IPT & RKI Partnership Symposium: Current Challenges of Biological Risks and Health Security”

IPT & RKI PARTNERSHIP SYMPOSIUM: „CURRENT CHALLENGES OF BIOLOGICAL RISKS AND HEALTH SECURITY”

Presentation of TUN-GER Program activities

Dr Rym BENKHALIFA

République TunisienneMinistère de la Santé

September, 22- 23, 2016Ramada Plaza Hotel – Gammarth, Tunisia

CURRENT CHALLENGES?

2015-2019 United Nations Development Assistance Framework (UNDAF)

UNDAF is structured around four strategic dimensions:

democratic governance,

inclusive, sustainable and resilient economic model,

social protection

equitable access to social services.

IPT & RKI Partnership Symposium Gammarth, 22-23 September, 2016


Health is a human right

It highlights that :

•The State should ensure preventive and curative health services and

provides sufficient resources to guarantee security and quality of services.

•The State guarantees free health care for poor people.

• It guarantees also social protection as stated in law.

Article 38 of the new Constitution (2014)

ChallengesA health system reform is needed to implement an integrated approach, based on :

- primary care- focusing on prevention and health promotion, - including provision of palliative care and rehabilitation following specialist management, in order to respond better to the increased chronic and infectious diseases and their risk factors and change in etiology of disability.

This is a priority for the MOH.


State of the art in Tunisia



1990: Tunisian Occupational Health and Safety Institute 1995: Agency for Coastal Protection and Development1996: International Centre for Environmental Technologies 2005: National waste Management Agency

Pleiad of texts has…• strengthened the legislative and regulatory framework related to environmental

protection Against pollution For the conservation of water and soil

• established a national emergency intervention plan against marine pollution incidents for waste and control of their management and their disposal for air quality.

Actions engaged in Tunisia


The Cartagena Protocol on Biosafety, ratified by Tunisia in 2002 , is an important instrument that ensures the safe transfer, handling and use of GMOs.

but… up until 2009, no national consensus was reached between national departments in the Tunisian government : only a draft law on GMO and GMO products was reviewed in Tunisia.

In 2011, a new context emerged : National Plan and Strategy for Biosafety

Control Device and institutional support Information and awareness Skills development : Capacity development through research and training

By 2014, the national technical biosafety commission drafted a new version of the law on biosafety that integrates the issues of GMO, pathogens and invasive alien species.

Ministry of Environnement: National Strategy and Action Plan in Biosafety


HEALTH POLICIES AND SYSTEMS

Other noteworthy developments in 2013-2014 are:

National institute for accreditation in health including guidelines development National strategy on mental health National strategy for reduction of maternal and neonatal death

The Tunisian health system can build on well-developed public infrastructure throughout the country :

2085 PHC centers and 109 district hospitalsa dynamic private sector and an extended workforce.

However, specialized resources (including in the private sector) are unevenly distributed.

Public sector = 2/3 of consultations and 90% of hospitalization while most human and financial resources are being diverted to the private sector.


Cooperation for Health

Present in Tunisia:

Various organizations of the United Nations are present in Tunisia: (UNICEF, UNDP, FAO, UNFPA, UNIDO, IOM, UNAIDS, UN Women, UNOPS, WFP, OHCHR, UNHCR, WB, UNESCO)

Several international donors (EU, ADB and the French, Italian, and Spanish international cooperation agencies).

Renewed interest in investing in the health sector.

CBRN Risks

Within the security mission of the International Cooperation Office of Tunisian Customs

• National Focal Point of Center of Excellence for Chemical, Biological, Radiological and Nuclear risks management : UNICRI / UE

IPT, ONMNE, Universities, Ministries


UNICRI / CoE CBRN risks management projects

National Focal Point : the International Cooperation Office of Tunisian Customs

National Team: 1 member from each ministry

Project 23

Project 3

Project 26

Project 35 …….


National Experts Team : 6 NEs

Colonel Professor Mohamed Ben Moussa : Military Hospital of Tunis (Ministry of Defense)

Dr Anissa Chouikha : IPT (MoH)

Mr Khaled Trabelsi : IPT (MoH))

Mrs Hazar Belli : Department of Biodiversity and Genetic Ressources (Ministry of

Environnement)

Mr Taha Chebbi: Legal Studies Centre (Ministry of Justice)

• Mr Chedy Bahleli : Directorate of Major Risks of Planning in the Office of the National Civil

Protection (Ministry of Interior)



German Partnership for Excellence in Biologic and Health Safety

German Partnership for Excellence in Biological and Health Safety

• The program lasts 3 years (2013-2016) and is part of the German commitment to the global partnership of the G8.

• The program is guided by the available biological safety of the sub-working group of the G8 on Biosafety (start).

• The program is funded and run by German Federal Foreign Office of business.

