Revision of the International Health Regulations

  Published: 27.07.04 Updated: 27.07.2004 09:39:07
Kuulo Kutsar, Elena Ryabinina, Health Protection Inspectorate, Estonia

Contemporary International Health Regulations (IHR) origin dated back to the middle 19th century when cholera epidemics overran Europe. These epidemics started intensive infectious disease diplomacy and cooperation in public health, starting with the first International Sanitary Conference in Paris in 1851.
In 1951 WHO member states adopted the International Sanitary Regulations, which were published by WHO in 1969 as the International Health Regulations. These regulations were modified in 1973 and 1981. The IHR were originally intended to help monitor and control six serious infectious diseases: cholera, plaque, yellow fever, smallpox, relapsing fever and typhus; today it covers only cholera, plaque and yellow fever.
The IHR are a set code of practices and procedures designed to prevent the international spread of infectious diseases. They are binding international legal instrument that prescribes measures to WHO and member states of WHO for stopping infectious diseases crossing from one country to another. The procedures and practices they require at airports, seaports and ground crossings are intended to prevent the international spread of infectious diseases while at the same time not interfering unnecessarily with the international movements of people and goods.
Since the 1980s, a series of developments and events have made it apparent that IHR are inadequate as a legal response to global infectious disease outbreaks, emerging and re-emerging infections, and the rising incidence of particular infectious diseases.
WHO and its ruling body, the World Health Assembly (WHA), have been developing new regulations since 1995. Following a series of resolutions passed by WHA between 2001 and 2003, a draft set of improved IHR was issued on the 12 of January 2004. WHO regional consultations have been held in spring 2004 with a view to a final version to be approved by WHA in spring 2005. IHR should come into force in January 2006.
Much of the revised regulations reflect what has become good practice by WHO member states in the past decade in response to threats such as SARS, avian influenza and viral haemorrhagic fevers, and outbreaks of unknown etiology.
The major changes in the draft revised IHR include:

1. Notification – member states are required to notify WHO of events potentially constituting a public health emergency of international concern and to respond to requests for verification of information regarding urgent national risks.
The draft revised IHR define “a public health emergency of international concern” as an event which includes the following four criteria:
a) seriousness of the public health impact;
b) unusual or unexpected nature of the event;
c) potential for the event to spread internationally;
d) the risk that  travel or trade restrictions may result from the event.

2. National IHR Focal Points – National IHR Focal Points are required to establish; these are the operation link from member states to WHO.

3. Definition of core capacities – a member state must have the basic public health capacities to detect, report and respond to public health risks and potential or actual public health emergencies of international concern. Specific capacities for the implementation of routine measures at points of entry are required.

4. Recommended measurements – WHO’s response may include temporary or standing recommendations for measures for application by the member state affected by a public health emergency of international concern, other states and operators of international transport.

5. External advice regarding the IHR – the draft revised IHR include the procedures for obtaining independent advice concerning IHR implementation from an Emergency Committee during public health emergencies or from an IHR Review Committee which will consider disputes, the development of standing recommendations and evaluate how the IHR are functioning.

The responsibility of implementing the IHR rests with WHO and member states. National health administrations are responsible for implementing the revised IHR and WHO will provide technical assistance to all member states.

Key obligations for member states include:

  • to notify WHO of all events potentially constituting a public health emergency of international concern;
  • to respond to request for verification of information regarding public health risks;
  • to respond to public health risks that threaten to transmit infectious disease to other member states;
  • to inform WHO of evidence of public health risks occurring in another territory that may result in international infectious disease spread;
  • to provide routine inspection and control activities at international points of entry to prevent international infectious disease transmission;
  • to make every effort to fully implement WHO-recommended measurements;
  • to develop and maintain the capacity to detect, report and respond to certain events defined in IHR.

A second draft revised IHR will be distributed to WHO member states in summer - early autumn 2004 for the Intergovernmental Working Group on the Revised International Health Regulations scheduled to be held in Geneva in November 2004.