gue de l\222Inde qui est la strat\351gie de la )Tj 0.029 Tw T* (r\351gion africaine d\222agir d\222une fa\347on d\222int\351grer que ce \ soit la surveillance ou le syst\350me de )Tj 0.102 Tw T* (r\351ponse pour les diff\351rentes maladies infec)Tj (tieuses. Et la mise en oeuvre de RSI dans la )Tj 0.038 Tw T* [(r\351gion, )0.5(ce )0.5(renforcement )0.5(dans )0.5(le )0.5(contexte )0.5(de )0.5(syst\350me )0.5(de )0.5(surveillance... \340 )0.6(ce )0.5(moment)]TJ 0 Tw 33.714 0 Td (-)Tj 0.038 Tw [(l\340 )0.5(de )]TJ 0.14 Tw -33.714 -1.74 Td (placer des ressources ou investir des ressources et s\222engager sur des\ risques potentiels )Tj 0 Tw T* (futurs devient une d\351cision polit)Tj (ique difficile. )Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.094 Tw 3 0 Td (Et moi je crois qu\222il y a deux strat\351gies possibles sur \347a. La \ premi\350re justement )Tj 0.022 Tw -3 -1.72 Td (c\222est l\222int\351gration et c\222est \347a que vient de d\351noter l\ e coll\350gue de l\222Inde qui est la strat\351gie )Tj 0.033 Tw 0 -1.74 TD [(de )0.5(la )0.5(r\351gion )0.5(africaine )0.5(d\222agir d\222une )0.5(fa\347on )0.5(int\351gr\351e )0.5(que )0.5(ce )0.5(s)]TJ 23.369 0 Td [(oit )0.5(la )0.5(surveillance )0.5(mais )0.5(aussi )0.5(le )]TJ 0.138 Tw -23.369 -1.72 Td (syst\350me de r\351ponse pour les diff\351rentes maladies infectieuses, \ et la mise en oeuvre de )Tj 0.215 Tw 0 -1.72 TD (RSI dans la r\351gion, ce renforcement dans le contexte de syst\350me de\ surveillance de )Tj 0 Tw T* (r\351ponse int\351gr\351e. Et \347a c\222est la premi\350re chose. )Tj 19.046 0 Td ( )Tj -22.046 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.013 Tw 3 0 Td (Et la deuxi\350me je trouve, un peu touch\351 assez rapidement hier sur \ \347a, les \351l\351ments )Tj 0.242 Tw -3 -1.72 Td (fondamentaux de base qui sont vraiment n\351cessaires et qui sont pas fo\ rc\351ment trop )Tj 0.04 Tw T* (co\373teux, trop complexes, qui demandent pas trop de ressources et qui \ peut utiliser ce qui )Tj 0 Tw T* (e)Tj 0.072 Tw (xiste d\351j\340 dans la meilleure fa\347on. Il faut pas, et je crois qu\ e \347a va \352tre le danger peut)Tj 0 Tw 35.667 0 Td (-)Tj 0.052 Tw -35.667 -1.74 Td (\352tre de certains pays africains, \352tre trop ambitieux, c\222est)Tj 0 Tw 22.742 0 Td (-)Tj (\340)Tj (-)Tj 0.052 Tw (dire aller construire de grands )Tj 0.045 Tw -22.742 -1.72 Td (laboratoires au niveau P3 ou P4 ou P6 qui existe quand m\352me, ou essay\ er)Tj 0 Tw 30.024 0 Td ( )Tj 0.045 Tw 0.295 0 Td (de d\351velopper )Tj 0.06 Tw -30.319 -1.72 Td (des syst\350mes trop complexes autour d\222un risque parce qu\222\340 ce\ moment)Tj 0 Tw (-)Tj 0.06 Tw (l\340 je crois que la )Tj 0.112 Tw T* (r\351ponse politique, la r\351ponse de ressources et peut)Tj 0 Tw (-)Tj 0.112 Tw (\352tre aussi la r\351ponse de bailleurs de )Tj 0.276 Tw 0 -1.74 TD (fonds potentiels va \352tre n\351gative ou limit\351e, si vous voulez. E\ t)Tj 0 Tw 27.591 0 Td ( )Tj 0.276 Tw 0.526 0 Td (c\222est une v\351ritable )Tj 0 Tw -28.118 -1.72 Td (approche strat\351gique qu\222il faut faire, mais je crois que le d\351f\ i sera justement ici.)Tj 31.849 0 Td ( )Tj -34.849 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.025 Tw 3 0 Td (Par contre on a peut)Tj 0 Tw (-)Tj 0.025 Tw (\352tre une attention \340 ces probl\350mes dans les pays africains qui \ )Tj 0.06 Tw -3 -1.72 Td (peuvent sont plus relev\351s que dans les autres r\351gions ce qui ren)Tj 25.906 0 Td (dra certaines choses plus )Tj 0.003 Tw -25.906 -1.74 Td [(faciles et je suis optimiste que beaucoup de pays en Afrique )0.5(soient d\351j\340 bien avanc\351s dans )]TJ 0.064 Tw 0 -1.72 TD [(les concepts. Ils ont d\351j\340 pas mal )0.5(de choses en place, pas mal de ressources disponibles. )]TJ 0.269 Tw T* (Ce sera peut)Tj 0 Tw (-)Tj 0.269 Tw (\352tre le cas de mieux les organiser, )Tj 21.467 0 Td (mieux les g\351rer et les d\351velopper )Tj 0 Tw -21.467 -1.72 Td (davantage si on peut. Voil\340.)Tj ( )Tj ET endstream endobj 432 0 obj <> endobj 433 0 obj <> endobj 434 0 obj <> endobj 435 0 obj <> endobj 436 0 obj <> endobj 437 0 obj <> endobj 438 0 obj <> endobj 439 0 obj <> endobj 440 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 441 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 442 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 443 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 444 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 445 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (45)Tj ( )Tj ET Q BT 0.36 Tw 12 0 0 12 107.88 709.08 Tm (it\222s important that such systems continue to be in place, otherwise i\ t can affect )Tj 0 Tw 0 -1.72 TD (International Health Regulations.)Tj 13.302 0 Td ( )Tj -16.302 -1.72 Td (AB:)Tj ( )Tj 0.12 Tw 3 0 Td (Merci beaucoup. Th\351oriquement oui. Donc je crois que... je vais d)Tj 27.662 0 Td (onc s\222il le faut... les )Tj 0.089 Tw -27.662 -1.74 Td (coll\350gues de l\222OMS vont me compl\351ter sur l\222effet par rapport\ \340 \347a. Mais ce que j\222ai pu )Tj 0.332 Tw T* (dire en tant que observateur attentif des questions de sant\351 en Afriq\ ue c\222est que )Tj 0.038 Tw T* (th\351oriquement on a un cadre qui nous permet d\222agir ensemble. Or)Tj 0 Tw 26.675 0 Td ( )Tj 0.038 Tw 0.288 0 Td (comme je l\222ai dit dans )Tj 0.031 Tw -26.963 -1.72 Td (la pr\351sentation c\222est pas tr\350s envisageable que chacun des 46)Tj 0 Tw 24.574 0 Td ( )Tj 0.031 Tw (pays puisse agir de mani\350re )Tj 0.079 Tw -24.574 -1.74 Td (isol\351e. Donc l\222id\351al c\222est qu\222on puisse agir ensemble et \ on a un cadre pour cela c\222est la )Tj 0.002 Tw T* (r\351gion Afrique donc de l\222OMS plus connue sous le nom)Tj 0 Tw ( )Tj 0.002 Tw 22.685 0 Td (de Afro. Et donc ce syst\350me dont )Tj 0.513 Tw -22.685 -1.72 Td (vous parlez pourrait par exemple \352tre envisag\351 dans ce cadre)Tj 0 Tw 28.909 0 Td (-)Tj 0.513 Tw (l\340. Et c\222est l\340 )Tj 0.314 Tw -28.909 -1.72 Td [(malheureusement )0.5(la )0.5(limite. )0.5(Vous )0.5(comprendrez )0.5(que )0.5(dans )0.5(la )0.5(r\351gion )0.5(africaine )0.5(il )0.5(y )0.5(a )]TJ 0.312 Tw 0 -1.74 TD (beaucoup de priorit\351s et tout est prioritaire. Et dans le cas de )Tj 28.148 0 Td (RSI il s\222agit d\222un )Tj 0 Tw -28.148 -1.72 Td (m\351canisme de r\351ponse \340 des crises. )Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.03 Tw 3 0 Td (\307a veut dire que vous r\351pondez \340 quelque chose et tant que \347\ a ne survient pas, en )Tj 0.108 Tw -3 -1.72 Td (tout cas de mani\350re vraiment tr\350s imposante, vous pouvez \352tre h\ \351sitant par rapport aux )Tj 0.133 Tw T* (programmes et politiques que v)Tj (ous allez mettre en oeuvre. Et ce syst\350me pourrait \352tre )Tj 0.162 Tw 0 -1.72 TD (victime des h\351sitations qui a moins \340 faire avec une volont\351 d\222\ aller de l\222avant que la )Tj 0.548 Tw T* [(gestion )0.5(du )0.5(r\351el, )0.5(du )0.5(quotidien )0.5(qui )0.5(fait )0.5(qu\222il )0.6(y )0.5(a beaucoup )0.5(des )0.5(priorit\351s )0.5(qui )]TJ 0.052 Tw T* (malheureusement sont toutes pressante)Tj (s. Et ceci remet sur la table l\222importance qu\222il y a )Tj 0.112 Tw 0 -1.74 TD (de r\351pandre le message que constitue le RSI. Il faudrait que les gens\ sachent que c\222est )Tj 0.244 Tw 0 -1.72 TD [(tr\350s )0.5(bien )0.5(de )0.5(g\351rer )0.5(le )0.5(quotidien )0.5(mais )0.5(\351galement )0.5(c\222est )0.5(tr\350s )0.5(bien )0.6(de )0.5(se pr\351parer )0.5(\340 )0.5(des )]TJ 0.108 Tw T* (situations qui ne manqueront pa)Tj (s de toute fa\347on de se poser. Et donc l\340 je crois que la )Tj 0.307 Tw T* [(responsabilit\351 est partag\351e entre les \351tats membres mais )0.5(\351galement )0.5(l\222OMS )0.6(en )0.6(tant )]TJ 0.228 Tw 0 -1.74 TD (qu\222agence responsable et interpell\351e pour aider la mise en oeuvre \ des strat\351gies qui )Tj 0 Tw 0 -1.72 TD (rendent cette partie pr\352te ou pou)Tj 12.911 0 Td (r le moins quelque peu pr\352te \340 mettre en oeuvre le RSI.)Tj /TT1 1 Tf 10.8 0 0 10.8 527.382 212.28 Tm ( )Tj /TT0 1 Tf 12 0 0 12 71.88 191.64 Tm (DF:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Lazzari?)Tj ( )Tj -3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 0.003 Tw 1.555 0 Td (Monsieur Basse, je crois que vous avez touch\351 le probl\350me plus gra\ ve effectivement de la )Tj 0.089 Tw 0 -1.74 TD (mise en oeuvre de RSI dans la r\351gion africaine. Et c\222est le fait q\ u\222ici on est en train de)Tj 0 Tw 36 0 Td ( )Tj 0.255 Tw -36 -1.72 Td [(discuter des risques potentiels et essayer de mieux s\222organiser pour \ r\351pondre )-0.6(\340 des )]TJ 0.205 Tw 0 -1.72 TD (risques potentiels. D\350s que la plupart des pays africains font face c\ haque jour \340 des )Tj 0.012 Tw T* (v\351ritables fl\351aux tels que le sida, la malaria, la tuberculose et \ beaucoup de maladie)Tj 33.17 0 Td (s, et ils )Tj ET endstream endobj 446 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (44)Tj ( )Tj ET Q BT 0.012 Tw 12 0 0 12 107.88 709.08 Tm [(d\222entr\351e )0.5(terrestre )0.5(pour )0.5(une )0.5(raison )0.5(toute )0.5(simple. )0.5(L\222essentiel )0.5(de )0.5(l\222activit\351 )0.5(transfrontali\350re )0.6(en )]TJ 0.084 Tw 0 -1.72 TD (Afrique, en tou)Tj (t cas le mouvement des personnes, se fait par ce biais)Tj 0 Tw 28.389 0 Td (-)Tj 0.084 Tw (l\340 et ceci est d\373 \340 )Tj 0.312 Tw -28.389 -1.72 Td (diverses raisons parmi lesquelles la plus \351vidente c\222est le caract\ \350re artificielle des )Tj 0 Tw 0 -1.74 TD (fronti\350res entre pays africains.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.121 Tw 3 0 Td (Je vais donner un exemple tout simple: entre le S\351n\351gal qui)Tj 0 Tw 24.981 0 Td ( )Tj 0.121 Tw 0.371 0 Td (est mon pays et la )Tj 0.016 Tw -28.351 -1.72 Td [(Gambie qui est au passage \340 l\222int\351rieur m\352me du S\351n\351ga\ l, vous )0.5(avez d\222un c\364t\351 comme de )]TJ 0.057 Tw 0 -1.72 TD [(l\222autre )0.5(de )0.5(la )0.5(fronti\350re )0.5(les )0.5(m\352mes )0.5(populations. )0.5(Et )0.5(vous )0.5(pouvez )0.5(par )0.5(exemple )0.5(prendre )0.5(votre )]TJ 0 Tw 0 -1.74 TD (petit)Tj (-)Tj 0.045 Tw [(d\351jeuner au S\351n\351gal et avant )0.5(midi vous retrouver en Gamb)]TJ 25.975 0 Td (ie pour prendre un th\351 et )Tj 0.249 Tw -25.975 -1.72 Td (revenir au S\351n\351gal pour prendre votre d\351jeuner. Donc je donne c\ et exemple \340 titre )Tj 0 Tw 0 -1.72 TD (anecdotique pour montrer le caract\350re artificiel de ces fronti\350res\ . )Tj 26.097 0 Td ( )Tj -29.097 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.051 Tw 3 0 Td (Et donc si on adapte \347a au RSI en cas de survenance d\222une maladie \ infectieuse)Tj 0 Tw 32.144 0 Td ( )Tj 0.301 0 Td (il )Tj 0.086 Tw -35.444 -1.74 Td (est \351vident que la personne qui se prom\350ne avec autant de facilit\351\ dans la fronti\350re, s\222il )Tj 0.073 Tw T* [(n\222y )0.5(a )0.5(pas )0.5(un )0.5(dispositif )0.5(ou )0.5(un )0.5(filet )0.5(de )0.5(s\351curit\351, )0.5(il )0.5(est )0.5(\351vident )0.5(que )0.5(la )0.5(maladie )0.5(se )0.5(propagera )]TJ 0.168 Tw T* (d\222une mani\350re vraiment insoup\347onn\351e. Donc c\222est la raison\ pour laquel)Tj 30.056 0 Td (le entre autres )Tj 0.13 Tw -30.056 -1.72 Td (nous avons estim\351 qu\222il est bon, pour une fois, parce que ce n\222\ \351tait pas le cas dans le )Tj 0.189 Tw 0 -1.74 TD (pr\351c\351dent RSI que ce volet)Tj 0 Tw (-)Tj 0.189 Tw (l\340 puisse \352tre pris en charge. En le faisant nous sommes )Tj 0.094 Tw 0 -1.72 TD (conscients du fait qu\222il va falloir, comme c\222est le cas aujourd\222\ hui )Tj 27.303 0 Td (pour les a\351roports ou )Tj 0.02 Tw -27.303 -1.72 Td (les ports o\371 il y des syst\350mes plus ou moins avanc\351s, parce que\ tout simplement ils ont le )Tj 0.323 Tw T* ([privil\350ge] d\222\352tre [trait\351s] auparavant, il va falloir dans \ le cas des points d\222entr\351e )Tj 0.112 Tw 0 -1.74 TD (terrestres, faire preuve de patience compte tenu de l\222\351n)Tj 22.804 0 Td (orme d\351fi que \347a constitue pour )Tj 0.188 Tw -22.804 -1.72 Td (tout le monde. Et donc nous nous inscrivons dans une dynamique de d\351v\ eloppement )Tj 0.105 Tw 0 -1.72 TD (progressif des m\351canismes de contr\364le au niveau des points d\222en\ tr\351e terrestres. Je vous )Tj 0 Tw T* (remercie.)Tj /TT1 1 Tf 10.8 0 0 10.8 152.8448 253.8 Tm ( )Tj /TT0 1 Tf 12 0 0 12 71.88 232.92 Tm (DF:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Krishnan?)Tj ( )Tj -3 -1.72 Td (SK:)Tj ( )Tj 0.143 Tw 3 0 Td (I think about two years )Tj 10.187 0 Td (back we read a lot about the Afro region disease surveillance )Tj 0.074 Tw -10.187 -1.72 Td (system, and in fact when we were helping the Indian government prepare t\ he integrated )Tj 0.106 Tw T* [(disease surveillance project we copied or relied heavily on the Afro )0.5(system of )0.5(diseases )]TJ 0.148 Tw 0 -1.74 TD (surveillance which i)Tj (nvolved all these countries together, not as individual surveillance )Tj 0.387 Tw 0 -1.72 TD (systems but putting all these countries together and having a unified ty\ pe of a )Tj 0.084 Tw T* (surveillance system. And lately I\222ve not been hearing much about that\ system. Is it that )Tj 0.05 Tw T* (because of funding)Tj 0 Tw ( )Tj 0.05 Tw 8.008 0 Td (constraints or anything that this has slowly gone in decline? Because )Tj ET endstream endobj 447 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (43)Tj ( )Tj ET Q BT 0.274 Tw 12 0 0 12 107.88 709.08 Tm (Troisi\350me recommandation et c\222est par l\340 o\371 nous allons term\ iner c\222est l\222)Tj 32.31 0 Td (appui au )Tj 0.078 Tw -35.31 -1.72 Td (renforcement des capacit\351s. Il s\222agit... hier je crois c\222\351ta\ it le premier pr\351sentateur, le professeur )Tj 0.083 Tw 0 -1.72 TD (David Filbert, je crois, a parl\351... a fait le rapport entre le RSI et\ les diff\351rentes prises de parole )Tj 0.003 Tw 0 -1.74 TD (publiques du secr\351taire de l\222ONU. Il a \351ga)Tj (lement fait mention des OMD c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.003 Tw (dire les Objectifs )Tj 0.112 Tw 0 -1.72 TD (du mill\351naire pour le d\351veloppement. Je vais ajouter \340 cela que\ juste avant que le RSI ne soit )Tj 0.434 Tw T* (adopt\351 en mai 2005, l\222Assembl\351e g\351n\351rale de l\222ONU avai\ t adopt\351 une r\351solution qui )Tj 0.087 Tw T* (encourageait les \311tats \340)Tj 0 Tw ( )Tj 0.087 Tw 10.012 0 Td (aller assez rapidement dans le sens de l\222adoption et ceux qui ont vu \ la )Tj 0 Tw -10.012 -1.74 Td (r\351solution par laquelle l\222assembl\351e de la sant\351 a adopt\351 \ le RSI s\222en rendront ais\351ment compte.)Tj 37.57 0 Td ( )Tj 0.05 Tw -34.57 -1.72 Td (Je veux dire qu\222il y a un contexte politique \351galement qui entoure\ le RSI et il est bon )Tj 0 Tw 35.056 0 Td (de )Tj 0.172 Tw -38.056 -1.72 Td (saisir cette opportunit\351 qui est offerte pour appuyer le renforcement\ des capacit\351s et \347a peut )Tj 0.02 Tw T* (prendre diverses formes parmi lesquelles je crois que c\222est surtout l\ es agences de d\351veloppement )Tj 0.064 Tw 0 -1.74 TD (qui seraient interpell\351es, il s\222agirait pour elles en particu)Tj 22.973 0 Td (lier d\222envisager la possibilit\351 d\222int\351grer )Tj 0.083 Tw -22.973 -1.72 Td [(le )0.5(RSI )0.5(dans )0.5(leur )0.5(programme )0.5(de )0.5(coop\351ration )0.5(avec )0.5(les )0.5(pays )0.5(concern\351s. )0.5(Je )0.5(crois )0.5(que )0.5(\347a )0.5(serait )0.5(une )]TJ 0.046 Tw 0 -1.72 TD (mani\350re concr\350te et pratique d\222avancer cet agenda et RSI dans c\ es pays)Tj 0 Tw 29.022 0 Td (-)Tj 0.046 Tw (l\340 qui malheureusement )Tj 0.076 Tw -29.022 -1.72 Td (ont un probl\350me de capaci)Tj (t\351, l\222int\351gration du RSI ou en tout cas certains de ces volets \ dans les )Tj 0 Tw 0 -1.74 TD (programmes de coop\351ration.)Tj ( )Tj 0.135 Tw 3 -1.72 Td (Donc voil\340 si vous voulez les trois recommandations qui \351mergent d\ es d\351fis que nous )Tj 0.336 Tw -3 -1.72 Td (avons identifi\351s plus t\364t et c\222est avec \347a donc que je voudr\ ais terminer )Tj 32.664 0 Td (en me mettant )Tj 0.193 Tw -32.664 -1.72 Td (naturellement \340 votre disposition pour les interpellations et comment\ aires \351ventuels. Je vous )Tj 0 Tw T* (remercie.)Tj ( )Tj /TT1 1 Tf 10.8 0 0 10.8 71.88 295.32 Tm ( )Tj /TT2 1 Tf 12 0 0 12 71.88 275.16 Tm (Dr. David Fidler)Tj ( )Tj /TT0 1 Tf 0.114 Tw 3 -1.66 Td (Et je vous remercie M.)Tj 0 Tw ( )Tj 0.114 Tw (Basse pour votre intervention. J\222ai l\222impression qu\222il doit avo\ ir )Tj 0.047 Tw -3 -1.72 Td (des questions et des commentair)Tj (es \340 la suite... )Tj (I\222m opening the floor for questions or comments. )Tj 0 Tw 0 -1.72 TD (Mr.)Tj ( )Tj (Bruce Potkin or he likes to be known doctor.)Tj ( )Tj 0 -1.74 TD ( )Tj /TT2 1 Tf 0 -1.72 TD (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.74 Td (AB:)Tj ( )Tj 0.067 Tw 3 0 Td (Merci beaucoup Bruce pour cette question. Oui, je crois que pendant les \ n\351gociations le )Tj 0.168 Tw 0 -1.72 TD (groupe africain n\222a e)Tj (u de cesse d\222articuler en rapport avec d\222autres groupes, je pense \ )Tj 0.319 Tw T* (notamment au groupe [SIRO], n\222a eu de cesse d\222articuler l\222impor\ tance des points )Tj ET endstream endobj 448 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (42)Tj ( )Tj ET Q BT 0.072 Tw 12 0 0 12 71.88 709.08 Tm (communication il y a surtout le syst\350me interne qui soutient, qui per\ met n\222est)Tj 0 Tw 31.772 0 Td (-)Tj 0.072 Tw (ce pas \340 ce point )Tj 0 Tw -31.772 -1.72 Td (focal l\340 d\222agir en temps de crise.)Tj 13.022 0 Td ( )Tj 0.053 Tw -10.022 -1.72 Td (Voil\340 si vous voulez donc les trois d\351fis que j\222ai pu identifie\ r pour c)Tj (e qui est en tout cas )Tj 0.127 Tw -3 -1.74 Td (de la mise en oeuvre du RSI dans un contexte africain. Par rapport \340 \ ces trois d\351fis il y a un )Tj 0.029 Tw 0 -1.72 TD (certain nombre de recommandations qu\222on peut \351noncer et c\222est l\ \340 la troisi\350me et derni\350re partie )Tj 0 Tw T* (n\222est)Tj (-)Tj (ce pas de notre pr\351sentation.)Tj ( )Tj 0.126 Tw 3 -1.72 Td (La pre)Tj (mi\350re recommandation naturellement tend \340 r\351pondre au d\351fi d\ e l\222appropriation. )Tj 0.07 Tw -3 -1.74 Td [(Comment faire face \340 ce )0.5(d\351fi? Je )0.5(crois qu\222il s\222agirait aujourd\222hui comme l\222ont fait par exemp\ le )]TJ 0.037 Tw T* (des pays comme l\222Inde et l\340 \351galement j\222ai suivi avec beauco\ up d\222int\351r\352t l\222atelie)Tj 32.594 0 Td (r national qu\222ils )Tj 0.225 Tw -32.594 -1.72 Td (ont eu r\351cemment sur \347a. Il s\222agirait pour nous de faire ce que\ nous appelons r\351pandre le )Tj 0.058 Tw T* (message RSI. C\222est quoi le RSI et cibler des personnes qui peuvent fa\ ire la diff\351rence en temps )Tj 0.053 Tw 0 -1.74 TD (de crise pour qu\222elles comprennent n\222est)Tj 0 Tw (-)Tj 0.053 Tw (ce pas c\222es)Tj (t quoi r\351ellement le RSI. Parce que ce n\222est )Tj 0 Tw 0 -1.72 TD (qu\222en le comprenant qu\222ils seront en mesure demain d\222agir. )Tj 24.103 0 Td ( )Tj 0.14 Tw -21.103 -1.72 Td (Donc il s\222agit surtout pour l\222OMS en tout cas, qui est la principa\ le agence concern\351e, )Tj 0.166 Tw -3 -1.72 Td (d\222aider les pays \340 r\351pandre le message RSI par l\222explication\ par)Tj 0 Tw 27.147 0 Td ( )Tj 0.166 Tw 0.416 0 Td (la sensibilisation et \347a peut )Tj 0.29 Tw -27.562 -1.74 Td (prendre diff\351rentes formes parmi lesquelles des discussions officiell\ es mais \351galement des )Tj 0.356 Tw T* (ateliers interminist\351riels ou des s\351minaires pour permettre aux di\ ff\351rentes administrations )Tj 0.045 Tw T* (concern\351es de comprendre r\351ellement, donc )Tj 18.048 0 Td (ce qu\222est le RSI et quel en est finalement l\222objectif. )Tj 0.168 Tw -18.048 -1.72 Td (Donc premi\350re recommandation donc c\222est r\351pandre ce message)Tj 0 Tw 26.971 0 Td (-)Tj 0.168 Tw (l\340, de vulgariser en quelque )Tj 0 Tw -26.971 -1.74 Td (sorte le RSI dans sa formulation actuelle. )Tj 16.718 0 Td ( )Tj 0.122 Tw -13.718 -1.72 Td (Deuxi\350me recommandation c\222est pour r\351pondre au d\351fi des ress\ ources h)Tj 29.951 0 Td (umaines. Il est )Tj 0.099 Tw -32.951 -1.72 Td (important d\222or et d\351j\340, je crois qu\222on est \340 quelques moi\ s de l\222entr\351e en vigueur du RSI, il est )Tj 0.039 Tw T* (important que d\222or et d\351j\340 qu\222on puisse pr\351parer les ress\ ources humaines \340 la mise en oeuvre du )Tj 0.08 Tw 0 -1.74 TD (RSI donc c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.08 Tw (dire \340 traduire sur le terrain)Tj 0 Tw 18.467 0 Td ( )Tj 0.08 Tw 0.33 0 Td (le RSI. Et ceci ne pourra se faire que par le biais )Tj 0.063 Tw -18.797 -1.72 Td (entre autres de la formation, mais \351galement par le biais de cr\351at\ ion de cadres types de mise en )Tj 0.044 Tw 0 -1.72 TD (oeuvre que ce soit par exemple comme l\222a dit ce matin notre coll\350g\ ue de l\222Inde, des l\351gislations )Tj 0.028 Tw T* (types ou )Tj (bien en tout cas des cadres types dans le mod\350le des proc\351d\351s o\ p\351rationnels qui sont en )Tj 0.007 Tw 0 -1.74 TD [(train )0.5(d\222\352tre )0.5(d\351velopp\351s )0.5(dans )0.5(le )0.5(cadre )0.5(que )0.5(constitue )0.5(le )0.5(groupe )0.6(informel )0.5(de )0.5(travail )0.5(sur )0.5(les )0.5(transports )]TJ 0.069 Tw 0 -1.72 TD [(qui )0.5(concerne )0.5(les )0.5(a\351roports, )0.5(les )0.5(ports )0.5(et )0.5(les )0.5(moyens )0.6(de... )0.6(et )0.6(les )0.6(po)]TJ 0.068 Tw 26.37 0 Td (ints d\222entr\351e terrestres. Donc il )Tj 0.029 Tw -26.37 -1.72 Td (s\222agit sur ce plan)Tj 0 Tw (-)Tj 0.029 Tw (l\340 de la pr\351paration des ressources humaines en les formant mais \351\ galement en )Tj 0 Tw T* (leur donnant des outils d\222action en temps de crise.)Tj 20.022 0 Td ( )Tj ET endstream endobj 449 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (41)Tj ( )Tj ET Q BT 0.112 Tw 12 0 0 12 107.88 709.08 Tm (Le deuxi\350me d\351fi qui se pose en termes de mise en oeuvre c\222est \ le d\351fi des ressources )Tj 0.075 Tw -3 -1.72 Td (humaines. Nous constatons que le RSI, en tout cas dans sa formulation ac\ tuelle, va au)Tj 0 Tw 35.344 0 Td (-)Tj 0.075 Tw (del\340 des )Tj 0.021 Tw -35.344 -1.72 Td (minist\350res de la sant\351. Le RSI n\222interpelle pas uniquemen)Tj 23.246 0 Td (t les minist\350res de la sant\351. Il interpelle )Tj 0.027 Tw -23.246 -1.74 Td (beaucoup d\222administration au plan national que ce soient les douanes,\ les forces de s\351curit\351 dans )Tj 0.098 Tw 0 -1.72 TD (certains cas ou d\222autres administrations, le RSI est un document qui \ appelle par d\351finition une )Tj 0.339 Tw T* (approche nationale)Tj 0 Tw ( )Tj 0.339 Tw 8.507 0 Td (int\351gr\351e. Pour qu\222il ait cette approche il faut non seulement q\ ue les )Tj 0.274 Tw -8.507 -1.72 Td (ressources humaines soient disponibles, donc la s\351lection, mais il fa\ udrait surtout que ces )Tj 0.042 Tw 0 -1.74 TD (ressources humaines soient en mesure d\222agir parce que c\222est \347a \ l\222objectif final du RSI, c\222est)Tj 0 Tw 37.264 0 Td ( )Tj 0.292 0 Td (que )Tj 0.11 