The International Health Regulations (IHRs) (2005) was developed with the aim of governing international responses to public health risks and emergencies. The document requires all 194 World Health Organization (WHO) Member States to detect, assess, notify and report any potential public health emergency of international concern (PHEIC) under specific timelines. Annex 2 of the IHR outlines decision-making criteria for State-appointed National Focal Points to report potential PHEICs to the WHO and is a critical component to the effective functioning of the IHRs.
Global nuclear proliferation, bioterrorism, and emerging infections have challenged national capacities to achieve and maintain global security. Over the last century, emerging infectious disease threats resulted in the development of the preliminary versions of the International Health Regulations (IHR) of the World Health Organization (WHO). The current IHR (2005) contain major differences compared to earlier versions and call for increased accountability. They also call for strengthened national capacity, global partnerships, human rights, and procedures of monitoring. Under these evolved regulations, as well as other measures, global health security could be maintained in the response to infectious disease outbreaks.
The importance of public health legal preparedness has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to the application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Only limited research has been conducted in this field to date. This review highlights the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.
Concerns are mounting that the threat of another influenza pandemic will become a reality and that the epicenter of the outbreak could be the Asia–Pacific region. We assessed the documents that some Asia–Pacific countries have published as part of preparedness planning for an outbreak of influenza in people. Regional approaches were polarised. Thailand, China, and Vietnam had set out a strategic vision to strengthen future capacity in preparedness planning. By contrast, Hong Kong, Australia, and New Zealand took a strategic approach aimed mainly at harnessing available resources or preparing for the deployment of resources such as stockpiled antiviral agents and vaccines. The plans of Hong Kong, Australia, and New Zealand compared favorably with the best European plans. The plans of resource-poor countries addressed some issues that were largely neglected by most European plans. Other countries (including those that do not yet have plans) could benefit from analysis of the strengths and weaknesses of the plans drawn up by countries in the region and in Europe.
Southeast Asia is a hotspot for emerging infectious diseases, including those with pandemic potential. Emerging infectious diseases have exacted heavy public health and economic tolls. Severe acute respiratory syndrome rapidly decimated the region’s tourist industry. Influenza A H5N1 has had a profound effect on the poultry industry. Southeast Asia is at risk from emerging infectious diseases for an array of complex reasons. As a result, the regional challenges in control of emerging infectious diseases are formidable and range from influencing the factors that drive disease emergence, to making surveillance systems fit for purpose, and ensuring that regional governance mechanisms work effectively to improve control interventions.
There is a growing realization that the livestock sector is in a process of change, resulting from an expansion of intensive animal production systems and trade to meet a globalized world’s increasing demand for livestock products. One unintended consequence has been the emergence and spread of transboundary animal diseases and, more specifically, the resurgence and emergence of zoonotic diseases. This development has increased the risk of transmission of infections from wildlife to human beings and livestock. This article proposes a new framework in support of a research and policy-generation strategy to help to address the challenges posed by emerging zoonoses.
Infectious disease outbreaks primarily affect communities of individuals with little reference to the political borders which contain them; yet, the state is still the primary provider of public health capacity. This duality has profound effects on the way disease is framed as a security issue, and how international organizations, such as the World Health Organization, assist affected countries. The article explores the role that domestic political relationships play in mediating the treatment of diseases as security issues. Drawing upon an analysis of the securitization of avian influenza in Vietnam and Indonesia, the authors discuss the effect that legitimacy, competing referents, and audiences have on the external and internal policy reactions to infectious diseases.
The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. Here, the authors examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels to make recommendations for policy action.
Since the severe acute respiratory syndrome (SARS) outbreak in 2003, it has been argued that there has been a substantial revision to the norm dictating the behaviour of states in the event of a disease outbreak. This article examines the evolution of the norm to report and verify disease outbreaks and evaluates the extent to which this revised norm has begun to guide state behaviour. Examination of select East Asian countries affected by human infections of the H5N1 (avian influenza) virus strain reveals the need to further understand the mutually constitutive relationship between the value attached to prompt reporting against the capacity to report, and how states manage both in fulfilling their duty to report.
