Mass gatherings training

programme

Public health: Cross cutting issues

WHO Mass Gathering work
• Summer Olympics: Athens 2007, Beijing 2008, London 2012,
Rio 2016, Tokyo 2020
• Winter Olympics : Vancouver 2010, Sochi 2014, S Korea
2018
• FIFA: South Africa 2010, Brazil 2014
• UEFA 2012 in Poland/Ukraine
• African Cup of Nations: Equatorial Guinea 2012 (2013)
• Kingdom of Saudi Arabia: the Hajj (annual)
• Iraq: Aber’aeen (annual)
• Asian Indoor Games: Turkmenistan 2017
• Baku European Games 2015
• Kazan City University Olympic games for students, 2013;
• European Basketball Championship, Slovenia, 2013;

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Defining Mass Gatherings

Mass gatherings (MGs) are events attended by a sufficient

number of people for a defined period of time to strain the
planning and response resources of a community, state or nation

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The MG difference
• For planned events decision to host is made in advance and
are often of high national status; high political and media
interest
• Planning is of paramount importance and is complex; working
with stakeholders is critical as no one organisation or
individual can manage all the issues
• Responsibilities for different parts of MG planning will overlap
• Health must be integrated into overall planning
• Requires All hazards approach to risk mitigation across
disciplines / ministries;
• Advanced risk assessment and system enhancements are
critical to identifying risks and preventing and responding to
public health incidents
• Planning for legacy and evaluation is critical
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Event context

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Challenges: Contextual pressure

Global High-profile
Security perception
interconnectedness sponsorships

Health security Media visibility

context

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Challenges: Mass Gathering Health
Increased public health risks
• Weather-related conditions (heat, cold)
• Trauma – crowd management
• Introduction and dissemination of non-endemic diseases and
and epidemic-prone diseases
• Deliberate release of biological, chemical or radio nuclear
substances

Challenge for control measures

• Integrated surveillance to provide intelligence
• Potential for international spread
• Mobile population (contact tracing)

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International Health
Regulations (IHR) 2005
MG considerations
MGs may fall under a number of different aspects of the
IHR and provide opportunities to improve a host nations
compliance with the regulations.

1. State obligations to notify, report or verify public health

events to WHO
2. State and WHO activities involving risk assessment and
public health response:
3. Provisions specifying health measures that states may
or may not apply to international travellers

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Key considerations
• Consider using the momentum and planning process of
the MG to build up IHR capacity and address gaps
identified in the JEE
• Ensure that those involved in health planning are
briefed, prepared and equipped to meet reporting
obligations under the IHR
• Ensure that the NFPs are involved in public health
planning for the MG
• Implement IHR provisions for MG associated measures
for international travel and transportation

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Coordination and planning
process
Strategic planning
Integrate and communicate
• Internal
• External

To consider:
• Key stakeholders:
− Roles and responsibilities?
− Are they the normal links?
• Business as Usual
− New organisations e.g. organising committee. Health and
event managers need to work together
− Robust but flexible planning – scalable
− Resources: human (resilience) and finance

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Areas of Health Sector
Planning: “Inside and Outside
the Fence”
• Hospital Care
• Primary Health care
• Emergency Health Care
• Public Health and Hygiene:
1. Disease Surveillance and Outbreak Response
2. Environmental and Food Safety Control
3. Public Information and Health Promotion
• Health System Organization and Coordination

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 Opportunities - legacy
What you leave behind. Enhanced:
• Public health systems – surveillance, reporting, laboratory
• Environmental health – food, water and air quality
• Intersectorial / stakeholder collaborations & improved data
systems & data sharing
• Internal organisational collaborations / behaviour
• Understanding / knowledge of public health
• Legal agreements
• Emergency planning and response, improved national
response capabilities for PH risks/incidents
– global health security
What do you pass on:
• Improved planning for mass gatherings across the globe
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Key planning steps
Risk assessment What might happen?
How likely is it to
happen?
Surveillance How will you know when
it happens?

Response What will you do when it

happens?

