World Health Organization 7 April, 2017 International Health Regulations Building international public health security

Why revised International Health Regulations? World Health Organization Why revised International Health Regulations? 7 April, 2017 In today’s world, diseases travel fast and no single country can protect itself on its own. Acknowledging this, the 193 WHO Member States unanimously adopted a new version of the International Health Regulations (IHR). The revised IHR enter into force in June 2007. It will now be up to the world to translate the new code of the Regulations into the reality of greater international public health security. Dr Margaret Chan, WHO Director-General

Our world is changing as never before World Health Organization 7 April, 2017 Populations grow, age, and move Diseases travel fast Microbes adapt Chemical, radiation, food risks increase Health security is at stake The unique conditions of the 21st century have amplified the invasive and disruptive power of epidemics and other public health emergencies. The dynamics of disease spread in the world have changed greatly in the last decades. We all are living in a global “village” where diseases can travel at the speed of jetliners on the wings of international travel and trade, and can jump from one continent to another in a matter of hours. This has made all nations vulnerable – not just to invasion of their territories by pathogens, but also to the economic, political and social shocks of public health events elsewhere. They have the power to disrupt the entire global system in ways that cannot be controlled by one nation acting alone.   SARS was the first disease of the 21st century to expose the world’s vulnerabilities. It will not be the last. Shared vulnerabilities imply shared responsibilities and create a need for strong collective action to protect lives and livelihoods from disease spread. To address these public health risks, the world's countries, through WHO, initiated an intensive process to revise the IHR, eventually adopted by the World Health Assembly in May 2005.

30 years of international health in security World Health Organization 30 years of international health in security 7 April, 2017 HIV/AIDS CHERNOBYL PLAGUE EBOLA / MARBURG NvCJD NIPAH YELLOW FEVER ... ANTHRAX SARS MENINGITIS CHOLERA CHEMICAL AVIAN INFLUENZA XDR-TB ... The AIDS pandemic, December 2006 39.5 Mo HIV infected 2.9 Mo deaths in 2006 Drug-Resistance No vaccine A new virus recognized in the early 1980s Ebola, Kikwit, Zaïre, April 1995 315 cases 250 deaths (CFR 80%) Global concern WHO Coordinated response Bovine spongiform encephalopathy A new prion disease Crossed the species barrier Spread through the food-chain March 2003: a new and severe acute atypical pneumonia emerges in China, Hanoi, Hong-Kong, Singapore and Toronto. 8098 cases 774 deaths 26 countries affected A new coronavirus Poliomyelitis: threat to global eradication effort …global spread has never been so easy H5N1 Avian Influenza, Human cases, Pandemic Threat Accidental or deliberate release of infectious agents Smaller, more powerful, more affordable, biotechnologies Increased risk for accidental release of infectious agents (e.g. SARS 2004) The deliberate release of infectious agents is no longer a remote threat Chernobyl, Ukraine, 1986 1000 people with highest radiations 600,000 people contaminated > 5 million people exposed > 4000 thyroid cancer cases (by 2002)

2003: SARS changes the world World Health Organization 7 April, 2017 Screening of exit passengers WHO travel recommendations WHO travel recommendations removed 27 March 2 April 25 May 23 June 120000 SARS: an unknown coronavirus 8098 cases 774 deaths 26 countries affected trends in airline passenger movement drop economic loss: US$ 60 billion 102 165 100000 80000 Number of passenger 60000 SARS taught us how quickly a new disease can spread along the routes of international air travel. This universal vulnerability creates a need for collective defences and for shared responsibility in making these defences work. SARS finally spurred the energy of world’s States, coordinated by WHO, to strongly take action and strengthen global defences to health threats without boundaries 40000 36 116 20000 14 670 13 May 3/16 3/19 3/22 3/25 3/28 3/31 4/3 4/6 4/9 4/12 4/15 4/18 4/21 4/24 4/27 4/30 5/3 5/6 5/9 5/12 5/15 5/18 5/21 5/24 5/27 5/30 6/2 6/5 6/8 6/11 6/14 6/17

H5N1: Avian influenza, a pandemic threat World Health Organization 7 April, 2017 The greatest threat to international health security would be an influenza pandemic. It has not receded, but early warnings allow the world a chance to prepare. Implementation of the IHR is the chance to prepare

