international health regulations (2005) · pdf fileinternational health regulations (2005)...

International Health Regulations (2005)

Daniel L Menucci Technical AdvisorDaniel L. Menucci, Technical Advisor

Ports Airports and Ground Crossings Lyon OfficePorts, Airports and Ground Crossings, Lyon OfficeInternational Health Regulations Coordination (IHR)

Health Security and Environment (HSE)

CAPSCA Americas – First Steering Committee MeetingMexico City – 25-26 June 2009

Health Security and Environment IHR Coordination

C i t f 15 J 2007*C i t f 15 J 2007*Came into force on 15 June 2007*Came into force on 15 June 2007*

L ll bi di f 194 t i d WHOLegally binding for 194 countries and WHO10 Parts

66 Articles9 A

“ to prevent, protect against, control and provide a public health response to the

9 Annexes

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)


What do the IHR call for?What do the IHR call for?Strengthened national capacity for surveillance and control, including international travel and transport international travel and transport –ports, airports and ground crossingsPrevention, alert and response to e e t o , a e t a d espo se tointernational public health emergencies (e.g. pandemic (H1N1) 2009)Gl b l t hi d i t ti l Global partnership and international collaboration (e.g. IAEA, FAO, OIE, IMO, ICAO, IATA, ACI, MERCOSUR, CARECOM, EU)EU)Rights, obligations, procedures and progress monitoring


progress monitoring

“National IHR Focal Point” means the national centre, designated by each

Responsible authorities (Article 4)

State Party, which shall be accessible at all times for communications with WHO IHR Contact Points under these Regulations;

N ifi i► Notification

► Reports

►Consultation►Consultation

► Verification

WHO IHR National IHR WHO IHR Contact Point

National IHR Focal Point

(One per State Party) (One per WHO Region)


( p y) ( p g )

PART IV PART IV –– POINTS OF ENTRYPOINTS OF ENTRY(airports, ports and ground crossings)(airports, ports and ground crossings)

PART I DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND RESPONSIBLE AUTHORITIESPART II INFORMATION AND PUBLIC HEALTH RESPONSEPART II INFORMATION AND PUBLIC HEALTH RESPONSEPART III RECOMMENDATIONSPART IV POINTS OF ENTRYPART V PUBLIC HEALTH MEASURES

Chapter I General provisionsChapter I General provisionsChapter II Special provisions fro conveyances and conveyance operatorsChapter III Special provisions for travellersChapter IV Special provisions for goods, containers and container loading areas

Designation of points of entry to maintain the core capacities in Annex 1B (Article 19)

Identification of “competent authority” at each designated point of entry for IHR

Designation of points of entry to maintain the core capacities in Annex 1B (Article 19)

Identification of “competent authority” at each designated point of entry for IHRPART VI HEALTH DOCUMENTSPART VII CHARGESPART VIII GENERAL PROVISIONPART IX THE ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE REVIEW COMMITTEE

Authorization of ports to issue Ship Sanitation Certificates (SSC) (Article 20)Authorization of ports to issue Ship Sanitation Certificates (SSC) (Article 20)

Chapter I The IHR Roster of ExpertsChapter II The Emergency CommitteeChapter III The Review Committee

PART X FINAL PROVISIONS


Seven strategic actions to guide IHR(2005) implementation

Awareness

Four Technical areas

A legal and monitoring frame ork


framework

World Health Report 2007

IHR Annex 1A• Health system• Epidemiology

IHR Annex 1A

• Laboratory• Preparedness• Case management

National disease alert and response system

Case management• Infection control• Social mobilisation

C i ti


• Communication• …

• Ports

• Airports

IHR Annex 1B, (also 3, 4, 5, 8, and 9)

p

• Ground crossings Intersectoral collaboration

• Aviation sector (ICAO, ACI, IATA)

• Shipping (IMO, ISF, CLIA)

• Railways (UIC)


CORE CAPACITIES• At all times

Annex 1B

• Access to medical service

• Transport of ill travellers• Inspection of conveyancesInspection of conveyances• Ensure safe environment at PoE facilities• Control of vectors / reservoirs

• For responding to events

• Public health emergency contingency plan

• Arrangement for assessment, medical care andArrangement for assessment, medical care and isolation for travellers or animals

• Space for interview / quarantine travellers• Apply entry-exit control or other specific control


pp y y pmeasures

Core capacity requirements for surveillance and response and activities concerning designated ports, airports and ground crossings (Annex 1):

• Timeline 2 years + 3 + (2) + (up to 2)

2007 2009 2012 2014 2016


Planning Implementation

"As soon as possible but no later than five years from entry into force …"

Possible extensions

• Intelligence

• Verification

IHR Annex 2 (notification instrument)

• Risk assessment

• Response (GOARN)Surveillance and response at global level

• Logistics

• …

at global level


Decision instrument (Annex 2)4 diseases that shall be notified4 diseases that shall be notified polio (wild-type polio virus), smallpox, human influenza new subtype, SARS.

Disease that shall always lead to utilization of the algorithm: cholera, pneumonic plague, yellow fever, p p g , y ,VHF (Ebola, Lassa, Marburg), WNF, others….

Q1: public health impact serious?Q1: public health impact serious?