Tw -37.556 -1.72 Td (en temps de crise les gens puissent agir. Et pour qu\222ils puissent agi\ r il faudrait non seulement )Tj 0 Tw 0 -1.72 TD (qu\222ils soient comp\351tents pour le faire mais \351galement qu\222ils\ aient les outils n\351cessaires.)Tj 34.907 0 Td ( )Tj 0.058 Tw -31.907 -1.72 Td (Et donc il est important dans le contexte pr\351sent qu\222il y ait e)Tj 24.742 0 Td (n tout cas des strat\351gies qui )Tj 0.081 Tw -27.742 -1.74 Td (permettent aux ressources humaines de faire face \340 ces d\351fis et j\222\ ai entendu tout \340 l\222heure dans )Tj 0.068 Tw T* [(l\222une des pr\351sentations, je crois que c\222est notre )0.5(coll\350gue de l\222Inde qui parlait de la coordination )]TJ 0.061 Tw T* (intersectorielle qui en l\222esp)Tj (\350ce nous para\356t tr\350s important. Donc le d\351fi des ressources \ humaines )Tj 0 Tw T* (est le deuxi\350me d\351fi en termes de mise en oeuvre qui se pose donc \ dans le contexte africain. )Tj 37.014 0 Td ( )Tj 0.074 Tw -34.014 -1.74 Td (Troisi\350me d\351fi et non des moindres c\222est le d\351fi du renforce\ ment des capacit\351s. Comme )Tj 0.145 Tw -3 -1.72 Td (vous le)Tj 0 Tw ( )Tj 0.145 Tw 3.402 0 Td (constaterez \351galement, l\222annexe)Tj 0 Tw 13.089 0 Td ( )Tj 0.145 Tw (1 un RSI traite du volet capacit\351. Ceux qui ont \351t\351 \340 )Tj 0.285 Tw -16.491 -1.72 Td (Gen\350ve pendant les n\351gociations se souviennent des difficult\351s \ qu\222il y avait \340 obtenir un )Tj 0.065 Tw T* (consensus entre autres sur cette partie du document. Pourquoi? Parce que\ tout s)Tj 32.52 0 Td (implement c\222est )Tj 0.029 Tw -32.52 -1.74 Td [(de )0.5(notre )0.5(point )0.5(de )0.5(vue )0.5(en )0.6(tout )0.6(cas, )0.5(du )0.5(point )0.5(de )0.5(vue )0.5(n\222est)]TJ 0 Tw 22.198 0 Td (-)Tj 0.029 Tw [(ce )0.5(pas )0.5(d\222un )0.5(Africain, )0.5(\347a )0.5(va )0.5(d\351terminer )0.5(la )]TJ 0.169 Tw -22.198 -1.72 Td (r\351alit\351 du RSI sur le terrain. On a beau avoir compris ce qu\222es\ t le RSI, on a beau avoir les )Tj 0.194 Tw T* [(ressources )0.5(humaines )0.5(appropri\351es, )0.5(si )0.5(on )0.5(n\222a )0.5(pas )0.5(l)]TJ [(es )0.5(capacit\351s )0.5(on )0.5(ne )0.5(peut )0.5(pas )0.5(agir )0.5(et )0.5(donc )0.5(le )]TJ 0.008 Tw T* (renforcement des capacit\351s est un volet tr\350s important en tout cas\ pour ce qui nous concerne pour )Tj 0 Tw 0 -1.74 TD (ce qui est de la mise en oeuvre du RSI. )Tj ( )Tj 0.242 Tw 3 -1.72 Td (Et donc il s\222agit ici, en tout cas il s\222agirait pour nous de la cr\ \351ation )Tj 30.453 0 Td (de dispositifs )Tj 0.039 Tw -33.453 -1.72 Td (conform\351ment \340 l\222annexe dont je viens de parler, c\222est)Tj 0 Tw 22.05 0 Td (-)Tj (\340)Tj (-)Tj 0.039 Tw (dire l\222annexe)Tj 0 Tw ( )Tj 0.039 Tw (1. Et puis il est important )Tj 0.066 Tw -22.05 -1.72 Td (\351galement qu\222on sache que dans le cas du renforcement des capacit\351\ s il faudrait qu\222on aille au)Tj 0 Tw 38.667 0 Td (-)Tj 0.076 Tw -38.667 -1.74 Td (del\340 de la bureaucratie, c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.076 Tw (dire de la sim)Tj (ple communication de points focaux \340 l\222OMS. Un )Tj 0.251 Tw 0 -1.72 TD (point focal n\222aura de valeur en termes de mise en oeuvre que s\222il \ peut, au plan national, )Tj 0.265 Tw T* (s\222appuyer sur une administration qui peut l\222aider \340 r\351pondre\ \340 une crise donn\351e. Donc la )Tj 0.341 Tw T* (communication comme pr\351vu par )Tj (le RSI c\222est une excellence chose mais au)Tj 0 Tw 34.154 0 Td (-)Tj 0.341 Tw (del\340 de la )Tj ET endstream endobj 450 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 451 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 452 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 453 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 454 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 455 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (40)Tj ( )Tj ET Q BT 0.03 Tw 12 0 0 12 71.88 709.08 Tm (moyens de la performance. Par rapport \340 cette consid\351ration lumina\ ire il y a donc si vous voulez )Tj 0 Tw 0 -1.72 TD (trois d\351fis de mise en oeuvre qui se pr\351sentent dans le contexte a\ fricain. )Tj 28.934 0 Td ( )Tj 0.02 Tw -25.934 -1.72 Td (Le premier d\351fi c\222est celui d)Tj 11.401 0 Td (e l\222appropriation. On aurait dit en anglais )Tj /TT1 1 Tf 0 Tw 16.913 0 Td (ownership)Tj /TT0 1 Tf 0.02 Tw (. Qu\222est)Tj 0 Tw (-)Tj 0.01 Tw -31.314 -1.74 Td (ce que nous appelons appropriation? Nous parlons de l\222appropriation e\ n termes de sensibilisation )Tj 0.217 Tw T* (des d\351cideurs sur ce document, sur l\222importance n\222est)Tj 0 Tw 23.011 0 Td (-)Tj 0.217 Tw (ce pas que rev\352t ce document. Nous )Tj 0 Tw -23.011 -1.72 Td (parlons )Tj 0.05 Tw 3.243 0 Td [(\351galement d\222appropriation en termes d\222information et de sensibi\ lisation de la cit\351 )0.5(civile. )]TJ 0.104 Tw -3.243 -1.72 Td (Je pense en particulier aux organisations non gouvernementales et je vai\ s faire le rapport avec )Tj 0 Tw 0 -1.74 TD (l\222article)Tj ( )Tj 0.104 Tw (9 du R\350glement sanitaire international qui pour la premi\350re)Tj 0 Tw 27.851 0 Td ( )Tj 0.354 0 Td (fois)Tj ( )Tj (\226)Tj ( )Tj 0.104 Tw 2.604 0 Td (ce n\222\351tait pas le cas )Tj 0 Tw -30.81 -1.72 Td (auparavant)Tj ( )Tj (\226)Tj ( )Tj 0.09 Tw 5.476 0 Td (pr\351voit un m\351canisme de rapport autre que les notifications gouver\ nementales. Et )Tj 0.152 Tw -5.476 -1.72 Td (donc ces rapports pourraient entre autres sources venir la communaut\351\ des ONG dont la cit\351 )Tj 0 Tw 0 -1.72 TD (civile. )Tj ( )Tj 0.219 Tw 3 -1.74 Td (Il est bon que ces documents aie)Tj (nt d\351j\340 \351t\351 adopt\351s que des strat\351gies puissent \352tr\ e )Tj 0.096 Tw -3 -1.72 Td (envisag\351es pour permettre \340 cette cit\351 civile de s\222approprie\ r les documents pour que demain si )Tj 0.079 Tw T* (une maladie n\222est)Tj 0 Tw (-)Tj 0.079 Tw (ce pas survient dans un pays)Tj 0 Tw ( )Tj 0.079 Tw (X ou Y si pour une raison ou pour une autre le )Tj 0.234 Tw T* (gouvernement d)Tj (u pays concern\351 ne veut pas notifier que ce [_] en vertu du RSI elle \ a la )Tj 0.179 Tw 0 -1.74 TD (possibilit\351 d\222une rencontre \340 l\222OMS pour que les disposition\ s [douanes] puissent \352tre prises. )Tj 0 Tw 0 -1.72 TD (Donc je parle d\222appropriation \351galement sur ce plan)Tj 20.797 0 Td (-)Tj (l\340, la sensibilisation de la soci\351t\351)Tj ( )Tj (civile.)Tj ( )Tj 0.01 Tw -17.797 -1.72 Td (Je parle \351galement d\222appropriation en termes d\222adaptation l\351\ gislative et r\351glementaire. Le )Tj 0.395 Tw -3 -1.72 Td (RSI contrairement \340 d\222autres documents internationaux)Tj 0 Tw 24.107 0 Td ( )Tj (\226)Tj ( )Tj 0.395 Tw 1.395 0 Td (je parle des accords et trait\351s )Tj 0 Tw -25.503 -1.74 Td (classiques)Tj ( )Tj (\226)Tj ( )Tj 0.079 Tw 5.133 0 Td (n\222appelle pas au plan interne un m\351canisme de ratificat)Tj 22.676 0 Td (ion qui fait que si c\222\351tait le )Tj 0.023 Tw -27.809 -1.72 Td (cas, il y aurait un d\351bat forc\351ment au moins au niveau du Parlemen\ t pour ratifier ces documents)Tj 0 Tw 38.667 0 Td (-)Tj 0.077 Tw -38.667 -1.72 Td (l\340. C\222est pas le cas donc du RSI parce qu\222il a \351t\351 adopt\351\ comme l\222a rappel\351 hier le coll\350gue de )Tj 0 Tw T* (l\222OMS dans le cadre des articles )Tj (pertinents de la fonction de l\222OMS qui en font des r\350glements. )Tj 38.434 0 Td ( )Tj 0.078 Tw -35.434 -1.74 Td (Et donc il est aujourd\222hui important, en l\222absence de ces m\351can\ ismes de ratification qui )Tj 0.004 Tw -3 -1.72 Td (auraient permis d\222avoir un d\351bat qui permettrait aux uns et aux au\ tres, et au moins aux d\351cideurs, )Tj 0.14 Tw T* (de s)Tj (\222approprier le document qu\222il y ait des strat\351gies \351galement\ qui permettent aux d\351cideurs )Tj 0.034 Tw T* (politiques de savoir qu\222il y a un document qui est \340 leur disposit\ ion et qui doit \352tre utilis\351 en cas )Tj 0.37 Tw 0 -1.74 TD (de survenance d\222une crise de nature d\222ampleur nationale. Donc je)Tj 0 Tw 29.541 0 Td ( )Tj 0.37 Tw 0.62 0 Td (parle d\222appropriation )Tj 0.003 Tw -30.161 -1.72 Td [(\351galement )0.5(dans )0.5(ce )0.5(sens)]TJ 0 Tw 9.309 0 Td (-)Tj 0.003 Tw [(l\340. )0.5(Donc )0.5(voil\340 )0.5(les )0.5(trois, )0.5(si )0.5(vous )0.5(voulez, )0.5(les )0.5(trois )0.5(piliers )0.5(de )0.5(l\222appropriation. )]TJ 0.163 Tw -9.309 -1.72 Td (Les d\351cideurs politiques, la communaut\351 des ONG mais \351galement \ le processus d\222adaptation )Tj 0 Tw 0 -1.72 TD (l\351gislative et r\351glementaire en l\222absence)Tj 16.047 0 Td ( )Tj (de ratification.)Tj ( )Tj ET endstream endobj 456 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (39)Tj ( )Tj ET Q BT 0.102 Tw 12 0 0 12 71.88 709.08 Tm [(j\222aborderai )0.5(la )0.5(probl\351matique )0.5(de )0.6(la )0.6(mise )0.6(en )0.5(oeuvre )0.5(du )0.5(R\350glement )0.5(sanitaire )0.5(interna)]TJ 33.465 0 Td [(tional )0.5(dans )0.5(le )]TJ 0.206 Tw -33.465 -1.72 Td (contexte africain. Et enfin dans une troisi\350me partie donc j\222\351n\ oncerai un certain nombre de )Tj 0.039 Tw 0 -1.72 TD (recommandations qui de notre point de vue pourraient aider \340 une bonn\ e mise en oeuvre du RSI )Tj 0 Tw 0 -1.74 TD (dans les pays africain. Voil\340 donc ma proposition de che)Tj (minement que je vous fais. )Tj ( )Tj 0.005 Tw 3 -1.72 Td (Sans tarder je voudrais donc aborder la premi\350re partie c\222est)Tj 0 Tw 24.119 0 Td (-)Tj (\340)Tj (-)Tj 0.005 Tw (dire la mise en contexte du )Tj 0.093 Tw -27.119 -1.72 Td (RSI donc en Afrique. Et l\340 je voudrais \351noncer trois consid\351rat\ ions. La premi\350re consid\351ration )Tj 0.209 Tw 0 -1.72 TD (c\222est que la situation \351conomique et g\351op)Tj 17.807 0 Td (olitique de l\222Afrique fait qu\222elle est naturellement )Tj 0.014 Tw -17.807 -1.74 Td (expos\351e aux probl\350mes de sant\351 publique. En particulier les mal\ adies transmissibles infectieuses. )Tj 0.131 Tw T* (La deuxi\350me consid\351ration c\222est que quand on parle de l\222Afri\ que dans le cas pr\351sent, et l\340 je )Tj 0.025 Tw T* (parle sous )Tj (le contr\364le des coll\350gues du Secr\351tariat de l\222OMS, je parle \ des 46)Tj 0 Tw 30.761 0 Td ( )Tj 0.025 Tw (pays membres de la )Tj 0.156 Tw -30.761 -1.72 Td (r\351gion Afrique de l\222OMS car comme vous le savez les 53)Tj 0 Tw 24.553 0 Td ( )Tj 0.156 Tw (pays traditionnellement consid\351r\351s )Tj 0.058 Tw -24.553 -1.74 Td (comme pays africains, donc membres de l\222Union africaine, ne sont pas \ tous dans l)Tj 33.609 0 Td (e contexte de )Tj 0.236 Tw -33.609 -1.72 Td (l\222OMS membres de la r\351gion Afrique. Il n\222y a que 46)Tj 0 Tw 23.714 0 Td ( )Tj 0.236 Tw (pays et essentiellement les pays de )Tj 0.121 Tw -23.714 -1.72 Td (l\222Afrique sud)Tj 0 Tw (-)Tj 0.121 Tw (saharienne plus l\222Alg\351rie qui est le seul pays du Maghreb \340 \352\ tre membres de la )Tj 0 Tw T* (r\351gion Afrique de l\222OMS. )Tj ( )Tj 0.285 Tw 3 -1.74 Td (\307a m\222am\350ne donc \340 la deuxi\350me consi)Tj 17.147 0 Td (d\351ration c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.285 Tw (dire la relative homog\351n\351it\351 )Tj 0.364 Tw -20.147 -1.72 Td (\351pid\351miologique de ces pays)Tj 0 Tw 12.617 0 Td (-)Tj 0.364 Tw (l\340, de ces 46)Tj 0 Tw ( )Tj 0.364 Tw (pays. Donc ils ont une relative homog\351n\351it\351 )Tj 0.025 Tw -12.617 -1.72 Td (\351pid\351miologique qui fait que par rapport au d\351fi de sant\351 pu\ blique il est important qu\222il y ait une )Tj 0 Tw T* (approche int\351gr\351e.)Tj ( )Tj 0.116 Tw 3 -1.74 Td (La tr)Tj (oisi\350me consid\351ration dans leur mise en contexte c\222est la raret\ \351 ou si vous voulez )Tj 0.102 Tw -3 -1.72 Td (l\222insuffisance des ressources \351conomiques qui font qu\222il y a un\ int\351r\352t \351vident de coop\351rer, en )Tj 0.037 Tw T* (d\222autres termes de mise en commun des moyens pour faire face au d\351\ fi de sant\351)Tj 0 Tw 32.454 0 Td ( )Tj 0.037 Tw 0.287 0 Td (publique. Voil\340 )Tj 0.048 Tw -32.742 -1.72 Td (donc trois consid\351rations qui m\222am\350nent \340 la conclusion suiv\ ante que l\222Afrique a un int\351r\352t tout )Tj 0.02 Tw 0 -1.74 TD (particulier pour le RSI. Ceci d\222autant plus que le RSI actuel)Tj 0 Tw 24.051 0 Td ( )Tj (\226)Tj ( )Tj 0.02 Tw 1.02 0 Td (le RSI 2005)Tj 0 Tw ( )Tj (\226)Tj ( )Tj 0.02 Tw 5.837 0 Td (int\350gre d\351sormais la )Tj 0.19 Tw -30.908 -1.72 Td (dimension transport terrestre qui comme vou)Tj 18.919 0 Td (s le savez constitue l\222essentiel des mouvements )Tj 0.083 Tw -18.919 -1.72 Td (transfrontaliers entre pays africains. Par rapport \340 cette mise en co\ ntexte donc il y a la mise en )Tj 0 Tw 0 -1.72 TD (oeuvre elle)Tj (-)Tj (m\352me du RSI donc l\222objet de ce contexte)Tj (-)Tj (l\340. )Tj ( )Tj 0.388 Tw 3 -1.74 Td (Ceci m\222am\350ne donc au deuxi\350me grand point de ma pr\351s)Tj 26.23 0 Td (entation c\222est)Tj 0 Tw (-)Tj (\340)Tj (-)Tj 0.388 Tw (dire la )Tj 0.101 Tw -29.23 -1.72 Td (probl\351matique de la mise en oeuvre du RSI dans le contexte africain. \ Je commencerai par une )Tj 0.223 Tw T* (consid\351ration tout \340 fait luminaire qui voudrait que mettre en oeu\ vre le RSI reviendrait en )Tj 0.004 Tw T* (quelque sorte \340 l\222assimiler, \340 en avoir la conv)Tj 18.165 0 Td (iction que c\222est utile mais \351galement \340 se donner les )Tj ET endstream endobj 457 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (38)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.052 Tw 3 0 Td (But thanks to, say, the SARS epidemic )Tj 0 Tw (\226)Tj ( )Tj 0.052 Tw 16.971 0 Td (or pandemic, whatever )Tj 0 Tw (\226)Tj ( )Tj 0.052 Tw 10.343 0 Td (we\222ll just say, )Tj 0.007 Tw -30.313 -1.72 Td (\223Well, it\222s very dangerous, and we will have a huge headache,\224 \ so they immediately gave )Tj 0.08 Tw 0 -1.72 TD (us mo)Tj (ney and we bought nice equipment and equipped practically the whole __ c\ entres )Tj 0.114 Tw 0 -1.74 TD (throughout the country. Now they have nice equipment. This is the way we\ are living. )Tj 0 Tw 0 -1.72 TD (This is real life.)Tj ( )Tj -3 -1.72 Td (DF:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you, Dr.)Tj ( )Tj (Fedorov.)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 0.019 Tw 3 0 Td (My pleasure. Thank)Tj 0 Tw (-)Tj 0.019 Tw (you very much for your)Tj 0 Tw ( )Tj 0.019 Tw 18.239 0 Td (attention, and I got a lot from all of you so I )Tj 0 Tw -18.239 -1.74 Td (hope we\222ll cope with the International Health Regulations. [laughter]\ )Tj 27.63 0 Td ( )Tj -30.63 -1.72 Td (DF:)Tj ( )Tj 0.088 Tw 3 0 Td (I\222d like to invite everyone to take a short break, about fifteen minu\ tes. Coffee has been )Tj 0.065 Tw T* (served outside. We\222ll come back in at 11:15)Tj 0 Tw 18.063 0 Td ( )Tj 0.065 Tw 0.315 0 Td (to listen to the presentation from M. Andr\351 )Tj 0 Tw -18.379 -1.72 Td (Basse. Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.74 Td ( )Tj /TT1 1 Tf T* (COUNTRY 5: S\311N\311GAL)Tj ( )Tj 0 -1.64 TD (Dr. David Fidler)Tj ( )Tj /TT0 1 Tf 0.075 Tw 3 -1.66 Td (...listen to the presentation from Monsieur Andr\351 Basse. Thank you. T\ here you go. You )Tj 0 Tw -3 -1.72 Td (may take the mike.)Tj ( )Tj /TT2 1 Tf 10.8 0 0 10.8 71.88 380.04 Tm ( )Tj /TT1 1 Tf 12 0 0 12 71.88 359.64 Tm (M. Andre Basse)Tj ( )Tj /TT0 1 Tf 0.132 Tw 3 -1.64 Td (Merci beaucoup. Avant donc de comme)Tj (ncer ma pr\351sentation je voudrais juste signaler )Tj 0.128 Tw -3 -1.74 Td (que cette pr\351sentation donc je la fais \340 un double titre. D\222abo\ rd parce que j\222ai eu le privil\350ge )Tj 0.041 Tw 0 -1.72 TD (donc en tant que diplomate \340 la mission parlant du S\351n\351gal \340\ Gen\350ve de prendre part du d\351but \340 )Tj 0.011 Tw T* (la fin au proces)Tj (sus de n\351gociation du R\350glement sanitaire international. Ensuite p\ arce que en tant )Tj 0.062 Tw T* (que Africain moi)Tj 0 Tw (-)Tj 0.062 Tw (m\352me je crois \352tre en mesure de donner une perspective africaine p\ our ce qui )Tj 0.046 Tw 0 -1.74 TD [(est de la mise en oeuvre du R\350glement sanitaire international. Je le \ fais )0.6(donc )]TJ [(\340 )0.5(ce )0.5(double )0.5(titre )0.5(et )]TJ 0.019 Tw 0 -1.72 TD (c\222est la raison pour laquelle je voudrais donc adapter le contenu, le\ titre de la pr\351sentation \340 cela. )Tj 0.088 Tw T* (Donc au lieu de capacit\351 de sant\351 publique en Afrique il s\222agir\ a plut\364t de parler du R\350glement )Tj 0.01 Tw T* (sanitaire international, de la mise e)Tj (n oeuvre du R\350glement sanitaire international dans le contexte )Tj 0 Tw 0 -1.74 TD (africain en identifiant les obstacles \351ventuels et assortis certainem\ ent de recommandations.)Tj 36.348 0 Td ( )Tj 0.053 Tw -33.348 -1.72 Td [(Il y aura donc, si vous le permettez, trois parties )0.5(dans ma pr\351sentation. Dans la premi\350re )]TJ 0.136 Tw -3 -1.72 Td (partie j\222)Tj (essaierai de mettre le R\350glement sanitaire international en contexte \ donc de mettre \347a )Tj 0.315 Tw 0 -1.72 TD [(dans le contexte africain. Ce sera l\222objet de ma premi\350re )0.5(partie. Dans )0.5(la )0.5(seconde partie )]TJ ET endstream endobj 458 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (37)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (DF:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Lazar has )Tj (another question I believe for you, Dr.)Tj ( )Tj (Fedorov.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.023 Tw 1.389 0 Td (I just wanted again to make sure I understood. Of the, say, local and re\ gional people who )Tj 0.068 Tw 0 -1.72 TD (work in this field, how much of their budget comes from the Russian gove\ rnment, from )Tj 0 Tw 0 -1.74 TD (the federal government?)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (You mean public health?)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Yes.)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (One hundred per cent.)Tj ( )Tj -3 -1.74 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 0.121 Tw 3 0 Td (Sometimes they\222re allowed to make some extra analysis or something ev\ en for private )Tj 0.199 Tw 0 -1.72 TD (business so they can earn some more, let\222s say, but normally they are\ governmental )Tj 0 Tw T* (employees.)Tj ( )Tj -3 -1.74 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Funded from the top.)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (Funded by the top, yeah, from Moscow.)Tj ( )Tj -3 -1.72 Td (DF:)Tj ( )Tj 3 0 Td (If there are no... sorry, Dr.)Tj ( )Tj (Wilson?)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.286 Tw 1.056 0 Td (Within the competing funding priorities within Russia for where money sh\ ould be )Tj 0.253 Tw 0 -1.74 TD (allocated or where money should be provided, how important are )Tj 28.882 0 Td (the IHR and the )Tj 0.084 Tw -28.882 -1.72 Td (surveillance requirements that go along with the IHR with respect to man\ y other public )Tj 0 Tw 0 -1.72 TD (health issues that Russia is confronting now?)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (Russia )Tj 3.051 0 Td (\226)Tj ( )Tj 0.134 Tw 0.884 0 Td (I will explain something )Tj 0 Tw (\226)Tj ( )Tj 0.134 Tw 11.417 0 Td (they have a mentality, a Russian mentality that if )Tj 0.048 Tw -15.352 -1.74 Td (something is out)Tj (side, this is good. So in case )Tj 0 Tw 18.575 0 Td (\226)Tj ( )Tj 0.048 Tw 0.798 0 Td (and we\222ll ___ this for sure )Tj 0 Tw 11.066 0 Td (\226)Tj ( )Tj 0.048 Tw 0.798 0 Td (say it needs )Tj 0.061 Tw -31.238 -1.72 Td (some money for implementation, so it will go to the Ministry of Finance \ and I think get )Tj 0.026 Tw T* (some more money for service, because for the purposes of, say, diagnosti\ c, they should... )Tj 0 Tw T* (ac)Tj 0.196 Tw [(tually )0.5(they )0.5(were )0.5(involved )0.5(in )0.5(a )0.5(so)]TJ 0 Tw (-)Tj 0.196 Tw [(called )0.5(syndromic )0.5(approach )]TJ 0 Tw (\226)Tj ( )Tj 28.001 0 Td (remember? )Tj 4.943 0 Td (\226)Tj ( )Tj 0.945 0 Td (some )Tj 0.326 Tw -33.889 -1.74 Td [(years ago. But we were absolutely sure that the laboratory support is )0.5(crucial )0.5(for )]TJ 0.082 Tw T* (epidemiology, and if it will come to this syndromic approach it will rui\ n our laboratory )Tj 0 Tw T* (servic)Tj 0.327 Tw [(e. )0.5(And )0.5(laboratory )0.5(service )0.5(should )0.5(be )0.5(supplied )0.5(with )0.5(the )0.5(nice )0.5(equipment, )0.5(with )]TJ 0.373 Tw T* (different reagents: it needs money. So now the government gives us money\ for )Tj 0.038 Tw 0 -1.74 TD (development of our __ epi\(?\) service, say. Of course we\222ll need to \ increase the salary, of )Tj 0.082 Tw 0 -1.72 TD (course the eq)Tj (uipment should be up to date, this PCR business, you know, takes a lot o\ f )Tj 0 Tw T* (money.)Tj ( )Tj ET endstream endobj 459 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (36)Tj ( )Tj ET Q BT 0.107 Tw 12 0 0 12 107.88 709.08 Tm (this stuff. They have their stuff with them so we can bring by plane to \ any place. And )Tj 0.148 Tw 0 -1.72 TD (they can work for )Tj 0 Tw (\226)Tj ( )Tj 0.148 Tw 8.818 0 Td (our experience )Tj 0 Tw (\226)Tj ( )Tj 0.148 Tw 7.356 0 Td (they can work say one month, two months )Tj 0 Tw (\226)Tj ( )Tj 19.27 0 Td (it )Tj 0.056 Tw -35.444 -1.72 Td (depends on the situation )Tj 0 Tw (\226)Tj ( )Tj 0.056 Tw 10.973 0 Td (then we change the people, the stuff is in the place. So, those )Tj 0 Tw -10.973 -1.74 Td (mobile teams are very... we consider them very useful for different situ\ ations.)Tj 31.073 0 Td ( )Tj -34.073 -1.72 Td (DF:)Tj ( )Tj 3 0 Td (Are there any other comments or questions? Dr.)Tj ( )Tj (Lazzari?)Tj ( )Tj -3 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 0.221 Tw 1.555 0 Td (You defined the system as centralized or vertica)Tj 20.789 0 Td (l in many of its aspects, right? My )Tj 0.087 Tw -20.789 -1.72 Td (question is, Russia is changing like everything else, so would you say i\ n the future this )Tj 0.074 Tw 0 -1.74 TD [(could be revisited and modified, there could )0.5(be more decentralization of some of these? )]TJ 0 Tw 0 -1.72 TD (Is that the direction, in your view?)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 3 0 Td (S)Tj 0.169 Tw (ir, I got your question! They tried to modify us. [laughter] Well, actua\ lly... look, in )Tj 0.149 Tw T* (curative medicine they gave their power to the local levels, so now we\222\ ll see that the )Tj 0.232 Tw 0 -1.74 TD [(quality )0.5(of )0.5(assistance )0.5(for )0.5(the )0.5(population )0.5(came )0.5(lower, )0.5(and )0.5(like )0.5(in )0.5(many )0.5(countries )0.5(t)]TJ 0 Tw 35.056 0 Td (he )Tj 0.042 Tw -35.056 -1.72 Td (country is very huge, we have plenty of different small outbreaks, small\ episodes, and in )Tj 0.087 Tw 0 -1.72 TD (case it goes at the local level I think we\222ll ruin the country. We ca\ n assist in any... you )Tj 0.027 Tw T* (know, there are some areas where we can send people immediately. They d)Tj 30.475 0 Td (on\222t consider, )Tj 0.014 Tw -30.475 -1.74 Td (\223Well, to go or not to go? Where can we find finance?