IHR core capacity strengthening and assessment WP5


To improve core capacity in EU Member States as required by International Health Regulations (IHR) (2005) and Decision 1082/2013/EU.

The aim of this work package is to address gaps that exist in the IHR core capacities of countries, i.e., those essential public health functions that each country needs to have in place to effectively prevent, detect and control and manage health threats. These are basic functions such as legislation, surveillance systems, water and food safety functions, outbreak investigation, etc.

Expected results/outcomes

  • Improved levels of IHR capacities to prevent, prepare, detect and respond to cross-border threats to health
  • Practices related to IHR capacity building exchanged with a special emphasis on strengthening the core capacities of focus countries involved in the Joint Action.

Why this is important

The IHR are legally binding upon each WHO Member state’s government, rather than upon a single ministry, agency, office or sector. This means a multisectoral approach is central to the IHR (2005), with collaboration across all relevant national sectors to detect, assess and respond to a variety of potential public health emergencies of international concern.

It is well recognized that the capacity to address cross-border threats requires that countries first have the capability and capacity to control local, regional and national level health threats.

At the European level, on 3 March 2022, the Council adopted a decision to authorise the opening of negotiations for an international agreement on pandemic prevention, preparedness and response. (10 incentives and benefits of an international treaty on pandemics – Consilium (europa.eu))

Plus, the new cross-border threats to health legislation provides for the establishment of an EU health crisis and pandemic plan which will include provisions on exchange of information between EU and national level. Member states, when drawing up their national plans, will liaise with each other and the Commission to seek coherence with this EU level ‘prevention, preparedness and response plan’.

A key element of inter-state liaison is the operationalization of obligations related to response from health systems, cross-sectoral efforts and effective assistance between member states when needed. The Nordic health agreement provides an example of how this may be achieved.

Activities, outputs & deliverables

Work package 5 is supporting partners in building capability and capacity to control local, regional or even national level health threats through the following activities:

Supporting the countries in initiation of the evaluation process with regards to IHR implementation and thereby aiding in evaluation of capacities and needs for capacity building.

Participating countries participate in peer-to-peer exchange of knowledge and best practice, develop national IHR strengthening activities/initiatives to address the common identified gaps.

Improving capacity to send and receive public health assistance during crises. Public health emergencies might be of a magnitude that exceeds the national capacities. In these cases, there remain obstacles for effective international cooperation and support. The health sector often underestimates the complexity of intersectoral cooperation. According to the EU risk assessment report some scenarios could warrant the need to be able to move health personnel, capacities, or medevac of patients in large scale emergencies. Establishment of clear coordination and cooperation between the Civil Protection Mechanism and the European Medical Corps would be essential. The above-mentioned challenges also highlight the need for cooperation between national sectors and DG SANTE, DG ECHO and WHO respectively.

Gaps in capacity are not always captured by evaluations and much information exists in experiences gained through after-action reviews and exercise reports. In cooperation with ECDC, the WHO, and the Commission the possibility to collect and learn from these sources will be explored.

DateActivities, Outputs, Deliverables
15 October 2019A Background Baseline Analysis

An analysis based on country SPAR and JEE reports and telephone interviews of IHR strengths and weaknesses in Bosnia and Herzegovina, Croatia, Greece, Latvia, Lithuania, Malta, Moldova, Poland, Portugal, Serbia, Slovenia and Spain.

This insight on the present status of IHR implementation, recent accomplishments and possible barriers was presented at the One Health Security Conference, Helsinki, 14-15 October 2019. View the presentation: SHARP WP5 brief introduction – Strengthening IHR core capacities (SlideShare).

Plus, the report prioritised the core capacities for the first workshop: Risk Communication, Chemicals, Biosafety and Biosecurity and AMR-One Health.
30 January 2020WP5 Workshop One (MS16)

The first of three workshops (Task 5.1.1) on IHR Core Capacity strengthening and assessment took place in Riga, Latvia.

