 Demonstrate the understanding of the roles of IHR in

preventing and controlling spread of disease globally

 Demonstrate knowledge of how IHR function (existing
focal points, policies, criteria for assessments of diseases
which threat public health globally)
 Use knowledge and skills gained to develop quality
improvement plans and strategies for preventing and
controlling spread of disease.
 Apply knowledge and skills gained to manage the
implementation of IHR
 Introduction
 Public health emergency of international concern
 IHR Obligations for Member States
 IHR National Focal Points
 The successful events of the IHR system
 Challenges facing implementation of IHR
 Our world is changing as never before
Populations grow and move…

Microbes adapt…

Public health risks increase…

Diseases travel fast…

Health security is at stake
 International passenger numbers
◦ Was expected to grow from 1.11 billion in 2011 to
1.45 billion passengers in 2016,
 The infectious diseases are now spreading faster
by emerging more quickly, than ever before.

 There are now 40 diseases that were unknown a generation ago.

 During the last five years, WHO has verified more than 1100 epidemic
events worldwide.

 Consequently the need for international co-operation in order to

safeguard global health has become increasingly important.
 Emerging/re-emerging infectious diseases
1996 to 2001
Legionnaire’s Disease

Multidrug resistant Salmonella

Cryptosporidiosis
E.coli O157
E.coli non-O157
BSE Typhoid
Malaria E.coli O157
nvCJD
Lyme Borreliosis West Nile Virus Diphtheria
West Nile Fever
Reston virus Influenza A(H5N1)
Lassa fever Echinococcosis
Yellow fever Nipah Virus
Cholera 0139 Reston Virus
Venezuelan Buruli ulcer RVF/VHF
O’nyong-nyong Dengue
Equine Encephalitis Ebola haemhorrhagic
fever
haemorrhagic fever
Dengue fever Human
haemhorrhagic Monkeypox
Cholera Cholera Equine Ross River
fever
morbillivirus virus

Hendra virus
 Epidemics cost lives … and
money
United States: E. coli O157
Malaysia: Nipah virus
Food recall / destruction
Pig destruction – US$ 540 million
Periodic
United Kingdom: BSE 1999
US$ 9 billion
India: Plague
1990–1998
US$ 2 billion
1994
Peru: Cholera UR Tanzania: Cholera
US$ 36 million Hong Kong SAR:
US$ 770 million
1998 influenza A (H5N1)
1991
Poultry destruction
US$ 22 million
1997 & 2001
 International Health Regulations (2005)

A global legal instrument for

global public health security
Came into force on 15 June 2007*

Legally binding for 194 countries and WHO that have agreed to play by the same
rules to secure international health.
 Ensure the maximum security
against the international spread of
disease with a minimum
interference with world traffic”
 The IHRs are a multilateral initiative by countries to develop an effective
global surveillance tool for cross-border transmission of diseases.

 The IHRs recognize that in today’s world, it is better to control diseases

through effective surveillance and timely response than to try to stop trade
and travel altogether

 IHR is a legal instrument (forming an international law) governing the role of

WHO and its member countries in:
◦ Identifying,
◦ Responding to, and
◦ Sharing information about Public Health Emergencies of
International Concern (PHEIC).
 Aims to prevent and control public health
emergencies of international concern.

◦ Country points of entry (POEs) have been identified as

potential areas for effective interventions to prevent the
transmission of infectious diseases across borders.

◦ The agreement postulates that member states will

strengthen core capacities detailed in the IHR (2005).
 1830, 1847: Cholera epidemics in Europe were catalyst for intense infectious
disease diplomacy and multi-lateral co-operation.
 1951: WHO issued first set of legally binding international sanitary
regulation.

 1969: WHO adopted international sanitary regulation and renamed as

international health regulation.

 1973, 1981: Minor modifications in IHR, amended world wide.

 23rd May 2005: World health assembly adopted revised IHR

 15th June 2007: Revised IHR came into force.

 PHECI- “Public health emergency of international
concern” means an extraordinary event which is
determined, as provided in the IHR regulations:

(1) To constitute a public health risk to other

States through the international spread of disease
AND
(2) To potentially require a coordinated
international response
 4 diseases always need to be reported to WHO:
 Severe acute respiratory syndrome or SARS
 Smallpox
 New influenza viruses
 Wild-type polio

 Countries assess the magnitude and potential risk involved

with an event, and WHO’s role is to make the decision.

 Director-General of WHO determines if the event is a PHEIC.

