International Health Regulations Research Articles

PHEIC and Global Health Governance: Do Human Rights and Sovereignty Carry Any Value?

The emergence of COVID-19 and subsequent declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) has brought into focus the role of the international health body in global health governance. Declaration of PHEIC under the ‘International Health Regulations’ empowers the WHO Director General (DG) to make emergency recommendations for measures which may require suspension of travel, halting of movement of goods suspected of spreading the disease; isolation or quarantine of suspected cases of infection and compulsory medical examination of individuals in certain cases. The declaration of a PHEIC may also amount to a threat to international peace and security as the ‘Security Council’ has determined through its resolution 2177 in the case of the Ebola crisis. In this context, the article seeks to investigate the importance of the two principles that play a role in the governance of health during a pandemic—one is the principle of human rights of individuals since it is the fundamental principle which forms a part of a governance regime; second, the principle of sovereignty since it is the States that decide whether to impose the measures and the extent to which the measures must be imposed.

Toward Public Health Resilience in the Eastern Mediterranean Region: Findings From the Seventh Eastern Mediterranean Public Health Network Regional Conference.

The resilience of public health in the Eastern Mediterranean Region (EMR) varies from country to country, mostly based on the governmental and financial situation of the countries. With the theme of Towards Public Health Resilience in the EMR: Breaking Barriers, the seventh Eastern Mediterranean Public Health Network regional conference, held from November 14 to 18, 2021, was dedicated to exploring ways for achieving public health resilience. A total of 101 oral presentations and 13 poster presentations were presented on various public health topics. The conference included 6 keynote sessions, 10 roundtable sessions, and 5 preconference workshops. The preconference workshops were conducted on border health; the mobilization of Field Epidemiology Training Program (FETP) residents and graduates and rapid responders in EMR countries; continuous professional development for the public health workforce; brucellosis surveillance using the "One Health" approach; and strategies to integrate and use noncommunicable diseases data sources. The roundtable sessions included discussions on the following topics: the role of FETPs in responding to COVID-19, institutionalization of rapid response to public health emergencies, health systems resilience, integration of early warning and response with event-based and indicator-based surveillance, sustaining international health regulations, strengthening the "One Health" approach, the anticipated future of public health in the post COVID-19 era, supporting public health research capacity in a diverse region, and COVID-19 vaccines and routine immunization synergies and drawbacks. The keynote speaker sessions covered topics on essential public health functions and the universal health coverage challenge in the EMR, lessons from the US COVID-19 public health response, learning from COVID-19, reshaping public health after the pandemic era, COVID-19 resilient primary health care, and the cohesion of society during and after a pandemic. The conference sessions provided highly promising opportunities to explore ways to achieve such goals in the EMR and shed light on the latest scientific findings, important lessons learned, and discussions on the ways in which current barriers can be broken down through coordination and collaboration.

Public health in Asia during the COVID-19 pandemic: global health governance, migrant labour, and international health crises

Any book on the topic of ‘public health in Asia during the COVID–19 pandemic’ must tick three boxes. It must be ambitious in scope; discuss the political, sociological and economic aspects of public health (not just the science of public health) at the national level; and examine Asia's role in global health governance. This book does indeed tick all three. In addition, it has some strong highlights. The edited volume brings together 15 chapters, which are arranged into four themes: health policies in Asia; Asia's role in global health governance; national-level responses of Asian countries; and the impact of the COVID–19 pandemic on migrants’ health in Asia. The contributors include scholars of Asia area studies, International Relations (IR), economics, political science and public policy. The three editors are specialists in IR, global health and the politics of modern China. For context, the reviewers are specialists in health systems, public health and global health. We welcome other disciplines analysing health questions, especially as they shed light on social determinants and political economy dimensions, using IR theory to resolve global health commons problems, such as pandemics. These perspectives from other disciplines are especially welcome given the paucity of literature on the impact of the COVID–19 pandemic in Asia, from regional and interdisciplinary approaches. Therefore, we commend the book's three main strengths. First, there is a strong initial focus on the political and international relations in the context of past pandemics, such as the SARS outbreak in 2003 and the development of the International Health Regulations legal instrument in 2005. This focus is helpful because public health teaching tends to focus more on questions of epidemiology, science and the clinical impact of pandemics. Consequently, public health knowledge often downplays the international political, social and economic drivers and impacts. Second, the book demonstrates in-depth knowledge about the current governance structures, especially when applying the lenses of political science, IR and political economy to the study of pandemics. This is testament to the skills of the contributors and editors. Third and last, this book has an entire section on migrant health, which remains under-researched and under-discussed despite its importance to equity, justice and general public health common sense.

