The presentation focuses on status of IHR-2005 with emphasize in Afghanistan

1. Islamic Republic of Afghanistan
Ministry of Public Health
Afghanistan National Public Health Institute ( ANPHI )
Surveillance / DEWS Directorate
Overview of International
Health Regulations
(IHR-2005)
Dr. Islam Saeed, Director Surveillance, ANPHI-MoPH
MD, MSc-HPM, MSc-FELTP
Afghanistan National Public Health Institute
Disease Early Warning System

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Disease Early Warning System
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Outline
• Need for ensuring global health
• IHR (2005)- a legal framework
• Assessment of public health events
• National Core capacities
• Implementation of IHR 2005
• Situation in Afghanistan
• Achievements and Challenges
• Conclusion

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What is concern?
• Epidemics took days, weeks/months to
reach far territories
• Emergence/re-emergence of infectious
diseases and increased pace of spread
• Threat of deliberate use of biological and
chemical agents
• Events of international concern of unknown
causes or sources
• Impact on health, economy, security

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What are IHR (2005)?
A legal framework
• International legal instrument which is legally
binding on all WHO States Parties to protect
global health
• The international commitment for shared
responsibilities and collective defence against
disease spread
Rights, Obligations
and procedures
entered into force
on 15 June 2007

5. The 58th World Health Assembly adopts the revised
International Health Regulations, “IHR”
Ensuring maximum public health security while minimizing
interference with international transport and trade
Legally binding for WHO and the world’s countries that have agreed
to play by the same rules to secure international health.
Afghanistan National Public Health Institute
Disease Early Warning System

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International Health regulations (2005)
10 Parts, 66 Articles, 9 Annexes
• PART I DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND RESPONSIBLE AUTHORITIES
• PART II INFORMATION AND PUBLIC HEALTH RESPONSE
• PART III RECOMMENDATIONS
• PART IV POINTS OF ENTRY
• PART V PUBLIC HEALTH MEASURES
• Chapter I General provisions
• Chapter II Special provisions fro conveyances and conveyance operators
• Chapter III Special provisions for travellers
• Chapter IV Special provisions for goods, containers and container loading areas
• PART VI HEALTH DOCUMENTS
• PART VII CHARGES
• PART VIII GENERAL PROVISION
• PART IX THE ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE REVIEW COMMITTEE
• Chapter I The IHR Roster of Experts
• Chapter II The Emergency Committee
• Chapter III The Review Committee
• PART X FINAL PROVISIONS

7. What’s new?
• From three diseases to all public health threats
• From preset measures to adapted response
• From control of borders to, also, containment at source
• New focus on national capacity
Afghanistan National Public Health Institute
Disease Early Warning System

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Purpose of IHR (2005)
“To prevent, protect against, control and provide
a public health response to the international
spread of disease in ways:
• that are commensurate with and restricted to
public health risks, and
• which avoid unnecessary interference with
international traffic and trade” – (Article 2)

9. Strengthen national capacity
1. Strengthen national disease surveillance, prevention,
control and response systems
2. Strengthen public health security in travel and transport
2 years +……………….. 3 + ……..(2)…….…..……+ (up to 2)
Afghanistan National Public Health Institute
Disease Early Warning System
• Timeline
2007 2009 2012 2014 2016
Planning Implementation

10. Core Capacity Technical Areas
Afghanistan National Public Health Institute
Disease Early Warning System
• 8 Core capacities
– Legislation and Policy
– Coordination
– Surveillance
– Response
– Preparedness
– Risk Communications
– Human Resources
– Laboratory
• Potential Hazards
– Infectious
– Zoonosis
– Food safety
– Chemical
– Radio nuclear
• 3 levels
– National
– Intermediate
– Peripheral/Community
• Events at Points of
Entry
– Ports
– Air ports
– Ground crossing

11. IHR Structure
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IHR Secretariat HQ
IHR Regional
Contact Points
CO NFPs
NFPs

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National IHR Focal Points (NFPs)
• Important role in implementation of IHR
• The national centre for communications with
WHO:
– On a 24/7 basis (by telephone, fax, email)
– NOT an individual person
• Legally required functions
• Potential additional tasks as determined by
State:
– Risk assessment, coordinated response etc.