\224 and so on a\ nd so forth. So I think )Tj 0.04 Tw T* (that the vertical system in this particular country in this particular t\ ime gives us a chance )Tj 0 Tw T* (to support the people.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.086 Tw 3 0 Td (And I should say that nowadays t)Tj (he government and the president, they allocate )Tj 0.221 Tw -3 -1.74 Td (more attention for this business. And probably you have heard that there\ was a G8 )Tj 0.086 Tw T* (meeting, we strongly support WHO idea about this infectious disease cont\ rol and so on )Tj 0.108 Tw T* (and so forth. Now, I can\222t say the golden)Tj 0 Tw ( )Tj 0.108 Tw 17.554 0 Td (rain had come in, but they bring much more )Tj 0.136 Tw -17.554 -1.72 Td (financial resources and I hope we can manage ourselves and for sure we c\ an help the )Tj 0.161 Tw 0 -1.74 TD [(other )0.5(countries, )0.5(for )0.5(example )0.5(countries )0.5(of )0.5(former )0.5(Soviet )0.5(Union, )0.5(I )0.5(mean )0.5(NIS )0.5(countries. )]TJ 0.187 Tw 0 -1.72 TD (According to our ideas and according to the)Tj 0 Tw ( )Tj 0.187 Tw 19.271 0 Td (decision of G8 we\222ll organize a special )Tj 0.185 Tw -19.271 -1.72 Td (centre on avian \222flu in Novosibirsk in Siberia. For NIS countries )Tj 0 Tw (\226)Tj ( )Tj 0.185 Tw 28.966 0 Td (and maybe other )Tj 0 Tw -28.966 -1.72 Td (countries who are just near )Tj (\226)Tj ( )Tj (they can send strains or materials to be examined and so on.)Tj 35.767 0 Td ( )Tj -38.767 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.085 Tw 3 0 Td (I also want to say that Australia is d)Tj (oing a lot, by the way, in this \222flu business. )Tj 0.206 Tw -3 -1.72 Td (They organized and utilized the idea of international cooperation and th\ ese table)Tj 0 Tw 34.389 0 Td (-)Tj (top )Tj 0.093 Tw -34.389 -1.72 Td (exercises in real)Tj 0 Tw (-)Tj 0.093 Tw (time. At least they got e)Tj 0 Tw (-)Tj 0.093 Tw (mails of all our cooperators, at least, \(but not )Tj 0 Tw T* (the last?\).)Tj ( )Tj ET endstream endobj 460 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 461 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 462 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 463 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 464 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 465 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (35)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (DF:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Fedorov?)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 0.072 Tw 3 0 Td (In some republics, I mean in some administrative territories, they also \ prepare a kind of )Tj 0.327 Tw 0 -1.72 TD (legislation, but it goes alongside)Tj 0 Tw ( )Tj 0.327 Tw 14.8 0 Td (the federal law, so it\222s approximately the same, )Tj 0 Tw -14.8 -1.74 Td (practically the same. Sometimes they even rewrite it with some, \(you kn\ ow?\), ___.)Tj 33.158 0 Td ( )Tj -36.158 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.001 Tw 1.389 0 Td [(And can you tell me what your )0.5(judgement is on Russia\222s )0.5(experience in managing diseases )]TJ 0 Tw T* (with this kind of vertical system)Tj (? Is it working well, in your opinion?)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 0.082 Tw 3 0 Td (Well... [laughs] I should say yes. Of course there are some weak points.\ Sometimes the )Tj 0.002 Tw 0 -1.74 TD (system of identification, for example, obliged them to send for... there\ is a list of diseases, )Tj 0.086 Tw 0 -1.72 TD (actually, more than 40 disease)Tj (s, and for so)Tj 0 Tw (-)Tj 0.086 Tw (called top dangerous diseases )Tj 0 Tw 30.302 0 Td (\226)Tj ( )Tj 0.086 Tw 0.836 0 Td (say cholera, )Tj 0.124 Tw -31.138 -1.72 Td (plague, some hemorrhagic fevers )Tj 0 Tw (\226)Tj ( )Tj 0.124 Tw 14.891 0 Td (they\222re obliged to send notification from the lower )Tj 0.227 Tw -14.891 -1.72 Td [(level, from... by the way, from immediately as soon )0.5(as the clinician finds a case )]TJ 0 Tw (\226)Tj ( )Tj 0.193 Tw 0 -1.74 TD (suppose there is a case of )Tj 0 Tw (something )Tj 16.153 0 Td (\226)Tj ( )Tj 0.193 Tw 0.943 0 Td (the clinician should inform, according to the )Tj 0.175 Tw -17.096 -1.72 Td [(legislation, inform Public Health Service at the local level. )0.5(Afterward the local level, )]TJ 0.022 Tw 0 -1.72 TD (within 24 hours should send the notification to the higher level. If eve\ rything\222s okay they )Tj 0.007 Tw T* (send the notifica)Tj (tion to the federal level. And there\222s also the monthly statistic and\ annual )Tj 0.032 Tw 0 -1.74 TD (statistic and so on. But for such diseases like cholera, say, and plague\ , they\222re allowed to )Tj 0.012 Tw 0 -1.72 TD (send to the federal immediately, just as soon as there is a kind of susp\ icion, then ca)Tj 33.405 0 Td (n send )Tj 0.008 Tw -33.405 -1.72 Td [(the )0.5(notification )]TJ 0 Tw (\226)Tj ( )Tj 0.008 Tw 7.104 0 Td [(or )0.5(at )0.5(least )0.5(information )]TJ 0 Tw (\226)Tj ( )Tj 0.008 Tw 9.896 0 Td [(by )0.5(e)]TJ 0 Tw (-)Tj 0.008 Tw [(mails, )0.5(faxes )0.5(and )0.5(so )0.5(on, )0.5(the )0.5(most )0.5(expedited )]TJ 0 Tw -17 -1.72 Td (manner.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.03 Tw 3 0 Td (Like in many countries I have heard here, the main operation of business\ is going )Tj 0 Tw -3 -1.72 Td (on the lower level, at the grassroots level...)Tj 17.134 0 Td ( )Tj -20.134 -1.72 Td (JL:)Tj 1.278 0 Td ( )Tj 1.722 0 Td (Another Chine)Tj (se expression! I like it very much.)Tj ( )Tj -3 -1.72 Td (YF:)Tj ( )Tj 0.228 Tw 3 0 Td (Yes, as they say, at the grass level. Okay, so in case they are not copi\ ng with the )Tj 0.023 Tw 0 -1.74 TD (situation, the same like in India where they are sending the team of exp\ erts, probably, for )Tj 0.014 Tw 0 -1.72 TD (according ___, sometimes without ____, i)Tj (t depends on the situation. And so we have also )Tj 0.219 Tw T* (mobile teams, mobile teams about 30 people, which can do laboratory, the\ y can do )Tj 0.024 Tw T* (epidemiological investigation, those teams are mobile teams, they are re\ ady to go in, say, )Tj 0 Tw 0 -1.74 TD (12)Tj ( )Tj 0.185 Tw [(hours, )0.5(they\222re )0.5(in )0.5(constant )0.5(readin)]TJ [(ess. )0.5(And )0.5(in )0.5(the )0.5(case )0.5(of, )0.5(say, )0.5(earthquakes )0.5(or )0.5(____ )]TJ 0.082 Tw 0 -1.72 TD (disease, in order to \(avoid the epidemiological?\) complications of dis\ turbances they can )Tj 0.204 Tw T* [(allocate... they have 15, I think, highly mobile teams with nice equipme\ nt, )0.5(and they )]TJ 0.1 Tw T* (include epidemiologists, bacteri)Tj [(ologists, virologists, )0.5(an )0.5(infectious )0.5(disease )0.5(doctor )0.5(and )0.5(all )]TJ ET endstream endobj 466 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (34)Tj ( )Tj ET Q BT 0.034 Tw 12 0 0 12 107.88 709.08 Tm (The [Russian name] )Tj 0 Tw 8.406 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (I mean, my federal service )Tj 0 Tw 11.055 0 Td (\226)Tj ( )Tj 0.034 Tw 0.784 0 Td (has a )Tj (vertical structure and presented )Tj 0.097 Tw -24.03 -1.72 Td (at the territorial management in every territorial level, with centraliz\ ed financing. It provides a )Tj 0.013 Tw 0 -1.72 TD (vertical policy, coordination between different levels of public health \ authorities from national to )Tj 0 Tw 0 -1.74 TD (regional and local lev)Tj (els.)Tj ( )Tj 0.071 Tw 3 -1.72 Td (The system of sanitary and epidemiological surveillance in Russia has a \ long and rather )Tj 0.345 Tw -3 -1.72 Td (successful history in terms of capacity to detect, notify, verify and re\ port public health )Tj 0.035 Tw 0 -1.72 TD (emergencies, including emergencies of international concern. As an examp\ )Tj 30.326 0 Td (le, I should say that a )Tj 0 Tw -30.326 -1.74 Td (couple of weeks ago we had celebrated the birthday, 84 years. It was est\ ablished 84 years before.)Tj 38.846 0 Td ( )Tj 0.058 Tw -35.846 -1.72 Td (It is necessary to add here that according to existing regulation every \ order or a solution )Tj 0.174 Tw -3 -1.72 Td (of the federal service should be considere)Tj (d by the Ministry of Justice in order to give them )Tj 0.217 Tw T* [(legislative power )0.5(obligatory )0.5(for )0.5(other )0.5(ministries )0.5(and )0.5(institutions. )0.5(I )0.5(mean, )0.5(in )0.5(the )0.5(case )0.5(where )]TJ 0.004 Tw 0 -1.74 TD (developed some order for our service and for the population it should be\ submitted to Ministry of )Tj 0 Tw 0 -1.72 TD (Justice, just)Tj ( )Tj (to stamp it, and in this case it\222s obligatory for other ministries.)Tj 29.829 0 Td ( )Tj 0.013 Tw -26.829 -1.72 Td [(The )0.5(Russian )0.5(Federation )0.5(took )0.5(an )0.5(active )0.5(part )0.5(in )0.5(a )0.5(number )0.5(of )0.5(discussions )0.5(on )0.5(development )0.5(of )]TJ 0.022 Tw -3 -1.72 Td (International Health Regulations. The Minister of Health and Social Deve\ lopment in the Russian )Tj 0 Tw 0 -1.74 TD (Fede)Tj 0.182 Tw (ration already informed the secretary of the World Health Organization t\ hat our federal )Tj 0.362 Tw 0 -1.72 TD (service for surveillance on consumer rights protection and human well)Tj 0 Tw 31.446 0 Td (-)Tj 0.362 Tw (being have been )Tj 0.251 Tw -31.446 -1.72 Td (recommended as a national coordinator as a focal point in Russia for Int\ ernational)Tj 0 Tw 35.834 0 Td ( )Tj 0.501 0 Td (Health )Tj -36.334 -1.72 Td (Regulations which were adopted in May, 2005.)Tj ( )Tj 3 -1.74 Td (I\222ll finish my presentation, and if you have questions I\222m ready t\ o answer. Thank)Tj 32.464 0 Td (-)Tj (you.)Tj ( )Tj 0.215 Tw -32.464 -1.72 Td (As you can see we have a highly vertical and very rigid system of epidem\ iological )Tj 0.127 Tw -3 -1.72 Td (surveillance. \(We have a law?\) and)Tj 0 Tw 14.685 0 Td ( )Tj 0.127 Tw 0.377 0 Td (of course one of the nice points for, I say for our federal )Tj 0 Tw -15.063 -1.72 Td (service, is vertical financing. It helps a lot, of course, to be frank.)Tj 26.019 0 Td ( )Tj -23.019 -1.74 Td ( )Tj /TT1 1 Tf -3 -1.72 Td (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (DF:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you, Dr.)Tj ( )Tj (Fedorov. A question from Dr.)Tj ( )Tj (Lazar.)Tj ( )Tj -3 -1.74 Td (HL:)Tj 1.611 0 Td ( )Tj 0.07 Tw 1.389 0 Td (I think I know the answer to this questio)Tj (n but I want to be sure. When you describe the )Tj 0.138 Tw 0 -1.72 TD [(Russian )0.5(system )0.5(and )0.5(the )0.5(Russian )0.5(Federation )0.6(as )0.5(vertical, if )0.6(I )0.5(interpreted )0.5(you )0.5(correctly )]TJ 0 Tw (\226)Tj ( )Tj 0.019 Tw T* [(which )0.5(I )0.5(always )0.5(don\222t )0.5(do )]TJ 0 Tw (\226)Tj ( )Tj 0.019 Tw 10.776 0 Td [(the )0.5(law)]TJ 0 Tw (-)Tj 0.019 Tw [(making is )0.5(vertical, )0.5(the )0.5(necessarily )0.5(legislation )0.5(is )0.5(passed )]TJ 0.274 Tw -10.776 -1.72 Td (at the level of the Russian F)Tj (ederation, but also the operations themselves are also )Tj 0 Tw 0 -1.74 TD (managed more in a top)Tj (-)Tj (down than in a bottom)Tj (-)Tj (up fashion.)Tj ( )Tj ET endstream endobj 467 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (33)Tj ( )Tj ET Q BT 0.138 Tw 12 0 0 12 107.88 709.08 Tm [(explicitly )0.5(being )0.5(introduced )0.5(as )0.5(a )0.5(component )0.5(of )0.5(the )0.5(legislation. )0.5(I )0.5(think )0.5(that\222s )0.5(clear )0.5(from )]TJ 0.094 Tw 0 -1.72 TD (your presentation. I jus)Tj (t was wondering )Tj 0 Tw (\226)Tj ( )Tj 0.094 Tw 17.49 0 Td (I mean, I don\222t want to get into an extensive )Tj 0.001 Tw -17.49 -1.72 Td [(discussion )0.5(and )0.5(this )0.5(is )0.5(probably )0.5(something )0.5(for )0.5(the )0.5(afternoon )]TJ 0 Tw (\226)Tj ( )Tj 0.001 Tw [(but )0.5(have )0.5(any )0.5(other )0.5(countries )]TJ 0 Tw 0 -1.74 TD (considered specifically introducing Annex 2 into legislation? No? Okay, \ thanks.)Tj 32.075 0 Td ( )Tj -35.075 -1.72 Td (DF:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.107 Tw (you again, )Tj 0 Tw (Dr.)Tj ( )Tj 0.107 Tw (Krishnan. I think we\222ll move over to Dr.)Tj 0 Tw ( )Tj 0.107 Tw (Yuri Fedorov from The )Tj 0 Tw 0 -1.72 TD (Russian Republic.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf 0 -1.74 TD (COUNTRY 8: RUSSIA)Tj ( )Tj 0 -1.64 TD (Dr.)Tj ( )Tj (Yuri Fedorov)Tj ( )Tj /TT0 1 Tf 0.076 Tw 3 -1.66 Td (My presentation is short because of time problems. Anyway, I\222m here t\ o present to you )Tj 0.955 Tw -3 -1.72 Td (information on the state national governance rela)Tj 25.333 0 Td (tive to International Health )Tj 0.11 Tw -25.333 -1.72 Td (Regulations.Beforehand, I\222d like to excuse me for my not very fluent \ English, say, and if you )Tj 0 Tw 0 -1.72 TD (will have questions I\222ll try to respond.)Tj ( )Tj 0.236 Tw 3 -1.74 Td (So, dear colleagues, the Russian Federation is a state with a federative\ structure. It )Tj 0 Tw -3 -1.72 Td (consi)Tj 0.177 Tw (sts of 88 \(equal)Tj 0 Tw (-)Tj (in)Tj (-)Tj 0.177 Tw (rights?\) administration units, including 21 republics, 7 territories, 4\ 8 )Tj 0 Tw T* (regions, and one regional autonomy.)Tj ( )Tj 0.042 Tw 3 -1.72 Td (The Minister of Health and Social Development of the Russian Federation \ is responsible )Tj 0.038 Tw -3 -1.74 Td (for all questions of curative care and p)Tj (reventive medicine in Russia. It defines national policy in )Tj 0.095 Tw T* (the fields of medicine and public health with the Russian Federation, in\ cluding prevention and )Tj 0.296 Tw T* [(control )0.5(of )0.5(communicable )0.5(diseases. )0.5(According )0.5(to )0.5(the )0.5(national )0.5(legislation, )0.6(development )0.5(and )]TJ 0 Tw T* (implementati)Tj 0.024 Tw (on of the policy in the field of provision of sanitary and epidemiologic\ al well)Tj 0 Tw (-)Tj (being )Tj 0.247 Tw 0 -1.74 TD (of the population of the Russian Federation have been entrusted to the f\ ederal service for )Tj 0.147 Tw 0 -1.72 TD (surveillance on consumer rights protection and human well)Tj 0 Tw 24.719 0 Td (-)Tj 0.147 Tw (being. For short, [Ru)Tj (ssian name], )Tj 0 Tw -24.719 -1.72 Td (which I present here.)Tj ( )Tj 0.053 Tw 3 -1.72 Td [(The )0.5(federal )0.5(law, )0.5(on )0.5(30 )0.5(March )0.5(of )0.5(1999 )0.5(with )0.5(amendments )0.5(of )0.5(2003 )0.5(and 2004 )0.5(established )0.5(a )]TJ 0 Tw -3 -1.74 Td (legal framework of state policy with regard of the provision of...)Tj 25.742 0 Td ( )Tj -25.742 -1.72 Td ([Start of Side 3])Tj ( )Tj T* (...sanitary and epidemiologic well)Tj (-)Tj (being of the popu)Tj (lation.)Tj ( )Tj 0.08 Tw 3 -1.72 Td (The federal law defined various terms in the field of sanitary and epide\ miological well)Tj 0 Tw 35.667 0 Td (-)Tj 0.396 Tw -38.667 -1.74 Td (being of the population, its provision and powers of disseminational ent\ ities and local )Tj 0 Tw T* (administration.)Tj ( )Tj ET endstream endobj 468 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (32)Tj ( )Tj ET Q BT 0.056 Tw 12 0 0 12 107.88 709.08 Tm (Because in fact the rapid investigation response teams are going to be t\ he main provider )Tj 0.039 Tw 0 -1.72 TD (of information you need as a national focal point and as WHO to determin\ e whether it is )Tj 0 Tw T* (a public health emergency of international concern or not.)Tj 23.185 0 Td ( )Tj -26.185 -1.74 Td (SK:)Tj ( )Tj 0.046 Tw 3 0 Td (The rap)Tj (id response teams, as far as our thing is concerned, is at the district \ level. That is )Tj 0.047 Tw T* (about 600 districts, so you\222ll have to actually identify population)Tj 0 Tw 26.307 0 Td (-)Tj 0.047 Tw (wise, because a district )Tj 0.071 Tw -26.307 -1.72 Td (in India is very large, it\222s about one to four million size, so we ha\ ve one )Tj 30.125 0 Td (rapid response )Tj 0 Tw -30.125 -1.72 Td (team per district.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.106 Tw 3 0 Td (Now, at the central level we train the state rapid response team, so fro\ m the 35 )Tj 0.011 Tw -3 -1.72 Td (states they send the team centrally, and it\222s for combined training )Tj 0 Tw 26.497 0 Td (\226)Tj ( )Tj 0.011 Tw 0.761 0 Td (WHO\222s also involved )Tj 0.298 Tw -27.258 -1.72 Td (in it )Tj 0 Tw (\226)Tj ( )Tj 0.298 Tw 3.478 0 Td (it\222s a one)Tj 0 Tw (-)Tj 0.298 Tw (week training, we train those.)Tj (.. it\222s a multi)Tj 0 Tw (-)Tj 0.298 Tw (disciplinary team of )Tj 0 Tw -3.478 -1.72 Td (physicians )Tj 4.622 0 Td (\226)Tj ( )Tj 0.151 Tw 0.901 0 Td (a pediatrician, entomologist, microbiologist and the epidemiologist )Tj 0 Tw 28.133 0 Td (\226)Tj ( )Tj 0.901 0 Td (and )Tj 0.095 Tw -34.556 -1.74 Td (sometimes a statistician also there. So, these teams are trained at the \ central level at an )Tj 0 Tw T* (ICD. It\222s a one)Tj (-)Tj (week training.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.158 Tw 3 0 Td (Now, th)Tj (ey are also the training of trainers, so they go back and they train the\ )Tj 0.091 Tw -3 -1.72 Td (district level teams in that state. So this is a continuous process, bec\ ause many of them )Tj 0.141 Tw 0 -1.74 TD (that the people may retire or transfer and things like that keep happeni\ ng, so this is a )Tj 0 Tw 0 -1.72 TD (cont)Tj (inuous process.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.063 Tw 3 0 Td (So the rapid response team is located at the district level as well as s\ tate level as )Tj 0 Tw -3 -1.72 Td (well at the central level.)Tj 9.579 0 Td ( )Tj -12.579 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.119 Tw 3 0 Td (Now, the exact role, they have not been used to the full extent. Many ti\ mes an )Tj 0.148 Tw -3 -1.72 Td (outbreak is concerned the family health cent)Tj 18.602 0 Td (re doctor just goes and carries out a very )Tj 0.048 Tw -18.602 -1.72 Td (simple investigation and comes back, so we have been emphasizing again a\ nd again that )Tj 0.017 Tw T* (the rapid response teams should be deployed more frequently to investiga\ te, because then )Tj 0 -1.74 TD (they go into much detail and you may f)Tj (ind out the real extent of the outbreak, just getting )Tj 0.102 Tw 0 -1.72 TD (otherwise more of an administrative report rather than an outbreak inves\ tigation report, )Tj 0.051 Tw T* [(so that emphasis we have been )0.5(stressing in the trainings, and it is improving but it\222s still )]TJ 0.022 Tw T* (not... at the state )Tj [(level, yes, the rapid response teams are quite effective, but )0.5(at the district )]TJ 0 Tw 0 -1.74 TD (level, some of them it\222s depending on the capacity of the different s\ tates.)Tj 29.102 0 Td ( )Tj -32.102 -1.72 Td (DF:)Tj ( )Tj 3 0 Td (Are there any further questions or comments? Kumanan Wilson?)Tj 26.047 0 Td ( )Tj -29.047 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 0.027 Tw 1.056 0 Td (A quick question actually for oth)Tj (ers around here and from the other presentation. Correct )Tj 0.148 Tw 0 -1.72 TD [(me )0.5(if )0.5(I\222m )0.5(wrong, )0.5(but )0.5(I )0.5(think )0.5(this )0.5(is )0.5(the )0.5(first )0.5(presentation )0.5(we )0.5(heard )0.5(where )0.5(Annex )0.5(2 )0.5(is )]TJ ET endstream endobj 469 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (31)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (SK:)Tj ( )Tj 0.088 Tw 3 0 Td (It\222s mostly, you can say, issues of allocation )Tj (of funding, some cross)Tj 0 Tw (-)Tj 0.088 Tw (border issues, they )Tj 0.118 Tw 0 -1.72 TD (may have some discussion about the border issues which the information h\ as not been )Tj 0.12 Tw T* (communicated to them, or shortage of staff or logistics like drugs, thos\ e are the issues )Tj 0 Tw 0 -1.74 TD (mostly. It is not much on the surveillan)Tj (ce as such but mostly it\222s the other issues.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.051 Tw 1.389 0 Td (I just want to follow up on one item in the presentation and that was an\ item concerning )Tj 0.031 Tw 0 -1.72 TD (preparation for dealing with some of the new international documentary r\ equirements, so )Tj 0.315 Tw T* (for those of you who deal with)Tj 0 Tw ( )Tj 0.315 Tw 14.728 0 Td (ports and airports and international shipping and )Tj 0.262 Tw -14.728 -1.74 Td (international air traffic, and who deal with international travellers, t\ he documentary )Tj 0.059 Tw T* (requirements, there are new forms in the IHR, there\222s a new maritime \ health declaration )Tj 0.125 Tw T* (to be filled out by ships on a)Tj (rrival with all kinds of information about sick persons or )Tj 0.027 Tw T* [(conditions )0.5(on )0.5(the )0.5(ship, )0.5(the )0.5(forms )0.5(for )0.5(international )0.5(air )0.5(traffic )0.5(are )0.5(being )0.5(revised )0.5(with )0.5(ICAO )]TJ 0 Tw 0 -1.74 TD (\226)Tj ( )Tj 0.043 Tw 0.793 0 Td (the International Civil Aviation Organization )Tj 0 Tw 18.518 0 Td (\226)Tj ( )Tj 0.043 Tw 0.793 0 Td (in conjunction with WHO, so those are )Tj 0.003 Tw -20.104 -1.72 Td (changing as well.)Tj 0 Tw ( )Tj 0.003 Tw 7.229 0 Td (The international model form of vaccination that is the one specific par\ t )Tj 0.1 Tw -7.229 -1.72 Td (of the little yellow booklet that international travellers carry around \ that has to do with )Tj 0.092 Tw 0 -1.72 TD [(yellow fever and maybe )0.5(other )0.5(diseases. )0.5(That )0.5(has )0.5(been )0.5(revised )0.5(as )0.5(well, as )0.5(also )0.5(the )0.5(main )]TJ 0 Tw 0 -1.74 TD (sa)Tj 0.121 Tw (nitation documentation having to do with ships, how many rats you\222ve \ killed, where )Tj 0 Tw 0 -1.72 TD (you\222ve looked, what kind of bugs you have and things like this.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.077 Tw 3 0 Td (And so to the extent that you deal with these or you work with people wh\ o deal )Tj 0.138 Tw -3 -1.72 Td (with these, these are all im)Tj [(portant international traffic issues )0.5(that )0.5(will )0.5(be )0.5(entering )0.5(into )]TJ 0.15 Tw 0 -1.74 TD (practice in the middle of the next year as well. So, your port people an\ d your airport )Tj 0 Tw 0 -1.72 TD (people will be seeing new forms, or forms that look similar but also hav\ e different parts.)Tj 35.352 0 Td ( )Tj -38.352 -1.72 Td (SL:)Tj 1.445 0 Td ( )Tj 1.555 0 Td (Dr.)Tj ( )Tj (Krishn)Tj (an, thank)Tj (-)Tj (you very much for the presentation.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.108 Tw 3 0 Td (You mentioned a few times the rapid response teams are present in every \ state, )Tj 0.171 Tw -3 -1.74 Td (and I think it\222s the first time that this comes into the discussion. \ And rapid response )Tj 0.041 Tw T* (teams we are considering as a key compone)Tj (nt or a key core capacity within the IHR, but )Tj 0.208 Tw T* (there\222s been quite a bit of discussion at what level we think they sh\ ould be placed, )Tj 0.041 Tw T* (actually, and it comes again is this a function of central level or the \ intermediate level as )Tj 0.09 Tw 0 -1.74 TD (mentioned in the IHR, and there)Tj (\222s a question of whether the intermediate level in India )Tj 0 Tw 0 -1.72 TD (would be the state level or a sub)Tj (-)Tj (level.