International Health Regulations (2005) Update on implementation WHO/EPR

World Health assembly resolution Early IHR implementation May 2006  Early implementation of IHR on a voluntary basis in the context of pandemic influenza preparedness and response  Differentiate between IHR start in June 2007 and voluntary compliance now Highlights  90 days to designate National Focal Points (NFP) and for WHO to designate IHR Contact Points  Notification to WHO of human influenza cause by new virus subtype  Surveillance, information sharing, consultation, verification and public health response  Measures for travellers  WHO to establish a roster of experts  Influenza pandemic task force

Elements for a WHO strategy 3 domains 7 areas of work Build on existing WHO alert & response operations WHO (relevant) control programmes (e.g. GIP, ADE, ERI, IVB, POL, FOS, PHE …) Regional strategies for surveillance & response (e.g. joint WPRO/SEARO, PAHO, IDSR in AFRO & EMRO) …

Coordination Monitoring Reporting Resource mobilisation Administration IHR Bodies & Procedures IHR Focal Points Roster of experts Emergency Committee Review Committee National legislation Alert & Response Ops IHR Contact Point Intelligence Verification Risk assessment Risk communication Notification Response Country Alert & Response IHR NFP Operations National ARO Laboratory training / support Epidemiology training / support National system assessment Response preparedness -Social mobilization -Case management IHR Communication information education advocacy Points of Entry Ports Airports Ground crossings Specific threats influenza polio smallpox SARS Chemical/Radionuclear others Project Management National Core Capacity WHO Alert, Preparedness, and Response Operations

Coordination: Many players to bring on board WHO Senior Management WHO Country Offices Country relevant professionals Country IHR Focal Points WHO Governing Bodies Media / The public International Organisations (FAO, OIE, WTO, …) Regional Organizations (ASEAN, EU, …) Potential Donors

IHR Bodies & Procedures National Focal Points (NFPs) “National IHR Focal Point” means the national centre, designated by each State Party, which shall be accessible at all times for communications with WHO IHR Contact Points under these Regulations; As of mid September NFPs have been officially designated

IHR Roster of Experts l Experts in all relevant fields of expertise—primary source of members of Emergency Committees and Review Committees l DG appoints Roster members under WHO Regs for Expert Advisory Panels & Committees (except as specified in IHR) l Additionally, DG appoints 1 Roster member at request of each State-Party, and, as appropriate, experts proposed by relevant IGOs/REIOs l States must notify DG of qualifications / expertise of each expert l To date, 45 States have proposed experts for membership – 2 additional States are under final negotiations – 2 experts of EU will be integrated l Database - IHR Expert Roster:

Emergency Committee: Who is on it? l Members selected by DG from IHR Expert Roster (& other expert advisory panels when appropriate) l Selected on basis of: – expertise / experience for particular session/event – due regard for equitable geographical representation l At least one member should be nominated by SP where event arises l Meetings: Urgent, expedited, potentially electronic

Emergency Committee: What does it do? l Only involved in context of probable or declared PHEIC l Emergency Committee advises DG on the key determinations involving PHEICs: – Whether an event constitutes a PHEIC (only if SP does not agree with DG preliminary determination) – Termination of a PHEIC – Temporary Recommendations: Proposed issuance, modification, extension or termination l DG always makes the final determination

Review Committee: What does it do? l Review Committee provides technical advice to DG on: – Standing Recommendations, and modifications/termination (concerning specific ongoing public health risks on appropriate health measures for routine or periodic application) – Potential amendments to IHR – Any other matter referred by DG concerning functioning of IHR – Some reservations – Potential additional two-year extension to core capacity- building deadlines in exceptional circumstances

Coordination Monitoring Reporting Resource mobilisation Administration IHR Bodies & Procedures IHR Focal Points Roster of experts Emergency Committee Review Committee National legislation Alert & Response Ops IHR Contact Point Intelligence Verification Risk assessment Risk communication Notification Response Country Alert & Response IHR NFP Operations National ARO Laboratory training / support Epidemiology training / support National system assessment Response preparedness -Social mobilization -Case management IHR Communication information education advocacy Points of Entry Ports Airports Ground crossings Specific threats influenza polio smallpox SARS Chemical/Radionuclear others Project Management National Core Capacity WHO Alert, Preparedness, and Response Operations