République TunisienneMinistère de la Santé



1000 2000 3000 4000 Km0

Soudan

Tanzanie Nigeria

Brésil

Tadjikistan

OuzbékistanKazakhstan

Maroc Tunisie

Géorgie

ÉgyptePakistan

Kosovo

Sierra Leone

Cameroun

RD Congo

Mali

Guinée

Turkménistan

Kirghizistan

• 19 projects• 22 countries• budget: 23 millions €• 2013 - 2016

At the international level

Côte d'Ivoire

Objectives

• Reduce the biological risk and enhance national safety in health

• promote international scientific exchanges of qualified scientific personnel

• contribute to the fight against dangerous diseases

• support a safe conduct against pathogens and toxins


Toolbox : 6 Key topics


Tunisian-German cooperation and partnership for Excellence in Biological and Health Safety

Partnership implemented by RKI and GIZ

Technical advice Trainings &

workshops Know-how

transfer Staff exchange

Since November 2013: GIZ, RKI, MFA, MoH• Meetings and

workshops in Tunis• Visit study tour in

Germany

Assessment• Identification of needs

• creation of a priorized list

Key areas of cooperation • Biosafety & Biosecurity• Detection & Diagnostics

• Surveillance


Kick off meeting: 17 february 2015


Tunisian Key Parteners

• Minister of Health

• Institut Pasteur de Tunis (IPT)

• Basic Health Care Directorate (DSSB)

• National Observatory of New and Emerging Diseases (ONMNE)



Institut Pasteur de TunisIn 1958, a law defined Pasteur Institute of Tunis as "an institution for Scientific Research according to the Pasteur methods." and Its role is "to conduct all investigations, missions (diagnosis, research, vaccine and sera production), analysis or scientific research interest is human or animal health, or economic development in Tunisia."In January 1995, the IPT began a Public Establishment of Health

Committees for the implementation of a strategy of Excellence and Scientific Responsibility

• The Committee of Biomedical Ethics established in 1992• The Committee on Health and Safety at Work: ensures compliance with health and safety

regulations for work • December 1998 : The Quality Assurance department for the establishment of a quality

system for the development, production and control of vaccines and serums: In January 2015, creating a Quality Committee

• Biological Resources Committee created in 2014


National Observatory of New and Emerging Diseases: ONMNE

Missions:

Concerning new and emerging diseases

- Collect and analyze data to improve decision in the field of prevention,- Establish specific information systems to enhance early detection capacity, rapid

reporting and investigation - Monitor the international epidemiological situation to avoid or reduce the risk of their

cross-border introduction,

- Study and edit a scientific periodical on obtained results.

- Organize training sessions for health teams to improve their skills in the field

of Epidemiology and Prevention


http://www.santetunisie.rns.tn/

2058 Basic health centers

throughout the country provide health services to preventive and curative as

well as health education.

Treatment of common diseases

Maternal and infantile, including family planning;

Prevention and control of communicable and contagious diseases,

including vaccination;

Preschool medical benefits, schools and universities;

Dissemination hygiene rules and rules on environmental protection;

The collection and use of sanitary and epidemiological statistics.

Directorate of basic health care : DSSB

Key areas of cooperation

• Surveillance• Formation et infrastructure permettant la collecte, la diffusion et

l’échange de données• Training and infrastructure for the collection, dissemination and

exchange of data biosafety and biosecurity Working• Detection et diagnostic

• Training, proper equipment and continuous monitoring of quality • Biosafety and Biosecurity

• Adequate and sufficiently safe conditions • Appropriate training, • Responsible behavior and • Adequate equipment



Activities in Tunisia


• How, when and where to report new cases of illness? • What steps are necessary for the investigation of an outbreak?

How is an investigation team? • What information to communicate to the public and when not

to generate panic? • How can we protect the population, namely, to delegate and

prioritize multiple tasks under time pressure?

Be prepared in case of an outbreak : Preparedness plan : P2R2

• The risk of epidemics for emerging diseases, but also for other endemic diseases can be reduced by intervention epidemiology and this mostly by the rapid identification of cases and an adequate response. For this reason the DSSB has developed a technical guide to epidemiological investigations.

• In Tunisia, preparedness and response plans already exist health for certain diseases.• Plan de Préparation pour la Riposte en temps de Risque Sanitaire (P2R2) is the

preparedness and response plan that can be adapted to answer to specific diseases. • P2R2 refers to the existing specific guides• P2R2 : response and resilience of epidemic-prone diseases in Tunisia, the

implementation of a national epidemiological teleconference system based surveillance events.

Early Warning and Response system in Tunisia by integration of Event-Based Surveillance to the traditional surveillance system, Emergency and General practitioners networks, environmental data integration and mathematical modeling using time series analysis.