Forty-five professionals representing 15 countries shared insight on their own country’s IHR implementation, of conducting a Joint External Evaluation, current challenges and future work. The areas of focus were AMR-Stewardship, Risk Communication, Chemicals and Biosafety and Biosecurity. Read more on workshop one on IHR Core Capacity strengthening and assessment
22 March 2021Workshop 5.1.2 – Risk Communication (MS18)

Thirty-seven professionals representing 14 countries, the European Centre for Disease Prevention and Control and the World Health Organisation participated online.

Country presentations were made by partners in Poland, Slovenia, Serbia, Greece and Sweden on risk communication in the context of the COVID-19 pandemic. Participants selected two topics to discuss further the closing plenary discussion.
• gaining trust among the population & measuring this
• communication related to COVID-19 vaccination.

Read more on Workshop 2 – Risk Communication
19-20 September 2022Workshop on Strengthening of IHR Capacities and progress made on IHR core capacities during the pandemic, Ljubljana, Slovenia. (MS19)

The third and final workshop (5.1.3) to determine the extent to which the countries have addressed the existing IHR gaps with particular focus on IHR core capacities related to surveillance and risk communication.

The workshop started with an opening speech by Vesna Kerstin Petrič, of the Ministry of Health in Slovenia.

Sessions to share examples and foster dialogue on the advances in the IHR core capacities of surveillance and risk communication started with presentations from countries (SI, LV, PT & RS-online) on progress made in these areas within their country contexts.

In addition, there were presentations on
• The preliminary findings of the Task 5.3 report (FHI-NO)
• Germany’s JEE implementation
• Sustainability of the Joint Action (MOH-FR)
• WHO and ECDC on overarching legislative structures and IHR/1082 strengthening at the international level.

The workshop saw great benefit from the moderated round table discussion on IHR strengthening related to surveillance and risk communication from all countries participating (SI, PT, SE, SI, PL, GR, BA, DE, LV, HR, FI, NO). The insights generated guide the future work of work package 5.
9-12 November 202215th European Public Health Conference Berlin
“SHARP Joint Action – strengthening capacity in preparing for the unexpected” Lunch Symposium, included a presentation of key insights from Task 5.3 on better practices to strengthen selected capacities in the EU and neighbouring countries; plus an analysis of simulation exercises in Europe. View the EPHC 2022 presentations and watch a video of the symposium.
7-8 December 2022Nordic Health Preparedness Conference, Oslo
Svein Høegh Henrichsen, Senior advisor to Norwegian Directorate of Health (work package 5 co-lead) presents the achievements to date in supporting countries in building capacity required to fulfill the requirements of IHR and EU Decision 1082. Details were disseminated to an audience of 30 health protection experts from authorities responsible for health preparedness in their countries. View the WP5 Oslo presentation (PDF 1.07 MB)
December 2022Report on the use of simulation exercises and AAR (D5.4)
Highly relevant in post pandemic Europe considering experiences managing the COVID-19 pandemic, an analysis of the feasibility of using information from national and international simulation exercises and after-action reviews (AAR) to assess the state of public health preparedness in the EU. Plus, areas of improvements. (Norwegian Institute of Public Health).
Main findings:
– SimEx/AAR were found to be useful tools to evaluate preparedness on EU-level as there are currently no other existing tools
– There is no system in place to monitor the follow-up and implementation of the recommendations from the SimEx/AAR on EU level
– The comparison with the lessons learned from COVID-19 found that the recommendations from SimEx/AAR identify challenges that are important to address to strengthen preparedness.

Read the full Review of EU-level Simulation Exercises and After Action Reviews (PDF 1.32 MB)
SHARP hopes the outcome from this insight will see improved use of results from exercises and AAR as part of a comprehensive monitoring and evaluation strategy for IHR (2005) core capacities and implementation of Decision 1082/2013/EU at the European level.

5 December 2022Survey on international collaboration between authorities during crises with a focus on cross-border collaboration

SHARP Joint Action’s vision is that bilateral, cross-border agreements might be more widely adopted as a practical way to help solve difficulties related to cross-border assistance arising during an emergency.

Some EU states already have agreements and cooperation for mutual and bilateral support. The goal is not to replace these agreements, but to facilitate such agreements for more Member States, and to elaborate on and solve difficult issues related to cross-border assistance if necessary.

