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Public Disclosure Authorized
Adapting Disaster Risk
Management Systems
for Health-Related
Emergencies:
Public Disclosure Authorized
Early Lessons from
the Asia-Pacific Region
October 2020
Public Disclosure Authorized
Public Disclosure Authorized
Photo Copyright: ©World Bank / Henitsoa Rafalia
Adapting Disaster Risk Management Systems
for Health-Related Emergencies: Early Lessons
from the Asia-Pacific Region
Table of Contents
1. Summary 1
2. Managing the crisis: 3
States of Emergency and the role
of NDMOs during COVID-19
3. Handling public information: 16
COVID-19 awareness, early warning systems
4. Enhancing emergency management 22
Multiple risks during health related emergencies
5. Recommendations to enhance 28
disaster risk management systems
01 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
1 1.
Summary caused by a coronavirus.1 Countries around the world moved swiftly to declare states
of emergency, closing ports of entry and activating crisis management systems.
This technical note2
that are responding to public health emergencies resulting from the COVID-19
pandemic. Selecting these countries, which represent a variety of intragovernmental
arrangements in the disaster risk management and public health sectors, also made
3
has an established disaster management system (also referred to as its emergency
Abbreviations/ management or civil defense/protection system) and a public health system.
acronyms:
a public health emergency and to its subsequent escalation to a pandemic. By
COVID-19 – Coronavirus
disease 2019
CDC – Center for Disease
Control and Prevention
systems are applied or activated to manage health-related emergencies, focusing on
four main aspects:
EWS – Early Warning System
MoH – Ministry of Health
01 State of emergency declaration: this includes its type, content, and
NDMO – National Disaster relevant binding legislation, and can apply to a declaration from
Management Organization
either (or both) the legal regime for public health or the disaster/
/ Emergency Management
Agency or Service emergency management agency.
02 National Disaster Management Organization (NDMO): the roles
and responsibilities of a country’s NDMO (including disaster
risk management and civil protection services) in responding to
COVID-19 outbreaks and other health related emergencies at both
national and sub-national levels.
1
See https://www.who.int/dg/
speeches/detail/who-director- 03 Risk reduction, preparedness, and awareness: the effectiveness
general-s-opening-remarks-at-the-
media-briefing-on-covid-19---11-
of COVID-19 outbreak tracing, the availability of health risk
march-2020 information, the strength of community awareness campaigns, the
2 prevalence of monitoring, and the success of warning services,
This technical note was prepared by
a World Bank technical team led by
Jolanta Kryspin-Watson, Jian Vun, system (multi hazard or otherwise).
and Mizan Bisri, with inputs from
Silviana Puspita, Rifa Atsari, Juwita
Sari, M. Halik Rizki, Devan Kreisberg,
and Nuriza Saputra. 04 Multiplicity of disasters: preparedness for near-future disasters
due to natural hazards during the COVID-19 pandemic situation,
It was prepared with financial support
from the Global Facility for Disaster handling of multiple disasters with compounding effects, and
Reduction and Recovery (GFDRR). management of mobility and travel restrictions during emergency
3
response and post disaster recovery activities.
The countries that were selected for
review represent a variety of different
had more information available in the
public domain than other countries.
Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 02
This note summarizes how the selected countries the resultant technical recommendations, could
have applied disaster management systems be valuable for client countries as they prepare
and practices to COVID-19 response, following a for future emergencies that create compounding
multi-hazard approach for both natural and other effects during the ongoing COVID-19 response and
hazards. Some countries were able to draw on key recovery period, as well as for other health related
emergencies that could arise.
with health-related emergencies – for instance,
the need to have already established a legal basis This summary of the countries’ responses is
for intragovernmental cooperation in responding followed by three sections covering the four aspects
to such events. Having a legal framework in
place allows governments to swiftly make critical guidance for policymakers to enhance disaster
decisions, such as declaring a state of emergency risk management (DRM) systems and platforms to
and enacting travel and mobility restrictions. The better address health related emergencies. It offers
lessons learned during the present emergency, and
01 Review disaster risk management legislation, strategies, and policies. Enhance
interagency coordination; better integrate public health considerations into DRM legislation
and policy (and vice versa). Adapt multi-hazard approaches in DRM strategies and plans.
02 Update national risk analyses and impact-based scenarios via a multi-hazard approach. Governments
can more effectively target particularly vulnerable communities by incorporating epidemiological forecast
models into decision support platforms to identify priority vulnerable areas and to update multi-hazard
risk modelling.
03 Monitor feedback on COVID-19 risk and crisis communication, administer performance audits, and
improve MHEWS platforms. This can inform more holistic multi-hazard risk and crisis communication
strategies, and suggest approaches for future MHEWS designs that include public health risks.
04 Build on existing early warning systems for natural hazards. Develop road maps for MHEWS open data
platforms that integrate health surveillance and natural hazard information, incorporate alerts for health-
related emergencies, and function with strong interagency coordination between Ministries of Health and
National Disaster Management Organizations (NDMOs).
05 Enhance community-based disaster preparedness programs. Community-based programs could
include preparedness for health-related emergencies – and help with case tracing, relief distribution,
and maintenance of public safety.
06 Adapt emergency management systems. Update contingency plans and evacuation procedures,
and ensure there is no disruption to supply chains for relief and recovery goods and services.
2
03 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
2
Managing the crisis: States
of Emergency and the role of
NDMOs during COVID-19
T
he COVID-19 pandemic prompted many
countries to declare a state of emergency
and mandate travel and mobility
restrictions in an effort to limit and contain local
outbreaks. The restrictions affected various aspects
of economic and social life.
