Five Key changes in new IH R

International H ealth Regulations Page 5 public health emergencies. IH R will integrate with W H O s ongoing activities in epidemic preparedness and response and GO ARN. 1 N otification The revised IH R, unlike the existing IH R which requests notification of only three diseases, has a wider scope. H ence the term ‘Public health emergency of international concern’ PH EIC was coined. It requires notification of all public health emergencies of international concern, including such diseases, events and risks based on a decision matrix developed to assess and notify such events Annex 2 of the revised IH R. H owever, there were discussions regarding the need to define the scope further for better compliance. Some suggested that a list of priority conditions be drawn and communicated to M ember countries. Notification in the revised IH R is linked to an established mechanism for response actions and verification of suspected public health emergencies, both official notifications and rumours from unofficial information sources. 2 N ational Focal points Designation of a national IH R focal point is a new core-component in the revised IH R. The role of the national focal points includes direct operational link of states with W H O for notification and information purposes, to provide official inputs to the revision process, and in implementing the revised regulations. This is an important step as there is a need to link or encompass both technical and political decisions about identifying public health emergencies of international concern PH EIC, and notification of such events in a transparent and timely manner. 3 D efinition of core capacities The third important area of change is defining core capacities required at the various levels for surveillance, early recognition, notification and response to PH EIC. The revised IH R clearly outlines the various capacities required at points of entry and exit, at central, intermediate and community levels Annex 1 of revised IH R document. The meeting suggested that these overall requirements be further supported by more detailed guidelines which clearly provide M ember countries with a target to achieve in building these core capacities. Report of the First Regional Consultation of National IH R Focal Points Page 6 4 Recommended measures The document provides temporary and standing continuous recommended measures to be applied by M ember countries during public health emergencies of international concern. The recommendations will be based on the assessed risk and severity and recommended measures commensurate with the risk. W HO may make such temporary or standing recommended measures Annex 3 and 10 of the revised IH R. Routine sanitary measures at ports of arrival and departure and during journeys would continue to be necessary and should be modernised. 5 External advice regarding IH R The revised IHR has provisions for M ember States to seek external assistance as required and for W H O to offer this support. An advisory panel of experts, an IH R emergency committee for emergency recommendations, and an IH R review committee to settle disputes that may arise among countries will be established by the Director-General, W H O . These committees will offer standing recommendations and advice on IHR functioning and recommend the necessary changes to annexes Articles 10-12 and Annex 10 of the revised IHR.

4.6 Some key issues and controversies that may arise

1 Scope One important issue that may arise in IH R is whether notification should be based on a specific list of diseases or be for all PH EIC. Using disease lists makes it simple and clear, and it is congruent with most national legislation and pre-set measures. H owever, this list may become rapidly obsolete and cannot predetermine what will be important as it takes no account of the context and risk. Additionally, this may lead to stigmatisation where States may not be transparent and hence obscure true emergencies. Notification of all PH EIC is dependent on M ember countries definition and hence may lead to a long process. But this system has an overriding advantage to address emerging and remerging infectious diseases and risks from chemical and radio nuclear materials of concern. H ence, the revised IH R will be based on notification of all PH EIC. 2 Specificity vs. flexibility International H ealth Regulations Page 7 W hile specificity provides an opportunity to offer fixed measures for fixed diseases and defines clear mandate and applicability, it is also unable to cope with the unexpected or changing world. O n the other hand, if the system is too flexible, it contributes to uncertainty as to the interpretation of what constitutes a public health emergency, thereby delaying notification and interventions. The primary aim of the revised IH R is to achieve a balance between the two and ensure that there is an acceptable and practical notification system in M ember countries. 3 N ational sovereignty vs. international responsibility The issue of defining a PHEIC, its notification, and request for external assistance may be an issue for some Member countries. But, it is an accepted practice that all international agreements entail some compromise of national authority to achieve a benefit for all. To promote national and global health security, the revised IHR seeks to achieve a balance between sovereignty and responsibility. 4 Incentives and compliance The revised IH Rs define the roles and responsibilities of both M ember countries and W H O . It emphasizes that notification not only gives credibility but also an opportunity to seek external assistance for PH EIC. 5 Rapid response vs. transparentinclusive procedures In the existing system, defining and responding to PH EIC, consensus and wide consultation are not possible. Nor is a unilateral action by W HO acceptable to a M ember country. The revised IH R outlines the criteria to define the mechanism to notify PHEIC and seek external assistance. It also has provisions for establishing mechanisms including emergency committee, the review committee and W H O ’s governing bodies Annex 10 of the revised IH R. 6 Consistency with other international obligationstreaties The IH R revision team has consulted other related international treaties to ensure consistency. The draft was shared with stakeholders like W TO and ILO . 7 D eveloped vs. developing nation perspectives