1. We, the Health Ministers/Secretaries/Commissioner, meeting in Mexico City for our Third Ministerial Meeting have taken a number of decisions on actions to improve health security globally.
2. We underlined the devastating consequences that a deliberate use of smallpox virus would have upon the world’s populations, particularly in the developing world. We agreed on the following actions as instrumental to preparing and responding to such an incident, and mitigating its consequences.
   • We welcomed the 2002 World Health Assembly resolution urging member States to share expertise, supplies and resources in the event of an outbreak. We believe it is in the best interest of all countries to support and increase the existing WHO global vaccine reserve for emergency response to outbreaks of smallpox that might occur anywhere in the world, both for humanitarian reasons and to strengthen our capacity to protect our populations against smallpox infection. We, therefore, intend to pursue, to the extent possible, the means to increase the WHO reserve and encourage others to do the same.
   • We approved final plans, which have been spearheaded by Canada, to hold an unprecedented multi-nation exercise to evaluate and build on our current response plans and protocols for international assistance and collaboration in case of a smallpox incident. This smallpox emergency response exercise will be held in mid 2003, and link the multiple locations involved via communication networks. This exercise builds upon the workshop held in London, UK in November 2002.
   • We are now improving, in our respective countries, public health preparedness and response plans to address a smallpox outbreak and mitigate its effects. We also have shared and familiarized ourselves with each other’s preparedness and response plans.
   • We also welcomed the report from Germany on best practices in vaccine production for smallpox and other potential pathogens, and agreed to make this report widely available through the websites of WHO and the Paul Ehrlich-Institute.
   • We confirmed that:
     • the WHO and USA will co-host a pilot train-the-trainers session on smallpox outbreak containment in Geneva, Switzerland in March, 2003. Training modules developed from this session will be shared with other countries.
     • the WHO and Italy will hold a meeting on strategies in isolation techniques for patients with smallpox and other highly contagious viral infections in Rome in March, 2003.
3. We recognized that timely and effective collaboration among high level laboratories is essential for global preparedness and response to biological incidents. We launched a new international network of high level laboratories – the Global Health Security Laboratory Network – that is working to coordinate, standardize, and validate diagnostic capabilities, and contribute to global health surveillance and response to disease outbreaks.Work of the network will focus on: enhancing health security, improving collaboration among high level laboratories, expanding linkages in order to strengthen the ability to rapidly and accurately diagnose diseases whether naturally or intentionally occurring, and strengthening overall global public health capacity.The Global Health Security Laboratory Network will meet to validate smallpox diagnostic tests at the Centers for Disease Control and Prevention in Atlanta in Spring 2003.
4. Today, we also agreed on a number of other initiatives that will contribute further to strengthening health security globally:
   • In the area of risk management and communication, we approved work completed on an Incident Scale for use in the rapid communication of chemical, biological and radio-nuclear (CBRN) incidents. The scale will inform those responsible for emergency planning and response of the magnitude, gravity and immediate impact of such incidents to enable them to respond appropriately within and, where necessary, across national boundaries.
   • This Incident Scale will be tested as part of the smallpox emergency response exercise being held in mid 2003.
   • We also approved a proposal to develop agreed principles for a common approach to risk management and communication for CBRN incidents. The technical working group on risk management and communication led by the United Kingdom will carry forward this work.
     • We welcomed an agreement to develop a collaboration framework to improve global health preparedness and response to chemical incidents. We thanked Japan for its initiative and hosting the recent meeting that helped to move this important activity forward. We have established a working group on chemical incidents that will develop an action plan.
     • We welcomed the fact that all member countries of the Global Health Security Initiative are now linked to the European Enter-net programme* to ensure the sharing of data from national surveillance systems and information on unusual occurrences that could be potential public health threats related to the contamination of food and water supply chains.
5. We recognized that there are many commonalities in preparedness and response for bioterrorism and influenza pandemic. We agreed to establish a technical working group on influenza pandemic, which will be co-chaired by the US and the UK, to address existing gaps and research and development needs. This work should be carried out in conjunction with the WHO and other appropriate international organizations.
6. We reaffirmed our commitment to engage and share information with other countries and regional networks as necessary.
7. We welcomed the offer from the German Government to host our next Ministerial meeting in Berlin in the Fall of 2003.

The statement was endorsed by:

• Mr. Munir Sheikh, Associate Deputy Minister, on behalf of the Honourable Anne McLellan, Minister of Health, Canada
• Mr. David Byrne, Commissioner of Health and Consumer Protection, European Union
• Mr. Yoshiharu Otsuka, Vice-Minister of Policy Coordination, Ministry of Health, Labour and Welfare, Japan, on behalf of The Honourable Chikara Sakaguchi, Minister for Health, Labour and Welfare, Japan
• L’honorable Jean-François Mattéi, Ministre de la Santé, de la famille et des personnes handicapées, France
• The Honourable Julio Frenk, Minister of Health, Mexico
• The Rt. Honourable Alan Milburn, Secretary of State for Health, United Kingdom
• Mr. Franz-Josef Bindert, Deputy Assistant Secretary of State, Germany, on behalf of The Honourable Ulla Schmidt, Federal Minister for Health, Germany
• Professor Girolamo Sirchia, Minister of Health, Italy
• The Honourable Tommy G. Thompson, Secretary of Health and Human Services, United States

* The European Enter-net programme is an international programme for sharing information on gastrointestinal infections and on Salmonella and E. coli infections in particular.