The greatest risk to persons engaging in international medical emergency response is poor preparation.
The In Control handbook hopes to provide a remedy.
At the time of writing, we are living through the Coronavirus (COVID-19) pandemic, a health emergency that disregards physical borders, brin...gs into focus social inequalities and affects people on every continent. This shared challenge requires unprecedented measures and the collaboration of the brightest minds to support global health protection through this crisis and beyond. Healthcare infrastructures have to be strengthened, public health capacities and processes upgraded, medical countermeasures and vaccinations found and psychosocial side-effects treated.
Solidarity is the normative order of the day and the human species has to collaborate to face this invisible threat. Hiding and living in fear is not an option in this interconnected world. We have both a responsibility and an opportunity to make substantial contributions to a safer, healthier and more sustainable future for us all.
The existence of this handbook is an impressive example of solidarity. Over 50 authors from more than 15 institutes and organisations have come together voluntarily within a very short time to make their expertise available and enable cross-sectoral thinking. Knowledge is bundled, resources are combined, information gaps are filled. The In Control handbook is not a theoretical treatise of possible dangers, but a collection of subject-matter expertise, written by experts and practitioners who have shaped health topics over the past 20 years in the most diverse corners of the world.
The Centre for International Health Protection at the Robert Koch Institute (RKI) is collaborating with its partners and investing heavily in the build-up of operational know-how and capacity to support health crisis response abroad. This is done by preparing and enabling professionals to deploy safely across the world to assist those in need. In Control addresses the multi-faceted challenges of an international deployment. Readers will find not only technical medical information, but also insights into, for example, the fragility of our environment, the cultural differences that influence risk communication or the dilemmas arising from social distancing. Legal principles are highlighted, along with ethical guidance to ensure that our actions and decisions correspond to the highest moral standards.
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Since the last situation report on the multi-country outbreak of cholera was published on 1 June 2023 (covering data reported until 15 of May), no new country reported a cholera outbreak. In total, 24 countries have reported cases since the beginning of 2023. The WHO African Region remains the most ...affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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Millennium Development Goal 8E aims for affordable access to essential medicines. Essential medicines, as defined by WHO, are those that “satisfy the health-care needs of the majority of the population” and that should therefore “be available at all times in adequate amounts”. However, there... is a category of medicines that faces a unique challenge in terms of availability. These are the medicines governed by the international conventions on narcotic and psychotropic substances. “Controlled medicines” is the common definition for pharmaceuticals whose active principles are listed under the 1961 United Nations Single Convention on Narcotic Drugs as amended by the 1972 Protocol, such as morphine and methadone; the 1971 United Nations Convention on Psychotropic Substances, such as diazepam and buprenorphine; and the 1988 United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, such as ergometrine and ephedrine. The conventions list substances in “Schedules” according to their different levels of potential for abuse and harm, and the commensurate severity of control measures to be applied by countries.
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Brucellosis is widespread in both humans and livestock in many developing countries. The authors have performed a series of epidemiological studies on brucellosis in agro-pastoral areas in Tanzania since 2015, with the aim of the disease control. Previously, the potential of a community-based brucel...losis control initiative, which mainly consisted of the sale of cattle with experience of abortion and vaccinating calves, was assessed as being effective and acceptable based on a quantitative approach. This study was conducted to investigate the feasibility of community-based brucellosis control program using participatory rural appraisals (PRAs) and key-informant interviews. Four PRAs were performed together with livestock farmers and livestock and medical officers in 2017. In the PRAs, qualitative information related to risky behaviors for human infection, human brucellosis symptoms, willingness to sell cattle with experience of abortion, and willingness to pay for calf vaccination were collected, and a holistic approach for a community-based disease control project was planned. All of the communities were willing to implement disease control measures. To avoid human infection, education, especially for children, was proposed to change risky behaviors. The findings of this study showed that community-based disease control measures are promising.
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The Child Protection handbook provides a synthesis of good practice and learning and enables better advocacy and communication on child protection risks, needs and responses. Standards addressing child protection needs cover core work areas and critical issues. Those addressing strategy relate to ca...se management, community-based child protection, child-friendly spaces and protection of excluded children. A fourth set of standards gives guidance on how workers in other sectors can ensure that their programmes are accessible and beneficial to children. DOCUMENT ALSO AVAILABLE IN: Arabic, Chinese, French, Indonesian, Korean, Spanish, Turkish, Urdu on http://cpwg.net/minimum_standards-topics/cpms-full-version/.
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According to 2014 Census data, almost a third of the population in Myanmar do not have adequate identity and civil documentation. Of these, 54 percent are women.
Women who live in remote or conflict affected areas, who are displaced or belong to stateless ethnic and religious minorities face the... consequences of an insecure legal identity. They cannot enrol their children in school, open a bank account, travel freely or register land.
