Background

In 1995, the Member States of the World Health Organization (WHO) decided that they needed better disease surveillance and response tools on a global scale. Ten years later, the World Health Assembly accepted the revised International Health Regulations [IHR (2005)], which now consitutes the latest in the history of international communicable disease law.

The purpose and scope of IHR 2005 are 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. (Art. 2, IHR 2005

The revised International Health Regulations (2005), a legally binding international agreement (formal status: international law), provide the framework for improved international public health security. It represents a set of rules with defined procedures and responsibilities for WHO and States Parties. The International Health Regulations (2005) call on countries to assess and strengthen their national public health structures and, in time of a public health event which may constitute a public health emergency of international concern, to actively and collectively interact with WHO for information sharing, risk assessment, recommendation and implementation of public health measures.

It is critical that all countries have the capacity to detect, assess and respond to public health events of international concern. Enhanced international health security depends on all countries’ commitment to invest and ensure that this Public Health Capacity is in place. In this context 'Public Health Capacity' means a competent workforce (human resources) in combination with an adequate public health system (plans, procedures, legal framework, funding mechanism and infrastructure). Since such public health capacity is the basis of all defense against communicable diseases, it makes sense that the European Centre for Disease Prevention and Control (ECDC) has to fulfill article 9 of the ECDC Founding regulations: "The Centre shall, as appropriate, support and coordinate training programmes in order to assist Member States and the Commission to have sufficient numbers of trained specialists, in particular in epidemiological surveillance and field investigations, and to have a capability to define health measures to control disease outbreaks."

Topics covered by IHR are:

• International surveillance system
• International rules on response to international threats
• International rules on routine measures against international disease spread
• Procedural rules (WHO and states)

IHR define requirements for core capacities at various levels:

• Event detection
  • Local, regional, national level
• Event assessment and notification
  • National level
• Public health response to events 24/7
  • Support, including on-site assistance
  • Communication links
  • Public health emergency plan

In addition, specific core capacities for designated airports, ports and ground crossings are defined.

How is global public health security ensured?

Here are some key aspects of how the IHR 2005 ensure global public health security:

1. Reporting and notification: Member states are required to notify the WHO of any public health events or emergencies that may have international implications. This includes events involving chemical, radiological, and nuclear hazards as well as infectious diseases. Early notification and transparent reporting are essential to facilitate a rapid response and prevent the global spread of diseases.
2. Surveillance and response: The IHR 2005 establish guidelines for member states to develop and maintain core public health capacities for disease surveillance and response. This includes monitoring and detecting public health risks, reporting incidents, and coordinating an effective response to potential health emergencies.
3. Points of entry: The regulations outline measures to prevent the international spread of diseases at points of entry, such as airports, seaports, and ground crossings. These measures include health assessments, quarantine, isolation, and other appropriate public health actions.
4. Risk assessment and management: The WHO, in collaboration with member states, is responsible for assessing and managing public health risks based on available information.

What are the IHR and why have they been revised?

The International Health Regulations (IHR) 2005 is a legally binding international agreement that governs the prevention, detection, and response to public health emergencies of international concern. The IHR 2005 aims to enhance global public health security by preventing the spread of diseases and other health risks across borders, while minimizing interference with international trade and travel. The IHR 2005 applies to all World Health Organization (WHO) member states and covers not just infectious diseases, but also chemical, radiological, and nuclear hazards.

The IHR 2005 is a revised version of the earlier International Health Regulations (IHR 1969), which were primarily focused on controlling the spread of cholera, plague, and yellow fever. The revision was prompted by several factors:

1. Changing global health landscape: The emergence of new infectious diseases, such as Severe Acute Respiratory Syndrome (SARS) and the H5N1 avian influenza, highlighted the need for a more robust and comprehensive framework to address public health threats.
2. Increased international travel and trade: The rapid growth in international travel and trade led to a greater potential for diseases to spread across borders, making it essential to have an updated framework that could effectively prevent and manage such risks.
3. Advances in technology and communication: Technological advancements facilitated better detection, reporting, and response to public health threats. The IHR 2005 needed to incorporate these developments to maximize their benefits for global health security.
4. Need for a coordinated response: The previous regulations were limited in scope and did not adequately address the need for a coordinated international response to public health emergencies. The IHR 2005 aimed to rectify this.

What are the obligations for the WHO member states?

The IHR 2005 imposes certain obligations on WHO member states to enhance global health security. Key obligations include:

1. National Focal Points (NFPs): Each member state must designate a National Focal Point to be accessible at all times for communication with WHO about public health events and for coordinating IHR-related matters.
2. Core capacities: Member states are required to develop, strengthen, and maintain core public health capacities at the national and subnational levels to detect, assess, report, and respond to potential public health emergencies of international concern (PHEICs).
3. Notification: Member states are obliged to assess and notify WHO of events that may constitute a PHEIC within 24 hours of assessment using the IHR Decision Instrument.
4. Information sharing: Member states must report and share relevant public health information with WHO, including case definitions, laboratory results, sources of infection, routes of transmission, and prevention and control measures.
5. Verification and response: Member states must verify and respond to requests from WHO for information regarding potential public health risks, even if the event does not meet the criteria for a PHEIC.
6. Public health response: Member states are required to develop and implement appropriate public health measures to control potential PHEICs while minimizing disruption to travel and trade.

What are the implications for surveillance in Member States?

The IHR 2005 requires countries to establish and maintain effective and integrated disease surveillance systems, both nationally and locally. These systems should be capable of promptly detecting, assessing, and reporting public health events to prevent or mitigate potential public health emergencies of international concern (PHEICs). Key implications for surveillance include:

1. Core capacities: Member states must develop, strengthen, and maintain core surveillance capacities, including the ability to detect, assess, notify, and report public health events. This includes investing in human resources, laboratory facilities, data management systems, and communication infrastructure.
2. Event-based and indicator-based surveillance: Member states are encouraged to implement event-based surveillance (monitoring and reporting unusual health events) and indicator-based surveillance (routine data collection and analysis) to detect and assess potential public health risks.
3. Surveillance integration: Countries should integrate their surveillance systems across various sectors (e.g., human health, animal health, environmental health) to ensure a coordinated and effective response to potential PHEICs.
4. Early warning and response: Surveillance systems should have early warning and response mechanisms to detect and respond to public health events rapidly. This requires effective collaboration between various stakeholders, including public health institutions, laboratories, and other relevant sectors.
5. Information sharing: Member states must report and share relevant public health surveillance information with WHO and other member states as needed, enabling timely global risk assessment and response.
6. Cross-border collaboration: Surveillance systems should facilitate collaboration between neighboring countries and regions