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.107 Tw 3 0 Td (But in the case of India could you maybe go a bit more into the details \ of how )Tj 0.035 Tw -3 -1.72 Td (they are organized and how they function, and how they come into the dec\ ision)Tj 0 Tw 32.224 0 Td (-)Tj (making? )Tj ET endstream endobj 470 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 471 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 472 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 473 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 474 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 475 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (30)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.065 Tw 3 0 Td (But as far as the normal disease surveillance and response is concerned,\ at every )Tj 0 Tw -3 -1.72 Td (level the government has got the powers normally also to do it without l\ egal back)Tj 32.604 0 Td (ing.)Tj ( )Tj -35.604 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (You have the powers without the...?)Tj ( )Tj -3 -1.74 Td (SK:)Tj ( )Tj 0.019 Tw 3 0 Td [(The )0.5(surveillance )0.5(system )0.5(and )0.5(all )0.5(this )0.5(is )0.5(a )0.6(national program, )0.5(it )0.5(has )0.5(to be )0.6(done, )0.5(so )0.5(there\222s )0.5(no )]TJ 0 Tw 0 -1.72 TD (requirement of using the legal backup for it.)Tj 17.605 0 Td ( )Tj -20.605 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.024 Tw 1.389 0 Td [(Help me out, here. If there\222s a national )0.5(power and it needs )0.5(to b)]TJ 25.326 0 Td (e done, doesn\222t that power )Tj 0 Tw -25.326 -1.72 Td (rest on law?)Tj ( )Tj -3 -1.74 Td (SK:)Tj ( )Tj 0.012 Tw 3 0 Td (Yes, in the constitution itself. I agree, it is in the constitution itse\ lf, but what I\222m trying to )Tj 0.028 Tw T* (say is many of the laws are 1905 and things like that, but no one refers\ to them anymore, )Tj 0 Tw T* (it has just become acce)Tj (ptable.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (It\222s just the way it\222s done.)Tj ( )Tj -3 -1.74 Td (SK:)Tj ( )Tj 3 0 Td (Yes.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.004 Tw 1.389 0 Td (Okay. The other thing I wanted to clarify )Tj 0 Tw (\226)Tj ( )Tj 0.004 Tw 17.473 0 Td (I think maybe many people in this room know )Tj 0.009 Tw -17.473 -1.72 Td (it but for those who don\222t )Tj 0 Tw (\226)Tj ( )Tj 0.009 Tw 11.259 0 Td (in India the civil service is a united civil service, and you\222re a )Tj 0.038 Tw -11.259 -1.72 Td (civil servant in I)Tj (ndia you can be assigned to the federal or the state or the local level \ and )Tj 0.328 Tw 0 -1.74 TD (you\222re still part of the ICS. For the people who are involved in moni\ toring and )Tj 0.015 Tw 0 -1.72 TD (surveillance and reporting, are they usually civil servants or are many \ of them outside the )Tj 0 Tw T* (ICS? You)Tj ( )Tj (mentioned the private sector just a moment ago.)Tj 23.439 0 Td ( )Tj -26.439 -1.72 Td (SK:)Tj ( )Tj 0.271 Tw 3 0 Td (The district head is the... what do you call it? The IES, we call them t\ he district )Tj 0.044 Tw 0 -1.74 TD (magistrate or collector. So he\222s a non)Tj 0 Tw 15.179 0 Td (-)Tj 0.044 Tw (medical person, he\222s the head of the district. Now, )Tj 0.003 Tw -15.179 -1.72 Td (the District Surveillance Co)Tj (mmittee, the head is this person but the actual implementation )Tj 0.078 Tw 0 -1.72 TD (is the District Surveillance Unit, which is the medical person. So, all \ activities are done )Tj 0.139 Tw T* (with this but there will be a meeting once a month or once in two months\ where any )Tj 0.106 Tw 0 -1.74 TD [(issues )0.5(which )0.5(come )]TJ 8.065 0 Td [(up )0.5(are )0.5(discussed, )0.5(but )0.5(otherwise )0.5(they )0.5(are )0.5(separated )0.5(from )0.5(the )0.5(system, )]TJ 0 Tw -8.065 -1.72 Td (they do not interfere that much in the system.)Tj 18.134 0 Td ( )Tj -21.134 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (They are not part of the India Civil Service? No? Thank)Tj 22.381 0 Td (-)Tj (you.)Tj ( )Tj -25.381 -1.72 Td (BT:)Tj ( )Tj 0.184 Tw 3 0 Td [(Just a quick question of clarification or )0.5(elaboration. You mentioned bri)]TJ 30.246 0 Td (efly a dispute )Tj 0.107 Tw -30.246 -1.74 Td (resolution mechanism, I think the Central Council for Health and Family \ Welfare. Can )Tj 0.061 Tw 0 -1.72 TD (you explain a little bit how that works, what kinds of disputes they wou\ ld deal with and )Tj 0 Tw T* (how that works?)Tj ( )Tj ET endstream endobj 476 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (29)Tj ( )Tj ET Q BT 0.043 Tw 12 0 0 12 107.88 709.08 Tm (can compare it with... which is all)Tj 0 Tw (-)Tj 0.043 Tw (inclusive, because these legislations cannot be revised )Tj 0.065 Tw 0 -1.72 TD (frequently so naturally you like to be as comprehensive and cover all th\ e issues. So it is )Tj 0.082 Tw T* (not only for our country but I\222m sure many other countries )Tj 24.592 0 Td (will benefit, because if they )Tj 0.147 Tw -24.592 -1.74 Td (are going through a revision process they would like to have such a legi\ slation easily )Tj 0 Tw T* (available and incorporate as many applicable clauses into their own legi\ slations.)Tj 32.073 0 Td ( )Tj -35.073 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (DF:)Tj ( )Tj 3 0 Td (Dr.)Tj ( )Tj (Lazar?)Tj ( )Tj -3 -1.74 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Thank)Tj (-)Tj (you, Dr.)Tj ( )Tj (Krishnan. That was)Tj ( )Tj (a very comprehensive presentation.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.004 Tw 3 0 Td (I guess I\222ve been... as I listened to you I was wrestling with a comp\ arison between )Tj 0.094 Tw -3 -1.72 Td [(the )0.5(extraordinary )0.5(planning )0.5(effort )0.5(which )0.5(India )0.5(has )0.5(obviously )0.5(undertaken )0.5(in )0.5(this )0.5(area )0.5(and )]TJ 0.122 Tw T* (the seeming )Tj 0 Tw (\226)Tj ( )Tj 0.122 Tw 6.171 0 Td (if I interpreted you correctly )Tj 0 Tw 12.19 0 Td (\226)Tj ( )Tj 0.122 Tw 0.872 0 Td (extensive use of law and regulation as a )Tj 0.004 Tw -19.233 -1.74 Td (device for making sure that you can do what you need to do in the circum\ stances required )Tj 0.155 Tw T* [(as )0.5(compare )0.5(to )0.5(some )0.5(of )0.5(the )0.5(other )0.5(country )0.5(presentations )0.5(where )0.5(I )0.5(had )0.5(the )0.5(sense )0.5(that )0.5(the )]TJ 0.144 Tw T* (approach was one more of voluntary coope)Tj (ration, less reliance on law, in the belief )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj 0.019 Tw -35.5 -1.72 Td [(possibly, )0.5(I\222m )0.5(not )0.5(sure )]TJ 0 Tw (\226)Tj ( )Tj 0.019 Tw 9.814 0 Td [(possibly )0.5(in )0.5(the )0.5(belief )0.5(that )0.5(one )0.5(cannot )0.5(anticipate )0.5(all )0.5(circumstances )]TJ 0.166 Tw -9.814 -1.74 Td [(no )0.5(matter )0.5(how )0.5(hard )0.5(one )0.5(tries, )0.5(and )0.5(that )0.5(extensive )0.6(reliance )0.6(on )0.6(law )0.6(and )0.6(regulation )0.6(risks )]TJ 0.096 Tw T* (creating rigidities, perhaps, t)Tj (hat would not be in place in countries which relied less on )Tj 0 Tw T* (law and regulation.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.15 Tw 3 0 Td [(I )0.5(doubt )0.5(that )0.5(there\222s )0.5(a )0.5(right )0.5(or )0.5(a )0.5(wrong )0.5(approach, )0.5(I )0.5(think )0.5(different )0.5(countries )0.5(do )]TJ 0.108 Tw -3 -1.74 Td (things that are consistent with their history and their culture, but I g\ uess the question I )Tj 0 Tw T* (w)Tj 0.112 Tw (ould ask you is am I interpreting correctly that the Indian authorities \ believe that it\222s )Tj 0.164 Tw T* (important to specify in law and regulation as much as can be anticipated\ , that that is )Tj 0 Tw T* (consistent with the Indian tradition? Or am I misinterpreting you, perha\ ps.)Tj 29.715 0 Td ( )Tj -32.715 -1.74 Td (SK:)Tj ( )Tj 0.029 Tw 3 0 Td [(Actually, )0.5(I\222ll )0.5(clarify )0.6(I )0.5(think )0.5(the )0.5(slight )0.5(misinterpretation. )0.5(Most )0.5(of )0.5(the )0.5(diseases )0.5(surveillance )]TJ 0.154 Tw T* [(and )0.5(the )0.5(other )0.5(public )0.5(health )0.5(activities )0.5(are )0.5(being )0.5(done )0.5(without )0.5(the )0.5(law, )0.5(these )0.5(things )0.5(are )]TJ 0.047 Tw T* (done. Now, the issue comes up that more and more the private sector is g\ )Tj (etting involved )Tj 0.015 Tw T* (in the healthcare, and especially in the urban areas. You can say it\222\ s almost 40% is public )Tj 0.016 Tw 0 -1.74 TD (and 60% is private. So for them, yes, you have to have health legislatio\ n in place because )Tj 0.164 Tw 0 -1.72 TD (otherwise they\222re not bound to report certain cases. So t)Tj (hat is why the states and the )Tj 0 Tw T* (centre are realizing that a legal framework has to be there.)Tj 23.238 0 Td ( )Tj ET endstream endobj 477 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (28)Tj ( )Tj ET Q BT 0.135 Tw 12 0 0 12 71.88 709.08 Tm (Now, they have been informed very well that these are the areas where yo\ u can include as a )Tj 0 Tw 0 -1.72 TD (national disaster.)Tj ( )Tj 0.067 Tw 3 -1.72 Td (The basic obstacles to implementation would be the inter)Tj 0 Tw 23.36 0 Td (-)Tj 0.067 Tw (sectoral coordination. I\222ll give )Tj 0.048 Tw -26.36 -1.74 Td (you the example of avian \222flu. Beca)Tj 14.586 0 Td (use it was only with the chickens the agriculture sector took )Tj 0.15 Tw -14.586 -1.72 Td (complete control of the activities, which created a lot of problem. We c\ ould not do any IEC )Tj 0.079 Tw T* (activities for the risk to humans because that would plummet the sales o\ f chicken, so we had a )Tj 0.09 Tw T* (very to)Tj (ugh time with this issue, though throughout we have joint monitoring gro\ ups meeting )Tj 0 Tw (\226)Tj ( )Tj 0.058 Tw 0 -1.74 TD (every two weeks we have a joint monitoring group meeting )Tj 0 Tw 24.628 0 Td (\226)Tj ( )Tj 0.058 Tw 0.808 0 Td (but when the actual avian \222flu hit )Tj 0.318 Tw -25.435 -1.72 Td (the country then immediately there was a __ because the chicken sales ha\ d go)Tj 35.266 0 Td (ne down )Tj 0.171 Tw -35.266 -1.72 Td [(significantly, and we in the health could not take )0.5(much of a stand because we did not have )]TJ 0 Tw 0 -1.72 TD (human cases. So this will create a problem in the sectoral coordination.\ )Tj 28.464 0 Td ( )Tj 0.04 Tw -25.464 -1.74 Td (Then border crossings, we have a large border with a large number of mig\ rants, so ag)Tj 0 Tw 34.778 0 Td (ain )Tj 0.091 Tw -37.778 -1.72 Td [(that )0.5(is )0.5(going )0.5(to )0.5(be )0.5(a )0.5(major )0.5(problem. )0.5(And )0.5(we )0.5(have )0.6(frequently )0.5(large )0.5(outbreaks. )0.5(On )0.5(a )0.5(daily )0.5(basis )]TJ 0.045 Tw T* (we\222ll have about three to five important outbreaks. Like I have liste\ d now we\222re having chicken )Tj 0.255 Tw T* (pneumonia, about almost one million cases affecting about almo)Tj 27.838 0 Td (st six or seven states, the )Tj 0.037 Tw -27.838 -1.74 Td (Japanese encephalitis\(?\) outbreak going on, the leptospirosis outbreak\ after the floods. So we do )Tj 0.072 Tw T* (have at any time a large number of outbreaks of this type because the sh\ eer size of the country )Tj 0 Tw T* (makes a large number of cases, so )Tj (these are some of the obstacles to implementation.)Tj 34.044 0 Td ( )Tj 0.008 Tw -31.044 -1.72 Td (Another issue which is coming up increasingly is the corruption at some \ levels. Now, this )Tj 0.233 Tw -3 -1.74 Td (is either diversion of funds or the medical officers are not available, \ they\222re doing private )Tj 0.214 Tw T* (practice at some othe)Tj (r areas. So, those type of issues, which are state)Tj 0 Tw (-)Tj 0.214 Tw (centric, will be very )Tj 0 Tw T* (difficult to overcome, and which will also have an impact on the reporti\ ng system.)Tj 32.963 0 Td ( )Tj -29.963 -1.72 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.74 Td ([Applause])Tj ( )Tj T* ( )Tj /TT1 1 Tf T* (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.66 TD (DF:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj 0.073 Tw (you, Dr.)Tj 0 Tw ( )Tj 0.073 Tw (Krishnan. An impressive, comprehensi)Tj (ve review. The floor is now open )Tj 0 Tw 0 -1.72 TD (for comments and questions. Dr.)Tj ( )Tj (Bruce Plotkin?)Tj ( )Tj -3 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (SK:)Tj ( )Tj 0.024 Tw 3 0 Td (Actually, whenever the technical agencies put up any bills for approval,\ the first question )Tj 0.08 Tw 0 -1.74 TD (the government will ask is, \223Show us any other similar acts in other \ countr)Tj 30.924 0 Td (ies,\224 so they )Tj ET endstream endobj 478 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (27)Tj ( )Tj ET Q BT 0.208 Tw 12 0 0 12 107.88 709.08 Tm (Then involvement of the private sector for disease surveillance, includi\ ng the Indian )Tj 0 Tw -3 -1.72 Td (Medical Association and others, so )Tj (that is again a really important area.)Tj 28.63 0 Td ( )Tj 0.026 Tw -25.63 -1.72 Td (Then assessment of these disease surveillance and response capacities, t\ his checklist they )Tj 0.109 Tw -3 -1.74 Td (had wanted us to give it from the WHO. We are waiting for the list, but \ at the same time the )Tj 0 Tw 0 -1.72 TD (government will be going ahead an)Tj (d doing it around the middle of June of next year.)Tj 33.88 0 Td ( )Tj 0.067 Tw -30.88 -1.72 Td (And then identification of high)Tj 0 Tw (-)Tj 0.067 Tw (risk areas near international borders so that we can have )Tj 0.051 Tw -3 -1.72 Td (programs for cross)Tj 0 Tw (-)Tj 0.051 Tw (border control of diseases, because we have a lot of free movement betwe\ en )Tj 0.078 Tw 0 -1.74 TD (countries like Bhutan)Tj (, Nepal, Bangladesh, so this is including even now Pakistan also there\222\ s a )Tj 0.096 Tw 0 -1.72 TD (lot of trains between India and Pakistan, so this type of cross)Tj 0 Tw (-)Tj 0.096 Tw (border control of disease is very )Tj 0 Tw T* (important.)Tj ( )Tj 0.193 Tw 3 -1.72 Td (The national IHR focal point also has become very important, and so we h\ )Tj 32.281 0 Td (ave even )Tj 0.034 Tw -35.281 -1.74 Td (strengthened, we made a BSL3 lab level\(?\), always getting the samples \ earlier also. They do not )Tj 0.056 Tw T* (have a BSL3 lab, so some of the sample results had to be awaited from th\ e other BSL3 lab that )Tj 0.093 Tw T* (was at Pooning\(?\), so now this... and ICD itself has beco)Tj (me self)Tj 0 Tw (-)Tj 0.093 Tw (sufficient, they can do all the )Tj 0 Tw T* (tests themselves.)Tj ( )Tj 0.046 Tw 3 -1.74 Td (And then also operation of a national public health emergency response p\ lan, this is also )Tj 0 Tw -3 -1.72 Td (planned very much.)Tj ( )Tj 0.228 Tw 3 -1.72 Td (Then assessment of present capacities that are designated airports, port\ s and ground )Tj 0 Tw -3 -1.72 Td (cros)Tj 0.018 Tw (sings. This is a meeting which we actually do next month, and we are exp\ ecting even calling )Tj 0.17 Tw 0 -1.74 TD (some international experts from Australia regarding what are the issues \ actually faced at the )Tj 0.033 Tw 0 -1.72 TD (airports and ports, and as Dr.)Tj 0 Tw ( )Tj 0.033 Tw (Stefano said about already this meeting)Tj 0 Tw ( )Tj 0.033 Tw 28.185 0 Td (in Canada which occurred, )Tj 0.079 Tw -28.185 -1.72 Td (if we could some of those draft documents it would help a lot in this me\ eting. We will also be )Tj 0.195 Tw T* (having an increased number of public health units at the airport because\ a large number of )Tj 0 Tw 0 -1.74 TD (airports have now become international.)Tj 16.078 0 Td ( )Tj -13.078 -1.72 Td (Thi)Tj 0.052 Tw (s again is a revision of the )Tj /TT1 1 Tf (National Aircraft and Port Health Act and Rules)Tj /TT0 1 Tf 32.283 0 Td (, because )Tj 0.068 Tw -35.283 -1.72 Td (they have to change, and also prepare the updated health rules for desig\ nated ground crossings, )Tj 0.034 Tw 0 -1.72 TD (which is very large in number, there were almost 800 ground crossings, a\ nd)Tj 0 Tw 30.739 0 Td ( )Tj 0.034 Tw 0.284 0 Td (this is going to be a )Tj 0 Tw -31.023 -1.74 Td (very significant challenge. I do not know how we are going to address th\ is.)Tj 30.021 0 Td ( )Tj 0.264 Tw -27.021 -1.72 Td (The public health emergencies of international health concern, also the \ Ministry of )Tj 0.118 Tw -3 -1.72 Td (Health and Home Affairs, like I told you, has got the national disaster \ m)Tj (anagement authority. )Tj ET endstream endobj 479 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (26)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (this )Tj 0.298 Tw 1.993 0 Td (that transparency has started showing up and the government is now putti\ ng all the )Tj 0 Tw -1.993 -1.72 Td (information on the Web sites.)Tj ( )Tj 0.153 Tw 3 -1.72 Td [(You have trigger level in this program that the field worker )0.5(right at the village level, )]TJ 0.03 Tw -3 -1.74 Td (knows that if he gets two measles what action has to b)Tj 22.02 0 Td (e taken, the medical officer at the primary )Tj 0.079 Tw -22.02 -1.72 Td (health centre level knows what has to be taken, so there is action and r\ esponse component laid )Tj 0 Tw 0 -1.72 TD (down that what action to be taken, what samples to be collected, everyth\ ing is laid out in this.)Tj 37.436 0 Td ( )Tj 0.016 Tw -34.436 -1.72 Td (And there is a strea)Tj (mlining of the flow of funds to the districts directly so there is never\ a )Tj 0 Tw -3 -1.74 Td (shortage of funds as far as the surveillance program is concerned.)Tj 26.185 0 Td ( )Tj 0.034 Tw -23.185 -1.72 Td (Now, the same thing, you can say surveillance has got three links, one i\ s the government )Tj 0.027 Tw -3 -1.72 Td [(system. )0.5(WHO )0.5(itself )0.5(has )0.5(a )]TJ [(collaborative )0.5(network, )0.5(we )0.5(have )0.5(got )0.5(different )0.5(programs )0.5(of )0.5(tuberculosis, )]TJ 0.588 Tw T* (polio, disease surveillance, leprosy, viruses\(?\), malaria, kala)Tj 0 Tw 27.605 0 Td (-)Tj 0.588 Tw (azar, HIV/AIDS, routine )Tj 0.024 Tw -27.605 -1.74 Td (immunization, plague surveillance. So we\222ve got a complete network of\ WHO consultants in the )Tj 0 Tw T* (fiel)Tj (d )Tj 2.114 0 Td (\226)Tj ( )Tj 0.031 Tw 0.781 0 Td (more than a thousand people are there )Tj 0 Tw 15.683 0 Td (\226)Tj ( )Tj 0.031 Tw 0.781 0 Td (and so they always SMS us or send us e)Tj 0 Tw (-)Tj 0.031 Tw (mails if )Tj 0.11 Tw -19.358 -1.72 Td (they suspect any outbreak in that area. So they are informants, they inf\ orm us of an outbreak, )Tj 0.261 Tw T* (they do not divert from their programs which they\222re doing but they a\ )Tj 31.013 0 Td (t least give us the )Tj 0 Tw -31.013 -1.74 Td (information. So this works in alerting us for any outbreaks.)Tj ( )Tj 0.077 Tw 3 -1.72 Td (And the third group is the media, which is very active in the country. Y\ ou\222ll find many )Tj 0 Tw -3 -1.72 Td (times it is the media which reports first, and that helps a lot in the d\ isease surveill)Tj 32.576 0 Td (ance.)Tj ( )Tj 0.066 Tw -29.576 -1.72 Td [(And )0.5(lastly, )0.5(the )0.5(plan )0.5(of )0.5(action. )0.5(We )0.5(had )0.5(a )0.5(workshop )0.5(with )0.5(the )0.5(different )0.5(stakeholders )0.5(and )0.5(it )]TJ 0.03 Tw -3 -1.74 Td (was identified what are the areas of the IHR which require special atten\ tion. I will not discuss in )Tj 0.087 Tw T* (detail the issue but basically we followed up on the IHR acti)Tj 25.092 0 Td (vities to plan what are the actions )Tj -25.092 -1.72 Td (required to implement the IHR in the country, and this was discussed in \ very much detail, and )Tj 0.064 Tw T* (we got a whole matrix which I\222ll be giving to you, but basically some\ of the highlights are that )Tj 0.059 Tw 0 -1.74 TD (all rapid response team train)Tj (ings now include the IHR, so they know what is the IHR part of it. )Tj 0.017 Tw 0 -1.72 TD (Even the administrators and the politicians, \(there\222s trial cases?\)\ being done at national, state and )Tj 0.179 Tw T* (district levels, so they have been given a time)Tj 0 Tw (-)Tj 0.179 Tw (frame. And then rumour verification is )Tj 0 Tw 36.778 0 Td (being )Tj 0.138 Tw -36.778 -1.72 Td (strengthened at district, state and national levels, so this also has be\ en given so that by June, )Tj 0 Tw 0 -1.74 TD (2007 we should many of these things in place.)Tj ( )Tj 0.191 Tw 3 -1.72 Td (Then evaluation of isolation facilities and hospital infection practice \ in all states and )Tj 0.032 Tw -3 -1.72 Td (districts. This )Tj (is becoming a major issue. We feel that if we have a pandemic \222flu th\ e capacity at )Tj 0 Tw 0 -1.72 TD (the state and district level will be taxed heavily.)Tj 19.077 0 Td ( )Tj ET endstream endobj 480 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 481 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 482 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 483 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 484 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 485 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (25)Tj ( )Tj ET Q BT 0.159 Tw 12 0 0 12 71.88 709.08 Tm [(check if the information coming in is matching with the data. And you al\ so have the )0.5(Indian )]TJ 0.114 Tw 0 -1.72 TD (Council of Medical Research which is a network of organizations spread a\ ll over the country, )Tj 0.076 Tw T* (about 35 of them, which )Tj (have sophisticated labs doing research on particular diseases, so those \ )Tj 0 Tw 0 -1.74 TD (information also feed in.)Tj ( )Tj 0.126 Tw 3 -1.72 Td (And you can see that the emergency medical response is also very much a \ part of the )Tj 0.021 Tw -3 -1.72 Td (diseases surveillance system, so it is always built in that if it is to \ be)Tj 0 Tw ( )Tj 0.021 Tw 27.75 0 Td (declared an emergency they )Tj 0.079 Tw -27.75 -1.72 Td (are very much there. And the WHO country offices also are very much part\ of the information )Tj 0 Tw T* (coming directly to us also.)Tj ( )Tj 0.01 Tw 3 -1.72 Td [(And )0.5(these )0.5(are )0.5(showing )0.5(our )0.5(network )0.5(of )0.5(reference )0.5(laboratories. )0.5(These )0.5(are )0.5(mostly )0.5(the )0.5(ICMR )]TJ 0.043 Tw -3 -1.72 Td [(laboratories, )0.5(but )0.5(all)]TJ 0 Tw ( )Tj 0.043 Tw 8.125 0 Td [(states )0.5(also )0.5(have )0.5(a )0.5(state )0.5(level )0.5(laboratory, )0.5(and )0.5(some )0.5(of )0.5(them )0.5(have )0.5(got )0.5(disease)]TJ 0 Tw 30.542 0 Td (-)Tj 0.251 Tw -38.667 -1.72 Td (specific laboratories also, so that the total network is quite a large n\ etwork, and we have )Tj 0.154 Tw T* (established the network of this lab system to give more authentic inform\ ation and so t)Tj (he lab )Tj 0 Tw 0 -1.72 TD (confirmation doesn\222t get delayed.)Tj ( )Tj 0.154 Tw 3 -1.72 Td (Under the National Rural Health Mission the community health... there wi\ ll be a link )Tj 0.047 Tw -3 -1.72 Td (worker located at the village level who will also be assisting in passin\ g on this information, and )Tj 0.034 Tw 0 -1.74 TD (they\222re going to extend the ___)Tj 0 Tw 12.695 0 Td ( )Tj 0.034 Tw 0.284 0 Td (which ____ up to block level, that is up to the CHCS\(?\) level. It )Tj 0 Tw -12.979 -1.72 Td (will now go right up to the PHC\(?\) level.)Tj ( )Tj 0.051 Tw 3 -1.72 Td (There is also a use of the satellite for improving communications at the\ state and district )Tj 0 Tw -3 -1.72 Td (levels, and also lab services are being strengthened un)Tj 21.631 0 Td (der this program.)Tj ( )Tj 0.05 Tw -18.631 -1.74 Td (And this gives an idea of how the satellite linkages have been establish\ ed, especially the )Tj 0.177 Tw -3 -1.72 Td (recent one or two outbreaks, chicken pneumonia\(?\) and avian influenza.