Q2: unusual or unexpected?

Q3: risk of international spread?

Q4: risk of travel/trade restriction?

Insufficient information: reassess


Insufficient information: reassess

WHO Information sharing OperationsStates PartiesWHO Portal

EURO

Event Management System

PAHOPAHOEMROEMRO SEAROSEARO

AFROAFROWPROWPRO


Update on IHR implementationUpdate on IHR implementationAwareness and global partnership

– IHR Introduction Online training package g p g– Second edition of IHR (2005), including Annex 9 by ICAO– Working relationships with partner organizations and

networks, including ICAO, FAO/OIE, IATA, GOARN etcStrengthening national capacity

– Implementing regional strategies – Laboratory biosafety training programme– National influenza Centres (NICs)– POE capacity assessment and planning

W k h /t i i i f Shi S it ti C tifi tHealth Security and Environment IHR Coordination

– Workshops/training sessions for Ship Sanitation Certificates

Update on IHR implementationUpdate on IHR implementationManaging international public health emergency

– Networks of National IHR Focal Points for event communications– Global Public Health Security Exercise from 11-12 June 2008– WHO Interim Guidance on use of IHR decision instrument

bli h d (O t 2008) published (Oct 2008) – Event Management System (EMS)

• >700 events managed and analysed (since June• >700 events managed and analysed (since June 2007)

– Updated guidance on pandemic influenza preparedness and p g p p presponse (April 2009)

– Response to Pandemic (H(H11NN11) ) 20092009


Update on IHR implementationUpdate on IHR implementationLegal issues and monitoring

Th bli h f h IHR R f E – The establishment of the IHR Roster of Experts • >160 experts in the 21 subject areas (including

port health) nominated or proposedport health) nominated or proposed

Th t bli h t d f th IHR E t I f ti – The establishment and use of the IHR Event Information Site (EIS) to facilitate sharing of information on public health events among all the National IHR Focal Pointshealth events among all the National IHR Focal Points

• > 56 items (including H1N1 update) posted on EIS


Update on POE work in WHOUpdate on POE work in WHOPOE core capacity assessment tool Other technical guidelines or advice published, e.g. Revision of

Guide to Hygiene and Sanitation in Aviation (2009) and Guide for Guide to Hygiene and Sanitation in Aviation (2009) and Guide for TB on board of aircraft (2008)

As of March 2009, more than 1640 ports have been authorized to i Shi S it ti C tifi t b 69 t iissue Ship Sanitation Certificates by 69 countries

Participating in:C ti A t f P ti th S d f - Cooperative Agreement for Preventing the Spread of Communicable Diseases through Air Travel – CAPSCA (leadership of ICAO)

- EU SHIPSAN Trainet (passengers ships)- EU REACT Project (communicable diseases preparedness)


OTHERS EVENTS RELATE TO IHR OTHERS EVENTS RELATE TO IHR d AIR TRANSPORTd AIR TRANSPORTand AIR TRANSPORTand AIR TRANSPORT

Airport WHO Certification: informal consultation meeting for harmonization of procedures and requirements with ICAO, IATA and ACI – Geneva, Sept. 2008and ACI Geneva, Sept. 2008

IHR Annex V requirements for vector control at airportsIHR Annex V requirements for vector control at airports– Informal WHO expert meeting for YELLOW FEVER control-

Geneva, Sept. 2008– ICAO-WHO-IATA Informal expert meeting to consider ICAO

Resolution A36 on non-chemical disinsection and other methods of aircraft disinsection – Florida Dec 2008


methods of aircraft disinsection Florida, Dec. 2008

• Influenza• Polio• SARS

Driving forces at country level … but vertical and not

• Tuberculosis• Malaria• HIV/AIDSSARS

• Smallpox• Cholera• Meningitis

integrated …

when a pandemic situation

• HIV/AIDS• EPI

• Meningitis• Yellow fever• Food safety• Chemical safety

occurs global response is needed and will motivate i t ti d


• Chemical safety• Radionuclear safety• …

integration and synergy.

e.g. pandemic (H1N1) 2009

WHO IHR Contact Points WHO IHR Contact Points

WHO shall designate IHR Contact Points WHO shall designate IHR Contact Points, which shall be accessible at all times for communications with National IHR Focal Points (Article 4)


• Outbreak News

IHR e Library• IHR e-Library

• E-learning training tools

• WHO quarterly bulletin on IHR implementation• WHO quarterly bulletin on IHR implementation

• IHR references and archives

• AREAS OF WORK: e.g. Ports, airports and


S O O e g o s, a po s a dGround Crossings

IHR core capacity requirements IHR core capacity requirements Assessment designation and certification of Assessment designation and certification of Assessment, designation and certification of Assessment, designation and certification of

airportsairportsHow CAPSCA can be i t t d ith thiIHR

IHR

Gov.Designation

integrated with this designation?

IHR Framework

Annex1B

WHOSelf

What is their relationWith quarantine/health law and

Air transport legislation?

WHOCertificationAssessment

tool

WHO publish list of

certified airports & ports

How ICAO audit systemCan be integrated

With WHO Certification


Th kThank you

w w w . w h o . i n t / i h rHealth Security and Environment IHR Coordination

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