Human death due to H5N1 amid the COVID-19 pandemic and Mpox outbreak: A call for action.

Human death due to H5N1 amid the COVID-19 pandemic and Mpox outbreak: A call for action.

Judicial Trends in the Era of COVID-19: Public Health in Peril.

AffiliationsLawrence O. Gostin is Founding O’Neill Professor of Global Health Law and Faculty Director of the O’Neill Institute at Georgetown University, Washington, DC. He directs the World Health Organization Collaborating Center on National and Global Health Law and sits on the WHO Review Committee to Revise the International Health Regulations in light of the COVID-19 pandemic.

Decolonising Global Solidarity: The WHO’s Broken Alarm and Epidemiological Nationalism

The COVID-19 pandemic has traumatised world leaders, leading people to question the capability and accountability of global health governance. Against this background, we have heard multiple calls to strengthen ‘solidarity’ within and between states – which, weirdly, is practised by keeping a distance from ‘Others’ through, for instance, social distancing, lockdowns, and border control. In this paper, I first introduce the post-World War II international pandemic response regime, especially the International Health Regulations 2005, using the multiple positions of the Republic of China and/or Taiwan to illustrate the prioritisation of national sovereignty over health justice. In and beyond this context, I conceptualise epidemiological nationalism, which contains three dimensions (territorial, affective, and epistemic) to critically examine the responses to COVID-19 from the WHO and different states. This concept enables us to analyse the solidarity-through-distancing practices from a decolonial perspective to deconstruct the contemporary global health regime. The regime is underpinned by the coloniality of modern epidemiology, which creates the hierarchies between nations and races imposed on the making and working of geographical, population, and disease categories by racialising diseases and response measures. Such racialisation practices vary in different contexts and are often tied to states’ securitisation practices, which justify the exclusion of minority communities.

Мавпяча віспа (mpox) - нова проблема глобального масштабу для людства

Purpose - to draw attention to an infection that was little known, but has now become a global problem for society; to familiarize readers with the peculiarities of the 2022 monkeypox outbreak and to increase the level of alertness of doctors to this disease. Monkeypox is a global problem because the disease is spreading rapidly, covering 111 countries. Three cases were diagnosed in Ukraine. It is predominantly a self-limited infection, but there are severe and deadly complications. The lethality of this disease ranges from 0% to 11%. The course of the disease is more severe in children and people with reduced immunity. Vertical transmission of the virus from mother to child is possible, resulting in congenital monkeypox. Monkeypox is a zoonotic disease and its natural reservoir is not exactly known, but rodents are most likely to act. In most cases, person-to-person transmission of the virus occurs through close skin to skin contact, often during sexual intercourse. At the beginning of the outbreak 98% of cases of disease were was diagnosed in homo- and bisexuals. Airborne transmission is also possible. Infection is possible through close contact with infectious skin lesions. Clinically, the initial period resembles influenza, but lymphadenopathy is characteristic, which is considered a pathognomonic symptom of mpox. The rash is similar to that of chickenpox, but with more prevalent location on palms and soles than in chickenpox. In the presence of a vesicular rash in a patient, it is necessary to exclude monkeypox. PCR diagnostics of the virus in samples of vesicles or crusts has the greatest diagnostic value. Hygienic skin care is important. Antiviral drugs (tecovirimat, brincidofovir) are recommended only in severe cases. To reduce the spread of infection, international rules apply as for other infections, such as COVID-19. The monkeypox virus vaccine is recommended primarily for groups at risk of infection, including medical personnel who may come into contact with the patient or samples for laboratory testing. Being aware for this infection, following international health regulations, it is possible to prevent the further spread of monkeypox. No conflict of interests was declared by the authors.