\ The health minister )Tj 0.295 Tw 0 -1.72 TD [(sitting )0.5(in )0.5(his )0.5(office )0.5(can )0.5(have )0.5(a )0.5(teleconferencing )0.5(with )0.5(t)]TJ 24.115 0 Td [(he )0.5(state )0.5(health )0.5(ministers )0.5(and )0.5(their )]TJ 0 Tw -24.115 -1.72 Td (secretaries and discuss the preventive measures being applied.)Tj 24.88 0 Td ( )Tj 0.225 Tw -21.88 -1.74 Td (Now, this has got a lot of strengths. We have an integration of all the \ surveillance )Tj 0.064 Tw -3 -1.72 Td (components of the vertical programs. Now we have those in roving reporti\ )Tj 30.525 0 Td (ng which is what we )Tj 0.162 Tw -30.525 -1.72 Td (felt was very important, because otherwise cases were not being reported\ . It has a strong IT )Tj 0.039 Tw T* (component. It\222s still being finalized. A state will be reached when a\ ll this data will directly flow )Tj 0.045 Tw 0 -1.74 TD (into the Web site )Tj 0 Tw (\226)Tj ( )Tj 0.045 Tw 8.029 0 Td (there will be no inter)Tj (ference at any level )Tj 0 Tw (\226)Tj ( )Tj 0.045 Tw 17.537 0 Td (this will be available right on the )Tj 0.091 Tw -25.566 -1.72 Td (Web site. Even in the present outbreak of avian influenza, both the Mini\ stry of the Health and )Tj 0.001 Tw 0 -1.72 TD [(Family Welfare, as well as the animal husbandry )0.5(side, daily updates were put on the Web site. So )]TJ ET endstream endobj 486 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (24)Tj ( )Tj ET Q BT 0.004 Tw 12 0 0 12 71.88 709.08 Tm (well as we )Tj 0.005 Tw 4.484 0 Td [(have suspect case, probable case and )0.5(confirmed )0.5(case )0.5(reporting. )0.5(And )0.6(all )0.5(these )0.6(three )0.5(are )]TJ 0.01 Tw -4.484 -1.72 Td [(parallel, they do not merge at any level, so there\222s three informatio\ n is available at )0.5(national level. )]TJ 0.127 Tw 0 -1.72 TD (So this helps. Earlier what was happening was only lab)Tj 0 Tw (-)Tj 0.127 Tw (confirmed c)Tj (ases were being reported, )Tj 0.099 Tw 0 -1.74 TD (and that was a very small tip of the iceberg, so now we have a system th\ at all three are being )Tj 0 Tw 0 -1.72 TD (reported.)Tj ( )Tj 0.193 Tw 3 -1.72 Td (Then you have \(segment surveillance?\) which is a totally different age\ ncy, including )Tj 0 Tw -3 -1.72 Td (inter)Tj (-)Tj 0.098 Tw (sectoral. It comes from the police)Tj (, it comes from the water pollution control boards. And )Tj 0 Tw 0 -1.74 TD (we have also surveillance for non)Tj (-)Tj (communicable diseases also in this.)Tj ( )Tj 0.036 Tw 3 -1.72 Td (Now this is a phasing of the project, so at present we are already finis\ hed phases 1 and 2 )Tj 0.09 Tw -3 -1.72 Td (so reporting has started, and the phase)Tj 0 Tw ( )Tj 0.09 Tw 16.124 0 Td (3 states are being taken in, so by the time the IHR gets )Tj 0 Tw -16.124 -1.72 Td (into implementation the entire country will be covered under this progra\ m.)Tj 29.908 0 Td ( )Tj 0.295 Tw -26.908 -1.74 Td (Now, the structure in this is basically similar to the NSPCD\(?\) where \ the district )Tj 0.013 Tw -3 -1.72 Td (surveillance unit is the one which does )Tj (most of the reporting. But we have increased their district )Tj 0.153 Tw 0 -1.72 TD (surveillance committee so that inter)Tj 0 Tw 14.883 0 Td (-)Tj 0.153 Tw (sectoral coordination would be there, and this committee )Tj -14.883 -1.72 Td [(consists )0.5(of )0.5(all )0.5(members )0.5(including )0.5(veterinary, )0.5(pollution )0.5(control )0.6(board, )0.6(police )0.6(for )0.6(the )0.6(road )0.6(and )]TJ 0 Tw 0 -1.74 TD (traffic)Tj ( )Tj 0.181 Tw 2.874 0 Td (accidents, so all the groups which are involved are a part of that commi\ ttee, and the )Tj 0.038 Tw -2.874 -1.72 Td (administrative head is the bureaucrat that is the district magistrate or\ collector, and you have the )Tj 0 Tw 0 -1.72 TD (security is the district surveillance officer.)Tj 16.827 0 Td ( )Tj 0.106 Tw -13.827 -1.72 Td (And this information )Tj (flows to the state as well as to the national, this information, and )Tj 0.053 Tw -3 -1.74 Td (this is how the information flows in. And it also has built)Tj 0 Tw (-)Tj 0.053 Tw (in taking in information from a select )Tj 0.032 Tw T* (number of private practitioners, nursing homes, not all of them but a fe\ w number of them)Tj 0 Tw ( )Tj 0.032 Tw 36.496 0 Td (just to )Tj 0.117 Tw -36.496 -1.72 Td (get started, and then we may increase and expand to more of them. And th\ e whole flow goes )Tj 0.001 Tw T* (upwards from the district surveillance unit to the state surveillance un\ it to the central surveillance )Tj 0 Tw 0 -1.74 TD (unit.)Tj ( )Tj 0.169 Tw 3 -1.72 Td (It involves medical colleges also, which a large)Tj 0 Tw ( )Tj 0.169 Tw 20.543 0 Td (number of patients do go to medical )Tj 0.046 Tw -23.543 -1.72 Td (colleges so those hospitals also add on the information. And it also inv\ olves private laboratories )Tj 0 Tw 0 -1.72 TD (and the other areas that is military and municipalities.)Tj 21.466 0 Td ( )Tj 0.158 Tw -18.466 -1.74 Td (Now, the linkages at the central level again you can see clearl)Tj 26.391 0 Td (y the different national )Tj 0.032 Tw -29.391 -1.72 Td (health programs. These are the programs. This is the NICD which has a ce\ ntral surveillance unit )Tj 0.229 Tw T* (at NICD itself. You have the Central Bureau of Health Intelligence which\ was getting the )Tj 0.128 Tw T* (information earlier, on a monthly basis. That )Tj 19.028 0 Td (information still feeds back so you can counter)Tj 0 Tw 19.639 0 Td (-)Tj ET endstream endobj 487 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (23)Tj ( )Tj ET Q BT 0.066 Tw 12 0 0 12 71.88 709.08 Tm (reported on a daily basis the number of cases, and that\222s just any ou\ tbreaks reported in the past )Tj 0.013 Tw 0 -1.72 TD (week, and the rapid communications were established through fax and e)Tj 0 Tw (-)Tj 0.013 Tw (mails. And the state and )Tj 0.202 Tw T* (these district laboratories were strengthened to d)Tj (o a rapid confirmation or diagnosis. At the )Tj 0.179 Tw 0 -1.74 TD (district level it\222s basically rapid diagnostic kits, but at the state\ level you have a little more )Tj 0.037 Tw 0 -1.72 TD (sophisticated labs )Tj 0 Tw 7.407 0 Td (\226)Tj ( )Tj 0.037 Tw 0.787 0 Td (but not of the BSL3 labs )Tj 0 Tw (\226)Tj ( )Tj 0.037 Tw 11.067 0 Td (but basically they can do ELISA and those types )Tj 0 Tw -19.261 -1.72 Td (of tests, and a l)Tj (arge amount of capacity)Tj (-)Tj (building as well as IEC activities were involved in that.)Tj 38.155 0 Td ( )Tj 0.161 Tw -35.155 -1.72 Td (Now, this is how it was distributed, covering the entire country, 101 di\ stricts used to )Tj 0.017 Tw -3 -1.74 Td (report on a weekly basis directly to the National Institute of Communica\ ble Diseases )Tj 0 Tw 34.411 0 Td (\226)Tj ( )Tj 0.017 Tw 0.767 0 Td (they used )Tj 0.037 Tw -35.178 -1.72 Td (to bypass even the state )Tj 0 Tw (\226)Tj ( )Tj 0.037 Tw 10.662 0 Td (so that type of system was in place and this never had any problem as )Tj 0 Tw -10.662 -1.72 Td (far as the states were concerned. They felt it was an important program.\ )Tj 28.655 0 Td ( )Tj 0.043 Tw -25.655 -1.72 Td (It covered most of the epidemic)Tj 0 Tw (-)Tj 0.043 Tw (prone diseases which is common to the count)Tj 0 Tw (ry )Tj 32.802 0 Td (\226)Tj ( )Tj 0.043 Tw 0.793 0 Td (this is )Tj 0.054 Tw -36.595 -1.74 Td (cholera, viral hepatitis, dengue, Japanese encephalitis\(?\), meningitis\ , measles, viral hemorrhagic )Tj 0.181 Tw T* (fevers, leptospirosis and others )Tj 0 Tw (\226)Tj ( )Tj 0.181 Tw 14.291 0 Td (and also it had this thing that pathogens with bioterrorism )Tj 0.021 Tw -14.291 -1.72 Td (potential could also be included, as well as drug)Tj 0 Tw 19.361 0 Td (-)Tj 0.021 Tw (resistant pathogens. So it was a very simple and )Tj 0.191 Tw -19.361 -1.72 Td (a comprehensive program. And there was an outcome of early detection of \ outbreaks, early )Tj 0.11 Tw 0 -1.74 TD (institution of containment measures at the district level itself, and to\ reduce the morbidity and )Tj 0 Tw 0 -1.72 TD (mortality as well a)Tj (s minimize economic loss.)Tj ( )Tj 0.116 Tw 3 -1.72 Td (And you can see that over the years )Tj 0 Tw (\226)Tj ( )Tj 0.116 Tw 16.288 0 Td (that is 2001, 2002, 2003 )Tj 0 Tw (\226)Tj ( )Tj 0.116 Tw 11.362 0 Td (you can see that the )Tj 0.055 Tw -30.65 -1.72 Td [(outbreaks )0.5(were )0.5(increasingly )0.5(being )0.5(reported )0.5(and )0.5(the )0.5(state )0.5(and district )0.5(were )0.5(independently )0.5(able )0.5(to )]TJ 0.114 Tw 0 -1.74 TD (manage those outbreaks, otherwise earlier NICD )Tj (teams had to go in almost every fifteen days )Tj 0.086 Tw 0 -1.72 TD (travelling, investigating some outbreak or other in the country. So that\ reduced a lot, the states )Tj 0.163 Tw T* (became... capacity was developed to directly do the investigation themse\ lves. Too, whenever )Tj 0 Tw T* (they required centra)Tj (l assistance it was provided.)Tj ( )Tj 0.035 Tw 3 -1.74 Td (Now, this improved the capacity. It was not felt that we could expand th\ is program to all )Tj 0.049 Tw -3 -1.72 Td (the 600 districts and they wanted a more case)Tj 0 Tw 18.556 0 Td (-)Tj 0.049 Tw (based type of reporting where you find out actual )Tj 0.36 Tw -18.556 -1.72 Td (number of cases and actual number of dea)Tj (ths, so we shifted to the Integrated Disease )Tj 0 Tw T* (Surveillance Project, and even these 101 districts have into this progra\ m.)Tj 29.159 0 Td ( )Tj 0.043 Tw -26.159 -1.74 Td (Now, this is a World Bank related project with about $68 million spread \ over five years, )Tj 0.025 Tw -3 -1.72 Td (and it is a decentralized system, and it has ta)Tj 18 0 Td (rget diseases, it has a regular weekly surveillance of )Tj 0.02 Tw -18 -1.72 Td (the important diseases. The ones in yellow are the ones which come under\ the IHR, also cholera, )Tj 0.125 Tw T* [(polio, plague, unusual syndromes, and this has suspect cases of the synd\ romic surveillance )0.5(as )]TJ ET endstream endobj 488 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (22)Tj ( )Tj ET Q BT 0.093 Tw 12 0 0 12 107.88 709.08 Tm (But we are using the media also for providing information to the people,\ to convey the )Tj 0.089 Tw -3 -1.72 Td (status report as well as NIEC activities, so media can b)Tj 22.855 0 Td (e used and harnessed to play a positive )Tj 0 Tw -22.855 -1.72 Td (part in the IHR.)Tj ( )Tj 0.21 Tw 3 -1.74 Td (Now, as far as the surveillance is concerned we have got this National S\ urveillance )Tj 0.064 Tw -3 -1.72 Td [(Program for Communicable Diseases )0.5(which )0.5(has )0.5(now )0.5(been )0.5(replaced )0.5(with )0.5(the )0.5(IDSP )]TJ 0 Tw (\226)Tj ( )Tj 0.064 Tw 34.735 0 Td [(that )0.5(is, )0.5(the )]TJ 0.06 Tw -34.735 -1.72 Td (Integrated Disease Surve)Tj (illance Project )Tj 0 Tw (\226)Tj ( )Tj 0.06 Tw 17.044 0 Td (which is a World Bank project. And also we have the )Tj 0 Tw -17.044 -1.72 Td (five)Tj (-)Tj 0.098 Tw (year planning, the budget is allotted in a five)Tj 0 Tw 20.531 0 Td (-)Tj 0.098 Tw (year plan, so the [le)Tj 0 Tw (-)Tj (ven)Tj (-)Tj 0.098 Tw (fire?] plan, already )Tj -20.531 -1.74 Td (the budget support is there for the surveillance as well as IHR implemen\ tation. The la)Tj 0 Tw 35.612 0 Td (boratory )Tj 0.156 Tw -35.612 -1.72 Td (strengthening on the IDSP has been provided, especially in the context o\ f the avian \222flu and )Tj 0.062 Tw 0 -1.72 TD [(pandemic )0.5(\222flu )0.5(preparedness, )0.5(so )0.5(we )0.5(have )0.5(operated )0.5(our )0.5(labs. )0.5(All )0.5(year )0.5(we )0.5(had )0.5(only )0.5(one )0.5(BSL3 )0.5(lab, )]TJ 0.07 Tw T* (now there are going to be four more coming up so the lab stru)Tj 25.655 0 Td (cture has been in increased. And )Tj 0 Tw -25.655 -1.74 Td (the training of health staff is an ongoing process.)Tj 19.523 0 Td ( )Tj 0.387 Tw -16.523 -1.72 Td (Now, there were... initially the Disease Surveillance System was very lo\ cal and )Tj 0.044 Tw -3 -1.72 Td (information was not available at the centre level, and there were differ\ ent gaps. Some stat)Tj 36.43 0 Td (es had )Tj 0.025 Tw -36.43 -1.72 Td (very good surveillance systems, some states did not have a good surveill\ ance system in place, so )Tj 0.131 Tw 0 -1.74 TD (there was a need for uniformity and so the National Surveillance Program\ for Communicable )Tj 0.033 Tw 0 -1.72 TD (Diseases was started, and they trained the Rapid Response Team)Tj 26.181 0 Td (s both at the state as well as the )Tj 0.028 Tw -26.181 -1.72 Td (district levels and this information was passed to the centre. This one \ was covering 101 districts. )Tj 0.045 Tw T* (We\222ve got 600 districts in the country, so it covered all the states \ but only three or four districts )Tj 0.039 Tw 0 -1.74 TD (per state )Tj 0 Tw (\226)Tj ( )Tj 0.039 Tw 4.476 0 Td (just as)Tj (, you can say, the pilot )Tj 0 Tw (\226)Tj ( )Tj 0.039 Tw 12.864 0 Td (and the national focal point was at NICD __ which is )Tj 0 Tw -17.339 -1.72 Td (coordinating the whole activity.)Tj 12.719 0 Td ( )Tj 0.082 Tw -9.719 -1.72 Td (Just to give you an example of how the villager\(?\) works and the count\ ry office works, )Tj 0.556 Tw -3 -1.72 Td (we have one microbiologist, one epidemiologist placed in)Tj 0 Tw 27 0 Td ( )Tj 0.556 Tw 0.806 0 Td (the National Institute of )Tj 0.095 Tw -27.806 -1.74 Td (Communicable Diseases, and so whatever information comes from the states\ or districts to the )Tj 0.132 Tw 0 -1.72 TD (National Institute of Communicable Diseases is immediately available to \ the WHO. Similarly )Tj 0.039 Tw T* (now with the IHR and with the Emerging Infect)Tj (ious Diseases program expanding, a subregional )Tj 0.1 Tw T* (office of the CRO )Tj 0 Tw (\226)Tj ( )Tj 0.1 Tw 8.694 0 Td (the south)Tj 0 Tw (-)Tj 0.1 Tw (east regional office )Tj 0 Tw 12.285 0 Td (\226)Tj ( )Tj 0.1 Tw 0.85 0 Td (is also located in the National Institute of )Tj 0.004 Tw -21.83 -1.74 Td [(Communicable )0.5(Diseases. )0.5(So )0.5(again )0.5(there\222ll )0.5(be )0.5(an )0.5(epidemiologist )0.5(and )0.5(microbiologist )0.5(located )0.5(there. )]TJ 0 Tw T* (And so as far a)Tj (s the international health part is concerned I\222m sure that we\222ll b\ e taking care of it.)Tj 38.597 0 Td ( )Tj 0.146 Tw -35.597 -1.72 Td (Now, you\222re in this program, this was basically outbreak reporting on\ ly, so these two )Tj 0.101 Tw -3 -1.72 Td (only report... this was an early warning system, they used to report out\ breaks only)Tj 34.106 0 Td (, they never )Tj ET endstream endobj 489 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (21)Tj ( )Tj ET Q BT 0.167 Tw 12 0 0 12 107.88 709.08 Tm (And we have a dispute resolution system, the Central Council for Health \ and Family )Tj 0 Tw -3 -1.72 Td (We)Tj 0.019 Tw (lfare, which meets almost twice a year or whenever there is a dispute, s\ o this is also available )Tj 0 Tw 0 -1.72 TD (as far as conflict resolution is concerned.)Tj 16.355 0 Td ( )Tj 0.013 Tw -13.355 -1.74 Td (Now, as far as the budgetary issues are concerned, there are adequate re\ sources at present )Tj 0.032 Tw -3 -1.72 Td (to fulfill the basic obl)Tj (igations of IHR implementation but additional funds would be required fo\ r )Tj 0 Tw T* (capacity)Tj (-)Tj 0.118 Tw (building because that\222s a huge area, both at the centre, state and di\ stricts. The public )Tj 0.189 Tw T* (health laboratories, we do have funding for the public health laboratori\ es but to in)Tj 35.173 0 Td (clude the )Tj 0 Tw -35.173 -1.74 Td (networking and many... especially important reagents which have be impor\ ted.)Tj 31.574 0 Td ( )Tj 0.125 Tw -28.574 -1.72 Td (Then border crossings is a major area, and the number of border crossing\ s, we have a )Tj 0.049 Tw -3 -1.72 Td (very large international border so we have a large number of crossings. \ And the bord)Tj 34.647 0 Td (er network )Tj 0.124 Tw -34.647 -1.72 Td (has authority because the number of ports and airports in India is incre\ asing significantly and )Tj 0.06 Tw 0 -1.74 TD (some of them are becoming privatization, and this is another area where \ the private airports are )Tj 0.023 Tw 0 -1.72 TD (not willing to have the government port health offic)Tj (ers located in their airport, so this is going to )Tj 0 Tw T* (create a problem. We are still negotiating on how they are going to sort\ this out.)Tj 31.963 0 Td ( )Tj 0.022 Tw -28.963 -1.72 Td (And then hospitals for admitting large numbers of patients under isolati\ on, is this another )Tj 0 Tw -3 -1.74 Td (area which we find requires a l)Tj (ot of attention and would require additional funds.)Tj 32.434 0 Td ( )Tj 0.101 Tw -29.434 -1.72 Td (The other non)Tj 0 Tw (-)Tj 0.101 Tw (governmental actors, the major metros, we have got very large metros )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj 0.045 Tw -38.5 -1.72 Td (that is Mumbai, Kolkata, Chennai and Delhi, with populations of, you can\ say, about 20 million )Tj 0.022 Tw T* (population. So these are)Tj 0 Tw ( )Tj 0.022 Tw 9.945 0 Td (cities which their health budgets also are very huge, and they are almos\ t )Tj 0.077 Tw -9.945 -1.74 Td [(separated )0.5(from )0.5(the )0.5(state )0.5(government )0.5(system, )0.5(so )0.5(getting )0.5(them )0.5(involved... )0.5(but )0.5(they )0.5(do )0.5(not )0.5(have )0.5(a )]TJ 0.033 Tw T* (very organized structure compared to what we have in the states, as well\ as a lot of h)Tj 34.442 0 Td (ealthcare is )Tj 0 Tw -34.442 -1.72 Td (in the private sector, so getting them in is also a problem, but we are \ working on that.)Tj 34.159 0 Td ( )Tj 0.225 Tw -31.159 -1.72 Td (And then different airlines, railways, these others, they are all in dia\ logue, they are )Tj 0 Tw -3 -1.74 Td (providing the support, but that requires improvement.)Tj 21.44 0 Td ( )Tj 0.045 Tw -18.44 -1.72 Td (Now, as far )Tj (as the media is concerned, the freedom of press is a major factor in fre\ quent )Tj 0.138 Tw -3 -1.72 Td (reporting of outbreaks, so in every paper you\222ll find at least ten to\ twelve outbreaks reported )Tj 0.19 Tw T* (every day, and they often )Tj 0 Tw (\226)Tj ( )Tj 0.19 Tw 12.274 0 Td (for sensationalism )Tj 0 Tw (\226)Tj ( )Tj 0.19 Tw 8.874 0 Td (always report it as a mysterious )Tj (illness or )Tj 0.028 Tw -21.147 -1.74 Td (unknown disease, and this creates a problem for us because the networks \ pick it up, but until the )Tj 0 Tw T* (lab confirmation comes up invariably these diseases will be considered a\ s uncontrolled outbreak.)Tj 38.794 0 Td ( )Tj 0.003 Tw -35.794 -1.72 Td [(And )0.5(there )0.5(are )0.5(24)]TJ 0 Tw (-)Tj 0.003 Tw [(hour )0.5(news )0.5(channels, )0.5(so )0.5(they )0.5(want )]TJ [(news, )0.5(so )0.5(health )0.5(is )0.5(now )0.5(becoming )0.5(very )]TJ 0 Tw -3 -1.72 Td (interesting news for them and so they keep on getting a lot of informati\ on.)Tj 29.715 0 Td ( )Tj ET endstream endobj 490 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 491 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 492 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 493 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 494 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 495 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (20)Tj ( )Tj ET Q BT 0.127 Tw 12 0 0 12 71.88 709.08 Tm (which have a potential to spread rapidly, it has a list of epidemi)Tj 0 Tw 26.875 0 Td (c)Tj (-)Tj 0.127 Tw (prone diseases which cover )Tj 0.076 Tw -26.875 -1.72 Td [(most )0.5(of )0.5(the )0.5(important )0.5(diseases )]TJ 0 Tw (\226)Tj ( )Tj 0.076 Tw 13.617 0 Td [(29 )0.5(diseases )]TJ 0 Tw 4.928 0 Td (\226)Tj ( )Tj 0.076 Tw 0.825 0 Td [(plus )0.5(a )0.5(PHEIC )0.5(which )0.5(is )0.5(when )0.5(notified )0.5(by )0.5(WHO. )]TJ 0.024 Tw -19.371 -1.72 Td (So they implicitly have taken into consideration the decision instrument\ , and if WHO says that... )Tj 0.159 Tw 0 -1.74 TD (like, say, the country office says thi)Tj (s constitutes a potential PHEIC the government can take )Tj 0.051 Tw 0 -1.72 TD (action in this act. They also cover bioterrorism with 34 listed agents )Tj 0 Tw 28.023 0 Td (\226)Tj ( )Tj 0.051 Tw 0.801 0 Td (viral fungal and bacterial )Tj 0.073 Tw -28.824 -1.72 Td (agents, and others )Tj 0 Tw (\226)Tj ( )Tj 0.073 Tw 8.484 0 Td (and also disasters )Tj 0 Tw (\226)Tj ( )Tj 0.073 Tw 8.29 0 Td (mostly natural and man)Tj 0 Tw (-)Tj 0.073 Tw (made disasters, again others )Tj 0 Tw (\226)Tj ( )Tj -16.774 -1.72 Td (and )Tj 0.066 Tw 1.76 0 Td (the centre will have powers to direct the states when this type of occas\ ion occurs, and they )Tj 0.126 Tw -1.76 -1.74 Td (will declare that area )Tj 0 Tw 9.111 0 Td (\226)Tj ( )Tj 0.126 Tw 0.876 0 Td (it could be a district, it could be a state, or many states )Tj 0 Tw 23.608 0 Td (\226)Tj ( )Tj 0.126 Tw 0.876 0 Td (as a public )Tj 0.172 Tw -34.471 -1.72 Td (health emergency area for a three)Tj 0 Tw 14.211 0 Td (-)Tj 0.172 Tw (month duration and will have a)Tj (ll powers to coordinate all )Tj 0 Tw -14.211 -1.72 Td (activities in that area.)Tj 8.552 0 Td ( )Tj 0.027 Tw -5.552 -1.72 Td (Now, while this act was being reviewed there was a need for a draft mode\ l Public Health )Tj 0.022 Tw -3 -1.74 Td (Emergencies Act from countries so that we could adapt it, and we did sea\ rch the ___ WHO also, )Tj 0.052 Tw T* (country office, to se)Tj (arch for it. We searched, we found New Zealand has passed a recent act )Tj 0 Tw 37.865 0 Td (\226)Tj ( )Tj 0.802 0 Td (I )Tj 0.075 Tw -38.667 -1.72 Td (think in 2006 )Tj 0 Tw (\226)Tj ( )Tj 0.075 Tw 6.632 0 Td (but we were not able to get any material on these acts because the gover\ nment )Tj 0.027 Tw -6.632 -1.72 Td (wants to compare this act. I think it would be useful if we could have a\ draft model av)Tj (ailable for )Tj 0 Tw 0 -1.74 TD (countries who would like to amend their acts.)Tj 18.218 0 Td ( )Tj 0.057 Tw -15.218 -1.72 Td (As far as vertical policy coordination and coherence is concerned, the c\ urrent strategy is )Tj 0.215 Tw -3 -1.72 Td (we have one of the important programs called the National Rural Health M\ ission which is )Tj 0.093 Tw 0 -1.72 TD (covering the 18 maj)Tj (or states which are lagging behind, you can say, from the other states, \ and )Tj 0.079 Tw 0 -1.74 TD (this is an umbrella organization where all the public health programs ar\ e coming into this. It is )Tj 0 Tw 0 -1.72 TD (catering mainly for the rural areas.)Tj 13.827 0 Td ( )Tj 0.302 Tw -10.827 -1.72 Td (Then we have our India services system that t)Tj 20.691 0 Td (he bureaucrats )Tj 0 Tw 6.657 0 Td (\226)Tj ( )Tj 0.302 Tw 1.052 0 Td (that is the Indian )Tj 0.142 Tw -31.4 -1.72 Td (Administrative Service or the Indian Police Service, as well as the cent\ ral government health )Tj 0 Tw 0 -1.74 TD (schemes )Tj 3.704 0 Td (\226)Tj ( )Tj 0.066 Tw 0.816 0 Td (these officers are posted at all these states and districts so we have a\ central service. )Tj 0 Tw -4.52 -1.72 Td (So you can say their alleg)Tj (iance is to the centre although they function at the state level.)Tj 34.794 0 Td ( )Tj 0.14 Tw -31.794 -1.72 Td (Similarly we have the regional Offices of Health and Family Welfare cove\ ring all the )Tj 0.053 Tw -3 -1.72 Td [(states )0.5(and )0.5(union )0.5(territories, )0.5(so )0.5(their )0.5(main )0.5(role )0.5(is to )0.5(monitor )0.5(the )0.5(implementation )0.5(of )0.5(central )0.5(health )]TJ 0 Tw T* (progr)Tj (ams.)Tj ( )Tj 0.022 Tw 3 -1.72 Td (And then the whole communication network comes under the centre, so all \ information )Tj 0 Tw 35.5 0 Td (\226)Tj ( )Tj -38.5 -1.72 Td (whether it is through the IT or the telecom )Tj 17.189 0 Td (\226)Tj ( )Tj (is all under the central control.)Tj 12.968 0 Td ( )Tj ET endstream endobj 496 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (19)Tj ( )Tj ET Q BT 0.369 Tw 12 0 0 12 71.88 709.08 Tm (national health programs. So these are vertical programs and they ensure\ that two)Tj 0 Tw 37.001 0 Td (-)Tj (way )Tj -37.001 -1.72 Td (communication between)Tj ( )Tj (states and the centre.)Tj ( )Tj 0.156 Tw 3 -1.72 Td (As far as emergencies are concerned, like in SARS and avian influenza, t\ he centre is )Tj 0.072 Tw -3 -1.74 Td (always involved in these activities. They are monitoring it around the c\ lock. Although the state )Tj 0.074 Tw 0 -1.72 TD (has the powers to do most of their activities but )Tj 19.96 0 Td (the central team is always deputed and closely )Tj 0 Tw -19.96 -1.72 Td (support the response activities.)Tj ( )Tj 0.05 Tw 3 -1.72 Td (Now, states can also directly obtain external funding from different age\ ncies )Tj 0 Tw (\226)Tj ( )Tj 32.223 0 Td (including )Tj -35.223 -1.74 Td (the World Bank )Tj (\226)Tj ( )Tj (but for all these they have to get sanction from the centre.)Tj 30.435 0 Td ( )Tj 0.064 Tw -27.435 -1.72 Td (Now, the)Tj 0 Tw ( )Tj 0.064 Tw 4.044 0 Td (national health programs are listed out there. We\222ve got most of the \ important )Tj 0.022 Tw -7.044 -1.72 Td (diseases in them. They also have a strong surveillance component, diseas\ e)Tj 0 Tw 29.937 0 Td (-)Tj 0.022 Tw (specific, but these are )Tj 0.043 Tw -29.937 -1.72 Td (all vertical and it is direct information flows from the district, state\ , dire)Tj 29.232 0 Td (ctly to the centre, so the )Tj 0 Tw -29.232 -1.74 Td (centre\222s always aware of these diseases.)Tj ( )Tj 0.084 Tw 3 -1.72 Td (Now, as far as reform is concerned, there are already changes to existin\ g legislations at )Tj 0.108 Tw -3 -1.72 Td (national and state level which have been an ongoing process depending on\ the diseases which )Tj 0.055 Tw T* (have b)Tj (een coming up at different parts of years, and although disease surveill\ ance itself is not a )Tj 0 Tw 0 -1.74 TD (legal requirement but most states have a disease surveillance system.)Tj 27.547 0 Td ( )Tj 0.2 Tw -24.547 -1.72 Td (Now, some of the existing legislations which govern the key IHR)Tj 0 Tw (-)Tj 0.2 Tw (related issues, the )Tj /TT1 1 Tf 0.025 Tw -3 -1.72 Td (Public He)Tj (alth Act of 1925)Tj /TT0 1 Tf 0 Tw ( )Tj 0.025 Tw 10.819 0 Td (is being revised, but even that is quite broad enough, it covers a lot o\ f )Tj 0.072 Tw -10.819 -1.72 Td (area. The )Tj /TT1 1 Tf 4.114 0 Td (Public Health Emergencies Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.072 Tw 13.118 0 Td (is being processed at present. This should have come )Tj 0.048 Tw -17.232 -1.74 Td (out 2005 but with some additions from the IHR this is going to be... \(I\ \222)Tj (ll just clarify some more )Tj 0.104 Tw 0 -1.72 TD (on it?