IHR COORDINATION PROGRAMME Christian Frederickson – PhD, MPH, MPM, CAREC/PAHO/WHO International...

IHR COORDINATION PROGRAMME

Christian Frederickson – PhD, MPH, MPM,

CAREC/PAHO/WHO

International Health Regulations (2005)

Third Hemispheric Conference on Port Security of the Inter-American Committee on Ports.

7-10 April 2008

Punta Cana , Dominican Republic


In May 2005, The 58th World Health Assembly adopted the revised International Health Regulations, “IHR”

In May 2005, The 58th World Health Assembly adopted the revised International Health Regulations, “IHR”

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.


International Health Regulations IHR (2005)International Health Regulations IHR (2005)

The International Health Regulations are a formal code of conduct for public health emergencies of international concern.

They're a matter of responsible citizenship and collective protection.

They involve all 193 World Health Organization member countries.



They are an international agreement that gives rise to international obligations. They focus on serious public health threats with potential to spread beyond a country's border to other parts of the world.

Such events are defined as public health emergencies of international concern, or PHEIC. The revised International Health Regulations outline the assessment, the management and the information sharing for PHEICs.



IHRs serve a common interest.

First of all, they address serious and unusual disease events that are inevitable in our world today.

They serve a common interest by recognizing that a health threat in one part of the world can threaten health anywhere, or everywhere.

And they are a formal code of conduct that helps contain or prevent serious risks to public health, while discouraging unnecessary or excessive traffic or trade restrictions for, quote, "public health," purposes.


Why have IHR?Why have IHR?

Serious and unusual disease events are inevitable

Globalisation - problem in one location is everybody’s headache

An agreed International Public Health code of conduct for a global approach


Some facts and figures:Some facts and figures:

Over 90% of world trade is transported by the international shipping industry.

Today there are around 50,000 merchant ships that trade internationally and transport all types of cargo.

The world fleet is registered in over 150 nations and manned by over one million seafarers of virtually every nationality. (www.shippingfacts.com ).

From 1970-2000, a WHO review of over 100 outbreaks associated with ships found that more than one-third were related to foodborne transmission (http://www.who.int/water_sanitation_health/diseases/shipsancompendium/en/index.html


Infectious Disease Concerns in the CaribbeanInfectious Disease Concerns in the Caribbean

Dengue virus and Chikungunyavirus– Competent vector in Caribbean and Latin America

Malaria– 2007 outbreak Kingston, Jamaica – 2006 outbreak Exuma Is. Bahamas

Yellow Fever– Endemic in Guyana, Trinidad & Tobago– Epidemic of Yellow Fever in Paraguay, Brazil

Norovirus– Cruise ships & resort in Dominican Republic (2007)

Poliovirus– 21 cases in Hispaniola including 2 fatalities (2000-2001)


H5N1: Avian influenza, a pandemic threatH5N1: Avian influenza, a pandemic threat


What’s new?What’s new?

From three diseases to all public health risksFrom preset measures to tailored responseFrom control of borders to also include containment

at source


Decision instrument (Annex 2) of IHR (2005)for Assessment and Notification

Decision instrument (Annex 2) of IHR (2005)for Assessment and Notification

4 diseases that shall be notified polio (wild-type polio virus), smallpox, human influenza new subtype, SARS.

Disease that shall always lead to utilization of the algorithm: cholera, pneumonic plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, others….

Q1: public health impact serious?

Q2: unusual or unexpected?

Q3: risk of international spread?

Q4: risk of travel/trade restriction?

Insufficient information: reassess


1. Health Measures - Recommendations1. Health Measures - Recommendations

Temporary recommendations (Art 15)

Standing recommendations (Art. 16)

Examples of health measures for persons(Art. 18)

– Review travel history and proof of medical examination, lab analysis, vaccination or other prophylaxis;

– require medical examination, vaccination or other prophylaxis;

– Public health observation, quarantine, isolation and contact tracing

– Entry and exit screening– Refuse entry of suspect and affected

persons– Refuse entry of unaffected persons to

affected area.

Examples of health measures for baggage, cargo, containers, conveyances, goods and postal parcels (Art. 18)

-Review manifest, Proof of measures taken on departure or in transit, Routing and implement inspections

-Implement treatment to remove infection and contamination, vectors and reservoirs.

-Isolation and quarantine, seizure and destruction

-Refuse departure or entry.


