New International Health Regulations (IHRs) setting out how to respond to international health threats were approved by the World Health Assembly on May 23. Deficiencies in the current regulations were exposed during epidemics of severe acute respiratory syndrome (SARS) and ebolavirus. The encroaching spectre of a new influenza pandemic hastened the agreement, following a decade of deliberation. The IHRs establish structures and procedures for prompt notification of critical events to the WHO, who would then be responsible for declaring emergencies, recommending measures including any quarantine and travel restrictions, and coordinating an international response.
The notification criteria have been expanded to cover novel, unknown, or previously excluded diseases. New subtype human influenza, poliomyelitis due to wild-type poliovirus, smallpox, and SARS would be automatically notified. Cholera, plague, yellow fever, haemorrhagic fevers, West Nile fever, and any disease causing concern will be assessed to see if it presents a serious public-health impact, is unusual or unexpected, risks global spread, or risks international travel or trade restrictions. Any event meeting more than one of these criteria will be notified. “Early detection and response at a local level will prevent many infectious disease outbreaks from ever becoming an international problem”, says Max Hardiman (WHO Department of Communicable Disease Surveillance and Response).
The IHRs also require countries to communicate detailed public-health information during an outbreak, “including case definitions, laboratory results, … number of cases and deaths, and conditions affecting the spread of the disease”. This communication depends on surveillance and response infrastructure, which many countries currently lack. Member states are given 2 years to assess their capability to identify, verify, and respond to health emergencies and 5 years to develop these capabilities.
To meet the dangers presented by inadequate public-health systems, countries are expected to report epidemiological information from informal networks and non-governmental sources. The WHO is mandated to initiate surveillance independently and coordinate verification when potential threats are identified. “The regulations are putting into a legal form what is generally accepted to be good international practice”, says Angus Nicoll (Communicable Disease Surveillance Centre, Health Protection Agency, London, UK). “But countries shouldn't be saying, ‘we don't have to do anything until 2007 or 2012’ because certainly Mother Nature won't be waiting.”