Implementation Of International Health Regulations Research Articles

COVID-19 in Latin America: inequalities and response capacity of health systems to health emergenciesCOVID-19 en América Latina: desigualdades y capacidad de respuesta de los sistemas de salud ante emergencias de salud

To identify correlations between COVID-19, demographic and socioeconomic characteristics, and the capacity of Latin American health systems to respond to health emergencies. An ecological study was performed using secondary data from 20 Latin American countries regarding incidence, mortality, testing and vaccination coverage for covid-19 from 2020 to 2021 as well as demographic and socioeconomic indicators. The preparedness of countries to respond to health emergencies was explored based on the 2019 State Party Self-Assessment Annual Report on the implementation of the International Health Regulations (IHR). Statistical analyses were performed using the Spearman correlation test (rho). A high positive correlation was noted between gross domestic product per capita and the human development index with the incidence of COVID-19, testing, and vaccination coverage; and between the proportion of elderly population and vaccination coverage. No correlations were identified between the covid-19 indicators and previous IHR implementation capacities. The lack of correlation between indicators related to COVID-19 and the ability to implement the IHR may reflect limitations of the indicators used or of the IHR monitoring tool as an instrument that induces the preparedness of countries to face health emergencies. The results suggest the importance of structural conditioning factors and the need for longitudinal, comparative, and qualitative studies to understand the factors that influenced the response of countries to COVID-19.

Global capacities for Implementation of International Health Regulations

Global capacities for Implementation of International Health Regulations

Assessing core capacities for addressing public health emergencies of international concern at designated points of entry in cameroon during the COVID-19 Pandemic

BackgroundPoints of Entry (POEs) are at the frontline for prevention, detection and response to international spread of diseases. The objective of this assessment was to ascertain the current level of existing International Health Regulations (IHR) core capacities of designated airports, ports and ground crossings in Cameroon and identify critical gaps for capacity building for prevention, early warning and response to public health threats including COVID-19.MethodsData were collected from April to May 2020 in 5 designated POEs: Yaounde Nsimalen International Airport (YIA), Douala international Airport (DIA), Douala Autonomous Port (DAP), Garoua-Boulai ground crossing, Kye-Ossi ground crossing which were all selected for their high volume of passenger and goods traffic. The World Health Organization (WHO) assessment tool for core capacity requirements at designated airports, ports and ground crossings was used to collect data on three technical capacities: (i) communication and coordination, (ii) Capacities at all times and (iii) capacities to respond to Public Health Emergencies of International Concern (PHEIC).ResultsAll the investigated POEs scored below 50% of capacities in place. YIA recorded the highest percentage for all groups of capacities, coordination and communication and for core capacity at all times with a percentage of 42%, 58% and 32% respectively. For core capacity to respond to PHEIC, all the POEs recorded below 50%. The DAP and all ground crossings lacked trained personnel for inspection of conveyances. Only DIA had a public health emergency plan. There is no isolation/quarantine and transport capacity at the POEs.ConclusionAll POEs assessed did not meet IHR standards and need significant improvement to fulfill the IHR requirements. Unstructured communication channels between stakeholders make the implementation of IHR challenging. A coordination mechanism, with clear functions and structure, is necessary for well-coordinated response efforts to health emergencies at POEs. This assessment will serve as a baseline to inform planning and IHR implementation at designated POEs in Cameroon.

Strengths and weaknesses in the implementation of the IHR (2005) in low GNI countries

Abstract Background The International Health Regulations (IHR) 2005 are an international legal instrument adopted by World Health Organization General Assembly to strengthen global health security and empower the countries to prevent and respond to public health threats. Methods This study was done within the Joint Action on Strengthened International Health Regulations and Preparedness in the EU (SHARP JA) with the aim to assess the strengths and weaknesses in preparedness and IHR implementation in order to develop and improve countries’ IHR capacities. Desk-based review and analysis of available data from the States Parties Annual Report tool (SPAR) from 2019 were done. Data (for 13 IHR capacities with 24 indicators) were analyzed for 15 countries participating in SHARP JA with gross national income (GNI) less than 90% of the EU average. Results The overall capacity for IHR implementation in low GNI countries is 69%, ranging from 33% in Bosnia and Herzegovina to 84% in Spain. The highest capacities are recognized in the area of Legislation and financing - 78%, IHR Coordination & NFP Functions - 77%, Food Safety - 76%, and Health service provision - 76%. The weak areas with the need for further improvement are recorded in the Points of entry (PoE) - 51%, Risk Communication - 52%, Chemical events - 60%, National health emergency framework - 65%, Surveillance - 66%, and Human Resources - 67%. The overall IHR capacity of low GNI countries is lower compared to the SHARP JA countries and the European average (76% and 73% respectively). Conclusions The results have shown the strongest and the weakest points of the IHR implementation in low GNI countries. This indicates the need for capacity building and further development in identified areas (Points of entry, Risk Communication, Chemical events, National health emergency framework, Surveillance, and Human Resources). Key messages • The assessment of the strengths and weaknesses in preparedness and IHR implementation is the key prerequisite for identifying countries’ needs for their capacity enhancement. • Special attention should be given to the strengthening low GNI countries’ capacities.

