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International
Health Regulations
Building global public health security
What are the IHR?
A legally-binding instrument of international law about procedures to protect public health
Mandated by the WHO Constitution
Adopted at the World Health Assembly and binding on all of WHO’s Member States
The result of direct instructions from States to WHO
Legal Basis for the IHR - the WHA
Article 21 of the WHO Constitution:
The Health Assembly shall have the
authority to adopt regulations concerning:
(a) sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease;
Article 22 further provides:
Regulations adopted pursuant to Article 21 shall come into force for all Members after due notice has been given of their adoption by the Health Assembly except for such Members as may notify the Director-General of rejection or reservations within the period stated in the notice.
Global public health security
The activities required, both proactive and reactive, to
minimize vulnerability to acute public health events that
endanger the collective health of populations living across
geographical regions and
international boundaries.
Why the International Health Regulations?
In today’s world, diseases travel fast and no single country can protect itself on its own.
194 countries came together to agree on a new way of working and to commit themselves to
implementing the International Health Regulations (IHR).
The IHR entered into force on 15 June 2007.
Our world is changing as never before
Populations grow, age, and move
Diseases travel fast
Microbes adapt
Chemical, radiation, food risks increase
Health security is at stake
Global public health security is the goal
Ensuring maximum public health security
while minimizing interference with international transport and trade
Came into force on 15 June 2007
Legally binding for WHO and the world’s countries that have agreed to play by the same rules to secure international health.
Structure of the IHR
• Definitions and purpose( Part I: Art. 1-4)
• Detection and response (Part II, III: Art. 5-18)
• International traffic (Part IV, V, VI: Art. 19-39)
• Charges, additional measures, data protection (Part VII, VIII: Art. 40-46)
• Committees (Part IX: Art. 47-53)
• Legal / procedural matters (Part X: Art. 54-66)
• Annexes – Capacities, Decision Instrument, Certificates, Vaccination &
prophylaxis
Purpose and Scope of the IHR
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 public health risks,
and which avoid unnecessary interference with international
traffic.
All public health risks
The IHR recognize that international disease threats have increased
Scope is broad and applies public health event, risks and emergencies of
international concern
They include those caused by infectious diseases, chemical agents, radioactive materials and contaminated food
• Start of a dialogue to determine actions needed
• No automatic publication or response
• Decision instrument (Annex 2) to identify notifiable events
Notification under the IHR
Decision instrument
Notification criteria
Annex 2 – to decide on need for notification any public health event can be assessed by the criteria
– 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 travel or trade restrictions?
In addition 4 diseases must be notified
Diseases (some regionally defined) trigger assessment
Notification to IAEA and relationship with other international agreements
Under Article 6 of the IHR, if the notification received by WHO (from an IHR State Party) involves the competency of the
International Atomic Energy Agency (IAEA), WHO shall immediately notify the IAEA.
Article 57 of the IHR provides that:
States Parties recognize that the IHR and other relevant international agreements should be interpreted so as to be compatible. The
provisions of the IHR shall not affect the rights and obligations of any State Party deriving from other international agreements.
What do the IHR call for?
Strengthened national capacity for surveillance and control, including in travel and transport
Prevention, alert and response to
international public health emergencies
Global partnership and international collaboration
Rights, obligations and procedures,
Why must countries implement the IHR?
Countries receive:
WHO assistance in building core capacities
WHO’s guidance during outbreak investigation, risk assessment, and response
WHO’s advice and logistical support
information gathered by WHO about public health risks worldwide
To detect and contain public health threats faster, to contribute to global public health security, and to enjoy the benefits of being a
respected partner.
As each country builds its capacity, the entire world wins
The greatest assurance of public health security will come when all countries have in place the capacities for effective surveillance and response.
Timeline
15 June 2007 2009 2012 2014 2016 2 years + 3 + (2) + (up to 2)
"As soon as possible but no later than five years from entry into force"
Countries’ challenges for IHR implementation
Mobilize resources and develop national action plans
Strengthen national capacities in alert and response
Strengthen capacity at ports, airports, and ground crossings
Maintaining strong threat-specific readiness for known diseases/risks
Rapidly notify WHO of acute public health risks
Sustain international and intersectoral collaboration
Monitor progress of IHR implementation
What does WHO in support of IHR implementation?
Support States Parties in assessing their public health risks, through the notification, consultation, and verification processes and in their response actions
Inform State Parties of relevant international public health risks
Recommend adapted public health measures
Assist States Parties to strengthen IHR capacities
Cooperate and coordinate with other international organizations or bodies
Lives saved
Good international image
Mitigate travel and trade restrictions
Public trust
No political and social turmoil
Benefits of IHR implementation
Pandemic (H1N1) 2009 and the IHR Emergency Committee
First public health emergency of international concern (PHEIC) since the entry into force of the IHR in 2007 (25 April 2009).
Establishment of an Emergency Committee to advise the WHO Director-General (25 April 2009 to 10 August 2010)
Adoption of temporary recommendations by the WHO Director-General
Additional measures under the IHR
IHR Review Committee Objectives
Objectives of the review:
Assess the functioning of the IHR (2005);
Assess the global response to pandemic (H1N1) 2009, including the role of WHO; and
Identify lessons learned to strengthen preparedness for and
response to future pandemics and public-health emergencies.
IHR Review Committee
Terms of reference: Provide technical advice to the Director-General on the functioning of the IHR
Composition: Selected from the IHR Expert Roster and other WHO expert advisory panels.
The IHR Review Committee on the functioning of the IHR (2005) and on pandemic influenza A (H1N1) 2009 was established in 2010 and
submitted its final report in May 2011.
IHR Review Committee Conclusions
The IHR helped make the world better prepared to cope with public-
health emergencies. IHR core capacities are not fully operational or on track for implementation worldwide.
WHO performed well in many ways during the pandemic, confronted systemic difficulties and demonstrated some shortcomings. The
Committee found no evidence of malfeasance.
The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health
emergency.
IHR Review Committee Recommendations
Accelerate implementation of core capacities required by the IHR.
Enhance the WHO Event Information Site.
Reinforce evidence-based decisions on international travel and trade.
Ensure necessary authority and resources for all National IHR Focal Points.
Improve practices for appointment of an Emergency Committee.
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