INTERNATIONAL HEALTH
REGULATIONS
The International Health Regulations (IHR), first adopted by the World Health
Assembly in 1969 and last revised in 2005, are a legally binding instrument of
international law that aims for international collaboration "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 that avoid unnecessary interference with international traffic and trade"
IHR (2005)
1. From control of borders to containment at source
2. From diseases list to all threats
3. From pre-set measures to adapted and real time response
Determination of a
Public Health Emergency of International Concern (PHEIC)
1. Director-General (DG) seeks view of “Emergency Committee” (EC)
2. EC formed by IHR Roster of Experts - experts in all relevant fields of expertise
(including from the concerned state party of Emergency) in accordance with
the WHO Regulations for Expert Advisory Panels and Committees
3. DG - invite the State Party in whose territory the event arises to present
its views to the EC
4. Final decision: By DG
A. Is the Public Health Impact of the Event Serious?
1. Is the number of cases and/or number of deaths for this type of
event large for the given place, time or population?
OR
2. Has the event the potential to have a high public health impact?
OR
3. Is external assistance needed to detect, investigate, respond and
control the current event, or prevent new cases?
HIGH PUBLIC HEALTH IMPACT
1. Pathogen with high potential to cause epidemic
2. Indication of treatment failure
3. Cases reported among health staff or vulnerable population
4. Factors delaying public health response (natural catastrophes, armed
conflicts)
5. High population density
6. Spread of toxic, infectious or otherwise hazardous materials contaminating
a large geographical area
B. Is the Event Unusual or Unexpected?
Unusual:
1. An unknown agent or the source, vehicle, route of transmission is
unusual or unknown
2. Evolution of cases more severe than expected or with unusual
symptoms
3. Occurrence of the event itself unusual for the area, season or
population.
Unexpected:
Disease/agent that had already been eliminated or eradicated
C. Is there a significant risk of international spread?
A. Is there evidence of an epidemiological link to similar events in other
States?
OR
B. Is there any factor that should alert us to the
potential for cross border
movement of the agent, vehicle or host?
Eg. Index case (or other linked cases) with a history within the
previous month:
1. International travel or gathering (pilgrimage, sports event,
conference, etc.)
D. Is there a significant risk of
International travel or trade restrictions?
1. Similar events in the past resulted in international restriction on
trade and/or travel?
2. Source suspected or known to be a food product/water/other goods
that might be contaminated, that has been exported/imported to/from
other States?
3. In association with an international gathering or in an area of intense
international tourism?
4. Requests for more information by foreign officials or international
media?
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WHO Levels For Graded Emergencies
• A public health event or emergency that is being monitored by WHO but that does not require, a WHO
Ungrad operational response.
ed
• A single or multiple country event with minimal public health consequences that requires a minimal
WCO response or a minimal international WHO response.
Grade 1 • Organizational and/or external support required by the WCO is minimal.
• The provision of support to the WCO is coordinated by a focal point in the regional office.
• A single or multiple country event with moderate public health consequences that requires a moderate
WCO response and/or moderate international WHO response.
Grade 2 • Organizational and/or external support required by the WCO is moderate.
• An Emergency Support Team, run out of the regional office (the Emergency Support Team is only run
out of HQ if multiple regions are affected), coordinates the provision of support to the WCO.
• A single or multiple country event with substantial public health consequences that requires a
substantial WCO response and/or substantial international WHO response.
• Organizational and/or external support required by the WCO is substantial.
Grade 3 •
An Emergency Support Team, run out of the regional office, coordinates the provision of support to the
WCO.
Countries’ challenges for IHR implementation
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
What will WHO do under the IHR?
Designate WHO IHR contact points
Support States Parties in assessing their public health risks,
through the notification, consultation, and verification
processes
Inform State Parties of relevant international public health
risks
Recommend adapted public health measures
Assist States Parties in their efforts to investigate outbreaks
and meet the IHR national requirements for surveillance and
response
Benefit from IHR implementation
Lives saved
Good international image
No unilateral travel and trade
restrictions
Public trust
No political and social turmoil
THANK YOU
16-07-2018 Dr Tanveer Rehman PSM JIPMER 35
