WORLD HEALTH ORGANIZATION А27/WP /1 ORGANISATION MONDIALE DE LA SANTЁ 8 April 1974
TWENTY- SEVENTH WORLD HEALTH ASSEMBLY
Agenda item 3.14 INDEXED
EIGHTEENTH REPORT OF THE COMMITTEE ON INTERNATIONAL SURVEILLANCE OF COMMUNICABLE DISEASES
Note by the Director -General
1. An important part of the eighteenth report of the Committee on International Surveillance of Communicable Diseases refers to the reservations to the Additional Regulations (WHA26.55) to the International Health Regulations (1969). To facilitate the discussion of this subject, the Director -General submits a working paper entitled "Reservations to the Additional Regulations, • 1973, of the International Health Regulations (1969) (WHA26.55)" prepared for the Eighteenth Session of the Committee on International Surveillance of Communicable Diseases
2. A letter was received from the Italian Health Administration subsequent to the Eighteenth Session of the Committee on International Surveillance of Communicable Diseases. This letter is annexed hereto.
►yVV' A27 1WP /1 page 2
ANNЕХ 1
Roma, 6.2.1974
Ministero della Sanità Dr T. Mahler UFF.RAPP.INTERNAZ. Director General O.M.S. Avenue Appia 230/36.40/4.9/8.17 1211 GENEVA
OGGETTO: International Sanitary Regulations
Dear Dr Mahler,
Following our cable of 6th September 1973 concerning reservations to some amendments adopted by the 26th World Health Assembly, I am now in a position to give you the reasons for such reservations as they have been formulated on the basis of the conclusions arised from the discussions on the subject of our consultative body (Consiglio Superiors di Sanità).
1. From the recent experience of our country in this matter, even countries having advanced health services, the fear of cholera is strongly felt from a large part of the population which is still trusting the vaccination practice as a control measure against the disease. We feel that the Italian population as well as that of other countries, would not agree to drop a protective measure even scientifically demonstrated of little value. The knowledge that people coming from an infected area are somewhat controlled gives the feeling that something is done for the protection of the population.
2. It is agreed that the vaccination value is relatively low; however, there are still some discrepancies among the various sources, and even at its limited efficacy, it should be con- sidered yet as a protecting factor which, if added to other measures, would be able to contribute to keep under control the spreading of the disease. We noted in our recent experience that in various exposed families, few members not vaccinated have been attacked where other vaccinated components of the same family where not affected. This experience if valid on a family basis, should be also valid on international level.
3. There is the hope that from the studies carried out at present, a more efficacious vaccine could be produced in a very near future. If it so, it does not seem advisable to discourage now the use of the vaccine as a control means against the spreading of the disease, in view of the possibility of reinforcing the present regulations as they were before the amendments.
4. Because of its geographical situation in the middle of the Mediterranean Sea, Italy is more exposed in comparison with other coast countries as the heavy traffic passes through our country.
5. Finally, article 63 should not be deleted for the time being, because the surveillance provisions permit to detect an imported case at its incubation phase, at the mutual advantage both of the Health Services and of the patient himself.
I am confident that the above considerations will explain our position and I hope that our reservations will be withdrawn in a near future following the improvement of the epidemio- logical situation.
Sincerely Yours,
(Signed)
The Minister A27/WP/1
ANNEX 2
RESERVATIONS TO THE ADDITIONAL REGULATIONS, 1973, OF THE INTERNATIONAL HEALTH REGULATIONS (1969) (WHA26.55)
The Seventeenth Session of the Committee on International Surveillance of Communicable Diseases studied the implications of the removal of cholera from the International Health Regulations (1969).1 It was appreciated that the inclusion of cholera in the Regulations had not produced any significant effect in preventing the introduction of the cholera vibrio into any country. In addition although the vaccine was about 50% effective for six months in pre- venting clinical attacks of the disease, it did not prevent inapparent infection which is the more important factor in the spread of the disease. It was said however that removal of cholera from the Regulations could have adverse effects in countries without an adequate system of surveillance and that WHO would suffer because information on the occurrence of the disease would tend to be diminished. The Committee therefore proposed as an alternative to the removal of cholera from the International Health Regulations (1969)•a revision of Chapter II, Part V of these Regulations in such a way as to eliminate the references to vaccination and to re- • emphasize the need for surveillance. To avoid as far as possible the adoption of irrational requirements, it was still considered necessary to prescribe limits to the measures which Member States could take in international traffic with respect to cholera.
