SEVENTY-FOURTH WORLD HEALTH ASSEMBLY A74/9 Add.1 Provisional agenda item 17.3 5 May 2021 WHO’s work in health emergencies Strengthening preparedness for health emergencies: implementation of the International Health Regulations (2005) The Director-General has the honour to transmit to the Seventy-fourth World Health Assembly the report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 Response (see Annex). A74/9 Add.1 ANNEX Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 response Final Draft, 30 April 2021 Page Contents Acknowledgements ................................................................................................................................................ 4 Preface .................................................................................................................................................................... 6 Acronyms and abbreviations .................................................................................................................................. 8 Executive summary ................................................................................................................................................ 9 1. Introduction and background ............................................................................................................................ 18 1.1 A brief introduction to the IHR .................................................................................................................. 18 1.2 The mandate and report of this Review Committee ................................................................................... 19 2. Methods of work .............................................................................................................................................. 20 3. Findings and recommendations ........................................................................................................................ 22 3.1 Role and function of National IHR Focal Points........................................................................................ 22 3.2 Core capacity requirements for preparedness, surveillance and response .................................................. 23 3.3 Legal preparedness ..................................................................................................................................... 25 3.4 National notification and alert system ........................................................................................................ 27 3.5 Risk assessment and information sharing .................................................................................................. 31 3.6 COVID-19 Emergency Committee and the determination of a public health emergency of international concern ............................................................................................................................................................. 34 3.7 Travel measures ......................................................................................................................................... 41 3.8 Digitalization and communication ............................................................................................................. 45 3.9 Collaboration, coordination and financing ................................................................................................. 48 3.10 Compliance and accountability ................................................................................................................ 52 4. Implementation of recommendations from previous IHR Review Committees ............................................... 55 4.1 Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009 ................................................................................................................................... 55 4.2 Review Committee on Second Extensions for Establishing National Public Health Capacities and on IHR Implementation ........................................................................................................................................ 56 4.3 Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response ................................................................................................................................................... 57 5. Conclusions ...................................................................................................................................................... 59 Appendices ........................................................................................................................................................... 64 Appendix 1. Names and affiliations of Review Committee members ............................................................. 64 Appendix 2. List of documents presented to and reviewed by the Committee ................................................ 66 Appendix 3. Timeline of events relating to the functioning of the IHR during the COVID-19 response ........ 72 3 A74/9 Add.1 Annex ACKNOWLEDGEMENTS The Review Committee wishes to thank WHO Director-General Tedros Adhanom Ghebreyesus, Executive Director of WHO Health Emergencies Programme Michael Ryan, Assistant Director-General for Emergency Preparedness and International Health Regulations Jaouad Mahjour, and Assistant Director-General for Emergency Response Ibrahima Socé Fall for actively supporting its work. In addition, the Committee offer its thanks to the following people from the WHO Secretariat at headquarters and from the regional offices: IHR Review Committee Secretariat, led by Carmen Dolea, and staffed by the following WHO staff members: Magdalena Rabini, Fernando Gonzalez-Martin, Thomas Hofmann, Helge Hollmeyer, Olla Shideed, Keishi Abe, Jasmin Dian, Filiz Onalan, Anna Pashalishvili, Delphine Renard; WHO consultants: Genevieve Howse, Gian Luca Burci, Guenael Rodier; and writers: David Bramley, Joanne McManus. WHO technical support for subgroups: Stella Chungong, Nedret Emiroglu, Oliver Morgan, Jun Xing, Steve Solomon, Egle Granziera, Claudia Nannini. Regional focal points for the IHR Review Committee Secretariat: Roberta Andraghetti, Masaya Kato, Dorit Nitzan, Babatunde Olowokure, Dalia Samhouri, Mary Stephen, Jos Vandelaer. Iris Hunger of the Robert Koch Institute, Germany, supported the Chair of the Review Committee and the IHR Secretariat. WHO staff interviewed by the Committee: Nyka Alexander, Peter Ben Embarek, Richard Brennan, Sylvie Briand, Richard Brown, Patrick Drury, Gauden Galea, Anne Huvos, Takeshi Kasai, Chin-kei Lee, Jaouad Mahjour, Mamunur Rahman Malik, Garret Mehl, Ann Moen, Matshidiso R. Moetti, Charles Kuria Njuguna, Roderico Ofrin, Jukka Pukkila, Michael Ryan, Gina Samaan, Poonam Khetrapal Singh, Gabriella Stern, Ciro Ugarte, Endang Wulandari, N'da Konan Michel Yao. The Committee also thanks the experts and representatives of government agencies and of other organizations who were interviewed: Chairs of previous IHR Review and Emergency Committees: Chris Baggoley, Harvey V. Fineberg, David Heymann, Didier Houssin, John Mackenzie, Helen Rees, Robert Steffen, Oyewale Tomori. National IHR Focal Points and government representatives: Canada: Katharine Acs-Charter, Alixanderia Clymans, Aline Dimitri, Cindy Evans, Elizabeth Gooding, Boniface Kabore, Lee Lior, Diane MacDonald, Lynn Menard, Howard Njoo, Lina Shah, Manon Turcotte, Jennifer Watson; China: Zijian Feng, Juan Li, Yang Liu, Bin Ma, Yang Sun, Chenguang Wang, Yingge Xia, Zhen Xu, Xiaochen Yang, Lei Zhou; Finland: Mika Salminen; Indonesia: Endang Budi Hastuti, Rosmaniar, Andini Wisdhanorita; Italy: Emanuela M Frisicale; Sierra Leone: Mohamed Alex Vandi; Spain: Fernando Simón Soria; Sri Lanka: Sudath Dilhani Samarasekera, Arnold Mahendra and Sudath Samaraweera; United States of America: Umed Ajani, Ray Arthur, Ana Ayala, Ruvani Chandrasekera, Jose Fernandez, Robin Moudy, Adam Tewell, Kaytna Thaker and Serena Vinter. Experts from other organizations or agencies: Global Outbreak Alert and Response Network: Gail Carson, Dale Fisher, Nzelle Delphine Kayem; International Air Transport Association: James Wiltshire; International Civil Aviation Organization: Johanna Jordaan; International Maritime Organization: Heike Deggim; International Organization for Migration: Florian Forster, Alexander Klosovsky, Damien Thuriaux, Alice Wimmer; United Nations High Commissioner for Human Rights: Gianni Magazzeni. Academic experts: Lin H. Chen, Harvard Medical School, 4 Annex A74/9 Add.1 United States of America; Sara E. Davies, School of Government and International Relations, Griffith University, Australia; Kelley Lee, Faculty of Health Sciences, Simon Fraser University, Canada; Simon Rushton, Department of Politics and International Relations, University of Sheffield, United Kingdom; Maike Voss, German Institute for International and Security Affairs/Stiftung Wissenschaft und Politik, Berlin, Germany; Clare Wenham, London School of Economics and Political Science, United Kingdom; Catherine Z. Worsnop, School of Public Policy University of Maryland, United States of America. The Committee also thanks the following States Parties and international organizations that provided written submissions to the Review Committee: Argentina, Australia, Austria, Canada, Chile,