International Health Regulations (IHR 2005) - · PDF fileDivision of Communicable Diseases...

Division of Communicable Diseases International Health Regulations Unit 1

International Health Regulations (IHR 2005)

Dr John Jabbour, Regional Adviser

International Health Regulations Officer

WHO, EMRO, Cairo


Outline of presentation

IHR (2005)- a legal framework

Purpose and contents of IHR

Assessment of public health events

National Core capacities

Partners in IHR implementation

Structure of IHR

Implementation of IHR 2005

Regional Activities

Challenges


Global threats: why are we concerned?

Epidemics not new, but….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


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)

SARS Cases 19 February to 5 July 2003

China (5326)

Singa pore (206)

Hong Kong (1755)

Viet Na m (63)

Europe:10 countries (38)

Thailan d (9)

Brazil (3)

Malaysia (5)

South Afr ica (

Canada (243)

USA (72)

Colombia (1)

Kuwait (1)

South Afr ica (1)

Korea Rep. (3)

Macao (1)

Phi lip pines (14)

Indones ia (2)

Mongo lia (9)

India (3)

Australia (5)

New Zealand (1)

Taiwan (698)

Mongo lia (9)

Russian Fed . (1)

Total: 8,439 cases, 812 deaths,30 countries i n 7-8 months

Source: www.who.int.csr/sars


Highlights of IHR (2005)

Much broader scope National IHR Focal Point & competent authorities Consultation, notification, verification & assessment Recommended measures from WHO in public health

emergencies of international concern National core capacity requirements

Division of Communicable Diseases International Health Regulations Unit

From only control at borders to containment at source

From diseases list to wide range of public health threats

From preset measures to tailored responses

New focus on national capacity

A paradigm shift


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


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


Article 5 Surveillance

Article 6 Notification

Article 7 Information-sharing during unexpected or unusual public health events

Article 8 Consultation

Article 9 Other reports

Article 10 Verification

Article 11 Provision of information by WHO

Article 12 Determination of a public health emergency of international concern

Article 13 Public health response

Article 14 Cooperation of WHO with intergovernmental organizations and international bodies

International Health regulations (2005) PART II – INFORMATION AND PUBLIC HEALTH RESPONSE


IHR partners: Article 14 Intergovernmental organizations or international bodies:

– United Nations – International Labor Organization – Food and Agriculture Organization – International Atomic Energy Agency – International Civil Aviation Organization – International Maritime Organization – International Committee of the Red Cross – International Federation of Red Cross and Red Crescent Societies – International Air Transport Association – International Shipping Federation, and – International Organization for Epizootics

Regulations do not limit the provision by WHO of advice, support or technical or other assistance for public health purposes


New Structure of IHR


IHR Secretariat HQ

IHR Regional Contact Points

CO NFP

IHR Structure


National IHR Focal Points (NFPs)

Equally 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 (Sending urgent communications to WHO, Disseminating information to and consolidating inputs from relevant governmental sectors/institutes/agencies)

Potential additional tasks as determined by State: – Risk assessment, coordinated response etc.


THE ROSTER OF EXPERTS, EMERGENCY COMMITTEE AND REVIEW COMMITTEE

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 COMMITTEE Public Health Emergencies (PHEIC)

Temporary Recommendations


What is a 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)

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

Information and Public Health Response

•Consultation • Notification • Verification

Articles 5 -14


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 SP will receive timely international support when needed


a Public health (PH) emergency response, incl development of a contingency plan

PH assessment & care for affected travellers, or animals

b c Space to

interview suspect or affected persons

d Assessment, quarantine of suspect travellers, if required.

e

Implementation of recommended measures such as disinfection f

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 capacity requirements for responding to potential PHEICs


Implementing the IHR (2005)

Strengthening national capacities – Early detection, reporting and response – Points of entry

Strengthening International capacities – Detection, verification, information – Response

Establishing the systems and procedures – Legal advice – Committees, rosters – reports


Adequate Transparency

– Timely reporting and communication – The media are not enemies – Need for a positive relationship – Give early, regular, accurate and consistent information – Get messages to the public (avoid confusion and panic) – Let the world know what you are doing

Early Accurate Regular Consistent Media

Health Workers The Public

Government


Regional Activities Development of a Regional Plan of Action to help Member States for

assessment and planning for IHR 2005 implementation

Regional adaptation of the required tools for assessment of core capacities

Publication of advocacy material for IHR 2005

Initiation of advocacy missions in number of EMR countries

Establishment of Regional IHR Task Force

Creation of a regional roster of experts

Inter-country meetings to discuss all aspects related to IHR implementation


IHR Missions Conducted at EMRO WHO assessment missions

– Afghanistan, Bahrain, Djibouti, Egypt, Iran, Kuwait, Lebanon, Morocco, Oman, Qatar, Saudi Arabia, Syria, Yemen

Advocacy missions: – Bahrain, Egypt, Iraq, Lebanon, Morocco, Oman, Pakistan, Qatar,

Sudan, Syria

Legislation: – Egypt, Oman, Pakistan

Points of Entry; – Lebanon, Oman

27


IHR Missions Conducted at EMRO Plan of action development missions:

– Egypt – Sudan

28


Missions’ Outcomes


Major and Common Recommendations

Points of entry: – Coordinate with ports’ authorities – Promote cross-border collaboration – Establish coordination mechanisms among different authorities

at each point of entry

Other hazards: – Develop SOPs for multisectoral coordinated response to events

related to food safety, zoonotic, chemical and radiation and nuclear hazards (points of entry)

30


Major Areas of Work in EMR

Coordination Coordination Coordination

Event based surveillance

Laboratory capacities: Biorisk and quality management

Training and decentralization of rapid response teams

“All Hazards” approach within the context of IHR

Risk communication strategies

Points of entry capacities

31


Challenges Empowerment of the NFP

Development of core capacities at country level including those at PoE

Maintain disease surveillance, early warning and response system:

– Difficult: Human and financial resources – Awareness of decision-makers about the importance of surveillance activities – Ensure effective involvement of the private sector, an important source of data – Adequate funding

Transparency and information sharing

Maintenance and expansion of existing partnerships and sustaining commitment of stakeholders

Sustain IHR capacities after 15 June 2012

Improvement of advocacy and awareness-raising efforts


Thank You !!

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