Some countries, like the Republic of Korea,
Singapore, Vietnam, and Taiwan, China, have
learned from past experiences with SARS and
MERS. They were able to better respond to
COVID-19 by applying these lessons, which
included: having their public health system
establish a legal basis for responding to
"
health related emergencies, improving disease
surveillance, revising disease outbreak alert
Some countries,
systems and response protocols, and ensuring that
like Singapore, the medical and emergency response stockpiles were
Republic of Korea, and sufficient and replenished. In addition, having a
Vietnam, have learned legal basis for cooperation already in place helped
governments coordinate line ministries; outline
from past experiences clear priorities, mandates, and responsibilities;
with SARS and MERS, and respond swiftly with travel and mobility
and were able to restrictions.
better respond to
Some of the countries observed in this note
COVID-19 by applying
"
integrated emergency declarations made by
these lessons. both disaster management and public health
agencies; others relied on standalone executive
Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 04
order declarations or instructions specific to COVID-19. Republic of Korea, and Vietnam – is that it often
Similarly, countries chose differing institutional
arrangements when structuring their interagency across ministries and agencies, particularly if there is
response to the pandemic. This technical note explains strong leadership and vision.
three modalities of intragovernmental coordination
that emerged in the responses to COVID-19: 1) the In the Republic of Korea, when the national infectious
state directly heading an interagency task force (i.e., disease crisis level rose to “serious” on February 23,
leadership by a President or Prime Minister, or another 2020, the government assembled the Central Disaster
direct line of leadership); 2) the Ministry of Health and Safety Countermeasures Headquarters (CDSCHQ)
(MoH) leading or coordinating the response; and 3) the – which is headed by the Prime Minister – to increase
NDMO leading or coordinating the response. There are efforts on a government-wide response to COVID 19.
also countries that have applied a mixture of the above The Central Disease Control Headquarters (KCDC)
approaches. and the Central Disaster Management Headquarters
(Ministry of Health and Welfare) assisted in the
Four countries applied Type 1 coordination, with the 4
President or Prime Minister (or their vice or deputy) summarizes the response system in the Republic of
coordinating the response directly. The advantage Korea following the Level IV Crisis alert.
of this approach – taken by Japan, Myanmar, the
Crisis Alert Response System
Level
Local
Central Governments
Central Disaster and
Safety Counter measure Headquar ters Local Disaster and Safety
Countermea sure
(Minister of the inter ior and
Headquar ters
Safety or Prime Minister)
(local governments nationwide)
Central
Diseas e
Level IV Control
(highest level) Headquarters
(KCDC) Central Disaster Pan-government Local Disease
Management Countermea sures Control Task Force
Headqua rters Suppor t Headquar ters
(local governments
(Ministr y of Health (Ministr y of the
and Welfare) Interior and Safety) nationwide)
Figure 1 Republic of Korea’s Government’s Response System. (Source: Republic of Korea’s Central Disaster
and Safety Countermeasures Headquarters.)
4
http://ncov.mohw.go.kr/en/
05 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
In Japan, the parliament enacted the Act on Special contingency plans in the event of another emergency
during the COVID-19 outbreak.9
Diseases Preparedness and Response in March 2020
to provide the Prime Minister, relevant ministries, In Myanmar, the COVID-19 taskforce response is led by
and prefecture governments with greater authority to the Vice President and supported by multiple ministries,
respond to the situation. This response was similar
5
including the Ministry of Health and other high-level
to the measures that Japan took in 2012 following the government ministers, such as the Union Minister
for Defence, the Union Minister for Border Affairs,
the Union Minister for Home Affairs, and the Union
Among other measures, the Act provided government Minister for Labour, Immigration and Population.10 The
leaders the power to request the closure of certain COVID-19 taskforce is responsible for a wide range
types of businesses and public facilities, the of functions, including the investigation, detection,
distribution of relief items, and the distribution of and handling of persons infected with COVID-19, and
mandatory and optional cash assistance. Following 6
the coordination of various governmental and non-
this, from April 2020 onwards, states of emergency governmental organizations responding to COVID-19
have been declared in several prefectures. With Special
7
cases. The NDMO focuses on prevention, containment,
Measures in place, Japan’s Ministry of Health, Labour, and response plans for COVID-19 in its regular disaster
and Welfare (MHLW) led the medical and primary preparedness activities.11
response to COVID-19. The State Minister for Disaster
Vietnam mounted a highly coordinated COVID-19
supported the State of Emergency Legislation. Other response, largely thanks to its One Health Approach,
key actors include the prefecture governments and which calls for increased multidisciplinary and
the Ministry of Economy, Trade and Industry (METI). intersectoral cooperation and communication. This
In principle, the MHLW leads the medical response to integrated approach aims to address diseases that
COVID-19 as the Acting Head of the Novel Coronavirus emerge at the human–animal–ecosystem interface,
Response Headquarters (the head being the Prime
Minister). This includes maintaining an information animal and human health. One Health coordination in
system to track cases of COVID-19. However, the Vietnam includes the Ministry of Agriculture and Rural
MHLW-operated system has no direct feed to the Development (MARD), the MoH, and WHO Vietnam.12
country’s natural disaster information platform, which is
managed by the Japan Meteorological Agency (JMA).8 became an early adopter of One Health and is now a
Considering the pandemic, relevant agencies and global leader in this approach.13 It has been one of
ministries have also revised their business continuity
planning and their early action scenarios to create Vietnam.14
5 11
See https://japan.kantei.go.jp/98_abe/statement/202003/_00001.html See https://www.globalnewlightofmyanmar.com/
6
against-COVID-19/
See https://www.mhlw.go.jp/content/10900000/000620733.pdf
12
7
See https://www.pbs.org/wgbh/nova/article/
See https://japan.kantei.go.jp/ongoingtopics/_00020.html one-health-vietnam/
8
13
-
54f9a8dddebca003631b8 See http://onehealth.org.vn/upload/upload/Partner-
ship%20Framework%20ONE%20HEALTH%201.3.16.pdf
9
14
See https://www.pbs.org/wgbh/nova/article/one-health-vietnam/
See https://www.ilri.org/news/COVID-19-demonstrat-
10
ing-need-one-health-approach%E2%80%94-approach-
See https://eurocham-myanmar.org/uploads/5d142-notification-%2853-2020%29- ilri-has-long-championedFramework%20ONE%20
formation-of-COVID-19-control--emergency-response-committee---eng.pdf HEALTH%201.3.16.pdf
Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 06
disease emergence or re-emergence; (ii) detecting
Type 1 coordination mechanism. The government and responding rapidly and appropriately to cases
established the National Committee for Corona of new and emerging high-impact diseases in both
Prevention on January 30, 2020, the same day that animals and humans; and (iii) enhancing preparations
the WHO declared the outbreak to be a Public Health for the health-related and non-health consequences
Emergency of International Concern. Two days of any severe pandemics. These recommendations
later, on February 1, Vietnam announced a national strengthened responses and improved preventative
emergency for COVID-19. The National Committee
15
measures through Vietnam’s One Health Approach,
directs the mobilization of resources, coordinating and guided the government’s response to COVID-19.
