Eighteenth Ministerial Meeting of the Global Health Initiative (GHSI)

9 March 2018 – London, United Kingdom

  1. We, Ministers/Secretaries/Commissioner from Canada, France, Germany, Italy, Japan, Mexico, the United Kingdom, the United States and the European Commission, gathered today in London to discuss emerging health security events, and to explore joint actions across sectors to protect our populations, and strengthen health security globally.
  2. The GHSI continues to be an important network, strengthening our collective preparedness and response to threats of chemical, biological, and radio-nuclear terrorism (CBRN), as well as pandemic influenza. This meeting underscored the importance and value of this ongoing collaboration in protecting our collective security and that of the wider global community from such threats.
  3. This year is the 100th anniversary of the start of the 1918 Spanish Flu pandemic, which infected over 500 million people worldwide and killed between 50 and 100 million individuals. We solemnly remember the victims of this tragic event.
  4. In the time since the Spanish Flu, the world has seen more pandemics, including H1N1 influenza most recently in 2009. Fortunately, none of those events have been as severe as the 1918 pandemic; however, we know we remain at high risk of seeing the emergence of an aggressive virus and new strains continue to pose a particular threat to our populations. The most recent and concerning threats are from avian H7N9 viruses that have infected more than 1,500 people in China since 2013. While human-to-human spread thus far has been extremely limited, scientists around the world are watching for signs that the H7N9 virus may be adapting to spread efficiently between people. Given the zoonotic origins of the viruses, we emphasize the need to strengthen veterinary and public health collaboration through a One Health approach.
  5. Given the ongoing threat of pandemics, GHSI continues to identify and share best practices to improve preparedness and response. This includes research on novel vaccines, treatments and diagnostics; advances in science and technology that may enable the improvement or extension of the shelf life of our existing medicines and vaccines; and the capacity to manufacture new vaccines more quickly in the face of a pandemic. We recognize that each GHSI country will face unique challenges during an influenza pandemic, resulting not only from the unpredictable nature of viral spread and the variable impact associated with pandemics, but also related to the different structures of our populations, cultural values, and healthcare system configurations. Through the continued collaborative efforts of GHSI to proactively improve our preparedness, we will all be better equipped to face these challenges.
  6. We thank the World Health Organization’s (WHO) Deputy Director General, Dr. Peter Salama, for his insights into the current threat concerning potential pandemics. For 65 years, WHO has demonstrated global leadership with respect to pandemic influenza preparedness and response. We note that the Pandemic Influenza Preparedness (PIP) framework, established under the WHO, is an essential part of our collective pandemic preparedness, setting out a global approach to virus sample-sharing and an access and benefit regime for medical countermeasures. We also recognize seasonal influenza surveillance and sample sharing through the Global Influenza Surveillance and Response System, (GISRS) as a critical component that serve as the basis of our global pandemic preparedness efforts.
  7. We acknowledge the increasing importance of sequence and genome data for preparedness and response, and the need to ensure that it is shared in an inclusive, timely and transparent manner. We recognize the contributions of the well-established and widely used Global Initiative on Sharing All Influenza Data (GISAID) as a sharing mechanism for influenza virus data.  GHSI continues to partner with the WHO to raise critical issues for pandemic preparedness, including triggers for a switch from manufacturing seasonal to pandemic influenza vaccine and timely sample sharing of viruses with pandemic potential, such as H7N9. We acknowledge the importance of industry and of international coordination in global vaccine availability.
  8. Although we have made much progress in our preparedness for a major pandemic over the last century, we recognize that it will be the personal and community-based action taken early in a pandemic that will be the first front-line of response in our globalized world. Since pharmaceutical intervention measures like vaccines require sufficient time for their development, non-pharmaceutical interventions like staying at home when sick and, based on pandemic severity, reduction in social mixing will be critical in reducing the spread of illness until a treatment is confirmed effective. Recognizing that our countries and communities will be impacted differently and will react on the basis of our own contexts, we aim to collaboratively develop decision-making strategies for the use of non-pharmaceutical pandemic interventions through an understanding of the evidence for and against their effectiveness.
  9. We thank Dr. Vanderford for her presentation about public perception of risk in emergencies. We acknowledge that effective communication at the start of a health emergency relies on a pre-existing level of trust between health authorities and the public, and that timely and useful communications can be hampered by uncertainty and rapidly changing situations. Furthermore, the threat posed by these crises may be perceived very differently by and across different societal groups. This impacts how we communicate with the public, and highlights the importance of understanding the public’s knowledge, attitudes and beliefs in real-time. There is a need to continue to exchange best practices and experiences with strategic communications planning, public messaging efforts (especially on difficult, and sometimes conflicting, policy decisions), and to continue ongoing evaluation of the public’s perceptions of various health threats. Our discussions today re-emphasize the importance of having an ongoing awareness of public perceptions related to health threats in order to ensure that communication during an emerging or unfolding health crisis is as effective as possible.
  10. We will continue to place priority on our collaborations with the WHO on pandemic preparedness. In particular, we will work together in addressing gaps in pandemic communication approaches and strategies, to ensure that all groups during a pandemic receive the correct information they need to protect their health in a timely manner, while accounting for how they perceive risks and messages, and instilling and maintaining public confidence.
  11. We further acknowledge that not all threats may be naturally occurring. When we gathered last year in Brussels we committed to strengthen cooperation with the security sector to mitigate the impacts of CBRN terrorist attacks. We are pleased that progress has been made to improve collaborative preparedness and response to international CBRN terrorism. We reaffirm our support for cross-sectoral collaboration and we will continue our joint activities in 2018 to strengthen our collective preparedness and response capabilities for potential future CBRN terrorist attacks. We will continue to share lessons from our preparedness exercises and seek opportunities to involve GHSI partners in relevant exercises, thus reinforcing mutual readiness for public health emergencies.
  12. In particular, and with regard to, preparedness for radiological and nuclear events, and in light of the ever-evolving threat environment, we commend our experts for a continued commitment to strengthening preparedness, response, and recovery capabilities. This includes  expanding our bioassay and biodosimetry laboratory networks, revising utilization policies for medical countermeasures, discussing decontamination protocols, considering novel biodosimetry assays to guide treatment, exercising protocols for emergency and risk communication among GHSI countries, WHO, and the IAEA, and by committing to peer reviews of national radiological and nuclear emergency preparedness as offered by IAEA and WHO.
  13. With concern, we recognize the opioid crises being faced by Canada and the United States as an example of the public health and health security risks posed by highly potent synthetic psychoactive substances. Fentanyl and its analogues (e.g., carfentanil) are appearing in illicit drug supplies in North America and Europe with increasing frequency and further test our capacity to prevent harm, diagnose and treat our populations. The health security threat posed by opioids is an area in which we recognize a need to explore further collaboration with the security sector.
  14. When it comes to improving an epidemic intelligence capacity, we have decided on a joint approach between the GHSI, the Joint Research Centre of the European Commission (JRC), and the WHO, in which the WHO has agreed to lead the Epidemic Intelligence from Open Sources initiative. This capacity is intended to enhance the early detection, verification and assessment of risks within the context of global health. We support the transition of this initiative to WHO leadership under the WHO Health Emergencies Programme (WHE).
  15. We continue to collaborate with the WHO and other stakeholders on sample sharing, notably through the WHO’s 3rd Bio-Banking and Sample Sharing Meeting in October 2017. Such endeavours facilitate global efforts to enable the rapid sharing of biological material during or in preparations for the imminent threat of public health emergencies in accordance with national and international regulations. We call on the WHO to further address the global public health implications of sharing samples and associated benefits, and to highlight the importance of sharing sequences and associated meta-data.
  16. We are pleased to note the GHSI’s successful collaboration with the WHO to post the finalised Operational Framework for the Deployment of the WHO’s Smallpox Vaccine Emergency Stockpile in Response to a Smallpox Event on the WHO website. We will continue working with the WHO to address the regulatory challenges surrounding the emergency use of smallpox vaccines and other experimental medical countermeasures.
  17. In reviewing our accomplishments over the past year, we noted the ongoing collaboration of the Laboratory Network of GHSI in a number of important areas, including, the Laboratory Response Checklist, the rapid sharing of biological materials and the participation of GHSI member laboratories in the five-year EuroBioTox External Quality Assurance Exercise. The Laboratory Network is also assessing the potential threats posed by synthetic biology. These are excellent and concrete examples of the GHSI’s strength in sharing information and workload among a network of trusted partners in tackling shared health security challenges.
  18. We further directed officials to develop the next five-year GHSI Strategic Framework and to ensure it aligns with the WHO’s 13th General Program of Work and the Sustainable Development Goals.
  19. It is with deep appreciation that we thank the hosts of our meeting this year in the United Kingdom, and we welcome the proposal of Mexico to host the next Ministerial Meeting in 2019.

