international health regulation RULES AND GUIDELINES OF INTERNATIONAL HEALTH REGULATIONS: International health regulations evolution: The IHR originated with ISR adapted at the international sanitary conference in Paris in 1851 Cholera epidemic 🡪 Europe 🡪1830 & 1847 Need international cooperation 22nd World Health Assembly (1969) adopted, revised and consolidated the international sanitary regulations, renames as IHR in 1969 26th World Health Assembly 1973🡪amendment in IHR 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. summary: The International Health Regulations (IHR) are an international legal instrument that covers measures for preventing the transnational spread of infectious diseases. IHR is an instrument of international law that is legally binding on countries. IHR is a set of regulations that is legally binding upon 196 state parties. This legal binding is adopted by 196 countries, including all (194) WHO member states. IHR is a benchmark to state the rights and obligations of countries to report public health actions. The objective of IHR is to work together to protect global health security. IHR are the international agreements with the objective of preventing the spread of public health threats without unnecessary impairment of international travel and trade. The IHR was adopted by the 58th World Health Assembly in 2005 through Resolution WHA 58.3. International Health was in action since 15 June 2007 The International Health Regulations (IHR 2005) are a set of regulations legally binding on 196 States Parties, including all WHO Member States. They contribute to global public health security by providing a new framework for the coordination of the management of events that may constitute a public health emergency of international concern, and improve the capacity of all countries to detect, assess, notify and respond to public health threats. The IHR were adopted at the Fifty-eighth World Health Assembly on 23 May 2005 and entered into force on 15 June 2007.

4. RULES AND
GUIDELINES OF
INTERNATIONAL
HEALTH
REGULATIONS

5. International health regulations evolution
• The IHR originated with ISR adapted at the international sanitary
conference in Paris in 1851
• Cholera epidemic 🡪 Europe 🡪1830 & 1847
• Need international cooperation
• 22nd World Health Assembly (1969) adopted, revised and consolidated
the international sanitary regulations, renames as IHR in 1969
• 26th World Health Assembly 1973🡪amendment in IHR

6. Cont…..
• 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;

7. Cont….
• 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.

8. summary
• The International Health Regulations (IHR) are an international legal
instrument that covers measures for preventing the transnational spread of infectious
diseases.
• IHR is an instrument of international law that is legally binding on countries.
• IHR is a set of regulations that is legally binding upon 196 state parties.
• This legal binding is adopted by 196 countries, including all (194) WHO member states.
• IHR is a benchmark to state the rights and obligations of countries to report public health
actions.
• The objective of IHR is to work together to protect global health security.
• IHR are the international agreements with the objective of preventing the spread of public
health threats without unnecessary impairment of international travel and trade.
• The IHR was adopted by the 58th World Health Assembly in 2005 through Resolution
WHA 58.3.
• International Health was in action since 15 June 2007

9. IHR
• The International Health Regulations (IHR 2005) are a set of regulations legally binding on
196 States Parties, including all WHO Member States. They contribute to global public
health security by providing a new framework for the coordination of the management of
events that may constitute a public health emergency of international concern, and improve
the capacity of all countries to detect, assess, notify and respond to public health threats.
• The IHR were adopted at the Fifty-eighth World Health Assembly on 23 May 2005 and
entered into force on 15 June 2007. They require States Parties to notify a potentially wide
range of events to the WHO. Implementing the IHR is an obligation for WHO and States
Parties to the Regulations.

10. Cont….
• The IHR (2005) are not limited to specific diseases but apply to new and
ever- changing public health risks, they are intended to have long-lasting
relevance in the international response to the emergence and spread of
disease. The IHR also provide the legal basis for important health
documents applicable to international travel and transport and sanitary
protections for the users of international airports, ports, and ground
crossings.

11. 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.

12. The purpose and scope of the Regulations are “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”.
• Under the IHR (2005), all cases of these four diseases must be
automatically notified to WHO: smallpox, poliomyelitis due to
wild-type poliovirus, SARS and cases of human influenza
caused by a new subtype
• International health focuses on public health issues that may
not affect the student of public health directly; global
health deals with health issues that probably affect everyone,

13. IMPLEMENTATION
• The responsibility for implementing the IHR rests upon all States Parties that are
bound by the Regulations and on WHO. Governments are responsible, including all
of their sectors, ministries, levels, officials and personnel for implementing IHR at
the national level.
• WHO plays the coordinating role in IHR implementation and, together with its
partners, helps countries to build capacities.
• The IHR require that all countries have the ability to do the following:

