International health regulaiton (IHR-2005) Afghanistan Dr. Islam Saeed

1. Islamic Republic of Afghanistan Ministry of Public Health Afghanistan National Public Health Institute ( ANPHI ) Surveillance / DEWS Directorate Overview of International Health Regulations (IHR-2005) Dr. Islam Saeed, Director Surveillance, ANPHI-MoPH MD, MSc-HPM, MSc-FELTP Afghanistan National Public Health Institute Disease Early Warning System

2. Afghanistan National Public Health Institute Disease Early Warning System 2 Outline • Need for ensuring global health • IHR (2005)- a legal framework • Assessment of public health events • National Core capacities • Implementation of IHR 2005 • Situation in Afghanistan • Achievements and Challenges • Conclusion

3. Afghanistan National Public Health Institute Disease Early Warning System 3 What is concern? • Epidemics took days, weeks/months to reach far territories • Emergence/re-emergence of infectious diseases and increased pace of spread • Threat of deliberate use of biological and chemical agents • Events of international concern of unknown causes or sources • Impact on health, economy, security

4. Afghanistan National Public Health Institute Disease Early Warning System 4 What are IHR (2005)? A legal framework • International legal instrument which is legally binding on all WHO States Parties to protect global health • The international commitment for shared responsibilities and collective defence against disease spread Rights, Obligations and procedures entered into force on 15 June 2007

5. The 58th World Health Assembly adopts the revised International Health Regulations, “IHR” Ensuring maximum public health security while minimizing interference with international transport and trade Legally binding for WHO and the world’s countries that have agreed to play by the same rules to secure international health. Afghanistan National Public Health Institute Disease Early Warning System

6. Afghanistan National Public Health Institute Disease Early Warning System 6 International Health regulations (2005) 10 Parts, 66 Articles, 9 Annexes • PART I DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND RESPONSIBLE AUTHORITIES • PART II INFORMATION AND PUBLIC HEALTH RESPONSE • PART III RECOMMENDATIONS • PART IV POINTS OF ENTRY • PART V PUBLIC HEALTH MEASURES • Chapter I General provisions • Chapter II Special provisions fro conveyances and conveyance operators • Chapter III Special provisions for travellers • Chapter IV Special provisions for goods, containers and container loading areas • PART VI HEALTH DOCUMENTS • PART VII CHARGES • PART VIII GENERAL PROVISION • PART IX THE ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE REVIEW COMMITTEE • Chapter I The IHR Roster of Experts • Chapter II The Emergency Committee • Chapter III The Review Committee • PART X FINAL PROVISIONS

7. 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 • New focus on national capacity Afghanistan National Public Health Institute Disease Early Warning System

8. Afghanistan National Public Health Institute Disease Early Warning System 8 Purpose of 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 avoid unnecessary interference with international traffic and trade” – (Article 2)

9. Strengthen national capacity 1. Strengthen national disease surveillance, prevention, control and response systems 2. Strengthen public health security in travel and transport 2 years +……………….. 3 + ……..(2)…….…..……+ (up to 2) Afghanistan National Public Health Institute Disease Early Warning System • Timeline 2007 2009 2012 2014 2016 Planning Implementation

10. Core Capacity Technical Areas Afghanistan National Public Health Institute Disease Early Warning System • 8 Core capacities – Legislation and Policy – Coordination – Surveillance – Response – Preparedness – Risk Communications – Human Resources – Laboratory • Potential Hazards – Infectious – Zoonosis – Food safety – Chemical – Radio nuclear • 3 levels – National – Intermediate – Peripheral/Community • Events at Points of Entry – Ports – Air ports – Ground crossing

11. IHR Structure Afghanistan National Public Health Institute Disease Early Warning System 11 IHR Secretariat HQ IHR Regional Contact Points CO NFPs NFPs

12. Afghanistan National Public Health Institute Disease Early Warning System 12 National IHR Focal Points (NFPs) • Important role in implementation of IHR • The national centre for communications with WHO: – On a 24/7 basis (by telephone, fax, email) – NOT an individual person • Legally required functions • Potential additional tasks as determined by State: – Risk assessment, coordinated response etc.

