APEC Health Working Group

Terms of Reference
I. INTRODUCTIONThe emergence of Severe Acute Respiratory Syndrome (SARS) in the Asia Pacific Region during 2002-2003 and avian influenza H5N1 in 2004 has reminded us collectively of the impact that health challenges can have across a broad range of sectors, including health, agriculture, trade, tourism, transportation, and business. APEC’s leadership in the region and its wide-ranging economic workprogramme make it uniquely suited to address the multi-sectoral impact of today’s health threats. Creation of the Health Task ForceSenior Officials responded to calls in 2003 from both Health Ministers and delegates from APEC’s Industrial Science and Technology Working Group to establish a mechanism to address health within APEC more efficiently and effectively than in the past. In October 2003 they established an ad hoc Health Task Force (HTF) to address health-related threats to economies, trade and security, focusing mainly on emerging infectious diseases, including naturally occurring and manmade. The HTF must be consistent with APEC’s management process and regulations, respond to calls from Leaders and Ministers, and seek to add value, drawing upon APEC’s unique strengths and areas of comparative advantage. The HTF can provide critical support to Senior Officials by helping coordinate implementation of health-related instructions from Ministers and Leaders, and providing input to Senior Officials who in turn transmit Leaders’ decisions to the senior management of health and other ministries, who often are not able to appreciate the significance and importance of APEC Leaders decisions. Responsiveness to APEC LeadersIn 2000 in Brunei, Leaders called for the development of a proactive APEC Infectious Diseases Strategy. In 2001 in Shanghai, Leaders endorsed the APEC Infectious Diseases Strategy and called on all members and relevant fora to implement it. In Los Cabos in 2002 they “acknowledged that investing in health will benefit economic growth, worker performance and productivity, and poverty alleviation. We need to be more effective with our investment at every stage of the health care process, including primary prevention against disease risks, and focusing on most vulnerable populations.” Most recently in Bangkok (October 2003), Leaders called for “[implementation of] the APEC Action Plan on SARS and our Health Security Initiative to help APEC prevent and respond to regional health threats, including naturally-occurring infectious disease and bio-terrorism. We welcomed the establishment by Singapore and the United States of a Regional Emerging Disease Intervention (REDI) Center.” Thus, creation of the new HTF is clearly responsive to Leader’s calls to address infectious disease and other health threats in the region, including health security against naturally occurring and deliberately caused threats. Areas of APEC comparative advantageAPEC offers the advantage of rapidly bringing to the attention of Leaders important policy issues of common interest; pressing needs of an operational nature; and innovative approaches to cooperation within the region. Political leadership and support are often critical in addressing regional health problems so that their adverse impact on economies, trade and other vital sectors can be mitigated. APEC’s multi-sector composition and organization offers opportunities to add value to ongoing global health-related efforts of other international organizations. APEC offers unique opportunities for collaboration among member economies to address regional health issues by bringing together in a cooperative environment expertise in health, economics, trade and other relevant sectors. APEC has an established inter-sectoral Emerging Infections Network which demonstrated the added value of such communications during the SARS crisis, as recognized in the Leaders Statement of 2003. The strength of the HTF will be in its potential to draw together health, economic, and other sectoral interests – including the private sector -- to facilitate their interaction among economies. The HTF has a role in ensuring that relevant sectors duly support the health sector and have regard to the impact their decisions have on people’s health. This is critically important in managing communicable disease outbreaks. No other APEC forum offers the opportunity to reliably engage the health sector, coordinate across sectors, and focus on APEC’s priority health problems. Furthermore, neither the WHO nor the World Trade Organization can focus as well as APEC on the economic impact of health problems, including infectious diseases, in the Asia Pacific Region. The HTF will also support the economic interests of APEC in dealing with a regional health agenda in partnership with the WHO and other authorities with relevant expertise. Initial orientation of the HTFThe creation of the HTF, with a time-limited mandate, places major pressure on APEC to show that it is able to show added value in health. Consequently, it is highly desirable for the HTF to focus its action in a limited number of areas in which it can produce tangible results in the short term and create confidence in its value into the future. At the same time, the HTF should not be myopic or politically driven by limited numbers of stakeholders with short-term profits in their mind. The HTF will function particularly as a gateway to technical experts and also as a central policy “think tank”. The main activities of the Task Force should be centered on inter-sectoral policy coherence and communications. An initial broad goal is to enhance and strengthen infrastructure (collective and in each economy) and networking for a better response to regional health threats, including capacity to assess readiness and response, conduct impact analysis, conduct foresight or response simulation exercises, and to share relevant information in an effective and timely manner. II. TERMS OF REFERENCE Objectives
To enhance APEC cooperation and integration of health-related efforts across relevant APEC sectors and fora
To implement explicit priorities of Leaders and Ministers
To take a primarily strategic (rather than opportunistic) and efficient approach to determining priorities for cooperation, taking into account capacity and volunteers readily available among APEC members
To complement and not duplicate the work of the World Health Organization (WHO) and other relevant international and/or regional organizations
Additional details are provided in Annex 1.
