1. We, the Ministers/Secretaries/Commissioner of Health, met in Tokyo for the Seventh Ministerial Forum of the Global Health Security Initiative (GHSI). We have achieved significant progress since the creation of the GHSI in 2001, and we remain committed to strengthening global health security and protecting the health and safety of our respective populations. Our meeting today served to advance our work on several fronts
2. Pandemic preparedness remains a key GHSI priority. We are pleased to note the important work accomplished over the past year by the UK and U.S. led Working Group and its members in conjunction with the World Health Organization (WHO). In May 2006, Germany hosted a pandemic influenza workshop on the approaches to development and use of vaccines; in 2006 the United States hosted a communications planning workshop for GHSI members in Washington, D.C.; and Canada hosted an October 2006 meeting to discuss global influenza vaccine manufacturing capacity, stockpiling and considerations for the use of H5N1 human influenza vaccines in the pre- pandemic period. These meetings provided valuable opportunities to share information, identify best practices, and explore further areas of cooperation.We commended the WHO for its leadership with respect to the announcement of their Global Pandemic Influenza Action Plan to increase vaccine supply. The ongoing development of this plan constitutes a key advancement with respect to enhancing international pandemic influenza coordination and preparedness efforts. We thanked the United States and Canada for their contribution of funds to this important effort.

   We are pleased to report the comparison and analysis of our respective pandemic preparedness plans. This exercise has served to strengthen our common preparedness efforts. We are also pleased to report the advancement of work on harmonized approaches to the development of high-level communications messages, presented at the United States October 2006 workshop, which will serve to strengthen our collective approaches to informing our respective decision-makers, health professionals and citizens regarding a pandemic situation. In addition, we recognized the development of an early containment protocol over the past year by the WHO and technical experts. We encourage the WHO to exercise and evaluate this protocol.

   We recognized that key challenges to global preparedness and response on pandemic influenza remain, and we have agreed to continue to address these challenges. In 2007, priority topics for the GHSI Pandemic Influenza Working Group include: assessment of risks and on-going comparison and analysis of GHSI members’ national plans, with particular attention to better understanding the rationale for differences in planning assumptions and approaches to community containment measures; sharing policies for pre- pandemic and pandemic vaccine production and distribution, as well as antiviral use, stockpiles and distribution; on-going review and discussion of our respective communications plans and sharing of communications and behavioral research; and sharing lessons learned from national and regional exercises.

3. The Canada-led Global Health Security Action Group (GHSAG) Laboratory Network continued to make progress on various fronts. The work of the Network has led to numerous advancements with respect to building health security capacity. To this end, we have agreed to review current laboratory security processes and procedures with a view towards expediting interchange and movement of scientists among member countries’ high security laboratories, with the objective of rapid and timely knowledge exchange and research collaboration, primarily in the area of threat agents.We thanked the United States for hosting a successful smallpox lab workshop in Atlanta in September 2006. We also thanked Canada for hosting a workshop on environmental sampling in conjunction with the 2nd National Conference on Environmental Sampling and Detection for Bio-Threat Agents held in New York in October 2006.

   A number of key Network initiatives are planned for 2007, all of which will build on past Network advancements. Canada will host a laboratory workshop on viral haemorrhagic fevers (such as Marburg, Ebola, and Lassa); the UK will host a workshop on Q fever; Germany will host an electron microscopy diagnostic workshop; Canada will host a deployable laboratory workshop for all Network members and will coordinate, with the UK, an infectious disease samples transportation exercise in early 2007; and Germany will develop a proposal for a GHSAG External Quality Assurance program. The aforementioned exercises and workshops will result in valuable information sharing opportunities for GHSI member countries on diagnostic best practices and related techniques, and consequently improve GHSI capacity to detect and respond to natural or man-made public health emergencies.

4. Risk management and communications continues to be a key focal point of our common activities. To this end, we thanked Germany for hosting a workshop on proactive risk communication in 2006. We welcomed the UK’s plan to host an explosive devices symposium in 2007 in order to develop best practices for managing injuries. Germany will host a workshop on the risks related to an intentional release of botulinum toxin in January 2007, as well as a workshop on the advanced management of biological threats. Japan plans to host a workshop on surveillance for early detection and assessment of risk, utilizing the results of the UK study on existing early warning networks. We welcomed the United States’ offer to host a workshop in 2007 on public health decision making and lessons learned from Hurricane Katrina, which will provide an opportunity for member countries to discuss their public health response efforts and decision-making processes during emergencies. And we welcomed the UK’s offer to host a workshop on the current Polonium-210 incident.Work in consultation with the WHO Secretariat is being completed on operational planning around potential smallpox outbreaks. We also noted the importance of the ongoing research on live variola virus, at the two authorized repositories under the auspices of the WHO.

   We noted the additional progress made by the Emergency Contact Network, which was subject to continued testing. Such testing and related work will continue. A revised Network protocol was also recently completed, and the Network is available for emergency and routine videoconferencing. The ability to quickly connect GHSI members through a variety of communications technologies continues to be useful. This proven capability further enhances our ability to rapidly communicate during emergencies.

   We thanked the UK for its leadership in creating a calendar of major exercises and activities that involve the health sector, and emphasized the need for members to share lessons learned from these exercises. And we endorsed the proposal to organize a strategic workshop involving all GHSI working groups to assess current chemical, biological, radio-nuclear, explosive and pandemic influenza threats and risks. This workshop will facilitate the further prioritization during 2007 of threats and risks that will require our collective attention and action.