Effect of Implementation of Community – Based Surveillance Initiative Approach in Algableen Locality - White Nile States Sudan, 2020: Cross-Sectional Study

Background: Surveillance system of infectious diseases and event is recognized as the cornerstone of public health decision-making and practice additionally the International Health Regulation requested counties to implement other type of surveillance to support the routine surveillance system and to increase the detection rate and sensitivity in reporting the diseases, event, or any public health emergency with international concern (PHEIC). The aim of this study was to assess the implementation level of community-based surveillance systems to ensuring that the system implemented efficiently and effectively. Methods: This was descriptive cross-sectional community-based study was conducted in Algableen locality White Nile states –from 2017 to 2020 involved 40 community volunteers to identify the effect of community – based surveillance in locality as initiative approach, Data was collected by using a per-prepared and pretested questionnaire followed WHO/EMRO tools for community volunteers at villages level felt through phone calls. Data were analyzed by using Statistical Packages for Social Sciences (SPSS) (version 20). Written and verbal consents were obtained from all participants as appropriate. Results: Community based surveillance started in 2016 endorsement and approval of guidelines Standard Operation Procedures (SOPs) and training materials has been developed in 2017, there were significant positive changes in implementation of this system the system was implemented in 17 states with percentage 94.4%, the evidence for this is the result revealed availability of guidelines and SOPs was 94.1% and 88.2%, completeness, and timeliness of system data was 94.1% the system database and shared the system finding with partners at state level were 70.6%. At community level the result revealed that the community volunteers had clear contribution in reporting the cases and event this support the indicator-based surveillance and increased the system sensitivity in the study area, 35% of them the report syndromic diseases, disaster, and animals’ deaths, 57% of them they report syndromic diseases and disaster, related to that, the result revealed97% of them they had the reporting format available and 75% reporting signal to locality level regularly. From the analysis of biological events the volunteer had report 54% of signal as diarrheal diseases and 81% of signal reported as flood from the natural events, also they are reported the increases of Mosquito in the study area. Conclusion: The study revealed significant positive impact when implementation of community-based surveillance system this system it helps in reflection of the epidemiological situation in the villages and locality, based on these finding the study recommended that, rapid and early response for the reported cases and rumors or any other event from the locality and state level reported by community volunteers, Regular refresh and basic training for community volunteers and secure the communication facilities and running cost.

<p><strong>Dream of Polio Free Pakistan - when will it become a reality?</strong></p>

Pakistan is one of the two endemic countries for polio, reporting co-circulation of WPV1 and cVDPV2. Pakistan is classified by the International Health Regulations (IHR) as a state infected with Wild Poliovirus type 1 (WPV1) and circulating Vaccine derived poliovirus type 2 (cVDPV2) with potential risk of international spread. We describe an ongoing outbreak of WPV1 in North Waziristan district of southern Khyber Pakhtunkhwa (KP) province in Pakistan and the last documented outbreak of cVDPV2. The first case of the WPV1 outbreak was documented in the month of April 2022, after more than a year of polio free status. Since then, 20 cases in total have been reported, of which 87 percent had never received OPV through essential immunization. Major reasons which might be responsible for Pakistan’s failure in the eradication of polio including governance issues, lack of health facilities, low routine immunization, or refusal of immunization, security threat to immunization staff, extensive public movement, and presence of polio reservoirs/zones in border regions with Afghanistan. Pakistan’s struggle against polio eradication was further fuelled by the COVID-19 pandemic which brought a standstill to the routine immunizations. The threat to the Global Polio Eradication stems from reintroduction of the poliovirus and emergence of circulating vaccine derived poliovirus (cVDPV) in the polio-free countries. Hence, control of the WPV1 and cVDPV2 transmission in Pakistan is an international concern.