The report provides an analysis of the gender aspects of citizenship legislation in Myanmar and its application in light of the standards set by the UN Convention on the Elimination of Discrimination Against Women (CEDAW). It analyses in detail women’s ability to acquire citizenship on an equal basis as men, their ability to acquire, retain or confer citizenship following marriage and their ability to confer citizenship to their children. The report highlights the normative and practical challenges faced by women and proposes ways forward.
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Following the release of the Wheelchair Service Training Package – Basic level (WSTP-B), WHO in partnership with United States Agency for International Development (USAID) has developed the Wheelchair Service Training Package – Intermediate Level (WSTP-I). WSTP-I is the second part of the WHO w...heelchair service training package series and focusses more on addressing the needs of people who have severe difficulties in walking and moving around and also having poor postural control . While developing this training package, special attention was given on the provision of appropriate wheelchairs for children who have poor postural control and are unable to sit upright independently.
Purpose of the training
The need for wheelchair personnel is universal. WSTP-I is designed to support the training of personnel or volunteers to provide an appropriate manual wheelchair and cushion for children and adults who need additional postural support to sit upright. The main purpose of this training package is to:
increase the number of wheelchair users who receive a wheelchair which meets their needs;
increase the number of personnel trained in intermediate level wheelchair service delivery;
improve the competencies of wheelchair service delivery personnel;
increase the quality of wheelchair service delivery for people who need a comparatively higher level of intervention than basic level;
include this training package in regular paramedical/rehabilitation training programmes;
achieve greater integration of wheelchair service delivery within rehabilitation services.
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This joint ECDC-European Union Aviation Safety Agency (EASA) document aims to support Member States in determining a coordinated approach to reduce the risks related to the movement of people by air within and between the EU/EEA countries and the UK in the context of the COVID-19 pandemic, noting th...at the impact of quarantine and testing is likely to vary according to levels of ongoing community transmission, and in the context of ECDC’s current advice that non-essential travel should be avoided during the end-of year festive period
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Mpox is an emerging zoonotic disease caused by the mpox virus, a member of the Orthopoxvirus genus closely related to the variola virus that causes smallpox. Mpox was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research. The first human case was recorde...d in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox and since then the infection has been reported in a number of African countries. Mpox can spread in humans through close contact, usually skin-to-skin contact, including sexual contact, with an infected person or animal, as well as with materials contaminated with the virus such as clothing, beddings and towels, and respiratory droplets in prolonged face to face contact. People remain infectious from the onset of symptoms until all the lesions have scabbed and healed. The virus may spread from infected animals through handling infected meat or through bites or scratches. Diagnosis is confirmed by polymerase chain reaction (PCR) testing of material from a lesion for the virus’s DNA. Two separate clades of the mpox virus are currently circulating in Africa: Clade I, which includes subclades Ia and Ib, and Clade II, comprising subclades IIa and IIb. Clade Ia and Clade Ib have been associated with ongoing human-to-human transmission and are presently responsible for outbreaks in the Democratic Republic of the Congo (DRC), while Clade Ib is also contributing to outbreaks in Burundi and other countries.
In 2022‒2023 mpox caused a global outbreak in over 110 countries, most of which had no previous history of the disease, primarily driven by human-to-human transmission of clade II through sexual contact. In just over a year, over 90,000 cases and 150 deaths were reported to the WHO. For the second time since 2022, mpox has been declared a global health emergency as the virus spreads rapidly across the African continent. On 13 Aug 2024, Africa CDC declared the ongoing mpox outbreak a Public Health Emergency of Continental Security (PHECS), marking the first such declaration by the agency since its inception in 2017.7 This declaration empowered the Africa CDC to lead and coordinate responses to the mpox outbreak across affected African countries. On August 14, 2024, the WHO declared the resurgence of mpox a Public Health Emergency of International Concern (PHEIC) emphasizing the need for coordinated international response.
As of August 2024, Mpox has expanded beyond its traditional endemic regions, with new cases reported in countries including Sweden, Thailand, the Philippines, and Pakistan. Sweden has confirmed its first case of Clade 1 variant, which has been rapidly spreading in Africa, particularly in DRC. The emergence of this new variant raises concerns about its potential for higher lethality and transmission rates outside Africa.
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Evidence shows that oral pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV during sexual intercourse by more than 90% when taken daily. It is for this reason the National HIV Prevention Strategy 2015-2020 (2018 Revision) emphasises the role of preexposure prophylaxis (PrEP) in ...reducing new HIV infections in Malawi.
The Ministry of Health has prioritised PrEP use among the populations most at-risk of HIV infection in Malawi: young women ages 10 to 24 years, sero-discordant couples, female sex workers, men who have sex with men, and other priority populations (such as members of the uniformed services, prisoners, and mobile populations).