Event NOT an emergency, but expect the unexpected

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What might happen: risk
assessment
Planning - Strategic Risk Assessment
• Determines all planning, including testing and exercising,
and operational activities
• Iterative process – start before the event, review
• Identifies risks that may enhance, prevent, degrade or
delay the MG and mitigation measures

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How will you know when something
happens: surveillance
• Focus on enhancing current (business as usual) surveillance
systems, microbiological services, investigations etc.
– Aim for them to be sustainable (legacy)
– Don’t reinvent the wheel
– Strategic Health Operations Centre
– Good stakeholder relations
– Testing and training
• New systems:
– Capture baseline data (minimum of one year)
– Concept of operations agreed across all stakeholders
• Maintain business as usual but plan for a disaster

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What will you do when it
happens - response
Plan to address the following areas:
• What is the MG difference?
• Outbreak response
• Emergency response
• Medical response

Surge capacity:
• Access to international expertise in case critical staff are
affected

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Working with partners and
stakeholders
 Coordination with others
CDD'S vs. Public Health vs. Larger (National) Security

Labs

Risk Communication

Communicable
Disease Command and Control
Director
Mass casualties

Alert and
Response
Public Health Domain

Quarantine Security

Mass Gathering/ National/Int'l Domain

Military

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Why is stakeholder engagement so
important?
• Effective engagement establishes relationships and trust
• Ensures public health representation at key levels and in
organizing structures
• Clear communications with stakeholders
• Clarity and accessibility of any reporting to non-health
experts
• Well tested operational plans, understanding of roles
and responsibilities and reporting requirements across
all stakeholders
• Established processes to ensure everyone involved
understands and agrees standards for reporting and
media statements
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Stakeholder engagement
• Who would be the key stakeholders/health partners for
public health planning for a MG event?
• Who would be the broader stakeholders for public health
planning for a MG event?

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 Inner ring: host country
Framework health partners
Outer ring: broader
stakeholders

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Stakeholder Working and Engagement

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Testing and exercising
Levels of testing and exercising

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Why is exercising and testing so
important?
• Ensures procedures and plans e.g. ConOps are effective
• Equipment should function as expected
• Staffing and other resources are adequate for the
response required and trained
• Participants understand their own role and the roles of
others
• Resilience - capacity to meet event commitments
• Communications issues; clarity on the lead organisation

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Key considerations
Purpose:
– Informed by risk assessment - identify and assess
planning deficiencies
– Validation of planning and training

• Start early and establish an ongoing process

• Informs changes to plans and training needs
• Focus on daily operations and arrangements before
testing emergency response arrangements. Look at
decision making and rapid response capability
• Cover both MG participants and the general public
• Engage and test across partners and stakeholders
• Include communications

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Learning from others:
summary of key
considerations
Lessons Learned from Mass
Gatherings
• Public health officials need involvement from the onset -
leadership
• Consider type and length of events, physical facilities,
availability of qualified staff, weather, local capacity for
routine medical care, and relations
• Surge capacity of the EMS medical care systems within
the affected community needs to be assessed
• Surveillance systems need to be designed and
implemented to provide useful information on a timely
basis
• Communication, coordination and formalized
approaches to incident command should be established
and tested

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Lessons Learned from Mass
Gatherings (2)
• Environmental health and food and water safety
regulations to be reviewed and provisions made for
consultation, inspections, and enforcement
• Assess the treatment (and decontamination) capacities
of local health services; and supplies and planning for
rapidly obtaining and distributing additional resources
• Opportunities to provide educational messages,
including health promotion and preventive measures,
consistent with public health risks and objectives
• Costs should be estimated and funds for public health
preparations secured in advance of mass gatherings
• Leave a legacy
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 QUESTIONS

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Core Reference Documents
• Public health for mass gatherings: key considerations. April 2015:
http://www.who.int/ihr/publications/WHO_HSE_GCR_2015.5/en/

• WHO Emergency Response Framework:

http://www.who.int/hac/about/erf/en/

• WHO International Health Regulations (2005), 2nd edition:

http://www.who.int/ihr/9789241596664/en/

• Hospital Emergency Response Checklist:

http://www.euro.who.int/en/health-topics/emergencies/disaster-
preparedness-and-response/publications/2011/hospital-emergency-
response-checklist

• WHO Interim Guidance for International Meetings Attended by

Individuals from Ebola Virus Disease-affected countries
(PDF,482KB):
http://apps.who.int/iris/bitstream/10665/135751/1/WHO_EVD_GUID
ANCE_MG_14.1_eng.pdf?ua=1
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 THANK YOU

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