Aylward: Te first thing that you’ve got to do is establish the necessary networks. WHO has been working for years to establish and support something called the Global Outbreak Alert and Response Network, which we’re secretariat to. We’re trying to tap all those great insti- tutions like the U.S. CDC [Centers for Disease Control and Prevention], the E CDC [European Centre for Disease Prevention and Control], the Pasteur Institutes, the Public Health Agency of Canada, of China and of various other places, to create a network that can be used to provide international assistance in investigating and responding to infec- tious hazards.
Another network that we have set up is called the Emerging and Dangerous Pathogens Laboratory Network, which brings together leading laboratories at the international level that have the expertise to diagnose such pathogens safely and to put capacity on the ground, to do it locally if necessary. We are now devel- oping new networks around emergency medical teams, health logistics, commu- nity mobilization and other aspects of response.
A second thing is getting these networks to common standards, language and pro- cesses. For example, with our emergency medical team network, we now have a standardized accreditation process which includes ensuring that they can operate with our incident management system.
Te next thing, of course, is testing these networks and systems. Again, this is so familiar to any military. Simulations, simulations, simulations—you just can’t do enough, whether it’s desktop exercises, field exercises or other types of simula- tions across those networks and different players. Te final thing, and probably one of the most important, is actually using real events to create joint responses, joint opportunities. We will often mobi- lize a network even in relatively small outbreaks to make sure that this network is doing almost “live-fire” exercises.
In the case of infectious hazards, we have another great tool at our disposal called the International Health Regulations. Tis is like an international treaty that has been agreed to among the 190-plus member states of WHO on how they will identify outbreaks, notify WHO,
facilitate investigations, and manage or cooperate together in the response to cer- tain dangerous and emerging pathogens and other hazards as well.
All of these mechanisms have challenges and have problems. But the big les- son we’ve learned is that none of these things work if you don’t use them—you know, regularly test them and then rap- idly operationalize them in crises. Te problems are seldom the tools and the processes. It is more often just the sloth, let’s say, or lack of resources that have led to their lying idle for too long.
Army AL&T: Tat gets to the point of when these networks that are so impor- tant need to be set up.
Aylward: I think our experience in Ebola was that we hadn’t done enough of that in advance at some levels. We have to be clear: Even when you do look and plan ahead, you’re not always going to get it right. Tat’s why it’s so impor- tant
to do these after-action reviews
and evaluations and then put in place the additional capacities, networks, etc., that are needed. And that will continue
A NEW ARCHITECTURE
Aylward, right, speaks in June 2016 at a briefing to the U.N. General Assembly on the report from then-U.N. Secretary-General Ban Ki-moon, second from left, on strengthening the global health system. “The Ebola outbreak really brought new urgency to long-needed reform and improvements, not just within WHO and not just within its member states, but also within the whole international architecture,” Aylward told Army AL&T. (U.N. photo by Eskinder Debebe)
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CRITICAL THINKING
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