World Health Organization The 58th World Health Assembly adopts the revised International Health Regulations, “IHR” World Health Organization 7 April, 2017

International public health security is the goal World Health Organization International public health security is the goal 7 April, 2017 Come into force on 15 June 2007* Ensuring maximum public health security while minimizing interference with international transport and trade The IHR represent a major step forward in international public health security. They provide an agreed framework for the collective international management of epidemics and other public health emergencies while minimising disruption to travel, trade and economies. India Reservation (related to yellow fever) USA Reservation (related to federalism) 3 understandings (related to sources of incidents, to reporting concerning risks outside its territory, to the question of judicially enforceable private rights) Turkey Statement (related to a convention and regulations regarding the straits) . Legally binding for WHO and the world’s countries that have agreed to play by the same rules to secure international health. * A later date applies to States that have submitted reservations

World Health Organization What’s new? World Health Organization 7 April, 2017 From three diseases to all public health threats From preset measures to adapted response From control of borders to, also, containment at source The IHR are innovative because they move from purely a list of diseases to a dynamic process of risk identification, assessment and management they move from a concept of static defence at borders, airports and ports to the concept of early detection, reporting and containment at source they built on the concept that international health security is based on strong national public health infrastructure connected a global alert and response system.

All public health threats World Health Organization All public health threats 7 April, 2017 The revised IHR recognize that international disease threats have increased Scope has been expanded from cholera, plague and yellow fever to all public health emergencies of international concern They include those caused by infectious diseases, chemical agents, radioactive materials and contaminated food

World Health Organization Adapted response World Health Organization 7 April, 2017 International public health security is based on strong national public health infrastructure connected to a global alert and response system. This is at the core of the IHR. SARS taught us how quickly a new disease can spread along the routes of international air travel. This universal vulnerability creates a need for collective defences and for shared responsibility in making these defences work. The containment of SARS was due to unprecedented cooperation between countries which prevented a new disease gaining a foothold in the human population. The IHR build on this and many other efforts to respond to and contain disease threats and  will help to ensure that outbreaks and other public health emergencies are detected and investigated more rapidly and that collective international action is taken to support affected a states to contain the disease and apply life saving interventions. GOARN A “strike force” of specialized staff is rapidly deployed for on-the-spot emergency investigations through the Global Outbreak Alert and Response Network (GOARN). It interlinks in real time 120 networks and institutes. For chemical, radiological and food-related incidents GOARN is complemented by WHO Chemical Incidents and Emergencies Network (ChemiNet) Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) International Food Safety Authorities Network (INFOSAN)

World Health Organization Containment at source World Health Organization 7 April, 2017 Rapid response at the source is: the most effective way to secure maximum protection against international spread of diseases key to limiting unnecessary health-based restrictions on trade and travel The extent of international travels is an extraordinary opportunity for disease transmission.

World Health Organization What do the IHR call for? 7 April, 2017 Strengthened national capacity for surveillance and control, including in travel and transport Prevention, alert and response to international public health emergencies Global partnership and international collaboration Rights, obligations and procedures, and progress monitoring

Why should countries implement the IHR? World Health Organization Why should countries implement the IHR? 7 April, 2017 To detect and contain public health threats faster, to contribute to international public health security, and to enjoy the benefits of being a respected partner. Countries will receive: WHO assistance in building core capacities WHO’s guidance during outbreak investigation, risk assessment, and response WHO’s advice and logistical support information gathered by WHO about public health risks worldwide assistance to mobilize funding support

The IHR foster global partnership World Health Organization 7 April, 2017 Other intergovernmental organizations: 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 provide for cooperation between WHO and other competent intergovernmental organizations or international bodies in the implementation of the Regulations. WHO will therefore continue to foster its longstanding working relationships with a number of organizations such as the International Atomic Energy Agency, the International Air Transport Association, the International Civil Aviation Organization, the International Maritime Organization, the World Tourism Organization, Food and Agriculture Organization of the United Nations, the Office International d'Epizooties (World Organisation for Animal Health) and the World Trade Organization. In addition to these specialized organizations, WHO will work with regional economic integration organizations such as the European Union and the Mercado Común del Sur (MERCOSUR) in implementing the Regulations in the countries of their respective regions.

