Office of the WHO Representative in the Philippines

INTERNATIONAL HEALTH

REGULATION (IHR) 2005

ASEAN Regional Forum Workshop on

Biological Risk Management

27 September 2010

Makati City, Philippines

Ma. Nerissa N. Dominguez, MD,MPH

Communicable Disease Surveillance and Response (CSR)

WHO Philippines

Office of the WHO Representative in the Philippines

History of the IHR

• 1830-1847: the cholera epidemics in Europe

• 1851: 1st International Sanitary Conference, Paris

• 1948: The WHO Constitution came into force

• 1951: WHO Member States adopted Intl Sanitation Regulations

• 1969: Renamed as the International Health Regulations, 1969

– cholera, plague and yellow fever

• 1973, 1981: modification to IHR (1969)

• 1995: WHA48 called for the revision

• 2003: WHA56 established an intergovernmental working group

• 2005: WHA58 adopted the substantially revised IHR --- IHR(2005)

Office of the WHO Representative in the Philippines

Why revised International Health

Regulations?In today’s world, diseases travel

fast and no single country can

protect itself on its own.

Acknowledging this, the 193 WHO Member

States unanimously adopted a new version

of the International Health Regulations (IHR).

The revised IHR enter into force in June 2007. It will

now be up to the world to translate the new code of the

Regulations into the reality of greater international

public health security.

Dr Margaret Chan, WHO Director-General

Office of the WHO Representative in the Philippines

Our world is changing as never

before

Populations grow, age, and move

Diseases travel fast

Microbes adapt

Chemical, radiation, food risks increase

Health security is at stake

Office of the WHO Representative in the Philippines

30 years of international health in

security

• HIV/AIDS

• CHERNOBYL

• PLAGUE

• EBOLA / MARBURG

• NvCJD

• NIPAH

• YELLOW FEVER

• ...

• ANTHRAX

• SARS

• MENINGITIS

• CHOLERA

• CHEMICAL

• AVIAN INFLUENZA

• XDR-TB

• ...

Office of the WHO Representative in the Philippines

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WHO travel recommendations removed

36 116

WHO travel recommendations2 April

14 670

13 May

102 165

25 May27 March 23 June

Screening of exit passengers

SARS: an unknown

coronavirus

• 8098 cases

• 774 deaths

• 26 countries affected

• trends in airline passenger

movement drop

• economic loss: US$ 60 billion

2003: SARS changed the world

Office of the WHO Representative in the Philippines

H5N1: Avian influenza, a

pandemic threat

Office of the WHO Representative in the Philippines

The 58th World Health Assembly adopted

the revised International Health

Regulations, “IHR”

Office of the WHO Representative in the Philippines

International public health

security is the goal

Ensuring maximum public

health security

while minimizing interference

with international transport and

trade

* A later date applies to States that have submitted

reservations

Legally binding for WHO and the world’s countries that have

agreed to play by the same rules to secure international health.

Office of the WHO Representative in the Philippines

Purpose of the IHR (2005)

“To prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoidunnecessary interference with international traffic and trade” – Article 2

Office of the WHO Representative in the Philippines

What’s new?

• From three diseases to all public health

threats

• From preset measures to adapted response

• From control of borders to, also, containment

at source

Office of the WHO Representative in the Philippines

All public health threats

• The revised IHR recognize that

international disease threats have

increased

• Scope has been expanded from

cholera, plague and yellow fever to

all public health emergencies of

international concern

• They include those caused by

infectious diseases, chemical agents,

radioactive materials and

contaminated food

Office of the WHO Representative in the Philippines

IHR Definition of “PHEIC”

• PHEIC - “Public health emergency of

international concern” means an

extraordinary event which is determined,

as provided in these Regulations:

(i) to constitute a public health risk to other

States through the international spread of

disease

AND

(ii) to potentially require a coordinated

international response

Office of the WHO Representative in the Philippines

A Broader Concept of Risk

Management….

