INTERNATIONAL SANITARY - WHO

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OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 37 INTERNATIONAL SANITARY REGULATIONS PROCEEDINGS OF THE SPECIAL COMMITTEE AND OF THE FOURTH WORLD HEALTH ASSEMBLY ON WHO REGULATIONS No. 2 WORLD HEALTH ORGANIZATION PALAIS DES NATIONS GENEVA April 1952

Transcript of INTERNATIONAL SANITARY - WHO

OFFICIAL RECORDSOF THE

WORLD HEALTH ORGANIZATION

No. 37

INTERNATIONAL SANITARYREGULATIONS

PROCEEDINGS OF THE SPECIAL COMMITTEEAND OF THE

FOURTH WORLD HEALTH ASSEMBLYON

WHO REGULATIONS No. 2

WORLD HEALTH ORGANIZATIONPALAIS DES NATIONS

GENEVA

April 1952

ABBREVIATIONS

The following abbreviations are used in the Official Records of the World Health Organization:

ACC - Administrative Committee on Co-ordination

ECA - Economic Co-operation Administration

ECAFE - Economic Commission for Asia and the Far East

ECE - Economic Commission for Europe

ECLA - Economic Commission for Latin America

FAO - Food and Agriculture Organization

ICAO - International Civil Aviation Organization

ICITO - Interim Commission of the International Trade Organization

ILO - International Labour Organisation (Office)

IMCO - Inter-Governmental Maritime Consultative Organization

IRO - International Refugee Organization

ITU - International Telecommunication Union

OIHP - Office International d'Hygiène Publique

PASB - Pan American Sanitary Bureau

PASO - Pan American Sanitary Organization

TAB - Technical Assistance Board

TAC - Technical Assistance Committee

UNESCO - United Nations Educational, Scientific and Cultural Organization

UNICEF - United Nations International Children's Emergency Fund

UNKRA - United Nations Korean Reconstruction Agency

UNRRA - United Nations Relief and Rehabilitation Administration

UNRWAPRNE - United Nations Relief and Works Agency for Palestine Refugees in the Near East

WFUNA - World Federation of United Nations Associations

WMO - World Meteorological Organization

For Index see page 411

TABLE OF CONTENTS

Page

Introduction 1

Part I

PROCEEDINGS

SPECIAL COMMITTEE APPOINTED BY THE THIRD WORLD HEALTH ASSEMBLYTO CONSIDER THE DRAFT INTERNATIONAL SANITARY REGULATIONS

Page

List of Delegates and other Participants 5

Agenda 9

Text of the Draft International Sanitary Regulations 10

MINUTES OF SPECIAL COMMITTEE

Page Page

First meeting 36 Nineteenth meeting 132Second meeting 38 Twentieth meeting 137Third meeting 43 Twenty-first meeting 141Fourth meeting 46 Twenty-second meeting 146Fifth meeting 51 Twenty-third meeting 153Sixth meeting 55 Twenty-fourth meeting 161Seventh meeting 61 Twenty-fifth meeting 169Eighth meeting 67 Twenty-sixth meeting 174Ninth meeting 73 Twenty-seventh meeting 181Tenth meeting 78 Twenty-eighth meeting 188Eleventh meeting 83 Twenty-ninth meeting 192Twelfth meeting 89 Thirtieth meeting 202Thirteenth meeting 94 Thirty-first meeting 209Fourteenth meeting 101 Thirty-second meeting 218Fifteenth meeting 108 Thirty-third meeting 222Sixteenth meeting 113 Thirty-fourth meeting 231Seventeenth meeting 120 Thirty-fifth meeting 240Eighteenth meeting 125 Thirty-sixth meeting 246

MINUTES OF SUB-COMMITTEE ON THE MECCA PILGRIMAGE

Page Page

First meeting 248 Fourth meeting 260Second meeting 252 Fifth meeting 264Third meeting 256

11624Ç.,

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REPORTS OF SUB-COMMITTEES AND WORKING PARTIESPage

Sub-Committee on CredentialsFirst report 269Second report 269

Sub-Committee on the Mecca Pilgrimage 270

Juridical Sub-CommitteePart I : Report 276Part II : Report on Article 8 of Annex B and Article 4 of Annex A 280

Working Party on the Proposal of the Delegation of the United States to establish an InternationalSanitary Council and the Proposal of the Delegation of France to establish a Judicial BodyPart I : Report of the working party 281

Part II : Minority report of the delegation of the United Kingdom 284

Working Party on the Definition of " Infected Local Area " 285

Drafting Sub-Committee 286

Working Party on the Kamaran Quarantine Station 288

COMMITTEE ON INTERNATIONAL SANITARY REGULATIONSOF THE FOURTH WORLD HEALTH ASSEMBLY

Agenda 289

MINUTES

Page Page

First meeting 290 Third meeting 299

Second meeting 296 Fourth meeting 307

RESOLUTIONS

Resolutions adopted by the Committee on International Sanitary Regulations for presentation to theFourth World Health Assembly 316

FOURTH WORLD HEALTH ASSEMBLY IN PLENARY SESSION

Adoption of the International Sanitary Regulations and pertinent resolutions 321

Report of the Rapporteur of the Special Committee on Draft International Sanitary Regulations 324

Part II

THE INTERNATIONAL SANITARY REGULATIONS

Explanatory Memorandum 329

Text of the International Sanitary Regulations 334

Table of Comparison with the existing International Sanitary Conventions and similar Agreements 366

Index to the International Sanitary Regulations 381

General Index 411

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INTRODUCTION

Up to the middle of the nineteenth century, so far as international travel was concerned, sanitary measureswere applied by countries only when pestilence arrived at their shores. Quarantine practices were primitiveand differed widely from one place to another. Port administrations decided in each case what measuresshould be imposed. Decisions were, therefore, arbitrary and depended on the whims and caprices of localofficials.

Exactly one hundred years ago, in 1851, the rapid expansion of international trade and travel resultingfrom the advent of steam navigation and the great variety of quarantine practices led the French Governmentto convene, in Paris, the first of a long series of international conferences. The purpose of this conference wasto work out an agreement between the various countries for the application of the best preventive measuresagainst cholera, plague and yellow fever, and to discuss the adoption of a uniform sanitary code to govern inter-national traffic. Reluctance to adopt a common code, however, was strong and the conference did not meet withthe success it deserved. This first attempt was followed by a succession of further international conferences :in Paris in 1859 ; in Constantinople in 1866 ; in Vienna in 1874 ; in Washington in 1881 and in Rome in 1885 ;but it was not until 1892 that, for the first time, a convention dealing with the sanitary control of internationaltraffic was approved by all the participating countries.

The next date of interest is 1893 when, as a result of the cholera pandemic, an international conferencemet at Dresden. A year later, in 1894, the first sanitary conference on the Mecca Pilgrimage was held in Paris.In 1897 the appearance of plague in Bombay caused uneasiness in Europe and led to a similar meeting in Venice.

In the Americas, the Pan American Sanitary Bureau was established in Washington, D.C. in 1902, and thePan American Sanitary Convention signed in 1905. In 1903, a conference which met in Paris adopted resolutionsto establish an international health office and as a result the Office International d'Hygine Publique (OIHP)was set up by the Rome Agreement of 1907. The successful work of these two bodies in their early years,helped by the progress in scientific and technical knowledge, is demonstrated by the results of the succeedinginternational conferences. Following a conference in Paris, a new convention was adopted in 1912, and in1924 the Pan American Sanitary Code was signed at Habana.

After the first world war the Permanent Committee of the Office International d'Hygiène Publique held along series of meetings devoted to the preparation of a new and revised international sanitary convention,which was signed in 1926 in Paris by the representatives of 66 countries and subsequently ratified by 44. Thisconvention, as well as that of 1912, is still in force, although the former has been twice modified : by a conventionsigned in Paris in 1938 and by the International Sanitary Convention, 1944.

The development of air travel, still a relative new comer to international traffic (the Atlantic was firstflown in 1919, and in the same year the pioneer flight was made from England to Australia), showed the needfor a comparable code of practice to apply to aerial navigation. The Office International d'Hygiène Publique,in consultation with appropriate bodies, drafted the text of a convention which was presented for signature atThe Hague in 1933. This convention - the 1933 International Sanitary Convention for Aerial Navigation -was, like the 1926 convention for maritime traffic, modified by the International Sanitary Convention forAerial Navigation, 1944.

In 1934, the International Agreement for dispensing with Bills of Health and the International Agreementfor dispensing with Consular Visas on Bills of Health were signed in Paris.

The 1944 conventions referred to above came into force on 15 January 1945, by which time they had beensigned by 17 governments. Protocols to prolong the 1944 conventions were signed in Washington in 1946.

Thus, during the first half of the twentieth century there were no less than thirteen conventions or arrange-ments of a diplomatic character relating to health control measures to be taken at frontiers. Unfortunately,however, none of these conventions had ever completely superseded all its predecessors. The multiplicityof the obligations undertaken by States-some being party to certain of these diplomatic instruments but notto others-has always been a cause of trouble and confusion in international traffic. Further, the procedureby which conventions had to be signed subject to ratification did not allow the rapid simultaneous application

1

2 INTRODUCTION

of the agreed texts everywhere, nor could they readily and easily be brought up to date to take into account thechanging epidemiological situation, the experience gained or the progress of science and technique.

The question of the revision of the International Sanitary Conventions and their consolidation into onetext applicable to all means of transport was considered in March and April 1946 by the Technical PreparatoryCommittee of the International Health Conference. It was again taken up by the conference itself in June andJuly of the same year, and the universal recognition of the need for unification of international sanitary arrange-ments found expression in the inclusion, among the constitutional functions of the World Health Organization,of that of proposing conventions and regulations and making recommendations with respect to internationalhealth matters. The principle is further developed in Article 21, which gives the Health Assembly " authorityto adopt regulations concerning sanitary and quarantine requirements and other procedures designed toprevent the international spread of disease ". Nevertheless, the necessity for revising and codifying theconventions and the urgency of the work were not actually mentioned until the second session of the InterimCommission of the World Health Organization, in November 1946.

In conferring on the World Health Organization authority to adopt international sanitary regulations,the authors of the Constitution clearly intended to set up a new procedure to achieve the required unification,and to give the new regulations the flexibility made necessary by the rapidity of present advances in medicalknowledge and means of transport, impossible under the older system with its cumbersome procedure ofspecial international conferences and ratifications. That flexibility is provided by Article 22 of the Constitution,in pursuance of which regulations adopted by the Health Assembly come into force for all Members, exceptfor those signifying rejection or reservations within a given period, after simple notification. The procedure foramendment of the regulations is equally simple, and the World Health Assembly can ensure that the regulationsare promptly and continually adapted to changing circumstances and needs.

In the early months of its existence, the Interim Commission of the World Health Organization establishedexpert committees to prepare a revision of existing sanitary conventions by the study of such questions as thesanitary control of the Mecca Pilgrimage and modern advances in epidemiology and methods of disinsecting.The technical documentation thus produced was used by the Expert Committee on International Epidemiologyand Quarantine in framing a set of principles to serve as a guide in the preparation of the new internationalsanitary regulations. After approval of these principles by the Second World Health Assembly, the expertcommittee, with the help of its legal sub-committee, produced preliminary draft regulations which, after furtherstudy of comments and suggestions from governments, led to the draft to which the Special Committee gavefinal form with a view to its adoption by the Fourth World Health Assembly.

Among the main principles which have guided the authors of the Regulations must be mentioned the searchfor maximum security against international spread of disease with minimum interference with world traffic.Despite the circumstances and the difficulties encountered in reaching agreement, the text was deemed to be thebest possible attainable at present and was adopted unanimously on 25 May 1951 by the representatives ofthe 60 governments present at the Fourth World Health Assembly.

In conclusion, it may be reaffirmed that the Regulations are a revision and a consolidation of the texts ofthe numerous conventions and similar agreements still extant ; they will enter into force for all Member Statesof the World Health Organization (and also for those non-member States who so signify) on 1 October 1952,unless a reservation accepted by the Health Assembly, or a rejection, has previously been made.

* *

The first part of this publication consists of the proceedings of the Special Committee appointed by theThird World Health Assembly ; of the Committee on International Sanitary Regulations of the Fourth WorldHealth Assembly and of the plenary session of the Fourth World Health Assembly at which the Regulationswere adopted. The second part of the volume contains the text of the Regulations with an explanatory memo-randum, a table of comparison between the provisions of the Regulations and those of previous sanitaryconventions and similar agreements, and an index to the Regulations.

PART I

PROCEEDINGS

The Special Committee established by the Third World Health Assembly (resolutionWHA3 .71.1) to consider the draft International Sanitary Regulations met from 9 Apriluntil 15 May 1951 in the Palais des Nations, Geneva, and held 36 plenary meetings underthe chairmanship of Dr. M. T. Morgan (United Kingdom).

The Fourth World Health Assembly, also held in the Palais des Nations (7 to 25 May),appointed as one of its main committees the Committee on International Sanitary Regula-tions-again with Dr. Morgan as Chairman-which considered the text of the Regulationsprepared by the above Special Committee.

Participation in the meetings of the committee of the Fourth Health Assembly differedsomewhat from the membership of the Special Committee, since all Assembly delegationsare entitled, under the Rules of Procedure, to take part in the sessions of main committees.The names of members of these delegations are not reproduced in this volume, as a full listof delegates and other participants is contained in Official Records No. 35, Proceedings ofthe Fourth World Health Assembly.

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SPECIAL COMMITTEEAPPOINTED BY THE THIRD WORLD HEALTH ASSEMBLY

TO CONSIDER THE DRAFT INTERNATIONAL SANITARY REGULATIONS

LIST OF DELEGATES AND OTHER PARTICIPANTS

Delegations of Member States

AUSTRALIADelegate:

Dr. D. A. DOWLING, Chief Medical Officer,Australia House, London

AUSTRIA

Delegate :Mr. K. STROBL, Assistant Director, Federal

Ministry of Social Affairs

BELGIUMDelegates :

Dr. P. J. J. VAN DE CALSEYDE, Directeur généralde l'Hygiène, Ministère de la Santé publique etde la Famille (Chief Delegate)

Dr. A. N. DUREN, Inspecteur général de l'Hygiène,Ministère des Colonies

M. L. A. D. GEERAERTS, Directeur au Ministèredes Affaires étrangères et du Commerce extérieur

Adviser :

M. F. A. E. BOSMANS, Conseiller adjoint pour lesRelations internationales, Ministère de la Santépublique et de la Famille

BURMADelegate :

Dr. BA MAUNG, Port Health Officer, Rangoon

CANADADelegate:

Dr. H. D. REID, Chief, Quarantine, Immigration,Medical and Sick Mariners Services, Depart-ment of National Health and Welfare

Alternate:Dr. B. BUNDOCK, Medical Officer, Immigration

Medical Department, Canadian Embassy, TheHague

CHILEDelegate:

Dr. A. L. BRAVO, Executive Vice-President,Compulsory Social Insurance Fund

DENMARKDelegates :

Dr. E. J. HENNINGSEN, Deputy Chief MedicalOfficer, National Health Service (Chief Delegate)

Dr. J. A. LORCK, Assistant Chief of Section,Ministry of the Interior

DOMINICAN REPUBLICDelegate :

Mr. J. B. PEYNADO, Minister Plenipotentiary inSwitzerland

EGYPTDelegates :

Dr. M. A. NASR Bey, Under-Secretary of Statefor Health, Ministry of Public Health (ChiefDelegate)

Dr. M. S. EL-FAR Bey, Deputy Director-General,Quarantine Administration, Alexandria

Dr. A. EL-HALAWANI, Director, Fouad I ResearchInstitute of Tropical Medicine, Cairo

Adviser :

Mr. Z. HASHEM, Ministry of Foreign Affairs ;Member of the Council of State

FRANCEDelegates :

Dr. R. DUJARRIC DE LA RIVIÈRE, Sous-Directeurde l'Institut Pasteur, Paris (Chief Delegate)

M. R. MASPÉTIOL, Conseiller d'Etat

Dr. M. GAUD, Directeur du Centre internationalde l'Enfance, Paris ; ancien Directeur de l'OfficeInternational d'Hygiène Publique

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6 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Adviser :

Dr. A. BOYER, Chef du Bureau de la Prophylaxieinternationale et du Comité sanitaire auxFrontières, Ministère de la Santé publique etde la Population

GREECEDelegate:

Dr. G. P. ALIVISATOS, Professor of Hygiene at theUniversity and Professor of Epidemiology atthe School of Hygiene, Athens

ICELANDDelegate:

Dr. J. SIGURJÓNSSON, Professor of Hygiene,University of Iceland

INDIADelegate:

Dr. K. C. K. E. RAJA, Director-General of HealthServices

INDONESIADelegate:

Dr. MA'MOEN AL RASHID KOESOMADILAGA,

Director, Quarantine Service, Ministry of Health

Adviser :

Mrs. M. VANLONKHUIZEN BIEMOND, Head, Sectionfor Legal Affairs, Ministry of Health

IRANDelegates:

Dr. M. A. M0A1ED HEKMAT, Director-General,Ministry of Health (Chief Delegate)

Mr. Z. DAVIDIAN, Acting Director, InternationalHealth Relations Department, Ministry ofHealth

ITALYDelegates:

Professor G. A. CANAPERIA, Chief Medical Officer,Office of the High Commissioner for Hygieneand Public Health (Chief Delegate)

Dr. M. GRISOLIA, Chief Inspector and Chief,Division of Quarantine Services, Office of theHigh Commissioner for Hygiene and PublicHealth

Dr. R. MALAN, Health Inspector, Office of theHigh Commissioner for Hygiene and PublicHealth

Advisers:Mr. R. FERRARA, Vice-Consul in GenevaMr. S. CALLEA, Attaché, Consulate-General in

GenevaLAOS

Delegates:M. Ourot SOUVANNAVONG, COnseiller du Gou-

vernement royal du Laos ; Conseiller de l'UnionFrançaise (Chief Delegate)

Dr. P. CARON, Conseiller du Gouvernement royaldu Laos pour les Questions sanitaires

LUXEMBOURGDelegate:

Dr. P. SCHMOL, Directeur du Laboratoire bactério-logique de l'Etat

MONACODelegate:

M. R. BICKERT, Consul général à Genève

NETHERLANDSDelegates:

Dr. C. VAN DEN BERG, Director-General for Inter-national Health Affairs, Ministry of SocialAffairs (Chief Delegate)

Dr. G. D. HEMMES, Inspector of Public Health,Utrecht

Mr. P. S. VAN'T HAAFF, Inspector-General ofShipping, Ministry of Traffic and Waterways

Advisers:Mr. D. HUDIG, formerly Director, Royal Nether-

lands Steamship Company, AmsterdamDr. L. J. M. LENTJES, Medical Superintendent,

Royal Netherlands Steamship Company, Ams-terdam

Dr. K. M. SLOTBoom, Director of Medical Services,K.L.M. Royal Dutch Airlines, Amsterdam

Miss J. SCHALU, Department for InternationalHealth Affairs, Ministry of Social Affairs

NEW ZEALANDDelegate:

Dr. F. S. MACLEAN, Director, Division of PublicHygiene, Department of Health

NORWAYDelegate:

Dr. J. BJORNSSON, Deputy Director-General,National Health Services

LIST OF DELEGATES AND OTHER PARTICIPANTS 7

PAKISTAN

Delegate:Dr. M. JAFAR, Director-General of Health

PHILIPPINESDelegates:

Dr. R. G. PADUA, Under-Secretary of Health(Chief Delegate)

Dr. R. ABRIOL, Director, Quarantine Service,Department of Health

Alternate:Mr. M. C. ANGELES, Administrative Officer,

Department of Health

PORTUGALDelegate:

Dr. A. A. DE CARVALHO-DIAS, Senior Inspectorof Health ; Director of Maritime and AirHealth Services, Ministry of the Interior

SAUDI ARABIADelegates:

Dr. R. PHARAON, Minister Plenipotentiary inFrance (Chief Delegate)

Dr. B. ROUMY, Director of Health, Mecca District

Advisers:

Mr. A. R. HELAISSI, Secretary, Embassy, London

Mr. F. S. HUSSEINI, Secretary, Ministry ofForeign Affairs

Mr. S. KHANACHET, Press Attaché, Legation,Paris

SWEDENDelegates:

Dr. R. K. BERGMAN, Counsellor, Royal MedicalBoard (Chief Delegate)

Mr. A. LARSSON, Ministry of the Interior andHealth

SWITZERLAND

Delegates:Dr. P. VOLLENWEIDER, Directeur du Service fédéral

de l'Hygiène publique (Chief Delegate)Professeur H. MOOSER, Directeur de l'Institut

d'Hygiène de l'Université de Zurich

Adviser :

M. R. GORGÉ, Service fédéral de l'Hygiènepublique

SYRIADelegates:

Dr. M. SADAT, Under-Secretary of State for Health(Chief Delegate)

Dr. J. ARACTINGI, Director of Laboratories,Ministry of Health

THAILANDDelegate:

Dr. S. DAENGSVANG, Deputy Director-General,Department of Public Health, Ministry ofHealth

UNION OF SOUTH AFRICADelegate:

Dr. H. S. GEAR, Deputy Chief Health Officer forthe Union, Union Department of Health

UNITED KINGDOMDelegates:

Dr. M. T. MORGAN, Medical Officer, Port ofLondon Authority (Chief Delegate)

Mr. D. C. HASELGROVE, Assistant Secretary,Ministry of Transport (Deputy Chief Delegate)

Dr. R. H. BARRETT, Medical Officer, Ministry ofHealth

Mr. N. M. BRILLIANT, Senior Executive Officer,Ministry of Health

UNITED STATES OF AMERICA

Delegates:Dr. J. A. BELL, Medical Director, National

Institutes of Health (US Public Health Service)Bethesda Md. (Chief Delegate)

Mr. C. I. BEVANS, Assistant for Treaty Affairs,Department of State

Mr. H. B. CALDERWOOD, Office of United NationsEconomic and Social Affairs, Department ofState

Mr. K. STOWMAN, Foreign Affairs Health Adviser,Division of International Health, US PublicHealth Service

Lt-Col. L. C. KOSSUTH, Chief, Preventive MedicineBranch, Office of the Air Surgeon, Head-quarters US Air Force Europe, Paris

Mr. P. REIBER, Legal Counsel, Air TransportAssociation of America

1 Acted as Chief Delegate after Dr. Morgan's election asChairman of the Special Committee

8 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

YUGOSLAVIADelegate :

Dr. I. BRODAREC, Director, Institute of Hygiene,Zagreb ; Deputy Minister, Ministry of Healthfor Croatia

Observers for Non-Member States

COLOMBIA

Mr. G. GIRALDO-JARAMILLO, Consul-General inSwitzerland

FEDERAL REPUBLIC OF GERMANY 2

Dr. A. HABERNOLL, Counsellor, Department ofPublic Health, Federal Ministry of the Interior,Bonn

Professor O. E. W. OLSEN, Geneva

SPAIN 3

Dr. G. CLAVERO, Director, National School ofHealth, Madrid

Mr. A. DE AGUILAR, Minister Plenipotentiary ;Consul in Geneva

Representatives of the United Nations and otherInternational Organizations

UNITED NATIONS

Mr. P. DE BELLAIGUE, Transport and CommunicationDivision, Department of Economic Affairs

2 Admitted to membership of WHO, 16 May 1951 ; instru-ment of acceptance of the Constitution deposited 29 May 1951

3 Admitted to membership of WHO, 16 May 1951 ; instru-ment of acceptance of the Constitution deposited 28 May 1951

INTERNATIONAL LABOUR ORGANISATION

Mr. J. L. MOWAT, Chief, Maritime Division

Mr. A. COHEN, Migration Section, ManpowerDivision

INTERNATIONAL CIVIL AVIATIONORGANIZATION

Mr. R. J. MOULTON, Chief, Facilitation (FAL)Division

Dr. F. E. DE TAVEL, Medical Adviser

INTERNATIONAL TELECOMMUNICATION UNION

Mr. H. TOWNSHEND, Assistant Secretary-General

PAN AMERICAN SANITARY ORGANIZATION

Dr. N. N. BICA, Chief, Section of Epidemiologyand Statistics

Observers for Related Non-Governmental Organiza-tions

INTERNATIONAL AIR TRANSPORT ASSOCIATION

Sir Harold E. WHITTINGHAM, Chairman, MedicalCommittee

WORLD MEDICAL ASSOCIATION

Dr. J. MAYSTRE, Liaison Officer with WHO, Geneva

AGENDA

[A3-4/SR/3]1 March 1951

1 Introductory remarks by the Director-General

2 Election of Chairman

3 Election of Vice-Chairmen

4 Adoption of the agenda

5 Draft International Sanitary Regulations : WHO Regulations No. 2

5.1 Articles in the main body of the Regulations and the international forms of certificates

5.2 Annex A-Sanitary control of pilgrim traffic approaching or leaving the Hedjaz during the season of thePilgrimage

5.3 Annex B-Standards of hygiene and welfare on pilgrim ships and on aircraft carrying pilgrims

6 Control of insect vectors of malaria in international air traffic and the desirability of keeping in forcethe provisions contained in paragraph 2 of Article XVII of the International Sanitary Convention forAerial Navigation, 1944, pending the adoption of special WHO regulations on the subject

7 Draft memorandum introducing the International Sanitary Regulations and outlining the principles onwhich they are based

8 Other business

9 Election of Rapporteur

I Added by the Special Committee at its first meeting

DRAFT INTERNATIONAL SANITARY REGULATIONS[A3-4/SR/1]

Reproduced below is the draft text of the Regulations, which formed the basis of theSpecial Committee' s work (see Introduction and minutes of the first meeting, section I).Through the amendment of the draft Regulations by the committee, the original numberingof the articles was changed. To facilitate reference, therefore, the numbers of the corre-sponding articles in the Regulations as approved (page 334) have been inserted insquare brackets after the article numbers of the draft Regulations below.

The ... World Health AssemblyConsidering that one of the aims of international co-operation in public health is the eradication of disease ; that prolonged

efforts will be required until such eradication can be achieved ; that for the present there is danger of the spread of communicablediseases and that therefore Regulations remain necessary to limit the extension of outbreaks of disease ;

Recognizing the necessity to revise and consolidate the several International Sanitary Conventions and similar Arrangementsat present in force and to replace them by International Sanitary Regulations applicable to the several means of internationaltransport and aimed at ensuring the maximum security against the international transmission of communicable diseases withthe minimum interference with world traffic ;

Considering that, by virtue of such replacement, periodical revisions, in order to take account of future progress in science,will be facilitated ;

Having regard to Articles 2 (k), 21 (a), 22, 29, and 64 of the Constitution of the World Health Organization,ADOPTS, this ... 19.. , the following Regulations which are hereinafter referred to as " these Regulations "

PART I - DEFINITIONS

Article 1 [Art. 1]

For the purposes of these Regulations :" Addes aegypti index " means the percentage ratio, determinedafter examination of all habitations in a given area occupiedby a single family, between the number of such habitationsand the number in which breeding-places of larvae of Aëdesaegypti are found ;

" aircraft " means an aircraft making an internationalvoyage ;

" airport " means an airport designated by the State in whoseterritorx it is situated as an airport of entry or departure forinternational air traffic ;

" approved port " means a port which possesses the equipmentand personnel necessary for the deratting of vessels and whichis authorized to issue the Deratting and Deratting ExemptionCertificates referred to in Article 46 ;

" arrival" of a ship, an aircraft, an inland navigation vessel,a train, or a road vehicle means,

(a) in the case of a ship or an aircraft, arrival at a port ;(b) in the case of a train or a road vehicle, arrival at afrontier post ;(c) in the case of an inland navigation vessel, arrival eitherat a port or at a frontier post, as geographical conditionsand agreements among the States concerned, under Article 98or under the laws and regulations in force in the territory ofentry, may determine ;

" authenticated", when used in connexion with the signatureof a vaccinator on a certificate of vaccination, means :either (a) if the vaccinator is a member of a national or local

health service or of the armed forces of a State, theplacing on the certificate of the official stamp of hisservice ;

Or (b) in any other case, certification of the professionalstatus of the vaccinator by the health authority or anyother person qualified to do so by the Governmentof the territory where the certificate was issued orwhere the subsequent vaccination took place ;

" baggage " means the personal effects of a traveller or of amember of the crew ;

" crew " means the personnel of a vessel, aircraft, train, orroad vehicle who are employed for duties on board ;

" day " means an interval of twenty-four hours ;

" direct transit area " means a special area established inconnexion with an airport, approved by the health authorityconcerned and under its direct supervision, for accommodatingdirect transit traffic and, in particular, passengers and crewsbreaking their air journey without leaving the airport ;

" epidemic" means an extension or multiplication of a foyer ;

" epidemic diseases " means plague, cholera, yellow fever,smallpox, typhus, and relapsing fever ;

" first case " means the first non-imported case of an epidemicdisease in a local area hitherto free from it, or in which it hadceased to occur during the period indicated for each suchdisease in Article 6 of these Regulations ;

" foyer " means the occurrence of one or more secondarycases of an epidemic disease in the neighbourhood of a firstcase. The first case of yellow fever transmitted by Aëdesaegypti shall be considered as a foyer ;

" health administration" means the governmental authorityresponsible over the whole of a territory to which these Regula-tions apply for the implementation of the sanitary measuresprovided herein ;

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TEXT OF THE DRAFT REGULATIONS 11

" health authority" means the authority immediatelyresponsible for the application in a local area of the sanitarymeasures provided for that area by these Regulations ;

" imported case" means a case brought from one territoryto another ;

" infected local area" means a local area which is part ofa yellow-fever endemic area or a local area in which a firstcase of plague or cholera has occurred or where there is afoyer of yellow fever or an epidemic of smallpox, typhus, orrelapsing fever or where plague infection among rodents hasbeen found during the last six months on land or on craftwhich are part of the equipment of a port ;

" infected person" means a person who is suffering from anepidemic disease, or who is believed to be infected with sucha disease, or who is otherwise considered to be capable of trans-mitting the infection ; in the application of this definition, aperson presenting clinical signs of cholera shall, pendingbacteriological confirmation, be regarded as suffering fromcholera ;

" inland navigation port " means a port, other than a portnormally frequented by seagoing vessels, which is used forforeign trade ;

" inland navigation vessel" means a vessel making an inter-national voyage, other than a ship ;

" international journey " means a journey extending over atleast two territories whether different States or the same Statebe responsible for the international relations of these terri-tories ;

" international voyage" means, in the case of a ship, a voyagebetween ports of different territories, or between ports of thesame territory, but, in the latter instance, only in so far asregards the relations of the ship with any other territory ; in thecase of an aircraft or an inland navigation vessel, a voyageextending over at least two territories ; in each case, whetherdifferent States or the same State be responsible for the inter-national relations of the territories referred to ;

" isolation", when applied to a person or group of persons,means the separation of that person or group of persons fromother persons except the health staff on duty ;

" local area" means a part of a territory, which may be a portor an airport, possessing a health organization able to take theappropriate sanitary measures permitted or prescribed by theseRegulations ;

" medical examination" includes visit to and inspection of avessel, aircraft, train, or road vehicle, and the preliminaryexamination of persons on board ;

" Organization" means the World Health Organization ;

" pilgrim" means a person making the Pilgrimage, and, in thecase of passengers on board a pilgrim ship, includes everyperson accompanying or travelling with persons making thePilgrimage ;

" pilgrim ship " means a ship :(a) which voyages to and from the Hedjaz during a periodbeginning four months before and ending three months afterthe season of the Pilgrimage, and(b) which carried pilgrims in a proportion of not less thanone pilgrim per 100 tons gross ;

" Pilgrimage " means the pilgrimage to the Holy Places in theHedjaz ;

" relapsing fever " means louse-borne relapsing fever ;

" sanitary station" means a port, an airport, or a frontierpost at which the sanitary measures provided for in Annex Aare applied to pilgrims, and which is provided with adequatestaff, installations, and equipment for the purpose ;

" seaport " means a port which is normally frequented byseagoing vessels and used for foreign trade ;

" shiP " means a seagoing vessel making an internationalvoyage ;

" ship's surgeon", in the case of a pilgrim ship, means aqualified medical practitioner required to be employed on sucha ship, or, if there are two or more such medical practitionersso employed, the senior of them ;

" suspect " means a person who has been in contact with aninfected person under conditions exposing him to the risk ofinfection or who otherwise is considered by the health authorityas having been under such risk ;

" typhus" means louse-borne typhus ;

" valid certificate " when applied to vaccination means acertificate conforming with the rules and the model laid downin Appendix 2, 3, or 4, as appropriate ;

" vessel" means a ship or an inland navigation vessel ;

" yellow-fever endemic area" means an area in which Aëdesaegypti is present but is not obviously responsible for themaintenance of the virus which persists among jungle animalsover long periods of time and where its recent occurrence inhumans may be detected by appropriate methods ;

" yellow-fever receptive area " means an area in which yellowfever does not exist but where conditions would permit itsdevelopment if introduced.

PART II - NOTIFICATIONS AND EDPIDEMIOLOGICAL INFORMATION

Artzcle 2 [Art. 2]1. For the application of these Regulations each Staterecognizes the right of the Organization to communicatedirectly with the health administration of its territory orterritories. Any notification or information sent by the

Organization to the health administration shall beconsidered as having been sent to the State, and anynotification or information sent by the health administrationto the Organization shall be considered as having been sentby the State.

12 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

2. Any such notification or information received or sent bythe Organization by telegram or telephone shall be classed asa government telegram or telephone call respectively andentitled to the priority accorded to any such telegram ortelephone call.

Article 3 [Art. 31

I. Each health administration shall notify to the Organizationby telegram :

(a) the first case of plague, cholera, or yellow feverrecognized in a local area of its territory, designating thelocal area in which the case has occurred. Each such caseshall be confirmed by laboratory methods as far as localresources permit ;(b) the occurrence of an epidemic of smallpox, typhus, orrelapsing fever, designating the local area, or areas, affected ;

(c) the first discovery of rodent plague in a local area whichhas been free from this infection during the previous sixmonths. Each such case shall be confirmed by laboratorymethods as far as local resources permit.

2. Any such notification shall be made by the health adminis-tration as soon as it is informed of the occurrence and at thelatest within twenty-four hours of the receipt of such informa-tion.

Article 4 [Art. 4]

1. Any notification required under (a) and (b) of paragraph 1of Article 3 shall be promptly supplemented by informationas to the source and type of the disease, the number of casesand deaths, the conditions affecting the spread of the disease,and the prophylactic measures taken.

2. Any notification required under (c) of paragraph 1 ofArticle 3 shall be supplemented with monthly reports on theoccurrence.

Article 5 [Art. 5]

I. During an epidemic the notifications and informationrequired under Articles 3 and 4 shall be followed by subsequentcommunications sent at regular intervals to the Organization.

2. These communications shall be as frequent and as detailedas possible. The number of cases and deaths shall be com-municated at least once a week. The precautions taken toprevent the spread of the disease shall be stated, in particularwhat measures are being resorted to in order to prevent thespread of the disease to other territories by vessels, aircraft,trains, or road vehicles leaving the local area affected. In thecase of plague the measures taken against rodents shall bespecified. In the case of epidemic diseases transmitted by insectvectors the measures taken against such vectors shall also bespecified.

Article 6 [Art. 6]

1. The health administration for a territory in which aninfected local area is situated shall inform the Organizationwhen that local area is free from infection.

2. An infected local area, other than a local area within ayellow-fever endemic area, may be considered as free from

infection when all measures of prophylaxis have been takenand maintained to prevent the recurrence of the disease or itsspread to other areas, and when :

(a) in the case of plague, cholera, smallpox, typhus, andrelapsing fever, a period of time equal to twice the incubationperiod of the disease, as hereinafter provided, has elapsedsince the last case identified has died, recovered or beenisolated, and infection from that disease has not occurredin any other local area in the vicinity, provided that, inthe case of plague, if rodent plague is also present, theperiod determined under (c) of this paragraph has elapsed ;

(b) in the case of yellow fever outside a yellow-fever endemicarea, one year has elapsed after the occurrence of the lastdiagnosed human case, or two months after the reduction ofthe Aecles aegypti index to not more than one per cent ;

(c) in the case of rodent plague, six months have elapsedsince measures for the suppression of the epizootic have beensatisfact orily completed.

Article 7 [Art. 7]

Each health administration shall notify the Organizationforthwith of evidence of the presence of the virus of yellowfever in any part of its territory where it has not previously beenrecognized, and shall report the extent of the area involved.

Article 8 [Art. 8]

Each health administration shall notify the Organizationforthwith of any change in the immunization requirements forforeign travel. It shall furnish the Organization once a yearwith a recapitulation of all measures in force.

Article 9 [Art. 10]

Any notification and information required under Articles 3to 8 inclusive shall also be sent, on request, to any diplomaticmission or consulate established in the territory in which theinfected local area or areas are situated, the virus of yellowfever has been recognized, or any change in the immunizationrequirements has been made.

Article 10 [Art. II]

The Organization shall transmit to all health administrations,as soon as possible, all epidemiological and other informationwhich it has received under Articles 3 to 8 inclusive.

Article II

I. Each health administration shall immediately notify tothe Organization the measures which it has decided to applyto arrivals from an infected local area and the withdrawal ofany such measures, indicating the date of application orwithdrawal.

2. The Organization shall at once forward such informationto all other health administrations.

TEXT OF THE DRAFT REGULATIONS 13

PART III - SANITARY ORGANIZATION, METHODS, AND PROCEDURE *

Article 12

1. There shall be in each territory, in proportion to the im-portance of its international trade and intercourse, a numberof seaports or airports designated as sanitary ports or airports.

2. Where sanitary control is not carried out at the frontierthe same rule shall apply to inland navigation ports.

3. Sanitary ports or airports shall be furnished with anorganization and equipment sufficient for the reception of avessel or aircraft, whatever its health conditions may be, andshall fulfil the conditions laid down in Article 13 as well as inArticles 14 and 15 respectively.

Article 13

There shall be provided in each sanitary port or airport :

(a) an organized medical service with adequate staff,equipment, and premises ;

(b) facilities for the transport, isolation, and careinfected persons or suspects ;

(c) facilities for efficient disinfection and disinsecting andfor any other prophylactic measure that may be requiredunder these Regulations ;

(d) a bacteriological laboratory or facilities for dispatchingsuspected material to such a laboratory ;(e) arrangements for immediate vaccination againstcholera, yellow fever, and smallpox ;

(f) an effective system for the removal and safe disposal ofexcrement, refuse, waste water, condemned food, and othermaterial dangerous to health.

(a) the supply of pure drinking-water and clean food ;

(b) the cleanliness of all accommodation for passengers,crew, and ground staff ;

(c) the medical supervision of ground staff in relation toepidemic disease.

2. Every effort shall be made to keep the airport free ofrodents and of insect vectors of epidemic diseases and toextend rat-proofing to all airport installations.

3. The entry to or exit from the airport of any person shallalways be under the supervision of a competent authority.If an epidemic disease occurs in the surrounding area, accessto the airport by any route other than the air shall be forbiddento any person who might contaminate the airport, and adequatemeasures shall be applied to keep the airport free from vectorsof such disease.

4. If a sanitary airport is part of a yellow-fever endemicof area, the following complementary provisions shall apply :

(a) The airport shall :(i) be provided with mosquito-proofed dwellings andsick quarters for passengers, crews, and airport per-sonnel ;

(ii) be freed from mosquitos by systematically destroyingthem in their larval and adult stages within the perimeterof the airport and in a protective zone of four hundredmetres around that perimeter.

(b) For the purposes of this Article, the perimeter of anairport means a line enclosing the area containing theairport buildings and any land or water used or intended tobe used for the parking of aircraft.

(c) In the case of airports constructed after the coming-into-force of these Regulations, the protective zone shall bebuilding-free.

(d) Shelters for radio aids to navigation, control vans, andsimilar devices may be located within the protective zone iflocal circumstances make it necessary.

(e) Access to the protective zone shall be forbidden to allunauthorized persons.

Article 14

I. In addition to the requirements of Article 13 there shallbe provided in each sanitary port :

(a) an adequate supply of pure drinking-water at thedisposal of the port and of shipping ;

(b) a competent and adequate staff and equipment for thederatting of vessels, shipyards, docks, and warehouses ;

(c) a permanent organization for the collection andexamination of rats.

2. Every effort shall be made to extend rat-proofing to all portinstallations.

Article 15

1. In addition to the requirements of Article 13 and with aview to maintaining in sanitary airports, particularly in airportswith direct transit areas, a high level of hygiene, cleanliness,and prevention of epidemic disease, there shall be in suchairports general supervision of hygiene, particularly in regard to

* In view of the extensive changes in Part III, comparisonof articles in the draft text with those in the final text is imprac-ticable ; the numbers in square brackets have therefore beenomitted.

Article 16

Sub-paragraph (a) of paragraph 4 of Article 15 shall alsoapply to an airport other than a sanitary airport if it is part ofa yellow-fever endemic area.

Article 17

I. Each health administration shall :

(a) send to the Organization :

(i) a list of the sanitary ports and airports in its territory,stating in respect of each of them the sanitary services andfacilities which it possesses ;

14 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

(ii) a list of the approved ports in its territory ;

(b) notify any change which may occur from time to timein the lists under sub-paragraph (a) of this paragraph.

2. The Organization shall transmit forthwith to all healthadministrations the information received in accordance withparagraph 1 of this Article.

Article 18

Wherever the volume of international traffic is sufficientlyimportant and whenever epidemiological conditions so require,sanitary facilities shall be provided for the application of themeasures provided for in these Regulations at frontier posts,on railway lines, and roads and, where sanitary control overinland navigation is carried out at the frontier, also on inlandwaterways.

Article 19

1. Disinfection, disinsecting, deratting, and other sanitaryoperations shall be so carried out as :

(a) not to cause discomfort to, nor to be injurious to thehealth of, passengers and crew ;

(b) not to produce any deleterious effect on the structure ofthe vessel, aircraft, or vehicle or on its operating equipment ;

(c) not to create any fire hazard.

2. In carrying out such operations on goods, baggage, andother articles, every precaution shall be taken to avoid anydamage. Rags not carried as merchandise and other articlesof inconsequential value may, however, be destroyed.

Article 20

1. A health authority, when so requested, shall issue, free ofcharge, to the carrier, a certificate specifying the measuresapplied to the vessel, aircraft, railway carriage, wagon, orroad vehicle, the parts thereof treated, the niethods employed,and the reasons why the measures have been applied. In thecase of an aircraft this information shall instead be' entered, onrequest, in the General Declaration.

2. Similarly, a health authority, when so requested, shall issuefree of charge to any traveller a certificate specifying the dateof his arrival or departure and the measures applied to himand his baggage, and to any party concerned a certificatespecifying the measures applied to goods.

PART IV - PROVISIONS APPLICABLE TO ALL EPIDEMIC DISEASES

Chapter I - General Provisions

Article 21 [Art. 23]

The sanitary measures permitted by these Regulations arethe maximum measures, applicable to international traffic,which a State may require for the protection of its territoryagainst epidemic diseases. Any measure in excess of thismaximum shall constitute an infringement of these Regulations.

Article 22 [Art. 24]

Sanitary measures and health formalities shall be initiatedforthwith and completed without any avoidable delay.

Article 23 [Art. 27]

A person under surveillance shall not be isolated and maymove about freely, provided that the health authority for anyplace to which he intends to proceed is notified beforehandof his coming. Any such health authority may require theperson under surveillance to report to it on arrival and ifnecessary at specified intervals during the period of sur-veillance. Apart from the provision of Article 62, the healthauthority may also subject such a person to medical investiga-tion and make any inquiries which are necessary for as-certaining his state of health.

Article 24 [Art. 28]

Except in case of grave emergency, the health authority fora port or airport shall not on account of any other communi-

cable disease withhold free pratique from a ship or aircraftwhich is not infected with an epidemic disease, or suspected ofbeing so infected.

Chapter II - Sanitary Measures on Departure

Article 25 [Art. 30]

I. The health authority for a port or airport or for the localarea in which a frontier post is situated may, when it considersit necessary, medically examine any person before his departureon an international journey. This examination shall be soarranged as to time and place, with regard to the customsexamination and other formalities, as to avoid any delay.

2. The health authority referred to in paragraph 1 of thisArticle shall take all practicable measures :

(a) to prevent the departure of any infected person orsuspect ;

(b) to prevent the introduction on board a vessel, aircraft,train, or road vehicle of possible agents of infection, aswell as of vectors of any epidemic disease present in thelocal area of departure.

3. Notwithstanding the provisions of sub-paragraph (a) ofparagraph 2 of this Article, a person on an international voyagewho on arrival is placed under surveillance may be allowed tocontinue his journey by air. The health authority of the airportshall record the fact on the General Declaration.

TEXT OF THE DRAFT REGULATIONS 15

Chapter III - Sanitary Measures Applicable between Portsor Airports of Departure and Arrival

Article 26 1 [Art. 31]

No human dejecta or any other matter capable of producingan epidemic or other communicable disease shall be thrownor allowed to fall from an aircraft when it is in flight.

Article 27 [Art. 32]

I. No sanitary measure shall be applied by a State to anyship which passes through its territorial waters withoutcalling at a port or on the coast.

2. If for any reason such call should be made, the sanitarylaws and regulations in force in the territory may be appliedwithout exceeding, however, the provisions of these Regu-lations.

Article 28 [Art. 33]

1. No sanitary measures shall be applied to a healthy ship,as hereinafter defined, which passes through a maritimecanal or waterway in the territory of a State on its way to aport in the territory of another State unless such ship comesfrom an infected local area or has on board any passengercoming from an infected local area.

2. The only measures which may be applied to such a shipcoming from such an area or having such a passenger on boardare :

(a) medical examination of the passengers and crew ;(b) if necessary, the stationing on board of a sanitaryguard to prevent all unauthorized contact between the shipand shore.

3. A health authority shall permit any such ship to take on,under its control, fuel and water.

4. An infected or suspected ship which passes through amaritime canal or waterway may be treated by the healthauthority for the maritime canal or waterway as if it were callingat a port in the same territory.

Article 29 [Art. 34]

Notwithstanding any provision to the contrary in theseRegulations, no sanitary measure, including vaccination, shallbe applied to :

(a) passengers and crew on board a healthy ship from whichthey do not disembark ;(b) passengers and crew on healthy aircraft who are intransit through a territory and who remain in a direct

1 It should be noted in this connexion that the followingprovision has already been adopted in 1948 by the InternationalCivil Aviation Organization in Annex 2 to the Conventionon International Civil Aviation opened for signature atChicago on 7 December 1944 :

" 2.11 - Dropping obiects: A pilot in command of anaircraft shall not permit anything to be dropped from theaircraft in flight that might create hazard to persons or propertyon the ground or water."

Consequently, therefore, Article 26 would appear to besuperfluous.

transit area of an airport of that territory, or, if the airportis not yet provided with such an area, submit to the measuresfor segregation prescribed in order to prevent the spreadof disease. If such persons are obliged to leave the airportat which they arrive solely in order to continue their journeyfrom another airport in the vicinity, no such measure shallbe applied to them if the transfer is made under the controlof the health authority or authorities.

Chapter IV - Sanitary Measures on Arrival

Article 30 [Art. 36]

The sanitary measures which may be applied to a vessel oraircraft shall be determined by the conditions on board whichexisted during the voyage or which exist at the time of themedical examination.

Article 31 2 [Art. 37]

Where measures provided in Part V depend on a vessel,aircraft, persons, or articles having arrived from an infectedlocal area, the geographical limits of that area shall be takeninto account in applying these measures, provided that theState in whose territory that area is situated is taking allmeasures necessary for checking the spread of the disease andis applying the measures provided for in paragraph 2 ofArticle 25.

Article 32 [Art. 36]

The health authority for a port, airport, or frontier stationmay subject to medical examination on arrival any vessel,aircraft, train, or road vehicle as well as any person on aninternational journey.

Article 33 [Art. 38]

On arrival of a vessel, aircraft, train, or road vehicle, aninfected person on board may be removed and isolated. Suchremoval shall be compulsory if it is required by the person incharge of the means of transport.

Article 34 [Art. 39]

1. Apart from the provisions of Part V of these Regulations,a health authority may place under surveillance any suspect onan international journey arriving by whatever means in its localarea from an infected local area. Such surveillance may becontinued until the end of the period of incubation specifiedhereinafter.

2 The Legal Sub-Committee of the Expert Committee onInternational Epidemiology and Quarantine has left unchangedArticle 31 (the wording of which is that suggested for Article24, on page 16 of WHO/Epid/5l Rev. 1), as the sub-committeeis not clear as to the meaning and purpose of the phrase " themeasures shall have regard to the geographical limits of thatarea " [i.e., an infected local area]. This phrase might suggestthat the basis of the application of measures on arrival isnot always the local area, but something wider, and thiswould appear to conflict with the intent of Article 3 andthe detailed provisions of Part V.

16 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

2. Apart from sub-paragraph (a) of paragraph 1 of Article 56,paragraph 3 of Article 75, sub-paragraph (a) of paragraph 1 ofArticle 77, and Article 79, isolation may not be substituted forsurveillance unless the health authority considers the risk oftransmission of the infection by the suspect to be exceptionallyserious.

Article 35 [Art. 40]

Except as provided under paragraph 2 of Article 71, sanitarymeasures other than medical examination applied at a port orairport shall not be repeated at any subsequent port or airportwhere a ship or aircraft may call, unless, after the departure ofthe ship or aircraft from the port or airport where the measureswere applied, an incident of epidemiological significance hasoccurred either in that port or airport or on board theship or aircraft, calling for a further application of any ofsuch measures.

Article 36 [Art. 41]

Subject to paragraph 1 of Article 71, a vessel or an aircraftmay not be prevented for sanitary reasons from calling atany port or airport. If the port or airport, however, is notequipped for applying those sanitary measures which arepermitted by these Regulations and which in the opinion ofthe health authority for the port or airport are required, suchvessel or aircraft may be ordered to proceed at its own risk tothe nearest convenient port or airport.

Article 37 [Art. 42]

An aircraft shall not be considered as having come from aninfected local area merely because on its way over infectedterritory it has landed at a sanitary airport, or airports, whichare not themselves infected local areas.

Article 38 [Art. 43]

Any person on board an aircraft which has flown over aninfected local area, but has not landed there or has landed thereunder the conditions laid down in Article 29, shall not beconsidered as having arrived from such an area.

Article 39 [Art. 44]

Except in the case of a ship or aircraft infected with yellowfever or suspected of being so infected and arriving in a yellow-fever receptive area, any ship or aircraft which calls at a port

or airport and is unwilling to submit to the measures required,in accordance with these Regulations, by the health authorityfor that port or airport shall be allowed to depart forthwithwithout calling during its voyage at another port or airportof the same territory. Such ship or aircraft, however, shall bepermitted to take on fuel, water, and spare parts, providedthat it remains in isolation. If, on medical examination, a shipis found to be healthy, it shall not lose the benefit of Article 28.

Chapter V - Measures concerning the InternationalTransport of Goods, Baggage, and Mail

Article 40 [Art. 46]

1. Goods shall be submitted to sanitary measures only in sofar as there is reason to believe that they may have becomecontaminated by the infection of an epidemic disease or mayserve as a vehicle for insect vectors of any such disease.

2. Apart from the measures provided for in Article 61,goods, other than live animals, in transit without transhipmentby whatever means of transport shall not be detained at anyport, airport, or frontier.

Article 41 [Art. 47]

Except in the case of an infected or suspected person,baggage may be disinfected or disinsected only in the case of aperson carrying infective material or insect vectors of anepidemic disease.

Article 42 [Art. 48]

1. Mail, newspapers, books, and other printed matter shallnot be subject to any sanitary measure.

2. Postal parcels may be subject to sanitary measures onlyif they contain :

(a) any of the foods referred to in paragraph 1 of Article 61which the health authority has reason to believe comes froma cholera-infected area, or(b) linen, wearing apparel, or bedding which has beenused or soiled and to which the provisions of Part V of theseRegulations are applicable.

3. Until the Organization has adopted regulations withregard to the international transport of infectious laboratorymaterial, such transport remains subject to the laws andregulations in force in each territory.

PART V - SPECIAL PROVISIONS AS TO EACH OF THE EPIDEMIC DISEASES

Chapter I - Plague

Article 43 [Art. 49]For the purposes of these Regulations the incubation

period of plague is six days.

Article 44 [Art. 50]Vaccination against plague shall not be required as a

condition of admission of any person to a territory.

Article 45 [Art. 51]

Each State shall employ all means in its power to diminishthe danger from the spread of plague by rodents. Its healthadministration shall keep itself constantly informed by syste-matic collection and regular examination of rodents and theirectoparasites of the conditions in any local area, especiallyany port, infected or suspected of being infected by rodentplague.

TEXT OF THE DRAFT REGULATIONS 17

Article 46 8 [Art. 52]

1. Every vessel shall be either,

(a) periodically deratted ; or

(b) permanently kept in such a condition that the numberof rats on board is negligible.

In the former case, there shall be delivered for the vessela Deratting Certificate, and in the latter a Deratting ExemptionCertificate.

2. A Deratting Certificate or a Deratting Exemption Certifi-cate shall be issued only by the health authority of an approvedport. Every such certificate shall be valid for six months,but this period may be extended by one month for a shipproceeding to an approved port if the deratting or inspection,as the case may be, would be facilitated by the operationsdue to take place there.

3. Deratting Certificates and Deratting Exemption Certi-ficates shall conform with the model specified in Appendix 1to these Regulations.

4. If a valid certificate is not produced, the health authorityat an approved port, after inquiry and inspection, may proceedin the following manner :

(a) it may derat the vessel or cause the deratting to bedone under its direction and control. It shall decide in eachcase the technique which should be employed to secure theextermination of rats on the vessel. Deratting shall becarried out so as to avoid as far as possible damage to thevessel and to any cargo and shall not take longer thantwenty-four hours. Wherever possible it shall be done

of a vessel in ballast,it shall be done before loading. When deratting has beensatisfactorily completed, the health authority shall issue aDeratting Certificate ;

(b) or it may issue a Deratting Exemption Certificate ifit is satisfied that the number of rats on board is negligible.Such a certificate shall be issued only if the inspection of thevessel has been carried out when the holds are empty orwhen they contain only ballast or other material, unattractiveto rats, of such a nature or so disposed as to make a thoroughinspection of the holds possible. A Deratting ExemptionCertificate may be issued for an oil-tanker with full holds.

5. Should deratting have been effected under conditionswhich, in the opinion of the health authority for the portwhere the operation was performed, are not suitable forobtaining a satisfactory result, a note explaining the circum-stances and stating the need for a renewed deratting as soonas practicable shall be made on the Deratting Certificate.

3 The Legal Sub-Committee has been advised as follows :It is important that, in the interest of shipping, there should

be as many ports as possible approved for the issue of DerattingCertificates. It is questionable whether it is necessary toapprove ports for the issue of Exemption Certificates.

The inspection of a ship, even of large tonnage, can berapidly completed by one well-trained sanitary inspector andthe only equipment he requires is a hand torch. There isno reason, therefore, why an inspector from a large portshould not visit a ship in a small port to inspect the shipwhen the certificate has expired and if the ship is free from ratsissue a Deratting Exemption Certificate.

Article 47 [Art. 53]

In exceptional circumstances, when the presence of rodentsis suspected on board, an aircraft may be deratted.

Article 48 [Art. 54]

Before departure on an international journey from a localarea where there is an epidemic of pulmonary plague, suspectsshall be placed in isolation for a period of five days reckonedfrom the date of the last exposure to infection.

Article 49 [Art. 55]

1. A vessel or an aircraft shall be regarded as infected if :(a) it has a case of human plague on board ; or(b) a plague-infected rodent is found on board.

A vessel shall also be regarded as infected if a case of humanplague has occurred more than six days after embarkation.

2. A vessel shall be regarded as suspected if a case of humanplague has occurred within the first six days after embarkationor if there is evidence of an abnormal mortality amongrodents on board of which the cause is not known.

An aircraft shall be regarded as suspected if a case of humanplague has occurred on board during the voyage, but haspreviously been disembarked.

3. Even when coming from an infected local area or havingon board a person coming from an infected local area, avessel or an aircraft shall be regarded as healthy if, on medicalexamination, the health authority is satisfied that :

(a) there has been no human plague or rodent plague onboard since the departure from that area, and(b) in the case of a vessel, there is no evidence of anabnormal mortality among rodents on board.

Article SO [Art. 56]

1. On arrival of an infected or suspected vessel or aircraft,the following measures may be applied by the health authority :

(a) disinsecting of suspects and their surveillance for aperiod of not more than six days reckoned from the dateof arrival ;(b) disinsecting and, if necessary, disinfection of anybaggage of any infected person or suspect, as well as of anyother article, such as bedding which has been used andsoiled linen, and of any part of the vessel or aircraft, whichmay be contaminated.

2. If there is rodent plague on board a vessel it shall bederatted, if necessary in quarantine. Deratting operations shallbe effected in accordance with Article 46, subject to thefollowing provisions :

(a) the deratting operations shall be effected as soon as theholds have been emptied ;(b) one or more preliminary derattings of a vessel with thecargo in situ or during its unloading may be ordered toprevent the escape of infected rodents ;(c) if the complete destruction of rodents cannot be securedbecause only part of the cargo is due to be unloaded, a vesselshall not be prevented from unloading that part, but thehealth authority may apply any measures, including placing

18 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

the vessel in quarantine, which it considers necessary toprevent the escape of infected rodents.

3. If there is rodent plague on board an aircraft it shall bederatted, if necessary in isolation.

4. The vessel or aircraft shall cease to be regarded as infectedor suspected when the measures ordered by the health authorityin accordance with this Article have been carried out and shallthereupon be given free pratique.

Article 51 [Art. 58]

On arrival, a healthy vessel or aircraft shall be given freepratique but, if it comes from an infected local area, the healthauthority may :

(a) place any suspect under surveillance for a period ofnot more than six days reckoned from the date on whichthe vessel or aircraft left the infected local area(b) in exceptional cases and for reasons communicatedin writing to the master or pilot in command, derat the wholeor part of the vessel or aircraft.

Article 52 [Art. 59]

If, on arrival of a train or a road vehicle, a case of humanplague is discovered, the measures provided for in paragraph 1of Article 50 may be applied by the health authority, themeasures of disinsecting and, if necessary, disinfection beingapplied to any part of the train or road vehicle which may becontaminated.

Chapter II - Cholera

Article 53 [Art. 60]

For the purposes of these Regulations the incubation periodof cholera is five days.

Article 54 4 [Art. 61]

1. The possession of a valid anticholera vaccination certificateshall be taken into consideration by health authorities inapplying the measures provided for in these Regulations.

2. Until the Organization has adopted regulations concerningstandards for anticholera vaccines the standards in force in thecountries where the vaccine is administered shall be accepted.

3. The health authority of a local area which is not infectedmay require any person who arrives there on an internationaljourney from an infected local area and who is unable toproduce a valid certificate of vaccination against cholera to beso vaccinated or to be placed under surveillance for a periodnot exceeding five days from the date of departure from theinfected local area.

4 The Legal Sub-Committee has been advised as follows :As this Article is at present worded the traveller has the

option between vaccination or surveillance. It is importantto give the authorities of arrival the power to submit potentialcases of cholera to surveillance whether in possession or not ofa valid certificate.

4. Subject to sub-paragraph (a) of paragraph 1 of Article 56,the health authority of an infected local area shall not requirea person arriving there on an international journey to producea certificate of vaccination against cholera.

Article 55 [Art. 62]

1. A vessel shall be regarded as infected if it has a case ofcholera on board or if a case of cholera has occurred onboard during a period of five days before arrival.2. A vessel shall be regarded as suspected if a case of cholerahas occurred on board during the voyage, but a fresh case hasnot occurred during a period of five days before arrival.3. An aircraft shall be regarded as infected if it has a caseof cholera on board. It shall be regarded as suspected if acase of cholera has occurred on board during the voyage buthas previously been disembarked.4. Even when coming from an infected local area or havingon board a person coming from an infected local area, a vesselor an aircraft shall be regarded as healthy if, on medicalexamination, the health authority is satisfied that no case ofcholera has occurred on board during the voyage.

Article 56 [Art. 63]

1. On arrival of an infected vessel or aircraft, the followingmeasures may be applied by the health authority :

(a) for a period of not more than five days, reckoned fromthe date of arrival, surveillance of any passenger or memberof the crew who produces a valid certificate of vaccinationagainst cholera, and isolation of all others ;(b) disinfection of any baggage of any infected person orsuspect, as well as of any other article, such as bedding whichhas been used or soiled linen, and of any part of the vessel oraircraft, which may be contaminated ;(c) disinfection and removal of any water carried on boardthat may be contaminated and disinfection of the con-tainers, which shall then be refilled with wholesome water.

2. Human dejecta, waste water including bilge-water, wastematter, and any other contaminated substance shall not bedischarged or unloaded without previous disinfection. Theirsafe disposal shall be the responsibility of the health authority.

Article 57 [Art. 64]

1. The measures provided under sub-paragraphs (b) and (c)of paragraph 1 and under paragraph 2 of Article 56 may beapplied to a suspected vessel or aircraft.2. In addition, any passenger or member of the crew may beplaced under surveillance for a period of not more than fivedays reckoned from the date of arrival.

Article 58 [Art. 65]

The vessel or aircraft shall cease to be regarded as infectedor suspected when the measures required by the healthauthority in accordance with Articles 56 and 57 respectivelyhave been carried out and shall thereupon be given freepratique.

Article 59 [Art. 66]On arrival, a healthy vessel or aircraft shall be given free

pratique but, if it comes from an infected local area, the health

TEXT OF THE DRAFT REGULATIONS 19

authority may place the passengers and crew under surveillancefor a period of not more than five days reckoned from thedate on which the vessel or aircraft left that area.

Article 60 [Art. 67]

If, on arrival of a train or a road vehicle, a case of cholerais discovered, the following measures may be applied by thehealth authority :

(a) surveillance of any suspect for a period of not morethan five days reckoned from the date of his arrival ;

(b) disinfection of any baggage of the infected person and,if necessary, of any suspect, as well as of any other article,such as bedding which has been used or soiled linen, and ofany part of the carriage or other vehicle, which may becontaminated.

Article 61 [Art. 681

I. On arrival of an infected or suspected vessel or aircraft,of a train or a road vehicle on which a case of cholera hasbeen discovered, or of a vessel, aircraft, train, or road vehiclecoming from an infected local area, the health authority mayprohibit the unloading of, or may remove, any of the followingfresh or refrigerated foods which can be eaten uncooked,namely, fish, shellfish, fruit, and vegetables, which it hasreason to believe to be contaminated. If such food is removed,arrangements shall be made for its safe disposal.

2. If such food forms part of the cargo, only the healthauthority of the place of importation may exercise the powerto remove it.

3. The pilot in command of an aircraft may always requirethe removal of such food.

Article 62 5 [Art. 69]

Persons without symptoms of cholera arriving on an inter-national journey from a cholera-infected area shall not berequired to submit to stool examination or rectal swabbing.

Chapter IH - Yellow Fever

Article 63 [Art. 70]

Each yellow-fever endemic and receptive area shall bedelineated by the Organization in consultation with each of theStates concerned, and may be altered similarly from time totime. These delineations shall be notified by the Organizationto all health administrations.

5 The Legal Sub-Committee has been advised :1. that a stool examination for cholera is an essential elementin the diagnosis of the disease and it seems difficult, therefore,to prevent a health authority from resorting to it, whenthey suspect a person is infected.2. on the other hand the Expert Committee on InternationalEpidemiology and Quarantine agreed that any measures suchas injections to which certain persons may strongly objectshould not be made compulsory. Rectal swabbing is clearlya measure to which the same consideration should apply.

Article 64 [Art. 711

For the purpose of these Regulations the incubation periodof yellow fever is six days.

Article 65 [Art. 72]

1. Vaccination against yellow fever shall be required of anyperson leaving an infected local area on an internationaljourney and proceeding to a receptive area.2. Should such a person be in possession of a certificate ofvaccination which is not yet valid, he may nevertheless bepermitted to depart, but the provisions of paragraph 1 ofArticle 67 may be applied to him on arrival.3. A person in possession of a valid certificate of vaccinationagainst yellow fever shall not be treated as a suspect, even ifhe comes from an infected local area.

Article 66 [Art. 73]

1. Every person employed at an airport situated in an infectedlocal area and every member of the crew of an aircraft usingany such airport shall be in possession of a valid certificateof vaccination against yellow fever.2. Every aircraft leaving an airport situated in an infectedlocal area and bound for a receptive area shall be disinsectedbefore departure. This measure shall be taken in sufficienttime to avoid delaying the departure of the aircraft. TheStates concerned may agree that the accessible portions of theaircraft shall be disinsected during flight.3. Every aircraft leaving a local area where Aëcles aegyptiexists and bound for a receptive area already freed fromAeares aegypti shall similarly be disinsected.

Article 67 [Art. 74]

1. The health authority for any receptive area may require aperson on an international journey who arrives there from aninfected local area and is unable to produce a valid certificateof vaccination against yellow fever to be isolated until hiscertificate becomes valid or until a period of six days reckonedfrom the date of last possible exposure to infection has elapsed,whichever occurs first.

2. The health authority for an infected local area shall notrequire any person arriving there on an international journeyto produce a valid certificate of vaccination against yellowfever on arrival, even if he has come from another infectedlocal area.

Article 68 [Art. 76]

1. A vessel shall be regarded as infected if it has a case ofyellow fever on board or if a case has occurred on boardduring the voyage. It shall be regarded as suspected ifa period of six days has not elapsed reckoned from thedate of its departure from an infected local area. Any othervessel shall be regarded as healthy.2. An aircraft shall be regarded as infected if it has a caseof yellow fever on board. It shall be regarded as suspected ifthe health authority is not satisfied with a disinsecting carriedout under the terms of paragraph 2 of Article 66. Any otheraircraft shall be regarded as healthy.

20 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Article 69 [Art. 77]

1. On arrival of an infected or suspected vessel or aircraft,the following measures may be applied by the health authority :

(a) in a receptive area the measures provided for in para-graph 1 of Article 67 to any passenger or member of thecrew who disembarks and is not in possession of a validcertificate of vaccination against yellow fever ;

(b) inspection of the vessel and destruction of Milesaegypti, if any, on board. In a receptive area, the vesselmay, until such measures have been carried out, also berequired to keep at least four hundred metres from land.

2. The vessel or aircraft shall cease to be regarded as infectedor suspected when the measures ordered by the health authorityin accordance with paragraph 1 of this Article have beencarried out and shall thereupon be given free pratique.

Article 70 [Art. 78]

On arrival of a healthy vessel or aircraft coming from aninfected local area, the measures provided for in sub-para-graph (b) of paragraph 1 of Article 69 may be applied. Thevessel or aircraft shall thereupon be given free pratique.

Article 71 [Art. 79]

I. A State shall not prohibit the landing at its sanitaryairports of any aircraft as long as the measures provided forin paragraph 2 of Article 66 are duly applied. In a receptivearea, however, the State may designate a specified airport orairports as the only ones where aircraft coming from an infectedlocal area may land.

2. In the case of an aircraft disinsected in accordance withthe terms of paragraphs 2 and 3 of Article 66, a further dis-insecting on arrival shall not be required unless there are specialreasons for suspecting the presence on board of Aecies aegypti.

Article 72 [Art. 801

On arrival of a train or a road vehicle in a receptive area,the following measures may be applied by the health authority :

(a) isolation, as provided for in paragraph 1 of Article 67,of any person coming from an infected local area who isunable to produce a valid certificate of vaccination againstyellow fever ;

(b) disinsecting of the train or vehicle if coming from aninfected local area.

Article 73 [Art. 81]

In a receptive area the isolation provided for in Article 33and in this Chapter shall be in mosquito-proof accommodation.

Chapter IV - Smallpox

Article 74 [Art. 82]

For the purposes of these Regulations the incubation periodof smallpox is fourteen days.

Article 75 6 [Art. 831

I. A person on an international journey who arrives from alocal area which is not an infected local area shall not berequired on arrival to produce a certificate of vaccinationagainst smallpox.

2. A person on such a journey who has left an infected localarea within the previous fourteen days and who in the opinionof the health authority is not sufficiently protected by vaccina-tion or by a previous attack of smallpox may be required onarrival to submit to vaccination against smallpox, or sur-veillance.

3. A person refusing vaccination may be isolated.

4. The period of isolation or surveillance shall not exceedfourteen days reckoned from the date of departure of theperson from the infected local area.

Article 76 [Art. 84]

A vessel or an aircraft shall be regarded as infected if ithas a case of smallpox on board or if a case has occurred onboard during the voyage. Any other vessel or aircraft shallbe regarded as healthy.

Article 77 [Art. 85]

I. On arrival of an infected vessel or aircraft, the followingmeasures may be applied by the health authority :

(a) vaccination, or surveillance, or isolation, or vaccinationand surveillance, or vaccination and isolation, of anypassenger or member of the crew who is a suspect and who,in the opinion of the health authority, is not sufficientlyprotected by vaccination or by a previous attack of smallpox,the period of surveillance or isolation being not more thanfourteen days reckoned from the date of the disembarkationof the suspect ;(b) disinfection of any baggage of any infected person orsuspect as well as of any other article, such as beddingwhich has been used and soiled linen, and of any part of thevessel or aircraft, which may be contaminated.

2. A vessel or an aircraft shall cease to be regarded as infectedwhen the measures ordered by the health authority inaccordance with paragraph 1 of this Article have been carriedout and shall thereupon be given free pratique.

Article 78 [Art. 86]

On arrival, a healthy vessel or aircraft, even when comingfrom an infected local area, shall be given free pratique.

Article 79 [Art. 87]

If, on arrival of a train or a road vehicle, a case of smallpoxis discovered, the measures provided in Article 77 may beapplied by the health authority, the period of surveillance orisolation, if any, of suspects being reckoned from the date of

6 The Legal Sub-Committee has been advised as follows :It is important that a person arriving from an infected local

area should not be forced to submit to vaccination. On theother hand, it is equally important that the health authorityshould have the power to place the person under surveillanceeven if the person has accepted vaccination.

Further, a health authority may in certain circumstancesrequire isolation until the result of the vaccination is known.

TEXT OF THE DRAFT REGULATIONS 21

arrival of the train or road vehicle and measures of disinfection,of any, being applied to any part of a train or road vehiclewhich may be contaminated.

Chapter V - Typhus

Article 80 [Art. 881

For the purposes of these Regulations the incubation periodof typhus is fourteen days.

Article 81 [Art. 89]

Vaccination against typhus shall not be required as a con-dition of admission of any person to a territory.

Article 82 [Art. 901

1. On departure from an infected local area any person onan international journey whom the health authority considersliable to transmit typhus shall be disinsected as well as theclothes he is wearing and his baggage.

2. A person on such a journey who has left an infected localarea within the previous fourteen days may, if the healthauthority considers it necessary, be disinsected and put undersurveillance for a period of not more than fourteen daysreckoned from the date of disinsecting.

Article 83

A vessel or aircraft shall be regarded as infected if it has acase of typhus on board or if a case has occurred on boardduring the voyage. Any other vessel or aircraft shall beregarded as healthy.

Article 84

1. On arrival of an infected vessel or aircraft, the followingmeasures may be applied by the health authority :

(a) disinsecting and surveillance, for a period of not morethan fourteen days reckoned from the date of disinsecting,

of any passenger or member of the crew who is a suspect,including any person harbouring lice ;(b) disinsecting and, if necessary, disinfection of anybaggage of infected persons or suspects, as well as of anyother article, such as bedding which has been used and soiledlinen, and of any part of the vessel or aircraft, which maybe contaminated.

2. The vessel or aircraft shall cease to be regarded as infectedwhen the measures ordered by the health authority inaccordance with paragraph 1 of this Article have been carriedout and shall thereupon be given free pratique.

Article 85 [Art. 91]

On arrival, a healthy vessel or aircraft, even when comingfrom an infected local area, shall be given free pratique.

Article 86 [Art. 92]

If, on arrival of a train or a road vehicle, a case of typhus isdiscovered, the measures provided in paragraph 1 of Article 84may be applied by the health authority, measures ofdisinsecting and, if necessary, disinfection, being applied to anypart of a train or road vehicle which may be contaminated.

Chapter V1 - Relapsing Fever

Article 87 [Art. 93]

For the purposes of these Regulations the incubation periodof relapsing fever is eight days.

Article 88 [Art. 94]

The measures provided for in Articles 81 to 86 inclusivewith respect to typhus shall apply to relapsing fever but, if aperson is placed under surveillance, the period of such sur-veillance shall not exceed eight days reckoned from the dateof disinsecting.

PART VI - SANITARY DOCUMENTS

Article 89 [Art. 95]

Bills of health, with or without consular visa, or any certifi-cate, however designated, concerning health conditions of aport or airport shall not be required from any vessel or aircraft.

Article 90 [Art. 96]

1. The master of a ship shall, before arriving at the firstport of a territory, ascertain the state of health of all personson board and shall, on arrival, sign and deliver to the healthauthority for that port a Maritime Declaration of Healthwhich shall be countersigned by the ship's surgeon, if oneis carried.

2. The master, and the ship's surgeon, if one is carried, shallsupply any information required by the health authority asto shealth conditions on board during the voyage.

3. A Maritime Declaration of Health shall conform with themodel specified in Appendix 5 to these Regulations.

Article 91 [Art. 97]

1. The pilot in command of an aircraft shall, on landing atan airport, sign and deliver to the health authority for thatairport a copy of that part of the Aircraft General Declarationwhich contains the health information specified in Appendix 6.

2. The pilot in command of an aircraft shall supply anyinformation required by the health authority as to healthconditions on board during the voyage.

Article 92 [Art. 98]

The certificates specified in Appendices 1, 2, 3 and 4 to theseRegulations shall be printed in English and in French. Anofficial language of the territory of issue may be added.

Article 93 [Art. 100]

No sanitary document, other than those provided for inthese Regulations, may be required in international traffic.

22 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

PART VII - SANITARY CHARGES

Article 94 [Art. 101]

1. No charge shall be made by a health authority for :(a) any medical examination provided for in these Regula-tions, and any supplementary examination, bacteriologicalor otherwise, which may be required to ascertain the stateof health of the person examined ;(b) any vaccination of a person on arrival and any certifi-cate thereof.

2. Where charges are made for applying the measures providedfor in these Regulations, other than those referred to inparagraph 1 of this Article, there shall be in each territoryonly one tariff for such charges and every charge shall :

PART VIII - VARI

Article 95

Any State to the territory or territories of which theseRegulations apply shall not, in carrying out the provisionshereof, discriminate against any other such State.

Article 96 [Art. 102]

In addition to these Regulations, Annexes A and B heretoshall apply to the Pilgrimage.

Article 97 [Art. 103]

1. Migrants or seasonal workers, and the vessels, aircraft,trains, or road vehicles carrying them, may be subjected toadditional sanitary measures in conformity with the laws andregulations of each State concerned, and with agreementsconcluded between any such States.

2. Each State shall notify the Organization of any measuresso provided.

Article 98 [Art. 104]

1. Special arrangements may be concluded between two ormore States having certain interests in common owing to their

(a) conform with this tariff ;(b) be moderate and not exceed the actual cost of theservice rendered ;(c) be levied without distinction as to the nationality,domicile, or residence of the person concerned, or as to thenationality, flag, registry, or ownership of the vessel,aircraft, carriage, wagon, or road vehicle. In particular,there shall be no distinction made between national andforeign persons, vessels, aircraft, carriages, wagons, androad vehicles.

3. The tariff and any amendment thereto shall be publishedten days in advance of any levy thereunder and communicatedforthwith to the Organization.

OUS PROVISIONS

geographical, social, or economic conditions, in order to makethe sanitary measures provided for in these Regulations moreefficacious and less burdensome, in particular on :

(a) the direct and rapid exchange of epidemiologicalinformation between neighbouring territories ;(b) the sanitary measures to be applied to internationalcoastal traffic and to international traffic on inland water-ways, including lakes ;(c) the sanitary measures to be applied in contiguousterritories at their common frontier ; or the combinationof two or more territories into one territory for the purposesof any of the sanitary measures to be applied in accordancewith these Regulations ;(d) arrangements for carrying infected persons, by meansof transport specially adapted for the purpose.

2. The arrangements referred to in paragraph 1 of thisArticle shall not be in conflict with the provisions of theseRegulations.

3. States shall inform the Organization of any such arrange-ments which they may conclude.

PART IX - FINAL PROVISIONS

Article 99 [Art. 105]

Upon their entry-into-force, these Regulations shall,subject to the provisions of Article 101 and the exceptionshereinafter provided, replace, as between the States bound bythese Regulations and as between these States and the Organi-zation, the provisions of the following International SanitaryConventions and similar Agreements :

1. International Sanitary Convention, signed in Paris,3 December 1903 ;

2. Pan American Sanitary Convention, signed in Wash-ington, 14 October 1905 ;

3. International Sanitary Convention, signed in Paris,17 January 1912 ;

4. Pan American Sanitary Code, signed at Habana,14 November 1924, except Articles... ; 7

7 Attention is drawn to the following paragraphs of theThird Report of the Legal Sub-Committee (WHO/Epid/39,pages 6 and 7) :

" It would seem advisable as regards the Pan AmericanSanitary Code to qualify the replacement provided for in

5. International Sanitary Convention, signed in Paris,21 June 1926 ;

6. International Sanitary Convention for Aerial Naviga-tion, signed at The Hague, 12 April 1933 ;

7. International Agreement for dispensing with Bills ofHealth, signed in Paris, 22 December 1934 ;

8. International Agreement for dispensing with ConsularVisas on Bills of Health, signed in Paris, 22 December1934 ;

Article 99, so that its provisions, in so far as they are unaffectedby the Regulations, should be maintained pending theirrevision. It is the understanding of the sub-committee thatthis revision will be undertaken as soon as the new interna-tional Regulations have been adopted.

" It would appear that the segregation of the elements ofthat Code which are to be replaced by the Regulations fromthose that are maintained is a task which could be moreusefully performed by the parties concerned. The expertcommittee might propose to the Regional Office of WHOin the Americas (Pan American Sanitary Bureau) that theyinitiate this task."

TEXT OF THE DRAFT REGULATIONS 23

9. Convention modifying the International SanitaryConvention of 21 June 1926, signed in Paris, 31 October1938 ;

10. International Sanitary Convention, 1944, modifyingthe International Sanitary Convention of 21 June 1926,opened for signature in Washington, 15 December 1944;

11. International Sanitary Convention for Aerial Naviga-tion, 1944, modifying the International Sanitary Con-vention of 12 April 1933, opened for signature inWashington, 15 December 1944, except paragraph 2of Article XVII ;

12. Protocol of 23 April 1946 to prolong the InternationalSanitary Convention, 1944, signed in Washington ;

13. Protocol of 23 April 1946 to prolong the InternationalSanitary Convention for Aerial Navigation, 1944,signed in Washington.

Article 100 [Art. 106]

1. The period provided under Article 22 of the Constitutionof the Organization for rejection or reservation shall be ninemonths from the notification by the Director-General of theOrganization of the adoption of these Regulations by theWorld Health Assembly.2. Any rejection or reservation received by the Director-General after the expiry of that period shall have no effect.

Article 101 8 [Art. 107]

1. If a reservation made by a State is found, on examinationby the World Health Assembly, to detract from any obligationor obligations, corresponding to the subject matter of suchreservation, which such State has accepted under the existingConventions and Agreements listed in Article 99, and if sucha reservation is not then withdrawn, that State shall continueto be bound by the corresponding obligation or obligationspreviously accepted by it. Nevertheless, the World HealthAssembly may determine that any such reservation does notconstitute an obstacle to the replacement referred to inArticle 99 of any or all of the provisions of the aforesaidConventions and Agreements.

8 The Legal Sub-Committee considered the possibility ofmaking the provisions of Article 104 (3) of these Regulationsapplicable to States which are Members of the Organization,as well as to States which are not. It was, however, consideredthat Article 22 of the Constitution (which is not altogetherclear as to the effect of reservations to Regulations adopted bythe World Health Assembly) might be so interpreted as toprevent a provision on the lines of Article 104 (3) being appli-cable to Member States.

Article 101 is, therefore, limited to giving the World HealthAssembly the power to decide which, if any, of the reservationsmade by States detract from obligations already accepted bythem under existing Conventions and Agreements, and toproviding that if States do not withdraw reservations of thatkind they shall continue to be bound (so far as the subjectmatter of the reservation is concerned) by their previousobligations.

The Legal Sub-Committee is, however, of the opinion thatit would be most desirable for a legal memorandum to beprepared and submitted to the World Health Assembly inwhich the whole question of reservations to internationalregulations would be dealt with and in which the authoritativeopinion could be given on the interpretation of Article 22of the Constitution, including the possibility of reservationsto Regulations adopted by the World Health Assemblyamounting to a rejection of such Regulations.

2. In particular, the following provisions :Article 3 of the International Sanitary Convention,

1926 ;

Article 20 of the International Sanitary Convention forAerial Navigation, 1933 ;

Article V of the International Sanitary Convention, 1944 ;and

Article VII of the International Sanitary Convention forAerial Navigation, 1944,

shall be excepted from Article 99 unless a State bound by anyof these provisions accepts without reservations paragraph 2of Article 2 of these Regulations.

Article 102 [Art. 108]A rejection, or the whole or part of any reservation, may

at any time be withdrawn by notifying the Director-General.

(See footnote 9 below)

Article 103 [Art. 109]

1. These Regulations shall come into force on[e.g., fifteen months from the date of the adoption of theRegulations by the World Health Assembly].2. After the date provided for in paragraph 1 of this Article,these Regulations shall come into force for any State whichbecomes a Member of the Organization and is not alreadya party to these Regulations, on the expiry of the periodprovided for in paragraph 1 of Article 100, unless such aState has made a reservation or reservations, in which casethese Regulations shall come into force three months afterthe World Health Assembly has concluded its examinationof such reservations, in accordance with the provision ofparagraph 1 of Article 101.

Article 104 [Art. 1101

1. Any State which is not a member of the Organization butwhich is a party to any of the Conventions or Agreementslisted in Article 99, or to which the Director-General hasnotified the adoption of these Regulations by the WorldHealth Assembly, may become a party hereto by notifying itsacceptance to the Director-General and, subject to the pro-visions of paragraph 3 of this Article, such acceptance shall

9 Attenfion is drawn to the following passage of the firstreport of the Legal Sub-Committee (document WHO/Epid/33,page 4) :

" The sub-committee recognized that the insertion oromission of a special clause concerning non-metropolitanterritories was a matter that should be considered by theWorld Health Assembly.