Membership
Economies will designate their own members, with little restriction.
Members from outside the health sector are encouraged, especially from the economic sector. Ideally, each economy would have at least two members – one from health and another from the trade, finance, economic or foreign affairs sector. This will enhance collaboration between health and other relevant sectors.
Although there are no strict limits, each economy may wish to limit membership to a maximum of five persons.
Chairing and internal organization arrangements
First Chair (USA), as designated by Senior Officials, is endorsed by HTF members.
One or more Vice Chairs to be named, taking geographic balance into account. Vice Chair/s to be nominated by the Chair and endorsed by HTF members through consensus. Vice Chair/s to serve same term as Chair. Suggest two years, corresponding to initial mandate of HTF.
If the HTF is renewed beyond its initial two-year term, next Chair to be selected by HTF members through consensus.
Ad hoc working groups to be established if/as needed.
Meeting arrangements
Mostly electronic communications, i.e., primarily virtual meetings
Initial face-to-face meeting, to determine priorities and modalities for cooperation, develop plan for near-term actions including priorities for soliciting APEC central funding, promote “bonding”, and develop health advocacy.
Any future on site meetings to be based on needs, emergencies, or when issues cannot be solved via electronic communications. Such meetings can also be aligned with other meetings in the region or on the fringes of SOM.
The host (voluntary) is strongly suggested to offer the accommodation (except flight tickets) for the economies’ HTF representative in lack of central funding.
Communications and administrative arrangements
Official letter or official E-Mail or fax transmission desirable
Use website/s, e.g., APEC Secretariat webpage, APEC EINet
Chinese Taipei has offered administrative services to the HTF, via an electronic communications platform they propose to develop and support, which is new and complementary to existing communications modalities such as the APEC EINet. (Additional details are provided in Annex 2.)
Modalities for cooperation and potential activities
Decisions are to be based on consensus.
Activities would be determined based on a primary goal of augmentation of people’s health and welfare, in terms of disease preparedness and response within economic, trade and resource contexts. (Potential activities are described in more detail in Annex 3.)
Tasks
Establish HTF membership, distribute list to members
HTF members to review and comment on draft TORs
HTF members to consider ways to cooperate in response to current avian influenza problem in the region, for those present to participate in an informal meeting to discuss ideas for cooperation prior to discussion at SOM-I
HTF Chair to present report to SOM-I and seek SOM approval of Terms of Reference
HTF Chair to participate in SOM-I discussion on avian influenza
HTF to meet in person as early as can be arranged, to finalize a short list of disease priorities and develop a plan for near-term action, including review and approval/ranking of proposals, especially those soliciting APEC central funds.
Promote information exchange among health and other policy makers and other stakeholders (e.g., business community) related to infectious disease, e.g., via APEC webpage, EINet, etc.
Reinforce and share the lessons learnt from SARS and consolidate preventive measures against SARS as soon as possible
Explore a potential appropriate role for APEC within current WHO efforts to revise its International Health Regulations.
Support/manage the broader APEC project on Pandemic Influenza Preparedness to be initiated in 2003 and completed by 2005.
III. POTENTIAL EARLY PRIORITIES FOR COOPERATIONNote: For each of these, focus would be on areas of APEC-specific interest and added value.
Severe Acute Respiratory Syndrome (SARS) – Action & Communications Plans
Avian influenza and pandemic influenza preparedness
Food safety
Dengue
Public health infrastructure: capacity building / strengthening
Drug access
Annex 1ADDITIONAL DETAILS ON OBJECTIVES
To enhance APEC cooperation and integration of health-related efforts across relevant APEC sectors and fora
Serve as a venue to critically analyze health consequences of economic or trade policies or vice-versa, and recommend actions to mitigate or prevent adverse impact.