• Disease Risk Identification & Characterization

• Disease Risk Reduction

• Disease/Threat-specific Preparedness & Readiness

• Event Detection

• Event Investigation &Risk Assessment

• Event Response

• Evaluation of Response & Future Risk

Office of the WHO Representative in the Philippines

Adapted response

International public health

security is based on strong

national public health

infrastructure connected to a

global alert and response

system.

This is at the core of the IHR.

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Containment at source

Rapid response at the source is:

• the most effective way to secure maximum protection against international spread of diseases

• key to limiting unnecessary health-based restrictions on trade and travel

Office of the WHO Representative in the Philippines

Shift of Public Health Efforts

• POE were the main implementers and partners for

the old IHR

• However, many new challenges faced in managing

acute public health risks and events at POE in the

changing world

• Key questions:

– What are new roles of POE under the new IHR?

– How can we shift our public health efforts at

POE to fit the changing situation?

Office of the WHO Representative in the Philippines

►Prevention (routine) Access to medical service

Transport of ill travellers

Inspection of conveyances

A safe environment for travellers

Control of vectors / reservoirs

POE work: Two Focuses

►Emergency Preparedness and Response Public Health Emergency contingency plan

Arrangement for treatment and isolation

Arrangement for interview / quarantine

Apply specific control measures

Office of the WHO Representative in the Philippines

What do the IHR call for? Strengthened national capacity for

surveillance and control, including in

travel and transport

Prevention, alert and response to

international public health emergencies

Global partnership and international

collaboration

Rights, obligations and procedures,

and progress monitoring

Office of the WHO Representative in the Philippines

Why should countries

implement the IHR?

To detect and contain public health

threats faster, to contribute to

international public health security,

and to enjoy the benefits of being a

respected partner.

Office of the WHO Representative in the Philippines

The IHR foster global partnership

• Other intergovernmental organizations:

– UN system (e.g. FAO, IAEA, ICAO, IMO)

– others: regional (e.g. EU, ASEAN), technical (e.g. OIE)

• Development agencies:

– governments, banks

• WHO Collaborating centres

• Academics & professional associations

• Industry associations

• NGOs and Foundations

Office of the WHO Representative in the Philippines

As each country builds its capacity,

the entire world winsThe greatest assurance of public health security will come when all

countries have in place the capacities for effective surveillance and

response, for:

• infectious diseases radiological-related

diseases

• chemical-related diseases food-related diseases

Timeline

"As soon as possible but no later than five years from entry into force …" (Articles 5, 13)

15 June 2007 2009 2012 2014 2016

Planning Implementation

2 years + 3 + (2) + (up to 2)

"As soon as possible but no later than five years from entry into force"

Office of the WHO Representative in the Philippines

Countries’ challenges for IHR implementation

• Designate a National IHR focal point

• Mobilize resources and develop national action plans

• Strengthen national capacities in alert and response

• Strengthen capacity at ports, airports, and ground

crossings

• Maintaining strong threat-specific readiness for

known diseases/risks

• Rapidly notify WHO of acute public health risks

• Sustain international and intersectoral collaboration

• Monitor progress of IHR implementation

Office of the WHO Representative in the Philippines

What will WHO do under the IHR?

• Designate WHO IHR contact points

• Inform State Parties of relevant international public health risks

Asia Pacific Strategy for Emerging Diseases and APSED 2010

• Support States Parties in assessing their public health risks, through the notification, consultation, and verification processes

• Recommend adapted public health measures

• Assist States Parties in their efforts to investigate outbreaks and meet the IHR national requirements for surveillance and response

Office of the WHO Representative in the Philippines

Benefit and Value of New IHR

• IHR (2005) has been widely and well applied to the current

pandemic response in a coordinated and collective way

• Proving to be a key framework for sharing information among

countries and partners related to pandemic (H1N1) 2009

• Timely notifications and reporting from countries have allowed

– global and regional pandemic situation to be assessed and

monitored

– technical guidance to be developed in a timely manner

• POE has played an important role in providing information to

international travellers, detecting and responding to early

suspected cases among people with travel history

Office of the WHO Representative in the Philippines

International

Health Regulations

Building international public health security

w w w . w h o . i n t / i h r

Office of the WHO Representative in the Philippines

Thank you