New global disease-control rules take effect

Jun 15, 2007 (CIDRAP News) – The revised International Health Regulations, substantially updated for the first time since 1969, take effect today, aiming to help protect the world from a host of emerging diseases and health threats such as pandemic influenza and bioterrorism.

The revised rules, approved by World Health Organization (WHO) member countries at the World Health Assembly in May 2005, spell out the commitments and responsibilities of countries and the WHO for limiting the global impact of epidemics and other public health emergencies, according to a press release yesterday from the WHO.

WHO Director-General Margaret Chan said SARS (severe acute respiratory syndrome) was a wake-up call concerning the world's vulnerability to the quick spread of new diseases.

"Today, the greatest threat to international public health security would be an influenza pandemic," Chan said in the WHO statement. "The threat of a pandemic has not receded, but implementation of the IHR will help the world to be better prepared for the possibility of a pandemic."

The new rules say that smallpox, polio, SARS, and new human influenza strains must be reported immediately to the WHO. In addition, the rules call for reporting several other diseases, including cholera, pneumonic plague, yellow fever, and viral hemorrhagic fevers (such as Ebola and Marburg), if they cause a serious public health impact or pose a risk of international spread. Under the old rules, only cholera, plague, and yellow fever had to be reported.

The revised IHR also require countries to report natural, accidental, or deliberate use of biological or chemical agents or radionuclear material.

To encourage more openness about health threats and to speed the international response, the new rules require member countries to:

  • Notify international officials of a public health emergency within 24 hours of assessment
  • Designate a national IHR focal point to stay in constant communication with the WHO
  • Develop and maintain core public health capacities for monitoring and responding to emerging threats, including those related to chemicals, radiologics, and food
  • Report health measures, such as border screening and quarantine, implemented in response to disease outbreaks, with a focus on measures that could impair international trade or travel

The WHO will assist countries that have difficulty complying with the new rules, said David Heymann, WHO assistant director-general for communicable diseases. "This is our responsibility and we expect that the entire international community is committed to the same goal of improving international public health security," he stated.

For the first time, the IHR set forth human rights provisions for international travelers who need medical interventions to prevent the global spread of disease.

Because of the evolving threat of a flu pandemic, countries that attended the 2006 World Health Assembly voted for early invocation of some IHR provisions that address avian influenza. The IHR call on countries to provide WHO collaborating centers, in a timely manner, with information and biological materials related to highly pathogenic avian influenza and other novel flu strains.

US approach to the rules
In December 2006, US Department of Health and Human Services (HHS) Secretary Mike Leavitt announced that the United States had formally accepted the revised IHR and would immediately implement the new rules, rather than waiting for them to take effect in June 2007, according to an HHS press release.

The measures described in the IHR are voluntary. HHS said countries that adopt the IHR can submit reservations and understandings about the implementation of the regulations.

The United States accepted the IHR with the reservation that it would implement them according to US federalism principles, HHS said. Also, the government submitted three understandings, which emphasize that (1) natural, accidental, or deliberate releases of chemical, biological, or radiological materials are notifiable under the IHR; (2) countries that accept the IHR are obligated to report, whenever possible, potential public health events that occur outside their borders; and (3) the IHR don't create a private right to legal action against the federal government.

In January HHS convened a working group of all government agencies affected by the new IHR, according to Katrin Kohl, deputy director of the Centers for Disease Control and Prevention's (CDC's) Division of Global Migration and Quarantine. She told CIDRAP News that the agency has held biweekly conference calls to ensure that all departments were making good progress on compliance.

Start dates for the IHR vary by country, and some are delayed somewhat because of the reservations they had when they accepted the new rules, according to Kohl. For the United States, the IHR take effect on Jul 17. "Almost everything is in place," she said. "In the United States, we're fortunate to have a robust public health system."

Kohl said the HHS secretary's operations center has been designated as the US focal point for communicating with the WHO. "That office also has the capacity to reach out to all US agencies," she said.

See also:

Jun 14 WHO press release
http://www.who.int/mediacentre/news/releases/2007/pr31/en/index.html

Full text of regulations (60 pages)
http://www.who.int/csr/ihr/WHA58-en.pdf

Baker MG, Fidler DP. Global public health surveillance under new International Health Regulations. Emerg Infect Dis 2007 Jul;12(7):1058-65 [Full text]

Dec 13, 2006, HHS news release
http://archive.hhs.gov/news/press/2006pres/20061213.html

May 24, 2005, CIDRAP News story "WHO updates rules to prevent spread of disease"

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