14. FROM THREE DISEASE TO ALL PUBLIC HEALTH THREATS
FROM PRESET MEASURE TO ADAPTED RESPONSE
FROM CONTROL OF BORDERS TO CONTAINMENT OF SOURCE

15. What are the Key Obligations for States (as per
the International Health Regulations (IHR)?
• States Parties to the IHR (2005) are required:
• to designate a National IHR Focal Point (see Question 4 above);
• to assess events occurring in their territory and to notify WHO of all events that may constitute a
public health emergency of international concern using the decision instrument included in Annex
2 of the Regulations (see Question 5 above);
• to respond to requests for verification of information regarding events that may constitute a public
health emergency of international concern;
• to respond to public health risks which may spread internationally;
• to develop, strengthen and maintain the capacity to detect, report and respond to public health
events;
• to provide routine facilities, services, inspections and control activities at designated international
airports, ports and ground crossings to prevent the international spread of disease;
• to report to WHO evidence of a public health risk identified outside their territory which may cause
international disease spread, manifested by exported/imported human cases, vectors carrying
infection or contamination, contaminated goods;
• to respond appropriately to WHO-recommended measures; and
• to collaborate with other States Parties and with WHO on IHR (2005) implementation.

16. How will Compliance with the IHR (2005) be
Achieved?
• IHR (2005) do not include an enforcement mechanism (by itself) for
States which fail to comply with its provisions. However, the potential
consequences of non-compliance are themselves a powerful
compliance tool.
• The best incentives for compliance are ‘peer pressure’ and public
knowledge. States do not want to be isolated.
• The consequences of non-compliance may include a
stained/tarnished international image, increased morbidity/mortality of
affected populations, unilateral travel and trade restrictions, economic
and social disruption and public outrage.

17. Advantages
• IHR provides an overarching legal framework that defines countries’ rights
and obligations in handling /dealing with public health events and
emergencies that have the potential to cross borders.
• IHR outlines the criteria to determine whether or not a particular event
constitutes a “public health emergency of international concern”
• IHR contributes to global public health security.
• IHR introduce important safeguards to protect the rights of travelers and
other persons: It protects the right of the travelers in relation to the
treatment of personal data, informed consent and non-discrimination in the
application of health measures under the Regulations.
• IHR is not limited to specific diseases/events, thus, it is very dynamic.
• IHR has long-lasting relevance in the international response to the
emergence and spread of disease.

18. 4 diseases
• According to International Health Regulations (IHR) (2005), there are four
diseases that require immediate notification to WHO in all circumstances.
• These diseases are considered to be unusual, unexpected and may have
serious public health impact, thus requires immediate notification to WHO:
• Smallpox
• Poliomyelitis due to wild-type poliovirus
• Human influenza caused by a new subtype
• Severe acute respiratory syndrome (SARS)
• Apart from these 4 diseases, IHR (2005) also require notification of all
(public health) events which may constitute a public health emergency of
international concern (PHEIC).

19. Other Potentially Notifiable Events:
• May include cholera, pneumonic plague, yellow fever, viral hemorrhagic
fever, and West Nile fever, as well as any others that meet the conditions
brought up by the IHR.
• Other natural, radiological, or biochemical events that run into IHR
conditions.
• Ever since the revised version of IHR was into action, WHO have declared
five PHEICs:
• H1N1 influenza (2009)
• Polio (2014)
• Ebola (2014)
• Zika virus (2016)
• COVID-19 (2019)
• When WHO makes a declaration regarding PHEIC, it helps to coordinate
immediate response with the affected country and other countries globally.

20. Declaration
• According to IHR (2005), the World Health Organization declares
a PHEIC if it meets 2 of 4 conditions i.e.
• 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 restriction(s) to travel
and trade?
• If the event is dogged to be acceptable under the international health
regulations, the country must alert WHO within 24 hours.

21. By agreeing to be bound by the IHR (2005), States will:
• enjoy the benefits of a respected partner in the international effort to maintain
international public health security;
• receive WHO guidance in building the core capacities necessary to quickly detect,
report, assess and respond to public health emergencies and public health risks,
including those of national and international concern;
• be offered technical assistance and receive help in efforts to mobilize possible
funding support to meet these new obligations;
• receive WHO guidance during outbreak assessment and response;
• have access to specific information gathered by WHO about public health risks
world-wide which is necessary for them to protect themselves;
• receive WHO advice and logistical support, when requested, to respond to disease
outbreaks and other public health events; and
• have access to the Global Outbreak Alert and Response Network (GOARN), a
‘one-stop shop’ of global resources to help manage public health risks and
emergencies of international concern.