An ecological study on the association between International Health Regulations (IHR) core capacity scores and the Universal Health Coverage (UHC) service coverage index

BackgroundThe pandemic situation due to COVID-19 highlighted the importance of global health security preparedness and response. Since the revision of the International Health Regulations (IHR) in 2005, Joint External Evaluation (JEE) and States Parties Self-Assessment Annual Reporting (SPAR) have been adopted to track the IHR implementation stage in each country. While national IHR core capacities support the concept of Universal Health Coverage (UHC), there have been limited studies verifying the relationship between the two concepts. This study aimed to investigate empirically the association between IHR core capacity scores and the UHC service coverage index.MethodJEE score, SPAR score and UHC service coverage index data from 96 countries were collected and analyzed using an ecological study design. The independent variable was IHR core capacity scores, measured by JEE 2016-2019 and SPAR 2019 from the World Health Organization (WHO) and the dependent variable, UHC service coverage index, was extracted from the 2019 UHC monitoring report. For examining the association between IHR core capacities and the UHC service coverage index, Spearman’s correlation analysis was used. The correlation between IHR core capacities and UHC index was demonstrated using a scatter plot between JEE score and UHC service coverage index, and the SPAR score and UHC service coverage index were also presented.ResultWhile the correlation value between JEE and SPAR was 0.92 (p < 0.001), the countries’ external evaluation scores were lower than their self-evaluation scores. Some areas such as available human resources and points of entry were mismatched between JEE and SPAR. JEE was associated with the UHC score (r = 0.85, p < 0.001) and SPAR was also associated with the UHC service coverage index (r = 0.81, p < 0.001). The JEE and SPAR scores showed a significant positive correlation with the UHC service coverage index after adjusting for several confounding variables.ConclusionThe study result supports the premise that strengthening national health security capacities would in turn contribute to the achievement of UHC. With the help of the empirical result, it would further guide each country for better implementation of IHR.

Response to reviews of Containing Contagion by Sara E. Davies

It was always known that implementing the IHR was going to be a long and difficult journey for many countries in the region, one pursued alongside other equally important health goals such as universal health care and vaccination coverage The COVID-19 pandemic has clearly demonstrated the cost of failing to incorporate a human rights framework as one of the essential core capacity requirements for meeting the IHR The Asia Pacific Strategy for Emerging Infectious Diseases (APSED) was developed to assist the two regional offices member states come to grips with the capacities required under the revised IHR I found that though there were profound differences between them, overall, ASEAN states had responded positively to the concept of shared infectious disease surveillance and the reporting of infectious disease outbreaks, both endemic and emerging diseases, to neighbouring states [Extracted from the article] Copyright of Singapore Journal of Tropical Geography is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Customizing Health Security Preparedness Activities in Sub-Saharan Africa: Leveraging Political Context to Enhance IHR Implementation

ABSTRACT The International Health Regulations (IHR) continue to be one of the driving forces behind health security preparedness in Sub-Saharan Africa (SSA). While progress has been made, there is still much work to do for these nations to meet IHR standards. Policy implementation and development activities tend to employ “best practices” with little emphasis on the institutional factors (e.g., cultural, social, and political) that would sustain them. This article will discuss the results of a mixed-methods study on relationships between state capacity proxies and global health security preparedness capacities. The conclusion being that health strengthening activities for preparedness should consider political, social, and economic context to enhance sustainability.

