International Health Regulation.pdf

8/10/2019 International Health Regulation.pdf

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International Health

Regulation

Dr. Riris Andono Ahmad MPH PhD

Courtesy of dr. Yodi Mahendradhata

Presentation structure

! International health security

! The international health regulation (2005)and implied mandates and obligations


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Part 1.

International health security

Security threat in the 21stcentury?


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Probable SARS transmission on

flight CA112 in March 2003


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Direct economic impact of selectedinfectious disease outbreaks, 19902003a

Threats to public health security

! Decisions and actions taken (bygovernments or individuals) ininvestments or surveillance measures

! Conflict, displacement, lack of

commitment, misinformation.! Microbial evolution andantibiotic

resistance.


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Inadequate investment

! Reduced vigilance of preventionprogrammes can result in outbreaks.

! Vector-born diseases re-emerged in sub-Saharan Africa after widespread use of

insecticides ended.! Real global threats of HIV/AIDS was only

recognized after first cases in the UnitedStates.


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Unexpected policy changes

! Oral polio vaccine was claimed to beunsafe in Nigeria in 2003.

! Government reduced immunization.

! A large outbreak of polio resulted;previously polio-free areas were infected.

! Thousands of children paralysed.

! The disease spread to polio-free countries.

Conflict

! Civil war in Angola hampered efforts tocontain an outbreak of Marburghaemorrhagic fever in 2005. (200 peopleaffected, 90% died).

!

Rwanda crisis up to 800 000 people fled tothe Democratic Republic of the Congo. Inthe absence of adequate sanitation, about50 000 died from cholera and dysentery.


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Microbial evolution and antibioticresistance

! Evolution of resistance to anti-infectivedrugs contributes to the emergence andre-emergence of infectious diseases.

! Bacteria develop resistance to antibiotics

through spontaneous mutation and

through the exchange of genes betweenbacterial strains and species.

Health and global security!Most cities in the US are within 36-hour

commercial flight of any area of the world lesstime than incubation period of many diseases Bill Clinton

! Forms of threats:" More casualties than wars, e.g. vietnam

" More military hospitals admisson than injuries" International peacekeeping efforts

" Impact on socioeconomic of developing world

" Challenge development in former communists


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Evolution of public health security

! Plague: In 1348, plague killed up to two-thirds of the population in Europe.

! Cholera: In 1855, cholera killed anestimated 500 people in a 10-day periodin London.

! Smallpox: Smallpox ravaged populationsuntil it was finally eradicated in 1979.

International cooperation origins

! Traditional control measures quarantine,sanitation and immunizationbecameinadequate.

! International cooperation needed tocontrol the spread of infectious diseases.

! International conventions on sanitationand health of the 1850s evolved into theInternational Health Regulations (1969).

! Revised IHR (2005) came into force inJune 2007.


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Milestones in international public health security

Part 2.

The international healthregulation


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IHR (2005) in brief (1)

! An international law to prevent the spreadof public health emergencies.

! WHO Member States bound to cooperationand transparency.

! Compliance will reduce outbreaks' impact.

! All countries must detect, assess, notifyand report events covered by IHR.

IHR (2005) in brief (2)

! Mandatory notification of a single case ofsome rare disease e.g. smallpox, polio.

! The IHR include emergencies caused byreleases of chemical or radionuclear

materials.! WHO can use early unofficial sources of

information, but will verify with countriesbefore taking any action.


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From IHR (1969) to IHR (2005):a major paradigm shift

! From control at borders to [also]containment at source

! From a list of diseases to all public healththreats

! From preset measures to adapted

response

IHR (2005) Main legal requirements (1)

! Core capacity requirements for countries to"detect, assess, notify and report events inaccordance with the regulations" and to "respondpromptly and effectively to public health risks"

! Obligation, permission or prohibition of certainpublic health actions in respect of international

travellers, goods, cargo and conveyances and theports, airports and border crossings that theyutilize

! Administration of IHR such as the nomination ineach country of a National IHR Focal point and,for WHO, the nomination of WHO IHR ContactPoints


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IHR (2005) Main legal requirements (2)

! Management of information and publichealth response for events which mayconstitute a "public health emergency ofinternational concern"

! Full respect of human rights and the

guidance provided by the Charter of theUnited Nations and the Constitution of theWorld Health Organization


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4 assessment criteria of events

! Is the public health impact of the eventserious?

! Is the event unusual or unexpected?

! Is there a significant risk of internationalspread?

! Is there a significant risk of internationalrestriction(s) to travel and trade?

Areas of work for implementation (1)

! Foster global partnerships

! Strengthen national diseasesurveillance, prevention, control and

response systems

! Strengthen public health security intravel and transport

! Strengthen WHO global alert and responsesystems


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Areas of work for implementation (2)

! Strengthen the management of specificrisks

! Sustain rights, obligations and procedures

! Conduct studies and monitor progress

Strengthen national disease surveillance,

prevention, control and response systems (1)

! Ensure that relevant public health functions foralert and response are in place and operational

! Conduct exercises to identify operational gaps inthe national surveillance and response systems.

! Ensure that the national surveillance andresponse system uses internationally recognized

quality standards! Consider strengthening human resources through

training in intervention epidemiology, outbreakinvestigation, laboratory diagnostics, casemanagement, infection control, socialmobilization, and risk communication.


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Strengthen national disease surveillance,prevention, control and response systems (2)

! Assess and plan operational links betweennational surveillance and responsesystems and points of entry

! Use standard WHO indicators to carry outregular assessments of core public healthcapacities to monitor progress and assess

future needs.! Where appropriate, develop proposals for

international partnerships and themobilization of external resources.

Strengthen national disease surveillance,

prevention, control and response systems (3)

! Ensure that all national action plans areimplemented within the set timeframe.

! Mobilize the necessary resources from thenational budget and, where proposalshave been developed, from international

partners.! Conduct drills on a regular basis to test

the continuous operational capacity of thenational surveillance and responsesystems.


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Strengthen public health security intravel and transport (1)

! Develop, strengthen and maintain corecapacities on a routine and emergencybasis.

! Identify designated PoE that must have

core capacities in place, and notify these

to WHO.! Identify the competent authority for each

designated PoE in its territory.

Strengthen public health security in

travel and transport (2)

! Put in place enhanced contingency andemergency planning mechanisms for allnew IHR provisions at all designated PoE:

" operational capacities are tested on a regularbasis with drills and exercises.

" requirements under the IHR are integrated intoexisting emergency, facilitation and securityplans at PoE.


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Strengthen public health security intravel and transport (3)

" States Parties are able to provide WHO withrelevant data regarding any potential publichealth risk.

! Integrate drills into the contingency andemergency mechanisms to testoperational capacity.

Three top priorities for ministries of health

! Establishing a national IHR focal point

! Ensure adherence to reportingrequirements and verification of publichealth events

! Assess and strengthen national capacities


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Timeline

! The IHR (2005) come into force on 15June 2007.

! States Parties shall meet the core capacityrequirements

" from 15 June 2007, States Parties have 2years to assess their national structures andresources and develop national action plans

" from 15 June 2009, States Parties have 3years to meet the core capacity requirements.

International Health Regulation.pdf

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