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was also raised as to whether IHR could be a guideline rather than a legal document. However, there was strong support for a
common legal framework and procedures for M ember States to follow in times of public heath emergencies of international
concern.
Ø
Sanctions
– The IH R does not outline what measures will be taken against countries that do not comply with the Regulations.
Ø
Scope – There were divided views about the inclusion of chemical
and radionuclear events and deliberate releases.
Ø
U se of other sources of information – Issues around the use of
unofficial information from credible sources.
6. REVIEW O F ARTICLES AND ANNEXES
This section lists articles and annexes where participants identified important issues and concerns that need to be resolved during the final revision of IHR.
A full list of the articles and annexes, along with comments, is included in Annex 5.
Article 1 D efinitions
These need to be expanded to include all key terms in IHR. W herever possible, these terms should be defined in a way that is consistent with
standard public health, risk assessment and epidemiological terminology.
Article 3 Communications
Need to clarify the role of National Focal Points for IHR, particularly as this relates to the role of the health administration.
Articles 4 and 5, Annexes 1 and 2 Surveillance and N otification
Some infections in animal populations are clearly events that create a potential for disease in humans, as has recently been demonstrated by avian
influenza. There are several points in IHR where the importance of zoonotic disease could be given greater recognition. These points include:
Ø
Annex 1 – A capacity to receive and assess reports of disease in animals that create the potential for disease in humans.
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Ø
Annex 2 – Disease in animals could be specifically mentioned in the list of examples of events with the potential to have a high
public health impact.
Article 5 N otification and Annex 2 D ecision Instrument
The majority favoured having the decision instrument as the core mechanism for deciding what should be notified, supplemented by a list that can be easily
amended e.g. annex or guideline.
The scope of IHR remains unresolved in terms of whether it should include:
Ø
Diseases and hazards with a biological or unknown etiology vs. also including hazards and diseases caused by chemical and radionuclear
agents.
Ø
Diseases and hazards that are accidental vs. those also caused by deliberate release.
Article 10 Response
Considering the importance of responding effectively to PHEIC, the articles and annexes contain few details about how such responses are organized and
what they may contain. An example is the role of quarantine in the containment of PHEIC caused by microbiological agents. Given that this
measure has recently demonstrated its effectiveness in supporting the response to SARS, it deserves to be defined and recognised in IHR.
Article 10 O n-site assistance
Participants endorsed the value of M ember States collaborating with W HO teams in on-the-spot studies to assess the threat posed by PHEIC and the
adequacy of control measures. However, the mechanism for initiating such responses needs further discussion.
Article 15 Ground crossings
There was some discussion about the status of ground crossing and “ dry ports” as these are the main points of entry for many M ember States in the Region.
This term should be defined in the definitions section Article 1. There are issues around when to “ designate” them and how to give them similar
recognition to ports and airports generally.
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Article 36 Rights of persons
The rights of persons to refuse public health measures in emergency situations need further discussion and clarification.
Article 45 Review
Participants thought it important that the Review Committee be multi- disciplinary. The committee should review and report on the operation of
IHR, at least annually for the first years of operation. There were a number of specific suggestions about the operation of this committee that are included in
the annex to this report.
Article 46 Amendments and additional annexes
There was some discussion as to whether the Executive Board EB should be able to adopt amendments to annexes without their having to go to the full
W orld Health Assembly W HA. There was some support for this approach as it helped to make a distinction between the articles, which can only be
amended by the full W HA, compared with the Annexes which can be amended by the EB on its own.
Article 52 Entry into force
Entry into force on 1 January 2006 may be too soon if countries are expected to have all measures in place by then. O ther options include:
Ø
Delay to June 2006
Ø
Phased implementation
Annexe 1 Core capacity requirements for surveillance and response
The ability of M ember States to meet core capacity needs resulted in considerable discussion.
7. IM PLICATIO NS FO R CAPACITY BUILD ING