Media training on risk and crisis communicationIn the event of an outbreak of disease, public communication by health authorities plays a key role in preventing panic among the population. • Media training courses on risk and crisis communication for senior staff in Tunisian health

institutions. • Press officers and selected representatives from health authorities learned :

communication during an outbreak of disease by simulated press conferences and interviews and pandemic simulation exercises.



SimEx April 2016

The evaluation of the simulation exercise SimEx has clearly demonstrated a large existing knowledge.

The treatment procedures to investigate the epidemiological outbreak or for the risk assessment should be strengthened through appropriate training at regional level.


04080

120

Number Of Workshops Participants

Regional Directorate Of

Health/ Departments

Experts Protocol Development

"Media Training" 12 120 24 2

2P2R 9 30 6 1Development

of National Strategy of

Risk Communicati

on in crisis

2 20 Communication Experts 1

Media Training VIP 1 20

EpiTec 2 24 1EBS 1 24 8


Biosafety, Biosecurity, Detection and Diagnosis

Partner : IPT

Improved capacity in Biosafety and diagnosis of highly pathogenic viruses• Laboratory of Virology / EBOLA• Rabies Laboratory / Rabies

• Study Visit in RKI

Joint Training• Training in B & B and BM• All IPT Staff• doctoral students and interns• Responsible research / dual use of concern / code of conduct

Institut Pasteur de Tunis, 28-29 juin 2016

IPT and biological risk management

WHO: The training of trainers in biological risk management and biosecurity of laboratories. 2 experts

UNICRI, EU Centre of Excellence CBRN: project 3: the development of knowledge and the transfer of best practices for the biological risk management, biosafety and biosecurity : 2 experts


RKI / IPT joint WORKSHOPS on B&B• 2 workshops in october 2015: administratives staff, scientific and medical

doctors, head of laboratories, researchers, technicians• 2 workshops in june 2016: researchers and lab technicians• Training for IPT students (master and PhD) and trainees : November 2015 et May

2016• Workshop for PhD students from the UTM Doctoral School september 2016,


Almost 100 participants…

Questions:

• Are there any risks associated with such ability to generate genetic data on people?

• How to manage access to data?

• Our current regulations are they sufficient?

• What changes do they bring to the practice of health professionals, industry or research involved?

• What about discoveries called "incident findings"?

• In the context, under which conditions these data can they be used for research of new knowledge on the understanding of genomes?


Capacity building on B&B

Code of conduct

LawsEthical

Committees

• The threat of biological warfare and bioterrorism.

• the dilemma of the dual responsibilities of researchers

• Implementation locally of the Convention against biological weapons and terrorism



2014…

The Rome Declaration is now calling the European institutions, the Member States, research and funding, as well as the private sector organizations and civil society to make the Research and Innovation Responsability (R.I.R) a common goal and to find sustainable and inclusive solutions to societal challenges which confront us collectively.

Side Event: Germany and Tunisia - Biosecurity - Biorisks – Bioethics

• Meeting of States Parties to the Biological Weapons Convention; Palais des Nations, Geneva, December , 1-5 , 2014


2 workshop in April 2015, then in June 2015 Developed with the RKI experts, the IPT Committee of Biomedical Ethics

members and IPT B&B experts, finalized in July 2015.

IPT Code of conduct


S WTO

• program achievementsskills

• Networks• upgrading knowledge• improved absorptions

events

Strengths• multiplication

collaborations: duplicates

• lack of intersectoral communication

• no staff dedicated to the project

• no internal budget

Weaknesses

• Continuity• Extention to other

sensitive sectors• Harmonization of existing

initiatives

Opportunities

• No budget for implementation...

• political stability

ThreatsSWOTAnalysis



From IPT• Hechmi Louzir• Sana Masmoudi• Anissa Chouikha• Khaled Trabelsi• CEBM members• Abdeljelil Ghram• Samir Boubaker• Hichem Ben Hassine• Souad Hajjam• Ali Bouattour• Naceur El Ouni• ….

• Nissaf Ben Alaya and Colleagues from ONMNE

• Souad Bekri and Colleagues from DSSB

From RKI• Walter Biederbick• Nicole Hanschmann• Luam Ghebreghiorghis• Olena Kysil• Iris Andernach• Nadine Zeitlmann• Stefan Klolth• Christine Uhlenhaut• Kristina Schmidt• Barbara Burkin• Matthias Nachtnebel

From GIZ• Joachim von Bonin• Annira Busch• LillianHollenweger • Nora Ben Ammeur• Dilan Kücükali• Zina Ben Jelloun

THANK YOU FOR YOUR ATTENTION

IPT & RKI Partnership Symposium Gammarth, 22-23 September,

2016

Health & Medicine

IPT & RKI Partnership Symposium: Current Challenges of Biological Risks and Health Security”