 Identify a national a “national standing task force” for IHR
(new)
 Develop core capacities for smooth implementation of
IHR (new):
◦ The core capacities include the national legislation,
policy and financing, coordination and national focal
point communication, surveillance, response,
preparedness, risk communication, human resources,
and laboratory
 The question: to what extent has the government strengthened
the core capacities?
 Notify public health emergencies (new)
 Verify unofficial reports of an emergency (new)
 Establish core capacities for points of entry (new)
 Comply with provisions for routine application
(same)
 WHO public health emergency information

Role 1:
Communicate WHO
risk/measures
information to key
national points National Focal Point

Other government agencies

Clinics Hospitals Airports Ground
crossings (public health laboratories)
 WHO Global Alert and Response

Role 2:
Gather & assess
national health event
information, inform
WHO as required National Focal Point

Other government agencies

Clinics Hospitals Airports Ground
crossings (public health laboratories)
 MOH Experts Other National Stakeholders

National Focal Point

WHO - IHR Revision Process

Developing the revised text Implementing the new IHR

in Member States
 Very successful considering the number of events notified
to WHO under the regulations.
• 1100 epidemic events reported worldwide by WHO.

 Efficiency minimizing unnecessary control measures

during the 2009 influenza pandemic.

 Rapid information exchange between two countries

directly through the National Focal Points.
 Events detected by national surveillance system or reported by media
or any non-governmental organization
KNOWN EPIDEMIC
UNUSUAL DISEASES Any event of PRONE DISEASES
Smallpox potential Cholera
Human influenza (new international Pneumonic plague
subtype) public health Viral haemorrhagic
Wild poliovirus concern fevers
Severe acute Yellow fever
respiratory syndrome West nile fever
Other locally or
regionally important
Is the public health impact of the event serious? diseases
Is the event unusual or unexpected?
Is there significant risk of international spread?
Is there significant risk of travel or trade restriction?

If yes to any two of these questions

National IHR focal point to notify WHO

 Confidential/provisional notification of
“PHEIC”
 events and risks
 Unofficial sources
 Verification support
 Response support
 Template of recommendations & measures
 Electronic publication and updates
• MOH web sites (National
institutes, public health laboratories)
• media wires news (TVs, Radios,
Newspapers etc.)
•NGO web sites
•WHO websites
• UN web sites (UNHCR, UNICEF)
• etc.
 EPIDEMIC ALERT & RESPONSE

I N T E R NAT I O NAL H EALT H R E G U LAT I O N S

Contain Respond to Improve

known risks the unexpected preparedness

G LO BAL PARTN E R S H I P
 Reports from Developing countries show that
implementation of IHR is facing a number of challenges:
◦ Low understanding and poor advocacy of the IHR (2005);

◦ lack of a clear coordination system for the implementation of the

regulations;

◦ Limited access to information on IHR (2005) among

implementers,

◦ lack of budget allocation for emergency preparedness plans.

◦ No guidelines on the outbreak response to food, chemical and

radio nuclear hazards
 The WHO through IHR aiming at ensuring security against
the international spread of disease with a minimum
interference with world traffic

 The IHR call WHO member states to develop systems

capable of detecting and responding to any public health
threat.

 However, all WHO member states need to ensure that the

human resources, technology, finance, and equipment
required for the effective IHR implementation are
adequately in place.
 World Health Organization (2008). Early warning and response to
outbreaks and other public health events: a guide. New Delhi:
WHO.
 World Health Organization. International Health Regulations
(2005): Toolkit for implementation in national legislation;
Questions and answers, legislative reference and assessment
tool and examples of national legislation. Geneva: WHO; 2009.
 World Health Organization. International Health Regulations
(1969). WHO Official Records 1969; 176: 22. (Resolution WHA
22.46).
http://whqlibdoc.who.int/publications/1983/9241580070.pdf
 United Republic of Tanzania (2010). Country report: core
capacity assessment for International Health Regulations (2005)
Implementation. Dar es Salaam, Tanzania: Ministry of Health and
Social Welfare.
 Edith Bakari and Frumence, Gasto. “Challenges to
implementation of international health regulations (2005) on
preventing infectious diseases: experience from Julius Nyerere
International Airport, Tanzania”. Global Health Action, 2013, 6:
20942
 Wamala J et al. Assessment of core capacities for the
International Health Regulations (IHR[2005]) – Uganda, 2009BMC
Public Health 2010, 10(Suppl 1):S9
Critically review one of these papers in relation to challenges facing the
implementation of IHR (2005) in developing countries and suggest the
best approach to address the challenges:

◦ Edith Bakari and Frumence Gasto. “Challenges to

implementation of international health regulations (2005)
on preventing infectious diseases: experience from Julius
Nyerere International Airport, Tanzania”. Global Health
Action, 2013, 6: 20942

◦ Wamala J et al. Assessment of core capacities for the

International Health Regulations (IHR[2005]) – Uganda,
2009BMC Public Health 2010, 10(Suppl 1):S9