International Health Regulations in the context of Pandemic Influenza

1. International Health Regulations in the context of Pandemic Influenza

2. Learning Objectives • Explain the application of the IHR decision instrument. • Interpret the application of the criteria for decision-making in verification and notification of public health events under the IHR 2005. • Decide when to communicate information of an event to WHO by using the IHR decision instrument. • Identify what measures of IHR apply to Pandemic Influenza and how to implement them.

3. Outline of presentation • Global/international threats to human health • IHR (2005)- a legal framework • Assessment of public health events • Public health emergencies and pandemic influenza Credit: GOARN, WHO

4. Global threats: why are we concerned? • Epidemics not new, but….took days, weeks/months to reach far territories • Emergence/re-emergence of infectious diseases and increased pace of spread • Threat of deliberate use of biological and chemical agents • Impact on health, economy, security

5. Global threats :International Health Security1980 - 2007 VHV /Ebola / Marburg HIV/AIDS XDR-TB Chernobyl Pest SARS BSE/ NvCJD Nipah Anthrax Chemical pollution Animal Flu meningitis cholera

6. What are IHR (2005)? A global framework • Legally-binding global agreement to protect public health • The international commitment for shared responsibilities and collective defence against disease spread

7. Why have IHR (2005)? • Serious and unusual disease events are increasing and inevitable • Globalisation– public health event in one location can be a threat to others • Need for collective effort and agreed rules • strong national public health system • international alert & response system Credit: MOH Viet Nam

8. Scope of IHR (2005): what does it include? • “Disease” under IHR (2005) • “an illness or medical condition, irrespective of origin or source • that presents or could present significant harm to humans” • Notification: All events that may constitute a public health emergency of international concern (PHEIC) • Significant/potentially international public health risks • Both national and international systems

9. Purpose of IHR (2005) “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 2)

10. IHR(2005): a paradigm shift From control of borders to (also)containment at source From diseases list toall threats From preset measures toadapted and real time response

11. Highlights of IHR (2005) • Much broader scope • National IHR Focal Point & competent authorities • Consultation, notification, verification & assessment • Recommended measures from WHO in public health emergencies of international concern • National core capacity requirements

12. National IHR Focal Point • The national centre for communications with WHO • On a 24/7 basis • NOT an individual person • Legally required functions • Sending urgent communications to WHO • Disseminating information to and consolidating inputs from relevant governmental sectors/institutes/agencies • Potential additional tasks as determined by State: • Risk assessment, coordinated response etc.

13. Importance of national capacity The best way to prevent international spread of diseases is to detect public health threats early and implement effective measures when the problem is small and at local level

14. Risk assessment for potential influenza pandemic • Under IHR (2005), WHO provides Member States with technicalassistance in • Conducting risk assessment of an event that may constitute a PHEIC (e.g. “signal” such as cluster of human cases with potential influenza pandemic) • Includes assessment on international spread, adequacy of control measures, interference with international traffic • May include mobilizing international support for on-site assessments • Advising control and containment measures

15. Early detection and consultation fora potential influenza pandemic • National capacity for detection is the key • Early consultation is essential • For any suspicious event or early “signal” (e.g. cluster of cases) • “Window of opportunity is narrow” • Do not need to wait until official notification • Critical to avoid “too late to contain” scenario

16. Surveillance and response capacity At local level Detection of events Reporting Control measures At intermediate levels Confirmation Assessment Reporting At national level Assessment Notification (to WHO) Public health response Control measures Support (staff, lab) On-site assistance Operational links/liaison Public health emergency response plan On 24 hour basis

17. Verification of events • Value of unofficial sources of information for early alert (to be assessed and verification requested) • WHO mandated to seek verification (from State Party in which event arising) of events which may be emergencies of international concern • States Parties must give initial reply within 24 hours and provide of information • Offer On-site assessment, when necessary

18. Event notification • Any event that may constitute a public health emergency of international concern (PHEIC) • To WHOwithin 24 hours of nationalassessment • Continue to provide WHO with detailed public health information including: case definition, cases/deaths, conditions affecting spread, measures • Does NOT mean an actual “PHEIC” is necessarily occurring

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

20. Determination of a PHEIC • DG of WHO determines whether an event constitutes a PHEIC • 5 key criteria: • Information from the State / States • Decision instrument (Annex 2) • Advice of the Emergency Committee • Scientific principles, scientific information, other relevant information • Risk assessment: to human health, of international spread and interference with international traffic

21. Decision instrument (Annex 2): A positive response to two questions requires a country to notify WHO 4 diseases that always have to be notified polio (wild type virus), smallpox, human influenza caused by a novel virus, SARS. Diseases that always lead to the use of the algorithm : cholera, pneumonique plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, meningitis, others *Q1: seriousgraves repercussions for public health? Q2: unusual or unexpected? Q3: risk of international spread? Q4: risk of travel or traffic restrictions? Insufficient information : re-evaluate

22. Designated Ports of Entry: Core capacity requirements for responding to potential PHEICs b PH assessment & care for affected travellers, or animals Space to interview suspect or affected persons c Public health (PH) emergency response, incl development of a contingency plan a Assessment, quarantine of suspect travellers, if required. d g Access to required equipment and trained personnel Implementation of recommended measures such as disinfection Entry/exist control for departing & arriving passengers e f Source: WHO/HQ IHR team (modified)

23. Early consultation • For events not requiring notification, Member States • May keep WHO advised, consult on appropriate measures, and request WHO technical assistance to assess the situation • Need to continue monitoring/assessing the event to see if notification becomes necessary

24. IHR (2005): Rapid Response Index Cluster • Two important aspects • IHR (2005) as an opportunity to strengthen core capacity for early detection and assessment of Index Cluster • Containment operation in line with IHR requirements, when applicable Risk assessment & Decision-making Response Operation Monitoring

25. Rapid Response operations • Some IHR requirements for international travellers may apply: • Measures applied to arriving or departing international travellers • Measures applied to travellers inside the country in course of departing • IHR provisions that may affect potential interventions: • Informed consent before prophylaxis, other measures etc • Care of travellers subject to quarantine/isolation etc (food, medical care…) • Measures must be applied in transparent and non-discriminatory manner • Respect for fundamental human rights

26. Conclusion • IHR (2005) is legal framework to protect public health • The decision instrument is a useful (and required) tool to assess and notify WHO about a PHEIC, including all cases of human influenza of new subtype • Key provisions of the IHR (2005) apply to and support to pandemic preparedness and responseincluding • Strengthening core public health capacities • Rapid notification and communication with WHO • Joint assessment