SHARP Joint Action – Strengthening International Health Regulations and preparedness in the EU

Although the preparedness to health emergencies of biological, chemical, environmental and unknown origin across the Europe is at high level, gaps do exist across the EU Member States and European countries. The previous coronavirus epidemic, SARS in 2002, showed that countries responded largely individually to this emerging threat. EU wide, joint responses were not taken. SARS epidemic showed that strengthening of the common EU efforts was needed.Many actions were taken, and since 2013 the European Commission Decision 1082/2013/EU on serious cross-border threats to health has provided a framework to improve preparedness and to strengthen the response capacities in Europe to health threats.SHARP Joint Action is a 3-year collaborative action of 26 countries and 61 partners, co-funded by the EC and coordinated by the Finnish Institute for Health and Welfare, Finland, and co-coordinated by Robert Koch Institute, Germany and National Institute of Infectious Diseases Lazzaro Spallanzani, Italy. SHARP started it's actions in June 2019, and it aims to strengthen implementation of the International Health Regulations (IHR) and the Decision 1082/2013/EU.SHARP consists of ten work packages covering core public health capacities, including: IHR core capacity strengthening and assessment, preparedness and response planning, training, laboratory preparedness and responsiveness, chemical safety and threats, and case management, infection prevention and control preparedness.Through this cross-sectoral approach, SHARP supports the Member States and partner countries in strengthening their capacities. In response to the COVID-19 outbreak, SHARP has also supported the EC and the Member States, and especially work packages for laboratory preparedness and responsiveness (WP7) and for case management and infection prevention and control preparedness (WP10) were activated. The activities regarding laboratory preparedness and response have been coordinated with the ECDC.Key messages SHARP Joint Action strengthens the implementation of Decision 1082/2013/EU on serious cross-border threats to health and the implementation of International Health Regulations in the EU.SHARP improves preparedness and response to serious cross-border threats to health, and resilience of the health systems at national, EU and regional level.

Surveillance of Aedes (Stegomyia) mosquitoes in and around International Airport, Kerala - Assessment of vector control efforts

Vector-borne Diseases (VBDs) such as malaria, dengue, chikungunya, zika virus and yellow fever are reported in over 100 countries and put up to 60% of the world’s population at risk of infection; more than 500 million cases are reported each year. The International Health Regulations (IHR) emphasizes to look after international seaports/airports and surrounding areas up to 400 meters free of Aedes aegypti mosquito and other vectors of epidemiological significance. Vector surveillance and control at Port of Entry (PoE) is an essential activity for the implementation of IHR. Hence Entomological surveillance was done inside and the residential areas around Cochin International Airport during 2013 to 2019. Aedes larval indices in both inside and residential areas outside the airport were found to be below the critical level in all these years. However the study showed no Aedes positivity inside the airport during 2014, 2016, 2018 and 2019. Effectiveness of vector control measures implemented in and around the airport is deliberated.

The COVID-19 pandemic preparedness ... or lack thereof: from China to Italy.

COVID-19, that emerged in December 2019 in the city of Wuhan, China and is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a pandemic. Italy has become one of the largest epicentres outside Asia, accounting now for at least 80,539 infections (cumulative incidence of 95.9/100,000) and 8,165 deaths (case fatality rate 10.1%). It has seriously affected people above the age of 60 years. The International Health Regulations (IHR) revised in 2005 bind governments to disclose vital information regarding the identification and detection of new disease outbreaks regardless of its causative agent. In contrast to the previous SARS epidemic, China timely informed the world about the onset of a new outbreak. It also soon disclosed the clinical characteristics of patients with COVID-19. Unfortunately, despite the fast recognition of the Chinese epidemic, the application of the 2005 IHR was not followed by an effective response in every country and most health authorities failed to rapidly perceive the threat posed by COVID-19. To further complicate matters, IHR implementation, which relies primarily on self-reporting data rather than on an external review mechanism, was limited in speed and further hindered by high costs. The response in Italy suffered from several limitations within the health system and services. The action against this threat must instead be quick, firm and at the highest trans-national level. The solution lies in further strengthening countries' preparedness through a clear political commitment, mobilization of proper resources and implementation of a strict surveillance and monitoring process.

The Effect of Weather Variables on Mosquito Activity: A Snapshot of the Main Point of Entry of Cyprus.

