International Strategy 2006 – 2011

1. EXECUTIVE SUMMARY

1.1 The Health Protection Agency is recognised internationally for the expertise it shares with other countries, the contribution it makes to international working groups and the specialist services it provides. This strategy aims to maximise the benefits of the Agency's international activities both in terms of their contribution to global health and to health protection in the UK. In delivering this Strategy, the Agency recognises the international expertise and collaborations developed by public health protection bodies in the devolved administrations and we plan to work closely with our partners and colleagues, nationally and internationally, to ensure that a co-ordinated approach is undertaken towards international health protection. 

1.2 Many aspects of health protection require a trans-national approach. Diseases such as SARS and influenza, which threaten national and global health security, and the increased reach of terrorism, have underlined the need to work internationally. Co-operation and collaboration are essential for sharing knowledge about infections, chemicals and radiation and for ensuring the best response to outbreaks and incidents.

1.3 The Agency's primary role is to protect the health of the UK population. However, experience gained internationally allows the Agency to address UK health issues in a more informed, efficient and effective way. 

The Agency will play a leading role in improving global health, particularly when that affects the health of people in the UK, and will be an internationally-recognised provider of health protection services and expertise.

1.4 This strategy sets out six objectives for the Agency's international activities and provides a framework to shape international priorities.

• To influence decision-making in international public health networks.
• To share and acquire the information and knowledge necessary to assess, control and prevent threats to health at international and national levels.
• To fulfil UK obligations under International Health Regulations.
• To contribute to the management and control of   international public health emergencies.
• To develop and increase international public health capacity.
• To increase external funding for Agency development work that builds international public health capacity.

2. SUPPORTING THE AGENCY'S STRATEGIC GOALS

2.1 The Agency's Corporate Plan for 2004 - 2009 identified 15 strategic goals, including goal 14: "To contribute to UK international health objectives and to global health." This goal underpins the International Strategy for 2006 - 2011. The Agency's strategic goals are achieved through 15 programmes of work. They include an international programme that cuts across many of the Agency's activities, integrating those with an international dimension.

2.2 The Agency believes that its authority, the expertise of its staff and their capacity to deal with threats to UK public health are strengthened and developed through international surveillance, collaborations and contacts. They allow the Agency to address UK health protection issues in a more informed, efficient and effective manner, to undertake broader research and development, to increase the Agency's knowledge base and to receive early warnings of issues that are not yet of concern in the UK.

2.3 The Agency is committed to supporting the development of international public health capacity through partnerships at institutional, regional or governmental levels. Such development work is not funded as part of the core work of the Agency. This strategy therefore recognises the need for external funding to support the Agency's international development work.

2.4 Geographical priorities for the Agency's international engagements vary according to the specific objectives and partnerships identified within Agency programmes and divisional business plans. Agreement of geographical priorities for the Agency's international development initiatives will be part of the implementation of this Strategy.

3. THE AGENCY'S INTERNATIONAL CAPABILITIES

3.1 The Agency has an increasingly important international role. It plays a leading role in international bodies such as the World Health Organisation (WHO) and is a member of, or hosts several European surveillance, research and public health networks. The Agency continues to develop relations with overseas governments and many other organisations on a bilateral basis. 

3.2 The Agency is unique in the range of specialist health protection services it provides as a single independent body. The Agency's remit and structure results in an innovative combination of expertise and inter-disciplinary working. At present, there are very few other national public health organisations with a similar structure. This model of organisation has attracted significant international interest, in particular from governments considering how their own health protection services may be structured, but also from scientific and humanitarian public health activities.

3.3 High regard for the expertise of Agency staff is reflected in the number of requests for them to participate on national and international working groups, committees and projects.  Such collaborations and engagements strengthen the authority and status of the Agency as an informed and independent source of advice.

3.4 The Agency's considerable research and development activities involve many international partners.  For example, 14% of external funding for the Agency's research and development comes from the European Commission (EC). Some research and development activities are undertaken on a commercial basis with national and international partners. The Agency has established commercial interests overseas that build on and develop the intellectual assets of the organisation. These commercial contracts strengthen and complement Agency core functions.

