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A new international framework, an opportunity for strengthening health systems. WHO / World Bank videoconference 19 September 2008. Guénaël Rodier, WHO, Geneva. HIV/AIDS CHERNOBYL PLAGUE EBOLA / MARBURG NvCJD NIPAH YELLOW FEVER. ANTHRAX SARS

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Gu na l rodier who geneva

A new international framework, an opportunity for strengthening health systems

WHO / World Bank videoconference 19 September 2008

Guénaël Rodier, WHO, Geneva


30 years of international public health threats

HIV/AIDS

CHERNOBYL

PLAGUE

EBOLA / MARBURG

NvCJD

NIPAH

YELLOW FEVER

...

ANTHRAX

SARS

MENINGITIS

CHOLERA

CHEMICAL

AVIAN INFLUENZA

XDR-TB

...

30 years of international public health threats


Gu na l rodier who geneva

May 1995, WHA Resolution on the Revision of the IHR

Overall drive and rationale

  • Economic impact (HIV/AIDS, meningitis, BSE/NvCJ, SARS, Avian influenza, BT …)

  • Global concern(international spread)

  • World unprepared:IHR(1969) obsolete

    • limited list of diseases (cholera, plague, yellow fever – revised 1983)

    • focus on borders (ports, airports)

    • pre-set rather than tailored measures

    • do not address international coordination


Gu na l rodier who geneva

“ 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)

International Health Regulations

1969, 2005: IHR purpose remains the same


Gu na l rodier who geneva

IHR (2005): public health response to the Three Paradigm Shifts

  • From control of borders to [also] containment at source

  • From diseases list toall public health threats

  • From preset measures toadapted responses

Entered into force on 15 June 2007


Gu na l rodier who geneva

Four Technical areas public health response to the

A legal and monitoring framework

Awareness

Seven strategic actions to guide IHR(2005) implementation

World Health Report 2007


The ihr foster global partnership

Other intergovernmental organizations: public health response to the

UN system (e.g. FAO, IAEA, ICAO, IMO)

others: regional (e.g. EU, ASEAN), technical (e.g. OIE)

Development agencies:

governments, banks

WHO Collaborating centres

Academics & professional associations

Industry associations

NGOs and Foundations

The IHR foster global partnership


Gu na l rodier who geneva

  • Health system public health response to the

  • Epidemiology

  • Laboratory

  • Preparedness

  • Case management

  • Infection control

  • Social mobilisation

  • Communication

IHR Annex 1A

At community, intermediate, and national level.


Gu na l rodier who geneva

Investing in public health response to the

Human resources (training, distance learning, twinning programmes …)

Infrastructure (buildings, equipments, logistics …)

Standard Operating Procedures (investigation, response, biosafety …)

(Annex 1A): “capacity to detect, assess, notify and report events in accordance with this Regulations …”

  • In the areas of

    • Laboratory quality system (EQA programmes, biosafety, specimen collection, lab regional network, twinning programmes …)

    • Surveillance and response systems (epidemic intelligence, field investigation, data analysis, risk assessment, reporting, points of entry …)

    • Communication (social mobilization, media, web, on-line training …)


Gu na l rodier who geneva

  • Ports public health response to the

  • Airports

  • Ground crossings

IHR Annex 1B, (also 3, 4, 5, 8, and 9)

  • Intersectoral collaboration

  • Aviation sector (ICAO, ACI, IATA)

  • Shipping (IMO, ISF, CLIA)

  • Railways (UIC)


Gu na l rodier who geneva

The LYO mission is to coordinate and public health response to the support WHO's effort in the Regions to strengthen laboratory diagnostic capacity, national surveillance and response systems, and facilities at designated points of entry (e.g. airports, ports) in order that all countries can meet the core capacity required under the IHR.


Gu na l rodier who geneva

2 years + 3 + (2) + (up to 2)

2007

2009

2012

2014

2016

Planning

Implementation

Possible extensions

"As soon as possible but no later than five years from entry into force …"

Core capacity requirements for surveillance and response (Annex 1A):

“capacity to detect, assess, notify and report events in accordance with this Regulations …”


Gu na l rodier who geneva

  • Intelligence public health response to the

  • Verification

  • Risk assessment

  • Response (GOARN)

  • Logistics

IHR Annex 2 (notification instrument)

"Event-based" surveillance and response at global level


Gu na l rodier who geneva

Global Outbreak Alert & Response Network (GOARN) public health response to the Institutions and Partner Network


Gu na l rodier who geneva

Responsible authorities (Article 4) public health response to the

“National IHR Focal Point” means the national centre, designated by each State Party, which shall be accessible at all times for communications with WHO IHR Contact Points under these Regulations;

  • Notification

  • Reports

  • Consultation

  • Verification

WHO IHR Contact Point

National IHR Focal Point

(One per State Party)

(One per WHO Region)


Gu na l rodier who geneva

  • Influenza public health response to the

  • Polio

  • SARS

  • Smallpox

  • Cholera

  • Meningitis

  • Yellow fever

  • Food safety

  • Chemical safety

  • Radionuclear safety

  • Tuberculosis

  • Malaria

  • HIV/AIDS

  • EPI

Driving forces at country level … but vertical and not integrated

GFATM

UNAIDS

GAVI

ICG

INFOSAN

IAEA


Gu na l rodier who geneva

Thank you public health response to the

w w w . w h o . i n t / i h r

IHR News

The WHO quarterly bulletin on IHR implementation