Focus on diseases with potential high economic impact, and on the cross-sector aspects of these, e.g., operational response across sectors, analysis of the impact of selected health threats on regional economics and trade. Examples include economic, trade, agriculture and transportation sectors.
Activities to complement and adjust liberalization and facilitation policies with a view to securing people’s lives and sustainable economic development.
To implement explicit priorities of Leaders and Ministers
Support regional policies on preparedness for and response to regional health threats, including naturally-occurring and deliberately caused infectious diseases, in response to Leaders’ 2003 Health Security Initiative;
To develop effective means within APEC to enhance implementation of the APEC Infectious Diseases Strategy including its priority on networking as a strategic approach.
To oversee/coordinate implementation of the 2003 APEC Action Plan on SARS and the 2003 APEC Communications Strategy on SARS
To take a primarily strategic (rather than opportunistic) and efficient approach to determining priorities for cooperation, taking into account capacity and volunteers readily available among APEC members
To complement and not duplicate the work of the World Health Organization (WHO) and other relevant international and/or regional organizations;
Working across sectors
HTF membership ideally to include officials from health and other sectors, at the discretion of each economy; consider an HTF vice chair from outside the health sector, e.g., from a Ministry of Foreign Affairs, Economy, or Trade.
Officials from different sectors should know each other and communicate on a frequent enough basis to establish comfort in cross-sector planning, and emergency or non-emergency response to emerging health threats.
Provide information across APEC on what the HTF has done. Reach across sectors as needed for meetings or discussion groups. Show successful models of collaboration.
HTF members and/or leadership to connect with relevant APEC fora, including but not limited to: Economic Committee, Trade and Investment Committee, Agriculture Technical Cooperation Working Group, Industrial Science and Technology Working Group, Human Resources Development Working Group, Telecommunications and Information Working Group, Tourism Working Group, Trade Promotion Working Group, Counter-Terrorism Task Force, Emergency Preparedness Virtual Task Force. NOTE: APEC health sector officials would benefit from the assistance of others in making the appropriate connections to these groups.
Development of a work plan, if required, to include all relevant sectors.
Implementing priorities of Leaders and Ministers
Prioritise naturally occurring infectious diseases in the region that historically have caused not only human suffering but trade and or travel disruption.
Determine interest and modalities for cooperation on deliberate health threats.
Establish additional information-exchange mechanism, if/as needed, to complement the EINET and to secure the in-time transparency
Undertake real-time internet/electronic/web communication and entertain assistance requests.
Request each economy’s own government to take the consentaneous action after the web discussion.
Establish training if/as requested by member economies.
Strategic orientation
The Task Force should be strategic and focus on identifying how responses could be improved
Priorities for cooperation should also be determined strategically.
Complementing and not duplicating the work of the WHO
Focus on areas not specifically addressed by the WHO or for which WHO programs are relatively weak and APEC would have a competitive edge.
This means focusing on issues related to interdependence of health and trade or economic development, with priority on major infectious diseases.
The HTF should be aware of key relevant activities of WHO and other international organizations.
Invite the WHO to participate as a guest at HTF meetings, and consult informally with WHO and other international organizations with relevant expertise, in accordance with APEC rules, as the HTF determines its priorities and modalities for cooperation.
Explore ways APEC can complement the efforts of WHO and other organizations to prevent/control regional economic impact caused by infectious disease, e.g., through facilitation of timely cross-sector communications and cooperation and rapidly bringing issues for collective action to the attention of Leaders (fast-tracking).
Beyond the prevention and control of infectious diseases, APEC could address several health issues of major economic importance, including human resource planning, non-communicable disease control, strengthening of health systems, etc.
Annex 2ADDITIONAL DETAILS ON COMMUNICATIONSChinese Taipei has graciously offered administrative services to the HTF, via an electronic communications platform they propose to develop and support, which is new and complementary to existing communications modalities such as the APEC EINet. The platform could use more advanced Web IT such as ICQ, chat room, closed web discussion areas, webcam, etc. Such dialogue could be used as a “daily bulletin” type format as well as for emergency response, for reaching consensus in real-time manner. Administrative support through this platform includes:
to serve as a information clearinghouse for all correspondence of the HTF;
to maintain the ICT and update website information and facilitate dialogue;
to assist in proposing meeting Agenda setting;
to provide timely consultation on APEC operational procedure and overall strategic implementation of the HTF TOR and overall APEC goals;
to assist in conference logistics with the host economies;
to assist in proving Chairman's Summary Reports, where necessary.