WHO / World Bank videoconference 19 September 2008 A new international framework, an opportunity for strengthening health systems WHO / World Bank videoconference 19 September 2008 Guénaël Rodier, WHO, Geneva

30 years of international public health threats HIV/AIDS CHERNOBYL PLAGUE EBOLA / MARBURG NvCJD NIPAH YELLOW FEVER ... ANTHRAX SARS MENINGITIS CHOLERA CHEMICAL AVIAN INFLUENZA XDR-TB ... The AIDS pandemic, December 2006 39.5 Mo HIV infected 2.9 Mo deaths in 2006 Drug-Resistance No vaccine A new virus recognized in the early 1980s Ebola, Kikwit, Zaïre, April 1995 315 cases 250 deaths (CFR 80%) Global concern WHO Coordinated response Bovine spongiform encephalopathy A new prion disease Crossed the species barrier Spread through the food-chain March 2003: a new and severe acute atypical pneumonia emerges in China, Hanoi, Hong-Kong, Singapore and Toronto. 8098 cases 774 deaths 26 countries affected A new coronavirus Poliomyelitis: threat to global eradication effort …global spread has never been so easy H5N1 Avian Influenza, Human cases, Pandemic Threat Accidental or deliberate release of infectious agents Smaller, more powerful, more affordable, biotechnologies Increased risk for accidental release of infectious agents (e.g. SARS 2004) The deliberate release of infectious agents is no longer a remote threat Chernobyl, Ukraine, 1986 1000 people with highest radiations 600,000 people contaminated > 5 million people exposed > 4000 thyroid cancer cases (by 2002)

May 1995, WHA Resolution on the Revision of the IHR Overall drive and rationale Economic impact (HIV/AIDS, meningitis, BSE/NvCJ, SARS, Avian influenza, BT …) Global concern (international spread) World unprepared: IHR(1969) obsolete limited list of diseases (cholera, plague, yellow fever – revised 1983) focus on borders (ports, airports) pre-set rather than tailored measures do not address international coordination

International Health Regulations “ to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade" (Article 2) 1969, 2005: IHR purpose remains the same

Entered into force on 15 June 2007 IHR (2005): Three Paradigm Shifts From control of borders to [also] containment at source From diseases list to all public health threats From preset measures to adapted responses Entered into force on 15 June 2007

A legal and monitoring framework Seven strategic actions to guide IHR(2005) implementation Awareness Four Technical areas A legal and monitoring framework World Health Report 2007

The IHR foster global partnership Other intergovernmental organizations: UN system (e.g. FAO, IAEA, ICAO, IMO) others: regional (e.g. EU, ASEAN), technical (e.g. OIE) Development agencies: governments, banks WHO Collaborating centres Academics & professional associations Industry associations NGOs and Foundations The IHR provide for cooperation between WHO and other competent intergovernmental organizations or international bodies in the implementation of the Regulations. WHO will therefore continue to foster its longstanding working relationships with a number of organizations such as the International Atomic Energy Agency, the International Air Transport Association, the International Civil Aviation Organization, the International Maritime Organization, the World Tourism Organization, Food and Agriculture Organization of the United Nations, the Office International d'Epizooties (World Organisation for Animal Health) and the World Trade Organization. In addition to these specialized organizations, WHO will work with regional economic integration organizations such as the European Union and the Mercado Común del Sur (MERCOSUR) in implementing the Regulations in the countries of their respective regions.

At community, intermediate, and national level. Health system Epidemiology Laboratory Preparedness Case management Infection control Social mobilisation Communication … IHR Annex 1A At community, intermediate, and national level.

Communication (social mobilization, media, web, on-line training …) (Annex 1A): “capacity to detect, assess, notify and report events in accordance with this Regulations …” Investing in Human resources (training, distance learning, twinning programmes …) Infrastructure (buildings, equipments, logistics …) Standard Operating Procedures (investigation, response, biosafety …) In the areas of Laboratory quality system (EQA programmes, biosafety, specimen collection, lab regional network, twinning programmes …) Surveillance and response systems (epidemic intelligence, field investigation, data analysis, risk assessment, reporting, points of entry …) Communication (social mobilization, media, web, on-line training …)

Intersectoral collaboration Ports Airports Ground crossings IHR Annex 1B, (also 3, 4, 5, 8, and 9) Intersectoral collaboration Aviation sector (ICAO, ACI, IATA) Shipping (IMO, ISF, CLIA) Railways (UIC)

The LYO mission is to coordinate and support WHO's effort in the Regions to strengthen laboratory diagnostic capacity, national surveillance and response systems, and facilities at designated points of entry (e.g. airports, ports) in order that all countries can meet the core capacity required under the IHR.

Timeline 2007 2009 2012 2014 2016 Planning Implementation Core capacity requirements for surveillance and response (Annex 1A): “capacity to detect, assess, notify and report events in accordance with this Regulations …” Timeline 2007 2009 2012 2014 2016 Planning Implementation 2 years + 3 + (2) + (up to 2) "As soon as possible but no later than five years from entry into force …" Possible extensions

"Event-based" surveillance and response at global level Intelligence Verification Risk assessment Response (GOARN) Logistics … IHR Annex 2 (notification instrument) "Event-based" surveillance and response at global level

Global Outbreak Alert & Response Network (GOARN) Institutions and Partner Network

Responsible authorities (Article 4) National IHR Focal Point “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; Notification Reports Consultation Verification National IHR Focal Point WHO IHR Contact Point (One per State Party) (One per WHO Region)

Driving forces at country level … but vertical and not integrated Influenza Polio SARS Smallpox Cholera Meningitis Yellow fever Food safety Chemical safety Radionuclear safety … Tuberculosis Malaria HIV/AIDS EPI Driving forces at country level … but vertical and not integrated GFATM UNAIDS GAVI ICG INFOSAN IAEA

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