1. 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

2. 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)

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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 …)

10. 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)

11. 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.

12. 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 (2) + (up to 2)
"As soon as possible but no later than five years from entry into force …"
Possible extensions

13. "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

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

15. 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)

16. 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

17. The WHO quarterly bulletin on IHR implementation
Thank you
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IHR News
The WHO quarterly bulletin on IHR implementation