The Seventeenth Report of the Committee on International Surveillance of Communicable Diseases which included the proposed revision of Chapter II, Part V of the Regulations, was considered by the Twenty -sixth World Health Assembly in May 1973 and led to the adoption of the resolution WHA26.55 - "Additional Regulations of 23 May 1973 amending the International Health Regulations (1969)" (Appendix 1).
The Director-General in his letter of 14 June 1973, C.L.18.1973, (Appendix 2), formally notified all Member States of the adoption of the Additional Regulations in accordance with Article 22 of the Constitution of the Organization and with Article 105 of the International Health Regulations (1969). Any State desiring to make reservations to the Additional Regulations was required to submit them to the Director -General prior to 14 September 1973 in conformity with Article 22 of the Constitution of the Organization and Article II of the Additional Regulations. Except for States submitting reservations within the period 14 June to 14 September 1973 for consideration by the Twenty- seventh World Health Assembly in May 1974 the Additional Regulations enter into force on 1 January 1974.
A similar notification was sent to certain non -Member States in accordance with Articles 104 and 105 of the International Health Regulations (1969).
The Member States submitting reservations to the Additional Regulations are listed in Appendix 3 (3.1 - 3.15) together with a copy of the original communication from the countries concerned.
Attention is drawn to the fact that not all of the reservations were received within the period stipulated in Article II of the Additional Regulations.
1 Off. Rec. Wld 11th Org., 1973, No. 209, p. 91. RESOLUTION OF THE W'ORI.D HEALTH ASSEMBLY RÉSOl.UTION DE L'ASSEAIBLEE MONDIALE DE LA SANTE РЕЗОЛЮЦИЯ ВСЕМИРНОЙ АССАМБЛЕИ ЭЦРАВООХРАНЕНИя RESOLUCION DE LA ASAMBLEA NIL NDIAL DE LA SALUD
TWENTY -SIXTH WORLD HEALTH ASSEMBLY WHA26.55
23 May 1973
ADDITIONAL REGULATIONS OF 23 MAY 1973 AMENDING THE INTERNATIONAL HEALTH REGULATIONS (1969), IN PARTICULAR WITH RESPECT TO A.RТICLES 1, 21, 63 -71 AND 92
• The Twenty -sixth World Health Assembly, Considering the need for amendment of certain of the provisions of the International Health Regulations (1969); and
Having regard to Articles 2(k), 21(a) and 22 of the Constitution of the World Health Organization,
ADOPTS, this 23 May 1973, the following Additional Regulations:
ARTICLE I
PART I - DEFINITIONS
Article 1
The definition of "airport" should be deleted and replaced by "means any airport designated by the Member State in whose territory it is situated as an airport of entry and departure for international air traffic, where the formalities incident to customs, • immigration, public health,l animal and plant quarantine and similar procedures are carried Out."
PART III - HEALTH ORGANIZATION
Article 21
Paragraph 1: delete sub -paragraphs (b) and (c).
PART V - SPECIAL PROVISIONS RELATING TO EACH OF THE DISEASES SUBJECT TO THE REGULATIONS
Chapter II. Cholera
Article 63. Delete.
Article 64. Re -word to read as follows and re- number as Article 63.
1 The public health facilities would include those listed in Articles 14 and 19 of the International Health Regulations (1969). WHA26.55 page 2
"1. If on arrival of a ship, aircraft, train, road vehicle or other means of transport a case of cholera is discovered, or a case has occurred on board, the health authority (a) may apply surveillance or isolation of suspects among passengers or crew for a period not to exceed five days reckoned from the date of disembarkation; (b) shall be responsible for the supervision of the removal and safe disposal of any water, food (excluding cargo), human dejecta waste water including bilge water, waste matter, and any other matter which is considered to be contaminated, and shall be responsible for the disinfection of water tanks and food handling equipment.
2. Upon accomplishment of (b) the ship, aircraft, train, road vehicle or other means of transport shall be given free pratique."
Article 65 -69 inclusive. Delete.
Article 70. Re -word to read as follows and re- number as Article 64.
"Foodstuffs carried as cargo on board ships, aircraft, trains, road vehicles or other means of transport in which a case of cholera has occurred during the journey, may not be subjected to bacteriological examination except by the health authorities of the country of final destination."
