SIXTY-NINTH WORLD HEALTH ASSEMBLY A69/21 Provisional agenda item 14.1 13 May 2016 Implementation of the International Health Regulations (2005) Report of the Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response Report by the Director-General The Director-General has the honour to transmit to the Sixty-ninth World Health Assembly the report of the Review Committee on the Role of the International Health Regulations (IHR) in the Ebola Outbreak and Response (see Annex). A69/21 ANNEX CONTENTS Page ACKNOWLEDGEMENTS ............................................................................................................ 4 PREFACE ....................................................................................................................................... 6 EXECUTIVE SUMMARY ............................................................................................................. 8 INTRODUCTION AND BACKGROUND .................................................................................... 13 METHODS OF WORK .................................................................................................................. 17 ASSESSMENT ............................................................................................................................... 18 RECOMMENDATIONS ................................................................................................................ 56 Appendices ...................................................................................................................................... 74 3 A69/21 Annex ACKNOWLEDGEMENTS The Review Committee received valuable contributions from States Parties, United Nations special agencies, governmental and nongovernmental organizations and individuals. In particular, the Committee wishes to thank the following persons who were interviewed before the Committee: Dr David Nabarro, Chairman of the Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies with Health and Humanitarian Consequences and UN Secretary-General Special Envoy on Ebola; Ms Catherine Fiankan-Bokonga, Geneva correspondent for African media; Dr Mustafa Sidiki Kaloko, Commissioner for Social Affairs of the African Union; Dr Scott Dowell, Director of Surveillance and Epidemiology at the Bill and Melinda Gates Foundation; Dr Steve Landry, Deputy Director of Multilateral Partnerships at the Bill and Melinda Gates Foundation; Dr Elizabeth Wilkinson, Head of Health Services at British Airways; Ms Sophie Van Zaelen, Manager of Health, Safety and Environment at Brussels Airlines; Dr Kashef Ijaz, Principal Deputy Director of the Division of Global Health Protection at the Centers for Disease Control and Prevention (CDC) in Atlanta; Mr Dennis Brodie, President of DRBC Consulting; Professor Ilona Kickbusch, Director of the Global Health Programme at the Graduate Institute of International and Development Studies and Member of the Ebola Interim Assessment Panel; Dr Denis Coulombier, Head of the Unit for Surveillance and Response Support at the European Centre for Disease Prevention and Control; Professor Larry Gostin, Director of the O’Neill Institute for National and Global Health Law at the Georgetown University; Dr Seth Berkley, Chief Executive Officer of the Global Alliance on Vaccines and Immunizations; Dr Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Dr Päivi Sillanaukee, Chairwoman of the Global Health Security Agenda and Permanent Secretary, Ministry of Health, Finland; Dr Outi Kuivasniemi, Global Health Security Agenda Focal Point, Ministry of Health, Finland; Dr Ray Arthur, Chairman of the Steering Committee of the Global Outbreak Alert and Response Network; Dr Keita Sakoba, National Coordinator of the Fight against Ebola, Ministry of Health, Guinea; Professor Robert Steffen, Vice-Chairman of the IHR Emergency Committee on Ebola and Professor at the Epidemiology, Biostatistics and Prevention Institute of the WHO Collaborating Centre for Travellers’ Health of the University of Zürich; Professor Chris Baggoley, Chairman of the IHR Emergency Committee on the MERS-CoV and Chief Medical Officer, Department of Health, Australia; Dr Alain Poirier, Associate Expert at the National Institute of Public Health of Québec, Canada; Dr Claude Thibeault, Medical Advisor at the International Air Transport Association; Dr Michiel Vreedenburgh, Chief of Aviation Safety Implementation at the International Civil Aviation Organization; Dr Martin Schueepp, Operations Coordinator for West Africa at the International Committee of the Red Cross and Red Crescent Societies; Dr Zaher Osman, Medical Doctor and Dr Esperanza Martinez, Head of the Health Unit in the Assistance Division of the International Committee of