13. WHO and 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 Afghanistan National Public Health Institute Disease Early Warning System

14. Roster of experts IHR Roster of Experts (Article 47) Emergency Committee – provides views on PHEIC, temporary recommendation (Articles 48, 49) Review Committee - reporting, review, standing recommendations, amendment and disputes (Articles 50-53) IHR ROSTER OF EXPERTS REVIEW COMMITTEE Standing Recommendations Afghanistan National Public Health Institute Disease Early Warning System Amendments EMERGENCY COMMITTEE Public Health Emergencies (PHEIC) Temporary Recommendations

15. Public Health Emergency of International Afghanistan National Public Health Institute Disease Early Warning System 15 Concern (PHEIC) • PHEIC is 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. • IHR require procedural steps by the DG/WHO in determining that a PHEIC exists

16. Afghanistan National Public Health Institute Disease Early Warning System 16 Event notification • Any event that may constitute a public health emergency of international concern (PHEIC) • NFP of the government should notify to WHO within 24 hours of national assessment • Continue to provide WHO with detailed public health information including: case definition, cases/deaths, conditions affecting spread, measures • Does NOT mean an actual “PHEIC” is necessarily occurring

17. Afghanistan National Public Health Institute Disease Early Warning System 17 Verification of events • Value of unofficial sources of information for early alert (to be assessed and verification requested) • WHO mandated to seek verification (from State Party in which event arising) of events which may be emergencies of international concern • States Parties must give initial reply within 24 hours and provide of information • Offer On-site assessment, when necessary

18. Afghanistan National Public Health Institute Disease Early Warning System 18 Early consultation • For events not requiring notification, Member States may: • keep WHO advised, consult on appropriate measures, and request WHO technical assistance to assess the situation • Need to continue monitoring/assessing the event to see if notification becomes necessary

19. Annex 2: Decision instrument for the assessment and notification of Afghanistan National Public Health Institute Disease Early Warning System 19 events that may constitute a PHEIC An event of potential international public health concern including those of unknown causes or sources *Q1: is the public health impact of the event serious? Q2: unusual or unexpected? Q3: risk of international spread? Q4: risk of travel or traffic restrictions? Insufficient information : re-evaluate

20. Decision Instrument (1) • Four diseases (a single case is notifiable): – Smallpox, Poliomyelitis, human influenza (caused by a new subtype), SARS • Utilization of the decision instrument: – Cholera, plague, viral haemorrhagic fevers, yellow fever, … – Diseases of regional concern: dengue fever, meningococcal diseases… Afghanistan National Public Health Institute Disease Early Warning System

21. Decision Instrument (2) Criteria for assessment • Is the public health impact of the event serious? • Is the event unusual or unexpected? • Is there a significant risk of international spread? • Is there a significant risk of international travel or trade restrictions? Answering "yes" to any two of the criteria requires a member state to notify WHO Afghanistan National Public Health Institute Disease Early Warning System

22. Combinations of answers requiring notification • Serious and unexpected • Serious and risk for international spread • Serious and risk for international restrictions • Unexpected and risk for international spread • Unexpected and risk for international restrictions Afghanistan National Public Health Institute Disease Early Warning System

23. Designated Ports of Entry: Core capacity requirements for responding to potential PHEICs Entry/exit control for departing & arriving passengers Afghanistan National Public Health Institute Disease Early Warning System 23 a Public health (PH) emergency response, including development of a contingency plan PH assessment & care for affected travellers, or animals b c Space to interview suspect or affected persons d Assessment, quarantine of suspect travellers, if required. e Implementation of recommended measures such f as disinfection g Access to required equipment and trained personnel Source: WHO/HQ IHR team (modified)

24. Implications of non-compliance to IHR • WHO will know from other sources • Position of the State Party will change from article 6 (notification) to article 10 (verification) Afghanistan National Public Health Institute Disease Early Warning System 24 –WHO will request verification –WHO will embark on investigation based on risk assessment • IHR allow WHO to use whatever available information to alert other partners • Compliant State Party will receive timely international support when needed

25. IHR Capacity analysis Afghanistan-2010 Afghanistan National Public Health Institute Disease Early Warning System 25

29. Major Achievements • IHR National Focal points • Assessments and plan • Training and capacity buildings • IHR 2005 translation and distribution • Surveillance and response • Laboratory support • Collaboration with international community • Reporting to WHO • Asking for extension • Still a long way to go Afghanistan National Public Health Institute Disease Early Warning System 29

30. Afghanistan National Public Health Institute Disease Early Warning System 30 Challenges • Empowerment of the NFP • Maintain disease surveillance, early warning and response system • Transparency and information sharing • Maintenance and expansion of existing partnerships • Resource mobilization • Strengthen capacity at airports, and ground crossings • Improvement of advocacy and awareness-raising efforts

31. Conclusion • IHR implementation is the responsibility of all sectors of the government of Afghanistan • Coordination is must • Capacities should be established • Proper implementation ensure saving lives and resources • Good international image • Capacity building and human resources • National and Global Health Security • Collaboration across countries Afghanistan National Public Health Institute Disease Early Warning System

32. Afghanistan National Public Health Institute Disease Early Warning System 32 Thanks Email: kmislamsaeed@gmail.com Mobile: 0093(0)700290955