Acute public health threats are collectively managed World Health Organization Acute public health threats are collectively managed 7 April, 2017 The IHR define a risk management process where States Parties work together, coordinated by WHO, to collectively manage acute public health risks. The key functions of this global system, for States and WHO, are to: detect verify assess inform assist Timely and enhanced epidemic intelligence Real-time exchange of situational reports and other data for decision-making Enhanced information management and risk communications Joint risk analysis and decision support Action planning and coordination of response activities Technical partnerships to support international health security.

WHO to help countries managing events World Health Organization WHO to help countries managing events 7 April, 2017 New WHO global Event Management System WHO Regional Alert and Response teams Train countries’ NFPs and WHO contact points for event management Expand GOARN and other specialized and regional support networks Develop new tools and standard operating procedures Carry out IHR exercises WHO wide-exercise tests the global system for international health security On, 15 June 2007, the day of the IHR’s entry into force, WHO will hold the first exercise to test its preparedness to successfully manage and support States during public health emergencies of international concern. As part of WHO's increased responsibilities under the revised IHR, considerable effort has been made to establish procedures, technological and human resource infrastructures to ensure WHO is ready to receive, analyse and disseminate information and make recommendations for dealing with public health emergencies of international concern. The exercise on 15 June is the first of a series meant to test the mechanisms in place, their compliance with the IHR and opportunities for improvement. It consists of notifying a public health event involving multiple regions. This is an occasion to validate policy direction and coordination, information management and risk assessment capacity as well as the ability to utilize communications methods to report events from the country level through the Regional Offices to Headquarters. Participants will span many levels of WHO across the globe, including selected country office staff, WHO IHR contact points, Regional Directors, Regional Advisors, WHO Emergency and Preparedness and Response group at Headquarters, and the office of the Director-General.

As each country builds its capacity, the entire world wins World Health Organization 7 April, 2017 The greatest assurance of public health security will come when all countries have in place the capacities for effective surveillance and response, for: infectious diseases  radiological-related diseases chemical-related diseases  food-related diseases Timeline "As soon as possible but no later than five years from entry into force" 2 years + 3 + (2) + (up to 2) Each country has committed to develop and maintain core public health capacities for surveillance and response. These capacities encompass outbreaks of infectious diseases and diseases of chemical, radiological and food origin. Health services and facilities are also to be developed at important international ports, airports and ground crossings. 15 June 2007 2009 2012 2014 2016 Planning Implementation

Countries’ challenges for IHR implementation World Health Organization Countries’ challenges for IHR implementation 7 April, 2017 Mobilize resources and develop national action plans Strengthen national capacities in alert and response Strengthen capacity at ports, airports, and ground crossings Maintaining strong threat-specific readiness for known diseases/risks Rapidly notify WHO of acute public health risks Sustain international and intersectoral collaboration Monitor progress of IHR implementation

What will WHO do under the IHR? World Health Organization What will WHO do under the IHR? 7 April, 2017 Designate WHO IHR contact points Support States Parties in assessing their public health risks, through the notification, consultation, and verification processes Inform State Parties of relevant international public health risks Recommend adapted public health measures Assist States Parties in their efforts to investigate outbreaks and meet the IHR national requirements for surveillance and response

Benefit from IHR implementation World Health Organization 7 April, 2017 Lives saved Good international image No unilateral travel and trade restrictions Public trust No political and social turmoil The legally binding nature of IHR(2005) does not include an enforcement mechanism per se for the States which fail to comply with its provisions. Nevertheless, the potential consequences of non-compliance, especially in economic terms, are a powerful compliance tool. Being a binding international agreement, the IHR(2005) are associated to greater expectations of compliance by their State Parties through greater expectations of compliance by other parties and concerns about potential retributive measures by other countries in case of non-compliance. Working together with WHO to control a public health event and to communicate accurately any associated to other States or their populations helps to protect against unjustified measures being adopted unilaterally by other States.

World Health Organization 7 April, 2017 w w w . w h o . i n t / i h r International Health Regulations Building international public health security