22. member states benefit from IHR by:
• Improving national and international surveillance
• Building on the current WHO system to detect and quickly respond to
public health risks and emergencies of international concern
• Encouraging the use of modern communication tools
• Recognizing that disturbances to international traffic constitute an
obstacle to reporting and that mechanisms to counter this interference
need to be developed
• Having a set of generic rules to evaluate and resolve different kinds of
urgent events
• Developing mechanisms to provide national and local protection
within a set of rules which enjoy a broad consensus among all WHO
Member States

23. • WHO provides adequate support, guidance, tool and training for
implementing IHR. WHO’s support focuses on the priority needs identified
by the WHO Regional and Country Offices. Support provided by WHO for
IHR implementation are:
• Designating WHO IHR Contact Points at the headquarters or the regional
level;
• Conducting global public health surveillance and assessment of significant
public health events;
• Disseminating public health information to Member States;
• Offering technical assistance to Member States;
• Supporting Member States in their efforts to assess their existing national
public health structures and capacities for surveillance and response,
including at designated points of entry;
• Monitoring the implementation of IHR (2005) and updating guidelines; and
• If required, determining whether or not a particular event constitutes
a public health emergency of international concern (PHEIC), with
advice from external experts.

24. Seven Areas of Work for Implementation of IHR:
• Implementing IHR and meeting its requirements are challenging tasks for any
nation. There are set of seven strategic actions that should be followed by
WHO and other countries to guide the IHR implementation.
• The seven areas of work (to support countries with challenges) for IHR
(2005) implementation:
• Foster global partnerships
• Strengthen national disease prevention, surveillance, control and response
systems
• Strengthen public health security in travel and transport
• Strengthen WHO global alert and response systems
• Strengthen the management of specific risks
• Sustain rights, obligations and procedures
• Conduct studies and monitor progress

25. SEVEN STRATEGIC ACTIONS TO GUIDE IHR

27. • Detect: Make sure surveillance systems can detect acute public health
events in timely matter
• Assess and report: Use the decision instrument in Annex 2 of the IHR
to assess public health event and report to WHO through their
National IHR Focal Point those that may constitute a public health
emergency of international concern
• Respond: Respond to public health risks and emergencies
• The goal of country implementation is to limit the spread of health
risks to neighbouring countries and to prevent unwarranted travel and
trade restrictions.

28. • IHR (2005) Monitoring and Evaluation Framework (MEF) provides a
roadmap for assessing a country’s health security capacity, enabling
them to identify areas for improvement.
• IHR MEF is composed of four processes:
• States Parties Self-Assessment Annual Reporting (SPAR),
• Joint External Evaluations, (JEE),
• After Action Reviews (AAR), and
• Simulation Exercises (SimEx).

29. UNITED NATION
SECURITY COUNCIL
RESOLUTION
1540

30. UNSCR
Resolution 1540 was adopted under Chapter VII of the United Nations
Charter, which covers "threats to the peace, breaches of the peace and
acts of aggression." The resolution itself states in its opening
paragraph: "proliferation of nuclear, chemical and biological
weapons, as well as their means of delivery, constitutes a threat to
international peace and security"

31. • 1540 is only the second resolution to invoke Chapter VII without relating
the fact to a specific time and place, the first being , which was voted in
the aftermath of the United Nations Security Council Resolution 1373.
• September 11 attacks as an attempt to counter international terrorism. The
possibility of terrorists accessing WMD was already considered in
Resolution 1373 paragraph 3a and 4, and UNSCR 1540 emerged from
those two paragraphs.
• The three main obligations created by the resolution are:
• To "refrain from providing any form of support to non-State actors that
attempt to develop, acquire, manufacture, possess, transport, transfer or
use nuclear, chemical or biological weapons and their means of delivery."
• To "adopt and enforce appropriate effective laws which prohibit any non-
State actor to manufacture, acquire, possess, develop, transport, transfer or
use nuclear, chemical or biological weapons and their means of delivery".
• To "take and enforce effective measures to establish domestic controls to
prevent the proliferation of nuclear, chemical, or biological weapons and
their means of delivery"

32. • Resolution 1540 was adopted under Chapter VII of the United
Nations Charter, which covers "threats to the peace, breaches of the
peace and acts of aggression." The resolution itself states in its
opening paragraph: "proliferation of nuclear, chemical and biological
weapons, as well as their means of delivery, constitutes a threat to
international peace and security". Even though the security
council had already recognized the proliferation of WMD as a threat
to international peace and security in the UNSC Presidential
Statement on 31 January 1992,it took the council until 2004 to adopt
such a decisive resolution.

