Dr. Sanjay KumarMD

Chief Medical OfficerAPHO-IGI, Delhi

International Health Regulation

International Health Regulation (2005)

are an international legal instrument

that

is binding on 194 countries across the globe, including all the Member States of WHO

(set of 66 articles)

The purpose and scope of IHR

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.

IHR Evolution

The International Health Regulations originated with the International Sanitary Regulations

1830 & 1847 -The cholera epidemics in Europe

1851 - International Sanitary Regulations - the International Sanitary Conference in Paris

In 1948, WHO Constitution

1969 - adopted, revised and consolidated the International Sanitary Regulations

&

renamed them as International Health Regulations (1969). (Cholera, Yellow fever, Plague, Small pox,

Relapsing fever, Typhus)

Contd…

•1973 - amended the IHR (1969) in relation to provisions on cholera.

•1981 - amended the IHR (1969) to exclude smallpox•1995 – WHA called for revision of IHR (69)•2001 – passed resolution on Global Health security :

Epidemic alert & Response•2003 – Resolution on Revision of IHR, IGWG was set •2005 –IHR 2005(2007 – adopted; By 2009 – Assessment; By 2012 –Implement. Extension for two may be provided)

Why IHR 2005

IHR -69: narrow scope of notifiable diseases(Cholera, Plague, Yellow fever)

The emergence of “new” infectious agents Ebola Hemorrhagic Fever, SARS (Hong Kong), Zoonoses, BSE, Nipah & avian influenza,

re-emergence of cholera (America) and plague in (India)

dependence on official country notification; and

lack of a formal internationally coordinated mechanism

Government areas and functions affected by International Health Regulations

Public health

Environment

Radio-nuclear and chemical activities / safety

Food safety

Borders / immigration

Agriculture (and animal health)

Customs

International ports, airports, ground crossings

Transportation (including dangerous goods)

Collection, use and disclosure of public health information

Activities of authorities at national,state/provincial/district, local levels.

Apply to government as a whole, not just particular ministry, department or agencies

Innovations in IHR(05)/ IHR-69 Vs IHR-2005

1. From disease list to broad range of serious public health emergencies

2. From control at borders to containment at source

3. State has obligation to develop & maintain minimum core public health capacities

4. From preset health measures to generalized rules and risk assessment in particular context

Innovations in IHR(05)/ IHR-69 Vs IHR-2005

5. Authorization of WHO to obtain verification of Unofficial report

6. Procedure for Determination of PHEIC & issuance of recommendation by Director General (WHO) & his team.

7. Protection of human rights persons & travelers

8. Establishment of National Focal point.

Broad scope and coverage of IHR (2005)

“Disease”: “an Illness or medical condition, irrespective of origin or source, that presents or could present significant harm to humans”

“Event”: “a manifestation of disease or an occurrence that creates the potential for disease”

"Public health risk": "the likelihood of an event that may adversely affect the health of human populations, …"

Events/risks may be:

Biological/infectious, chemical, radionuclear

Known or unknown, emerging or re-emerging

Transmissible by persons, transport conveyances, cargo/goods food/animals/products), vectors, environment, etc.

Obligation of State (IHR O5)

Designate or establish a National IHR Focal Point accessible at all times, 24 hours a day.

Strengthen and maintain the capacity to detect, report and respond rapidly to public health risks and PHEIC.

Respond to requests for verification of information regarding potential PHEIC.

Assess and notify WHO about of all events that may constitute a PHIEC. by using the decision instrument, within 24 hours.

Obligation of State (IHR O5)

Provide routine facilities, services, inspections and control activities at international airports, ports and ground crossings to prevent the international spread of disease.

Implement appropriate measures recommended by WHO.

Collaborate with other States Parties and with WHO on IHR(2005) implementation

Responsibility of WHO (IHR O5)

Designating WHO IHR Contact Points

Each of WHO’s 6 regional offices –

ofor communications with the National IHR Focal Points

oWorks with WHO HQ, Country office and National government on IHR events, technical support, capacity building

supporting States Parties to assess their existing national public health structures and resources, as well as to build and strengthen their core public health capacities for surveillance and response, and at designated points of entry

Responsibility of WHO (IHR O5)

coordinating global surveillance and assessment of significant public health risks, and disseminating public health information to States Parties

determining whether particular events constitute a public health emergency

developing and recommending measures for use by Member States during a PHEIC (after consultation with external experts)

Responsibility of WHO (IHR O5)

providing technical assistance to Member States in their response to PHEIC;

monitoring and evaluation of IHR(2005) implementation and adapting technical guidelines to reflect the evolving needs.

Key benefit of State (IHR O5)

As respected partner in the international effort to maintain global health security

Upon request, the country receives WHO guidance

Get technical assistance and receive help in mobilizing possible funding support to meet these new responsibilities.

Have access to information gathered by WHO about public health risks worldwide

Key benefit of State (IHR O5)

Get WHO guidance during the outbreak verification process.