Article 71. Retain text unchanged and re- number as Article 65.
PART VI - HEALTH DOCUMENТS
Article 92.
Sub -paragraph 1. Delete reference to Appendix 2 and re- number accordingly.
Sub -paragraph 3 re -word to read as follows:
"International certificates of vaccination must be signed in his own hand by a medical practitioner or other person authorized by the national health administration: his official stamp is not an accepted substitute for his signature."
Sub -paragraph 5. Delete reference to Appendix 2 and re- number accordingly.
Appendix 2. Delete and re- number Appendices accordingly.
ARTICLE II
The period provided in the execution of Article 22 of the Constitution of the Organization for rejection or reservation shall be three months from the date of the notification by the Director -General of the adoption of these Additional Regulations by the World Health Assembly.
ARTICLE III
These additional Regulations shall come into force on the first day of January 1974• WHA26.55 page 3
ARTICLE IV
The following final provisions of the International Health Regulations (1969) shall apply to these Additional Regulations: paragraph 3 of Article 100, paragraphs 1 and 2 and the first sentence of paragraph 5 of Article 101, 102 and 103, substituting the date mentioned in Article III of these Additional Regulations for that mentioned therein, 104 to 107 inclusive.
IN FAITH WHEREOF we have set our hands at Geneva this twenty -fourth day of May 1973.
²¦ SULIANTI President of the Twenty -sixth World Health Assembly.
• М. G. CANDAU Director -General of the World Health Organization.
Sixteenth plenary meeting, 23 May 1973 A26/VR/16
• ORGANISATION MONDIALE DE LA SANT$ WORLD HEALTH ORGANIZATION
ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ ORGANIZACION MUNDIAL DE LA SALUD
Telegr.: UNISANTЁ, Genéve 1211 Genève, 27 Suisse Tel. 34 60 61
§¶·¸ C.L.18.1973 Geneva, 14 June 1973
Sir,
I have the honour to inform you that by resolution WHA26.55 the Twenty -sixth World Health Assembly adopted on 23 May 1973, in accordance with sub -paragraph (a) of Article 21 of the Constitution of the World Health Organization, Additional Regulations amending the International Health Regulations (1969), particularly with respect to cholera and the international certificate of vaccination for that disease.
In accordance with Article 22 of the Constitution of the Organization and with Article 105 of the International Health Regulations (1969), I hereby formally notify you of the adoption of these Additional Regulations of which I enclose a copy, certified correct. Any State desiring to make reservations to these Additional Regulations should submit them to me within a period of three months expiring 14 September 1973, in conformity with Article 22 of the Constitution of the Organization and Article II of the Additional Regulations. Reservations so submitted will be considered by the Twenty- seventh World Health Assembly.
Except for States submitting reservations within the period indicated above, these Additional Regulations will enter into force on 1 January 1974. A similar notification has been sent to non -Member States in accordance with Articles 104 and 105 of the International Health Regulations (1969).
I have the honour to be,
Sir,
Your obedient Servant,
for M. G. Candau, M.D. Director -General APPENDIX ¤
MEMВER m1E3 of WH0 sUВМM ТГп'Ю .REsERVAтIONS To THE ADDITIONAL REGULATIDNS OF 23 MAY 1973 AMENDING THE 7NТERNATIONAL HEALTH REGULATIONS (1969)
EFR STATE DATE OF RESERVAтI0N1 NATURE OF RESERVATION (BASED ON IГi`1ERNATIONAL HEALTH RECUI.A'1'IONS (196у) (FIRST ANNOTATED EDITION))
EGYPT 24 August 1973 Article 21. Objection to the deletion of sub -paragraphs (b) and (c) of paragraph 1. Articles 63 -71, 92 and Appendix 2. Desire that these be retained unchanged. (Annex 3.1)
FEDERAL REPUBLIC OF GERMANY 7 September 1973 No reservation from technical point of view, but Federal constitutional requirements must just be fulfilled. (Annex 3.2)
GREECE September 19732 Reservations to amendments to Articles 64 and 70. (Annex ).3)
INDIA 1 September 1973 Unspecified reservation. (Annex ).4)
DЮONESIА 23 July 1973 Minor change proposed to the rewording of Article 64. Health Administration informed that in Secretariat's opinion the Indo- nesian suggestion need not constitute a reservation. (Annexes 3.5 and 3.6)