Two approaches have dominated International Relations in their approach to the international politics of health: (i) the statist approach, which is primarily security-focused, seeks to link health initiatives to a foreign or defence policy remit; and (ii) the globalist approach that seeks to advance health not because of its intrinsic security value but because it advances the well-being and rights of individuals. This article charts the evolution of these approaches and demonstrates why both have the potential to shape our understanding of the evolving global health agenda.
This capacity building workshop was jointly organized by ECDC and the Asia-Europe Foundation (ASEF) and convened over 60 public health experts. The discussions focused on strengthening the link between emergency risk communication and public health emergency preparedness planning, underlining the importance of integrating emergency risk communication into preparedness plans. The workshop sought to identify the competencies (skills) needed to secure implementation and subsequently what capacities (resources) and capabilities (knowledge) are required to ensure these skills.
The adoption of the new International Health Regulations (IHR) in May 2005 represents a historic development for international law and public health. This article describes the revision process and analyzes why the new IHR constitute an advance in global health governance.
Countries around the world face a perfect storm of converging threats that might substantially increase the risk from infectious disease epidemics, despite improvements in technologies, communication, and some health systems. A primary responsibility of any government is to protect the health and safety of its people, which relies on three key elements: disease prevention, disease detection, and response to outbreaks. By focusing global health security strategies and IHR implementation on a comprehensive list of threats, countries can improve health in an emergency and will be better able to address everyday health challenges.
Recent disease outbreaks have demonstrated that new highly infectious agents periodically emerge at the human–animal interface. The experiences of regional countries with the prevention and control of emerging diseases have reinforced the need for sustained, well-coordinated, multi-sector, multi-disciplinary, community-based actions to address emerging disease threats. One Health is a cost-effective, sustainable, and practical approach to find solutions for problems which need holistic, multidisciplinary approaches, particularly in resource-constrained countries. While there is a growing recognition of One Health, it has to be translated from concept into actions through country-level activities that are relevant to specific situations.
The Ebola virus disease outbreak in West Africa is pivotal for the worldwide health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership suggest the need for innovative reforms. Such reforms would transform the existing worldwide health system architecture into a purposeful, organized system with an empowered, highly capable WHO at its apex and enduring, equitable national health systems at its foundation. It would be designed not only to provide security against epidemic threats but also to meet everyday health needs. This analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilization, ill-defined responsibilities, and insufficient coordination.
Connecting Organizations for Regional Disease Surveillance (CORDS) is an international non-governmental organization focused on information exchange between disease surveillance networks in different areas of the world. By linking regional disease surveillance networks, CORDS builds a trust-based social fabric of experts who share best practices, surveillance tools and strategies, training courses, and innovations. This article describes the history, culture, and commitment of CORDS; and the novel and necessary role that CORDS serves in the existing international infectious disease surveillance framework.
Antimicrobial resistance is recognized as a grave threat to global health. The World Health Organization (WHO) has prepared a draft Global action plan on antimicrobial resistance that will be discussed at this year’s World Health Assembly. However, additional collective action is required in three main areas: (i) access to prevention tools, diagnostics and therapies; (ii) conservation to reduce the need for antimicrobials and ensure their responsible use; and (iii) innovation to develop the next generation of antimicrobials, vaccines, diagnostics and infection control technologies.
Globalization is leading to a rise in the emergence of diseases. Here, the author describes the existing international early warning systems and response mechanisms, discusses the role of international organizations in managing diseases that have pandemic potential, and underlines the importance of disease surveillance, detection and response at a national-level.
To formulate health development policy and strategies aimed at the Sustainable Development Goal 3, it is indispensable to revisit the issue of global health governance in the wake of the Ebola virus disease outbreak in West Africa. The issue of global health governance is also relevant in the Asia Pacific region, where Severe Acute Respiratory Syndrome (SARS), influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) are health security threats. To enhance preparedness for handling health crises, the organizational capacities of the World Health Organization (WHO) and its regional offices need to be strengthened. In addition, coordination among WHO and other actors should be facilitated in accordance with the situational categories based on the combination of (i) the capacity of the country where an outbreak of an infectious disease is occurring and (ii) the severity and magnitude of that respective disease.
