The International Health Regulations 10 years on: the governing framework for global health security

Autor: Eric A. Friedman, Lawrence O. Gostin, Mary C. DeBartolo
Rok vydání: 2015
Předmět:
Zdroj: Lancet (London, England)
ISSN: 1474-547X
Popis: Fundamental revisions to the International Health Regulations in 2005 were meant to herald a new era of global health security and cooperation. Yet, 10 years later, the International Health Regulations face criticism, particularly after the west African Ebola epidemic. Several high-level panels are reviewing the International Health Regulations’ functions and urging reforms. The Global Health Security Agenda, a multilateral partnership focused on preventing, detecting, and responding to natural, accidental, or intentional disease outbreaks, has similar capacity building aims, but operates largely outside the International Health Regulations. Here, we review the International Health Regulations’ performance and future. The International Health Regulations is a legally binding instrument, which came into force in June, 2007, and now has 196 States Parties—every WHO member state plus Lichtenstein and the Holy See. The scope of the International Health Regulations is “to prevent, protect against, control and provide a public health response to the international spread of disease” (article 2). The scope embraces an all-hazards strategy, covering health threats irrespective of their origin or source (article 1), which is distinct from the disease-specifi c model used in previous versions of the International Health Regulations. The intention was to incorporate biological, chemical, and radionuclear events. The International Health Regulations requires States Parties to develop core capacities for rapid detection and response, including for surveillance, laboratories, and risk communication—buttressed by legislation, fi nancing, and national focal points. Core capacities embrace a public health strategy of strengthening local infrastructure and systems to detect, prevent, and contain outbreaks at their source before spreading internationally. States Parties agreed to “collaborate with each other” to develop and maintain core capacities. Furthermore, States Parties must promptly notify WHO of events that might constitute a public health emergency of international concern, with a continuing obligation to inform WHO of any updates. To guide notifi cations, annex 2 of the International Health Regulations contains a “decision instrument” to aid in assessing whether to notify WHO of a health event of potential international concern. Certain threats, such as smallpox, always require notifi cation. For other threats, States Parties must use the instrument to establish whether they need to notify WHO. Departing from previous versions, the International Health Regulations authorises WHO to consider unoffi cial sources, such as scientists and the media. When it receives an unoffi cial report, WHO seeks verifi cation from States Parties in whose territory the event occurs. The declaration of a public health emergency of international concern is the crucial governance activity of the International Health Regulations. The Director-General has sole power to declare and to terminate a public health emergency of international concern but must consider information provided by a State Party; the decision instrument; Emergency Committee advice; scientifi c principles and evidence; and a risk assessment of human health, international spread, and interference with international traffi c. If the Director-General declares a public health emergency of international concern, she must issue temporary, non-binding recommendations describing health measures that States Parties should take. Since 2007, the Director-General has declared three public health emergencies of international concern. During the 2009 H1N1 infl uenza pandemic, WHO declared the fi rst ever public health emergency of international concern but was criticised for fuelling public fear. State Parties widely disregarded WHO’s temporary recommendations; however, in 2011, the Review Committee on International Health Regulations functioning during the H1N1 infl uence pandemic cautioned, “The world is ill-prepared to respond to a severe infl uenza pandemic.” In 2014, the Director-General declared two further public health emergencies of international concern, for polio and for Ebola. The designation of polio seemed counterintuitive because only a handful of cases had been diagnosed compared with previous years. Yet, small pockets of polio in Afghanistan, Pakistan, and Nigeria were putting global eradication at risk. In the case of Ebola, the Director-General waited 4 months after Medecins Sans Frontieres announced an “unprecedented outbreak” to declare a public health emergency of international concern on Aug 8, 2014. WHO’s Ebola Interim Assessment Panel in July, 2015, said urgent warnings “either did not reach senior leaders or senior leaders did not recognise their signifi cance.” Several health emergency events have not resulted in a declaration of a public health emergency of international concern. Currently, the world is watching outbreaks of Middle East Respiratory Syndrome, which has not triggered a public health emergency of international concern declaration despite reaching more than 26 countries and causing 575 deaths by November, 2015. The Emergency Committee advised that, without sustained community transmission, the conditions for a public health emergency of international concern have not been met. The Director-General did not even convene an Emergency Committee for major events such Lancet 2015; 386: 2222–26
Databáze: OpenAIRE
Externí odkaz: