New set of International Health Regulations to manage public health emergencies of international concern

Today, the World Health Assembly approved a new set of International Health Regulations to manage public health emergencies of international concern. The new rules will "prevent, protect against, control and provide a public health response to the international spread of disease."

Many of the provisions in the new regulations are based on the experience gained and lessons learnt by the World Health Organization (WHO) and the global community over the past 30 years. The need for new rules and operational mechanisms for a more coordinated international response to the spread of disease has been most clearly shown during the recent outbreaks of SARS in 2003 and avian influenza in 2004-2005.

The regulations govern the roles of countries and WHO in identifying and responding to public health emergencies and sharing information about them. WHO country offices around the world, together with the Global Outbreak Alert and Response Network (GOARN), provide operational support to countries in identifying and responding to disease outbreaks.

"This is a major step forward for international health," said Dr LEE Jong-wook, WHO Director-General. "These new regulations recognize that diseases do not respect national boundaries. They are urgently needed to help limit the threats to public health."

The revision of the International Health Regulations has been under way for several years and has required an enormous amount of work by all 192 Member States of the World Health Organization. This work culminated in several lengthy sessions of an Intergovernmental Working Group chaired by Ambassador Mary Whelan of Ireland.

The original International Health Regulations agreed in 1969 were designed to help monitor and control six serious infectious diseases - cholera, plague, yellow fever, smallpox, relapsing fever and typhus. The new rules will govern a broader range of public health emergencies of international concern, including emerging diseases.

"The new regulations bring disease control into the twenty-first century," said Dr Anarfi Asamoa-Baah, Assistant Director-General in charge of communicable diseases. "With this framework, we can now support the work of countries in controlling outbreaks more effectively. The regulations provide WHO with new, clearly defined roles and responsibilities as we help countries to respond to disease outbreaks."

Under the revised regulations, countries have much broader obligations to build national capacity for routine preventive measures as well as to detect and respond to public health emergencies of international concern. These routine measures include public health actions at ports, airports, land borders and for means of transport that use them to travel internationally.

The purpose of the International Health Regulations is to ensure the maximum protection of people against the international spread of diseases, while minimizing interference with world travel and trade.

They include a list of diseases such as smallpox, polio and SARS whose occurrence must be notified to WHO. The regulations also include a matrix for countries to decide whether other incidents constitute public health events of international concern. Consideration is made of whether an outbreak is serious, unusual or unexpected, whether there is a significant risk of international spread and whether there is a significant risk of international travel or trade restrictions.

"The existing regulations were written for a very different world from the one we live in today. Air travel was a luxury and the movement of goods and people around the world was relatively slow," said Dr Guenael Rodier, WHO Director of Communicable Disease Surveillance and Reponse. "Today, travel and trade have expanded far beyond what was envisaged under the original regulations. The new rules respond to a globalized, 24-hour world in which a disease outbreak in one country can rapidly move around the world."

Now that the regulations have been adopted by the World Health Assembly, countries will have to assess their capacities to identify and verify events, as well as to control them. The regulations identify specific capacity requirements that must be in place in each country within a fixed timeframe.

"Every country already has some of these capacities but almost no country has a perfect system," said Dr Max Hardiman of WHO, who has coordinated the process of revising the International Health Regulations. "The new regulations set clear standards and will help countries to identify where their disease surveillance and response must improve."

The rules also provide a code of conduct for how to notify and respond to public health events of international concern. They highlight areas where strengthening is required, including within WHO.

The regulations will formally come into force two years from the date on which they were approved by the Assembly.