between ministries, ministry-level and governmental
agencies, and People’s Committees of provinces and Six of the analyzed countries have
cities. It is led by the Deputy Prime Minister, while the
Deputy Ministers of Health are positioned as Deputy implemented Type 2 coordination,
Heads within the group. Other ministries and agencies i.e., a COVID-19 response led or
are also participating, supporting the implementation
of plans launched by the Ministry of Health.
coordinated by their Ministries of
Health with support from other
In recent years, the MoH of Vietnam has invested
ministries.
heavily in preparedness for health-related
emergencies. It started with the National Integrated
These countries are Cambodia, Fiji, India, Papua New
Operational Program for Avian and Human Influenza
Guinea, the Philippines, and Singapore.
(OPI) 2006–2010,16 which was then updated by the
Vietnam Integrated National Operational Program
In Fiji, the Ministry of Health and Medical Services
on Avian Influenza, Pandemic Preparedness and
established and led the Incident Management Team
Emerging Infectious Diseases (AIPED) 2011–201517
in response to COVID-19, with support from other
to cover other potentially serious emerging and
ministries. The NDMO provides direct support to the
re-emerging diseases. The objective of the AIPED
MoH through community awareness and prevention
was to reduce the risk to humans and animals from
measures. In the Philippines, the National Disaster
the H5N1 avian influenza, but additional guidance
Risk Reduction and Management Council (NDRRMC)
outlined how to reduce risk from other emerging
provides support to the public health–led response as
infectious diseases, such as the COVID-19 pandemic.
part of a national-level interagency task force, as does
The AIPED clearly outlined the following steps for
the National Disaster Management Authority (NDMA)
managing outbreaks of emerging infectious diseases:
in Papua New Guinea. In Cambodia and India, the
(i) controlling infectious diseases at the source
response is led unequivocally by the MoH.
and implementing appropriate measures to prevent
17
15
The program describes mechanisms that could be used to achieve the program objectives,
See https://www.vir.com.vn/vietnam-announces-
national-emergency-over-coronavirus-73535.html non-government agencies to work together, improving on recent developments, sustaining
partnerships, and meeting international core requirements for preparedness for and response
16 to emerging infectious diseases and pandemics; ii) providing a structure for domestic and
See “National Integrated Operational international resource mobilization to enhance and sustain critical functions, to address gaps
Program for Avian and Human Influenza and to facilitate donor coordination to support the activities and the integrated program; iii)
(OPI) 2006-2010,” Ministry of Agriculture building the evidence base for public health policy, risk communication, and public health action
and Rural Development (MARD), Socialist to address emerging infectious diseases; iv) applying a One Health approach that recognizes the
Republic of Vietnam, May 2006. http:// risks arising at the interface between animal health (both domestic and wild animal species),
animaldiseaseintelligence.com/wordpress/ human health and ecosystem health, noting that the majority of new human diseases globally
wp-content/uploads/2011/12/AIPED.pdf over the past 60 years have originated in animals. A copy of the document can be found here.
07 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
In Singapore, as well, the MoH is leading the Operations of Civil Emergency Response Plan.19 On
public health response to COVID-19 and, with the February 7, 2020, the Singaporean Ministry of Health
Ministry of National Development, is co-chairing elevated the DORSCON level of the country to orange
the taskforce for overall COVID-19 response and (the second-highest out of four levels), indicating
major disruptions to general public businesses and
support to MoH-led medical operations. The activities, the institution of public control measures,
MoH leads and maintains coordination with other and the activation of a government response plan.
ministries, and produces the primary updates on the Such measures are commonly known as “circuit
COVID-19 response situation.18 Singapore’s public
health system is strongly linked with the country’s response in Singapore.20 Singaporean ministries also
emergency management framework, including have prepared business continuity and contingency
through the Disease Outbreak Response System plans corresponding to the DORSCON Alert Levels.
Condition (DORSCON) and Singapore’s Declaration of
DORSCON ALERT LEVELS (Disease Outbreak Response System Condition)
GREEN YELLOW ORANGE RED
NATURE OF Disease is mild
OR
Disease is severe and
spreads easily from person
Disease is severe AND spreads
easily from person to person,
Disease is severe AND is spreading
widely
DISEASE Disease is severe but
to person but is occurring but disease has not spread
outside Singapore. widely in Singapore and is being
does not spread easily contained (e.g. SARS
from person to person OR experience in Singapore)
(e.g. MERS. H7N9) Disease is spreading in Singapore
but is (a) Typically mild i.e only
slightly more severe than seasonal
influenza. Could be severe in
vulnerable groups. (e.g. H1N1
pandemic) OR (b) being contained
IMPACT ON Minimal disruption e.g. border
screening, travel advice
Minimal disruption e.g. additional
measures at border and/or
Moderate disruption e.g.
quarantine, temperature
Major disruption e.g. school closures,
work from home orders, significant
DAILY LIFE healthcare settings expected, screening, visitor restrictions number of deaths.
higher work and school at hospitals
absenteeism likely
ADVICE TO • Be socially responsible;
if you are sick, stay at home
• Be socially responsible: if
you are sick, stay at home
• Be socially responsible:
if you are sick, stay at home
• Be socially responsible: if
you are sick, stay at home
PUBLIC
• Maintain good • Maintain good personal • Maintain good personal • Maintain good personal
personal hygiene hygiene hygiene hygiene
• Look out for health • Look out for health • Look out for health • Look out for health advisories
advisories advisories advisories
• Comply with control measures
• Comply with control
measures • Practise social distancing:
avoid crowded areas
Figure 2 Disease Outbreak Response System Condition (DORSCON) Alert Levels in Singapore. (Source: Ministry of Health Singapore.)
