International Health Regulations – Background

What has changed in the International Health Regulations (2005)

The International Health Regulations (2005)

International Health Regulations

Background

The purpose of the International Health Regulations is to ensure the maximum security against the international spread of diseases with minimum interference with world traffic. Its origins date back to the mid-19th century when cholera epidemics overran Europe between 1830 and 1847. These epidemics were catalysts for intensive infectious disease diplomacy and multilateral cooperation in public health, starting with the first International Sanitary Conference in Paris in 1851.

Between 1851 and the end of the century, eight conventions on the spread of infectious diseases across national boundaries were negotiated. The beginning of the 20th century saw multilateral institutions established to enforce these conventions, including the precursor of the present Pan American Health Organization (PAHO).

In 1948, the WHO constitution came into force and in 1951 WHO Member States adopted the International Sanitary Regulations, which were renamed the International Health Regulations in 1969. The regulations were modified in 1973 and 1981. The IHR were originally intended to help monitor and control six serious infectious diseases: cholera, plague, yellow fever, smallpox, relapsing fever and typhus. Today, only cholera, plague and yellow fever are notifiable diseases.

What has changed in the International Health Regulations (2005)

1) Updating existing measures of the current IHR

In addition to revising the permanent, routine measures for reducing the spread of disease at airports and ports, the existing technical guides on ship sanitation and hygiene and sanitation in aviation are being revised and updated.

New technical guides are also being developed to address the specific requirements of the IHR(2005), including guidance on the early warning components of national surveillance, public health actions at points of entry, and roles and responsibilities of National IHR Focal Points.

2) Proposed key changes and benefits to Member States

Real time event management system

The IHR(2005) requires the establishment at WHO and in Member States of real time event management systems for addressing public health risks and emergencies of international concern which work alongside the updated permanent and routine IHR environmental and epidemiological provisions. This real time event management system, already implemented in WHO's alert and response operations, relies on a variety of sources to identify potential public health emergencies of international concern. These sources include unofficial and confidential notifications by Member States, by WHO partners such as nongovernmental organizations and research institutes as well as by the media.

National core surveillance capacities

Consultations with Member States were started in 2001 to develop the core surveillance and response capacities required by countries in order to fulfil the IHR requirements of detecting, reporting and responding to public health risks and emergencies of international concern. These capacities are now set out in Annex 1 of the IHR(2005).

Notification of potential public health emergencies of international concern

The purpose and scope of the IHR(2005) is no longer limited to the notification of specific diseases. States are now required to notify WHO of all events that may constitute public health emergencies of international concern in accordance with the decision instrument in Annex 2.

This decision instrument identifies a limited set of criteria that will assist Member States in deciding whether an event is notifiable to WHO. The criteria are:

• 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 international restriction(s) to travel and trade?

A number of specific diseases are also identified either for immediate notification under the IHR(2005) or for assessment against the criteria given above.

Support for States Parties

WHO will coordinate the provision of international technical assistance at the request of States Parties, in support of activities such as investigating, controlling or containing public health risks and emergencies. Through the Global Outbreak Alert and Response Network, the affected Member State will have access to over 120 network partners who can provide highly qualified staff and technical supplies.

When requested, WHO will work closely and confidentially with the affected Member State on verification of a public health event and the subsequent assessment of the international risk and any public health measures to be implemented. If the Director-General of WHO determines that a particular event constitutes a public health emergency of international concern, WHO will guide the appropriate response actions for Member States by issuing time-limited recommendations tailored to the assessed risk of the event. The Director-General will only issue such recommendations after having sought the advice of an Emergency Committee as set out in the IHR(2005).

National IHR Focal Points

The designation of National IHR Focal Points has made an important contribution to the process of developing the IHR (2005). Under the Regulations National IHR Focal Points are to play an equally important role in implementing the Regulations at the national level. The National IHR Focal Point is charged with maintaining a continuous official communication channel between WHO and States Parties. In addition to this legal requirement, the National IHR Focal Point will need to ensure the analysis of national public health risks in terms of international impact, participate in collaborative risk assessment with WHO, advise senior health and other government officials regarding notification to WHO and implementation of WHO recommendations, and distribute information to and coordinate input from several national sectors and government departments.

Benefits of the IHR(2005) to Member States

Working within a multilateral framework based on partnership and collaboration, Member States stand to benefit from the IHR(2005) by:

·        Improving national and international surveillance

·        Building on the current WHO system to detect and quickly respond to public health risks and emergencies of international concern

·        Encouraging the use of modern communication tools

·        Recognizing that disturbances to international traffic constitute an obstacle to reporting and that mechanisms to counter this interference need to be developed

·        Having a set of generic rules to evaluate and resolve different kinds of urgent events

·        Developing mechanisms to provide national and local protection within a set of rules which enjoy a broad consensus among all WHO Member States