A proposed template should consider and propose suggestions for the necessary legal, structural and organisational issues that need to be in place to facilitate effective and rapid cross-border response. It is our hope that the enabling such a template could facilitate multisectoral preparedness within each member state as well as strengthening preparedness in the EU overall.

The proposed template should be seen as an additional strengthening, not as a substitute for the Union Mechanism. It could be used in situations that can be handled on a lower level than big-scale incidents where the assistance of the Emergency Response Coordination Centre (ERCC) will be needed. Or it could, subject to circumstance, be facilitated by the ERCC.

We first need to understand the current situation in member states via an online survey. SHARP Joint Action partners have been asked to share the EUSurvey – Survey (europa.eu) with the relevant national authorities and Contact Points in their organisations and the National focal points (NFPs) for the International Health Regulations (2005).

The survey was also promoted on 9 December 2022 at the International Tabletop Exercise on control measures and contact tracing at points of entry in Athens.

The insight gathered from the 20 respondents will allow initial ideas on template agreements to be tabled further discussion at a workshop on cross-border collaboration 27-28 February 2023 in Portugal.
27-28 February 2023Workshop on International collaboration between authorities during crisis with focus on cross border assistance, Portugal. To discuss and consolidate the survey findings with the aim of informing a recommendation on improvements to international collaboration between authorities during crises (D5.2)
February 2023

Reports on improving IHR implementation (D5.2)
A final report analysing the findings from the three workshops, the interviews with the WP5 partners on IHR strengthening and the benchmarks made to strengthen IHR Core Capacities.
8 May 2023Federation of European Academies of Medicine (FEAM) webinar Are we ready for the next cross-border health crisis? Sara Bengtsson of the Public Health Agency of Sweden (work package 5 lead) was able to join the discussions.  Disseminating how SHARP Joint Action helps strengthen preparedness for all hazards cross border threats to health and its particular focus on lower GNI countries.   SHARP Joint Action had identified that countries themselves report that their IHR capacities have strengthened prompted by the efforts made in the management of the pandemic. 
The high-level speakers attracted an audience of over eighty.
Elements of the agenda had relevance with the outputs and outcomes of SHARP Joint Action, including the importance of bio-security and the One Health approach for future pandemics and outbreaks; and the continued need for collaboration internationally for both preparedness and response.  Plus, the crucial role of multi-sectoral coordination. Recording of the FEAM webinar Are we ready for the next cross-border health crisis?
June 2023Click links to read full reports published to provide health protection experts and policymakers with some new thinking and valuable direction on cross-border collaboration during crises:
D5.2 IHR Core Capacity Strengthening and Assessment (1.4 MB)
Plus, plus insight on how IHR core capacities in low GNI member states have improved in recent years:
D5.3 International collaboration between authorities during crisis (1.5 MB)
Read an overview here
In DevelopmentJournal publication, Assessing Public Health Preparedness and Response in the European Union. A Review of Eu-Level Simulation Exercises and After Action Reviews Globalization and Health, https://doi.org/10.21203/rs.3.rs-2637752/v1 preprint; it has not been peer reviewed by a journal

Work Package (WP) People and Partners

Lead: Public Health Agency of Sweden (FOHM)
E: Anders Wallensten, anders.wallensten(at)folkhalsomyndigheten.se

Folkhälsomyndigheten (FOHM) is the national agency for public responsible for both epidemiological and microbiological surveillance of communicable diseases. The agency is the national contact point for IHR as well as Early Warning and Response System (EWRS) and coordinates the national implementation of actions to strengthen health security.

The agency has a national responsibility for the laboratory preparedness for high consequence pathogens and for this purpose has both BSL3 and BSL4 laboratories.

Co-lead: Associated partner: Norwegian Directorate of Health (HD) – Helsedirektoratet
The directorate is an executive agency and professional authority under the Ministry of Health and Care Services.

Affiliated partner: The Norwegian Institute of Public Health (NIPH)
NIPH acts as a national competent institution reporting directly under the Ministry of Health and Care Services. The NIPH has national responsibility for conducting surveillance of infectious diseases, carrying out epidemic intelligence activities for national events and international events, and providing support to local and national authorities and health care institutions during outbreaks. The NIPH is the IHR (2005) National Focal Point and the contact point for EUs early warning and response system (EWRS).