18 19 20
See https://www.moh.gov.sg/ The ‘Disease Outbreak Response System Condition’ (DORSCON) is a color-coded See https://www.gov.sg/
COVID-19 framework that shows the current disease situation. The framework provides the article/COVID-19-updates-
general guidelines on what needs to be done to prevent and reduce the impact of and-announcements
infections. https://www.gov.sg/article/what-do-the-different-dorscon-levels-meanAdapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 08
Five countries are employing Type 3 coordination, technical advice and resource support.22 The NDMO
using their NDMO as the lead agency for COVID-19 is responsible for leading the National Coronavirus
response. They include Indonesia, New Zealand, Taskforce; the taskforce itself includes the MoH and
Samoa, Tonga, and Vanuatu. its partners, which focus on COVID-19 prevention and
preparedness activities.
There are several reasons why NDMOs might be
the preferred lead agency during health-related The government has also established the Recovery
emergencies. Operations Center (ROC) under the Prime Minister’s
handling a variety of emergencies deriving not only
from natural disasters but also from various other for both COVID-19 and Tropical Cyclone Harold, which
hazards, including epidemics and pandemics. For affected Vanuatu during the pandemic in early April
Vanuatu understands 2020. The ROC will assist in the effective transition
that the country's high travel volume and tourism from the NDMO’s response phase to the post-disaster
recovery from both emergencies.
Therefore, its NDMO also manages this kind of
hazard, in coordination with the Ministry of Health, Similarly, in Tonga, the National Emergency
which is responsible for the monitoring, detection,
and treatment of any outbreaks.21 Second, several the coordination of resources during a disaster
countries already require NDMOs and relevant or emergency, either natural or non-natural, which
ministries and agencies to operate under one includes COVID-19 response. This function is being
umbrella when it comes to disaster response so performed in conjunction with the Central Control
that coordination is more effective. In Vanuatu, Group, with the coordination activities based within
such coordination occurs through the National the National Emergency Operations Centre (NEOC).
Disaster Committee. The NDMO works intensively The NEOC was activated on March 20, 2020, as a
with relevant ministries and agencies (including the result of Tonga’s State of Emergency declaration for
COVID-19.
Photo: People crossed the flooded street in Jakarta - Indonesia / Dani Daniar / Shutterstock
21 22
See Government of The Republic of Vanuatu (2010). National Disaster Plan, from https://reliefweb.int/sites/ Ibid.
reliefweb.int/files/resources/Vanuatu_Final%20Review%20National%20Disaster%20Plan_2010.pdf09 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
Samoa has also activated its National Emergency
"
Operation Centre (NEOC), which is part of the
Each pattern of country’s National Emergency Response Plan as
intergovernmental per the National Disaster Management Plan under
the National Disaster and Emergency Act 2007. The
coordination for COVID-19
NEOC is the focal point of the country’s response
has its own value. An NDMO- activities, facilitating collaboration and operational
led or -coordinated response coordination amongst all stakeholders, with
can enable rapid adjustment advice and technical guidance from the Ministry of
Health for the duration of the emergency period.
of preparedness measures The Ministry of Health is also responsible for
alongside other types of implementing awareness programs for COVID-19
risks in response to the prevention.
COVID-19 pandemic.
" In New Zealand, there are three main legislative acts
giving the government authority to take necessary
1956, the Civil Defense Emergency Management Act
2002, and the Epidemic Preparedness Act 2006. All
these acts reference each other and can be invoked
independently. The Health Act 1956 (HA 1956)
gives broad powers to the Minister of Health and
The Health Act was also amended as of March 11,
disease and a quarantinable infectious disease.23
powers to carry out necessary prevention measures,
instituting social distancing orders.
The Epidemic Preparedness Act 2006 enables
government agencies to try and prevent the outbreak
of epidemics in New Zealand. The Act only applies
to a “quarantinable disease” – and, as a result of the
amendment to the Health Act noted above, COVID-19
Act 2006 to be enforced, the government must
23
See https://COVID19.govt.nz/resources/key-documents-and-
Photo: Sanitizing streets in Telangana India / Sujeeth Potla / UnsplashAdapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 10
Photo: Medical tents assembled at Emergency entrance of Kiang Wu Hospital, Macau / Macau Photo Agency / Unsplash
issue a notice in the gazette,24 of the Civil Defence Emergency Management Act
government notice board. The Prime Minister may 2002 (CDEM Act) and the National Civil Defence
issue an epidemic notice if it is recommended by the Emergency Management Plan Order 2015 – to
Director-General of Health, with the agreement of manage the COVID-19 emergency and prevent its
26
are being used
that an outbreak of a disease is "likely to disrupt where necessary to slow the spread of COVID-19 by
or continue to disrupt the central government and reducing and managing its impacts. The act grants
business activity in New Zealand (or stated parts
conservation and supply of fuel and other essential
Prime Minister issued the Epidemic Preparedness supplies – to help manage wider impacts, and the
(COVID-19) Notice 2020, which came into effect on authority to close roads, proscribe activities that may
March 25, 2020. This notice activated a range of
provisions in both the Social Security Act (beginning
March 25) and the Immigration Act (beginning April
2) intended to deal with the practical effects of the emergency, the Director and National Controller Civil
COVID-19 outbreak. Defence Emergency Management issued a “Direction
to CDEM Groups and Group Controllers for the
The declaration of a state of national emergency25 duration of the COVID-19 response and recovery” to
gave the Director and National Controller the help localize the control of operations.
