New International Health Regulations Now In Force
New International Health Regulations (IHR)-designed to halt the international spread of dangerous diseases and other threats-are now in force, with the chief aim of reducing the time it takes to identify an illness or other public health threat-including chemical and radiological hazards-that could have an international impact, in order to mobilize a more timely and effective response.
Revisions of the regulations have been in the works for several years, but the 2003 SARS epidemic and concerns about a possible influenza pandemic have given new urgency to the revised rules. The new regulations were approved by the World Health Assembly in 2005 and officially came into force in 2007.
Under the old rules, PAHO/WHO member countries were only officially required to notify outbreaks of cholera, plague, and yellow fever. Under the new regulations, countries must report, verify, and respond to any event that is potentially a "public health emergency of international concern."
The change reflects concerns about new kinds of international health threats and the fact that new diseases have been emerging at the rate of about one per year in the past four decades.
The new International Health Regulations (IHR) mean expanded roles and responsibilities for countries and for PAHO/WHO. The rules spell out four main tasks that countries must undertake:
* Establish a national IHR focal point, which must be available 24/7 for official information exchange with PAHO/WHO.
* Develop a national plan for building the country's capacities in surveillance and response.
* Upgrade laboratory capacity to be able to identify dangerous pathogens.
* Improve capacities for field investigation, social mobilization, and case management.
Countries have two years to formally assess how capable they are in all these areas and to develop action plans for getting up to par. After that, they have three years to implement the action plans. The regulations also allow a two-year extension beyond the initial five years for countries that need it. But, says Dr. Marlo Libel, PAHO regional communicable diseases advisor, "We think PAHO member countries will be up and running well within the five-year period."
The new International Health Regulations include a decision instrument that countries should use to decide if a health event constitutes a "public health emergency of international concern." According to the instrument, any outbreak of smallpox, wild polio, SARS, or a new subtype of influenza automatically qualifies as a notifiable event.
Other outbreaks are subject to the following questions:
* Is the public health impact of the event serious?
* Is the event unusual or unexpected?
* Is there a significant risk of international spread?
* Is there a significant risk of international travel or trade restrictions?
If the answer is "yes" to any two of these questions, countries are required to notify the event within 24 hours to WHO.