International health regulaiton (IHR-2005) Afghanistan Dr. Islam Saeed

Afghanistan National Public Health Institute

Disease Early Warning System

Overview of International Health Regulations

(IHR-2005)

Dr. Islam Saeed, Director Surveillance, ANPHI-MoPH

MD, MSc-HPM, MSc-FELTP

Islamic Republic of Afghanistan

Ministry of Public Health

Afghanistan National Public Health Institute ( ANPHI )

Surveillance / DEWS Directorate


Disease Early Warning System2

Outline• Need for ensuring global health• IHR (2005)- a legal framework• Assessment of public health events • National Core capacities• Implementation of IHR 2005• Situation in Afghanistan• Achievements and Challenges• Conclusion



What is concern?

• Epidemics took days, weeks/months to reach far territories

• Emergence/re-emergence of infectious diseases and increased pace of spread

• Threat of deliberate use of biological and chemical agents

• Events of international concern of unknown causes or sources

• Impact on health, economy, security



What are IHR (2005)? A legal framework

• International legal instrument which is legally binding on all WHO States Parties to protect global health

• The international commitment for shared responsibilities and collective defence against disease spread

Rights, Obligations

and procedures

entered into force

on 15 June 2007



The 58th World Health Assembly adopts the revised International Health Regulations, “IHR”

Legally binding for WHO and the world’s countries that have agreed

to play by the same rules to secure international health.

Ensuring maximum public health security while minimizing

interference with international transport and trade



International Health regulations (2005)10 Parts, 66 Articles, 9 Annexes

• PART I DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND RESPONSIBLE AUTHORITIES

• PART II INFORMATION AND PUBLIC HEALTH RESPONSE

• PART III RECOMMENDATIONS

• PART IV POINTS OF ENTRY

• PART V PUBLIC HEALTH MEASURES

• Chapter I General provisions

• Chapter II Special provisions fro conveyances and conveyance operators

• Chapter III Special provisions for travellers

• Chapter IV Special provisions for goods, containers and container loading areas

• PART VI HEALTH DOCUMENTS

• PART VII CHARGES

• PART VIII GENERAL PROVISION

• PART IX THE ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE REVIEW COMMITTEE

• Chapter I The IHR Roster of Experts

• Chapter II The Emergency Committee

• Chapter III The Review Committee

• PART X FINAL PROVISIONS



What’s new?

• From three diseases to all public health threats

• From preset measures to adapted response

• From control of borders to, also, containment at source

• New focus on national capacity



Purpose of IHR (2005)

“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 and trade” – (Article 2)



1. Strengthen national disease surveillance, prevention,

control and response systems

2. Strengthen public health security in travel and transport

• Timeline

2007 2009 2012 2014 2016

Planning Implementation

2 years +……………….. 3 + ……..(2)…….…..……+ (up to 2)

Strengthen national capacity



Core Capacity Technical Areas

• 8 Core capacities – Legislation and Policy

– Coordination

– Surveillance

– Response

– Preparedness

– Risk Communications

– Human Resources

– Laboratory

• Potential Hazards– Infectious

– Zoonosis

– Food safety

– Chemical

– Radio nuclear

• 3 levels – National

– Intermediate

– Peripheral/Community

• Events at Points of Entry– Ports

– Air ports

– Ground crossing



IHR Secretariat HQ

IHR Regional

Contact Points

CO NFPs

IHR Structure

NFPs



National IHR Focal Points (NFPs)

• Important role in implementation of IHR

• The national centre for communications with WHO:

– On a 24/7 basis (by telephone, fax, email)

– NOT an individual person

• Legally required functions

• Potential additional tasks as determined by State:

– Risk assessment, coordinated response etc.



WHO and IHR• Designate WHO IHR contact points

• Support States Parties in assessing their public health risks, through the notification, consultation, and verification processes

• Inform State Parties of relevant international public health risks

• Recommend adapted public health measures

• Assist States Parties in their efforts to investigate outbreaks and meet the IHR national requirements for surveillance and response



Roster of experts

IHR Roster of Experts (Article 47)Emergency Committee – provides views on PHEIC, temporary recommendation (Articles 48, 49)Review Committee - reporting, review, standing recommendations, amendment and disputes (Articles 50-53)

IHR ROSTER OF EXPERTS

REVIEW COMMITTEE

Standing Recommendations

Amendments

EMERGENCY COMMITTEEPublic Health Emergencies (PHEIC)

Temporary Recommendations



Public Health Emergency of International Concern (PHEIC)

• PHEIC is an extraordinary event which is determined, as provided in these Regulations:

i. to constitute a public health risk to other States through the international spread of disease and

ii. to potentially require a coordinated international response.