means – in accordance with section 9 and Part 5
24 26
See https://gazette.govt.nz/ Emergency powers under the CDEM Act 2002 enable the Director of Civil Defence Emergency (and CDEM Group
notice/id/2020-go1368 Controllers) to, among other things: (i) close or restrict access to roads or public places; (ii) remove or secure
dangerous structures and materials; (iii) provide rescue, first aid, food, shelter, etc.; (iv) conserve essential
25
supplies and regulate traffic; (v) dispose of dead persons and animals; (vi) enter into premises, e.g., to rescue
See https://COVID19.govt.nz/alert-
system/state-of-national-emergency/ equipment, materials and assistance. https://COVID19.govt.nz/alert-system/state-of-national-emergency11 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
On May 13, 2020, the New Zealand Parliament
passed the COVID-19 Public Health Response
Bill,27 which establishes standalone legislation
that provides a different legal framework for
(or sooner, if the pandemic is brought under
control before that time). The Act aims to support
a public health response to COVID-19 that
(a) prevents, and limits the risk
of, the outbreak or spread
of COVID-19 (considering
its infectious nature and
potential for asymptomatic
transmission);
(b) avoids, mitigates, or
remedies the actual or
potential adverse effects
of the COVID-19 outbreak
(whether direct or indirect);
(c) is coordinated, orderly,
and proportionate; and
(d) has enforceable measures
that augment the relevant
voluntary measures and
public health and other
guidance supporting the
COVID-19 response.
Photo: (Top) Heatmap by the Center for Systems Science and Engineering (CSSE) / Clay
Banks / Unsplash | (Bottom) Unsplash
27
See http://www.legislation.govt.nz/bill/government/2020/0246/latest/LMS344134.htmlAdapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 12
In addition, New Zealand has adopted an alert system management of disasters.” The National Disaster
for COVID-19 that includes four distinct levels. This Management Authority (NDMA) is the lead agency for
system enables target populations to prepare and coordinating disaster management, with the Prime
plan for the different kinds of restrictions that will Minister as its Chairperson. The Government of India
be in place depending on the level of the alert. Each later announced a complete lockdown.
alert level refers to different legislative acts (e.g., the
COVID-19 Public Health Response Bill governs Alert In Indonesia, both the disaster management and
Level 2). health agencies had previously recognized the risk
of potential disease outbreak, learning from their
In India
25, 2020, of the spread of the novel coronavirus, an Disaster Management describes “non-natural disaster”
interministerial meeting was called by the Principal as a “non-natural event or a series of non-natural
Secretary to the Prime Minister. In March 2020, the events such as technological failure, modernization
government declared a 21-day national lockdown failure, and epidemic.” Before the COVID-19 pandemic,
in 82 districts in 22 states and Union Territories of two key regulations had already been enacted: Law
28
No. 6/2018 on Health Quarantine and MoH Regulation
to combat the spread of COVID-19. This lockdown 75/2019 on Health Crisis Response. The MoH had also
invested in preparing health emergency action plans
provisions of the National Disaster Management Act and other related measures in cooperation with health-
2005, which was enacted to “provide for the effective
29
related stakeholders.30
Photo: Medical students in training, Yogyakarta, Indonesia / World Bank / Flickr
28 29 30
See https://www.hindustantimes.com/in- See https://www.hindustantimes.com/ See https://www.who.int/docs/default-
dia-news/82-districts-under-lockdown-over- india-news/covid-19-disaster-act- source/searo/indonesia/non-who-
covid-19-what-s-open-and-what-is-shut/ invoked-for-the-1st-time-in-india/story- publications/health-crisis-action-plan-
story-c1AEMZXuuXN6FvmrAdRvsJ.html 2015-2019-bahasa.pdf?sfvrsn=1b9f18fe_213 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
emergency response by BNPB and other ministry-
two COVID-19 cases (announced on March 2, 2020), level government agencies. However, the NDRF
the Indonesian MoH published national guidelines does not guide emergency responses related to
pandemics. Hence, BNPB adjusted to accommodate
pandemic.31 The document outlines procedures for the establishment of the COVID-19 Task Force with
medical workers handling the disease. The MoH also the Head of BNPB as the chairperson. The framework
published an Operational and Mitigation Response
Plan, which describes the coordination line between and principles of operation, and designates the
ministries and agencies managing COVID-19. To coordinating authority for each phase (see table 1).
coordinate a government-wide response, the National The government determines the alert level. Each level
Disaster Management Authority (BNPB, Indonesia’s stipulates the public health and social measures
NDMO) is leading the interagency COVID-19 Task to be taken against COVID-19, including increasing
Force. or decreasing limits on human contact, travel, and
business operations. Restrictions are cumulative (e.g.,
Before the COVID-19 pandemic, BNPB had developed at Alert Level 4, all restrictions at Alert Levels 1, 2, and
a National Disaster Response Framework (NDRF), 3 also apply). Different parts of the country may be at
which sets out a Concept of Operations to guide different alert levels.
