International Health Regulations Research Articles

A Delphi study to assess the effect of changes in language between the first and second editions of the WHO’s Joint External Evaluation

IntroductionCountries use the WHO Joint External Evaluation (JEE) tool—part of the WHO International Health Regulations (2005) Monitoring and Evaluation Framework—for voluntary evaluation of global health security (GHS) capacities. After releasing...

International Health Regulations and Role of State to Protect Health in India with Special Reference to International Health Regulation 2005: a Critical Study

The apt observation by the great philosopher of India, Mahatma Gadhi emphasizes the importance of health and healthy person. The health of any nation is dependent on health of individual and society. The protection of public health is responsibility of state. It ensures the physical and mental wellbeing of individual to enjoy the life to fullest extent. The ill health is root cause for many problems including dirt, disease, poverty etc. The right to health is one of the cherished rights recognized and protected at national and international level. It is responsibility of state to enable every individual to protect health of individual.. There are several international instruments provided for regulation of regulation of health of individual. The International Health Regulations 2005 is adopted by World Health Assembly. It specifically provides for responsibility of state to develop capacity to detect, protect and to respond the public health crisis and risks. It also requires the state to coordinate with WHO on any issue on concern on public health which may create danger to world health. The recent example of CORONA emerged as challenge before the public health which is tackled with coordination and cooperation The present research explores the international health regulation and duties of state with special reference to public health in India. The International treaties and pacts are binding on state once it is signed by state. The signatory state shall implement the obligations created by it. India is signatory to many instruments. This research further explored the laws and measures and health system provided by India for implementation of international health standard as provided by international health regulation. The research critically examined the loopholes in implementation of such regulations. The research concludes that IHR is crucial initiative by WHO to disease surveillance and prevent disease outbreak endangering world health. It suggests that government must strengthen public health system in coordination with organizations like WHO.

Shaping the future of AI in healthcare through ethics and governance

The purpose of this research is to identify and evaluate the technical, ethical and regulatory challenges related to the use of Artificial Intelligence (AI) in healthcare. The potential applications of AI in healthcare seem limitless and vary in their nature and scope, ranging from privacy, research, informed consent, patient autonomy, accountability, health equity, fairness, AI-based diagnostic algorithms to care management through automation for specific manual activities to reduce paperwork and human error. The main challenges faced by states in regulating the use of AI in healthcare were identified, especially the legal voids and complexities for adequate regulation and better transparency. A few recommendations were made to protect health data, mitigate risks and regulate more efficiently the use of AI in healthcare through international cooperation and the adoption of harmonized standards under the World Health Organization (WHO) in line with its constitutional mandate to regulate digital and public health. European Union (EU) law can serve as a model and guidance for the WHO for a reform of the International Health Regulations (IHR).

Pandemic treaty as an instrument to strengthen global health security: Global health diplomacy at its crux.

The World Health Assembly (WHA), on 1st December 2021, unanimously agreed to launch a global process to draft and negotiate a convention, agreement, or other international instrument under the World Health Organization's (WHO's) constitution to strengthen pandemic prevention, preparedness, and response. We aimed to explore the role of global health diplomacy (GHD) in pandemic treaty negotiations by providing deep insight into the ongoing drafting process under the WHO leadership. We conducted a narrative review by searching Scopus, Web of Sciences, PubMed, MEDLINE, and Google Scholar search engine using the keywords "Pandemic Treaty," OR "International Health Regulations," OR "International conventions," OR "International treaties" in the context of recent COVID-19 pandemic. Besides, we included articles recommending the need for GHD, leadership and governance mechanisms for this international treaty drafting approved by the WHA. Amid the COVID-19 pandemic, the concept of GHD bolstered the international system and remained high on the agendas of many national, regional and global platforms. As per Article 19 of the WHO constitution, the Assembly established an intergovernmental negotiating body (INB) to draft and negotiate this convention/ agreement to protect the world from disease outbreaks of pandemic potential. Since GHD has helped to strengthen international cooperation in health systems and address inequities in achieving health-related global targets, there is a great scope for the successful drafting of this pandemic treaty. The pandemic treaty is a defining moment in global health governance, particularly the pandemic governance reforms. However, the treaty's purpose will only be served if the equity considerations are optimized, accountability mechanisms are established, and a sense of shared responsibility is embraced. While fulfilling treaty commitments might be complex and challenging, it provides an opportunity to rethink and build resilient systems for pandemic preparedness and response in the future.

