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International health regulations go into effect

New opportunity to respond to international public health threats

International Health Regulations enter into force

by the World Health Organization

The revised International Health Regulations (IHR) entered into force on Friday, 15 June. The regulations consist of a comprehensive and tested set of rules and procedures, which will help to make the world more secure from threats to global health. They were agreed by the World Health Assembly in 2005 and represent a major step forward in international public health security.

The regulations establish an agreed framework of commitments and responsibilities for states and for WHO to invest in limiting the international spread of epidemics and other public health emergencies while minimizing disruption to travel, trade and economies. Under the revised IHR, states will be required to report all events that could result in public health emergencies of international concern, including those caused by chemical agents, radioactive materials and contaminated food.

In the early 21st Century, demographic, economic and environmental pressures have created a unique combination of conditions that allow new and re-emerging infectious diseases to spread as never before. The experience of recent decades shows that no individual country can protect itself from diseases and other public health threats. All countries are vulnerable to the spread of pathogens and their economic, political and social impact.

The emergence of SARS in 2003 demonstrated as no previous disease outbreak ever had how interconnected the world has become and how rapidly a new disease can spread. This shared vulnerability has also created a need for collective defenses and for shared responsibility in making these defenses work. This is the underlying principle of the International Health Regulations.

"SARS was a wake-up call for all of us. It spread faster than we had predicted and was only contained through intensive cooperation between countries which prevented this new disease from gaining a foothold," said Dr. Margaret Chan, Director-General of the World Health Organization. "Today, the greatest threat to international public health security would be an influenza pandemic. The threat of a pandemic has not receded, but implementation of the IHR will help the world to be better prepared for the possibility of a pandemic."

The regulations build on the recent experience of WHO and its partners in responding to and containing disease outbreaks. Recent experience shows that addressing public health threats at their source is the most effective way to reduce their potential to spread internationally. The regulations will help to ensure that outbreaks and other public health emergencies of international concern are detected and investigated more rapidly and that collective international action is taken to support affected states to contain the emergency, save lives and prevent its spread.

WHO has already developed and built an improved events management system to manage potential public health emergencies. WHO has also built strategic operations centers at its Geneva headquarters and in regional offices around the world, which are available round-the-clock to manage emergencies. WHO has also been working with its partners to strengthen the Global Outbreak Alert and Response Network (GOARN), which bring together experts from around the world to respond to disease outbreaks.

"Implementing the IHR is a collective responsibility and depends on the capacity of all countries to fulfill the new requirements," said Dr. David Heymann, WHO Assistant Director-General for Communicable Diseases. "WHO will help countries to strengthen the necessary capacities to fully implement the regulations. This is our responsibility and we expect that the entire international community is committed to the same goal of improving international public health security."

Summary of the revised IHR requirements

Notification --- greater openness demanded by a world in which serious disease events are increasingly visible

The regulations recognize that media and other unofficial reports often appear in advance of official notification of a public health emergency of international concern. To expedite the flow of timely and accurate information, countries are required to notify all events that may constitute a public health emergency of international concern within 24 hours of assessment.

Designation of national IHR focal points: world on 24-hour alert

Under the IHR every country is required to designate a national IHR focal point, charged with providing to and receiving information from WHO on a 24-hour basis, seven days a week.

Establishment of core public health capacities to maximize surveillance and response

Under the IHR, each country is committed to develop and maintain core public health capacities for surveillance and response. These capacities also include outbreaks of chemical, radiological and food origin. States are required to establish such core capacities as soon as possible, with a deadline of five years after entry into force of the revised IHR.

New recognized rights for international travelers

The IHR for the first time include express requirements that international travelers be treated with respect for their dignity, human rights and fundamental freedoms when health measures are applied. At the same time, they provide for examinations and other health measures as necessary to protect against the international spread of disease.

Cross-sectoral international collaboration key to implementing IHR

WHO needs the support of all stakeholders to ensure international public health security. The IHR foster multi-sectoral global partnership to respond collectively in the face of epidemics and other major health emergencies.

Threat-specific international programs to improve international health security

The IHR provide for strengthening existing international disease control programs, addressing infectious diseases, food safety and environmental safety. These programs make a vital contribution to the global alert and response system as they allow development of generic and threat-specific capacities.