Construction of public health core competence and the improvement of its legal guarantee in China.

Public health core capacity, first established by the 58th United Nations General Assembly in 2003 and recognized by the World Health Organization when "the International Health Regulations" were revised, refers to the basic and necessary capacity to allocate human, financial, and material resources for the prevention and control of public health events that a country or region should have. It includes national and regional levels, and its constituent elements and their basic requirements differ, but public health core capacity building at both national and regional levels requires certain legal safeguards. At present, there are still some problems, including the imperfect legal system, conflicting legal norms, the non-sufficient supply of local legislation, and the weak operability of legislation in the legal guarantee of public health core capacity building in China. China should make improvements in terms of comprehensive cleaning of existing public health laws, strengthening their post-legislative evaluation, adopting parcel legislation, strengthening legislation in key areas of public health, and promoting the supply of local legislation. The goal is to provide a perfect and comprehensive legal system to guarantee the construction of China's core capacity in public health.

The Containment Bias of the WHO International Health Regulations

Abstract The ordinary meaning of the term ‘prevention’ is to prevent harm from occurring. But what ‘harm’? For over 170 years, the system now embodied in the World Health Organization’s (WHO) International Health Regulations (IHRs) has answered this question by focusing on the prevention of disease ‘spread’ across countries, rather than on the ‘spillover’ of pathogens from animals to humans, which constitute the main source of pandemic risk today. This bias towards the containment of disease has deep roots. In the historical context from the IHRs emerged, focusing on pathogen spillover was beyond the possibilities of the science of the time; it was also pointless to the extent that the effort focused on pathogens which were already prevalent in humans, causing diseases such as cholera or plague. Transposed to the present day, this containment bias has important consequences for global health governance. Most importantly among these is that the global health security architecture still lacks a specific system to prevent spillovers of pathogens at the origin of outbreaks and subsequent spread of diseases such as COVID-19, SARS, MERS or Ebola. This article investigates the roots of this focus on containment. Relying on the proceedings of the International Sanitary Conferences that preceded the IHRs, as well as on an untapped documentary archive relating to the revision of the IHRs between 1995-2005, the article explains the reasons underpinning this enduring bias and its implications for global health governance.

Study of the Challenges and Ways of Improvement of International Health Regulations -based on regulations related to cooperation between Contracting States

The International Health Regulations (IHR) (2005) gives health guidance to prevent global outbreaks of infectious diseases and help contracting parties to become open and cooperate. The lack of horizontal information shared among States parties, the need for pre-epidemic prevention, and the wide variation of State parties' action capacity are the problems that IHR (2005) has to face in COVID-19. The revision of the IHR is necessary. Improving the information-sharing mechanism between States Parties, strengthening the capacity of States Parties to prevent public health incidents, improving the implementation of State parties' response in public health events and refining the health construction regulations of States Parties, and urging States Parties to improve the level of medical and health emergency response are important four aspects which should be implemented now.

An assessment of the laboratory network in Ghana: A national-level ATLAS survey (2019-2020).

Integrated health systems with strong laboratory networks are critical in improving public health. The current study assessed the laboratory network in Ghana and its functionality using the Assessment Tool for Laboratory Services (ATLAS). A national-level laboratory network survey was conducted among stakeholders of the Ghanaian laboratory network in Accra. Face-to-face interviews were conducted from December 2019 to January 2020, with follow-up phone interviews between June and July 2020. Also, we reviewed supporting documents provided by stakeholders for supplementary information and transcribed these to identify themes. Where possible, we completed the Laboratory Network scorecard using data obtained from the ATLAS. The Laboratory Network (LABNET) scorecard assessment was a valuable addition to the ATLAS survey as it quantified the functionality of the laboratory network and its overall advancement toward achieving International Health Regulations (2005) and Global Health Security Agenda targets. Two significant challenges indicated by respondents were laboratory financing and delayed implementation of the Ghana National Health Laboratory Policy. Stakeholders recommended a review of the country's funding landscape, such as funding laboratory services from the country's internally generated funds. Also, they recommended laboratory policy implementation to ensure adequate laboratory workforce and standards.