In the opinion of the majority of the members of the sub-committee it would be more in consonance with the Constitu-tion to insert no special clause of this kind in the Regulationsadopted by the Assembly, since States wishing to exclude theapplication of the Regulations to certain territories could availthemselves of the right to make reservations under Article 22of the Constitution.

Should, however, the Assembly be of a different opinion,the sub-committee would recommend the following provision :

Each State to which these Regulations apply shall bringthem to the notice of the Governments of the territories forwhose international relations it is responsible, and mayat any time notify the Director-General of the Organizationthat the Regulations shall extend to any or all of suchterritories with or without reservations."

24 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

become effective upon the date of coming-into-force of theseRegulations or after that date upon the date of receipt of suchnotification by the Director-General.2. Any non-Member State which becomes a party to theseRegulations shall, for the purpose of the application of theseRegulations, be bound by Articles 23, 33, 62, 63 and 64 ofthe Constitution of the Organization.3. If a non-Member State makes a reservation to theseRegulations, such reservation shall not be valid unless it ismade at the same time as the notification of acceptance andunless it is accepted by the World Health Assembly, and sucha State shall not become a party to these Regulations untilsuch reservation has been so accepted or has been withdrawn.4. Any non-Member State which has become a party tothese Regulations may at any time withdraw from participa-tion in these Regulations, by means of a notification addressedto the Director-General of the Organization which shall takeeffect six months after the receipt of such notification. TheState which has withdrawn shall, as from that date, continueto be bound by the provisions of any of the Conventions orAgreements listed in Article 99 to which it was previously aparty.

Article 105 [Art. 111]

The Director-General of the Organization shall notify allMembers and Associate Members and also the parties toany of the Conventions and Agreements listed in Article 99of the adoption by the World Health Assembly of theseRegulations. These States as well as any other State which hasbecome a party to these Regulations shall similarly be notifiedof any additional Regulations amending or supplementingthese Regulations, of any rejection, reservation, or with-drawal of rejection, or reservation made under Articles 100and 102 respectively, as well as of any acceptance or withdrawalmade under Article 104.

Article 106

By virtue of Article 29 of the Constitution of the Organi-zation, the Executive Board may define recommendedpractices, methods and procedures such as disinsecting,disinfecting, and deratting, standards for vaccines and thelike, the adoption of which by national health administrationswould facilitate the discharge of their obligations under theseRegulations.

Article 107" [Art. 112]

1. Any question or dispute concerning the interpretation orapplication of these Regulations or of any Regulationssupplementary to these Regulations may be referred by anyState concerned to the Director-General who shall attemptto settle the question or dispute. If such question or disputeis not thus settled, the Director-General shall, or any Stateconcerned may, submit the question or dispute to...2. Any State concerned shall be entitled to be representedbefore...3. Any such dispute which has not been settled as a resultof the submission to... may, by written application, bereferred by any State concerned to the International Court ofJustice for decision.

Article 108 [Art. 113]

The original texts of these Regulations shall be deposited inthe Archives of the Organization. Certified true copies shallbe delivered by the Director-General of the Organization tothe Secretary-General of the United Nations for registrationin accordance with Article 102 of the Charter of the UnitedNations. The Director-General shall similarly notify theSecretary-General of any rejections or reservations or with-drawal of such rejections or reservations.

IN FArru WHEREOF, we have set our hands this... day of...19.

The President of the World Health AssemblyThe Director-General of the World Health Organization

10 The Legal Sub-Committee appreciates that the questionof what body within the Vv orld Health Organization shall dealwith questions or disputes concerning the interpretation orapplication of the Regulations is one that can be decided onlyby the Special Committee of the World Health Assemblywhich is to meet in April 1951. In preparing a draft of Article107 for consideration by the Special Committee it has accord-ingly left unidentified the body to which disputes concerningthe interpretation or application of the Regulations whichcannot be settled by the Director-General will be submitted.The Legal Sub-Committee, however, is of the opinion thatthis body should not be the World Health Assembly itself, sinceit does not seem fitting that the body which will exercise alegislative function in adopting these Regulations should becalled upon to assume judicial functions in respect to them.

PART X - TRANSITIONAL PROVISIONS

Article 109 [Art. 114]1. Notwithstanding the provisions of paragraph 1 of Ar-ticle 100 and paragraph 1 of Article 103, the provision ofparagraph 2 of this Article shall come into force on ... [e.g.,three months from the date of the adoption of these Regula-lation by the World Health Assembly] and the period providedfor rejection or reservation shall be one month from the dateof notification by the Director-General of the Organization ofthe adoption of these Regulations by the World HealthAssembly. The application of this Article, however, shall belimited to States which have made no reservations either tothis Article or to Appendix 2, 3, or 4 as the case may be.2. Notwithstanding any provision to the contrary of anyof the existing Conventions and Agreements, a certificateof vaccination conforming with the rules and the model laiddown in one of the Appendices 2, 3, and 4 shall be acceptedas equivalent to the corresponding certificates provided forin the existing Conventions and Agreements.

Article 110 [Art. 115]

1. A certificate of vaccination issued in accordance with theConvention of 21 June 1926, as amended by the Conventionof 15 December 1944, or in accordance with the Conventionof 12 April 1933, as amended by the Convention of 15 De-cember 1944, before the entry-into-force of these Regulationsshall continue to be valid for the period for which it waspreviously valid. Moreover, the validity of a certificate ofvaccination against yellow fever shall be extended for twoyears after the date on which it would otherwise have ceasedto be valid.2. A Deratization Certificate or a Deratization ExemptionCertificate issued in accordance with Article 28 of the Conven-tion of 21 June 1926, before the entry-into-force of theseRegulations, shall continue to be valid for the period for whichit was previously valid.

of the ¡ ship(a)\ inland navigation vessel }

navire I (a)du bateau

Appendix 1

DERATTING CERTIFICATE (a) -DERATTING EXEMPTION CERTIFICATE (a)

given under Article 46 of the International Sanitary Regulations

CERTIFICAT DE DÉRATISATION (a)- CERTIFICAT D'EXEMPTION DE DERATISATION (a)

- delivre conformement a l'article 46 du Reglement Sanitaire International

(Not to be taken away by Port Authorities.) -(Ne devant pas etre retire par les autorites du port.)

PORT OF - PORT DEDate - Date

THIS CERTIFICATE records the inspection and { derattingexemption

} (a) at this port and on the above date

LE PRÉSENT CERTIFICAT atteste l'inspection et f la deratisation } (a) en ce port et A la date ci-dessus1 l'exemptionof f net tonnage (for a ship)

l tonnage (for an inland navigation vessel)f tonnage net (dans le cas d'un navire)1 tonnage (dans le cas d'un bateau)de

in accordance with the Sanitary Laws and Regulations of - conformément aux Lois et Reglements sanitaires de

At the time of f inspection (a) the holds were laden with tons ofi deratting ({Au moment de l'inspection (a)} ' ' les cales etaient chargees de tonnes dela deratisation

cargo

cargaison

COMPARTMENTS (b)

RATINDICATIONS

TRACESDE RATS

(c)

RAT HARBOURAGEREFUGES A RATS

DERATTING - DERATISATION

COMPARTIMENTS (b)

by fumigation - par fumigationFumigant Gaz utiliseHours exposure - Exposition (heures)

by catching, trapping,or poisoning

par capture ou poison

discovered

trouvés

(d)

treated

supprimesSpace

(cubic feet)Espaces(metrescubes)

Quantityused

Quantitésemployees

(e)

Ratsfound deadRats trouves

morts

Traps setor poisonsput out

Pièges oupoisons mis

Rats caughtor killed

Rats prisou tues

Holds I.

Shelter deck spaceBunker spaceEngineroom and shaft alleyForepeak and storeroomAfterpeak and storeroomLifeboatsCharts and wireless roomsGalleyPantryProvision storeroomsQuarters (crew)Quarters (officers)Quarters (cabin passengers)Quarters (steerage)

Ca les 1.

EntrepontSoute A charbonChaufferies, tunnel de l'arbrePeak avant et magasinPeak arriere et magasinCanots de sauvetageChambre des cartes, T.S.F.CuisinesCambusesSoute A vivresPostes (equipage)Chambres (officiers)Cabines (passagers)Postes (emigrants)

Total Total

a) Strike out the unnecessary indications. - Rayer les mentions inutiles.b) In case any of the compartments enumerated do not exist on the ship or inland navigation vessel, this fact

must be mentioned. - Lorsqu'un des compartiments enumeres n'existe pas sur le navire ou bateau,on devra le mentionner expressement.

(c) Old or recent evidence of excreta, runs, or gnawing. - Traces anciennes ou recentes d'excrements, depassages ou de rongements.

RECOMMENDATIONS MADE. - OBSERVATIONS. -In the case of exemption, state here the measuresnegligible. -Dans le cas d 'exemption, indiquer ici les mesures prises pour que le navire ou bateau soit maintenu

Seal, name, qualification, and signature of the inspector.

(d) None, small, moderate, or large. - Neant, peu, passablement ou beaucoup.(e) State the weight of sulphur or of cyanide salts or quantity of HCN acid used. - Indiquer les poids de soufre

ou de cyanure ou la proportion d'acide cyanhydrique.(f) Specify whether applies to metric displacement or any other method of determining the tonnage.- Specifier

s'il s'agit de &placement metrique ou, sinon, de quel autre tonnage il s'agit.taken for maintaining the ship or inland navigation vessel in such a conditon that the number of rats on board isdans des conditions telles que le nombre de rats A bord soit négligeable.- Cachet, nom, qualite et signature de l'inspecteur.

26 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Appendix 2

INTERNATIONAL CERTIFICATE OF VACCINATION OR REVACCINATION AGAINST CHOLERA

CERTIFICAT INTERNATIONAL DE VACCINATION OU DE REVACCINATION CONTRE LE CHOLERA

This is to certify thatJe soussigné(e) certifie que

whose signature follows Idont la signature suit

age sexAge J sexe

has on the date indicated been vaccinated or revaccinated against cholera.a été vacciné(e) ou revacciné(e) contre le choléra A la date indiquée.

Date Signature and professional status of vaccinatorSignature et qualité professionnelle du vaccinateur

Signature and status of authenticator over official stampSignature, qualité et timbre de la personne qui authentifie

1

3

5

7

The vaccination or revaccination shall be by a single dose of a vaccine of known potency.The validity of this certificate shall commence five days after the date of vaccination, or, in the case of revaccination within

six months, from the date of revaccination, and shall extend to a period of six months from the date of vaccination or revaccination.Notwithstanding the above provisions, in the case of a pilgrim, this certificate shall indicate that two injections have been

given at an interval of seven days and its validity shall commence from the date of the second injection.The professional status of the vaccinator must be certified by the health authority or by another person qualified to do so by

the Government of the territory where the certificate was issued or where the subsequent vaccination took place. If the vaccinatoris a member of a national or local health service or the Armed Forces of a State, the placing on the certificate of the officialstampof his service will suffice. In the case of the Armed Forces, the location of the issuing unit is not required.

Any amendment or erasure on this certificate, or failure to complete any part of it, may render it invalid.

La vaccination ou la revaccination doit 'are faite au moyen d'une simple dose de vaccin d'activité connue.La validité de ce certificat est acquise cinq jours après la date de la vaccination ou, en cas de revaccination dans les six mois,

partir de la date de la revaccination ; cette validité couvre une période de six mois A compter de la date de la vaccination ou dela revaccination.

Nonobstant les dispositions ci-dessus mentionnées, lorsqu'il s'agit de pèlerins, le présent certificat doit indiquer qu'il a étéprocédé A deux inoculations A. sept jours d'intervalle et la validité du certificat est acquise A la date de la seconde inoculation.

La qualité professionnelle du vaccinateur doit &re certifiée par l'autorité sanitaire ou par toute autre personne habilitée à cefaire par le gouvernement du territoire où le certificat a été délivré ou bien là oil la vaccination subséquente a été effectuée. Si levaccinateur appartient à l'administration ou aux forces armées de l'Etat, l'apposition du timbre officiel du service auquel leditvaccinateur est rattaché suffit. Dans le cas des forces armées, l'indication du lieu oA se trouve l'unité qui délivre le certificat n'estpas requise.

Toute correction ou rature sur le certificat ou toute omission quant à l'une de ses énonciations peut affecter sa validité.

TEXT OF THE DRAFT REGULATIONS 27

Appendix 3

INTERNATIONAL CERTIFICATE OF VACCINATION AGAINST YELLOW FEVER

CERTIFICAT INTERNATIONAL DE VACCINATION CONTRE LA FIÈVRE JAUNE

This is to certify thatJe soussigné(e) certifie que

whose signature follows kdont la signature suit

age }, sex }

age sexe

has on the date indicated been vaccinated or revaccinated against yellow fever.a été vacciné(e) ou revacciné(e) contre la fièvre jaune A la date indiquée.

Date

Signature and professionalstatus of vaccinator

Signature et qualitéprofessionnelle du vaccinateur

Origin and batch no.of vaccine

Numéro du lot etorigine du vaccin

employé

Official stamp of inoculation centre

Timbre du centre de vaccination

1 I 2

2

3 3 4

4

This certificate is valid only if the vaccine used has been approved by the Organization and if the Vaccinating Centre has beendesignated by the health administration for the territory in which that Centre is situated.

The validity of this certificate shall commence 10 days after the date of vaccination, or, in the case of revaccination within sixyears, from the date of such revaccination, and shall extend to a period of six years from the date of such vaccination or revaccina-tion. In the case of the Armed Forces, the location of the issuing unit is not required.

Any amendment or erasure on this certificate, or failure to complete any part of it, may render it invalid.

Ce certificat n'est valable que si le vaccin employé a été approuvé par l'Organisation et si le centre de vaccination a été désignépar l'administration sanitaire du territoire dans lequel ce centre est situé.

Ce certificat devient valable 10 jours après la date de la vaccination. Toutefois, dans le cas de personnes revaccinées dans lessix ans, il devient valable à partir de la date de la revaccination. La validité s'étend sur une période de six ans à partir de la date dela vaccination ou de la revaccination.

Dans le cas des forces armées, l'indication du lieu où se trouve l'unité qui délivre le certificat n'est pas requise.Toute correction ou rature sur le certificat ou toute omission quant A l'une de ses énonciations peut affecter sa validité.

28 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Appendix 4

INTERNATIONAL CERTIFICATE OF VACCINATION OR REVACCINATION AGAINST SMALLPDX

CERTIFICAT INTERNATIONAL DE VACCINATION OU DE REVACCINATION CONTRE LA VARIOLE

This is to certify thatJe soussigné(e) certifie que

}whose signature followsdont la signature suit

1 age}agesexsexe

has on the date indicated been vaccinated or revaccinated against smallpox.a été vacciné(e) ou revacciné(e) contre la variole à la date indiquée.

Date

Signature and professional Signature and status of authenticatorstatus of vaccinator over official stamp

Signature et qualité profes- Signature, qualité et timbre de la personnesionnelle du vaccinateur qui authentifie

Result

Résultat

Signature and professionalstatus of observer

Signature et qualité profes-sionnelle du contrôleur

Date ofobservation

Date du contrôle

1 21 1

2

3 4 3

4

The result of vaccination or revaccination to be recorded in the following notation :POSITIVE or POS. when an accelerated vesicular reaction (vaccinoid) appears between the fifth and eighth day inclusive,

or if a typical pustular vaccinal reaction occurs.NEGATIVE or NEG. when no reaction or early non-vesicular reaction appears during the four days following the

vaccination.The term " Reaction of immunity " will not be used.

This certificate is valid for three years from the date of vaccination or most recent revaccination.The professional status of the vaccinator must be certified by the health authority or by any other person qualified to do so by

the Government of the territory where the certificate was issued or where the subsequent vaccination took place. If the vaccinatoris a member of a national or local health service or the Armed Forces of a State, the placing on the certificate of the official stampof his service will suffice. In the case of the Armed Forces, the location of the issuing unit is not required.

Any amendment or erasure of this certificate, or failure to complete any part of it, may render it invalid.

Le résultat de la vaccination ou de la revaccination doit être indiqué de la manière suivante :POSITIVE ou POS, lorsqu'une réaction vésiculaire accélérée (vaccinoïde) se montre entre le cinquième et le huitiéme

jour (inclus), ou en cas de réaction vaccinale typique (pustule).NEGATIVE ou NEG. lorsque aucune réaction n'apparaît, ou s'il se produit une réaction précoce (non vésiculaire)

pendant les quatre jours qui suivent la vaccination.L'expression « Réaction d'immunité » ne doit pas être employée.

Ce certificat est valable pendant trois ans à partir de la date de la vaccination ou de la revaccination la plus récente.La qualité professionnelle du vaccinateur doit être certifiée par l'autorité sanitaire ou par toute autre personne habilitée à ce

faire par le gouvernement du territoire oa le certificat a été délivré ou bien la oil la vaccination subséquente a été effectuée. Si levaccinateur appartient à l'administration ou aux forces armées de l'Etat, l'apposition du timbre officiel du service auquel leditvaccinateur est rattaché suffit. Dans le cas des forces armées, l'indication du lieu où se trouve l'unité qui délivre le certificat n'estpas requise.

Toute correction ou rature sur le certificat ou toute omission quant à l'une de ses énonciations peut affecter sa validité.

TEXT OF THE DRAFT REGULATIONS 29

Port of

Appendix 5

MARITIME DECLARATION OF HEALTH

(To be rendered by the masters of ships arriving from ports outside the territory.)

Date

Name of Ship From To

Nationality Master's name

Net Registered Tonnage

Deratting or Certificate Date

Deratting Exemption Issued at

Cabin Number of crewNumber ofpassengers Deck

List of ports of call from commencement of voyage with dates of departure :

Health Questions

I. Has there been on board during the voyage * any case or suspected case of plague, cholera, yellow fever, smallpox,typhus, or relapsing fever ? Give particulars in the Schedule.

2. Has plague occurred or been suspected among the rats or mice on board during the voyage,* or has there been anunusual mortality among them ?

3 . Has any person died on board during the voyage * otherwise than as a result of accident ? Give particulars inSchedule.

4. Is there on board or has there been during the voyage * any case of illness which you suspect to be of an infectiousnature ? Give particulars in Schedule.

AnswerYes or No

5. Is there any sick person on board now ? Give particulars in Schedule.

Note : In the absence of a surgeon, the Master should regard the following symptoms as ground for suspecting the existence ofinfectious disease : fever accompanied by prostration or persisting for several days, or attended with glandular swelling ;or any acute skin rash or eruption with or without fever ; severe diarrhoea with symptoms of collapse ; jaundiceaccompanied by fever.

6. Are you aware of any other condition on board which may lead to infection or the spread of infectious disease ?

I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the Schedule)are true and correct to the best of my knowledge and belief.

Signed

Master

Countersigned

Date Ship's Surgeon

* If more than 6 weeks have elapsed since the voyage began, it will suffice to give particulars for the last 6 weeks.

30 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Appendix 5 (continued)

SCHEDULE TO THE DECLARATIONParticulars of every case of illness or death occurring on board

Name Class orrating Age Sex Nationality Port of

embarkationDate of

embarkationNature of

illnessDate ofits onset

Results ofillness *

Disposalof case**

* State whether recovered ; still ill ; died.** State whether still on board ; landed at (give name of port) ; buried at sea.

Appendix 6

HEALTH PART OF THE AIRCRAFT GENERAL DECLARATION

to include information on :(a) Illness other than airsickness that has occurred on board during the flight.(b) Any other condition on board which may lead to the spread of infectious disease.(c) Details of each disinsecting or sanitary treatment (place, date, time, method) during the flight. If no disinsecting has beencarried out during the flight give details of most recent disinsecting.

TEXT OF THE DRAFT REGULATIONS 31

Annex A

SANITARY CONTROL OF PILGRIM TRAFFIC APPROACHING OR LEAVING THE HEDJAZDURING THE SEASON OF THE PILGRIMAGE

PART I - MEASURES APPLYING TO ALL PILGRIMS

Article I [Art. Al]

1. Before departure, every pilgrim shall be in possession ofa valid certificate of vaccination against smallpox and of acertificate of vaccination against cholera, irrespective of thelocal area from which he comes or the sanitary conditionsin that area ; and, if he comes from a yellow-fever infectedlocal area, of a valid certificate of vaccination against yellowfever.

2. Every pilgrim, on his arrival in the Hedjaz, shall be inpossession of a valid certificate of vaccination against cholera.

PART II - PILGRIM SHIPS

Chapter I - Pilgrim Ships passing through the Suez Canal

Article 2 [Art. A2]

Every pilgrim ship passing through the Suez Canal shallproceed in quarantine.

Chapter II - Pilgrim Ships going to the Hedjaz

Article 3 [Art. A3]

1. On arrival of a pilgrim ship at Port Said, pilgrims shall bein possession of :

(a) a valid certificate of vaccination against smallpox ;(b) a certificate of vaccination against cholera due tobecome valid before arrival of the ship at the Hedjaz ;(c) if the pilgrim comes from a yellow-fever infected localarea a valid certificate of vaccination against yellow fever.

2. Any pilgrim who is not in possession of any of thecertificates required in paragraph 1 of this Article shall bevaccinated and given a certificate of such vaccination.

3. If on medical examination of a pilgrim ship at Port Saidno case of epidemic disease is discovered, the ship shall beallowed to proceed to the Hedjaz, without calling at anyintermediate port, as soon as the provisions of paragraph 2of this Article have been complied with.

Article 4 [Art. A4]

1. Every pilgrim ship going to the Hedjaz from the southshall before arriving there stop at the sanitary station atKamaran for medical examination.

2. Paragraphs 1 and 2 of Article 3 shall apply on arrival ofthe pilgrim ship at Kamaran.

3. If during the voyage there has not been on board a case ofepidemic disease, the pilgrim ship shall be allowed to proceed

to the Hedjaz, without calling at any intermediate port, assoon as the provisions of paragraph 2 of Article 3 have beencomplied with.4. If there has been on board a case of plague, cholera, oryellow fever, every pilgrim shall be disembarked and a medicalexamination shall be carried out daily. Infected persons shallbe isolated. After deratting, disinsecting, and disinfection ofthe ship, if appropriate, any pilgrim who is not an infectedperson shall be allowed to re-embark five days after the lastcase of cholera, or six days after the last case of plague oryellow fever has occurred, and the ship allowed to proceed tothe Hedjaz, without calling at any intermediate port.5. If there has been on board a case of smallpox, typhus, orrelapsing fever, every infected person shall be disembarked andisolated and the pilgrim ship, after disinsecting and disinfection,if appropriate, shall be allowed to proceed to the Hedjaz,without calling at any intermediate port.

Chapter III - Pilgrim Ships returning from the Hedjaz

Article 5 [Art. A5]

Any pilgrim returning from the Hedjaz who wishes todisembark in Egypt shall travel only in a pilgrim ship whichstops at the sanitary station at El Tor, or at some other sanitarystation appointed by the health administration for Egypt,where the sanitary measures provided for in the EgyptianQuarantine Regulations may be applied to him.

Article 6 [Art. A6]

The health administration for Saudi Arabia shall notifyevery diplomatic mission in its territory immediately thereoccurs in the Hedjaz during the season of the Pilgrimage acase of plague, cholera, or yellow fever, or an epidemic ofsmallpox, typhus, or relapsing fever. On receipt of suchnotification, the diplomatic mission of any country to whichany pilgrim ship is returning may instruct the master to proceedto the sanitary station at El Tor or Kamaran, as the casemay be.

Article 7 [Art. A7]

1. If there has not been in the Hedjaz during the season of thePilgrimage a case of plague, cholera, or yellow fever, or anepidemic of smallpox, typhus, or relapsing fever, any pilgrimship returning northwards may go from the Hedjaz, withoutcalling at any intermediate port, to Suez, where the pilgrimsshall be medically examined.2. If there has not been a case of epidemic disease on boardduring the voyage, and five days have elapsed, reckoned fromthe date on which the pilgrim ship left the Hedjaz, the healthauthority at Suez shall allow it to enter the Suez Canal, evenat night. The health authority may allow any such pilgrimship to enter the Suez Canal less than five days after it left theHedjaz if the first two pilgrim ships returning from the Hedjaz

32 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

via El Tor as well as the aircraft carrying pilgrims who havelanded there before the arrival of the second ship have beenfound to be free from infection.'3. If there has been a case of plague, cholera, or yellow feveron board during the voyage, the pilgrim ship shall be directedto go to the sanitary station at El Tor.4. If there has been a case of smallpox, typhus, or relapsingfever on board during the voyage, the pilgrims shall bedisembarked at Suez, the pilgrim ship shall be put inquarantine, and the appropriate measures of revaccination,disinsecting, and disinfection shall be taken before it is allowedto continue its voyage.

Article 8 [Art. A9]

I. On arrival at El Tor or at Kamaran of any pilgrim shipdirected there under Article 6, or, in the case of El Tor,paragraph 3 of Article 7, of this Annex, the health authorityfor the sanitary station shall apply the following measures :

(a) if there is a case of plague, cholera, or yellow feveron board, every pilgrim shall be disembarked and thesuspects submitted to such sanitary measures as the healthauthority considers appropriate. The pilgrims shall beisolated, in the case of cholera for a period of not morethan five days, and in the case of plague or yellow fever for aperiod of not more than six days, after the last case hasoccurred ;(b) if there is a case of smallpox, typhus, or relapsing feveron board, every suspect shall be disembarked and disinfectedor disinsected ;(c) the appropriate measures of deratting. disinsecting, anddisinfection of the pilgrim ship shall be taken if necessary.

2. When the measures provided for in this Article have beenapplied, any pilgrim who is not an infected person shall beallowed to re-embark and the ship allowed to continue itsvoyage.

Article 9 [Art. A10]

Every pilgrim ship returning from the Hedjaz and going toa territory on the African coast of the Red Sea shall, withoutcalling at any intermediate port, proceed to such sanitarystation as may be appointed by the health administration forthat territory, and any sanitary measures considered necessaryby the appropriate health authority shall be applied at suchsanitary station.

PART III - TRANSPORT BY AIR

Article 10

1. On arrival of a pilgrim at an airport in the Hedjaz, thehealth authority shall ascertain that the pilgrim fulfils therequirements provided for in Article 1 of this Annex.2. If any pilgrim does not fulfil such requirements, he shallundergo the necessary vaccinations and shall be given theappropriate certificates.3. Should the pilgrim refuse to be so vaccinated, the healthauthority may refuse to allow him to enter the Hedjaz.

" It appears from document WHO/Epid/44, page 109, tbatthe Egyptian authorities are prepared to accept a reductionto two ships but, in turn, require that mention should bemade of aircraft carrying pilgrims which have landed atEl Tor in the meantime.

Article 11 [Art. All]

1. Any pilgrim returning from the Hedjaz who wishes todisembark in Egypt, except as provided in Article 29 of theRegulations, must first call at El Tor, or at some other sanitarystation appointed by the health administration for Egypt,where the sanitary measures provided for in the EgyptianQuarantine Regulations may be applied to him.

2. No sanitary measures other than those provided for in theRegulations shall apply during the voyage to other pilgrimsreturning by air from the Hedjaz.

3. The health administration for any territory to which thepilgrim returns may determine the sanitary measures to beapplied to him.

PART IV - TRANSPORT BY LAND

Article 12 [Art. Al2]

Every pilgrim who wishes to enter Saudi Arabian territoryby land shall do so only at a sanitary station appointed by thehealth administration for Saudi Arabia, where the measuresprovided for in the Regulations may be applied.

Article 13 [Art. A13]

If there has been in the Hedjaz during the season of thePilgrimage a case of plague, cholera, or yellow fever, or anepidemic of smallpox, typhus, or relapsing fever, the appro-priate health authority for the first area adjoining SaudiArabia which a pilgrim returning therefrom enters may eitherisolate him at a sanitary station, or place him under sur-veillance, as it considers necessary, for not longer than theincubation period of the disease which has occurred.

PART V - NOTIFICATIONS

Article 14 [Art. A14]

The health administration for Saudi Arabia shall inform theOrganization weekly by telegram of the epidemiologicalconditions prevailing in its territory during a period beginningtwo months before the commencement of the season of thePilgrimage and ending two months after the termination of thatseason. This information, which shall take into account thedata furnished and the notifications made to that administra-tion by the medical missions accompanying the pilgrims, shallbe transmitted by the Organization to the health administra-tions of the territories from which the pilgrims come with aview to enabling them to apply the appropriate provisions ofthese Regulations on the return of the pilgrims.

Article 15 [Art. A15]

During the season of the Pilgrimage all health administrationsconcerned shall transmit periodically and if necessary by themost rapid means to the Organization all sanitary informationthey may collect concerning the Pilgrimage. They shall alsopresent to the Organization not later than six months afterthe end of the Pilgrimage an annual report thereon. Thisinformation shall be forwarded by the Organization to allhealth administrations concerned.

TEXT OF THE DRAFT REGULATIONS 33

Annex B

STANDARDS OF HYGIENE AND WELFARE ON PILGRIM SHIPS AND ON AIRCRAFT CARRYING PILGRIMS

PART I - PILGRIM SHIPS

Article I [Art. Bl]

Only mechanically propelled ships shall be permitted tocarry pilgrims.

Article 2 [Art. B2]

I. Every pilgrim ship shall be able to accommodate thepilgrims on the between-decks.2. Pilgrims shall not be lodged on any deck lower than thefirst between-deck below the water-line.3. The following space provisions shall be made on a pilgrimship for each pilgrim, irrespective of age :

(a) on the between-decks, in addition to the space providedfor the crew, an area of not less than 1.5 square metres orapproximately 16 English square feet and a cubic capacityof not less than 3 cubic metres or approximately 106 Englishcubic feet ;(b) on the upper deck, a free area of not less than 0.56square metres or approximately 6 English square feet inaddition to the area upon that deck required for the workingof the ship or reserved for the crew or taken up by temporaryhospitals, douches, and latrines.

4. Satisfactory ventilation, augmented by mechanical meansat least in the case of decks below the first of the between-decks, shall be provided.

Article 3 [Art. B3]

1. Every pilgrim ship shall be provided on deck with screenedplaces supplied at all times, even if the ship is lying at anchor,with sea-water under pressure, in pipes which shall be fittedwith taps or douches, in the proportion of not less than onetap or douche for every 100 or fraction of 100 pilgrims.2. A sufficient number of such places shall be for the exclusiveuse of women.

Article 4 [Art. B4]

1. In addition to closet accommodation for the crew, everypilgrim ship shall be provided with latrines, fitted with flushingapparatus or water-taps, in the proportion of not less thanthree latrines for every 100 pilgrims or fraction of 100 pilgrims ;provided that, for existing ships in which it is impracticableto provide that proportion, the health authority for the portof departure may permit the proportion to be not less thantwo latrines for every 100 pilgrims or fraction of 100 pilgrims.2. A sufficient number of such latrines shall be for the exclu-sive use of women.3. No latrine shall be in a hold of the ship.

Article 5 [Art. B15]

No pilgrim shall be permitted to cook food on board apilgrim ship.

Article 6 [Art. 135]

1. Every pilgrim ship shall be provided with satisfactoryhospital accommodation situated on the upper deck unlessthe health authority for the port of departure considers thatsome other situation would be equally satisfactory.2. Such hospital accommodation, including temporaryhospitals, shall be of sufficient size, allowing not less than 9square metres or approximately 97 English square feet forevery 100 pilgrims or fraction of 100 pilgrims, and so con-structed as to enable infected persons or suspects to be suitablyisolated.3. Separate latrines shall be provided exclusively for suchaccommodation.

Article 7 [Art. B6]

1. Every pilgrim ship shall carry medicaments and otherarticles for the treatment of the sick pilgrims, as well as disinfec-tants and insecticides. The health administration for theterritory in which is situated the port of departure shallprescribe the quantities of such substances or articles to becarried.

2. Every pilgrim ship shall be provided with anticholeravaccine, antismallpox vaccine, and any other immunizingsubstance which may be prescribed by the health administra-tion referred to in paragraph 1 of this Article, and suchvaccines and substances shall be stored under suitable con-ditions.

3. Medical attendance and medicines shall be provided freeof charge to pilgrims on a pilgrim ship.

Article 8 [Art. B7]

1. The crew of every pilgrim ship shall include a properlyqualified medical practitioner employed for medical serviceon the ship.2. If the number of pilgrims on board exceeds 1,000, thecrew shall include two such practitioners.3. Every such practitioner shall be so recognized by thehealth administration for the territory in which is situated theport of departure.

Article 9

1. The master of a pilgrim ship shall exhibit, on board, noticesshowing :

(a) the destination of the ship ;(b) the price of each ticket ;(c) the daily ration of each article of food and fresh waterto be provided for each pilgrim without extra charge, inaccordance with the regulations of the country or countriesof origin of the pilgrims ;(d) the prices of additional articles of food which may bebought on board.

2. The master shall also exhibit on board such extracts ofthis Annex as may be required by the health administration forthe territory in which is situated the port of departure.

34 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

3. Every such notice and extract shall be exhibited in con-spicuous places accessible to all the pilgrims on board andkept so exhibited during the whole of the voyage, and it shallbe printed in the language or languages of the country inwhich the ship is registered and in the principal languagesunderstood by the pilgrims.

Article 10 [Art. B9]

1. Each pilgrim on board a pilgrim ship shall keep with himonly such light baggage as is essential for the voyage.

2. The heavy baggage of each pilgrim shall be registered andnumbered.

3. The nature, amount, and dimensions of the baggage whicha pilgrim may take on a pilgrim ship or keep with him for thevoyage shall be determined by regulations of the territory inwhich the ship is registered.

Article 11 [Art. B10]

The sanitary charges which each pilgrim will normally incurthroughout his voyage to and from the Hedjaz shall beincluded in the price of his ticket. The health authority forthe port where a pilgrim is due to embark shall decide whetherthe total of such charges shall be paid to it by the master of theship or by the agent of the shipping company.

Article 12 [Art. B11]

I. The master of every pilgrim ship or the agent of theshipping company shall notify the health authority for eachport at which pilgrims are due to be embarked of the intentionto do so, three days before the ship leaves the port of departureand twelve hours before it leaves any subsequent port of call.2. Every such notification shall specify the proposed date ofdeparture and the destination of the ship.

Article 13 [Art. B12]

1. The health authority for a port, on receiving a notificationprovided for in Article 12 of this Annex, shall inspect theship, and may measure it if the master cannot produce acertificate of measurement by another competent authorityor if the inspecting authority has reason to believe that suchcertificate no longer represents the actual conditions of theship.

2. The cost of any such inspection and measurement shall bepayable by the master.

Article 14 [Art. B13]

The health authority for a port shall not permit the departureof a pilgrim ship until satisfied that :

(a) the ship is thoroughly clean and, if necessary, has beendisinfected ;

(b) the ship is properly ventilated and provided withawnings of sufficient size and thickness to shelter the decks ;

(c) there is nothing on board which is or may becomeinjurious to the health of the pilgrims or crew ;

(d) there is on board, properly stowed away, in addition tothe requirements of the ship and crew, sufficient food ofgood quality for all the pilgrims during the voyage ;

(e) the drinking-water on board is wholesome andsufficient ;

(f) the tanks for the drinking-water on board are properlyprotected from contamination and so closed that the watercan be drawn from them only by means of taps or pumps ;(g) the ship carries a condenser capable of distilling notless than 5 litres of drinking-water per day for each personon board ;(10 the ship has a proper and sufficient disinfectingchamber ;(i) the ship carries as part of the crew a properly qualifiedand registered medical practitioner with experience ofmaritime health conditions, or in the case of paragraph 2of Article 8 of this Annex, two such medical practitioners,and sufficient medical stores ;(f) the deck is free from merchandise and unencumbered ;(k) any appropriate measure provided for in this Annex canbe applied on board ;(1) the master has obtained :

(i) a list, countersigned by the health authority for eachport at which pilgrims have been embarked, showing thenames and sex of the pilgrims embarked there and themaximum number of pilgrims which may be carried onthe ship ;(ii) a document giving the name, nationality, and ton-nage of the ship, the names of the master and ship'ssurgeon or surgeons, the exact number of persons em-barked, and the port of departure. This document shallinclude a statement by the health authority for the portof departure, showing whether the maximum number ofpilgrims which may be carried has been embarked, and, ifnot, the additional number of pilgrims the ship is author-ized to embark at subsequent ports of call.

Article 15 [Art. B14]

1. The document referred to in sub-paragraph (1) (ii) ofArticle 14 of this Annex shall be countersigned at each portof call by the health authority for that port, which shall enteron such document :

(a) the number of pilgrims disembarked or embarked atthat port ;(b) anything that has happened at sea affecting the healthof persons on board ;(e) the sanitary conditions at the port of call.

2. If any such document is altered in any other manner duringthe voyage, the ship may be treated as infected.

Article 16 [Art. B16]

During the voyage of a pilgrim ship, the deck allotted topilgrims shall be kept free from merchandise and unen-cumbered, and reserved for their use at all times, even at night,without charge.

Article 17 [Art. B17]

The between-decks of a pilgrim ship shall be properlycleansed every day during the voyage at a time when they arenot occupied by the pilgrims.

Article 18 [Art. B18]

Every latrine on a pilgrim ship shall be kept clean and ingood working order, and shall be disinfected as frequently asnecessary and in no case less than three times daily.

Article 19 [Art. B21]

The ship's surgeon shall be responsible to the master of apilgrim ship for all necessary measures of disinfection or

TEXT OF THE DRAFT REGULATIONS 35

disinsecting on board, which shall be carried out under thesupervision of the ship's surgeon.

Article 20 [Art. B19]1. Not less than 5 litres of drinking-water shall be provideddaily, free of charge, to each pilgrim, irrespective of age.2. If there is any reason to suspect that the drinking-water ona pilgrim ship may be contaminated, or if there is any doubtas to its quality, it shall be boiled or sterilized, and it shallbe removed from the ship at the first port at which a freshand wholesome supply can be obtained. The tanks shall bedisinfected before being filled with the fresh supply.

Article 21 [Art. B20]I. The ship's surgeon shall visit all the pilgrims on a pilgrimship during its voyage, give medical attention to them as maybe necessary, and satisfy himself that hygienic standards arebeing observed on board.

2. The ship's surgeon shall, in particular, satisfy himself :(a) that the rations issued to the pilgrims are of good qualityand properly prepared and that the quantity is in accordancewith the carriage contract ;(b) that drinking-water is distributed as provided inparagraph 1 of Article 20 of this Annex ;(c) that the ship is always kept clean and that the latrinesare cleaned and disinfected as provided for in Article 18 ofthis Annex ;(d) that the pilgrims' quarters are kept clean ;(e) that in the case of the occurrence of any communicabledisease, the appropriate measures of disinfection and dis-insecting have been carried out.

3. If there is any doubt as to the quality of the drinking-water, the ship's surgeon shall draw the attention of themaster, in writing, to the provisions of Article 20 of thisAnnex.4. The ship's surgeon shall keep a day-to-day record of everyoccurrence relating to health during the voyage and, if sorequested by the health authority for any port of call or for theport of destination, he shall produce the record for inspection.

Article 22 [Art. B22]Only the persons charged with the nursing of patients

suffering from communicable diseases shall have access to

them. Such persons shall not come in contact with pilgrimsif such contact would be liable to convey infection.

Article 23 [Art. B23]

1. If a pilgrim dies during the voyage, the master shall recordthe fact opposite the name of the person on the list requiredby sub-paragraph (I) (i) of Article 14 of this Annex and he shallalso enter in the ship's log the name of the person, his age,the place from which he came, and the cause or assumed causeof death.

2. If the person has died at sea from communicable disease,the corpse shall be wrapped in a shroud impregnated with adisinfecting solution and shall be buried at sea.

Article 24

The master of a pilgrim ship shall enter in the ship's logevery prophylactic measure taken during the voyage, and, ifso requested by the health authority for any port of call or forthe port of destination, he shall produce the log for inspection.

Article 25 [Art. B24]

This Annex does not apply to pilgrim ships engaged on shortsea voyáges, accepted locally as coasting voyages, which shallconform with special requirements agreed between the Statesconcerned.

PART II - AIRCRAFT

Article 26 [Art. B25]

The international regulations governing the transport ofpassengers by air, the application of which may affect the healthand welfare of such passengers, shall not be relaxed merelybecause an aircraft is carrying pilgrims ; in particular, on anaircraft carrying pilgrims, passengers or cargo shall not becarried in excess of such regulations.

Article 27 [Art. B26]

A health administration may designate a specified airportor airports as the only ones in its territory where pilgrims maydisembark.

MINUTES OF THE SPECIAL COMMITTEE

APPOINTED BY THE THIRD WORLD HEALTH ASSEMBLY

FIRST MEETING

Monday, 9 April 1951, at 10 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Opening of the Session by the Deputy Director-General

Dr. DOROLLE, Deputy Director-General, in wel-coming the delegations to the Special Committee,in the enforced absence of the Director-General,noted that the committee was meeting in the yearwhich marked the centenary of the first attempt toreach an international agreement designed to limitthe spread of pestilential diseases. Though thatfirst attempt had failed, and though it had not beentill the year 1892 that the first International SanitaryConvention had been signed, the perseverance ofthose early pioneers might still serve as an example.The chief milestones in the history of InternationalSanitary Conventions were : 1894, the first SanitaryConference on the Mecca Pilgrimage ; 1902, thesetting up of the Pan American Sanitary Bureau ;1903, the Paris Convention, whose provisions,incorporated in the Rome agreement of 1907, had ledto the creation of the Office International d'HygiènePublique (OIHP) ; 1905, the Pan American SanitaryConvention ; 1912, the important InternationalSanitary Convention drafted in Paris ; 1924, thePan American Sanitary Code ; 1926, through theefforts of the Office International d'Hygiène Publique,an International Sanitary Convention signed by66 nations and ratified by 44 ; 1933, the InternationalSanitary Convention for Aerial Navigation ; 1944,under the auspices of UNRRA, conventions toamend those of 1926 and 1933.

Unfortunately, none of those conventions had evercompletely superseded any of its predecessors.Moreover, the fact that they were diplomatic instru-ments subject to the formal ratification of signatory

States meant that some governments were partiesonly to the earlier conventions, others to the morerecent. Hence at the present moment no less thaneight agreements were simultaneously in force, whilevery often the national regulations designed toimplement them had failed to keep pace with theagreements themselves. The resulting impressionwas one of inextricable confusion, and it was onlythrough the goodwill and good sense of all authoritiesand organizations concerned that still graver diffi-culties had not arisen.

The universal recognition of the need for a uni-fication and rationalization of international sanitaryarrangements had found expression in the inclusion,among the constitutional functions of WHO, of thatof proposing conventions and regulations andmaking recommendations with respect to inter-national health matters. That principle was furtherdeveloped in Article 21, which gave the HealthAssembly " authority to adopt regulations concerningsanitary and quarantine requirements and otherprocedures designed to prevent the internationalspread of disease ". In conferring on WHO authorityto adopt international sanitary regulations, theintention had clearly been to set up a new procedurecalculated not only to promote the needed unification,but also to give the new regulations the flexibilitymade necessary by the rapidity of present advancesin medical knowledge and means of transport, butwhich could not be attained under the older systemwith its cumbrous procedure of special internationalconferences and ratifications. That flexibility wasprovided by Article 22 of the Constitution, inpursuance of which regulations adopted by theHealth Assembly came into force for all Members

- 36 -

FIRST MEETING 37

after simple notification, except for those signifyingrejections or reservations within a given period.At the same time any regulations adopted could beamended by a procedure equally simple.

In the early months of its existence, the InterimCommission of WHO had set up expert committeesto prepare a revision of existing sanitary conventionsby the study of such questions as the sanitary controlof the Mecca Pilgrimage, and modern advances inepidemiology and methods of disinsecting. Thetechnical documentation thus produced had beenused as a basis by the Expert Committee on Inter-national Epidemiology and Quarantine in framinga set of principles for the new international sanitaryregulations. After approval of those principles bythe Second World Health Assembly, the expertcommittee, with the help of its legal sub-committee,had produced its preliminary draft regulations, whichafter further study and suggestions, had led to thedraft to which the special committee was to givefinal form with a view to its adoption by the FourthWorld Health Assembly.

The result of the long preparatory work to whichhe had referred was that the committee had beforeit a single slim working document, framed in theform of regulations. That text, which naturallycontained much of the substance of previous con-ventions, laid down the maximum measures to beimposed upon international traffic for the sanitaryprotection of frontiers. In many cases those maximumprovisions would not have to be applied fully oreven at all. The final aim was, through a properorganization of national health services, to destroydiseases at their source and to establish hygienicconditions in which they could not develop. Untilthat end was attained it was for the committee toframe the best regulations possible in the circum-stances.

The main problem before the committee was toadopt a method of working which would enable it todraw the greatest advantage from the patient pre-liminary work which had been done and so find away out of the present confusion. The word" method " recalled the remark of the philosopherDescartes that where the truest opinions could notbe discovered the most probable course must beadopted, and his picture of travellers lost in a forestand walking always in a straight line rather thanwandering hither and thither, in the hope that inthat way they would at least arrive at a place whichwas better than the middle of the forest. To emerge

from the present forest of confusion the committeeshould walk straight in the direction indicated bythose who prepared the present draft, whose opinions,if not irrefutable, were undoubtedly the mos tprobable.

Despite the patient preliminary work that had beendone, the task remaining before the committee wasa hard one, but he was sure that it would be broughtto a successful conclusion if the committee, mindfulof the possibility of improving whatever regulationsit was to adopt, sought, without aiming at impossibleperfection, to find a fair balance between the mini-mum necessary to avoid the spread of diseases andthe maximum practically possible without needlesslyimpeding international trade. At the same time, itwould be remembered that whatever value the regu-lations framed were to have would depend aboveall on how they were applied.

2. Election of Chairman

On the proposal of Dr. DUJARRIC DE LA RIVIÈRE(France), seconded by Dr. VAN DEN BERG (Nether-lands) and Dr. BELL (United States of America),Dr. M. T. Morgan (United Kingdom) was unani-mously elected Chairman, and took the Chair.

Dr. MORGAN thanked the Special Committee forhis election as Chairman. He was sure that thecommittee would prove a worthy successor toprevious conferences on sanitary regulations. Hewould carry out the office to which he had beenelected with complete impartiality.

3. Election of Vice-Chairmen

On the proposal of the CHAIRMAN, it was agreedthat four vice-chairmen should be elected. In theinterests of a wide geographical representation, itwas suggested that the regional organization ofWHO should serve as a basis for nominations,namely, South-East Asia ; Western Pacific (includingAustralia and New Zealand) ; the Americas ; theEastern Mediterranean and Africa, the last twobeing taken together.

It was subsequently decided, after a short adjourn-ment, to defer the nomination and appointment of thefour vice-chairmen pending the arrival of all delega-tions.

4. Composition of Sub-Committee on Credentials

It was agreed that the Sub-Committee on Cre-dentials should consist of representatives from the

38 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

following countries : Canada, Indonesia, Italy, Laos,Luxembourg, Netherlands, Norway, New Zealand,Philippines, Saudi Arabia, Syria and Thailand.

5. Adoption of the Provisional Agenda

On the proposal of Dr. BARRETT (United Kingdom),seconded by Dr. VAN DEN BERG and Dr. VAN DECALSEYDE (Belgium), it was agreed that an additionalitem, namely the appointment of a rapporteur,should be included in the agenda.

The committee decided to leave the actualnomination open to a later date.

Decision: There being no other observations, theprovisional agenda, amended as above, wasadopted (see page 9).

6. Procedure of Work

The CHAIRMAN proposed that the text of the draftRegulations should be considered in daily plenarysessions, so that all members could take full part inthe discussions.

He further suggested that, provisionally, only twosub-committees should be set up : (1) a drafting sub-committee (for which nominations would be madelater), to ensure complete concordance betweenthe French and English texts ; (2) a sub-committee-which all delegations were free to attend-toconsider the pilgrimage clauses in Annexes A and B.

It was so agreed.

The meeting rose at 12 noon.

SECOND MEETING

Tuesday, 10 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. First Report of the Sub-Committee on Credentials

Dr. PADUA (Philippines), Rapporteur of the Sub-Committee on Credentials, introduced the report(see page 269), which was adopted unanimously.

2. Consideration of Draft International SanitaryRegulations

The committee proceeded to the considerationof the draft Sanitary Regulations (as reproduced onpage 10).

Preamble

The proposal of the United Kingdom delegationto amend the words " communicable diseases " inthe second paragraph of the Preamble was referredto the Drafting Sub-Committee.

Dr. VAN DEN BERG (Netherlands) expressed hisdelegation's appreciation of the fact that WHO hadbegun the important work of revising existing sanitaryconventions, thus continuing the task previouslycarried out by the Office International d'HygiènePublique.

Commenting on the threefold aim of the draftSanitary Regulations, he said that his delegation

fully agreed about the importance of the codificationof all existing sanitary conventions. He regrettedthat the opinions expressed by his delegation inregard to the first draft had not found sufficientsupport, and mentioned three reasons why a newconvention was preferable to WHO Regulations,namely : (1) Real codification could not be attainedbecause WHO Sanitary Regulations would onlybe binding on Member States, thereby necessitatingthe maintenance of existing sanitary conventions formany countries not Members of the World HealthOrganization ; (2) The draft Sanitary Regulationsunder discussion went beyond the competence of theOrganization ; (3) While the drafting of sanitaryregulations was an important development in inter-national law, it was dangerous to use so untried aninstrument for a matter as important as internationalquarantine, since the regulations-if uns uccessful-might be prejudicial to future regulations in otherfields.

Dr. GEAR (Union of South Africa) said that therehad been only limited discussion by previous HealthAssemblies of the principles on which the draftSanitary Regulations would be based. Neverthelesshe believed the revised draft did not accord with

SECOND MEETING 39

the resolutions of the Health Assemblies, in particularwith resolution WHA2.15 of the Second WorldHealth Assembly concerning the " need for elimi-nating quarantine restrictions of doubtful medicalvalue which interfere with international trade andtravel, and . . . the present unsatisfactory tendencyto multiply the number of immunization certificatesrequired from travellers ".

He believed it was therefore important that,throughout its examination of the draft Regulations,the Special Committee should have constantly inmind the principles-epidemiological and publichealth-on which the prevention of epidemic diseasewas based. These principles implied that funda-damentally the protection of a community frominfectious disease depended upon its own internalconditions and on the improvement of its ownpublic-health and medical services, and not on barrierquarantine methods. It was therefore important toavoid such methods, especially when they causedsuch serious interference to international relationship,traffic and trade.

The concept of restrictive quarantine was not incomplete accord with modern knowledge of epidemio-logy. The diseases covered by the draft Regulationswere no longer the serious menace they had been 20years previously. They could now be controlled bypublic-health measures and internal arrangementswhich did not interfere with international travel.Average quarantine procedure would not excludeinfection, and no practicable organization couldcontrol the casual and irregular movement acrossfrontiers and along coasts. Countries should look totheir own internal development and the improvementof their own internal public-health services, and notrely on quarantine methods which only created afalse sense of security. He referred the SpecialCommittee to his minority report to the ExpertCommittee on International Epidemiology andQuarantine 1 setting forth in more detail his argu-ments in favour of the reduction of the presentobstructive forms of quarantine procedure.

Dr. BELL (United States of America) referred to thedifficulty inherent in efficient quarantine administra-tion owing to the numerous existing sanitary con-ventions and the differences in their application to theseveral means of international transport. He com-mended the work of the Expert Committee on Inter-national Epidemiology and Quarantine. It had donean excellent job of co-ordinating and consolidatingthe provisions of existing conventions. However,

1 Document WHO/Epid/52, unpublished

his Government was of the opinion that the presentdraft did not fully utilize the potential value ofWHO, nor did the draft Regulations fully cover thepresent changes in the world situation, with thechanges in the foci of dangerous epidemic diseasesand the discovery of new methods of control. Inaddition the general improvement of health standardshad lessened the danger of epidemics. WHO SanitaryRegulations should therefore be limited to simplecontrol measures directed primarily to the com-paratively few ports which were sources of worldinfection. He gave instances of the essential measuresnecessary for preventing the export of each diseasecovered by the draft Regulations, emphasizing thatit was already known what measures should beapplied, when they should be applied, and where ;there remained only to decide how control was to beeffected.

In general, the United States delegation consideredthat the draft Sanitary Regulations should be alteredto clarify certain passages, and to provide for betterreporting of disease, for adequate measures atdeparture and for more flexibility, through periodicalreview of their practical application.

WHO should increase its activities for the stimu-lation of health protection, particularly in themajor ports receiving international traffic, in order torender them non-receptive to the introduction ofepidemics. The Organization should also stimulateresearch for the development of new and bettermethods for the control of epidemic diseases.

Professor CANAPERIA (Italy) believed there wasroom for compromise between the two extremepoints of view. His delegation believed that the draftSanitary Regulations should be modified to maketheir application less obstructive to internationaltraffic.

Dr. EL-HALAWANI (Egypt) said that the Utopiareferred to by Dr. Gear of raising the standard ofhealth in all countries, while desirable, could not beachieved so rapidly as was hoped and, therefore,international sanitary regulations could not bedispensed with. It should be remembered that thediseases covered by the draft Regulations caused ahigh mortality and disorganized trade and traffic incountries in which they broke out, as had beendemonstrated by the cholera epidemic in Egypt in1947. In his opinion, countries should be protectedagainst epidemic diseases by tightening up certainarticles in the present draft.

40 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

The CHAIRMAN invited Sir Harold Whittingham,Observer for the International Air TransportAssociation, to make a statement.

Sir Harold WHITTINGHAM (International AirTransport Association) expressed the thanks of hisassociation at being allowed to send an observer.He explained that IATA as a whole had not yetfully considered the present WHO draft SanitaryRegulations and indicated that there was somedifference of opinion as between the medical andadministrative officers of IATA, the latter beingmainly concerned with facilitating and maintainingspeed of transport, whereas the medical committeehad also to consider prevention of disease. Aweakness of the draft before the Special Committeewas that it took no account of diseases other than thesix specifically mentioned in the proposed Regula-tions. The Regulations should be practical, scientificand sound. He instanced the recent case of a countrywhich had required travellers to hold a certificate ofinoculation for one injection against influenza, andwhich had stipulated that the expenses of anynecessary quarantining of passengers should be borneby the transport company concerned. He urgedthat immunization against any additional diseasesshould not be required without prior approval ofWHO, in order to avoid any cleavage of internationalopinion, and that the procedure be reduced to aminimum for all epidemic diseases.

He suggested that the type of any vaccine used andthe technique of application should be standardizedand included as an annex to the Regulations foreasy reference, and that approved sources of vaccineshould be published by WHO, as was being done inthe case of yellow-fever vaccine.

Many international sanitary airports did notconform to the minimum standards required underthe existing conventions and he recommended thatWHO should arrange for periodic visits to inter-national sanitary airports to ensure that the properstandards of hygiene and sanitation were maintained.A suitable clause to that effect should be insertedin the Sanitary Regulations.

With regard to disinsecting, it was considered thatdetails of aircraft disinsecting practice should alsobe published as an annex to the Regulations ; suchan annex should cover accepted formulae of insec-ticides, dosage and technique of application, so thatthe propedure of one nation could automatically beaccepted by any other.

With regard to transit areas, the present definitiontook account only of direct transit and overlooked

the case of passengers delayed in transit. The" holding " areas in the transit zones should be madehygienic in the full sense of the term, in the interest ofrapid transport and the avoidance of the spread ofdisease.

Lastly, whatever body was selected to deal withdisputes should act expeditiously in the interest ofrapid air travel.

M. GEERAERTS (Belgium) thought that, as one ofthe primary aims of the Organization was to promotethe highest possible standards of health throughoutthe world, some delegations might be placing undueemphasis on the importance of not impeding inter-national traffic.

Decision: The preamble was adopted subject tothe proposed amendments, which were to betaken into consideration by the Drafting Sub-Committee.

Article 2 [2]

The CHAIRMAN suggested that the committeeproceed to examine Article 2. The definitions con-tained in Article 1 would be considered in turn asthe words defined appeared in the various articles.The committee would note a reference in Article 2to government telegrams. Discussions on thequestion had been held with the InternationalTelecommunication Union, which was preparedto send a representative to make a statement, pro-bably at the following meeting ; he thereforesuggested that consideration of paragraph 2 ofArticle 2 be deferred.

M. GEERAERTS drew attention to differencesbetwen the English and French texts. For instance,in the English text of paragraph 1 of Article 2 thereappeared the words " territory or territories "whereas the equivalent phrase in the French textwas " son territoire ".

The CHAIRMAN and Dr. DUJARRIC DE LA RIVIÈRE(France) said that neither text was a translation of theother ; each text had equal value. If there was anydifficulty, the matter might be referred to the DraftingSub-Committee.

M. GEERAERTS thought that he had raised morethan a drafting point. The question was whether a

2 Throughout the minutes the articles of the Regulations arereferred to by the numbers under which they appear in thedraft text on page 10. To facilitate reference, however, thenumber of the corresponding article in the Regulations asapproved has been added in square brackets, where practicable,in the relevant sub-headings.

SEC OND MEETING 41

reference was intended to metropolitan territories ofMember States alone or, as implied in Article 95,to all territories under their jurisdiction.

Mr. HOSTIE, Chairman, Legal Sub-Committeeof the Expert Committee on International Epidemio-logy and Quarantine, said that it had been intendedthat the provisions of Article 2 should apply to allterritories to which the draft Regulations would beapplicable. The time to decide whether they shouldapply to all territories not specifically exempted, or tometropolitan territories together with any territoriesto which governments might extend them, would bewhen the final provisions of the Regulations weredecided on.

Dr. BELL said that his delegation had had somedifficulty in understanding what was meant by theword " territory ". Presumably it meant the wholearea under the jurisdiction of a single health adminis-tration. If other countries had experienced similardifficulties he suggested that a definition of " terri-tory " be included in Article 1.

The CHAIRMAN thought that the question raised bythe delegate of the United States was answered bythe definition of " health administration " as the

authority responsible for implementingsanitary measures over the whole of a territory.

It was agreed to defer further consideration ofArticle 2 until after the statement by the represen-tative of the International Telecommunication Union.(Continued in third meeting, section 4.)

Article 3 [31

Dr. VAN DEN BERG thought that a provision for thenotification of local areas established by governmentsmight be inserted between Articles 2 and 3.

Mr. STOWMAN (United States of America) feltthat the definition of " local area " was too closelyrelated to the type of health organization in existencein the area. An area might be infected although nohealth organization existed, or the infection mightextend over several areas. He therefore suggestedeither that the definition be deleted or that eachgovernment be left to provide its own definition,which should be notified to WHO.

The CHAIRMAN called on Dr. Gaud to provide anelucidation of the point from his knowledge of theevolution of the concept of local areas.

Dr. GAUD (France) said that the concept of localareas had first been introduced in the InternationalSanitary Convention of 1912 to permit the leastpossible hampering of international traffic, in viewof the previous tendency to consider a whole countryas infected, even when the infection was entirelylocalized. The difficulty had been to define thelimits of such local areas, which varied considerablyaccording to the country. In densely populatedcountries the tendency had been to try to reacha definition which would minimize unnecessaryupheavals in the life of a large part of thepopulation, with the result that the concept ofa local area had become progressively narrowerand had finally become meaningless. To remedythat situation the Expert Committee on Inter-national Epidemiology and Quarantine had decidedto define a local area as a clearly delimited partof a territory under the control of an administra-tive and sanitary authority capable of taking allmeasures necessary for preventing the spread ofinfection.

Dr. RAJA (India) attached great importance tothe definition of " local area ". In India, figures forthe incidence of cholera were given for areas rangingfrom seaport towns to provinces as large as Europeancountries. He noted that in the International SanitaryConvention for Aerial Navigation the definition of" local area " ranged from provinces and cantonsto villages and districts of towns. Such a definitionwas clearly useless and he therefore supported thesuggestion of the delegate of the United States thatindividual countries be asked to give their owndefinitions.

Dr. MA'MOEN (Indonesia) said that as in hiscountry there was not only a national health authoritybut also local health authorities, a problem mightarise as to which was to take action ; he was thereforein agreement with the proposal of the delegate of theUnited States.

The CHAIRMAN explained that the definitionintended to convey that a " local area " could not besmaller than the area covered by a health authorityunit.

Mr. STOWMAN agreed with the Chairman's inter-pretation and suggested that the definition be referredto the Drafting Sub-Committee to find a betterformula.

Dr. DOWLING (Australia) asked what was thepractical purpose of the definition. The idea was

42 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

apparently that, if a " local area " were infected, othergovernments should take action only against thatarea. He wondered whether that would serve anypurpose. If a single town were infected with smallpox,what was to prevent any inhabitant of that town fromleaving by train and going anywhere he wished ?

Dr. RAJA agreed that local facilities might notnecessarily be adequate to prevent the spread ofinfection, but in view of the importance, emphasizedby Dr. Gear, of impeding international traffic aslittle as possible, he felt that wherever possible a" local area " should be limited to the area whereadequate health facilities existed for the preventionof the spread of disease.

Dr. EL-HALAWANI said that if an airport was a" local area " it could not be independent of thetown or city to which it belonged.

The CHAIRMAN remarked that there were someairports, for example in the middle of the desert,which were entirely independent of any town. Itwould be impossible to find a hard and fast rule.He suggested that in accordance with the proposalof the United States delegate the definition shouldbe referred to the Drafting Sub-Committee.

It was so agreed.

Dr. DUREN (Belgium) wished in connexion withArticle 3 to raise a point with regard to the definitionof " foyer ". Though it was clear enough what wasa foyer of yellow fever, it was not clear what consti-tuted a foyer in the case of cholera and other epidemicdiseases covered by the Regulations. How manycases were required to constitute a foyer, and at whatpoint did a foyer become an epidemic ?

Dr. PADUA (Philippines) noted that paragraph 1 (a)of Article 3 referred only to plague, cholera and yellowfever as diseases the first case of which should benotified to the Organization. In the Far East,however, smallpox was still regarded as epidemiologi-cally important and it was undesirable that Article 3should suggest that health administrations shouldwait for an epidemic before notifying the Organi-zation. He therefore proposed that in paragraph 1 (a)the word " smallpox " be inserted after the word" cholera ".

Mr. STOWMAN introduced a proposed amendmentto Article 3. The United States Government con-

sidered that complete epidemiological informationwas essential for preventing the spread of diseaseswith the minimum of restriction on traffic. TheUnited States proposals were therefore intended,first, to extend to the whole world a reporting systemfor international port and airport cities similar to thatof the Singapore Epidemiological Intelligence Station,which had proved invaluable for twenty-five years ;secondly, to give smallpox, which at present wasmore widespread than the other diseases mentioned,an equal rating and, thirdly, to omit relapsing fever.The third point might be discussed in connexion withArticles 87 and 88. It was proposed that Article 3read as follows :

Article 3

1. Each health administration shall notify to theOrganization by telegram :

(a) the first case of plague, cholera, yellowfever, or smallpox recognized in its territory,designating the location of the case ;(b) the occurrence of a foyer of typhus de-signating the area, or areas, affected ;(c) the first discovery of rodent plague in anarea which has been free from this infectionduring the previous six months.

2. Any such notification shall be made by thehealth administration as soon as it is informed ofthe occurrence and at the latest within twenty-four hours of the receipt of such information.Each first case notified shall be confirmed bylaboratory methods as far as resources permit.

3. In addition to the notifications required underparagraphs 1 and 2 of this Article, each healthadministration shall report to the Organization bytelegraph the number of cases of epidemic diseasesand deaths therefrom which are known tohave occurred during the previous week ineach of its seaport or airport cities open to inter-national traffic. The absence of such cases shallbe reported, and such negative reports may besent by airmail.

The provision for the sending of negative reportswas important ; nil returns constituted more definiteinformation than no returns at all. There was noreason why other countries should not be able toemulate what had been done in South-East Asia,where facilities were in no way superior to thoseelsewhere. The question of what was to be donewith information supplied would of course remainto be decided, but there would be general agreementthat the maximum possible information should bemade available.

THIRD MEETING 43

Dr. BERGMAN (Sweden) thought that for a countrylike his, where smallpox did not normally occur, aprovision for the notification of first cases would beuseful.

Mr. HASELGROVE (United Kingdom) approved ofa provision for the notification of first cases ofsmallpox, but he thought that the Director-Generalmight not be entirely in favour of the proposal forsending nil returns.

Dr. BIRAUD, Secretary, agreed that if a local areawere defined as a small part of a territory it would beimpracticable from the point of view of the countriesthemselves, and the Director-General, for nil returnsto be required every week for every local area. Nilreturns would not be necessary for all areas, but onlyfor those which had been infected and which hadrecently ceased to be so.

Mr. STOWMAN said that the intention of the UnitedStates proposal was in fact that nil returns should begiven for all internationally important towns, airportand seaport cities, whether recently infected or not.The procedure could be very simple, involving onlythe sending of an airmail letter once a week.

Dr. DOWLING understood that the United Statesdelegation was proposing two kinds of notification :

one of the occurrence of cases ; the other ofnon-occurrence, or nil returns. If that was a correctinterpretation, he felt that the proposal was notappropriate to Article 3, which dealt only with thenotification of first cases.

Mr. STOWMAN had no objection to making para-graph 3 of the text proposed by the United Statesdelegation into a separate Article 4, to meet the pointraised by Dr. Dowling. Australia had been sendingnil returns to Singapore for 25 years without anyinconvenience.

The CHAIRMAN said that the committee appearedto be agreed on the principle that first cases of small-pox should be notified and that provision to thateffect should therefore be included in paragraph 1 (a).The second main point in the United States proposalcould be considered after the text had been circulated.

Dr. PADUA pointed out that the insertion of theword " smallpox " in paragraph 1 (a) would involveits deletion from paragraph 1 (b).

It was so agreed.

The meeting rose at 11.55 a.m.

THIRD MEETING

Tuesday, 10 April 1951, at 2.15 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Election of Vice-Chairmen (continuation from firstmeeting, section 3)

It was unanimously agreed to elect four vice-chairmen from the following delegations : Syria,Chile, India, Australia, the nomination of theindividual being left in each case to the head of thedelegation.

2. Appointment of Drafting Sub-Committee

On the proposal of the CHAIRMAN, a drafting sub-committee was appointed, consisting of the following

delegations which would designate their own membersto serve on the committee : Belgium, Chile, France,Italy, Laos, United Kingdom, United States ofAmerica.

In reply to a question by Dr. DUREN (Belgium)on the definition of a " local area ", the CHAIRMANsaid that a clear directive had been given at the secondplenary meeting to the Drafting Sub-Committee toprepare a new text on the basis that the minimum areafor a local area was that under the sanitary jurisdic-tion of a unit of local health administration.

44 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

3. Appointment of Sub-Committee on the MeccaPilgrimage

After some discussion, it was agreed that the sub-committee to consider the pilgrimage clauses shouldconsist of the following 12 delegations, with a quorumof seven : Chile, Egypt, France, India, Indonesia,Netherlands, Pakistan, Philippines, Saudi Arabia,Syria, Thailand, United Kingdom.

It was further agreed that any delegations arrivinglater which were interested in the pilgrimage clausesshould be added to the sub-committee, and thatmembers of other delegations could take part in thediscussions, without voting. The sub-committeewould elect its own chairman and meet daily untilits work was completed. (For minutes of this sub-committee, see page 248).

4. Consideration of Draft International SanitaryRegulations

Article 2 [2] (continuation from previous meeting,section 2)

The committee had before it a statement by theDirector-General to the effect that the provisions ofparagraph 2 of Article 2 concerning the priority tobe accorded to telegrams and telephone calls sent bythe Organization conflicted with the provisions ofannex 2 of the International TelecommunicationConvention, 1947, which excluded specializedagencies of the United Nations from the authoritieswith whom Government telegrams or telephone callsmight originate. Since the parties to the InternationalTelecommunication Convention, 1947, were for themost part Members of WHO, paragraph 2 should beamended, otherwise Member States would be boundby articles in two international agreements whichwere in substance in conflict. The amendmentsuggested by the Director-General read as follows :

Any such notification or epidemiologicalinformation sent by a government to the Organi-zation will be classed as a matter of course as agovernment telegram or government telephone calland the originating government shall, if it judgesnecessary, request priority for it. Any such noti-fication or epidemiological information sent by theOrganization may be treated as a governmenttelegram or government telephone call provided thegovernment or governments parties to its trans-mission over their own telecommunication systems,or the systems of the telecommunication privateoperating agencies which they recognize, agree thatit may be so treated. In that event the Organizationmay demand priority if it judges this to benecessary.

Mr. HOSTIE, Chairman, Legal Sub-Committee ofthe Expert Committee on International Epidemiologyand Quarantine, felt that it was incumbent upon himto draw attention to the fact that the statementwas based upon a misapprehension as regarded thepresent legal position. In the opinion of the LegalSub-Committee (which had considered the mattervery thoroughly) the relevant provisions of existingSanitary Conventions (listed in paragraph 2 ofArticle 101) had not been abrogated by the 1947Convention. Unless the committee was of theopinion that they should now be abrogated by theHealth Assembly, paragraph 2 of Article 2 should beretained. An alternative method of achieving thesame result would be to list the relevant provisionsamong those excepted from abrogation by Article 99.He suggested that the question of the procedure tobe adopted in transmitting vital information shouldbe kept apart from the financial aspect of thematter.

Mr. TOWNSHEND (Assistant Secretary-General,International Telecommunication Union) explainedthat the question had not yet been considered by theMembers of ITU. Its officials had, however, dis-cussed the matter with WHO and it seemed that aconflict existed between some of the provisions ofthe International Telecommunication Convention,1947, by which the 92 member countries of ITU hadbound themselves, and the provision of paragraph 2of Article 2 of the draft International SanitaryRegulations, by which a number of the same countrieswere proposing to bind themselves. ITU had inJanuary 1951 sent a circular letter to all its Members,suggesting that they might wish to consider theirposition in regard to the proposed provision inparagraph 2 of Article 2 of the draft SanitaryRegulations, and that those Members of ITU whowere also Members of WHO might wish to giveinstructions to their delegates to the Special Com-mittee. As very few replies had been received, hecould not say what were the views of Members ofITU. The legal aspect had not been considered bythe officials of his organization.

The telegraph services of the world, which wereconducted under the telegraph regulations of theInternational Telecommunication Convention, didnot provide government privileges for telegrams ortelephone calls of the United Nations or any of itsspecialized agencies.

The extension of such privileges to the UnitedNations or specialized agencies had been consideredby the ITU several times since 1947, but not approved.

THIRD MEETING 45

Mr. Townshend would report the position to theAdministrative Council of ITU when it met inGeneva the following week. He thought it would befor the Member Governments of ITU to decidewhether the International Telecommunication Con-vention was to be strictly observed or whetherspecial arrangements should be made to meet theneeds of WHO.

M. MASPETIOL (France) considered the statementfrom ITU important. The Special Committee shouldcarefully examine the modified text suggested forparagraph 2 of Article 2.

Referring to Mr. Hostie's suggestion, the questionof reservations to the acceptance of the SanitaryRegulations was a delicate one, which should be dealtwith when Article 99 and the following articleswere considered by the committee.

Mr. HOSTIE pointed out that the position whichexisted was further complicated by Section 11 of theConvention on the Privileges and Immunities of theSpecialized Agencies which was a later conventionthan the International Telecommunication Con-vention, and, if implemented by all Member States,would fully cover the question.

Mr. TOWNSHEND, commenting on Mr. Hostie'sreference to the application of the Convention on thePrivileges and Immunities of the Specialized Agencies,said that that convention had been examined indetail by the Administrative Council of ITU at itslast session six months previously. The Councilhad recommended to all Members of ITU to acceptthe part of the convention relating to telegramsand telephone calls, with a note that governmentprivileges should not be accorded to telegrams andtelephone calls emanating from the specializedagencies. He understood that some Member Gov-ernments of the ITU had accepted the Council'sview.

Mr. BEVANS (United States of America) said thatthe general classification of telegrams and telephonecalls to and from WHO as government com-munications was not within the competence of theHealth Assembly. He agreed that the classificationfor priority purposes was appropriate but felt that toclassify them as proposed in paragraph 2 would begoing beyond the authority of the Assembly asdefined in the Constitution of WHO.

He thought it would be better not to carry forwardany of the provisions of former conventions.

The CHAIRMAN, referring to the compromise draftfor paragraph 2 (see page 44), which had beensuggested as a result of discussions between the twoorganizations, said that the Special Committee hadfelt that such communications deserved prioritybecause of their importance from a health pointof view.

Mr. TOWNSHEND explained that outgoing com-munications from WHO could only get priorityby means of special arrangements between govern-ments and the private companies concerned and thatthe proposed text would render such prioritypossible.

Mr. BEVANS suggested that the second sentence ofthe proposed text be amended to read :

Any such notification or epidemiologicalinformation received or sent by the Organizationby telegram or telephone shall, when requested,be entitled to the priority accorded to governmenttelegrams and telephone calls.

Mr. HASELGR OVE (United Kingdom) thoughtthat the proposed text offered a solution, butsuggested that members of the committee shouldstudy it and also hear the views of the AdministrativeCouncil of ITU before deciding to include it in theSanitary Regulations.

Decision : It was agreed that further considerationof Article 2 be deferred until the views of theAdministrative Council of ITU were known.(Continued in twenty-fourth meeting, section 2.)

Articles 3 [3] and 4 [4]It was agreed, on the proposal of the CHAIRMAN,

that consideration of the two articles be deferreduntil the alternative draft text for Article 3 beingprepared by the United States delegation-whichwould also involve amendments to Article 4-hadbeen circulated.

Article 5 [5]

Dr. DUJARRIC DE LA RIVIÈRE (France) askedwhat was the definition of " bateaux " in the Frenchtext. He considered it unnecessary to use the word,since paragraph (b) of Article 98 provided thesolution of the whole problem of sanitary measuresto be applied " to international coastal traffic and tointernational traffic on inland waterways, includinglakes ".

Mr. HASELGROVE said that his delegation hadprepared a memorandum for circulation which

46 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

contained suggestions for definitions occurringin the English text.

It was therefore agreed to reconsider the definitionsas they arose later in the draft Regulations, in viewof the documents being prepared by the UnitedKingdom and United States delegations respectively.

Definition of "Foyer"

In reply to Dr. DUREN, who felt that the presentdefinitions of " foyer " and " epidemic " wereunsatisfactory, the CHAIRMAN explained the diffi-culties which had been encountered in trying todefine " foyer " without also defining " epidemic ".He suggested that the latter definition be left vaguefor the time being, in the hope that a more precisedefinition could be arrived at during the session.He invited members to submit suggestions.

Dr. DUREN replied that it might be arbitrary, butmore accurate, to use numerical data when deter-mining the end of a " foyer " and the start of an" epidemic ".

His view was supported by Professor CANAPERIA(Italy).

Definition of " Epidemic Diseases "

Dr. GEAR (Union of South Africa) raised thequestion of the inclusion of relapsing fever and louse-borne typhus in the Regulations. He accepted theCHAIRMAN'S suggestion that discussion of thequestion should be deferred until the committeedealt with typhus.

Definition of "Aircraft"The committee accepted the definition of

" aircraft ".

Definition of "Infected Local Area"A long discussion took place on the definition of

an " infected local area ", during which severaldelegates expressed their views and varioussuggestions were made.

The CHAIRMAN suggested setting up a smallworking party to consider the definition in relationto Article 3.

A discussion took place on the terms of referenceof the working party, Dr. JAFAR (Pakistan) proposingthat it should consider all definitions together whileDr. DUREN suggested that the Chairman's proposalmight be widened to include two or three definitionswhich already appeared to the committee to beimportant. Dr. DOWLING (Australia) advocatedsetting up a standing working party to which anydefinition which gave rise to a difference of opinioncould be referred.

It was finally decided to set up a working party offive members to consider the definition of " infectedlocal area " and all its implications in the Regu-lations.

On the proposal of the CHAIRMAN it was agreedthat the working party should be composed of arepresentative from each of the following delegations :Belgium, India, Pakistan, United Kingdom, UnitedStates of America (continued in sixth meeting,section 3).

The meeting rose at 4.45 p.m.

FOURTH MEETING

Wednesday, 11 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations (continuation)

Article 6 [6]The CHAIRMAN recalled that the committee had

completed its consideration of Articles 3, 4 and 5,which had been referred to the working party set upto consider the definition of " infected local area ".

The committee might proceed to consider Article 6 inprinciple, though, as it contained a reference toinfected local areas, its final form might depend onthe decisions of the working party with regard to theother three articles.

Decision: Paragraph 1 of Article 6 was adoptedunanimously.

FOURTH MEETING 47

Definition of "Yellow-Fever Endemic Area"

The CHAIRMAN, in connexion with paragraph 2 ofArticle 6, called attention to the definition in Part Iof " yellow-fever endemic area ".

Mr. STOWMAN (United States of America) thoughtthat the words " and where its recent occurrence inhumans may be detected by appropriate methods "in the definition, though not harmful, were unneces-sary. He proposed their deletion.

Dr. BARRETT (United Kingdom), proposed, sinceAedes aëgypti was by no means the only yellow-fever vector, that the word " stegomyia" be used inArticle 6 and throughout the Regulations, anddefined as " Aëdes aegypti or any other mosquitovector of yellow fever ".

Dr. DUREN (Belgium) noted that the definition inquestion, though referring properly to an endemiccondition, i.e., to the presence of yellow fever inhumans, laid most stress on its persistence amonganimals. It was an analytic definition, but it wouldbe possible also to give a synthetic definition, statingonly the most important fact, for example ; " anarea where, periodically and at varying intervals,indigenous cases of yellow fever occur in humans ".An analytic definition, on the other hand, mightintroduce a whole series of elements : first, the threeelements in the chain of infection, namely, the reser-voir of infection, the transmitting agent and thereceiver ; secondly, the evidence of the occurrence ofthe disease ; and, thirdly, the degree of permanence.Such an analytic definition might read " an areawhere Aëdes aegypti is present ; where, at varyingintervals and for long periods, indigenous cases ofyellow fever occur in human beings, and where thepersistence of the virus in humans or in certainanimals may be detected by recognized methods ".

An analytic definition would be dangerous assome relevant points might be omitted ; his delegationtherefore preferred the synthetic.

Dr. DUJARRIC DE LA RIVIÉRE (France), supportedby the delegate of Egypt, agreed with the UnitedKingdom delegation that the term " Aëdes aegypti"was too restrictive, but so was the word " stego-myia". The words " transmitting agents of yellowfever " would be adequate.

Dr. BMA (Pan American Sanitary Organization)agreed with the United States delegation that thewords " and where its recent occurrence in humansmay be detected by appropriate methods " should be

deleted. In view of the difficulty, due to such technicaladvances as the increasing use of vaccine, of detectingthe recent occurrence in humans of the yellow-fever virus, its persistence among animals was abetter criterion for determining the boundaries ofinfected areas.

The reference to Aëdes aegypti must however beretained as it was the most important vector.

Dr. DUJARRIC DE LA RIVIERE felt that the fact thatAëdes aegypti was the most important vector wasirrelevant. The Regulations should take accountof all cases together.

After a brief exchange of views, the delegates ofFrance, the Philippines and the United States ofAmerica agreed to propose that the words " Aëdesaegypti" in the definition be replaced by the words" Aëdes aegypti or any other insect vector of humanyellow fever ".

Dr. DOWLING (Australia) thought " vectors ofyellow fever " satisfactory.

Dr. BIRAUD, Secretary, explained that the existingdraft definition, based on the recommendations ofthe Yellow-Fever Panel, had been intended to providea clear distinction between urban yellow fever andjungle yellow fever, which latter might be carried byvectors other than Aëdes aegypti but did not, on theother hand, call for prolonged international action.The proposed changes would destroy that carefullymade distinction.

After a further exchange of views, the CHAIRMANput to the vote the proposal that the first line of thedefinition of " yellow-fever endemic area " remainunchanged.

Decision: The proposal was adopted by 11 votesto 9.

The CHAIRMAN put to the vote the alternativedefinition proposed by the delegate of Belgium.

Decision: The amendment was rejected by 2 votesto 1.

The CHAIRMAN put to the vote the United Statesproposal to delete the words " and where its recentoccurrence in humans may be detected by appropriatemethods ".

Decision: The proposal was adopted by 9 votes to 1.

Article 6 [6] (continuation)

Mr. HASELGROVE (United Kingdom) wonderedwhat was the origin of the provision in paragraph 2 (c)of Article 6 for a waiting period of 6 months after

48 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

completion of measures for the suppression of theepizootic. The period seemed quite arbitrary, and heproposed its deletion, which would of course involvea change in the definition of " infected local area ".

Mr. STOWMAN thought that the reference in thatparagraph to the completion of measures for thesuppression of the epizootic was unduly vague.What was important was not the taking of measuresbut the suppression itself.

Dr. DUREN supported the proposal by the delegateof the United Kingdom to delete the provision for awaiting period in paragraph 2 (c) of Article 6. Hewould himself propose similar amendments in thecase of the waiting periods provided for in para-graph 2 (b) of the same article, where the maximumestimated incubation period for yellow fever wouldbe a sufficient waiting period. He also wonderedwhether the Chairman could explain why the periodprovided for in paragraph 2 (a) was twice the incu-bation period ; it appeared arbitrary.

The CHAIRMAN agreed that the period in the caseof paragraph 2 (a) was arbitrary ; three times theincubation period might equally well have beendecided upon, but twice had seemed reasonable.

Dr. RAJA (India) agreed with the delegate of theUnited States that it was the suppression and not thetaking of measures for suppression that was im-portant. He also wondered whether the six months'waiting period might not be reduced to twice theincubation period, as for the diseases covered byparagraph 2 (a).

Mr. STOWMAN felt that some waiting period shouldbe provided for in paragraph 2 (c) for two reasons :first, because the persistence of an epizootic amongrats could not be so thoroughly checked as couldcases of plague in humans ; secondly-and this alsoapplied in the case of yellow fever-because ofseasonal variations which sometimes gave a falseimpression that an epizootic had been suppressed.

Dr. BRAVO (Chile) agreed with the United Statesdelegation that the reference to completion ofmeasures should be deleted. What was required wasa precise definition as in the case of yellow fever andthe other diseases. A definite waiting period shouldbe provided for, but it should date from the lastdiagnosed case of plague.

