Health security
PAHO Countries:
Ready for IHR?

The new International Health Regulations (IHR)—designed to halt the international spread of dangerous diseases and other threats—formally took effect in June.

But are member countries of the Pan American Health Organization/World Health Organization (PAHO/WHO) ready to comply with these "faster, stronger, and broader" rules?

"The question is, do our countries have the structures and resources needed to meet their core responsibilities?" said Marlo Libel, PAHO regional communicable diseases advisor, at a meeting of PAHO's Epidemic Alert and Response Task Force in April. "Not all of them do, but we can help them to identify and address the gaps."

The chief aim of the new regulations, to which all PAHO/WHO member countries are signatories, is to reduce the time it takes to identify an illness or other public health threat—including chemical and radiological hazards—that could have an international impact, in order to mobilize a more timely and effective response.

For this to happen, countries must be able to play an active role in detecting, verifying, and controlling public health threats, in partnership with PAHO/WHO.

"Countries need to have sufficient surveillance and response capacity to detect, assess, and control outbreaks and other emergencies, including controlling their borders and their points of entry," said Libel.

Revisions of the regulations have been in the works for several years, but the 2003 SARS epidemic and concerns about a possible influenza pandemic have given new urgency to the revised rules. The new regulations were approved by the World Health Assembly in 2005 and officially came into force on June 15 of this year.

Under the old rules, PAHO/WHO member countries were only officially required to notify outbreaks of cholera, plague, and yellow fever. Under the new regulations, countries must report, verify, and respond to any event that is potentially a "public health emergency of international concern" (see box below). The change reflects concerns about new kinds of international health threats and the fact that new diseases have been emerging at the rate of about one per year in the past four decades.

The new International Health Regulations (IHR) mean expanded roles and responsibilities for countries and for PAHO/WHO. The rules spell out four main tasks that countries must undertake:

• Establish a national IHR focal point, which must be available 24/7 for official information exchange with PAHO/WHO.
• Develop a national plan for building the country's capacities in surveillance and response.
• Upgrade laboratory capacity to be able to identify dangerous pathogens.
• Improve capacities for field investigation, social mobilization, and case management.

Countries have two years to formally assess how capable they are in all these areas and to develop action plans for getting up to par. After that, they have three years to implement the action plans. The regulations also allow a two-year extension beyond the initial five years for countries that need it. But, says Libel, "We think PAHO member countries will be up and running well within the five-year period."

All 35 PAHO member countries have designated national IHR focal points. One of their main jobs is to respond within 24 hours to PAHO/WHO queries about outbreaks or other events identified through official or unofficial sources, including press reports. The focal points are also expected to actively monitor outbreaks within and beyond their borders. "For the new regulations to work, detection cannot be only passive; we need early warning and detection," said Libel.

A chief aim of the new regulations is to improve communication and coordination between WHO and its member countries. WHO has already established IHR contact points at its Geneva headquarters who are available 24/7 to respond to member country requests and queries. WHO will also maintain active global surveillance, seeking information from its member governments but also from unofficial sources, particularly the media. WHO will also play an active role in helping member countries assess their abilities to comply with the new regulations and improve that ability as needed.

At PAHO, the Communicable Diseases team has been designated as IHR contact point, and two other entities will play key roles under the new regulations. One is the Emergency Operations Center (EOC), originally established in 1998 to monitor natural disasters. Under the new IHR, it will serve as a clearinghouse for outbreak and hazard communications, providing "continuous, proactive epidemic intelligence," said Jarbas Barbosa, PAHO area manager for Health Surveillance and Disease Management.

In addition, PAHO has formed a new Regional Health Emergency Rapid Response Team, which is recruiting and training experts from throughout the PAHO region in fields ranging from epidemiology to water and sanitation. Team members will be deployable on short notice in the event of any "public health emergency of international concern" under the new regulations (members have already been mobilized to respond to several natural disasters over the past year).

To help member countries identify gaps in their ability to implement the new rules, PAHO is developing a National Assessment of IHR Core Capacity tool. The results of member countries' assessments using this tool will allow PAHO to tailor its technical cooperation to meet identified needs.