IRAN 25 August 1Э73 Unspecified reservation to amendments to Articles 63, 65 paragraph 1, sub- paragraph (a), 68, 69 sub -paragraph (a), and Article 92 paragraph 5. (Annex 3.7)
IRAQ 27 June 1973 Reservation to amendments to Article 63 and Article 92 paragraph 5 as it relates to Appendix 2. (Annex 3.8)
ITALY 7 September 1973 Unspecified reservation. (Annex 3.9)
LI[зYAN ARAB REPUBLIC 26 July 1973 Reservation considered to relate specifically to amendments to Article 63 and Article 92 paragraph 5 in relation to Appendix 2. (Annex 3.10)
MADAGASCAR 11 September 1973 Reservation to amendments to Articles 63-71 and Article 92 paragraphs 3 and 5 and Appen- dix 2. (Annex 3.11)
MALTA 3 October 19732 Reservation to amendments to Articles 63 -71 and Appendix 2. (Annex 3.12)
THA п.AND 31 August 1973 Reservation to amendments to Article 63 and Appendix 2. (Annex 3.13)
YUGOSLAVIА 3 October 19732 Reservation to amendments to Article 63 and Appendix 2. (Annex 3.14 and 3.15)
1 Date of the communication by Member State
2 Date undefined or beyond that of 14 September 197) APPENDIX 3.1
E G Y P T
TRANSLATION
Arab Republic of Egypt Ministry of Health International Health
Ref. No. 8774 24 August 1973
I wish to refer to WHO letter No. CL.18/1Q73 of 14 June 1973 enclosing resolution WHА26.55 which was adopted by the Twenty -sixth World Health Assembly in lay 1973 amending the International Health Regulations.
In view of the importance of the geographic situation of the Arab Republic of Egypt which lies at the centre of the world, and due to the increase in international traffic and the increasing number of arrivals to Egypt from cholera endemic countries and from countries recently infected with this disease; and in the light of our special circumstances, we have decided as follows:
1. PART I - DEFINITIONS
Article 1 - The Arab Republic of Egypt accepts the amendment requested.
2. PART III - HEALTH ORGANIZATION
Article 21 - The Arab Republic of Egypt makes reservation as regards the amendment requested.
3. PART V - SPECIAL PROVISIONS RELATING TO EACH OF THE DISEASES SUBJECT TO THE REGULATIONS
Chapter II - Cholera - The Arab Republic of Egypt makes reservation as regards the amendment requested and wishes to maintain Articles 63, 64, 65, 66, 67, 68, 69, 70 and 71 of the International Health Regulations as they stand.
4. PART VI - HEALTH DOCUMENTS
The Arab Republic of Egypt makes reservation as regards the amendment requested, and wishes to maintain Article 92 and Appendix 2 of the International Health Regulations as they stand.
5. FINAL PROVISIONS
The Arab Republic of Egypt accepts the amendment requested.
Yours respectfully,
The Regional Director F/Dr. A.М. Mahmoud EMRO - Alexandria Under- Secretary for Health APPENDIX 3.2
FEDERAL REPUBLIC OF GERMANY
Permanent Mission of the Federal Republic of Germany to the international organizations at Geneva
7 September 1973
Mr Director General,
With reference to your letter of 14 June 1973 (Ref: 0.L.18.1973) by which you formally notified the adoption of the Additional Regulations amending the International Health Regulations (1069), I have the honour to communicate the following on behalf of the Government of the Federal Republic of Germany:
The Additional Regulations amending the International Health Regulations (1969) can enter into force in the Federal Republic of Germany only subject to the approval of the legislative bodies of the Federal Republic of Germany. The Federal Government has taken appropriate measures but cannot secure that this approval will be obtained until 1 January 1974.
The Federal Government, therefore, in accordance with Article 22 of the Constitution of the World Health Organization and Article IV of the Additional Regulations amending the International Health Regulations (1969), makes the following reservation:
a) The Additional Regulations of 23 May 1973 amending the International Health Regulations will not enter into force in the Federal Republic of Germany unless the Director General of the WHO has been notified by the Federal Republic of Germany that the domestic prerequisites are fulfilled.
b) Until the entry into force of the Additional Regulations of 23 May 1973 amending the International Health Regulations with respect to the Federal Republic of Germany the Federal Government reserves its rights to make reservations with regard to these provisions.
I would appreciate if you would kindly acknowledge receipt of this letter.