China’s Compliance to International Health Law and Its Implication to Global Health Security

The Covid 19 pandemic presented a defining challenge to public health and global security. The outbreak of the pandemic in China and its global implications raised persistent doubts of states’ compliance to international health laws. The pandemic therefore, provides an opportunity for us to ascertain the extent to which China adhered to the International Health Regulations. Though a great deal of experts have scrutinized Chinese public health policies in the aftermath of the pandemic, China’s compliance to the 2005 International Health Regulation and its implication to global health security remained unclear. The analysis is largely derived from the Global Health Security-GHS Index and other primary legal texts. The GHS Index represents the first comprehensive unit of measurement of global health security across 195 countries that are parties to the 2005 International Health Regulations. The outcome of the analysis exposed significant gaps in China’s compliance to international health laws. It also indicates that, though international health laws provide useful guidance to prevent, respond and manage pandemics, they are implemented in an ad hoc manner and generally have few tools at their disposal to enforce compliance. China’s failure to timely and adequately discharge its duties under the International Health Regulation prior to and in the wake of Covid 19 shows that the international community needs a new legal enforcement mechanism to ensure that states act promptly, transparently and effectively to protect the world’s population against pandemics. The challenge of a lack of statutory enforcement mechanism is insurmountable and it remains uncertain what the future holds for global health security. 

Evaluation of the International Health Regulations core capacities at designated points of entry in Liberia, December 2019

Evaluation of the International Health Regulations core capacities at designated points of entry in Liberia, December 2019

Intra-Action Review of Ethiopian’s Response to the COVID-19 Pandemic, July 2022

The COVID-19 pandemic has had an unprecedented impact on health, society, and the economy globally and in Ethiopia. The World Health Organization (WHO) recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 response. The International Health Regulations (2005) has recommended that countries share COVID-19 best practices and lessons learned with peer countries through IARs. Using WHO established methodology, we conducted the IAR of Ethiopian’s COVID-19 response from Hamle, 2021 to Hamle 2022. The review covered 11 thematic areas(pillars): (1)country-level coordination, planning and monitoring; (2) Regional coordination and risk communication and community engagement; (3) Vulnerable population, (4) Epi-surveillance, (5) laboratory, (6) Point of entry, (7) Case management and HBIC, (8) IPC, (9) MHPSS, (10) Admin section, (11) Digitalization. We held six focus group discussions with a variety of stakeholders from a range of government departments and non-governmental organizations. We used the results of the focus group discussions and other key findings from the IAR to formulate recommendations. The IAR identified key areas for improvement at national and subnational levels across all 11 pillars. Priority recommendations included improving multispectral coordination and monitoring of COVID-19 response plan indicators; strengthening implementation of public health response measures, including case detection, isolation, infection prevention and control, contact tracing; and improving data collection, analysis, and reporting to inform public health risk assessment and response. The IAR is a useful tool for reviewing progress and identifying areas to improve the COVID-19 response in real time and provides a means to share information on areas of need with COVID-19 response partners and contributes to International Health Regulations (2005) core capacity development.

Forum shifting in global health security.

Global health security is an increasingly complex regime. The failures of global governance and norms of cooperation during the coronavirus disease 2019 (COVID-19) pandemic and the re-entrenchment to nationalist policy-making have created impetus for new governance arrangements, institutions and policy development. These changes include amendments to the International health regulations (IHR), development of a pandemic convention or accord, convening of the High-Level Meeting on Pandemic Preparedness and Response, establishment of the Pandemic fund, and development of the medical countermeasures platform, among others. These various developments claim to be in synergy with each other, but understanding of regime complexes and forum shifting from international relations reveal the power dynamics which underlie these processes. I use these concepts to demonstrate how states are transferring negotiations from one institutional location to another in search of more favourable outcomes, or are creating strategic uncertainty within negotiations to avoid future accountability. I further highlight three risks posed by these developments: (i)an increasingly complex landscape for global health security; (ii)erosion of the World Health Organization's authority in global health security; and (iii)dominance of high-income state positions within these negotiations.

When the Background Looms Large over the Foreground: Medical Professionals, Diplomats, and Co-Managing SARS-CoV-2

Abstract The Public Health Emergency of International Concern (PHEIC) is the highest alert that the World Health Organization (WHO) can issue. Even though the International Health Regulations (IHR 2005) prescribe tight deadlines and an expeditious decision-making process to determine such a PHEIC, it took many weeks for the alert to be declared to counter the spread of SARS-CoV-2 (coronavirus). What explains the delay? Drawing from recent advances in the literature on international orders, our argument zooms in on the troubled relations between medical professionals and diplomats. Practices enacting a hierarchical relationship between the medical and diplomatic communities of practice (background) undermined crucial parts of the decision-making mechanism laid out in the IHR, which puts medical professionals in a strong position (foreground). This study contributes to a better understanding of PHEICs, global health governance, and, beyond this, to how actors employing different lenses to make sense of the world fail or succeed to manage crises together. Our findings also have important policy implications for discussions about a Pandemic Treaty.