World Health Organization Regime Effectiveness in Controlling COVID-19: Case Study of Malaysia, Thailand, and Indonesia

The World Health Organization (WHO) is the only international organization to be given authority by the Charter of the United Nations to promote and protect the health of all people. Then it is not surprising that people look after the response and action of the WHO when COVID-19 cases explode worldwide. Observing the response of the WHO, some analysts criticized the organization for late, incomprehensive, and unsystematic policy. Some even blame the way the organization work, that is reactive rather than predictive, the shortage of the budget, and the decision-making process that is not transparent. This paper intends to analyze the effectiveness of the WHO's rule, norms and regulation in controlling the spread of the COVID-19. It tries to answer the question of how effective the WHO regime is in controlling COVID-19 spread. Using the theory of regime effectiveness, it studies the case of Malaysia, Thailand, and Indonesia. The three countries are chosen because WHO has appreciated Malaysia and Thailand for their compliance with International Health Regulations (2005) (IHR) core capacity requirements and have strong capacity and self-sufficiency in outbreak preparedness and response. Meanwhile, Indonesia faced considerable difficulties at the beginning of the pandemic, but currently Indonesia achieves better performance in controlling the pandemic than that Malaysia and Thailand. Keywords: World Health Organization, International Health Regulation, COVID-19, international regime, effectiveness

The health of the public: What has gone wrong?

COVID-19, a new pandemic, has swept the world. How could this have happened? In theory the world should have been prepared, armed as it has been since 2005 with a new set of International Health Regulations with universal commitment by WHO Member States. Yet disaster has struck. The authors of this paper consider that fundamental rethinking is needed, with a new review of the post-World War 2 international system for global governance for health. Whilst WHO and its present and future actions will be scrutinized, the organization is fundamentally made up of 194 Member States, which must share the responsibility for ensuring better global health protection in the future. It is clear the world needs a more effective WHO, but it also needs countries to support and develop their public health infrastructure to face today’s more complex health challenges, which can only grow in scope and complexity over coming years. The paper proposes several key steps to achieve these goals.

Securitising infectious disease outbreaks: The WHO and the visualisation of molecular life

AbstractFollowing its exceptional response to the 2003 severe acute respiratory syndrome (SARS) outbreak, the World Health Organization (WHO) gained new powers to securitise infectious disease outbreaks via the revised 2005 International Health Regulations (IHRs) and the ability to declare a Public Health Emergency of International Concern (PHEIC). This article investigates the declaration of a PHEIC in relation to the 2009 H1N1 flu pandemic, the 2014–16 Ebola outbreak, and the ongoing COVID-19 pandemic. It argues that the securitisation of these outbreaks was dependent upon global surveillance networks that utilised genetic technologies to visualise the molecular characteristics and spread of the pathogen in question. Genetic evidence in these cases facilitated the creation of a securitised object by revealing the unique and ‘untypable’ nature of the H1N1 and SARS-CoV-2 viruses and made visible the widespread prevalence of Ebola across the population of West Africa. The power of this evidence draws from a societal perception of science as producing objective ‘facts’ about the world that objectivise their objects of concern and empower political actors in the implementation of their security agendas. As a result, scientific evidence provided by genetic technologies now plays a necessary and indispensable role in the securitisation of infectious disease outbreaks.

