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International Health Regulations - IHR (2005)

Central Asia Regional Health Security Workshop George C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany. International Health Regulations - IHR (2005). Dr Hashim Elzein Elmousaad Public Health Specialist 19 April 2012. Contents.

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International Health Regulations - IHR (2005)

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  1. Central Asia Regional Health Security WorkshopGeorge C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany • International Health Regulations - IHR (2005) Dr Hashim Elzein Elmousaad Public Health Specialist 19 April 2012

  2. Contents • Introduction: What is IHR? Purpose and scope • Historical Background • Public Health emergency of international concern (PHEIC) and reporting • Infectious Diseases of Concern & events • IHR Implementation and approaches • IHR Challenges • Core Capacity Requirements • Partners • Implementation Progress

  3. What is IHR? The International Health Regulations (2005) IHR - are an international agreement that is legally binding on 194 countries (States Parties), including all WHO Member States. Entry into force on 15 June 2007

  4. Health Security Response: International Health Regulation The purpose and scope of these Regulations are to prevent, protect, and provide a public health response to the international threat and spread of diseases. Also, avoid unnecessary disruption of international travel and trade Maintain the sovereignty of states and cause minimal disruption to international flow of people and goods Contain the international spread of diseases

  5. Efforts to control Infectious Diseases • 1838 – Superior Council of Health of Constantinople is established to supervise the sanitary regulation of the Turkish port in order to prevent the spread of cholera from Asia to Europe. • 1851 – The first International Sanitary Conference held in Paris to draft uniform quarantine measures for all Mediterranean ports. • 1902 – The International Sanitary Bureau of the Americas, the precursor of PAHO was formed • 1907 – The Office International D'HygiènePublique is established to administer the international sanitary conventions and provide epidemiological intelligence • 1923 – The Health Organization of the League of Nations is formed. • 1948 – The World Health Organization (WHO) is founded. • 1951 – The World Health Assembly (WHA) adopts the International Sanitary Regulations. • 1969 – The WHA adopts the International Health Regulations. • 1981 – The IHR are amended to include only 3 diseases. • 2005 – The WHA adopts the IHR (2005). • 2007 – The IHR (2005) enter into force.

  6. IHR(2005) - Fromcontrol of borders to containment at source - Fromdiseases list toall threats - Frompreset measures toadapted and real time response 6

  7. Public Health emergency of international concern (PHEIC) PHEIC is an extraordinary event which is determined, as provided in these Regulations: • to constitute a public health risk to other States through the international spread of disease and • to potentially require a coordinated international response. • IHR require procedural steps by the DG/WHO in determining that a PHEIC exists

  8. Notify, report, consult and inform WHO • Notification – States Parties are required to notify WHO of all events that are assessed as possibly constituting a PHEIC • Within 24 hours of assessment (decision instrument provided in Annex 2 of the Regulations). • Four criteria that States Parties must follow in their assessment of events within their territories and their decision as to whether an event is notifiable to WHO: • 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 restriction(s) to travel and trade?

  9. Notify, report, consult and inform WHO Notify • Consultation - In cases where the SP is unable to complete a definitive assessment with the decision instrument in Annex 2, (confidential consultations with WHO) • Other Reports - State Parties must inform WHO on receipt of evidence of a public health risk identified outside their territory that may cause international disease spread. Consult

  10. 4 diseases that shall be notified polio (wild-type polio virus), smallpox, human influenza new subtype, SARS. Disease that shall always lead to utilization of the algorithm: cholera, pneumonic plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, others…. Q1: public health impact serious? Q2: unusual or unexpected? Q3: risk of international spread? Q4: risk of travel/trade restriction? Insufficient information: reassess Decision instrument (Annex 2) of IHR (2005)for Assessment and Notification

  11. 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

  12. Core Capacity Requirements • 8 Core capacities • Legislation and Policy • Coordination • Surveillance • Response • Preparedness • Risk Communications • Human Resources • Laboratory • 3 levels • National • Intermediate • Peripheral/Community • Potential Hazards • Infectious • Zoonosis • Food safety • Chemical • Radio nuclear • Events at Points of Entry

  13. Infectious Diseases of Concern in Central Asia • In 2010, the first WPV importation into the European Region resulted in 476 confirmed cases: 458 in Tajikistan, 14 in Russia, three in Turkmenistan, and one in Kazakhstan. • Foot Mouth Disease: Kazakhstan May – August 2011(More than 2,7 thousand cattle had to be destroyed) • Multidrug-resistant (MDR) TB (serious problem) • Hepatitis A & E • Typhoid

  14. Public health risks and emergencies1 October 2010 - 9 February 2011 • 137 events were recorded in the Event Management System and tracked • European Region: chemical events, food safety-related events, earthquake, dengue fever, West Nile fever, poliomyelitis, measles, malaria, acute hepatitis, cryptosporidiosis and influenza

  15. Globalization of food • Rapid globalization of food production and trade has increased. • From 1970 – 2000: • Over 100 outbreaks associated with ships 1/3rd were related to food borne transmission (WHO review). • Rapid exchange of food safety information at both national and international level.

