Risk assessment and international agency response to health events
During an event that may impact health, the FAO, OIE, and WHO must each appropriately gauge their response at the international level, advise countries and regions on the best options for local response, provide technical assistance as requested, and effectively communicate risks to countries, stakeholders , and the public. Each of the Tripartite agencies must continually assess the likelihood and potential impact of relevant events and, based on the assessment and if a need is identified, devise practical options to mitigate risks. Such assessments need to draw on international and local expertise in a variety of disciplines (depending on the type of event) which may include disease ecology, epidemiology, clinical aspects, case/outbreak management, socio-economics, and expertise on the specific etiological agent (including laboratory diagnostics), as well as knowledge and experience from the field. Importantly, for health threats that are either emerging or existing at the interface, including food safety issues, neither the technical data and other information important to conduct a comprehensive assessment nor the appropriate breadth of technical expertise and experience are routinely available within a single agency or sector. Therefore, when a need is identified, the FAO, OIE, and WHO must work together to conduct – and engage other institutions to collaborate in conducting – risk assessments for health threats at the interface.
Why a GLEWS+ Risk Assessment Component?
The GLEWS framework has been providing the FAO, OIE, and WHO with health event information and a mechanism for information sharing and verification since its inception. Risks associated with these health events have been assessed according to the immediate needs, but on an ad hoc and informal basis.
As event-based and routine surveillance systems at the country, regional and global levels have improved, more potential public health events requiring assessment have been identified. The informal approach to risk assessment is no longer sufficient to meet this increasing need. In recognition of this, GLEWS+ will develop and incorporate a standard process for risk assessment in order to have a consistent, structured and harmonized approach to provide robust and timely assessments, when relevant, in order to inform an appropriate institutional response.
Practical considerations & consensus
A first step is defining under which circumstances a risk assessment will be carried out and what type of assessment is needed. An algorithm to facilitate these decisions will be developed as part of the development of the Risk Assessment Component (RAC). Under some circumstances, a risk assessment could also be conducted upon agreement of the GLEWS task force or at the suggestion of the GLEWS+ Management Committee or FAO, OIE, or WHO individually, the Tripartite Secretariat, or countries/regions, especially when there are highly sensitive health events or events of specific concern for the international community or consumers.
Risk assessment, management, and communication are part of the fundamental work of FAO, OIE, and WHO. The RAC is intended to interlink and complement the ongoing work of the agencies, and to ensure seamless linkages with these internal FAO, OIE, and WHO functions.
Specific activities and impact of the Risk Assessment Component
The RAC will undertake triage-based or iterative qualitative assessments for disease events according to the GLEWS criteria established in the agreement signed by the three partners in 2006. In addition, specific planned assessments for some priority diseases and specific regions could be conducted under the RAC with public health aspects included or not depending on the zoonotic potential of the disease.
A new area to be considered under GLEWS+ is food safety. The impact of food hazards on public health as well as on food chains and livestock production systems could also be addressed through planned assessments.
One of the main challenges of risk assessment activities is the availability of quality data to assess risks. Planned assessments will benefit from supplementation with relevant data on factors or drivers for emergence and persistence of animal diseases, and will contribute to build a more complete body of evidence towards understanding disease epidemiology and trends, and to reinforce preventive and predictive capacities.
The results of risk assessments can be presented in different ways, such as text, matrices, maps, and graphs. Further, risk models can be developed and validated using, for instance, data available on reported outbreaks, vaccination coverage, and surveillance activities carried out by countries. Combining this information with other data and information available in FAO, OIE, WHO and other institutions (e.g. land use, trade, livestock population, wildlife, climate change, animal movements) can provide a better understanding of potential drivers of disease emergence or spread of animal or human health events.
This evidence will allow better assessment of the health risks, and ultimately support FAO, OIE, and WHO in providing guidance and options for prevention, control and effective containment of these disease risks at the global level.
Objectives of the risk assessments
- summarize the state of knowledge of selected health threats or events
- determine the likelihood and impact of emerging or evolving health threats (and provide level of certainty of the results)
- identify data gaps and propose next steps on how the agencies might fill them
- make proposals on how FAO, OIE, and WHO might best assist regions and member countries to prevent, manage, or respond to events
- make proposals on what information might be communicated by FAO, OIE, and WHO to different stakeholders (and how and when)
- link with technical and communications departments in FAO, OIE, and WHO to facilitate appropriate and timely implementation of the RAC outcomes