Fifty-First Regional Committee of South-East Asia Region

International Health Regulations

1.      Introduction

Currently, the reporting of three communicable diseases – cholera, plague and yellow fever – is required under the International Health Regulations (IHR) 5 which were adopted by the World Health Assembly in 1969 in an attempt to ensure maximum security against international spread of disease. No international body, however, has the mandate to enforce reporting under IHR, and reporting is therefore less than optimal. In some instances, failure to report is due to stigma and adverse consequences to tourism and trade that may arise if these diseases are reported by name. The economic impact of inappropriate quarantine measures has been recorded in millions of dollars lost in commerce, trade and tourism. As a result, in 1995, the World Health Assembly adopted a resolution requiring the review of the International Health Regulations with modification and updating as necessary.

In renewing IHR, the following important changes were proposed: 

1.     Notification: The revised IHR will require immediate reporting of the number of defined disease syndromes that are of international importance. This will facilitate timely notification, which would normally be followed by disease-specific reporting once the diagnosis has been confirmed. This will also provide reporting of disease outbreaks of unknown origin where a potential hazard to international travel and trade is identified. There are five groups of syndromes, namely, (i) haemorrhagic fever syndrome, (ii) acute respiratory syndrome, (iii) acute gastrointestinal syndrome, (iv) neurological syndrome, and (v) category covering other unidentified syndromes of presumed infectious origin.

2.     Structure of the revised IHR: The proposed structure will take the form of:

– a framework document consisting of course provisions as an enabling basis for the adoption of national legislation, and

– a separate series of annexes describing technical provisions and specific requirements and forming otherwise an integral part of IHR. These annexes will be regularly reviewed and updated as necessary, without having to modify the main contents of IHR.

2.     Progress in Revision of Ihr

All Member States were asked to nominate focal points for the purpose of revision of IHR. The provisional draft of IHR was sent to all Member States on 30 January 1998. On the basis of the comments received, some modifications have been made.

 
A pilot study is proceeding in 21 selected countries in each WHO region with the objective of evaluating the proposed notification of defined clinical syndromes within the existing national disease surveillance systems. The information accruing from this study will guide any necessary revision of the case definitions of the syndromes and will enable operational guidelines for the revised IHR to be completed. In the SEA Region, three countries, namely, India, Sri Lanka and Thailand, were selected for the pilot study. Every effort has been made to initiate this study as rapidly as possible. However, some delays have been encountered and not all the countries have been ready to begin the study as soon as planned. It is therefore proposed to continue this study at least until end of 1998. A review meeting will be held with the participating counties after the completion of the study and a full evaluation will be carried out in the first half of 1999.

Because of the complex interactions between trade and health, WHO has proposed that mutual legislative recognition of the International Health Regulations and the Sanitary/ Phytosanitary (SPS) Agreement of the World Trade Organization (WTO) be made. The benefits of this recognition would be the formal availability of WHO advice, statements and rulings to WTO for trade disputes and standard setting, as well as increased compliance capacity for IHR.

 
The original target, which had been provisionally envisaged, was to complete work on the revision of IHR in 1998 in order to submit the revised IHR to the Executive Board and the World health Assembly in 1999. It is now clear that a longer period is needed to fully evaluate the proposed approach to syndromic notification in selected countries and to hold further consultations on other technical and legal aspects of IHR. It has therefore been decided to set a new target for completion of the revised IHR in 1999/2000.
 
A meeting of the Committee on International Surveillance of Communicable Diseases (CISCD) has been planned to be held in November 1998 to review the revised version of the provisional draft text; review draft operational guidelines; consider the progress of the revision process; carry out an interim evaluation of the pilot study and discuss legal aspects of IHR with legal advisers drawn from each of the WHO regions. The second meeting of CISCD, planned for 1999, hopes to finalize the revised IHR.

3.      Actions to be taken by the Regional Committee

Member States are requested to ensure that the focal point, officially designated by the government, carefully reviews the provisional draft text (that was sent to them in March 1998), both from public health point and legal aspects. Regarding the legal review, it will be important to consider the provisional draft in the context of each country’s existing or planned public health legislation.

To ensure that the three Member States in the Region (India, Sri Lanka and Thailand) selected for the pilot study make every effort to immediately initiate this study and forward their reports to WHO on time, as proposed.

Until such time the revised IHR comes in to effect, Member States are requested to comply with the current IHR.