2. Protections for travellers2. Protections for travellers

Overarching rights (Arts. 3 & 32)

Sanitation and hygiene of transport (Art.s 22 & 24)

Charges (Art. 40)

Data protection (Art. 45)

Unjustified measures(Art.s 23, 30, 31, 35 & 43)


3. Health Measures - General application3. Health Measures - General application

Generic– Arrival and departure (Art.s 23 & 31)

• Information about travellers itinerary, destination, non-invasive medical examination

• Inspection of baggage, cargo, containers, conveyances, goods, postal parcels and human remains

Specific– Yellow fever vaccination

(Art. 36, Annexes 6&7)– Vector control - Disinsection of conveyances

(Annex 5)


4. Affected conveyances and imported cases4. Affected conveyances and imported cases

Affected or diverted conveyances and emergencies (Art.s 25,26,27 & 28)

Imported cases (Art. 9)


4. Health Measures - additional4. Health Measures - additional

Additional (National and International Law) health measures (Art 43)


Learning from experience: the example of SARSLearning from experience: the example of SARS

Identification of the problem

Linking events in different countries

Co-ordinating international response• Field Teams• Laboratory • Epidemiology• Clinical• Travel advice, entry and exit screening at PoE

Timely information & recommendations for control

Provision of direct support and assistance


What do the IHR call for?What do the IHR call for?

Strengthened national capacity for surveillance and control, including in travel and transport

Prevention, alert and response to public health emergencies of international concern

Rights, obligations and procedures, and progress monitoring

Global partnership and international collaboration


►Requires a commitment of States Parties

Mobilization of national resources: e.g. staff, infrastructure, budget

Development of national action plans, integrated and coordinated with

intermediate and local levels and points of entry (ports, airports, ground crossings)

► Builds on existing national and regional strategies

► Requires sustained multisectorial approach and international collaboration

Strengthen national disease surveillance, prevention, control and response system


NATIONAL SURVEILLANCE AND RESPONSE

WHO GLOBAL ALERT AND

RESPONSE SYSTEM

THREAT-SPECIFIC CONTROL

PROGRAMMESINTERNATIONAL TRAVELS AND TRANSPORTS

GLOBAL PARTNERSHIP

International initiatives and networking

National Capacity Strengthening

IHR Strategic Implementation Plan

if IHR was a lighthouse …

LEGAL PROCEDURESAND MONITORING


GLOBAL PARTNERSHIP

1. Foster global partnerships (example CAPSCA PROJECT)

STRENGTHEN NATIONAL CAPACITY

2. Strengthen national disease surveillance, prevention, control and response systems

3. Strengthen public health capacities in travel and transport, including routine measures and emergency preparedness at points of entry

PREVENT AND RESPOND TO INTERNATIONAL PUBLIC HEALTH EMERGENCIES

4. Strengthen WHO global alert and response system

5. Strengthen threat-specific international control programmes

LEGAL ISSUES AND MONITORING

6. Sustain rights, obligations and procedures

7. Conduct studies and monitor progress

IHR Implementation Plan


The IHR foster global partnershipThe IHR foster global partnership

Other intergovernmental organizations:– UN system (e.g. FAO, IAEA, ICAO, IMO, UNWTO)

– others: regional (e.g. EU, ASEAN, MERCOSUR), technical (e.g. OIE)

Development agencies:– governments, banks

WHO Collaborating centres

Academics & professional associations

Industry associations (e.g. IATA, ISF)

NGOs and Foundations


STRENGTHEN NATIONAL CAPACITY FOR PUBLIC HEALTH RESPONSE

2. Strengthen national disease surveillance, prevention, control and response systems

3. Strengthen public health capacities in travel and transport – points of entry

• Timeline • Timeline

2007 2009 2012 2014 2016

Assessing Planning

Implementation

2 years + 3 + (2) + (up to 2)

"As soon as possible but no later than five years from entry into force …" (Articles 5, 13)

extensions


Containment at sourceContainment at source

Rapid response at the source is:

the most effective way to secure maximum protection against international spread of diseases

key to limiting unnecessary health-based restrictions on trade and travel


Importance of national capacityImportance of national capacity

The best way to prevent international spread of diseases is to detect public health events early and implement effective response actions when the problem is small

– Early detection of unusual disease events by effective national surveillance (both disease and event based)

– Systems to ensure response (investigation, control measures) at all levels (local, regional, and national)

– Routine measures and emergency response at ports, airports and ground crossings.