Table 1 Adjusted National Disaster Response Framework in Indonesia to Concept of
Operations for COVID 19 Response (Source: Indonesian Ministry of Health)
Statement of Operations principle Coordinator /
phase (threshold) Commander
(General) Zero COVID-19 cases Strengthening detection, National: MoH
Preparedness in Indonesia surveillance, prevention Sub-national:
Head of local
government
Emergency Early and sporadic Case detection, National: MoH
Preparedness COVID-19 cases contact tracing, and Sub-national:
case isolation Head of local
government
Emergency At minimum, two clusters Case detection, contact National: MoH
Response of COVID-19 in Indonesia tracing, case isolation, Sub-national:
pandemic mitigation, Head of local
physical distancing, and government
business continuity plan
Rehabilitation No new case after two Response de-escalation, Head of local
incubation periods, stringent surveillance, and government
counted from the last functional rehabilitation
31
Revised on March 27, 2020: https://www.kemkes.go.id/article/view/20012900002/Kesiapsiagaan-menghadapi-Infeksi-Novel-Coronavirus.htmlAdapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 14
and Singapore). This early declaration enabled quick
resource mobilization for public health responses
emergency (SoE) related to COVID-19 for most of the (including case tracing and tests) and swift decision-
countries studied in this note. In accordance with their making on social mobility restrictions (e.g., lockdown,
respective approaches to managing the crisis, countries large-scale social restrictions, or quarantine) while
declared the SoE through the public health authority
(e.g., Republic of Korea, Singapore, and Vietnam) or the countries (e.g., India) have even declared nationwide
disaster management authority (e.g., India, Indonesia, lockdowns without SoE declarations. In Indonesia,
following the SoE declaration, while social mobility
3 illustrates, countries with public health agencies restrictions were in place during the weeks of March
leading the crisis declared the public health emergency and April, relevant Indonesian ministries developed and
earlier, around the beginning of February 2020 and 32
COUNTRIES
Cambodia Indonesia Myanmar Phillipines Singapore
Fiji Japan New Zealand Korea, Rep Vietnam
4500
WHO declared COVID-19 as
Public Health Eemergency of
International Concern
4000
Indonesia
JP National
SoE
3500
SG start
Circuit Breaker
3000
NZ SoE
declaration
2500 SG end
PH SoE Circuit Breaker
declaration
2000
Phillipines
KR SoE
(Alert Level #4)
1500 SG
Dorscon
Alert #3
(max. 4)
Myanmar
1000
VN
declared
SoE
500 Japan
Korea, Rep
0 time
W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2
January February March April May June July August September October
Figure 3
32
See complete list here: https://COVID19.go.id/p/protokol?page=1Adapting Disaster Risk Management Systems
BOX 1 for Health-Related Emergencies: Early
Lessons from the Asia-Pacific Region
Continuity and
Digitalization of
Public Services
during COVID-19
The COVID-19 pandemic has prompted many countries to rethink how
they communicate with their citizens and explore how to continue
providing services for the community despite the need to limit mobility
and interpersonal contact. In sectors such as government services,
education, the media, communication systems, and the economy,
digital solutions have allowed some day-to-day activities to continue
during the lockdown. For instance, Vietnam took the opportunity 33
to accelerate digital transformation and, under direction from the See https://iotbusiness-
platform.com/blog/
Prime Minister, created digital applications and encouraged business covid-19-challenges-
activities to continue in the digital environment.33 Vietnam had already opportunities-and-the-road-
ahead-for-vietnams-digital-
launched a digital National Public Services Portal in December 2019; economy/
by February 2020, nine out of 22 ministries and government agencies, 34
as well as all 63 provinces or cities, had integrated their respective See http://hanoitimes.vn/
vietnams-efforts-towards-e-
public services into the online portal. By May 2020, the portal
34
government-to-help-contain-
included six more government services intended to help businesses covid-19-pm-301041.html
and individuals affected by the COVID-19 pandemic.35 35
See http://hanoitimes.
vn/more-public-services-
Other countries, like Singapore, also shifted the provision of public launched-online-to-support-
people-businesses-hurt-by-
services primarily to digital platforms, scaling down or temporarily covid-19-312061.html
closing physical service centers and deferring non-urgent physical
36
service appointments.36 In New Zealand, the focus is on ensuring See https://www.psd.gov.sg/
that all agencies providing public services can operate at maximum press-room/press-releases/
end-of-circuit-breaker--public-
capacity while complying with applicable public health measures.37 service-adopts-phased-
approach-to-re-opening-
Each government agency is encouraged to determine its own planning physical- service-centres-
to maintain the delivery of public services during the pandemic and and-public-facilities
is responsible for deciding how to apply these guidelines. At the
37
same time, governments need to ensure that vulnerable populations, See https://www.
including people with disabilities and disaster-affected people, are publicservice.govt.nz/
resources/covid-19-
able to easily access digitized public services. workforce-guidelines/3
16 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
3
Handling public information:
COVID-19 awareness, early
warning systems
I
n order to improve their understanding of
COVID-19 risks and implications, the countries
analyzed in this note have established a range
of case tracing, data dashboard, and information
management platforms. Most of the COVID-19
platforms analyzed here provide data visualization
related to the number and location of COVID-19
cases, rather than projections or forecasting.
But a commonality between pandemics, cyclones,
38
Simply
tracking COVID-19 infection rates, contact tracing,
and case hotspots in a country is not enough. It is
critical to overlay the COVID-19 epidemiological
models on risk models of other natural hazards.
The inclusion of seasonal events may enable
governments to consider worst-case risk scenarios,
dynamic of COVID-19–related policies – particularly
decisions to activate and cancel SoEs, large-scale
social restrictions, or lockdowns – may increase
the probability that diverse hazards will interact
with COVID-19 cases and stimulate concurrent and
cascading crises.
Some of the COVID-19 platforms discussed here
are managed and operationalized by the country's
38
See https://doi.org/10.1016/j.pdisas.2020.100102Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 17
NDMO, some by the MoH; and there is considerable in the daily Situation Report of the Inter-Agency
variation in whether a country’s COVID-19 data Task Force for COVID-19.43 This practice builds on
dashboard is linked to its early warning system (EWS) NDRRMC’s standard practice for natural disasters, and
platform (whether multi-hazard or standalone). provides consistency in terms of structured crisis-
management reporting.