4. THE AGENCY'S INTERNATIONAL ACTIVITIES

4.1 The Agency's international work falls into broad areas: epidemiological surveillance, advice and consultancies, representation on public health committees and networks, training, and research and development. Within these categories, work may involve long-term projects undertaken for the European Union (EU), short-term advisory roles for the World Health Organisation (WHO), formal WHO collaborations, research projects, educational projects and ad hoc work.

4.2 Specific examples of international collaborations include:

(a) Six WHO collaborating centres, eight WHO national reference laboratories and a WHO global reference laboratory are housed by the Agency. It is also the European Co-ordinating Centre for the Global Programme on Drug Resistant Tuberculosis;

(b) A small number of Agency staff were seconded to WHO following the Indian Ocean tsunami in December 2004. The staff had expertise in disaster planning, infectious disease and managing large numbers of dead;

(c)  Consultancy work for the International Atomic Energy Agency;

(d) Three specialists were part of an international effort in Darfur, Sudan. Two carried out a mortality study for the Sudanese Ministry of Health and one was investigating an outbreak of hepatitis E;

(e) Two of the Agency's specialists in influenza are among 10 European scientists selected by the European Centre for Disease Prevention and Control (ECDC) to serve on a scientific panel on influenza;

(f) The Agency is part of an EU-funded programme, known as FLUSECURE, to help manufacturers to develop vaccines against pandemic influenza;

(g) A Memorandum of Understanding signed with the Hong Kong Centre for Health Protection in May 2004;

(h) Laboratory assistance and training for dealing with bioterrorism was provided to the Greek government for the Olympic games in 2004;

(i) Specialists in emergency planning ran two EU-wide exercises to evaluate communications and responses during the deliberate release of biological agents and an influenza pandemic.

4.3 Appendix 1 provides an overview of the global context in which the Agency operates and a summary of external and international influences.

5. THE SIX STRATEGIC OBJECTIVES

Strategic Objective 1:

To influence decision-making in international public health networks.

5.1 Representation on international bodies is crucial if the Agency is to influence international policy, standards and health protection practice. Staff contribute to a range of national and international committees and working groups. In some areas of Agency work, almost all standards are set internationally. For example, standards for radiation are set by the International Commission on Radiological Protection (ICRP) and the International Council on Non-Ionising Radiation Protection (ICNIRP). This is increasingly the case for chemicals.

Under this objective, the Agency will:

• Provide staff and expertise for the strategic and operational development of key international networks, including those of the European Centre for Disease Prevention and Control (ECDC), the WHO and other UN agencies.
• Provide training and development opportunities to ensure that Agency staff who have the appropriate scientific expertise also have the skills necessary to become effective contributors to international networks.

5.2 Examples of how to achieve this objective:

(a) Centre/divisional directors and/or programme boards to report annually on international engagements, identifying key international networks that support the Agency's strategic goals and providing a forward look at international priorities;

(b) The corporate development programme to offer training opportunities that develop the communication skills necessary to influence national and international networks;

(c) A programme of regular briefings by WHO, EU or other agency representatives to be introduced for Agency staff involved in WHO collaborating centres, reference laboratories, EU research and surveillance networks and other international networks.

5.3 Benefits to stakeholders:

(a) More effective participation in international policy-making and standard-setting and increased opportunities to develop regular dialogue with international bodies such as WHO.

(b) Participation on international networks will be endorsed at strategic level and its contribution to programme goals identified.

Strategic Objective 2:

To share and acquire the information and knowledge necessary to assess, control and prevent threats to health at international and national levels.

5.4 The Agency participates in a wide range of information networks where knowledge about health protection is exchanged. These include EU and WHO public health projects, working groups, and research and surveillance networks (including many networks for which the Agency acts as a host). Much of this work is innovative, for example the Global Chemical Incident Alert, Surveillance and Response System being developed by the Agency. Research and development, advice and consultancy initiatives by the Agency also enable information to be shared. Many Agency staff are internationally renowned experts who provide advice and consultancies for the WHO and other international organisations.

