IHR Revision Process and health diplomacy: The Brazilian Experience DANIEL LINS MENUCCI Health Surveillance Secretariat

1. PAHO / WHO  World Health Day The Role of Health Diplomacy: Building a Safer Future IHR Revision Process and health diplomacy: The Brazilian Experience DANIEL LINS MENUCCI Health Surveillance Secretariat Health Ministry of Brazil

2. Health Policy and Foreign Affairs in BrazilHISTORICAL BACKGROUND The first public health measures in Brazil were also related to TRADE : to protect the country against international dissemination of disease at ports, following the same direction of international practice of quarantine measures in Europe: • 1809 -was created the first health bureau, one year after opening Brazil’s ports for commerce with friendly nations - imported diseases like cholera and plague. Historical participation of Brazil in Regional Agreements and Europeans health forums: • 1887, Sanitary Convention between Brazil, Argentina and Uruguay (sanitary measures for cholera, plaque and y. fever) • 1902, First Americas Sanitary Conference • 1903, International Sanitary Conference and the subsequent Rome Agreement • 1924, Pan American Sanitary Code • 1946, WHO Constitution I International Sanitary Conference • 1951, 1969, 1973, 1981, 2005 - International Health Regulations

3. Health Policy and Foreign Affairs Globalization process in the XX Century Investments in Healthas fundamental for economic growth and development X Threats to health may compromise a country’s stability and security X Health measures may compromise trade

4. Health Policy and Foreign Affairs Globalization process in the XX Century International agreements and its impact on national laws Increase of global communication and transportation Health impact of international traffic and trade Sharing global solutions and international responsibilities The role of intergovernmental organizations: PAHO/WHO International actions: life and health as fundamental rights

5. Different Global scenarios of health epidemics situation and foreign affairs (trade, security, etc.). Two different approaches for the IHR revision process. The Brazilian Participation at IHR (2005) Revision Process

6. First phase – Surveillance of Syndromes Resolution WHA48.7,1995-1999 emerging and re-emerging infectious diseases, exemplified by outbreaks of pest (India 1984), cholera (South America, 1990 and 1995) and Ebola (Africa, 1994) and its impact on international trade and global health. The need to work with a global notification and response system, able to deal with infectious diseases and not restricted only to the existing 3 diseases list. The Brazilian Participation at IHR (2005) Revision Process

7. First phase – 1999-2000 Surveillance of Syndromes Restricted participation of Member States MOH Legal Expert as focal point for IHR Infectious diseases & health measures at points of entry major concern MOH of Brazil participation on IHR syndromes surveillance proposal validation process MERCOSUR Health WG first meetings Restricted to technical and legal MOH meetings and no interference of Brazilian Foreign Affairs Ministry The Brazilian Participation at IHR (2005) Revision Process

8. second phase – 2000- 2005 Public Health Events of International Concern (irrespective its origin or source) 10 January 2000, WHO circulate a document with political guidance, in which no more is mentioned any list of diseases or surveillance for signs and symptoms, instead, appears a notification proposal for events ofurgent international public health importance. New global public health risks and treats to security: Sept.11th, Anthrax, Chemicals weapons, SARS, etc. Pandemics, global security matters, trade and health impact and the need of a different IHR approach beyond infectious diseases. The Brazilian Participation at IHR (2005) Revision Process

9. Second phase – 2000- 2005 Public Health Events of International Concern Increased participation of Member States Pub. Health Events irrespective its origin or source Special IHR Commission at MERCOSUR Health Minister Meetings Brazil and MERCOSUR Member States participation on several IHR informal consultations and Intergovernmental WG National inter-ministries meetings coordinated by Brazilian Foreign Affairs Ministry Concerns about animal and plants, sovereignty, national security, health and human rights and respect to other international agreements The Brazilian Participation at IHR (2005) Revision Process

10. WHA 58TH – IHR (2005) DRAFT ON THE FLOOR Americas and Intergovernmental WG meetings MERCOSUR sub-regional health advocacy approach for IHR(2005): negotiating a consensus integrated with foreign affairs Brazil- Rio de Janeiro Sub Regional meeting: new actors on the floor (foreign affairs, agriculture, etc) Canada regional meeting: living with differences and getting to know sub-regional approaches Geneva Intergovernmental Working Group meetings: South Americas contributions (Montevideo and Buenos Aires documents) The Brazilian Participation at IHR (2005) Revision Process

11. LESSONS LEARNED When countries shares common health policies and confidence building, it makes international negotiation and cooperation easier (B.Aires and Montevideo documents). Regional agreements plays an important role on developing, strengthening and maintain national health systems and supporting harmonized health actions of preparedness and response. Health International agreements which considers both national health policy and foreign affairs policy during negotiation process has better chance during negotiation and in its implementation. The Brazilian Participation at IHR (2005) Revision Process

12. LESSONS LEARNED (cont.) Developing national health policy should take into consideration global health, like pandemics treats. The IHR(2005) represents a great effort to strength global health and its implementation relies in the international cooperation in health and other foreign affairs actors. Intergovernmental organizations, like PAHO/WHO, plays an important role, regarding harmonization of rules and procedures, support countries to develop, strengthen and maintain core capacities and sharing information. The Brazilian Participation at IHR (2005) Revision Process

13. Principles Instruments Challenges GLOBAL HEALTH AND DIPLOMACYChallenges Protect health Save lives Improve Live quality Live and health as fundamental rights To deal with differences, share responsibilities and solutions to build a healthier and safer future Health policy Health diplomacy

14. “how to make ‘impact on health’ a point of departure and a defining lens that each of our countries will use to examine key elements of foreign policy and development strategies, and to engage in a dialogue on how to deal with policy options from this perspective” [1]. [1]“OSLO MINISTERIAL DECLARATION – Global health – a pressing foreign policy issue of our time”. Statement issued in Oslo on 20 March 2007, by Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand, under their initiative on Global Health and Foreign Policy, launched in September 2006. ‘impact on health’ POINT OF DEPARTURE FOR HEALTH DIPLOMACY

15. THANK YOU! GRACIAS! MERCI! Obrigado ! daniel.menucci@saude.gov.br

16. www.saude.gov.br/svs