Review of the state of art of Li-based inhibitors and coating technology for the corrosion protection of aluminium alloys

The quest for novel alternatives to hexavalent-chromium-based corrosion inhibitors is of utmost significance and urgency. Strict international health and safety regulations, due to growing concerns regarding the impact of hexavalent chromium on human health and the environment, have pushed the commercial introduction of many alternative inhibitor types, but the implementation of alternative active protective primers for structural parts in the aerospace industry is still pending. This endeavour has proven to be remarkably challenging, as the potential replacement coating types must meet numerous functional requirements encompassing cost-effectiveness and exceptional corrosion protection for intrinsically corrosion susceptible aerospace aluminium alloys. In recent years, considerable attention has been drawn to lithium salts as environmentally friendly corrosion inhibitors forming the basis for a novel active protective coating technology. The involvement of lithium ions has been shown to play a pivotal role in the conversion process of aluminium alloy surfaces by stabilizing the reaction products, thereby facilitating the gradual development of a protective layer with a multi-layered configuration, which exhibits considerable variability in morphology, depending on local chemical and electrochemical conditions. The versatility of the lithium-based corrosion protection extends to their application as corrosion inhibiting pigments in organic coatings or as a pre-treatment, directly forming conversion layers, thereby enhancing their practical implementation. However, previous chromate replacement reviews only introduced the promising outcomes provided by the lithium technology, omitting key details of its development and formation mechanism. This paper critically reviews and summarizes the studies conducted to date on lithium-based inhibitor technologies for the corrosion protection of aluminium alloys as well as topics to be investigated in the future.

Dental health in the shadows of global commitments: Addressing neglected priorities in lower middle-income countries.

I am writing to draw your attention to a serious concern that requires our attention around global health commitments: the frequently disregarded and undervalued dental reforms. In the realm of global health commitments, dental reforms are often ignored and underestimated. (1) Despite significant advancements in many other facets of health owing to these commitments, dental health remains marginalized within its sphere creating a glaring disparity, especially in lower middle-income countries where it’s a crucial concern.(2) Dental health has a significant impact on a person's quality of life in addition to preventing oral diseases. It has a significant impact on a person's quality of life, having an impact on their mental and physical well-being. Neglected oral health can affect speech, self-esteem, and psychosocial wellbeing as well as cause pain, infections, malnutrition, and systemic health problems.(3) The disruptive relationship between oral diseases and significant medical conditions like diabetes, cardiovascular disease, and adverse pregnancy outcomes emphasizes the complex relationship between dental health and overall health. Despite efforts to promote understanding, such as Universal Health Coverage (UHC) and the International Health Regulations (IHR), oral health is often disregarded in global discussion. Particularly in lower middle-income countries, oral health is neglected due to a lack of tailored interventions, which decreases its significance. A significant leap forward has been made with the recent World Health Organization (WHO) resolution that declares oral health a global priority and calls for its inclusion in national strategies. The WHO has acknowledged the need to address this problem immediately.(4) The challenge, however, is recognition into concrete, commitment-backed activities and specific interventions. The resolution has potential, but its effectiveness will be judged by the concrete measures taken to bridge the gaps. The Sustainable Development Goals (SDGs) offer a potential reference point for rectifying this gap. By integrating oral health in SDGs like Goal 3 on excellent health and well-being, a holistic approach may be taken. This integration could help bridge the gap between international commitments, raise the public's awareness of oral health, and foster tailored initiatives for dental reforms. ---Continue

A closer look at the international health regulations capacities in Lebanon: a mixed method study

