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I had the opportunity to attend the IMED (International Meeting on Emerging Diseases and Surveillance) in Vienna, Austria on Feb 23-25. It was co-sponsored by Program for Monitorinbg Emerging Diseases (ProMED-mail), the European Centre for Disease Prevention and Control, the OIE, the European Commission and the WHO regional office for Europe.
There were over 600 participants from 65 countries. About half represented fields in human health and half in animal health.
I thought I'd do several postings and start with a review of several sessions on the new IHR (International Health Regulations) which are set to take effect on June 15, 2007. There are some somewhat subtle but 'paradigm shifting' changes which hopefully will prove useful. They seem to reflect the new electronic age which provides for rapid dissemination of information worldwide (WHO currently gets about 65% of its outbreak information from informal (non state related) sources.
This is a very brief overview of a very detailed legal document which was drawn up with the help of many people with expertise in public health, epidemiology and lab science as well as those familiar with diplomatic language.
One of the basic concepts is some infrastructure building. Each country will be expected to have a national IHR focal point available 24/7 as a basis to interact with the WHO. This document defines better the obligation of both WHO and member states to report on communicable diseases as well as chemical and nuclear threats.
Surveillance is at the heart of the document. For the first time WHO can formally accept informal reports and if they think them credible can formally ask the affected member state for verification which they are obligated to provide expeditiously. Interestingly, under the old regulations WHO was not obligated to distribute similar types of information to countries although we expected them to do so. Now they are obligated also to supply this information to countries especially if it is for these countries protection against these threats.
Under the old system if a country detected a problem they would then determine its significance and then if they felt it necessary would notify WHO and at that point it would likely be made public. Under the new system countries are expected to notify WHO as soon as they detect a problem/event (they don't have to know the exact etiology) ie they can report an outbreak of watery diarrhea without having identified it as cholera. Then WHO determines the significance of the problem and determines what means can be taken. This is expected to start a dialogue whch can initially be done confidentially. This change in responsibility for determining the significance of the event from the affected country to WHO is a major point of the new IHR.
Anyone can be an event detective for WHO and potentially initiate this dialogue. One of the problems with the old system was that if a country reported a problem there were associated punitive problems such as trade and tourist restrictions which may have been over reactions. One of the duties of WHO will be to try and recommend appropriate measures for other countries to take in response to a given event.
This is essentially a new system to try and deal with epidemic intelligence. It certainly will have its problems and the 'teeth' are largely meant to be incentives for reporting information which can also result in help being provided and an expectation that the economic repercussions will be reasonable.
I thought one of the interesting aspects of all this is that in regard to global health it is somewhat a refection of moving health from a philanthropic aspect of foreign policy to a matter of national security and that the best results can be anticipated if the reporting of events come directly from public health professionals rather than from political offices. And then appropriate and expeditious dialogue is carried on between WHO and the countries IHR focal point.
There were over 600 participants from 65 countries. About half represented fields in human health and half in animal health.
I thought I'd do several postings and start with a review of several sessions on the new IHR (International Health Regulations) which are set to take effect on June 15, 2007. There are some somewhat subtle but 'paradigm shifting' changes which hopefully will prove useful. They seem to reflect the new electronic age which provides for rapid dissemination of information worldwide (WHO currently gets about 65% of its outbreak information from informal (non state related) sources.
This is a very brief overview of a very detailed legal document which was drawn up with the help of many people with expertise in public health, epidemiology and lab science as well as those familiar with diplomatic language.
One of the basic concepts is some infrastructure building. Each country will be expected to have a national IHR focal point available 24/7 as a basis to interact with the WHO. This document defines better the obligation of both WHO and member states to report on communicable diseases as well as chemical and nuclear threats.
Surveillance is at the heart of the document. For the first time WHO can formally accept informal reports and if they think them credible can formally ask the affected member state for verification which they are obligated to provide expeditiously. Interestingly, under the old regulations WHO was not obligated to distribute similar types of information to countries although we expected them to do so. Now they are obligated also to supply this information to countries especially if it is for these countries protection against these threats.
Under the old system if a country detected a problem they would then determine its significance and then if they felt it necessary would notify WHO and at that point it would likely be made public. Under the new system countries are expected to notify WHO as soon as they detect a problem/event (they don't have to know the exact etiology) ie they can report an outbreak of watery diarrhea without having identified it as cholera. Then WHO determines the significance of the problem and determines what means can be taken. This is expected to start a dialogue whch can initially be done confidentially. This change in responsibility for determining the significance of the event from the affected country to WHO is a major point of the new IHR.
Anyone can be an event detective for WHO and potentially initiate this dialogue. One of the problems with the old system was that if a country reported a problem there were associated punitive problems such as trade and tourist restrictions which may have been over reactions. One of the duties of WHO will be to try and recommend appropriate measures for other countries to take in response to a given event.
This is essentially a new system to try and deal with epidemic intelligence. It certainly will have its problems and the 'teeth' are largely meant to be incentives for reporting information which can also result in help being provided and an expectation that the economic repercussions will be reasonable.
I thought one of the interesting aspects of all this is that in regard to global health it is somewhat a refection of moving health from a philanthropic aspect of foreign policy to a matter of national security and that the best results can be anticipated if the reporting of events come directly from public health professionals rather than from political offices. And then appropriate and expeditious dialogue is carried on between WHO and the countries IHR focal point.
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