601:
improved upon. A significant problem is the inadequate level of core capacities in some countries, and the question of how to build upon them has been frequently raised. The reports make several recommendations to encourage governments to increase investment in outbreak identification and response programs. These include technical help from external sources conditional on mobilizing domestic resources, external financing for low income countries, pressure from the international community to increase investment, and considering outbreak preparedness as a factor in the
International Monetary Fund's country economic assessments, which influence governments' budget priorities and access to capital markets. Another avenue under discussion is reform of Article 44 of the IHR, potentially through a new pandemic convention.
122:
394:. The aim of this recommendation was to prevent and minimize the consequences of natural outbreaks of dangerous infectious diseases, as well as the threat of alleged use of biological weapons against BTWC States Parties. The conference also noted the significance of the sanitary epidemiological reconnaissance in assessing the sanitary-epidemiological situation, organizing and conducting preventive activities, indicating and identifying
25:
614:
international community about the outbreak. Potential solutions raised included the WHO and the UN more assertively "naming and shaming" countries and private companies that impose unjustified restrictions on WHO working with the World Trade
Organization, International Civil Aviation Organization, and International Maritime Organization to develop standards and enforcement mechanisms for trade and travel restrictions.
552:. The Director-General takes the EC's advice following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration of the PHEIC, the EC then makes recommendations on what actions the Director-General and Member States should take to address the crisis. The recommendations are temporary and require three-monthly reviews.
564:"The DGWHO shall select the members of the Review Committee on the basis of the principles of equitable geographical representation, gender balance, a balance of experts from developed and developing countries, representation of a diversity of scientific opinion, approaches and practical experience in various parts of the world, and an appropriate interdisciplinary balance."
623:
support as soon as they do report were also recommended. A novel approach to encourage early notification is the World Bank's
Pandemic Emergency Financing Facility. This was created to provide rapid financing for the control of outbreaks and to protect countries from the devastating economic effects of outbreaks via an insurance program.
270:: during the Forty-Eighth World Health Assembly, the WHO and Member States agreed on the need to revise the IHR (1969). Several challenges were placed against the backdrop of the increased travel and trade characteristic of the 20th century. The revision of IHR (1969) came about because of its inherent limitations, most notably:
622:
The third compliance issue relates to countries' obligation to rapidly report outbreaks. The reports recommend strengthening this obligation by WHO publicizing when countries delay reporting suspected outbreaks. In contrast, mechanisms ensuring that countries rapidly receive operational and financial
146:
response to the international spread of disease in ways that are commensurate with and restricted to public health risks and that avoid unnecessary interference with international traffic and trade". The IHR is the only international legal treaty with the responsibility of empowering the World Health
613:
There was broad consensus across the reports that bringing such restrictions to a minimum is critical to avoid further harm to countries experiencing outbreaks. Moreover, if governments assume that reporting will lead to inappropriate travel and trade restrictions, they may be hesitant to notify the
600:
The IHR requires countries to assess their disease surveillance and response capacities and to identify if they can adequately meet their requirements. The seven Ebola reports universally agree that the country's self-assessment capabilities are insufficient and that verification measures need to be
580:
One publication reviewed seven of these major reports and identified areas of consensus on action. The seven reports noted inadequate compliance with WHO's
International Health Regulations as a major contributor to the slow response to Ebola. They found three major obstacles that contributed to poor
560:
The formation of an IHR Review
Committee is the responsibility of the DGWHO. They are selected from the IHR Experts Committee, and "when appropriate, other expert advisory panels of the Organization." Furthermore, the DGWHO "shall establish the number of members to be invited to a meeting, determine
609:
The second issue frequently raised is ensuring that restrictions on trade and travel during outbreaks are justified. Because of increased attention and concern from the public and the media, many governments and private companies restricted trade and travel during the Ebola outbreak, though many of
576:
brought renewed international scrutiny to the
International Health Regulations. By 2015, 127 of the 196 countries were unable to meet the eight core public health capacities and report public health events as outlined. Numerous published reports by high-level panels have assessed the International
179:
The original
International Health Regulations (IHR) were adopted in 1969. However, its underpinnings can be traced to the mid-19th century, when measures to tackle the spread of plague, yellow fever, smallpox and particularly cholera across borders, with as little interference to global trade and
643:
systems in order to improve them and help prevent, detect and quickly respond to public health risks (whether natural, accidental or deliberate) in the future. Developed as a result of the IHR Review
Committee on Second Extensions for Establishing National Public Health Capacities and on IHR
435:, is defined in the IHR (2005) as, "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response". This definition implies a situation that is:
639:) is "a voluntary, collaborative, multisectoral process to assess country capacities to prevent, detect and rapidly respond to public health risks whether occurring naturally or due to deliberate or accidental events". The JEE helps countries to identify critical gaps within their
416:
outbreaks, and the findings of a number of high-level assessments of the global response to these crises, that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response."