This article describes the context, practice, and components of global health diplomacy. The authors examine the foundations of various approaches to global health diplomacy, along with the implications the policies have for shaping the international public health and foreign policy environments. Based on these observations, they conclude that the deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives.
The International Health Regulations (IHR) 2005 present a challenge and opportunity for global surveillance and control of infectious diseases. This article examines the opportunity for regional networks to address this challenge. Two regional infectious disease surveillance networks, established in the Mekong Basin and the Middle East, are presented as case studies. The public-private partnerships in the networks have led to an upgrade in infectious disease surveillance systems in capacity building, purchasing technology equipment, sharing of information, and development of preparedness plans in combating avian influenza. These regional networks have become an appropriate infrastructure for the implementation of the IHR 2005.
The fragility of health systems is now of great interest and importance. The 2014 Ebola epidemic has highlighted potential loss of life, social disruption, and health system collapse during a public health crisis when systems are not adequately prepared. This article outlines the five core characteristics – aware, diverse, self-regulating, integrated, and adaptive – of resilient health systems.
In 2005-6 Arab and Israeli collaboration contained outbreaks of avian flu in the Middle East. This initiative shows how building relationships through joint efforts create an infrastructure for cross-border collaboration during emergencies.
For the response to a zoonotic disease outbreak to be effective, animal health authorities and disease specialists must be involved. Animal health measures are commonly directed at known diseases that threaten the health of animals and impact owners. The measures have long been applied to zoonotic diseases, including tuberculosis and brucellosis, and can be applied to emerging diseases. One Health and all-hazards preparedness work have done much to aid interdisciplinary understanding and planning for zoonotic diseases, although further improvements are needed. This article outlines numerous actions along the prevention, preparedness, response and recovery continuum should be considered to improve health security.
Emerging infectious diseases have demonstrated that we remain vulnerable to health threats caused by infectious diseases. The importance of strengthening global public health surveillance to provide early warning has been the primary recommendation of expert groups for at least the past two decades. However, despite improvements in the past decade, public health surveillance capabilities remain limited and fragmented, with uneven global coverage. Recent initiatives provide hope of addressing this issue, and new technological and conceptual advances could, for the first time, place capability for global surveillance within reach. Improved understanding of factors driving infectious disease emergence and new technological capabilities in modeling, diagnostics and pathogen identification, and communications, such as using the increasing global coverage of cellphones for public health surveillance, can further enhance global surveillance.
This commentary explores novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area – the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. GPHIN has resulted in an important shift in the relationship of public health and news information by creating a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media’s challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.
The 2014 Ebola epidemic occurred in a region with a recent history of civil war, unstable health systems, and widespread poverty. Despite these contextual challenges, the national Ebola response in Liberia controlled transmission under strong leadership that was able to rapidly coordinate activities, to manage local and international players, and to adapt upon recognizing missteps. Such leadership has persisted to improve public health capacity in post-Ebola Liberia. The author, an incident manager of Liberia’s Ebola response, highlights the progress made toward developing a resilient health security system with capacity to prevent, detect, and respond to disease threats before they reach epidemic level. To better protect the country’s population and the greater global community from health threats, emerging institutions and policies in Liberia will depend on leadership and governance that draws from the successes and lessons learned during the Ebola outbreak.
The Armed Forces Health Surveillance Center, Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) has the mission of performing surveillance for emerging infectious diseases that could affect the United States (U.S.) military. This mission is accomplished by orchestrating a global portfolio of surveillance projects, capacity-building efforts, outbreak investigations and training exercises. In 2009, this portfolio involved 39 funded partners, impacting 92 countries. This article discusses the current biosurveillance landscape, programmatic details of organization and implementation, and key contributions to force health protection and global public health in 2009.
