Transcript International Health Regulations Preben Aavitsland Main concents of current IHR (1969) • Notification to WHO of cases of cholera, plague and yellow fever •

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
New
IHR
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
Events detected
by national
surveillance
systems
Any event of
potential
international
public health
concern,
including those of
unknown causes
or sources
Yes
No
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
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.
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 emergency
of 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