5.5 The surveillance of disease and other hazards is one of the key information-sharing activities at international level. Pooling of data across borders can result in the earlier detection of outbreaks or exposures than would be possible through national surveillance alone and can increase the speed of response to national incidents by providing information on potential sources or vehicles of infection. For example, the European surveillance scheme for travel-associated legionnaires' diseases, which is managed by the Agency, detects clusters of the disease in tourists and can limit the number of people affected by an outbreak. The Agency has also been working in the field of global alerting and public health intelligence systems, through its innovative geographical information system development work with ProMED.

5.6 Sharing of knowledge and expertise, particularly in the face of emerging infections or other novel threats to health, either through research or through the response to emergent problems such as SARS, can reduce the time and cost associated with developing diagnostic or control tools.  New approaches to surveillance or control of established priorities can also be exchanged and assessed.  For example, the extension of the Environmental and Health Information System across the EU is being led by the Agency.

Under this objective, the Agency will:

• Ensure that resources are agreed for Agency participation in key international surveillance and monitoring networks.
• Contribute to the development and implementation of ECDC and other international agencies' surveillance, information and knowledge strategies.
• Continue to identify and work with partners to develop global alerting systems.

5.7 Examples of how to achieve this objective:

(a) The International Office to lead a project to share information about international activities across the Agency.

5.8 The benefit to stakeholders will be better health protection services as a result of informed and authoritative practice.

Strategic Objective 3:

To fulfil UK obligations under International Health Regulations.

5.9 The Agency is the UK national focal point for the International Health Regulations (IHR), forming the operational link between the UK and WHO so that, during emergencies, information and recommendations about response measures can be communicated effectively. This role is in addition to the Agency's statutory role in health protection, conferred by the  Health Protection Agency Act 2004.

Under this objective, the Agency will:

• Fulfil its role as the UK focal point for the International Health Regulations.
• Work with the ECDC, WHO and other UN and EU organisations in responding to international and global health concerns.

5.10 Examples of how to achieve this objective:

(a) Develop a protocol with the Department of Health on how the Agency will fulfil its function as the national focal point for IHR.

(b) Review of surveillance capacities to detect potential public health emergencies of international concern.

5.11 Benefits to stakeholders include:

(a) Improved international co-operation in managing infectious diseases and other health issues that fall within the remit of the IHR.

(b) Greater understanding of the Agency's role in IHR shared with national and international bodies.

Strategic Objective 4:

To contribute to the management and control of international public health emergencies.

5.12 The expertise of Agency staff is often sought during international public health emergencies. Requests for assistance are usually mediated by external agencies such as the WHO (possibly through the Global Outbreak Alert and Response Network) or other UN agencies, such as the International Atomic Energy Agency. The Agency also contributes to international public health by supporting the development of preparedness for emergencies. Requests for assistance of this sort are often mediated through government ministries.

 

The Global Outbreak Alert and Response Network (GOARN) is a WHO collaboration of institutions and networks that are contacted when additional capacity is required to respond to outbreaks of international importance. The Agency recently provided specialist staff for outbreaks in Indonesia, the Philippines and Turkey.

 

5.13 The Agency can assist during emergencies by providing advice and information, briefings, diagnostics or logistics support. Assistance may or may not involve short-term secondment of staff with specialist skills or expertise. The WHO collaborating centres and reference laboratories at the Agency are a source of advice and expertise internationally. These international links are important for establishing effective communication and co-operation during emergencies.

5.14 The Agency has to balance requests for international assistance against national and local responsibilities for service provision. Directors of the Agency are responsible for assessing the demand for assistance against national priorities.

Under this objective, the Agency will:

• Contribute Agency expertise to the management and control of international public health emergencies.
• Develop processes to support the short-term secondment of staff to assist in international responses to public health emergencies.

5.15 An example of how to achieve this objective:

(a) Develop policies for seconding Agency staff to assist in the responses to international public health emergencies.