In Cambodia, the country’s Center for Disease
Control and Prevention (CDC) provides a COVID-19 The Government of Vietnam is providing COVID-19
tracking website; however, it does not feed into the
39
data to the public that includes the demography,
country’s EWS platform (named EWS1294). Similarly, precise locations, and ages of patients. The MoH
in Myanmar, 40
the distribution map of COVID-19 launched a website to publish information related to
cases was developed by MoH and is not linked to COVID-1944 on February 9, 2020 – two days before
the EWS platform operated by the Department of the WHO even named the novel coronavirus disease
Disaster Management or to the one managed by the “COVID-19.” Once Vietnam declared that the country
Department of Meteorology. Conversely, in Vietnam, was entering the second phase of COVID-19 response,
although the NDMO’s EWS (VnAWARE) provides the MoH prepared and released a new tool: a mobile
information on COVID-19, it does not integrate with application that facilitates a bottom-up approach to
the monitoring platform provided by the MoH.41 tracking the disease. Through the app, communities
can report their health status and follow the contact-
In the Philippines, on the other hand, the Department tracing process. This action was also taken just before
of Health–managed COVID-19 tracker feeds into the the WHO declared a global pandemic on March 11,
Emergency Operations Center (EOC) of the National 2020. The low number of reported infections and
Disaster Risk Reduction and Management Council deaths in Vietnam may indicate that the government’s
(NDRRMC).42 Data and information from the platform, early efforts to prepare communities and disseminate
along with contributions from other agencies and local risk information on COVID-19 may have helped
government units, are then compiled by the NDRRMC contain local transmissions.
Photo: People riding motorbike and wearing mask in Ho Chi Minh City, Vietnam / Markus Winkler
39 41 43
See https://COVID-19-map.cdcmoh.gov.kh/ See https://ncov.moh.gov.vn/ See http://www.ndrrmc.gov.ph/9-
ndrrmc-advisory/4036
40 42
44
See https://doph.maps.arcgis.com/ See https://www.doh.gov.ph/COVID-19tracker
See https://ncov.moh.gov.vn/
f8fb4ccc3d2d42c7ab0590dbb3fc26b818 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
Even when a country’s NDMO is leading the from becoming overburdened; assess the volume
government’s COVID-19 response, case tracing of emergency management items needed more
information is not necessarily integrated into accurately (as a miscalculation could affect logistical
the country’s EWS platform. In New Zealand, the
government has developed a dedicated platform services.47
for COVID-19 information. While the website of the
Ministry of Civil Defence and Emergency Management In many countries, the NDMO’s and MoH’s EWS
(CDEM) contains general information on the status platforms remain independent. In Singapore, the
of local COVID-19 outbreaks, it remains focused on
providing information regarding natural disasters. This risk, while MetService Singapore operates the EWS on
means that the four color-coded alert levels in New hydrometeorological risk. Nevertheless, both agencies
Zealand (prepare, reduce, restrict, and lockdown) and have access to Singapore’s MoH and GovTech
its advisories for each alert level, as well as guidance
on risk assessment and the range of measures to be locations of, and detailed information about, COVID-19
taken by the public at risk, have yet to be subsumed cases.
45
In Japan, the State Minister for Disaster Management
In Indonesia, although BNPB is the lead agency of
the Task Force for COVID 19 and manages the data broad disaster risk management policy, strategies,
dashboard on COVID-19 cases and response, it is 46
preparedness, and response to natural hazards.48 As
not yet apparent whether COVID-19 risk information is
considered when updating the country’s multi-hazard input to the State of Emergency stipulation under the
risk level – that is, it remains unclear whether the new COVID-19 law. Early warning system operations
process goes beyond the current approach of simply remained with the Japan Meteorological Agency
adding risk layers relevant to COVID-19 infections by and related bureaus under the Ministry of Land,
analyzing additional data (such as vulnerabilities and Infrastructure and Transportation.
indication that COVID-19 case tracing and hotspots
are being integrated into the current EWS platforms authority under the law to take effective emergency
with other anticipated future risks or potential measures, as they can take into account the
disasters (e.g., hydrometeorological risks, or disasters characteristics of each area and provide careful
caused by geological hazards). Governments could 49
The Government
improve preparedness by integrating early warning Response Headquarters is coordinating as necessary
systems, thereby helping to: prevent medical and with designated prefectures, which will help the
governmental emergency-services operations government inform residents of the difference
45 48
See https://doi.org/10.1016/j.ijdrr.2020.101674 According to law, this is limited to heavy rain, typhoons, earthquakes, tsunamis,
landslides, volcanic eruptions, flooding, and heavy snow.
46
See https://www.COVID-19.go.id/situasi-virus-corona/ 49
47
COVID-19: https://www.bousai.metro.tokyo.lg.jp/_res/projects/default_project/_
See https://doi.org/10.1017/dmp.2020.51 page_/001/007/698/2020041510.pdfAdapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 19
"Tracking COVID-19 infection rates,
contact tracing, and case hotspots
in a country is not enough. It is
critical to overlay the COVID-19
epidemiological models on risk
models of other natural hazards.
The inclusion of seasonal events
may enable governments to
consider worst-case risk scenarios.
"
between the emergency measures and "lockdown" tested daily at 5:00 p.m. The speakers, located on
procedures. Designated prefectures will also ask the streets, are linked to a national system that can
people to refrain from travel across prefectures transmit disaster warnings to local governments
and call for a calm response to prevent confusion throughout the country within seven seconds. This
(including panic buying of food, medicine, and daily same system is currently being used by municipal
necessities). Government support also included governments, broadcasting public announcements
establishing an information-management platform that call for residents’ collaboration in ensuring
physical distancing, avoiding crowded spaces,
tracing, although detailed risk information on
50
similar messages through internet and smartphone
early warning system and public information systems messaging applications, advising citizens to stay
for disasters.51 By focusing the response and public home.
communication efforts at the prefectural level, Japan
other types of disasters, including the systems for Cyclone Harold in April 2020 (Fiji, the Solomon
announcing public information, managing information, Islands, Tonga, and Vanuatu) have an EWS in place for
and dispatching emergency and medical workers. natural hazards. In Samoa, the Samoa Meteorological
Service provides cyclone advisories. The public
In addition, Japan has a local government disaster received COVID-19 information and case updates
administration wireless broadcast (“goji no chaimu” from government websites, radio, TV, and social media
(Facebook and Twitter).
