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

2. 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 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

3. 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.

4. 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)

5. 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
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

6. 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

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

8. 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

9. 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.

10. 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

11. 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)

12. 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.

13. 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

14. 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

15. 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.

16. 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.

17. 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.

18. 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 (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

19. 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

20. 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

21. 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.

22. 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