5.16 Benefits to stakeholders include:

(a) Improved links with other organisations dealing with public health emergencies and the opportunity to develop improved preparedness for emergencies.

(b) Contributing to international public health emergencies raises the profile of the Agency as a source of expertise and also as a responsive organisation.

Strategic Objective 5:

To develop and increase international public health capacity.

5.17 The Agency already makes significant contributions to public health capacity in both developed and developing countries and is committed to continuing to do so in the future. Effective and expert public health protection requires significant international knowledge and contacts and the Agency has well established international links through European and international research and surveillance networks which we pursue, and will continue to pursue, as part of our core business.

5.18 However, the Agency is not funded for international development work and its ability to undertake this work is dependent on securing funding from external sources. To the extent that this is available, the Agency is committed to increasing public health capacity, wherever possible and appropriate, through training, exchange of personnel, consultancy or advice.

5.19 For example, the Agency has provided training and teaching to a wide range of international organisations, thereby developing international capacity to reduce public health threats.

 

Specialised briefings at the request of UK government departments and international organisations contribute to building international capacity. In 2005/06, Agency staff provided more than 40 briefings to experts from 26 countries.

 

5.20 As a member of the International Association of National Public Health Institutes (IANPHI), the Agency has provided staff for projects in developing countries that build capacity in public health.

Under this objective, the Agency will:

• Identify criteria for entering into engagements with international partners that develop and exchange skills and expertise relevant to health protection.
• Contribute to international capacity building initiatives in public health, including those undertaken by IANPHI, the UK government or agencies working in international health.
• Produce guidance for external funding agencies and potential partners that sets out the Agency's distinctive contribution to global health initiatives.

5.21 Examples of how to achieve this objective:

(a) Agree geographical priorities for Agency international development work in consultation with relevant UK government departments and other international stakeholders.

(b) Produce advice for Agency staff about working in an international development context; create an Agency policy statement on international secondments, and establish a funded secondment programme for Agency staff.

(c) Develop an International section on the Agency website to set out the Agency's international priorities and promote the Agency's international profile.

(d) Publish by March 2007 an agreed programme of international partnerships for 2006-2011.

(e) Hold a joint event with the Hong Kong Centre for Health Protection in May 2009 to celebrate the fifth anniversary of the Memorandum of Understanding.

5.22 Benefits to stakeholders include:

(a) Development of public health capacity in targeted countries will improve local responsiveness.

(b) Improved communication with other agencies working in international public health and greater understanding of the Agency's international role.

Strategic Objective 6:

To increase external funding for Agency development work that builds international public health capacity

5.23 Funding for international activities undertaken as part of the Agency's responsibilities as a national health protection body comes from core grant funding, external grants or commercial activities. However, funding for international development work as set out in strategic objective 5 is not part of the Agency's core funding and must be generated externally.

5.24 Objective 6 concerns the generation of income to support Agency participation in building international public health capacity. It does not include income generation for Agency international engagements in research and development.

5.25 Potential funding sources for Agency international development initiatives include UK government departments (such as the Department for International Development and the Department of Health), foreign governments, funding and grant organisations, and international agencies including the UN and the EC.

Under this objective, the Agency will:

• dentify priority international development initiatives and partnerships.
• Agree potential funding sources for these initiatives and initiate discussions with potential funders.

5.26  Examples of how to achieve this objective:

(a) The Agency's International Office to lead in identifying external funding sources for international development work.

(b) Seminars for potential funders to be held where the Agency will present its expertise in international health protection development initiatives (similar to the Centre for Infection's Charities Day).

5.27 Benefits to stakeholders include:

(a) Potential partner organisations will benefit from the Agency bringing funding to development initiatives.

(b) More resources for Agency international developmental activities.

(c) Funding bodies will better understand the Agency's expertise and skills.

6. MEASURING PROGRESS AND IMPACT

6.1 The impact of the Agency's international work will be measured as part of the evaluation of whether Agency corporate goals have been achieved. The operational implementation of the International Strategy will be included in the business plan for the International Office. The strategy will be reviewed annually through the International Programme.