13. WHO and IHR
• Designate WHO IHR contact points
• Support States Parties in assessing their public health
risks, through the notification, consultation, and
verification processes
• Inform State Parties of relevant international public
health risks
• Recommend adapted public health measures
• Assist States Parties in their efforts to investigate
outbreaks and meet the IHR national requirements for
surveillance and response
Afghanistan National Public Health Institute
Disease Early Warning System

14. Roster of experts
IHR Roster of Experts (Article 47)
Emergency Committee – provides views on PHEIC,
temporary recommendation (Articles 48, 49)
Review Committee - reporting, review, standing
recommendations, amendment and disputes
(Articles 50-53)
IHR ROSTER OF EXPERTS
REVIEW COMMITTEE
Standing Recommendations
Afghanistan National Public Health Institute
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Amendments
EMERGENCY COMMITTEE
Public Health Emergencies (PHEIC)
Temporary Recommendations

15. Public Health Emergency of International
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Concern (PHEIC)
• PHEIC is an extraordinary event which is
determined, as provided in these Regulations:
i. to constitute a public health risk to other
States through the international spread of
disease and
ii. to potentially require a coordinated
international response.
• IHR require procedural steps by the DG/WHO in
determining that a PHEIC exists

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Event notification
• Any event that may constitute a public health
emergency of international concern (PHEIC)
• NFP of the government should notify to WHO within 24
hours of national assessment
• Continue to provide WHO with detailed public health
information including: case definition, cases/deaths,
conditions affecting spread, measures
• Does NOT mean an actual “PHEIC” is necessarily
occurring

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Verification of events
• Value of unofficial sources of information for early
alert (to be assessed and verification requested)
• WHO mandated to seek verification (from State
Party in which event arising) of events which may be
emergencies of international concern
• States Parties must give initial reply within 24 hours
and provide of information
• Offer On-site assessment, when necessary

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Early consultation
• For events not requiring notification, Member
States may:
• keep WHO advised, consult on appropriate
measures, and request WHO technical
assistance to assess the situation
• Need to continue monitoring/assessing the
event to see if notification becomes
necessary

19. Annex 2: Decision instrument for the assessment and notification of
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events that may constitute a PHEIC
An event of potential international
public health concern including those of
unknown causes or sources
*Q1: is the public health impact of the
event serious?
Q2: unusual or unexpected?
Q3: risk of international spread?
Q4: risk of travel or traffic restrictions?
Insufficient information : re-evaluate

20. Decision Instrument (1)
• Four diseases (a single case is notifiable):
– Smallpox, Poliomyelitis, human
influenza (caused by a new subtype),
SARS
• Utilization of the decision instrument:
– Cholera, plague, viral haemorrhagic
fevers, yellow fever, …
– Diseases of regional concern: dengue
fever, meningococcal diseases…
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Disease Early Warning System

21. Decision Instrument (2)
Criteria for assessment
• 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 travel or
trade restrictions?
Answering "yes" to any two of the criteria
requires a member state to notify WHO
Afghanistan National Public Health Institute
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22. Combinations of answers requiring
notification
• Serious and unexpected
• Serious and risk for international spread
• Serious and risk for international
restrictions
• Unexpected and risk for international
spread
• Unexpected and risk for international
restrictions
Afghanistan National Public Health Institute
Disease Early Warning System

23. Designated Ports of Entry: Core capacity
requirements for responding to potential PHEICs
Entry/exit control
for departing &
arriving passengers
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a
Public health (PH)
emergency
response,
including
development of a
contingency plan
PH assessment
& care for
affected
travellers, or
animals
b
c Space to
interview
suspect or
affected
persons
d
Assessment,
quarantine of
suspect
travellers, if
required.
e
Implementation
of recommended
measures such
f as disinfection
g Access to required
equipment and
trained personnel
Source: WHO/HQ IHR team (modified)

24. Implications of non-compliance to IHR
• WHO will know from other sources
• Position of the State Party will change from
article 6 (notification) to article 10 (verification)
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–WHO will request verification
–WHO will embark on investigation based on
risk assessment
• IHR allow WHO to use whatever available
information to alert other partners
• Compliant State Party will receive timely
international support when needed

25. IHR Capacity analysis Afghanistan-2010
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26. IHR Capacity analysis Afghanistan-2011
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27. IHR Capacity analysis Afghanistan-2012
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28. IHR Capacity analysis Afghanistan-2013
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29. Major Achievements
• IHR National Focal points
• Assessments and plan
• Training and capacity buildings
• IHR 2005 translation and distribution
• Surveillance and response
• Laboratory support
• Collaboration with international community
• Reporting to WHO
• Asking for extension
• Still a long way to go
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Challenges
• Empowerment of the NFP
• Maintain disease surveillance, early warning and
response system
• Transparency and information sharing
• Maintenance and expansion of existing partnerships
• Resource mobilization
• Strengthen capacity at airports, and ground
crossings
• Improvement of advocacy and awareness-raising
efforts

31. Conclusion
• IHR implementation is the responsibility of all
sectors of the government of Afghanistan
• Coordination is must
• Capacities should be established
• Proper implementation ensure saving lives and
resources
• Good international image
• Capacity building and human resources
• National and Global Health Security
• Collaboration across countries
Afghanistan National Public Health Institute
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Thanks
Email: kmislamsaeed@gmail.com
Mobile: 0093(0)700290955