Accept, Mr Director General, the assurances of my highest consideration.
(Otto Baron von Stempel) Acting Permanent Representative
Dr H. Mahler Director General World Health Organization Avenue Appia 1211 Geneva 27 APPENDIX 3.3
G R E E C E
TRANSLATION
Ministry of Social Services Services for International Relations
Ref. No. 24 /34 4 8 Athens, September 1973
Sir,
In reply to your letter of 14 June l073 concerning certain amendments in the International Health Regulations (1960) I am pleased to inform you that, in principle, we are in agreement with the proposed changes, with the following reservations:
As concerns Article 64, renumbered as Article 63, the health authority will retain the right to take samples and have stool cultures made in the case of certain persons subject to surveillance.
As concerns Article 70, the health authority will retain the right to take samples and have cultures made of any foodstuff coming from an infected area, even if no positive or suspect case has been detected on the means of transport.
In conclusion so as to avoid serious financial consequences in countries where there are a large number of tourists, and taking into consideration the finding that the disease has recently presented a benign variation, we feel that the abrogation of Article 63 of the International Health Regulations could be combined with the replacement of the word "cholera" by some other word which does not cause, both among permanent residents and among visitors to a country, the panic caused in the past because of the seriousness and the nature of the disease.
I have the honour to be, Sir, your obedient servant,
Ioannis Ladas Minister
Dr H. Mahler Director -General World Health Organization Geneva Switzerland APPENDIX 3.4
INDIA
Bharat Sarkar SwasthyaAur Parivar Niyojan Mantralaya (Swasthya Vibhag)
New Delhi • No. м.11011/7/?3-IH 1st September 1973 Sub:- Resolution No. WHA 26.55 regarding additional regulations amending the International Health Regulations (1969)
Sir,
With reference to your letter No. C.L.18.1973, dated the 14th June 1973, on the above subject, I am directed to say that the question of making reservations to the Additional Regulations amending the International Health Regulations, 1969, is under consideration in consultation with the Port /Airport Health Officers which requires detailed examination. As such it is not possible to adhere to the date of 14th September, 1973 fixed by you for sending the reservations, if any, which will be sent to you as soon as the views of the Port /Airport Health Officers are received and finalised. It is requested that the date fixed as 14th September 1973 may kindly be suitably extended.
. Yours faithfully,
(P.N. Sadhoo) UNDER SECRETARY
The Director General World Health Organization 1211 Geneva 27 Switzerland APPENDIX 3.5
I N D O N E S I A
Departemen Kesehatan R.I. Direktorat Jendral Pencegahan Pemberantasan/Pembasmian, Penyakit Menular Jalan Percetakan Negara Kotak Pos 223 Jakarta
No. 2607/DK/73.- 23 July 1973
Subj: Additional Regulations amending the International Health Regulations
Dear Sir,
Referring to your letter dated 14 June 1973 Ref: C.L.18.1973 concerning Additional Regulations amending the International Health Regulations (1969), I would like to inform you that the Indonesian Government prefers Article 63 paragraph 1 to read as follows:
If on arrival of ship, aircraft, train, road vehicle or other means of transport a case of cholera is discovered, or a case has occurred on board within a period of five days before arrival the health authority (a) may apply surveillance or isolation of suspects among passengers or crew for a period not to exceed five days reckoned from the date of disembarkation; (b) etc
With the exception of the abovementioned change the whole amendment is accepted without any reservation.
Yours sincerely,
Ignatius F. Setiady, M.D. ,D .P.H. Director of Quarantine Services Directorate -General of CDC Ministry of Health Jalan Percetakan Negara I P.O.Вох 223 Jakarta
Director -General World Health Organization 1211 Geneva 27 Switzerland APPENDIX 3.6
I N D O N E S I A
i4/439/2 (2) 8 August 1973
Your Ref: 2607/LM/73. -
Dear Sir,
I wish to acknowledge, with thanks, your letter of 23 July 1973 addressed to the Director -General, concerning the Additional Regulations amending the International Health Regulations (1969) approved by the World Health Assembly in its Resolution WHА26.55•
It is noted that the Indonesian Government would prefer that the phrase "within a period of five days before arrival" be inserted in Article 63, paragraph 1, as indicated in your letter.
