International Health Regulations (IHR)- the international law on communicable diseases: International Health Regulations (IHR) - the international law on communicable diseases Preben Aavitsland


IHR is not only about rat control: IHR is not only about rat control


”Acute watery diarrhoeal syndrome”: ”Acute watery diarrhoeal syndrome”


SARS cases by week of onset, 2003: SARS cases by week of onset, 2003 Unofficial reports from Guangdong WHO global warning12. March First reports to WHO, 11 February Hotel Metropol 21 February


Situation in 2003: Situation in 2003 No well-functioning international surveillance system New diseases not covered in IHR 1969 Sars was hidden by countries, no incentive to report No rules to guide international measures Countries applied different measures Trade measures disguised as publichealth measures? Anarchy!  A law is needed  a new IHR


History of international communicable disease law: History of international communicable disease law Cholera epidemics in Europe 1830-1847 International Sanitary Conference, Paris 1851 International Sanitary Convention, Paris 1926 International Sanitary Regulations, 1951 International Health Regulations 1969 (1973, 1981) Cholera, plague, yellow fever, smallpox, relapsing fever, typhus


The IHR revision process: The IHR revision process 1995, May (WHA 48): Decision to revise IHR 1995-2003: Worskhops, consultations etc. 2004, January: First draft for consultation 2004, March-June: Regional consultations 2004, November: Intergovernmental Working Group I 2005, February and May: Intergovernmental Working Group II 2005, 23 May (WHA 58): Adoption of the IHR 2007, June: Entry into force 2008, May: First evaluation


IHR – an international treaty: IHR – an international treaty


The Intergovernmental Working Groups: The Intergovernmental Working Groups IGWG I – November 2004 – Palais de Nations, Geneva IGWG II – February and May 2005 – WHO HQ, Geneva All countries represented. Regional and plenary meetings. Political. Few public health experts present Every article (every word!) negotiated separately Consensus needed – every country had veto powers. Difficult! Strange results some places (e.g. § 7) Last article (§ 43) agreed on 14 May 03:06 IGWG agrees on 14 May 04:20 World Health Assembly adopts IHR 23 may 2005


National laws on communicable diseases: National laws on communicable diseases Stop the national spread of the disease Protect the rights of the individuals with disease and cause minimal harm


International lawon communicable diseases: International law on communicable diseases Stop the international spread of the disease Protect the sovereignty of states and cause minimal harm (restrictions)


Purpose and scope of IHR (§ 2): Purpose and scope of IHR (§ 2) 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.


The International Health Regulations: The International Health Regulations International surveillance system International rules on response to international threats International rules on routine measures against international disease spread Procedural rules (WHO and states)


Contents of the IHR: Contents of the IHR Part I Definitions and purpose Part II Surveillance and response Part III WHO recommendations concerning specific threats Part IV – VIII Routine measures Part IX Procedures Part X Reservations, disputes, etc


Contents of the IHR: Contents of the IHR Part I Definitions and purpose Part II Surveillance and response Part III WHO recommendations concerning specific threats Part IV – VIII Routine measures Part IX Procedures Part X Reservations, disputes, etc


The IHR surveillance system: The IHR surveillance system National IHR Focal Point WHO Local level Mass media, NGOs etc. assess national events do surveillance notify, inform, consult in confidence verify do surveillance


Non-governmental sources: Non-governmental sources NGOs


The Kon-fu-tse principle of surveillance: The Kon-fu-tse principle of surveillance ”Notify to WHO the events that you would like to know about if they occured in your neighbour country.”


Decision instrument(annex 2) to determine a potential public health ermergency of international concern (pheic): Decision instrument (annex 2) to determine a potential public health ermergency of international concern (pheic)


Slide20: Two or more yes  notify WHO. Events detected by national epidemic intelligence


Question 1: Question 1 Is the public health impact of the event serious? Large number of cases/deaths for this type of event for the given place, time or population? Potential to have a high public health impact? External assistance needed?


Question 2 and 3: Question 2 and 3 Is the even unusual or unexpected? Is there a significant risk of international spread? Evidence of epi link to similar events in other states? Any factor to alert us of potential for cross border movement of the agent vehicle or host?


Question 4 : Question 4 Is there a significant risk of international trade of travel restrictions? International restrictions in the past with similar events? Source food or other product that has been exported or imported? Event in intrnational gathering or area of intense tourism? Requests for information from foreign officials or international media?


Notification = the start of a dialogue(i.e. ”not a big deal”): Notification = the start of a dialogue (i.e. ”not a big deal”) Potential pheic Declared pheic Dialogue


Key attributes of IHR surveillance: Key attributes of IHR surveillance


WHO recommendationsregarding a pheic: WHO recommendations regarding a pheic National IHR Focal Point WHO Local level Emergency committee implement consult National IHR Focal Point inform and recommend


Basis for WHO recommendations: Basis for WHO recommendations Views of the states concerned Advice of the Emergency committee Science Adjusted to risk assessment  no more restrictions than necessary


Examples of recommendations: Examples of recommendations Reviw travel history Mandatory vaccination of travellers Mandatory medical examination Quarantine Refusal of entry to affected areas Exit screening from affected area Destruction of cargo


National core capacities (annex 1): National core capacities (annex 1) Event detection Local, regional, national level Event assessment and notification National level Public health response to events 24/7 Support, including on-site assistance Communication links Public health emergency plan


Potential barriers to effective IHR: Potential barriers to effective IHR


Why should Epiet fellows care?: Why should Epiet fellows care? Evaluate / improve national surveillance and response capacity (annex 1) In training site country or home country In other country as part of a mission Apply IHR in National IHR Focal Point Notify or inform WHO and respond to requests Provide on-site assistance Be a member of a WHO response team


Literature: Literature IHR resolution and text http://www.who.int/csr/ihr/en/ Baker MG, Fidler DP. Global public health surveillance under new International Health Regulations. Emerg Infect Dis 2006; 12: 1058-65. Nicoll A, Jones J, Aavitsland P, Giesecke J. Proposed new International Health Regulations. BMJ 2005; 330: 321-2.