International Health Regulations

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International Health Regulations

• Preben Aavitsland

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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

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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

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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)

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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

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(No Transcript)
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NewIHR
www.who.int/csr/ihr/en/
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www.who.int/csr/ihr/en
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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.

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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

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Annex 2 The algorithm to decide events to be
notified to WHO
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Any event of potential international public health concern, including those of unknown causes or sources 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). 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?
Events detected by national surveillance systems
Two or more yes ? notify WHO. Other events ?
consult WHO.
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Examples to guide the use of the algorithm
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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

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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

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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)

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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

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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