In many situations in which adequate medical control is present on board ship or other means of transport, the addition of this phrase on epidemiological grounds is well understood. However, the Committee on the International Surveillance of Communicable Diseases (CISCD) in its Seventeenth Session in recommending the present wording felt that many health administrations would not be prepared to accept a situation in which there had been cholera on board a ship and in which there was not sufficient epidemiological competence to ensure the absence of the vibrio.
There is no reason why the Indonesian Health Administration, should it so wish, apply this Article in the manner suggested without actually including the phrase in question into the paragraph. A health administration may, in fact as in this case, take the measures it deems appropriate as long as they do not exceed those of the International Health Regulations (1969).
It is felt, therefore, that no reservation is required by the Indonesian Health Administration although the point in question will be drawn to the attention of the
Eighteenth Session of the C2" ;' . Your acknowledgement of this situation would be greatly appreciated thus confirming the applicability of the Additional Regulations to Indonesia.
Yours faithfully,
Erik Roelsgaard, M.D.,M.P.H. Chief Medical Officer Epidemiological Surveillance of Communicable Diseases
Dr. I.F. Setiady Director of Quarantine Services Directorate -General of CDC Ministry of Health Jalan Percetakan Negara I P.O. Box 223 Jakarta Indonesia APPENDIX 3.7 IRAN
International Health Relations Department Ministry of Health Tehran Iran
Our Ref.: 2/1918/37 25 August 1973
Dear Dr Mahler,
With reference to Dr Candau's letter C.L.18.1973 dated 14th June 1973, and its enclosure the copy of Resolution adopted by the Twenty-Sixth World Health Assembly on 23rd May 1973, concerning "Additional Regulations of 23rd May 1973 Amending the Inter- national Health Regulations (1969)"wе would like to inform you that the resolution mentioned is under study. At this stage we register our reservation on Articles 63, 65 (paragraph a), 68, 69 (paragraph a) in part 5 and subparagraph No. 5 Article 92 in part 6.
Sincerely yours,
M. Shahgholi M.D. Minister of Health
Dr H. Mahler Director General World Health Organization 1211 Geneva 27 Switzerland APPENDIX 3.8
I R A Q
Cable: CIVHEALTH Republic of Iraq Ministry of Health Ref.: 28154 Baghdad Iraq
27 June 1973
Dear Dr Candau,
I acknowledge with thanks the receipt of your letter No. C.L.18.1973 dated 14 June concerning the additional regulations amending the International Health Regulations 1969 which the Twenty -sixth World Health Assembly adopted on 23 May 1973.
I have the honour on behalf of my government to inform you that we accept these amendments pending ratification of my government with the following reservation.
The government of the Republic of Iraq reserve the right not to accept the deletion of Article 63 Chapter II Cholera & the appendix 2 - the form of Cholera certificate until such time arrive when it consider that sanitary conditions in Iraq could permit not to request cholera vaccination certificates from persons arriving from cholera endemic area.
Please accept my highest consideration.
Sincerely yours,
Minister of Health,
M.G. Candau, M.D. Director-General WHO/Ave. Appia 1211 Geneva 27 Switzerland
cc: Ministry for Foreign Affairs, Baghdad D.G. of Preventive Medicine, Baghdad APPENDIX 3.9
I T A L Y
тRANSLATION
Dr Mahler, Unisante, 1200 Geneva 7 seрtember 1973
F.EРЕRF.NcE c.L.18.1973 ADD1'гIONAL REGULAтmNS AMEND2DTG IN�FtNAтIONAL ALTH ;iECULATIG;IU
FORMUiA28 F.EЅЕниAтlоNS AN1ЕNDMENтs ARTICIES 63, 64, б5, 66, 67, 68 AND 69 sTOP RE,°;sO:I.:i
,'iTT.T RE GIVEN 1N LE'1'1R TO FOLLOИJ. Gui Minister of Health •
• APPENDIX 3.10
LIBYAN ARAB REPUBLIC
TRANSLATION Libyan Arab Republic Ministry of Health Department of Planning & Ref. No. 6/3/10131 Follow -up
26 July 1973
I wish to refer to your letter No. М/2/37/2)/4628 of 16 July 1973 concerning introduction of additional regulations amending u:.е ternational Health Regulations (1969), particularly with respect to cholera and the international certificate of vaccination for that disease.
I am sending you herewith the text of the reservations made by this Department in respect of the proposed changes for onforwarding to the Director -General, World Health Organization.
