This slide provides an overview on the global disease surveillance system and the international health regulation.

1. IHR-based global
surveillance and cooperation
WHO Regional Office for the Western Pacific
Division of Programmes for Disease Control
Changgyo Yoon
* Views and contents included in this presentation are solely the presenter's and not necessarily reflecting the agency’s viewpoint or guidelines

2. Table of Contents
Overview of the International Health Regulations
– Brief history, purpose, functions
– Public Health Emergencies of International Concern
Notifiable diseases through IHR
Monitoring, connecting countries for global
surveillance
Future look on the next generation of IHR
– Pandemic treaty

3. International Health Regulations
 Legally binding set of regulations adopted by WHO for
its Member States to better respond to infectious
diseases spread internationally and other health risks
 Originated from the International Sanitary Regulations
adopted in 1951: connected to the international
sanitary convention
 In 1969, ISR revised to IHR to cover only cholera,
plague, yellow fever
 In 1995 (48th
WHA), a call for revision of IHR for
emerging and re-emerging diseases such as Ebola
hemorrhagic fever
 In 2005, IHR(2005) has been adopted after the SARS
pandemic
 In 2007, IHR(2005) comes into effect

4. Key reasons of IHR revision
 Increased cross border travel, trade and
communication technologies
 The previous IHR focused only on three
diseases (cholera, plague and yellow fever)
so it was not enough to address new and
re-emerging communicable diseases
– SARS was not designated as notifiable
disease in IHR(1969)
 Reluctance to promptly report outbreaks
of notifiable diseases for fear of
unwarranted and damaging travel and
trade restrictions
– IHR national focal points
4 Global Public Health Governance and the Revised International Health Regulations | I
nfectious Disease Movement in a Borderless World: Workshop Summary |The National
Academies Press

5. International Health Regulations (2005)
 From three infectious diseases to all public health risks
 From preset & reactive measures to proactive tailored responses
 From border control to also include containment of source
A paradigm shift

6. Key changes in IHR(2005)
 Not limited to any specific diseases
 State Party obligations to develop certain minimum core public health
capacities
 Obligations on State Parties to notify WHO of events that may constitute a
public health emergency
 Provisions authorizing WHO to obtain verification from State Parties
concerning such events (IHR article 10)
 Determination and recommendations by the WHO DG of PHEIC based on
technical advice from the emergency committee
 Protection of the human rights of persons and travelers (IHR article 43)
 National IHR focal points and WHO IHR contact points for urgent
communications

7. Major obligations for Member States

8. Monitoring of the IHR implementation
 15 June 2007: the initial start date of IHR(2005)
 June 2012: WHO provided a set of IHR core capacities
monitoring framework to support Member States’ capacity
building
 2014: Only 42 countries reported meeting the minimum
requirement of IHR core capacities, WHA granted 2 years
of extension but only 64 countries reported back to WHO
 2016: WHO and the Global Health Security Agenda
developed the Joint External Evaluation for Member States
that would like to get voluntary assessments on their
capacities
 2018: A toolkit for the Sate Parties Self-assessment Annual
Reporting) has been developed and distributed
 As of May 2022, 116 countries had requested and
completed the voluntary joint external evaluations using
the first and the second editions of the JEE tool.

9. IHR SPAR – surveillance section
International health regulations (2005): state party self-assessment annual reporting tool, 2nd ed (who.in

11. Joint external evaluation tool: International Health R
egulations (2005) - third edition (who.int)
IHR JEE – surveillance section

12. Current status of countries assessed by IHR JEE

13. Asia Pacific Strategy for Emerging Diseases and
Public Health Emergencies (APSED III)
The Asia Pacific Strategy for Emerging
Diseases and Public Health
Emergencies (APSED III)
– Bi-regional framework for action for two
WHO Regions (SEAR and WPR)
– APSED III supports Member States to
meet IHR core capacity requirements
– A common framework to prepare for and
respond to all emerging diseases and
public health emergencies
– Developed in 2005, revised in 2010,
upgraded in 2016

14. APSED approach
 Countries at the centre
 Generic system for preparedness, alert and
response (everything in “One framework”)
 Stepwise approach to developing capacity
 Connecting surveillance, risk assessment
and response systems at all levels
 Value of learning from real-world events for
continuing improvement
 Invest in preparedness between events
 Partnerships for collective action

15. GAO-01-722 Global Health: Challenges in Improving Infectious Disease Surveillanc
e Systems

16. WHO Hub for Pandemic and Epidemic
Intelligence
 A new WHO hub located in
Berlin, Germany is to:
 Works closely with Member
States and WHO Regional and
Country Offices to strengthen
their data-sharing capacities
 fosters a collaborative
environment for innovators,
scientists and experts from
across a wide spectrum of
disciplines

17. The next stage of IHR: pandemic treaty
 A new legally binding agreement to
strengthen political engagement
– A reflection on IHR(2005) that many
functions of IHR have not been activated
 To improve equity in access to quality
medical services
 One health approach
 Sharing of monitoring data, genetic data,
samples, technologies
 To strengthen national, regional and global
resilience
 Member States would not agree on draft
treaty that may conflict with its sovereignty
– Negotiation processes

18. Conclusion
 The information sharing or surveillance part of IHR has been challenged by COVID-
19 pandemic during last three years
 Over the sixty years, IHR has been providing a legally binding global framework to
respond to public health risks but the framework has not been effective than
expected
– Information sharing and monitoring has been a key function of WHO since its
establishment and the initial form of IHR had focused only on limited number of diseases
– Despite of revisions, toolkits to support its implementation (SPAR, JEE and etc), legal bind
as international law/regulation has been seen weak to support timely and effective public
health activities at regional or country level
 Pandemic treaty is to ensure global cooperation and health equity to better
respond to the next pandemic but there are foreseeable challenges before its
endorsement
– International law vs. Sovereignty / Nicely developed public health regulation vs. How to
activate in the real situation
– In 2024, 77th
World Health Assembly will discuss a draft pandemic treaty