6th December 2006

 

 

APPENDIX 1- The Global context in which the Agency operates

1. The Agency's first International Strategy was agreed by the Board in March 2004. Since then, external and internal changes have affected the way the Agency operates internationally. The impact of these changes means that it is timely to review and update the International Strategy.

2. Diseases such as Severe Acute Respiratory Syndrome, HIV, tuberculosis and avian influenza, as well as the increased risk of terrorism, have underlined the need for global preparedness and strategic co-operation. Many national public health institutions have recognised the value of collaborating internationally and sharing expertise and good practice in health protection issues. In response to its growing international profile, in February 2006 the Agency was invited to join the International Association of National Public Health Institutes, which has more than 39 member countries and has received funding from the Rockefeller and Gates Foundations for public health initiatives in developing countries.

3. The Agency's Radiation Protection Division (RPD) inherited from its precursor body, the National Radiological Protection Board, a major international role in all aspects of radiation protection.  This division is represented on the International Commission on Radiological Protection and the International Council on Non-Ionising Radiation Protection and also works closely with the EU, WHO, UN and the International Atomic Energy Agency.  In the case of chemical exposures, senior staff at the Chemical Hazards and Poisons Division (CHAPD) made important international contributions prior to joining the Agency.  The Division is now rapidly establishing itself as a significant international player, particularly through work with the EU and WHO.

4. The Agency's Centre for Emergency Preparedness and Response is involved in a number of international programmes.  The Special Pathogens Reference Laboratory is an accredited WHO laboratory and staff are actively involved in international biosafety groups in Europe, the US and worldwide.  It is part of the US National Network of Laboratories, and hosts international workshops on live agents for the Global Health Security Network and the EU. The Centre offers training for other governments, ranging from bespoke courses on high threat agents for Greece in support of the Olympics to safety training for the Singapore government. Pre-clinical studies in aerosol infection models are being undertaken for two EU sponsored TB vaccine development projects: TB - VAC and MUVAPRED and CEPR is represented on the WHO TB animal models task force.  It receives a significant income from the EU and the US National Institutes of Health and is one of the lead partners in a number of EU programmes, especially the FLUSECURE initiative on rapid vaccine development.

5. The Agency's Centre for Infections has well established international links and was a founder member of the WHO's Global Outbreak and Alert Response Network (GOARN) and was a co-founder of the European Programme for Interventional Epidemiology (EPIET). The Centre hosts 8 WHO reference/collaborating laboratories, 2 WHO Global reference laboratories and leads 80% of the EC infectious diseases networks. Many staff are special advisors to the WHO and also members of the ECDC specialist advisory panels. The Centre represents the Department of Health and Devolved Administrations on the ECDC Advisory Forum and has been commissioned by the EC to support selected EU Accession countries to meet public health standards.

6. The establishment of the European Centre for Disease Prevention and Control (ECDC) as an EU agency in May 2005 has had major implications for the development of Agency collaborations and research activities. The EU continues to expand its membership and in 2007 Romania and Bulgaria will join its existing 25 members.

7. The Agency has taken forward the UK contribution to the Child Environmental Health Action Plan for Europe (CEHAP) which covers 52 countries.

8. The Agency has continued to work closely with national and international organisations such as the World Health Organisation, which regularly contacts the Agency for advice or expertise, including secondments of Agency staff.

9. Internally, the Agency has continued to evolve. In April 2005, it became a non-departmental public body and its responsibilities for international co-operation were included in the HPA Act 2004, which stated that international bodies are included in the "other bodies" with whom the agency must co-operate. A small International Office was established in November 2004 and an International Programme was included in the Agency's Corporate Plan. In April 2005, the Agency merged with the National Radiological Protection Board, which has an important international profile in radiation protection advice.   In addition, subject to legislation, the Agency will merge with the National Institute for Biological Standards and Control (NIBSC) which will bring its own significant international role to the Agency.

Last reviewed: 20 May 2008