\). Then there is, under the concurrent list, entry 29, there is a\ prevention of extension of )Tj 0.034 Tw T* (infectious diseases from one state to another. Port quarantine is again \ a very old listing based on )Tj 0 Tw T* (the union list entry.)Tj ( )Tj 3 -1.74 Td (The )Tj /TT1 1 Tf 1.927 0 Td (Natio)Tj 0.123 Tw (nal Disaster Act)Tj /TT0 1 Tf (, which came into existence last year )Tj 0 Tw (\226)Tj ( )Tj 25.638 0 Td (2005 )Tj 2.373 0 Td (\226)Tj ( )Tj 0.123 Tw 0.873 0 Td (it gives very )Tj 0.082 Tw -33.811 -1.72 Td (broad powers under the... it\222s just a management authority totally in\ dependent under the whole )Tj 0 Tw T* (ministry, controls all the other activities and inter)Tj 19.717 0 Td (-)Tj (sectoral cooperation.)Tj ( )Tj 0.128 Tw -16.717 -1.72 Td [(And )0.5(the )]TJ /TT1 1 Tf 3.699 0 Td [(Right )0.5(to )0.5(Information )0.5(Act)]TJ /TT0 1 Tf [(, )0.5(this )0.5(was )0.5(recently )0.5(passed )0.5(in )0.5(2005, )0.5(where )0.5(any )0.5(person )]TJ 0 Tw -6.699 -1.74 Td (from the public or a journalist can get any information from the governm\ ent on any issue.)Tj 35.879 0 Td ( )Tj 0.005 Tw -32.879 -1.72 Td (Now, this is draft )Tj /TT1 1 Tf (Public Health Emergencies Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.005 Tw 20.06 0 Td [(which under process. It provides for )0.5(the)]TJ 0 Tw ( )Tj 0.106 Tw -23.06 -1.72 Td [(control and management of all public health emergencies, including )0.5(PHEIC. )0.5(And )0.5(the )0.5(scope )0.5(of )]TJ 0 Tw T* (the )Tj /TT1 1 Tf 1.508 0 Td (Act)Tj /TT0 1 Tf 0.036 Tw (, basically from the draft which we have seen, it covers the invasive\(?\ \) epidemic diseases )Tj ET endstream endobj 497 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (18)Tj ( )Tj ET Q BT 0.101 Tw 12 0 0 12 107.88 709.08 Tm (Now, states also obtain significant funding from the centre for their su\ b)Tj 0 Tw (-)Tj 0.101 Tw (centres, that is )Tj 0.087 Tw -3 -1.72 Td (the health unit which is in the villages, so those are completely funded\ by the centre. Then we )Tj 0.188 Tw 0 -1.72 TD [(have )0.5(the )0.5(primary)]TJ 0 Tw ( )Tj 0.188 Tw 7.587 0 Td [(health )0.5(centre )0.5(or )0.5(the )0.5(community )0.5(health )0.5(centre )0.5(which )0.6(is )0.6(a )0.5(little )0.5(bigger)]TJ 0 Tw 29.136 0 Td (-)Tj (level )Tj 0.139 Tw -36.724 -1.74 Td (health centre covering 1 lakh to 3 lakh population )Tj 0 Tw 21.387 0 Td (\226)Tj ( )Tj 0.139 Tw 0.889 0 Td (so 100,000 to 300,000 population )Tj 0 Tw (\226)Tj ( )Tj 15.28 0 Td (and )Tj -37.556 -1.72 Td (some of the temporary staff, the drugs, the lab equipment, these are all\ funded by the )Tj 34.184 0 Td (centre.)Tj ( )Tj 0.08 Tw -31.184 -1.72 Td (And also we have another system which is from the social welfare departm\ ent which is )Tj 0.137 Tw -3 -1.72 Td (called the Integrated Child Development System, which has )Tj /TT1 1 Tf 0 Tw 25.342 0 Td (anganwadis)Tj /TT0 1 Tf ( )Tj 0.137 Tw 5.221 0 Td (which look after the )Tj 0 Tw -30.563 -1.74 Td (under)Tj (-)Tj 0.399 Tw (five children. It\222s more like a government creche, and we provide n)Tj 33.963 0 Td (utrition and )Tj 0.032 Tw -33.963 -1.72 Td (immunization, so these are all supported by the centre. So a centre has \ a large amount of control )Tj 0 Tw T* (in many of the activities because of their funding support.)Tj 23.105 0 Td ( )Tj 0.084 Tw -20.105 -1.72 Td (Now, also the centre... although we have district rapid response teams w\ hich have bee)Tj 0 Tw 35.5 0 Td (n )Tj 0.01 Tw -38.5 -1.74 Td [(trained )0.5(by )0.5(the )0.5(centre, )0.5(as )0.5(well )0.5(as )0.5(we )0.5(have )0.5(state )0.5(rapid response )0.5(teams )0.5(which )0.5(are )0.5(multidisciplinary )]TJ 0 Tw 38.5 0 Td (\226)Tj ( )Tj 0.546 Tw -38.5 -1.72 Td [(consisting )0.5(of )0.5(epidemiologists, )0.5(microbiologists, )0.5(entomologists )0.5(and )0.5(the )0.5(other )0.5(specialists, )]TJ 0.028 Tw T* (pediatrician and physicians )Tj 0 Tw 11.22 0 Td (\226)Tj ( )Tj 0.028 Tw 0.778 0 Td (but as long as if it\222s a small outbr)Tj (eak and it is able to be controlled )Tj 0.151 Tw -11.998 -1.72 Td (by the district it is controlled at that level and the information is pa\ ssed on, but otherwise if )Tj 0.042 Tw 0 -1.74 TD [(suppose )0.5(two )0.5(or )0.5(more )0.5(districts )0.5(are )0.5(affected )0.6(the )0.5(state )0.5(rapid )0.5(response )0.5(teams )0.5(enter )0.5(into )0.5(the )0.5(situation. )]TJ 0.186 Tw 0 -1.72 TD (But if the outbreak is)Tj 0 Tw ( )Tj 0.186 Tw 9.623 0 Td (significantly large and there are, say, reported deaths, then the centre\ )Tj 0.072 Tw -9.623 -1.72 Td (usually sends a central team, and this central rapid response team is ma\ de up of members from )Tj 0.105 Tw T* (the National Institute of Communicable Diseases )Tj 0 Tw 20.516 0 Td (\226)Tj ( )Tj 0.105 Tw 0.855 0 Td (which functions somewhat like the CDC )Tj 0 Tw 17.129 0 Td (\226)Tj ( )Tj 0.047 Tw -38.5 -1.74 Td (and they co)Tj 0 Tw (-)Tj 0.047 Tw (opt other members, and so they could go in with or without the request o\ f the state. )Tj 0.073 Tw T* (Most of them, the states do request, but invariably... I mean, it is aut\ omatically understood that )Tj 0 Tw T* (they can move in.)Tj ( )Tj T* ([Start of Side 2])Tj ( )Tj 0.009 Tw 3 -1.74 Td (The centre is also inv)Tj (olved in a large amount of capacity)Tj 0 Tw 22.752 0 Td (-)Tj 0.009 Tw (building and laboratory support, )Tj 0.282 Tw -25.752 -1.72 Td (so most of the samples as far as samples, as far as communicable disease\ outbreaks are )Tj 0.066 Tw T* (concerned, would land up in a central laboratory or a referral laborator\ y, so the centre\222s always )Tj 0 Tw T* (aw)Tj (are of what is happening in states.)Tj ( )Tj 0.01 Tw 3 -1.74 Td (Now, many of the programs like the Integrated Disease Surveillance Proje\ ct, the National )Tj 0.098 Tw -3 -1.72 Td (Aids Control Project, the Revised National Tuberculosis Control Project,\ or the National Polio )Tj 0.158 Tw T* (Surveillance project, so these are p)Tj (rojects which function on a project mode and are directly )Tj 0.193 Tw T* (funded by the centre for these important diseases, and as they progress \ they can move into )Tj ET endstream endobj 498 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (17)Tj ( )Tj ET Q BT 0.142 Tw 12 0 0 12 71.88 709.08 Tm (existing systems are already in place for the basic requirement of imple\ menting the IHR, but )Tj 0 Tw 0 -1.72 TD (definitely much more could have been done.)Tj 17.799 0 Td ( )Tj -14.799 -1.72 Td (Now)Tj 0.204 Tw (, many of the health legislations are quite old but still they are very \ broad and )Tj 0.116 Tw -3 -1.74 Td (they\222re still being utilized, and there are some areas where the amen\ dments are already in the )Tj 0.305 Tw T* [(process. )0.5(Much )0.5(before )0.5(the )0.5(IHR )0.5(they )0.5(were )0.5(already )0.5(in process )0.5(but )0.5(now, )0.5(after )0.5(IHR, )0.5(c)]TJ 0 Tw (ertain )Tj 0.076 Tw T* (amendments have been added to it. But at the same time we find that many\ of the places other )Tj 0.003 Tw T* (legislations have been used, like during the avian influenza outbreak in\ Madhya Pradesh the CPC )Tj 0 Tw 0 -1.74 TD (\226)Tj ( )Tj 0.07 Tw 0.82 0 Td (the Communicable Procedure Code )Tj 0 Tw 14.777 0 Td (\226)Tj ( )Tj 0.07 Tw 0.82 0 Td (was used, and then simil)Tj (arly Maresha\(?\) the )Tj /TT1 1 Tf 18.375 0 Td (Police Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.155 Tw -34.793 -1.72 Td (was used which basically is a broad heading of maintenance of public law\ and order, so the )Tj 0.018 Tw 0 -1.72 TD (administrative head of the district can impose a law and coordinate all \ activities with that type of )Tj 0 Tw T* (a law.)Tj ( )Tj 0.06 Tw 3 -1.74 Td (Now, many states have... t)Tj (here are different states in the country, there are 35 states and )Tj 0.019 Tw -3 -1.72 Td (union territories, so some are very well developed )Tj 0 Tw (\226)Tj ( )Tj 0.019 Tw 21.161 0 Td (you can see the southern states, and some of )Tj 0.004 Tw -21.161 -1.72 Td (the northern states )Tj 0 Tw (\226)Tj ( )Tj 0.004 Tw 8.348 0 Td (but some are backwards states and less developed or they got statehood)Tj 0 Tw 28.622 0 Td ( )Tj 0.254 0 Td (later )Tj 0.225 Tw -37.224 -1.72 Td [(on )0.5(so )0.5(they )0.5(are )0.5(still )0.5(lagging )0.5(behind. )0.5(So )0.6(there\222s a )0.6(vast )0.5(difference )0.5(of )0.5(the )0.5(state )0.5(legislations )0.5(in )]TJ 0 Tw 0 -1.74 TD (different states.)Tj ( )Tj 0.005 Tw 3 -1.72 Td (States have a surveillance system. Though surveillance is not a legal re\ quirement but they )Tj 0.186 Tw -3 -1.72 Td (all have a surveillance system, and initially)Tj 0 Tw 18.36 0 Td ( )Tj 0.186 Tw 0.436 0 Td (they were just reporting about 30 diseases on a )Tj 0.063 Tw -18.796 -1.72 Td [(monthly basis, which is more of a health information because most of )0.5(the )0.5(activity )0.5(is to be done )]TJ 0.112 Tw T* (by the state, but later on the government has introduced a central progr\ am called the National )Tj 0.204 Tw 0 -1.72 TD (Surveillance Pro)Tj (gram for Communicable Diseases, and this was directly getting informatio\ n )Tj 0.125 Tw T* [(from )0.5(101 )0.5(districts, )0.5(and )0.5(this )0.5(was )0.5(being )0.5(coordinated )0.5(by )0.5(the )0.5(National )0.5(Institute )0.5(of )0.5(Communicable )]TJ 0 Tw T* (Diseases which I told you was the coordinating authority for communicabl\ e diseases.)Tj 34.103 0 Td ( )Tj -31.103 -1.74 Td (Now, )Tj 0.036 Tw 2.48 0 Td (a district in the country is the independent administrative unit, and it\ can vary with )Tj 0.205 Tw -5.48 -1.72 Td (a population of one to four million population, and they do the early wa\ rning, they do the )Tj 0 Tw T* (response, but at the same time they do inform the state and he centre.)Tj 27.63 0 Td ( )Tj 0.042 Tw -24.63 -1.72 Td (Now, st)Tj (ates do report sometimes late to the centre due to various reasons, and \ one of the )Tj 0.079 Tw -3 -1.74 Td [(major causes could be lack of information or diagnosis, because )0.5(many of )0.5(our labs are centrally )]TJ 0.238 Tw T* (located. Though we have state labs which are of good quality but they\222\ re not l)Tj (inked very )Tj 0 Tw T* (effectively with the surveillance system.)Tj 16.133 0 Td ( )Tj ET endstream endobj 499 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (16)Tj ( )Tj ET Q BT 0.107 Tw 12 0 0 12 107.88 709.08 Tm (India has a federal structure where health is a state subject in the mai\ n. We have three )Tj 0 Tw -3 -1.72 Td (li)Tj 0.032 Tw (sts, basically, a central or a union list, a state list, and a concurren\ t list. So the central list is the )Tj 0.173 Tw 0 -1.72 TD (one which has most of the public health legislations which are more link\ ed to public health )Tj 0.015 Tw 0 -1.74 TD (aspects like water, sanitation and many other issues. The)Tj 0 Tw ( )Tj 0.015 Tw 23.048 0 Td (state lists do have some of the same but )Tj 0.032 Tw -23.048 -1.72 Td (also have a lot of areas like health emergencies, especially of diseases\ specific to the states. And )Tj 0.103 Tw 0 -1.72 TD (we also have a concurrent list which has a lot of areas which can be int\ erstate issues and also )Tj 0 Tw T* (which we have the)Tj (se emergencies which can be made by the state or the centre.)Tj 31.791 0 Td ( )Tj 0.052 Tw -28.791 -1.74 Td (Now, a new development is that certain diseases, like pandemic diseases \ like in the case )Tj 0.084 Tw -3 -1.72 Td (of SARS or avian \222flu or pandemic \222flu it could be declared as a p\ ublic health disaster and the )Tj 0.304 Tw T* (centre cou)Tj (ld take complete control. We have also recently established a national d\ isaster )Tj 0.02 Tw T* (management authority, so these issues come up in front of them and it is\ controlled by the Home )Tj 0.124 Tw 0 -1.74 TD (Ministry so all the issues )Tj 0 Tw (\226)Tj ( )Tj 0.124 Tw 11.686 0 Td (especially inter)Tj 0 Tw (-)Tj 0.124 Tw (sectoral coordination and funding )Tj 0 Tw (\226)Tj ( )Tj 0.124 Tw 21.623 0 Td (is much more )Tj 0 Tw -33.309 -1.72 Td (easier in this type of a system.)Tj ( )Tj 0.027 Tw 3 -1.72 Td (The Constitution of India guarantees the right to life in Article 21, an\ d right to health has )Tj 0.291 Tw -3 -1.72 Td (also been a prerequisite recognized by the Supreme Court. And many judge\ ments of the )Tj 0.023 Tw T* (Supreme Court have helped a l)Tj (ot in health legislation. I was just giving the example of including )Tj 0 Tw 0 -1.72 TD (pollution )Tj 3.96 0 Td (\226)Tj ( )Tj 0.098 Tw 0.848 0 Td (air pollution )Tj 0 Tw 5.363 0 Td (\226)Tj ( )Tj 0.098 Tw 0.848 0 Td (in \(the list, that it was?\) controlled by the Supreme Court giving an \ )Tj 0.006 Tw -11.019 -1.72 Td (order that most of the industries have to move out, and a shift from die\ sel to CNG gas in)Tj 0 Tw ( )Tj 35.724 0 Td (vehicles )Tj -35.724 -1.72 Td (has made a big difference in bringing down pollution in Delhi.)Tj 25.022 0 Td ( )Tj 0.131 Tw -22.022 -1.74 Td (Many times, though, individuals have got rights but the public health ca\ n override the )Tj 0.103 Tw -3 -1.72 Td (individual rights in many cases. In this example of the recent outbreak \ which we had in avian )Tj 0 Tw T* (in)Tj 0.089 Tw (fluenza, social isolation and limited quarantine were introduced in the \ affected areas, and we )Tj 0.041 Tw T* (had a lot of cooperation from the poultry farmers in this area, but I\222\ m sure that even if we had a )Tj 0.053 Tw 0 -1.74 TD (legislation in place there could have been some problems. And )Tj (also I will give you an example, )Tj 0.107 Tw 0 -1.72 TD (if the outbreak had not been controlled in the short time)Tj 0 Tw (-)Tj 0.107 Tw (frame that we had there would be an )Tj 0.025 Tw T* (issue of farmers committing suicide because they\222ve lost their income\ , you know, so that type of )Tj 0.009 Tw T* (issue which Dr.)Tj 0 Tw ( )Tj 0.009 Tw (Allison raised y)Tj [(esterday would also make a big impact on the government )0.5(taking )]TJ 0 Tw 0 -1.74 TD (a decision in such long)Tj (-)Tj (drawn outbreaks.)Tj ( )Tj 0.35 Tw 3 -1.72 Td (Now, there would be a requirement of enactments and amendments for effec\ tive )Tj 0.009 Tw -3 -1.72 Td (implementation of IHR, but as Dr.)Tj 0 Tw ( )Tj (Lazzari )Tj 17.297 0 Td (\226)Tj ( )Tj 0.759 0 Td (Stefano )Tj 3.313 0 Td (\226)Tj ( )Tj 0.009 Tw 0.759 0 Td (said yesterday, the I)Tj (HR implementation is )Tj 0.08 Tw -22.127 -1.72 Td (already linked with many other issues like disease surveillance, early w\ arning and response, so )Tj ET endstream endobj 500 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 501 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 502 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 503 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 504 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 505 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (15)Tj ( )Tj ET Q BT 0.101 Tw 12 0 0 12 107.88 709.08 Tm (but to provide them with a forum not dissimilar to the one we have ourse\ lves with our )Tj 0.128 Tw 0 -1.72 TD (states and territories, but the Pacific islands all being individual nat\ ions they\222re saying )Tj 0.03 Tw T* (they lacked that kind of ability to share informa)Tj 19.293 0 Td (tion and experience on a regular basis, so )Tj 0 Tw -19.293 -1.74 Td (we\222ve helped in that way.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.072 Tw 3 0 Td (And I\222m afraid I just didn\222t check this before I left )Tj 0 Tw (\226)Tj ( )Tj 0.072 Tw 22.019 0 Td (because I used to be in the )Tj 0.199 Tw -25.019 -1.72 Td (international branch )Tj 0 Tw 8.673 0 Td (\226)Tj ( )Tj 0.199 Tw 0.949 0 Td (one of the activities we agreed to was to help Pacific nations )Tj 0.12 Tw -9.622 -1.72 Td (implement the I)Tj (HR\222s and we set off an activity where they were going to do a sort of\ )Tj 0.108 Tw 0 -1.74 TD (inventory of where they thought they were up to, and as I say I apologiz\ e I just didn\222t )Tj 0.079 Tw 0 -1.72 TD (check where that process is up to but I believe that\222s still moving f\ orward. And if there )Tj 0.072 Tw T* (are area)Tj (s that Australia can provide financial support that it would be effectiv\ e I\222m sure )Tj 0 Tw T* (that we will.)Tj ( )Tj -3 -1.74 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Thank)Tj (-)Tj 0.175 Tw (you very much. If there are no further questions we can move on to our n\ ext )Tj 0 Tw T* (speaker, from India.)Tj ( )Tj -3 -1.72 Td ( )Tj /TT1 1 Tf T* (COUNTRY 6: INDIA)Tj ( )Tj 0 -1.66 TD (Dr.)Tj ( )Tj (Sampath Krishnan)Tj ( )Tj /TT0 1 Tf 3 -1.64 Td (Good morning.)Tj ( )Tj (I will be presenting the implementation of IHR in India.)Tj 28.745 0 Td ( )Tj 0.099 Tw -28.745 -1.74 Td (First of all I\222d also like to clarify that I am the IHR contact point\ in the WHO country )Tj 0.072 Tw -3 -1.72 Td (office in India. The actual IHR national focal point was the director of\ the National Institute of )Tj 0 Tw 0 -1.72 TD (Communicab)Tj 0.246 Tw [(le )0.5(Diseases )0.5(which )0.5(composed )0.5(the )0.5(entire )0.5(communicable )0.5(diseases )0.5(network )0.6(in )0.6(the )]TJ 0.138 Tw T* (country, but the present director, Dr.)Tj 0 Tw ( )Tj 0.138 Tw (Shiv Lal, could not make it at the last minute so I\222ll be )Tj 0 Tw 0 -1.74 TD (presenting on that.)Tj ( )Tj 0.128 Tw 3 -1.72 Td (But I\222d also like to emphasize, like the Australian team had jus)Tj 26.572 0 Td (t said, that the country )Tj 0.217 Tw -29.572 -1.72 Td [(office\222s )0.5(role )0.5(is )0.5(very )0.5(particular )0.5(as )0.5(far )0.5(as )0.5(the )0.5(IHR )0.5(is )0.5(concerned, )0.5(and )0.5(we )0.5(work )0.5(very )0.5(much )0.5(in )]TJ 0 Tw 0 -1.72 TD (coordination with the government of India in most of their activities re\ lated to the IHR.)Tj 34.908 0 Td ( )Tj 0.134 Tw -31.908 -1.74 Td (I will be making a presentation on three major area)Tj (s, that is the health legislation and )Tj 0.273 Tw -3 -1.72 Td (governance; the disease surveillance in the country; as well as the plan\ of action for the )Tj 0.012 Tw T* (implementation of IHR because we have already had a few workshops planni\ ng for this, how it\222s )Tj 0.082 Tw T* (going to be implemented. And I\222ll)Tj 0 Tw ( )Tj 0.082 Tw 14.408 0 Td (be a little diverting from the template that was given by the )Tj 0.184 Tw -14.408 -1.74 Td [(organizers, but I\222m sure that )0.5(at )0.5(the )0.5(end of the meeting most of the issues would have been )]TJ 0 Tw T* (clarified.)Tj ( )Tj ET endstream endobj 506 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (14)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm ( )Tj 3 0 Td ( )Tj 0.204 Tw 3 0 Td (We als)Tj (o have another issue in our northern border area where, one, we have )Tj 0.105 Tw -3 -1.72 Td (allowed traditional movement in the Torres Strait between Papua, New Gui\ nea and the )Tj 0.05 Tw 0 -1.72 TD (Torres Strait islanders who traditionally related and had a lot of tradi\ tional activities that )Tj 0.047 Tw 0 -1.74 TD (they und)Tj (ertake, so there\222s free movement there. And we also have a lot of ill\ egal fishing )Tj 0 Tw 0 -1.72 TD (\226)Tj ( )Tj 0.078 Tw 0.828 0 Td (fishers we\222re supposed to call them )Tj 0 Tw 14.855 0 Td (\226)Tj ( )Tj 0.078 Tw 0.828 0 Td (fishing people coming in from the north. While )Tj 0.112 Tw -16.511 -1.72 Td (there\222s a major detection operation going on up there we don\222t rea\ lly have any control )Tj 0.077 Tw T* [(over )0.5(it. )0.5(So, )0.5(what )0.5(we\222ve )0.5(said )0.5(to )0.5(the )0.5(government )0.5(is )0.5(we )0.5(believe )0.5(border )0.5(control )0.5(would )0.5(only )]TJ 0.098 Tw 0 -1.74 TD (be effective if it was really comprehensive, border closure would only b\ e effective if it )Tj 0.001 Tw 0 -1.72 TD (was really comprehensive. We don\222t think it\222s that realistic to sa\ y that you co)Tj 30.944 0 Td (uld close