The CHAIRMAN said that the committee had to takeaccount of two types of situation. A distinctionshould be made between ports, for example, whereplague was endemic with seasonal variations, or inother words chronic, and ports normally completelyfree. If plague was brought into a port of the latterkind by a ship, an impossible situation would arisewhere, although the epizootic was suppressedwithin a few days, the port was regarded, by virtueof paragraph 2 (c), as infected for six months.

Dr. PADUA (Philippines) was in favour of thesuppression proposed by the United States delegation,with, however, the addition of a provision to theeffect that measures to prevent the reappearance ofthe epizootic should be continued.

Dr. DUJARRIC DE LA RIVIÈRE agreed that a waitingperiod of six months was excessive. As to thecontinuation of preventive measures, however, noregulations could be effective unless governmentswere to be trusted to do what was necessary.

The CHAIRMAN remarked that the draft Regulationsdid in fact contain an article providing that signatorygovernments should take all necessary measuresto keep ports free of plague.

He put to the vote a proposal by the delegate ofthe United States that the words " since measures forthe suppression of the epizootic have been satis-factorily completed " be replaced by " since thesuppression of the epizootic ".

Decision: The proposal was adopted unanimously.

The CHAIRMAN put to the vote the proposal of thedelegate of the United Kingdom that the words" six months have elapsed since measures for thesuppression of the epizootic have been satisfactorilycompleted " be replaced by the words " whensuppression of the epizootic has been achieved ".

Decision: The proposal was rejected by 11 votesto 5.

The CHAIRMAN called for suggestions as to thewaiting period to be provided for.

Dr. JAFAR (Pakistan) wondered how the period ofsix months in the draft had been reached. Perhapsthe Chairman, who had been a member of theexpert committee, could throw some light on thequestion.

FOURTH MEETING 49

The CHAIRMAN could not remember how the periodof six months had been decided upon but heremembered that the suggestion of the WHO ExpertCommittee on Plague (whose report had beenstudied by the Expert Committee on InternationalEpidemiology and Quarantine) had been one month.

Mr. HASELGROVE formally proposed that thewords " one month " be substituted for " sixmonths ".

Decisions:

(1) The proposal was adopted by 20 votes to 3.(2) The text of paragraph 2 (c), as amended bythe proposals of the delegates of the United Statesof America and the United Kingdom, was adoptedby 22 votes to 9.

The CHAIRMAN asked the delegate of Belgium,who had considered that the waiting periods providedfor in paragraph 2 (b) of Article 6 were unnecessarilylong, what alternative proposals his delegationwished to make.

Dr. DUREN suggested that, purely for the sake ofuniformity, the same waiting period as the committeehad just adopted in the case of plague, namelyone month, should be provided for after the reductionof the Aëdes aegypti index to not more than one percent. The waiting period after the occurrence ofthe last diagnosed human case might be reduced tothree months, the probable maximum survival periodof Aëdes aegypti.

Dr. BICA, supported by the delegate of India,suggested that the waiting period after the reductionof the 'Moles aegypti index to one per cent be twomonths and, after the last diagnosed human case, sixmonths.

The CHAIRMAN noted that, with regard to thewaiting period after the reduction of the Aëdesaegypti index, there were two alternatives, namely,two months as in the original text and one month asproposed by the delegate of Belgium ; in the case ofthe waiting period after the last diagnosed humancase there were three alternatives, namely, one yearas in the original text, six months as proposed by therepresentative of the Pan American Sanitary Organi-zation and three months as proposed by the delega-tion of Belgium. He therefore put first to the vote theproposal that the words " two months " in para-graph 2 (b) be replaced by " one month ".

Decision: The proposal was adopted by 12 votesto 6.

The CHAIRMAN put to the vote the alternativeproposals regarding the waiting period after thelast diagnosed human case.

The result of the vote was as follows :For three months 12 votesFor six months 5 votesFor one year 1 vote

Decision: It was decided that the waiting periodwould be three months.

Dr. BRAVO wished to make some observations inconnexion with the reference to " yellow-feverendemic areas " in paragraph 2 (b). He felt that itmight lead to some confusion, as there were areasoutside the yellow-fever endemic areas where theyellow-fever virus persisted among animals forconsiderable periods even when Aëdes aegyptiwas not present. The text as it stood might thereforebe taken as including as endemic areas regions whereepizootic foyers existed or villages and small com-munities where Aëdes aegypti existed but which werenot included in the yellow-fever endemic areas.Consequently for the sake of precision he suggestedthat the words " in a yellow-fever epidemic area "be employed in place of " outside a yellow-feverendemic area ".

The CHAIRMAN said that the Expert Committeeon International Epidemiology and Quarantinehad considered a suggestion similar to that of thedelegate of Chile, but had found it unsatisfactorysince it was extremely important that the first caseshould be reported. One case was sufficient toconstitute an infected area, but the occurrence of acase in a yellow-fever endemic area would make nodifference to procedure as the area would beconsidered as permanently infected. It was un-necessary for the committee to define " yellow-feverepidemic area ", as had been done in an earlierdraft, since action was to be taken as soon as a singlecase occurred.

Definition of "Aëdes aegypti Index "

Dr. BELL (United States of America) proposedthat the draft definition be amended to show howthe Aëdes aegypti index was to be determined, andsuggested the following wording :

An " Aëdes aegypti index" means a percentageof all habitations in a given area in which breedingplaces of Aëdes aegypti exist.

Dr. DUREN, supported by Dr. BRAVO, suggestedthat the definition in the draft Regulations would be

50 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

acceptable if a phrase such as " or other premises "were inserted. In the English text the words wouldfollow " habitations ".

Dr. DOWLING, in supporting the United Statesamendment, drew attention to the loose wording ofthe original definition in which-if retained-thewords " in a given area occupied by a single family "should be omitted.

Dr. EL-HALAWANI (Egypt), seconded by Dr. JAFAR,proposed that the words " and other vectors of humanyellow-fever " should be added after " Aëdesaegypti " in the last line, so as to include all insectvectors of the disease.

Dr. GEAR (Union of South Africa) recommendedthat the present definition of the Aëdes aegyptiindex be maintained, leaving it to the DraftingSub-Committee to find a more suitable phraseology.It should be remembered that what was wanted wasan index or a measure, not a complete descriptionof all places where vectors of yellow fever might befound.

Dr. BELL, while agreeing to the addition of thewords " or other premises " was not prepared toaccept a reference in the definition to other vectors.

Dr. DUJARRIC DE LA RIVIÉRE was in favour ofleaving the definition as it stood in the text, merelyadding a phrase to the effect that the same indexcould be determined for other vectors, in order tocover the point raised.

The CHAIRMAN explained that the experts, inproposing the definition, had not overlooked theepidemic of yellow fever in the Nubian mountainsin which breeding-places of larvae of Aëdes aegyptihad been found in water holes of baobab trees. Thedefinition could not cover all eventualities.

M. GEERAERTS (Belgium) proposed the followingwording :

" Aëdes aegypti index" means the percentage ratiobetween the number of premises occupied, eventemporarily or intermittently, in a given areaand the number of such premises in which breedingplaces of larvae of Aëdes aegypti are found.

Dr. GEAR argued against any change in thedefinition, which had been drafted to establish abasis of comparison between different localities.

Replying to Mr. BRILLIANT (United Kingdom),the CHAIRMAN confirmed the view of the SpecialCommittee to be that the wording proposed by the

delegation of the United States did not constituteany change in substance in the definition of " Aëdesaegypti index "

Decision: The Special Committee agreed, by vote,to adopt the substance of the draft definition, onthe understanding that the Drafting Sub-Committee would take account of the new wordingproposed by the United States delegation. Itrejected, by vote, the proposal to add " or otherpremises " after the word " habitations ".

Replying to a question put by Dr. EL-HALAWANI,the CHAIRMAN said that for the purpose of deter-mining the Aëdes aegypti index, an apartment blockoccupied by a number of families would constituteas many units as there were families.

Artkle 6 [6] (continuation)Replying to a further question by Dr. EL-HALA-

WANI, the CHAIRMAN said that in his opinion therewas no need, at the present stage, to make provisionin Article 6 for the systematic reduction of rodents,the point being fully covered in Articles 12, 13 and 14.

Decision: Article 6 was referred to the DraftingSub-Committee for consideration in the light ofthe discussion.

Article 7 [7]Dr. BELL proposed that the words " exclusive of

virus for research purposes " should be added after" yellow fever ".

Decision: Article 7 was referred to the DraftingSub-Committee.

Article 8 [8]Dr. HEMMES (Netherlands) proposed that the last

sentence should be amended to read : " It shallfurnish the Organization once a year with a recapitu-lation of all measures in force, at a date to be fixedby the Organization ".

Mr. BRILLANT supported the above proposal. Hefurther suggested that the word " forthwith " shouldbe replaced by " in advance ".

Dr. DOWLING suggested that the word " foreign "should be amended to read " international ".

Dr. GEAR maintained that Article 8 was redundant.If adopted, it would be an invitation not only tovary international immunization certificates but to

FIFTH MEETING 51

extend certificate requirements to many otherdiseases.

In the course of discussion, objections to theproposal of the delegation of the United Kingdomwere raised by a number of delegations on thegrounds that it might lead to interference in domesticlegislation.

Mr. BRILLIANT explained that that was in no waythe intention of his delegation's proposal ; he

suggested that the words " as long notice in advanceas may be practicable " might be acceptable.

Decision: The Special Committee agreed to theproposals of the delegations of the Netherlandsand Australia, leaving it to the Drafting Sub-Committee to consider an alternative phrase forthe word " forthwith ".

The meeting rose at 12 noon.

FIFTH MEETING

Thursday, 12 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Article 8 [81 (continuation)Dr. RAJA (India) proposed that a cross-reference

to Article 21 should be inserted in Article 8, in orderto draw the attention of countries to the fact thatsanitary measures in the Regulations were the maxi-mum measures applicable to international traffic.

Dr. GEAR (Union of South Africa), in supportingthe above proposal, suggested that the point couldbe dealt with under Article 11-suitably redrafted.Article 11 was a general article covering notificationof all changes, including immunization. Article 8was really redundant.

Decision: The matter was referred to the DraftingSub-Committee for consideration in connexionwith Articles 11 and 21.

Article 9 [I 0]Replying to Dr. PADUA (Philippines) who queried

the necessity for retaining the words " on request ",the CHAIRMAN explained that the procedure wasdifferent from that under the International SanitaryConvention, 1926, when notifications were trans-mitted through diplomatic channels. The ExpertCommittee on International Epidemiology andQuarantine had considered that diplomatic missionsinterested in the state of health of a country obtainedfull satisfaction under the present terms of Article 9.

Article 10 [I I]No observations.

Article 11Mr. STOWMAN (United States of America) pro-

posed that Article 11 should be placed earlier inthe text, before Article 9, in which case the secondparagraph of Article 11 would become redundant.

Professor CANAPERIA (Italy) proposed that theword " measures " in the second line should becompleted by the words " provided for in theseRegulations ".

The proposal was referred to the Drafting Sub-Committee.

Sir Harold WHITTINGHAM, (International AirTransport Association) suggested that the word" immediately " should be replaced by " in advance ".In drawing attention to the serious interference withtrade and travel and the difficulties experienced byinternational airlines resulting from new or changedquarantine requirements, he said that, in the case oftravel from the Far East (particularly Australia andNew Zealand) passengers tended to take the Pacificrather than the Western route owing to the quarantinemeasures enforced on air passengers travelling on thelatter.

Dr. PADUA preferred the text as it stood.

52 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. BELL (United States of America) wished theDrafting Sub-Committee to consider whether allnotifications required under the Regulations shouldnot be included in Part II. This was agreed.

Decision: The Drafting Sub-Committee was askedto consider an alternative wording for " im-mediately " in Article 11 on the lines suggested theprevious day for " forthwith " in Article 8.

Part Ill - Sanitary Organization, Methods andProcedure

Dr. BELL, referring to his previous remarks aboutthe need for periodic appraisal of the application ofthe Regulations and modifications to meet changingconditions, proposed the insertion of an article,to precede Article 12, covering the establishment ofan international sanitary council responsible for theregular supervision of the operation of the Regula-tions and entrusted with the duty of recommendingsuch changes as might be deemed necessary by WHO.

Dr. DUJARRIC DE LA RIVIÈRE (France), secondedby the delegations of Belgium, India and the Nether-lands, proposed that the United States proposalshould be discussed in connexion with Article 107.

Mr. STOWMAN and Dr. BARRETT (United Kingdom)urged the immediate discussion .of the proposal.

At the request of Mr. STOWMAN, Dr. DUJARRICDE LA RIVIÈRE agreed to amend his proposal tothe extent that the judicial character of an inter-national sanitary council should be discussed inconnexion with Article 107, but that the establish-ment of such a council might be discussed underPart III. He expressed some surprise that it wasproposed to insert an article on the establishment ofa body to review the Regulations in the middlerather than at the end of the text.

Decision: The committee agreed, by 11 votes to10, to defer consideration of the proposal of theUnited States delegation pending a study ofArticle 107 (see page 158).

Articles 12 to 17

Mr. HASELGROVE (United Kingdom) introduced thetext of two articles which his delegation proposedshould replace Articles 12 to 16, and an alternativetext for Article 17. He explained his delegation's

view that the provisions of Articles 12 to 16 were toodetailed and unlikely to be readily accepted. It wasnot considered necessary to provide for sanitaryseaports ; nor should the provisions of formerconventions relating to sanitary airports be retained.It should be sufficient to state in the Regulationsthat seaports and airports should have as far aspossible at their disposal adequate medical andsanitary facilities to meet the needs of internationaltraffic.

As regards provisions for deratting, his delegationconsidered that there should be two kinds of approvedports : one should have available the staff and equip-ment for inspecting and deratting ships and beempowered to issue both Deratting Certificates andDeratting Exemption Certificates ; the othermight have merely facilities for inspection and shouldbe empowered to issue Deratting Exemption Certi-ficates only.

The proposed articles read as follows :

Article 12

1. Each health administration shall as far aspossible ensure that ports and airports in itsterritory shall have at their disposal an organi-zation and equipment sufficient for the applicationof the measures provided for in these Regulations.

2. In any case there shall be available to thelarger ports and airports, in proportion to theimportance of their international trade and inter-course, an organized medical service with adequatestaff, equipment and premises, and in particularfacilities for the prompt isolation and care ofinfected persons, for disinfection or any otherprophylactic measure required by these Regula-tions, and for bacteriological investigation.

3. There shall be in every port and airport anefficient organization for the destruction ofrodents in all port and airport installations. Everyeffort shall be made to extend rat-proofing to suchinstallations.

Article 13

1. Each health administration shall ensure thatthere is available at a sufficient number of theports in its territory the personnel competent toinspect ships with a view to the issue of theDeratting Exemption Certificates referred to inArticle 46 and the health administration shallapprove such ports for that purpose.

FIFTH MEETING 53

2. The health administration shall designate anumber of the approved ports in its territory, inproportion to the importance of its internationaltrade and intercourse, as having at their disposalthe equipment and personnel necessary for thederatting of ships with a view to the issue of theDeratting Certificates referred to in Article 46.

Article 17

1. Each health administration shall :(a) send to the Organization lists of the approvedports and designated ports in its territory ;(b) notify to the Organization any changewhich may occur from time to time in the listsrequired by sub-paragraph (a) of this paragraph.

New Definitions

" approved port" means a port approved inaccordance with paragraph 1 of Article 13." designated approved port" means an approvedport designated in accordance with paragraph 2 ofArticle 13.

The CHAIRMAN wondered whether the committeewished first to discuss the United Kingdom draftamendment or would prefer to begin by consideringArticles 12 to 17 in the draft Regulations.

Dr. DOWLING (Australia), as he was strongly infavour of the United Kingdom amendment, wishedit to be discussed first.

Professor CANAPERIA did not think that the intro-duction of the idea of " approved ports " (definedas ports which were competent to issue DerattingExemption Certificates) would constitute an improve-ment on the text of the draft Regulations, since itwas in the interests of international traffic to haveas many ports as possible where such certificatescould be issued, and there was nothing to preventcompetent persons being sent when needed fromlarger to smaller ports. For that reason, and becausehe considered the concept of a sanitary airport inthe original text of some importance, he wouldprefer the draft Regulations to be the basis ofdiscussion.

A discussion took place in which the variousdelegations stressed the more detailed nature of theprovisions in the draft Regulations and Mr. HASEL-GROVE said that he had no wish for the latter to beignored.

Finally, Dr. DOWLING withdrew his suggestionand it was agreed that Articles 12 to 17 of the draftRegulations be taken as the basis of discussion.

Dr. RAJA said in connexion with Article 12 that anumber of definitions were involved, including thatof " seaport ".

Mr. BRILLIANT (United Kingdom) called attentionto his delegation's note proposing the deletion of thedefinition of seaport and certain other definitions,as well as some new and amended definitions.3He wondered whether those points should bediscussed immediately.

The CHAIRMAN thought that the proposals wereperhaps all matters of drafting which might beconsidered by the Drafting Sub-Committee in thelight of the committee's discussions of the articles atpresent under consideration.

Dr. DUJARRIC DE LA RIVIÈRE, while approving theintroduction of the concept of " sanitary ports ",noted that no definition was provided in Part I ofthe draft Regulations. Since it was a new conceptit ought perhaps to be defined.

Professor CANAPERIA agreed with MT. HOSTIE,Chairman, Legal Sub-Committee of the ExpertCommittee on International Epidemiology andQuarantine, whose opinion it was that paragraph 3of Article 12 was in itself a definition of " sanitaryports ".

Dr. DUJARRIC DE LA RIVIÈRE agreed that para-graph 3 of Article 12 was an adequate definition.Some reference to that paragraph should be included

3 In this note the United Kingdom delegation proposeddeletion of the definitions " inland navigation port ", " inlandnavigation vzssel ", " seaport " and " vessel " (this latter termto be replaced by " ship " throughout the Regulations).

New or amended definitions read :" arrival " of a ship, an aircraft, a train or a road vehiclemeans :

(a) in the case of a seagoing vessel, arrival at a port ;(b) in the case of an aircraft, arrival at an airport ;(c) in the case of an inland navigation vessel, arrivaleither at a port or at a frontier post, as geographicalconditions and agreements among the States concerned,under Article 98 or under the laws and regulations inforce in the territory of entry, may determine ;(d) in the case of a train or a road vehicle, arrival at afrontier post.

" port " means a seaport or an inland navigation portwhich is normally frequented by ships." ship " means a seagoing or an inland navigation vesselmaking an international voyage.

54 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

in Part I so that a definition would not be looked forin vain in the list. It was of course a purely draftingpoint.

Mr. HASELGROVE agreed with the Chairman thatthe new definitions proposed might be left to theDrafting Sub-Committee.

As to the proposal that a definition of " sanitaryports " be inserted in Part I, the United Kingdomdelegation naturally wished for no such definitionas it was proposing that the concept be eliminatedaltogether.

Decision: It was agreed that the proposals of theUnited Kingdom delegation regarding definitionsbe referred to the Drafting Sub-Committee forconsideration in the light of discussions on therelevant articles.

Dr. BRAVO (Chile) thought that in connexion withsanitary airports the definition of " airport " wouldrequire re-examination. If, as appeared in Part I," airport " meant only the landing field and not thelocal area in which the airport was situated, then, ifthe requirements for sanitary airports were to bevery stringent, very few airports in the world wouldbe able to satisfy them.

The CHAIRMAN asked for the views of the com-mittee on the elimination of the term " sanitary ",on the understanding that ports and airports wouldnevertheless have to comply with the provisions ofArticles 12 to 16.

Dr. RAJA wondered whether the elimination ofthe term " sanitary " would not necessarily involvethe elimination of the relevant articles in the textof the draft Regulations.

The CHAIRMAN was of the opinion that portscould comply with the provisions of Articles 12 to16 without necessarily being called " sanitary ".

Dr. VAN DE CALSEYDE (Belgium) thought that toeliminate the term " sanitary " and retain Articles 12to 17 would imply that small fishing ports had tocomply with all the provisions, which would beimpossible.

Mr. HASELGROVE said that the concept of " sanitaryport " was new and in the opinion of the UnitedKingdom delegation unnecessary. It was felt thatinstead of certain ports being set aside as required tofulfil certain conditions, criteria should be prescribedapplicable to all ports in proportion to the volume

of traffic passing through them. That was providedfor in the United Kingdom draft Article 12, para-graph 2, which stipulated the facilities that must beprovided in the " larger ports and airports ".

Professor CANAPERIA thought that the essentialpoint was not whether ports were to be called" sanitary ", as in the draft Regulations, or" approved ", as in the proposed United Kingdomamendment but whether they were to have thefacilities to fulfil the requirements of the Regulations.

Mr. HOSTIE thought that the question of omittingor retaining the word " sanitary " was not merelyone of name, since some articles of the Regulations,for example Article 71, were specifically applicableto sanitary airports.

Dr. DOWLING could still see no point in retainingthe word " sanitary ". The United Kingdom draftsupplied definitions of two kinds of port and set outthe relevant requirements. The more detailed require-ments in the draft Regulations could not possiblybe fulfilled in certain countries because of geo-graphical conditions.

Dr. VAN DE CALSEYDE thought that whether theword " sanitary " was to be retained would dependon whether Article 12 of the draft Regulations wasor was not to be replaced by the United Kingdomdraft.

Dr. RAJA said that the term " sanitary airport "had been used in the past and caused no difficulties.The present proposal was merely to extend the term" sanitary " to seaports.

Dr. EL-FAR Bey (Egypt) wished the term " sani-tary " to be retained to maintain the distinctionimplied by the use of the term " specified airports "in Article 71.

Mr. HASELGROVE wondered whether the com-mittee fully appreciated the implications of the useof the term " sanitary " in Article 12. Certainseaports and airports were to be set aside under aspecial name and the facilities that must be providedin them were specified in detail in the followingarticles. The United Kingdom delegation thought itbetter that the Regulations should define in generalterms the responsibility of national authorities inthe matter of facilities to be provided in ports to beused internationally. Many of the requirements setout in Articles 13 to 15 of the original text could not

SIXTH MEETING 55

possibly be fulfilled in many ports, and the resultwould either be a large crop of reservations orconsiderable impediment to international traffic.

He felt that if the Regulations were framed as inthe United Kingdom draft, the national authoritieswould in general do what was required wherever itwas practically possible.

Dr. BRAVO thought that if certain ports were to bequalified as " sanitary ", their qualifications mightwell be different from those of airports. With regardto the latter, if they were to be considered simply aslanding fields, it might be impossible to fulfil theserequirements. He therefore insisted once more thatthe definition in Part I of " airport " should be mademore precise.

Professor CANAPERIA felt that considerable confu-sion had arisen in the discussion. While the term" sanitary port " was new, the idea had appearedbefore in Article 14 of the International SanitaryConvention, 1944, which required governmentsto undertake to maintain in their larger ports and thesurrounding areas, and as far as possible in otherports and the surrounding areas, sanitary servicesadequately equipped to apply the prophylacticmeasures described by the convention.

That provision, in his opinion, constituted a defini-tion of " sanitary port " ; it also met the pointraised by the delegate of Chile as it referred not onlyto ports but also to the surrounding areas.

He wished to stress once more than it was not thename, but the provision of the required facilities,which was important.

Dr. VAN DE CALSEYDE asked the Secretary toexplain why the expert committee had introducedthe concept of the " sanitary port ".

Dr. BIRAUD, Secretary, said that the main reasonhad been that it had seemed useful for nationalhealth authorities to know what sanitary facilitiesexisted in the ports and airports of other countries.Hence the expert committee had decided both todefine the requirements in the matter of facilitiesand also to designate by a special name the portsfulfilling those requirements. The requirementswould not necessarily have to be fulfilled in all portsof whatever size, and he felt that a compromise mightwell be possible between the United Kingdomproposal, whereby requirements would be flexibleand varied according to the size of the port, and theconcept of establishing a special standard and aspecial name for ports conforming to that standard.

The CHAIRMAN suggeste.d that the discussion onthe United Kingdom proposals be closed for thetime being. (For continuation, see sixth meeting,section 4).

2. Establishment of a Working Party to consider theProposal of the Delegation of the United Statesto establish an International Sanitary Council

The CHAIRMAN said it had been suggested to himthat, as the United States proposals with regard tothe establishment of an international sanitarycouncil were to be further considered when thecommittee came to discuss Article 107 of the draftRegulations, a working party might be set up tostudy them in detail in the meantime. He proposedthat the working party should be composed of thedelegates of Egypt, France, Italy, the Netherlands,the United Kingdom and the United States ofAmerica.

Decision: The Chairman's suggestion was adoptedunanimously.

The meeting rose at 11.45 a.m.

SIXTH MEETING

Friday, 13 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Second Report of the Sub-Committee on Credentials

Dr. PADUA (Philippines), Rapporteur of the Sub-Committee on Credentials, introduced the secondreport of that sub-committee (see page 269) whichwas adopted unanimously.

2. Proposal of the Delegation of the United Statesto establish an International Sanitary Council(continuation from fifth meeting, section 2)

Dr. DUJARRIC DE LA RIvItRE (France), recallingthat a working party had been set up to consider

56 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

the proposal of the United States delegation toinsert in Part III of the draft Regulations a furtherarticle relating to the provisions of Article 107,introduced a document containing a modified draftof Article 107 (see page 283) which his delegationwished also to be taken into consideration by theworking party.

The CHAIRMAN suggested that the proposals of theUnited States and French delegations should beconsidered at the same time by the working party,together with a memorandum on Article 107,submitted by the Director-General (see page 152).

Decision : The Chairman's suggestion was adoptedunanimously.

3. Report of the Working Party on the Definitionof " Infected Local Area "

Dr. JAFAR (Pakistan) introduced the report of theworking party (see page 285).

The CHAIRMAN suggested that the report beapproved and remitted to the Drafting Sub-Com-mittee. It might be left open to members to discussthe suggested use of the term " yellow-fever endemiczone " when the committee came to consider therelevant articles of the Regulations.

Dr. VAN DEN BERG (Netherlands), noting that thereport stated that the working party had consideredthe definition of " local area " and was remittingsome observations on it to the Drafting Sub-Com-mittee, saw no indication that the suggestion of theNetherlands delegation regarding the notificationto WHO of local areas established by nationalauthorities had been referred to in those observations.He therefore reserved the right to raise the matteragain when the report of the Drafting Sub-Committeewas considered.

Mr. CALDERWOOD (United States of America),speaking as Chairman of the Drafting Sub-Com-mittee, said that that sub-committee had been informedthe day before that the working party had madesome suggestions with regard to the definition of" local area ". It had been agreed that the DraftingSub-Committee was not competent to consider thesuggestions until they were passed to it by the SpecialCommittee.

The CHAIRMAN observed that in any case it was notin the terms of reference of the working party todiscuss the definition of " local area ", which had

been previously remitted to the Drafting Sub-Committee.

Dr. DUREN (Belgium) informed the committeethat although the working party had taken intoconsideration his delegation's proposal to deletethe reference to yellow-fever endemic zones fromthe definition of " infected local area ", he wished toraise the matter again during the general discussionof the chapter on yellow fever (see fourteenth meeting,page 101).

Decision: It was agreed that the report of theworking party be referred to the Drafting Sub-Committee.

4. Consideration of Draft International SanitaryRegulations

Articles 12 to 17 (continuation from page 52)

Dr. BELL (United States of America) said that hisdelegation agreed in principle with the UnitedKingdom's proposals (see page 52) in so far as theyrelated to seaports, but that requirements as regardsairports were fundamentally different, firstly becausethe risk of exposure to disease was not the same inboth cases, and secondly because the rapidity of airtravel destroyed what had been one of the basicfactors in successful control of epidemic diseases inthe past. He recognized that the detailed provisionsof the draft Regulations might be inapplicable wherethere were many seaports of varying sizes, but hefelt that real benefits would be derived from theestablishment of a separate category of sanitaryairports, and therefore proposed that the UnitedKingdom delegation modify its suggestions accor-dingly. Redrafting by the United Kingdom delegationmight take several days, and for the moment thediscussion might be confined to principles.

Dr. BJORNSSON (Norway), speaking as a represen-tative of a seafaring nation whose ships called inports all over the world, in many of which sanitaryprovisions were known to be inadequate, was infavour of retaining the category of sanitary ports.It would help towards that final repression ofepidemic diseases which would make regulationsunnecessary, because countries would have aninterest in making their ports " sanitary " as soonas possible, since trade would centre on such ports.

Mr. HASELGROVE (United Kingdom) said that hisdelegation had been impressed by some of the remarksmade but felt that their purport, while having greatmerit, might not be fully acceptable to the committee.

SIXTH MEETING 57

His delegation therefore accepted the suggestionof the United States delegation that the proposals bereconsidered. He hoped that the debate wouldcontinue so that any further views expressed mightalso be taken into consideration.

Dr. RAJA (India) said that, provided the provisionsrespecting sanitary airports, which existed in previousagreements and had given no trouble, were retained,his delegation recognized the force of the UnitedKingdom argument regarding the difficulty ofapplying all the proposed provisions with regard tosanitary seaports.

Dr. DUJARRIC DE LA RWIÈRE, while agreeing that itwas greatly to be desired that all ports and airportsshould one day be supplied with all necessarysanitary equipment, thought that, meanwhile, froma purely epidemiological point of view, the draftRegulations constituted a great advance. He agreedwith the United States delegation that the value ofestablishing a category of sanitary airports had notbeen fully recognized in the United Kingdom pro-posals and he was in favour of a modification ofthose proposals by the United Kingdom delegationon the lines suggested by the delegate of the UnitedStates.

Mr. LARSSON (Sweden) thought that, pending theintroduction of facilities for the control of epidemicdiseases at all ports, it would be well to establish acategory of ports where the existence of such facilitieswas assured.

Dr. VAN DE CALSEYDE (Belgium) said that hisdelegation was prepared to help the United Kingdomdelegation to revise its proposals by submitting theviews of the Belgian delegation in writing.

Mr. HASELGROVE gladly accepted the offer andhoped that other delegations would also expresstheir views as soon as possible either in writing orat the present meeting.

Dr. EL-HALAWANI (Egypt) wondered whetherparagraph 1 of Article 12 of the draft Regulationsimplied that every vessel or aircraft was requiredto call first at a seaport or airport designated as" sanitary ".

The CHAIRMAN did not think that that was theintention of the paragraph.

Dr. EL-HALAWANI felt that there was a fundamentaldifference in the points of view regarding the articlesin question. Certain countries which considered

themselves immune from epidemics were notinterested in restrictions, while others, subject tofrequent epidemics, were naturally apprehensive.Hence the draft Regulations did not provide forevery case ; he hoped that some adjustment wouldbe possible.

Dr. GEAR (Union of South Africa) recognized theforce of the arguments put forward by many delegates,but recalled the remarks of the delegate of Australiaat the previous meeting to the effect that suchquestions as sanitary conditions in the areas sur-rounding ports were the concern of national govern-ments and not a matter for international regulations.Still, it was certainly within the competence of WHOto use its influence to encourage governments toimprove such conditions, and perhaps a resolution onthose lines, separate from the Regulations them-selves, could later be drafted for submission to theWorld Health Assembly.

Dr. BELL supported the suggestion that such aresolution be drafted.

With regard to the points raised by the delegatesof Norway and Sweden, he agreed, naturally, thatthe highest standards of sanitation in seaports weredesirable ; but there was nothing in the draft Regu-lations to indicate that any benefit would be derivedfrom the establishment of a separate category ofseaports designated as sanitary ports, whereasArticles 37, 38, 39 and possibly 36 contained pro-visions giving point to the establishment of thecategory of sanitary airports. Unless, therefore,such provisions in the case of seaports were to beinserted later, he thought that the Regulations needcontain no more than a recommendation that highsanitary standards be maintained in seaports.

Dr. RAJA agreed that WHO might use its influenceto encourage improvement in sanitary standards inports, but as to the point raised by the delegatesof the Union of South Africa and Australia, that thearticles in question encroached on matters properlywithin the competence of national authorities, heobserved that the Regulations, which the committeehad met to frame in co-operation, were themselvesinfringements of sovereign rights. He did nottherefore feel that paragraph 4 of Article 15, forexample, could be thrust aside on such an argument,particularly as it had been adopted by the ExpertCommittee on International Epidemiology andQuarantine.

Dr. DOWLING (Australia) thought that the delegateof the Union of South Africa had stated a very

58 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

important principle. The draft Regulations as theystood-he was thinking in particular of Article 13-contained many detailed prescriptions, such asthose concerning facilities for immediate vaccination,which would in many cases be quite inapplicable.The result would be that many reservations would bemade and that many provisions would be ignoredaltogether.

Dr. DUJARRIC DE LA RIVIÈRE thought that theprovisions in question were intended as a maximum.

The CHAIRMAN thought that the word maximumin Article 21 must be taken as referring to theextent to which traffic might be interfered with andnot to the facilities which might be provided.Obviously there would be no objection to govern-ments providing more facilities than prescribed in theRegulations.

He asked the delegate of the Union of SouthAfrica to present a paper setting forth the views whichhe had expressed, to which Dr. GEAR agreed.

It was agreed to close the discussion of Articles 12to 17.

Article 18

Mr. HASELGROVE thought that the expression" inland navigation " in Article 18 was obscure,and that what was meant was " inland navigationvessels ".

It was agreed to refer the question to the DraftingSub-Committee.

Artkle 19

Dr. VAN DE CALSEYDE proposed that, for the sakeof uniformity, the expression " to avoid as far aspossible ", used in paragraph 4 (a) of Article 46,be employed in place of " not to cause " in para-graph 1 (a) of Article 19.

Dr. BARRETT (United Kingdom) wished in the sameparagraph to add the word " undue " before theword " discomfort " since a certain amount ofdiscomfort in such circumstances was unavoidable.

Dr. DUJARRIC DE LA RIVIÈRE Could not accept thechange suggested by the Belgian delegation. In nocircumstances should disinfection be injurious to thehealth of anyone. He wished to see the UnitedKingdom suggestion adopted.

Professor CANAPERIA (Italy) noted that in thearticle under consideration a reference to disinsectingand deratting appeared for the first time in theRegulations, but the articles dealing with disinsectingcontained no provisions as to the methods to beemployed. In the case of deratting, the DerattingCertificate appended to the Regulations did, however,provide for a statement of the method employed.As the disinsecting and deratting methods employedby certain nations might not be universally acceptable,it was important that standard practices, recognizedas valid everywhere, should be included in theRegulations.

Dr. BIRAUD, Secretary, explained that the ExpertCommittee on International Epidemiology andQuarantine had not recommended any definiteprovision with regard to methods of disinsecting inview of the rapidity of developments in techniques,which might necessitate constant modification in aset of Regulations intended to remain in force for aconsiderable period. It had been the intention ofthe expert committee that recommended practicesshould be given as a supplement to the Regulations.

Dr. GEAR, supported by MT. STOWMAN (UnitedStates of America), proposed either the deletion ofthe last sentence of paragraph 2, or modification ofthe wording, to imply that no article, howeversmall its value, could be destroyed except by per-mission of the owner.

Dr. DUREN agreed with the United Kingdomproposal to add " undue " after " discomfort "in paragraph 1 (a). With regard to paragraph 1 (b) ,

he proposed that the text should be re-drafted tobring it into line with paragraph 4 (a) of Article 46,namely, " to avoid as far as possible damage . ".

Dr. EL-HALAWANI also supported the amendmentof the United Kingdom delegation.

In connexion with disinsecting practice, he recalledthe recommendations of the International AirTransport Association that accepted formulae ofinsecticides, dosage and technique of usage shouldbe published as an annex to the Sanitary Regu-lations.

Dr. DUJARRIC DE LA RIVIÈRE agreed about the needfor harmonizing the wording of paragraph 1 (b)of Article 19, and paragraph 4 (a) of Article 46concerning possible damage caused to vessels inderatting and disinfection operations. He expressed

SIXTH MEETING 59

some concern about the legal implications ofparagraph 2 as worded in the French text.

Dr. BARRETT preferred the wording of para-graph 1 (b) to remain unchanged. No risk should betaken with the fragile navigation control and otherinstruments in aircraft or ships. He had no objectionto the deletion of the last sentence in paragraph 2.

Some discussion took place on a point raisedby Dr. REID (Canada) to the effect that disinfectionoperations sometimes necessitated operations, suchas the breaking down of locked doors on ships,which might be interpreted as causing damage tothe structure of a vessel and therefore constitutingan infringement of Article 19.

Dr. DOWLING suggested that the wording ofparagraph 1 (b) should be qualified to meet the viewsof the delegate of Canada.

Dr. BELL and Mr. HASELGROVE maintained thatthe provisions of the article should be mandatoryin so far as the operating equipment of a vessel andaircraft was concerned.

Mr. HOSTIE, Chairman, Legal Sub-Committeeof the Expert Committee on International Epidemio-logy and Quarantine, was definitely of the opinionthat the breaking down of a door could not beconsidered as an infringement of Article 19, whichwas limited to the effect of the actual disinfectionprocedure. He further pointed out a discrepancybetween the English and French texts of the article.

Decisions : The committee agreed :(1) to add the word " undue " after " discom-fort " in paragraph 1 (a) of Article 19, the Frenchtext to be adjusted accordingly ;(2) that the French text of paragraph 1 (b)should be brought into line with the Englishwording ;(3) to delete the last sentence of paragraph 2.

Article 20

Dr. DOWLING proposed the deletion of the words" free of charge " in both paragraphs. He also drewattention to the loose wording of the last phrase inparagraph 2 which, in his view, should either bedeleted or modified to provide for the issue of acertificate to any one party, specifying the measuresapplied to his goods.

On a vote being taken, the proposal to delete thewords " free of charge " was rejected.

A further vote resulted in rejection of the proposalto delete the last clause in paragraph 2.

The committee agreed, by vote, to a proposal ofMr. BRILLIANT (United Kingdom) that the issue of acertificate be restricted to the sender, the receiver,or the agent of either, and referred the proposal tothe Drafting Sub-Committee.

Definition of "Health Authority"

A proposal of the United States delegation todefine " health authority " as the " smallestadministrative unit immediately responsible for theapplication of the sanitary measures provided for inthe Sanitary Regulations " was referred to theDrafting Sub-Committee for consideration in con-nexion with the definition of " local area ".

Part III - Sanitary Organization, Methods andProcedure

The CHAIRMAN invited Sir Harold Whittinghamto make a general statement on Part III.

Sir Harold WHITTINGHAM (International AirTransport Association) raised the question ofincluding other than " convention diseases " in thenew International Sanitary Regulations. After abrief reference to the ideals of the InternationalAir Transport Association, namely, to facilitate thecommerce of aviation so as to attain the maximumof speed in travel, transit and turn-round, he drewattention to the importance of the good health ofaircrews. IATA would like to see the maximum ofhygiene and the minimum of immunization, quaran-tine and documentation, which tended to embarrassand delay commercial aviation. It was importantthat there should be a high standard of hygiene andsanitation at all international airports and transitareas, at least on main trunk routes, to obviatedelay in services owing to preventable illness. Thatnecessitated local control, not only of the " con-vention diseases " but also of such conditions asdysentery, food-poisoning and gastro-enteritis. Ifthe necessary sanitary measurés could not be includedin the new Sanitary Regulations, he urged that thematter be considered by WHO at an early date. Hehad gained the impression from the discussions thatmeasures regarding the hygiene and sanitation of air-ports would be left in general terms only for appli-cation " as far as possible " by the health authorityconcerned. The International Air Transport Asso-ciation feared that airport authorities would jumpat an opportunity to cut expenses in connexion withhygiene and sanitation.

60 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. DWARRIC DE LA RIVIÈRE thought that itwould be of great value if airports could be properlyequipped for the treatment of aircrews.

Dr. EL-HALAWANI stressed the importance ofproviding sanitary airports and seaports for aircraftand ships arriving from another territory.

Speaking of diseases other than " conventiondiseases ", he explained that malaria had againcrossed the Egyptian borders through the introduc-tion of Anopheles pharaoensis, which attacked humansin the absence of cattle, and mentioned Anophelesgambiae as the cause of the recent spread of malariaepidemics. For that reason it was important to takeaccount of diseases such as malaria which brokeout in epidemic form and might prove to have evenmore serious results than some of the " conventiondiseases ".

After the CHAIRMAN had explained that the presentcommittee was competent to take action only in thematter of certain diseases, the committee askedSir Harold Whittingham to prepare a resolution, inconsultation with the Secretariat, to be submittedto the Special Committee, for eventual referenceto the World Health Assembly.

Amendment to Article 3 [3] proposed by theDelegation of the United States of Amerka

Dr. HEMMES (Netherlands) made the followingcomments on the amendment proposed by thedelegate of the United States to Article 3 (see page 42):

(a) the committee, when discussing para-graph 2 (c) of Article 6, had reduced from six monthsto one month the period which was to elapse betweenthe suppression of a plague epizootic and the decla-ration that the local area concerned was free frominfection (see page 49) ;

(b) the United States amendment to para-graph 1 (a) would mean that a health administrationwas required to notify to WHO by telegram only thefirst case of cholera, plague, yellow fever or smallpoxoccurring in a local area in its territory, no provisionbeing made for similar telegraphic notification ofsubsequent first cases occurring in other local areas ;

(c) the Netherlands delegation would requestclarification of the term " city airport

(d) the terms " location " and " area " appearingin the amendment should be replaced by " localarea ".

Dr. DUREN thought that it would be preferable toreplace the sentence " Each first case notified shallbe confirmed by laboratory methods as far asresources permit " by a statement along the followinglines : " Each first case notified shall be verified bylaboratory methods, as far as resources permit, andif necessary shall be the subject of a subsequentconfirmation or otherwise ". Thus, health admi-nistrations would have the added obligation ofnotifying WHO of the result of laboratory tests.

Referring to the last sentence in paragraph 3 of theUnited States proposal, his delegation thought thata time limit not exceeding the period provided for inArticle 6 should be fixed for notification of theabsence of cases.

Mr. STOWMAN agreed to the proposed amendmentsof the delegate of Belgium.

Decision: The United States proposal for Article 3,as amended by the delegate of Belgium, wasadopted, subject to alteration of paragraph 1 inaccordance with the suggestions of the workingparty set up to consider the definition of " infectedlocal area " (see page 285).

The meeting rose at 12 noon.

SEVENTH MEETING 61

SEVENTH MEETING

Saturday, 14 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations (continuation)

Title of Part IV : Provisions applicable to allEpidemic Diseases

Dr. BELL (United States of America) reserved hisdelegation's position with regard to the wording of thetitle of Part IV.

Article 21 [23]

M. MASPÉTIOL (France) said that Article 21, layingdown that the provisions in the draft Regulationswere the maximum that a State could impose, wasthe keystone to the Regulations. It was importantthat the wording of the article should be as clear aspossible and that its interpretation should be decidedupon in plenary meeting.

Furthermore, the draft Regulations contained twocategories of provisions : maximum measures whicha State could impose on travellers, and other provi-sions relating to internal organization, such as thosein Article 12, paragraph 3, on sanitary ports andairports. It might be advisable to specify thatArticle 21 applied to the former only.

It remained also to be decided whether in circum-stances of exceptional danger States might not bepermitted to exceed temporarily the maximummeasures laid down in the Regulations.

If Article 21 applied to the Regulations as a wholeand not to Part IV alone, it should be placed eitherat the beginning or at the end of the text.

Mr. HOSTIE, Chairman, Legal Sub-Committee ofthe Expert Committee on International Epidemio-logy and Quarantine, in reply, said : (1) that the textof Article 21 drew a sufficiently clear distinctionbetween permissive and imperative measures by thewords " measures permitted " ; (2) the question asto whether countries might exceed the maximum ofpermissive measures in exceptional circumstances wasa question of substance and would involve the draftingof a new text ; (3) the words " by these Regulations "

made it quite clear that the provisions of the articlewere applicable not only to Part IV but to the wholetext.

Dr. PADUA (Philippines), in supporting the viewsexpressed by the delegate of France, added that thesecond sentence of Article 21 was couched in toodrastic terms, and proposed that it be along thefollowing lines :

Any measure in excess of this maximum, ifdeemed necessary, shall be submitted to WHO forapproval before the same is enforced.

Dr. VAN DEN BERG (Netherlands), while agreeingwith the interpretation given by Mr. Hostie, suggestedthat, in order to avoid any misunderstanding, thearticle should be placed elsewhere in the Regulations.

Replying to Dr. EL-HALAWANI (Egypt), theCHAIRMAN said that reservations to any articlewould have to be referred to the Health Assemblyfor consideration under the procedure set forth inArticle 101.

Dr. DOWLING (Australia) agreed with the previousspeakers about the place of Article 21 which he feltwould be more appropriately placed at the end ofthe Regulations. In his view, the article as draftedwas far too rigid and should be qualified by somepermissive element in order not to deprive nationalgovernments of any liberty of action. For instance,it was quite conceivable that some new discoverymight lead to vastly improved methods for dealingwith one or more of the epidemic diseases.

Mr. HASELGROVE (United Kingdom) maintainedthat the very object of the Regulations would bedefeated if there was any modification of the ideathat measures laid down therein were maxima.

Dr. GEAR (Union of South Africa) said that,first, the Regulations were intended to apply tointernational travel and not to conditions within

62 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

the administrative area of a State-thus a State wasfree to deal with any emergency within its ownborders as it thought fit ; secondly, the Regulationswere being drafted under the Constitution of WHO,Article 28(i) of which provided for the ExecutiveBoard " to take emergency measures within thefunctions and financial resources of the Organizationto deal with events requiring immediate action. Inparticular it may authorize the Director-Generalto take the necessary steps to combat epidemics... "Therefore sufficient provision was made in theConstitution for necessary action in the case ofemergencies. Any modification of the principleof maximum measures would defeat the aim of theRegulations.

Dr. RAJA (India) supported the views of the delega-tions of the United Kingdom and the Union ofSouth Africa.

M. GEERAERTS (Belgium) thought it clear that themaximum provisions of Article 21 were applicableto the whole body of the text.

The CHAIRMAN queried whether the word " all "in the title of Part IV should not be omitted in viewof the definition of " epidemic diseases ".

Professor ALIVISATOS (Greece) said that theRegulations should clearly state that any measuresimposed in excess of the maximum laid downconstituted a violation of the Regulations, exceptwhen a country was threatened by a very seriousdanger. In that case, however, some way must befound of preventing each individual country fromacting as it thought fit and laying itself open to theaccusation of violating the Regulations when forcedby circumstances to take certain steps.

Mr. CALDERWOOD (United States of America),proposed, in order to make the provisions of thearticle less rigid, an entirely new wording forArticle 21, and an additional article to follow it,which he read :

Article 21

1. The sanitary measures permitted by theseRegulations are the maximum measures, applicableto international traffic, which a State may requirefor the protection of its territory against epidemicdiseases except in the event of unusual danger tothe public health.

2. A State desiring, in the event of unusualdanger to the public health from any cause, torequire with respect to international traffic sanitarymeasures additional to those permitted by theseRegulations shall do so only after the head of thehealth administration of that State has formallydetermined that such measures are necessary.3. The health administration making such deter-mination shall immediately transmit by telegrama full report thereof to the Director-General,setting forth the basis for its determination anddetails as to the scope and effect of the measuresto be taken pursuant to that determination. Thehealth administration shall thereafter make suchfurther reports as the Director-General mayrequest.

New Article 221. Upon the receipt by the Director-General ofnotification of any determination, given pursuantto Article 21, the Director-General may forthwithmake such inquiries as he considers appropriate,and, at the request of any State concerned, maydispatch competent public-health personnel tothat State to study relevant conditions in thatState and to report thereon promptly to theOrganization. The Director-General shall forth-with transmit by telegram the results of suchinquiries and investigations to all States to whichthese Regulations apply.2. Should the Director-General, on the basis ofsuch inquiries or investigations, consider itnecessary he shall forthwith convene the appro-priate body of the Organization and lay the matterbefore it. After consideration of all relevant data,the body which considers the matter shall promptlyreport its findings to the Director-General andmake such recommendations as it considersappropriate.It was later agreed that the United States proposal

should be submitted for circulation before furtherdetailed consideration took place thereon.

Dr. EL-HALAWANI, in view of the provisions ofArticle 101, proposed the deletion of Article 21.

Dr. DUJARRIC DE LA RIVIÈRE (France) thought that,in certain circumstances, countries could exceed theprovisions of the Regulations, subject to communica-tion to WHO of the action taken. However, theUnited States proposal that measures taken by aState should be referred to the head of an interna-tional organization might constitute an infringementof national sovereignty. He wished for the opinionof a legal expert on that point.

SEVENTH MEETING 63

Dr. DOWLING welcomed the compromise proposalof the United States delegation, and suggested certaindrafting modifications.

Dr. GEAR did not consider that the United Statesproposal could be discussed in view of the terms ofresolution WHA2.15 which clearly set forth theprinciple that the requirements of the Regulationsshould not be exceeded. He asked whether thecommittee was competent to consider the entirelynew concept of a WHO mission visiting nationalareas to determine the effect of measures applied inan emergency situation by a national administration.He again maintained that any interference with theprinciple of maximum measures would destroy thewhole intention of the Regulations. Moreover theRegulations, which were designed to cover inter-national traffic, in no way interfered with the rightsof countries to take what measures they chose todeal internally with emergencies. He urged thecommittee to give serious consideration to a matterof such fundamental importance in the light of itsimplications for public health and internationaltraffic.

Mr. HOSTIE, replying to the remarks of the delegateof France, said that the general principle governingall treaties was that undertakings freely concededby a State were not derogatory to sovereignty butwere the very exercise of it. He understood the UnitedStates proposal as a procedure intended to smoothout difficulties arising from an unusual situation, soas to reconcile the interests of States confrontedtherewith with the general interest of world traffic andintercourse.

Mr. CALDERWOOD could not agree with Dr. Gearthat the committee was bound by any action of theHealth Assembly, which was free to accept or rejectthe new set of draft Sanitary Regulations.

Dr. BIRAUD, Secretary, asked for clarification inregard to the area or areas to which it was proposedto send a mission of inquiry-whether to the infectedcountry or to that which had imposed measuresexceeding the provisions of the Regulations. In theformer case, it was doubtful whether such a missionwould be welcome and whether the infected countrywould not demand that all States should complywith the maximum provisions of the Regulations.For example, at the time of the outbreak of cholerain Egypt in 1947 many countries imposed excessive

measures and it would have been out of order to senda mission of inquiry into Egypt where the situationwas perfectly clear.

Dr. RAJA speaking on a point of order, wonderedwhether the committee was justified in ignoring theinstructions of the Health Assembly in regard tomaximum requirements. It was a dangerous pre-cedent to assume that the Special Committee, setup by the Health Assembly, could frame its own rulesand go beyond the instructions of the Assembly.

Dr. DUJARRIC DE LA RIVIÈRE agreed that the pointraised by the Secretary should be made perfectlyclear. There was a danger that, if countries wereallowed to exceed the maximum in certain cir-cumstances, some might take excessive measures, butWHO would be informed and any complainingcountry could bring the case before a special body.

Mr. BEVANS (United States of America) proposedthat a working party should be set up to considerthe legal implications of his delegation's proposal.

Dr. VAN DEN BERG suggested that a working partyshould likewise consider the terms of reference of theSpecial Committee.

Mr. HASELGROVE thought that the conception ofinternational regulations had always been that theirprovisions should constitute a maximum : it was nowproposed to depart from that conception. Heconsidered, therefore, that the committee shouldreach agreement on that issue before any decisionwas taken regarding the setting-up of a workingparty.

The CHAIRMAN'S suggestion that the establishmentof a working party be resorted to only if, aftercirculation of the United States proposal, rapidagreement proved impossible, was adopted.

Article 22 [24]

Mr. BEVANS read out a further paragraph whichhis delegation wished to see inserted in Part IV :

Each health administration shall apply appro-priate preventive measures for the control ofepidemic diseases whenever and wherever suchdiseases are present within its jurisdiction, espe-

64 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

cially in its seaport and airport cities and thevicinity thereof.It was agreed that the paragraph in question

be considered after it had been circulated.

Mr. HASELGROVE proposed that the word " any "in the second line of Article 22 be deleted.

Decision: Article 22 was remitted to the DraftingSub-Committee.

Article 23 [27]

Dr. BELL (United States of America) announcedthat his delegation intended to submit an amendmentto Article 23. Since, however, it was only a draftingmatter the substance of the article could be discussedat once.

The CHAIRMAN, in reply to remarks made by thedelegates of Greece and Egypt, suggested that thecommittee proceed with its discussion of Article 23,on the understanding that any conclusions reachedmight have to be modified in the light of subsequentdiscussions of Article 62. It would be preferable, asfar as possible, to take the articles in the order inwhich they were set out.

Professor CANAPERIA (Italy) wondered whether thewords " health authority " in the first sentence ofArticle 23 referred only to health authorities of thecountry in which a person had been placed undersurveillance or whether it also included those of anycountry to which he might proceed. Were the healthauthorities of the first country to notify those of thesecond ?

The CHAIRMAN said that such notification betweencountries was in fact the normal procedure.

Decision: Article 23 was adopted subject to draftingchanges to be proposed by the United Statesdelegation.

Article 24 [28]

Dr. DOWLING, supported by the Philippinedelegation, feared that Article 24 as it stood mightmake it impossible for national health-authorities toprovide protection against dangerous diseases otherthan the six with which the Regulations were specifi-cally concerned.

He noted that no definition was provided of " freepratique " which he believed was differently inter-preted in different countries. In his country itimplied complete freedom of movement for pas-sengers and crew and that would be quite un-acceptable with regard to protection against otherdiseases than those covered by the Regulations, suchas measles, which in the Australian dependency ofNew Guinea was as serious a threat as smallpoxelsewhere.

Professor ALIVISATOS informed the committeethat, since the International Convention for MutualProtection against Dengue Fever, 1934, was still inforce, and since the disease in question was a seriousthreat to Greece, his delegation considered that itwas included among the exceptions provided for bythe words " Except in case of grave emergency ".

Dr. RAJA said, with reference to the remarks of theAustralian delegate, that there would presumably beno objection to individual countries taking specialmeasures under national legislation for protectionagainst diseases not covered by the Regulations.

The CHAIRMAN agreed with the delegate of India.According to his own interpretation of Article 24,health authorities would be permitted to take anyaction they liked with regard to persons so long asthey did not delay the movements of the ship oraircraft.

Dr. DOWLING replying to the delegate of India,said that Article 24 as worded did in fact refer todiseases other than the six to which the Regulationswere to apply.

He agreed with the interpretation of the articlegiven by the Chairman, but said that the connotationof " free pratique " accepted in Australia impliedfar more.

Mr. HASELGROVE accepted the Chairman's inter-pretation ; there was no intention to limit quarantinemeasures against passengers, but only to preventdelays in the movement of ships and aircraft, whichwere to be free to carry out such necessary operationsas taking on cargo.

If, however, the term " free pratique " was in anyway equivocal, a more exact phrase should beemployed instead.

Professor CANAPERIA objected to the phrase" Except in case of grave emergency " since " freepratique " was not to be refused even in the case ofepidemic diseases.

SEVENTH MEETING 65

After some further discussion, Mr. BRILLIANT(United Kingdom) suggested that, as it seemedimpossible to define the term " free pratique " tothe satisfaction of all delegations, Article 24 bereworded as follows :

Except in case of grave emergency, the healthauthority for a port or airport shall not on accountof any other communicable disease prevent a shipor aircraft which is not infected with an epidemicdisease, or suspected of being so infected, fromdischarging or loading cargo or stores or takingon fuel or water.

M. MASPÉTIOL thought it would be preferable toretain the term " free pratique " and provide adefinition.

Mr. HOSTIE preferred the solution suggested by theUnited Kingdom delegation since in other articles ofthe Regulations the term was used in a sense lessrestrictive than the committee wished it to have inArticle 24.

M. GEERAERTS thought that, if the United Kingdomsuggestion was adopted, it might not be so easy tofind an equivalent formula in the case of otherarticles.

The CHAIRMAN thought that the committee mightaccept the United Kingdom's suggestion and facedifficulties arising in connexion with the otherarticles when those articles were discussed.

In connexion with a point raised by the delegatesof the United States of America and Australia, hedid not think it necessary to state specifically thatnational regulations could make separate provisionswith regard to the bringing ashore of infected food-stuffs and pests.

Dr. BELL thought that " unusual danger to publichealth " would be more precise than " grave emer-gency ".

The CHAIRMAN approved the suggestion, which hethought would meet the point raised by the delegateof Italy.

Decision: Article 24 was remitted to the DraftingSub-Committee for redrafting in accordance withthe suggestions of the United Kingdom and theUnited States delegations.

Definition of International Journey"

Mr. BRILLIANT announced that his delegationwould later circulate some suggestions with regardto drafting of the definition of " international

journey " ; they would not affect the substance ofthe definition.

Dr. DOWLING wondered whether the use of theword " State " in the definition of " internationaljourney " might not give rise to difficulties ofinterpretation in federal countries.

Dr. VAN DEN BERG COUld not see how any difficultiescould arise, since he knew of no case where a singleState forming part of a federation of States wasresponsible for international relations.

The CHAIRMAN suggested the matter be left to theDrafting Sub-Committee.

Article 25 [301

The CHAIRMAN said that the word " any " inthe last line of paragraph 1 of Article 25 should bedeleted, as in Article 22.

Mr. HASELGROVE pointed out that a comma shouldbe inserted after the word " vectors " in para-graph 2 (b) and that, so that the last line of the sameparagraph might correspond to the first line of thearticle, the words " port, airport or " should beinserted before the words " local area ".

Dr. VAN DEN BERG noted that the definition of" frontier post ", which had appeared in an earlierdraft, had been deleted. It might be left to theDrafting Sub-Committee to provide a new definition.

The CHAIRMAN, in answer to a point raised by thedelegate of the United States, explained that Article 25contained no specific reference to infected portsbecause the intention was that health authoritieswere to prevent the departure of infected personswhether the port was infected or not.

Dr. GEAR thought that since " infected person "as defined in Part I included persons believed to beinfected, paragraph 2 as it stood might lead to mutualaccusations between nations of not having takenadequate measures.

Professor CANAPERIA wished the words " or bysea " to be added after the word " air " in para-graph 3. The provisions of the paragraph would thusbe brought into harmony with accepted practice.

Mr. BRILLIANT thought that the term " inter-national voyage " had been used in paragraph 3

66 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

in error for " international journey ". The DraftingSub-Committee might consider the definitions ofboth terms together.

Mr. HOSTIE confirmed that " international voyage "should read " international journey ".

The CHAIRMAN observed that the words " by air "could be deleted.

In reply to a point raised by the delegate of Egypt,he thought that the intention of the article was thata person who arrived by air and was placed undersurveillance, and who wished to continue his journeyby sea, would be under surveillance while movingfrom the airport to the seaport.

Decision: Article 25 was remitted to the DraftingSub-Committee for redrafting in the light of thevarious suggestions made.

Artkle 26 [31]

There followed a discussion of Article 26 and thefootnote thereto. The general feeling was that thearticle should be retained, firstly because it wasmore precise than the provision of the Conventionon International Civil Aviation referred to in thefootnote, and secondly because not all Membersof WHO were signatories to that convention.

Dr. BELL suggested the deletion of the words" human dejecta or any other " and " epidemic orother ".

Decision: Article 26 was remitted to the DraftingSub-Committee for consideration in the light ofthe United States suggestion.

Article 27 [32]

Decision: Article 27 was adopted unanimously.

Article 28 [331

Dr. BARRETT (United Kingdom) noted that in thelast line but one of paragraph 1 of Article 28 theword " passenger " was used where what was meantwas presumably passengers and crew. He suggestedthat throughout the Regulations the word " persons "be employed in place of " passengers " or " pas-sengers and crew ".

At the end of the same sentence the words " withinthe incubation period of that disease " should beadded.

Dr. EL-HALAWANI proposed that Article 28 beamended so as to provide for inspection by healthauthorities of ships passing through maritime canals.He was thinking in particular of the Suez canal,which was very narrow. It should be made quiteclear which health authorities were to decide that aship was healthy.

The CHAIRMAN pointed out that the provisiondesired by the Egyptian delegation was already inArticle 32.

Dr. VAN DE CALSEYDE (Belgium) suggested that thewords " fuel and water " at the end of paragraph 3be replaced by " fuel, water and stores ".

The CHAIRMAN agreed that as it was a question oftaking on and not of disembarking there could be noobjection.

Mr. HOSTIE thought that the objections raised bythe Egyptian delegation corresponded to a realweakness in the drafting of the article. Since themedical examination was necessary in order todetermine whether or not a ship was healthy-andshould apply therefore also to the ship-it would belogical to refer to it at the beginning of the articleand not in the second part. He therefore suggestedthat the words " other than medical examination "be inserted after the word " measures " in the firstline of paragraph 1, and that sub-paragraph (a)be deleted in paragraph 2.

Dr. DOWLING, noting the words " as hereinafterdefined " in paragraph 1, said that he could find nosuch definition anywhere in the Regulations.

The CHAIRMAN thought that the definition inquestion consisted simply of the specific provisionsof the Regulations with regard to each disease.

Dr. RAJA thought that some precise phrase to thateffect should be inserted after the words " as herein-after defined ".

Dr. BELL proposed that a fifth paragraph be addedreading : " Notwithstanding any of the provisionsof this Article no state shall be prevented from takingmeasures to protect its territorial waters fromcontamination. " Contamination was possible fromhealthy ships.

Mr. HASELGROVE thought that the suggestion ofMr. Hostie met the difficulty of the Egyptian delega-tion, but the proposal of the delegate of the United

EIGHTH MEETING 67

States would destroy the whole effect of the articleby suggesting that, apart from what was permittedthereby, national authorities could do anything elsethey chose.

Dr. BELL said that his proposal was intended onlyto permit countries to protect their territorial watersfrom contamination.

The CHAIRMAN agreed that it was reasonable thatif governments could prevent rubbish from beingthrown into their docks they should also be allowedto prevent it being thrown into their canals. Perhaps

some such provision as suggested by the UnitedStates delegation should be inserted.

Mr. HOSTIE thought that from a purely legal pointof view, since the committee had decided to retaina similar provision in respect of matter thrown fromaircraft, the omission of a provision in the case ofcanals might be interpreted as implying a specificintention to except them.

Decision : Article 28 was remitted to the DraftingSub-Committee for redrafting in the light of thevarious suggestions made.

The meeting rose at 12.10 p.m.

EIGHTH MEETING

Monday, 16 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Welcome to Representative of the United Nations

The CHAIRMAN welcomed M. de Bellaigue,representative of the United Nations, Division ofTransport and Communications.

M. DE BELLAIGUE (United Nations) thanked theChairman for his welcome and on behalf of theUnited Nations wished the Special Committeesuccess in its important work on the draft Regula-tions which, after adoption by the Health Assembly,would mark a decisive stage in the campaign againstthe spread of epidemic disease.

2. Consideration of Draft International SanitaryRegulations

Article 28 [33] (continuation)

Dr. HEMMES (Netherlands) suggested that it wasnecessary to determine whether or not a medicalexamination was to be considered as a sanitarymeasure. Articles 28 and 35 for instance appearedto be in contradiction on that point. He proposedthat it should not be so considered, though he waschiefly concerned with consistency.

The CHAIRMAN drew attention to Article 32,according to which a health authority at the place

of arrival might, whatever was laid down in otherarticles, require medical examination.

Mr. BRILLIANT (United Kingdom), pointing outthat inspection of a vessel was included in thedefinition of " medical examination ", suggestedthat such examination should not be regarded in itsnarrowest sense but should for the purposes of theRegulations be considered a sanitary measure.

Dr. EL-HALAWANI (Egypt) wished Article 28 tobe so worded as to leave no doubt that when a shippassed through a maritime canal the health authorityshould first carry out an examination to determinewhether it was healthy or infected and then applythe appropriate sanitary measures.

Dr. RAJA (India) wondered whether, unlessmedical examination was considered a sanitarymeasure, Article 32 would be rightly placed inChapter IV.

Decision: It was agreed that medical examinationshould be regarded as a sanitary measure, theDrafting Sub-Committee to make the necessaryadjustment in the relevant articles.

68 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Definition of "Direct Transit Area"The CHAIRMAN informed the committee that the

definition of " direct transit area " had been draftedin close collaboration with the International CivilAviation Organization.

Decision: The definition was adopted withoutdiscussion.

Article 29 [34]

Dr. DUREN (Belgium) said the word " ségrégation ",which was not defined in Article 1, had a derogatorysense in French. He interpreted the paragraph asmeaning that sanitary measures would not be appliedto passengers and crew who had not left a specifiedarea fixed by the health authority of the airports.

Dr. EL-FAR Bey (Egypt) proposed the addition after" vicinity " in Article 29 (b) of " of the same city ".

Mr. BRILLIANT thought that the provision referredto the vicinity of the airport at which the personshad arrived.

Dr. DOWLING (Australia) suggested that, as aresult of the decision just taken to regard medicalexamination as a sanitary measure, even medicalexamination would be precluded under Article 29.His Government was anxious that more liberty ofaction should be allowed. He therefore suggestedadding after " vaccination " in the second line" except as designated by a Member State ".

Dr. BELL (United States of America) said that, inorder to determine whether or not a ship or anaircraft was healthy, a medical examination must becarried out.

The CHAIRMAN thought that, as regards aircraft,the point might be met if the words in paragraph (b)" passengers and crew on a healthy aircraft " wereamended to read " passengers and crew on an air-craft found to be healthy on arrival ".

Mr. HOSTIE, Chairman, Legal Sub-Committee ofthe Expert Committee on International Epidemio-logy and Quarantine, said that, since Article 32applied only to measures on arrival, and since para-graphs 1 and 2 of Article 28 applied to healthy ships,it might be argued that medical examination was notpermitted under the terms of Article 28. Since theintention was to permit medical examination, expressprovision therefore should be made, both in Article 28(preferably in paragraph 1) and in Article 29.

Decisions:(1) It was agreed to refer Article 29 to the DraftingSub-Committee for amendment along the linessuggested by the Chairman, Mr. Hostie and thedelegate of Belgium.(2) A vote was taken and the proposal of thedelegate of Australia to add " except as designatedby a Member State " was rejected.

A discussion took place on the proposal ofDr. PADUA (Philippines) to omit the words in-cluding vaccination ". His country required certainvaccination certificates for the passengers andcrew of aircraft, even if only transferring from oneairport to another.

Mr. BRILLIANT stressed that the effect of Dr. Padua'sproposal would appear to be that a person travellingon a healthy ship, who did not disembark, shouldbe liable to vaccination-a requirement which heheld to be utterly unreasonable. So far as passengersby aircraft were concerned, the whole purpose ofinstituting direct transit areas was to avoid thenecessity of subjecting to such measures personswho only went from one airport to another in thevicinity.

The CHAIRMAN said that he had been advised thatfrom the legal point of view it made no differencewhether the words " including vaccination " wereincluded or not. He put to the vote the proposal todelete those words.

Decision: The proposal was rejected.

Article 30 [36]Dr. HEMMES thought that, in the light of the

decision that medical examination was a sanitarymeasure, Article 30 could not be applied in practice.

Mr. HOSTIE thought the point could be met byplacing Article 32 before Article 30 and amendingArticle 30 to read " Further sanitary measures ... "

Mr. STOWMAN (United States of America),seconded by Dr. VAN DE CALSEYDE (Belgium),suggested adding " primarily " after " determined "in the second line because, although the mainemphasis was on the conditions on the ship, certainmeasures to be applied depended on the place ofdeparture of the vessel, for instance in the case of ayellow-fever area.

Mr. BRILLIANT said the proposed addition woulddestroy the whole certainty of the article by allowing

EIGHTH MEETING 69

the health authority to take into consideration anyconditions it chose. Medical examination as definedincluded inspection of the vessel or aircraft and hefelt strongly that if the measures to be applied werenot to be determined from the conditions whichexisted on board throughout the voyage, whereverthe vessel or aircraft came from, and from thoserevealed by examination on arrival, the wholearticle might as well be suppressed.

Replying to the CHAIRMAN, who asked whetherMr. Hostie's proposal would meet his point,Mr. STOWMAN said that it would be helpful. Realizingthe misuse that might occur from the insertion of theword " primarily " he suggested as an alternative" unless permitted elsewhere in these Regula-tions ".

Dr. DOWLING considered that the words " whichexist at the time of the medical examination " wereambiguous, since medical examination of passengersand inspection of the ship might not be carried outat the same time.

Suggesting that, in certain circumstances, thearticle might be too rigid, he referred to the recentthreat of infantile paralysis in the South Sea islands.Those islands constituted an isolated communityfree from that disease and in the absence of knowledgeof suitable scientific measures to combat the spreadof infantile paralysis, their only defence was toexclude people coming from infected areas.

Decision: It was decided by vote that Article 32should be placed before Article 30, and that theDrafting Sub-Committee should be asked torevise the text of both articles in order to clarifythem.

Mr. HASELGROVE (United Kingdom) referring tothe remarks of the delegate of Australia, did notpersonally consider that any difficulty arose in theEnglish text over the expression " at the time of themedical examination ". A possible alternative wouldbe " during the medical examination " but thatcould be left to the Drafting Sub-Committee.

With regard to the second point, he recalled thatthe Drafting Sub-Committee had been asked toclarify Article 24. But that article did not imposerestriction on the health authority concerning inspec-tion and quarantine of persons who might constitutea danger from the point of view of communi-cable diseases not specifically dealt with in theRegulations.

The CHAIRMAN thought the change of position ofArticle 32 would meet the points raised by thedelegate of Australia.

Dr. HENNINGSEN (Denmark) asked whether " trainor road vehicle " which appeared in Article 32should not be included in Article 30.

Decision: A vote was taken and it was decided toadd " train or road vehicle " after " aircraft "in Article 30.

Dr. DUJARRIC DE LA RIvIèRE (France) suggestedthat the various points raised during the discussionwould be met by wording on the following lines,which would cover any incident that might haveoccurred : " The sanitary measures which may beapplied to a vessel or aircraft shall be determined bythe conditions which existed during the voyage orwhich exist on board at the time of the medicalexamination ".

The CHAIRMAN suggested that acceptance of theproposal (made earlier by the delegate of the UnitedStates) that the area from which the ship or aircraftcame should be taken into consideration, would bea retrograde step. He recalled that under theexisting conventions a ship or aircraft could not becondemned because it had left an infected area.

Dr. BFLL replied that, even if there were no caseof illness on board, there might be persons who hadarrived from an infected area and were still in theincubation period. He reiterated his request for theaddition either of " primarily " or " except asprovided elsewhere in these Regulations ".

Mr. BRILLIANT objected to the use of the word" primarily ". He suggested some such words as" or which are permitted by these Regulations tobe applied to a ship or aircraft arriving from aninfected local area ".

Decision: A vote was taken and the UnitedKingdom proposal was accepted.

Dr. DOWLING wished it to be made quite clear thatthe provisions of the article applied to the ship oraircraft, and not to passengers. He proposed theinsertion of a new article to cover the protectionof isolated communities and, at the CHAIRMAN'Srequest, agreed to submit a draft to the committee.

Definition of "Arrival"Dr. VAN DE CALSEYDE Said that it should be made

clear that " arrival " referred to arrival in a port in

70 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

a territory other than that of the place of departure.He suggested the addition of " on an internationalvoyage " between " vehicle " and " means " in thesecond line of the definition, or the addition of " inanother territory " at the end of paragraph (a).

The point raised by the delegate of Belgium wasreferred to the Drafting Sub-Committee.

Article 31 [371

Mr. HASELGROVE, referring to the footnote, thoughtthat the Legal Sub-Committee's difficulties had beendisposed of by the adoption of a revised definitionfor " infected local area " and that reversion couldbe made to the original text circulated to governmentsbefore the third session of the Expert Committeeon International Epidemiology and Quarantine. Hetherefore proposed replacing the present text by thefollowing :

I. The application of the measures provided forin Chapters IV and V shall be limited to arrivalsfrom an infected local area.

2. This limitation is subject to the condition thatthe health authority of the infected local area istaking all measures necessary for checking thespread of the disease and is applying the measuresprovided for in paragraph 2 of Article 25.

Dr. DUREN said that the proposal of his own dele-gation was similar to that of the United Kingdomdelegation and was as follows :

When the application of the measures providedin Chapters IV and V depends on the arrival of aship, an aircraft, a person or an article from aninfected local area, the health authority need notapply these measures if the State in whose territorythe infected local area is situated has effectivelyapplied the measures provided for in paragraph 2of Article 25 and has so notified the health authorityof the port, the airport or the station of arrival.

The CHAIRMAN thought that the proposal of thedelegate of Belgium, although in the negative form,contained more elements than that of the UnitedKingdom and included a requirement that the portof arrival be notified. There was also the questionof whether responsibility should lie with the healthauthority of the local area or with the health adminis-tration.

Dr. BELL asked for the revised text of the articleand submitted a proposal by his delegation to beconsidered with the other proposed amendments.

Dr. BRAVO (Chile) proposed that the words " poli-tical limits " be substituted for " geographicallimits " in the present text.

The CHAIRMAN'S suggestion that further considera-tion of Article 31 be deferred until the proposedamendments and the new definition of an " infectedlocal area " had been circulated was approved.

Article 32 [36]

Decision: Article 32, having already beendiscussed in connexion with Article 30, it wasadopted subject to the insertion of a comma beforeand after the words " as well as any person ".

Definition of "Isolation"The definition was accepted without amendment.

Definition' of "Suspect"

At the request of Dr. GEAR (Union of South Africa)who considered that the definition of " infectedperson " must be read in conjunction with that of" suspect ", the latter definition was considered first.

Dr. BELL proposed that, as there were sources ofinfection other than by an infected person, the words" an infected person " be replaced by " a source ofinfection ".

Mr. BRILLIANT thought that the words " or whootherwise is considered by the health authority ashaving been under such risk " met the wishes of theUnited States delegation.

M. GEERAERTS (Belgium) thought that, notwith-standing the definition of " an infected person ",the definition of " suspect " could be dealt withsimply by saying : " ' Suspect ' means a person who,for any reason, is considered by the health authorityas having been exposed to the risk of infection ".

Dr. DOWLING proposed : " ' Suspect ' means aperson who has been exposed to the risk of infectionby an epidemic disease ".

Dr. MACLEAN (New Zealand), who thought thatsome discretion should be left to the health authority,proposed : " . . a person who, in the opinion of thehealth authority, has been exposed to the risk ofinfection by an epidemic disease."

EIGHTH MEETING 71

Dr. DOWLING and M. GEERAERTS accepted thisamendment of their respective proposals.

Dr. GEAR, whilst he had no alternative wordingto suggest, thought that the proposed amendmentswould confer too wide powers on the quarantineadministration. He made that remark in line withthe general statement he had made at the first meeting.

Dr. RAJA thought that, as it would be difficult fora health authority to declare that a person hadactually been exposed, it would be better to say :" . .. is likely to have been exposed ... "

Dr. BELL suggested a further limitation by adding :" in such a manner as possibly to become infected ".

Mr. BRILLIANT felt that all the additions suggestedbad clouded rather than clarified the matter. Allthat was necessary was to give discretionary powersto the health authority. He therefore supported theproposal of the delegate of Australia, as amended bythe delegate of New Zealand.

Dr. BELL said that certain persons, such as thoseimmunized against yellow fever, even if exposedto infection, would not be capable of spreading it ;his proposal had been intended to cover that point.

Dr. DUJARRIC DE LA RIITIÈRE said that, whilstit was obvious that, from a scientific point of view,conditions of contamination could vary considerably,a general regulation could not go into details.

The CHAIRMAN then proposed the followingwording :

" suspect " means a person who, in the opinionof the local health authority, has been exposed tothe risk of infection by an epidemic disease andis capable of spreading the infection.

Dr. RAJA still felt that the amendment proposedby the delegate of the United States was more directand took into account the possibility of a personbeing completely immunized and therefore notcapable of transmitting infection to others.

Dr. PADUA preferred the text proposed by theChairman but without the words : " and is capableof spreading the infection ".

Mr. BRILLIANT, whilst maintaining his preferencefor the simplest possible wording, said that, afterhearing the remarks of the delegate of the UnitedStates, there was justification for the words " and iscapable of spreading the infection ". He therefore

proposed that the definition be redrafted on thefollowing lines :

" suspect " means a person who, in the opinion ofthe health authority, has been exposed to the riskof infection by an epidemic disease and is capableof spreading the disease.

Decision : The above text, on being put to the vote,was adopted.

Definition of "Infected Person"Dr. GEAR proposed that the words : " or who is

otherwise considered to be capable of transmittingthe infection " be deleted, as they had been includedin the definition of " suspect ".

Professor CANAPERIA (Italy) did not understandwhy cholera was specifically mentioned. He proposedthe deletion of the rest of the definition from thewords : " in the application of this definition... ".

Dr. JAFAR (Pakistan) supported the proposal ofthe delegate of Italy.

M. GEERAERTS thought that the words " pendingbacteriological confirmation " could be deleted butnot those referring to the presentation of clinicalsigns of cholera.

Dr. EL-HALAWANI said his delegation consideredit important that the phrase referring to clinicalsigns of cholera be retained.

Dr. DOWLING agreed with the delegate of Italy.On the other hand he did not agree with the proposalof Dr. Gear to delete " or who is otherwise consideredto be capable of transmitting the infection " as thephrase had been included to deal with germ carriers.

The CHAIRMAN put to the vote the respectiveproposals of Dr. Gear and Professor Canaperia.

Decisions :(1) Dr. Gear's proposal to delete the words" or who is otherwise considered to be capable oftransmitting the infection " was adopted(2) Professor Canaperia's proposal to delete thewords following the semi-colon was adopted by12 votes to 6.

Article 33 [38]

Dr. DOWLING proposed deletion of the secondsentence because, in his opinion, the decision as toremoval of a'n infected person should rest with thehealth authority.

72 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

The CHAIRMAN explained that the provision hadbeen inserted to prevent the use of a vessel, or othermeans of transport, as an isolation hospital.

Dr. JAFAR proposed the addition of a clause to theeffect that " The vessel, etc. carrying such a personshall not be used as an isolation hospital ".

Dr. GEAR considered that, although an infectedperson on board a vessel, etc. in transit should beremoved, there might be circumstances in which thelocal health authority might not wish to remove suchperson. The sentence had been included in order tomake it possible for the person in charge of themeans of transport to obtain the removal of aninfected person.

Dr. DUJARRIC DE LA RIVIERE thought that thepresent text did not stress sufficiently the two distinctaspects of the problem : the request by the personin charge of the means of transport for the removalof the infected person, and (2) agreement on thepart of the health authority to remove the infectedperson and to take the necessary measures. Hesuggested that the article be redrafted by the DraftingSub-Committee.

Mr. HASELGROVE considered that the secondsentence should be retained.

Decision: On a vote being taken, it was decidedthat the second sentence should be retained andthat the Drafting Sub-Committee should in-corporate the addition proposed by the delegate ofPakistan.

Article 34 [39]The article was adopted without discussion.

Article 35 MOTMr. HASELGROVE proposed that the article be

amended to read as follows :Except as provided under paragraph 2 of

Article 71, any sanitary measure other thanmedical examination which has been applied at aprevious port or airport to the satisfaction of ahealth authority of a subsequent port or airportshall not be repeated at that port or airport unless,after the departure of the ship or aircraft, anincident of epidemiological significance hasoccurred either at that port or airport or on boardthe ship or aircraft calling for a further applicationof any of such measures.He thought it unreasonable to suggest that

countries should have the right to repeat sanitary

measures previously taken at another port but, onthe other hand, there might be cases where therewas reasonable cause for doubt about the measuresalready applied ; in such cases the health authorityshould be given discretion to take such measures asit considered necessary.

Dr. VAN DE CALSEYDE called attention to Article 95.Acceptance of the United Kingdom proposal couldlead to the discrimination which it had been desiredto avoid in the Sanitary Regulations.

Mr. MOULTON (International Civil AviationOrganization) submitted that the United Kingdomproposal would invite duplication of measures. Ifhealth authorities did not trust each other, transportenterprises would be faced with an unwarrantedamount of duplication of effort. The article wasimportant from the standpoint of avoiding suchduplication.

Dr. BELL, whilst agreeing with the substance ofthe United Kingdom amendment, suggested that asimpler and more restrictive form would be toinsert, after the word " aircraft ", the words " orunless there is definite evidence that the measureswere not substantially effective ".

The CHAIRMAN put to the vote the question ofwhether some discretionary power should be givento the health authority.

Decision: The committee agreed that somediscretionary power should be given to the healthauthority.

Mr. HASELGROVE proposed that his amendmentbe combined with that of the United States delegation.

Decision: On the proposal of the CHAIRMAN, thecommittee accepted the United Kingdom sugges-tion in principle, leaving it to the Drafting Sub-Committee to draft a text incorporating the UnitedKingdom proposal and the United States amend-ment and the addition suggested by the delegate ofThailand of the words " train or road vehicle ".

3. Appointment of Juridical Sub-Committee toconsider Parts IX and X of the Draft Inter-national Sanitary Regulations

On the proposal of Dr. VAN DEN BERG (Nether-lands) it was agreed that a juridical sub-committee(the composition of which would be decided later)be appointed to consider the problems connectedwith Parts IX and X of the Regulations.

The meeting rose at 12.25 p.m.

NINTH MEETING 73

NINTH MEETING

Tuesday, 17 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Composition of the Juridical Sub-Committee toconsider Parts IX and X of the Draft InternationalSanitary Regulations

Following the decision, taken at the eighth meeting,to appoint a juridical sub-committee to examine thearticles in Parts IX and X of the draft Regulationsand make recommendations to the Special Com-mittee in connexion with any amendments con-sidered necessary, it was agreed that the sub-committee should be composed of members of thefollowing delegations :

Belgium, Egypt, France, India, Indonesia, Nether-lands, Switzerland, United Kingdom, UnitedStates of America.

It was also agreed, on the proposal of Dr. BELL(United States of America), that the sub-committeeshould not deal with Article 106, which would beconsidered in plenary session, or with Article 107,for which a working party had already beenappointed.

The CHAIRMAN asked delegates not represented onthe Juridical Sub-Committee, and observers, tosubmit to the Secretariat memoranda on anyquestions they wished to put before the sub-committee.

2. Appointment of Rapporteur to the Fourth WorldHealth Assembly

On the proposal of Dr. VAN DEN BERG (Nether-lands), supported by Professor CANAPERIA (Italy),it was unanimously agreed that Dr. Raja (India)should act as Rapporteur for the Special Committeeto the Fourth World Health Assembly.