BackgroundLebanon ratified the International Health Regulations (IHR) (2005) in 2007, and since then, it has been facing complex political deadlocks, financial deterioration, and infectious disease emergencies. We aimed to understand the IHR capacities’ scores of Lebanon in comparison to other countries, the IHR milestones and activities in Lebanon, the challenges of maintaining the IHR capacities, the refugee crisis's impact on the development of these capacities; and the possible recommendations to support the IHR performance in Lebanon.MethodsWe used a mixed-method design. The study combined the use of secondary data analysis of the 2020 State Party Self-Assessment Annual Report (SPAR) submissions and qualitative design using semi-structured interviews with key informants. Semi-structured interviews were conducted with nine key informants. The analysis of the data generated was based on inductive thematic analysis.ResultsAccording to SPAR, Lebanon had levels of 4 out of 5 (≤ 80%) in 2020 in the prevention, detection, response, enabling functions, and operational readiness capacities, pertaining that the country was functionally capable of dealing with various events at the national and subnational levels. Lebanon scored more than its neighboring countries, Syria, and Jordan, which have similar contexts of economic crises, emergencies, and refugee waves. Despite this high level of commitment to meeting IHR capacities, the qualitative findings demonstrated several gaps in IHR performance as resource shortage, governance, and political challenges. The study also showed contradictory results regarding the impact of refugees on IHR capacities. Some key informants agreed that the Syrian crisis had a positive impact, while others suggested the opposite. Whether refugees interfere with IHR development is still an area that needs further investigation.ConclusionThe study shows that urgent interventions are needed to strengthen the implementation of the IHR capacities in Lebanon. The study recommends 1) reconsidering the weight given to IHR capacities; 2) promoting governance to strengthen IHR compliance; 3) strengthening the multisectoral coordination mechanisms; 4) reinforcing risk communication strategies constantly; 5) mobilizing and advancing human resources at the central and sub-national levels; 6) ensuring sustainable financing; 7) integrating refugees and displaced persons in IHR framework and its assessment tools; 8) acknowledging risk mapping as a pre-requisite to a successful response; and 9) strengthening research on IHR capacities in Lebanon.

A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned

Uganda has been implementing the Global Health Security Agenda (GHSA) since 2015 to build its capacity according to World Health Organization (WHO) benchmarks on International Health Regulations capacities. The country remains prone to outbreaks, with more than 20 disease outbreaks reported in the past five years, including Ebola virus, Crimean-Congo haemorrhagic fever, Marburg haemorrhagic fever, measles, yellow fever, coronavirus disease 2019 (COVID-19), and cholera. Antimicrobial resistance (AMR) is an ongoing challenge. Uganda scored capacity level 3 on infection prevention and control (IPC) and antimicrobial stewardship (AMS) in the 2017 Joint External Evaluation (JEE) assessment. Identified gaps were being addressed after a self-assessment in 2021. This paper describes the technical assistance approaches provided to Uganda by the Medicines, Technologies, and Pharmaceutical Services Program, funded by the US Agency for International Development, and implemented by Management Sciences for Health. The program, through a One Health approach, supported systematic capacity strengthening based on the JEE’s capacity advancement framework for global health security, specifically relating to AMR. The program’s interventions impacted 32 WHO benchmark actions (7 for AMR multisectoral coordination, 16 for IPC, and 9 for AMS), contributing to Uganda’s strengthened GHSA capacity. Leveraging success built on the AMR platform, the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams. The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions, covering 45 districts and reaching 5,452 health workers at 858 health facilities.

Forming International Instrument Through One Health Approach for Health Justice

Covid-19 is the proof that human health depends on animal and environmental health, these objects have interlinked with each other and provide impact to each other. Therefore, since international instruments have been formed, it will need the approach which is able to present these objects as the concerns to reach the global understanding on how to deal with pandemic situations, this is introduced through the one health approach for health justice, because disparities in COVID-19 infections, disease outcomes, and access to healthcare were stark and linked not only to health care system discrimination and inequality, but also to inequity throughout society. The purpose of this research is to discuss the importance of one health for health justice as the concept and approach to form international instruments. The method of this research uses qualitative methods and uses normative legal research or library research includes research on legal principles and this presents indirect data through scientific articles and books of the library conducted and supported with secondary and tertiary data. The discussion illustrates that one health as the approach which recognizes human, health and environment have bound each other and interlinked. Therefore, this approach will introduce the integration of interdisciplinary and cross-sectoral cooperation such as health diplomacy as a forum for negotiation between various states. In the end it shows that everyone may play an important role as the actor to promote the health of the populace in the future, one health concern will focus on zoonotic diseases, antimicrobial resistance, and food security for the future pandemic treaty. Health diplomacy through WHO can make a forum for International Health Regulations (IHR) requiring countries to designate a National IHR Focal Point.

[The World Health Organization: Project of novels in the field of controlling international medical sanitary regulations].

The article considers draft of new edition of the International Health Regulations. The possible risks associated with changing of the document are evaluated from perspective of member countries, in whose territories occur or supposedly occur emergency situations in field of public health having international importance.

