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   International Health Regulations (IHR)

• Background and Process
• The Revised Regulations: IHR (2005)
• Actions Taken by PAHO and Its Member Countries
• Frequently Asked Questions

Background and Process: The International Health Regulations (IHR) represents the earliest multilateral initiative to develop an effective framework to prevent the international spread of disease. The IHR was first adopted in 1969 to monitor, report, and control six communicable diseases: cholera, plague, yellow fever, smallpox, relapsing fever, and typhus. In 1973, the IHR was amended to include additional provisions for cholera; and in 1981, it was subsequently revised to exclude smallpox, eradicated by an unprecedented international effort. By that time the diseases reportable to WHO were only cholera, plague, and yellow fever (IHR [1969]). After an extensive revision process, the 58^th World Health Assembly (WHA) adopted on 23 May 2005 the revised International Health Regulations or IHR (2005) (resolution WHA58.3 with full text of revised regulations).

The Revised Regulations: IHR (2005)

"public health emergency of international concern" (PHEIC) was introduced to define "an extraordinary event which is determined to:

• constitute a public health risk to other States through the international spread of disease and
• potentially require a coordinated international response".

A decision instrument and the criteria for assessment and notification of events that may constitute a PHEIC were adopted and are found in Annex 2. Regarding its implementation, IHR (2005) stipulates that countries shall develop, strengthen and maintain core capacities to detect, assess and intervene so as to control public health events of international concern (Annex 1). It also specifies the obligations that WHO's headquarters, regional and country offices are to meet.

On 26 May 2006, the WHA adopted Resolution WHA59.2 regarding the application of the IHR (2005), taking into consideration the serious risk to human health, arising from ongoing outbreaks in poultry and humans of highly pathogenic avian influenza, caused by the H5N1 strain of Influenza virus A. This resolution calls upon WHO Member States to comply immediately, on a voluntary basis, with provisions of the International Health Regulations (2005) considered relevant to the risk posed by avian influenza and pandemic influenza. It is also recognized in this resolution that strengthening the "capacity to respond to human cases of avian influenza and the corresponding pandemic threat will strengthen the capacity to respond to many other emerging and epidemic-prone infectious diseases, and thus increase global public health security against the threat of infectious diseases."

Actions Taken by PAHO and its Member Countries: The Pan American Health Organization (PAHO) has been actively involved since the beginning of the IHR revision process. PAHO worked with Member States to obtain their comments on the proposed revisions and to keep them informed on the progress made. An IHR Task Force was created and then expanded its terms of reference to become a PAHO Epidemic Alert and Response Task Force, which is currently in charge of developing the regional response plan for influenza pandemic preparedness. This task force includes all areas of the Organization involved in providing technical cooperation to countries including the Communicable Diseases Team as lead to its implementation, Legal Affairs, Veterinary Public Health, Disaster Preparedness and Emergency Relief, Vaccines and Immunization, Technology and Health Services Delivery (Essential Medicines and Laboratories), Sustainable Development and Environmental Health, Health Policies and Systems, and Public Information.