3. Consideration of Draft International SanitaryRegulations (continuation)

Dr. GEAR (Union of South Africa) said that, inthe light of his own attitude, which he had definedin his statement at the second meeting (see page 38)and in his minority report to the Expert Committee

on International Epidemiology and Quarantine 4he was slightly disturbed by the decisions taken bythe Special Committee during the past few days.

He had consistently argued the necessity, inconsidering the draft Regulations, for not increasingthe obstructive forms of quarantine which, in hisopinion, had slight medical value but would havevery disturbing effects on international traffic andtrade.

He did not wish it to be understood that his viewwas based on considerations other than the healthand epidemiological factors with which, he agreed, theRegulations were primarily concerned. But themembers of the Special Committee were alsomembers of national delegations and the committee'sterms of reference indicated that, in taking part in thediscussions, they should come armed with infor-mation on the other aspects of the subject.

He therefore appealed to the committee, in itsfurther examination of the draft Regulations, tobear all aspects of the subject in mind. Althoughinternational trade and traffic relationships were notthe primary factors, they were important in connexionwith international health, because much of nationalhealth depended on them. The transport of foodwas an example of that relationship.

He felt that some of the decisions taken at theprevious meeting were not wise from a public-healthpoint of view and, if unwisely applied, would haveconsiderable influence on international traffic andtrade.

Article 36 [41]Dr. BELL, referring to the phrase " nearest con-

venient port or airport " in the last line, wished it tobe made clear that the vessel or aircraft could proceedin the direction of its route. He therefore proposedsubstitution of the word " next " for " nearest ".

He would also like the word " sanitary " to beinserted after " convenient ", but, as no decision hadyet been reached as to the retention of the terms" sanitary port " and " sanitary airport " he woulddefer that proposal.

4 Document WHO/Epid/52, unpublished

74 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. DOWLING (Australia) called attention to anapparent discrepancy between the first and secondsentences : the first sentence stated that a vessel oran aircraft might not be prevented from calling atany port or airport, whereas, according to the secondsentence, such vessel or aircraft would, in effect,be prevented from entering at certain ports orairports.

Australia had a large number of small ports andseveral airports which could not be opened to inter-national traffic, mainly because of the danger ofintroducing rabies, which might destroy two of thecountry's chief industries-wool and cattle. For thatreason, his delegation felt that Australia must beable to designate both ports and airports. He there-fore suggested that the phrase " any port or airport "be qualified by the use of the word " sanitary "or by a phrase to indicate that the port or airport mustbe designated by the State.

Mr. HOSTIE, Chairman, Legal Sub-Committee ofthe Expert Committee on International Epidemiologyand Quarantine, explained that the definition of" airport " met the suggestion of the delegate ofAustralia. The position in regard to travel by seawas someWhat different. In principle, according tothe present text, seagoing vessels might call at anyport, but a " seaport " as now defined meant aport normally frequented by seagoing vessels, i.e.,ships engaged on an international voyage. Therewas therefore no danger of the provision beingapplied to a port only exceptionally visited by vesselson an international voyage.

In reply to a question by Dr. DUJARRIC DE LARIVIÈRE (France), Mr. HOSTIE said that the provisionsof Article 36 were intended to apply equally toinland navigation ports-such as on the large lakesof Africa and North America-where sanitarymeasures were not taken at the frontier.

Decision: It was agreed that the Drafting Sub-Committee should incorporate in the text theamendment proposed by the delegate of theUnited States, and that further consideration ofArticle 36 be deferred until decisions had beentaken on Articles 12 to 17.

Article 37 [42]

Decision: It was agreed to defer consideration ofArticle 37 until decisions had been taken on Articles12 to 17.

Article 38 [43]Dr. DOWLING proposed deletion of the words :

" or has landed there under the conditions laiddown in Article 29 ".

Decision: On being put to the vote, the proposalof the delegate of Australia was rejected and thearticle was adopted.

Definition of "Yellow-Fever Receptive Area"The definition of " yellow-fever receptive area "

was accepted.

Article 39 [441Dr. BELL thought that the word " isolation " in

the penultimate sentence of Article 39 was notappropriate in connexion with measures applyingto ships and aircraft. He suggested substitution ofthe word " quarantine ".

It was agreed that the Drafting Sub-Committeeshould make the necessary amendment.

Dr. DUREN (Belgium) asked why yellow fever hadbeen mentioned specifically in Article 39 and whetherthe provisions should not apply in the case of a shipor aircraft infected with other epidemic diseases.

Dr. RAJA (India) replied that the Expert Committeeon International Epidemiology and Quarantine hadinserted the qualification because, by the time it hadbeen established that an aircraft was infected, it wouldbe possible for infected mosquitos to have escapedfrom the aircraft. There was not the same possibilityof rapid transmission of infection into a local area ofcholera, smallpox and other diseases, even from aninfected ship or aircraft.

Dr. DUREN admitted that the argument of thedelegate of India had some weight. However, ifthere were danger, it would not arise because aship was suspected or infected (i.e., if it had a case ofyellow fever on board or had had one during thevoyage) but from the presence on board of Aëdesaegypti. Moreover his delegation did not see whya vessel which refused to submit to the measuresprescribed and which would be allowed to depart,should not take on food supplies for consumptionon board.

It was agreed that the Drafting Sub-Committeeshould make the necessary amendment to thearticle to permit a ship to take on food for consump-tion on board.

Dr. EL-HALAWANI (Egypt) drew attention to thefact that a ship infected with cholera, being allowedunder the provisions of Article 39 to depart from

NINTH MEETING 75

Suez, would pass through the Suez Canal and thatworkers on the Canal and inhabitants of villagesbordering it would be exposed to danger of infection.He considered that infected ships should not beallowed to depart without submitting to the necessarymeasures.

Dr. El-Halawani proposed the insertion of a clauserelating to maritime canals, because the presenttext clearly provided for refusal to submit to themeasures required.

It was agreed that the Drafting Sub-Committeebe instructed to take account of the proposal of thedelegate of Egypt.

Dr. DUJARRIC DE LA RWIÈRE remembered thatdiscussions had taken place in the Expert Com-mittee on International Epidemiology and Quarantinein regard to aircraft. The danger of the entire Orientbecoming infected with yellow fever was considerable.He did not remember that similar discussions hadbeen held in regard to ships.

Dr. RAJA (India) recalled that the question ofincluding ships had been discussed. A person onboard ship who was in the first two or three days ofthe onset of disease could infect mosquitos whichhad access to him, thus giving the possibility of thedisease being spread. As a safeguard, ships should beincluded in the article : the implications of theirexclusion would be considerable.

Dr. DUREN said that, while his delegation had nomajor objection to the provisions concerning infectedships or aircraft, they objected to the words " orsuspected ". He quoted the description of an infectedship or aircraft in Article 68. Although the reviseddefinition of " infected local area " (see page 285)did not mention yellow-fever endemic areas, itmight be that the Health Assembly would decidethat such areas were to be considered as infectedin their entirety, which would mean that any shiphaving left a yellow-fever endemic area less than sixdays previously would be considered as suspectedand measures would be applied to it. He consideredthat provision excessive and therefore proposed thedeletion of the words " or suspected of being soinfected " and the insertion in an appropriate placeof a clause reading :

and if the medical examination should show thatthe infected person has not been isolated in timeand if 'Wes aegypti are discovered on board . . .

Mr. MOULTON (International Civil AviationOrganization) recalled that both the InternationalSanitary Convention, 1926, and the International

Sanitary Convention for Aerial Navigation, 1933,included an article permitting ships and aircraftunwilling to submit to the measures required toproceed. There was no restriction whatsoever on thelines of the first paragraph of Article 39. He believedthat the present text of that article represented abackward step but one which was justified. Hisorganization had no desire to create additionalproblems for other means of transport but theydid insist on equal treatment for aircraft in thatconnexion.

He asked what epidemiological facts had come tolight since 1926, or 1933, which would warrant theadditional restrictions, and the separation of shipsand aircraft, in the article. He reminded the com-mittee that the one known case of the introductionof insect vectors of a disease from the continent ofAfrica to South America had been by sea and notby air.

The CHAIRMAN put to the vote the proposal of thedelegate of Belgium, which related only to ships.

Decision: The proposal was adopted by 11 votes to6 and it was agreed that the Drafting Sub-Com-mittee be instructed to prepare a revised draft ofthe article, taking into account all the amendmentswhich had been proposed and accepted.

Proposed New Article for Chapter IV

Dr. BELL made some general proposals concerningChapter IV. In the first place, in view of the con-fusion in that chapter and in other parts of theRegulations as to the diseases to which each articleapplied, the United States delegation proposed theintroduction of a new article, on the following lines,enumerating the articles applying to communicablediseases other than the six specified epidemic diseases :

The provisions of these Regulations shall haveapplication only to international control ofepidemic diseases except Articles 19, 20, 22, 24,25 (first paragraph only), 26, 27, 28, 29, 30, 32, 40,41, 42, 89, 90, 91, 93, 94, 95, 97 and 98, which applyalso to other communicable diseases.

Dr. DUREN felt that the Regulations should belimited to the six epidemic diseases, measuresconcerning other diseases forming a separate set ofRegulations. He considered that that limitationshould be specified either in Article 1 or Article 2of the Regulations. He further suggested that thesix diseases should be called " maladies épidémiquesréglementées ".

76 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. RAJA said that if the proposal of the UnitedStates delegation were adopted it would automaticallybecome the duty of governments to take action underthe Regulations in respect of other communicablediseases. If action were to be taken, the correctprocedure would appear to be for the committeeto widen the definition of epidemic diseases toinclude other communicable diseases and lay downthe specific measures in respect of each of them.

The CHAIRMAN said that if the Regulations werelimited to the six epidemic diseases, the elementof the protection of international transportationagainst excessive measures on medical or sanitarygrounds would be abolished. Moreover, it wouldbe necessary to redraft the whole of the Regulations.

Mr. HASELGROVE (United Kingdom) said hisGovernment had understood that the presentRegulations were intended to apply only to the sixspecific diseases. The United Kingdom Governmentwas in favour of setting up a complete code of sanitarymeasures for international traffic but believed that itwas not possible to do so at that stage.

Dr. DUJARRIC DE LA RIVIhRE supported the viewsof the United Kingdom delegate.

The CHAIRMAN explained that the Regulations laiddown the only sanitary measures to which ships andaircraft might be subjected. Passengers and crews,however, if suffering from other communicablediseases, might be required to submit to nationalmeasures of the country to which they went.

Mr. HOSTIE said that the decision regarding theamendment proposed by the United States delegationshould be taken with the legal implications well inmind. The existing Conventions of 1926, 1933 and1944 exhausted the possibilities of sanitary measuresin respect of all diseases and their permissive measuresconstituted a maximum. The regulations as at 'resentdrafted abrogated those conventions except for onearticle in the International Sanitary Conventionfor Aerial Navigation, 1944.

Dr. PADUA (Philippines) supported the UnitedStates proposal on the understanding that nationalgovernments would be free to enforce measures onpassengers and crew for the control of other com-municable diseases.

Decision: The United States proposal to add anew article concerning the application of somearticles of the Regulations to other communicablediseases was rejected by 19 votes to 5.

Definition of "Epidemic Diseases"

A lengthy discussion took place on the nomencla-ture of the six diseases at present defined, for thepurpose of the Regulations, as " epidemic diseases ".

The CHAIRMAN, explaining that the Expert Com-mittee on International Epidemiology and Quarantinehad discussed the matter at considerable lengthwithout arriving at a better name than " epidemicdiseases ", ruled the discussion closed. It could bereopened if there was general agreement on analternative term as the result of unofficial con-versations.

Proposed New Article on Radio Pratique

Dr. BELL introduced the proposal of the UnitedStates delegation for a new article on radio pratique,to be inserted after Article 31, which it was thoughtwould help to speed up international traffic :

As far as feasible States shall authorize grantingof pratique by radio to vessels or aircraft when, onthe basis of information received from themprior to their arrival, the health authority is ofthe opinion that their entry will not result inthe introduction or spread of a communicabledisease.

Dr. DUREN, while supporting the proposal,suggested that the reference in the last line should beto " epidemic " disease.

Professor CANAPERIA and Mr. HASELGROVEseconded the United States proposal, the latteralso seconding the substitution of " epidemic " for" communicable ".

In reply to Dr. EL-HALAWANI, the CHAIRMANsaid he took it that each State would decide on theconditions under which it would grant pratique byradio.

Decision: The article on radio pratique proposedby the United States was unanimously adoptedsubject to revision by the Drafting Sub-Committee.

Definition of "Baggage"

After a short discussion it was agreed that thedefinition of " baggage " did not exclude personaleffects sent either in advance or following.

Decision: The definition of " baggage " wasadopted as drafted.

NINTH MEETING 77

Article 40 [46]

Professor CANAPERIA suggested adding " rodentsand " after " vehicle for " in Article 40, paragraph 1.

Dr. PADUA, seconded by Dr. RAJA and Dr. EL-HALA WANI, agreeing that the article should not belimited to insect vectors, proposed " may serve asa vehicle for the transmission of such disease ".

Professor A LIVISATOS (Greece) proposed that inparagraph 1, Article 40 the words " may serve asa vehicle for insect vectors of any such disease " bereplaced by " may serve as a vehicle for the primaryor intermediate vectors of any such disease " ; thephrase would then cover rodents as well.

Decision: The proposal of the delegate of thePhilippines was accepted subject to revisioñ by theDrafting Sub-Committee.

Dr. DOWLING thought that, as drafted, the articlemight prove too restrictive, preventing, for instance,disinfection of a cabin after a case of measles.

A lengthy discussion took place on whether thearticle did or did not exclude measures under nationallegislation in case of contamination from otherdiseases.

Mr. HASELGR OVE thought it was clear that para-graph 1 was intended to refer to the epidemicdiseases as defined. He suggested that the first lineshould read " Goods shall be submitted to thesanitary measures provided for in these Regulationsonly in so far ... "

Mr. HOSTIE, said he had always felt that Article 40and many of the other articles in the general part ofthe Regulations required elucidation. The UnitedStates proposal (see page 75) which was intended toclarify the position had been rejected. If it wasdesired to limit the scope of paragraph 1 of Article 40,so as to permit further measures for other diseases,then it might be advisable to add the words suggestedby the United Kingdom delegate.

Dr. GEAR said the object of the article was toprevent enforced unloading of goods in internationaltrade which were in transit at ports. When unloadedat the port of arrival goods came under the control ofthe national health-administration.

A short discussion then took place on whetherparagraph 1 was necessary.

Dr. GEAR suggested that unless the paragraph wereretained the provisions for boarding ships and aircraftin the articles concerning individual diseases wouldconstitute the right for considerable interference.

Dr. BELL seconded the United Kingdom proposal.

Dr. MACLEAN (New Zealand) suggested that theparagraph should commence " Goods remainingon board ship or aircraft shall... ".

Decision: The United Kingdom proposal to insertthe words " provided for in these Regulations "after " sanitary measures " in paragraph 1 ofArticle 40 was accepted, subject to revision by theDrafting Sub-Committee.

Mr. HASELGROVE proposed amending paragraph 2after " transport " to read : " shall' not be subject tosanitary measures or detained at any port, airport orfrontier."

Dr. DOWLING asked whether Mr. Hostie couldstate whethersuch a provision.

Mr. HOSTIE thought the delegate of Australia needhave no misgivings. He was convinced that nobodywould consider the Regulations as applying tomeasures other than sanitary measures.

Dr. MACLEAN suggested that if the amendmentsof paragraph 2 proposed by the United Kingdom wereaccepted, paragraph I would become useless.

Decisions :

(1) It was agreed to amend the last part ofparagraph 2 of Article 40 to read " shall not besubjected to sanitary measures at any port, airportor frontier ".

(2) Article 40 was referred to the Drafting Sub-Committee for revision in accordance with theamendments accepted.

The meeting rose at 12.5 p.m.

78 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

TENTH MEETING

Tuesday, 17 April 1951, at 2 p.m.

Chairman : Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations (continuation)

Article 41 [471

Dr. DOWLING (Australia) said that his delegationhad the same objection to the present drafting ofArticle 41 as to that of the previous article.Apparently all measures of disinfection or disinsec-ting with regard to diseases other than the sixepidemic diseases with which the draft Regulationswere concerned were to be specifically forbidden.

Dr. DUJARRIC DE LA RIVIÈRE (France) thought thatit should be understood once and for all that theRegulations were to apply only to six diseases.Separate regulations should be made for otherdiseases.

Dr. RAJA (India) agreed with the delegate ofFrance.

As he saw it, the word " only " in Article 41 was tobe taken in connexion with the words " a person "and not with the words " an epidemic disease ". Thesense was that the measures prescribed were to becarried out only in the case of a person carryinginfected material or insect vectors of an epidemicdisease, and not only if the disease of which hecarried infective material or insect vectors was" epidemic ".

The countries represented at the present conferencehad assembled to give up part of their sovereigntyin respect of the six diseases enumerated ; at thesame time, Article 21, if adopted, would providethat no action beyond that was to be taken. Againstthat background it was clear that governmentswere limiting their freedom of action only in respectof the six epidemic diseases and within the scope ofthe Regulations.

Mr. HASELGROVE (United Kingdom) thoughtthat the delegate of Australia had been right to bringup in connexion with Article 41 the same pointwhich the committee had had to settle in connexionwith Article 40-and which would arise again in

Article 42. Rather than deal with it separately foreach article, the committee might prefer to modify theheading of Chapter V on the following lines :" Measures under these Regulations concerning theInternational Transport of Goods, Baggage andMail ".

The CHAIRMAN, after some further discussion,said that he agreed with the delegate of India. Thesense of the article was that as long as a ship andthe persons on board were healthy, national author-ities were not to resort to wholesale disinfection anddisinsecting except in the case of persons carryinginfective material or insect vectors of an epidemicdisease.

Dr. DOWLING was prepared to accept the inter-pretation of the delegate of India if it was to beexpressly stated in the Regulations and not left to beunderstood.

The CHAIRMAN thought that a matter for theDrafting Sub-Committee.

Dr. HENNINGSEN (Denmark) thought that nochange in drafting could meet the case ; a separatearticle would be necessary.

The CHAIRMAN regretted that the suggestion fora separate article must be ruled out of order as theUnited States proposal for an additional articlespecifying the articles applicable to communicablediseases other than the six epidemic diseases (seepage 75) had already been rejected.

Dr. BELL (United States of America) suggestedthat the article be redrafted so as to specify whatmeasures were permissible with regard to threeclasses of baggage, namely baggage free from infec-tive rnateiial or insects, baggage carrying infectivematerial or insect vectors of an epidemic disease,and baggage carrying infective material or insectvectors of other diseases.

TENTH MEETING 79

Dr. DUREN (Belgium) formally proposed thatArticle 41 be left unchanged.

Decision: The proposal was adopted by 21 votesto 7.

Article 42 [48]Mr. HASELGROVE proposed that paragraph 3 of

Article 42 be deleted.

Professor CANAPERIA (Italy) agreed that para-graph 3 served no purpose. Instead it might bestated that infectious laboratory material was to beentrusted to the person in charge of the ship, aircraftor train.

Decision: It was unanimously agreed to deleteparagraph 3.

Dr. DOWLING proposed that in the first line ofparagraph 2 of Article 42, after the word " only ",be inserted the words " if designated by a MemberState or ".

Decision: The proposal was rejected.

Dr. PADUA (Philippines) proposed that para-graph 1 of Article 42 be redrafted to permit thedisinfection of bags containing mail, newspapers,books, and other printed matter (the contents wouldof course remain untouched). That would bringparagraph 1 into harmony with paragraph 2.

Dr. DUJARRIC DE LA RIVIÈRE said that experiencehad shown that infection was not carried by printedmatter.

Decision: The proposal of the Philippine delega-tion was rejected by 20 votes to 2.

Part V, Chapter 1 - PlagueDr. BICA (Pan American Sanitary Organization)

said that the entire chapter on plague had beenwritten on the assumption that only rats wereimportant in the spread of the disease. However,actual transmission of plague, except in the case ofpneumonic plague, was by insects, which could bemore surely and more easily eliminated, at leasttemporarily, than could rats. While the eliminationof rats was very important, it would seem that someprovision should be made for the use of insecticides,particularly in cases where, because of cargo distri-bution, deratting could not be satisfactorily under-taken.

Article 43 [491Decision: Article 43 was adopted.

Article 44 [501

Dr. EL-HALAWANI (Egypt) proposed the deletionof Article 44.

Dr. RAJA thought that the article should beretained as certain countries in the past had in factdemanded plague vaccination certificates as a condi-tion of admission.

Decision: Article 44 was adopted.

Article 45 [51]The CHAIRMAN suggested that in Article 45 the

objection of the representative of the Pan AmericanSanitary Organization regarding the deficiency inChapter 1 of Part V of provisions regarding the useof insecticides might be met by inserting the words" and their ectoparasites " at the end of the firstsentence.

Dr. DUJARRIC DE LA RIVIÈRE supported the Chair-man's suggestion, particularly as it would bring thefirst sentence into harmony with the second.

Dr. BELL proposed that Article 45 be amended,first, by the insertion of the words " or airport "after the word " port ", and secondly, by the additionof a second paragraph laying stress on measures tobe carried out in ports of embarkation, as opposedto ports of arrival, and reading :

Prior to departure from a port or airport infectedwith plague, vessels or aircraft shall be inspectedfor rats and fleas and measures for their destruc-tion shall be taken if necessary. During the stayin such a port or airport special care shall be takento prevent rodents from boarding the vessel oraircraft.

The CHAIRMAN put to the vote the first part of theUnited States proposed amendment, namely theinsertion of the words " or airport ", which wasadopted.

With regard to the second part of the amendment,he wondered whether the United States delegatewould agree that it was sufficiently covered byparagraph 2 (b) of Article 25.

Dr. BELL thought that since throughout the draftRegulations the practice was, in addition to layingdown general provisions such as those of Article 25,to specify in detail what measures were to be takenin respect of each of the six diseases, the same shouldbe done in respect of measures against plague inports of departure.

80 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. BARRETT (United Kingdom) thought that, inview of the provisions of Article 25 and of Article 13,the measures prescribed in the proposed additionalparagraph would be a further and unnecessaryimposition.

Dr. BELL did not feel that the purport of theadditional paragraph he proposed was properlyunderstood. Since the first International SanitaryConventions had been drafted, conditions hadchanged considerably, and at the present day therewere very few plague-infected ports in the world.The adequate application of measures at such portswould make quarantine unnecessary elsewhere.

The draft Regulations contained specific provisionsfor measures to be taken in respect of each diseaseat ports of arrival and during the voyage. Similarprovisions for ports of departure would provide asound epidemiological basis for the control of disease.

In reply to a question by the CHAIRMAN, he addedthat the proposed provisions would apply to vesselswith cargo in situ.

Mr. HASELGR OVE said that since the recognizedprocedure for keeping a vessel free from rats wascomplete fumigation, the United States proposalas he understood it would provide, whenever a vesselvisited an infected port, for a fumigation in additionto that provided for in Article 46. Either the cargomust be removed or the ship must be fumigated withthe cargo still inside ; and that, as his delegationhad maintained, would be an additional imposition.

Dr. RAJA thought that Article 25 already providedfor inspection. If the inspection showed the presenceof rats, then presumably deratting must follow.

Dr. BELL, replying to the United Kingdomdelegation, said that his proposal provided fordestruction of rats " if necessary ", or in otherwords if there were rats aboard. In that case, itwould make no difference whether the inspectionwas carried out at the port of arrival or at the portof departure. Vessels with or without cargo were inany case being inspected for rats every day.Moreover, fumigation was not the only method ofdestroying rats.

Dr. JAFA R (Pakistan), in the light of his ownexperience, was of the opinion that fumigation wasin fact the only satisfactory method of deratting. Hehad known cases where ships from the East had askedfor deratting certificates without unloading the cargo.The requests had been refused and traps set without

result. Later, fumigation had revealed the presenceof up to 100 rats.

It would therefore be unrealistic to insist on inspec-tion in ports of departure except where resultsseemed likely. However, he saw some point inthe United States proposal and thought that thechapter on plague should contain some specificprovisions with regard to the prevention of theboarding of vessels and aircraft by rats.

The CHAIRMAN raised the point as to whether theUnited States proposal, if accepted, might notproperly be included in Article 51.

Mr. HASELGR OVE maintained that the proposednew paragraph introduced an entirely new elementwhich, in his view, was completely impracticablefrom the point of view of shipping. The wordingimplied that a health authority had the power, in itsdiscretion, to require all cargo to be unloaded.

Dr. D OWLING failed to understand any objectionto the proposal, which concerned measures to beautomatically applied in all circumstances whethera ship was loaded or not.

Decision : The United States proposal was adoptedby 12 votes to 4 and the text referred to theDrafting Sub-Committee.

Article 46 [52]Mr. HASELGR OVE recalled his delegation's pro-

posals regarding new definitions of approved portsfor the issue of deratting certificates (see page 53).

Professor ALIVISAT OS (Greece) proposed thedeletion of paragraph 1 (b) of Article 46 owing to thedifficulty, even impossibility, of interpreting theword " negligible " in connexion with the numberof rats on board a ship. Moreover, rodent plague inits chronic form must be taken into account, and alsothe fact that not only the number of rats, but thenumber of fleas per rat, was of great importance.The only effective means, in his view, was periodicalderatting.

The CHAIRMAN agreed that it was not easy tolay down any simple standard for the interpretationof " negligible ". Different conditions applied asbetween the number of rats found in a cir-cumscribed area and the same number distributedthroughout the whole ship.

Professor CANAPERIA thought that the new defini-tions proposed by the United Kingdom delegationshould be considered, and a decision taken as regards

TENTH MEETING 81

Articles 12 to 17, before any decision was taken onthe first sentence of paragraph 2.

He was of the opinion that the period of onemonth for prolongation of a deratting certificate wasnot always sufficient. A longer period might berequired for a ship to reach a port where effectivederatting could take place. The paragraph should,moreover, indicate that deratting had to be effectedafter a ship had been unloaded.

Referring to the footnote to Article 46, he wasopposed to the designation of approved ports on thegrounds that, if the inspection of the ship revealedthe necessity for deratting, it would be a simplematter to send an inspector from a large port tocarry out deratting operations.

Dr. DOWLING preferred the text as it stood. Hewas in favour of the United Kingdom's suggestionregarding definitions of approved ports for the issueof Deratting and Deratting Exemption Certifications.Practical considerations of distance should not beoverlooked in regard to the suggestion of sending aninspector from a large to a small port.

Dr. HEMMES (Netherlands) referred the committeeto a note on deratting procedure submitted by hisdelegation. The proposals were : (1) to replace thewords " and shall not take longer than twenty-four hours " in paragraph 4 (a) by " and shall nottake longer than is absolutely necessary ", since24 hours might not always be sufficient where cyanicacid was used ; (2) to delete paragraph 5, because itwas not considered that a deratting certificate shouldbe issued if the health authority were not fullysatisfied with the results obtained.

Dr. MA'MOEN (Indonesia), in supporting theNetherlands proposal regarding paragraph 4 (a),explained that deratting in his country could not becarried out by means of cyanic acid but only bysulphur gas, owing to climatic conditions ; thatgenerally took about two to three days.

Dr. BERGMAN (Sweden) likewise supported theNetherlands proposal, pointing out that the timebefore the ship became free from the effects ofcyanide depended on temperature and climate and,in northern countries, often exceeded 24 hours.

Decision: On a vote being taken, the proposalof the Netherlands delegation to amend thewording of paragraph 4 (a) was adopted.

Mr. HASELGROVE, referring to the proposal of theNetherlands delegation to delete paragraph 5, said

that his Government had been responsible, at anearlier stage, for suggesting the inclusion of theparagraph, in order to cover the case where renewedderatting was considered necessary. He submittedthat the paragraph gave shipping companies-whichcould not always unload cargoes at will-areasonable procedure, leaving it to the health author-ity to decide when its provisions should be applied.

Dr. JAFAR supported the proposal for deletion.The issue of a modified deratting certificate wouldlead to complications for port administrations, andthere was nothing to prevent a ship from resortingto subterfuges. No certificate should be issued unlessderatting had been satisfactory.

Mr. HASELGROVE suggested, in order to avoid anypossible confusion, that it might be possible toprovide for the issue of a special form of certificate.He maintained that paragraph 5 served a usefulpurpose.

Dr. DUREN said that, under the terms of Article 20,a Deratting Certificate could be requested, if derattinghad been carried out, even in cases where the derattingoperation was incomplete.

The CHAIRMAN agreed with Dr. Jafar about theloose wording of paragraph 5, and also that nomodified type of provisional certificate should beissued. He suggested the following wording for theconsideration of the Drafting Sub-Committee :" If in a port conditions are not suitable for obtaininga satisfactory result from deratting, a statement tothat effect shall be made on the existing derattingcertificate ". The paragraph provided a procedureby which a port health authority could take areasonable line and not rigidly enforce derattingeven with consequent unloading of cargo, if itconsidered that a ship could be allowed to proceed.

Decision: Article 46 was referred to the DraftingSub-Committee for consideration in the light of thediscussion. (See also eleventh Meeting, page 83.)

Article 47 [531

Dr. RAJA proposed the deletion of the words" In exceptional circumstances ".

Dr. DE TAVEL (International Civil Aviation Organi-zation) thought that the words had been included toavoid any routine deratting of aircraft, which woulddelay international traffic.

82 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. BELL, seconded by Dr. GEAR (Union of SouthAfrica), agreed that the provision was too broad andshould be limited to aircraft coming from placesinfected with plague.

Dr. BARRETT, while agreeing with the point of viewof the delegate of the United States, preferred toretain the safeguard implied in " In exceptionalcircumstances ", on the grounds that aircraft, to beeconomic, must be flown during the whole timethey were airworthy.

The CHAIRMAN suggested that the words " suchas the risk of transmission of plague " should beinserted after " circumstances ".

Decision: The Chairman's suggestion was approvedand Article 47 was referred to the Drafting Sub-Committee.

Article 48 [541

On the proposal of Dr. RAJA, supported by anumber of delegations, the committee agreed thatthe isolation period of five days should be amended tosix days, to bring the wording into line with Article 43.

Decision: Article 48 was approved, subject to theamendment of the period of isolation from fiveto six days.

Article 49 [551

Dr. RAJA, queried the need for paragraph 1 (a).Human plague presumably meant bubonic plague,which in itself was not a source of infection.

Dr. EL-HALAWANI proposed the insertion inparagraph 2, after the word " embarkation " of theclause " or if the ship has arrived within six days ofleaving a plague infected port ... "

Mr. HASELGROVE thought that the point wasadequately covered by the provisions of paragraph 3.

Dr. DUREN asked for clarification of the secondparagraph. For a ship to be regarded as suspectedonly, the case of human plague which had occurred

on board would be either deceased, cured or havebeen disembarked.

Professor CANAPERIA observed that the essentialpoint was there should not be a case of plague onboard at the time of arrival of the vessel.

Dr. DOWLING interpreted paragraph 2 to meanthat if a case of human plague occurred on board-whether within the first six days after embarkationor later-the ship would be regarded as infected.If, on the other hand, the case occurred within thefirst six days and had either died, or was cured, thenthe ship would be regarded only as suspected.

The CHAIRMAN suggested that the opening clauseof paragraph 2 should be amended to read : " Avessel shall be regarded as suspected if there has beena case of human plague on board, within the firstsix days after embarkation ".

Dr. DUREN while agreeing with the Chairman'sproposal, suggested the addition of the words :" and if the case is deceased, cured or disembarked ".

Dr. BELL thought there was no need to distinguishbetween an infected and a suspected vessel or aircraftsince measures provided for in Article 50 were thesame in both cases.

The CHAIRMAN recalled that the reason for thedifferentiation had been to allow more stringentmeasures to be taken in the case of infected vessels.He asked whether the committee wished to eliminateparagraph 2 of Article 49 with the consequentialdeletion of the word " suspected " in Article 50.In that case the only distinction would be betweena healthy vessel and an infected vessel.

Dr. DOWLING thought that Article 50 did drawa distinction between the measures to be applied toinfected and suspected vessels.

Further discussion was postponed until thefollowing meeting.

The meeting rose at 4.10 p.m.

ELEVENTH MEETING 83

ELEVENTH MEETING

Wednesday, 18 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Artkle 46 [52] (continuation from previousmeeting)

Mr. VAN'T HAAFF (Netherlands), reverting toArticle 46, suggested that, in the last line of para-graph 4 (b) " tanker" should be substituted for" oil-tanker ", to cover water and wine tankers.

The CHAIRMAN said the Expert Committee onInternational Epidemiology and Quarantine hadconsidered that the provision should be restricted tooil-tankers because there could be no danger of ratsin such tankers.

Decision: A vote was taken and the proposal wasrejected.

Articles 49 [55] and 50 [561 (continuation fromprevious meeting)

The CHAIRMAN recalled the suggestion, made at thetenth meeting,that since the measures laid down inArticle 50 for infected ships and for suspected shipswere identical, it was unnecessary to maintain thedistinction in Article 49. If paragraph 2 of Article 49were suppressed, the words " or suspected " and themeasures to be applied to suspected ships in Article 50could be deleted.

Dr. DOWLING (Australia) thought the words" or suspected " should be retained. All shipsshould not be considered infected when there was onlysuspicion of infection.

Dr. BELL (United States of America), secondedby Dr. RMA (India), suggested that the first line ofparagraph 1 of Article 49 should read " A vessel oraircraft shall be regarded as infected or suspectedif... ". Paragraphs 1 and 2 could be merged,Article 50 remaining unchanged.

Dr. MACLEAN (New Zealand) felt that deletion ofthe conditions under which a vessel should be

regarded as suspected might make it possible for acountry to claim that any vessel was suspected.

Dr. DUJARRIC DE LA RIVIÈRE (France) thought that,if no distinction were made between suspected andinfected vessels, health authorities might be temptedto take no measures in the case of a suspected ship.

Dr. DUREN (Belgium) thought the two categoriesshould be maintained so that under Article 50 thehealth authority could choose what should be thedegree of severity of the measures to be applied.

The CHAIRMAN suggested that in paragraph 2 ofArticle 49 the words " of which the cause is notknown " should be replaced by " pending confirma-tion of the cause of mortality ".

Dr. BELL would agree with the Chairman's proposalif abnormal mortality among rodents were adoptedas a criterion for determining whether a ship wasinfected. He personally considered the basic measurefor the prevention of the spread of plague should beto prevent rats from infected areas from coming onboard. To take as a criterion abnormal mortalityamong rats found on board on arrival would be tomake a retrospective diagnosis. Moreover, theremight be infected rats on board without abnormalmortality ; that also would constitute a danger.

The CHAIRMAN explained that the Expert Com-mittee on International Epidemiology and Quarantinehad felt that measures taken to prevent entry of ratsmight not be completely effective, and if there wereabnormal mortality among rats on board-even inthe absence of a clinical case of plague-the shipmust be considered suspect until the cause of thatmortality was discovered.

Dr. MACLEAN proposed the addition of a referenceto Article 33 in paragraph 4 of Article 50 to coverremoval and isolation of infected persons.

84 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

The CHAIRMAN explained that the Legal Sub-Committee had felt that since removal of infectedpersons was a measure common to all the epidemicdiseases, provision for it could be included in thegeneral part of the Regulations, to avoid repetitionunder each disease.

Mr. BRILLIANT (United Kingdom) thought that, inthe light of the Chairman's explanation regardingabnormal mortality among rodents, paragraph 4 ofArticle 50 would have to be expanded to provide fora ship to be considered healthy if, after investigationof the cause of abnormal mortality among rats, thatmortality was found not to be due to plague.

The CHAIRMAN asked whether the United Kingdomdelegate would be satisfied by the addition of wordsto the following effect : " or when the health authorityhas discovered that the abnormal mortality amongrodents referred to in Article 49, paragraph 2,reveals that the condition is not due to plague ".

Mr. BRILLIANT agreed so far as the article referredto ships.

Decision : In the absence of objections the proposedaddition to paragraph 4 of Article 50 wasadopted, subject to revision by the Drafting Sub-Committee.

Dr. DOWLING, reverting to the United Statesdelegate's remarks concerning abnormal mortality,agreed with the principle that efforts should bedirected primarily towards the sources of infection.It was, however, established that abnormal mortalityamong rodents was the first sign of infection onboard and he, therefore, considered that paragraph 2of Article 49 should be retained. Secondly, the word" effectively " should be added before " carried out "in paragraph 4 of Article 50. Thirdly, referringto the term " free pratique ", he stated that in Aus-tralia there existed three types of pratique, rangingfrom partial pratique covering the port of entryto full pratique covering all ports in the country.There should either be a definition of " freepratique " or, preferably, the word " free " shouldbe deleted so as to leave it to the health authorityto determine the extent of pratique granted.

Dr. EL-HALAWANI (Egypt), agreeing that para-graph 2 of Article 49 should be retained, recalled thathe had suggested at the previous meeting an amend-ment of the same paragraph to the effect that a shipwhich arrived within six days of leaving a plague-infected port should be considered suspected.

Dr. GEAR (Union of South Africa) agreed that,theoretically, measures at the port of departure shouldbe sufficient to prevent the spread of infection,but in practice that was not the case. The world didnot consist of a few closed communities with regulardefined communications with each other. In mostparts of the world it was not aircraft nor the regularshipping lines that carried the potential vectors ofplague but the small vessels that had no regularschedule and followed no fixed route. He thoughtthat the danger could not be averted by internationalregulations. The committee should try by means ofresolutions addressed to the Health Assembly tobring to the attention of Member States the im-portance of national internal measures for increasingprotection, of paying special attention to the smallerforms of transport he had mentioned, and ofrefraining, save in exceptional circumstances, fromapplying to international traffic the maximummeasures permitted in the Regulations.

Dr. BELL, referring to paragraph 3 of Article 49,and paragraph 4 of Article 50, asked whether thecommittee really wanted the Organization to goon record as saying that a ship could leave a plague-infected area on an international voyage with athousand rats on board and still would not be adanger for the spread of plague.

The CHAIRMAN said there were four proposalsbefore the committee. The first was that of thedelegate of New Zealand to add a reference toArticle 33 in paragraph 4 of Article 50. He hadconsulted Mr. Hostie who was in agreement fromthe legal point of view.

Decision : The proposal was adopted, the necessaryadjustment being left to the Drafting Sub-Committee.

The CHAIRMAN said the second proposal was thatof the delegate of Australia to define " free pratique "or to suppress the word " free ".

A discussion followed, the CHAIRMAN explainingthat the measures laid down in Article 50 andArticle 33 might not have been completed until theship had called at several ports in the country. Therewas nothing to prevent the health authority fromgranting pratique for each of the ports at which theship called while the measures were being carriedout. Once they had been completed, full pratiquemust be given in respect of the disease with which

ELEVENTH MEETING 85

the ship had been infected and the measures could notbe required to be repeated at subsequent portsunless a new incident of epidemiological significance,whether relating to the same or to another diseasehad occurred, as laid down in Article 35. The term" free pratique " was consecrated by many years ofpractice and was generally accepted to apply only tothe port at which it was granted. As he understoodit " free pratique " meant unconditional pratique,whereas if " free " were omitted the pratique grantedmight be conditional.

Dr. DOWLING would accept " free pratique "as meaning unconditional pratique, provided itapplied only to the port where it was granted, butproposed that the word " free " be deleted in para-graph 4 of Article 50.

Dr. MACLEAN and Dr. VAN DEN BERG (Netherlands)considered " free pratique " should be defined.

Dr. JAFAR (Pakistan) and Mr. HASELGROVE

(United Kingdom) agreed with the interpretationof " free pratique ", a term used in the SanitaryConventions and which had not given rise toconfusion in the past, the latter adding that thedeletion of the word " free " would defeat the objectof the article.

After a further exchange of views, Dr. JAFARsuggested that the committee accept the term " freepratique " as relating only the port where it wasgranted (an interpretation recognized by manycountries). The master of the vessel would besufficiently protected by the terms of Article 35against repetition at subsequent ports of measurestaken in respect of a particular epidemiologicalincident.

It was agreed to leave paragraph 4 of Article 50unchanged in that respect.

The CHAIRMAN asked whether the committeewished to make any other changes in Article 50.

Mr. HASELGROVE asked for the following amend-ment of paragraph 1 (b) for purposes of clarification :" (b) disinsecting and, if necessary, disinfection of(i) any baggage of any infected person or suspect and(ii) of any other article... ".

He recalled his suggestion in the Sub-Committeeon the Mecca Pilgrimage that the Drafting Sub-Committee should consider the desirability ofdefining quarantine. He asked whether "isolation "in paragraph 3 of Article 50 should not be replaced

by " quarantine ", the definition of the formerrelating only to persons.

Decisions :

(1) A vote was taken and it was decided not todefine quarantine.(2) In the absence of objections, the Australianproposal to add " effectively " before " carriedout " in paragraph 4 was accepted.(3) The drafting amendments suggested by thedelegate of the United Kingdom were referred tothe Drafting Sub-Committee.

Dr. EL-HALAWANI repeated his proposal forinsertion in paragraph 2 of Article 49 of a clause tothe effect that a vessel " even if found to be healthy-should be regarded as suspected if, coming from aplague-infected port, it arrived within the incubationperiod of the disease.

Decision : The proposal was rejected by 9 votes to 7.

Replying tO Dr. HENNINGSEN (Denmark), whoremarked that paragraph 1 (b) of Article 50 providedthat disinsecting could be applied to any part of avessel, whilst paragraph 2 provided for a vessel tobe deratted in accordance with Article 46, whicharticle made no reference to ectoparasites, theCHAIRMAN said that disinsecting might be applied ifconsidered necessary. To have rodent plague onboard and not to derat would be a serious matter.

However, to cover the possibility of the methodof deratting used not effecting the destruction ofectoparasites, he suggested that the followingwording might be used : " If there is rodent plagueon board a vessel it shall be deratted and the ecto-parasites destroyed, if necessary in quarantine ".On the other hand, it might be left to the discretionof the health authority, who would be anxious todestroy the ectoparasites as well as the rats.

Dr. DAENGSVANG (Thailand) thought the pointraised by the delegate of Denmark was covered inparagraph 1 (b) of Article 50.

Dr. DDREN, further to the suggestions made by hisdelegation at the previous meeting, proposed thatparagraph 2 of Article 49 should be amended asfollows : " A vessel shall be regarded as suspectedif, in the absence of human plague on board, therehas occurred a case of that disease on board withinthe first six days after embarkation ... "-theremainder of the text to be as at present drafted.

It was agreed that the Drafting Sub-Committeebe asked to take account of the amendment.

86 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. BELL said that, as most of the provisions inArticles 49 and 50 were concerned with humaninfection, the essential measure to be taken was toprevent the egress of rats and rat-fleas from vesselscoming from ports infected with plague. The presentRegulations permitted a vessel from a plague-infected port to proceed, even though it might beheavily infested with rats. There should be a pro-vision that at the first port of call the vessel must bederatted.

He proposed that, in paragraph 2 of Article 49after the words " A vessel shall be regarded assuspected ", the following clause should be inserted :" when arriving from a plague-infected local areaand when it is found to be heavily infested withrats ", and that paragraph 3 (b) should be replacedby words to the effect that a vessel should not beregarded as healthy when it arrived from an infectedlocal area and was found to be heavily infested withrats.

Replying to a question by the CHAIRMAN regardinghis definition of " heavily infested " Dr. BELL saidit could not be defined but decision must be left tothe health authority concerned.

Professor CANAPERIA (Italy) supported the UnitedStates proposal. Under the provisions of para-graph 2 of Article 50, deratting would only be carriedout if there was rodent plague on board, but itwould be reasonable to allow the health authorityto demand deratting of a vessel, arriving froman infected local area and heavily infested withrats.

The United States proposal was supported byDr. EL-HALAWANI, Dr. PADUA (Philippines) andDr. DOWLING, but the latter suggested that theamendment to paragraph 3 (b) of Article 49 shouldread : " in the case of a vessel, there is no evidenceof an abnormal mortality among rodents on boardnor evidence of heavy infestation by rodents ".

Dr. GEAR thought no one would dispute theepidemiological principles on which the proposal wasbased, but many other practical factors must betaken into account.

He thought that the fears that had been expressedwere adequately covered by the provisions ofArticles 46, 49 and 50. In addition, the measuresunder Article 51 (b) provided adequate protection forStates which feared the introduction of plague byvessels heavily infested with rats. If national adminis-

trations applied the measures provided for in theRegulations, many small vessels would be completelyimmobilized in the ports.

The CHAIRMAN asked the committee to refer to thetext of Article 51 before taking a decision on theUnited States proposal.

Dr. JAFAR reminded the committee that, as allvessels engaged in international traffic must be inpossession of a valid Deratting Certificate or aDeratting Exemption Certificate, renewable everysix months, Articles 49 and 50 provided for alleventualities and Articles 51 for that visualized bythe United States delegation. It would be unusualfor a vessel to have a valid certificate and at the sametime to be heavily infested with rats ; in the lattercase the health authority could apply paragraph (b)of Article 51.

Dr. BELL agreed with Dr. Jafar that paragraph (b)of Article 51 would cover the case of a vessel arrivingfrom a plague-infected area and found to be heavilyinfested with rats, but considered that his proposalto amend paragraph 3 of Article 49 should stand.

The CHAIRMAN thought that Article 51, particularlyparagraph (b), governed the provisions of Article 49in that paragraph 3 of the latter article could bemodified in exceptional cases under the provisionsof Article 51.

Dr. DUREN emphasized the importance of theUnited States amendment, which would modifycertain principles established in the Regulations.Whilst his delegation did not refuse to examine theproposed amendment, a decision should be deferred,to allow time to study the amendment.

Decision: On being put to the vote, the proposal topostpone a decision was rejected.

The CHAIRMAN then put to the vote the proposalof the delegate of the United States to amend para-graph 2 of Article 49.

Decisions :

(1) The proposal was adopted by 12 votes to 5.

(2) With the foregoing decision, the UnitedStates proposal to amend paragraph 3 of Article 49was automatically adopted.

ELEVENTH MEETING 87

Dr. DOWLING asked for it to be recorded that hisdelegation was not in agreement with the text ofArticle 50 as just adopted by the Special Committee.

Article 51 [58]The CHAIRMAN asked whether, in view of the

decision to amend Article 49, the committee con-sidered that paragraph (b) of Article 51 was necessaryor, at any rate, whether the words " in exceptionalcases " were still operative.

Mr. HASELGROVE proposed the deletion of para-graph (b) of Article 51.

The CHAIRMAN then asked whether, in the light ofthe United States amendment, the committeeconsidered it necessary to insert in paragraph 2 ofArticle 50, after the words " If there is rodent plagueon board a vessel. . . ", the following clause : " . . . or ifthe vessel is heavily infested, ... ".

Dr. BELL considered that in the case of a vesselwhich was suspected merely because it came froman infected local area and which was found to beheavily infested with rodents, deratting should beonly permissive. He suggested that paragraph (b)of Article 51 be deleted and the phrase " in excep-tional cases " incorporated in paragraph 2 ofArticle 49 as already amended.

Professor CANAPERIA suggested that, in view of theadoption of the United States amendment, Article 50

could be simplified by adding, in paragraph 1, anew sub-paragraph (c) reading : " deratting of thevessel " and by inserting, at the beginning of para-graph 2, the clause : " The deratting operations shallbe carried out in accordance with Article 46, ... ".

Decision: By 21 votes to none, it was agreed thatparagraph (b) Article 51 be deleted and that thearticle be referred to the Drafting Sub-Committee.

Article 52 [59]Decision: The article was adopted subject to theinclusion of a reference to Article 33, as proposedby the delegate of New Zealand.

Article 53 [60]Decision: The article was adopted without dis-cussion.

Article 54 [611Dr. EL-HALAWANI proposed that paragraph 3 be

amended to read :

The health authority of a local area which isnot infected may require any person who arrivesthere on an international journey from an infectedlocal area and who is unable to produce a validcertificate of vaccination against cholera to beplaced under observation for a period notexceeding five days from the date of departurefrom the infected local area.

As the article was drafted, if a person acceptedvaccination he would not be subjected to any furthermeasures. In view of the dangerous nature of thedisease, he considered his proposal was justified inorder to prevent the spread of the disease to othercountries.

Dr. PADUA proposed the deletion of paragraph 2

of Article 54, in consequence of the deletion of para-graph 3 of Article 42.

Dr. BIRAUD, Secretary, believed that paragraph 2

of Article 54 should be retained. Some countrieswere tempted to fix their own standards for anti-cholera vaccines, which differed from those of othercountries, so that a person who had been vaccinatedwith a vaccine prepared according to the standardof his own country might have to be revaccinatedwhen entering another country. Under the provisionsof the present Regulations, that could not be required.

Dr. BOYER (France) proposed the insertion inparagraph 3 of a clause stating that vaccinationshould be followed by surveillance.

Dr. GEAR, being of the opinion that compulsoryvaccination certificates were unsatisfactory as appliedto international travel-as they created a false senseof security and led some countries to neglect thedevelopment of internal sanitary conditions whichwould enable them to resist cholera and otherdiseases-proposed that a provision be inserted onthe lines of Article 44 which related to plague.

Mr. BRILLIANT said his delegation fully supportedthe view expressed by the Secretary and opposeddeletion of paragraph 2 of Article 54.

Regarding the proposal of the delegate of Egyptto amend paragraph 3, he asked if the word " obser-vation " used in that amendment was intended tomean surveillance.

The CHAIRMAN said he interpreted it as meaning" isolation ", as defined.

88 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Mr. BRILLIANT said that his delegation wouldsupport the proposal if the word " surveillance "were substituted for " observation ".

Dr. EL-HALAWANI gave a detailed explanation ofhis reasons for considering that surveillance alone wasnot sufficient to protect a country against the intro-duction of cholera.

Dr. BICA (Pan American Sanitary Organization)presented that organization's proposals for theamendment of Article 54, as follows :

1. The possession of a valid anticholera vaccina-tion certificate shall be required of any personleaving an infected local area on an internationaljourney.

2. Should such a person be in possession of acertificate of vaccination which is not yet valid,he may nevertheless be permitted to depart, but theprovisions of paragraph 3 of this Article may beapplied to him on arrival.

3. The health authority of a local area mayrequire any person who arrives there on an inter-national journey from an infected local area andwho is unable to produce a valid certificate ofvaccination against cholera to be so vaccinated orto be placed under surveillance, or both, for aperiod not exceeding five days from the date ofdeparture from the infected local area.

Paragraph 4 should be deleted, because it wasunreasonable in that it would permit reintroductionof cholera into an area which had been declaredinfected at a time when active measures were beingtaken to eradicate the disease.

Dr. DOWLING, believing that the Expert Committeeon International Epidemiology and Quarantine hadgood reasons for considering that vaccination againstcholera had some value, supported that view. Inconnexion with paragraph 3, however, he thoughtthat it would be a doubtful epidemiological proce-dure to insist on vaccination on arrival, i.e., possiblyduring the incubation period. He therefore proposedamending the paragraph by deleting the words " tobe so vaccinated " after the words " who is unableto produce a valid certificate against cholera ".

Dr. DUJARRIC DE LA RIVIERE said that paragraph 3,as drafted by the expert committee, reflected thegreat value of vaccination. Vaccination did not,

however, prevent a person from being a germcarrier and for that reason his delegation consideredthat vaccination should be followed by surveillance.

Dr. DOWLING withdrew his proposal.

Dr. JAFAR proposed that paragraph 3 be amendedto read :

The health authority of a local area which is notinfected may require any person who arrives thereon an international journey from an infected localarea within the incubation period and who isunable to produce a valid certificate of vaccinationagainst cholera to be placed under surveillance. . .

He explained that the measure could not be appliedto a person for all time if he happened to come froman infected local area and that the period musttherefore be restricted.

As a preventive measure, vaccination had a highvalue, not only in endemic areas but also for peopletravelling abroad. A survey in Southern India hadestablished the fact that vaccination had a definiteplace in measures against cholera. He thought thathis proposed amendment would allay the fearsexpressed by the delegate of Egypt.

Professor ALWISATOS (Greece) said that anti-cholera vaccination as a prophylatic measure didnot always give complete protection to the vaccinatedperson. It was, however, a means of mass protectioninasmuch as it considerably reduced the sources ofinfection. The experience which Greece had acquiredon this point in 1912-1913 had, moreover, beenconfirmed by statistics.

Dr. RAJA supported the proposal.

Dr. BARRETT (United Kingdom) also supportedDr. Jafar's proposal as regarded surveillance.His delegation could not agree with any measurewhich would place healthy persons in isolation.

Dr. PADUA having withdrawn the proposal he hadmade earlier, a vote was taken on the proposal ofDr. Gear to insert a provision on the lines ofArticle 44.

Decision: The proposal was rejected.

It was agreed to vote on the remainder of theproposals relating to Article 54 at the subsequentmeeting.

The meeting rose at 12.30 p.m.

TWELFTH MEETING 89

TWELFTH MEETING

Thursday, 19 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Article 54 [61] (continuation from previousmeeting)

Dr. JAFAR (Pakistan) proposed an alternativewording for the amendment to paragraph 3 he hadtabled at the previous meeting. He later agreed tothe following wording suggested by the UnitedKingdom delegation :

Subject to the provisions of Article 29, the healthauthority of a local area which is not infected may,in the case of a person who arrives there within theincubation period on an international journeyfrom an infected local area, impose the followingmeasures :

(i) If he is in possession of a valid certificate ofvaccination against cholera, he may be placedunder surveillance for a period not exceedingfive days from the date of departure from theinfected local area.(ii) If he is not in possession of such a certificate,he may be placed in isolation for a like period.

A person who is unwilling to submit to isolationmay be refused admission to the territory but shallbe permitted to continue his journey.

Dr. RAJA (India) supported the above proposal.

Mr. HUSSEINI (Saudi Arabia) was in favour of theviews expressed by the Egyptian delegation at theprevious meeting, namely that surveillance did notconstitute sufficient protection to prevent the spreadof cholera by persons coming from an infected area.Nor was anticholera vaccination of persons leavingan infected area sufficient to ensure the protection ofa country in which such persons arrived : the pro-visions of paragraph 2 of Article 34 gave support tothat view.

Professor ALIVISATOS (Greece) recalled his remarksat a previous meeting, namely, that anticholera

vaccination could not be considered as an absolutemeasure for the protection of a country against thatdisease. Moreover, satisfactory immunization couldnot be presumed before the twelfth day after theinjection, and resistance was obtained only afterrepeated injections. By accepting anticholeravaccination as a protective measure, he was notconvinced that Greece could be preserved from theintroduction of cholera.

As far as surveillance was concerned, Greece couldonly accept the provision in the case of persons whoremained either in Piraeus, Athens or Salonika,owing to the lack of adequate sanitary services inother places. For those reasons he was opposedto the first alternative, i.e., vaccination, but wasprepared to accept surveillance subject to the personsremaining in the ports mentioned for the period ofsurveillance.

Dr. DUJARRIC DE LA RIVIÈRE (France) was definitelyof the opinion that vaccination, under paragraph 3of Article 54, should be followed by surveillanceor observation according to circumstances. Hewished to call the attention of the Drafting Sub-Committee to the word " require " (" exiger ") inparagraph 3 which should be amended to make clearthe intention that a person could choose betweenvaccination or other measures.

Dr. PADUA (Philippines) was opposed to the viewexpressed by a number of delegations that vaccina-tion was not a reliable sanitary measure. On thecontrary, experience in his country had shown thatanticholera vaccination, although it did not conferabsolute immunity, was a sound measure if properlycarried out with the right strain, titre, dose, and atproper intervals. It would afford protection to anindividual who had arrived in an infected local area.He urged that the paragraph be retained as it stood,and interpreted to mean that if an individual wasunable to produce a valid certificate of vaccination,he should either be vaccinated or placed under

90 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

surveillance, or both, at the discretion of the healthauthority, for the protection of persons in that areaand also of the individual coming from an infectedlocal area.

Dr. DUREN (Belgium) supported the proposal toamend paragraph 3, as drafted by the United King-dom, and proposed that it be put to the vote.

Dr. EL-HALAWANI (Egypt) recalled his delegation'sproposal at the previous meeting to replace the word" surveillance " by " observation ", meaning isola-tion, pointing out that " observation " would belimited to persons coming from infected local areas.Experience during the 1947 epidemic in Egypt hadshown that mortality amongst those vaccinatedagainst cholera amounted to 14 %, and at least untilreliable vaccine standards had been laid down by theOrganization, real reliance could not, in his opinion,be placed on vaccination. He maintained his amend-ment, which he urged should be accepted as a soundcourse to take on epidemiological grounds.

Dr. RAJA spoke of the high degree of protectionafforded by anticholera vaccination in India, whereafter government measures had been taken topi event non-vaccinated persons from entering festivalcentres-formerly the cause of widespread infection-successful results had been achieved.

The CHAIRMAN explained that the proposals of thedelegates of Pakistan and Egypt were identicalexcept for the addition of a reference to Article 29.

Dr. EL-HALAWANI maintained that a traveller whowas permitted to continue his journey should be keptin isolation until he re-embarked. In connexionwith the validity of cholera vaccination certificates,he pointed out that immunity began on the fourthday and was complete only on the eighth day.

The CHAIRMAN, speaking as a member of theExpert Committe on International Epidemiologyand Quarantine, explained that, for the purpose ofthe Regulations, the incubation period of cholerawas five days, after which it must be assumed thatthe person would not contract the disease. Thevalidity of the certificate came into force after fivefull days, namely on the sixth day.

Dr. BRAVO (Chile) supported the amendment of thedelegate of Pakistan, as worded by the UnitedKingdom delegation. He felt, however, that, pending

the drafting by the Organization of standards for anti-cholera vaccines, the standards in force in thecountries administering vaccines should be accepted.He proposed the deletion of paragraph 4 on thegrounds that it would permit the reintroductionof cholera into an area which had been declaredinfected, at the very moment when the authoritiesof that area were taking action to eliminate infection.

Decision: The new text of paragraph 3, as proposedby the delegate of Pakistan, was adopted unani-mously and referred to the Drafting Sub-Com-mittee.

Mr. STOWMAN (United States of America) sup-ported the proposal of the delegation of Chile. It wasimportant to recognize that measures could be takenafter a place had become infected ; moreover, thedanger of an epidemic increased if different strainswere introduced from an outside area. Accordingly,the right to impose vaccination in such cases shouldnot be restricted.

The CHAIRMAN, replying to requests for clarifica-tion from Dr. RAJA and Dr. BARRETT (UnitedKingdom) in regard to the correct interpretation ofparagraph 4, said he understood the intention of thatparagraph to be that, in the case of a person wishingto enter an infected local area, the certificate ofvaccination should not be a condition of entry.If, however, he wished to remain in that area, forwhatever period, he could then be required to submitto the laws of the country concerned.

Decision: The proposal of the delegate of Chile todelete paragraph 4 was put to the vote and rejectedby 11 votes in favour to 11 against.

Article 55 [62]

Dr. BELL (United States of America) did notthink that the period of 5 days provided for inArticle 55 was in accordance with scientific facts,since it was generally agreed that a cholera caseremained infective for 14 days from the onset of thedisease. He would make no formal proposal butmerely wished to bring the matter to the attention ofthe committee.

Dr. EL-HALAWANI agreed with the delegate of theUnited States. He proposed to add to the end ofparagraph 2 the words " or if it arrives from aninfected local area within the incubation period ".The same question had arisen before in connexionwith canals and the committee had upheld the pointof view of his delegation.

TWELFTH MEETING 91

Dr. RAJA and Mr. HASELGROVE (United Kingdom)thought the Egyptian proposal too drastic, as itwould mean in effect that all ships arriving from aninfected local area would be treated as suspected.

Mr. HUSSEIN! proposed that to the end of para-graph 4 be added the words : " provided that theperiod of incubation has elapsed from the date ofdeparture ".

Decision: The Egyptian amendment was rejected by12 votes to 9.

Dr. RAJA thought that by the rejection of theEgyptian amendment the amendment proposed bythe delegation of Saudi Arabia was automaticallyruled out.

Dr. BELL said that if Article 55 was adopted asit stood the same situation would arise as had arisenwith regard to plague : a ship arriving from aninfected local area, even the day after departure,would be considered healthy as long as no case hadoccurred. He wondered whether it was necessary forthe definitions of " healthy " and " suspected "to be mutually exclusive. Even if, as the committeeappeared to feel, the Saudi Arabian amendment wasruled out, a vote on the definition of a healthy shipneed not necessarily affect the definitions of" infected " and " suspected ".

He did not, however, accept an invitation by theChairman to propose a new category in addition to" infected " and " suspected ".

Decision: Article 55 was adopted.

Article 56 [63]The CHAIRMAN, replying to a question by the

delegate of Belgium, said that, as he understood it,the last sentence of Article 56 implied that healthauthorities were required to ensure that the provisionsof paragraph 2 were carried out. He also drew atten-tion to a discrepancy between the English and Frenchtexts of the sentence in question. It was agreed thatthe French text should be brought into line with theEnglish.

Dr. EL-HALAWANI proposed that the words " orisolation " be added after the word " surveillance "in the second line of paragraph 1 (a).

There followed an exchange of views between theChairman and the delegate of Egypt in which thelatter maintained that his proposal was intended tobring paragraph 1 (a) of Article 56 into line with theamended text adopted for paragraph 3 of Article 54,while the Chairman considered that the two texts

were already in agreement and that the Egyptianamendment would involve a change in Article 54.

Finally, the CHAIRMAN put to the vote a proposalof the delegate of Pakistan that Article 56 be adoptedas it stood.

Decision: Article 56 was adopted subject to adjust-ment of the French text by the Drafting Sub-Committee.

Article 57 [64]The CHAIRMAN observed that if the Drafting Sub-

Committee chose to employ the word " person "in place of " passenger or member of the crew "in paragraph 2 of Article 57 it would be free to do so,but for the sake of consistency a similar change wouldhave to be made throughout.

Decision: Article 57 was remitted to the DraftingSub-Committee.

Article 58 [65]Dr. DUJARRIC DE LA RIVIÈRE suggested that the

Drafting Sub-Committee be asked to considerinserting the word " effectively " before the words" carried out ".

Dr. MACLEAN (New Zealand) noted that the articleshould contain a reference to Article 33 as well as toArticles 56 and 57, in accordance with the decisionof the committee reached in the case of the articleon plague.

Decision: Article 58 was remitted to the DraftingSub-Committee to incorporate the above twoproposals.

Articles 59 [66] and 60 [67]Decision: Articles 59 and 60 were adopted.

Article 61 [6s]Mr, HASELGR OVE suggested for the consideration

of the Drafting Sub-Committee that the word" only " in paragraph 2 of Article 61 be removedfrom its present position and placed after the word" importation ".

Mr. STOWMAN proposed that the words " any ofthe following fresh or refrigerated foods which canbe eaten uncooked, namely fish ", beginning atthe end of the fourth line of Article 61, be replacedby the words " unsealed foods or beverages that canbe consumed uncooked such as fish.. . ". Sealedfoods were not subject to contamination.

92 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

He also suggested that the Drafting Sub-Committeeconsider inserting at the beginning of paragraph 3the words " Notwithstanding the provisions ofparagraphs 1 and 2 ... ".

Dr. RAJA noted that under the provisions of para-graph 2 health authorities at ports other than theplace of importation would be prohibited fromremoving the food in question, if it formed part ofthe cargo. Was that not contrary to the interests ofpublic health ?

The CHAIRMAN explained that the expert committeehad decided that food cargo in holds was not likelyto become infected with cholera.

Dr. RAJA wondered whether the fact that the cargoreferred to was the cargo in the hold could be madeclear in the text.

Dr. MALAN (Italy) thought that with a view tostrengthening prophylactic measures and at the sametime avoiding commercial loss as far as possible,the following words should be added to the article :" The importing of fish, shellfish, and fresh orrefrigerated fruit and vegetables coming from aninfected local area may be forbidden, the unloadingof such goods prohibited, and the goods in questiondestroyed. The prohibition of such imports must benotified in advance, in accordance with the provisionsof Article 11."

Dr. JAFAR thought that a reference could also beincluded to the freight compartments of aircraft.

The CHAIRMAN accordingly put to the vote theproposal that the Drafting Sub-Committee be askedto insert after the word " cargo " in paragraph 2a phrase to the following effect : " in the hold of aship or the freight compartment of an aircraft ".

Decision: The proposal was adopted by 12 votesto 1.

Dr. MACLEAN proposed an amendment to thatof the United States delegation. He thought that theenumeration of foodstuffs in the sixth line ofArticle 61 weakened the effect of its provisions,since certain foodstuffs, such as cooked meats,which were not mentioned, might also conveyinfection. The words " such as fish, shellfish, fruitand vegetables " should therefore be deleted.

The CHAIRMAN explained that the expert committee,after careful consideration had decided that risk ofinfection by foodstuffs other than those mentionedwas slight.

Dr. DUJARRIC DE LA RIVIÈRE agreed with theChairman. Tests had shown, for example, thatpreserved fruits, whose importation from Egypt hehad himself at one time proposed to forbid, containedsufficient sugar to obviate all risks of infection. Inperiods of epidemic there was a general tendency torestrict unnecessarily the importation of manycategories of foodstuffs.

After some further discussion, the CHAIRMAN putthe amendment proposed by the delegate of NewZealand to the vote.

Decisions:(1) The amendment was rejected by 14 votes to 2.(2) The amendment proposed by the UnitedStates delegation was adopted unanimously.

The CHAIRMAN, replying to a question by thedelegate of New Zealand, said that the " place ofimportation " meant the place to which the cargowas destined and at which it was discharged. TheDrafting Sub-Committee would be asked to clarifythe point.

Decision: Article 61 was remitted to the DraftingSub-Committee.

Artkle 62 [69]The CHAIRMAN called attention to the footnote

to Article 62. It had been inserted as a result of adiscussion in the Legal Sub-Committee of the ExpertCommittee on International Epidemiology andQuarantine regarding the rights of health authoritiesto enforce the measures in question.

Dr. EL-HALAWANI proposed that Article 62 beamended to read : " Persons arriving from a cholerainfected area may be required to submit to bacterio-logical examinations ". The article as it stood seemedin conflict with scientific knowledge. If bacterio-logical examination were to be permitted in the caseof the other epidemic diseases, it seemed illogicalto include a special article prohibiting it in the caseof the most dangerous.

Dr. MALAN suggested that, since healthy carrierswere a danger, it might perhaps be advisable toallow persons who were not in possession of avalid vaccination certificate the choice between stoolexamination followed by surveillance, and isolation.

Dr. DUJARRIC DE LA RIVIÈRE supported theproposed amendment subject to some small amend-ments. In his opinion, it constituted a compromise,

TWELFTH MEETING 93

justified by the present state of epidemiologicalknowledge, between Article 62 as it stood and theprovisions of the International Sanitary Convention,1926, under which persons under observation mustsubmit themselves to any clinical examinationsconsidered necessary by the health authorities. Whileit was true that cholera vaccination did not makebacteriological examination wholly unnecessary,it had been established that in general only personsrecently infected with cholera were any real danger,and then only for a short time.

Professor ALIVISATOS drew attention to the factthat besides the classic cases of cholera there were alsocertain cases of slight diarrhoea, caused by choleravibrios, which did not prevent the persons affectedfrom travelling or from following their occupations,but which did make them a danger. Such cases couldonly be diagnosed clinically by bacteriologicalexamination, and such examination should thereforebe authorized.

Dr. RAJA recalled that it had been largely on thebasis of an investigation carried out over a period ofa year in endemic areas by the Indian Council ofMedical Research that the Expert Committee onInternational Epidemiology and Quarantine haddecided that the carrier was unimportant in thespread of cholera. That investigation had alsoshown that the period during which a person whohad recovered from cholera still excreted vibrios fromthe gut rarely exceeded five days. He referred thecommittee to a paper by Dr. C. G. Pandit, " Therole of the carrier in the spread of cholera " (issued byWHO as document WHO/Epid/48) in which theresults of the investigation had been made public.Since that paper there had been a further outbreakand a further investigation had confirmed theconclusions reached previously, namely that thedanger of the spread of cholera by contact-even,in the area where the outbreak occurred-was smalland that persons acquiring the infection did notcarry it sufficiently long to constitute a danger fromtheir participation in international traffic : in the caseof maritime traffic, most voyages lasted longer thanfive days ; in the case of air traffic, the standardsof living and hygiene of persons who normallytravelled by air were higher than those of the personswho were the subject of the investigation.

The proposed insistence on stool examinationswas therefore of little significance ; the article shouldremain unchanged.

Dr. EL-HALAWANI agreed with the delegate ofGreece that persons suffering from diarrhoeaprovoked by the cholera vibrio might be a danger.

It must not be supposed that the results of theinvestigation carried out in India had found generalacceptance. None of the text-books used in medicalschools all over the world, even those published withinthe past year, denied the importance of the carrier inspreading cholera. The same was true of officialpublications such as those of the War Office inLondon and of the United States Government.

As to the claimed shortness of the period duringwhich vibrios might persist, records of Egyptiancases of cholera in 1947 showed that vibrios werefound after 15 days in no less than twenty per centof cases, which could hardly be called an insignificantproportion. Furthermore, nobody would claim thatthe possibility of ambulatory cases could be neglected.

Dr RAJA observed that the delegation of Egyptappeared to think that India was alone in maintainingthe unimportance of the cholera carrier. As far backas 1932 the Office International d'Hygiène Publiquehad ordered extensive investigations which had beencarried out between 1934 and 1940 in five laboratoriesin different parts of India. The results of thoseinvestigations had been in accordance with the viewshe had expressed.

Dr. DUJARRIC DE LA RIVIERE suggested that since,according to recent evidence, cholera vibrios wereconsidered to constitute a real danger only for alimited period, Article 62 might be adjusted byintroducing the notion of a time-limit. Though nothimself an expert in the matter, he thought that theperiod of real danger was probably about 15 daysafter onset of the disease.

Professor MOOSER (Switzerland) said that theresults of an investigation conducted in Egypt in1947 by the Swiss Red Cross contradicted the viewsput forward by Dr. El-Halawani. In a village wheremore than ten per cent of the population had beeninfected with cholera, rectal swabs taken of more thana thousand persons 14 days after the occurrence of thelast case had revealed no vibrios.

Dr. EL-HALAWANI said that the figures on whichhe placed his conclusions were those for the whole ofEgypt and not merely for a local area, like thosequoted by the delegate of Switzerland. He approvedthe suggestion of the delegate of France.

94 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

In reply to a question by Dr. BARRETT, he saidthat the text proposed by the delegation of Egyptwas intended to be applied with discrimination soas not to detain traffic unduly.

Dr. JAFAR had gathered from the remarks of thedelegate of Egypt that he had the convalescent inview. Since it was unimaginable that a cholera casecould be capable of travelling within 14 days of hisrecovery, there seemed to be no need for the pro-posed provision.

Dr. BELL observed that the remarks of the delegateof Egypt had implied that United States officialpublications stressed the importance of the carrierin spreading cholera. In fact, The control of com-municable diseases in man,5 while enumerating the

5 American Public Health Association (1950) The controlof communicable diseases in man, New York

various sources of cholera infection, did not evaluatetheir relative importance.

He was inclined to agree with the delegate ofIndia that the importance of the carrier was slightand thought that the article should remain un-changed unless convincing evidence to the contrarycould be brought.

The case of diarrhoea mentioned by the delegateof Greece were surely cases with symptoms of cholera,incipient or otherwise, and were therefore notrelevant to the discussion of an article dealing withpersons without symptoms of cholera. Those personshad symptoms suggestive of cholera, and Article 62did not prohibit their bacteriological examination.

The discussion of Article 62 was adjourned.

The meeting rose at 12.15 p.m.

THIRTEENTH MEETING

Thursday, 19 April 1951, at 2.15 p.m.

Chairman : Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Arficle 62 [69] (continuation)

Dr. PADUA (Philippines) said the observations of thedelegate of Egypt at the previous meeting were borneout by the experience in the Philippines at the timewhen they had epidemics. Although the extent ofthe part played by carriers of vibrios was still un-known, experiments had shown that there was acorrelation between them and the incidence ofcholera cases.

Dr. RAJA (India) said that since Pakistan hadbecome a separate country, cholera had not beenintroduced into Western Pakistan, although EasternPakistan was an endemic area and hundreds ofpersons travelled from Eastern to Western Pakistandaily without any let or hindrance. In those cir-cumstances, although his delegation had the fullestsympathy with a country which feared the disease,it asked that a more sober attitude be adopted withregard to the measures applied to foreign travellers.

Dr. EL-HALAWANI (Egypt) thought that it was nopossible to draw a parallel between Pakistan andEgypt which was an extremely receptive country andwas not likely to forget very soon the experience of1947. Although Western Pakistan was an epidemicterritory, a good deal of cholera was present there.He did not understand the delegate of India'sobjection to incorporating a safety measure. As hehad stated earlier, it was not in the interest of Egyptto apply the measures indiscriminately and sincestool examination had been introduced there hadbeen no objections. His amendment left it to thediscretion of the health authority to impose thatmeasure or not.

Professor ALIVISATOS (Greece), reverting to a pointhe had raised at the previous meeting, said thatArticle 62 only took account of classical symptomsand left aside all abortive, latent and sub-clinicalforms of the disease. Knowledge accumulated overa long period was confirmed by the Hamburgepidemic, when it was found that there were approxi-mately four times the number of cases of diarrhoea

THIRTEENTH MEETING 95

(more or less serious in nature) than of confirmedcases of cholera. The small Nietleben epidemic hadbeen caused by an undeveloped case from Hamburgwhich did not show the classical symptoms of cholera.Greece had had the same experience in 1912-1914.The case of germ-carriers-which might not be ofvery great importance in the spread of the disease-must therefore not be confused with that ofundetected forms of cholera, which were very dan-gerous. The negative way in which Article 62 wasworded made it impossible to establish a clinicaldiagnosis in such cases. Moreover, the article wasin opposition with the modern concepts of medicine.The Greek Government could not accept this limita-tion and stool examination would be resorted to ifnecessary and carried out with all discretion. Heproposed the deletion of the words " stool examina-tion or " from Article 62.

Dr. JAFAR (Pakistan) confirmed the remarks of thedelegate of India concerning the non-introductionof cholera into Western Pakistan from EasternPakistan and said that, contrary to the statementof the delegate of Egypt, there had been no cases ofcholera in Western Pakistan since Pakistan became aseparate State. He asked that the Egyptian amend-ment be put to the vote.

The committee decided, by vote, to take a decisionimmediately on the Greek amendment, whichconstituted an amendment to the Egyptian proposal.

The CHAIRMAN recalled that the Greek proposalwas to delete " stool examination or " in Article 62as drafted. The Egyptian proposal was to replace thearticle by " Persons arriving from a cholera-infectedarea may be required to submit to bacteriologicalexamination ".

In reply to Dr. RAJA who, on a point of order, saidthat bacteriological examination could be interpretedas either stool examination or rectal swabbing,or both, Dr. EL-HALAWANI said his amendmentreferred to stool examination only.

The CHAIRMAN disagreed and further pointed outthat the amendment made no reference to personswithout symptoms.

Decisions :

(1) A vote was taken on the amendment of thedelegate of Greece, which was adopted.(2) The proposal of the delegate of Egypt wasrejected by 14 votes to 7.

Dr. EL-HALAWANI asked that the Egyptian reser-vation on the point of stool examinations be recorded.

The CHAIRMAN replied that the reservation wouldarise for consideration by the Health Assemblyunder Article 104 of the Regulations.

The second vote just taken meant that Article 62remained as drafted. He questioned, however,whether bacteriological examination was not a partof the preliminary examination referred to in thelast sentence of Article 23.

Dr. RAJA said he had understood from thediscussion on Article 23 that, while the medicalinvestigation under that article might includebacteriological examination, stool examination wasprecluded in the case mentioned in Article 62. Herecalled that the delegate of Egypt had at that timereserved the right to bring the question up in con-nexion with Article 62. Dr. Raja assumed that inview of the decision to maintain Article 62 as drafted,the position was as he had described it.

The CHAIRMAN and Dr. VAN DEN BERG (Nether-lands) agreed with the interpretation of the positiongiven by the delegate of India.

Replying to a question by the CHAIRMAN,Mr. HOSTIE, Chairman, Legal Sub-Committee of theExpert Committee on International Epidemiologyand Quarantine, said he thought the Drafting Sub-Committee, which was at that moment discussingArticle 23, would propose that the last sentenceshould be amended to read " Except as limitedin Article 62 ".

Dr. BELL (United States of America), fearing thatreservations would impair the effectiveness of theRegulations, asked whether the reservations toArticle 62 could be withdrawn if a second para-graph were added to the following effect : " Aperson arriving from a cholera-infected area withinthe period of incubation of the disease and presentingsymptoms suspicious of cholera may be submittedto stool examination ".

After a discussion as to whether it was necessary todecide by a two-thirds majority to reopen discussionof Article 62, the CHAIRMAN ruled that the proposalshould be treated for the time being as a new article.

Dr. BJORNSSON (Norway), Dr. DUREN (Belgium)and Dr. PADUA (Philippines) supported the UnitedStates proposal.

96 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Following a remark by Dr. DUREN, the CHAIRMANsuggested replacing the word " suspicious " by" indicative ".

Professor CANAPERIA (Italy), seconded by Dr. VANDEN BERG, suggested that the United States proposalwas unnecessary. The definition of " infectedperson " referred to a person presenting clinicalsigns of cholera. Moreover, the ship or aircraftbeing infected, stool examination of the persons onboard must be possible since there were no othermeans of determining whether they had cholera.

Dr. BELL said the United States proposal tookaccount of the objection. The interpretation of" persons without symptoms " had given rise tomisapprehension and resulted in expressed reserva-tions. He interpreted Article 62 as meaning that if aperson from a cholera-infected area had any symp-toms of cholera he could be subjected to stoolexamination, but others had obviously interpreted" without symptoms of cholera " as meaning personswithout all classical symptoms. The new sentencesuggested by the United States delegation wasexclusively to clarify interpretation in the hope ofpreventing reservations. He accepted a proposal byDr. MACLEAN (New Zealand) to substitute " cholera-infected local area " for " cholera-infected area ".

Dr. RAJA suggested that bacteriological examina-tion might be interpreted as including rectal swabbingby health authorities who considered that the mosteffective way of obtaining a sample. It should bemade clear that rectal swabbing was excluded.

Dr. BELL, replying to a question by the CHAIRMAN,said his intention had been to leave it to the personcarrying out the bacteriological examination whetheror not to take a rectal swabbing and that rectalswabbing should not be done when the patientobjected and other non-objectionable measures wereavailable.

The CHAIRMAN said it might be desirable to includean article in the Regulations to the effect thatvaccination and rectal swabbing and any bacterio-logical procedure involving an operation on theperson should not be carried out without the consentof the person concerned.

Decision : A vote was taken and the committeeadopted the United States suggestion to insert anew provision to the effect that " A person arriving

from a cholera-infected local area within the periodof incubation of the disease and presentingsymptoms suspicious (indicative) of cholera maybe required to submit to stool examination ". Theprovision was referred to the Drafting Sub-Committee for drafting in the light of thediscussions and for a proposal as to whether itshould form a separate article or a second para-graph to Article 62.

Appendix 2 : International Certificate of Vacci-nation or Revaccination against Cholera

Dr. EL-HALAWANI reverted to remarks he had madeat the previous meeting and proposed extending theperiod before the certificate of vaccination becamevalid from 5 to 7 days.

Dr. RAJA felt that there was too wide a differencebetween the requirements for pilgrims and thosefor ordinary passengers. He seconded the proposalto alter to 7 days the period specified in the secondparagraph of the text below the form.

The CHAIRMAN suggested that, the incubationperiod for cholera being 5 days, it was not necessaryin the case of an ordinary passenger to stipulate afurther period before the certificate became valid.In comparing pilgrims and ordinary passengers thequestion of the degree of immunity required arose.

Dr. RAJA thought that the question of the in-cubation period, which was 5 days, should be keptdistinct from that of the period required for fullimmunity which was 7 days. A person might beinoculated a day or two before leaving an infectedarea by air and although the incubation period mightbe over when he arrived, he might not be immuneand might still develop cholera.

Professor ALIVISATOS expressed the opinion that asingle strong dose of vaccine only gave a moderatedegree of immunity. He proposed that two injectionsshould be required at an interval of seven days, thecertificate becoming valid on the date of the secondinjection.

Dr. EL-HALAWANI, supporting the views of thedelegate of India, said his delegation was prepared toaccept seven days as a compromise, although itconsidered that immunity would not be completeuntil the eighth day.

THIRTEENTH MEETING 97

The CHAIRMAN put to the vote the question whetherthe period required for a certificate of vaccinationto become valid should be prolonged. The result ofthe vote was in favour of prolongation.

Decision: It was decided by vote that the validityof the certificate of vaccination against cholerashould commence six days after the date of vacci-nation.

Dr. GEAR (Union of South Africa) said that theprocedure of authentication was not a medical orhealth procedure but an administrative and legalone and should be considered from that aspect.There was much evidence that it was a difficult andexpensive procedure to arrange and supervise. Hetherefore proposed that the paragraph beginning" The professional status of the vaccinator . "be replaced by the following

An official stamp indicating the official statusof the vaccinator as prescribed by the nationalhealth administration shall be placed in the spaceprovided.In reply to questions, Dr. Gear said that each

country could make arrangements that would includeterritories belonging to it and cover its ships andaircraft and, in the case of a ship's surgeon whovaccinated a person during a voyage, an appropriatestamp could be supplied to him which would validatethe certificate.

Mr. HASELGROVE (United Kingdom), Dr. BERGMAN(Sweden) and Dr. VAN DEN BERG supported theproposal.

The committee adjourned .for a short interval toallow delegates to study Dr. Gear's proposal.

Dr. JAFAR said there was the question on the onehand of cumbersome administrative procedure and,on the other, of the reliance which a country mustplace on certificates issued by another country. Hequoted instances where the health authorities of hisown and other countries had had to question thebona fides of persons who had signed certificates.The forging or faking of certificates was an un-pleasant fact but one which must be faced. Tberemust be a responsible person to identify a vaccinatorand say whether he was authorized to performvaccinations. He therefore strongly opposed theelimination of a governmental authority from theprocedure.

Professor ALIVISATOS said that his delegationcould not agree to accept certificates without authen-tication.