The NIPH performs microbiological laboratory analysis, including diagnostics and method development, and maintains a high containment laboratory with a 24/7 preparedness function for national microbiological diagnostics of high-consequence infectious agents. Since 2015, the NIPH has supported the implementation of the IHR (2005) in four, low- and middle-income countries through a range of twinning activities including strengthening surveillance, outbreak investigation and laboratory preparedness.

WP8 Core team of lead partners

Dr Anders Wallensten (MD, PhD) is the deputy state epidemiologist working at the Unit for Preparedness and Crisis Management, Department of Communicable Disease and Health Protection, Public Health Agency of Sweden (FOHM).

Sara Bengtsson is the Deputy Head of Unit, Unit for Preparedness and Crisis Management, Department of Communicable Disease and Health Protection, Public Health Agency of Sweden (FOHM).

Dr Andreas Bråve (PhD) is a senior advisor at the Department of Microbiology, FOHM. Andreas has been involved in several previous Joint Actions and led the work package on Training in the JA EMERGE.

Dr Andreas Skulberg, MD, Head of Department of Health Care Services, HD – responsible for infectious diseases preparedness and crisis management.

Bente Lund, Senior adviser Dep of Health Law and Biotechnology HD – responsible for legal framework of the infectious diseases act.

Bengt Skotheim, MA International Politics and Security, Senior adviser to Department of Global Health and Health Intelligence, HD.

Karin Nygård, DVM, PhD. Head of the preparedness programme, Division for Environmental health and Infectious Diseases, Norwegian Institute of Public Health. Extensive experience in epidemic intelligence activities, preparedness and response to infectious disease outbreaks. National focal point for ECDC in preparedness and threat detection.

Siri L Feruglio, MD, PhD, Senior Medical Officer, Department for Zoonotic, Food- and Water-borne Infections, Division for Environmental health and Infectious Diseases. Broad experience in the field of laboratory preparedness, medical microbiology and infectious diseases. Working with infection prevention and control, IHR implementation, high risk pathogens detection and prevention.

Line Vold, DVM, PhD. Director, Department for Zoonotic, Food- and Water-borne Infections, Division for Environmental health and Infectious Diseases, Norwegian Institute of Public Health.

Emily MacDonald, Senior Advisor, Department for Zoonotic, Food- and Water-borne Infections. Extensive experience in training, epidemic intelligence, infectious disease control, preparedness and response.

Pawel Stefanoff, MD, MS, Medical Officer, Department for Zoonotic, Food- and Water-borne Infections, Division for Environmental health and Infectious Diseases. Extensive experience in Public Health surveillance, teaching and international health.

Ingebjørg Skrindo, Norwegian Directorate of Health (HD) – Helsedirektoratet. Senior consultant at the Department of Otorhinolaryngology, Akershus University Hospital.

Svein Hoegh Henrichsen, Norwegian Directorate of Health, specialist in general practice, GP at Langbølgen medical centre in Oslo and head of the Norwegian College of General Practice’s reference group for asthma and COPD. He now works as a senior adviser in the department of general health services in the Directorate of Health.

Siren Borge, Advisor at Norwegian Directorate of Health.

Mari Utheim, MSc Anthropology, Mphil International Community Health, Department for Infection Control and Preparedness, Division for Outbreak Management. Extensive experience from outbreak response in humanitarian settings, surveillance and field research.

Monica Falk, MSc Epidemiology, Department for Infection Control and Preparedness, Division for Zoonotic, Food- and Water-born Infections, Experience from clinical emergency medicine, humanitarian field work and outbreak response.

Mohamed Gawad, MPharm, MPhil Healthcare Management and Economics, Department for Infection Control and Preparedness, Division for Antimicrobial Resistance and Infection Prevention, Hands-on experience from pharmaceutical business, antimicrobial resistance, epidemic preparedness, and global development projects.

Yvonne von Moisy, BSc Health Management and Economics, Department for Infection Control and Preparedness, Division for Outbreak Management. Experience from outbreak response and Public Health surveillance.


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