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Revising the International Health Regulations: Call for a 2017 Review Conference Comment Revising the International Health Regulations: call for a 2017 review conference The revised International Health Regulations (IHR)1 public health emergencies. With follow-up reporting Published Online entered into force on June 15, 2007, obligating (now) in 2014, only 64 nations reported that they had fully May 8, 2015 http://dx.doi.org/10.1016/ 196 States Parties to detect, assess, report, and respond implemented the IHR—an increase of only 10% over S2214-109X(15)00025-X to potential public health emergencies of international 2 years. The other 67% of nations either requested concern (PHEIC) at all levels of government, and to another 2-year extension (81) or reported nothing at all report such events rapidly to the WHO to determine (48).2 whether a coordinated, global response is required. In National compliance statistics are themselves the 8 years since its entry into force, there have been an indicator of the challenges associated with IHR three declared PHEIC, including pandemic infl uenza implement ation, particularly the paucity of mandated H1N1 in 2009, re-emerging wild-type poliovirus in April, funding to support capacity building. Additionally, 2014, Ebola virus disease in west Africa in August, 2014, it has become clear that the methods for assessing and the emergence of new diseases such as Middle East health security preparedness leave substantial room for respiratory syndrome coronavirus and infl uenza H7N9, interpretation, and there are ongoing disagreements with still uncertain risks to global population health. over the mandate for the airport or port health Implementation of the IHR has been tested under certifi cation programme outlined in Article 20. real world conditions. The regulations have served as Failure of the global community to respond rapidly a valuable guidepost for national and international and eff ectively to the Ebola virus disease outbreak in capacity building, coordination, and collaborations for west Africa demonstrates that there remain major global health security. Other international fora have implementation challenges, even beyond funding also recognised the importance of the IHR as a global and political will. It is time to consider whether or not framework, and have focused discussions among aspects of the foundation for global health security nations on IHR-related core capacities in meetings of the embodied in the IHR (2005) are too vague, missing, or Biological and Toxin Weapons Convention, the Global need to be strengthened in order for IHR to stay relevant Health Security Initiative, the North American Plan and useful. for Pandemic and Avian Infl uenza, the Convention on With the 10-year anniversary of the IHR’s entry into Biological Diversity, and United Nations Security Council force on June 15, 2017, a full and formal IHR review Resolution 1540, in addition to debate at the World conference could address the following issues (among Health Assembly. others): Other new partnerships have formed to strengthen • Metrics: assessing national capacity, including the global response to public health threats. In February, objective independent assessments of compliance 2014, the USA, along with almost 30 nations and the • Sample sharing: linking IHR and the Pandemic Directors-General of the WHO, Food and Agriculture Infl uenza Preparedness Framework, with approaches Organization, and Organization for Animal Health, for sample sharing beyond infl uenza launched the Global Health Security Agenda to address • International contact tracing: improved systems for several high-priority, global infectious disease threats. identifying and coordinating public health measures Foundations have become increasingly engaged in for high-risk travellers global health security, becoming primary funders for • Response: responsibilities for coordination in a capacity building around the world, and the World Bank multinational emergency response is playing an increasingly more prominent role in global • Capacity building: funded structures within WHO and health preparedness and response. the regional offi ces to assist nations with building Yet by 2012, only 42 nations (21%) reported that they required capacities had fully implemented the IHR and built appropriate • Zoonotic disease: application of IHR to animal diseases core capacities to detect, assess, report, and respond to and development of one health systems. www.thelancet.com/lancetgh Vol 3 July 2015 e352 Comment The WHO and designated committees of experts Health Assembly—on the 10th anniversary of the IHR’s have been reviewing these ideas and are committed entry into force. to strengthening the IHR, including examining performance after public health events.2,3 We argue *Rebecca Katz, Scott F Dowell that, although this is a necessary step, it is now time George Washington University, Milken Institute School of Public to open the debate to all Member States of the World Health, Washington, DC 20052, USA (RK); and Bill and Melinda Gates Foundation, Seattle, WA, USA (SD) Health Assembly, so that all nations, with varying [email protected] experiences, can provide input into how the regulations We thank Christopher L Perdue for his insights and comments in preparing this are strengthened. paper. SFD was formerly the director of the WHO Collaborating Center for IHR Implementation of National Surveillance and Response Capacity. We declare no States Parties should take the opportunity at the May, competing interests. 2015, World Health Assembly to begin to discuss the Copyright © Katz et al. Open access article published under the terms of CC BY. need for a review conference to consider amendments 1 World Health Organization. International Health Regulations (2005). to the IHR. Stakeholder meetings and regional http://www.who.int/ihr/publications/9789241596664/en/ (accessed May 6, 2015). consultations in 2015 and 2016, with formal discussion 2 World Health Organization. Implementation of the International Health Regulations (2005): report of the Review Committee on Second Extensions at the WHO Executive Board meeting in 2016, could for Establishing National Public Health Capacities and on IHR lead to formal resolutions at the 2016 World Health Implementation. http://apps.who.int/gb/ebwha/pdf_fi les/WHA68/ A68_22Add1-en.pdf (accessed May 5, 2015). Assembly calling for a 2017 review conference. 3 World Health Organization. WHO leadership statement on the Ebola This process would be consistent with Articles 2(k), response and WHO reforms. http://www.who.int/csr/disease/ebola/ joint-statement-ebola/en/ (accessed May 6, 2015). 21(a), and 22 of the WHO Constitution, and previous 4 World Health Assembly. Amendment of the International Health iterations of the regulations as amended.4 A formal Regulations (1969). WHA34.13. http://apps.who.int/iris/ bitstream/10665/156549/1/WHA34_R13_eng.pdf?ua=1 (accessed May 6, review conference in the spring of 2017 would produce 2015). amendments that could be adopted at the 2017 World e353 www.thelancet.com/lancetgh Vol 3 July 2015.
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