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High salt consumption is an important determinant of high blood pressure and reducing it would improve health outcomes by lowering cardiovascular disease and therefore death rates. Reducing salt intake has been identified as one of the most effective public health measures and is one of the leading ...targets at global, regional and national levels to reduce the burden of noncommunicable diseases. The purpose of the Dietary Salt Intake Survey in the Republic of Moldova was to establish current baseline average consumption of salt (sodium), potassium and iodine through 24-hour urinary excretion testing among a random sample of the adult population (aged 18–69 years), and to assess the knowledge, attitudes, practices and behaviour around dietary salt in order to enable more efficient planning and the implementation of an effective salt-reduction strategy in the Republic of Moldova.
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The following Emergency Response Plan for the COVID-19 pandemic seeks to set out activities that will be undertaken by humanitarian actors in Ukraine over the course of 2020 to respond to the public health impact of the epidemic – as well as the indirect, socio-economic impact on people’s well-b...eing, which will span across many areas. Given the extensive public exposure of the COVID-19 threat, the response will cover the whole of Ukraine, while providing a distinct focus on Donetska and Luhanska oblasts that have been ravaged by an armed conflict for the last six consecutive years. The planned COVID-19 response in the two conflict-affected oblasts will be treated as an annex to the current Humanitarian Response Plan for Ukraine
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The Global Burden of Disease (GBD) study, a collaborative endeavour of the World
Health Organization (WHO), the World Bank and the Harvard School of Public Health,
drew the attention of the international health community to the burden of neurological
disorders and many other chronic conditions. T...his study found that the burden of neurological
disorders was seriously underestimated by traditional epidemiological and health
statistical methods that take into account only mortality rates but not disability rates. The
GBD study showed that over the years the global health impact of neurological disorders
had been underestimated.
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Fostering resilient development through integrated action plan
The Myanmar Action Plan on Disaster Risk Reduction, 2017 is a comprehensive and unified action plan for disaster risk reduction with prioritized interventions across Myanmar till 2020. With a long term vision and considering deep-root...ed underlying drivers of disaster risk, it has set an overall target for 2030. it aims to provide a base for mobilizing and leveraging, primarily, national and external resources and will provide a basis for result printed outcomes.
The action plan identifies 32 priority actions under four pillars: risk information and awareness; risk governance; risk mitigation; and preparedness and response, rehabilitation and reconstruction. For each priority action, objectives, activities, outputs, duration, lead agencies, and supporting partners have been identified.
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The COVID-19 pandemic has been a formative experience for all humanity and a health emergency of global proportions, presenting a huge challenge to national leaders, health systems, and citizens. The findings of a new report by the OSCE Office for Democratic Institutions and Human Rights (ODIHR) sho...ws that it has also been a test to our democracies and the respect for human rights to which countries across the OSCE committed many years ago.
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We investigate whether and to what extent Chinese development finance affects infant mortality, combining 92 demographic and health surveys (DHS) for a maximum of 53 countries and almost 55,000 sub-national locations over the 2002-2014 period. We address causality by instrumenting aid with a set of ...interacted variables. Variation over
time results from indicators that measure the availability of funding in a given year. Cross-sectional variation results from a sub-national region’s “probability to receive aid.” Controlled for this probability in tandem with fixed effects for country-years and provinces, the interactions of these variables form powerful and excludable instruments. Our results show that Chinese aid increases infant mortality at sub-national scales, but decreases mortality at the countrylevel. In several tests, we show that this stark contrast likely results from aid being fungible within recipient countries.
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The document “Malaria Prophylaxis for Travellers: Guideline for Healthcare Workers” (2019) from Sri Lanka provides guidance for healthcare providers on preventing malaria among travelers to endemic areas.
It explains that since Sri Lanka was certified malaria-free in 2016, the main risk comes f...rom imported cases, mostly Sri Lankan travelers. The document emphasizes assessing travelers’ risk, advising on mosquito bite prevention, and prescribing appropriate chemoprophylaxis like chloroquine, mefloquine, atovaquone-proguanil, or doxycycline depending on destination and traveler profile.
It highlights that children, pregnant women, and immunocompromised individuals are particularly at risk, and stresses adherence to medications and protective measures. Special instructions are given on handling missed doses, long-term prophylaxis, and managing side effects. Overall, the guideline aims to maintain Sri Lanka’s malaria-free status by preventing reintroduction through well-informed traveler care.
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During the past five decades, the incidence of dengue has increased 30-fold. Some 50–100 million new infections are estimated to occur annually in more than 100 endemic countries, with a documented further spread to previously unaffected areas; every year hundreds of thousands of severe cases ari...se, including 20 000 deaths; 264 disability-adjusted life years per million population per year are lost , at an estimated cost for ambulatory and hospitalized cases of US$ 514–1394, often affecting very poor populations. The true numbers are probably far worse, since severe underreporting and misclassification of dengue cases have been documented.
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