Core capacity requirementsfor designated points of entry PoE

Art.19, 20 & 21

Core capacity requirementsfor designated points of entry PoE

Art.19, 20 & 21

DESIGNATION OF POINTS OF ENTRY– States Parties shall designate Airports and Ports for developing capacities –

Annex 1b– States Parties where justified for PH reasons, may designate ground crossings

for developing capacities – Annex 1b, taking into consideration volume and frequency of international traffic and public health risks of the areas in which international traffic originates.

– States Parties sharing common borders should consider:• Bilateral and multilateral agreements• Joint designation of adjacent ground crossing for capacities – Annex 1b

– Identify competent authority for each designated point of entry

WHO CERTIFICATION FOR AIRPORTS AND PORTS– Under request of State Party WHO may arrange to certify it

• Need to develop procedures and guidelines by WHO


(a) Assessment and Medical care, staff & equipment

(b) Equipment & personnel for

transport ill travellers

(c) Trained personnel for inspection of

conveyances

(d) ensure save environment: water, food, waste, wash rooms

& other potential risk areas - inspection programmes

(e) Trained staff and programme for vector

control

Capacity Strengthening at Points of Entry

PoE Core capacity requirements at all times (routine)


a

Public Health Emergency Contingency plan: coordinator, contact points for relevant PoE, PH & other agencies

Provide assessment & care for affected travellers, animals: arrangements with medical, veterinary facilities for isolation, treatment & other services

b cProvide space, separate from other travellers to interview suspect or affected persons

dProvide for assessment, quarantine of suspect or affected travellers

e

To apply recommended measures, disinsect, disinfect, decontaminate, baggage, cargo, containers, conveyances, goods, postal parcels etc

f To apply entry/exit control for departing & arriving passengers

gProvide access to required equipment, personnel with protection gear for transfer of travellers with infection/ contamination

PoE Capacity requirements for responding to potential PHEIC (emergency)


Some principle approaches Some principle approaches

Continuous risks

Routine measures in place "sanitary conditions" at points of entry

and conveyances travellers, goods etc.

Specific measures for certain known risks in place

Vector control, vaccination Standing recommendations

Sudden increase in risk

Detection information & verification notification risk assessment

Response Support to investigation and control Information and recommendations


Points of entry Key public health functions

PREVENTION EARLY WARNING RESPONSE

RISK MANAGEMENT INSPECTION CONTINGENCY

ROUTINE CONTROL SCREENING PLANS

CONTROLING KNOWNPUBLIC HEALTH RISKSAt PORTS, AIRPORTS, GROUND CROSSING

CONTROLING EVENTS & RESPONDING

TO EMERGENCIES

DETECTING PUBLICHEALTH EVENTS

OF INTERNATIONAL CONCERN


What does WHO do under the IHR?What does WHO do under the IHR?

Designate WHO IHR contact points

Support States Parties in assessing their public health risks, through the notification, consultation, and verification processes

Inform State Parties of relevant international public health risks

Recommend public health measures

Assist States Parties in their efforts to investigate outbreaks and meet the IHR national core capacities requirements for surveillance and response and points of entry


WHO to help countries managing eventsWHO to help countries managing events

New WHO global Event Management System

WHO Regional Alert and Response teams

Train countries’ NFPs and WHO contact points for event management

Expand Global Outbreak and Alert Response Network GOARN and other specialized and regional support networks

Develop new tools and standard operating procedures

Carry out IHR exercises


ResponseResponse Global Outbreak Alert and Response Network

WHO system of Global Outbreak Alert and Response Network GOARN Operations

Event Intelligence

Event Intelligence

VerificationVerification

Official, Statesources

Risk AssessmentRisk AssessmentWHO HQ, Regional & Country Offices, Collaborators and experts


Global distribution of GOARN institutions and partners A network of more than 130 technical institutions, WHO manages secretariat and logistic support


Global partnership and international collaborationGlobal partnership and international collaboration


Countries’ challenges for IHR implementation Countries’ challenges for IHR implementation

Mobilize resources and develop national action plansStrengthen national capacities in alert and responseStrengthen capacity at ports, airports, and ground crossingsMaintaining strong threat-specific readiness for known

diseases/risksRapidly notify WHO of acute public health risksSustain international and intersectoral collaborationMonitor progress of IHR implementation


• Public health services

• Health care system

• Veterinary services

• Agriculture

• Education

• Communication

• Transport

• Trade

• Security

• Army, air force, defense…

• Prime Minister’s Office/Presidential Cabinet

Scientific committee, Turkey , Avian Flu 2006

PHE- Multi-sectoral ApproachPHE- Multi-sectoral Approach

• Coordination with safety, security and facilitation local and national plans and operational procedures and committees on implementing public health emergency plans