Dr. RAJA explained that the paragraph in thecertificate drafted by the Expert Committee onInternational Epidemiology and Quarantine and nowbefore the meeting had been included because all thatwas being done in the matter of authentication wasthe identification of the signature of the vaccinator,and naturally the authenticator could not in all casessay he had seen the vaccination performed. It hadbeen felt that a variety of persons could be authorizedby a government or by the public-health administra-tion of a territory to certify that the vaccination hadbeen done.

He considered that for a country like India, forexample, it was desirable to retain the paragraph.However, if the authentication had in every case tobe made by a government official and a stamp puton the certificate, an undue strain would be placedon such officials.

Decision: The proposal was adopted by 12 votesto 10.

The CHAIRMAN, in reply to Dr. PADUA, who asked ifthe official stamp would include the signature of thevaccinator, said that the existing form of certificatewould be replaced by that reproduced in the draftRegulations when the latter entered into force, andthat the third column would be headed : " Officialstamp of the vaccinator ".

Dr. BELL asked if the effect of the amendmentwould mean that every country would automaticallyaccept vaccinations performed by military authorities,to which the CHAIRMAN replied that the internaladministrations of the countries concerned wouldrecognize an official stamp for military organizationsand such other organizations as they consideredappropriate.

Chapter V - Typhus, and Chapter VI -Relapsing Fever

Dr. HEMMES (Netherlands), commenting onChapters V and VI in general, said that paragraph 2of Article 82 contained provisions for disinsectingof persons leaving a local area infected with typhusor relapsing fever, and paragraph 2 (h) of Article 25provided that the health authority of the local areaof departure would take measures to prevent theintroduction of vectors on board a vessel, aircraft,train or road vehicle. If those measures were applied,it would appear superfluous to include other measuresto prevent the introduction of the two diseases, as inArticles 81, and 83 to 88. He therefore proposed thedeletion of the articles he had mentioned.

98 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. GEAR referred to the suggestion which he andsome other delegates had made at a previous meeting,that Chapters V and VI should be examined fromthe aspect of whether they were necessary in viewof the present development of medical science.It should particularly be borne in mind that theprovisions of Parts III and IV should be adequateto protect any country against the entrance of atyphus-infected person or of lice. Any emergencyactions which might be required were provided for inthe WHO Constitution.

He therefore proposed for consideration thepossibility that Chapters V and VI be deleted.

Definition of "Typhus"

Professor MOOSER (Switzerland) asked if everycase of typhus was to be considered as louse-bornetyphus, saying that murine typhus was probablythe type most commonly encountered. He proposedthat the definition be amended to say that cases oftyphus should be considered as louse-borne typhusuntil a proper laboratory diagnosis had provedotherwise.

The CHAIRMAN thought that, if the substance of theproposal were accepted, it would be preferable toinsert a separate article to the effect that personspresenting clinical signs of typhus should be regardedas suffering from louse-borne typhus until thecontrary had been proved by laboratory exami-nation.

Dr. RAJA was doubtful whether it would be rightto make the statement in that form since there werefairly definite geographical limits for the disease.

Professor MOOSER pointed out that the medicalofficer of a vessel or of a port would not be able todecide whether a case was louse-borne typhus.

Dr. BELL supported Dr. Raja's view. A person onboard a vessel coming from North America or otherparts of the world where louse-borne typhus had notbeen present for a long time should not, in theabsence of evidence, be regarded as having louse-borne typhus. It should not be necessary to takethe negative view..

On the suggestion of the CHAIRMAN, it was agreedto defer the question of amending the definitionuntil the separate articles had been considered.

Chapter V - Typhus, and Chapter VI -Relapsing Fever (continuation)

Returning to Dr. Gear's proposal, the CHAIRMANsaid that to delete the whole of Chapters V and VIwould be to delete the restrictions on measures whichcould be taken in respect of a vessel or aircraft onaccount of typhus or relapsing fever, so that the healthauthority at the port of arrival could do what itliked.

Dr. RAJA believed there was something definitein Dr. Gear's point of view, in the sense that louse-borne typhus did not enter into the picture in relationto international travel. There was also the questionof defining louse-borne typhus in such a manner asto make practical action possible. Taking all thingsinto consideration, he thought that it might bebetter not to make any specific reference to it in theRegulations.

Dr. EL-HALAWANI said his delegation could notaccept the deletion proposed by Dr. Gear. Onepidemiological grounds, disinsecting alone was notsufficient ; there was also the question of the excretaof infected lice. Moreover, the newer insecticideswere not readily available in some countries.

Mr. HASELGROVE pointed out that the provisionsof the Regulations were maximum measures whichcountries might apply against certain epidemicdiseases. The effect of deleting Chapter V would beto place typhus in the category of diseases in respectof which no maximum measures were laid down, withthe result that countries would be free to impose anymeasures they wished in respect of that disease. Hehoped that countries would not view the Regulationsin the sense that the measures must always be applied :it was for a country to decide not to apply them,either wholly or in part, if not necessary.

Dr. GEAR said he did not consider that the exclusionof typhus from the Regulations would allow anyhealth administration to do what it liked. If thatwere the view of the committee it was tantamount toinviting administrations to do what they liked inrespect of all diseases not covered by the Regulations.As he interpreted them, the Regulations wereintended to limit action against all diseases in inter-national travel in normal circumstances. That wasa fundamental point which he thought sh ould havebeen cleared up first of all.

The CHAIRMAN said that he and Mr. Hostie weredrafting a revised text of Article 24-to be submitted

THIRTEENTH MEETING 99

for the committee's consideration-which woulddeal with the point raised by the delegates of theUnion of South Africa and the United Kingdom.

He reminded Dr. Gear that his proposal could notbe considered if any delegation opposed it, as hadbeen done by the delegate of Egypt. The committeecould, however, decide to delete the separate articlesof the chapters one by one.

Dr. GEAR replied that, in the circumstances, asthere was a doubt as to the position of diseases otherthan the six specified, he must withdraw his proposal.

Dr. HEMMES said his delegation considered thatChapters V and VI could not be deleted in theirentirety, as the two diseases to which they referredwould then not be mentioned in the Regulations andthere would no longer be any reason for providingfor disinsecting under Article 25.

The articles in Chapters V and VI were thenconsidered by the committee seriatim.

Article 80 [88]

Decision: The article was adopted.

Article 81 [89]

Decision: The article was adopted.

Article 82 [90]

Decision: Discussion on the article was begun,deferred and reopened later.

Article 83

Decision: On the proposal of Dr. VAN DEN BERGit was decided by 9 votes to 6 to delete the article.

Article 84

Mr. HASELGROVE proposed the deletion of thearticle in consequence of the decision to deleteArticle 83.

Mr. STOWMAN (United States of America) sup-ported the proposal.

Decision: By 9 votes to 5, it was decide to deletethe article.

Article 85 [91]Dr. BRAVO (Chile) proposed that, in consequence

of the deletion of the two previous articles, thearticle be deleted.

Dr. MACLEAN proposed, as an alternative to thedeletion of the whole article, the deletion of theword " healthy " and insertion of the word " forth-with " before " free pratique ".

Decision: The proposal of the delegate of NewZealand was unanimously adopted.

Article 86 [92]

Dr. VAN DEN BERG proposed deletion of thearticle, in consequence of the deletion of Article 84.

Decision: The proposal was unanimously adopted.

Definition of " Typhus " (continuation frompage 98)

Returning to the point raised earlier by thedelegate of Switzerland, the CHAIRMAN said that, asArticles 80, 81, 82 and 85 remained in the chapter,the committee must decide whether a distinctionshould be made in respect of louse-borne typhus.

Dr. BELL considered, and Professor MOOSERagreed, that no distinction was necessary, becausethe remaining reference to typhus only concernedmeasures to be taken on departure.

Article 82 [90] (continuation)

Dr. EL-HALAWANI said that, as a result of thedeletions just made, there was no provision fordisinfection of the baggage of infected persons ;that should be rectified.

Discussion of Article 82 having been reopened, heaccepted the CHAIRMAN'S suggestion that a clauseshould be added to paragraph 1 of Article 82 tothe effect that, on departure from an infected localarea of any person considered by the health authorityto be liable to transmit typhus, the clothes he wore,and his baggage, might be disinfected and, ifnecessary, disinsected, or both.

Dr. RAJA proposed the addition of the words :" or any other articles likely to convey infection ".

100 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. DUREN believed it was necessary to add thosewords but that it was not necessary to require bothdisinfection and disinsecting in all cases. Hesuggested the following wording : " His clothes,baggage and other articles likely to convey infectionshall be disinsected and, if necessary, disinfected."

Dr. HEMMES said that, although a person would bedisinsected before departure from his own country,under paragraph 2 of Article 82, he was required tobe disinsected again. He did not consider thatnecessary.

The CHAIRMAN replied that disinsecting could berepeated only if the health authority considered itnecessary. Paragraph 1 of Article 82 provided formeasures on departure, but, even so, a person whohad left an infected local area within the previous14 days might, if the health authority at the place ofarrival so decided, be disinsected and put undersurveillance.

Dr. VAN DEN BERG said that, as he interpreted thearticle, the provisions in both paragraphs 1 and 2referred to measures on departure, and that measureson arrival began in Article 84.

The CHAIRMAN did not believe that was the inten-tion. He suggested that the Drafting Sub-Committeebe instructed to make it clear that paragraph 1

referred to the health authority of the place ofdeparture and paragraph 2 tb that of the place ofarrival.

Dr. BERGMAN then proposed that a clause beinserted in paragraph 2 of Article 82 stating that theclothes and baggage of an infected person must bedisinsected.

In reply to Dr. HEMMES, who said that if the healthauthority at the place of arrival were allowed todisinsect again, it would imply that the disinsectingat the place of departure was not reliable, Dr. BERG-MAN said that both paragraphs provided for thehealth authority to decide whether disinsecting wasnecessary.

Dr. HEMMES then said that the wording of para-graph 2 of Articles 25 made it appear compulsoryfor the health authority to apply the measures ondeparture.

Dr. MACLEAN said the possibility must be envisagedof a case of typhus occuring on board a vessel 14days after its departure and of the health authoritybeing advised, so that it could take action.

Dr. BARRETT (United Kingdom), supporting theproposal of the delegate of Sweden, said it was quiteclear that there were many reasons why a person,even though he had been disinsected at the place ofdeparture, might require to be disinsected again at aplace of arrival.

Dr. BERGMAN, on the suggestion of the CHAIRMAN,amended his proposal to the addition at the end ofparagraph 2 of the words " The same measuresmay be applied to his clothes and his baggage asin paragraph 1 ".

Decisions :

(1) The proposal of the delegate of Sweden wasadopted.

(2) Chapter V as amended was referred to theDrafting Sub-Committee.

Article 87 [93]

Decision: Thediscussion.

Article 88 [94]

Decisions:

article was adopted without

(1) The article was adopted subject to amend-ment of the numbers of the articles referred to inthe first line, in consequence of the deletions inChapter V.

(2) Chapter VI thus amended was referred to theDrafting Sub-Committee.

The meeting rose at 5 p.m.

FOURTEENTH MEETING 101

FOURTEENTH MEETING

Friday, 20 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations (continuation)

Chapter III - Yellow Fever

Dr. DUREN (Belgium) recalled that the SpecialCommittee had accepted a previous proposal byhis delegation to delete the reference to yellow-feverendemic areas from the definition of " infected localarea " (see page 56). That proposal had been madeon the grounds that :

(a) yellow-fever endemic areas might includelarge regions extending over several territories ;

(b) their limits were neither fixed by the govern-ments of the territories concerned nor specified inthe Regulations ;

(c) they were considered to be permanentlyinfected and conditions which had to be fulfilledbefore they could cease to be so regarded had notbeen laid down ;

(d) while, according to the definition in theRegulations, yellow-fever endemic areas were areasin which Aëdes aegypti was present and in which thevirus persisted in jungle animals, delimitation of theendemic areas was in fact based on the test forimmunity in man and therefore such areas extendedwell beyond the jungle.

Dr. Duren then summarized a note from hisdelegation which was a continuation of that previousproposal and which drew attention to the specialposition of yellow fever, as the only disease, of thesix epidemic diseases covered by the Regulations, forwhich the endemic areas had been delimited. Further-more, the yellow-fever endemic areas were consideredto be permanently infected.

In view of these factors, the Belgian delegationconsidered that :

(1) yellow-fever endemic areas should be given thechance of losing that characteristic, and conditionsshould be laid down under which the areas could bedeclared to be no longer endemic ;

(2) measures against Aëdes aegypti should be takenin ports and at frontier posts open to internationaltraffic both in the endemic and receptive areas ;

(3) in endemic areas, if local areas became infectedby the presence of a case of human yellow fever, theRegulations specifically concerned with local areasshould be applied ;(4) the various articles of Chapter III should bereviewed to determine which measures should beapplied to the endemic areas as a whole and whichto the infected local areas.

Article 63 701Dr. EL-HALAWANI (Egypt) believed there was no

necessity for consultation with the States concernedin the delineation of yellow-fever endemic areas :it could be done satisfactorily and quickly by WHOthrough its Expert Committee on InternationalEpidemiology and Quarantine. He therefore pro-posed the deletion from Article 63 of the words " inconsultation with each of the States concerned ".

Secondly, he proposed the addition of a secondparagraph, on the following lines :

A country inside whose territory are foundyellow-fever endemic or epidemic areas shall beconsidered wholly an infected area unless aninternal quarantine barrier is permanently es-tablished to guarantee that no infection passesto a non-infected area.

Dr. BARRETT (United Kingdom) said his delegationconsidered consultation with the States concernedabsolutely necessary. The economic systems of alarge number of territories which were either includedin or excluded from the delineations depended to agreat extent on the operation of the measures appliedto yellow-fever endemic areas and the alteration of adelineation might cause serious difficulty.

The United Kingdom delegation considered thesecond proposal of the delegate of Egypt a drasticone. Many countries in yellow-fever endemic areascould not possibly finance the establishment of a

102 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

really effective quarantine barrier ; it was thoughtthat countries outside such zones could help byestablishing their own barriers.

Dr. DUREN could not accept the second proposalof the delegate of Egypt ; it contained new elementsand some, regarding the creation of a permanentquarantine barrier against yellow fever, which wererather vague. The Belgian delegation recognizedthe necessity for including, in the chapter on yellowfever, a provision to replace the part of the definitionof infected local area which had been provisionallydeleted (see page 286). He suggested the following,which seemed to him preferable to the text proposedby the delegate of Egypt :

Unless otherwise stipulated, the measures appli-cable to yellow-fever infected local areas or yellow-fever suspected areas are applicable to yellow-fever endemic areas.

Dr. GEAR (Union of South Africa) asked what wasmeant by the term " yellow-fever suspected areas "in the Belgian proposal.

The CHAIRMAN drew attention to the workingparty's definition of " infected local area " andreminded Dr. Duren that the term he had used wasnot defined.

Dr. DUREN agreed to delete the words " or yellow-fever suspected areas " from the text he had pro-posed.

Dr. JAFAR (Pakistan) was of opinion that, in theinterests of all concerned, the question of the delinea-tion of yellow-fever epidemic or endemic and recep-tive areas should be judged entirely on scientificdata, which could be collected and examined by theExpert Committee on International Epidemiologyand Quarantine, and that economic and other factors-such as political ones-should not be taken intoaccount.

The CHAIRMAN said that the expert committeewould take no action without consulting the Yellow-Fever Panel.

Dr. RAJA (India), whilst agreeing that the funda-mental consideration in the delineation of yellow-fever infected areas should be the presence or absenceof infection, said WHO might often have to dependon the collaboration of the States concerned for the

collection of data. Clearly, such procedures as massprotection tests in humans, the investigation of theincidence of infection in animals and viscerotomyin the case of human deaths could not be carriedout inside a country by any international organizationwithout the consent and co-operation of the State.

The draft text of Article 63 under discussion putthe responsibility for delineation on WHO. In theinterests of satisfactory delineation and of goodwill-which would form an essential background for theoperation of the Regulations-the words " inconsultation with each of the States concerned "should be retained.

Dr. DUREN agreed with the delegate of Indiaregarding the necessity for consultation. His dele-gation wished to know the criteria to be used byWHO when deciding, in consultation with the Statesconcerned, whether a territory was entirely or partlyan endemic area. Those criteria did not appear tohave been adequately defined. According to thedefinition, there were two essential conditions :first, Aëdes aegypti must be present ; secondly, thevirus must have persisted for long periods amongjungle animals. However, in delineating endemicareas, yellow-fever experts took account of conditionsother than those covered by the definition ; they didnot look for the virus among jungle animals butcarried out tests for immunity in man, not only intropical jungle areas but also in regions well beyondthem.

In view of the apparent contradiction, he asked thecommitte to recommend the question to the HealthAssembly for further study.

Mr. STOWMAN (United States of America) alsoagreed that States must be consulted in regard todelineation.

He considered that the consequences of theaddition in the second proposal of the delegate ofEgypt would be much more serious. No quarantinebarrier could ever be established to guarantee thatno infection would pass. Moreover, his delegationfelt that it was beyond the competence of the presentcommittee to demand the establishment of such abarrier. From the practical point of view, also, itwould be impossible to establish a barrier overterritories in the interior of the South Americancountries or Africa. The only effective barrier wouldbe the eradication of Aëdes aegypti, and to say that awhole country should be considered as infectedbecause of jungle infection-which could notpossibly spread over the frontier-at some particular

FOURTEENTH MEETING 103

place would be to discount all the work which hadalready been done in that respect. He gave detailsof results achieved in the campaign being carriedon in co-operation with the Pan American SanitaryBureau.

Mr. Stowman felt sure that neither the UnitedStates nor the sister republics of the Americas,would be able to accept a proposal such as that ofthe delegate of Egypt.

Dr. BRAVO (Chile), supporting the point of view ofthe United States delegation, proposed that Article 63be retained in its present form. He could not acceptthe proposal of the delegate of Egypt, because manycountries in South America-fortunately Chile wasnot one of them-contained small yellow-fever areasand the proposal would mean that practically allSouth America would be considered as an infectedarea.

Dr. EL-HALAWANI said his amendment did not seekto impose an internal quarantine barrier in anycountry ; it merely stated that a territory would beregarded as infected unless an internal quarantinebarrier were permanently established.

Regarding the South American republics, he hadfound when visiting Brazil during the previous yearthat air travel was extensively used and that move-ment was not restricted. Unless there was someprovision such as he had proposed, there wouldbe no safeguard against the introduction of yellowfever into other countries.

Decision : By 15 votes to 2, the proposal of thedelegate of Egypt for the deletion of the words" in consultation with each of the States con-cerned " was rejected.

Dr. RAJA said that, if he had correctly interpretedthe statement of the delegate of the United States, abarrier such as that asked for by the delegate ofEgypt in his second proposal was established andbeing maintained.

The CHAIRMAN felt that it depended on what wasmeant by an internal quarantine barrier.

Dr. GEAR agreed, saying that the delegate of theUnited States had put forward the same argumentswhich he would have done. From a scientific pointof view, the only protection for a country againstyellow-fever was to be sure that it had either elimi-

nated Aëdes aegypti or had the means available todeal with them quickly. That was the kind of internalquarantine barrier which he thought the UnitedStates delegation envisaged and which his owncountry believed in.

Dr. DUREN believed the time was not opportuneto add a provision that the destruction or elimina-tion of Aëdes aegypti be considered as the kind ofbarrier being discussed : such an addition, in hisopinion, would be absolutely useless. The definitionof an endemic area was based entirely on the pre-sence of Aëdes aegypti : therefore, if they were notpresent, an area could no longer be considered asendemic.

Dr. EL-HALAWANI said that the purpose of hisamendment was to ensure that persons moving froman infected area to an endemic area and afterwardstravelling on an international journey should be inpossession of a valid certificate of vaccinationagainst yellow fever. He did not stipulate thatcountries should establish quarantine barriers in thesense interpreted by the other speakers : he had usedthe word " unless ".

The CHAIRMAN said that anyone travelling on aninternational journey from or through an endemicyellow-fever area was required to have a certificateof vaccination against the disease.

Decision : The proposal to add a second paragraphto Article 63 was rejected by 13 votes to 5.

Mr. HASELGROVE (United Kingdom) said that theproposal of the delegate of Belgium (see page 101)would appear to be necessary, since it would giveeffect to the recommendation of the working partyto delete from the definition of " infected localarea " any reference to a yellow-fever endemicarea. With the omission of the words " or yellow-fever suspected areas ", as agreed by Dr. Duren, theamendment was correct if it were to be understoodthat measures applicable to a yellow-fever infectedlocal area were also applicable to a yellow-feverendemic area.

He added that he understood the Belgian delegationwould prefer the use of the word " zone " in theEnglish text instead of " area ".

Decision : It was agreed that the term " yellow-feverendemic zone " be substituted for " yellow-feverendemic area " wherever it occurred in theEnglish text throughout the chapter.

104 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Mr. STOWMAN agreed with the United Kingdompoint of view and supported the Belgian proposal.

Decision: The text proposed by the delegate ofBelgium was adopted as a new article to followArticle 63 and referred to the Drafting Sub-Committee.

Article 64 [71]

Mr. HASELGROVE referred to the Belgian delega-tion's proposal that measures against Aëdes aegyptishould be taken in ports, airports and frontier postsopen to international traffic not only in endemicareas but in receptive areas as well (see page 101).The United Kingdom delegation was in general-although not in complete-agreement with theBelgian proposal and would therefore incorporate aprovision along similar lines in its revised texts forthose articles. He asked the committee to considerthe Belgian proposal at the same time as the revisedtext submitted by his delegation for Articles 12 to17 ; at that time the Belgian or any other delegationcould propose amendments to the United Kingdomproposals.

Dr. DUREN accepted the suggestion and it was soagreed.

Dr. GEAR supporting the remarks of the delegateof the United Kingdom, recalled that, in connexionwith Articles 12 to 17, he had suggested that thecommittee should draw the attention of the HealthAssembly to the necessity for reminding nationalhealth administrations of their duty, in implementingthe Regulations, to clean up areas from whichinfection might pass (see page 57). Although theprimary purpose of the Regulations was to dealwith international travel, he thought that such asuggestion could be included, applying not only toArticles 12 to 17 but also to yellow fever. He wouldsubmit to the committee a draft resolution on thoselines.

Decision: Article 64 was adopted without furtherdiscussion.

Article 65 [72]

Dr. GEAR emphasized that the procedure heopposed was automatic compulsory certification,not immunization. In his opinion, the former did notalways produce the desired scientific results and therewere disadvantages associated with compulsoryvaccination in connexion with international travel.

He would not press the point, as certification inregard to yellow fever was unlikely to be abandonedin the near future, but would ask delegates toexamine the question of certification in the light ofhis remarks.

Decision: Article 65 was adopted.

Article 66 [73]

Dr. EL-HALAWANI proposed the insertion inparagraph 1, after the words " situated in an infectedlocal area ", of the words : " or in an endemicarea."

Dr. BARRETT suggested that the last sentence ofparagraph 2 be made more positive by saying :

The States concerned may accept disinsection,during flight, of the parts of the aircraft whichcan be so disinsected.

Mr. STOWMAN suggested the following amend-ments :

(1) To insert the word " immediately " before thewords " before departure " in the first sentence ofparagraph 2 ;

(2) To delete in paragraph 3 the word " recep-tive ".

It would be difficult to establish under whatconditions an area where Aëdes aegypti was presentwould not be susceptible to yellow fever : the word" receptive " was confusing. Areas from which Aedesaegypti had been eradicated had a right to be pro-tected.

The CHAIRMAN reminded the delegate of the UnitedStates that " area " by itself was not defined.

Dr. DUREN, although not opposed to the insertionin paragraph 1 proposed by the delegate of Egypt,considered the addition unnecessary in view ofthe adoption of his own proposal for a new article tofollow Article 63.

Dr. JAFAR, referring to paragraph 2, said that forno other disease had the principle been observedthat sanitary measures taken by the commander ofan aircraft or the master of a ship during a journeywould be accepted at the place of arrival : in eachcase it had been decided that the measures shouldbe applied by the health authority at the place ofdeparture or the place of arrival. This instance wasa clear departure from the principles on which the

FOURTEENTH MEETING 1 05

committee had acted and he considered that theprovision in the last sentence should be deleted.

Dr. RAJA supported Dr. Jafar's statement.

Mr. M OULT ON (International Civil AviationOrganization), said his organization felt that the lastsentence of paragraph 2 as drafted-or as amendedby the delegate of the United Kingdom-should beretained. Much work was being done in connexionwith the development of clisinsecting of accessibleparts of an aircraft during flight and, when itseffectiveness had been proved to the satisfaction ofthe medical authorities, considerable duplication ofeffort could be avoided.

He explained that for several years disinsecting inflight had been carried out when approval of theprocedure had been obtained from the healthauthorities concerned.

Decisions :

(1) The proposal of the United Kingdom delega-tion to amend paragraph 2 was adopted.

(2) The proposal of the United States delegationto insert the word " immediately " in paragraph 2was adopted.

Mr. ST OWMAN withdrew his proposal to delete theword " receptive ".

Following a suggestion by Dr. BARRETT, anexchange of views took place on whether or notthe word " aegypti " should be deleted from thereference to Aëdes aegypti in paragraph 3. During thediscussion, the CHAIRMAN read out an extract froma letter received from Dr. Soper, Regional Directorfor the Americas, pointing out that Stegomyia wasthe official name of a sub-genus of Aëdes to whichaegypti itself belonged and that, while there wereseveral other members of the sub-genus in Africa,there were none, other than aegypti, in the Americasor in Asia.

The committee finally agreed to accept the sugges-tion of Dr. RAJA, supported by Dr. DUREN, that thefirst line should read :

Every aircraft leaving a local area where Aëdesaegypti or any other vector of human yellow-fever exists .

Decision: Article 66 was adopted subject to theagreed amendments and referred to the DraftingSub-Committee.

Article 67 [74]

Dr. BICA (Pan American Sanitary Organization)said the Pan American Sanitary Organizationwished to suggest substitution of " under sur-veillance " for " isolated " in paragraph 1, anddeletion of paragraph 2, since it was unreasonableto prevent the health authorities of an infected areafrom taking measures against the reintroduction ofinfection at a time when they were endeavouring torid the area of the disease.

Mr. ST OWMAN formally proposed adoption of thesuggestion of the representative of the Pan AmericanSanitary Organization to delete paragraph 2, for thesame reasons which had prompted his delegation topropose deletion of a similar provision in the chapteron cholera (see minutes of the twelfth meeting,page 90). To illustrate the reasons, he said thatBombay and Karachi had standing rules requiringpersons coming from an infected local area to possessvaccination certificates. But if one or two casesoccurred in those cities they would become infectedlocal areas, and the health authorities would have torescind that measure just at a moment when theyshould have the right to take all possible measuresto prevent further introduction of infection.

Dr. DUREN seconded the proposal to consider theamendment suggested by the Pan American SanitaryOrganization. He said that he was in favour ofdeletion of paragraph 2 if that meant that the healthauthority of a yellow-fever endemic zone would havethe possibility of requiring a vaccination certificatefrom any persons coming from infected areas.

Dr. RAJA also seconded deletion of paragraph 2.

Decision: In the absence of objection, it was agreedthat paragraph 2 of Article 67 should be deleted.

Dr. MACLEAN (New Zealand) suggested that itmight be desirable to add " Subject to the provisionsof Article 29 " at the beginning of paragraph 1, toprevent a quarantine officer requiring a personon a through journey to be detained at the port oftransit.

Dr. RAJA assumed that six days isolation wasallowed in paragraph 1 because that was the in-cubation period for yellow fever. It might beimpossible to recognize a case of yellow fever becausea person who had not developed a sufficient degree ofimmunity might be infected without showing any

106 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

of the usual signs of fever beyond a certain lassitude.Article 65, while requiring that a person leaving aninfected local area should be vaccinated, did notrequire that the certificate of vaccination shouldhave become valid on arrival so that passengersmight arrive with varying degrees of immunity.Moreover, during the first two or three days thevirus circulated in the blood of an infected person,so that an Aëdes aegypti mosquito might acquire theinfection and spread it in a receptive area. TheIndian Government, therefore, while recognizingthat extension of the period of isolation might notbe acceptable to a number of countries, had instructedhim to inform the committee that it reserved theright to extend the period for a further three days.He stressed that the matter was very necessary in thecase of India because all the factors favourable tothe spread of yellow fever were present there, namelyAëdes aegypti, monkeys-which unlike human beingsmaintained the infection throughout the illness-andnumbers of non-immune persons. There was there-fore a possibility of disaster through the spread of thedisease from India to the whole of Asia.

Dr. JAFAR thought that the incubation periodshould be extended to nine days to allow a safetymargin in the case of persons arriving in receptiveareas after having been exposed to infection. Thatwould affect the position with regard to the vaccina-tion certificate of persons exposed to infection aftervaccination. Up to the present, Pakistan had insistedon a period of 15 days before such certificates becamevalid, but he would agree to reduce that period bytwo days.

The CHAIRMAN said that as there was no mentionof the incubation period in Article 67, the period of6 days could be extended without affecting thedefinition of incubation period given in Article 64.

Professor ALIVISATOS (Greece), Dr. DAENGSVANG(Thailand) and Dr. EL-HALAWANI supported theproposal to increase the period to 9 days.

Dr. DE CARVALHO-DIAS (Portugal) suggested thata person coming from a non-infected area of a countrywhich had endemic zones should, if he had not beenvaccinated, furnish a certificate that he came froma non-infected area of the country in question.

Dr. RAJA understood that WHO intended todelimit all endemic zones. In that case the health

authority at a port of arrival would only have toinquire whether a passenger came from one of theendemic zones ; it was not necessary for passengersfrom other areas to have the certificate suggested bythe delegate of Portugal.

Dr. DE CARVALHO-DIAS pointed out that WHO insome cases recognized very small non-infected zonessurrounded by endemic zones, such as Caracas forinstance. In view of the rapidity of travel by air, aperson coming from Caracas should either produce avalid certificate of vaccination or a certified statementthat he came from that city and not from the neigh-bouring infected region.

The CHAIRMAN thought it would be difficult forpractical reasons to accept the Portuguese proposaluntil the measures for delineation of endemic zonesenvisaged in Article 63 had been carried out.

Dr. RAJA asked whether the effect of linkingArticle 29 with Article 67, as suggested by the delegateof New Zealand, would mean that each airport inthe same country which was a port of call for aninternational service would be considered a directtransit area and would have to possess facilitiesfor segregation and protection against mosquitobites.

The CHAIRMAN thought that if there was not adirect transit area in a particular port, an internationalpassenger might be required to be put in isolationor, if he did not wish to stay in the country, he mightbe allowed to proceed on his journey.

Dr. JAFAR, referring to the New Zealand suggestion,said that most of the eastward-bound internationalair traffic passed through Karachi and his country hadexperienced much difficulty over the question whetherto isolate for the rest of the incubation period aperson arriving there on his way to Australia orNew Zealand or whether he should be sent on to thenext port of call. That was a practical matter onwhich he would be glad to have clarification.

Mr. MOULTON said that aviation and airportauthorities throughout the world were endeavouring,in collaboration with health authorities and customsofficials, to establish direct transit areas at all pointsand hoped that Karachi, Calcutta, and Bombaywould soon have such areas at their airports and that

FOURTEENTH MEETING 107

all such direct transit areas would have the necessaryfacilities to ensure protection of passengers through-out their journey.

Mr. HASELGROVE recalled that his delegation hadmade a similar proposal in the case of cholera incollaboration with the Pakistan delegation to add areference to Article 29 so as to make it clear thatpersons who did not wish to submit to measuresmight continue their journey. The wording wouldbe similar to that in paragraph 3 of Article 54 asamended by the committee (see minutes of thetwelfth meeting, page 89).

The CHAIRMAN thought that the concern of thedelegate for Pakistan was whether, even thoughKarachi might have a direct transit area enablingthe health authorities to protect the country againsta non-immune person, such a person should beallowed to continue his voyage with the intention oflanding in a country which had no such area andwhich was highly receptive.

Mr. MOULTON replied that if a passenger leftan infected local area, he must be vaccinated in anycase, and if he came from Pakistan or India to anairport without a direct transit area, he could beisolated.

The CHAIRMAN pointed out that under paragraph 2,Article 65, a person could leave an infected areapending the validity of the vaccination certificate andtherefore be technically non-immune on arrival.Unless there was a direct transit area, he couldtherefore be isolated. Moreover under the terms ofArticle 71, it would be possible to direct an aircraftto a specified airport, which could be an airport witha direct transit area.

Dr. RAJA thought it advisable that each airportin a country at which international traffic calledshould have a direct transit area.

The CHAIRMAN said that as the policy was not toinclude recommendations in the Regulations, itwould be necessary for the delegate of India to putforward a recommendation to the Health Assemblyin the form of a proposal to the committee.

Dr. JAFAR recalled that the representative ofICAO had said that his Organization had made a

recommendation to governments. Until such directtransit areas were established, the difficulty remained.

The CHAIRMAN, supported by Dr. REID (Canada)and Dr. BELL (United States of America), suggestedthat the words following " valid " in paragraph 1 ofArticle 67 should be deleted.

Dr. RAJA was opposed to the suggestion becausethe period required for validity of the vaccinationcertificate was ten days, whereas if, for instance, aperson left on the eighth day after being vaccinatedin a yellow-fever area, there was a possibility ofhis developing the disease during the six followingdays. From the point of view of effectiveness, hethought it would be better to omit mention ofvalidity and to raise the isolation period to nine days.

The CHAIRMAN asked whether, if a person arrivedin India with a valid certificate and it was foundthat he had been in an infected area during the tendays before it was due to become valid, his certificatewas not accepted as valid.

Dr. RAJA replied that in that case, the certificatewould not be valid. Both Pakistan and India hadhitherto considered the safety period to be 15 days.He had proposed nine days because no distinctionwas made in the article between receptive and non-receptive areas and he realized that many non-receptive countries might find the addition of anotherthree days irksome. However, India might have tomake a reservation, even if nine days were accepted.

Dr. JAFAR explained that a person coming from ayellow-fever infected area was not detained at Karachiif his certificate was valid ; but if he left Karachibefore the certificate became valid, a margin ofthree days was allowed so that 15 days had elapsedbefore the passenger was clear of all restrictions. Hereiterated that he was prepared to reduce the periodso far as Pakistan was concerned to 12 days butsuggested that as a safety measure for receptivecountries the isolation period should be nine daysinstead of six.

Dr. GEAR felt that some of the arguments putforward were academic and that the addition of a fewdays would not materially increase the guarantee ofimmunity.

The meeting rose at 12.10 p.m.

108 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

FIFTEENTH MEETING

Friday, 20 April 1951, at 2.15 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Article 67 [74] (continuation)

The CHAIRMAN said that he had been given tounderstand that the delegates of India and Pakistanwould be prepared to accept Article 67 as it stoodon the understanding that their Governments wouldbe able to make reservations.

Mr. BRILLIANT (United Kingdom) asked whetherhe was right in assuming that, if Article 67 wereadopted as it stood, the same suggestions that hadbeen accepted in connexion with paragraph 3 ofArticle 54 would be applicable, namely that areference to Article 29 would be included and aprovision added to the effect that passengers refusingto submit to the conditions specified in the articlewould be allowed to continue their journey.

The CHAIRMAN thought that the committee hadagreed on the first point mentioned by the delegateof the United Kingdom, it being understood,naturally, that in countries where there was no transitarea Article 29 could not apply.

Dr. JAFAR (Pakistan) recalled that the point inquestion had been discussed at length during theprevious meeting. He himself had pointed out thatpassengers arriving at Karachi airport from thewest on a journey to countries further east who couldnot comply with the prescribed conditions must berequired either to return to Iraq or Egypt or tosubmit to isolation, since the next countries on theirroute would not be in a position to receive them.

Replying to the delegate of Egypt he explainedthat the procedure at present followed at Karachiairport was to keep any person who refused isolationin a mosquito-proof place until he could be returned.

Dr. MAUNG (Burma) agreed with the delegate ofPakistan. As no airports with adequate facilities yetexisted in Burma, passengers failing to fulfil theprescribed conditions could not be allowed to land

at Rangoon, and that would constitute a serioushandicap to international traffic.

Dr. RAJA (India) thought that, if Article 67 wereadopted with the addition of a reference to Article 29,countries whose airports had the necessary facilitieswould be obliged to send on persons insufficientlyprotected against yellow fever on the grounds thatthey nevertheless fulfilled the conditions prescribedin Article 29. India could provide the necessaryfacilities as far as Calcutta ; the result would thereforebe that the person in question would be sent on toRangoon where there were no facilities. Bangkok, hebelieved, was in the same position.

He therefore felt that the provisions of Article 29should be applied only when there was adequateassurance that the sending on of unprotected personswould not provoke a general outbreak of yellowfever. Some such stipulation was essential, sinceany focus of yellow-fever infection in Asia, whereversituated, would be a danger to the whole continent.

Dr. DAENGSVANG (Thailand) confirmed that therewere no transit facilities in Bangkok airport.

After some further discussion, the CHAIRMANsuggested that the point raised by the delegate ofIndia might be met by inserting in Article 67 somesuch provision as : " Notwithstanding the terms ofArticle 29, where transit facilities are not available theright of a passenger to continue his voyage mustdepend on the conditions of aerodromes along theroute of his voyage ".

Mr. HOSTIE, Chairman, Legal Sub-Committee ofthe Expert Committee on International Epidemiologyand Quarantine, agreed that such a provision shouldbe inserted, though, since Article 29 also began withthe word " notwithstanding ", the Drafting Sub-Committee would have to find a formula slightlydifferent from that suggested by the Chairman.

Dr. JAFAR and Dr. RAJA were prepared to acceptArticle 67 with the proposed addition, on the under-

FIFTEENTH MEETING 109

standing that their Governments might wish to makecertain reservations with regard to the length of theincubation period or the period after which vaccina-tion certificates would become valid.

Professor ALIVISATOS (Greece) had proposed thatthe word " six " in the fifth line of Article 67be replaced by the word " nine ". He thought thatthat proposal was in accordance with epidemiologicalprobabilities. It was also calculated to meet therequirements of conditions in his own country, whichhe then outlined, pointing out that, for the currentyear, and perhaps for years *to come, Greece wouldnot be able to obtain sufficient quantities of DDTadequately to control anophelines and other speciesof mosquitos, including Stegotnyia. Greece had beenobliged to reduce the quantities of DDT used andwas therefore exposed to the danger of freshoutbreaks of malaria, which had been very effectivelycontrolled during recent years. How could MemberStates in receptive areas be expected to takecertain measures for their protection, if they hadnot the necessary means to do so ?

At the CHAIRMAN'S suggestion that some countriesmight not wish to be bound to enforce an isolationperiod of nine days, he agreed to modify his proposaland to ask that the words " a period of six days "be replaced by the words " a period not exceedingnine days ".

Decision: The amendment was adopted by 11votes to 8.

Dr. DUREN (Belgium) wondered whether the com-mittee would wish to insert a stipulation that theperiod in question should not be less than six days.

Decisions :

(1) It was unanimously agreed to prescribe nominimum period for isolation.

(2) Paragraph 1 of Article 67 was remitted to theDrafting Sub-Committee.

(3) Paragraph 2 of Article 67 was deleted.

Article 68 [76]

Dr. EL-HALAWANI (Egypt) proposed the addition,at the end of the second sentence in paragraph 1 ofArticle 68, of the words : " or if arriving after morethan six days there is reason to believe that it maycontain adult Aëdes aegypti from the said localinfected area ". In such a case mosquitos mightfly ashore and infect the local population, to say

nothing of the fact that there might be infectedpersons on board still in the incubation period.

Dr. DUREN supported the Egyptian proposal.His delegation had a proposal relating to the

second sentence of paragraph 2. It was importantthat health authorities should not be permittedarbitrarily to declare that they were not satisfiedwith disinsecting carried out under the terms ofparagraph 2 of Article 66. Some criterion should beprovided for the non-acceptance of disinsecting whichwas considered unsatisfactory. Such a provisionmight read : " if the health authority has reason tobelieve that there are insects, and in particularCulicidae, alive in the aircraft ".

Mr. BRILLIANT thought the Egyptian proposalunreasonable, as it would empower health authoritiesto treat a vessel as suspected for an indefinite period.

Dr. EL-HALAWANI recalled that a provisionsimilar to that which he proposed had existed inprevious conventions.

Professor ALIVISATOS supported the Egyptianproposal, recalling that the yellow-fever epidemic atSt. Nazaire in 1894 had been caused by Stegonlyiahidden among bananas in holds during a voyagelasting more than ten days. Moreover, healthauthorities would not be bound to apply the pro-vision if they did not wish to.

Dr. GEAR (Union of South Africa) thought thepoint already sufficiently covered by Articles 69and 70. The Egyptian proposal would seriouslyimpede international traffic with no compensatingadvantages.

Dr. JAFAR thought that in view of the length of thelife of a mosquito, and the fact that a mosquito onceinfected remained so for life, the Egyptian proposalhad great merit, since in the circumstances to which itwas to apply the only practical course seemed to beto regard a vessel as suspected and to disinsect it assoon as possible.

Decision: The Egyptian proposal was adopted by12 votes to 10.

The CHAIRMAN, returning to the Belgian proposal,wondered why Culicidae were to be specified ratherthan Aëdes.

Dr. DUREN explained that the finding of anordinary Culex alive on board an aircraft would besufficient evidence that disinsecting had not beenproperly carried out. However, his delegation was

110 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

quite prepared to employ the word " mosquitos "in place of " Culicidae".

Decision: The Belgian proposal, as modified, wasadopted unanimously.

The CHAIRMAN observed that it would be leftto Mr. Hostie to decide what effect the adoptionof the Belgian proposal would have on the draftingof Article 35.

He recalled that the committee still had to dealwith a point raised by the delegate of Pakistan inconnexion with paragraph 2 of Article 68 (andapplying also to Article 66), namely that it wasnot made clear what authority was responsible forensuring that disinsecting was carried out. In thatconnexion it had been pointed out to him that inview of the definition of " health authority " inPart 1 of the Regulations a specification of theresponsible authority in individual articles seemedunnecessary.

Mr. HOSTIE agreed that such a specification wasnot strictly necessary, but it would do no harm. Hesuggested that at the end of the first sentence inparagraph 2 of Article 66 be added the words " underthe control of the health authority ".

It was so agreed.

Decision: Article 68 was remitted to the DraftingSub-Committee.

Article 69 [77]

Dr. MACLEAN (New Zealand) noted that para-graph 1 (b) of Article 69, apparently by a draftingerror, contained no reference to aircraft.

The CHAIRMAN thought that the Drafting Sub-Committee might be asked to insert a reference toaircraft, though it would have to be made clear thatthe second sentence of paragraph 1 (b), requiring avessel to keep at least 400 metres from land untilthe prescribed measures had been carried out, wasnot applicable to aircraft.

Mr. HOSTIE said that the omission of a referenceto aircraft in Article 69 had been intentional, asthey were intended to be covered by Articles 66and 68. However, in the light of the remarks of thedelegate of New Zealand he saw that there was aserious flaw in the drafting, since the second para-graph of Article 68 merely provided a definition andprescribed no measures. The suggestion of the

delegate of New Zealand would therefore have tobe adopted.

It was so agreed.

Decision: Article 69 was remitted to the DraftingSub-Committee.

Article 70 [78]

The article was adopted without change.

Article 71 [79]

Dr. DUREN questioned the utility of paragraph 2in the light of the revised text of Article 68-pro-viding for the disinsecting of aircraft if there wasreason to suspect the presence of Aëdes aegypti.

Dr. JAFAR made the following general observation :It was essential to be sure that no mosquitos were

on board an aircraft and verification should be madeimmediately upon landing. If doors and hatcheshad already been opened mosquitos could have hadtime to escape and might cause infection because therewas already the possibility of their having becomeinfected by a person on board coming from a yellow-fever area and not being properly protected byvaccination. It was not necessary for the healthauthorities to state the reasons on which theirsuspicions were based and they should be left freeto judge the special circumstances of each case.

Mr. MOULTON (International Civil AviationOrganization) took the opposite view. If an aircraftwere automatically suspected of harbouring mos-quitos before actually landing, that would inviteduplication of disinsecting measures. Under theRegulations as at present amended, three disinsectingsthroughout a flight were possible. In his opinion,from the scientific, medical and transport points ofview disinsecting should be done on departure.

The CHAIRMAN explained that the view of thelegal experts was that the provisions of paragraph 2of Article 71 were duplicated by those of paragraph 2of Article 68, and paragraph 1 (b) of Article 69, asamended by the committee.

Decision: On a vote being taken, paragraph 2 ofArticle 71 was deleted.

Article 72 [80]

The article was adopted without comment.

FIFTEENTH MEETING 111

Article 73 [81 ]

The article was adopted without comment.

Appendix 3 : International Certificate of Vacci-nation against Yellow FeverDr. JAFAR proposed the deletion of the last

sentence in the second paragraph of the text beforethe committee on the grounds that although it wasnot necessary for a country to specify whetherapproved vaccinating centres were civil or military,the names of all such centres should be communicatedto governments.

Replying to the CHAIRMAN, who asked whethertwo types of centres were implied, Mr. BRILLIANTexplained that in the United Kingdom vaccinationagainst yellow fever in the Armed Forces was carriedout by the Army, Navy and Air Force inoculationservices. It was surely sufficient for the certificateto show that it was issued by a branch of the ArmedForces without indicating the name or location of theparticular unit. WHO had been supplied with alist of approved centres for the inoculation of civiliansand had also been notified that the vaccinationservices of the Armed Forces were officiallyrecognized for the particular purpose.

Dr. JAFAR maintained that the same conditionsshould apply both to civil and military vaccinationcentres. It was essential to know the name of thecentre issuing the certificate so as to be certain thatit came from an authorized source. The provisionas it stood would involve the acceptance of acertificate issued by any officer from any ArmedForces and in that connexion it was important toremember the special conditions attached to yellow-fever vaccines, namely manner of preservation,technique and source of supply.

Dr. BICA (Pan American Sanitary Organization)said that the requirement that the origin and batchnumber of the vaccine be stated for yellow-fevervaccine was not in line with the requirements forother vaccines. During the period when the efficacyof yellow-fever vaccine had not been fully demon-strated and when post-vaccinal hepatitis sometimesoccurred following vaccination, it was important toknow the origin and batch number of the vaccineused. Such knowledge was no longer more essentialthan for other vaccines. Similarly, the requirementthat a vaccination centre be designated by the healthadministration tended to prevent vaccination againstyellow fever becoming more accessible to thetravelling public. If yellow-fever vaccine was to beused successfully in connexion with international

travel, it must be as readily available as othervaccines and the vaccination must be as simpleto record.

Dr. BELL (United States of America) agreed aboutthe impossibility of notifying the location of centreswhere yellow-fever vaccination was carried outby the Armed Forces. The certificates issued byArmed Forces should be recognized ; they wereofficial government certificates and there was nohigher authority for their issue.

Dr. JAFAR, replying to the representative of thePan American Sanitary Organization, said thatyellow-fever vaccine could not be made available onthe same scale as other vaccines because it had to bekept under special conditions and the vaccine fromsome sources was not active for more than threemonths.

Mr. BRILLIANT maintained that, in the case ofcertificates of vaccination against yellow fevercarried by members of the Armed Forces, it shouldbe sufficient for the certificate to state that it wasissued by the inoculation service of the ArmedForces. In the United Kingdom all vaccinationsagainst yellow fever for civilians were done at centresspecially authorized by the Government for thatpurpose and notified to WHO, who was also informedthat all the depots of the vaccination services of thethree Armed Forces were likewise officially recognizedfor the purpose. He failed to see why it should benecessary for the certificate of vaccination to showthe location of the particular depot at which theinjection was made. The vaccine was identical withthat used for civilians and it was obtained from thesame source and under the same conditions. Further,there were obvious reasons for not disclosing thelocation of individual depots of the Armed Forces.He therefore submitted that, in that respect, adistinction could be drawn between civilian certifi-cates and those issued by the Armed Forces, and thatthe statement on the form of certificate shown asappendix 3 of the draft Regulations-" In the caseof the Armed Forces, the location of the issuing unitis not required "-should stand.

Dr. BELL opposed the deletion of the sentenceunder discussion, since it was essential to have somereference on the certificate to indicate that the ArmedForces could carry out yellow-fever vaccinations.

Decision: On a vote being taken, the proposal todelete the sentence " In the case of the ArmedForces, the location of the issuing unit is notrequired ", was rejected.

I 12 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. GEAR proposed that the column concerning theorigin and batch number of yellow-fever vaccineshould be omitted. It had no real significance for theinnumerable junior quarantine officers throughoutthe world, and was of little value.

Dr. JAFAR said it was nevertheless important toknow the batch number, particularly when the lifeof the vaccine was only three months.

Decision: The proposal to delete the third columnwas rejected.

Dr. EL-FAR Bey (Egypt) proposed that the sentencereferring to the period of validity of the certificateshould be amended to read : " 12 days in the case ofa person coming from an infected area and 10 daysin the case of a person coming from a non-infectedarea ".

Decision: The proposal was rejected by 9 votesto 6.

Points referred back for Clarification to the Com-mittee by the Drafting Sub-Committee

Article 6 [6] and Definition of "Infected LocalArea"

Mr. HOSTIE said that the Drafting Sub-Committeewished to know whether, as a result of the newdefinition of " infected local area " (see page 286),the words " other than a local area within a yellow-fever endemic area " in the first line of paragraph 2,and the words " outside a yellow-fever endemicarea " in paragraph 2 (b) should be omitted.

Replying to a point raised by Dr. BELL, he explainedthat if the words were retained in the first line ofparagraph 2, the result would be that, once a localarea within a yellow-fever endemic zone becameinfected, it would remain permanently infected, sinceno mechanism existed for declaring it free frominfection (by virtue of the deletion of yellow-feverendemic zones from the revised definition of " infectedlocal area 7).

Mr. BRILLIANT considered that, in view of thedeletion of yellow-fever endemic zones from thedefinition of " infected local area ", the wordsreferred to in paragraph 2 (b) were unnecessary andtheir suppression was a matter of drafting. TheDrafting Sub-Committee, however, required guidance

as to whether the words " other than a local areawithin a yellow-fever endemic area " in the firstline of paragraph 2 should be retained, because apoint of substance was involved.

Dr. MACLEAN interpreted paragraph 2 (b) asreferring to an infected local area not within theyellow-fever endemic zone. He considered, however,that the words in the first line of paragraph 2 couldbe deleted, since it was his understanding that a localarea within a yellow-fever endemic zone couldnever be declared free from infection.

Dr. DUREN believed that Article 6 concernedinfected local areas as much as yellow-fever endemiczones. .The latter were at present considered per-manently infected and it was for that reason thathis delegation had proposed that a study be madeof the procedure for delimiting those areas, so thatthere might exist, in the future, criteria for declaringthem, in part or wholly, no longer endemic.

Mr. BRILLIANT directed attention to paragraph 2of the report of the working party (see page 286)concerning the definition of " infected local area ".He suggested that, since the committee's viewappeared to be that yellow-fever endemic zones werepermanently infected, both the words in the firstline of paragraph 2 and those in paragraph 2 (b)should be deleted.

Mr. HOSTIE emphasized the drafting difficultiesinvolved and urged that the definition of infectedlocal area and the text of Article 6 should b econsistent. He was under the impression that, whilethe committee considered a yellow-fever endemiczone to be a collectivity of infected local areas, it wasreluctant to say so.

Dr. RMA believed that, in deciding that the samemeasures should apply to yellow-fever endemic zonesas to local areas infected with yellow fever, it wasassumed that endemic zones always contained in-fection ; it was therefore logical to consider any partof such a zone as an infected local area.

The CHAIRMAN, following a suggestion by Dr. BELL,proposed that a fourth paragraph should be addedto the revised definition of " infected local area ",on the following lines : " An endemic yellow-feverzone is to be regarded as a collectivity of infectedlocal areas ".

SIXTEENTH MEETING 113

Dr. DUREN said that, should a fourth paragraph onthe lines suggested be added to the definition of" infected local area ", criteria for declaring certainparts of yellow-fever endemic zones free from

infection should be decided upon without delay.After a further exchange of views, the discussion

was postponed until the following meeting.

The meeting rose at 5 p.m.

SIXTEENTH MEETING

Saturday, 21 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Points referred back for Clarification to the Com-mittee by the Drafting Sub-Committee (continua-tion)

Article 6 [6], Definition of « Infected LocalArea" and Article 63 [70]

The CHAIRMAN said he had conferred with somedelegations and with Mr. Hostie on the suggestionmade at the previous meeting to delete the words" outside a yellow-fever endemic area " fromparagraph 2 (b) of Article 6. Departing, in thespecial circumstances, from the normal procedureunder which the Chairman did not make proposals,he suggested the addition of the following sub-paragraph to the definition of " infected local area "as amended by the working party (see page 286) :

(4) a local area or group of local areas in whichconditions exist as defined in a yellow-feverendemic zone.

It was thought that if that addition were accepted,Article 6 could stand as drafted, subject to modifica-tion of the period of time in paragraph 2 (b) alreadyadopted (see page 49).

He had also discussed the point raised by thedelegate for Belgium, which was strongly supportedby several other delegations, that there was nomachinery under the Regulations for enabling anarea situated in the yellow-fever endemic zone to bedeclared free of that stigma when conditions allowed.It had been thought preferable from a psychologicalpoint of view to link the question up with Article 63,which dealt with delineation of yellow-fever endemic

and receptive areas, by the addition of a secondparagraph to that article, to the effect that :

Where a State declares to the Organization thatin a local area which is part of a yellow-feverendemic zone the Aëdes aegypti index has con-tinuously remained for a period of one year belowone per cent, that local area shall thereupon ceaseto form part of the yellow-fever endemic zone.

The period of one year had been inserted in orderto take account of seasonal variations in Aëdesprevalence.

Dr. DUREN (Belgium) accepted the proposals onthe express condition that both were adopted by thecommittee.

Dr. JAFAR (Pakistan), while he was not opposedto the addition of a second paragraph to Article 63,recalled that under that article the responsibility fordelineation was left to the Organization. The secondparagraph as drafted gave the impression that thearea would automatically cease to be considered partof a yellow-fever endemic zone on receipt of notifi-cation from the State concerned. He thereforeproposed an amendment reading "...that local areashall, after the agreement of the Yellow-Fever Panelhas been obtained, cease to form part of the yellow-fever endemic zone ". He agreed to a suggestion ofthe CHAIRMAN to avoid reference to a particular organof WHO by substituting " the Organization " for" the Yellow-Fever Panel ".

Dr. RAJA (India) thought that, when deciding,under Article 63, on the procedure for delineation of

114 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

the zones, a procedure should also be adopted fordeclaring an area no longer part of an endemiczone, or for reintegrating it in an endemic zonewhen necessary.

Dr. DUREN, agreeing with the amendment of thedelegate of Pakistan, suggested a phrase to theeffect that a State should declare, in agreement withthe Organization, that a local area fulfilled theconditions required for its ceasing to form part of anendemic zone.

He thought an area would automatically againbecome part of a yellow-fever endemic zone if the

les aegypti index rose above one per cent, or ifa case of human yellow-fever occurred.

Dr. RAJA stressed that the responsibility should liewith the Organization in consultation with theState concerned.

Dr. EL-HALAWANI (Egypt) mentioned the case ofpersons residing in the Sudan north of latitude 15,or in Massawa or in Rio de Janeiro, where there werenon-endemic areas contiguous to endemic zones, andsuggested that it would be difficult in practice for thehealth authority to know whether such persons hador had not been in and out of the endemic zone beforeleaving the country.

Dr. JAFAR said the intention of his amendmentwas to provide that WHO should consider all suchpoints that would arise before an area could bedeclared non-endemic.

Dr. RAJA recalled that the Expert Committee onInternational Epidemiology and Quarantine haddecided to abolish the Personal Declaration ofOrigin and Health 6 which required a passengerarriving by air to state where he had spent theprevious 14 nights. It might be desirable toreintroduce that form.

The CHAIRMAN saw no reason why the declarationin question should not be reintroduced on anoptional basis.

Dr. DE CARVALHO-DIAS (Portugal) recalled theproposal he had made at an earlier meeting thatpassengers who arrived from a non-infected areaadjacent to an endemic zone should produce anattestation from the authority at the place ofdeparture (see page 106). Referring to the suggestion

6 Annexed to the International Sanitary Convention forAerial Navigation, 1944

of the delegate of India, he stated that experiencein Lisbon had shown that the information given inthe declaration was very often unreliable.

Decisions : In the absence of objections it wasagreed :

(1) to amend again the definition of " infectedlocal area " by the addition of a paragraph on thelines suggested by the Chairman ;(2) not to make further alterations in Article 6 ;(3) to add a second paragraph to Article 63 andto refer the draft suggested by the Chairman to theDrafting Sub-Committee for revision in the lightof the amendment proposed by the delegate forPakistan and of the discussion that had takenplace in the committee.

Article 67 [74]

The CHAIRMAN, recalling the point raised by thedelegate of Pakistan concerning the difficulty ofsecuring isolation in airports where the necessaryfacilities did not exist, said that it was proposed toadd a new article 67 (A) after Article 67 reading :

A person to whom Article 67 applies and whois due to proceed on his journey to an airport in areceptive area at which the means for securingisolation do not yet exist, may be prevented fromproceeding from an airport en route at which suchmeans are available.

Dr. JAFAR seconded the proposal.

Dr. MACLEAN (New Zealand) pointed out that areference to that new article would be needed inArticle 29.

Mr. HOSTIE, Chairman, Legal Sub-Committeeof the Expert Committee on International Epide-miology and Quarantine, said that, in his opinion,such a reference was, legally, required.

Dr. PADUA (Philippines) expressed satisfactionthat the question of procedure to be followed hadnow been clarified.

Mr. MOULTON (International Civil Aviation Orga-nization) considered paragraph 1 of Article 67 un-necessary because, under the Regulations, it wasthe obligation of the State concerned to see that aperson before departure from an infected local areahad been vaccinated.

Secondly, he thought that the proposed newarticle destroyed the whole system of handling

SIXTEENTH MEETING 115

direct transit traffic by air. Suggesting that ad hocarrangements should be made for single cases ofinfringement of the Regulations, he asked whetherthe same procedure was followed and the sameisolation measures imposed when a ship arrivedat Karachi from an infected area. He would preferdeletion of paragraph 2 of Article 65 to inclusion ofthe proposed Article 67 (A).

Dr. JAFAR replied that the principle of allowing aperson whose certificate had not yet become validto travel had been agreed, and it remained to makeprovision for his isolation while on the way.

With regard to the second point raised by therepresentative of ICAO, he said that a watch wasconstantly kept at Karachi, but up to now therehad been no case of a ship arriving before the endof the incubation period.

In reply to a suggestion by Dr. MA'MOEN (Indo-nesia) to delete paragraph 2 of Article 65 theCHAIRMAN said that the suppression of the provisionin that paragraph would involve serious interferencewith international commerce.

M. GEERAERTS (Belgium), on a point of order,suggested that Article 67 had already been adoptedand the discussion could not be reopened unlessthere were a two-thirds majority in favour of doing so.

The CHAIRMAN replied that he had taken the viewthat in proposing an additional article the point oforder did not arise. In any case, the substance ofArticle 67 (A) had already been adopted and referredto the Drafting Sub-Committee, which had proposedthe draft under discussion.

Decision: In the absence of objection, the drafttext of Article 67 (A) was adopted and referredback to the Drafting Sub-Committee, togetherwith the wording of the necessary reference inArticle 29.

New Article 8 (A) [9]

The CHAIRMAN recalled the proposal made by theUnited States delegation at the second meeting toinclude in the Regulations a provision for weeklyreports to be sent to WHO of the number of casesof, and deaths from, epidemic diseases, a nil reportto be returned when no cases had occurred (seeproposed text for Article 3, page 42). The proposalhad included the words " seaport or airport cities ",the interpretation of which had given rise to diffi-culties.

Mr. BRILLIANT (United Kingdom) explained thatdifficulty had arisen in the Drafting Sub-Committeebecause, first, ports and particularly airports hadlittle or no relation to a city ; secondly, the term" city " had a different interpretation in differentcountries ; and, thirdly, the area covered by a seaportwas often far greater than that of the city to which itwas attached. The Drafting Sub-Committee had notaccepted an amendment that he had suggested on thegrounds that it affected the substance. The sugges-tion was to replace " each of its airport or seaportcities open to international traffic " by " each of itstowns adjacent to a port or airport ". The words" open to international traffic " were omitted becausethey were included in the definition of port orairport.

Mr. STOWMAN (United States of America) saidthat, while city and town had a different interpreta-tion in the United States from the United Kingdom,he had no objection to use of the term " townsadjacent to " though " cities and towns adjacentto " might be even better. The matter was purelyone of drafting.

Decision: In the absence of objection it was agreedto refer back to the Drafting Sub-Committee theproposal to substitute " cities or towns adjacentto " for " seaport or airport cities " in Article 8 (A).

Article 1 0 [1 1 ]

The CHAIRMAN said it had been suggested for thesake of economy that, while (under Article 8 (A))Member States should send nil reports when appro-priate to WHO, it was not necessary for the Organi-zation to disseminate that information to other States;they would, however, be advised where returns werenot received or where the nil reports did not appearto be in order.

Mr. STOWMAN agreed with the suggestion. Theessential was that countries should be informed byWHO when nil reports were due to failure to complywith the requirement to send returns.

Decision: The proposal was accepted and referredback to the Drafting Sub-Committee.

Mr. BRILLIANT asked that it should be made clearto the Drafting Sub-Committee that the adjustmentof any overlapping between Article 10 and previousarticles which also required notifications and infor-mation to be sent to the Organization, would

116 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

not be a matter of substance for reconsiderationby the plenary committee.

The CHAIRMAN replied that he had discussed thatquestion with Mr. Hostie and it appeared to bepurely a matter of drafting and deciding on where thenew article should be placed in the Regulations.

Article 26 [31]

The CHAIRMAN said there appeared to have beensome confusion as to the decision taken by thecommittee on Article 26. His recollection was thatit had been re-drafted to read :

No matter capable of producing a communicabledisease shall be thrown or allowed to fall from anaircraft when it is in flight.

There had, however, been an understanding in theDrafting Sub-Committee that the wording was :"...capable of producing an epidemic disease... ".He therefore asked the committee to decide whichterm should be used.

Mr. STOWMAN said that the amendment proposedby his delegation, which the committee adopted,read as follows : " No matter capable of producinga communicable disease shall be thrown..."

Decision : It was agreed to retain the amendmentas previously adopted on the United Statesproposal, and return the article to the DraftingSub-Committee.

Article 29 [34]

The CHAIRMAN asked if the committee wished todelete or retain the words " including vaccination ".He reminded the committee that the words " otherthan medical examination " had been inserted after" sanitary measure ", making the text read :

Notwithstanding any provision to the contrary inthese Regulations, no sanitary measure, other thanmedical examination, shall be applied to :

Dr. RAJA thought that the words " includingvaccination " could be retained.

Decision : It was agreed that the words " includingvaccination " be deleted.

Chapter III - Sanitary Measures applicablebetween Ports or Airports of Departure andArrival

The CHAIRMAN said a question had arisen in theDrafting Sub-Committee as to whether the provisionsof Chapter III should apply to voyages betweenports or airports situated in two different territoriesunder the jurisdiction of the same State. He suggestedthat as the question was complicated, it should bereferred to the Juridical Sub-Committee for exami-nation.

Dr. JAFAR said there appeared to have been noconfusion in the application of the provisions ofprevious conventions, the provisions of which hadbeen applied between separate territories. He would,however, accept the Chairman's suggestion.

Mr. HOSTIE said that the complication referred toby the Chairman had arisen because the provisionsof the International Sanitary Conventions forAerial Navigation of 1933 and 1944 were applicableto territories under the same sovereignty.

Dr. EL-HALAWANI said that, although he agreedwith Dr. Jafar, there was a point of substance fromthe epidemiological point of view which should betaken into consideration.

Decision : It was agreed to refer the question to theJuridical Sub-Committee.

Article 74 [82]

Professor ALIVISATOS (Greece), referring to theincubation period of 14 days, said that experiencein Athens last year had led him to think it was notcorrect. He cited the case of a young man who hadbeen vaccinated in 1949, before leaving Athens forNigeria, with positive results. In 1950, on the 16thday of his return from Nigeria by air-a journeyof one day-he had developed a rash and was sentto hospital ; the diagnosis was chickenpox and noantismallpox measures were therefore applied. As aresult, a small epidemic had occurred, with 12 cases,at a time when there had been no cases since 1945.Among those 12 cases he had found incubationperiods of 6, 10 to 11, 12 to 13, 14, 16 and 17 days,one third of them being more than 14 days, whichcould not be a coincidence.

Professor Alivisatos asked what would be the effectof an incubation period of more than 14 days in thecase of a person coming from an infected local areawho developed the infection a few days after his

SIXTEENTH MEETING 117

arrival in a country where vaccination was notcompulsory or where the requirement was appliedin a " liberal " manner. He suggested that theincubation period might be stated as 16 days. Inparagraph 2 of Article 75 also, the period statedshould be 16 days.

Dr. DUJARRIC DE LA RIVIÉRE (France) said that,although the statement of the delegate of Greecewas interesting from an epidemiological point ofview, the Expert Committee on InternationalEpidemiology and Quarantine had been obliged toadopt an average figure when fixing the incubationperiods for the purpose of the Regulations. In thecase of smallpox, the average adopted had been14 days.

Dr. RAJA agreed with the delegate of France.Although the period of incubation of smallpoxcould extend to 21 days, account could not be takenof exceptional cases in framing regulations for uni-versal application, and he thought the provision inArticle 74 was adequate.

Decision: Article 74 was adopted and referred tothe Drafting Sub-Committee.

Article 75 [83]

Dr. HEMMES (Netherlands), referring to para-graph 2, said it was insufficient to require a personon arrival to submit to vaccination or surveillance :the health authority should be able to require vaccina-tion followed by surveillance. He therefore proposedto add, at the end of the paragraph, after the words" vaccination against smallpox, or surveillance ",the words " or to vaccination against smallpoxfollowed by surveillance ". The same measure hadbeen prescribed in the International Sanitary Con-ventions for Aerial Navigation, 1933 and 1944.

Dr. DUJARRIC DE LA RIVIÈRE thought there was adiscrepancy between the provisions of paragraphs 2and 3 : paragraph 2 gave the traveller the choice,on arrival, of being vaccinated or placed undersurveillance, whereas paragraph 3 said that a personrefusing vaccination-i.e., not accepting the alter-native provided in paragraph 2-could be isolated.

Professor CANAPERIA (Italy) supported the amend-ment proposed by the delegate of the Netherlands,but questioned the phrase : " who in the opinion ofthe health authority is not sufficiently protected byvaccination or by a previous attack of smallpox ".He asked how the health authority could decide that

a person was not sufficiently protected. A certainvalue must be placed on vaccination and he did notsee how it could be said that a person was notsufficiently protected if he possessed a valid certificateof vaccination. He suggested that paragraph 2 beamended to read :

A person on such a journey who has left aninfected local area within the previous fourteendays and who is not in possession of a validcertificate of vaccination against smallpox may ...

Dr. BICA (Pan American Sanitary Organization)made the following comments on behalf of the PanAmerican Sanitary Organization :

Paragraph 1 - It was considered that a validcertificate of vaccination against smallpox should berequired of all persons on an international journey,even coming from a non-infected local area. Thesuggestion that such certificates could be requiredonly of persons coming from known infected areaswould put too great a premium on the non-reportingof infected local areas.

Paragraph 2 - The following amended text wasproposed :

A person on such a journey who has left aninfected local area within the previous fourteendays and who is not in possession of a validcertificate of vaccination or who, in the opinionof the health authority, is not sufficiently protectedby a previous attack of smallpox, may be requiredon arrival to submit to vaccination or surveillance,or both.

Paragraph 4 - The following amended text wasproposed :

The period of isolation or surveillance shall notexceed fouiteen days reckoned from the date ofdeparture of the person from the infected area orshould terminate when vaccination becomessuccessful.

Professor ALIVISATOS proposed that in paragraph 2the word " fourteen " in the phrase " who has leftan infected local area within the previous fourteendays " be amended to " sixteen ".

Dr. VAN DE CALSEYDE (Belgium), replying to thedelegate of Italy, said that as regards the expression" not sufficiently protected by vaccination " tworeplies, " positive " and " negative ", were envisagedin the certificate of vaccination against smallpoxannexed to the draft Regulations. A negative reactioncould be due to the poor quality of vaccine or bad

118 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

methods used, or to the fact that a person was stillimmune on account of previous vaccinations. Hewould return to that aspect when the form of inter-national certificate in Appendix 4 was discussed.

In the case of a person who had been vaccinatedbut had shown no reaction and was still immune,would the health authority submit him to vaccinationor isolation ?

Dr. RMA agreed with the suggestions of thedelegates of Italy and Greece. It was not clear tohim, however, what would be the effect of retainingthe words " who in the opinion of the health authorityis not sufficiently protected by vaccination ". Heassumed that a health authority should considerthat a person was protected if he had a valid certificateof vaccination. On the other hand, if a person arrivedbefore the period of 14 days had elapsed, the healthauthority would be justified in deciding that he wasnot sufficiently protected. The paragraph should beso worded as to give some validity to the possessionof a vaccination certificate.

Dr. PADUA introduced a note submitted by hisdelegation in which it was proposed that paragraph 1of Article 75 should be modified so as to require avalid certificate of vaccination against smallpox ofall passengers, even from those coming from a non-infected local area. The reasons given were thatvaccination against smallpox provided protectionto the individual for a period ranging from three tonine years and also, when applied on a large scale ina country (to 85 % of the population or over) pre-vented the disease from developing there in epidemicform. The note emphasized that national law in thePhilippines required valid certificates of vaccinationfrom all incoming and outgoing passengers andprovided for compulsory vaccination of all personsresiding in the territory.

However, sensing from the remarks of previousspeakers that the proposal in his delegation's notewould be considered too drastic, he proposed that theword " shall " in paragraph 1 of Article 75, asoriginally drafted, be changed to " may ", so as toleave the decision to the health authority.

He added that his proposal was in conformity withthe national laws of countries where compulsoryvaccination was required.

In reply to a question by Dr. BERGMAN (Sweden)regarding the validity of a certificate of vaccinationagainst smallpox, the CHAIRMAN suggested that theform of international certificate in Appendix 4 shouldbe examined before the discussion on Article 75proceeded.

Dr. DAENGSVANG (Thailand) agreed with the viewsexpressed by the delegates of the Netherlands andGreece and others. Even if a person had beenvaccinated before departure and was revaccinatedon arrival, at a later stage of the incubation period,the latter vaccination would not sufficiently protecthim against development of the disease ; thereforesurveillance was needed.

Dr. MAUNG (Burma), supporting the proposal ofthe delegate of the Philippines, agreed that, in thecase of countries in Europe, and perhaps someparts of Africa, there was no justification for a healthauthority to demand a certificate from a person froma non-infected local area. It was different, however,for Burma, where smallpox was always present inendemic form, and where at Rangoon-one of thebiggest immigration ports in the East-dangers mightarise, the possibility of which could not be ignored.Experience had shown that there was no knownmethod of protecting a person against smallpoxexcept by vaccination, and an unprotected personarriving in an infected local area would be a potentialdanger to himself and others. Burma had compulsoryvaccination laws, but its public-health machinerywas not sufficiently developed to deal with the arrivalof unprotected persons. In the opinion of his govern-ment, the retention of Article 75, as drafted, wouldhinder attempts to control and eliminate the disease.

Dr. BELL (United States of America), while up-holding the rights of an individual by giving him thechoice of being vaccinated or placed in isolation orunder surveillance, was concerned about his endanger-ing others. A local community could protect itselfby vaccination of residents but could not be securefrom infection unless incoming travellers were alsovaccinated. He proposed the deletion of paragraph 1.

There were inconsistencies between ;paragraphs 2and 3 : the last words of paragraph 2, he thought,should read : " and/or surveillance ", allowingthe local health authority to decide in accordancewith the conditions.

Dr. DUJARRIC DE LA ItivIÈRE thought that para-graph 1 of Article 97 met the points raised by thedelegate of Burma.

Dr. REID (Canada) noted that paragraph 1 ofArticle 65 stated that persons coming from yellow-fever infected areas must be vaccinated ; he did notsee why there should not be the same provision in thecase of smallpox.

SIXTEENTH MEETING 119

He proposed a new paragraph reading :Vaccination against smallpox shall be required

of any person leaving an infected local area on aninternational journey.

He supported the view of the delegate of the UnitedStates but suggested the addition to paragraph 2 ofthe words " or isolation or vaccination and isola-tion ". In that case, paragraph 3 might be deleted.

Dr. BRAVO (Chile) supported the proposal of therepresentative of the Pan American Sanitary Organi-zation in regard to paragraph 4.

The CHAIRMAN put to the vote the proposal of thedelegate of the United States, which superseded theproposal of the delegate of the Philippines.

Decision : The proposal to delete paragraph 1 wasadopted by 15 votes to 11.

Professor CANAPERIA proposed that paragraph 2be amended to read :

A person on an international journey who hasleft an infected local area within the previousfourteen days and who is not in possession of avalid certificate of vaccination, or who, in theopinion of the health authority, is not sufficientlyprotected by a previous attack of smallpox, maybe required on arrival to submit to vaccinationagainst smallpox, or to surveillance, or to vaccina-tion followed by surveillance.

Dr. RAJA and Dr. DUJARRIC DE LA RIVIÈREsupported the proposal.

Dr. BJORNSSON (Norway) suggested that nofurther proposals be put to the vote until a decisionhad been reached on the form of the internationalcertificate of vaccination (Appendix 4).

Appendix 4 : International Certificate of Vacci-nation or Revaccination against Smallpox

Calling attention to the manner in which the resultof vaccination must be recorded on the draft certi-ficate, the CHAIRMAN said that the Joint OIHP/WHOStudy Group on Smallpox-of which he had beena member-had made a slightly different recom-mendation, i.e., that the positive reaction should bethat which occurred between the fourth and eighthday, so that the negative reaction would occur duringthe three days following vaccination, not four days.

It would appear that there had been an error in theredrafted form.

Referring to the validity of the certificate, he askedwhy a result was required if validity was to com-mence immediately from the date of vaccination : aresult, no matter what it was, could not invalidatethe certificate if properly completed.

Dr. RAJA said that a distinction should be madebetween primary vaccination and revaccination :a number of factors entered into the question of thesuccess or otherwise of revaccination, including thedegree of immunity which a person might possessagainst vaccination itself.

In regard to primary vaccination, recording of theresult as required in the draft would seem to neces-sitate the lapse of a period before the certificatebecame valid. In revaccination there might be nopositive result to record because a person had beenvaccinated at frequent intervals and had a highdegree of immunity. That might have to be con-sidered in relation to Article 75 as well as to thecertificate.

Dr. PADUA thought there was some confusionbetween the definitions of positive and negativeresults in the draft certificate. The textbooksmentioned three kinds of positive reaction in small-pox vaccination, which he described. If there wereno reaction at all the notation would be negative, butwhen no reaction appeared within four days theresult of vaccination was not negative but positive :that had been proved.

The CHAIRMAN said that the group of experts hadtaken a different view from that of Dr. Padua andthe textbooks, i.e., that the immediate early pustularreaction was not, or should not be regarded as,evidence of immunity. It might be due to trauma orreaction to the protein. They recognized only twopositive reactions-the typical primary reaction andthe vesicular vaccinoid.

Professor CANAPERIA agreed with the delegate ofIndia on the importance of a distinction betweenprimary vaccination and revaccination. He hadno doubt that the result of primary vaccination,which in the majority of cases was more or lesspositive, was of great importance. The recording ofthe result should remain on the certificate but mightbe differently placed. The certificate should statefirst the date of observation and, at the end, theresult.

120 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. JAFAR, referring to the validity of the certificate,said that, in regard to the positive result, it could beassumed that a person had developed immunityfrom the vaccine which would last for three years,but asked why, in the case of negative result, theperiod of validity had been fixed at three years.Whilst the reaction might be negative on oneoccasion, it might be positive the next time.

The CHAIRMAN said he believed that the draftersof the certificate (Dr. Gaud and himself) had beenreminded of a decision of the Expert Committee onInternational Epidemiology and Quarantine that, forseveral reasons, the result of vaccination should notbe required. If, however, one depended on the resultfor validity, it must be awaited and recorded.

The first consideration of the expert committeehad been that the vaccine must be potent and themethod good. Secondly, that a person might haveto wait six or seven days before the result could berecorded on his certificate, and they hesitated toimpose such waiting period on 99 % of travellers.They had thought that those practical considerationswhich, though not medical ones, were important,should be taken into account and had agreed that arecording of the result should not be required, butsome governments, when sending their observationsto the Organization, had not taken that view and hadasked for results to be recorded. The provision hadtherefore been re-inserted.

Dr. BERGMAN thought it should be deleted.

Dr. BELL said that experience in the United Stateshad shown that, with a fully potent vaccine and aproper method of insertion, a reaction could be

obtained regardless of prior immunity. He agreedthat it would not appear necessary to require personsfrom infected local areas to wait for the result to berecorded, but in the case of a person coming froman epidemic area it might be well to ensure hisimmunity before allowing him to depart. Thewisdom of such course had been demonstrated andconfirmed.

Dr. PADUA supported the view of the delegate ofthe United States.

In reply to Dr. JAFAR, who repeated his questionregarding the three years' validity in the case ofnegative result, the CHAIRMAN said that perhaps itshould not have been so fixed.

Dr. BARRETT (United Kingdom) proposed that theresult be deleted from the certificate, reliance beingplaced on the potency of the vaccine and propermethods of insertion for positive results, and, to acertain extent, on the provisions of paragraph 2 ofArticle 75, leaving it to the health authority to imposerevaccination if considered necessary.

Dr. BJØRNSSON supported the proposal.

Decisions :

(1) The proposal of the delegate of the UnitedKingdom was adopted by 17 votes to 2.

(2) It was agreed that, in the revised draft to bepresented to the committee at a subsequentmeeting, a distinction should be made betweenprimary vaccination and revaccination.

The meeting rose at 12.10 p.m.

SEVENTEENTH MEETING

Monday, 23 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Article 75 [83] (continuation from previousmeeting)

The CHAIRMAN, referring to the words " an inter-national journey " used in Article 75, said that theexisting definition of " international journey " did

not make it clear when a person ceased to be on aninternational journey, namely at what moment hebecame subject to the national laws of the countryhe entered. The same difficulty arose in connexionwith other articles of the Regulations.

M. MASPETIOL (France) believed that as long as aperson was in transit, the definition of " international

SEVENTEENTH MEETING 121

journey " applied. At the end of the journey, hebecame subject to the national laws for the durationof his visit.

Dr. RAJA (India) advocated a thorough discussionof the question. Varying interpretations of " inter-national journey " might lead, through the en-forcement of national laws, to the reversal of theprovisions of the Regulations.

Dr. GEAR (Union of South Africa) had understoodthat persons on an international journey (and there-fore subject to the provisions of the Regulations)were those travelling in ships or aircraft touching atinternational ports or passing through transit areas ;persons in other circumstances came under nationallaws. The opinion of the Juridical Sub-Committeeshould be sought for the guidance of the committee.

Dr. JAFAR (Pakistan) was of the opinion that theterm " international journey ", and hence the periodwhich a traveller would be considered in transit,should be interpreted in connexion with the incuba-ti on period of the various diseases covered by theRegulations.

Decision : The matter was referred to the JuridicalSub-Committee.

The CHAIRMAN, referring to the doubts in theminds of certain delegations in regard to the preciseeffect-in the light of the maximum measurespermitted under Article 21-of the decision takenat the previous meeting to delete paragraph 1 ofArticle 75 (see page 119), asked the legal expert ofthe French delegation to give his opinion on thematter.

M. MASPÉTIOL said that, in view of the provisionsof Article 21, the deletion of paragraph 1 of Article 75would have no practical effect on the provisions ofArticle 21.

Dr. BELL (United States of America) proposed-in view of the opinion of the legal experts-toretain paragraph 1 and to replace the words " shallnot be required " by " may be required ".

The CHAIRMAN explained that the United Statesproposal was an amendment to a proposal of thedelegation of the Philippines (see page 118) requiringvalid certificates of vaccination of all passengers,even from a non-infected local area.

Decision : The United States amendment to theproposal of the Philippines delegation was adoptedby 13 votes to 12.

Mr. HASELGROVE (United Kingdom) pointed outthat paragraph 1, as amended, provided only forpersons who produced vaccination certificate.What would happen to those who failed to presenta certificate ?

Dr. BELL said that the purpose of the article wasto protect States from the introduction of smallpox.The health authority should be able to place undersurveillance (for the incubation period of the disease)persons without vaccination certificates who didnot wish to be vaccinated. Some countries did notreport smallpox cases, and travellers from suchcountries should be required to be vaccinated orsubmitted to surveillance on arrival because of theunknown status of the country from which theycame.

While another article in the Regulations providedfor notification, some time would elapse before theprocedure became reliable and it was for that reasonthat the United States would like protection.

Mr. MOULTON (International Civil AviationOrganization) asked whether the Drafting Sub-Committee-without changing the substance-couldre-word paragraph 1 to indicate the exact require-ments with which a traveller must comply and themeasures to be taken in the event of failure to meetthose requirements.

Decision : Paragraph 1 was referred to the DraftingSub-Committee.

The CHAIRMAN, replying to Dr. DUJARRIC DE LARIVIF.RE (France) who pointed out that the measuresunder paragraphs 1 and 2 now appeared identical,explained that, under the provisions of paragraph 3,a traveller from an infected local area could besubjected to isolation if he refused vaccination.

Dr. VAN DEN BERG (Netherlands) considered thatthe United States' proposal eliminated the differencebetween infected and non-infected local areas as faras smallpox was concerned. The difference intreatment of persons arriving from the two types ofareas was based on the procedure of notification,and countries should be trusted in the matter ofproper reporting.

Dr. BARRETT (United Kingdom), supported byDr. MACLEAN (New Zealand) said it was essential

122 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

to make a clear distinction between the intentions ofthe two paragraphs. Paragraph 1 should provideonly for surveillance of a person not in possession ofa vaccination certificate. The measures under para-graph 2 should include vaccination or surveillance,and the present paragraph 3 should be linked upwith paragraph 2 so that a person refusing vaccina-tion could be isolated. In no case should isolationfollow the measures outlined in paragraph 1.

