New Health Regulations Reviewed

The Pan American Health Organization (PAHO) has been gathering feedback from its member countries on proposed changes to the International Health Regulations (IHR), the rules that govern cooperation between World Health Organization (WHO) member countries in controlling disease outbreaks that threaten international health.

The need for changes in the IHR has become increasingly apparent in recent years with the emergence of new diseases such as severe acute respiratory syndrome (SARS) and the resurgence of older infectious diseases. The regulations have been under review for nearly 10 years, and the new rules are expected to be approved at the next World Health Assembly in May 2005 in Geneva.

The underlying premise of the proposed new IHR framework is that the best way to prevent the international spread of diseases is by detecting and containing them at the local level. Among the most important changes is that countries will be required to report any outbreak that poses a potential international threat. The current regulations require countries to report only outbreaks of cholera, plague and yellow fever.

Among other changes under discussion:

• WHO may use information other than official notifications from Member States to help identify and control urgent international events.
• Member States will respond to WHO requests to verify nonofficial information.
• National focal points will be appointed to exchange information with WHO and disseminate information to hospitals, other health officials, and airports.
• Countries will establish surveillance and response systems that incorporate the health services as well as ports, airports and border crossings, and which include early warning systems.

The proposed regulations say the criteria for reporting a given disease event should include the potential seriousness of its public impact, whether the disease has an unusual or unexpected nature, its potential for international spread, and whether travel and trade restrictions might come into play in containing it.

“When there is an event with possible international repercussions, national administrations (with input from several sectors) will be required to determine whether the event fulfills the criteria and, therefore, whether it must be reported to WHO,” says a PAHO report prepared for the Directing Council.

PAHO member countries have been stepping up efforts to prepare for emerging and reemerging diseases. The results include:

• Subregional surveillance networks have been established in the Amazon Basin, the Southern Cone, Central America and, most recently, the Caribbean. They allow epidemiologists, clinicians and laboratory scientists to share information and get help from one another in responding to outbreaks.
• Argentina, Bolivia and Brazil are undertaking a comprehensive reorganization of their surveillance systems, with emphasis on building local capacity to detect and respond to outbreaks.
• PAHO has helped its member countries strengthen their epidemiological and laboratory capacities for disease surveillance and control and has organized networks of laboratories for specific pathogens and diseases.
• The proposed changes to the IHR have been placed on the agendas of such regional groups as the Andean Health Agency (ORAS) and MERCOSUR, which has pledged unanimous support for the revision process and endorsed its implications for border health and trade.