33. UNSCR 1540 (2004)
• Adopted by unanimity on 28 April 2004 under Chapter VII of the UN
Charter.
• First formal decision taken by the Security Council to address the
proliferation of weapons of mass destruction First formal decision taken
by the Security Council to address the proliferation of weapons of mass
destruction (WMD) as a global threat to international peace and security.
• Establishes binding obligations on all States to Establishes binding
obligations on all States to take a series of steps to prevent the
proliferation of WMD, their means of delivery and related materials.
• Each State decides for itself how to implement resolution 1540. Each
State decides for itself how to implement resolution 1540. I. UNSCR
1540 (2004) Nature

34. DEFINITIONS
• UNSCR 1540 (2004)
• NON-STATE ACTOR: individual or entity, not acting under the lawful
authority of any State in conducting activities which come within the scope
of this resolution.
• RELATED MATERIALS: materials, equipment and technology covered
by relevant multilateral treaties and arrangements, or included on national
control lists, which could be used for the design, development, production
or use of nuclear, chemical and biological weapons and their means of
delivery

35. “All States shall refrain from providing any form of support to non-
State actors that attempt to develop, acquire, manufacture, possess,
transport, transfer or use nuclear, chemical or biological weapons
[WMD] and their means of delivery.”
UNSCR 1540 Prohibitions: Non-support clause

36. “All States, in accordance with their national procedures, shall adopt
and enforce appropriate effective laws which prohibit any non-State
actor to manufacture, acquire, possess, develop, transport, transfer, or
use nuclear, chemical or biological weapons and their means of
delivery, in particular for terrorist purposes, as well as attempts to
engage in any of the foregoing activities, participate in them as an
accomplice, assist or finance them.”
NATIONAL
LEGISLATION

37. NATIONAL LEGISLATION
to account for, secure and physically protect
• “All States shall take and enforce effective measures to establish
domestic controls to prevent the proliferation of nuclear,
chemical, or biological weapons, their means of delivery,
including by establishing appropriate controls over related
materials and to this end shall:”
• “(a) Develop and maintain appropriate effective measures to
account for and secure such items in production, use, storage or
transport”
• “(b) Develop and maintain appropriate effective physical
protection measures”

38. • c) Develop and maintain appropriate effective border controls and law
enforcement efforts to detect, deter, prevent and combat the illicit
trafficking and brokering in such items
• (d) Establish, develop, review and maintain appropriate effective
national export and transhipment controls over such items, including
appropriate laws and regulations to control export, transit, trans-
shipment and re-export and controls on providing funds and
services related to such export and trans-shipment such as
financing, and transporting that would contribute to proliferation
• as well as establishing end-user controls; and establishing and
enforcing appropriate criminal or civil penalties for violations of such
export control laws and regulations”

42. UNSCR AND PAKISTAN
• Pakistan is one of nine states to possess nuclear weapons. Pakistan
began development of nuclear weapons in january 1972 under prime
minister zulfikar ali bhutto, who delegated the program to the
chairman of the pakistan atomic energy commission (PAEC) munir
ahmad khan with a commitment to having the bomb ready by the end
of 1976
• Pakistan's nuclear weapons development was in response to the loss
of east pakistan in 1971's bangladesh liberation war. Bhutto called a
meeting of senior scientists and engineers on 20 january 1972,
in multan, which came to known as "multan meeting". Bhutto was the
main architect of this programme, and it was here that bhutto
orchestrated the nuclear weapons programme and rallied pakistan's
academic scientists to build an atomic bomb in three years for national
survival

43. • on 28 May 1998, a few weeks after India's second nuclear test (Operation
Shakti), Pakistan detonated five nuclear devices in the Ras Koh Hills in
the Chagai district, Balochistan. This operation was named Chagai-I by
Pakistan, the underground iron-steel tunnel having been long-constructed
by provincial martial law administrator General Rahimuddin Khan during the
1980s. The last test of Pakistan was conducted at the sandy Kharan
Desert under the codename Chagai-II,
• In Balochistan, on 30 May 1998. Pakistan's fissile material production takes
place at Nilore, Kahuta, and Khushab Nuclear Complex, where weapons-
grade plutonium is refined. Pakistan thus became the seventh country in the
world to successfully develop and test nuclear

44. • Pakistan media welcomed the US Atoms for Peace initiatives,
followed by the establishment of Pakistan Atomic Energy
Commission (PAEC) in 1956.
• Pakistan's nuclear energy programme was established and started in
1956 following the establishment of PAEC. Pakistan became a
participant in US President Eisenhower's Atoms for Peace program

45. List of parties to weapons of mass destruction treaties
• The list of parties to
weapons of mass
destruction
treaties encompasses
the states which have
signed and ratified,
succeeded, or acceded
to any of the major
multilateral treaties
prohibiting or
restricting weapons of
mass
destruction (WMD), in
particular nuclear, biol
ogical, or chemical
weapons.