Yours respectfully,
Dr А.А. El Sharif Under -Secretary for Health
The Chief, United Nations and Specialized Agencies Division Ministry for Foreign Affairs Libyan Arab Republic
cc: WHO Representative, Libya
EXACT COPY OF ENСLOSURE RECEIVED UNDER COVER OF «¬¨©¬§ OF WE LIBYAN ARAB REPUBLIC REF. WRLIB .7/52
We have following reservation to proposed changes of the International Health Regulations.
We consider important to continue in the surveillance of persons coming from cholera infected areas. According to this, a person on an international voyage who will come to L.A.R. from cholera infected area within the incubation period, may be placed under surveillanc for a period of not more than five days, reckoned from the date of his departure from the infected area.
We have no reservation to other proposed changes. signature APPENDIX 3.11
MALAGA3Y ЕЕ PUBLIC
Malagasy Republic Minister of Foreign Affairs Department for Mult.lateral Relations No. 9 б0G-AE /DP1'д/NU/OMS Tananarive
Subject: Reservations concerning the additional 11 September 1973 regulations of 2) May 1973 amending the Inter- national Health Regulations (1969), in particular Articles 1, 21, -71 and 92.
Reference: Your letter of l June 197), 0.L.18.1973
Sir,
In reply to your letter referred to above I have the honour to transmit herewith the agreements and reservations formulated by the national health administration of the Malagasy Republic concerning the additional regulations of 2) May 197) amending the International Health Regulations (1969), in particular Articles 1, 21, 6) -71 and 92.
I have the honour to be, Sir, Your obedient Servant,
Joan Ernest Bezaza Director-General of Foreign Affairs for the Minister of Foreign Affairs
The Director -General World Health Organization Geneva Switzerland • •
AGREEMENTS AND RESERVATIONS FORMULATED BY THE NATIONAL HEALTH ADMINISТFAТION OF THE MALAGASY REPUBLIC CONCERNING THE ADDITIONAL REGULATIONS of 23 MAY 173
AMENDING THE INTERNATIONAL HEALTH : GULATIONS (1969), IN PARTICULAR ARТICIES 1, 21, 5-71 AND 92
Additional regulation of 23 May 1973 Agreements and reservations formulated
PART I - DEFINITIONS
Article 1 - Replace the definition of "airport" by the following: "means any airport designated by the Member State in whose territory it is situated as an airport of entry and Agreement departure for international air traffic, where the formali- ties incident to customs, immigration, public health, animal and plant quarantine and similar procedures are carried out ".
PART III - HEALTH ORGANIZATION
Article 21 - Paragraph 1: delete subparagraphs (b), (c). Agreement
PART V - SPECIAL PROVISIONS RELAТING TO EACH OF THE DТSEASES The national health administration of the Malagasy Republic, SUBJECT TO THE REGUTAT IONS through the airport health authorities of its territory, Chapter II - Cholera reserves the right to apply Articles 63, 64, 65, 66, 67, 63, Article 63 - Delete 69, 70 and 71 of the present International Health Regulations without amendment. Article 64 - Renumber as Article 6) and amend as follows: (1969), "1. If on arrival of a ship, aircraft, train, road vehicle This reservation is motivated by: or other means of transport a case of cholera is discovered, - the geographical situation of Madagascar (an island) betwee or a case has occurred on board, the health authority Africa and Asia, two continents where cholera is endemic in (a) may apply surveillance or isolation of suspects among many countries; passengers or crew for a period not to exceed 5 days reckoned - the inadequate health infrastructure in the national terri- from the date of disembarkation; rory; (b) shall be responsible for the supervision of the removal - the dishonesty of certain crews in making their General and safe disposal of any water, food (excluding cargo), human Declaration. dejecta, waste water including bilge water, waste matter, and - the low level of hygiene in the national territory, so that any other matter which is considered to be contaminated, and if a case of cholera were introduced it would make Madagascar shall be responsible for the disinfection of water tanks and an endemic country for several months, or even years; food handling equipment. - the fact that certain countries, even Members of the World 2. Upon accomplishment of (b) the ship, aircraft, train, Health Organization, do not declare their infected areas, or road, vehicle or other means of transport shall be given free do so only after some delay; pratique." Additional regulation of 23 Nay 1973 Agreements and reservations Cormиlated
Articles 65 -69 inclusive - To be deleted - the time required, which is sometimes considerable, for the Weekly Epidemiological Record to reach the airport authorities Article 70 - Renumber as Article б and reword as follows: of distant Member States; "Foodstuffs carried as cargo on board ships, aircraft, trains, - the rapidity and multiplication of the international means road vehicles or other means of transport in which a case of of transport made available to international passengers who, cholera has occurred during the journey may not be subjected in a time less than the incubation period of the diseases to bacteriological examination except by the health authori- subject to the regulations, can travel from an infected area ties of the country of final destination." to an uninfected country; - etc. Article 71 - Retain text unchanged, and renumber as Article 65.