This report proposes a comprehensive framework for countering the risk of infectious-disease crises. Inevitably, there will be debate as to whether implementing only some will suffice. But policy frameworks are most effective when the elements complement each other; partial implementation is much less effective. Moreover, investment in prevention and preparation is worth much more than spending on response, and the best response is a well-prepared one. The battle against infectious-disease outbreaks will be fought on the ground within specific communities and will be won only if these communities are fully engaged, but science is our most powerful weapon in combating infectious diseases, and the development of tools such as vaccines and diagnostics must begin before a crisis occurs.
The state-of-art of risk assessment for vector-borne diseases has been described. The absence of guidelines for risk assessment produced heterogeneous analyses. These analyses are often of unknown quality or comparability. The development of a standard, quantitative risk assessment is recommended.
Early detection of emerging disease events is a priority focus area for cooperative bioengagement programs. Communication and coordination among national disease surveillance and response networks are essential for timely detection and control of a public health event. Although systematic information sharing between the human and animal health sectors can help stakeholders detect and respond to zoonotic diseases rapidly, resource constraints, and other barriers often prevent efficient cross-sector reporting. This article uses three case studies – highly pathogenic avian influenza (HPAI) H5N1, rabies, and brucellosis – to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Jordan in order to identify the nodes of communication, coordination, and decision-making where health and veterinary sectors intersect, and to identify priorities and gaps that limit action.
Political commitment to Ebola preparedness was high in all countries. Planning was most advanced for components that had been previously planned or tested for influenza pandemics: multilevel and multisectoral coordination; multidisciplinary rapid response teams; public communication and social mobilization; drills in international airports; and training on personal protective equipment. Major vulnerabilities included inadequate risk assessment and risk communication; gaps in data management and analysis for event surveillance; and limited capacity in molecular diagnostic techniques. Many countries had limited planning for a surge of Ebola cases. Other tasks needing improvement included: advice to inbound travelers; adequate isolation rooms; appropriate infection control practices; triage systems in hospitals; laboratory diagnostic capacity; contact tracing; and danger pay to staff to ensure continuity of care.
Emerging infectious diseases are on the rise due to multiple factors, including human-facilitated movement of pathogens, broad-scale landscape changes, and perturbations to ecological systems. Epidemics in wildlife are problematic because they can lead to pathogen spillover to new host organisms, erode biodiversity and threaten ecosystems that sustain human societies. Although developing new analytical models, diagnostic assays and molecular tools will significantly advance our abilities to respond to disease threats, addressing difficult EID problems will require considerable shifts in international health policy and infrastructure. While there are currently international organizations responsible for rapidly initiating and coordinating preventative measures to control infectious diseases in human, livestock, and arable systems, there are few comparable institutions that have the authority to implement transnational responses to EIDs in wildlife. This absence of well-developed infrastructure hampers the rapid responses necessary to mitigate the international spread of EIDs.
The Strategic Framework for Emergency Preparedness is a unifying framework which identifies the principles and elements of effective country health emergency preparedness. It adopts the major lessons of previous initiatives and lays out the planning and implementation process by which countries can determine their priorities and develop or strengthen their operational capacities. The framework capitalizes on the strengths of current initiatives and pushes for more integrated action at a time when there is both increased political will and increased funding available to support preparedness efforts.
The purpose of this document is to support competent authorities in charge of IHR implementation to improve national capacities for the prevention, detection, and control of events, by strengthening communications and coordination between points of entry and the national health surveillance systems. This document provides steps for implementing/strengthening communication mechanisms and defines criteria for deciding what and how events should be reported between points of entry and the national health surveillance system.
Hemorrhagic fever outbreaks constitute a major public health issue in Sub-Saharan Africa. This document seeks to describe the preparedness, prevention, and control measures that have been implemented successfully during previous epidemics to district-level health-care workers (doctors, nurses, and paramedics), as well as intermediate- and central-level health-care workers responsible for epidemic control, and International Health Regulations (IHR) National Focal Points (NFPs).
This guidance document is for States Parties who would like information for determining whether they have met or will meet the national core capacity requirements outlined in Annex 1 of the IHR.