Event notification and determination under IHR (2005) WHO DG Various disease and event surveillance systems within a country National IHR Focal Points National IHR Focal Points WHO IHR Contact Points WHO IHR Contact Points Emergency Committee Other competent Organizations (IAEA etc.) Detect and report any urgent or unexpected events Consult events or notify WHO of any events that may constitute a PHEIC Receive, assess and respond to events notified Ministries/ Sectors Concerned Determine whether an event constitutes a PHEIC and recommend measures External advice Coordinate Communicate Report

WHO Regional level 1 (dedicated) telephone number + 1 (dedicated) fax number + 1 (dedicated) for each Region. Roster of duty Officers in each Region and HQ – 24/7 coverage SOPs to all Regions WHO Country Offices to be part of the Alert and Response system through contact with IHR NFP link to the Regional Contact Point IHR briefing / Operational Guide WHO IHR contact points - Status

Specific threats Influenza Pandemic Task Force l Somewhat similar functions to Emergency Committee for AI/PI issues–but only until IHR (2005) enter into force - 15-June-07 l IPTF mandate – Provides technical advice to DG: – Response to avian influenza – Appropriate phase of pandemic alert and the corresponding response measures – Declaration of an influenza pandemic – International response to a pandemic l IPTF operational – 21 members – meets end of Sept

Coordination Monitoring Reporting Resource mobilisation Administration IHR Bodies & Procedures IHR Focal Points Roster of experts Emergency Committee Review Committee National legislation Alert & Response Ops IHR Contact Point Intelligence Verification Risk assessment Risk communication Notification Response Country Alert & Response IHR NFP Operations National ARO Laboratory training / support Epidemiology training / support National system assessment Response preparedness -Social mobilization -Case management IHR Communication information education advocacy Points of Entry Ports Airports Ground crossings Specific threats influenza polio smallpox SARS Chemical/Radionuclear others Project Management National Core Capacity WHO Alert, Preparedness, and Response Operations

International Consultation on Strengthening National Capacities for Epidemic Preparedness and Response in Support to the National Implementation of the International Health Regulations (IHR) Lyon, France May 2006 Strategic approaches to improving national capacities for epidemic alert and response in the context of IHR Key Components and Essential Elements Strategies and Mechanisms WHO Strategies to Support Development of National Capacities 100 participants

Advance draft on “Minimum and Desirable Core Capacities” Peripheral Intermediate National Link with requirement for AI pandemic preparedness Includes preparation to the response National core capacities for IHR

IHR M & E : 5 Pillars System W H O R e s o u r c e s I D S R – A P S E D – E I D – H M N GOARN – EMS – E-Health- Global Atlas – Health Mapper – CSUN- GLADNet… Pillar 1 Policy Planning Financing Pillar 3 IHR Human Resources knowledge & skills Pillar 4 IHR Technical Resources Pillar 5 IHR Systems and Services 15 Early Warning System 16 Verification and risk assessment system 17 Rapid Investigation & Response Team 18 Equipments and Stockpiles 19 Functioning laboratory system for PHEIC Pillar 2 IHR Infrastructures & Institutions 4 National IHR Focal Point 5 Focal Point for communication with Media 6 Points of Entry 7 National Emergency Committee 1 Legal framework for IHR 2 National Plan for PHEIC 3 Budget allocation for IHR 8 IHR training and continuous education 9 Roster of professionals with IHR “qualification” 10 Active Participation in International IHR related Networks 11 IHR Resources Mapping 12 Telecommunication Resources 13 Infection Control SOPs 14 Clinical Management guidelines for PHEIC

Points of Entry Montreal meeting outcomes 3 working groups have produced SOPs on designation and certification criteria for ports, airports and ground crossings These SOPS will be further refined and tested, and finalized in Vancouver, Canada, in November for May 2007 product delivery

1. Inspection for conveyances(for passenger,cargo vessels & aircrafts) 2. Quarantine/isolation facilities at PoE/off PoE(for suspects, animals) 3. Contingency plans for ports, airports, ground crossings 4. Disinsection/decontamination methods & measures for conveyances, cargo, goods, persons, animals 5. Qualifications for persons carrying out public health inspection/environmental audit/pest control 6. Minimum requirements for designated hospital & clinic 7. Reporting sickness on board and reporting on containers 8. Recovering cost Epidemic and Pandemic Alert and Response (EPR)15 Capacity Strengthening at Points of Entry Lyon- 2-5 April '06 Capacity strengtening at Points of Entry Standard operating procedures

Guides l Guide to ship sanitation – publication early 2007 l Guide to hygiene and sanitation in aviation – in progress (peer review June 2007)