Dr. BELL agreed with the United Kingdom delega-tion, and proposed the addition to paragraph 1 ofthe following sentence :

A person not in possession of a valid certificateof vaccination may be required to submit tosurveillance for a period not exceeding 14 daysreckoned from the date of departure from thelocal area.

Dr. REID (Canada) recalled a proposal tabled byhis delegation at the previous meeting (see page 119),namely that the following clause should be insertedsomewhere in Article 75 : " Vaccination againstsmallpox shall be required of any person leavingan infected local area on an international journey ".While a traveller who refused to be vaccinated ondeparture could hardly be prevented from leaving acountry, he should be subject, on arrival, to vacci-nation and isolation.

The above proposal was supported by Dr. BELLand Dr. PADUA (Philippines).

Dr. BARRETT thought that the proposal was toosweeping. The provisions of paragraph 2 weresufficient.

Dr. REID recalled a further proposal he had madeat the previous meeting, namely, to add, at the endof paragraph 2 : " or isolation, or vaccination andisolation " (see page 119). If that amendment wereaccepted, his earlier proposal would become un-necessary because the case of a person who hadrefused vaccination on arrival would be covered.

Replying to the Chairman, he said that the periodof isolation for a person accepting vaccination wouldnot exceed the incubation period of the disease.

Dr. BRAVO (Chile) proposed the addition of thefollowing sentence at the end of paragraph 4 :" or should end when vaccination becomes success-ful ".

Dr. MALAN (Italy) recalled the proposal of hisdelegation at the previous meeting for the amendmentof paragraph 2 (see page 119).

Dr. REID and Dr. RAJA considered that a personwilling to submit to isolation should be permittedto refuse vaccination.

The CHAIRMAN observed that the committee hadbefore it three proposals. The Italian proposal,namely to replace the words " may be required onarrival to submit to vaccination against smallpox,or surveillance " in paragraph 2 by the words" may be required on arrival to submit either tovaccination or to surveillance or to vaccinationfollowed by surveillance ", was in effect an amend-ment to the Canadian proposal and should thereforebe voted upon first. If the Italian amendment wereadopted, the Canadian amendment would auto-matically be ruled out, but the Chilean proposal,namely to add to the end of paragraph 4 the words" or should end when vaccination becomes success-ful " would not be affected.

Decisions :(1) The amendment proposed by the Italiandelegation was adopted by 18 votes to 2.(2) The amendment proposed by the delegate ofChile was rejected by 13 votes to 8.

The CHAIRMAN, in reply to the delegate of theUnited States, explained that the Italian amendmentdid not involve the deletion of paragraph 3, but itsaddition to paragraph 2 as a further sentence.

Article 76 [84]

Mr. HASELGROVE proposed that the words " thevoyage " at the end of the first sentence of Article 76be replaced by the words " the last six weeks of thevoyage ".

The CHAIRMAN explained that in the UnitedKingdom a voyage was considered to last as longas the period for which the crew was signed on, whichmight be three years. There must be some reasonableperiod after which a ship would cease to be regardedas infected even when cases had occurred on board.

Dr. JAFAR remarked that in Part I of the Regu-lations " international voyage " was defined as avoyage between two ports, which would rarelylast anything approaching six weeks.

The CHAIRMAN asked the delegate of Pakistan toconsider the example of a ship on which a case ofsmallpox had arisen and been landed at port A,

SEVENTEENTH MEETING 123

and which two days later put in at port B. The healthauthorities at port B might naturally wish to takeaction in view of the possibility that there might becases on board in the incubation stage, and theUnited Kingdom delegation had suggested a periodduring which such action might be taken.

Dr. RAJA thought that, in the example postulatedby the Chairman, the carrying out of the measureslaid down in paragraph 1 (b) of Article 77 twicewithin three days, especially if no further caseshad occurred, would be an undue imposition onpassengers and crew. It was hard to say when a shipshould cease to be regarded as infected, but certainlyafter the measures prescribed in Article 77 had beencarried out and after no further cases had arisen forfourteen days it should be considered, at the worst,as suspected.

Dr. MACLEAN thought that in the hypotheticalcase quoted, at any rate, the United Kingdomproposal would be in conflict with the provisionsof Article 35.

Mr. M OULT ON pointed out that if the UnitedKingdom amendment was adopted the words " oran aircraft " would have to be deleted.

Dr. HEMMES (Netherlands) supported the UnitedKingdom proposal subject to one modification.Since it was proposed to treat an infected ship likean infected local area, then for the sake of conformitywith Article 6, which prescribed general rules forinfected local areas, a period of four weeks, or twicethe incubation period, would be preferable to sixweeks.

Mr. HASELGROVE said that his delegation wasprepared to modify its proposed amendment inaccordance with the suggestions of the delegateof the Netherlands and the representative of ICAO.

Dr. JAFAR said that the proposed amendment hadconsiderable bearing on paragraph 2 of Article 77,which should therefore perhaps be discussed first.It was true, as the Chairman had said, that someprovision should be made for the possibility thatcases might be on board in the incubation stage, butparagraph 2 of Article 77 laid down that a ship wasto be given free pratique after the measures prescribedin paragraph 1 had been carried out.

After some further discussion, Mr. HASELGROVEin answer to the various objections raised to his

proposed amendment, said that its real purpose wasas follows : If a case of smallpox occurred on a ship,then the provisions of Article 77 would be applicablewhen it reached port. The ship would, however,leave that port and might reach another while therewas still the possibility that cases were on board inthe incubation stage, in which case the local healthauthority at the second port would naturally regardthe passengers and crew as suspected, though bythe provisions of Article 35 no further measurescould be taken with regard to the ship itself. Thequestion was therefore how long it should be per-missible for health authorities to regard persons onboard as suspected ; he had first proposed six weeksand had since modified this proposal to four weeksin accordance with the suggestion of the Netherlandsdelegate. He had also accepted the suggestion ofthe ICAO representative to delete the words " oran aircraft ".

Decision: The amendment proposed by the UnitedKingdom delegation, as modified, was adoptedunanimously.

Mr. HASELGROVE, to meet a point raised by thedelegate of Pakistan, said that his delegation wouldhave no objection to redrafting the amendedArticle 76 on the following lines : " A vessel shall beregarded as infected if it has a case of smallpox onboard or suspected if a case has occurred... " Theword " suspected " could also be added in the firstsentence of Article 77. It was a drafting point, and hewas not himself proposing any difference in thetreatment of the infected or suspected vessel.

Dr. SLOTB 00M (Netherlands) remarked that in thatcase the reference to aircraft could be restored, thecategory of " suspected " applying, of course, onlyto vessels.

Dr. JAFAR pointed out that the proposed draftingchange would not be entirely satisfactory, since a shipon board which a case had occurred must be regardedas infected, not suspected, until the measuresprescribed in Article 77 had been carried out.

The CHAIRMAN agreed that further drafting changeswould be necessary. First, however, the committeemight consider Article 77, since the two articles werebound up together.

Article 77 [85]

Dr. JAFAR thought that since the United Kingdomamendment to Article 76 had been adopted, para-graph 2 of Article 77 should be deleted, since even if

124 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

a ship ceased to be regarded as infected, it could notbe given free pratique while it was still suspected.

Mr. HASELGR OVE said that a suspected ship wasnot to be refused free pratique. At the most thepassengers and crew would be isolated and theirbaggage might be disinfected.

The CHAIRMAN pointed out that passengers andcrew would not even be isolated ; they would merelyhave to remain on board.

Dr. MACLEAN wondered whether the notion offree pratique was compatible with the taking ofmeasures against persons on board. He understoodfree pratique as free intercourse between the shipand the land.

The words " an infected vessel or aircraft " in thefirst line of Article 77 should be replaced by " aninfected vessel or aircraft or a suspected vessel ",and a reference to Article 33 should be fncluded inparagraph 2.

After some further discussion it was agreed thatparagraph 2 should be modified so as to indicatethat free pratique was to be granted, except thatpersons would not be allowed to land where a vesselwas regarded as suspected under the provisions of theamended Article 76.

Dr. BARRETT proposed that, to clarify the measuresto be taken, paragraph 1 (a) of Article 77 be amendedto read :

...vaccination, or surveillance, or vaccinationfollowed by surveillance, or in exceptional cir-cumstances vaccination followed by isolation, fora period not exceeding 14 days from the date ofdisembarkation, of any person who is a suspectand who in the opinion of the health authorityis not sufficiently protected by vaccination or bya previous attack of smallpox.

He also proposed the addition of a new sub-paragraph (b) reading " a person refusing vaccina-tion may be isolated ". The original sub-para-graph (b) would become sub-paragraph (c).

Decision: The amendment was adopted by 16votes to 1.

After some further discussion it was agreed that,since it was difficult to appreciate properly the effectof the many amendments adopted and draftingchanges proposed to Articles 76 and 77, a roughdraft of those two articles as modified should becirculated for further consideration before theirreference to the Drafting Sub-Committee.

Articles 78 [86] and 79 [87]

Decision: Articles 78 and 79 were adopted.

Article 89 [95]

Dr. EL-FAR Bey (Egypt) proposed that Article 89be amended to allow bills of health, without consularvisa, to be required from vessels or aircraft.

Dr. JAFAR asked whether the Chairman couldexplain how the Expert Committee on InternationalEpidemiology and Quarantine had come to decidethat bills of health, even without consular visa,should no longer be required.

The CHAIRMAN said that about twenty yearspreviously the Office International d'HygiénePublique had come to the conclusion that a shipshould not be condemned as infected merely becauseit came from an infected area, but should be judgedby the findings at the port of arrival. The OIHP hadtherefore drawn up two international agreements,one for the abolition of bills of health and the otherfor the abolition of consular visas. The first agree-ment had been signed by many countries and thesecond by slightly less. Further signatures hadsince been obtained and there were at presentrelatively few countries whose regulations auto-matically required bills of health. The expert com-mittee had drafted Article 89 in accordance with thattrend.

In reply to an observation by the delegate ofPakistan, he pointed out that a bill of health con-cerned exclusively the state of health of the ports.Under the provisions of Article 25 of the draftRegulations any document concerning the state ofhealth of the passengers or crew would be un-necessary, since persons already ill would not beallowed to embark, and the state of health of thosegill in the incubation stage could in any case not beascertained.

If any alternative to a bill of health was necessary,it was provided by the notifications required underPart II of the draft Regulations.

Dr. EL-FAR Bey pressed his proposed amendment,since the application of many of the articles of thedraft Regulations was bound up with the distinctionbetween infected and non-infected areas. Withoutbills of health no such distinction could be made.

Decision: The proposed amendment was rejectedby 13 votes to 1.

EIGHTEENTH MEETING 125

Article 90 [96]

The CHAIRMAN, in reply to a question by thedelegate of the Netherlands, said that it was fornational authorities to decide whether a surgeon wasto be carried on ships other than those carryingpilgrims.

Mr. STOWMAN (United States of America) thoughtthat, since the master of a ship was not an expert onhealth matters, the words " ascertain the state ofhealth of all persons on board " in paragraph 1 ofArticle 90 should be replaced by " record any illnessor death on board ".

After some further discussion, Dr. DUJARRICDE LA RIVIÈRE suggested that it would be sufficientmerely to provide that the master of the ship or ship'ssurgeon fill out and sign the declaration of health.

Dr. MA'MOEN (Indonesia) stated that Indonesianships carried a book of health, in which the masterwas required to record all happenings on boardrelevant to health. His country would like to retainthe institution, which had proved of practical use,and he proposed that provision therefor should bemade in Article 90.

Dr. MACLEAN suggested that Article 90 be leftunchanged, since the expert committee had pre-sumably adopted it after mature consideration.

Decision: Discussion of Article 60 was adjournedpending consideration of Appendix 5 (MaritimeDeclaration of Health).

The meeting rose at 12.10 p.m.

EIGHTEENTH MEETING

Monday, 23 April 1951, at 2.15 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations (continuation)

International Certificate of Vaccination orRevaccination against Smallpox

The committee considered the revised draft formof the International Certificate of Vaccination orRevaccination against Smallpox (see page 131),prepared in accordance with the decisions taken atthe sixteenth meeting.

Dr. MACLEAN (New Zealand) proposed that thefourth column be headed " State whether primaryvaccination ", omitting the words " or revaccina-tion ".

In reply to a question by Dr. JAFAR (Pakistan)regarding the omission of the column headed " Originand batch number of vaccine " which appeared onthe certificate in the 1944 Conventions, the CHAIRMANsaid that the Expert Committee on InternationalEpidemiology and Quarantine had not considered itimportant except in the case of yellow fever.

Dr. DUJARRIC DE LA RIVIÈRE (France), referringto the heading of the third column, said that themajority of medical practitioners did not have a

seal or stamp. If a stamp were required the certificatewould have to be authenticated and it would thereforebe preferable to state " Official stamp of authenti-cation ".

The CHAIRMAN explained that the heading had beensimplified so that, after the vaccination had beendone, the vaccinator could complete the certificate,add his signature and professional status and affixthe stamp approved by the health administration ofthe country or territory, and the traveller could leavewithout further delay.

Dr. RAJA (India) suggested that the heading shouldbe : " Approved stamp of vaccinator ", showingthat the stamp was approved by the governmentconcerned.

He asked whether the period of validity wouldstart from the date of vaccination in regard to bothprimary vaccination and revaccination, and whether,in the latter case, it would not be justifiable to have ashorter period than three years.

The CHAIRMAN reminded the delegate of Indiathat the committee had decided by vote, at thesixteenth meeting, that the result should not be

126 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

recorded (see page 120) : the certificate wouldmerely record that vaccination had been performed,and would become valid immediately.

Dr. HEMMES (Netherlands) proposed that " dateof birth " be substituted for " age " in the first line.

Dr. RAJA felt that it would be desirable, in respectof primary vaccination, to prescribe a period afterwhich the certificate would become valid, adding thatfull immunity would be achieved within seven oreight days.

Dr. MACLEAN, referring to the vaccination ofinfants, thought that, in most countries, it would beconsidered that an infant under three months oldwas not likely to have been exposed to infection.He therefore suggested that the certificate shouldstate that vaccination was not required for an infantunder three months.

Dr. DUJARRIC DE LA RIVIÈRE believed that infantsshould be vaccinated as soon after birth as possible.That was done in France, where, as a result, therewere few cases of post-vaccinal encephalitis. Hewould oppose postponing vaccination until infantswere three months old.

Dr. BELL (United States of America) was alsoopposed to an exemption for infants under threemonths old. He considered that that was the besttime for them to be vaccinated. Moreover they werejust as susceptible to smallpox as adults or olderchildren.

Regarding immunity, immunization was differentfrom vaccination and the certificate related to vacci-nation and not immunization.

Dr. MACLEAN, while agreeing with the delegatesof France and the United States, said that theremight be occasions when an infant was requiredto travel by air within a few days of birth and therewould be no time for vaccination. He had suggestedthree months as the maximum period of exemptionbut would agree to one month if that were the viewof the committee.

The CHAIRMAN said that, as the new form ofcertificate became valid immediately after vaccination,an infant could be vaccinated at any time if a physi-cian advised that it should be done.

Dr. VAN DE CALSEYDE (Belgium) said there wassome repetition between the words " has ... been

vaccinated or revaccinated . . " in the third line,and the fourth column : " State whether primaryor revaccination ".

The CHAIRMAN replied that it had been consideredbetter to draft the form so that a definite statementmust be made, rather than so that merely theinappropriate word could be crossed out.

Dr. DUJARRIC DE LA RIvIÈRE, although accepting thesimplification of the certificate, regretted that it didnot include a space for a statement as to the originand nature of the vaccine. He considered that theprofessional status of the vaccinator and the qualityof the vaccine were of equal importance. In case ofaccident the necessary measures could be taken ifthe origin and nature of the vaccine were known.

Dr. DUREN (Belgium) supported the view of thedelegate of France with regard to the origin andnature of the vaccine. He would not ask for inclusionof the information in the certificate, but did askwhether, if certain governments felt that they wishedto include it in their own certificates, such an additionwould invalidate them.

The CHAIRMAN replied that, notwithstanding thefinal paragraph, he did not think that any governmentwould object if others added information whichmight be useful.

A discussion took place on the question of whethervaccinators who were not medical practitionersshould be permitted to use the approved stamp, withor without counter-signature by the medical officerin charge of the service.

The CHAIRMAN considered that it should be amatter for decision by the government of the countryconcerned : if such procedure were approved, thegovernment would no doubt introduce an appropriatesystem for carrying it out.

Dr. DUJARRIC DE LA RIVIÈRE agreed, saying thateach government should be responsible for what wasdone in its own territory.

Dr. JAFAR and Dr. RAJA explained the customaryprocedures in their respective countries, where low-grade officials specially trained for the work-suchas health visitors, sanitary inspectors, etc.-carriedout vaccinations.

Dr. EL-HALAWANI (Egypt) felt that, as the certi-ficate was for international use, vaccination mustbe approved by the governments concerned. He

EIGHTEENTH MEETING 127

therefore suggested that the word " approved "be included in the heading of the third column.

Dr. BIRAUD, Secretary, said that in the applicationof the Regulations, there were two questions whichmight give rise to serious difficulties.

If the right of certification were refused to anybut approved vaccinators, it would, from the inter-national point of view, be equivalent to depriving alarge number of medical practitioners of a rightwhich was conferred on them with their diplomas.Dr. Maystre of the World Medical Associationhad called attention to the matter in his note con-cerning the certificates of vaccination annexed tothe draft Regulations.'

The second question was how all countries couldbe kept informed of forms of stamps or seals whichhad been adopted by other countries, and of themedical practitioners entitled to use such stamps.

The only practical identification would be forevery stamp or seal to be numbered, but such asystem would cause administrative difficulties and wasnot to be recommended.

The CHAIRMAN thought there was no suggestionin the minds of members of the committee of with-holding a stamp from any practitioner whom thegovernment of a country considered entitled to use it :it was a question to be decided by each government.The distribution of the stamp was also an internalmatter. He added that similar stamps were used inconnexion with the administration of other thanmedical matters.

7 The note submitted by the World Medical Associationread :

In many countries when vaccination has been carried outand certified by a medical practitioner, the traveller mustalso go to the health authority to get the vaccinator'scertificate authenticated. This application to the healthauthority causes loss of time ; it gives rise, moreover, todiscrimination between the cas6s in which the practitioner'sattestation is valid and the cases in which it is not. Obviously,practitioners have only been able to vaccinate and certifyin virtue of a decision of the health authority which grantedthem the right to practise medicine in general, and tovaccinate and certify in particular. By proceeding in thesecases to authentication, the health authority stultifies itself,seeing that it no longer recognizes as valid the medicaldeclarations made by the practitioners to whom it hasgranted the right to vaccinate and certify.

The World Medical Association expresses the earnesthope that the International Sanitary Regulations shouldmake no distinction between the various groups of medicalmen, by discriminating between a valid and a non-validattestation. Accordingly, it draws the committee's attentionto the terms of the article concerning the expression " au-thenticated " and to the text of the certificates as set out inAppendix 2 and Appendix 3 ; it would like to have clearerstatements on the interpretation of these texts, which requirethe collaboration of all doctors.

Dr. PADUA (Philippines) said that the nationallaws of his country required that, even when signedby a medical practitioner, a vaccination certificatebe authenticated by a quarantine officer. His govern-ment considered that the certificate of vaccinationwas a delicate matter and asked that there should beprovision for authentication of the signature of thevaccinator.

Dr. MACLEAN proposed the following amendments,which he thought would cover the point raised bythe delegate of the Philippines :

(1) that the third column be headed " Approvedstamp(2) that the second paragraph below should read :

The stamp must be in a form approved bythe health administration of the territory inwhich the vaccination is performed.

It would thus be left to each country to approveits own stamps.

Decision: The proposal of the delegate of NewZealand was adopted.

Dr. REID (Canada) referred again to the questionof the validity of the certificate and Dr. RMAproposed that a period be included, in the firstparagraph, in respect of primary vaccination.

Dr. BARRETT (United Kingdom) proposed that thecertificate as amended be adopted.

Decision:(1) The proposal of the delegate of India wasrejected by 11 votes to 11.(2) The draft certificate was adopted, subject tothe separate amendments already approved.

International Certificate of Vaccination orRevaccination against Cholera

The CHAIRMAN recalled that the heading of thethird column of the revised draft of the certificate(see page 131) had been altered in accordance withthe amendment proposed by the delegate of SouthAfrica in the thirteenth meeting (see page 97).He assumed that Dr. Gear would agree to change" official stamp " to " approved stamp " in theheading of the third column and to amend para-graph 4, first line, to read : " The approved stampof the vaccinator must be in the form prescribed . . . ",as had been done in the case of the certificate ofvaccination against smallpox.

Dr. DUJARRIC DE LA RIVIÈRE said that as hisdelegation did not consider one dose of vaccine

128 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

sufficient from a scientific point of view, he couldonly accept the certificate if the word " may " weresubstituted for " shall " in the first line below theform.

The CHAIRMAN said that there was of course noobjection to a vaccination carried out with two ormore injections, but that the validity of the certificatecame into force six days after the first injection or,in the case of revaccination within six months,immediately after the first injection.

Decision: The proposal was accepted.

A discussion took place on the proposal ofDr. EL-HALAWANI to specify the amount and strengthof the dose. Unless that were done, he held, it wouldbe impossible to rely on the certificate. He suggestedthat 8,000 million vibrios per c.c. should be specified.

The CHAIRMAN recalled that the Expert Committeeon International Epidemic Control had, in its reportof 26 April 1948,8 recommended that " for practicalpurposes of international quarantine a single injectionof vaccine should be accepted ". It had furtherrecommended that cholera vaccine and the methodsof its preparation should be standardized as soonas possible.

The SECRETARY said that the Expert Committeeon Biological Standardization had unanimouslydeclared that standard methods of appraising theprotective value of the vaccine were not yet availableand had emphasized that the vibrio content couldnot be used as a criterion. The size of the vibriosvaried, so that in some cases it would be materiallyimpossible for a vaccine to be liquid with a contentof 3,000 million per c.c. It therefore seemed desirablethat no specific requirements should be laid down inthe certificate until the expert committee had recom-mended standards.

Decision: After a further exchange of views, a votewas taken and the certificate of vaccination againstcholera was adopted, subject to the amendmentproposed by the delegate of France and thesubstitution of " approved stamp " for " officialstamp " (with consequential amendments) asin the case of the certificate of vaccination againstsmallpox.

Article 90 [96] (continuation from page 125)

Dr. MA'MOEN (Indonesia) thought that, at theprevious meeting, he had not made clear the positionregarding the book of health which his country

8 Unpublished report-document WHO.IC/Epid/8 Rev.1

required (see page 125). The sanitary documentsrequired under the quarantine regulations of Indo-nesia were bills of health, books of health and decla-rations of health. The book of health was a kindof diary of the state of health on board which washanded to every ship at its first port of call in Indo-nesia and was countersigned by the harbour masterat each subsequent port of call in the country. Itwas consulted by the health authority of a port beforefree pratique was given and facilitated medicalinspection of the ship. He proposed that booksof health should be included in the requirementsunder Article 90 and asked for postponement of afinal decision until his delegation had circulated amemorandum giving full details.

Decision: A vote was taken and it was decided notto delay conclusion of consideration of Articles 90and 92.

Appendix 5 : Maritime Declaration of Health

Dr. LENTJES (Netherlands) suggested that theperiod of time in the footnote to the maritime decla-ration of health should be reduced to 28 days ortwice the incubation period, in accordance withparagraph 2 (a) of Article 6 and with the decisiontaken on Article 76 (see page 123).

Dr. BARRETT felt that a suggestion of Dr. RAJAto specify double the incubation period for eachdisease might make things difficult for the masterof the ship if there were no doctor on board.

Decision: It was agreed to amend " six weeks " inthe first and second lines of the footnote to read" four weeks ".

Dr. MACLEAN thought that 28 days would notcover the case of plague among rodents and thereforesuggested suppression of the reference to the footnotein question 2.

Dr. BARRETT wondered whether it would beappropriate to specify the same period as in the case ofa local area under Article 3, namely one month.

Dr. JAFAR suggested that since six weeks had beenchosen arbitrarily in the first place, that period shouldbe maintained, as it would cover all cases.

Dr. MACLEAN considered that the risk would bevery considerable if abnormal mortality amongrodents on board even seven or eight weeks beforewere not notified on arrival. He proposed that thefootnote reference should be suppressed and

EIGHTEENTH MEETING 129

question 2 should read : " Has plague occurred orbeen suspected among the rats or mice on boardsince the last port of call or. ... ".

Decision A vote was taken and the proposal wasadopted.

Dr. DE CARVALHO-DIAS (Portugal) suggestedadding a further question to ascertain the numberof crew and passengers disembarking to enter thecountry, which he considered would facilitate thesanitary formalities.

Decision: A vote was taken and the proposal wasrejected.

Dr. DAENGSVANG (Thailand) proposed bringingthe declaration into line with the measures laid downin Articles 49 and 50 by adding " or is the shipheavily infested with rats ? " at the end of question 2.

Replying to a question by Dr. JAFAR the CHAIRMANsaid there was no definition of rat infestation and theonly criteria were indicated in paragraph 1 (b) ofArticle 46 which stipulated that " Every vessel shallbe ...permanently kept in such a condition that thenumber of rats on board is negligible ".

Decision : The proposal of the delegate of Thailandwas rejected by 7 votes to 6.

Dr. EL-FAR Bey (Egypt) proposed that a questionshould be added inquiring whether the cargo in-cluded skins or hides, because of the danger ofanthrax.

Decisions :

(1) A vote was taken and the proposal wasrejected.

(2) The declaration was adopted as amended.(3) In the absence of objections, the schedule tothe declaration was adopted.

Article 91 [97]

Mr. STOWMAN (United States of America) saidthe United States airlines were anxious for theaddition in paragraphs 1 and 2 of " or a represen-tative of the aircraft operator " after " The pilot incommand of an aircraft ", because the pilot did notalways have time to undertake the requirements.

Dr. BARRETT thought the dispensation should onlybe granted in the case of short journeys and that it

was a matter for agreement between the two Statesconcerned.

Mr. REIBER (United States of America) said theproposal was in accordance with the recommendedpractices of ICAO. The pilot was often not thebest informed person to give the informationrequired and moreover in the case of blame theoperator would have to take responsibility.

Dr. BARRETT said his delegation could agreeprovided the person who signed the declaration hadbeen on board throughout the voyage. He suggested" The pilot in command or member of the crewdesignated by him "

Mr. REIBER thought the health authority wouldprefer signature by the operator responsible who,in the case of the United States, was the operatorof the airline and not necessarily the pilot.

Mr. MOULTON (International Civil AviationOrganization) suggested " The pilot in command orhis authorized agent ". " Authorized agent " wasdefined in the ICAO agreement and the air conven-tions as the person responsible to the operator forrecording all formalities concerning crew, passen-gers, baggage and goods and although he mightnot be on board he was generally in a better positionthan the captain of the aircraft to know aboutthe conditions on board. It was the duty of thecaptain to fill out the details on the declaration butit had always been the practice for the operatoror his authorized agent to sign at the bottom andswear to what had occurred on board.

Decision: It was decided by 6 votes to 5 to add thewords " or his authorized agent " in Article 91paragraphs I and 2 after " The pilot in commandof an aircraft ".

Article 92 [98]

A lengthy discussion took place on the questionof the languages in which the certificates in Appen-dices 1, 2, 3 and 4 were to be printed.

Mr. STOWMAN supported by Dr. JAFAR proposedthat the forms should be printed in either Englishor French as well as an official language of theterritory of issue. Up to the present the UnitedStates had printed the forms in English only. Therehad been no objections and they would be unwillingto go to the expense of printing in both languages.

130 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. DUJARRIC DE LA RIVIÈRE was opposed to theproposal. The principle of issuing documents intwo working languages had been adopted not onlyby WHO but also by the United Nations.

Mr. STOWMAN felt that the certificates in questioncould not be considered as WHO documents.

Dr. BRAVO (Chile) agreed that the use of Englishand French might be desirable in the case of inter-continental voyages, but in the case of voyagesbetween countries speaking the same language, asin South America for instance, it was a uselessexpense to print the forms in French and English.

Dr. DUJARRIC DE LA RIVIÈRE said they should beprinted in languages understood all over the world.With regard to whether the certificates were WHOdocuments, he pointed out that they formed part ofthe draft WHO Regulations No. 2 under discussion.Moreover since Spanish had been admitted as oneof the working languages of WHO he saw no objec-tion to the forms being printed in English, French,and Spanish as well as an official language of thecountry which printed them.

Dr. JAFAR supported the first observation of thedelegate of France.

Dr. MA'MOEN thought that the forms should berequired to be completed in the same languages,since a form filled in Arabic, for instance, would beunintelligible in many countries.

Decision: The United States proposal that theforms should be printed in French or English andin an official language of the territory of issue wasrejected by 12 votes to 8.

Dr. DE CARVALHO-DIAS proposed that the certi-ficates should be printed in three languages, English, The meeting rose at 5.10 p.m.

French and an official language of the territory ofissue.

Decision(1) The proposed amendment was rejected by 12votes to 7.(2) The amendments having been rejected, Ar-ticle 92 was retained as drafted.

Mr. STOWMAN proposed the addition of a secondparagraph to Article 92 reading :

Immunization documents provided by themilitary forces of each country and carried bymembers of those forces in uniform shall be acceptedin lieu of the international certificates if judgedby the Organization to be in substantial conformitywith the medical requirements indicated inAppendices 2, 3 and 4.

He explained that when military forces left atshort notice and in considerable numbers it was notconvenient to have all their vaccination certificateschanged. Moreover, military vaccination certificatescontained details and covered additional vaccinationsnot required for international purposes.

In reply to Dr. DUJARRIC DE LA RIVIÈRE whothought it would be necessary for WHO to laydown standards of comparison, Mr. STOWMANsaid that the Organization had judged the inter-national vaccination certificate as printed in theUnited States which differed from the form in the1944 Convention, to be in substantial conformitytherewith, with the result that it was acceptedthroughout the world.

The CHAIRMAN suggested, and Mr. STOWMANagreed, that the new paragraph might more appro-priately come under Article 93.

Decision: The United States proposal was adoptedby 10 votes to 3, the question of where the newparagraph should be inserted being left in abeyance.

EIGHTEENTH MEETING 131

Appendix

INTERNATIONAL CERTIFICATE OF VACCINATION OR REVACCINATION AGAINST SMALLPDX *

This is to certify that age sex

whose signature follows has on thedate indicated been vaccinated or revaccinated by me against smallpox.

Date Signature and professional statusof vaccinator Official stamp of vaccinator State whether primary

or revaccination

1. 1. 2.

2.

3. 3. 4.

4.

This certificate is valid for three years from the date of vaccination or most recent revaccination.The official stamp of the vaccinator must be in the form prescribed by the health administration of the territory in which the

vaccination is performed.Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid.

INTERNATIONAL CERTIFICATE OF VACCINATION OR REVACCINATION AGAINST CHOLERA *

This is to certify that age sex

whose signature follows has on the dateindicated been vaccinated or revaccinated by me against cholera.

Date Signature and professional statusof vaccinator Official stamp of vaccinator

. 1. 2.

.

. 3. 4.

.

. 5. 6.

.

. 7. 8.

.

The vaccination or revaccination shall be by a single dose of vaccine.The validity of this certificate shall commence six days after the date of vaccination or, in the case of revaccination within

six months, from the date of revaccination, and shall extend to a period of six months from the date of vaccination or revaccination.Notwithstanding the above provisions, in the case of a pilgrim, this certificate shall indicate that two injections have been given

at an interval of seven days and its validity shall commence from the date of the second injection.The official stamp of the vaccinator must be in the form prescribed by the health administration of the territory in which the

vaccination is performed.Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid.

* In its final form, this certificate is bilingual.

132 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

NINETEENTH MEETING

Tuesday, 24 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations (continuation)

Article 75 [831Amendment submitted by the Canadian Delegation

The CHAIRMAN reminded the committee of anamendment to Article 75 of the draft regulationssubmitted by the Canadian delegation at the sixteenthmeeting (see page 118) and, through a misunder-standing, not voted upon.

After some discussion, it was agreed that, since ithad been decided to resume discussion of Article 75after the circulation of a revised text incorporatingthe amendments so far adopted, it would be inorder to consider the amendment proposed by theCanadian delegation at that stage.

Article 91 [97] (continuation from page 129)

Dr. JAFAR (Pakistan) wished for a clear definitionof the term " agent " employed in the amended textadopted for Article 91.

The CHAIRMAN thought that the committee couldreopen the discussion of Article 91 only by a two-thirds majority.

Dr. JAFAR thought that a simple majority wassufficient.

After some discussion, it was agreed to seek a legalopinion on the majority required under the Rules ofProcedure.

Article 93 [100]

Dr. RAJA (India) proposed that a sentence on thefollowing lines be added to Article 93 : " Never-theless, individual governments may at their discre-tion require that passengers arriving by air at adesignated port of call in their territories shall fillthe personal declaration form prescribed in the Inter-national Convention for Aerial Navigation, 1944 ".

Dr. MALAN (Italy) supported the views of thedelegate of India. The Personal Declaration ofOrigin and Health provided for in the International

Convention for Aerial Navigation, 1944, served auseful purpose and should be retained. He agreedwith the comment on Article 93 submitted by theGovernment of Ireland.9

The regulations should also provide for thedelivery on arrival, by the person in charge of avessel to the sanitary authorities, of a list ofpassengers and members of crew, the places fromwhence they came and their destinations.

Dr. RAJA added that since it had been agreed thatsmall local areas in yellow-fever endemic zonesmight from time to time be declared free frominfection, a provision empowering health authoritiesof airports to inspect the log-books of aircraft ondemand would also be useful.

In reply to a question put by the CHAIRMAN, hesuggested that, though his country was primarilyinterested in yellow fever, provision for the PersonalDeclaration should be made in general terms,since other delegations might require it from tra-vellers arriving from local areas infected with otherepidemic diseases.

Dr. GEAR (Union of South Africa) recalled thatthe Expert Committee on International Epidemiologyand Quarantine had decided after mature considera-tion that personal declarations of health were ofdoubtful epidemiological value. The informationrequired in particular instances where there wasdoubt as to the validity of vaccination certificatescould be obtained by direct questioning.

Dr. BERGMAN (Sweden) supported that view.

Dr. JAFAR supported the proposal of the delegateof India. His own experience had been that personsin a hurry did not give satisfactory answers to oralquestions.

9 In this document the Government of Ireland proposed theretention of the Personal Declaration of Origin and Healthwhich, it considered, would avoid questioning of passengers(a procedure regarded as unsatisfactory) and enable healthcontrol staff to clear transit and embarking passengers with theminimum of delay.

NINETEENTH MEETING 133

Dr. RAJA agreed that oral questioning was in-adequate. Moreover, on the arrival of an aircraftfrom a local area infected with yellow fever, it wasessential for the required information to be availableimmediately on landing, to permit of rapid segrega-tion of persons whose vaccination certificates werenot in order.

Dr. EL-FAR Bey (Egypt) agreed with the delegatesof India and Pakistan.

Mr. STOWMAN (United States of America) thoughtthat, rather than open up the possibility of more andmore declarations being demanded, Article 93should be adopted as it stood. At most, declarationsshould be required from persons coming from yellow-fever endemic zones and at the port of destinationonly.

Dr. BARRETT (United Kingdom) agreed with thedelegate of the United States. His own experienceover the past ten years had been that, as personaldeclaration forms did not fully allow for the meansof transport used and changes during the voyage,much of the information was useless, to say nothingof the fact that many passengers objected to theimposition and refused to give the informationrequired.

Dr. JAFAR, in reply to the observation of the UnitedStates delegate, said that he himself in travelling toand from Europe had filled in many declarationforms, always for submission at the port of desti-nation.

Dr. GEAR said that, particularly in the tropics,many persons were not in a fit state to fill in formson board an aircraft ; the result was delay afterlanding.

His own country, one of the few which had requiredpersonal declaration forms in the past, had foundthem unsatisfactory from epidemiological and otherpoints of view.

Mr. MOULTON (International Civil AviationOrganization) said that the body which he representedconsidered personal declaration forms at least asout-dated as, and worse in principle than, bills ofhealth, which the committee had already decidedshould no longer be required. It would be recalledthat there had been concern in the committee as towhether the master of a ship had sufficient knowledgeto sign a maritime declaration of health, and yet itwas the individual passenger who was required tosign the personal declaration.

With no sound epidemiological basis, the require-ment of personal declarations was discriminatoryagainst aviation as opposed to other forms oftransport. It had been applied in only a few countries,and there, as in South Africa, it had soon fallen intodisrepute and disuse.

With regard to the last remarks of the delegateof Pakistan, it would be seen from the observationssubmitted by the Government of Ireland (see foot-note 9 to page 132) that it was in fact to transitpassengers that the provision was to apply.

Finally, with regard to the second suggestion ofthe delegate of India, there was a provision in theICAO convention under which airport authoritiescould inspect log-books at any time.

The CHAIRMAN suggested that the committeeproceed to vote on the proposed amendment.

Dr. RAJA, following a point raised by Mr. HASEL-GROVE (United Kingdom), stated that he wished thePersonal Declaration to be permissive, and only foraircraft coming from local areas infected with yellowfever. He was agreeable to his proposal being votedupon in that sense.

Dr. EL-FAR Bey wished the Personal Declarationto be permissive also in the case of aircraft comingfrom local areas infected with cholera.

The CHAIRMAN put first to the vote the Egyptianamendment to the proposal of the delegate ofIndia.

Decisions :

(1) The amendment of the delegate of Egyptwas rejected by 17 votes to 1.(2) The proposal of the delegate of India wasrejected by 14 votes to 8.(3) Article 93 was adopted as drafted.

Article 91 [971 (continuation from page 132)

Dr. BIRAUD, Secretary, announced that a legaladviser to WHO had given as his opinion that inpursuance of Rule 53 of the Rules of Procedure ofthe Health Assembly, the committee could changeits decisions by a simple majority.

The CHAIRMAN said that a vote could thereforebe taken on the request made earlier in the meetingby the delegate of Pakistan for a reopening of thediscussion of Article 91.

Decision : It was agreed by 12 votes to 8 to reopenthe discussion.

134 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

The CHAIRMAN explained that the specific pointfor clarification concerned the responsibility, andpresence on board an aircraft during the flight, of theperson authorized to sign a copy of the HealthPart of the Aircraft General Declaration.

Dr. JAFAR mentioned that the document was rela-tively small. He strongly advocated that it shouldbe signed by the pilot in command as the responsibleauthority in charge, even if prepared by an authorizedagent. Otherwise the person signing might well be thestewardess or some minor official.

Mr. REIBER (United States of America) argued thatit was the operator of the airline, not the pilot incommand, who was responsible to the governmentwhich had originally signed the ICAO agreement.Therefore the question of responsibility did not arise.He urged the committee, for practical reasons, toadopt the addition of the words " or his authorizedagent ".

Mr. MOULTON, replying to questions put by theCHAIRMAN and Dr. DUJARRIC DE LA RIVIÈRE (France)explained that a pilot in command-although he hadsole responsibility for the aircraft and its passengersduring flight, did not have the same overall andconclusive responsibility as the master of a shipunder maritime law. The Aircraft Declaration ofHealth now formed part of the Aircraft GeneralDeclaration-a complicated document which had tobe prepared very rapidly. Most ICAO Membershad agreed that that declaration could be signed bythe pilot, or by the authorized agent if the pilot wasnot available.

Dr. REID (Canada) objected to the wording asamended. In his view, the words "authorizedagent ", if adopted, should be qualified by : " whois also a member of the crew ".

Decision: It was decided by 8 votes to 5 to retain thewording of paragraph 2 as it stood in the originaldraft.

Article 92 [98] (continuation from page 129)

Mrs. VANLONKHUIZEN BIEMOND (Indonesia) re-peated the amendment tabled by her delegation atthe previous meeting, namely, that the blank spacesin the certificates specified under Appendices 1, 2,3, and 4 should, for practical reasons, be completedeither in English or in French.

Dr. GEAR indicated that, should the proposal beaccepted, his Government would be obliged to make

a reservation since in his own country either of itsofficial languages could be used for the completionof official documents.

The CHAIRMAN explained that the proposal did notapply to the printed text but only to the blank spacesto be filled in.

Decision: The proposal was adopted by 12 votesto 3.

Articles 12 to 17, New Articles 18, 19

Draft submitted by the United Kingdom Delegation

Mr. HASELGROVE introduced his delegation'sproposed amendments to Articles 12 to 17, redraftedto meet the views expressed during formal orinformal discussions (for previous draft, see page 52).The amendments read :

Article 12

1. Each health administration shall as far aspracticable ensure that ports and airports in itsterritory shall have at their disposal an organizationand equipment sufficient for the application of themeasures provided for in these Regulations.

2. Every port and airport shall be provided witha supply of pure drinking water.

Article 13

The health authority for each port shall :

(a) take all practicable measures to keep rodentsin the port installations to a negligible number ;

(b) make every effort to extend rat-proofing tothe port installations.

Article 14

There shall be available to as many of the portsin a territory as practicable an organized medicalservice with adequate staff, equipment andpremises, and in particular facilities for theprompt isolation and care of infected persons, fordisinfection, for bacteriological investigation, andfor any other appropriate measure required bythese Regulations.

Article 15

1. Each health administration shall ensure thatthere is available at a sufficient number of theports in its territory the personnel competent to

NINETEENTH MEETING 135

inspect ships for the issue of the Deratting Exemp-tion Certificates referred to in Article 46 and thehealth administration shall approve such portsfor that purpose.2. The health administration shall designate anumber of these approved ports in its territory,depending upon the volume and incidence of itsinternational traffic, as having at their disposal theequipment and personnel necessary for thederatting of ships for the issue also of the DerattingCertificates referred to in Article 46.

Article 16As soon as it is practicable, and where it is

necessary for the accommodation of direct transittraffic, airports shall be provided with directtransit areas.

Article 171. Each health administration shall designate assanitary airports a number of the airports in itsterritory, depending upon the volume of itsinternational traffic.2. Every such sanitary airport shall have at itsdisposal :

(a) an organized medical service with adequatestaff, equipment and premises ;(b) facilities for the transport, isolation, andcare of infected persons or suspects.(c) facilities for efficient disinfection anddisinsecting, and for any other appropriatemeasure required by these Regulations ;(d) a bacteriological laboratory, or facilitiesfor dispatching suspected material to such alaboratory ;(e) facilities for vaccination against cholera,yellow fever and smallpox ;(f) an effective system for the removal andsafe disposal of excrement, refuse, waste water,condemned food, and other material dangerousto health.

New Article 181. Every port situated within a yellow-feverendemic zone or a yellow-fever receptive area, andthe area within the perimeter of every airport sosituated, shall as far as practicable be kept freefrom Aëdes aegypti in their larval and adultstages.

2. Every airport situated within a yellow-feverendemic zone :

(a) shall be provided with mosquito-proofeddwellings and sick quarters for passengers,crews, and airport personnel ;

(b) shall be freed from mosquitos by systema-tically destroying them in their larval and adultstages within the perimeter of the airport, andwithin a protective area extending for a distanceof four hundred metres around that perimeter ;(c) shall, if it is a sanitary airport constructedafter the coming-into-force of these Regulations,have no buildings in the protective area, exceptthat shelters for radio aids to navigation,control vans, and similar devices may be placedwithin the area if required by local circumstances.

3. No unauthorized person shall be allowedwithin the protective area specified in paragraph 2of this Article.4. For the purposes of this Article, the perimeterof an airport means a line enclosing the areacontaining the airport buildings and any land orwater used or intended to be used for the parkingof aircraft.

New Article 19

1. Each health administration shall send to theOrganization :

(a) a list of the ports in its territory approvedunder Article 15 for the issue of :

(i) Deratting Exemption Certificates only,and(ii) Deratting Certificates and DerattingExemption Certificates ;

(b) a list of the sanitary airports in its territory.2. The health administration shall notify to theOrganization any change which may occur fromtime to time in the lists required by paragraph 1of this Article.3. The Organization shall send immediately toall health administrations the information receivedin accordance with this Article.

Consequential amendments involved were thedeletion of the definition of " approved port " andmodifications to paragraphs 2 and 4 of Article 46.

Mr. HASELGROVE explained the purpose of theproposed amendments as follows :

Article 12 was drafted in the form of a generalarticle applying to both ports and airports, a secondparagraph having been added concerning the supplyof pure drinking water. It would be noted that theconception of special ports designated as sanitaryports had not been introduced ; instead the principlewas expressed that ports should be generally equippedfor international traffic to the best of the ability ofthe government concerned.

136 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

His delegation attached considerable importanceto the requirement of Article 15-although it was byno means obligatory-that competent personnel,qualified to inspect ships on the spot for the issueof Deratting Exemption Certificates, should beavailable at certain ports other than the larger ports.

Article 16 set forth the principle of providingdirect transit areas in connexion with internationalair travel.

Article 17 retained the conception of sanitaryairports-in deference to majority views expressed.

Article 19 merely provided machinery for dissemi-nating information to WHO and to the countriesconcerned.

After a number of speakers had paid a tributeto the draft of the United Kingdom delegation andexpressed general approval of the proposed amend-ments, the CHAIRMAN suggested that the articlesshould be considered seriatim, and observationsmade in that order for the guidance of the DraftingSub-Committee.

Revised Articles 12, 13 and 14Decision: The articles, in the absence of objections,were adopted.

Revised Article 15

Dr. JAFAR expressed some misgivings about theprocedure outlined for the designation of portsmerely for inspection purposes. First, difficultieswould arise in the case of an interim port with nofacilities for the proper inspection of a ship for thepresence or absence of rats. Secondly, if a derattingexemption certificate had been refused after inspectionat an interim port, would an empty ship have toproceed to an approved port for the purpose ofderatting and then return to the first port forreloading ? He was definitely opposed to a secondcategory of approved ports.

Dr. MACLEAN (New Zealand) disagreed. Theessential point was that a ship should be empty,and that often occurred at secondary ports. InNew Zealand competent officers were available atsecondary ports to inspect a ship and issue a derattingexemption certificate. It lay with each country todesignate the ports approved for the purpose. Hesupported the article as drafted by the UnitedKingdom.

Dr. JAFAR, replying to the CHAIRMAN, said he wasnot opposed to the practice followed in the UnitedKingdom, namely that, should the need arise, an

inspector could be sent from another port and couldissue the necessary certificate.

The CHAIRMAN suggested an alternative draft forparagraph 1 of Article 15 :

Each health administration shall ensure that asufficient number of ports in its territory shall haveat their disposal the personnel competent toinspect ships . . .

Dr. EL-HALAWANI (Egypt) proposed the additionof a sentence on the following lines : " Any shipcoming from an infected local area shall make itsfirst call at a designated port ".

Mr. HASELGROVE thought that the point was fullycovered under Article 36.

Decisions:(1) On a vote being taken, the proposal wasrejected.(2) Article 15 was adopted as amended by theChairman.

Revised Article 16

Dr. MACLEAN proposed the omission of the words" As soon as it is practicable ".

Mr. STOWMAN, supported by Dr. RAJA andMr. HASELGROVE, proposed the addition of thefollowing sentence : " Transit areas in yellow-feverendemic zones or receptive areas shall be mosquito-proof ".

Mr. HASELGROVE, replying to the delegate of NewZealand, felt that while the Regulations should notbe made immediately mandatory, it was preferableto lay down the principle that direct transit areasshould be provided.

Decision: The New Zealand proposal to delete thewords " As soon as it is practicable " was rejectedby 15 votes to 3.

Mr. STOWMAN thought that it was sufficient toplace the words " As far as it is practicable " at thebeginning of the article.

Decision: The United States proposal was unani-mously adopted.

2. Credentials of the Delegate of Portugal

The committee decided, without convening ameeting of the Sub-Committee on Credentials, toaccept the credentials of Dr. de Carvalho-Dias(Portugal)-examined and found in good order.

The meeting rose at 12 noon.

TWENTIETH MEETING 137

TWENTIETH MEETING

Tuesday, 24 April 1951, at 2 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of Draft International SanitaryRegulations

Articles 12 to 17, New Articles 18, 19

Draft submitted by the United Kingdom Delegation(continuation from previous meeting)

Revised Article 17

Dr. VAN DE CALSEYDE (Belgium) proposed that" sanitary airports " should be defined and that inthe French text the first sentence of paragraph 2should read " Chaque aéroport sanitaire doit pouvoirdisposer .. . " to concord more precisely with theEnglish text.

It was agreed that by implication a sanitary airportwas an airport that complied with the provisionsof paragraph 2.

Decision:

(1) It was agreed that, in the French text, para-graph 2 should be redrafted as suggested by thedelegate of Belgium.(2) On the proposal of Dr. RAJA (India) it wasagreed to amend paragraph 2 (c) to read " facilitiesfor efficient disinfection, disinsecting and destruc-tion of rodents, and for any.. .

(3) A vote was taken and a proposal of Dr. SLOT-Boom (Netherlands) was adopted that para-graph 2 (f) should apply to every airport open tointernational traffic.(4) Article 17 was adopted subject to the aboveamendments and referred to the Drafting Sub-Committee.

New Article 18

Dr. DUREN (Belgium) proposed the deletion ofparagraph 2 (c) and paragraph 3.

Mr. STOWMAN (United States of America) felt thatparagraph 2 should be maintained and thoughtthe provisions would be feasible if the word" sanitary " were added before " airport " in thefirst line.

Dr. DUREN, while agreeing to the addition, main-tained his proposal. Paragraph 2 (c), would be verydifficult of application and was in any case coveredby sub-paragraph (b). Paragraph 3 was a matter forthe local police and need not appear in internationalregulations.

Decisions:(1) The proposals of the delegates of the UnitedStates and Belgium were put to the vote andadopted.(2) A proposal by Dr. EL-HALAWANI (Egypt)to delete the words " as far as practicable " inparagraph 1 was adopted by 13 votes to 5.(3) A proposal by Dr. RAJA to add " and runwaysand landing ground " at the end of paragraph 4was put to the vote and adopted.

New Article 19

Mr. STOWMAN, seconded by Dr. VAN DE CALSEYDE,proposed that a new sub-paragraph (c) should beadded in paragraph 1 requiring that a list of airportsprovided with transit areas should be furnished assoon as practicable.

Decisions:

(1) The proposal was put to the vote and adopted.(2) Article 19 was adopted subject to the aboveamendment.(3) In the absence of observations the con-sequential amendments were approved.

Appendix 6 : Health Part of the Aircraft GeneralDeclaration

Dr. BARRETT (United Kingdom) suggested thatparagraph (a) should be brought into line with theMaritime Declaration of Health and should read :" Illness suspected of being of an infectious naturethat has occurred on board during the flight "because there were physiological conditions thatmight be due to the height and rapidity of the flightwhich need not be included. Moreover he suggestedthat to draw attention to airsickness was not a goodadvertisement for civil aviation.

138 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

The CHAIRMAN suggested that as it would be alayman who would interpret the health part of theAircraft General Declaration it might be advisableto add a note on the lines of that included underquestion 5 in the Maritime Declaration of Healthin Appendix 5 to the Draft Regulations.

Replying to Dr. EL-FAR Bey (Egypt) who askedthat information on the number of passengers onboard and passengers disembarking should beincluded, the CHAIRMAN explained that the declara-tion under discussion formed part of a book whichincluded all such information.

Decision: Appendix 6 was adopted subject to theamendment suggested by the delegate for theUnited Kingdom and was referred to the DraftingSub-Committee.

Artkle 94 [101]

Dr. BERGMAN (Sweden) asked whether the pre-liminary inspection of a vessel before granting aDeratting Exemption Certificate was to be consideredas a medical examination for the purposes of para-graph 1 (a) of Article 94. The definition of " medicalexamination " included " visit to and inspection ofa vessel ".

Dr. EL-HALAWANI said that charges should not beabolished. If they were, the health authority mightbe obliged to limit the number of its medical officers,with a resulting delay in inspection of vessels.Moreover, WHO should not infringe on the domainof the finance ministers who might have includedsuch charges in the national budget, nor would it bejust to expect the taxpayer to contribute towardsinternational trade. He therefore proposed thedeletion of paragraph 1 and the reference theretoin paragraph 2.

Mr. STOWMAN said the United States Governmentbased its approval of Article 94 on the principlethat the various measures were prescribed for theprotection of the national community. Medicalexamination of persons arriving in a country wascarried out to protect the population of that country,as was vaccination, which was included in para-graph 1 (b) of Article 94, so that it would not beproper to charge the cost to the persons arriving.It might be argued that when a ship was infested withrats the shipowners should pay, but his Governmentfelt that examination for the presence of rats was amatter of national protection. Therefore, althoughhe would not call it a medical examination, heproposed that the inspection should be exemptedfrom charges.

Dr. MALAN (Italy), while agreeing in principlewith Article 94, felt that payment of indemnities topersonnel in special circumstances, for instance, inthe case of night work, should be envisaged.

Dr. EL-HALAWANI said that he was not asking forthe deletion of paragraph 1 (b), since vaccination wasa general protective measure. It should, however,be possible to charge for medical examination, andespecially night work, involving laboratory expenseswhich might be a heavy burden to a State which hada large expenditure for health schemes.

Mr. HASELGROVE (United Kingdom) was ingeneral agreement with the observations of theUnited States delegate. In principle, the cost ofquarantine measures should be boilne by the countrieswhich the measures were designed to protect, and notby international traffic. However, he felt that thearticle in its present form struck a fair balance inrespect of the levying of charges.

Dr. MACLEAN (New Zealand) said that paragraph 1appeared to refer to persons. If the committee wasnot in favour of charges in the case under discussion,a new sub-paragraph should be added to the followingeffect : " Any inspection of a ship before the grantingof a deratting exemption certificate ".

Dr. BERGMAN proposed that the definition of" medical examination " should be amended byinclusion of the words " does not include periodicexamination of vessels for the granting of certificatesunder Article 46 ".

Decision: It was decided by 14 votes to 6 thatStates should have the right to charge for theinspection of a ship before the issue of a periodicDeratting Exemption Certificate. The questionwhether there should be a sub-paragraph toparagraph 1 of Article 94, or whether the definitionof " medical examination " should be amended,was referred to the Drafting Sub-Committee.

Dr. EL-HALAWANI, reverting to his proposalto delete paragraph 1 (a), pointed out that in thecase of the Suez Canal, which was a waterway throughwhich as many as 40 ships a day passed on theirway to various countries, the measures taken werefor the protection of all those countries.

Decision: A vote was taken and the proposal ofthe delegate of Egypt was rejected.

In reply to a question by Dr. PADUA (Philippines),it was agreed that the " actual cost of the servicerendered " in paragraph 2 (b) included the costsof the materials used.

TWENTIETH MEETING 139

Dr. LENTJES (Netherlands), seconded by M. MAS-PÉTIOL (France) suggested that the second sentence ofparagraph 2 (c) was redundant and could be deleted.

Mr. GUTTERIDGE (Secretariat) speaking at theinvitation of the CHAIRMAN, explained that the secondsentence had been inserted in order to make it clearthat there was not only to be no distinction betweenone foreign person or vessel and another but alsobetween a national person or vessel and a foreignperson or vessel.

M. MASPÉTIOL suggested a draft on the followinglines : " be levied without distinction as to nationality,domicile or residence in the case of persons, or as tonationality, flag, registry or ownership, and withoutdistinction being made as between national andforeign vessels, aircraft, carriages, wagons and roadvehicles ".

Decision: It was agreed that the text should bereferred to the Drafting Sub-Committee forrevision.

Dr. MALAN said that as a result of the decisionstaken his proposal was no longer appropriate.

Decision: Article 94 was approved as amended andreferred to the Drafting Sub-Committee forrevision in the light of the discussion.

Article 95

Dr. LENTJES proposed the addition, after the words" these Regulations " in the first line, of the words" including Annexes A and B ".

Dr. RAJA asked what were the words " discriminateagainst any other such State " intended to mean.He said that quite often, even in the applicationof the Regulations, one country might wish to applymeasures against another country so far as travellersand goods were concerned.

Mr. GUTTERIDGE thought that the words could beread in conjunction with paragraph 2 (c) of Article 94.That paragraph, however, dealt merely with dis-crimination against private persons, so that it wasnecessary to have a special provision to deal with thequestion of discrimination between States.

He believed the intention of the wording in Ar-ticle 95 was that, for example, if State A were applyingcertain measures it should apply them equally againstState B and State C.

Dr. MACLEAN suggested the following explana-tion : if State A were a yellow-fever receptive area

and States B and C were in endemic zones, andState B was considered by State A to have a betterhealth service than State C, State A might be temptedto impose restrictions on persons coming fromState C.

M. MASPÉTIOL thought there could be two inter-pretations : one rigid, allowing of no distinction ;the other, more elastic, enabling a distinction to bemade if justified by health considerations. Hesuggested that the final phrase be amended on thefollowing lines : after " provisions hereof ", " makeany distinction not justified by health conditions ".

Dr. RAJA thought that, given the same conditionswith respect to more than one country, a Statewishing to impose any measures should not makea distinction between, say, two other States. Itwould appear that, where provisions in the Regu-lations were of a permissive character, a State couldact as envisaged by the delegate of New Zealand.The use of the word " shall " in Article 95, however,made it mandatory on States not to do so.

It had repeatedly been stated that the purpose ofthe Regulations was to ensure minimum obstructionto the transportation of persons and goods. Wherethe provisions were permissive, a State could relaxthe measures : such relaxation would be in the publicinterest and would not be regarded as a form ofdiscrimination.

He added that, as now drafted, the clause could beinterpreted in a number of ways.

The CHAIRMAN said that, in view of the provisionsof Article 94, no discrimination was likely to be madeon other than health grounds. There was a question,however, of whether a State making a distinctionwould have to justify it.

Dr. RAJA said that, if the word " shall " were usedin Article 95, and the present wording of Article 21were retained, and if an international sanitarycouncil, with provision for appeals, were established,any country which felt it had not been fairly treatedcould submit its complaint through the machineryprovided, and even to the International Court ofJustice if necessary.

M. MASPÉTIOL believed that if such a case arose,it could be dealt with according to the provisionsof Article 107.

Decision: It was agreed that the Juridical Sub-Committee be asked to examine the article in thelight of the opinions expressed, and that the

140 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Drafting Sub-Committee, when redrafting the text,should make it quite clear that it applied to theannexes, appendices and certificates as well as themain body of the Regulations.

Article 96 [102]Decision: The article was adopted without dis-cussion.

Article 97 [103]Dr. REID (Canada) proposed that the words

" who are " be substituted for " or " between" migrants " and " seasonal workers " in para-graph 1.

The CHAIRMAN suggested that the word "migrants"might be used in the French text instead of " emi-grants ", but Dr. DUJARRIC DE LA RII/IÈRE (France)said that the word " migrants " would have nomeaning in French and would not be used in anofficial document.

Mr. MOWAT (International Labour Organisation)said that, although the word " migrants " was notgood French, it was used by ILO. He thought that" emigrants " as used in the article was not satis-factory, because the measures would be applied moreto immigrants than emigrants.

Regarding Article 97 as a whole, Mr. Mowatexplained the work which ILO had been doing formany years in connexion with migration problemsand presented proposals for amending the article.

Since the article, as worded, might, in his opinion,encourage States to impose additional measures, hewould like it deleted, but he realized that might notbe acceptable to the committee for health reasons.He proposed, however, the deletion of Article 97and the insertion, in Article 98, paragraph 1, of asub-paragraph (e) reading " migrants or seasonalworkers ". The new sub-paragraph would begoverned by the first sentence of paragraph 1.

If that proposal were not acceptable, he suggestedthat the word " additional " in paragraph 1 ofArticle 97 be deleted and the words " not mentionedin these Regulations " added after " sanitarymeasures ".

Dr. DUJARRIC DE LA RIVIÈRE said that, apart fromhis remarks regarding the word " migrants ", heconsidered that paragraph 1 was important from theepidemiological point of view. In Southern Franceseasonal workers were employed during part of theyear, and they were responsible for importing small-pox into the country.

The CHAIRMAN thought it would be difficult toincorporate in Article 98 the amendment suggestedby the representative of ILO, because it mightrestrict the liberty of States to make bilateral arrange-ments.

Dr. VOLLENWEIDER (Switzerland) said his delega-tion considered that Article 97 should be retainedin its present from. Switzerland employed a largenumber of seasonal workers, who were examinednot only for epidemic diseases but also for tuber-culosis and syphilis ; from 1 % to 1.5 % were refusedbecause of tuberculosis.

Mr. STOWMAN said that his country had con-siderable interest in the question of immigrants andseasonal workers. As States accepting them wouldbe bound by the Regulations, he thought that thewords " Migrants or seasonal workers " must beretained in Article 97. If those words were in-corporated in Article 98, many agreements alreadymade by the United States with other countries wouldbe affected. He saw no objection, however, todeletion of the word " additional ".

In reply to Dr. DUREN who thought that the word" additional " could be interpreted to mean goingbeyond the maximum stated in Article 21, or thatthe measures could be applied to diseases other thanthose covered by the Regulations, the CHAIRMANexplained that in former years, when large numbersof Eastern European emigrants had passed throughthe United Kingdom on the way to the UnitedStates as immigrants there, agreements had beenmade between the government of the country oforigin, the United Kingdom and the United Stateson the application of certain routine measuresconnected with the health and sanitary conditionsof the travellers, additional to those laid down in thethen existing Sanitary Conventions.

Dr. JAFAR (Pakistan) considered that, as theprinciple had already been established that, wherenecessary, special measures should be applied-asin the case of the Pilgrimage traffic-there was nodifference between one kind of mass migration andanother. He therefore asked for the retention ofArticle 97, with the inclusion of the word " addi-tional ", to cover any additional action which mightat any time be considered necessary.

Decision: Article 97 was retained, subject todeletion of the word " additional " and the in-clusion of " not mentioned in these Regulations "after " sanitary measures ".

TWENTY-FIRST MEETING 1 41

Article 98 [104]Mr. STOWMAN proposed the insertion, in the

first paragraph, of the word " health " between" geographical " and " social ".

Decision: The amendment was accepted and thearticle was referred to the Drafting Sub-Committee.

Article 106The CHAIRMAN said that the Juridical Sub-Com-

mittee had rightly considered that there was no needfor them to examine the article, but had also ques-tioned whether the article was necessary.

Mr. HASELGROVE proposed that the article bedeleted because it purported to define the Constitution

of the Organization, and the sentiments expressedwere unnecessary.

Dr. DUJARRIC DE LA RIVIÈRE supported the pro-posal.

Decision: It was decided by vote to delete thearticle.

Appendix 1 : Deratting Certificate

Decision: The draft certificate was accepted subjectto amendment of footnote (b) in view of the newdefinition of " ship " (see page 53).

The meeting rose at 3.45 p.m.

TWENTY-FIRST MEETING

Wednesday, 25 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Credentials of the Delegate of the DominicanRepublic

The credentials of the delegate of the DominicanRepublic (presented by Dr. Soper, Regional Directorfor the Americas) having been found in goodand due form, it was agreed to accept themwithout convening a meeting of the Sub-Committeeon Credentials.

2. Composition of the Juridical Sub-Committee

The committee confirmed the nomination of thedelegate of Chile as a co-opted member of theJuridical Sub-Committee.

3. Consideration of the Report of the Sub-Committeeon the Mecca Pilgrimage

No observations having been made on the sub-stance of the report of the Sub-Committee on theMecca Pilgrimage (see page 270), or on the definitionsit had proposed, it was agreed, on the suggestionof the CHAIRMAN, to consider, article by article,Annexes A and B of the draft Regulations as amendedby the sub-committee.

Annex Ai.°Article 1 [A 1]

Mr. HASELGROVE (United Kingdom) proposedthat the words " refuse to allow him to enter theHedjaz " in paragraph 2 should be amended to read :" or until arrangements can be made for his repa-triation ". While the present text resulted from adecision, taken at the third meeting of the sub-committee (see page 259) to extend the requirementof Annex A, Article 10 (applying to aircraft only) ofthe draft as first submitted to the Special Committee,it might happen that a ship carrying pilgrims to theHedjaz would have to proceed elsewhere.

Dr. RAJA (India) supported the United Kingdomamendment. He further proposed to add a sentenceas follows : " In the case of yellow fever, the pilgrimshould complete his period of incubation in isola-tion ".

Dr. DUJARRIC DE LA RIVIÈRE (France) thought itwas sufficient for the second paragraph to end after

10 The numbers given to the articles in this annex are thoseof the draft as revised by the Sub-Committee on the MeccaPilgrimage (see page 271). The numbers appearing in squarebrackets in the headings are those of the final text (seepage 360).

142 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

" the relevant period of incubation " (as in the caseof other diseases).

Decision: On a vote being taken the UnitedKingdom proposal was adopted.

Replying to a request for clarification by Dr. JAFAR(Pakistan), Dr. ROUMY (Saudi Arabia) said that apilgrim must either be vaccinated, or isolated untilthe expiry of the relevant period of incubation.Otherwise he would not be allowed to perform hispilgrimage and could return to his own country.

Decision: The proposal of the delegate of Indiawas adopted.

Article 2 [A 21The article was adopted without comment.

Article 3 [A 31Dr. DUJARRIC DE LA RIVIÈRE said that, in the

French text, the words " en droiture " should read" directement ".

A discussion took place, initiated by Dr. DAENGS-VANG (Thailand), on whether or not the article hadalready been deleted by the Sub-Committee on theMecca Pilgrimage.

Dr. JAFAR argued that thedeletion subject to reopening of the discussion, ifnecessary. As the discussion had not been reopened,in his opinion, the Drafting Sub-Committee had noauthority to retain the article. He then formallyproposed its deletion.

Dr. RAJA supported the above proposal, particularlysince the terms of paragraph 2 of Article 1 coveredthe provision of paragraph 1 of Article 3.

Decision: The proposal to delete Article 3 wasrejected by 6 votes to 6.

Article 4 [A 41Mr. KHANACHET (Saudi Arabia) proposed that the

article should be completed by a sentence to theeffect that the health administration of Saudi Arabiawould decide the sanitary measures to be applied topilgrims on arrival in its territory.

Dr. MACLEAN (New Zealand) said that, if theprinciple of the Saudi Arabian amendment wereaccepted, the article should be deleted, since itsobject was to allow pilgrim ships which had passedthrough the Suez Canal to disembark their passengerswithout undergoing the quarantine procedurerequired of other ships.

Dr. RAJA thought the article should be retainedsince the Kamaran station was to be discontinued.If the Saudi Arabian proposal were adopted, itwould be necessary also expressly to lay down thatthe main principles of the Regulations could not beviolated by any additional measures, otherwise theamendment might give the Saudi Arabian authoritieslatitude to take measures (such as stool examinations)in excess of the provisions in the Regulations.

Mr. KHANACHET explained that Saudi Arabia hadno intention of exceeding the measures prescribedeither in the main body or in the Annexes to theRegulations. He only wished the text to make itclear that Saudi Arabia had the right of imposing onpilgrims any sanitary measures considered essential.

Dr. JAFAR thought that the article as drafted gaveSaudi Arabia absolute authority to decide on addi-tional sanitary measures should the need arise.

M. MASPÉTIOL (France) thought the amendmentserved no useful purpose. On the contrary, its veryinclusion might imply some doubt as to the right ofSaudi Arabia to take certain sanitary measures underthe provisions of the Regulations and its Annex.

Dr. EL-HALAWANI (Egypt) supported the proposedamendment. As to stool examinations, the mattershould be considered from the point of view ofcholera and the danger of spreading that disease inthe Hedjaz.

M. MASPÈTIOL said that, if Article 21 applied tothe Regulations as a whole, including the Annexes,the amendment proposed by the delegate of SaudiArabia would add nothing and have no practicaleffect. It might be well for the Juridical Sub-Committee to consider the relation between Article 21and the Annexes to the Regulations.

Mr. HASELGROVE said that the matter was perfectlyclear from the wording of Article 96 : " In additionto these Regulations, Annexes A and B hereto shallapply to the Pilgrimage ".

The CHAIRMAN proposed that, if the questionwere referred to the Juridical Sub-Committee, itshould be informed that the committee endorsedthe view of the Sub-Committee on the MeccaPilgrimage that all regulations were applicable to thePilgrimage, the Annexes A and B providing foradditional measures.

Decision: The proposal to request the JuridicalSub-Committee for the interpretation of Articles 21

TWENTY-FIRST MEETING 143

and 96 in relation to the pilgrimage clauses wasapproved. It was further agreed that an amend-ment on the lines proposed by Saudi Arabia shouldbe discussed later if considered in order by theJuridical Sub-Committee. (For continuation ofdiscussion see below.)

Article 5 [A 5]

Dr. DUJARRIC DE LA RIVIÈRE, seconded byDr. LENTJES (Netherlands), proposed that the word" either " should be inserted before " at El Tor ",in order to make the text perfectly clear.

Mr. KHANACHET proposed the deletion of Article 5.

Dr. JAFAR supported the proposal in view of theprovisions of paragraph 3 of Article 11 concerningair traffic, which enabled countries to take sanitarymeasures without indicating any special station inthat connexion.

Mr. KHANACHET explained that his proposal wasfor replacement of Article 5 by wording similar tothe terms of paragraph 3 of Article 11.

The CHAIRMAN reminded the meeting of thedecision, taken by the Sub-Committee on the MeccaPilgrimage at its third meeting, to retain Article 5.

Dr. RAJA thought that it had later been decided todelete the last phrase referring to the EgyptianQuarantine Regulations.

Decisions:

(1) The proposal to delete Article 5 was rejectedby 9 votes to 5.

(2) A proposal to delete the last phrase wasrejected by 7 votes to 7.

Articles 6 [A 6] and 7 [A 7]

Decision: These articles were adopted withoutcomment.

Article 8 [A 81

The CHAIRMAN, in reply to a question by thedelegate of Egypt, explained that it had been con-sidered that the provisions of Article 11 made itunnecessary to refer to travel by air in Article 8.

Decision: Article 8 was adopted,

Article 4 [A 4] (continuation from page 142)

Dr. EL-HALAWANI proposed that the original textof that article, with its provision that pilgrim shipsgoing to the Hedjaz from the south should stop at thesanitary station at Kamaran, be restored.

Dr. RAJA recalled that the question had beendiscussed at great length in the Sub-Committee onthe Mecca Pilgrimage. Kamaran had been retainedas a sanitary station by virtue of an agreementconcluded between the United Kingdom (whenIndia and Pakistan were not yet independent) andthe Netherlands (when Indonesia was still a Nether-lands dependency). India, Indonesia and Pakistanhad since agreed no longer to send their pilgrimships to Kamaran and had expressed the view that itwas for the Government of Saudi Arabia to takethe necessary quarantine measures. The latter hadaccepted that responsibility. Hence, since the threecountries in question would no longer contributeto the expense of maintaining a sanitary station atKamaran and since their ships would not call there,there seemed little point in the Egyptian proposal.

After some discussion, the CHAIRMAN, in replyto a question by the delegate of Egypt, said that theExpert Committee on International Epidemiologyand Quarantine had been in favour of retainingKamaran as a sanitary station.

Decision: The Egyptian proposal was rejectedby 5 votes to 1.

Article 9 [A 9]

Dr. PADUA (Philippines) was under the impressionthat the Sub-Committee on the Mecca Pilgrimagehad agreed to transfer the reference to smallpoxfrom paragraph 1 (b) to paragraph 1 (a). Thatchange had not been made in the text before thecommittee. It would also be necessary to insert thewords " and in the case of smallpox for a period ofnot more than 14 days " in the last line of para-graph 1 (a) before the words " after the last case hasoccurred ".

Decision: Article 9 was remitted to the DraftingSub-Committee for the amendment suggestedby Dr. Padua.

Article 1 0 [A 1 0]

Decision: The article was adopted without com-ment.

144 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Article 11 [A 11]Dr. LENTJES thought that the words " by air "

should be inserted after the word " Hedjaz " inparagraph 1 of Article 11.

Decision: Articl e 11 was remitted to the DraftingSub-Committee .

Articles 12 [A 12] and 13 [A 13]Decision: The articles were adopted withoutcomment.

Article 14 rA 141Mr. KHANACHET, insisting that the health authori-

ties of his country should alone be consideredcompetent to supply information to WHO concerningsanitary conditions in its territory during the pil-grimage season, proposed the deletion, from thesecond sentence of Article 14, of the words " whichshall take into account the data furnished and thenotifications made to that administration by themedical missions accompanying the pilgrims ".

Decisions :(1) The proposal was rejected by 7 votes to 2.(2) Article 14 was adopted.

Article 15 [A 15]Decision: The article was adopted without com-ment.

Annex B "Article 1 [B 1]

Decision: The article was adopted without com-ment.

Article 2 [B 2]Mr. HASELGROVE thought that the word " equally "

in paragraph 4 was too precise and should be deleted.He also recalled that it had been left to his delegationand that of the Netherlands to suggest a satisfactorywording for paragraph 5. After consultation withexperts they had decided that the words " of which thedeck is above the water-line " should be inserted afterthe words " upper between-decks " in the last line.

Decision: Article 2 was remitted to the DraftingSub-Committee for incorporation of the suggestionby the delegates of the Netherlands and UnitedKingdom.

Articles 3 [B 3] and 4 [B 4]Decision: The articles were adopted withoutcomment.

11 The numbers given to the articles in this annex are thoseof the draft as revised by the Sub-Committee on the MeccaPilgrimage (p. 273). The numbers appearing in square bracketsin the headings are those of the final text (see p. 362).

Article 5 [B 5]The CHAIRMAN, in reply to a question put by the

Indonesian delegation, said that, in modifyingArticle 5, the Sub-Committee on the Mecca Pil-grimage had considered that the word " separate "in paragraph 2 covered adequately the notion ofisolation. However, there would presumably be noobjection to replacing " separate accommodation "by " isolation accommodation ".

To meet a point raised by the delegate of thePhilippines, he suggested that the words " anddrinking-water taps " be inserted after the word" latrines " in paragraph 3.

Decision: The suggestions were adopted andArticle 5 was remitted to the Drafting Sub-Committee.

Article 6 [B 6]Dr. DUJARRIC DE LA RIVIÈRE thought the term

" autres objets " in the French text of paragraph 1too vague. If it was customary to undertake smallsurgical operations on board pilgrim ships, then somesuch phrase as " instrumentation nécessaire pour letraitement des malades " should be employed.

He also considered that the term " substanceimmunisante " in paragraph 2 should be replacedby " vaccin ". On the Chairman's expressing theview that " immunizing substance " in the Englishtext was intended to include sera, he said that inthe French text the word " médicaments " in thefirst paragraph would cover sera.

The CHAIRMAN suggested that the English textof paragraph 2 should be retained and that Dr. Gaudshould be asked to improve the French text. In theEnglish text of paragraph 1 " appliances " mightreplace " articles ". Replying to a question by thedelegdte of New Zealand, he explained that only twokinds of vaccine were mentioned, since yellow-fevervaccination could be carried out only at approvedcentres.

Decision: Article 6 was remitted to the DraftingSub-Committee.

Article 7 [B 71Dr. RAJA thought that to ensure absolute clarity

the word " medical " should be inserted before theword " practitioners " in paragraph 2 and beforethe word " practitioner " in paragraph 3.

Dr. DUJARRIC DE LA RIVIÈRE thought that thewords " with experience of maritime health condi-tions ", employed in sub-paragraph (a) of Article 13,should be inserted after the words " medical prac-titioner " in the first paragraph of Article 7.

TWENTY-FIRST MEETING 145

The CHAIRMAN said that the term " a properlyqualified and registered medical practitioner " usedin Article 13 (a) should also be used in Article 7." A properly qualified medical practitioner " wasnot sufficient.

Decision: Article 7 was remitted to the DraftingSub-Committee.

Article 8 FB 81

Mr. HASELGROVE thought that the text of Article 8before the committee was not in accordance with thedecision of the Sub-Committee on the MeccaPilgrimage, reached in the light of an explanationby Mr. Hostie at the fourth meeting (see page 262).

Dr. RAJA recalled that the sub-committee haddecided that a State might submit its own shipsembarking pilgrims in its ports to requirements inexcess of those prescribed in Articles 2, 3, 4, 5, 6, and7, but might not do so to the ships of other States.

M. MASPÉTIOL thought that since the provisionsof Article 8 were closely related to those of Article 21and 96 of the draft Regulations, the matter might bereferred to the Juridical Sub-Committee, in line withthe similar procedure adopted with regard toArticle 4 of Annex A.

Decision: The suggestion of the delegate of Francewas adopted.

Article 9 [13 9]

Decision: The article was adopted without com-ment.

Article 10 [13 10]

Mr. HASELGROVE recalled that the Sub-Committeeon the Mecca Pilgrimage had decided, at its fifthmeeting, that every pilgrim should be required to bein possession of a return ticket (see page 264). Nosuch provision appeared in the text before thecommittee. The Drafting Sub-Committee mightrectify the omission by adopting wording similarto the corresponding article in the InternationalSanitary Convention, 1926.

Decision: Article 10 was remitted to the DraftingSub-Committee.

Articles 11 [13 11] and 12 [13 12]

Decision: The articles were adopted withoutcomment.

Article 13 r B 13]Mr. STOWMAN (United States of America) recalled

that it had been decided at the fifth meeting of thesub-committee that " condenser " in sub-para-graph (h) should be replaced by ." distilling appa-ratus ".

Decision: Article 13 was remitted to the DraftingSub-Committee.

Articles 14 [13 14], 15 [13 15], 16 [E3 16],17 [13 17] and 18 [B 18]

Decision: The articles were adopted withoutcomment.

Article 19 [13 19]

The CHAIRMAN, in reply to an observation madeby the delegate of France, said that the distillingapparatus was to be used only if necessary to ensurethe daily supply of five litres of drinking water foreach pilgrim.

Decision: Article 19 was adopted.

Articles 20 [13 201, 21 [13 21] and 22 [13 221Decision: The articles were adopted withoutcomment.

Article 23 [13 23]The CHAIRMAN said that the words " from which "

after " place " in paragraph 1 should be replacedby " whence ".

Decision: Article 23 was remitted to the DraftingSub-Committee.

Articles 24 and 25 [13 24]Decision: The articles were adopted withoutcomment.

Article 26 [E3 251Dr. LENTJES pointed out that as the word

" welfare " had been deleted from the title of Annex Bit should also be deleted from Article 26.

Decision: Article 26 was remitted to the DraftingSub-Committee.

Article 27 [13 26]Decisions :

(1) Article 27 was adopted without comment.(2) The report was remitted to the DraftingSub-Committee.

The meeting rose at 11.55 a.m.

146 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

TWENTY-SECOND MEETING

Wednesday, 25 April 1951, at 2 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Consideration of the Report of the WorkingParty on the Proposal of the Delegation of theUnited States to establish an International SanitaryCouncil and the Proposal of the Delegation ofFrance to establish a Judicial Body

In the unavoidable absence of Professor Canaperia(Italy), Chairman of the working party, the CHAIRMANasked Mr. Stowman (United States of America)to present the report (reproduced on page 281).

Mr. STOWMAN said that the Special Committee'swork in connexion with the Regulations wasextremely important and might eventually be amilestone in the history of international quarantine.The proposal now before the committee would,he thought, provide the best possible means ofensuring flexibility in the operation of the Regu-lations.

He suggested that the report be considered in threeparts :

(1) the proposed new Articles 11 (A) and 11 (B) ;

(2) the amended Article 107-which could not bediscussed until it had been examined by theJuridical Sub-Committee ; and

(3) the draft resolution on the internationalsanitary commission to be submitted to theFourth World Health Assembly.

With reference to new Article 11 (A), Mr. Stowmansaid that paragraph 1 would provide for an annualreport which, whilst being easy to prepare, wouldcontain data not obtainable through the normalchannels ; paragraph 2 represented the first step inanalysing the information thus received.

The proposal in paragraph 1 of the new Ar-ticle 11 (B) to establish an international sanitarycommission was the cornerstone of the wholestructure. It was essential that it be established by theRegulations rather than in any other way. Para-graph 2 showed that the main purpose of thecommission would be continuously to review theoperation of the Regulations.

With regard to paragraph 3, the working partyhad felt that the composition should be establishedat the time when the commission was set up. Itsinternal regulations would be formulated by theExecutive Board.

There had been a difference of opinion regardingthe method of appointing the members, but themajority had favoured alternative 1, namely appoint-ment by the Director-General, subject to approvalby the Executive Board.

It had been considered necessary to make thestipulation that membership should not include morethan one representative from any country or morethan three from any continent. A number of addi-tional members, which might be fewer than theseven suggested, could be appointed for a particularsession but they would serve for that one session.

In recommending the report to the committee'sspecial attention, Mr. Stowman said that if theworking party had adhered too much to formerconceptions-(he referred here to the uncertaintyabout several questions, including that of whethe rthe Regulations should be restricted to the sixepidemic diseases, measures against which wereonly a small part of international public-healthwork)-it was because hitherto the experiencegained in the operation of international sanitaryconventions had not been presented in an analytica 1form from which an annual review could be made.

The CHAIRMAN invited general comments on thereport as a whole.

Mr. HASELGROVE (United Kingdom) expressedhis delegation's regret at not being able to subscribeto the working party's report and paid tribute to theefforts of its Chairman to secure agreement.

He said that his delegation, being unable to agreeon the object in view and the procedure proposed,had, with the agreement of the Chairman of theworking party, expressed their dissension in aminority report (see page 284). They also submitted the

TWENTY-SECOND MEETING 147

draft of a proposed alternative resolution (see page 285)representing their view of the kind of recommenda-tion which the Special Committee should send to theFourth World Health Assembly.

The United Kingdom delegation were in agree-ment with the proposal in Article 11 (A), but did notagree with the principle expressed in Article 11 (B)that any body set up for the purpose of reviewingthe Regulations should be set up under the Regu-lations themselves. It was felt to be a profoundmistake to define in the Regulations, prior to theirentry-into-force, the kind of body to be establishedfor their review. It was a matter of constitutionalimportance and it should be for the Health Assembly,by resolution, to establish the necessary machinery.The Health Assembly could then modify its reso-lution from year to year should the body appointedbe found in any way unsuitable to deal with theRegulations in the manner desired. The UnitedKingdom further considered that such a bodywould not be suitably constituted for dealing withdisputes under Article 107.

