International Health

Regulation (IHR) 2005

Dr. ANM Shamsul Islam

Program Coordinator- MPH
Associate Professor
Public Health & Hospital Administration
NIPSOM
 Introduction
• International Health Regulation (IHR) are
global rules to enhance national, regional and
global public health security.
• It is known that serious and unusual disease
or events are inevitable.
• The aim is therefore to prevent and respond
to acute public health risks that have potential
to cross borders and threaten people
worldwide.
 Introduction
• In the globalize world, disease can spread far
and wide via international travel and trade.
• A health threat in one part of the world can
threaten health anywhere or everywhere and
have impact on livelihoods and economies in
many parts of the world.
• The IHR also require countries to strength
their existing capacities for public health
surveillance and response.
 Introduction
• WHO is working closely with countries and
partners to provide technical guidance and
support to mobilize the recourses needed to
implement the new rules in an effective and
timely manner.
• The IHR are a formal code of conduct that
helps to contain or prevent serious risks to
Public Health Emergency of International
Concern (PHEIC).
 History of IHR 2005
• 1851 - The IHR originated with the 1st
International Sanitary Regulations adapted at
the International Sanitary Conference in Paris
in 1851.
• 1969 - The 22nd World Health Assembly (1969)
adopted, revised and consolidated the
International Sanitary Regulations, which are
renamed International Health Regulation.
 History of IHR 2005
• 1973 - The 26th World Health Assembly (WHA)
in 1973 amended the IHR (1969).
• 1995 - During the 48th WHA in 1995 , WHO
and Member States agreed on the need to
revised IHR (1969).
• 2005 - IHR 2005 were adopted by the WHA on
23 May 2005 and entered into force on 15
June 2007.
• Since then, globally 194 state parties including
193 member countries are implementing
these global rules.
 International
Health
Regulation
2005
(IHR-2005)

5/21/2021
 Why Revision of IHR
The revision of IHR 2005 came about because
of its inherent limitations, most notably
➢Narrow scope of notifiable diseases (cholera,
plague, yellow fever only).
➢The emergence and re-emergence of
infectious diseases in past few decades.
➢Dependence on official country notification.
➢Lack of formal internationally coordinated
mechanism to prevent the international
spread of disease.
 What's New

• From three diseases to all public health risks

• From preset measures to tailored response
• From control of borders to also include containment at
source
5/21/2021
 Purpose of IHR 2005
• To prevent, protect, control and respond to
the international spread of disease that are
commensurate with and restricted to public
health risks.
• To avoid unnecessary interference with
international traffic and trade.
 Global Threat & Impact on
Health, Economy, Security
• Emerging disease
• Re-emerging diseases
Impact on
• Biological and Chemical
agents
• Pesticide poisoning
✓ Health
• Food Safety & Security
• Chemical incidents ✓Economy
• Radio-nuclear events
✓Security
• Natural Disaster &
Disease out-break
5/21/2021
 International Health Regulations IHR
(2005)
• 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.
e.g. defined as Public Health Emergencies of
International Concern (PHEIC).

5/21/2021
 Benefit from IHR implementation

• Lives saved
• Good international image
• No unilateral travel and trade restrictions
• Public trust
• No political and social turmoil

5/21/2021
 IHR Timeframe
• May 2005 World Health Assembly adopted
the revised HR.
• 15 June 2007 IHR entered into force and are
binding on 194 States Parties.
• 2007-2009 Member States assess and
improve their national core capacities for
surveillance and reporting.
• 2012 the core capacities are in place and
functioning in each country.
5/21/2021
 The key functions of IHR
for States and WHO

1. Detect
2. Verify
3. Assess
4. Inform
5. Assist

5/21/2021
 The Core Rules of IHR 2005
• WHO member countries must notify WHO
about the events that meet the defined
criteria (i.e. incidents that involve natural,
accidental or deliberate release of chemical,
biological or radiological materials).
• All member countries must enhance their
event management (i.e. alert and response
action)
• All member countries must meet minimum
core capacities notably in surveillance,
response and point of entry.
 Scope and Coverage of IHR 2005
• The application of IHR is not limiting to
specific diseases, rather it is intended its
applicability to the evolution of disease and to
the factor determining the emergence and
transmission.
• All states have obligations to develop certain
minimum core public health capacities.
• All states have obligation to notify WHO about
the events that constitute a public health
emergency of international concern.
 Scope and Coverage of IHR 2005
• According to IHR, WHO is authorized to
consider unofficial reports of public health
events and to verify it from particular state.
• IHR provides protection of the human rights
of persons and travelers.
 Key Structures and Mechanism
• National IHR Focal Point:
➢Means the national center, designated by
each state party, which shall be accessible at
all times for communication with the WHO
IHR contact point.
In Bangladesh, Director (Communicable
Disease Control), DGHS is the National IHR
focal Point.
 Key Structures and Mechanism
➢In all countries available 24/7/365 for urgent
communication with WHO IHR Contact Point
on urgent events under the IHR (for i.e.
notification/verification/follow-up) involving
any covered risks.
➢Responsible for obtaining information from all
government sectors on IHR covered events
(should include animal health) and for
disseminating information to them.
 Key Structures and Mechanism
• National IHR Technical Focal Institute
➢Institute of Epidemiology, Disease Control
and Research (IEDCR) has been designated as
the National IHR Technical Focal Institute.
➢The institute is responsible for all the
surveillance activities and other related
activities needed for implementation of IHR
2005.
 Key Structures and Mechanism
• WHO IHR Contact Point:
➢Located in each of WHO’s six regional offices –
communication with the National IHR Focal
Point.
In Bangladesh, National Professional Offices
(Epidemiology), WHO is the WHO IHR Contact
Point.
 Development of Core Public health
Capacities for Surveillance and Response
• All states must develop/maintain national
minimum public health capacities, including
surveillance, assessment & response.
• Required capacities:
➢Detect, assess, control and report internally
on public health events - according to
specified criteria at all levels and throughout
national territory.
➢Zoonosis and floor-related risks - Critical area
for inter-sectoral collaboration.
National IHR Core Public Health Capacities
• Core Capacity 1: National legislation, policy
and financing
• Core Capacity 2: Coordination and National
Focal Point (NFP) communications
• Core Capacity 3: Surveillance
• Core Capacity 4: Response
• Core Capacity 5: Preparedness
• Core Capacity 6: Risk Communication
• Core Capacity 7: Human Recourses
development
• Core Capacity 8: Laboratory facility
 Countries’ Challenges for IHR
Implementation
• Mobilize resources and develop national
action plans.
• Strengthen national capacities in alert and
response in any kind of emergency.
• Strengthen capacity at seaports, airports, and
ground crossings.
• Maintaining strong threat-specific readiness
for known diseases/risks.