  16. Chemical incident “types” • Technological • Complex • Deliberate • Natural • Others An estimated 8.3% of all deaths and 5.7% of all disease burden were attributable to exposure to selected chemicals in 2004. Source: Knowns and unkowns on burden of disease due to chemicals, Prüss-Uestun et al., Environmental Health, 2011 Accident, Bhopal, India Sarin attack, Tokyo As, Bangladesh

  17. Radio-nuclear Events

  18. Responsibility Of IHR Implementation Jointly with States Parties and WHO • States Parties capacity: • Well established national surveillance and response infrastructure. • Collaborate actively with each other, together & with WHO, • Mobilize the financial resources • Facilitate the implementation of their obligations under the IHR. • WHO: • (Upon request) WHO assists developing countries in mobilizing financial resources and provides technical support to build, strengthen and maintain the capacities set out in Annex 1 of the Regulations.

  19. New implementation approach • National Focal Points, WHO Contact Points in ROs, IHR in HQ, • Annual reporting to WHA, • Capacity building, • Event information system, Site: Efficient mechanism for information sharing, 182 countries accessed EIS • Major global events, • Coordination with other sister organization such as FAO, OIE and regional focal points in food and chemical safety, radiation and nuclear fields. • Event based surveillance, national guidelines and SoPs for multisectoral coordinated response • Hazard analysis activities based on “All Hazards” approach • Biorisk management plans • Risk communication • Points of entry

  20. IHR Challenges • IHR 2005 is not for ministries of health only • Empowerment of the NFP • Development of core capacities at country level • Maintain disease surveillance, early warning and response system: • Human resources • Ensure effective involvement of the private sector • Adequate funding • The importance of transparency • Maintenance and expansion of existing partnerships and sustaining commitment of stakeholders • Advocacy and awareness-raising

  21. What Member States need to do? • Monitor and report on IHR implementation progress • Notify, report, consult and inform WHO • Understand WHO’s role in international event detection, joint assessment and response • Participate in the PHEIC determination and WHO recommendations - making processes • Strengthen national surveillance and response capacities • Increase public health security at ports airports and ground crossings • Use and disseminate IHR health documents at points of entry

  22. Timeline 2 years + 3 + (2) + (up to 2) 2007 2009 2012 2014 2016 Planning Implementation STRENGTHENING NATIONAL CAPACITY "As soon as possible but no later than five years from entry into force …" (Articles 5, 13)

  23. IHR partners: Article 14 • Intergovernmental organizations or international bodies: • United Nations (e.g. FAO, IAEA, ICAO, IMO, UNWTO) • International Labor Organization (ILO) • Development agencies: governments, banks • WHO Collaborating centres • Academics & professional associations • Industry associations (e.g. IATA, ISF) • NGOs and Foundations • International Committee of the Red Cross (ICRC) • International Federation of Red Cross and Red Crescent Societies (IFRCS) • International Organization for Epizootics governments, banks • Regulations do not limit the provision by WHO of advice, support or technical or other assistance for public health purposes

  24. Monitoring Progress: Current situation (Article 54) • In resolution WHA61.2, States Parties and the DG would report annually to the WHA • Self-assessment questionnaire Mid-February 2010 • 126 responses, representing 65% of the 194 States Parties • Tracking implementation on Eight types of core capacity and five relevant hazard types • Four-point scale: Level <1(foundational); Level 1 (inputs and processes in place); Level 2 (outputs and some outcome demonstrated); and Level 3 (capacities beyond the State’s borders)

  25. Main Results of Monitoring the IHR Implementation 1 • Eight core capacities: (132 SP) • 58% have developed national plans • 30% have Good progress in national legislation • About 50% the reporting States at the foundational level (Level <1) for two types of core capacity preparedness and human resources; • 90% of reporting SP are using the decision instrument in Annex 2 of the Regulations to notify WHO. • 50% of reporting SP have developed national public health emergency response plans for discharging their obligations under IHR with regard to hazards and points of entry.

  26. Results of Monitoring Implementation 2 Progress on hazard types: • More attributes being achieved for zoonotic and food safety-related events, and fewer being achieved for chemical and radio-nuclear events • For chemical and radio-nuclear events, nearly 50% of reporting SP are still in the foundational level (Level <1) in terms of overall capacity. Progress on points of entry: • 62% of reporting SP have reached Level 1 • 28% of reporting SP achieved Level 2, with 41% at Level 1. • Response capacities are weaker; 46% of the reporting SP at Level <1.

  27. Conclusions of the Monitoring Report • SPs have made progress in implementing the IHR (2005) with the support of the WHO regional offices {response to pandemic (H1N1) 2009} • Governments’ awareness raised regarding the importance and uniqueness of IHR. • The implementation of the IHR in countries continues to present serious challenges, a number of countries may not meet the core capacity requirements for surveillance and response described in Annex 1A of the Regulations by the deadline of 15 June 2012.

  28. Questions?

  29. Dr Hashim A. Elzein Elmousaad Public Health Specialist Cairo – Egypt elmousaadh@gmail.com Tel: 00201120400733

  30. References • INTERNATIONAL HEALTH REGULATIONS (2005) -SECOND EDITION - World Health Organization 2008. • http://www.who.int/archives/fonds_collections/bytitle/fonds_1/en/index.htm • WHO/CDS/EPR/IHR/2007.1, “International Health Regulations (2005): areas of work for implementation” at http://www.who.int/ihr/area_of_work/en/index.html • http://www.who.int/water_sanitation_health/diseases/shipsancompendium/en/index.html • Implementation of the International Health Regulations (2005) - Report by the Director-General 64th WHA. A64/9; 17 March 2011. • Implementation framework at http://www.who.int/ihr/checklist/en/index.html • http://www.who.int/csr/don/archive/year/2010/en/

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