the )Tj 0.161 Tw -30.944 -1.72 Td (borders and therefore our advice would be to increase border control mea\ sures in the )Tj 0.014 Tw T* (initial stages in the hope of buying time to get ourselves organized to \ deal with a possible )Tj 0 Tw 0 -1.74 TD (pandemic and always trying to buy time until the development of )Tj 26.355 0 Td (a vaccine.)Tj ( )Tj -29.355 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Dr.)Tj ( )Tj (von Tigerstrom?)Tj ( )Tj -3 -1.72 Td (BT:)Tj ( )Tj 0.115 Tw 3 0 Td (Thanks. I don\222t know whether or to what extent you\222ll be able to a\ nswer this, but you )Tj 0.06 Tw 0 -1.72 TD (mentioned regional cooperation briefly and I wonder if you could speak a\ little bit more )Tj 0.051 Tw 0 -1.74 TD (about that. I\222m wondering about the assist)Tj (ance and cooperation that Australia\222s involved )Tj 0.225 Tw 0 -1.72 TD (with in the region, with especially the small Pacific islands and trying\ to deal with )Tj 0.188 Tw T* (bringing them into compliance with IHR obligations, and more broadly the\ extent to )Tj 0 Tw T* (which Australia acts as a resource for p)Tj (ublic health in the region.)Tj ( )Tj -3 -1.74 Td (CH:)Tj ( )Tj 0.007 Tw 3 0 Td (Yes, well, we\222ve had very strong... an increased regional engagement \ in the last couple of )Tj 0.033 Tw T* (years. We\222ve had a very strong program with Vietnam with exchange vis\ its, we\222ve had a )Tj 0.008 Tw T* (couple of very senior)Tj 0 Tw (-)Tj 0.008 Tw (level delegations going t)Tj (o Vietnam, but we\222ve also provided money )Tj 0.133 Tw T* (through AusAID to help boost surveillance and reporting, and I think we\222\ re funding a )Tj 0.051 Tw 0 -1.74 TD (field epidemiology program at the moment as part of that effort )Tj 0 Tw 26.189 0 Td (\226)Tj ( )Tj 0.051 Tw 0.801 0 Td (that\222s been very much )Tj 0.233 Tw -26.99 -1.72 Td (appreciated in Vietnam)Tj 0 Tw (-)Tj ( )Tj 0.233 Tw 10.61 0 Td (and there have als)Tj (o been exchange visits where we\222ve had )Tj 0 Tw -10.61 -1.72 Td (delegations come into Australia to undertake sort of study tour type act\ ivities.)Tj 31.104 0 Td ( )Tj -34.104 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.244 Tw 3 0 Td (We also have quite an investment in Indonesia as well. That\222s a littl\ e more )Tj 0 Tw -3 -1.74 Td (difficult for us, but still the relationship\222s pretty stro)Tj 20.802 0 Td (ng on the health side.)Tj ( )Tj -23.802 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.11 Tw 3 0 Td (In relation to the Pacific we a couple of years ago established somethin\ g called )Tj 0.067 Tw -3 -1.72 Td (the Pacific Leaders Network, which is the heads of Pacific health depart\ ments, and they )Tj 0.044 Tw 0 -1.72 TD [(meet with our senior staff yearly, )0.5(not just specifically about)]TJ 0 Tw 24.219 0 Td ( )Tj 0.044 Tw 0.294 0 Td (pandemic or avian influenza )Tj ET endstream endobj 507 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (13)Tj ( )Tj ET Q BT 0.329 Tw 12 0 0 12 107.88 709.08 Tm (out to the other hospitals because obviously Darwin couldn\222t cope wit\ h that. So, )Tj 0.238 Tw 0 -1.72 TD (administrative processes were set in place following that, and the Austr\ alian Health )Tj 0 Tw T* (Committee )Tj 4.739 0 Td (\226)Tj ( )Tj 0.045 Tw 0.795 0 Td (I don\222t remember what they were called, a very lon)Tj 20.899 0 Td (g name they had before )Tj 0.122 Tw -26.434 -1.74 Td (they were called the Australian Health Protection Committee )Tj 0 Tw 25.634 0 Td (\226)Tj ( )Tj 0.122 Tw 0.872 0 Td (was established. SARS )Tj 0.036 Tw -26.506 -1.72 Td [(obviously )0.5(tested )0.5(those )0.5(arrangements )0.5(to )0.5(some extent. We had )0.5(the )0.5(National )0.5(Incident )0.5(Room )]TJ 0.044 Tw T* (by then, and it was operational on a 24)Tj 0 Tw (-)Tj 0.044 Tw (hour basis during all o)Tj (f the SARS activities. We, )Tj 0.049 Tw T* (as some of you will know, were very strong supporters of the renegotiati\ on of the IHR\222s )Tj 0.468 Tw 0 -1.74 TD (because of the changed global environment and because we realized our ow\ n )Tj 0.087 Tw 0 -1.72 TD (arrangements needed strengthening and clearly others would as well,)Tj 0 Tw 28.269 0 Td ( )Tj 0.087 Tw 0.337 0 Td (particularly in our )Tj 0.195 Tw -28.606 -1.72 Td (region, so we have supported that very strongly. And I suppose the IHR\222\ s have just )Tj 0.004 Tw T* (provided the additional motivation to have a look at our legislative bas\ is. We say we have )Tj 0.042 Tw 0 -1.74 TD (a very strong capacity to respond, to detect and respond, but)Tj 0 Tw ( )Tj 0.042 Tw 24.764 0 Td (we\222ve had reason to look at )Tj 0.105 Tw -24.764 -1.72 Td (that over and over in the last few years because of SARS and AI and we\222\ ve obviously )Tj 0.009 Tw 0 -1.72 TD (found areas in which we could improve, and the ability to share data con\ fidently is one of )Tj 0 Tw T* (the areas that we think needs legislative improvemen)Tj 21.187 0 Td (t.)Tj ( )Tj -24.187 -1.74 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Dr.)Tj ( )Tj (Veyrat?)Tj ( )Tj -3 -1.72 Td (SV:)Tj ( )Tj 0.082 Tw 3 0 Td (France is a small country but has got many islands all over the world, a\ nd one of those )Tj 0.014 Tw T* [(islands )0.5(is )0.5(near )0.5(your )0.5(country, )0.5(Australia, )0.6(so )0.5(my )0.6(question )0.6(is )0.5(if )0.5(there )0.5(is )0.5(some )0.5(resortment\(?\) )0.5(of )]TJ 0 Tw T* (virus )Tj (\226)Tj ( )Tj (H5N1, for example )Tj (\226)Tj ( )Tj (should you close the bor)Tj (ders? Because you are an island.)Tj ( )Tj -3 -1.74 Td (CH:)Tj ( )Tj 0.082 Tw 3 0 Td (We\222ve had to advise government a couple of times on this. What we\222\ ve said to them is )Tj 0.259 Tw T* (our advice on border control )Tj 0 Tw (\226)Tj ( )Tj 0.259 Tw 13.938 0 Td (we don\222t call it border closure anymore because it )Tj 0.077 Tw -13.938 -1.72 Td (wouldn\222t necessarily be that )Tj 0 Tw (\226)Tj ( )Tj 0.077 Tw 12.632 0 Td (our advise on how dra)Tj (stic the measures need to be at the )Tj 0.247 Tw -12.632 -1.72 Td (border would be dependent on how lethal and infectious the virus was whe\ n it hit )Tj 0.041 Tw 0 -1.74 TD (Australia, so it would be a proportional response. If we had a very leth\ al, very infectious )Tj 0.095 Tw 0 -1.72 TD (virus that was going to have a major impact, we)Tj 0 Tw 20.018 0 Td ( )Tj 0.095 Tw 0.345 0 Td (may say that... the Health Department )Tj 0.088 Tw -20.363 -1.72 Td [(might )0.5(advise )0.5(the )0.5(government )0.5(that )0.5(the )0.5(best )0.5(health )0.5(action )0.5(would )0.5(be )0.5(to )0.5(stop )0.5(flights )0.5(from )0.5(a )]TJ 0.074 Tw T* (certain region or possibly... we don\222t think, realistically, we can s\ top all flights. I mean, )Tj 0.038 Tw 0 -1.74 TD (Australians would want to come home)Tj 0 Tw ( )Tj 0.038 Tw 15.893 0 Td (and it\222s very difficult to not let Australians home, )Tj 0.181 Tw -15.893 -1.72 Td (so that if the border\222s not closed it\222s not going to be effective.\ So, just letting some )Tj 0.212 Tw 0 -1.72 TD (people in defeats the purpose of closing the borders, so we don\222t rea\ lly think it\222s a )Tj 0 Tw T* (practical measure.)Tj ( )Tj ET endstream endobj 508 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (12)Tj ( )Tj ET Q BT 0.126 Tw 12 0 0 12 107.88 709.08 Tm [(biological and chemical agents, and as it just so happens responsibility\ for all )0.5(three of )]TJ 0.02 Tw 0 -1.72 TD (those things rests all or to some extent in the Department of Health and\ Ageing. We have )Tj 0.227 Tw T* (the agency that loo)Tj (ks after radiological issues, we also have an Office of Chemical )Tj 0.121 Tw 0 -1.74 TD (Safety, and I have responsibility for laboratories in the sense of polic\ y. So we have to )Tj 0.218 Tw 0 -1.72 TD [(implement )0.5(the )0.5(recommendations )0.5(from )0.5(that )0.5(process )0.5(which )0.5(include )0.5(setting )0.5(up )0.5(national )]TJ 0.033 Tw T* (authorities to regis)Tj (ter and monitor laboratories and to monitor the movement of chemical )Tj 0.274 Tw T* (agents of interest to terrorists, and radiological agents which are alre\ ady obviously )Tj 0 Tw 0 -1.74 TD (heavily regulated, so we needed to do that and that\222s got a clear sec\ urity focus.)Tj 31.489 0 Td ( )Tj -34.489 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.184 Tw 3 0 Td (And as I mentione)Tj (d, our pandemic planning has thrown up a lot of questions )Tj 0.073 Tw -3 -1.72 Td (around the )Tj /TT1 1 Tf (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.073 Tw 11.235 0 Td (or what powers actually do sit with the Commonwealth, and )Tj 0.022 Tw -11.235 -1.72 Td (the discussion has been around )Tj 0 Tw (\226)Tj ( )Tj 0.022 Tw 13.517 0 Td (as we\222ve all been talking about )Tj 0 Tw (\226)Tj ( )Tj 0.022 Tw 13.565 0 Td (whether or not to give )Tj 0.103 Tw -27.082 -1.74 Td (the federal government m)Tj (ore explicit powers in relation to health emergencies which it )Tj 0.025 Tw 0 -1.72 TD (currently has in relation to communicable disease. And at the end of thi\ s month, which is )Tj 0.026 Tw T* (the next of next week, we\222ll be having a discussion with the Australi\ an Health Protection )Tj 0.013 Tw T* (Committee to )Tj (get down to some level of agreement on that, what kind of powers we want\ )Tj 0 Tw 0 -1.74 TD (to give to the Commonwealth.)Tj ( )Tj -3 -1.72 Td ( )Tj 3 0 Td ( )Tj 0.037 Tw 3 0 Td (The final module that we\222re thinking of putting in this legislation i\ s a governance )Tj 0.018 Tw -3 -1.72 Td (module which might just formalize the coordination and, I suppose, d)Tj 0 Tw 28.012 0 Td (ecision)Tj (-)Tj 0.018 Tw (making role )Tj 0.012 Tw -28.012 -1.72 Td (of the Commonwealth in health emergencies, but it\222s not a definite th\ at we\222re going to go )Tj 0 Tw T* (that way.)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Mr. Plotkin?)Tj ( )Tj -3 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (CH:)Tj ( )Tj 0.391 Tw 3 0 Td (Certainly. SARS provided the motivation for us to set up a whole new set\ of )Tj 0 Tw T* (arrangements. The National Inciden)Tj 14.383 0 Td (t Room\222s actually set up...)Tj ( )Tj -17.383 -1.72 Td (BP:)Tj ( )Tj 3 0 Td ( )Tj -3 -1.72 Td (CH:)Tj ( )Tj 0.097 Tw 3 0 Td (Incident Room, the Health National Incident Room. We call it Bali 1 and \ Bali 2. After )Tj 0.178 Tw 0 -1.72 TD (Bali 1 where we had I think 88 Australians died and many were very badly\ injured, )Tj 0.229 Tw 0 -1.74 TD (many, many more than that, were coming back through)Tj 0 Tw 23.995 0 Td ( )Tj 0.229 Tw 0.479 0 Td (Darwin and it exposed our )Tj 0.155 Tw -24.474 -1.72 Td (complete lack of coordination in a health emergency. Not that we didn\222\ t cooperate in )Tj 0.063 Tw 0 -1.72 TD (emergencies but we didn\222t have any specific processes or committee or\ anything to deal )Tj 0.099 Tw T* (with this issue because what we needed to do was get the )Tj 24.29 0 Td (patients through Darwin and )Tj ET endstream endobj 509 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (11)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (JS:)Tj ( )Tj 0.006 Tw 3 0 Td (Jeff Scott from Nova Scotia. If you have an outbreak occurring between s\ tates, how is the )Tj 0.131 Tw 0 -1.72 TD (management of that coordinated and what\222s the role of the Commonwealt\ h in a major )Tj 0 Tw T* (incident?)Tj ( )Tj -3 -1.74 Td (CH:)Tj ( )Tj 0.236 Tw 3 0 Td (What would happen is that the Communicable Dis)Tj 21.839 0 Td (ease Network of Australia would )Tj 0.157 Tw -21.839 -1.72 Td (immediately convene and share views on how to deal with that outbreak. I\ n terms of )Tj 0.041 Tw T* (sharing specific information about individuals and so on we\222re on sha\ ky ground in terms )Tj 0.323 Tw T* (of sharing data, but certainly there would be an info)Tj (rmal immediate exchange of )Tj 0.021 Tw 0 -1.74 TD [(information )0.5(about )0.5(that. )0.5(The )0.5(Commonwealth, )0.5(if )0.5(it )0.5(was )0.5(a )0.5(serious )0.5(incident )0.5(that )0.5(one )0.5(state )0.5(felt )]TJ 0.12 Tw 0 -1.72 TD (they couldn\222t manage, the Australian Health Protection Committee woul\ d be convened )Tj 0.055 Tw T* (and the chief health officers of each state and territo)Tj 21.289 0 Td (ry and our chief medical officer and )Tj 0.027 Tw -21.289 -1.72 Td (deputy secretary would decide on what action to take. So the states and \ territories always )Tj 0.036 Tw 0 -1.74 TD (have the operational responsibility but if it was multi)Tj 0 Tw 21.453 0 Td (-)Tj 0.036 Tw (state it would be coordinated at the )Tj 0 Tw -21.453 -1.72 Td (Commonwealth level.)Tj ( )Tj -3 -1.72 Td (JS:)Tj ( )Tj 3 0 Td (Thank)Tj (-)Tj (you.)Tj ( )Tj -3 -1.72 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Dr.)Tj ( )Tj (Fidler and Dr.)Tj ( )Tj (Plotkin?)Tj ( )Tj -3 -1.74 Td (DF:)Tj ( )Tj 0.156 Tw 3 0 Td (I was intrigued by your brief forays into the )Tj /TT1 1 Tf 19.15 0 Td (National Health Security Act)Tj /TT0 1 Tf (. I was just )Tj 0.061 Tw -19.15 -1.72 Td (wondering if you could give us a bit more of the scope and content of wh\ at that\222s about )Tj 0 Tw 0 -1.72 TD (and why a security approach is being taken.)Tj ( )Tj -3 -1.72 Td (C)Tj (H:)Tj ( )Tj 0.129 Tw 3 0 Td (Actually, I probably can\222t. Well, I can guess why the last one, becau\ se security was a )Tj 0.037 Tw 0 -1.74 TD [(very )0.5(trendy )0.5(word )]TJ 0 Tw 7.246 0 Td (\226)Tj ( )Tj 0.037 Tw 0.786 0 Td [(and )0.5(still )0.5(is )]TJ 0 Tw 4.471 0 Td (\226)Tj ( )Tj 0.036 Tw 0.786 0 Td (in Australia. Security issues have been very much at the )Tj 0.208 Tw -13.29 -1.72 Td (forefront of policy in the last few years. I wasn\222t actually in this \ positi)Tj (on when the )Tj 0.03 Tw 0 -1.72 TD (national health security legislation was being formed, but I would guess\ it was to bring it )Tj 0 Tw T* (in line with other actions.)Tj ( )Tj -3 -1.74 Td (DF:)Tj ( )Tj 0.013 Tw 3 0 Td (I was just wondering whether that\222s the approach being used because s\ ecurity is usually a )Tj 0 Tw T* (federal or a Commonwealth auth)Tj (ority from the constitution.)Tj ( )Tj -3 -1.72 Td (CH:)Tj ( )Tj 0.081 Tw 3 0 Td (Yes, it is. That\222s right. If I just described to you what\222s in it \ you\222ll also see that. We\222re )Tj 0.115 Tw T* (taking a modularized approach to this legislation so that we can add bit\ s onto it as we )Tj 0.01 Tw 0 -1.74 TD (need to. The first module will be a surve)Tj (illance module to meet our obligations. We don\222t )Tj 0.048 Tw 0 -1.72 TD (think it\222s major changes, but some changes to meet our obligations un\ der the IHR\222s. We )Tj 0.248 Tw T* (also have responsibility... there was a recent Commonwealth and state an\ d territory )Tj 0.019 Tw T* (process looking at hazardous materia)Tj (ls of interest to terrorists. That includes radiological, )Tj ET endstream endobj 510 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 511 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 512 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 513 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 514 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 515 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 516 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 517 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 518 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 519 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 520 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 299.88 36.12 12 13.68 re W n BT 12 0 0 12 299.88 38.76 Tm (10)Tj ( )Tj ET Q BT 12 0 0 12 71.88 709.08 Tm (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Dr.)Tj ( )Tj (Wilson )Tj 4.772 0 Td (\226)Tj ( )Tj 0.828 0 Td (Kumanan )Tj 4.216 0 Td (\226)Tj ( )Tj 0.828 0 Td (mentioned )Tj 0.078 Tw 4.549 0 Td (that he thought he saw a pattern emerging, and his )Tj 0.362 Tw -15.193 -1.72 Td (interpretation of your presentation was that Australia was relying on a \ relatively )Tj 0.66 Tw 0 -1.72 TD (cooperative intergovernmental process. I interpreted your presentation s\ lightly )Tj 0.095 Tw 0 -1.74 TD (differently. See how controversial you can)Tj 0 Tw 17.468 0 Td ( )Tj 0.095 Tw 0.345 0 Td (be without even trying! I make a distinction )Tj 0.184 Tw -17.813 -1.72 Td (between who sets the rules and sort of the framework for action and then\ the actual )Tj 0.207 Tw 0 -1.72 TD (operational activity. My sense from your presentation was that because o\ f the treaty )Tj 0.476 Tw T* (power in Australia that in fact the Austr)Tj 19.243 0 Td (alian government, the Commonwealth )Tj 0.112 Tw -19.243 -1.74 Td (government, has extensive powers to set the legal framework. 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I\222d say not so much that the Australian government has a \ lot of )Tj 0.16 Tw -5.461 -1.72 Td [(power, )0.5(it )0.5(has )0.5(a )0.5(lot )0.5(of )0.5(authority, )0.5(so )0.5(we )0.5(don\222t )0.6(necessarily )0.6(currently )0.6(have )0.6(the )0.6(legislative )]TJ 0.162 Tw 0 -1.74 TD (power to do things that we may need to do, but we\222ve seen an increasi\ ng trend over )Tj 0 Tw 0 -1.72 TD (recent )Tj 0.529 Tw 3.221 0 Td (years in response to emergencies of states and territories wanting the )Tj 0.058 Tw -3.221 -1.72 Td (Commonwealth to take the lead. As I\222ve said, we\222ve only got the )Tj /TT1 1 Tf (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.058 Tw 33.526 0 Td (as our )Tj 0.133 Tw -33.526 -1.72 Td (only specific health power, but in the national health security legislat\ ion the states are )Tj 0 Tw 0 -1.74 TD (indicati)Tj 0.009 Tw (ng a fairly strong desire for the Commonwealth to have more explicit pow\ ers that, )Tj 0.01 Tw 0 -1.72 TD [(as )0.5(you )0.5(say, )0.5(would )0.5(set the )0.6(framework )0.5(and )0.5(provide )0.5(an )0.5(overarching )0.5(governance )0.5(structure )0.5(for )]TJ 0 Tw T* (their operational activities.)Tj 10.69 0 Td ( )Tj -13.69 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 0.002 Tw 1.389 0 Td (Let me more specific. I think you said that some of )Tj 20.687 0 Td (the powers around surveillance and so )Tj 0.133 Tw -20.687 -1.74 Td (forth were state powers, but if the Commonwealth government chose to use\ the treaty )Tj 0 Tw T* (power it could basically override...)Tj ( )Tj -3 -1.72 Td (CH:)Tj ( )Tj 3 0 Td (If they weren\222t agreeable we most probably could.)Tj 20.159 0 Td ( )Tj -23.159 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (That theoretical power exists.)Tj ( )Tj -3 -1.74 Td (CH:)Tj ( )Tj 3 0 Td (That)Tj (\222s right.)Tj ( )Tj -3 -1.72 Td (HL:)Tj 1.611 0 Td ( )Tj 1.389 0 Td (Okay.)Tj ( )Tj ET endstream endobj 521 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (9)Tj ( )Tj ET Q BT 0.151 Tw 12 0 0 12 71.88 709.08 Tm (providing some direct support to Pacific island nations to help them imp\ lement the IHR\222s as )Tj 0 Tw 0 -1.72 TD (well.)Tj 1.972 0 Td ( )Tj 1.028 -1.72 Td (I think that\222s the end of my presentation. Has anyone got)Tj ( )Tj (any questions?)Tj ( )Tj 0 -1.74 TD ( )Tj /TT1 1 Tf -3 -1.72 Td (Questions and Answers)Tj ( )Tj /TT0 1 Tf 0 -1.64 TD (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Thank)Tj (-)Tj 0.088 Tw (you very much. Anybody have any questions? If not, maybe I could start w\ ith a )Tj 0.089 Tw 0 -1.74 TD (couple. I guess we\222re starting to see some of the same themes emerge \ in some of these )Tj 0.082 Tw 0 -1.72 TD (presentations about whether some of these p)Tj (owers should be centralized or not, and my )Tj 0.061 Tw T* (sense is Australia\222s primarily going upon a collaborative approach wi\ th the exception of )Tj 0 Tw T* (this new security legislation you were talking about.)Tj 20.884 0 Td ( )Tj -23.884 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.1 Tw 3 0 Td [(I )0.5(sort )0.5(of )0.5(had )0.5(two )0.5(questions. )0.5(On )0.5(the )0.6(issue )0.5(of )0.6(this )0.6(new )0.6(security )0.6(legis)]TJ 27.623 0 Td [(lation, )0.5(would )]TJ 0.214 Tw -30.623 -1.72 Td (there be any explicit Commonwealth powers to require data sharing or dat\ a transfer )Tj 0.23 Tw T* (through this legislation? And the second question is you mentioned the s\ urveillance )Tj 0.082 Tw T* (capacity that\222s been developed at the state level. Is there harmoniza\ tion i)Tj 29.95 0 Td (n the nature of )Tj 0.05 Tw -29.95 -1.74 Td (the data collected through the various dates, and is this data shareable\ and with common )Tj 0 Tw T* (standards?)Tj ( )Tj -3 -1.72 Td (CH:)Tj ( )Tj 0.176 Tw 3 0 Td (In relation to your first question, yes, the national health security le\ gislation, the key )Tj 0.241 Tw T* (module of that legislation will be a surveill)Tj 18.881 0 Td (ance module which will give legislative )Tj 0.178 Tw -18.881 -1.74 Td (support to the sharing of data specifically for the purpose of meeting o\ ur obligations )Tj 0.13 Tw T* (under the IHR\222s, but as I mentioned we\222re looking at strengthening\ some of our other )Tj 0.225 Tw T* (surveillance elements such as the list of no)Tj 18.652 0 Td (tifiable diseases and so on. That will be )Tj 0 Tw -18.652 -1.72 Td (included.)Tj ( )Tj -3 -1.74 Td ( )Tj 3 0 Td ( )Tj 0.149 Tw 3 0 Td (In relation to your second question, the data that we ask for from the s\ tates is )Tj 0.009 Tw -3 -1.72 Td (standardized and harmonized, though within their states they will collec\ t a different set of )Tj 0.065 Tw T* (data, so they\222ve got their o)Tj 10.987 0 Td (wn lists and their own requirements but what we ask them to )Tj 0.271 Tw -10.987 -1.72 Td (give to us is standardized. And when we build the biosecurity surveillan\ ce system )Tj 0.042 Tw 0 -1.74 TD (obviously the data will be much more shareable electronically and so on.\ And we\222re still )Tj 0.005 Tw 0 -1.72 TD (working through exactly t)Tj (he degree to which it\222ll be shared, given privacy constraints and )Tj 0.053 Tw T* (so on, but certainly the states are very willing to share data with us a\ nd have us perform )Tj 0 Tw T* (an analysis and detection function.)Tj ( )Tj -3 -1.74 Td (KW:)Tj 1.944 0 Td ( )Tj 1.056 0 Td (Thank)Tj (-)Tj (you. Dr.)Tj ( )Tj (Lazar?)Tj ( )Tj ET endstream endobj 522 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (8)Tj ( )Tj ET Q BT 0.131 Tw 12 0 0 12 71.88 709.08 Tm (us to get real)Tj 0 Tw (-)Tj 0.131 Tw (time data and also obviously to do better analysis and so on. But the fu\ nding\222s )Tj 0 Tw 0 -1.72 TD (already committed, we don\222t need additional funding for that.)Tj 24.659 0 Td ( )Tj 0.072 Tw -21.659 -1.72 Td [(We )0.5(fund )0.5(the )0.5(states )0.5(and )0.5(territories )0.5(for )0.5(health. )0.5(It\222s )0.5(a )0.5(cost)]TJ 0 Tw (-)Tj 0.072 Tw [(shared )0.5(arrangement)]TJ [(, )0.5(but )0.5(through )]TJ 0.224 Tw -3 -1.74 Td (the Australian healthcare agreements )Tj 0 Tw (\226)Tj ( )Tj 0.224 Tw 16.916 0 Td (which are five)Tj 0 Tw (-)Tj 0.224 Tw (year agreements )Tj 0 Tw (\226)Tj ( )Tj 0.224 Tw 14.694 0 Td (we transfer funds )Tj 0 Tw -31.611 -1.72 Td (annually to the states and territories to support their health services.