5/21/2021
 Countries’ Challenges for IHR
Implementation
• Rapidly notify WHO of acute public health
risks.
• Sustain international and inter-sectoral
collaboration.
• Monitor progress of IHR implementation.

5/21/2021
 Criteria of an event to be
notify to WHO?
✓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
restrictions to travel and trade?

5/21/2021
 Capacities Development at Three
Levels

• The local community level

• Intermediate public health response levels
• At the national level

5/21/2021
National IHR Core Public Health Capacities
• In addition to above care capacities, all
member states should have minimum Core
Public Health Capacity in
➢Designated Ports, Airports and Ground Crossing
➢Dealing Potential Hazards of :
- Biological events:
Infectious, Zoonosis, Food safety
- Chemical events
- Radio Nuclear events
 PHEIC Notification, Reporting and Monitoring

• PHEIC is “an extra ordinary public health

event which constitutes a public health risks
to other states, through the international
spread of disease and may require a
coordinated international response”.
• To determine whether an event would be
reportable to WHO under the revised IHR, the
circumstances of the event would have to
assessed within the context of the decision
algorithm in Annex 2, IHR 2005, 2nd edition P
43-46.
 PHEIC Notification, Reporting and Monitoring

• To be considered a potential PHEIC, the

event would have to meet two of the four
following criteria/questions:
1. Is the public health impact of the event
serious?
2. Is the event unusual or unexpected?
3. Is there a significant risk of international
spread?
4. Is there a significant risk of international
travel or trade restriction?
 Levels of Response to PHEIC
• Reporting of potential PHEIC will follow a
chain of response from community to the
national level:
– Community/first contact health service providers
– Upazila Rapid Response Team (URRT)
– District Rapid Response Team (DRRT)
– National Rapid response Team (NRRT)

5/21/2021
 Capacities at the National Level
• Capacities for assessment and notification:
- To assess all report of urgent events within 48
hours.
- To notify WHO immediately (within 24 hours
assessing a PHEIC) through the National IHR Focal
Point.
• Capacities for public health response:
- To determine the control measures
- To provide support
- To provide direct operational link, etc.
5/21/2021
 Core Capacities under IHR 2005
• Every member states within 5 years after IHR
enters into force, should achieve the required
minimum capacity level in eight operational
core capacities for effective implementation
of IHR 2005.

5/21/2021
 Operational areas of Core Capacities
under IHR 2005
• National legislation, policy and financing
• Coordination and National Focal Point (NFP)
communications
• Surveillance
• Response
• Preparedness
• Risk communication
• Human resources
 Operational areas of Core Capacities
under IHR 2005
• Laboratory
• ICD-10 is the 10th revision
• The code set allows more than 14,400
different codes and permits the tracking of
many new diagnoses.

5/21/2021
Ministries and Functions involved by IHR

• Health & Family Welfare

• Livestock
• Environment
• Science and Technology
• Agriculture
• Education
• Defense
• Home
Ministries and Functions involved by IHR

• Civil Aviation and Tourism

• International Ports, Air-ports, Ground
Crossings (points of entry)
• Travel/Transportation (including
dangerous goods)
• Food safety, Radio-nuclear and Chemical
events/safety
 Annex 2, IHR 2005, 2nd Edition P 43
• Events detected by National Surveillance
System:
➢A case of the following diseases-
- Smallpox
- Poliomyelitis due to wild type polio virus
- Human influenza caused by new sub type
- Severe acute respiratory syndrome
 Annex 2, IHR 2005, 2nd Edition P 43
• Events detected by National Surveillance
System:
➢Any event of potential international public
health concern, including those of unknown
causes or sources.
 Annex 2, IHR 2005, 2nd Edition P 43
• Events detected by National Surveillance
System:
➢A case of the following diseases-
- Cholera
- Pneumonic plague
- Yellow fever
- Viral hemorrhagic fever (Ebola, Lassa)
- West Nile fever
 Annex 2, IHR 2005, 2nd Edition P 43
• Apply criteria in decision algorithm:
1. Is the public health impact of the event
serious?
2. Is the event unusual or unexpected?
3. Is there a significant risk of
international spread?
4. Is there a significant risk of
international travel or trade restriction?
 Annex 2, IHR 2005, 2nd Edition P 43

• Yes to any 2 of the above criteria.

• Event shall be notified to WHO according to

IHR 2005.
Thank you