1. National IHR Focal Points Overview of IHR Information-Sharing Mechanisms

2. Outline Responsible authorities for reporting under the IHR
IHR operational framework
Types of notifications and communications
Regional IHR event management
Challenges/questions

3. World Health Organization
Responsible Authorities
World Health Organization
8 September, 2018
Notification
Reports
Consultation
Verification ◄
National IHR Focal Point
WHO IHR Contact Point
(One per State Party)
(One per WHO Region)
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
“WHO IHR Contact Point” means the unit within WHO which shall be accessible at all times for communications with the National IHR Focal Point

4. IHR Operational Framework
Determine Public Health Emergency of International Concern (PHEIC)
Make temporary and standing recommendations
Emergency
Committee
Expert
Roster
WHO
Director-General
Review
Committee
24/7 accessibility
Primary channel for WHO-NFP event-related communications
Disseminate information within WHO
"Activate" the WHO assessment and response system
WHO IHR Regional
Contact Points
Other competent
organizations
(IAEA etc.)
Notification
Consultation
Report
Verification
Art.6-12
Annex 1.A
24/7 accessibility
Communication with WHO
Dissemination of information nationally
Consolidating input nationally
National IHR
Focal Points (NFP)
Ministries and
sectors concerned
Art.4
Unusual health
events
Detect
Assess
Report
Respond
National surveillance and response systems
Incl. Points of Entry
Annex 1
Art.22
Art.27

5. Initial communication between IHR NFP and WHO IHR Contact Points
Annex 2: algorithm of decision for national authorities to engage in a dialogue with PAHO/WHO; it is not the equivalent of “risk assessment”
How Annex 2 is used (levels, mechanical use); Who is using it?
Tools to support the use of Annex 2 (e.g., forms)
Joint risk assessment process: State Party and WHO/PAHO assessment against the four criteria

6. What type of event should be notified under the IHR?
Four immediately notifiable conditions:
Smallpox
Polio (due to wild-type poliovirus)
Human influenza caused by a new subtype
SARS
Four criteria to decide on notification:
Is the public health impact of the event serious?
Is the event unusual or unexpected?
Is there any significant risk of international spread?
Is there any significant risk of international travel or trade restrictions?
YES to any two (2) or more criteria indicates that notification of the WHO is required

7. National biosurveillance infrastructure
Local responsibility to detect and respond immediately to an event
Essential public health activities absolutely critical to global health security
How to fulfill this “responsibility” at the global scale?
Who is responsible for this at the global scale?
WHO Notification
Kenneth D. Mandl et al. J Am Med Inform Assoc 2004;11:

8. Types of IHR communications
IHR(2005): Working Together to Secure Global Health
Types of IHR communications
Article 6 – Notification
Use Annex 2 to assess events and notify WHO by way of the National IHR Focal Point, all events that may constitute a potential public health emergency of international concern (PHEIC).
Article 8 – Consultation
If notification under Article 6 is not required, (especially if insufficient information), consider entering into a consultation / discussion with WHO on appropriate health measures / next steps.
Article 9 – Other reports
WHO may take into account reports from other sources (i.e., reports from other countries, informal information, media reports, etc.).

9. Types of IHR communications
Article 9 – Other reports: WHO may take into account reports from other sources (i.e., reports from other countries, informal information, media reports, etc.).
States Parties, shall inform WHO within 24 hours of receipt of evidence of a public health risk identified outside of their territory as manifested by exported or imported…
Article 10 – Verification Requests : Responding to WHO requests for verification of reports from sources other than notifications or consultations of events which may constitute a public health emergency of international concern allegedly occurring in the State's territory
Article 44 – Collaboration and Assistance: States Parties shall undertake to collaborate with each other, to the extent possible, in the detection and assessment of, and response to, events as provided under these regulations. Furthermore, collaboration under this Article may be implemented through multiple channels, including bilaterally, through regional networks and the WHO Regional Offices, and through intergovernmental organizations and international bodies.

10. Verification request
Reasons for WHO Regional IHR Contact Point to initiate verification dialogue with States Parties
Strong indications of international public health implications
Maintaining the channels of communication open
Opportunity to support capacity building activities
Lack of information/access to additional sources to triangulate the information
WHO approached by IHR NFP for verification/confirmation purposes
Verification and “triggered notification”
NFPs that shared internal daily/weekly report with WHO are not overburdened. WHO is already aware.

11. Most are infectious diseases…
There are other international alert and response networks, such as:
INFOSAN: Food safety event
DRUG ALERT: SSFFC: WHA 65.19
USIE-IAEA: radio nuclear events
OIE: zoonosis
SAICM: Approach to International Chemicals Management
Need to coordinate and consolidate information from different sectors to ensure consistent information is shared internationally.

12. Summary
The IHR NFP is responsible for notifying the WHO IHR Regional Contact Point
Event notifications under the IHR are the official position and information from a State Party and are national public health responsibility/obligation under the IHR, which cannot be contracted to non-government entities
Countries should adapt domestic processes to ensure that the IHR NFP can quickly access/receive event information within the timelines set by the IHR to coordinate and make notifications to the WHO
Adapting existing information flows for the IHR NFP to receive information directly from several institutions, and information about events of varying magnitude, and working to improve the flows between these institutions, improves processes for making decisions about when and which events to notify using Annex 2
Pan American Health Organization / World Health Organization. Multilateral IHR NFP Strengthening Workshop Toolkit. June. Washington, DC: PAHO/WHO; 2017

13. Pan American Health Organization / World Health Organization
Pan American Health Organization / World Health Organization. Multilateral IHR NFP Strengthening Workshop Toolkit. June. Washington, DC: PAHO/WHO; 2017