PHEIC & Decision Instrument

1. PHEIC & Decision Instrument Dr Reuben Samuel WHO Country Office - India

2. What is a PHEIC? • PHIEC – Public Health Emergency of International Concern • An extraordinary event which is determined, as provided in these Regulations: • to constitute a public health risk to other Member States through international spread of disease and • to potentially require a coordinated international response.

3. Alert and Response Operations Events that may constitute aPublic Health Emergency of International Concern need: Detection Verification Risk assessment Response

4. Verification of events • Value of unofficial sources of information for early alert • WHO requests for verification of potential public health events of international importance • Member States provide initial reply within 24 hours and provision of information • On-site assessment, when necessary

5. Event notification • Any event that may constitute a Public Health Emergency of International Concern (PHEIC) • Within 24 hours of assessment • By the most efficient means of communication • Continue to provide WHO with detailed information • Does NOT mean a real “PHEIC”

6. Disease List • 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…

7. Decision Instrument • Is the public health impact of the event serious? • Is the event unusualor unexpected? • Is there a significant risk of internationalspread? • Is there a significant risk of international travelor trade restrictions? Criteria for assessment Answering "yes" to any two of the criteria requires a member state to notify WHO

8. Is the event serious? Yes No Is the event unexpected? Is the event unexpected? No Yes No Yes Could it (or has it) spread internationally? Could it (or has it) spread internationally? Yes No Yes Risk for international sanctions? No Not notified at this stage. Yes No Notify the event under the International Health Regulations

9. Is the event serious? • Morbidity and mortality • Does the event have potential for high impact? • Population at risk • Cases in health staff; highly infectious • Factors affecting response e.g. war, natural catastrophe • High population density • Immediate or potential need for external assistance

10. Is the event unexpected? • Is the cause of the event unknown? • Are the circumstances unusual? • Cases worse than usual • Treatment failures • Event unusual for place/season • Caused by eliminated/eradicated agent • Suspected or known intentional or accidental release of chemical, biological or radiological agent

11. Is the event likely to spread internationally? • Similar cases in other countries where it was unexpected? • Factors alerting to cross-border implications? • Caused by epidemic-prone organism • Source suspected/ known to be related to food import/export • Index case with international travel history • In area with international tourism/ traffic, person or goods • In border areas with limited capacity for control

12. Is event likely to result in international travel and trade restrictions? • Similar events previously led to restriction on travel/ trade? • Source known or suspected food product/ goods known to be imported or exported? • In area with international tourism? • Attracted media attention?

13. 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

14. Thanks