50 51
See https://stopCOVID-19.metro.tokyo.lg.jp/en/ See https://map.bousai.metro.tokyo.lg.jp/en/pc/map.20 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
In Vanuatu, the COVID-19 taskforce created to the curfew as stated in the SoE order, and a stricter
travel advisory was released. On April 3, 2020, the
updates.52 In addition, the government has created NDMO released a statement detailing the Scenario 2
a Health Promotions Vanuatu page on Facebook to
disseminate COVID-19 information and updates to cases in Vanuatu) of the country’s COVID-19 response,
the public. The NDMO has taken the lead in overall and announced a stimulus package.
coordination of the COVID-19 response since the end
of March 2020, when there were only suspected cases On April 1, 2020, during the initial two-week SoE
period, the NDMO released a public cyclone alert
and travel restrictions have been in place since then, based on the weather outlook of the VMGD Vanuatu
and the NDMO advised the public to practice good Meteorological and Geo-hazard Department. The
hygiene and physical distancing while it monitored NDMO also announced three other, non-COVID–
the situation with a suspected COVID-19 case cluster. related warnings during this period: high potential that
On March 26, 2020, the Prime Minister declared Tropical Cyclone Harold would reach Vanuatu in 24 to
a two-week SoE. To raise public awareness and 48 hours; alert level 2 for ash fall from Mt. Yasur on
increase preparedness, the NDMO, with support from
the Emergency Telecommunication Cluster, set up
a toll-free number for the public to call to request On April 5, 2020, the NDMO prioritized the response
information regarding COVID-19. Information is also to Tropical Cyclone Harold. Some areas received red
disseminated via SMS. and yellow alerts; people in those provinces were
advised to remain alert and listen to Radio Vanuatu
to stay updated. Power and water outages occurred
cases in Vanuatu, the NDMO stepped up preventive in Santo, and people in the northern areas were
action by installing several hand-washing stations and moved to evacuation centers with support from
enforcing strict social-distancing measures. During Provincial Emergency Operation Centers. The NDMO
the two-week SoE, the public was advised to adhere also released Directive no. 37, which stated that the
52
See https://COVID-19.gov.vuAdapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 21
regulations restricting social gatherings of more status from Scenario 2 to Scenario 1 (SoE declaration
for preparedness and containment measures, but
response would not apply to those seeking shelter in
safe houses or evacuation centers. 39, which lifted all domestic restrictions on air and
maritime operations (subject to normal safety and
The NDMO once again prioritized Tropical Cyclone regulatory requirements). This was due to unintended
Harold response above COVID-19 in its April 7 ambiguity in responding to Tropical Cyclone Harold
situation report. The NDMO issued an “all clear” against the backdrop of the pandemic – even with
status for northern and central provinces, but still no cases of COVID-19 in Vanuatu – which resulted
advised people to listen to Radio Vanuatu for the in the quarantining (for seven days) of relief supplies
latest updates; it also released a preliminary report from other nations. These much-needed supplies
on the cyclone’s impact on some areas of Vanuatu. were therefore not immediately available to disaster-
Regarding COVID-19, the NDMO changed the national affected people.
Figure 4 Epidemiological forecast models for COVID-19 fatalities and infections of selected countries relative to the rate of other
hazards.53
53
See https://www.essoar.org/doi/10.1002/essoar.10502915.2 and https://covid19-scenarios.org/4
22 Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region
4
Enhancing emergency
management: Multiple
risks during health related
emergencies
A
s we begin to understand how the COVID-19
pandemic is multiplying risks and changing
become clear that we must bolster our preparedness
for current and future natural hazards and health
related emergencies, particularly biohazards. It
is critical to understand that disasters can occur
at multiple levels simultaneously, and that the
response to one hazard (such as the COVID-19
pandemic) can expose further vulnerability problems
and raise additional concerns for the response to
another concurrent hazard.54 These concerns include
whether the government and other related actors
are preparing or revising their contingency plans
or other guidelines in response to such situations.
Disaster preparedness strategies and resourcing plans
should carefully consider the impact of COVID-19
on future response operations. Governments should
adapt implementation modalities to account for those
impacts, which could include the disruption of critical
supply chains, the potential localization of response
efforts due to restricted mobility of humanitarian
actors, the limited availability of evacuation centers
with capacity for social distancing, the constrained
capacity of humanitarian workers or volunteers and
medical staff to respond to natural disasters in areas
affected by COVID-19, and health systems’ limited
supply of personal protective and medical equipment
COVID-19 cases. 55
54 55
See https://onlinelibrary.wiley.com/doi/ Op. cit.
full/10.1111/1469-8676.12890Adapting Disaster Risk Management Systems for Health-Related Emergencies: Early Lessons from the Asia-Pacific Region 23
Photo: World Bank / Flickr
For instance, New Zealand’s lockdown means that to Tropical Cyclone Harold to consider the unique
mobilization restrictions are in place. However, the characteristics of the COVID-19 setting. Lockdown
notice and curfew was lifted to allow people to
of an emergency, the protocol for natural disasters move to a safe place and prepare for cyclones,
would override the lockdown order. Communities but communities were advised to maintain social
distancing during evacuation. However, there are
take necessary measures for COVID-19 prevention, still some challenges surrounding how to maintain
including maintaining safe distances and personal physical distancing and prevent outbreaks in
hygiene. The Civil Defense Management Authority has
not yet issued a separate protocol to address natural
emergency situations during COVID-19; citizens are to kit is not readily available in Tonga, and importing
of tests, travel restrictions, and quarantine policies.
countries that responded to natural disasters during
the current COVID-19 situation. number of evacuation centers, which has resulted
in overcrowding. Tropical Cyclone Harold damaged
towards Fiji as a Category-4 storm. When it caused usually communities’ preferred option for use as
evacuation centers. The community now has few
Emergency Operations Centre was activated. The options for evacuation centers, and during the
NDMO worked closely with the MoH to ensure that aftermath of the cyclone, the government struggled
physical distancing was practiced in evacuation to keep the occupancy rate of evacuation centers at a
centers. In Tonga, the NDMO adjusted its response safe level. 56
56
See https://www.undrr.org/publication/undrr-asia-pacific-COVID-19-brief-combating-dual-challenges-climate-related-disastersYou can also read