158:, several changes were made to the previous revised IHRs originating from 1969. The 2005 IHR came into force in June 2007, with 196 binding countries that recognised that certain public health incidents, extending beyond disease, ought to be designated as a
1577:
1040:
World Health
Assembly (1981). "WHA34.13 Amendment of the International Health Regulations (1969)". Thirty-fourth World Health Assembly, Geneva, 4–22 May 1981: part I: resolutions and decisions: annexes. World Health Organization. p.
547:
Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms now they are. These members are selected according to the disease in question and the nature of the event. Names are taken from the
188:
became established between London and Paris. 12 nations attended this conference, of which 11 were
European states and three would sign the resulting convention. In the 19th century. there were 10 of these conferences.
610:
these measures were not necessary from a public health standpoint. These restrictions worsened financial repercussions and made the work of aid organizations sending support to affected regions more difficult.
398:
in the environmental sites, conducting laboratory analysis of biological materials, suppressing hotbeds of infectious diseases, and providing advisory and practical assistance to local health authorities.
141:
in 1969 and last revised in 2005, are legally binding rules that only apply to the WHO that is an instrument that aims for international collaboration "to prevent, protect against, control, and provide a
572:
Revisions to the International Health Regulations in 2005 were meant to lead to improved global health security and cooperation. However, the WHO's perceived delayed and inadequate response to the
932:
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Implementation, WHO, in collaboration with partners and initiatives, developed the JEE process and published the first edition of the tool in 2016. A second edition was published in 2018.
536:
is required to take into account factors which include the risk to human health and international spread as well as advice from an internationally made up committee of experts, the
817:"Assessment of Public Health Events through International Health Regulations, United States, 2007–2011 - Volume 18, Number 7—July 2012 - Emerging Infectious Diseases journal - CDC"
408:
entitled "Strengthening global health security by embedding the International Health Regulations requirements into national health systems", in which the authors argued that "the
180:
commerce, were debated. To address the realisation that countries varied with regards to their sanitary regulations and quarantine measures, the first of these series of early
395:
498:
513:, who "shall establish a roster composed of experts in all relevant fields of expertise... In addition, shall appoint one member at the request of each State Party."
375:
On 15 June 2007, the IHR (2005) entered into force, and were binding as of June 2020 on 196 States Parties, including all 194 Member States (countries) of WHO.
985:
540:(EC), one of which should be an expert nominated by the State within whose region the event arises. Rather than being a standing committee, the EC is created
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42:
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Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and Their Destruction
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in view of the global eradication of smallpox, the Thirty-fourth World Health Assembly amended the IHR (1969) to exclude smallpox in the list of
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873:"An analysis of International Health Regulations Emergency Committees and Public Health Emergency of International Concern Designations"
68:
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Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin (2018).
1420:
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Since 2007, the WHO Director-General has declared public health emergencies of international concern in response to the following:
1086:"Strengthening global health security by embedding the International Health Regulations requirements into national health systems"
75:
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767:
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L. Gostin et al. "The International Health Regulations 10 years on: the governing framework for global health security,"
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World Health Organization, Communicable Diseases Surveillance and Response, Epidemic and Pandemic Alert and Response
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Health Regulations for inadequacies and proposed actions that can be taken to improve future responses to outbreaks.
108:
1578:
International Infectious Disease Law, Revision of the World Health Organization's International Health Regulations
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413:
1243:
Solomon, Danielle. (9 January 2019). "Brexit and health security: why we need to protect our global networks".
46:
82:
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States have, in accordance with the Charter of the United Nations and the principles of international law,
1566:
155:
871:
Mullen, Lucia; Potter, Christina; Gostin, Lawrence O.; Cicero, Anita; Nuzzo, Jennifer B. (1 June 2020).