the Red Cross and Red Crescent Societies; Mr Brendan Shaw, Assistant Director-General of the International Federation of Pharmaceutical Manufacturers and Associations; Dr Julie Hall, Director of Health and Care at the International Federation of the Red Cross and Red Crescent Societies; Dr Teresa Zakaria, Head of Unit, and Kolitha Wickramage, Health Officer for Migration Health Emergency Operations at the International Organization for Migration; Dr Craig Stark, Regional Medical Director in the Government Services (Asia Pacific, Middle East and Africa) at International SOS; Dr Abdullah Al Asiri, Assistant Deputy Minister of Health for Preventive Health and IHR National Focal Point in the Ministry of Health, Kingdom of Saudi Arabia; Mr Thomas K. Nagbe, Director, Disease Prevention and Control, Ministry of Health, Liberia; London School of Hygiene and Tropical Medicine; Dr Peter Piot, Chair of the Independent Panel on the Global Response to Ebola and Director and Professor of Global Health, London School of Hygiene and Tropical Medicine; Ms Rosa Crestani, Emergency Coordinator, Médecins Sans Frontières; Mr Pallava Bagla, Science Editor, New Delhi Television; Paul Spiegel, Deputy Director, Division of Programme Support and Management, Office of the United Nations High 4 Annex A69/21 Commissioner for Refugees; Dr Theresa Tham, Deputy Chief Public Health Officer and Assistant Deputy Minister of the Infectious Disease Prevention and Control Branch, Public Health Agency of Canada; Professor Lothar Wieler, President, and Dr Lars Schaade, Vice-President and Head, Centre for Biological Threats and Special Pathogens of the Robert Koch Institute; Ms Stephanie Nebehay, Senior Correspondent of Reuters; Dr David Heymann, Head and Senior Fellow of the Centre on Global Health Security at The Royal Institute of International Affairs (Chatham House); Douglas Webb, Team Leader for Health and Innovative Financing at the UN Development Programme; Ms Ingrid Nordström-Ho, Head of the Policy and Planning Unit at the Civil-Military Coordination Section of the UN Office for the Coordination of Humanitarian Affairs; Mr Thomas Peter, Head of the Secretariat of the Global Disaster Alert and Coordination System at the UN Office for the Coordination of Humanitarian Affairs; Mr John Ging, Director of the Operational Division at the UN Office for the Coordination of Humanitarian Affairs; Mr Ramesh Rajasingham, Director of the Secretariat of the UN Secretary General’s High-Level Panel on the Global Response to Health Crises; Dr Arlene King, Adjunct Professor at the Dalla Lana School of Public Health of the University of Toronto; Dr Laurie Garrett, Science journalist and Senior Fellow at the United States Council on Foreign Relations; Dr Tim Evans, Senior Director for the Health, Nutrition and Population Global Practice at the World Bank; Mr Sharif Georges, Head of the Quality Assurance Unit/Aviation Service at the World Food Programme; Gretchen H. Stanton, Senior Counsellor for the Agriculture and Commodities Division of the World Trade Organization; Rudolf Adlung, Retired Senior Economist of the World Trade Organization; and Dr Robert Glasser, Special Representative of the UN Secretary-General for Disaster Risk Reduction. The following provided responses to the open electronic consultation survey: Missions to the UN: Argentina, Cambodia, Colombia, Denmark, France, Islamic Republic of Iran, Latvia, Laos, Malaysia, Mauritius, Mexico, Mongolia, Montenegro, Netherlands, Pakistan, Peru, Russian Federation, Singapore, Sri Lanka, Uganda, Venezuela, and Viet Nam; Intergovernmental organizations: Asian Development Bank, Australian Medical Association; and Nongovernmental organizations: Management Sciences for Health: Save the Children, International Medical Corps and the African Field Epidemiology Network. In addition, the following staff members of the WHO Secretariat at headquarters and in the regions provided input to the Committee: Sylvain Aldighieri, Ala Alwan, Roberta Andraghetti, Bruce Aylward, Philippe Barboza, Mohamed Belhocine, Ties Boerma, Sylvie Briand, Gian Luca Burci, Stella Chungong, Patrick Drury, Daniel Epstein, Florence Fuchs, Keiji Fukuda, Erika Garcia, Alex Gasasira, Gregory Härtl, Thomas Hofmann, Anne Huvos, Hamid Jafari, Edward Kelley, Daniel Kertesz, Marie-Paule Kieny, Florimond Tshioko Kweteminga, Ailan Li, Daniel Menucci, Rebecca Matshidiso Moeti, Ezzeddine Mohsni, Roderico Ofrin, Bardan Rana, Guenael Rodier, Ibrahima Soce-Fall and Zabulon Yoti. The Review Committee wishes to thank WHO Director-General Dr Margaret Chan, Deputy Director- General Dr Anarfi Asamoa-Baah and Executive Director Dr Ian Smith and Director Dr Isabelle Nuttall, for actively supporting the work of the Review