International Health Regulations

International Health Regulations

Preben Aavitsland

Main concents of current IHR (1969)

• Notification to WHO of cases of cholera, plague and yellow fever

• Certain health related rules for international travel and trade

• Prescription of maximum border measures against cholera, plague and yellow fever (deratting, desinsection…)

• Health documents for people, aircraft and ships

Limitations of current IHR

• Concerns only cholera, plague and yellow fever

– The old paradigm of case-based surveillance

– Difficult to revise disease list

• Dependent on official notification from the member state

• No incentives to notification

– Very few notifications

– Notifications seemed as a very serious act by states

• No formal mechanisms for collaboration between member state and WHO

• No dynamic in the response for stopping international spread

A rationale for the revision

• Current IHR almost irrelevant

• Infectious diseases know no borders; member states should collaborate to stop them where they emerge

• More international travel and trade

• Early warning is essential and depends on collaboration and guarantees to notyfing member state against misue of information

• Measures should be coordinated internationally; WHO may take this role

• Anthrax attacks (2001) and sars (2003)

The revision process

• 1995 (WHA 48): Decision to revise IHR

• 1995-2003: Worskhops, consultations etc.

• January 2004: First draft for consultation

• March-June 2004: Regional consultations

• November 2004: Intergovernmental Meeting I

• February and May 2005: Intergovernmental Meeting II

• May 2005 (WHA 58): Adoption of the IHR

• June 2007: Entry into force

NewIHR

www.who.int/csr/ihr/en/

www.who.int/csr/ihr/en

Purpose of IHR

Article 2 Purpose and scope• The purpose and scope of these

Regulations are to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to risks to public health, and which avoid unnecessary interference with international traffic and trade.

Surveillance and notification

• Article 5 and 6 and annex 2

• A shift of paradigm from the previous IHR– From case-based (cholera, plague…)

– To event based (event of potential international public health concern)

• To be determined by National IHR Focal point

Annex 2: The algorithm to decide events to be notified to WHO

Any event of potential international public health concern, including those of unknown causes or sources

A case of the following diseases is unusual or unexpected and may have serious public health impact, and thus shall be notified: Smallpox, Poliomyelitis due to wild-type poliovirus, Human influenza caused by a new subtype, Severe acute respiratory syndrome (SARS).

Yes No Yes No

Is the public health impact of the event serious?

Is the event unusual or unexpected?

Is there a significant risk of international spread?

Is there a significant risk of int. travel and trade restrictions?

Two or more yes notify WHO. Other events consult WHO.

Events detected by national surveillance systems

Examples to guide the use of the algorithm

WHO may use other sources of information

• Not only notifications and consultations from National IHR Focal Points

• Also unofficial information– Non-governmental organisations– Newspapers– Internet– Rumours

• WHO shall then consult with Member State to find out more about the event

Public health emergencyof international concern (pheic)

• An extraordinary public health event– constitutes a public health risk to other States

through the international spread of disease and

– potentially requires a coordinated international response

• Determined by WHO after consultation with Emergency Committee

WHO recommendations on measures

• Articles 15-18, for verified pheic• After consultation with the Emergency Committee• Ad hoc, time-limited, risk-specific measures• Measures could be directed towards persons,

baggage, cargo, containers, ships, aircraft, road vehicles, goods or postal parcels

• Recommendations to affected state or other states or both

• States must follow recommendations• States should not take other measures (see

article 43)

Notification is smart

• Notification is a start of a dialogue with WHO– Verification and information sharing– Assistance

• Reporting criteria are very sensitive and less specific most events are not pheic

• WHO follows strict procedures– to determine whether event is ”public health

emergency of international concern” (pheic)– to issue recommendations

• Notification is a protection against unjustified measures from other states

Main obligations of Member States

• Notify WHO of all events that may constitute a public health emergency of international concern

• Respond to requests for verification of information regarding public health risks

• Respond to public health risks which may spread internationally

• Develop, strengthen and maintain the capacity to detect, report and respond to public health events

• Implement WHO-recommended measures• Provide scientific justification for any additional measures

adopted