International health regulation

INTERNATIONAL
HEALTH
REGULATIONS
By
DR.VENU BOLISETTI
M.B.B.S,D.P.H,
pg in M.D (community medicine)

AIM
 a) assist countries to work together to save
lives and livelihoods endangered by the spread
of diseases and other health risks, and
 b) avoid unnecessary interference with
international trade and travel.

The international health regulations
evolution
The International Health Regulations originated with
the International Sanitary Regulations adapted at the
International Sanitary Conference in Paris in 1851.
The cholera epidemics that hit Europe in 1830 and
1847 made apparent the need for international
cooperation in public health.
 In 1948, the World Health Organization
Constitution came about.

The Twenty-Second World Health Assembly (1969)
adopted, revised and consolidated the International
Sanitary Regulations, which were renamed the
International Health Regulations (1969).
 The Twenty-Sixth World Health Assembly in
1973 amended the IHR (1969) in relation to
provisions on cholera.
 In view of the global eradication of smallpox, the
Thirty-fourth World Health Assembly amended the
IHR (1969) to exclude smallpox in the list of
notifiable diseases.

During the Forty-Eighth World Health Assembly in
1995, WHO and Member States agreed on the need
to revise the IHR (1969) most notably:
narrow scope of notifiable diseases
(cholera, plague, yellow fever),
The past few decades have seen the emergence and
re-emergence of infectious diseases.
The emergence of “new” infectious agents
Ebola, Hemorrhagic Fever and the re-emergence of
cholera and plague in South America and
India, respectively;

dependence on official country notification; and
lack of a formal internationally coordinated
mechanism to prevent the international spread of
disease.
These challenges were placed against the backdrop
of the increased travel and trade characteristic of the
20th century.
The IHR (2005) entered into force, generally, on 15
June 2007, and are currently binding on 194
countries (States Parties) across the globe, including
all 193 Member States of WHO.

 In 2010 at The Meeting of the States Parties to the
Convention on the Prohibition of the
Development, Production and Stockpiling of
Bacteriological (Biological) and Toxin Weapons and
Their Destruction in Geneva the sanitary
epidemiological reconnaissance was suggested as
well-tested means for enhancing the monitoring of
infections and parasitic agents, for practical
implementation of the IHR (2005) with the aim was
to prevent and minimize the consequences of natural
outbreaks of dangerous infectious diseases as well
as the treat of alleged use of biological weapons
against BTWC States Parties.

The significance of the sanitary epidemiological
reconnaissance is pointed out in assessing the
1. sanitary-epidemiological situation,
2. organizing and conducting preventive activities,
3. indicating and identifying pathogenic biological
agents in the environmental sites,
4. conducting laboratory analysis of biological
materials,
5. suppressing hotbeds of infectious diseases,
6. providing advisory and practical assistance to local
health authorities.

Achieving international public health security is one
of the main challenges arising from the new and
complex landscape of public health.
 Strengthening countries' disease surveillance and
response systems is central to improving public
health security in each country and globally.
 WHO's unique public health mandate, worldwide
network, well established global partnership and
long-standing experience in international disease
control constitute an exceptional and unique asset
for supporting countries in strengthening their
capacity and for achieving international health
security.

The IHR comprise a legal instrument
specifically designed to support the attainment
of this goal.

Meeting the requirements in the revised IHR
(2005) is a challenge that requires time,
commitment and the willingness to change.
The Regulations in the implementation of the
obligations contained in them.

Of the seven areas of work to guide IHR
implementation, four of these (2, 3, 4 and 5) are key,
2. Strengthen national disease surveillance,
prevention, control and response systems and
3 . Strengthen public health security in travel and
transport, address countries' public health capacities
to fulfill IHR (2005) requirements.
 4 .Strengthen WHO global alert and response
systems and
5 . Strengthen the management of specific risks,
focus on the necessary surveillance, prevention,
control, and response systems at international level.

EPIDEMIC-PRONE DISEASES
 Cholera, epidemic meningococcal diseases and
yellow fever made an alarming come back in the last
quarter of the 20th century and call for renewed
efforts in surveillance, prevention, and control.
 Emerging viral diseases such as avian influenza in
humans, Ebola and Marburg hemorrhagic fevers
, Nipah virus, SARS and West Nile fever have
triggered major international concern, raised new
scientific challenges, caused major human suffering
and enormous economic damage.

FOOD-BORNE DISEASES
 The food chain has undergone considerable and
rapid changes over the last 50 years, becoming
highly sophisticated and international.
 Although the safety of food has dramatically
improved overall, progress is uneven and food-borne
outbreaks remain common in many countries.
In addition, some new food-borne diseases have
emerged and create considerable concern, such as
the recognition of the new variant of Creutzfeldt-
Jakob disease associated with Bovine spongiform
encephalopathy.

ACCIDENTAL AND
DELIBERATE OUTBREAKS

TOXIC CHEMICAL ACCIDENTS
 West Africa, 2006: the dumping of approximately
500 tons of petrochemical waste in at least 15 sites
around the city of Abidjan left eight people dead and
nearly 80,000 more complaining of ill health and
seeking medical help while other countries were
wondering if they could have also been put at risk;
 Southern Europe, 1981: 203 people died after
consuming poisoned cooking oil that was
adulterated with industrial rapeseed oil.
 A total of 15 000 people were affected by the
tainted oil and no cure was ever found.

RADIO NUCLEAR ACCIDENTS
 Eastern Europe, 1986: the Chernobyl disaster is
regarded as the worst accident in the history of
nuclear power.
The explosion at the plant resulted in the radioactive
contamination of the surrounding geographic area
and a cloud of radioactive fallout drifted over parts
of the western Soviet Union, eastern and western
Europe, Scandinavia, the United Kingdom, Ireland
and eastern North America. Large areas of the
Ukraine, Belarus and the Russian Federation were
badly contaminated, resulting in the evacuation and
resettlement of over 336 000 people.

ENVIRONMENTAL DISASTERS
Europe, 2003: the heat wave in Europe that
claimed the lives of 35 000 persons was linked
to unprecedented extremes in weather in other
parts of the world during the same period.

 Global Outbreak Alert and Response Network
(GOARN) provides a framework for the technical
coordination of international alert and response
activities with institutions and countries around the
world.
 They lay out new obligations devised to collectively
respond to international public health challenges of
the 21st century, taking advantage of new
developments in biotechnology, surveillance
systems, and information technology, such as rapid
data sharing.
 Unprecedented tools are now available to rapidly
detect, assess, and respond to events which represent
international public health threats.

IHR (2005) Main legal
requirements
Implementing IHR (2005) is an
obligation for WHO and States
Parties to the
Regulations.
The obligations under the IHR
(2005) can be regrouped as
follows:

 those related to the core capacity requirements for
countries to "detect, assess, notify and report events
in accordance with the regulations" and to "respond
promptly and effectively to public health risks”
 those related to the obligation, permission or
prohibition of certain public health actions in
respect of international travelers, goods, cargo and
conveyances and the ports, airports and border
crossings that they utilize.
those related to the administration of IHR such as
the nomination in each country of a National IHR
Focal point and, for WHO, the nomination of WHO
IHR Contact Points

The six areas for results identified by the WHO
Director-General: WHO’s Medium-Term Strategic
Plan (MTSP) 2008-2013,
1. Health development,
2. Health security,
3. Capacity,
4. Evidence,
5. Partnership and
6. Performance.

International health regulation

International health regulation

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