Workshop: The State of National Governance Relative to the International Health Regulations (2005)
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Workshop: The State of National Governance Relative to the International Health Regulations (2005) Ottawa, Canada, 20-21 September 2006 Overview: United States of America Anthony A. Marfin Centers for Disease Control and Prevention. Goal.

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Workshop: The State of National Governance Relative to the International Health Regulations (2005)

Ottawa, Canada, 20-21 September 2006

Overview: United States of America

Anthony A. Marfin

Centers for Disease Control and Prevention


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Goal International Health Regulations (2005)

Describe the extent to which United States has a system of governance that will enable effective implementation of the revised International Health Regulations 2005


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Background: Political Structure International Health Regulations (2005)

  • Federal system of government

  • States independent sovereign governments

  • States retain powers not expressly delegated to Federal government

  • Full presidential system


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Who does public health? International Health Regulations (2005)

  • Concurrent jurisdiction

  • U.S. Constitution division of jurisdiction:

  • “[P]owers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States, respectively, or to the people.”

  • Federal government given power “to regulate commerce with foreign nations, among the several States (interstate)” Movement of disease affects commerce


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Who does public health? International Health Regulations (2005)

  • Responsibility for public health is shared but most functions are decentralized

    • Within a single state: All aspects of surveillance, reporting, & public health clearly belong to state/local HDs

    • International and interstate events: Jurisdiction of federal government

  • Federal public health entities DONOT have direct authority over state/local public health entities


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National Core Capacities International Health Regulations (2005)Where public health activities are performed

Activity National State Local

Case detection/notification No Yes Yes

Collection of case data No Yes Yes

Analysis & interpretation Yes Yes Yes

Investigation of cases & confirmation of diagnosis:

  • Epidemiologist * Yes Yes

  • Clinician No * Yes

  • Laboratory * * Yes

    Dissemination Yes Yes Yes

    Response/Intervention * Yes Yes

* Upon request


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Notifiable Diseases International Health Regulations (2005)

  • “Notifiable diseases” vary between counties & states

  • Federal government, only 9 quarantinable diseases

  • Harmonization through consensus with professional organizations of state/local public health officers

  • Example (CSTE): “…by supporting the use of effective public health surveillance and good epidemiologic practice through training, capacity development, and peer consultation, developing standards for practice …”


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IHR negotiation & approval International Health Regulations (2005)

USG will implement IHRs in a manner consistent with our fundamental principles of federalism

IHRs will be implemented by the Federal Government to the extent that the implementation of the Regulations comes under the legal jurisdiction of the Federal Government

To the extent that IHR obligations come under the legal jurisdiction of the state/local governments, the USG will bring these obligations with a favorable recommendation to the notice of the appropriate state authorities


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Development of surveillance systems International Health Regulations (2005)

  • Work with professional groups representing state and local health officers and epidemiologists to adopt the IHR 2005 requirements as a standard

  • As necessary, provide financial and technical support to states to adopt a new standard


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Surveillance: Detection, notification, verification & reporting

  • Performed by state/local government; technical / lab assistance from federal government (upon request)

  • Federal government has constitutional authority to ensure that these processes meet IHR 2005 requirements in interstate or international settings

    • No authority over events that occur within a state (without an interstate or commerce connection)

    • Mechanisms to ensure that these processes meet IHR 2005 requirements are being discussed

  • Currently, USG works with professional groups representing state/local government to adopt requirements as their standard


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Surveillance: Detection, notification, verification & reporting

  • Communication:

    • CDC’s Epi-X – Rapid, firewall-protected privileged information sharing system between federal, state, and local health officials

    • Health Alert Networks

    • CDC forward-deployed field stations (Quarantine Stations)


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Jurisdictional authority for PHEICs reporting

  • Federal government will express authority over PHEICs within specific jurisdictions (i.e., international and interstate events)

  • Otherwise, U.S. state/local governments will have such authority (intrastate events involving non-Federal assets or resources)

  • Regarding PHEICs in intrastate settings, USG will take appropriate measures to facilitate the implementation of IHRs at the local level


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Potential Obstacles reporting

  • Potential obstacles to communication/collaboration

    • Dual reporting system

    • Variation in technologic capacity amongst states/counties

    • Need for rapid movement of information

    • Establishing and using a National IHR Focal Point for all international communications


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Overcoming these obstacles reporting

  • How to overcome these obstacles

    • Standardize data collection based on scientific principles

    • Simplify data transfer (“NECESSARY not desirable”)

    • Web-based data systems (“workspaces”) that are jointly accessible and maintained by 3 levels of government

    • XML file transfers between data systems

    • Dedicated communication system for public health practitioners

    • Communication protocols between 3 levels of government

    • Communication protocols within federal government for sending/receiving international communications

  • Methods to overcome obstacles will require:

    • Agreements regarding data sharing

    • Development and access to secured electronic communication systems


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Summary & conclusions reporting

  • Obstacles to implementation include:

    • Decentralized public health delivery system

    • Implementing in a manner consistent with fundamental U.S. principles of federalism.

    • Full implementation relies cooperation from state and local governments

    • Rapid communication between 3 levels of government

    • Technical support for state/local HDs

  • No expectations of outside agencies for any assistance with implementation


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