This statement was endorsed by Ministers, Secretaries, and Commissioner for Health and Food Safety.

  • The Right Honourable Jeremy Hunt, Secretary of State for Health and Social Care, United Kingdom
  • The Honourable Ginette Petitpas Taylor, Minister of Health, Canada
  • Karin Knufmann-Happe, Director General for Health Protection, Disease Control and Biomedicine, on behalf of the Honourable Hermann Gröhe, Federal Minister of Health, Germany
  • Martin Seychell, Deputy Director General for Health, on behalf of the Honourable Vytenis Andriukaitis, Commissioner for Health and Food Safety, European Commission
  • Dr. Jérôme Salomon, Director General of Health, Ministry of Solidarity and Health, on behalf of the Honourable Agnès Buzyn, Minister of Solidarity and Health, France
  • Dr. Sandro Bonfigli, Directorate General of Health Prevention, Ministry of Health, on behalf of the Honourable Beatrice Lorenzin, Minister of Health, Italy
  • Dr. Chieko Ikeda, Senior Assistant Minister for Global Health, Ministry of Health, Labour and Welfare, on behalf of the Honourable Katsunobu Kato, Minister of Health, Labour, and Welfare, Japan
  • Dr. Pablo Kuri, Undersecretary for Prevention and Health Promotion, on behalf of the Honourable José Ramón Narro Robles, Secretary of Health, Mexico>
  • Dr. Robert P. Kadlec, Assistant Secretary for Preparedness and Response, on behalf of the Honourable Alex M. Azar II, Secretary of Health and Human Services, United States