Mosquitoes are vectors of pathogens, causing human and animal diseases. Their ability to adapt and expand worldwide increases spread of mosquito-borne diseases. Climate changes contribute in enhancing these “epidemic conditions”. Understanding the effect of weather variables on mosquito seasonality and host searching activity contributes towards risk control of the mosquito-borne disease outbreaks. To enable early detection of Aedes invasive species we developed a surveillance network for both invasive and native mosquitoes at the main point of entry for the first time in Cyprus. Mosquito sampling was carried out for one year (May 2017–June 2018), at bimonthly intervals around Limassol port. Morphological and molecular identification confirmed the presence of 5 species in the study region: Culex. pipiens, Aedes detritus, Ae. caspius, Culiseta longiareolata and Cs. annulata. No invasive Aedes mosquito species were detected. The Pearson’s correlation and multiple linear regression were used to compare number of sampled mosquitoes and weather variables for three most numerous species (Cx. pipiens, Ae. detritus and Ae. caspius). The population densities of the most numerous species were highest from February to April. Number of Cx. pipiens (−0.48), Ae. detritus (−0.40) and Ae. caspius (−0.38) specimens sampled was negatively correlated with average daily temperature. Monthly relative humidity showed positive correlation with the numbers of the species sampled, Cx. pipiens (0.66) Ae. detritus (0.68), and Ae. caspius (0.71). Mosquito abundance of Cx. pipiens (0.97) and Ae. detritus (0.98) was strongly correlated to seasonal precipitation as well. Our work is a stepping stone to further stimulate implementation of International Health Regulations and implementation of early warning surveillance system for detection of invasive Aedes mosquitoes, native mosquitoes and arboviruses they may transmit. A network for the surveillance of both invasive and native mosquito species at the main point of entry for the first time in Cyprus was developed. Number of mosquitoes sampled was correlated with weather factors to identify parameters that might predict mosquito activity and species distribution to the prevention of international spread of vector mosquitoes and vector-borne diseases.

Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016\u20132018

BackgroundEmerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018.MethodsWe abstracted data from several sources, including: the WHO African Region’s weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources.Data analysisWe used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5–9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports.ResultsOver 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis.ConclusionsThe frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.

Minimizing the risk of international spread of coronavirus disease 2019 (COVID-19) outbreak by targeting travelers

The Coronavirus Disease-2019 (COVID-19) outbreak has become a global health emergency owing to its magnitude, attributed deaths, and its propensity to spread across the world. In-fact, owing to its quick spread across international boundaries and the resulting caseload, the disease has been declared as a Public Health Emergency of International Concern on 30 January 2020. It is worth noting that out of the 395 cases detected in other nations, 165 (41.8%) have a positive history of travel to China. As of now, the World Health Organization has not recommended for any restrictions on the travel or trade aspects, but has clearly specified that implementation of International Health Regulations should be strictly done at the airports and seaports. In conclusion, the COVID- 19 outbreak has created an alarm across the globe as the causative virus is novel in nature. However, strengthening of standard infection control practices and adoption of preventive measures for travelers can significantly minimize the threat of further transmission of the disease.

Implementation of International Health Regulations in India

The International Health Regulations (IHR) is a worldwide legitimate instrument appropriate to all WHO part nations and came into power in 2007. The goal of the IHR is to forestall global spread of malady by empowering part nations experience limit working for early identification, revealing and taking control measures against any general wellbeing crises of worldwide concern. The advancement of general wellbeing framework for gathering IHR standards should enable India to build up its reconnaissance, reaction and readiness limits which would improve results of its general wellbeing projects and help contain flare-ups. The present analysis was made through random sampling method where the survey was taken from common public, professionals, etc. The sample size in the present analysis is 1895 samples, the independent variable is in the analysis is gender and the dependent variables is reliable on the statement.The research tools used in the present paper such as cross tabulation, chi-square and case summary and graphical representation was also used to analyse the study. The study found that India faces difficulties in gathering its developing requirements for prepared disease transmission experts of a restorative foundation, entomologists, nourishment investigators and other pro staff occupied with general wellbeing observation exercises. It can be concluded that India ought to likewise not be content with gathering fundamental IHR standards but rather ought to endeavor to accomplish propelled abilities allowing it to help its neighboring nations with restricted general wellbeing foundation in gathering their IHR objectives.

Monitoring global public health threat - surveillance of Aedes (Stegomyia) mosquitoes in new Mangalore sea port, India

Vector surveillance and control at port of entry (PoE) is an essential activity for the implementation of International Health Regulations (IHR). The present study was undertaken in and around New Mangalore sea port. Inside the port area, a total of 13 water holding containers at 33 premises were checked and no containers were found positive for larval breeding. In the residential area, 132 water holding containers were checked in 100 houses. The breeding preference ratio was highest for earthen containers (18.8) followed by grinding stone (4.72), metal (1.72), cement tank (1.62) and plastic (0.24). The House index, Container index and Breteau index were found to be 7.0, 5.3 and 7.0% respectively. The nearness of residential colony to NMPT, consequently enhances the chances of spreading of Aedes mosquitoes in the port area. From the present study it is evident that inside the sea port there are ample habitats for the mosquitoes to breed and thrive in rainy season. Routine entomological surveillance is required not only to monitor the mosquito breeding in and around port area but also to prevent transportation and establishment of mosquito species in newer areas.

