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Improving emergency preparedness and response in the Asia-Pacific
  1. Ben J Marais1,
  2. Stephanie Williams2,
  3. Ailan Li3,
  4. Roderico Ofrin4,
  5. Angela Merianos5,
  6. Joel Negin6,
  7. Jenny Firman7,
  8. Robin Davies2,
  9. Tania Sorrell1
  1. 1 Centre for Research Excellence in Emerging Infectious Diseases (CREID) and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Department of Foreign Affairs and Trade, Indo-Pacific Centre for Health Security, Canberra, Australia
  3. 3 Division of Health Security and Emergencies, WHO Health Emergencies Programme, WHO Western Pacific Regional Office, Manila, Philippines
  4. 4 WHO Health Emergencies Programme, WHO South-East Asia Regional Office, New Delhi, India
  5. 5 Pacific Health Security, WHO Communicable Disease and Climate Change Division, Suva, , Fiji
  6. 6 School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  7. 7 Department of Health, Office of Health Protection, Canberra, Australia
  1. Correspondence to Professor Ben J Marais; ben.marais{at}

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Summary box

  • Addressing regional health security threats require functional health systems that have integrated surveillance and response capacity, as specified by the International Health Regulations (IHR).

  • Country-level IHR implementation is often suboptimal with limited intra-regional and inter-regional coordination and collaboration.

  • Joint external evaluations provide multidimensional country-level assessments, but human and animal disease surveillance data are poorly integrated and subnational vulnerability is rarely considered.

  • Retaining political commitment in between outbreaks/disasters requires better informed leadership and recognition of Health Security as a standing priority.

  • Weak health systems require increased domestic investment, coordinated international assistance and a commitment to universal health coverage, including investment in quality-assured laboratory infrastructure and reporting systems.


The severe acute respiratory syndrome (SARS) outbreak in 2002/2003,1 which affected 37 countries and resulted in nearly 800 deaths,2 prompted a critical re-think of the global health security architecture. Recognition of the threat posed by emerging infectious diseases (EIDs) and the need to improve national and global surveillance and outbreak response systems motivated the World Health Assembly to adopt the International Health Regulations (IHR) in 2005.3 In the interim, the fateful tsunami of 2004 provided another turning point, emphasising the need for emergency preparedness in order to respond to and recover from major natural disasters. Against this backdrop, WHO’s Western Pacific and South-East Asia regions adopted an all-hazards approach, encompassing disease outbreaks and natural disasters such as cyclones, tsunamis and earthquakes in order to strengthen their health emergency programmes.

Despite these constructive developments, most countries faced significant challenges to implement IHR recommendations once the ‘sense of crisis’ passed. The global health security agenda was revived only after the 2014/2015 Ebola virus outbreak in West Africa. Post hoc analyses of the nature and impact of this outbreak, which killed more than 11 000 people, emphasised the contribution of dysfunctional health systems and …

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