Dr. MACLEAN (New Zealand) agreed with thedelegation of the United Kingdom that a body suchas that proposed was not suitable to carry out twosuch diverse functions. In the case of the medicalmembers, for instance, the reviewing of the operationof the Regulations would need scientists, researchworkers, laboratory workers and those with expe-rience of quarantine procedure and administration.The value of including laboratory workers who wereexperts on particular diseases was shown by theclear way in which the provisions regarding vaccina-tion had now been drafted.

In settling disputes concerning quarantine admi-nistration procedures, in which personal factorsplayed such a large part, the most useful servicecould be given by men with experience of suchadministration.

Regarding the legal members of the committee,whilst those accustomed to drafting regulationswould play an important part, the settlement ofdisputes called for men who were used to weighingevidence and giving a judicial opinion. He did notsee how the same men could give equally goodservice in both respects. The services of the legalexperts of WHO should continue to be used, as inthe drafting of the Regulations.

The principle of flexibility must be taken intoaccount. The nature of disputes would vary con-siderably, according to the disease and to the con-ditions of the country. Flexibility would be lost ifone body were set up to carry out two functions.

Economy was also important : the Organization'sfunds were limited and, if used for the purposeproposed, would not be available for other importanthealth needs.

He could agree with the provisions of Article 11 (A).He could also agree with the setting up of some bodysimilar to that which had prepared the draft Regu-lations, with perhaps a more permanent character.He could not agree that such a body would be properto deal with the settlement of disputes. Remindingthe committee that the Director-General had statedin his memorandum on Article 107 (reproduced onpage 152) that the majority of the disputes which hadoccurred during 1949 and 1950 had been settledby the Director-General, he said that those whichcould not be so settled should be discussed by a smallbody set up specially for the purpose.

Dr. RAJA (India) believed there was considerableforce in the arguments put forward by the UnitedKingdom delegation.

Regarding the settlement of disputes, the existingmachinery should be tried before an attempt wasmade to set up any other, especially in view of theDirector-General's memorandum, to which thedelegate of New Zealand had called attention. Allthe functions connected with the operation of theSanitary Conventions in the past had been performedby the Office International d'Hygiène Publique,before being taken over by WHO. It would thereforeseem essential that the machinery of the Organizationshould be closely associated with the operation ofthe new Regulations.

Another matter was relevant to the present dis-cussion. The Second World Health Assembly, inapproving (in resolution WHA2.15) the report ofthe Expert Committee on International Epidemiologyand Quarantine on its first session, had also acceptedAnnex I to the report,12 which contained the follow-ing paragraph 1.4.2 :

Cases of violation of the regulations, if notsettled through ordinary channels, might bebrought formally to the attention of the WorldHealth Assembly.

Presumably, therefore, the Second World HealthAssembly had considered that questions regardingviolations of the Regulations should formally bebrought to the notice of the Health Assembly.

In dealing with disputes concerning quarantinematters, the best available scientific opinions,supplemented by advice from the Organization's

12 Off. Rec. World Hlth Org. 19, 12

148 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

legal experts, should be placed before the HealthAssembly, where every Member State would berepresented. Whilst that might appear to be a slowprocess, it was the only way, in his opinion, ofensuring the enforcement of the decisions reached.So far as he knew there was no machinery inexistence for enforcing a decision of the Interna-tional Court of Justice.

In view of resolution WHA2.15 the Special Com-mittee was not required, in the first instance, toexamine the machinery to be created for the investi-gation of disputes.

In conclusion, Dr. Raja said it would be a greatmistake to maintain the idea-as did both themajority and minority reports-that disputes shouldgo straight to the International Court of Justice :that would mean a long legal process, to whichWHO would be committed as a party to it, and anappreciable part of its funds might thus be wasted.

Dr. VAN DEN BERG (Netherlands) emphasized thatthe report of the working party represented acompromise : it had succeeded, with one memberdissenting, in combining the two original proposals.He thought that the committee should endeavour toeliminate differences of detail and accept the reportwithout alterations.

As there appeared to be general agreement thatthere were two functions for which special bodiesmust be established-the supervision of the operationof the Regulations and settlement of disputes-thefirst question to be decided was whether there shouldbe one or two bodies. In his opinion, the twofunctions should be combined in one body, not onlyfor reasons of economy-although that was impor-tant-but because there was a close connexionbetween the two functions.

In conversations with individual delegates duringthe past week, he had found there was still a feelingthat administration and jurisdiction should not bein the same hands. In the particular instance underconsideration, he thought that it was not so muchjurisdiction as mediation and conciliation-whichbelonged to administration-that were involved,and that it would therefore be a mistake to separatethe two functions. The committee must considercarefully the question of settling disputes, because-as the delegate of the United States had said-a new period in the history of international co-operation was starting. Although all were notcompletely satisfied with them, the new Regulationsmight nevertheless mark the beginning of futurerelationships which would ensure the maximum

safety for public health with the least difficulties forinternational traffic. But, in order to get such afuture development, they must have the co-operationnow of all interested parties.

For the small number of cases where the Director-General might not be able to settle a legal dispute,there should be an independent body, including inits composition not only experts concerned withpublic health but also with shipping and aviation.Then, for the extremely small number of disputes ofa special legal character-such as border disputes-it would be wise to provide for appeal to theInternational Court of Justice.

Dr. MA'MOEN (Indonesia) said his delegation didnot consider the establishment of the proposedinternational sanitary commission strictly necessary,first, because the task of studying the operation of theRegulations and making recommendations to theHealth Assembly could be carried out by the ExpertCommittee on International Epidemiology andQuarantine, or one of the expert panels, and,secondly, because experience had shown that disputescould be settled quite satisfactorily by the procedureat present in use, described in the Director-General'smemorandum (see page 152).

He asked why the introduction of new Regulationsshould imply the need for a completely new juridicalcommittee. The recently adopted policy of havingexpert panels should suffice to help the Director-General to settle all questions requiring expertknowledge.

His delegation had always felt reluctant about theestablishment of new bodies, resulting in an increasein the administrative staff, more questionnairesand correspondence for Member States, and, ofcourse, additional expenditure, and it was completelyin agreement with the views expressed by the UnitedKingdom delegation in its minority report. Hethought it unlikely that a body such as the oneproposed would be able to settle the few disputeswhich could not be settled by the existing machineryof the Organization.

Dr. SOKHEY, Assistant Director-General, Depart-ment of Central Technical Services, said the Director-General was in complete agreement that there weretwo functions to be performed. The first was theconstant review of the Regulations and their adjust-ment in the light of new knowledge. The view hadbeen expressed that more should be done, that thereview should cover the suitability of vaccines andtheir preparation, particularly plague vaccine and

TWENTY-SECOND MEETING 149

smallpox vaccine in a dried form. WHO had alwayshad those objectives in mind. The second functionwas settlement of disputes.

The question was how could those two functionsbest be performed. He recalled that the OfficeInternational d'Hygiène Publique had dealt with thematter until 12 months previously when the functionsof the Office had been transferred to WHO. Hecould assure the committee that the mechanismexisting during the past 40 years had allowed ofconstant review of the International Sanitary Con-ventions, which had frequently been changed andexpanded. Since the transfer of functions, the firsttask of WHO had been to combine the provisionsof the conventions into a set of regulations. Thattask had been carried out by the Expert Committeeon International Epidemiology and Quarantine whichhad at the same time dealt with the settlementof disputes. As the Special Committee was aware,both tasks had been very satisfactorily carried out.The function of settlement of disputes was the lessimportant of the two because little difficulty had beenencountered and it was not to be expected that manydisputes would arise in the future. The Director-General had been able to resolve the greater numberof the disputes and the rest had been successfullysettled by the expert committee.

Explaining the existing mechanism, Dr. Sokheysaid the Expert Committee on InternationalEpidemiology and Quarantine functioned in ac-cordance with the excellent rules of procedure thatthe World Health Assembly had devised for thecarrying-out of the work of the Organization. Underexisting arrangements panels of experts from allover the world could be constituted and organizedin such a way as to keep any subject under constantreview. When any point required special attentionpersons especially competent on that particularsubject were selected from the panels. That procedureensured flexibility. The Special Committee wouldappreciate the very satisfactory procedure underwhich any new piece of knowledge was first con-sidered by a group of experts and then by the ExpertCommittee on International Epidemiology andQuarantine. The panels could consist of any numberof persons competent and interested in assistingthe work of the Organization and all members ofthe panels were free to communicate with theDirector-General at any time so that they couldmaintain constant contact with WHO, bringing to itsattention matters that required special considerationand giving the Organization guidance. MoreoverWHO was free to use the laboratories and organi-

zations of the Member States. The same methodcould be followed in the case of disputes, when thepersons most likely to be helpful in their settlementcould be selected.

Thus machinery already existed which had beencarrying out the two functions very satisfactorily.On behalf of the Director-General he asked thata new body should not be Treated unless the com-mittee were convinced that the existing machinerywas inadequate. In the latter case, he asked that adecision should be postponed until there had beentime to see how the existing machinery functionedin respect to the new regulations, and that a newrigid body with a long tenure of office, constitutedin a manner that differed from the usual WHOprocedure, should not be created at the presentstage.

Turning to the two proposals before the committee,Dr. Sokhey said the main difference between themwas that the United Kingdom proposed that theexisting procedures should be used to the bestadvantage. An expert committee would in anycase be required to deal with scientific questions, butin considering the creation of a body to settledisputes, which might meet only at long intervals,the matter of expense should be borne in mind.The Director-General urged the committee not tomake proposals that would involve additionalexpense unless it was absolutely necessary.

The recommendation concerning the InternationalCourt of Justice appeared to be sound from atheoretical point of view and for the sake of complete-ness, but the Organization was more interestedin solving the difficulties with which it was faced thanwith trying to attain perfection. As the delegate ofIndia had pointed out, WHO had no means ofimposing sanctions following a judgement of theCourt. He thought the better way would be forthe committee to influence public opinion by pre-senting resolutions to the Health Assembly to ensurethat legislation was adopted for the protection of thepublic health of all countries. He suggested thatin the case of disputes an ad hoc committee mightbe set up, including experts on quarantine regulationsand representatives of the parties to the dispute.Such a procedure would be more in keeping withthe present structure of the Organization than apurely legal procedure which would involve the Statesand WHO in additional expense. In that connexionhe recalled that the Second World Health Assemblyhad suggested to the Expert Committee on Inter-national Epidemiology and Quarantine that disputes

150 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

that could not be resolved by ordinary means shouldbe brought to the Health Assembly.

Finally, he suggested that the purposes of theSpecial Committee would be served by inserting areference to the World Health Assembly in theappropriate place and passing a resolution such asthat suggested by the United Kingdom delegation,drawing the attention of the Health Assembly to thework it desired to have done and suggesting that theHealth Assembly should create suitable bodies underthe present organization and procedures. If thecommittee did not follow that procedure it wouldbe indicating that the existing machinery was notfunctioning satisfactorily.

Dr. JAFAR (Pakistan) recalled that the decision totransfer the functions of the Office Internationald'Hygiène Publique to WHO, to avoid duplicationof functions between two international bodies, hadbeen taken barely a year ago. The committee wasnow considering transferring those functions to a newbody. Was the committee to believe that WHO hadnot even been able to make a good beginning of thework ?

Referring to the settlement of disputes, he said theexperience of his country had been that WHO hadplayed a very important role. The Expert Committeeon International Epidemiology and Quarantine hadlistened to views of the countries concerned andreached decisions which, to a great extent, had beenaccepted. To adopt the proposal of the workingparty would mean that the committee was dissatisfiedwith the WHO machinery and that the section of theOrganization at present carrying on those functionsshould be liquidated. It would moreover be contraryto the decision of the Second World Health Assemblythat disputes which could not be settled by theDirector-General should be brought before theHealth Assembly.

With regard to the functions proposed for theinternational sanitary commission, it was obviousthat WHO had begun the work in a very satisfactorymanner. The Organization had experts at its disposaland a competent secretariat. He therefore felt thatit was unnecessary to set up a new body.

During the discussions it had been stressed thatthe International Sanitary Regulations were pro-visional in that they played only a subsidiary partin preventing the spread of diseases from one countryto another, and that controls were only necessaryas long as the public-health conditions of somecountries had not reached a certain level. On theone hand, all countries were trying to improve theirpublic health so that the spread of diseases and, in

consequence, the likelihood of disputes, wouldgradually diminish. On the other hand, it wasproposed to set up machinery of a new and morestringent kind, providing even for judicial pro-ceedings. A very important point had been raisedby Dr. van den Berg at the second meeting (seepage 38) when he had questioned whether WHOwas competent to compile such Regulations andwhether when completed they would be acceptedby Member States. While that doubt still persistedin his mind, the committee was discussing settingup an international sanitary commission andbringing disputes to the International Court ofJustice. If the commission had been defied, whowould implement the decisions of the Court ? Thathad to be done through moral force and he felt thatmore importance should be attached to the Organi-zation that the States had created and to whichthey had given the highest technical position in theworld.

In view of those considerations he suggested thatArticle 107 should be maintained as drafted with theaddition, in the spaces left blank, of the name ofthe expert body of WHO.

Dr. RAJA put forward an amendment to newArticle 11(B), providing for the periodic review of theRegulations and the settlement of disputes to beundertaken by the appropriate expert committee,with asistance from the expert panels and such legaladvice as might be required.

At the suggestion of Mr. STOWMAN, the CHAIRMANruled that consideration of the proposal of thedelegate for India be deferred until after the generaldiscussion (see minutes of the twenty-third meeting,page 155).

Mr. STOWMAN noted that there was generalagreement, also on the part of the Secretariat, on thefirst proposal of the working party that there shouldbe an annual review of the Regulations. On theother hand there appeared to be considerable mis-apprehension as to the intentions of the otherproposal. First, it seemed perfectly obvious thatthere was no question of transferring matters con-cerning the application of the Regulations to anybody outside the Organization. The working partyhad suggested an international sanitary commissionof WHO, appointed by the Director-General andcompletely integrated into the general structure ofthe Organization. The working party had had inmind a body that was not an ordinary expert com-mittee because it felt that the work to be undertaken

TWENTY-SECOND MEETING 151

differed from that carried out up to the present bythe Expert Committee on International Epidemiologyand Quarantine. The principal task of the expertcommittee during the last three years had been thepreparation of the Sanitary Regulations. That taskwas now completed and it had been felt that whenthe Regulations were in force a body would beneeded, inside WHO, but with a more permanentstructure and with more standing than an ordinaryexpert committee which was only convened whenthe Director-General thought it desirable and whenfinances permitted. Moreover it had been felt thatthe composition of the proposed commission shoulddiffer from that of a normal expert committee becausemore questions of an administrative nature wouldarise.

Secondly, with regard to expenditure, he felt thatif the commission was a small one, as suggested bythe working party, it should cost no more than themeetings of an expert committee.

Thirdly, the working party hoped that the Director-General could continue to settle a very large pro-portion of the disputes. Although the settlement ofdisputes might thus represent a rather small part ofthe commission's work, that part might be important.Moreover, as the delegate for the Netherlands hadpointed out, the settlement of disputes was relatedto the general functioning of the Regulations becausedisputes occurred in places where the Regulations hadnot been working well.

Fourthly, flexibility had been provided for. Theproposal was that there should be a nucleus in theinternational sanitary commission, appointed for acertain term of years, and that the Director-Generalcould call upon additional persons for any meetingheld to review the Regulations. For a meeting onlegal matters, he could add a number of legal experts.The experts could be drawn from a panel if considereddesirable. It had been thought necessary to have astable nucleus because in legal cases it was not a soundprinciple to select the new judges on each occasion.

Fifthly, although he had no objection to a referencebeing made to the Health Assembly, the internationalsanitary commission would report to the HealthAssembly each year so that unsettled cases wouldautomatically be brought before the Health Assembly,which would be entirely free to decide whether itwished to pronounce itself on those cases.

He hoped he had made it clear that while theworking party had no intention of depriving theOrganization of any activity it had been carryingon heretofore, it had felt that the new body proposedcould do much to strengthen the hands of theDirector-General and he failed to see why difficulties

should arise and why there should be any particularopposition to the proposal on his part. He felt thatworld public-health opinion would even be pacifiedby the creation of such a body by the Organization.The committee had been legislating on measures to beapplied to international traffic in respect of sixdiseases which constituted only a very small part ofthe whole problem of world health, and all exceptone of which were on the wane. The committeecould say that it had no data to show that anythingelse was necessary, but it was now setting up thebest machinery it could devise to deal with suchmatters in the future.

Dr. MA'MOEN said his delegation was opposed tothe creation of a new body because it consideredthat the function of reviewing the Regulations couldbe undertaken by the existing expert committeesof WHO and because the Special Committee shouldnot lay too much stress on the possibility of disputes.It was meeting with the object of creating a spirit ofinternational goodwill and co-operation and theIndonesian delegation believed that it should bepossible to settle health problems without setting upa special body to deal with disputes.

Dr. BRAVO (Chile) said the responsibility of WHOto ensure that world public-health conditions weresatisfactory obliged it constantly to 'appraise thepractical results of its work. His delegation feltthat that was the most important function of theproposed permanent commission and that the reviewshould be carried out annually. The importanceattached by the various countries to the questionof public health was demonstrated by the very factthat the Special Committee had been meeting forthree weeks to set up certain regulations and thatthe members were binding their countries to complywith certain minimum standards for the protectionof public health. All the facts relating to publichealth which had been mentioned during thediscussions showed that there was a constant stateof evolution ; the Regulations drawn up today mighthave become obsolete in six months' time. For thatreason it was necessary that a committee of public-health experts should carry out the function ofconstant revision of the Regulations and ensure theirapplication in the various countries. It had beensuggested that certain financial and administrativefactors might hinder the creation of such a body.He did not think that the cost of the proposed com-mission would represent a large item in the budgetof WHO since it would not be an independent bodybut would form part of the administrative machineryof the Organization.

152 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Finally he considered that the juridical powers ofthe commission for the settling of disputes were alsovery important because such problems which affectedpublic health should also be settled by technicalexperts. It would not always be possible to bringsuch questions before the International Court ofJustice because, however competent its membersmight be in matters of international law, theywere not experts in problems of international health.On the other hand, he did not consider that theprocedure of bringing such disputes to the HealthAssembly would be very effective. It would bepreferable that they should be first examined by asmall group of experts who would submit a proposalto the Health Assembly.

In view of those considerations he supportedthe proposal to set up an international sanitarycommission.

Dr. SOKHEY, while agreeing with previous speakersregarding the nature of the work that would haveto be carried out as a result of the coming-into-forceof the Regulations, said that his intention had beento explain that, in the opinion of the Director-General, the best way to carry out that work wasby using the existing machinery. He had describedthe existing machinery so that the committee couldtake its decision in full knowledge of the position.The Director-General's suggestion was an additionunder Article 11 (A) and the passing of a resolution,as suggested by the delegate of the United Kingdom,indicating the wishes of the committee regardingany body that might be appointed. The body couldhave any composition and be suitable for dealingwith the items on its agenda.

Dr. VAN DEN BERG thought the statement that theadoption of the working party's proposal wouldinvolve the transfer to another body of the functionstransferred from the Office International d'HygianePublique to WHO, was due to a misunderstanding.Whether the functions were performed by theDirector-General, the Expert Committee on Inter-national Epidemiology and Quarantine, by a specialcommittee or by an international sanitary com-mission, they would still be performed by WHO.

The provision that disputes should be broughtto the Health Assembly had been wrongly includedin the principles of the Regulations because it wasnot a principle. There was, however, nothing toprevent the committee from proposing that theFourth World Health Assembly change that decision.

He considered it encouraging that there wasagreement in both the majority and minority reportson the very important point that there should be a

special body to deal with the review of the Regu-lations. Some members did not agree either withthe report of the working party or with the UnitedKingdom proposal and suggested that if a new bodywere created in addition to the Expert Committeeon International Epidemiology and Quarantine itwould be tantamount to declaring that up to nowthe work had not been carried out in a satisfactorymanner. He recalled that in the preparation of theRegulations the expert committee had called on thehelp of outside legal experts and any body set upto study the permanent working of the Regulationsshould include, from the beginning, some personswith legal qualifications. He was not criticizing thework of the expert committee nor of its Legal Sub-Committee but he thought that the work could havebeen carried out somewhat more quickly and moresatisfactorily if there had been constant co-operationthroughout between those two committees, and ifthe expert committee had included not only legalexperts but also experts on shipping and aviation.

The meeting rose at 5 p.m.

Appendix [A3-4/SR/12110 April 1951

ARTICLE 107 OF THE DRAFT INTERNATIONALSANITARY REGULATIONS

Memorandum by the Director-General

It is proposed that the words " the competent body of theWorld Health Organization " be added to paragraphs 1, 2and 3 of Article 107 to define the body to which questions ordisputes arising out of the interpretation or application of theRegulations may be referred.

Since 1949 the established procedure for dealing with suchquestions and disputes arising out of the interpretation orapplication of the International Sanitary Conventions hasbeen that laid down in Official Records No. 19, page 6,namely :

(1) by the Secretariat acting on its own initiative ;(2) by correspondence between the Secretariat and themembers of the Section on Quarantine of the Expert Com-mittee on International Epidemiology and Quarantine ;(3) by the Section on Quarantine in session, at which thedisputants are invited to be present to state their case ;(4) by the Expert Committee on International Epidemio-logy and Quarantine in plenary session, attended by thedisputants so that the respective sides of the problem canbe represented.

The following statement on complaints and disputes which,during the years 1949 and 1950, have been dealt with inaccordance with this procedure, demonstrates the successthereby achieved.

TWENTY-THIRD MEETING 153

During 1949 and 1950 there were : 66 inquiries referred toWHO Headquarters-appropriately answered by the Secre-tariat ; and 48 disputes-of which 45 were settled by theSecretariat acting on its own initiative. One arising in 1950 isstill in course of settlement. Two were referred by the Secre-tariat to the Section on Quarantine of the Expert Committeeon International Epidemiology and Quarantine-one at therequest of the government lodging the complaint, the otherhaving proved beyond the competence of the Secretariat tosettle.

This factual statement does not include a record of the manyquestions referred to headquarters by the EpidemiologicalInformation Stations at Alexandria, Singapore and Washing-ton, or of disputes settled by these stations, independentlyor on advice from headquarters.

Despite the success previously achieved by the procedure

in force, it is felt that an improvement in the system will beeffected by employing for the purpose of settling those disputeswhich have proved incapable of solution by the Secretariatalone the now adopted policy regarding expert advisorypanels. This would provide the essential degree of flexibilityin the composition of the WHO body to permit it to be in thenature of an expert committee comprising, in addition toexperts on quarantine, other technical experts from WHOpanels and legal experts selected according to the nature of thecases on the agenda of each particular session.

Any decision given by such a body would, by providing aconstructive solution based on expert knowledge and opinion,prove probably more acceptable to disputants than a baldverdict of right or wrong according to legal opinion of thefacts.

TWENTY-THIRD MEETING

Thursday, 26 April 1951, at 9.30 a.m.

Chairman : Dr. M. T. MORGAN (United Kingdom)

1. Credentials of the Delegate of Greece

Decision: The credentials of the delegate of Greece'having been found in order, they were acceptedby the committee.

2. Consideration of the Report of the Working Partyon the Proposal of the Delegation of the UnitedStates to establish an International SanitaryCouncil and the Proposal of the Delegation ofFrance to establish a Judicial Body (continuationfrom previous meeting)

Dr. BJORNSSON (Norway) agreed with the state-ment made at the previous meeting by the delegateof Pakistan.

His Government supported the principle laid downin the Constitution of WHO making the Director-General responsible (with the guidance of the Exe-cutive Board and the various expert committees)for carrying out the programmes of the Organizationand implementing Health Assembly decisions. TheDirector-General's own view, set out in his memoran-dum on Article 107 (see previous page), was thatexisting machinery was adequate for dealing withquestions and disputes arising from the applicationof the Sanitary Regulations. His Government consi-

dered that the international sanitary commissionwhich it was now proposed to set up would performthat function no better and certainly more expen-sively, and was therefore opposed to its establishment.

Dr. BELL (United States of America) wished toclarify some issues which had been clouded in thecourse of the discussion of the original United Statesproposal (see page 282) by a tendency shown by somedelegations to exaggerate the importance of minorpoints.

The United States proposal had provided for abody, set up within the existing structure of theOrganization, to perform the functions, generallyadmitted to be necessary, of keeping the Regulationsalive by examining their practical application andreporting annually on changes needed. No specialprocedure was provided for either in the United Statesproposal or in that of the working party (see page 281) ;a body was to be set up which would differ from otherWHO bodies only in that, since its functions wouldlast as long as the Regulations, its establishmentwould be provided for in them.

Comparing the report of the working party withthe minority report submitted by the United Kingdomdelegation (see page 284), he noted that such differences

154 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

as existed were to the advantage of the former, whichin the first place provided for a body consisting ofseven members, not ten, and which was, therefore,despite statements to the contrary, more economical.At the same time, also despite statements to thecontrary, it would be more flexible, since provisionwas made for additional members to be added atthe discretion of the Director-General, and moreeffective, since provision was made for reports on thebasis of which it could carry out its functions.

Finally, one minor issue which had been exag-gerated in the discussion was the question of thesettlement of disputes, or rather of mediation, as hepreferred to call it, since there was no question ofsetting up a form of high court to pass judgementsand fix fines. The majority report stipulated that thework of mediation should be carried out by the bodyresponsible for examining the application of theRegulations, simply because disputes regarding thatapplication would indicate the need for changes,which could be judged only by a body with first-hand knowledge. In any case, the issue was un-important since most such disputes would be settledpersonally by the Director-General.

Professor ALIVISATOS (Greece) said that the draftRegulations, despite the care with which they hadbeen prepared, had undergone considerable modi-fications during the present session mainly becausethe various delegations, however anxious to avoidunnecessary interference with international traffic,felt bound to take into account possible differencesin the application of the Regulations, necessitatedby differences in various factors such as geographicalposition. At the same time, as long as epidemiologicalknowledge remained incomplete, even the mostliberally-inclined countries would remain some-what apprehensive as to possible outbreaks ofepidemics.

In addition, the widely differing significance of,for example, a case of cholera in different regions,and the different manner in which public opinionwas formed and affected official decisions, explainedwhy the Regulations must represent a compromise.Generally speaking, the delegates who had in generalexpressed .the most radical and courageous views hadbeen from countries where the unlikelihood ofepidemic outbreaks made the necessity of applyingmeasures beyond those allowed for in the Regulationsequally unlikely. Hence in times of emergency theapplication of the Regulations would naturallydiffer from one country to another.

It was for those reasons that, seeing the necessityof setting up a body to minimize differences and to

approve or condemn action taken outside theprovisions of the Regulations, he had submitteda proposal (in the form of an alternative text forArticle 21). is His Government favoured the establish-ment of such a body ; however, to avoid expense itshould, so long as it could be provided with thenecessary power to take action with sufficientpromptness, be set up within the existing machineryof the Organization.

The articles proposed in the report of the workingparty were considered seriatim.

New Article 11 (A)

Dr. GEAR (Union of South Africa) had listened withgreat approval, earlier in the session, to the remarksof the United States delegation regarding the needfor WHO to build up a fund of sound epidemio-logical knowledge. He hoped that the committeemight later submit to the Health Assembly a pro-posal recommending that the Director-Generalexpand and make more efficient the machinery forcollecting epidemiological knowledge not only withregard to the six diseases with which the Regulationswere concerned but with regard to all diseases. Sucha programme, by helping to put the six diseases inquestion in proper perspective, would incidentallyshow in the end that many of the regulations adoptedwere undesirable. If the United States delegationwas proposing to submit such a resolution, he wouldcertainly support it.

That being his general point of view, he could notsee the purpose of the proposed new Article 11 (A),seeing that Articles 3, 4, 5, 6 and 7 already providedfor the collection of the information required for thepurposes of the Regulations. Furthermore, if it wasdesired that the general epidemiological informationhe had referred to be supplied fully and promptly,it was perhaps ill-advised to associate the requestfor it with a set of Regulations providing for penalties

Finally, he did not understand the stress placedon epidemic disease due to international traffic.Outbreaks of that kind were extremely rare and toask for information on them was almost to inviteinternational recriminations. In view of theirrarity, the information obtained would in any casebe negligible.

Mr. STOWMAN (United States of America) didnot consider that Articles 3 to 7 provided for theinformation required. Moreover, it was simplybecause, as the delegate of South Africa had said,

1 3 Unpublished working document

TWENTY-THIRD MEETING 155

governments might be less willing to supply infor-mation if it was associated with clauses providingfor penalties, that the working party had decided toput the request for information on epidemic diseasedue to or carried by international traffic in a separatearticle and to provide for it to be supplied in anannual report to the Director-General.

With regard to the opening remarks of the delegateof South Africa, the United States delegation sawno need for a separate resolution to the HealthAssembly since the proposed new article containedall its thought on the question.

Dr. GEAR hoped that the United States delegationmight be prepared to extend the separation, thenecessity for which it admitted, by formulating therequest for information to be used for strictlyepidemiological purposes in an instrument entirelyseparate from the Regulations. At the present stage,the only action that could be taken in that directionwas to submit a resolution to the Health Assembly,and if necessary he would himself place such aresolution before the committee.

The CHAIRMAN, in answer to a question by thedelegate of India, said that under Article 62 of theConstitution the Director-General already had powerto ask for the information referred to in the proposedArticle 11 (A), but only with the authorizationof the Health Assembly. He suggested that a votebe taken on whether the information in questionshould in principle be supplied.

Decision: It was decided by 26 votes to 1 that theinformation should be supplied.

The CHAIRMAN asked for the views of the com-mittee on whether the principle approved should beembodied in the proposed Article 11 (A) or in aseparate resolution to the Health Assembly.

Dr. GEAR observed that the proposed Article 11 (A)provided for the supply both of general epidemio-logical information and of information concerningepidemic disease due to international traffic. Therewas naturally no objection to the latter provisionbeing included in the Regulations, but he thoughtthat that had already been done, particularly inArticle 4.

Dr. BELL saw no reference to general epidemio-logical information in the proposed Article 11 (A),which seemed to him very specific.

With regard to the general remarks of the delegateof South Africa, if the Regulations were to live

there must be somebody to examine them constantlyand recommend changes, and that function couldnot be carried out unless every case of epidemicdisease due to international traffic were reported.

Mr. HASELGROVE (United Kingdom) said that inthe matter at present under discussion there was noconflict between the majority and minority reports.The United Kingdom delegation had learnt in theworking party that information supplied on theapplication of existing conventions had variedgreatly in quantity and quality. It agreed thatinformation of the kind provided for in the proposedArticle 11 (A) should be supplied regularly to allowfor review of the Regulations, and since it wasconsidered that the necessary provision should beincluded among the Regulations he would supportthe inclusion of the paragraph in question.

On a point of drafting, he thought that the words" the Director-General, in accordance with Article 62of the WHO Constitution " should be replaced by" the Organization ".

Decisions :

(1) Paragraph 1 of the new Article 11 (A) wasadopted by 18 votes to 1.

(2) The principle of paragraph 2 was approvedunanimously.

(3) Paragraph 2 was adopted by 24 votes to 1.

New Article 11 (B)

The CHAIRMAN noted that in the case of theproposed Article 11 (B) there was also a measure ofagreement between the majority and minority reports,both recognizing the advantages of establishing aninternational sanitary council or some such body.

Dr. RAJA (India) put forward his proposal for themachinery to review the International Sanitary Regu-lations and to settle disputes arising from theRegulations. The proposal read :

(a) The appropriate expert committee of theWorld Health Organization should, with theassistance of the Organization's expert panels andof the WHO Secretariat and with such legalassistance as may be required in individual cases,perform the functions of a periodic review of theRegulations and of settlement of disputes forwhich the majority opinion of the working partyhas suggested the establishment of an internationalsanitary commission.

156 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

(b) In view of paragraph (2) of resolution WHA2.15of the Second World Health Assembly all dis-putes which are not resolved by the machineryproposed under (a) above shall be referred to theHealth Assembly.

He felt that WHO, as a young organization, shouldnot be too precipitate in the creation of new bodies ;moreover, in the present case haste was unnecessary.At the meeting of the Juridical Sub-Committee theprevious day it had been decided that the periodduring which Member States should be allowed tosubmit reservations should be one year. Somedelegations had thought the period should be longer,and in any case since it seemed to be the opinion thatreservations would have to be accepted or rejectedby the Health Assembly it would probably be threeyears before the Regulations came fully into effect.

One of the most important functions of the bodywhich it was proposed to set up would be thecollecting of epidemiological information, a functionwhich could best be performed by the Organization'smaking the best use of existing expert committees andpanels. Legal advice would admittedly also be needed,but the Organization could always arrange that.

For the above reasons, he was opposed to thecreation of bodies of the kind recommended eitherin the majority or in the minority report. He alsocalled particular attention to paragraph (b) of hisproposal. In international disputes, where even theverdicts of international courts could not be im-plemented by force, everything depended on buildinga strong public opinion. The appropriate body inwhich to build such opinion was the Health Assembly.

Dr. VAN DEN BERG (Netherlands) had attended thesame meeting of the Juridical Sub-Committee as thedelegate of India, but had reached different conclu-sions with regard to the probable future complica-tions in the matter of reservations. His own feelingwas that the proposed body could perform a usefulfunction in collecting the information necessary fordeciding whether reservations were to be acceptedor rejected. With regard to the provisions of para-graph 2 (b) of the proposed Article 11 (B), also, itwould be all to the good if the new body couldstart its work as soon as possible.

Dr. BELL stressed once more, in reply to thedelegate of India, that no new procedure was to beset up. The new body would be like the existingexpert committees of WHO. It was proposed togive it a different name because it would havedifferent functions ; it Was to be a " living com-mittee ", actively concerned with the working of the

Regulations, and its establishment should thereforebe provided for in the Regulations.

In connexion with the remarks of the delegateof the Netherlands, there was no reason why separateprovision should not be made for the sanitarycommission to come into operation before theRegulations came into force.

Dr. JAFAR (Pakistan) had imagined that all WHOcommittees were " living ". He wished to knowwhether the delegate of the United States attachedany special significance to his use of the word in thepresent connexion.

Mr. HASELGROVE said that on the point underdiscussion there was less common ground betweenthe majority and minority reports than in some otherrespects. The United Kingdom delegation did not,for instance, consider that the body set up to reviewthe Regulations should also have the function ofsettling disputes, nor did it feel that the establishmentof that body should be provided for in the Regulationsin preference to the normal practice whereby com-mittees were set up by the Health Assembly. Thatpractice was flexible and prevented overlapping offunctions.

He agreed with the delegate of India that there wasno urgent need to decide on the setting up of thereviewing body.

Dr. RAJA said that if, as the delegate of the Nether-lands had suggested, the proposed body was tosupply the information by which the acceptabilityof reservations was to be judged, a special provisionto that effect would have to be inserted in theproposed Article 11 (B).

Dr. GEAR wished to know whether the workingparty, in preparing its report, had had before it thereport of the Expert Committee on InternationalEpidemiology and Quarantine on its third session,which reproduced the substance of two resolutionsfor consideration by the Fourth World HealthAssembly, recommending the setting-up of twocommittees, one concerned with quarantine and onewith epidemiology.14

14 Unpublished report. In the passage referred to, theExpert Committee on International Epidemiology andQuarantine suggested that it should be split into two com-mittees : (1) the Expert Committee on Quarantine, to beresponsible for the administration, application and inter-pretation of the International Sanitary Regulations ; for thesettlement, where necessary, of disputes referred to theDirector-General, and for the preparation of additionalregulations ; (2) the Expert Committee on Epidemiology, tomake recommendations concerning research on and controlof communicable diseases (other than tuberculosis, malariaand venereal diseases) and, if need be, to co-ordinate the workof expert groups working on specific communicable diseases.

TWENTY-THIRD MEETING 157

Dr. BELL summarized the two points at issue :(1) whether or not an international sanitary councilshould be established and given a particular nameto define its special functions. By the word " living ",he had meant that its functions would be continuous.Existing expert committees might, through lack offunds or other reasons, become dormant, whereasthe International Sanitary Regulations requiredconstant and continued review ; (2) whether sucha body should be established (a) by a provisionin the Regulations ; or (b) by a specific resolution ofthe Health Assembly.

Dr. VAN DEN BERG said that no decision could betaken on the functions of any body established inconnexion with the Regulations until a decisionhad been reached on the policy regarding reserva-tions.

Dr. GEAR believed that the committee had a choiceof four proposals : (1) the majority proposal of theworking party ; (2) that contained in the minorityreport of the United Kingdom delegation ; (3) theproposal of the Director-General regarding Ar-ticle 107 ; (4) the proposals of the Expert Committeeon International Epidemiology and Quarantine.In his view the latter would achieve the object of theproposal of the United States delegation and deservedsome consideration. Two sets of machinery wererequired, one to deal with the problems arising fromthe application of the International Sanitary Regu-lations and another with the epidemiological andscientific situation as revealed by the informationcollected under the provisions of the Regulations orfrom other sources. All were agreed that the attentionof the Health Assembly should be drawn to the needfor periodic review of the Regulations and for settle-ment of differences arising from their application.The divergence of opinion was on the means by whichthose objects should be achieved. Organizationaland administrative problems were involved. It wasimportant not to prejudge the conclusions of theStanding Committee on Administration and Financeset up by the Executive Board to report on theorganizational structure and efficiency of WHOas a whole, including the operation of expert com-mittees.

The views of his Government expressed in hisinstructions were as follows : While the SouthAfrican Government fully supported the principleof the review of the Regulations and of procedurefor the settlement of disputes, it required thatwherever possible the existing machinery of theOrganization should be used for the purpose. South

Africa was opposed to the establishment of anygroup which might lead to duplication or under-mining of existing structures. Moreover the questionof precedent should not be overlooked, since otherregulations dealing with various subjects wouldbe drawn up.

Therefore, although he entirely supported theprinciples of the majority report, he pleaded forcareful examination before those principles werewritten into the Regulations.

Dr. BARRETT (United Kingdom) was not sure thatthe report of the Expert Committee on InternationalEpidemiology and Quarantine had been taken intoaccount by the working party, but he submitted thatthe Health Assembly and the Executive Board wouldcertainly take the recommendation into considerationwhen the matter came before them.

Dr. VAN DEN BERG felt that the establishment of theproposed international sanitary body would in noway harm the efficiency of the Organization. Hecould not agree that a precedent would be createdbecause the present Regulations differed from anywhich might follow.

Dr. MACLEAN (New Zealand) fully supportedthe United States proposal concerning the need toreview the operation of the Regulations.

He also agreed with the delegation of the UnitedKingdom that the proposed body should be appointedby the Health Assembly under Article 18 of theConstitution of WHO on a semi-permanent basisand that it should not be established under theprovisions of the Regulations.

He questioned the proposed title of " commission "as contrary to established usage.

Mr. STOWMAN, in reply to the delegate of SouthAfrica, explained that the terms of reference of theworking party had been to consider the United Statesproposal to establish an international sanitarycouncil and the French proposal to establish ajudicial body, although he agreed that it would havebeen useful to bear in mind the recommendationsof the Expert Committee on International Epidemio-logy and Quarantine.

The CHAIRMAN summarized the discussion. Twoalternative proposals concerning the body to reviewthe working of the Regulations were before themeeting, namely, that of the delegate of India (seepage 155) to the effect that the appropriate expertcommittee of the World Health Organization should

158 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

perform the functions of a periodic review of theRegulations, and the proposal of the working partyrecommending the establishment of what he wouldcall an " ad hoc committee ".

Decision: The proposal of the delegate of Indiawas adopted by 16 votes to 7.

Article 107 [112]The CHAIRMAN called for observations on the

recommendation of the working party that theproposed international sanitary council shouldexercise the functions specified under paragraph 1 ofArticle 107 for the settlement of disputes, to whichthe proposal of the delegate of India constituted anamendment, namely, that the appropriate expertcommittee of the World Health Organization shouldperform such functions.

Mr. HASELGROVE explained that the minorityreport took the view that no reference should be madeto the settlement of disputes, beyond a statementthat they should be referred to the Director-Generalwho would deal with them as might seem appropriate.The provision for ultimate recourse to the Inter-national Court of Justice should be retained inArticle 107.

Dr. BJØRNSSON submitted, in the name of hisdelegation, the proposal of the Director-General inhis memorandum on Article 107 (see page 152) thatthe words " the competent body of the WorldHealth Organization " should be added to para-graphs 1, 2 and 3 of Article 107.

Mr. HASELGROVE, replying to Dr. RAJA, explainedthat under Article 107 disputes would be settled bythe Director-General either by correspondence, orthrough an ad hoc body or expert committee. TheDirector-General should be left free to settle eachdispute as he thought fit. Paragraph 1 of Article 107might simply state " WHO shall attempt to settlethe question or dispute ".

Dr. RAJA withdrew his amendment in favour ofthe proposal of the United Kingdom delegation.

Dr. BIRAUD, Secretary, replying to Dr. VAN DENBERG, said that up to the present only one inter-national dispute had been submitted to the HealthAssembly, after the Director-General and the ExpertCommittee on International Epidemiology andQuarantine had failed to bring about agreementbetween the parties concerned. The Health Assemblyhad not been able completely to resolve the difference

but on that occasion the parties to the dispute hadnot been bound by any established text. As far asthe Sanitary Regulations were concerned, thesituation would be quite different owing to theexistence of texts formally agreed to by MemberStates.

Dr. BJØRNSSON repeated his proposal to add thewords " the competent body of the World HealthOrganization " (meaning a selected panel of expertsto be consulted by the Director-General in settlingdisputes) to paragraphs 1, 2 and 3 of Article 107.

Mr. HASELGROVE thought the proposal of thedelegate of Norway unnecessary. It was obviousthat the Director-General would have all themachinery of WHO at his disposal.

Decision: The Norwegian proposal was adoptedby 19 votes to 5.

The CHAIRMAN called for comments on whetherthe committee's decisions should be drafted in theform of a series of recommendations to the forth-coming Health Assembly.

Dr. GEAR thought it expedient to submit thecommittee's findings in the form of resolutions tothe Fourth World Health Assembly, bringing outthe important points made by the United Statesdelegation : (1) that there should be continuoussupervision of the Regulations ; (2) that the epidemio-logical aspect of the Regulations should receiveparticular attention.

Decision: It was agreed that appropriate resolu-tions should be drafted for presentation to theFourth World Health Assembly.

3. Consideration of the Draft International SanitaryRegulations

Article 107 [1 12] (continuation)

The committee continued its consideration ofArticle 107, already begun in connexion with thediscussion on the working party's report.

Dr. RAJA questioned the utility of filling in theblank space in paragraph 1, in view of the decisiontaken that existing machinery would be used for thesettlement of disputes.

Miss GUTTERIDGE (United Kingdom) proposedthat paragraph 1 should end after the first clause.On the other hand, the United Kingdom delegation

TWENTY-THIRD MEETING 159

favoured the retention of the reference to the Inter-national Court of Justice in paragraph 3. Somepurely legal question might be involved or anallegation of a breach of international obligationswith which only the International Court of Justiceshould deal.

Replying to the CHAIRMAN, she thought thatparagraph 2 contained a useful provision.

Dr. VAN DEN BERG supported the views of theUnited Kingdom delegation in regard to para-graph 3.

Miss GUTTERIDGE, replying to the suggestion ofDr. RAJA that disputes not resolved under existingprocedure should be referred to the Health Assembly,drew attention to the footnote to the article settingforth the views of the Legal Sub-Committee. It wasevidently not right that a body which had adoptedthe Regulations should be called upon to settledisputes. Moreover, was the Health Assembly, bynature of its size and existing procedure, really anappropriate body for the purpose ?

Dr. JAFAR, referring to the footnote to Article 107,thought it was improper for the Special Committee-under its terms of reference-to offer any sugges-tions to the Health Assembly concerning the specificbody to exercise legislative functions.

Dr. MACLEAN suggested that paragraph 2 shouldbe completed by the words " any body which theDirector-General may consult ".

Referring to the third sentence, of the footnote toArticle 107, he questioned the competence of theInternational Court of Justice in the matter ofquarantine procedure. Any decision given by theInternational Court of Justice would in any case notlead to further action or be likely to receive muchpublicity. He therefore agreed with the view thatdisputes not settled by the Director-General shouldbe referred to the Health Assembly.

The SECRETARY, replying to the request from thedelegate of Pakistan for an explanation of theexisting machinery for settling international disputes,said that, as a first step, mediatory action wasundertaken by the Director-General without recourseto any body resembling a tribunal. It would benoted from the memorandum of the Director-

General on Article 107 that about 95 per cent ofcomplaints and disputes had been thus settled. TheDirector-General could obtain technical advice notonly from officials of the Organization but also,directly or by correspondence, from the membersof the Expert Committee on International Epidemio-logy and Quarantine, or from the various expertadvisory panels of the Organization. Legal advicecould be given by the appropriate members of theSecretariat, or recourse could be had to the legalexperts which had already assisted the ExpertCommittee on International Epidemiology andQuarantine in the drafting of the sanitary regu-lations.

The Director-General would probably wish toincrease the number of legal experts on the appro-priate advisory panel to provide him with advice onthe interpretation of the Regulations, to assist withtheir revision or with the texts of new sets of Regu-lations.

Under its existing terms of reference, the ExpertCommittee on International Epidemiology andQuarantine was competent to prepare the text ofinternational sanitary regulations and to assist in thesettlement of disputes arising out of the InternationalSanitary Conventions in force. Its terms of referencewould have to be extended to cover disputes underthe Regulations.

It would be for the committee to recommendto the Health Assembly the necessary modificationsin the terms of reference of the expert committee.

He recalled that an unsettled dispute had alreadybeen submitted to the Third World Health Assembly.

He stated that the Executive Board had ruledthat the countries concerned had the right to berepresented at meetings of the Expert Committeeon International Epidemiology and Quarantinewhen disputes were under discussion.

Dr. RAJA maintained his earlier view, namely,that " existing machinery " included the HealthAssembly, particularly in view of the desirabilitythat questions should be decided mainly on thetechnical plane.

He agreed with the delegate of Pakistan that itwas not for the Special Committee to give instructionsto the Health Assembly.

Dr. VAN DEN BERG agreed With the delegate of theUnited Kingdom that an administrative body shouldnot be given legislative functions.

160 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

M. GORGÉ (Switzerland), seconded by M. MAS-PÉTIOL (France), proposed that Article 107 shouldbe referred to the Juridical Sub-Committee forconsideration of the deletion or retention of thereference to the International Court of Justice inthe text.

Decision: Article 107 was referred to the JuridicalSub-Committee for consideration in the light of thediscussion.

Article 21 [23] (continuation from page 61)

The CHAIRMAN recalled that discussion on Ar-ticle 21, begun at the seventh meeting, had beendeferred pending a discussion of Article 107.

Dr. RAJA proposed, in the light of the decisiontaken in regard to Article 107, that Article 21 shouldremain unchanged. He recalled the fundamentalpoints he had raised during earlier discussion.

The Special Committee could not ignore theprinciple regarding maximum requirements adoptedby the Expert Committee on International Epidemio-logy and Quarantine at its first session 15 and endorsedby the Second World Health Assembly in resolutionWHA2.15.

Secondly, unless governments freely restrictedtheir sovereign rights by agreeing to certain commonlines of action in respect to particular diseases,it would be difficult to reach agreement on theaction to be taken in the case of governmentsexceeding the measures stipulated in the Regulations.

Mr. BEVANS (United States of America) said thathis delegation's amendments to Article 21 (seepage 62) were designed primarily to avoid reservationsto the Regulations. He believed that the provisionsin the draft submitted by the United States delegationwould serve to control justified measures imposedby a State in certain circumstances. In his opinionthe existing text of Article 107 was inadequate owingto the length of time required for the settlement ofa dispute. An attempt had been made to provide

for practical machinery whereby a State could becalled upon to enlist the help of WHO to solve anyparticular problem. As far as infringement of themaximum measures was concerned, States Membersof WHO should be relied upon not to exceed thescope of their commitments.

Dr. VAN DEN BERG was not prepared to accept anyamendment of Article 21 which, in his opinion, wasthe keystone of the whole of the Regulations.

Mr. HASELGROVE, while in favour of the articleas it stood, thought, however, that the wording ofthe second sentence was not particularly happy andthat the sentence should be deleted.

Dr. DUREN (Belgium) recalled the opinion alreadyexpressed by his delegation (in a note on the UnitedStates proposal), namely, that the procedure proposedwas too complicated and likely to result only insterile inquiry, since any measures taken by a Stateto meet exceptional circumstances would probablyhave been withdrawn before the completion of theinquiry. His delegation agreed with the delegationof the United Kingdom that Article 21 was parti-cularly important and that no additional clauseshould be allowed to annul its provisions and leavethe door open to arbitrary action. The last sentenceof the article, however, should be deleted.

Dr. PADUA (Philippines) supported the UnitedStates proposal.

The CHAIRMAN proposed that Articles 21 and 107should be linked up so as to ensure that if a countryexceeded the maximum provisions laid down,Article 107 would come into force.

Dr. JAFAR disagreed. In his opinion the provisionsof the two Articles should remain quite separate.

Decision: The United States amendment wasrejected by 15 votes to 7. The proposal to deletethe second sentence of Article 21 was unanimouslyadopted.

15 Off. Rec. World Hlth Org. 19, 12 The meeting rose at 12.15 p.m.

TWENTY-FOURTH MEETING 161

TWENTY-FOURTH MEETING

Friday, 27 April 1951, at 9.30 a.m.

Chairman Dr. M. T. MORGAN (United Kingdom)

1. Credentials of the Delegate of Austria

The committee formally approved the credentialsof Dr. Strobl (Austria), examined and found in goodand due form.

2. Consideration of the Draft International SanitaryRegulations

Article 2 [21 (continuation from page 44)

Dr. BIRAUD, Secretary, recalled that some diffi-culties had arisen from the fact that certain rightsinherited by WHO from the Office Internationald'Hygiène Publique and UNRRA concerning thetransmission, by the Organization, of epidemiologicaldata by telegram and telephone had not beenrespected by inclusion in the International Tele-communication Convention of 1947. He hadpresented WHO's case to the Administrative Councilof the International Telecommunication Union. TheCouncil had unanimously agreed (see page 168) torecommend to the Members of the Union that therevised ITU Convention (to be discussed at thePlenipotentiary Conference in Buenos Aires in 1952)

should include specific provisions for urgent epide-miological telegrams and telephone calls fromWHO and accord them the priority treatmentgranted to meteorological communications affectingthe safety of life.

Accordingly he suggested that paragraph 2 ofArticle 2 be amended to refer only to the right(already recognized by ITU) to government privilegesof epidemiological notifications sent to the Organi-zation, and that a third paragraph be added to thearticle to the effect that epidemiological notificationssent, under the Regulations, by telegram or telephone,should be granted the privileges accorded by ITU totelegrams and telephone calls affecting the safetyof human life.

Pending the revision of the ITU Convention of1947, he hoped that some privileges would begranted by governments at the request of the ITUAdministrative Council and that from 1952 onwards

WHO would enjoy the priority referred to on thebasis of the amended ITU Convention.

Mr. HASELGROVE (United Kingdom) expressedthe committee's gratitude to ITU for its willingnessto grant substantial privileges and paid a tribute toDr. Biraud for so ably presenting the case of WHO.He doubted, however, whether the matter was onefor legislation by the Organization, or whether itwas proper for WHO to include any provision inits permanent Regulations on the basis of resolutionsadopted by ITU. Paragraph 2 of Article 2, in hisview, should merely state that telegraphic and tele-phonic communications sent to or from WHOshould be transmitted by the quickest availablemeans.

Replying to a point made by the CHAIRMAN,he said that WHO should be left free to arrangewith ITU the best possible means for the purpose.

The SECRETARY explained that the amendmentshe proposed merely recognized that ITU had a moralengagement in the matter of privileges for epidemio-logical communications. From the psychologicalpoint of view, he submitted that it was useful officiallyto recognize the good intentions of ITU.

M. MASPETIOL (France) considered that the textproposed by the Secretary was not open to thecriticisms raised by the delegate of the UnitedKingdom and agreed that official recognition shouldbe given to facilities offered by another organization.

Mr. STOWMAN (United States of America) believedthat paragraph 2 might be dangerous since it mightraise the question of rates of payment. It was in anycase redundant.

The SECRETARY, replying to a question by Dr. RAJA(India) explained that, while no official pledge couldbe given by the ITU at the present stage concerningthe adoption by its Plenipotentiary Conference of therecommendations of its Administrative Council, he

162 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

believed there could be little doubt as to the outcomeof the discussion in view of the unanimity of thoserecommendations. Moreover the AdministrativeCouncil included representatives of the most im-portant countries of the world from the point of viewof volume of telegraphic communications.

Dr. RAJA agreed with the delegate of the UnitedKingdom. If there were any possibility of the recom-mendation of the Administrative Council of the ITUbeing modified, paragraph 2 would best be draftedas suggested by the delegate of the United Kingdom ;further negotiations should be left to WHO andITU, and the final decision communicated togovernments.

The SECRETARY said that he would not press forthe inclusion of his suggestion. He repeated thatITU had pledged themselves to the fullest possibleextent pending the Plenipotentiary Conference in1952, and no further negotiation was necessary.

The CHAIRMAN put to the vote the United Kingdomproposal ; namely, that paragraph 2 should bedeleted and replaced by : " Any such notification orinformation received or sent by the Organizationby telegram or telephone shall be dispatched by themost rapid means possible ".

Decision: The United Kingdom proposal wasadopted by 12 votes to 3, and Article 2 referredto the Drafting Sub-Committee.

The SECRETARY hoped that the Secretariat wouldnot be obliged to interpret the text adopted asimplying that all epidemiological data should bedispatched by means of priority telegrams. Obviouslyuntil ITU had granted special treatment in thatconnexion, WHO was obliged to continue to dispatchpriority material at the normal rate, namely threetimes as high as the ordinary tariff.

3. Report of the Juridical Sub-Committee on Article8 of Annex B and Article 4 of Annex A

Article 8 [B 8]The SECRETARY read the amended text of Article 8

proposed by the Juridical Sub-Committee in itsreport (see page 280).

Mr. HASELGROVE said that Article 8 as rewordedshould be omitted, since Annex B referred tominimum standards of hygiene in regard to thepilgrimage. There should be no provision in Annex Bwhich would seem to nullify those minimumstandards. It was perfectly clear that a State, in so far

as its jurisdiction extended, could impose suchadditional requirements as it thought fit.

M. MASPÉTIOL explained the reasons for thewording suggested by the Juridical Sub-Committee.

Owing to the fact that by virtue of Article 21 themajority of the provisions in the Regulations coveredmaximum measures, it seemed necessary to statethat such was not the case for Articles 2 to 7 ofAnnex B. The very fact that some doubt on thepoint had been expressed in the Juridical Sub-Committee proved the need for clearly stating thatArticles 2 to 7 referred to minimum measures.Accordingly, he considered that the text should becompleted as proposed by the Juridical Sub-Com-mittee. Indeed, under the terms of Article 8 (as itappeared in the Report of the Sub-Committee onthe Mecca Pilgrimage-see page 274), a State mightbe able to discriminate between ships of variousnationalities as regards the requirements it imposedupon them. In order to avoid such discriminatoryaction the Juridical Sub-Committee, althoughagreeing on the need for a definite statement thatArticles 2 to 7 were minimum measures, hadsubmitted the wording for Article 8 proposed in itsreport.

Dr. MACLEAN (New Zealand) believed that thepurpose of the article-to permit better hygienicstandards on pilgrim ships-would be better achievedby an addition to Article 21 making it clear that therequirements in Articles 2 to 7 of Annex B wereminimum requirements.

The CHAIRMAN said it was essential to make itquite clear that only articles 2 to 7 were minima andnot the whole of the articles in Annex B.

Mr. HASELGROVE said his proposal was exactlythat of the delegate of New Zealand, namely, thatArticle 21 should make it clear that Articles 2 to7 of Annex B referred to minimum and not maximumrequirements.

Decision: The United Kingdom proposal wasadopted by 12 votes to 2 and Article 21 referredto the Drafting Sub-Committee.

Article 4 [A 4]The SECRETARY read the proposals of the Juridical

Sub-Committee (see page 280).

Mr. KHANACHET (Saudi Arabia), recalling hisearlier statement that the Government of SaudiArabia had no intention of exceeding the provisions

TWENTY-FOURTH MEETING 163

either of the Regulations or of their annexes,suggested adding to the amendment he had proposedat the twenty-first meeting (see page 142) a statementto the effect that the measures would be applied" within the limits stipulated in the Regulations ".

Dr. RAJA feared that addition of such a clausemight give Saudi Arabia the right not to complywith mandatory provisions.

Dr. JAFAR (Pakistan) suggested that the JuridicalSub-Committee should be requested to give anopinion on the need for the proposed addition. Inhis opinion, the point was already covered and thearticle should remain as drafted.

The CHAIRMAN proposed an alternative wording :" in conformity with these Regulations ".

M. MASPETIOL, said that, legally, under the firstamendment (" within the limits stipulated in theRegulations "), Saudi Arabia could not be requiredto apply the whole of the mandatory provisions.On the other hand, the second amendment (" inconformity with these Regulations ") served no usefulpurpose. The first formula was dangerous, the seconduseless.

Mr. KHANACHET, replying to the delegate of India,said that until WHO had machinery at its disposalfor the effective control of the application of theRegulations, countries should be trusted to apply themeasures laid down. Saudi Arabia, for its part, wasprepared loyally to implement the Regulationsafter signature thereof.

Replying to the delegate of France, he failed tosee why the stipulation requested on behalf of SaudiArabia should not be accorded. His Government wasnot askiiig for concessions, but simply for the possi-bility of taking action--should the need arise-con-sidered necessary for the protection of its ownterritory and in the interest of those countries fromwhich vast numbers of pilgrims came each year.

He was prepared to accept the alternative wordingproposed by the Chairman so that his amendmentwould read : " The Saudi Arabian Governmentshall decide the quarantine measures to be appliedto pilgrims disembarking on its territory, in con-formity with these Regulations ".

Decisions :

(1) The amendment of the delegation of SaudiArabia was adopted by 12 votes to 3.

(2) Article 96 was referred to the Drafting Sub-Committee for amendment as proposed by theJuridical Sub-Committee in its report.

4. Review of Certain Articles amended by the SpecialCommittee : Cholera

The CHAIRMAN opened the discussion on theamended text of certain articles as prepared by theDrafting Sub-Committee on the basis of the directivesof the Special Committee.

Article 54 [61]

The text prepared by the Drafting Sub-Committeeread :

I. The possession of a valid certificate of vaccina-tion against cholera shall be taken into conside-ration by health authorities in applying themeasures provided for in these Regulations.

2. Until the Organization has adopted regulationsconcerning standards for anticholera vaccines thestandards in force in the countries where thevaccine is administered shall be accepted.

3. The health authority for a local area which isnot infected may, in the case of a person whoarrives there within the incubation period on aninternational journey from an infected local area,impose the following measures :

(a) if he is in possession of a valid certificate ofvaccination against cholera, he may be placedunder surveillance for a period not exceedingfive days from the date of his departure from theinfected local area ;

(b) if he is not in possession of such a certificate,he may be placed in isolation for a like period.

4. A person who is unwilling to submit to themeasures provided in paragraph 3 of this Articlemay be refused admission to a territory but heshall not be prevented from continuing his journeyunder the conditions specified in Article 29.

5. Subject to sub-paragraph (a) of paragraph 1 ofArticle 56, the health authority for an infected localarea shall not require a person arriving thereon an international journey to produce a certificateof vaccination against cholera.

Mr. KHANACHET proposed that the word " sur-veillance " in paragraph 3 (a) should be replaced by" isolation ".

164 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. RAJA considered that, although isolation mightbe enforced as a special measure in connexion withthe pilgrimage, the right to impose such a measureshould not apply to international traffic as a whole.

Dr. JAFAR supported the inclusion of such ameasure in Annex A.

The CHAIRMAN ruled out of order any proposalregarding Annex A, on which a decision had alreadybeen taken.

He noted that nothing similar to the provisionsof paragraph 4 of Article 54, which empoweredhealth authorities to refuse admission to a territoryto a person who refused to submit to surveillance orisolation, had existed previously in internationalconventions relating to quarantine.

In reply to a question put by the delegate of Egypthe said that the validity of a vaccination certificatewas governed by the date of vaccination.

Dr. DE TAVEL (International Civil Aviation Organi-zation) referring to the Chairman's remarks onparagraph 4, said that if a person's state of health wassuch as to justify refusing him admission to a territory,his presence in the confined space of an aircraft wouldbe equally undesirable ; and yet, if the territoryof destination refused to receive him, the airline bywhich he travelled might be required to return himwhence he came.

Dr. MACLEAN thought that, as paragraph 4introduced an entirely new concept, and in view ofthe difficulty pointed out by the representative ofICAO, it might be best to delete the paragraph andto insert at the beginning of paragraph 3 the words" Subject to the conditions laid down in Article 29 ".

The CHAIRMAN observed that Article 29, whetherreferred to or not, would apply in the present case,as to many other articles.

Dr. MACLEAN had suggested the reference onlyin order to make the meaning of the article clearerto a local quarantine officer.

Mr. HASELGROVE agreed that paragraph 4 couldbe deleted and noted that the difficulty raised by therepresentative of ICAO would apply also to vessels.As to the suggestion of the delegate of New Zealand,there was always a difficulty that a reference in oneparticular place to an article raised doubts as to itsgeneral applicability.

Dr. PADUA (Philippines), supported by the dele-gations of Egypt and Saudi Arabia, proposed that thewords " or in isolation " be inserted after the word" surveillance " in paragraph 3 (a).

Dr. RAJA thought that the insertion of such aprovision, admissible in his opinion in the case ofdraft Annex A but ruled out of order, would be quiteunjustifiable in the case of an article dealing withinternational traffic in general.

Decisions:

(1) The proposal of the delegate of the Philip-pines was rejected by 11 votes to 4.(2) It was agreed by 17 votes to 6 to deleteparagraph 4.

Mr. STOWMAN observed that the provisions ofparagraph 5 would make it impossible for the healthauthority of an area where two cases of cholerahad occurred to require persons arriving to producecertificates of vaccination.

After some discussion, he proposed that the para-graph be deleted.

Decision: The proposal was adopted by 22 votesto 1.

Dr. MACLEAN pointed out that the difficulty towhich the United States delegation had calledattention also arose in connexion with paragraph 3.He therefore proposed the deletion of the words" which is not infected ".

Decision: The proposal was adopted unanimouslyand Article 54 was remitted to the Drafting Sub-Committee.

Article 55 [62]

The text prepared by the Drafting Sub-Çommitteeread :

1. A ship shall be regarded as infected if it hasa case of cholera on board or if a case of cholerahas occurred on board during a period of fivedays before arrival.2. A ship shall be regarded as suspected if acase of cholera has occurred on board during thevoyage, but a fresh case has not occurred duringa period of five days before arrival.3. An aircraft shall be regarded as infected if ithas a case of cholera on board. It shall be regardedas suspected if a case of cholera has occurred onboard during the voyage but has previouslybeen disembarked.

TWENTY-FOURTH MEETING 165

4. Even when coming from an infected local areaor having on board a person coming from aninfected local area, a ship or an aircraft shall beregarded as healthy if, on medical examination,the health authority is satisfied that no case ofcholera has occurred on board during the voyage.

Dr. LENTJES (Netherlands) proposed that the words" the last ten days of " be inserted after the word" during " in paragraph 2.

Dr. EL-HALAWANI (Egypt) thought the originaltext preferable.

Decisions:(1) The Netherlands proposal was adopted by17 votes to 2.(2) Article 55 was remitted to the Drafting Sub-Committee.

Article 56 [63]

The text prepared by the Drafting Sub-Committeeread :

1. On arrival of an infected ship or aircraft, thefollowing measures may be applied by the healthauthority :

(a) for a period of not more than five days,reckoned from the date of arrival, surveillanceof any passenger or member of the crew whoproduces a valid certificate of vaccinationagainst cholera, and isolation of all others ;(b) disinfection of

(i) any baggage of any infected person orsuspect ;(ii) any other article, such as used beddingor linen and any part of the ship or aircraft,which may be contaminated ;

(c) disinfection and removal of any watercarried on board that may be contaminated anddisinfection of the containers, which shall thenbe refilled with wholesome water.

2. Human dejecta, waste water including bilge-water, waste matter, and any other contaminatedsubstance shall not be discharged or unloadedwithout previous disinfection. Their safe disposalshall be the responsibility of the health authority.

Dr. DUREN (Belgium) thought that the meaningof paragraph 1 (c) in the French text was not entirelyclear as it suggested that the containers had to berefilled with water at the time of disinfection. Perhapsthe word " ensuite " should be inserted. In the

last sentence of paragraph 2 the words " bonneexécution de ces mesures " would be preferable to" toute évacuation de cette nature ".

The CHAIRMAN agreed that if the second suggestionof the delegate of Belgium was adopted the Frenchand English texts would accord better. With regardto the first suggestion, since it was presumably notintended that there should be any compulsion torefill the containers, but merely that, if they wererefilled, it should be with wholesome water, hesuggested that the word " shall " be replaced by" may ".

Dr. RAJA proposed that the word " other " in thesecond line of paragraph 2 be deleted since itsuggested that dejecta of healthy persons, forexample, were contaminated.

The CHAIRMAN thought that the words " onboard who wished to disembark " should be insert edat the end of sub-paragraph 1 (a) to make it clearthat persons wishing to stay on board were not to beisolated.

Mr. HASELGROVE suggested that the point raised bythe Chairman might be better met by substitutingthe word " disembarkation " for " arrival ", somaking it clear that the whole sub-paragraphconcerned only persons who wished to disembark.

Decision: Article 56 was remitted to the DraftingSub-Committee.

Article 57 [64]

The text prepared by the Drafting Sub-Committeeread :

1. The measures provided under sub-para-graphs (b) and (c) of paragraph 1 and underparagraph 2 of Article 56 may be applied to asuspected ship or aircraft.2. In addition, without prejudice to the measuresprovided by sub-paragraph (b) of paragraph 3and paragraph 4 of Article 54, any passenger ormember of the crew may be placed under sur-veillance for a period of not more than five daysreckoned from the date of arrival.

The SECRETARY pointed out that since paragraph 4of Article 54 had been deleted, the reference theretoshould also be removed.

Mr. HASELGROVE noted that since paragraph 2 ofArticle 57, like sub-paragraph I (a) of Article 56,should be applicable only to persons not remainingon board, the words " any passenger or member

166 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

of the crew " should be replaced by " any persondisembarking ".

Decision: Article 57 was remitted to the DraftingSub-Committee.

Article 58 [65]The text prepared by the Drafting Sub-Committee

read :A ship or an aircraft shall cease to be regarded

as infected or suspected when the measures requiredby the health authority in accordance withArticle 33 and Articles 56 and 57 respectively havebeen effectively carried out. The ship or aircraftshall thereupon be given free pratique.Decision: The article was adopted withoutcomment.

Article 59 [66]The text prepared by the Drafting Sub-Committee

read :On arrival, a healthy ship or aircraft shall be

given free pratique but, if it comes from an infectedlocal area, the health authority may apply topassengers and members of the crew the measuresprovided for in Article 54.

Mr. HASELGROVE observed that his remark onArticle 57 applied also to Article 59.

Decision: Article 59 was remitted to the DraftingSub-Committee.

Article 60 [67]The text prepared by the Drafting Sub-Committee

read :If, on arrival of a train or a road vehicle, a case

of cholera is discovered, the following measuresmay be applied by the health authority :

(a) without prejudice to the measures providedby sub-paragraph (b) of paragraph 3 and para-graph 4 of Article 54, surveillance of anysuspect for a period of not more than five daysreckoned from the date of his arrival ;(b) disinfection of

(i) any baggage of the infected person andif necessary of any suspect ;(ii) any other articles such as used beddingor linen and any part of the carriage or othervehicles which may be contaminated.

The SECRETARY noted that the reference to para-graph 4 of Article 54 should be deleted.

The CHAIRMAN noted that there was no point inusing the word " carriage " rather than " train "in sub-paragraph (b) (ii).

Decision: Article 60 was remitted to the DraftingS ub-Committee.

Article 61 [68]The text prepared by the Drafting Sub-Committee

read :1. On arrival of an infected or suspected ship oraircraft, of a train or a road vehicle on which a caseof cholera has been discovered, or of a vessel,aircraft, train, or road vehicle coming from aninfected local area, the health authority mayprohibit the unloading of, or may remove, anyfish, shellfish, fruit or vegetables to be consumeduncooked, or beverages which are not completelyprotected from contamination or which the healthauthority has reason to believe are contaminated.If such food is removed, arrangements shall bemade for its safe disposal.2. If such food forms part of the cargo in a hold ofa ship or a freight compartment of an aircraft,the health authority for the port or airport atwhich such food is unloaded only may exercisethe power to remove it.3. The pilot in command of an aircraft mayalways require the removal of such food.

The CHAIRMAN recalled that an amendmentproposed by the delegation of the United Statesto Article 61 had been adopted. He wonderedwhether the United States delegation was satisfiedwith the new text which the Drafting Sub-Committeehad produced.

In reply to a question put by the United Kingdomdelegation, he recalled that the words " in a holdof a ship or a freight compartment of an aircraft "had been inserted because, as the delegate of Indiahad remarked, deck cargo, for example, might beaccessible to passengers.

Dr. MACLEAN, referring to paragraph 1, believedthat the original United States amendment hadreferred to sealed containers. It might be betterto retain that reference since the present wordingmight leave the way open to disputes as to themeaning of " completely protected from contami-nation ".

After some discussion, Mr. STOWMAN suggestedthat the words " or beverages which are not com-pletely protected from contamination or which thehealth authority has reason to believe are contami-

TWENTY-FOURTH MEETING 167

nated " be replaced by " unless such foods orbeverages are in sealed containers and the healthauthority has no reason to believe them contami-nated ".

Decision: The wording suggested by the delegate ofthe United States of America was adopted.

Article 62 [69]The text prepared by the Drafting Sub-Committee

read :

1. A person without clinical symptoms of choleraarriving on an international journey from aninfected local area shall not be required to submitto stool examination or rectal swabbing.2. A person presenting clinical symptoms ofcholera and arriving on an international journeyfrom an infected local area within the incubationperiod of the disease may be required to submitto stool examination.

Professor ALIVISATOS (Greece) thought that thetext of paragraph 2, for reasons which he hadalready put before the committee, provided insuf-ficiently for protection against cholera infection ; hetherefore proposed its replacement by the followingtext : "A person presenting clinical symptomssuspected of being those of cholera and arriving froman infected local area within the incubation periodof the disease provided under Article 53 may berequired to submit to stool examination ".

Dr. EL- HALAWANI, while disliking Article 62 asa whole, particularly objected to the word " clinical ",which he thought suggested bedridden cases andtherefore excluded all provision for ambulatorycases.

Dr. RAJA thought that the whole question of theimportance of the cholera carrier and its implicationswith regard to stool examinations had been discussedto exhaustion and that the decisions of the committeecould not be reversed. He saw, however, no specialobjection to removing the word " clinical ".

Dr. BELL (United States of America) fully agreedwith the delegate of India and recalled that hisamendment to Article 62, which had been adopted,had not, as he had himself worded it, included theword " clinical ".

The CHAIRMAN thought that full satisfaction couldbe given to the delegate of Greece and partialsatisfaction to the delegate of Egypt by employingthe words " symptoms indicative of cholera " inplace of " clinical symptoms of cholera ". That

form of words had been employed in an earlier draftbut had been removed by the Drafting Sub-Com-mittee, which had been unable to find a satisfactoryFrench equivalent for " indicative ". He was surethat such an equivalent would be found.

A proposal by Dr. DAENGSVANG (Thailand) todelete the words " within the incubation period ofthe disease " in paragraph 2 was rejected.

Decision : The Chairman's suggestion was adoptedand Article 62 was remitted to the Drafting Sub-Co mmittee.

The meeting rose at 12 noon

Appendix [A3-4/SR/50]26 April 1951

PRIVILEGES OF EPIDEMI OLOGICAL TELEGRAMS ANDTELEPHONE C OMMUNICATI ONS IN INTERNATIONAL

TRAFFIC

The following resolutions were adopted by theAdministrative Council of the International Telecom-munication Union at the plenary meeting on 23 April1951 :

226. International Epidemiological Telegrams of theWorld Health Organization

The Administrative Council

considering

1. that the International Telecommunication Con-vention of Atlantic City 1947, and the Telegraph andRadio Regulations annexed thereto, make noprovision for priority treatment of internationalepidemiological telegrams of the World HealthOrganization ;2. that WHO is preparing International SanitaryRegulations, which will eventually replace existingInternational Sanitary Conventions, which latter con-tain provisions granting to epidemiological telegramsthe priority enjoyed by Government telegrams ;

desirous

1. of avoiding any conflict between the Conventionand Regulations of the International Telecommuni-cation Union, on the one hand, and the proposedInternational Sanitary Regulations of WHO, on theother hand ;2. that measures be taken to facilitate the mostexpeditious possible treatment of epidemiologicaltelegrams of exceptional urgency affecting the safetyof life ;

168 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

urges all Members of the Union1. to grant to epidemiological telegrams of excep-tional urgency affecting the safety of life, sent by theheadquarters of WHO or by the regional offices ofthat Organization, the same treatment as they accordto communications concerning safety of life at seaor in the air, in virtue of Article 45 of the InternationalTelecommunication Convention of Atlantic City andof Articles 35 and 40 of the Telegraph Regulationsannexed thereto ; and to this end, to give instructionsto their offices that such treatment be accorded totelegrams sent by the regional offices of WHO or bythe headquarters of that Organization, which arecertified by the sender as being communications ofexceptional urgency concerning safety of life ;

2. to approach the private operating agenciesrecognized by them, with a view to ensuring, so faras possible, that these agencies grant to the telegramsin question the treatment provided in paragraph 1above ;

requests the Secretary GeneralI. to communicate this resolution to all Membersof the Union and to WHO forthwith ;

2. to communicate to WHO in due course anyobservations on the matter which he may receive fromMembers of the Union.

227. International Epidemiological Telephone Con-versations of the World Health Organization

The Administrative Council

considering

I. that the International Telecommunication Con-vention of Atlantic City 1947, and the TelephoneRegulations annexed thereto make no provisionfor priority treatment of international epidemio-logical telephone conversations of the World HealthOrganization ;

2. that WHO is preparing International SanitaryRegulations, which will eventually replace existingInternational Sanitary Conventions, and proposedto introduce into these new Regulations provisions

relative to telephone conversations with a view toobtaining priority in cases of exceptional urgencyaffecting safety of life ;

desirous

1. of avoiding any conflict between the InternationalTelecommunication Convention and the TelephoneRegulations annexed thereto, on the one hand, andthe proposed International Sanitary Regulations ofWHO, on the other hand ;2. that measures be taken in order that the treat-ment applied to epidemiological telephone con-versations of exceptional urgency affecting the safetyof life may be the most expeditious ;

urges all Members of the Union1. to grant to epidemiological telephone calls ofexceptional urgency affecting the safety of life, madeby the Headquarters of WHO or by the regionaloffices of that Organization, the same treatment asthey accord to distress calls in virtue of Article 45of the International Telecommunication Convention ;2. to approach the private operating agenciesrecognized by them, with a view to ensuring, so far aspossible, that these agencies grant to the telephoneconversations in question the treatment providedin paragraph 1 above ;

invites

WHO to specify the cases in which internationalepidemiological telephone conversations of excep-tional urgency are necessary ;

requests

the CCIF to study urgently the best means ofmeeting the wishes of WHO so that the XVIth PlenaryAssembly of the CCIF, in October 1951, may issuea recommendation on the subject and modifyaccordingly the Instructions to Operators of theInternational Telephone Service of the EuropeanSystem ;

instructs

the Secretary-General to communicate this reso-lution to all Members of the Union and to WHOforthwith.

TWENTY-FIFTH MEETING 169

TWENTY-FIFTH MEETING

Friday, 27 April 1951, at 2 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Credentials of the Delegate of Iceland

The committee formally accepted (without con-vening a meeting with the Sub-Committee onCredentials) the credentials of Dr. Sigurjónsson(Iceland) which had been examined and found ingood order.

2. Review of Certain Articles amended by the SpecialCommittee : Smallpox

In reply to a question by Dr. JAFAR (Pakistan)the CHAIRMAN explained that in view of the com-plexity of the discussions that had taken place onChapter IV-Smallpox, the committee had asked theDirector-General to submit a revised draft of someof the articles, in accordance with the decisions taken,for reconsideration before reference to the DraftingSub-Committee. He would allow as much discretionas possible with regard to reconsideration of thearticles, but felt that discussion could not be reopenedon points on which a decision had been reachedby vote.

Article 74 [82]

The CHAIRMAN said that no change had beenmade in the English text. In the French text, however,it was proposed to say " est fixée à quatorze jours "instead of " est de quatorze jours ". If there were noobjections he suggested that the same amendmentshould be made throughout the Regulations.

Decision: In the absence of objection the amend-ment to the French text of Article 74 was adopted.

Article 75 [83]

The text prepared at the request of the committeeread :

1. A person on an international journey whoarrives from a local area which is not an infectedlocal area may be required on arrival to producea certificate of vaccination against smallpox ;in the absence of such a certificate this person maybe subjected to surveillance unless he prefers

vaccination and the immediate granting of acertificate.

2. A person on such a journey who has left aninfected local area within the previous fourteendays and who, in the opinion of the health authorityis not sufficiently protected by vaccination or bya previous attack of smallpox may be required onarrival to submit at the discretion of the healthauthority to vaccination against smallpox, or tosurveillance, or to vaccination followed by sur-veillance ; a person refusing vaccination may beisolated.

3. The period of isolation or surveillance shallnot exceed fourteen days reckoned from the dateof departure of the person from the infected localarea.

The CHAIRMAN asked the delegate of the UnitedStates to raise any points of substance on whichthe draft proposed by his delegation for the articlesunder consideration differed from the text submittedby the Director-General. Differences of draftingcould be referred to the Drafting Sub-Committee.

Dr. HEMMES (Netherlands), proposing that para-graph 1 should be deleted, said that his delegationconsidered that a traveller should not be submittedto surveillance unless on arrival he was held to bea danger to others. Moreover, vaccination andsurveillance of travellers coming from a non-infected local area were contrary to the fundamentalprinciples of the Regulations indicated in thePreamble.

Dr. BELL (United States of America) said that theproposals of the United States delegation regardingparagraph 1 were covered by the revised text.

The CHAIRMAN thought the text would be sim-plified if it read " this person may be subjected tovaccination or to surveillance " instead of " thisperson may be subjected to surveillance unless heprefers vaccination and the immediate grantingof a certificate ".

170 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Mr. HASELGROVE (United Kingdom) thoughtthat the proposal just made changed the meaning.The intention of the paragraph was to give thetraveller the choice between vaccination and sur-veillance.

Dr. RAJA (India) considered it inconsistent withthe principles of the Regulations that the treatment,under paragraph 1, of a person coming from a non-infected local area was almost identical with that ofa person who came from an infected area.

The CHAIRMAN ruled that as a definite decisionhad been taken on the first part of paragraph 1discussion could not be reopened. The drafting ofthe second part might not be clear and was open forimprovement.

Dr. RAJA said that his point, which was of funda-mental importance, was not met by the words " aperson refusing vaccination may be isolated " atthe end of paragraph 2. He felt that as a responsiblebody the Special Committee should not lay down ininternational regulations provisions that lackedconsistency.

Dr. MACLEAN (New Zealand) suggested deletingthe words " unless he prefers vaccination and theimmediate granting of a certificate ".

Dr. HEMMES formally proposed reopening of thediscussion on the first part of paragraph 1.

Decision: The proposal to reopen the discussionon the first part of Article 75, paragraph 1, wasrejected by 16 votes to 12.

The CHAIRMAN put to the vote the proposal of thedelegate of New Zealand that the words " unlesshe prefers vaccination and the immediate granting ofa certificate " should be deleted.

Decision: The proposal was rejected by 14 votesto 8.

Dr. MALAN (Italy) requested that the words" who is not in possession of a valid certificate ofvaccination " be inserted after " fourteen days "in paragraph 2.

Dr. BELL thought that the proposal was contraryto the intention of paragraph 2 since it would pre-clude measures in the case of a person vaccinatedonly the day before arrival. He reminded the com-mittee that the certificate of vaccination againstsmallpox, as adopted, was valid from the date ofvaccination even though the person did not developimmunity until some days later.

Dr. RAJA thought the objection would be met bystating " A person on such a journey who has leftan infected local area within the previous fourteendays who has not been vaccinated against smallpox,or a person who in the opinion of the healthauthority... "

Dr. BELL thought that the suggested wordingwould still preclude any action, at the discretionof the health authority, when a person had a validcertificate, even though he might not becomeimmune until some days later.

The CHAIRMAN suggested " and who, even thoughin possession of a valid certificate of vaccination,is not, in the opinion of the health authority... "

Dr. RAJA felt obliged to raise again the question ofvalidity of the certificate because he felt stronglythat the Special Committee should not allow glaringinconsistencies to appear in the Regulations. Theprovision on the certificate that it became valid onthe day of vaccination could not be justified scienti-fically. The whole purpose of vaccination was toensure that a person possessed a sufficient amount ofimmunity, and in the case of primary vaccinationat least it was absolutely necessary that some periodshould elapse between the date of vaccination andthe date when immunity was considered to havebeen acquired. The Special Committee had adoptedthat principle in the case of cholera and yellow-fever and it would hardly be to its credit to ignore itin the case of smallpox.

Dr. JAFAR (Pakistan) agreeing with the delegatefor India, said he was opposed to the inclusion of theword " valid " in the certificate of vaccination againstsmallpox. The Special Committee had throughoutdescribed a certificate as valid when the personvaccinated was judged to have acquired sufficientimmunity, but in the case of the smallpox certificatethe word " valid " would be used in a differentsense.

Decision: After a further exchange of views it wasdecided by 13 votes to 8 to eliminate the word" valid " in the certificate of vaccination againstsmallpox.

Dr. BELL suggested that in view of the decisionjust taken it would be necessary to state on thecertificate that it expired three years after the lastvaccination.

Decision: Paragraphs 2 and 3 of the revised textwere adopted.

TWENTY-FIFTH MEETING 171

Article 76 [84]The text prepared at the request of the committee

read :

1. A ship or an aircraft shall be regarded asinfected if it has a case of smallpox on board.2. A ship shall be regarded as suspected if acase has occurred on board within the last 28 daysof the voyage, unless appropriate measures havebeen taken.3. Any other vessel or aircraft shall be regardedas healthy.