\ )Tj 27.02 0 Td ( )Tj 0.034 Tw -24.02 -1.72 Td (We also have special)Tj 0 Tw (-)Tj 0.034 Tw (purpose appropriations. For example, we recently gave $63 )Tj 0 Tw (million )Tj 0.119 Tw -3 -1.72 Td (over a few years to Royal Darwin Hospital to build itself up as a trauma\ centre. Most of you )Tj 0.105 Tw 0 -1.74 TD (would be aware we had major impacts from the two Bali bombings, and peop\ le have been in. )Tj 0.093 Tw 0 -1.72 TD (And when there was trouble in East Timor recently they always come)Tj 0 Tw 28.934 0 Td ( )Tj 0.093 Tw 0.343 0 Td (through Darwin, and so )Tj 0.191 Tw -29.277 -1.72 Td (we\222ve boosted Darwin\222s capacity to deal with all kinds of emergenc\ ies including if we had )Tj 0 Tw T* (people coming back in because of communicable disease and so on.)Tj 27.186 0 Td ( )Tj 0.089 Tw -24.186 -1.74 Td (I mentioned that privacy issues are... well, it\222s not an obstacle for\ us, we )Tj 0 Tw 30.379 0 Td (currently )Tj 3.949 0 Td (\226)Tj ( )Tj 0.839 0 Td (as )Tj 0.119 Tw -38.167 -1.72 Td (others have mentioned )Tj 0 Tw 9.661 0 Td (\226)Tj ( )Tj 0.119 Tw 0.869 0 Td (we share information on a fairly voluntary level at the moment. The )Tj 0.086 Tw -10.53 -1.72 Td (Commonwealth doesn\222t receive any identified data from the states and \ territories, but we think )Tj 0.118 Tw T* (that we need to have that capacity and that\222s another )Tj 22.397 0 Td (question for the WHO. We think we do )Tj 0.031 Tw -22.397 -1.74 Td [(need )0.5(to )0.5(have )0.5(the )0.5(capacity )0.5(to )0.5(receive )0.6(personalized )0.5(information )0.5(from )0.5(the )0.5(states, )0.5(and )0.5(for )0.5(them )0.5(to )0.5(be )]TJ 0.027 Tw T* (able to share that information between states, and for us to be able to \ give it to the WHO in very )Tj 0.01 Tw T* (limited circumstances,)Tj 0 Tw ( )Tj 0.01 Tw 9.267 0 Td (and we don\222t think our legislation... we know it doesn\222t support t\ hat at the )Tj 0 Tw -9.267 -1.72 Td (moment, so we think we\222re going to clarify our ability to do that.)Tj 25.995 0 Td ( )Tj 0.065 Tw -22.995 -1.74 Td [(We )0.5(also, )0.5(as )0.5(is )0.5(the )0.5(case )0.5(for )0.5(anyone, )0.5(the )0.5(nation )0.5(emergency )0.5(capacity )0.5(to )0.5(non)]TJ 0 Tw 29.799 0 Td (-)Tj 0.065 Tw [(disease )0.5(threats )]TJ 0.197 Tw -32.799 -1.72 Td (needs to be strengthen)Tj (ed. We\222ve got good powers in the )Tj /TT1 1 Tf (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.197 Tw 31.5 0 Td (for communicable )Tj 0 Tw -31.5 -1.72 Td (disease but not necessarily for other emerging issues.)Tj 21.272 0 Td ( )Tj 0.204 Tw -18.272 -1.72 Td (We also think that regional cooperation is a very important element for \ Australia in )Tj 0.137 Tw -3 -1.74 Td (helping our neighbours meet their obligations under)Tj 0 Tw 21.597 0 Td ( )Tj 0.137 Tw 0.387 0 Td (the International Health Regulations, and )Tj 0.055 Tw -21.984 -1.72 Td (we\222re an active participant in all kinds of regional forums. We\222re\ committed to the Asia)Tj 0 Tw 35.891 0 Td (-)Tj (Pacific )Tj 0.062 Tw -35.891 -1.72 Td (Strategy for Emerging Diseases, but I know we were a little disappointed\ recently. 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We immediately convened a )Tj 0.144 Tw -12.596 -1.72 Td (teleconference with the states and territories just to get shared v)Tj 26.874 0 Td (iews and decide whether any )Tj 0.223 Tw -26.874 -1.72 Td (action was required at that stage. So it\222s a very strong informal net\ work that was recently )Tj 0.24 Tw 0 -1.72 TD [(formalized )0.5(in )0.5(a )0.5(process )0.5(that\222s )0.5(described, )0.5(the )0.5(reporting )0.5(arrangements )0.5(up )0.5(through )0.5(the )0.5(Health )]TJ 0 Tw 0 -1.74 TD (Minister\222s Advisory Council.)Tj ( )Tj 0.076 Tw 3 -1.72 Td (We also have the)Tj 0 Tw ( )Tj 0.076 Tw 7.413 0 Td (Communicable Disease Network of Australia which is made up of all )Tj 0.015 Tw -10.413 -1.72 Td (directors of public health in the states and territories, it\222s got Co\ mmonwealth members and it has )Tj 0.089 Tw 0 -1.72 TD (other experts )Tj 0 Tw (\226)Tj ( )Tj 0.089 Tw 6.459 0 Td (some of them are not government experts )Tj 0 Tw 17.479 0 Td (\226)Tj ( )Tj 0.089 Tw 0.839 0 Td (who are part of that. That netwo)Tj 0 Tw 13.39 0 Td (rk )Tj 0.134 Tw -38.167 -1.74 Td (meets by teleconference on a fortnightly basis and meets face)Tj 0 Tw 25.783 0 Td (-)Tj (to)Tj (-)Tj 0.134 Tw (face a few times a year, but )Tj 0.039 Tw -25.783 -1.72 Td [(again )0.5(they )0.5(convene )0.5(all )0.5(the )0.5(time )0.5(by )0.5(teleconference )0.5(if )0.5(there\222s )0.5(an )0.6(emerging )0.5(issue and it )0.5(needs )0.5(to )0.5(be )]TJ 0.218 Tw T* [(discussed. )0.5(So )0.5(it )0.5(provides )0.5(a )0.5(great )0.5(support )0.5(to )0.5(the )0.5(directors )0.5(of)]TJ 0 Tw ( )Tj 0.218 Tw 26.055 0 Td [(public )0.5(health )0.5(in )0.5(the )0.5(states )0.5(and )]TJ 0 Tw -26.055 -1.72 Td (territories.)Tj ( )Tj 0.078 Tw 3 -1.74 Td (What\222s not shown up there is the Public Health Laboratory Network, wh\ ich is a similar )Tj 0.157 Tw -3 -1.72 Td (setup to the Communicable Diseases Network, it\222s the heads of all the\ public laboratories in )Tj 0 Tw T* (Australia and they also meet re)Tj (gularly by teleconference and face)Tj (-)Tj (to)Tj (-)Tj (face a couple times a year.)Tj 38.23 0 Td ( )Tj 0.023 Tw -35.23 -1.72 Td [(We )0.5(also )0.5(have )0.5(an )0.5(Environment )0.5(Health )0.5(Committee )0.5(that )0.5(operates )0.5(on )0.5(a )0.5(similar )0.5(basis, )0.5(and )0.5(my )]TJ 0.068 Tw -3 -1.74 Td (area provides the secretariat to all of those committees, so we certainl\ y are across what\222s going )Tj 0 Tw T* (on in )Tj (the states and territories at all those different levels.)Tj 22.909 0 Td ( )Tj 0.04 Tw -19.909 -1.72 Td (Financing for Australia, we don\222t think we\222re needing a major addi\ tional commitment of )Tj 0.034 Tw -3 -1.72 Td [(funding, )0.5(here. )0.5(We\222re )0.5(going )0.5(to )0.5(build )0.5(on )0.5(existing )0.5(surveillance )0.5(and )0.5(reporting )0.5(infrastructure. )0.5(We\222ve, )]TJ 0.007 Tw 0 -1.74 TD (as I mentione)Tj (d earlier, already committed funds to build a new biosecurity surveillan\ ce system to )Tj 0.088 Tw 0 -1.72 TD (try and... we will be converting our current manual system into an elect\ ronic system. We were )Tj 0.027 Tw T* (talking to Public Health in Canada about their system in the last couple\ of d)Tj 30.644 0 Td (ays. This will enable )Tj ET endstream endobj 524 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (6)Tj ( )Tj ET Q BT 0.021 Tw 12 0 0 12 107.88 709.08 Tm [(I )0.5(mentioned )0.5(under )0.5(the )]TJ /TT1 1 Tf [(Quarantine )0.6(Act)]TJ /TT0 1 Tf 0 Tw ( )Tj 0.021 Tw 15.619 0 Td [(the )0.5(Commonwealth )0.5(has )0.5(a )0.5(range )0.5(of )0.5(powers )0.5(in )0.5(cases )]TJ 0.056 Tw -18.619 -1.72 Td (of epidemic or disease emergency, no)Tj 15.386 0 Td (t necessarily in relation to other things )Tj 0 Tw 15.974 0 Td (\226)Tj ( )Tj 0.056 Tw 0.806 0 Td (and that imposes )Tj 0.004 Tw -32.166 -1.72 Td (the reporting obligations on ships and aircraft to notify of ill passeng\ ers and other incidents )Tj 0 Tw 36.802 0 Td (\226)Tj ( )Tj 0.754 0 Td (and )Tj 0.112 Tw -37.556 -1.74 Td (we also have a range of powers that can be exercised in relation to peop\ le who are subject to)Tj 0 Tw 39 0 Td ( )Tj 0.079 Tw -39 -1.72 Td [(quarantine, )0.5(including )0.5(the )0.5(power )0.5(to )0.5(order )0.5(a )0.5(person )0.5(into )0.5(quarantine )0.5(and )0.5(to )0.5(submit )0.5(to )0.6(treatment )0.5(as )]TJ 0.166 Tw 0 -1.72 TD (required. But as I have said to a couple of people here, our )Tj /TT1 1 Tf (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.166 Tw 32.559 0 Td (hasn\222t changed, )Tj 0.134 Tw -32.559 -1.72 Td (basically, since 1908, and it\222s very broad powers that have never b)Tj 28.106 0 Td (een tested, and during our )Tj 0.096 Tw -28.106 -1.74 Td (pandemic planning we )Tj 0 Tw (\226)Tj ( )Tj 0.096 Tw 10.437 0 Td (as others would have found too )Tj 0 Tw (\226)Tj ( )Tj 0.096 Tw 14.198 0 Td (there\222s all of those questions, \223Are )Tj 0.04 Tw -24.635 -1.72 Td (you sure you can do that? Does it really allow to do that? And what if y\ ou do it, who\222s going to )Tj 0.011 Tw T* [(protect you?\224 We\222re )0.5(having )0.5(a )0.5(good )0.5(hard )]TJ [(think )0.5(about )0.5(this )0.5(at )0.5(the )0.5(moment, )0.5(whether )0.5(we )0.5(want )0.5(to )0.5(take )]TJ 0.109 Tw T* [(such )0.5(broad )0.5(power. )0.5(We )0.5(do )0.5(want )0.5(to )0.5(take )0.5(the )0.5(broad )0.5(power, don\222t )0.5(get )0.6(me )0.5(wrong, but )0.5(whether )0.5(we )]TJ 0.251 Tw 0 -1.74 TD [(think the broad power )0.5(is )0.5(sufficient to give us the authority for specific actions is another )]TJ 0 Tw 0 -1.72 TD (question.)Tj ( )Tj 0.022 Tw 3 -1.72 Td (The stat)Tj (es and territories, as I\222ve mentioned, have public health and emergen\ cy laws, and )Tj 0.206 Tw -3 -1.72 Td (one state in particular has recently updated its legislation to give ver\ y, very comprehensive )Tj 0.241 Tw 0 -1.74 TD (powers, and we\222re having a look at that as a model, possibly, for nat\ ional healt)Tj 34.843 0 Td (h security )Tj 0 Tw -34.843 -1.72 Td (legislation that could be picked up by all the states and territories if\ they were agreeable.)Tj 35.376 0 Td ( )Tj 0.207 Tw -32.376 -1.72 Td (Some of the powers that the states and territories have include the powe\ r to restrict )Tj 0.058 Tw -3 -1.72 Td (movement in and out of places )Tj 0 Tw (\226)Tj ( )Tj 0.058 Tw 13.708 0 Td (again, not tested )Tj 0 Tw (\226)Tj ( )Tj 0.058 Tw 7.758 0 Td (impose areas )Tj (of quarantine, detain persons, )Tj 0.233 Tw -21.466 -1.74 Td (require medical examinations and to seize goods, buildings, land, cleani\ ng and disinfecting )Tj 0.018 Tw 0 -1.72 TD (buildings and disinfecting or destroying goods. As I said, the powers ar\ e there but we\222ll wait and )Tj 0 Tw T* (see what the reaction would be if )Tj (we actually exercised those powers in an emergency situation.)Tj 38.375 0 Td ( )Tj 0.215 Tw -35.375 -1.72 Td (Coordination arrangements in Australia are fairly strong. We have Austra\ lian Health )Tj 0.125 Tw -3 -1.74 Td [(Ministers )-0.6(Advisory )-0.6(Council, )-0.6(which )-0.6(is )-0.6(comprised )-0.6(of the heads of all of the health departments )]TJ 0.212 Tw T* (including the Com)Tj (monwealth Department of Health. It sits at the top of the tree under the\ )Tj 0 Tw T* (minister\222s council.)Tj ( )Tj 0.009 Tw 3 -1.72 Td [(The )0.5(Australian )0.5(Health )0.5(Protection )0.5(Committee )0.5(is )0.5(the )0.5(key )0.5(health )0.5(committee )0.5(for )0.5(coordinating )]TJ 0.117 Tw -3 -1.74 Td (emergency responses between states and territories and the Commonwealth.\ Th)Tj 32.879 0 Td (at\222s chaired by )Tj 0.077 Tw -32.879 -1.72 Td (my deputy secretary for the Department of Health and Ageing. It has the \ chief medical officer, )Tj 0.076 Tw T* (and all of the chief health officers from the states and territories are\ members. We also include )Tj 0.108 Tw T* (Emergency Management Australia, defence )Tj 0 Tw 18.231 0 Td (\226)Tj ( )Tj 0.108 Tw 0.858 0 Td (New Z)Tj (ealand is a member of that as well )Tj 0 Tw 17.608 0 Td (\226)Tj ( )Tj 0.858 0 Td (and )Tj ET endstream endobj 525 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (5)Tj ( )Tj ET Q BT 0.39 Tw 12 0 0 12 71.88 709.08 Tm [(screening, )0.5(but )0.5(obviously )0.5(we )0.5(don\222t )0.5(currently )0.5(do )0.5(that )0.5(and )0.5(it )0.5(certainly )0.5(would )0.5(need )0.5(some )]TJ 0 Tw 0 -1.72 TD (administrative support.)Tj ( )Tj 0.08 Tw 3 -1.72 Td (We have to work with the state and territory governments to implement bo\ rder controls )Tj 0.004 Tw -3 -1.74 Td (of any )Tj (kind while the chief medical officer delegates his power under the )Tj /TT1 1 Tf 29.517 0 Td (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.004 Tw 6.452 0 Td (to chief )Tj 0.133 Tw -35.969 -1.72 Td (quarantine officers in the states and territories, and they work with ou\ r Australian Quarantine )Tj 0.068 Tw T* (Inspection Service at the border once the Quarantine Service finds so)Tj 28.34 0 Td (meone who might need to )Tj 0 Tw -28.34 -1.72 Td (be assessed, and they\222ll be picked up by the state and territory heal\ th departments.)Tj 32.851 0 Td ( )Tj 0.4 Tw -29.851 -1.74 Td (The Commonwealth government has responsibility for animal, food, surveil\ lance, )Tj 0.008 Tw -3 -1.72 Td (chemical, radionuclear hazards, environmental hazards detection and )Tj 27.904 0 Td (response capacity, although )Tj 0 Tw -27.904 -1.72 Td (the environmental hazards a lot of powers reside at the state level as w\ ell.)Tj 29.434 0 Td ( )Tj 0.063 Tw -26.434 -1.72 Td (All of the states and territories have given their in)Tj 0 Tw 20.421 0 Td (-)Tj 0.063 Tw (principle agreement to implement the )Tj 0 Tw -23.421 -1.74 Td (IHR in their jurisdictions, and as I said we feel we\222re fair)Tj 22.826 0 Td (ly well placed at the moment.)Tj 11.83 0 Td ( )Tj 0.401 Tw -31.655 -1.72 Td (I mentioned that our notifiable diseases arrangements are voluntary betw\ een the )Tj 0.077 Tw -3 -1.72 Td (Commonwealth government states and territories. One of the things we\222\ re considering with the )Tj 0.06 Tw T* (national health security legislation is whether we wa)Tj 21.383 0 Td (nt to give some more formal status to a list )Tj 0.096 Tw -21.383 -1.74 Td (of notifiable diseases, although we don\222t think that we want to put t\ he actual list in legislation )Tj 0.079 Tw T* (because it would be far too difficult to change when we needed to, but w\ e wonder whether we )Tj 0.071 Tw T* (might want to put...)Tj 0 Tw ( )Tj 0.071 Tw 8.367 0 Td (in fact, some of the states and territories were asking us whether perha\ ps a )Tj 0 Tw -8.367 -1.72 Td (bit of compulsion or a bit of authority from us would help them to meet \ their obligations.)Tj 35.633 0 Td ( )Tj 0.016 Tw -32.633 -1.74 Td [(Each )0.5(jurisdiction )0.5(forwards )0.5(the )0.6(data )0.6(to )0.6(us. )0.5(At )0.5(the )0.5(moment )0.5(it\222s )0.5(a )0.5(manual )0.5(process )0.5(where )0.5(yo)]TJ 0 Tw (u )Tj 0.171 Tw -3 -1.72 Td (have sending it in basically by fax and e)Tj 0 Tw (-)Tj 0.171 Tw [(mail )0.5(and other means, but we\222re in the process of )]TJ 0 Tw T* (building a new system which I\222ll talk a little bit about.)Tj 21.69 0 Td ( )Tj -18.69 -1.72 Td (The )Tj /TT1 1 Tf 0.302 Tw 2.106 0 Td (Privacy Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.302 Tw 5.545 0 Td (provides safeguards against collection and use of personal health )Tj 0.059 Tw -10.651 -1.74 Td (information, which we )Tj (don\222t intend to override but the )Tj /TT1 1 Tf 22.583 0 Td (Privacy Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.059 Tw 5.06 0 Td (is one of our... is in fact the )Tj 0.019 Tw -27.644 -1.72 Td (key obstacle that we\222re concerned about in meeting our obligations un\ der the IHR\222s, and I\222ll talk )Tj 0 Tw T* (about that.)Tj ( )Tj 0.045 Tw 3 -1.72 Td (Verification of incidents undertaken at the local level, as I said th)Tj 26.6 0 Td (e WHO focal point has )Tj 0.034 Tw -29.6 -1.74 Td (been incorporated into the surveillance system. That focal point, for us\ , is very hazy because the )Tj 0.182 Tw T* (National Incident Room )Tj 0 Tw (\226)Tj ( )Tj 0.182 Tw 11.392 0 Td (which is a health incident room )Tj 0 Tw (\226)Tj ( )Tj 0.182 Tw 14.854 0 Td (is the place that all states and )Tj 0.059 Tw -26.246 -1.72 Td (territories would go to for any kind of inc)Tj (ident or emerging issue of concern, so it\222s an obvious )Tj 0 Tw T* (contact point for us. That sits within the Office of Health Protection a\ s well.)Tj 30.409 0 Td ( )Tj ET endstream endobj 526 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (4)Tj ( )Tj ET Q BT 0.126 Tw 12 0 0 12 71.88 709.08 Tm (also see that the Commonwealth is supported by advisory committees, whic\ h I\222ll go into in a )Tj 0.112 Tw 0 -1.72 TD (little bit of detail later. At the regional level state and territory he\ alth departments, emergency )Tj 0.153 Tw T* (services and laboratories provide the )Tj (support as well, and at the local level we have medical )Tj 0 Tw 0 -1.74 TD (practitioners, emergency departments, local hospitals and local health c\ entres.)Tj 31.183 0 Td ( )Tj 0.067 Tw -28.183 -1.72 Td (Our assessment of where activities are performed is not that dissimilar \ to others who\222ve )Tj 0.039 Tw -3 -1.72 Td (shown it. You can see most of t)Tj (he public health powers lie at the regional and local level )Tj 0 Tw 36.379 0 Td (\226)Tj ( )Tj 0.789 0 Td (state )Tj 0.195 Tw -37.167 -1.72 Td (or local level for us )Tj 0 Tw (\226)Tj ( )Tj 0.195 Tw 9.947 0 Td (and the state and territory health departments collect notifications of \ )Tj 0.112 Tw -9.947 -1.74 Td (communicable disease, and they voluntarily forward this on to the Common\ wealth. Each state )Tj 0 Tw 0 -1.72 TD (a)Tj 0.075 Tw (nd territory has a list of notifiable diseases, we don\222t actually hav\ e a national list of notifiable )Tj 0 Tw T* (diseases in a formal sense, although we have a list of things that we as\ k them to report on.)Tj 35.991 0 Td ( )Tj 0.018 Tw -32.991 -1.72 Td (Laboratory services are also an integral part of the surveilla)Tj 23.959 0 Td (nce and reporting system, and )Tj 0 Tw -26.959 -1.74 Td (I\222ll talk a little about our networks there.)Tj 16.217 0 Td ( )Tj 0.08 Tw -13.217 -1.72 Td (The power to enter into the International Health Regulations for Austria\ is an executive )Tj 0.137 Tw -3 -1.72 Td (power under Section 61 of our constitution. Under the constitution the C\ ommonwealth enters )Tj 0 Tw T* (i)Tj 0.001 Tw (nto all treaties. We\222re using the External Affairs power to use as th\ e head of power to implement )Tj 0 Tw 0 -1.74 TD (any legislation that we need to meet our obligations.)Tj 20.912 0 Td ( )Tj 0.063 Tw -17.912 -1.72 Td (The existing Commonwealth, state and territory administrative practices \ already provide )Tj 0.009 Tw -3 -1.72 Td (a very strong fo)Tj (undation for us to meet our obligations under the IHR\222s. We\222re cur\ rently taking a )Tj 0.035 Tw 0 -1.72 TD (consensus approach with the states and territories, encouraging them to \ use their own legislation )Tj 0.121 Tw 0 -1.74 TD [(where )0.5(possible )0.5(to )0.5(meet )0.5(those )0.5(obligations, )0.5(but )0.5(I )0.5(mentioned )0.6(yesterday )0.6(that )0.6(we )]TJ 0.12 Tw (are consideration )Tj 0.051 Tw 0 -1.72 TD (national health security legislation at the moment and we\222re consider\ ing how far to go with that )Tj 0 Tw T* (in terms of Commonwealth power.)Tj ( )Tj 0.289 Tw 3 -1.72 Td (As I mentioned, public health measures for surveillance and response is \ mandated )Tj 0.101 Tw -3 -1.74 Td (through state and territory )Tj [(public health legislation. It\222s a little )0.5(variable in the kinds )0.5(of powers )]TJ 0.232 Tw T* (that it gives some states and territories: some have very comprehensive \ powers, others are )Tj 0 Tw T* (looking to us, perhaps, to give them some support.)Tj ( )Tj 0.674 Tw 3 -1.72 Td (The responsibility for border protection )Tj 19.451 0 Td (is the Commonwealth government\222s )Tj 0.079 Tw -22.451 -1.74 Td (responsibility. The )Tj /TT1 1 Tf (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.079 Tw 14.51 0 Td (provides, obviously, for incoming screening. We also )Tj 0 Tw 22.217 0 Td (\226)Tj ( )Tj 0.829 0 Td (and )Tj 0.113 Tw -37.556 -1.72 Td (this perhaps is something that we want to confirm with the WHO, what are\ obligations are in )Tj 0.199 Tw T* [(relation )0.5(to )0.5(exit )0.5(screen )]TJ 0 Tw (\226)Tj ( )Tj 0.199 Tw 10.628 0 Td [(we )0.5(think )0.5(ou)]TJ 0 Tw (r )Tj /TT1 1 Tf 0.199 Tw 5.9 0 Td [(Quarantine )0.5(Act)]TJ /TT0 1 Tf 0 Tw ( )Tj 0.199 Tw 6.84 0 Td [(gives )0.5(us )0.5(the )0.5(power )0.5(to )0.5(undertake )0.5(exit )]TJ ET endstream endobj 527 0 obj <>stream BT /CS0 cs 0 0 0 scn /GS0 gs /TT0 1 Tf 12 0 0 12 71.88 38.76 Tm ( )Tj ET q 302.76 36.12 6.24 13.68 re W n BT 12 0 0 12 302.76 38.76 Tm (3)Tj ( )Tj ET Q BT 0.197 Tw 12 0 0 12 107.88 709.08 Tm (The plan today is for four country presentations this morning, a very br\ ie)Tj 31.553 0 Td (f synthesis )Tj 0.145 Tw -34.553 -1.72 Td (session that the organizers will present back to the group early in the \ afternoon, followed by )Tj 0.086 Tw 0 -1.72 TD (structured discussion on some of the issues that have been emerging thro\ ugh the presentations. )Tj 0 Tw 0 -1.74 TD (So we\222re hoping to have Australia, India, Russia and S)Tj 21.913 0 Td (enegal speak this morning.)Tj ( )Tj 0.082 Tw -18.913 -1.72 Td (If I may suggest, I think in the importance of getting the country prese\ ntation done this )Tj 0.056 Tw -3 -1.72 Td (morning we\222ll do our coffee break like we did yesterday, we won\222t \ actually take time out but if )Tj 0.07 Tw 0 -1.72 TD (people want to come in and out during the m)Tj 18.545 0 Td (orning, I\222ll announce when the coffee has arrived. )Tj 0 Tw -18.545 -1.74 Td (That way I think we\222ll make sure we do get through the presentations.\ )Tj 28.02 0 Td ( )Tj -25.02 -1.72 Td (So I think we\222ll begin with Australia.)Tj ( )Tj T* ( )Tj /TT1 1 Tf -3 -1.72 Td (COUNTRY 7: AUSTRALIA)Tj ( )Tj 0 -1.66 TD (Ms Cath Halbert and Ms Lisa McGlynn)Tj ( )Tj /TT0 1 Tf 0.135 Tw 3 -1.64 Td (Good morning. Again, thanks very much )Tj 17.476 0 Td (to the organizers and the other presenters so )Tj 0.23 Tw -20.476 -1.74 Td (they can be swapped \222round because I\222m the person who is catching \ a flight later on this )Tj 0.202 Tw 0 -1.72 TD (morning, so... this afternoon, but I have to leave this morning, so than\ ks very much to the )Tj 0 Tw T* (organizers.)Tj ( )Tj 0.067 Tw 3 -1.72 Td (Just as a matter )Tj (of introduction, I guess Australia thinks that we\222re pretty well plac\ ed to )Tj 0.014 Tw -3 -1.74 Td [(meet our obligations under the )0.5(International Health Regulations but we do have some work to do )]TJ 0 Tw T* (to make sure that we\222re \(on the second round?\), meeting those oblig\ ations.)Tj 29.853 0 Td ( )Tj 0.103 Tw -26.853 -1.72 Td [(As )0.5(a )0.5(bit )0.5(of)]TJ 0 Tw ( )Tj 0.102 Tw 4.854 0 Td (background, Australia is a federation with six states and two territorie\ s, the )Tj 0.217 Tw -7.854 -1.72 Td [(two )0.5(territories )0.5(being )0.5(basically )0.5(Canberra )0.5(and )0.5(the )0.5(Northern )0.5(Territory. )0.5(There\222s )0.5(a )0.5(separation )0.5(of )]TJ 0.406 Tw 0 -1.74 TD (powers between the Commonwealth and the states. What\222s not explicitly\ given to the )Tj 0 Tw 0 -1.72 TD (Commonwealth in the constitution resides with the states.)Tj 23.108 0 Td ( )Tj 0.061 Tw -20.108 -1.72 Td (We don\222t have )Tj 0 Tw (\226)Tj ( )Tj 0.061 Tw 7.131 0 Td (as I said yesterday )Tj 0 Tw (\226)Tj ( )Tj 0.061 Tw 8.664 0 Td (any specific powers in relation to public health at )Tj 0.149 Tw -18.795 -1.72 Td (the Commonwealth level apart from the )Tj /TT2 1 Tf (Quarantine Act)Tj /TT0 1 Tf 0 Tw ( )Tj 0.149 Tw 23.852 0 Td (which only deal with communicable )Tj 0.16 Tw -23.852 -1.74 Td (disease but certainly)Tj 0 Tw ( )Tj 0.16 Tw 8.894 0 Td (gives us very broad powers. 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