Overview of International Health Regulations (IHR-2005)

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Overview of International Health Regulations (IHR-2005) Dr. Islam Saeed, Director Surveillance, ANPHI-MoPH MD, MSc-HPM, MSc-FELTP Islamic Republic of Afghanistan Ministry of Public Health Afghanistan National Public Health Institute ( ANPHI ) Surveillance / DEWS Directorate

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2 Outline Need for ensuring global health IHR (2005)- a legal framework Assessment of public health events National Core capacities Implementation of IHR 2005 Situation in Afghanistan Achievements and Challenges Conclusion

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3 What is concern? Epidemics took days, weeks/months to reach far territories Emergence/re-emergence of infectious diseases and increased pace of spread Threat of deliberate use of biological and chemical agents Events of international concern of unknown causes or sources Impact on health, economy, security

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4 What are IHR (2005)? A legal framework International legal instrument which is legally binding on all WHO States Parties to protect global health The international commitment for shared responsibilities and collective defence against disease spread Rights, Obligations and procedures entered into force on 15 June 2007

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The 58th World Health Assembly adopts the revised International Health Regulations, “IHR” Legally binding for WHO and the world’s countries that have agreed to play by the same rules to secure international health. Ensuring maximum public health security while minimizing interference with international transport and trade

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6 International Health regulations (2005) 10 Parts, 66 Articles, 9 Annexes PART I DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND RESPONSIBLE AUTHORITIES PART II INFORMATION AND PUBLIC HEALTH RESPONSE PART III RECOMMENDATIONS PART IV POINTS OF ENTRY PART V PUBLIC HEALTH MEASURES Chapter I General provisions Chapter II Special provisions fro conveyances and conveyance operators Chapter III Special provisions for travellers Chapter IV Special provisions for goods, containers and container loading areas PART VI HEALTH DOCUMENTS PART VII CHARGES PART VIII GENERAL PROVISION PART IX THE ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE REVIEW COMMITTEE Chapter I The IHR Roster of Experts Chapter II The Emergency Committee Chapter III The Review Committee PART X FINAL PROVISIONS

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What’s new? From three diseases to all public health threats From preset measures to adapted response From control of borders to, also, containment at source New focus on national capacity

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8 Purpose of IHR (2005) “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)

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Strengthen national disease surveillance, prevention, control and response systems Strengthen public health security in travel and transport Strengthen national capacity

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Core Capacity Technical Areas 8 Core capacities Legislation and Policy Coordination Surveillance Response Preparedness Risk Communications Human Resources Laboratory Potential Hazards Infectious Zoonosis Food safety Chemical Radio nuclear 3 levels National Intermediate Peripheral/Community Events at Points of Entry Ports Air ports Ground crossing

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11 IHR Secretariat HQ IHR Regional Contact Points CO NFPs IHR Structure NFPs

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12 National IHR Focal Points (NFPs) Important role in implementation of IHR The national centre for communications with WHO: On a 24/7 basis (by telephone, fax, email) NOT an individual person Legally required functions Potential additional tasks as determined by State: Risk assessment, coordinated response etc.

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WHO and 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 adapted public health measures Assist States Parties in their efforts to investigate outbreaks and meet the IHR national requirements for surveillance and response

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Roster of experts IHR Roster of Experts (Article 47) Emergency Committee – provides views on PHEIC, temporary recommendation (Articles 48, 49) Review Committee - reporting, review, standing recommendations, amendment and disputes (Articles 50-53)

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15 Public Health Emergency of International Concern (PHEIC) PHEIC is an extraordinary event which is determined, as provided in these Regulations: to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response. IHR require procedural steps by the DG/WHO in determining that a PHEIC exists

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16 Event notification Any event that may constitute a public health emergency of international concern (PHEIC) NFP of the government should notify to WHO within 24 hours of national assessment Continue to provide WHO with detailed public health information including: case definition, cases/deaths, conditions affecting spread, measures Does NOT mean an actual “PHEIC” is necessarily occurring

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17 Verification of events Value of unofficial sources of information for early alert (to be assessed and verification requested) WHO mandated to seek verification (from State Party in which event arising) of events which may be emergencies of international concern States Parties must give initial reply within 24 hours and provide of information Offer On-site assessment, when necessary

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18 Early consultation For events not requiring notification, Member States may: keep WHO advised, consult on appropriate measures, and request WHO technical assistance to assess the situation Need to continue monitoring/assessing the event to see if notification becomes necessary

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19 Annex 2: Decision instrument for the assessment and notification of events that may constitute a PHEIC

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Decision Instrument (1) Four diseases (a single case is notifiable): Smallpox, Poliomyelitis, human influenza (caused by a new subtype), SARS Utilization of the decision instrument: Cholera, plague, viral haemorrhagic fevers, yellow fever, … Diseases of regional concern: dengue fever, meningococcal diseases…

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Decision Instrument (2) Is the public health impact of the event serious? Is the event unusual or unexpected? Is there a significant risk of international spread? Is there a significant risk of international travel or trade restrictions? Answering "yes" to any two of the criteria requires a member state to notify WHO Criteria for assessment

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Combinations of answers requiring notification Serious and unexpected Serious and risk for international spread Serious and risk for international restrictions Unexpected and risk for international spread Unexpected and risk for international restrictions

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23 a Public health (PH) emergency response, including development of a contingency plan PH assessment & care for affected travellers, or animals b c Space to interview suspect or affected persons d Assessment, quarantine of suspect travellers, if required. e Implementation of recommended measures such as disinfection f Entry/exit control for departing & arriving passengers g Access to required equipment and trained personnel Source: WHO/HQ IHR team (modified) Designated Ports of Entry: Core capacity requirements for responding to potential PHEICs

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24 Implications of non-compliance to IHR WHO will know from other sources Position of the State Party will change from article 6 (notification) to article 10 (verification) WHO will request verification WHO will embark on investigation based on risk assessment IHR allow WHO to use whatever available information to alert other partners Compliant State Party will receive timely international support when needed

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IHR Capacity analysis Afghanistan-2010 25

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IHR Capacity analysis Afghanistan-2011 26

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IHR Capacity analysis Afghanistan-2012 27

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IHR Capacity analysis Afghanistan-2013 28

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Major Achievements IHR National Focal points Assessments and plan Training and capacity buildings IHR 2005 translation and distribution Surveillance and response Laboratory support Collaboration with international community Reporting to WHO Asking for extension Still a long way to go 29

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30 Challenges Empowerment of the NFP Maintain disease surveillance, early warning and response system Transparency and information sharing Maintenance and expansion of existing partnerships Resource mobilization Strengthen capacity at airports, and ground crossings Improvement of advocacy and awareness-raising efforts

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IHR implementation is the responsibility of all sectors of the government of Afghanistan Coordination is must Capacities should be established Proper implementation ensure saving lives and resources Good international image Capacity building and human resources National and Global Health Security Collaboration across countries Conclusion

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32 Thanks Email: kmislamsaeed@gmail.com Mobile: 0093(0)700290955