Law and the JEE: Lessons for IHR Implementation.

In an increasingly globalized world, countries face infectious disease threats and public health emergencies that transcend borders, making health security of paramount importance. Legal frameworks, at both the international and national levels, can empower governments to strengthen public health and preparedness systems to better detect and respond to infectious disease threats and public health emergencies. The development of the International Health Regulations (IHR) (2005) and the Global Health Security Agenda (GHSA), and the resulting Joint External Evaluation (JEE), are examples of coordinated global efforts to build capacity to prevent, detect, and respond to the international spread of disease. This article uses 3 case studies to describe a role for law in IHR implementation. It highlights the Centers for Disease Control and Prevention's (CDC's) Global Health Security Public Health Law Project and describes how legal mapping data and the resources developed are being used by countries to strengthen health systems and support IHR implementation.

The International Health Regulations (2005): State of Implementation in Côte D&amp;apos;Ivoire in 2011

Cote d'Ivoire has decided to implement the International Health Regulations (IHR) (2005), which came into effect in June 2007. However, after a period of 5 years without the actual start, several observations have found deficiencies in the application of this legal instrument binding law. In collaboration with the World Health Organization (WHO), actions have been undertaken for its implementation. The purpose of this work was to assess the key minimum core capabilities required to prevent, detect early and respond to public health emergencies. A documentary review on the table took place from 01 to 09 December 2011 at the National Institute of Public Hygiene with all the sectors involved in the implementation of the IHR (2005). For this purpose following a sampling for convenience, An interview grouped by sub-themes made it possible to collect information from the questionnaire developed by WHO. The data collected was analyzed by highlighting the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the 13 components of the IHR. Confidentiality and anonymity have been respected in order to accelerate the implementation of the capacities of this Regulation. In this study with 51 sectors involved, the minimum required such as legislation, coordination and National Focal Point (NFP) communication represented respectively 50%, 73% and 57% regarding the entities rate of involvement in the implementation of the IHR. Human resources and monitoring were not developed (0%) unlike the laboratories (90%), the response to events represented (85%). In addition, other aspects are in the early stages of implementation to various degrees. The assessment of strengths, weaknesses, opportunities and threats revealed significant progress in some technical areas (preparedness, response) and many insufficiencies in the implementation of the IHR (2005). All this shows the degree of involvement of entities in the implementation of the IHR in Cote d’Ivoire. IHR implementation is an investment to ensure the safety and health of global and Ivorian populations.

Integrating laboratory networks, surveillance systems and public health institutes in Africa.

The Ebola outbreak in West Africa underlined the urgent need for integration of public health systems, including the establishment of national laboratory networks, surveillance systems, and health research institutions at all levels of service delivery. The integration schema presented here would assist in driving the immediate steps needed for integration of public health systems, particularly laboratory networks, in support of the implementation of International Health Regulations and the Global Health Security Agenda in the African region. Increased funding, political willingness from countries, and coordination through enhanced technical assistance from international partners, are critical in achieving this objective.

Contribution of Peru in initiatives to promote global health security

This article describes the concept of global health security and its development over time. It emphasizes the need to control challenges against global health such as those produced by biologic agents both natural and intentional. It presents world initiatives that have developed during the last two decades and the contribution of Peru to the Global Health Security Agenda (GHSA) and the Monitoring and Evaluation Framework. In order to accelerate the implementation of the International Health Regulations Peru has played an important role to accelerate the implementation of International Health Regulations (IHR), participating with a group of countries, World Health Organization (WHO), and GHSA in the creation of the Joint External Evaluation Tool (JEE).

Assessment of Core Capacities for the Implementation of International Health Regulations (2005) at selected Points of Entry (POEs). A case for Southern, Western and Lusaka Provinces of Zambia.

31Jul 2016 Assessment of Core Capacities for the Implementation of International Health Regulations (2005) at selected Points of Entry (POEs). A case for Southern, Western and Lusaka Provinces of Zambia. Emmanuel. H. Kooma , Jelita Chinyonga , Rose Chityaba Banda , Rose Mbita Nondo , Leornard Sakalunda , Trihest Muchaya and Hambuliino Chiiya. Ministry of Health Provincial Medical Office, Choma, Zambia. Ministry of Health District Medical Office, Livingstone, Zambia. Ministry of Health Harry Mwaanga Nkumbula International Airport Port Health Office, Zambia. Ministry of Health Victoria Falls Ground Crossing Port Health Office, Zambia.