330:
In 2005, a values statement document entitled "The Principles Embodying the IHR" was published and said
1599:
756:"Part of Chapter 4. Public Health, Global Governance, and the Revised International Health Regulations"
185:
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162:(PHEIC), as they pose a significant global threat. Its first full application was in response to the
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1137:"Public Health Emergencies of International Concern: Global, Regional, and Local Responses to Risk"
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933:"Of plagues, planes, and politics: controlling the global spread of infectious diseases by air"
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301:(modern-day Democratic Republic of Congo) and the re-emergence of cholera and plague in
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carries implications for public health beyond the affected State's national border; and
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was suggested as a well-tested means for enhancing the monitoring of infections and
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Youde, Jeremy (2010), Youde, Jeremy (ed.), "The International Health Regulations",
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The IHR Experts Roster, which is regulated by Article 47 of the IHR, is tended by
1570:
1335:
Gostin, Lawrence O.; Klock, Kevin A.; Finch, Alexandra (November–December 2023).
948:
730:"What are the International Health Regulations and Emergency Committees? Q&A"
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showed that the nation had very high level of capacity of response. Australia's
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1189:"Transparency in IHR emergency committee decision making: the case for reform"
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Kohl, Katrin S.; Arthur, Ray R.; O'Connor, Ralph; Fernandez, Jose (2012).
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S. Moon et al. "Post-Ebola reforms: ample analysis, inadequate action,"
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the ISR were revised and renamed the 'International Health Regulations'.
402:
In January 2018, a group of WHO bureaucrats published an article in the
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the WHO issued its first infectious disease prevention regulations, the
473:
1352:
1581:, Journal of the American Medical Association, June 2, 2004, at 2623.
986:"The scientific background of the International Sanitary Conferences"
785:
Biopolitical Surveillance and Public Health in International Politics
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was developed to help to implement the recommendations from the JEE.
1288:"An International Agreement on Pandemic Prevention and Preparedness"
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40(1): 1–4. doi: 10.1057/s41271-018-00160-3. Retrieved 6 April 2020.
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goal of their universal application for the protection of all people
24:
1286:
Gostin, Lawrence O.; Halabi, Sam F.; Klock, Kevin A. (2021-09-15).
760:
Infectious Disease Movement in a Borderless World: Workshop Summary
669:
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289:). The past few decades had seen the emergence and re-emergence of
222:
1511:"Australia's Human Biosecurity Portal – International Obligations"
698:"WHO EMRO | Background | About | International Health Regulations"
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full respect for the dignity, human rights and fundamental freedom
1559:
Frequently Asked Questions about International Health Regulations
278:
226:
210:
1083:
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in pursuance of their health policies. In doing so, they should
1061:"opbw.org - Meeting of the states parties to the convention..."
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762:. Washington D.C.: National Academies Press. pp. 180–195.
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inability to ensure that governments report outbreaks quickly.
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was convened in Paris in 1851. This was in the same year that
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the sovereign right to legislate and to implement legislation
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amended the IHR (1969) in relation to provisions on cholera.
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Kamradt-Scott, Adam; Eccleston-Turner, Mark (1 April 2019).
209:(ISR 1951), which focussed on six quarantinable diseases;
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421:
Public Health Emergency of International Concern (PHEIC)
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A Public Health Emergency of International Concern, or
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A JEE of Australia's capacity following the 2013–2016
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of the world from the international spread of disease;
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lack of a formal internationally coordinated mechanism
787:, New York: Palgrave Macmillan US, pp. 147–175,
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In 2010, at the Meeting of the States Parties to the
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and the Constitution of the World Health Organization
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561:its date and duration, and convene the Committee."
49:. Unsourced material may be challenged and removed.
1529:National Action Plan for Health Security 2019-2023
653:National Action Plan for Health Security 2019-2023
1421:"Joint External Evaluation (JEE) mission reports"
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1135:Bennett, Belinda; Carney, Terry (31 March 2017).
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692:
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1451:"IHR (2005) Monitoring and Evaluation framework"
1337:"Making the World Safer and Fairer in Pandemics"
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528:Public Health Emergency of International Concern
427:Public health emergency of international concern
160:Public Health Emergency of International Concern
321:to prevent the international spread of disease.