• Integration of local public health emergency plan with a national surveillance and response plan

• Coordinating airport operations with national and international public health response plans


Information on IHR(2005)Information on IHR(2005)

IHR text: http://www.who.int/csr/ihr/WHA58_3-en.pdf

More information, FAQs on IHR: http://www.who.int/csr/ihr/en/

For more queries on IHR

international travel and transport:

[email protected]


Note on arrangements for the issuance of Ship Sanitation Certificates SSC

Note on arrangements for the issuance of Ship Sanitation Certificates SSC

As of 15 June 2007 the International Health Regulations (2005) ("IHR (2005)") have introduced new certification procedures for ships. The new certificates are entitled Ship Sanitation Control Exemption Certificate/Ship Sanitation Control Certificate ("Ship Sanitation Certificates" or "SSC"). These SSC replace the previous Deratting/Deratting Exemption certificates ("DC/DEC") provided for under the 1969 Regulations.

After 15 December 2007, no Deratting Certificate will be valid.


Interim technical advice for inspection and issuanceof Ship Sanitation Certificates SSC


Valid for six month period

Used to identify and record all areas of ship-borne public health risks (not limited to rodents), together with any required control measures to be applied.

The SSC may be required from all ships, whether seagoing or inland navigation vessels, on an international voyage calling at the port of a State Party.

It may be renewed at any port authorized to issue such renewals by a State Party.

Authorized ports must have the capability to inspect, issue and implement (or supervise implementation of) necessary measures for the Ship Sanitation Control Certificate.




Ship Sanitation Control Exemption Certificate issued when

no evidence of a public health risk is found on board and

the competent authority is satisfied that the ship is free of infection and contamination, including vectors and reservoirs.

This certificate shall normally be issued only if the inspection has been carried out when the ship and holds are empty or when they contain only ballast or other material, of such nature or so disposed as to make a thorough inspection of the holds possible.




Ship Sanitation Control Certificate: issued when

evidence of a public health risk, including sources of infection and contamination, is detected on board and

after required control measures have been satisfactorily completed;

the SSC must record the evidence found and the control measures taken.

IHR COORDINATION PROGRAMME• http://www.who.int/csr/ihr/ssc/en/index.html


Ports Listing for issuing SSCPorts Listing for issuing SSC

WHO is requesting information from States Parties regarding which ports each State Party is authorizing to issue these certificates and their extensions. As it becomes available, this information will be made accessible through the "SSC Ports List" which will be published on the IHR website http://www.who.int/csr/ihr/

It should be noted that the listing of ports authorized by States Parties for the purpose of issuing SSC is not the same as the separate designation by them of points of entry PoE for development of core public health capacities as specified under Annex 1B of the IHR (2005).

PoE include international ports but also airports and ground crossings, and the capacities required extend beyond inspection and certification1.

IHR COORDINATION PROGRAMME• http://www.who.int/csr/ihr/portslanding/en/index.html


Port authorized to issue SSC by WHO Regions and States Parties

Port authorized to issue SSC by WHO Regions and States Parties

49 / 184 States Parties (SP) Total: 1338 portsas of 20/03/2008

33%

(72)

WPRO

12 / 28 SP

AFRO

03 / 46 SP

AMRO

08 / 36 SP

EMRO

06 / 21 SP

EURO

17 / 53 SP

SEARO

03 / 11 SP


TRAVEL AND TRANSPORT IHR(2005)Challenges

TRAVEL AND TRANSPORT IHR(2005)Challenges

Designation of authorized ports to issue SSC

Designation of PoE to develop, maintain and strength core capacities

Assessment of core capacities for designated points of entry

Implementation of WHO Certification for IHR core capacities requirements for ports and airports

Integration of points of entry activities to national surveillance system

Development of Intersectorial approach of Public Health concerns at PoE (e.g.;facilitation, security, safety and trade)

Development of integrated emergency contingency plans for PoE

Development of strategic approach for international communication and cooperation for response to events involving points of entry, travel and transport


Thank you. Any questions?Thank you. Any [email protected]

Or

Daniel MENUCCI IHR Technical Officer Lyon FR.

[email protected]

IHR COORDINATION PROGRAMME Christian Frederickson – PhD, MPH, MPM, CAREC/PAHO/WHO International...

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