It was agreed to defer consideration of Article 76pending the decision on Article 77. (For continuationsee below.)

Article 77 [85]The text prepared at the request of the committee

read :

1. On arrival of an infected ship or aircraft or ofa suspected ship, the following measures may betaken by the health authority :

(a) vaccination or surveillance or vaccinationfollowed by surveillance or, in exceptionalcircumstances, vaccination followed by isolationfor a period not exceeding fourteen days fromthe date of disembarkation of any person whois a suspect and who in the opinion of the healthauthority is not sufficiently protected by vacci-nation or by a previous attack of smallpox ;(b) a person refusing vaccination may beisolated for a period not to exceed fourteendays reckoned from the last date of possiblecontamination ;(c) disinfection of any baggage of any infectedperson or suspect as well as of any other article,such as bedding which has been used and soiledlinen, and of any part of the ship or aircraft,which may be contaminated.

2. A ship or an aircraft shall cease to be regardedas infected when the provisions of Article 33 andthe measures ordered by the health authority inaccordance with paragraph 1 of this article havebeen carried out ; it shall continue to be regardedas suspected until 28 days have elapsed since themeasures specified in paragraph 1 of this articlehave been carried out ; it shall thereupon begiven free pratique. While suspected, a ship maybe given restricted pratique subject to the isolationof passengers on board.

As an alternative to " the isolation of passengerson board " the Director-General suggested " pas-

sengers on board being prevented from disem-barking ".

Mr. HASELGROVE (United Kingdom) referring toparagraph 2 of Article 77 proposed that the words" it shall thereupon be given free pratique " shouldfollow the first clause and that the rest of the sentenceshould be corrected to read : " on arrival at asubsequent port it may continue to be regarded assuspected until 28 days have elapsed from theoccurrence of the last case ".

Dr. MACLEAN considered the last part of para-graph 2 too far-reaching. The situation was coveredby Article 35 which allowed the health authorityto take action in the event of a subsequent incidentof epidemiological significance. Moreover, para-graph 2 was in direct conflict with paragraph 2Article 76. He proposed the deletion of the words" it shall continue. . . have been carried out ".

Dr. JAFAR supported the proposal and Mr. HASEL-GROVE withdrew his proposal in favour of that ofthe delegate of New Zealand.

Decision: The proposal of the delegate of NewZealand was adopted unanimously.

Mr. HASELGROVE suggested, as a consequence ofthe decision thus taken, the deletion of the secondsentence of paragraph 2.

Decision: It was so agreed. The revised text ofArticle 77 was adopted subject to the aboveamendments.

Article 76 [84] (continuation)Dr. BELL, seconded by Dr. RAJA, said that under

paragraph 1 of Article 76 as drafted, if a person diedfrom smallpox on board and his body was thrownoverboard, the ship would no longer be infected.He proposed adding the words " and it remainsinfected until the measures provided in Article 77have been effectively carried out ".

Dr. MACLEAN considered the addition unnecessary,because in the case described the ship would becomesuspected under the provisions of paragraph 2 ofArticle 76 so that the measures prescribed in para-graph 1 of Article 77 would apply.

The CHAIRMAN considered that a ship wouldcontinue to be regarded as infected in the casedescribed by the delegate of the United States untilthe cabin, baggage and material used had beendisinfected. He suggested adding to paragraph 1 ofArticle 76 " or if it has had a case on board, until

172 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

the necessary measures described in Article 77have been carried out ".

In reply to a question by Dr. JAFAR, the CHAIRMANsaid that the deletion of the second sentence inparagraph 2 of Article 77 would have no effect onArticle 76.

He thought Article 76 would be clearer if thesecond paragraph read " A ship shall be regardedas suspected for a period of 14 days following disposalof a case on board provided the appropriate measuresdescribed in paragraph 1 of Article 77 have beentaken ".

Dr. MACLEAN suggested " A ship shall be regardedas suspected if the health authority has reason tobelieve that infection arising from a case on boardstill persists ".

Dr. BELL suggested the following wording forArticles 76 and 77 (phrases amended or added arein italics ; those deleted are in square brackets):

Article 76 [84]

1. A ship or an aircraft shall be regarded asinfected if it has a case of smallpox on board.

Such a vessel remains infected until the appropriatemeasures described in paragraph 1 of Article 77have been effectively carried out.2. A vessel or aircraft may be regarded as suspectedwhen it carries persons who are suspects.

3. Any other vessel or aircraft shall be regardedas healthy.

Article 77 [85]

1. On arrival of an infected ship or aircraft [orof a suspected ship], the following measures maybe taken by the health authority :(a) vaccination or surveillance or vaccinationfollowed by surveillance or, in exceptional cir-cumstances, vaccination followed by isolation fora period not exceeding fourteen days from thedate of disembarkation of any person who is asuspect and who in the opinion of the healthauthority is not sufficiently protected by vaccina-tion or by a previous attack of smallpox ;(b) a person refusing vaccination may be isolatedfor a period not to exceed fourteen days reckonedfrom the last date of possible contamination.(c) disinfection of any baggage of any infectedperson or suspect as well as of any other article,such as bedding which has been used and soiledlinen, and of any part of the ship or aircraft, whichmay be contaminated.

2. Upon arrival of a suspected ship the measuresprovided in paragraph 1 (a) may be carried out.3. A ship or an aircraft shall cease to be regardedas infected when the provisions of Article 33and the measures ordered by the health authorityin accordance with paragraph 1 of this Articlehave been carried out ; it shall thereupon be givenfree pratique.

Dr. MACLEAN, while agreeing with the proposalof the delegate of the United States as regardsArticle 76, was opposed to the suggested amendmentof Article 77 on the grounds that it would precludeisolation of persons suspected of having beenrecently exposed to infection and who refusedvaccination. Moreover there might be suspectedbaggage or bedding on board that had been usedby a passenger who had died the day before arrivalof the ship.

Dr. BELL explained that the first point raised bythe delegate of New Zealand was covered by para-graph 1 (b), which it was not proposed to change.As regards the second point, by reason of thedefinition of a suspected ship contained in Article 76,the ship would in such a case be regarded as suspectedand would be disinfected.

Dr. RAJA urged that paragraph 1 of Article 76should clearly cover the case of continuing infectionresulting from the first case of smallpox. He proposedadding words to the following effect : " If a case ofsmallpox has died or recovered, the ship shall beconsidered free from infection only after the measuresindicated in Article 77 have been carried out ".

The CHAIRMAN, with the agreement of Dr. BELL,thought the point would be met by replacing thewords " if it has " in the first sentence of paragraph 1,by " if there is or has been ".

After a further exchange of views on the point,during which Dr. BJØRNSSON (Norway) drew atten-tion to Article 35, the CHAIRMAN asked the delegateof India to accept the text proposed by the delegationof the United States, as amended, on the understand-ing that if he was not satisfied with the final draftwhen circulated, the discussion could be reopened.

Decisions :

(1) On the proposal of Dr. JAFAR it was agreedthat the words " or suspected " should be addedafter " infected " in paragraph 3 of Article 77as amended by the delegation of the UnitedStates.(2) As thus amended, the United States proposalfor Articles 76 and 77 was accepted, subject toa further reading after circulation of the text.

TWENTY-FIFTH MEETING 173

International Certificate of Vaccination or Re-vaccination against Smallpox (continuationfrom page 125)

In reply to a request by Dr. MACLEAN (NewZealand) that the revised form of the InternationalCertificate of Vaccination or Revaccination againstSmallpox (adopted by the committee at its eighteenthmeeting) be discussed, the CHAIRMAN said that, asdecision regarding the certificate had been reachedby vote, the discussion could not be reopened.

Dr. BELL, whilst accepting the Chairman's ruling,said that, in view of the decision just taken not toinclude the word " valid " in the certificate (seepage 170), the certificate must be amended to indicatethat it would be no longer valid after three years.

The CHAIRMAN suggested amending the relevantparagraph by stating that after the lapse of threeyears a fresh vaccination would be required, andDr. JAFAR proposed the following wording :

This certificate expires three years from thedate of vaccination or most recent vaccination.

Decision : It was agreed to amend the certificate asproposed by Dr. Jafar.

3. Proposal by the United States Delegation for anArticle to cover the Forced Landing of Aircraft

The CHAIRMAN explained that, throughout itsdiscussions on the draft Regulations, the ExpertCommittee on International Epidemiology andQuarantine had inadvertently overlooked the questionof the action to be taken if an aircraft, for reasonsbeyond the control of the pilot in command, wereforced to land elsewhere than at a designated airport.During the discussions in Paris on the compilationof the International Sanitary Convention for AerialNavigation, 1933, the aviation interests had askedfor provision to be made to cover cases of forcedlanding, and a paragraph was inserted in Article 25of that convention.

The United States delegation had submitted aproposal for a new article, provisionally numbered39 (A), to be inserted in an appropriate place in theRegulations.

Article 39 (A) [45]

Colonel KOSSUTH (United States of America)read out the text of the proposed new article :

When an aircraft, on entering a territory, forreasons beyond the control of the pilot in com-

mand, lands elsewhere than at an airport designatedfor such landing, the pilot in command shallnotify the nearest local health authority of thelanding. The latter shall take such action as isappropriate to these circumstances, being guidedby the general principles of these regulations, in nocase exceeding the measures laid down therein.No cargo shall be unloaded and no persons onboard the aircraft shall leave the vicinity of theaircraft except with the permission of the localhealth authority. When the reasons for thelanding no longer exist, the aircraft may proceedto a convenient designated airport. Notwith-standing the foregoing and the regulations ordi-narily applicable, the pilot in command, whileawaiting the instructions of the local healthauthority or if he is unable to contact this authority,shall be authorized to take such emergencymeasures as necessary for the health and safetyof passengers and crew.

He suggested that the words " shall be unloaded ",in the third sentence, be omitted, as, in the case ofdamage to the hull of a flying-boat, it might beimportant for the preservation of the cargo for itto be removed from the aircraft.

Dr. JAFAR supported the inclusion of the articlein the Regulations.

When Dr. RAJA questioned the meaning of thewords " shall be authorized ", in the last sentence ofthe proposed text, Mr. HASELGROVE suggested,and the United States delegation agreed to, thesubstitution of the word " may " for " shall beauthorized to ".

Dr. DE TAVEL (International Civil Aviation Organi-zation) said that ICAO had included in Annex 9to the Convention on International Civil Aviationa provision in terms similar to the wording of theUnited States proposal. He added that Article 36of the draft International Sanitary Regulationsprovided for the landing of an aircraft at an airportnot possessing the required facilities. With theomission of the words " shall be unloaded ", thearticle proposed by the United States delegationwould be acceptable to the ICAO representative.

Decision : It was agreed that the new article beincluded in the draft Regulations, the appropriateplace to be decided by the Drafting Sub-Committee.

The meeting rose at 4 p.m.

174 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

TWENTY-SIXTH MEETING

Saturday, 28 April 1951, at 9.30 a.m.

Chairman Dr. M. T. MORGAN (United Kingdom)

1. Application of the Sanitary Regulations to Diseasesother than Epidemic Diseases : Proposal of theUnited Kingdom Delegation

Mr. HASELGROVE (United Kingdom) introducinga note 16 by his delegation on the application of theRegulations to diseases other than epidemic diseases,recalled that some doubt had arisen in the course ofthe Special Committee's discussions as to the exactscope of the Regulations which it was preparing.It was clear that the Expert Committee on Inter-national Epidemiology and Quarantine, in drawingup the original draft, had had in mind only the sixdiseases described as " epidemic " and that theSpecial Committee was not in a position to frameregulations applicable to other diseases. It wasequally clear, however, that Article 24, for example,laid down an important general principle whichwas that, with regard to international traffic, freepratique should not be withheld from a ship oraircraft on account of the presence of other com-municable diseases. By implication, persons infectedwith such diseases could be dealt with by the localhealth authorities under the national laws of thecountry concerned. It would be remembered that inthe discussion on Article 24 difficulty had arisenconcerning the definition of " free pratique " andthat the delegate of Australia, pointing out that somediseases not covered by the Regulations, thoughcommon in Europe, were almost unknown in someparts of the world and therefore a grave dangerwhen introduced, had foreseen objections to theimplementation of the article until it had beenexplained that " free pratique " as understood by

26 The note said that considerable doubt appeared to existas to the measures which might be applied by Member Statesin connexion with communicable diseases other than epidemicdiseases as defined in the draft Regulations. The UnitedKingdom delegation therefore suggested amendments to thedraft Regulations.

The amendments proposed are reproduced in the minutes ofthis meeting. They involved a consequential amendment toArticle 41, in which the words, " an infected or suspectedperson ", would be replaced by " a person suffering from acommunicable disease ", and the words, " an epidemicdisease ", by " a communicable disease ".

the committee in general applied only to the vesselor aircraft and did not imply that quarantinemeasures could not be taken by health authoritiesagainst persons in the case of other diseases. TheUnited Kingdom delegation, in accordance withthe view of the committee that the use of the term" free pratique " should be avoided in that particulararticle, had attempted to expand the article so as tomake clear both its exact meaning and the extentof its applicability to diseases other than thosetermed " epidemic ".

The text proposed read :

1. If, on the arrival of a ship or aircraft, there ison board any communicable disease, other thanan epidemic disease, which is duly verified by thehealth authority as a result of medical examination,the following provisions shall apply :

(a) any person suffering from the disease,together with his baggage and personal effects,may be removed, and the usual measures inforce in the territory may be applied. Suchremoval shall be compulsory if it is required bythe person in charge of the ship or aircraft.The accommodation which has been occupiedby any person suffering from the disease may bedisinfected.

(b) any person not suffering from the diseaseshall be allowed to disembark, in which case theusual measures in force in the territory maybe applied, or he shall be permitted to continuehis journey.

2. On completion of any measures taken by thehealth authority in accordance with sub-para-graph (a) of paragraph 1 of this Article, the shipor aircraft shall forthwith be given free pratique.

3. Nothing in this Article shall prevent theapplication of any measure permitted by the Inter-national Convention for Mutual Protection againstDengue Fever of 25 July 1934 or by paragraph 2of Article XVII of the International SanitaryConvention for Aerial Navigation of 1944.

TWENTY-SIXTH MEETING 175

It was proposed to re-number the article 34(A)since it was felt that, as it was concerned with arrival,it should be transferred to the appropriate chapter.It would also be noted that in paragraph 3 referencewas made to measures not to be superseded by thepresent Regulations.

Mr. Haselgrove said that it was proposed toamend the heading of Part III to read " SanitaryOrganization " since only the last two articles ofthat chapter-Articles 19 and 20-were concernedwith procedure, and it was therefore proposed totransfer them to Part IV, whose heading was to bechanged to " Sanitary Measures and Procedure ".The United Kingdom delegation, noting that thePart contained both articles applicable only to thesix epidemic diseases and articles of general appli-cation, proposed the insertion at the beginning ofthe Part of the new Article 18(A) reading :

The sanitary measures and procedure providedfor in this Part of these Regulations apply to allcommunicable diseases, except where an Articleor part of an Article is specifically restricted tomeasures in connexion with the epidemic diseases.

It might be, however, that the committee wouldprefer to adopt the solution of putting the two typesof article under different headings.

Professor ALIVISATOS (Greece) could not acceptthe new Article 18(A) proposed by the UnitedKingdom delegation. Its provisions, taken in con-nexion with those of Article 34 might lead, in the caseof a whole range of communicable diseases forwhich no effective methods of vaccination or pro-phylaxis existed and which were mainly transmittedby persons in the incubation period, to the applicationof measures disastrous to international traffic. Hewould not go into the efficacity of such measures orthe question of whether it would not be preferable,until effective prophylaxis was discovered, to allowthose diseases to become endemic, so immunizing thepopulation by latent infections, but he could not seewhy the committee, which had shown itself so liberalin some respects, should expressly authorize con-troversial measures whose result no one couldpredict.

For similar reasons, he asked for the deletion ofparagraph 1 (b) of Article 34(A) ; the rest of thatarticle would then be acceptable.

Dr. HENNINGSEN (Denmark) welcomed the notepresented by the United Kingdom delegation andagreed that the clarification referred to in the pream-ble thereto was necessary. Danish quarantine laws

contained a provision authorizing the Minister forHome Affairs to declare applicable to other diseasesmeasures framed for epidemic diseases. He mentionedthat fact not because he claimed that Danish qua-rantine legislation was of great importance, butbecause it had been drawn up with the assistance ofDr. Madsen, who had for many years been activein the preparation of former International SanitaryConventions, two of which, at least, contained clausesdefining the extent of their application to diseasesother than those now referred to as " epidemic ".

It would be seen, therefore, that the UnitedKingdom proposal was in harmony with the practiceadopted in former conventions.

Dr. RAJA (India) welcomed the United Kingdomnote but wished to comment upon some points ofdetail. First, he wondered whether the proposedArticle 18(A) would make necessary a definition of" communicable diseases ". Secondly, since it hadbeen agreed that the Regulations were to be applicableonly to the six epidemic diseases, and since there alsoseemed to be a general feeling that WHO should laterextend its activities to other diseases convenient forinternational action, he thought that the committeemight perhaps prefer to submit to the Health Assem-bly a resolution recommending that the framing ofregulations applicable to other diseases be consideredat an early date.

With regard to the remarks of the delegate ofDenmark, he wondered whether national authorities,in framing regulations applicable to other diseases,need really have their attention brought to theinternational regulations concerning the six epidemicdiseases.

Mr. STOWMAN (United States of America) agreedthat the possibility of framing international regula-tions in respect of other diseases must soon beconsidered. The problem of the international trans-mission of malaria, for example, was becomingincreasingly serious.

The proposed Article 34(A) was in every waymore clear than the original Article 24 which it wasintended to replace, its only fault being that someprovision should perhaps be inserted to precludeunnecessary interference with transit passengers,unless the word " arrival " in the chapter headingalready precluded that possibility.

With regard to the proposed Article 18(A), onthe other hand, he felt far more doubtful, since ithad been definitely decided that the Regulationswere applicable only to the six epidemic diseases.If more time had been left to the committee he wouldhave suggested the setting-up of a working party to

176 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

consider the effect which the adoption of Article18(A) would have on the Regulations as a whole,but in the present circumstances he thought that itwould be best to reject the proposed article and leavequestions which might arise as to the extent of theapplicability of the Regulations to be decided throughthe existing machinery of WHO.

Dr. EL-HALAWANI (Egypt) agreed with the delegatefor India that, if Article 18(A) were adopted, theterm " communicable disease " might need defining.

As to the recommendation on the framing offurther Regulations, he thought that, although thecommittee had met to deal only with six diseases andthere were notable gaps in the results achieved, itwas of the utmost importance to frame, in the nearfuture, special regulations for the control of oneof the most dangerous of other diseases, namelymalaria. As the committee was aware, certainanophelines were especially dangerous when newlyintroduced to a region and had done great damageboth in his own country and in Brazil.

The CHAIRMAN noted that the delegate of Egyptwould have an opportunity to discuss the possibleframing of regulations applicable to malaria whenthe Special Committee discussed item 6 of its agenda.

Dr. PADUA (Philippines) said that the adoption ofthe United Kingdom proposal for Article 18(A)would remove partially the restrictions which theRegulations might impose on measures to preventthe spread of diseases other than the six termed" epidemic ". While the Health Assembly mightdecide to set up a committee to draft regulations forother diseases, the adoption of Article 18(A) wouldfill in a serious gap during the long time which mustelapse meanwhile.

Dr. GAUD (France) approved the United Kingdomproposal, regretting only that it had been submittedtoo late for a proper discussion of its effect onthe Regulations as a whole. Nevertheless, hethought that the distinction implied in the proposedArticle 18(A) between " communicable diseases "and " epidemic diseases " might not be generallyunderstood, and he therefore proposed that thecommittee replace the term " epidemic diseases ",which it had hitherto employed in a sense morerestricted than that generally accepted throughoutthe world, by " quarantinable diseases " or " conven-tional diseases ". At the same time, the term " com-municable disease " was too wide, covering many

diseases to which neither the present nor any probablefuture regulations would be applicable, and shouldtherefore be replaced by " epidemic diseases " whichcould be more suitably employed in that sense.

Mr. HASELGROVE stressed-in connexion with theremarks of the delegate of France-that the UnitedKingdom delegation had been careful not to proposeany changes of substance in Part IV of the Regulationsand he drew attention to the existing definitions ofterms used in certain of the articles, such as " infectedlocal area ", " infected person " and " suspect "which related to the six epidemic diseases. The onlychange of substance it had ventured to suggest hadconcerned the clarification of the fact that Article 24(to become Article 34(A)) was intended to be ofgeneral application.

M. BOSMANS (Belgium), with regard to the possibleframing of further regulations applicable to otherdiseases, drew attention to a note by his delegationrequesting the Special Commitee to recommend tothe Fourth World Health Assembly that the ExpertCommittee on International Epidemiology andQuarantine be instructed to prepare draft regulationson the steps to be taken to prevent the spread byinternational traffic of epidemic or communicablediseases other than those covered by WHO Regula-tions No. 2.

Dr. PADUA thought that the question of the appli-cability of the present Regulations to diseases ingeneral had been sufficiently discussed in the com-mittee, but with regard to the proposal of the delegateof France, he recalled that the use of the word" quarantinable " in place of " epidemic " had beensuggested before and found unacceptable by some.The word " pestilential " might be used instead. Inany case, the word " epidemic ", if retained wouldsuggest to laymen that it was applicable to alldiseases which might become epidemic.

Dr. DE CARVALHO-DIAS (Portugal) agreed that thecommittee might employ the word " pestilential " if" quarantinable ", which his own Government hadsuggested, was not acceptable. Alternatively, inthe French text the words " maladie réglementée "might be used.

Dr. BELL (United States of America) said thatfurther time would be needed properly to study theimplications of the broad principles laid down in theproposed Article 34(A). Would paragraph 1(a), for

TWENTY-SIXTH MEETING 177

example, empower local health authorities to removefrom a ship or aircraft a person suffering fromchickenpox or athlete's foot ?

Provisions applying to diseases other than the sixalready covered (in so far as it proved possible toprescribe useful measures), might later be includedin the Regulations, but in the meantime he couldnot see what specific action could be taken anddoubted the utility of the United Kingdom proposal.

The CHAIRMAN put to the vote the proposal of thedelegation of France that throughout the Regulationsthe term " epidemic disease " be replaced by " qua-rantinable disease " and the term " communicabledisease " by " epidemic disease ".

Decision: The proposal was adopted by 24 votesto 2.

The CHAIRMAN put to the vote the amendmentsproposed by the United Kingdom delegation to theheadings of Part III and Part IV of the Regulations.

Decision: The amendments were adopted unani-mously.

At the request of the delegation of the UnitedStates, it was agreed to defer further considerationof the other United Kingdom proposals. (Forcontinuation of discussion, see minutes of twenty-seventh meeting.)

2. Control of Insect Vectors of Malaria in Interna-tional Air Traffic

The CHAIRMAN thought that the committee wouldagree that it could not at the present stage considerincluding provisions for the control of malaria inthe Regulations. He noted, however, that theproposal submitted by the delegation of Belgium(see page 176), and the one being prepared by thedelegation of South Africa (see page 179) concerningthe framing of further regulations applicable toother diseases, could be considered as referringimplicitly to malaria. He also noted that the Director-General, with the help of recommendations submittedby the Expert Committee on Malaria, had alreadyundertaken a preliminary study of the possibility ofcontrolling the spread of that disease by internationalaction.

3. Consideration of the Draft International SanitaryRegulations

Article 75 [83] (continuation from page 169)

Dr. BELL recalled, that (in the seventeenth meeting)during the discussion on Chapter IV, a proposal

had been made by the delegation of Canada to addthe following sentence somewhere in Article 75 :" Vaccination against smallpox shall be requiredof any person leaving an infected local area on aninternational journey ". Should not a vote be takenon that proposal ?

Dr. BARRETT (United Kingdom), Dr. RAJA andDr. MACLEAN (New Zealand) were of the opinionthat sufficient safeguards had been laid down.The measures to be applied to persons on arrival froman infected local area were clearly stated elsewhere inthe Regulations.

Decision: The Canadian proposal was rejected by12 votes to 13.

Article 36 [41] (continuation from page 73)

The CHAIRMAN understood that the word " for-ward " had been added after " proceed " in thepenultimate line.

Decision: Article 36 was remitted to the DraftingSub-Committee.

Article 37 [42] (continuation from page 74)

Dr. HENNINGSEN wondered whether some definitionwas not required for the term " infected territory ".

Decision: It was decided to replace the words" infected territory " by " a territory where thereare infected local areas ".

Dr. EL-HALAWANI proposed, in order to clarifythe text, the addition of the words " provided that anaircraft has not taken on passengers from a localinfected area ". In some countries, where travelwas mainly by air it was possible for persons from anarea infected with yellow fever to board a plane ata sanitary airport, and thence to proceed to anotherterritory.

Dr. RAJA thought that the provisions of Article 65covered the point raised.

Dr. JAFAR (Pakistan) thought that the point raisedby the delegate of Egypt deserved careful considera-tion. He proposed-in order to clarify the text-the addition of the words " without having takenon board any person from the infected territory ".

The CHAIRMAN proposed an alternative wording :" provided it has not taken any persons on boardat that airport ".

178 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. BARRETT said that the point raised was coveredin respect of each of the six quarantinable diseasesin the relevant chapters.

Dr. RAJA interpreted Article 65 to mean thatwhether an aircraft came from an infected localarea or not, it was permissible for a health authorityto make sure that any person on board insufficientlyprotected against yellow fever could be isolated forthe required period. He was not sure whether theRegulations permitted a health authority to imposedisinsecting measures in the case of an aircraft notconsidered to be infected-even though it mighthave on board persons from an area infected withyellow fever and who were therefore liable to spreadinfection.

Dr. JAFAR maintained that the article was notnecessary and had been included only to show thatan aircraft-merely because of its flight over infectedterritory-could not be considered as included in thecategory of infected aircraft. All doubts would beremoved by the addition he had proposed and whichwould clarify the meaning of the word " merely "in the text.

The CHAIRMAN explained the reasons for theinsertion of article 37, for which he was originallyresponsible. There had been cases where an aircrafton arrival had been considered to be infected becauseit had flown over an infected territory withoutlanding. That was thought to be unreasonable. Ithad then been thought that even if an aircraft landedat a sanitary airport, situated within an infected localarea, that did not mean that it could be regarded asinfected or suspected.

Dr. JAFAR still felt there was no harm in clarifyingthe position. A person, even in possession of avaccination certificate, might still not be immunefrom yellow fever if the certificate were not yetvalid.

Mr. HASELGROVE said that the specialized chaptersdealing with the various quarantinable diseases laiddown specific measures to be applied to aircraft andpersons on arrival. The purpose of the article wasto stress that an aircraft landing at a sanitary airport-by definition free from infection-could not beconsidered as having come from an infected localarea merely because that sanitary airport happenedto be situated therein.

Decisions :

(1) The proposal to add the words " providedit has not taken persons on board at that airport "was rejected by 6 votes to 11.

(2) Article 37 was remitted to the Drafting Sub-Committee.

4. Draft Resolutions for Submission by the SpecialCommittee to the Fourth World Health Assembly

Additional National Health and Sanitary Measures

Dr. GEAR (Union of South Africa) explained thathe had prepared the draft resolution on behalf of anumber of delegations. As a result of the discussionon Part III (Sanitary Organization), the need hadbecome apparent for sanitary measures to be takenin endemic and receptive areas not only at ports ofdeparture and arrival, but also in the environment ofthose ports.

The draft resolution read :

The Fourth World Health Assembly,

Believing that

(a) the International Sanitary Regulationsrepresent only part of the action required toremove the international threat of epidemicdiseases ;

(b) parallel action is equally necessary toremove insanitary conditions conducive to theexistence of such diseases, especially in andaround ports and airports ;

(c) health administrations in improving sani-tary conditions and in expanding their health andmedical services, especially in and around portsand airports, are thereby securing their ownprotection against the entry and establishmentof epidemic diseases ;

(d) territories with satisfactory sanitary con-ditions and efficient health and medical servicesmay reduce quarantine measures against inter-national traffic ;

(e) the freest possible movement of inter-national traffic is highly desirable in the interestsof world economic and social, including health,progress,

1. RECOMMENDS to all governments that theyimprove sanitary and environmental conditions,

TWENTY-SIXTH MEETING 179

especially in and around ports and airports and, inparticular, they

(1) eliminate and prevent the breeding ofrodents, Aëdes mosquitos and ectoparasites ;

(2) eliminate infection of cholera by providing,inter alia, pure water and food supplies, andservices for the proper disposal of humanwastes ;

(3) raise the level of protection by vaccinationwhere appropriate or by other means againstplague, cholera, yellow fever, smallpox andtyphus ;

(4) relax, when necessary and health circum-stances are satisfactory, the application to theirterritories of appropriate articles of the Inter-national Sanitary Regulations ;

2. REQUESTS the regional committees of theOrganization to take early and continuous actionto persuade Member States in their regionsto adopt the recommendations in paragraph 1

above ;

3. REQUESTS the Executive Board in its prepara-tion of programmes and otherwise to give effectto the recommendations in paragraph 1 above.

Decision : The word Aëdes in paragraph 1 (1) wasdeleted and the draft resolution unanimouslyadopted for submission to the Fourth WorldHealth Assembly.

Hygiene and Sanitation of Airports

The Special Committee adopted the substance of adraft resolution on the hygiene and sanitation ofairports presented by the Observer for the Inter-national Air Transport Association (for text aspresented to the committee of the Fourth WorldHealth Assembly see page 319).

Terms of Reference for a WHO Expert Committeeto deal with Non-Pestilential Epidemic Diseases

Functions of the Expert Committee to deal with theApplication of the International Sanitary Regula-tions and Existing International Sanitary Con-ventions

The Special Committee had before it draft reso-lutions on the above subjects prepared by the dele-gate of the Union of South Africa. The first ofthese, on the terms of reference of a WHO expertcommittee to deal with non-pestilential epidemicdiseases, read :

The Fourth World Health Assembly

REQUESTS the Executive Board

(1) to examine and report on the presentarrangements and their possible improvementfor the collection and analysis of epidemiologicalinformation in respect of all communicablediseases and not only the six epidemic diseasesmentioned in the Regulations ;(2) to study the ways and means for co-ordina-ting WHO activities as regards the non-pesti-lential epidemic diseases and the modificationof the terms of reference of the present ExpertCommittee on International Epidemiology andQuarantine required for the purpose.

The second, on the functions of the expert com-mittee to deal with the application of the Inter-national Sanitary Regulations and existing Inter-national Sanitary Conventions, read :

Preamble

The Special Committee considers that theapplication of the proposed International SanitaryRegulations will require special attention beinggiven to the constitution and functions of the expertcommittee, the establishment of which it is herebyrecommending.

The Regulations will probably in applicationreveal deficiencies. Further, the changing natureof international epidemic disease, of methods ofdisease control and of world transport cannot begiven due recognition in static Regulations. TheSpecial Committee therefore wishes to emphasizethat the present regulations require as an essentialfeature in their application continuous appraisalwith consequent amendment by all the appropriateorgans of the Organization-Health Assembly,Executive Board, expert committees and theSecretariat. Only thus will up-to-date Regulationsbe maintained.

The committee considers it also appropriate torequest the Health Assembly, in giving the neces-sary authority for the establishment of the requiredexpert committee, to indicate the need for advicebeing secured by it in all the fields of activityaffected by the application of the Regulations.Such comprehensive advice will be particularlyrequired in dealing with problems calling forinterpretation or mediation in disputes.

With the above considerations in mind, theSpecial Committee on International SanitaryRegulations recommends to the Fourth WorldHealth Assembly the adoption of the followingresolution :

180 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Resolution

The Fourth World Health AssemblyREQUESTS

(1) the Executive Board to entrust to anappropriate expert committee the followingduties connected with tbe International SanitaryRegulations :

(a) a systematic and critical review of theRegulations and other relevant legislation,and the making of recommendations thereon ;(b) the preparation of additional regulationswhere necessary on diseases not covered inRegulations No. 2 ;(c) the submission of reports as required onpractices, methods and procedures in con-nexion with the subjects included in theRegulations ;(d) the consideration of any matters referredto it in pursuance of Article 107 of RegulationsNo. 2 ;

(2) the Director-General, in constituting andconvening the expert committee, to take noteof the need

(a) for making available to it appropriateexpert advice, inter alia, on such subjects asepidemiology, port sanitation, quarantineprocedure, international law, aviation andshipping ;(b) for ensuring continuity of action ;(c) for providing to the committee thetechnical co-operation and advice of theappropriate WHO expert committees andstudy-groups.

The CHAIRMAN explained that the resolution onthe terms of reference for an expert committee todeal with non-pestilential epidemic diseases waspractically identical with the draft proposal submittedby the Belgian delegation (see page 176).

Dr. GEAR said that he had been requested toprepare the draft resolutions on behalf of a numberof delegations. It had been agreed, after discussionof Article 107, that the attention of the HealthAssembly should be drawn to the imperative needfor a review of the operation of the Regulations, andfor action with regard both to the diseases coveredin the Regulations and those which fell outside itsprovisions. The draft resolutions therefore includedthe whole substance of the majority report onArticle 107, the substance of the United Kingdomminority report, the substance of the proposals putforward by the French delegation and also verbal

contributions during the debate (see minutes of thetwenty-second and twenty-third meetings). Theapplication of the Regulations required continuousstudy, by the appropriate organs of the Organization(Health Assembly, Executive Board, expert com-mittees and the Secretariat), not only of the quaran-tinable diseases but also of other communicablediseases ; machinery had also to be provided for theimplementation of Article 107. That machineryalready existed but the draft resolution had beenframed in general terms in order to integrate theresolutions adopted by the First, Second and ThirdWorld Health Assemblies and the subsequentaction taken by the Executive Board thereon.

Decision: The draft resolution on the terms ofreference for an expert committee to deal withnon-pestilential epidemic diseases was adopted fortransmission to the Fourth World Health Assembly

Dr. VAN DEN BERG (Netherlands), while in generalagreement with the wording of the resolution justadopted, expressed the view that the proposed ma-chinery should be established on a permanent basis.

Dr. BERGMAN (Sweden) thought that a cleardecision had been taken not to recommend theestablishment of any new committee but to use theexisting machinery of the Organization, includingthe Expert Committee on International Epidemiologyand Quarantine. He was of the opinion that a votehad been taken in favour of the proposals which thedelegate of India had made at the committee'stwenty-third meeting (see page 155).

Dr. RAJA was in favour of the consultative bodyset up by the Director-General being of a flexiblenature so as to include technical advice of all kinds.

Mr. HASELGROVE agreed that a definite decisionhad been taken not to recommend the establishmentof any new committee but to recommend thatappropriate action should be taken through existingmachinery of the Organization.

In connexion with the draft resolution on thefunctions of the expert committee to deal with theapplication of the International Sanitary Regulations,the CHAIRMAN suggested that in paragraph (1) thewords " the appropriate expert committee or com-mittees " should replace " an appropriate expertcommittee ". In paragraph (2) the words " inconstituting " might be omitted.

Dr. RAJA, replying to the delegate of Sweden, saidthat his proposal had been accepted on the questionof periodical review. In regard to the settlement of

TWENTY-SEVENTH MEETING 181

disputes under Article 107, he had accepted theUnited Kingdom proposal that existing machineryshould be employed for the purpose.

Dr. BARRETT agreed to the Chairman's suggestion.He proposed, however, that the word " expert "should be omitted both in paragraphs (1) and (2).

Mr. ST 0 WMAN supported the United Kingdomsuggestion to omit the word " expert " in order toleave the Executive Board and the Director-Generalfree in the matter.

Dr. GEAR explained that the draft resolution tookfull account of existing instructions issued by HealthAssemblies for the establishment of existing expertcommittees, including the Expert Committee onInternational Epidemiology and Quarantine ; itlikewise covered the decisions taken by the presentcommittee ; namely

(1) the recommendation of the delegate of Indiathat there should be an expert committee toperform the functions of a periodical review of theRegulations ;(2) the proposal of the delegate of Norway thataction under Article 107 should be undertaken bythe appropriate body of the Organization.

The original terms of reference of the ExpertCommittee on International Epidemiology andQuarantine should not, however, be overlooked.Pending the issue of new instructions from theHealth Assembly the present mandate of thatcommittee would not be in harmony with thefunctions envisaged for the proposed new body.

The point raised by the delegate of the Netherlandscould not be covered in the resolution because itwould create a difficult administrative problem

involving a departure from previous instructions ofthe Health Assembly concerning expert committeesand related bodies.

He assured the delegates of Sweden and the UnitedKingdom that there had been no reversal of decisionstaken.

The Committee on Administration, Finance andLegal Matters of the Fourth World Health Assemblymight wish to revise the wording but, so far as hecould judge, the draft resolution was in line bothwith the administrative requirements of the Organi-zation and with the general policy of the HealthAssembly and Executive Board.

An exchange of views took place as to whether thewords " with consequent amendment " (in thesecond paragraph of the preamble), should bemodified or omitted.

Dr. BARRETT moved their deletion.

The proposal of Mr. ST OWMAN to replace thewords " with consequent amendment " by " withmodifications when necessary " was adopted.

Decision: The draft resolution on the functionsof the expert committee to deal with the applicationof the International Sanitary Regulations wasadopted, with one dissenting vote, for submissionto the Health Assembly.

It was agreed, on the suggestion of Dr. JAFAR, IC)refer the text to the Juridical Sub-Committee forconsideration as to whether it conformed with theproposal of the delegation of India adopted at thetwenty-third meeting, on the understanding thatno further discussion was necessary unless anycontention arose.

The meeting rose at 12.30 p.m.

TWENTY-SEVENTH MEETING

Monday, 30 April 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Application of the Sanitary Regulations to Diseasesother than Epidemic Diseases : Proposal of theUnited Kingdom Delegation (continuation)

Discussion was resumed on the United Kingdomproposal for a new Article 18 (A) and replacementof Article 24 by an Article 34 (A).

Dr. HEMMES (Netherlands) agreed with the UnitedKingdom delegation that the provisions of Article 24were not well defined and that the interpretationwould depend entirely on the opinion of the localhealth authority, but felt that the same could be saidof the proposed Article 34 (A), which, as drafted,

182 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

did not sufficiently safeguard the interests of tra-vellers. If there were danger of the spread of othercommunicable diseases by international traffic, astudy would be necessary to ascertain whether itwas possible to institute effective and reasonablemeasures, either in the present Regulations, or inseparate regulations. Such a study would take time ;in order, therefore, not to delay the entry-into-forceof the Regulations, he proposed the replacement ofArticle 24 by a text on the following lines :

Pending the adoption by the Organization ofregulations covering the sanitary measures appli-cable to non-pestilential communicable diseasestransmitted by international traffic, the healthauthority for a port or an airport, on arrival of aship or aircraft having on board a case of one ofthese diseases, may take sanitary measures notexceeding the principles mentioned in Chapter IVof this Part, provided that

(a) they are based on thorough knowledge ofthe epidemiology of the disease concerned ;

(b) they are the least burdensome of thoselikely to be effective ;

(c) they correspond to the measures applied atfrontiers for the same disease.

Free pratique shall be granted immediately aftercompletion of the measures prescribed.

The health authority shall inform the Organi-zation within 48 hours of the application of thisArticle, giving at the same time complete com-plementary information on the epidemiologicalsituation.

Dr. DUJARRIC DE LA RIVIÈRE (France) welcomedthe principle underlying the United Kingdom pro-posal. His delegation had for some time beenasking for a study to be made of epidemic diseasesother than the quarantinable diseases. In view of itsrepercussions on the Regulations, a detailed study ofthe whole question was required and the authorityof the Health Assembly should be requested forthat work.

Dr. Dujarric de la Rivière added that the term" communicable disease " was unsuitable, because itincluded tuberculosis, venereal diseases, etc.

Dr. BELL (United States of America) did notclearly understand the implications of the proposalsmade by the United Kingdom delegation.

Regarding the proposed Article 18 (A), the impli-cations could not be judged until the amendeddefinitions which had been adopted for certain termswere available in written form, but the suggestionthat one part of the Regulations should apply to allepidemic diseases except where the six quarantinablediseases were specifically mentioned, whereas toother parts the contrary applied, was confusingand likely to lead to misunderstanding. He pre-ferred the proposal submitted by his delegationand defeated at an earlier meeting (see page 75), tomention by number all articles applying to diseasesother than the six quarantinable diseases.

With regard to the proposed Article 34 (A), hedrew attention to the purpose of the Regulations,as stated in the Preamble. It had been agreed thatrestrictions on international traffic were not justifiedin respect of communicable diseases other than the sixspecified in the Regulations, and in his view Article 24,as at present drafted, provided all that could be donein the way of Regulations against such diseases. TheUnited Kingdom proposals would open the door tothe imposition by health authorities of restrictionson commerce in respect of any communicable diseaseand would thus defeat the whole purpose of theRegulations.

Dr. RAJA (India), referring to the proposedArticle 34 (A), was inclined to think that, since theship or aircraft would presumably be in the territorialwaters or on the territory of a State, the healthauthority had the right, under national law, toimpose measures against that ship or aircraft. Legaladvice might perhaps be necessary to clarify thesituation.

Dr. MACLEAN (New Zealand) said that the textproposed by the United Kingdom delegation wouldbe unlikely to cause any confusion, provided certainminor amendments were made. For instance, if theword " epidemic " were retained in Article 21, itwould ensure that no country could impose un-reasonable measures in respect of other com-municable diseases.

Assuming also that the definitions of " infectedlocal area ", " infected person " and " suspect "were amended so as to refer only to the quaran-tinable diseases the effect of the proposal would bethat Part IV, which was chiefly concerned withlimiting the measures which could be applied, would

TWENTY-SEVENTH MEETING 183

limit the action which could be taken in respect ofthe other communicable diseases.

Regarding the definitions, it was important thatthe definition of " suspect " be made to apply onlyto persons who had been exposed to risk of infectionfrom a quarantinable disease.

In his opinion the provisions of the proposedArticle 34 (A) did not go beyond those of the presentdraft. He therefore supported the United Kingdomproposal.

Dr. JAFAR (Pakistan) was not in favour of theUnited Kingdom proposals, first because, althoughmeasures had been suggested for application againstcertain other communicable diseases, the SpecialCommittee had not yet listed those diseases. Thatshould be done, taking into account their endemicareas and the possibility of their spread to othercountries.

Secondly, during his own experience of quarantinework, he had never found any difficulty in applyingthe necessary measures to any vessel or aircraft onboard which a case of one of the diseases hadoccurred. He described the measures which hadbeen taken by the former Government of India toprevent the spread of chigger. All vessels arrivingfrom East Africa had been required to enter theharbours of Bombay or Karachi in quarantine, everyperson suffering from the disease had been treatedand, after disinfection of the affected parts of theship, free pratique had been granted. Similarly inregard to measles and like diseases, there had neverbeen any protest when the port health authorityhad decided that certain measures were necessaryin the interests of passengers and crews.

He supported the view of the United States delega-tion that the United Kingdom proposal , wouldmake it possible for local health authorities tointerfere with any mode of transport in respect ofany disease.

Mr. HASELGROVE (United Kingdom) said that, inspite of some criticism of his delegation's proposal,there was agreement on the objective in view, namelythat international traffic should not be hamperedon account of diseases other than the six quaran-finable diseases. It was because of the doubts whichhad been expressed in regard to the original textof Article 24 that his delegation had attempted aclarification.

Dealing with the proposed Article 34 (A), he saidthat his delegation had been satisfied with Article 24,as originally presented to the Special Committee. But

the words " except in case of grave emergency "had been altered to " except in case of unusualdanger to public health " (see page 65) which,he considered, gave too great a latitude to healthauthorities. It appeared from discussion thatArticle 34 (A) was open to the same objection and heagreed that, if the maximum measures permittedthereunder were invariably applied, undue restrictionson traffic would result.

With regard to Article 18 (A), his delegationconsidered that the principles embodied in Part IV,which restricted the power of health authorities tointerfere with international traffic, should be ofgeneral application. At the same time, it did notwish to make all the provisions of Chapter IVapplicable to the epidemic diseases.

He proposed, therefore, that Article 18 (A) shouldbe adopted, with the consequential amendmentsreferred to by the delegate of New Zealand, and that,in place of Article 34 (A), which he withdrew,Article 24 should be retained as originally worded.

Asked by the CHAIRMAN if his delegation wouldsupport the retention of Article 24 as originallydrafted, Dr. BELL said that the article was notsufficiently precise, but on the other hand the wordingof the substitute article went too far. The maximummeasures which could be imposed by a healthauthority ought to have been more precisely definedbut it was too late for the committee to undertakethat task. Moreover, at the previous meetingresolutions had been adopted for submission to theFourth World Health Assembly, recommending thatspecial studies be undertaken in connexion with thecommunicable diseases.

He therefore agreed to retain the original Article 24,except that the words " Except in case of gravedanger to public health " might be more acceptablefor the opening phrase.

Dr. DUJARRIC DE LA RIVIÈRE said that his delega-tion could accept the new proposal of the UnitedKingdom delegation to retain Article 24 if it wereamended to begin : " Except in case of an epidemicdisease which would greatly endanger publichealth ... "

On the other hand, he thought that the appropriateexpert committee should later be asked to examineand report on the implications which Article 24would have on the Regulations as a whole.

Dr. RAJA asked whether the provisions of Article 24as drafted would prevent a local health authority

184 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

from imposing measures in respect of communicablediseases other than the six quarantinable diseaseson a vessel or aircraft arriving in its territory.

The CHAIRMAN replied that, except in the case ofgrave emergency, a health authority could notwithhold free pratique but could do anything elsewithin its own national laws.

Mr. HASELGROVE asked the delegate of the UnitedStates if he would agree to the use of the words" grave emergency " instead of those he had proposed(" grave danger to public health ").

Dr. BELL thought that perhaps both terms mightbe included. He had introduced the reference topublic health because he thought it was not impliedin the original text.

Dr. MACLEAN thought that the words " graveemergency " were sufficiently qualified by the phrase" on account of any other communicable disease ".

Dr. HENNINGSEN (Denmark) thought that theremight be confusion because the term " free pratique "was not interpreted in the same way in all countries,and asked whether the Drafting Sub-Committeehad defined it. In Denmark measures such aspreventing passengers and crews from havingcontact with the shore, and constant medical super-vision, could be applied, if necessary, in respect of allcommunicable diseases, but there was no inter-ference with loading or unloading of cargo, nor withother normal operations of the ship.

The CHAIRMAN thought there could be no con-fusion if it were remembered that " free pratique "applied to a vessel or aircraft and not to the pas-sengers or crew on board.

Dr. HENNINGSEN said that the Chairman's inter-pretation stressed the need for a definition of " freepratique ".

After Mr. HASELGROVE and Dr. BELL had acceptedhis amendment of the first line of Article 24 to read :" Except in case of emergency constituting a gravedanger to public health ", the CHAIRMAN askedthe committee to vote on the proposal to retainArticle 24.

Decision: It was unanimously agreed that Article 24be retained as amended by the Chairman.

After an exchange of remarks between Mr. HASEL-GROVE and Dr. BELL during which the latter said hebelieved that the proposed Article 18 (A) wouldlead to more confusion, Mr. HASELGROVE saidthat, in view of the changes which had been made inthe headings of Parts III and IV, his delegation feltthat Article 18 (A) was not necessary and wouldtherefore withdraw the proposal.

Decision: It was agreed that there should be nofurther consideration of the proposals for Ar-ticles 18 (A) and 34 (A). The proposals to amendthe headings of Parts III and IV and to transferArticles 19 and 20 to Part IV, following Article 22,adopted at the twenty-sixth meeting, were con-firmed.

Article 21 [231

Dr. MACLEAN considered that in Article 21 thewords " epidemic diseases " should not be changedto " quarantinable diseases " because the articlecould otherwise be interpreted as meaning that noneof the restrictive measures, as opposed to thepermissive measures, in the Regulations could beapplied to diseases other than the six quarantinablediseases.

The CHAIRMAN said that, to meet the point raisedby the delegate of New Zealand, the words " quaran-tinable and epidemic diseases " would have to beused.

Dr. BELL, seconded by Mr. HASELGROVE, suggestedthat the reference should be to quarantinable diseasesbecause the Regulations did not provide measuresfor the other communicable diseases covered underArticle 24.

Decision: It was agreed to substitute " quaran-finable diseases " for " epidemic diseases " inArticle 21.

2. Review of Draft International Sanitary Regulationsprepared by the Drafting Sub-Committee : Amex A- Sanitary Control of Pilgrim Traffic approachingor leaving the Hedjaz during the Season of thePligrima ge

The CHAIRMAN said that the document before thecommittee was a revised draft of Annex A 17 pre-pared by the Drafting Sub-Committee and takingaccount of the decisions of the Special Committeeat its twenty-first meeting. He suggested that no

17 The numbers given to the articles in this annex are thoseof the draft as revised by the Sub-Committee on the MeccaPilgrimage (p. 271). The numbers appearing in square bracketsin the headings are those of the final text (p. 360).

T WENTY-SEVENTH MEETING 185

changes should be made unless the committee feltthat the amendments made did not faithfully reflecttheir decisions or unless modifications introduced bythe committee had entailed consequential amend-ments whose implications had not been realized.

It was so agreed.

Article 1 [A 1]

The text prepared by the Drafting Sub-Committeeread :

1. The health authority for the port or airportof embarkation, or in the case of transport byland the health authority for the place of departure,shall ensure that every pilgrim before departureshall be in possession of a valid certificate ofvaccination against smallpox and cholera, ir-respective of the local area from which he comesor the sanitary conditions in that area : if he hasleft a yellow-fever infected local area or a yellow-fever endemic zone within the previous six days,he shall also be in possession of a valid certificateof vaccination against yellow fever.

2. On arrival in the Hedjaz, any pilgrim who isnot in possession of the certificates required byparagraph 1 of this Article shall be vaccinatedagainst the disease for which he has no certificateand shall be given a certificate of such vaccination.If the pilgrim refuses to be so vaccinated, the healthauthority may place him in isolation until theexpiry of the relevant period of incubation, oruntil arrangements can be made in the meantimefor his repatriation. In the case of yellow fever,however, a pilgrim who has not been vaccinatedshall be kept in isolation until the end of theperiod of incubation.

Decision: On the proposal of Dr. RAJA (India)it was agreed : (1) in the light of the decisionregarding the smallpox vaccination certificate(see page 170) to amend paragraph 1 of Article A 1to read " shall be in possession of a valid certificateof vaccination against cholera and of a certificateof vaccination against smallpox"; (2) to amend" sanitary " in paragraph 1 to " health ".

Article 2 [A 2]

There were no comments on the article, in whichno change had been made (for text see page 31).

Article 3 [A 3]

The text prepared by the Drafting Sub-Committeeread :

1. On arrival of a pilgrim ship at Port Said, anypilgrim who is not in possession of the certificatesrequired by paragraph 1 of Article 1 of this Annexshall be vaccinated against the disease for whichhe has no certificate and shall be given a certificateof such vaccination.

2. If on medical examination of a pilgrim ship atPort Said no case of epidemic disease is discovered,the ship shall be allowed to proceed to the Hedjaz,without calling at any intermediate port, as soonas the provisions of paragraph 1 of this Articlehave been complied with.

The CHAIRMAN, drawing attention to the words" epidemic disease " in paragraph 2, said thenecessary changes resulting from a decision to alterthe nomenclature of the diseases (see page 177) wouldbe made in the final draft of Annex A.

There were no other observations on Article 3.

Articles 4 [A 4] and 5 [A 5]The text prepared by the Drafting Sub-Committee

read :Article 4

Every pilgrim ship going to the Hedjaz otherwisethan through the Suez Canal shall proceed to thequarantine station at Jeddah designated by thehealth authority and shall not disembark pilgrimsand their luggage until free pratique has beengiven. The Saudi Arabian Government shall decidethe quarantine measures, in conformity with theRegulations, to be applied to pilgrims disem-barking on its territory.

Article 5

Any pilgrim returning from the Hedjaz whowishes to disembark in Egypt shall travel onlyin a pilgrim ship which stops either at the sanitarystation at El Tor, or at some other sanitary stationappointed by the health administration for Egypt,where sanitary measures, in conformity with theRegulations, may be applied to him as providedfor in the Egyptian Quarantine Regulations.

Mr. HASELGR OVE (United Kingdom) said that theDrafting Sub-Committee had presumably added thewords " in conformity with the Regulations " inArticle 5 because they had been used in the lastsentence of Article 4. It might not, however, be clearto the layman whether they referred to the Inter-national Sanitary Regulations or to national regu-lations.

186 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

On the proposal of Dr. JAFAR (Pakistan) it wasagreed that the words " the Regulations " inArticles 4 and 5 should read " these Regulations ".

Dr. EL-FAR Bey (Egypt) considered that the words" in conformity with these Regulations " in Article 5should be deleted, since the committee had agreedthat the Egyptian Government should be free to applyits national regulations. In view of the decision tosuppress the control at Kamaran, the EgyptianGovernment was not prepared to relax the measuresat El Tor.

Dr. RAJA, supporting the delegate for Egypt, saidit would be unreasonable to consider as a pilgrim,and therefore exempt from national sanitary laws, aperson who had completed the pilgrimage and was intransit through Egypt by land or who was visitingEgypt on his way home.

Mr. HOSTIE, Chairman, Legal Sub-Committee ofthe Expert Committee on International Epidemiologyand Quarantine, recalled that he had previouslysuggested deletion of the words " where sanitarymeasures may be applied to him as provided for inthe Egyptian Quarantine Regulations " because theywere superfluous. On the request of the delegateof Egypt for their retention, he had said that althoughunnecessary they had no disadvantageous implica-tions. Since then the second sentence had been addedto Article 4. Although that sentence was in hisopinion superfluous, as long as it was retained, itwould be necessary to repeat the words " inconformity with these Regulations " in Article 5,which would otherwise be open to the interpretationthat, while the Saudi Arabian Government couldapply measures within the Regulations, the EgyptianGovernment could apply measures that were inexcess of those prescribed in the Regulations. Ifthe deletion requested by the delegate for Egypt wereadopted, it might be considered that that involved achange of substance.

The CHAIRMAN asked the delegate for SaudiArabia whether he would agree to suppression ofthe second sentence of Article 4 in the light of thelegal opinion that its suppression had no effect onthe right of Saudi Arabia to apply whatever measuresit chose, provided they were in conformity with theInternational Sanitary Regulations.

Mr. KHANACHET (Saudi Arabia) felt that since theEgyptian Government had the right under Article 5

to apply the measures it judged necessary to pilgrimsreturning from the Hedjaz, which was not an endemiczone, the Government of Saudi Arabia should havethe right to apply the measures it considered neces-sary for its own protection and the protection ofcountries from which thousands of pilgrims cameevery year.

Should the committee decide to suppress the secondsentence of Article 4 on account of the repercussionsit might have on other articles, his delegation wouldwish for renewed consideration to be given to itsproposal (see page 143) to replace Article 5, whichconcerned only the Egyptian Government, by a moregeneral provision.

Dr. EL-HALAWANI (Egypt) maintained that theEgyptian Quarantine Regulations with regard toEl Tor had been in existence for more than a quarterof a century and had proved their usefulness for theprotection of all countries. A grave danger wouldensue if they were abolished. He had no objectionto the Saudi Arabian proposal as such, but did notwish the principles of epidemiology to be disregarded.He emphasized that the present text of Article 5had been discussed and agreed upon in both the Sub-Committee on the Mecca Pilgrimage and the SpecialCommittee.

The CHAIRMAN said that the essential differencebetween Articles 4 and 5 was that Article 4 dealtwith pilgrims entering Saudi Arabia who were notnationals of that country, whereas Article 5 dealtmostly with Egyptians returning to Egypt.

Dr. MACLEAN (New Zealand) asked for clarificationon the legal question whether, if either Saudi Arabiaor Egypt made a reservation to the Regulationsand acted in accordance with the reservation,such action would be in conformity with theRegulations.

Mr. HOSTIE said the question of reservations wasstill under discussion by the Juridical Sub-Committeewhich proposed to deal with it in a different mannerfrom Article 101. It might be advisable to postponediscussion of the question until Article 101 came upfor consideration.

He said that the treatment of Egyptian nationalsreturning to Egypt could not become the subjectof an international dispute. The limitation inArticles 4, 5 and 11 had a practical effect only on therelationship between a government and the nationalsof another country.

TWENTY-SEVENTH MEETING 187

Mr. KHANACHET agreed that the cases in the twoarticles were different. Article 5 dealt with Egyptiansreturning from the Hedjaz and Egyptian nationallaws applied to them. But the case of Saudi Arabiawas different. It was a non-infected country whichwas obliged to admit, for a specified period, pilgrimsfrom other countries, some of whom came fromendemic zones. In accordance with generallyrecognized epidemiological standards, Saudi Arabiaought to be allowed to take maximum measures inthe case of such persons.

He asked whether from a legal point of view itwould be possible to replace Article 5 by a wordingsimilar to paragraph 3 of Article 11 (see page 189).

M. MASPÉTIOL (France) agreed with Mr. Hostiethat it would be advisable to delay consideration ofthe question of reservations in connexion withArticles 4 and 5 until the Juridical Sub-Committeehad submitted a proposal concerning the wholematter.

He considered that the revised text of Articles 4and 5 might be accepted, with the understandingthat non-Egyptian pilgrims who wished to disembarkin Egypt would automatically be subject to thenational sanitary regulations of that country. ThePilgrimage was of international concern, but apilgrim who disembarked in Egypt ceased to be apilgrim and became an ordinary traveller subject tothe same measures as other travellers. That being so,the two provisions under discussion were both inconformity with the general principles of inter-national law.

Dr. JAFAR said that either the second sentence ofArticle 4 was superfluous or, if it meant that SaudiArabia could take any measures it liked, it wascontrary to the decision taken by the Special Com-mittee. With regard to Article 5, the committeehad decided that ships entering the Suez canal wouldbe entering Egyptian territory ; anyone who wishedto disembark would be treated under nationalregulations but anyone remaining on board would betreated in conformity with the International Regu-lations. Therefore the reference to the EgyptianQuarantine Regulations was superfluous.

Dr. RAJA proposed deletion of the second sentenceof Article 4 and the words in Article 5 " wheresanitary measures, in conformity with these Regu-lations, may be applied to him as provided for inthe Egyptian Quarantine Regulations ".

The CHAIRMAN, after a discussion with Mr. HOSTIE,suggested as an alternative solution to add in Article 5" in the case of pilgrims in transit through Egyptianterritory " after " in conformity with these Regu-lations ", deleting the comma after " measures ".

Dr. EL-HALAWANI said that Article 5 dealtspecifically with El Tor and it would not be logicalto exclude a small minority of passengers from themeasures taken there. He stressed that while theEgyptian Government was averse from takingmeasures unless forced thereto by threat of diseases,it could not accept provisions that would hinderit from protecting its own territory. It was out oforder to make an amendment that would weakenthe provisions of the article which had alreadybeen adopted by the committee.

The CHAIRMAN said that Mr. Hostie had suggestedremoval of all mention as to measures to be appliedto people entering Egypt or Saudi Arabia fromArticles 4 and 5 and paragraphs 1 and 3 ofArticle 11. It would be fully understood underArticle 4 that the International Regulations appliedand under Article 5 that the Egyptian QuarantineRegulations applied to persons entering Egyptianterritory.

Dr. EL-HALAWANI maintained that it was necessaryto state in Article 5 that the Egyptian QuarantineRegulations would be applied, because the EgyptianGovernment could not agree to exempt the smallminority of pilgrims going to El Tor who were notEgyptians.

Mr. HOSTIE, replying to Mr. Khanachet's question,said Article 5 could hardly be replaced by a sentencesimilar to paragraph 3 of Article 11, because, whilethe latter concerned persons returning to the placefrom whence they came, Article 5 concerned twocategories of persons, those returning to Egypt andthose passing through Egypt in transit.

Dr. RAJA, seconded by Dr. JAFAR, formally movedthe proposal to delete the second sentence of Article 4,all the words following " health administration forEgypt " in Articles 5 and in paragraph 1 of Article 11and the whole of paragraph 3 of Article 11.

Dr. EL-HALAWANI objected to a vote being takenon the proposal on the grounds that a vote hadalready been taken on the article at an earliermeeting.

188 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

The CHAIRMAN ruled that the vote was in orderbecause of the amendment to paragraph 5 con-sequential to the addition of the second sentence toArticle 4.

Decision: A vote was taken and the proposal ofthe delegate of India was adopted.

Dr. EL-HALAWANI asked that his contrary vote berecorded.

The meeting rose at 12.5 p.m.

TWENTY-EIGHTH MEETING

Monday, 30 April 1951, at 2 p.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Review of Draft International Sanitary Regulationsprepared by the Drafting Sub-Committee : Annex A- Sanitary Control of Pilgrim Traffic approachingor leaving the Hedjaz (continuation)

The committee continued its examination of therevised draft of Annex A 18 prepared by the DraftingSub-Committee.

Article 6 [A 6]The article remained as amended by the Sub-

Committee on the Mecca Pilgrimage (for text seepage 271).

Dr. EL-FAR Bey (Egypt) objected to the substanceof the article.

Decision: The article was adopted without furthercomment.

Article 7 [A 7]At the suggestion of the CHAIRMAN the article.

which remained as amended by the Sub-Committeeon the Mecca Pilgrimage, was adopted (for text seepage 271).

Article 8 [A 8]The article, which remained as drafted by the

Sub-Committee on the Mecca Pilgrimage, wasadopted without comment (for text see page 272).

Article 9 [A 9]The text prepared by the Drafting Sub-Committee

read :1. On arrival at El Tor of any pilgrim shipdirected there under paragraph 3 of Article 7,or under Article 8, of this Annex, the health

18 The numbers given to the articles in this annex are thoseof the draft as revised by the Sub-Committee on the MeccaPilgrimage (p. 271). The numbers appearing in square bracketsin the headings are those of the final text (p, 360.)

authority for the sanitary station shall apply thefollowing measures :

(a) if there is a case of plague, cholera oryellow fever or smallpox on board, everypilgrim shall be disembarked and the suspectssubmitted to such sanitary measures as thehealth authority considers appropriate : thepilgrims shall be isolated for a period, reckonedfrom the date when the last case occurred, of notmore than five days for cholera, six days forplague or yellow fever or fourteen days forsmallpox ;

(b) if there is a case of typhus or relapsingfever on board, every suSpect shall be disem-barked and disinfected or disinsected ;(c) the appropriate measures for deratting,disinsecting or disinfection of the pilgrim shipshall be taken if necessary.

2. When the measures provided for in thisArticle have been applied, any pilgrim who is notan infected person shall be allowed to re-embarkand the ship allowed to continue its voyage.

At the suggestion of Dr. RAJA (India), the words :" prescribed in these Regulations " were insertedafter " measures " in the third line of sub-para-graph (a).

At the suggestion of the CHAIRMAN, sub-para-graph (b) was amended to read : " if there is a caseof typhus or relapsing fever on board, every suspectshall be disembarked and they and their baggagedisinsected and, if necessary, disinfected ".

Decision: The article, as amended, was adopted.

Article 10 10]

The article, which remained as drafted by the Sub-Committee on the Mecca Pilgrimage, was adoptedwithout comment (for text see page 272).

TWENTY-EIGHTH MEETING 189

Article 11 [A 111

The text prepared by the Drafting Sub-Committeeread :

1. Any pilgrim returning from the Hedjaz byair who wishes to disembark in Egypt, except asprovided in Article 29 of the Regulations, shall firstcall either at the sanitary station at El Tor, or atsome other sanitary station appointed by thehealth administration for Egypt, where sanitarymeasures, in conformity with the Regulations,may be applied to him as provided for in theEgyptian Quarantine Regulations.

2. No sanitary measures other than those providedfor in the Regulations shall apply during the voyageto other pilgrims returning by air from the Hedjaz.

3. The health administration for any territoryto which the pilgrim returns may determine thesanitary measures to be applied to him.

The CHAIRMAN reminded the committee that it hadalready decided, at its previous meeting, whenconsidering Article 5 (see page 187) to delete fromparagraph 1 the phrase " where sanitary measures,in conformity with the Regulations, may be appliedto him as provided for in the Egyptian QuarantineRegulations " and to delete the whole of paragraph 3.

Dr. MACLEAN (New Zealand) proposed that theopening phrase of paragraph 1 should be amendedto read : " Any aircraft conveying pilgrims returningfrom the Hedjaz and wishing to land in Egypt . . . ".

Dr. EL-HALAWANI (Egypt) agreed to the suggestedwording on the condition that the words " exceptas provided in Article 29 of the Regulations " weredeleted.

Dr. RAJA agreed to the deletion of the words" except as provided in Article .29 of the Regu-lations ", if the wording proposed by the delegateof New Zealand were to be adopted.

Mr. HASELGROVE (United Kingdom) consideredthat the reference to Article 29 should be retained,to cover the case of aircraft bound for Egypt but notcarrying pilgrims wishing to enter that country.

Dr. EL-HALAWANI said that the Regulationscontained no provision whereby measures couldbe taken against aircraft in the event of an epidemicin the Hedjaz itself. If the reference to Article 29

were retained, a provision, similar to the provisionmade for infected ships, should be added to ensurethat, in the case of an epidemic in the Hedjaz, aircraftreturning from the Hedjaz and landing in Egyptshould first land at El Tor.

The CHAIRMAN explained the Egyptian thesis :any aircraft carrying pilgrims, whether they wishedto land in Egypt or not, must, if bound for Egypt,first land at El Tor in order to make sure that noinfected pilgrims were on board. The point was areasonable one. If aircraft were not required to landat El Tor how could they be declared free frominfection as described in Article 7 ?

Dr. MACLEAN suggested that paragraph 2 shouldread " No sanitary measures other than thoseprovided for in the Regulations shall apply to otheraircraft returning from the Hedjaz ".

Mr. STOWMAN (United States of America) objectedthat the wording for the first part of paragraph 1proposed by the delegate of New Zealand would beliable to hinder regular international airline services.He would agree, however, to the wording " Anyaircraft conveying pilgrims returning from the Hedjazand wishing to land pilgrims in Egypt . . . "

Dr. EL-HALAWANI said that the safeguard forwhich he was asking would not cause any inter-ference with regular international airline services.He was not aware of any regular service connectingEgypt with the Hedjaz.

In reply to a question by Mr. KHANACHET(Saudi Arabia) on the status of El Tor, Dr. EL-HALAWANI explained that it was a national portapplying international regulations.

The CHAIRMAN said that the right of Egypt torequire aircraft carrying pilgrims to land at El Torwas already fully conceded by Article 27 of Annex B.

In order to clarify the discussion, Dr. MA'MOEN(Indonesia) described the usual procedure followedduring the pilgrimage season in the case of pilgrimsreturning by air from the Hedjaz to Egypt : pilgrimswere flown only by Egyptian aircraft ; one aircraftcarried pilgrims to El Tor and returned to Jeddah,while another aircraft took pilgrims from El Tor toEgypt ; non-pilgrims were flown by special planedirect to Cairo.

190 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

After a further exchange of views, the CHAIRMANread the wording of the Article as amended duringthe course of discussion :

1. Any aircraft conveying pilgrims returning fromthe Hedjaz and wishing to land pilgrims in Egypt,shall first call either at the sanitary station atEl Tor, or at some other sanitary station appointedby the health administration for Egypt.2. No sanitary measures other than those pro-vided for in the Regulations shall apply to otheraircraft returning from the Hedjaz.

Decision: Article 11, as amended, was adopted.

Article 12 [A 12]The article remained as originally drafted (for

text see page 272).

Dr. JAFAR (Pakistan) proposed that in Article 12and throughout the Regulations the words " theRegulations " should be replaced by " these Regu-lations ".

Decision: The proposal of the delegate of Pakistanwas adopted.

Articles 13 [A 131, 14 [A 14] and 15 [A 15]Decision: The articles, which remained as amendedby the Sub-Committee on the Mecca Pilgrimage,were adopted without comment (for text seepage 272).

2. Review of Draft International Sanitary Regulationsprepared by the Drafting Sub-Committee : Annex B- Standards of Hygiene on Pilgrim Ships and onAircraft carrying Pilgrims

The Special Committee proceeded to examine therevised draft of Annex B 19 prepared by the DraftingSub-Committee.

Articles 1 [B 1] to 7 [B 7]Decision: The articles were adopted withoutcomment (for text see page 362).

Article 8 [B 8]The text prepared by the Drafting Sub-Committee

read :Each State may apply to pilgrim ships embarking

for the Hedjaz in its ports, requirements in excessof those prescribed in Articles 2 to 7 inclusive

19 The numbers given to the articles in this annex are thoseof the draft as revised by the Sub-Committee on the MeccaPilgrimage. (p. 273) The numbers appearing in square bracketsin the headings are those of the final text (p. 362).

of this Annex, which prescribe minimum require-ments, if the additional requirements conformwith its national legislation.

Mr. HASELGROVE thought that the Special Com-mittee had agreed that Article 8 be deleted and thata sentence be inserted somewhere in the mainRegulations to the effect that Articles 2 to 7 ofAnnex B prescribed minimum and not maximumrequirements.

The CHAIRMAN agreed. He thought that the requiredreference could best be inserted in Article 96, whichmight be amended to read :

In addition to these Regulations, Annexes Aand B, which prescribe minimum requirements,shall apply to the Pilgrimage.

Dr. JAFAR was not sure that the deletion ofArticle 8 had been decided by vote. If not, its reten-tion would be harmless and perhaps even usefulsince many persons concerned in applying theprovisions of Annexes A and B would not take thetrouble to read the main Regulations.

M. MASPETIOL (France) recalled that the committeehad in fact decided to transfer the provisions ofArticle 8 to Article 96 of the main Regulations.Nevertheless, he thought that there was considerablepoint in the remarks of the delegate of Pakistan.He therefore proposed that an insertion on the linessuggested by the Chairman be made in Article 96and that Article 8 of the Annex be retained at thesame time. It might add something, both for thereason given by the delegate of Pakistan and becauseit laid down clearly that the provisions of Articles 2to 7 had equal force for all Member States.

Decision: The proposal of the delegate of Francewas adopted.

ArtiCle 9 [B 9]The article, which remained as adopted by the

Sub-Committee (in the Mecca Pilgrimage, wasadopted without comment (for text see page 274).

Articles 10 [B 10] to 13 [B 13]The articles were adopted without comment (for

text see pages 363-4).

Article 14 [B 14]The text of the article, which remained as drafted

by the Sub-Committee on the Mecca Pilgrimage,read :

1. The document referred to in sub-paragraph (ii)of paragraph (1) of Article 13 of this Annex shall

TWENTY-EIGHTH MEETING 191

be countersigned at each port of call by the healthauthority for that port, which shall enter on suchdocument :

(a) the number of pilgrims disembarked orembarked at that port ;(b) anything that has happened at sea affectingthe health of persons on board ;(c) the sanitary conditions at the port of call.

2. If any such document is altered in any othermanner during the voyage, the ship may be treatedas infected.

The CHAIRMAN, supported by the delegation ofFrance, thought that the word " other " in para-graph 2 should be deleted. The Drafting Sub-Committee had apparently considered that entriesmade under the provisions of paragraph 1 constitutedan alteration of the document.

Dr. RAJA observed that paragraph 1 (b) suggestedthat it was the health authority for each port whichwas to make the entry in question. Surely that shouldbe the task of the ship's surgeon. The sub-paragraphmight be deleted and a new paragraph inserted pro-viding that the health authority should be responsiblefor ensuring that anything that had happened at seaaffecting the health of persons on board was enteredon the document.

Dr. JAFAR thought it would be enough to deletethe sub-paragraph ; there was no need to insertany new provisions. What happened at sea must inany case be entered on the document before puttingin at the port. Actually, no entries at all were to bemade during the voyage, since the document wasmerely completed by each health authority for thebenefit of the next, and he therefore also supportedthe proposed deletion of the word " other " inparagraph 2.

Decision: It was agreed to remove sub-para-graph 1 (b) and to delete the word " other " inparagraph 2. Article 14 was remitted to theDrafting Sub-Committee.

Articles 15 [B 15] to 19 [B 191Decision: The articles were adopted withoutcomment (for text see page 364).

Article 20 [B 20]The article was discussed in connexion with

Article 24 (see below).

Articles 21 [B 21] to 23 TB 23]Decision: The articles were adopted withoutcomment (for text see page 365).

Articles 20 [B 20] and 24The articles remained as drafted by the Sub-

Committee on the Mecca Pilgrimage (see page 275)except that the references to Article 13 were alteredto correspond with the changed order of the sub-paragraphs of that article.

Dr. JAFAR, in answer to a question by the CHAIR-MAN, said that he took it that the words " prophy-lactic measures " in Article 24 meant measurestaken after the occurrence of a case of disease, forexample inoculations.

Dr. RAJA thought that the measures in questionshould rather be entered in the record to be kept bythe ship's surgeon under the provisions of paragraph 4of Article 20. Since inoculation, if that was what" prophylactic measures " meant, was an occurrencerelating to health, it seemed illogical that it shouldnot be entered for the benefit of health authorities inthe same record as other such occurrences.

The CHAIRMAN felt that, apart from such majorevents as death, the master of a ship should not berequired to copy every detail from the surgeon'slog into his own, since the former could be regardedas part and parcel of the latter.

Dr. JAFAR thought that, though Article 24 mightperhaps provide for some duplication of work, itwas necessary to retain a clause providing for thesupervision of prophylactic measures by the personwho was, after all, permanently responsible for theship and for all that happened on board.

Dr. MACLEAN thought that Article 24 should notbe retained unless the committee was absolutelycertain of the meaning of " prophylactic measures ",which might well be taken to include, for example,latrine cleaning. If the interpretation of the delegateof Pakistan was correct, perhaps the words " afterthe occurrence of cases of disease " should beinserted after the word " taken ".

Dr. PADUA (Philippines) suggested that the word" prophylactic " be replaced by " preventive ".

The CHAIRMAN thought that the two words meantmuch the same. If the committee did not wish todelete Article 24, it might agree to replace " everyprophylactic measure " by " any major healthmeasures " or something to that effect.

192 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

Dr. EL-HALAWANI agreed with the delegate ofIndia. Article 24 should be deleted and a referenceto prophylactic measures should be inserted inparagraph 4 of Article 20.

Dr. MACLEAN formally proposed the deletion ofArticle 24. Paragraph 4 of Article 20, as it stood, wassufficient to ensure that the ship's surgeon enteredall that was necessary in his records.

Mr. HASELGROVE agreed with the delegate ofNew Zealand.

He noticed that Article 24 was based on Article 125of the International Sanitary Convention, 1926,where the word employed was " preventive ". Inreply to a question put by the delegate of India, hesaid that the 1926 Convention contained nothingcorresponding to the detailed provisions of Article 20and laid down the duties of the surgeon only ingeneral terms.

Decision It was agreed to delete Article 24.

Dr. JAFAR thought that, in view of the deletion ofArticle 24, the provisions of paragraph 4 of Article 20should be strengthened.

Dr. DUJARRIC DE LA RIVIÈRE (France) wonderedwhether the surgeon's record had to be counter-signed by the master. If so, the guarantee requiredby the delegate of Pakistan was already provided.

The CHAIRMAN, during his own period as a ship'ssurgeon, had had to present his records to themaster of the ship every day. If the committeewished to make that practice obligatory on all

pilgrim ships, the words " which shall be counter-signed by the master " might be inserted after thewords " day-to day record " in paragraph 4.

Dr. JAFAR insisted that some reference to preven-tive measures should be included in the paragraph.

Dr. MACLEAN thought that the record should becountersigned daily.

Mr. HASELGROVE thought that the words " Heshall produce the record for inspection " should bereplaced by " The record shall be produced forinspection ", since it was not entirely certain whowould produce the record.

Decision: The following text was adopted forparagraph 4 of Article 20, and remitted to theDrafting Sub-Committee :

The ship's surgeon shall keep a day-to-dayrecord, countersigned daily by the master, ofevery occurrence relating to health, includingpreventive measures taken during the voyageand, if so requested by the health authority forany port of call or for the port of destination,the record shall be produced for inspection.

Articles 25 [B 241, 26 [B 251 and 27 [B 26]Decision:

(1) The articles were adopted without comment(for text see Articles B 24, B 25 and B 26, page 365).(2) Annexes A and B were remitted to theDrafting Sub-Committee.

The meeting rose at 2.10 p.m.

TWENTY-NINTH MEETING

Tuesday, I May 1951, at 9.30 a.m.

Chairman: Dr. M. T. MORGAN (United Kingdom)

1. Review of Draft International Sanitary Regulationsprepared by the Drafting Sub-Committee

The Special Committee had before it the draftof the main body of the International SanitaryRegulations as prepared by the Drafting Sub-

Committee in accordance with the decisions takenat previous meetings.

On the proposal of the CHAIRMAN it was agreedto defer consideration of the Preamble until therevised articles had been examined.

TWENTY-NINTH MEETING 193

Article 1 fl I

The following definitions, in which no changehad been made, were confirmed by the committee(for text see pages 10 and 11) :

aircraftairportbaggagecrewdayepidemichealth administrationOrganizationpilgrimPilgrimagerelapsing feversanitary stationyellow-fever receptive area

The following amended definitions were adoptedby the committee without comment (for text seepage 336) :

health authorityimported caseinfected personship

No observations were made on the deletion of" bateau " from the French text.

The definitions of " first case " and " epidemicdisease " were adopted by the committee, subjectto the substitution, in accordance with a decisiontaken at the twenty-sixth meeting (see page 177),of the word " quarantinable " for " epidemic "(for text see page 336).

The remaining definitions were read in the Frenchalphabetical order and discussed as follows :

" Arrival"The text prepared by the Drafting Sub-Committee

read :" Arrival" of a ship, an aircraft, a train or a roadvehicle means :

(a) in the case of a seagoing vessel, arrival ata port ;(b) in the case of an aircraft, arrival at anairport ;(c) in the case of an inland navigation vessel,arrival either at a port or at a frontier post, asgeographical conditions and agreements amongthe States concerned, under Article 98 or underthe laws and regulations in force in the territoryof entry, may determine ;(d) in the case of a train or road vehicle,arrival at a frontier post.

Decision: On the proposal of the CHAIRMAN itwas agreed that " ship " should be substitutedfor " seagoing vessel " in paragraph (a).

" Valid Certificate"The text remained as originally drafted (see

page 11).

Dr. MACLEAN (New Zealand) said, and the com-mittee agreed, that in view of the form of smallpoxvaccination certificate adopted, reference to Ap-pendix 4 should be deleted.

" Local Area"The text prepared by the Drafting Sub-Committee

read :

Local area" means :(a) the smallest area within a territory, whichmay be a port or an airport, having a definedboundary and possessing a health organizationwhich is able to apply the appropriate sanitarymeasures permitted or prescribed by theseRegulations : the situation of such an areawithin a larger area which also possesses sucha health organization shall not preclude thesmaller area from being a local area for thepurposes of these Regulations : or(b) an airport in connexion with which a directtransit area has been established.

Mr. STOWMAN (United States of America) thoughtthere was some confusion over the use of the words" direct transit area " and proposed that para-graph (b) be deleted.

Mr. HASELGROVE (United Kingdom) thought theintention was to ensure that persons who had landedat an airport under direct transit conditions shouldnot be considered as coming from the local area inwhich the direct transit area was situated.

The CHAIRMAN asked whether substitution of" which may be a port, airport or direct transitarea " for " which may be a port or an airport "in paragraph (a) would meet the situation.

Dr. RAJA (India) suggested that a difficulty arosefrom the fact that a direct transit area was notlikely to possess a health organization as prescribedin paragraph (a).

Dr. BELL (United States of America) stated that,if a direct transit area, as defined, provided foradequate segregation of transit passengers, para-graph (b) could remain. He therefore proposed that

194 SPECIAL COMMITTEE ON DRAFT INTERNATIONAL SANITARY REGULATIONS

decision on the definition of local area should bepostponed until the committee had examined thedefinition of a direct transit area.

It was so agreed.

" Infected Local Area"

The text prepared by the Drafting Sub-Committeeread :

" Infected local area" means :

(a) a local area in which there is at least oneof the cases of a foyer of plague, cholera, yellowfever or smallpox, or(b) a local area where there is an epidemic oftyphus or relapsing fever, or(c) a local area where plague infection amongrodents exists on land or on craft which are partof the equipment of a port ;(d) a local area or a group of local areas inwhich the existing conditions are those of ayellow-fever endemic zone.

Dr. BARRETT (United Kingdom) thought para-graph (a) should read " a local area where there isa foyer of yellow fever, plague, cholera or smallpox "as proposed by the working party on the definitionof infected local area (see page 286).

Dr. BELL explained that the wording had beenchanged to cover the case when the foyer spread overtwo contiguous areas, for instance, when an importedcase of disease occurred in a port and the next casein the local area in which the port was situated.

Dr. BARRETT said the working party's definitionof " foyer " was an epidemiological definition andwas not related to any particular local area. Hethought it had been the definite opinion of theworking party that where a foyer of plague, yellowfever or smallpox appeared in a local area, it shouldbe declared an infected local area, and that thestandard of the amount of infection should not bereduced below that.

Dr. RAJA proposed the retention of the workingparty's definition, which had been reached as acompromise after a lengthy discussion, and beenendorsed by the Special Committee.

Dr. BELL said that in a large city such as Londonthere might be, say, ten local areas. There might beten cases of disease but under the working party's

definition, at least two would have to be in the samelocal area before any of the areas could be declaredinfected. He did not think that was the intentionof the working party.

Dr. MACLEAN thought the word " territory "in the definition of " foyer " was too wide a term,as it would cover a single case occurring in each oftwo widely separated parts in certain large countries.

Dr. RAJA also thought the term too wide. " Terri-tory " should be changed to " local area ".

Dr. BELL said the difficulty arose on account ofthe definition of " local area ". A local area shouldbe an epidemiological unit.

If a case of smallpox or cholera occurred in a localarea of a big city, the infection might easily spreadto the whole city. Mode of transihission and riskof spread of infection varied with each disease sothat, epidemiologically, the local area might bedifferent for each disease. Since it was impossible,therefore, to arrive at an epidemiological definitionfor infected local area, he considered that theDrafting Sub-Committee's definition was the mostsatisfactory that could be achieved. He suggestedthat the definition of " foyer " should read " foyermeans the occurr