16:Legally binding instrument of international law
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736:. World Health Organization. 19 December 2019.
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588:unjustified trade and travel restrictions, and
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568:Criticism of international health regulations
147:Organization (WHO) to act as the main global
931:Budd, Lucy; Bell, Morag; Brown, Tim (2009).
325:
1481:"Joint External Evaluation tool (JEE tool)"
1457:(in Latin). 9 February 2018. Archived from
1397:(in Latin). 6 December 2019. Archived from
988:. World Health Organization; Geneva, p. 13.
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445:may require immediate international action.
313:dependence on official country notification
293:. The emergence of "new" infectious agents
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1546:International Health Regulations (1969)
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439:serious, sudden, unusual or unexpected;
388:sanitary epidemiological reconnaissance
369:uphold the purpose of these Regulations
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1564:IHR 2005: From the Global to the Local
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1193:British Medical Journal Global Health
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125:Logo of the World Health Organization
1548:. Third Annotated Edition, WHO, 1983
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649:Western African Ebola virus epidemic
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468:Western African Ebola virus epidemic
47:adding citations to reliable sources
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1263:vol. 386, pp. 2222–2226, 2015.
1003:"13. Communication with the public"
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275:narrow scope of notifiable diseases
13:
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1011:Introduction to Pandemic Influenza
207:International Sanitary Regulations
182:international sanitary conferences
58:"International Health Regulations"
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1427:. 9 February 2018. Archived from
532:In order to declare a PHEIC, the
1245:Journal of Public Health Policy.
627:Joint External Evaluations (JEE)
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131:International Health Regulations
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1391:"Joint External Evaluations"
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821:Emerging Infectious Diseases
396:pathogenic biological agents
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984:Howard-Jone, Norman (1975)
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585:countries' core capacities,
574:West African Ebola epidemic
264:subject to the IHR (1969).
10:
1626:
1009:; Sellwood, Chloe (eds.).
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424:
199:Constitution was founded.
186:telegraphic communications
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164:swine flu pandemic of 2009
1610:World Health Organization
1485:World Health Organization
1455:World Health Organization
1425:World Health Organization
1395:World Health Organization
1205:10.1136/bmjgh-2019-001618
1103:10.1136/bmjgh-2017-000656
889:10.1136/bmjgh-2020-002502
633:Joint External Evaluation
326:21st century developments
197:World Health Organization
459:2014 setbacks in global
137:), first adopted by the
1305:10.1001/jama.2021.16104
1013:. Wallingford, Oxford:
793:10.1057/9780230104785_7
754:Heymann, David (2010).
538:IHR Emergency Committee
522:IHR Emergency Committee
156:2002–2004 SARS outbreak
154:In 2005, following the
1341:Hastings Center Report
834:10.3201/eid1807.120231
499:mpox clade 1b outbreak
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1153:10.1093/medlaw/fwx004
969:– via Elsevier.
297:Hemorrhagic Fever in
252:World Health Assembly
139:World Health Assembly
124:
1575:Lawrence O. Gostin,
1515:Department of Health
1096:(Suppl 1): e000656.
1001:Collins, E. (2010).
556:IHR Review Committee
534:WHO Director-General
43:improve this article
1554:. WHO. Geneva. 2006
1517:. 27 September 2017
1431:on October 19, 2017
937:Political Geography
481:Kivu Ebola epidemic
291:infectious diseases
262:notifiable diseases
149:surveillance system
1569:2014-11-10 at the
1141:Medical Law Review
1050:Art. 3, IHR (2005)
618:Outbreak reporting
550:IHR Experts Roster
505:IHR Experts Roster
493:monkeypox outbreak
455:swine flu pandemic
127:
1600:International law
1491:on March 11, 2018
1461:on April 22, 2016
1401:on April 18, 2019
1353:10.1002/hast.1538
1298:(13): 1257–1258.
1090:BMJ Global Health
1073:on March 2, 2016.
1024:978-1-84593-578-8
1015:CAB International
1007:Van-Tam, Jonathan
877:BMJ Global Health
802:978-0-230-10478-5
769:978-0-309-14447-6
517:Pro-tem structure
487:COVID-19 pandemic
461:polio eradication
250:the Twenty-Sixth
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670:Pandemic
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