TWN Info Service on Health Issues No. 7

WHA adopts landmark International Health Regulations

By Martin Khor*
Geneva, 24 May 2005

The World Health Assembly (WHA) has adopted the International Health Regulations (IHR 2005) and a resolution accompanying it at its plenary meeting on Monday.

The adoption of the IHR 2005, which is aimed at better managing public health emergencies of international concern, is the landmark event of this year's 58th session of the WHA.

The WHO Director-General, Dr Lee Jong-wook, told a press briefing that it was a very important event that will affect public health activities around the world for many years to come, adding that the previous regulations dating back to 1969 are now out of date.

The process leading up to the adoption of the IHR was long and difficult, he said, costing an estimated $10 million. He looked forward to working with WHO members to ensure that the new regulations will be fully implemented.

A major improvement through the new IHR would be greater transparency in the decision-making process in relation to dealing with disease outbreaks, he said.

Dr Anarfi Asamoa-Baah, Assistant Director-General for Communicable Diseases, said that to fulfil the ambitions of the IHR, action was required at national and international levels. At the international level, several streams of WHO's work would be involved, including improving its watchdog function, getting on top of the present 10-15 disease outbreaks around the world, and verifying the information that WHO gets from member states, he said.

Asamoa-Baah also referred to the WHO's role in risk assessment with respect to a particular outbreak of disease to determine the actions required, and in mounting a response. For example, the Marburg virus outbreak in Angola would need international coordinating efforts and the IHR would allow the WHO to improve its work at points of entry such as airports.

The IHR is a 55-page document whose main aspects involve roles and obligations of the World Health Organisation's member states to deal with public health emergencies of international concern, as well as guidelines on the WHO's role and responsibilities in the event of such crises.

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."

Article 3 on principles says the Regulations' implementation shall respect dignity, human rights and fundamental freedoms of persons and be guided by universal application. States have the sovereign right to legislate health policies, while upholding the Regulations' purpose.

Each country is to establish a national IHR focal point responsible for communicating with the WHO concerning implementation and information dissemination.

Within five years, each state shall develop capacity to detect, assess, notify and report events in accordance with the regulations. Spelled out in Annex I, this includes the capacities for surveillance and assessment of public health events and for public health responses including an emergency response plan; and capacities to act at airports, ports and ground crossings. An extension of two years of the deadline to fulfil the obligation can be requested, and in exceptional circumstances up to another two years.

Article 6 on notification requires a state to assess events by using a "decision instrument" (in Annex 2), which comprises a flow chart for assessing a significant health event as to whether its impact is serious, and whether there is a significant risk of international spread.

The country has to notify the WHO within 24 hours of all events which may constitute a public health emergency of international concern and any health measure in response. It also has to provide the WHO with all relevant information of an unexpected or unusual public health event which may constitute a public health emergency.

The WHO may also take into account reports from other sources and inform and consult with the government of the country where the event is occurring. The WHO shall also request verification from a government of reports from other sources of events that may be a health emergency of international concern.

The WHO may also offer to collaborate with the state concerned to assess the potential for international disease spread. If the government does not accept the offer to collaborate, the WHO may share the information with other countries.

Article 11 deals with conditions under which the WHO will send information about the public health event to all States Parties and the public. Article 12 deals with how the WHO is to determine whether an event is a public health emergency of international concern.

The WHO, upon request, is obliged to provide technical assistance and mobilize international expert teams when needed, to respond to a country's public health risks.

Under Part III on recommendations, the WHO Director General shall issue temporary recommendations if a public health emergency of international concern is occurring. These recommendations may include health measures regarding persons, baggage, cargo, containers, conveyances, goods and postal parcels to prevent or reduce international spread of disease. The WHO may also make "standing recommendations" of a similar type.

Examples of these recommendations regarding persons, baggage and cargo are provided.

Part IV on points of entry spell out in detail the obligations of states to develop capacities to act (including through control certificates, and through control measures such as monitoring, decontaminating, removal and disposal of baggage and cargo) in relation to airports, ports and ground crossings.

Part V on public health measures says that a state party may require information from and medical examination of travellers as well as vaccination or other health measure (with their prior informed consent). Separate chapters spell out detailed measures for conveyances and conveyance operators, travellers, goods, containers and container loading areas.

General provisions under Part VIII state that the Regulations do not preclude countries from health measures that achieve the same or greater level of health protection than WHO recommendations. However, such measures shall not be more restrictive of international traffic and not more invasive or intrusive to persons than reasonably available alternatives that achieve the appropriate level of health protection.

States shall base their determinations (whether to implement health measures) on scientific principles, evidence of risk to human health and specific WHO guidance or advice.

Part IX deals with the establishment (by the WHO Director General) of three bodies:

* A IHR roster of experts (in all relevant fields of expertise);

* The Emergency Committee (to provide views on whether an event constitutes a public health emergency of international concern, the termination of such an emergency and the issuance or termination of temporary recommendations); and

* The Review Committee, to make recommendations regarding amendments to the Regulations, provide advice on standing recommendations (including modifications and termination) and any matter regarding the Regulations' functioning.

Part X on final provisions has an article 56 on dispute settlement. States parties having a dispute shall first seek to settle it through negotiation or any other peaceful means. If this fails, they can refer it to the Director General. A party can write to the Director General that it accepts arbitration as compulsory, and the arbitration shall be conducted in accordance with the Permanent Court of Arbitration Optional Rules for Arbitrating Disputes between Two States. The parties that agreed to compulsory arbitration shall accept the arbitral award as binding and final.

The parties also recognize that the IHR and other relevant international agreements should be interpreted so as to be compatible. The IHR provisions shall not affect the rights and obligations of any State party deriving from other international agreements.

Article 59 is on entry into force and period of rejection or reservations. The period provided for rejection of or reservation to these Regulations shall be 18 months from the date of notification by the Director General of the adoption of the Regulations by the Health Assembly. Any rejection or reservation after the expiry of that period will have no effect.

The Regulations shall enter into force 24 months after the date of notification, except for a state that has rejected the regulations or made a reservation or a state that becomes a WHO member after the date of notification.

If a state notifies the Director General of its rejection of the Regulations, they will not enter into force with respect to that state. States may make reservations (including a rejection in part of the Regulations) but these shall not be incompatible with the object and purpose of the Regulations.

The IHR also has two major general annexes: Annex I on core capacity requirements for surveillance and response and core capacity requirements for designated airports, ports and ground crossings; and Annex 2 on Decision Instrument for assessing and notifying events that may constitute a public health emergency of international concern (including examples for applying it).

There are also five other more technical annexes: Annex 3 on a model ship sanitation control exemption certificate; Annex 4 on technical requirements for conveyances and conveyance operators; Annex 5 on specific measures for vector-borne diseases; Annex 6 on Vaccination, prophylaxis and related certificates; and Annex 7 on Requirements for vaccination or prophylaxis for specific diseases.

(* With inputs from Kanaga Raja.)