Intrpduction of IHR, History,Functions,Challanges

1. International Health Regulations
(IHR)
Sandeep Ghimire
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3. IHR
• The International Health Regulations (IHR) are
an international legal instrument that is
binding on 196 countries across the globe,
including all the Member States of WHO to
work together for global health security
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4. Aim of IHR
• The IHR (2005) aim to prevent, protect
against, control and respond to the
international spread of disease while avoiding
unnecessary interference with international
traffic and trade
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5. Why have IHR?
• Serious and unusual
disease events are
inevitable
• Globalisation - problem
in one location is
everybody’s headache
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6. International tourist arrivals by region
(in millions), 1950–2020.
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UNWTO

7. • About half of the people on Earth
live in urban areas (Wilcox et al.,
2008)
• Most of the population and
projected growth are in low-latitude
urban many surrounded by vast slum
areas that lack clean water and
sanitary facilities
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8. • Animals such as dogs, chickens, cows,
and rats live in and near human living
quarters, which have been assembled
from whatever materials can be found
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9. Animals have been the origin of many of
the recently identified emerging
infectious diseases
• HIV/AIDS
• H5N1 avian influenza,
• severe acute respiratory syndrome
(SARS)
• Swine-origin H1N1 influenza A
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10. H5N1: Avian influenza, a pandemic
threat
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11. What is IHR?
This legally-binding agreement.
It significantly contributes to global public
health security.
 providing a new framework for the
coordination of the management of events
that may constitute a public health
emergency of international concern.
improve the capacity of all countries to
detect, assess, notify and respond to public
health threats.
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12. Purpose and scope of IHR 2005
• To prevent, protect against, control and
provide a public health response to the
international spread of diseases.
• Restricted to public health risks, and avoid
unnecessary interference with international
traffic and trade.
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13. History of the IHR
• The cholera epidemics that overran
Europe between 1830 and 1847 were
catalysts for intensive infectious disease
diplomacy and multilateral cooperation
in public health
• This led to the first International Sanitary
Conference in Paris in 1851
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14. History of the IHR
• In 1948, the WHO Constitution entered into
force
• In 1951 WHO Member States adopted the
International Sanitary Regulations
• replaced by and renamed the International
Health Regulations in 1969
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15. History of the IHR
The 1969 IHR were primarily intended to
monitor and control six serious infectious
diseases
• cholera,
• plague,
• yellow fever,
• smallpox,
• relapsing fever and typhus
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16. History of the IHR
• In May 2001, the World Health Assembly
adopted resolution WHA 54.14
• Global health security: epidemic alert and
response, in which WHO was called upon to
support its Member States in strengthening
their capacity to detect and respond rapidly to
communicable disease threats and
emergencies.
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17. History of the IHR
• The World Health Assembly adopted the IHR
(2005) on 23 May 2005 by way of resolution
WHA58.3
• The IHR (2005) entered into force on 15 June
2007.
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18. 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
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19. All public health threats
 IHR recognize that international
disease threats have increased
 Scope has been expanded from
cholera, plague and yellow fever
to all public health emergencies of
international concern (PHEIC)
 They include those caused by
infectious diseases, chemical
agents, radioactive materials and
contaminated food.
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20. What do the IHR call for?
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 Strengthened national capacity for
surveillance and control, including in
travel and transport
 Prevention, alert and response to
international public health emergencies
 Global partnership and international
collaboration
 Rights, obligations and procedures, and
progress monitoring

21. Main functions of the IHR
• Notification
• National IHR Focal Points and WHO IHR
Contact Points
• Requirements for national core capacities
• Recommended measures
• External advice regarding the IHR (2005)
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22. Acute public health threats
are collectively managed
The key functions of this global system, for States and WHO, are to:
 detect
 verify
 assess
 inform
 assist
The IHR define a risk management process where States Parties work
together, coordinated by WHO, to collectively manage acute public
health risks.

23. Containment at source
 Rapid response at the source
is:
 the most effective way to
secure maximum protection
against international spread of
diseases
 key to limiting unnecessary
health-based restrictions on
trade and travel
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24. Importance of national capacity
• The best way to prevent international
spread of diseases is to detect public health
events early and implement effective
response actions when the problem is small
– Early detection of unusual disease events by
effective national surveillance (both disease
and event based)
– Systems to ensure response (investigation,
control measures) at all levels (local, regional,
and national)
– Routine measures and emergency response at
ports, airports and ground crossings.
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25. Core capacity requirements for designated
points of entry (PoE)
• DESIGNATION OF POINTS OF ENTRY
– States Parties shall designate Airports and Ports for
developing capacities .
– States Parties where justified for PH reasons, may
designate ground crossings for developing capacities –
Annex 1b, taking into consideration volume and
frequency of international traffic and public health risks
of the areas in which international traffic originates.
– States Parties sharing common borders should consider:
• Bilateral and multilateral agreements
• Joint designation of adjacent ground crossing for
capacities

26. (a) Assessment
and Medical care,
staff & equipment
(b) Equipment &
personnel for
transport ill
travellers
(c) Trained
personnel for
inspection of
conveyances
(d) ensure save environment:
water, food, waste, wash
rooms & other potential risk
areas - inspection
programmes
(e) Trained staff and
programme for
vector control
PoE Core capacity requirements at all times (routine)
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27. What does 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 public health measures
• Assist States Parties in their efforts to investigate outbreaks and
meet the IHR national core capacities requirements for
surveillance and response and points of entry
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28. Response Global Outbreak Alert
and Response Network
WHO system of Global Outbreak Alert and Response Network GOARN
Operations
Event
Intelligence
Verification
Official, State
sources
Risk AssessmentWHO HQ, Regional & Country
Offices, Collaborators
and experts
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29. 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
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31. References
1. http://www.who.int/ihr/en/
2. Wilcox BA, Gubler DJ, Pizer HF. Urbanization and the social
ecology of emerging infectious diseases. In: Mayer K, Pizer
HF, editors. Social ecology of infectious diseases. London:
Elsevier; Academic Press; 2008. pp. 113–137
3. https://www.ncbi.nlm.nih.gov/books/NBK45725/#ch4.s2
4. http://www.who.int/ihr/about/FAQ2009.pdf?ua=1&ua=1
5. http://www.who.int/ihr/about/10things/en/#whatis
6. https://www.cdc.gov/globalhealth/stories/ten_years_ihr.h
tm
7. http://apps.who.int/iris/bitstream/10665/246107/1/9789
241580496-eng.pdf
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