PART VI - HEALTH DOCUMENTS The national health administration of the Malagasy Republic reserves the right: Article 92 - Subparagraph 1. Delete reference to Appendix 2 and renumber accordingly. - bearing in mind the reservation formulated above, to apply without change subparagraphs 1 -5 of Article 92 of the present Subparagraph ). Reword to read as follows: International Health Regulations (1969); "3. International certificates of vaccination must be signed - to refuse to recognize the validity of international vacci- in his own hand by a medical practitioner or other person nation certificates issued by any "other person authorized by authorized by the national health administration; his official the national health administration" who does not have the stamp is not an accepted substitute for his signature ". title of physician. Subparagraph 5. Delete reference to Appendix 2 - to maintain in force Appendix 2 of the present International and renumber accordingly. Health Regulations (1969).
Appendix 2 - Delete and renumber Appendices accordingly. APPENDIX 3.12
M ALT A
Department of Health Head Office 15 Merchants Street, Valetta
Our Ref: DH 1038/73 3 October 1073 • Your Ref: с.1.18.1973
Please refer to your Circular letter C.L.18.1U73 dated 14 June 1973.
I am to inform you that we find no objections to the deletion or changes of articles 1, 21 and 92.
With regards to the other articles, we do not agree to the proposals at the present time and wish to register our reservation in the sense that we reserve the right to require compliance with the measures therein provided for.
P.L. Bernard A /Chief Government Medical Officer
The Director General World Health Organization 1211 Genève 27 Switzerland APPENDIX 3.13
¨ ¡ A I L A N D
Ministry of Public Health Devaves Palace Bangkok
31 August 17
Our Ref. No. 0305/2022
Sir,
Reference is made to your letter 0.L.18.1Q73 dated 14 June 1973, regarding the resolution WHА26.55 adopted by the twenty -sixth World Health Assembly concerning the additional regulations amending the International Health Regulations (1Q6), particularly with respect to cholera and the international certificate of vaccination for that disease. In this connection I have the honour to inform you that the Royal Thai Government wishes to make a reservation to these Additional Regulations as follows:-
"Except for children under one year of age, any person travelling to Thailand from a country where cholera is considered to be endemic is required to carry with him or her a valid anticholera vaccination certificate."
I have the honour to be, Sir, Your obedient servant,
Dr Komol Pengsritong Under -Secretary of State for Public Health
The Director -General World Health Organization Avenue Appia 1211 Geneva Switzerland APPENDIX 3.14
Y U G O S L A V I А
UNISAN7E Geneva
REYOURIET C .L.18.1973 OF 14+ JUNE YUGOSLAV HEALTH AUTHORITIES HAVE
RESERVATIONS 1'0 ADDITIONAL REGULATIONS AMENDING INЕRNATIONAL HEALTH • REGULATIONS .TEXT WIT, BE COMMUNICATED SUBSEQUENTLY SIGNATURE: Zdravkom Jakovljevic
• APPENDIX 3.15
Y U G O S L A V I A
Yugoslav Commission for Cooperation with International Health Organizations Bulevar Avnoj -a 104, SIц -II 11070 Novi Beograd Yugoslavia
Dear Dr Mahler,
I have the honour to refer to your letter C.L.18.1973 of June 14, 1973 and accordingly inform you of the following:
"The Health Authorities of the SrR of Yugoslavia accept the Additional Regulations amending the International Health Regulations /19 69 /adopted by the Twenty -sixth World Health Assembly on 23 May 1973.
However, the Health Authorities of the SFR of Yugoslavia reserve the right to order, for persons in international traffic coming to Yugoslavia from any infected area in tre world, sanitary control in the duration of five days counting from the date of their departure from the infected area."
Yours sincerely,
Dj. Jakovljevic, M.D., P.H.D. President
Dr H. Mahler Director -General Worla Health Organization 1211 Geneva 27 Switzerland