Can we move beyond vaccine apartheid? Examining the determinants of the COVID-19 vaccine gap

ABSTRACT While global health leaders call disparities in access to COVID-19 vaccines an ‘apartheid,’ this gap is not the first such disparity. The recurrence of these gaps in low and middle-income countries and especially in Africa, raises questions about their determinants and about the persistent failures of global health institutions to remediate them. We interrogate these determinants and questions by examining: (1) the distribution of COVID-19 vaccines; (2) primary determinants of vaccine access including availability and affordability; (3) factors affecting availability (hoarding, COVAX, and manufacturing capacity); and (4) factors affecting affordability (pricing, intellectual property rights (IPR), the TRIPS waiver and a potential pandemic treaty). We conclude that IPR constrained the affordability and availability of COVID-19 vaccines in ways inadequately addressed by COVAX and a waiver compromise thwarted by political, corporate, and philanthropic interests. While stronger limits to IPR in a pandemic treaty and a reformed International Health Regulations will not resolve structural inequities, they could meaningfully expand LMIC autonomy to protect public health. We urge equity-seeking Global South and North actors to fight for such IPR reforms as small and meaningful steps towards a more equitable global health order. Otherwise, criminally racist ‘apartheids’ will continue to be the norm when it comes to the distribution of essential health goods during global health emergencies.

The Implementation of the International Health Regulations on Vector-Borne Diseases: A Scoping Review of the Qualitative Evidence Performed Worldwide

Introduction: The International Health Regulations were created by the World Health Organization with the purpose of preventing the international spread of diseases. The 196 signatory countries are bound by this international agreement. In this article, we conducted a scoping review of the literature concerning the implementation and operationalization of measures at both the continental and national levels to prevent the spread of vector-borne diseases. The purpose was to understand the main strategies and policies adopted, as well as how they have been operating. Methods: Out of an initial search on PubMed™, SCOPUS™, and Web of Science™ using combinations of “International Health Regulations” and “vector-borne diseases”, 75 references were obtained, of which 27 were included after careful qualitative analysis. Results: Publication dates of included articles ranged from 1996 to 2022. Four major categories of measures were identified: (a) surveillance and epidemic intelligence; (b) Declaration of Public Health Emergency of International Concern; (c) measures in Points of Entry; and (d) vaccination status. Implemented measures were found in all continents: Africa, Oceania (Australia), Asia (China, India, Taiwan), Europe (Ireland, the Netherlands, and Mediterranean countries), North America (USA), and South America (Brazil). Yellow fever, Zika, Dengue, and Chikungunya were the most cited vector-borne diseases but Crimean-Congo hemorrhagic fever, Japanese encephalitis, Lyme disease, Malaria, Leishmaniasis, Tick-borne encephalitis, and West Nile fever were also mentioned. Conclusion: There are severe asymmetries across countries on the implementation of international regulations with regards to vector-borne diseases, particularly on the issue of surveillance systems. State Parties should consider the lessons learned from the pandemic and perfect their core capacities to prevent future outbreaks of infectious diseases.

Kako učimo iz vanrednih situacija u javnom zdravlju? - obučavanje stručnjaka iz oblasti javnog zdravlja o proverama prilikom i nakon sprovođenja mera tokom pandemije COVID-19

Public health crises require continuous learning to improve preparedness and response to future public health threats. Intra- and after-action reviews (IAR/AAR), as part of the Monitoring and Evaluation Framework under the International Health Regulations (IHR, 2005), constitute important elements for initiating and implementing learning processes during and after public health events. However, in the early COVID-19 pandemic, experience with these formats was limited and there were few opportunities for exchange. As part of the Joint Action SHARP, we conducted two virtual trainings and a peer-to-peer review workshop in 2021 and 2022 to address this need. The trainings and workshop entailed an overview of the IAR/AAR methodology as well as practical exercises and interactive elements. Participants, generally, increased their understanding of IAR/ AARs and welcomed the opportunity for networking and exchange. We conclude that such trainings should be offered more broadly and possibly be expanded to build and maintain workforce capacities for learning from crises.

Re-emergence of Rift Valley fever: an update and preventive measures.

Re-emergence of Rift Valley fever: an update and preventive measures.