5. We thanked the European Commission for hosting the recent November 2006 Health Security Research Symposium in Brussels. The meeting provided an opportunity to explore how best to improve our global health preparedness and response to chemical, biological and radio-nuclear threats, and how research can contribute to our collective health policy decisions. Building on the recent Symposium, we have asked officials to consider ways in which information on research and research gaps related to GHSI objectives could best be identified and shared in a timely manner.
6. We thanked Japan for its continued leadership regarding the work of the GHSI chemical events working group, and in coordinating the February 2006 terrorist simulation event. We welcomed the offer from Japan with respect to holding future simulation workshops on selected chemical agents, the first of which was held in July 2006, which focused on clinical issues, mitigation plans and possible cross-border impacts.
7. The public health implications of radiological incidents and their international significance must continue to be better understood. We thanked France for hosting the June 2006 workshop and simulation exercise, to which the Organization for Economic Cooperation and Development’s Nuclear Energy Agency, the WHO and the International Atomic Energy Agency all contributed. This exercise allowed members to exchange best practices regarding the medical management of highly irradiated individuals and the management of the public health aspects of radiological terrorist acts. These findings will help guide our future activities and planning activities.We congratulated France and Germany for their presentations on their research results in the medical management of highly irradiated victims. We supported the proposal from officials to incorporate new experience into international protocols in the areas of urgent actions, novel triage approaches, and treatment protocols for acute radiation syndrome and radiological burns of highly irradiated victims.

   The June 2006 workshop identified the issue of international transfer of patients who are suffering from acute radiation sickness, specifically the potential “bottleneck” in the rapid provision of expert medical assistance. To resolve this issue, we have requested that officials assess the challenges and recommend solutions prior to the next meeting of Ministers.

8. International collaboration of field response to outbreaks remains an area of sustained effort for GHSI members. We welcomed Mexico’s continued leadership in advancing our common work around identifying needs in national epidemiology responses among members, which includes the development of a database of existing resources and networks in field epidemiology and outbreak response. A final report on this topic will be completed in early 2007.We also welcomed Italy’s plans to host a workshop on highly infectious patient isolation techniques in 2007.
9. We appreciated the German, French and WHO led initiative on capacity building, and welcomed the results of this initiative. We also thanked the WHO for working with the GHSAG Laboratory Network in supporting the implementation of the International Health Regulations (IHRs), and in identifying the requirements necessary to share protocols, expertise and diagnostic approaches with other countries.We noted the continuing work with respect to the implementation of IHRs. We are pleased that the 59th WHA followed the lead of the GHSI members in passing a consensus resolution in May 2006 that calls for early, voluntary implementation of the relevant provisions of the IHRs, rather than waiting for formal implementation in June 2007. We are also pleased that the WHO is required to report annually on progress achieved in providing support to member states on compliance with the implementation of the IHRs. We recognized the importance of the IHRs in strengthening our response to international public health threats – including a possible influenza-related pandemic – which all countries face in the 21st century. We also discussed the need for GHSI member countries to identify particular areas to assist developing countries with their implementation of the IHRs.

   We will continue to voluntarily apply the revised IHRs with the understanding that the regulations apply to all such health threats and causes and modes of events, irrespective of whether they are naturally occurring, accidental, or deliberate.

   We acknowledge our continued support to the WHO Secretariat in the implementation of the IHRs. Work will continue by GHSI members to support the WHO through training opportunities to build the necessary capacity in developing countries. GHSI countries will undertake further efforts to identify ways to initiate and support laboratory training to developing countries as part of their implementation of the IHRs.

10. We are pleased to have launched this year the public web site (www.ghsi.ca) for the GHSI. This new site has served to facilitate the sharing of information and outcomes from the Initiative.
11. We welcomed the invitation from the United States to host the next Ministerial Meeting in late 2007.

Statement endorsed by:

• The Honourable Hakuo Yanagisawa, Minister of Health, Labour and Welfare, Japan
• The Right Honourable Rosie Winterton, Minister of State for Health Services, United Kingdom
• The Honourable Alex Michael Azar II, Deputy Secretary, United States Department of Health and Human Services, on behalf of Secretary Michael O. Leavitt, Secretary of Health and Human Services, United States
• Dr. Klaus Theo Schröder, Deputy Minister, Federal Ministry of Health, on behalf of the Honourable Ulla Schmidt, Minister of Health, Germany
• Susan Cartwright, Associate Deputy Minister, Health Canada, on behalf of the Honourable Tony Clement, Minister of Health, Canada
• His Excellency Miguel Ruiz-Cabañas Izquierdo, Ambassador of Mexico to Japan, on behalf of Dr. José Ángel Córdoba Villalobos, Minister of Health, México
• Dr. Didier Houssin, Directeur général de la santé, on behalf of l’Honorable Xavier Bertrand, Ministre de la santé et des solidarités, France
• Dr. Maria Rosaria Capobianchi, Director, Laboratory of Virology, National Institute for Infectious Diseases, on behalf of the Honourable Livia Turco, Minister of Health, Italy
• Dr. Andrzej Rys, Director, Public Health and Risk Assessment, on behalf of Markos Kyprianou, Commissioner of Health and Consumer Protection, European Commission