• IHR require procedural steps by the DG/WHO in determining that a PHEIC exists



Event notification• Any event that may constitute a public health

emergency of international concern (PHEIC)

• NFP of the government should notify to WHO within 24 hours of national assessment

• Continue to provide WHO with detailed public health information including: case definition, cases/deaths, conditions affecting spread, measures

• Does NOT mean an actual “PHEIC” is necessarily occurring



Verification of events• Value of unofficial sources of information for early

alert (to be assessed and verification requested)

• WHO mandated to seek verification (from State Party in which event arising) of events which may be emergencies of international concern

• States Parties must give initial reply within 24 hours and provide of information

• Offer On-site assessment, when necessary



Early consultation• For events not requiring notification, Member

States may:

• keep WHO advised, consult on appropriate measures, and request WHO technical assistance to assess the situation

• Need to continue monitoring/assessing the event to see if notification becomes necessary



Annex 2: Decision instrument for the assessment and notification of events that may constitute a PHEIC

An event of potential international

public health concern including those of

unknown causes or sources

*Q1: is the public health impact of the

event serious?

Q2: unusual or unexpected?

Q3: risk of international spread?

Q4: risk of travel or traffic restrictions?

Insufficient information : re-evaluate



Decision Instrument (1)

• Four diseases (a single case is notifiable):

– Smallpox, Poliomyelitis, human influenza (caused by a new subtype), SARS

• Utilization of the decision instrument:

– Cholera, plague, viral haemorrhagic fevers, yellow fever, …

– Diseases of regional concern: dengue fever, meningococcal diseases…



Decision Instrument (2)

• 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?

Answering "yes" to any two of the criteria requires a member state to notify WHO

Criteria for assessment



Combinations of answers requiring notification

• Serious and unexpected

• Serious and risk for international spread

• Serious and risk for international restrictions

• Unexpected and risk for international spread

• Unexpected and risk for international restrictions



aPublic health (PH)

emergency

response,

including

development of a

contingency plan

PH assessment

& care for

affected

travellers, or

animals

b

cSpace to

interview

suspect or

affected

persons

d

Assessment,

quarantine of

suspect

travellers, if

required.

e

Implementation

of recommended

measures such

as disinfectionf

Entry/exit control

for departing &

arriving passengers

g Access to required

equipment and

trained personnel

Source: WHO/HQ IHR team (modified)

Designated Ports of Entry: Core capacityrequirements for responding to potential PHEICs



Implications of non-compliance to IHR

• WHO will know from other sources• Position of the State Party will change from

article 6 (notification) to article 10 (verification)–WHO will request verification–WHO will embark on investigation based on

risk assessment• IHR allow WHO to use whatever available

information to alert other partners• Compliant State Party will receive timely

international support when needed



IHR Capacity analysis Afghanistan-2010

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26




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Major Achievements

• IHR National Focal points• Assessments and plan• Training and capacity buildings• IHR 2005 translation and distribution• Surveillance and response• Laboratory support• Collaboration with international community• Reporting to WHO• Asking for extension• Still a long way to go

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Challenges• Empowerment of the NFP

• Maintain disease surveillance, early warning and response system

• Transparency and information sharing

• Maintenance and expansion of existing partnerships

• Resource mobilization

• Strengthen capacity at airports, and ground

crossings

• Improvement of advocacy and awareness-raising efforts



• IHR implementation is the responsibility of all sectors of the government of Afghanistan

• Coordination is must• Capacities should be established• Proper implementation ensure saving lives and

resources • Good international image• Capacity building and human resources• National and Global Health Security• Collaboration across countries

Conclusion



ThanksEmail: [email protected]

Mobile: 0093(0)700290955

mailto:[email protected]

International health regulaiton (IHR-2005) Afghanistan Dr. Islam Saeed

Healthcare

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