Receive WHO advice and assistance with the logistical support needed to respond to disease outbreaks and other public health emergencies

The country Get access to WHO’s Global Outbreak Alert and Response Network (GOARN), a “one-stop shop” of global resources

National IHR Core Public Health Capacities:

8 Core capacities

Legislation and Policy Coordination Surveillance Response Preparedness Risk Communications Human Resources Laboratory

(At 3 levels-National; Intermediate & Peripheral/Community)

Core Capacity For Events at Points of Entry

Core capacity for Potential Hazards

– Biological

• Infectious

• Zoonosis

• Food safety

– Chemical

– Radio nuclear

Core Capacities Need for IHR-05

States Parties and WHO:-

shall support assessments, planning and implementation processes

The States has to utilize their existing national structures and resources to meet core capacity requirements for

A) For surveillance & Response to PHEIC

B) For Designated Airports, Ports & ground crossing

A) For surveillance & Response core capacity requirements for:-

surveillance,

reporting,

notification,

verification,

response and

collaboration activities has to be

a) At the local community level and/or primary public health response level

b) At the intermediate public health response levels

c) At the national level

(A) Local community level and/or primary public health response level

to detect events involving disease or death above expected levels for the particular time and place

to report essential information immediately to the appropriate level of health care response-community health care institutions or the appropriate health personnel.

to implement preliminary control measures immediately.

(A) Intermediate public health response

Receive information

Verify the event

Help the community level

Forward information

(A) National level

1. Assessment of the event & Notification to WHO

2. Public Health Response

a) Rapidly determine control measure

b) Support by spl. Staff, Lab, Training, Logistics

c) On site assistance in local investigation

d) To provide direct operational link with senior health & other officials

e) Liaison with other ministry

f) To provide most efficient communication

g) To establish, operate & maintain National PHE plan

h) To provide the foregoing on 24 hr basis services

B) Designated Airports, Ports & ground crossing

At all times

The capacities:

(a) to provide access to(i) an appropriate medical service including

diagnostic facilities

(ii) adequate staff, equipment and premises;

(b) to provide access to equipment and personnel for the transport of ill travellers to an appropriate medical facility;

B) Designated Airports, Ports & ground crossing

At all times (c) to provide trained personnel for the inspection of

conveyances;

(d) to ensure a safe environment for including potable water supplies, eating establishments, flight catering facilities, public washrooms, solid and liquid waste disposal services

(e) to provide practicable a programme and trained personnel

Core capacity forResponding to events that may constitute a public

health emergency of international concern

Maintaining a public health emergency contingency plane

to provide assessment of and care for affected travellers or animals

to provide appropriate space, separate from other travellers, to interview suspect or affected persons;

B) Designated Airports, Ports & ground crossing

Core capacity forResponding to events that may constitute a

public health emergency of international concern

provide for the assessment and, if required, quarantine of suspect travellers,

to apply recommended measures to disinsect, derat, disinfect, decontaminate or otherwise treat baggage, cargo, containers, conveyances, goods or postal parcels

to apply entry or exit controls for arriving and departing travellers

B) Designated Airports, Ports & ground crossing

DECISION INSTRUMENT for assessment and

notification of events that may be a PHEIC

Poliomyelitis (wild virus)

Small pox

SARS

Human Influenza

(New Subtype)

Cholera, Pneumonic plague, Yellow fever, Viral haemorrhagic fevers (Ebola, Lassa, Marburg), West Nile fever & Other diseases that are of concern, e.g. dengue fever, Rift Valley fever, and meningococcal disease. Or

Any event of potential international public health concern

Directly

Notify to WHO

(As a case may have serious public health impact )

1. Unusual/unexpected event+ serious public health impact or

2.Unusual/unexpected event+ Not so serious public health impact +Significant risk of Int’l spread or

3.Unusual/unexpected event+ Not so serious public health impact + No signif. risk of Int’l spread + signif. risk of Int’l trade/travel restriction

or 4. Expected event+serious PH impact +Significant risk of Int’l spread

Or 5. Expected event+Not so serious PH impact +Significant risk of Int’l spread + signif. risk of Int’l trade/travel restriction

Notify to WHO

THANK YOU

PART I – DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND RESPONSIBLE AUTHORITIES

Article 1 DefinitionsArticle 2 Purpose and scopeArticle 3 PrinciplesArticle 4 Responsible authority

PART II – INFORMATION AND PUBLIC HEALTH RESPONSEArticle 5 SurveillanceArticle 6 NotificationArticle 7 Information-sharing during unexpected or unusual

public health eventsArticle 8 ConsultationArticle 9 Other reportsArticle 10 VerificationArticle 11 Provision of information by WHO

Article 12 Determination of a public health emergency of international concern

Article 13 Public health responseArticle 14 Cooperation of WHO with intergovernmental

organizations and international bodiesPART III – RECOMMENDATIONS Article 15 Temporary recommendationsArticle 16 Standing recommendationsArticle 17 Criteria for recommandationsArticle 18 Recommendations with respect to persons,

baggage, cargo, containers, conveyances, goods and postal parcels

PART IV – POINTS OF ENTRY Article 19 General obligationsArticle 20 Airports and portsArticle 21 Ground crossingsArticle 22 Role of competent authorities