47. • the establishment of PINSTECH – Pakistan Institute of Nuclear
Science and Technology, at Nilore near Islamabad. The principal
facility there was a 5MW research reactor, commissioned in 1965 and
consisting of the PARR-I, which was upgraded to 10 MWe by Nuclear
Engineering Division under Munir Ahmad Khan in 1990.
• A second Atomic Research Reactor, known as PARR-II, was a Pool-
type, light-water, 27–30 kWe, training reactor that went critical in
1989 under Munir Ahmad Khan.
• The PARR-II reactor was built and provided by PAEC under the IAEA
safeguards as IAEA had funded this mega project

48. •If India builds the bomb, we will eat grass and
leaves for a thousand years, even go hungry, but we
will get one of our own. The Christians have the
bomb, the Jews have the bomb and now the Hindus
have the bomb. Why not the Muslims too have the
bomb

49. • Pakistan acceded to the Geneva Protocol on 15 April 1960. As for its Biological
warfare capability,
• Pakistan is reported to have well developed bio-technological facilities and laboratories,
devoted entirely to the medical research and applied healthcare science.
• In 1972, Pakistan signed and ratified the Biological and Toxin Weapons
Convention (BTWC) in 1974. Since then Pakistan has been a vocal and staunch
supporter for the success of the BTWC.
• Pakistan is not known to have an offensive chemical weapons programme, and in 1993
Pakistan signed and ratified the Chemical Weapons Convention (CWC), and has
committed itself to refrain from developing, manufacturing, stockpiling, or using
chemical weapons.
• Pakistan is not a party to the Non-Proliferation Treaty (NPT) and is not bound by any
of its provisions.
• In 1999, Prime Ministers Nawaz Sharif of Pakistan and Atal Bihari Vajpayee of India
signed the Lahore Declaration, agreeing to a bilateral moratorium on further nuclear
testing. This initiative was taken a year after both countries had publicly tested nuclear
weapons.

50. Arms control proposals
❑Pakistan has over the years proposed a number of bilateral or regional
non-proliferation steps and confidence building measures to India,
including
❑A joint Indo-Pakistan declaration renouncing the acquisition or
manufacture of nuclear weapons, in 1978.
❑South Asian Nuclear Weapons Free Zone, in 1978.
❑Mutual inspections by India and Pakistan of each other's nuclear
facilities, in 1979.
❑Simultaneous adherence to the NPT by India and Pakistan, in 1979.
❑A bilateral or regional nuclear test-ban treaty, in 1987.
❑A South Asia Zero-Missile Zone, in 1994.
❑India rejected all six proposals

51. • National Security Council
• Economic Coordination
Committee (ECC)
• Development Control Committee
(DCC)
• Employment Control Committee
(ECC)
• Financial Monitoring Unit (FMU)
• Strategic combat commands
• Air Force Strategic
Command (AFSC)
• Army Strategic Forces
Command (ASFC)
• Naval Strategic Forces
Command (NSFC)
National Engineering & Scientific
Commission (NESCOM)
National Development
Complex (NDC), Islamabad
Project Management Organization
(PMO), Khanpur
Air Weapon Complex (AWC),
Hasanabdal
National Centre for Physics (NCP),
Islamabad
Maritime Technologies Complex
(MTC), Karachi
Ministry of Defense Production
Pakistan Ordnance Factories (POF),
Wah
Pakistan Aeronautical Complex (PAC),
Kamra
Defense Science and Technology
Organization (DESTO), Chattar
Pakistan Atomic Energy
Commission (PAEC)
Directorate of Technical Development
Directorate of Technical Equipment
Directorate of Technical Procurement
Directorate of Science & Engineering
Services
Ministry of Industries & Production
State Engineering Corporation (SEC)
Heavy Mechanical Complex Ltd.
(HMC)
Pakistan Steel Mills Limited, Karachi.
Pakistan Machine Tools Factory