Background

In addition to major humanitarian crises driven by natural disasters or conflicts, infectious disease events, including outbreaks, can trigger a humanitarian system-wide Scale-Up activation (see p. 128 for more details on emergency declarations). Responding to a health crisis in complex humanitarian settings brings distinct challenges for humanitarian actors, as evidenced from previous responses to major health events. Guidance and policy of the Inter-Agency Standing Committee (IASC) for humanitarian action and leadership includes agreed protocols for health emergencies – notably for the Ebola response and the COVID-19 pandemic.

Following the response to the Ebola outbreak of 2014-2016 in West Africa, the IASC developed standard operating procedures for infectious hazards to ensure that appropriate measures are in place to respond to future outbreaks. These reflect the critical link between IASC mechanisms and WHO responsibilities under International Health Regulations (IHR). The assessment of infectious disease events and the consultation and decision-making processes on activation and deactivation criteria and procedures are outlined in the IASC Protocol for the Control of Infectious Disease Events (2019). It states that:

“In the event of a multi-country, regional or global infectious disease event (e.g. a ‘pandemic’), response measures, including in particular the leadership model and inter-agency/inter-country coordination arrangements and CERF allocation, will be adapted, expanded and strengthened as appropriate. In addition, a leadership and coordination model for contingency and preparedness planning for multi-country, regional or global infectious disease events pandemic should be established.”

In summary, the designation of a Scale-Up response to an infectious disease event is issued by the Emergency Relief Coordinator (ERC), in close collaboration with the WHO Director-General and in consultation with IASC Principals as well as, potentially, principals of other relevant entities. The Scale-Up is based on both an analysis of the IASC’s five criteria (scale, complexity, urgency, capacity and risk of failure to deliver at scale to affected populations) adapted to meet IHR criteria, and WHO’s formal risk assessment of the event.

As stated in the Protocols of 2019, for all public health events assessed as high or very high risk at regional or global levels, and/or when WHO declares an internal corporate emergency, the WHO Director-General will notify the UN Secretary-General and the ERC through a memo issued within 48 hours of completion of the assessment. This will include details of the situation analysis, risk level at country/regional/global levels, initial country-level response and coordination efforts (including IASC engagement), and a WHO assessment of the need to discuss a system-wide scale-up response.

Leadership structures for responding to infectious diseases

WHO will provide the UN Secretary-General and the ERC with a draft statement of public health strategic priorities, a proposed response structure and the major activities required to control the infectious event. This initial recommendation will be the basis for guiding further discussions and decisions by the Humanitarian Country Team (HCT), Emergency Directors Group and IASC Principals.

The IASC Principals will decide on the most appropriate leadership model at country, regional and HQ levels to support national authorities, taking into consideration pre-established resources (e.g. the Humanitarian Coordinator Pool, the WHO Incident Managers Roster).

As soon as possible, but no later than 12 hours after receiving it, the ERC will share the draft statement of public health strategic priorities and proposed response structure with the HCT and the HC – or where there is no designated HC, with the UN country team via the RC.

Based on the specificity and technical implications of the infectious disease, the IASC will also decide on:

• The overall in-country mechanism to ensure coordination and links across the humanitarian system in alignment with national structures and processes, and the roles and responsibilities of each agency at country, regional and global levels.
• The activation of clusters in response to the specific infectious hazard and the necessary control measures, as well as humanitarian needs.
• The composition of surge capacity deployments (based on the nature of the infectious hazard, the response required and existing capacity at country level) and its interface with national coordination structures.
• The period during which the measures triggered by the Scale-Up activation should be in place (up to six months).
• Other specific arrangements including appropriate staff safety, security, protective measures, medical assistance and, in extreme cases, medical evacuation, including of responders.

Leadership structures for COVID-19 response

The COVID-19 pandemic is an unprecedented global health emergency with immediate consequences for countries in the midst of a humanitarian crisis. The outbreak has exacerbated current humanitarian needs and operational challenges in many countries and created new humanitarian caseloads in others. A massive global scale-up was required to respond to the immediate health needs resulting from the pandemic to ensure continuity of service for pre-COVID-19 needs, and to address the associated humanitarian and socioeconomic impacts on vulnerable populations – with a focus on reinforcing a localized approach where possible.

Following the declaration of a global pandemic, the IASC issued guidance specific to the COVID-19 virus: Activation of the IASC System-Wide Scale-Up Protocols Adapted to the Global COVID-19 Pandemic (April 2020). These are tailored protocols that build on the IASC Scale-Up activation for infectious diseases, reflecting the role of WHO and its Director-General and Member States under international health regulations, and the importance of non-IASC organizations and technical expertise in responding to infectious disease events.

Resources:

• IASC resources for COVID-19
• IASC COVID-19 resources relating to accountability and inclusion