PART V – PUBLIC HEALTH MEASURES Chapter I – General provisions

Article 23 Health measures on arrival and departure Chapter II – Special provisions for conveyances and conveyance

operators Article 24 Conveyance operatorsArticle 25 Ships and aircraft in transitArticle 26 Civilian lorries, trains and coaches in transitArticle 27 Affected conveyancesArticle 28 Ships and aircraft at points of entryArticle 29 Civilian lorries, trains and coaches at points of entry

Chapter III – Special provisions for travellers Article 30 Travellers under public health observationArticle 31 Health measures relating to entry of travellersArticle 32 Treatment of travellers

Chapter IV – Special provisions for goods, containers and container loading areas

Article 33 Goods in transit

Article 34 Container and container loading areasPART VI – HEALTH DOCUMENTS Article 35 General ruleArticle 36 Certificates of vaccination or other prophylaxisArticle 37 Maritime Declaration of HealthArticle 38 Health Part of the Aircraft General DeclarationArticle 39 Ship sanitation certificatesPART VII – CHARGES Article 40 Charges for health measures regarding travellersArticle 41 Charges for baggage, cargo, containers, conveyances,

goods or postal parcelsPART VIII – GENERAL PROVISIONS Article 42 Implementation of health measuresArticle 44 Collaboration and assistanceArticle 45 Treatment of personal data

Article 46 Transport and handling of biological substances, reagents and materials for diagnostic purposes

PART IX – THE IHR ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE REVIEW COMMITTEE Chapter I – The IHR Roster of Experts

Article 47 Composition Chapter II – The Emergency Committee

Article 48 Terms of reference and compositionArticle 49 Procedure

Chapter III – The Review Committee Article 50 Terms of reference and compositionArticle 51 Conduct of businessArticle 52 ReportsArticle 53 Procedures for standing recommendationsPART X – FINAL PROVISIONS Article 54 Reporting and reviewArticle 55 AmendmentsArticle 56 Settlement of disputes

Article 57 Relationship with other international agreementsArticle 58 International sanitary agreements and regulationsArticle 59 Entry into force; period for rejection or reservationsArticle 60 New Member States of WHOArticle 61 RejectionArticle 62 ReservationsArticle 63 Withdrawal of rejection and reservationArticle 64 States not Members of WHOArticle 65 Notifications by the Director-GeneralArticle 66 Authentic texts

ANNEX 1 A. CORE CAPACITY REQUIREMENTS FOR

SURVEILLANCE AND RESPONSE

B. CORE CAPACITY REQUIREMENTS FOR DESIGNATED AIRPORTS, PORTS AND GROUND CROSSINGS

ANNEX 2 DECISION INSTRUMENT FOR THE ASSESSMENT

AND NOTIFICATION OF EVENTS THAT

MAY CONSTITUTE A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN

ANNEX 3 MODEL SHIP SANITATION CONTROL EXEMPTION CERTIFICATE/SHIP

SANITATION CONTROL CERTIFICATEATTACHMENT TO MODEL SHIP SANITATION CONTROL EXEMPTION

CERTIFICATE/SHIP CONTROL EXEMPTION CERTIFICATEANNEX 4

TECHNICAL REQUIREMENTS PERTAINING TO CONVEYANCES AND CONVEYANCE OPERATORS

ANNEX 5 SPECIFIC MEASURES FOR VECTOR-BORNE DISEASES

ANNEX 6 VACCINATION, PROPHYLAXIS AND RELATED CERTIFICATES

ANNEX 7 REQUIREMENTS CONCERNING VACCINATION OR

PROPHYLAXIS FOR SPECIFIC DISEASESANNEX 8

MODEL OF MARITIME DECLARATION OF HEALTH

ANNEX 9

THIS DOCUMENT IS PART OF THE AIRCRAFT GENERAL DECLARATION, PROMULGATED BY THE INTERNATIONAL CIVIL AVIATION ORGANIZATION

APPENDIX 1

STATES PARTIES TO THE INTERNATIONAL HEALTH REGULATIONS (2005)

APPENDIX 2

RESERVATIONS AND OTHER STATE PARTY COMMUNICATIONS IN CONNECTION WITH THE INTERNATIONAL HEALTH REGULATIONS (2005)

INDIA

Reservations in respect of India under Article 62 of the recently circulated IHR 2005 :-

Proposed Reservation to IHR 2005:-

1. The Government of India reserves the right to consider the whole territory of a country as infected with yellow fever whenever yellow fever has been notified under Article 6 and other relevant articles in this regard of IHR (2005). The Government of India reserves the right to continue to regard an area as infected with yellow fever until there is definite evidence that yellow-fever infection has been completely eradicated from that area.

1. Yellow Fever disease will be treated as disease of Public health emergency of international concern and all health measures being applied presently like disinsection of conveyance, vaccination requirements and quarantine of passengers and crew (as may be required) (as per Article 7, 9.2(b), 42 and relevant annexure) will be continued as has been stipulated under Annex-II of IHR-1969 (Revised in 1983).