Maritime international trade and bioinvasions: A three‐year long survey of small mammals in Autonomous Port of Cotonou, Benin

Abstract International trade has been favouring the dissemination of a wide suite of invasive alien species. Upstream prevention through the monitoring of entry points is identified as an appropriate strategy to achieve control of bioinvasions and their consequences. Maritime transportation has been responsible for the introduction worldwide of exotic rodents that are major pests for crops and food stocks as well as reservoirs of many zoonotic pathogens. In order to limit further dissemination, the International Health Regulation constrains decisions makers and socio‐economic stakeholders to manage ship‐mediated import/export of rodents within seaports. Unfortunately, eco‐evolutionary insights into rodent introduction events that could guide preventive actions in seaports are very scarce. In order to bridge this gap, we here describe the results of a 3 year‐long survey of small mammals conducted in the Port of Cotonou, Benin. Our aim was to assess the spatiotemporal distribution, diversity and relative abundance of invasive and native rodents. 960 small mammal individuals were captured in nine within‐seaport sites. We found (i) a marked predominance of invasive species (84% of the individuals belonging to Mus musculus, Rattus rattus, R. norvegicus), (ii) with native species (i.e. Mastomys natalensis and the shrew Crocidura olivieri) essentially restricted to peripheral non‐industrial areas, as well as (iii) a fine‐scale spatial segregation stable over time between the invasive Norway rats and house mice on the one hand, and the black rats and shrews on the other hand. Furthermore, trapping before and after two successive rodent control campaigns indicates that they were ineffective and that subsequent rodent recolonisation occurred 6–12 months following intervention. Synthesis and applications. Our results are discussed in terms of ecological processes at play (e.g. interspecific interactions) and operational recommendations (e.g. assessment of proper eradication units, environmental modifications).

International health regulations and pre-travel health practices of international travelers at Nigerian airport: a cross-sectional study

BackgroundInternational Health Regulations (IHR) were developed by the World Health Organization (WHO) to curb the trans-border spread of epidemics. To our knowledge, no airport-based studies have assessed travelers’ health practices against a combination of diseases subject to IHR 2005. Therefore, we aimed to generate and describe the baseline travelers’ pre-travel health practices towards Cholera, Yellow Fever (YF), and Plague at Murtala Muhammed International Airport (MMIA) in Nigeria.MethodsA cross-sectional study was employed to collect data from 486 international travelers using a multistage sampling technique. Pre-travel health practices (a combination of pre-travel consultation, pre-travel vaccination, and preventive measures against insect bites) were assessed using an interviewer-administered questionnaire. Logistic regression models were used to estimates the association between selected variables and pre-travel health practices. Statistical significance level was set at 5%.ResultsA total of 479 complete questionnaires were analyzed. The median age of respondents was 34.0 years Interquartile range (IQR) = 28.0, 44.0). Of the total respondents, 311 (64.3%) were aware of pre-travel health consultation and sources of information, amongst others, including friends/relatives in 180 (37.6%) travelers, social media/internet in 155 (32.4%) travelers, and health professionals in 102 (21.3%) travelers. Two hundred and seventy-one (56.6%) had pre-travel consultation, 156 (32.6%) had YF vaccination, and 226 (47.2%) were prepared to use preventive measures against insect bites. Only 10.6% had good pre-travel practices against the diseases subject to 2 International Health Regulations (IHR). Travelers with bachelor/college degrees, when compared to those with secondary/high education, had 2.91 times higher odds of having good practices when adjusting for other factors (95% C.I: 1.10, 7.70; p < 0.03). Also, those traveling to destinations endemic for YF infection, when compared to those who are not traveling to endemic countries/areas, had 48% lower odds of having good practices after adjusting for other factors (95% C.I: 1.41, 7.77; p < 0.01).ConclusionsOur study revealed a low prevalence of good pre-travel health practices among participants. Educational level and endemicity of YF at the destination were predictors of pre-travel health practices. Introducing topics on travelers’ health into schools’ curriculums may have a ripple positive effect on health practices among international travelers. Also, there is a need for public enlightenment programs on pre-travel health practices using social media platforms.

International Law and the Crisis of COVID-19 on the International Security: A Case Study of Saudi Arabia

Purpose: This research aims to explore the role of Saudi Arabia in influencing the global system amid the COVID-19 pandemic, particularly examining its efforts in managing the crisis and its impact on international law and security.   Theoretical Framework: The study is anchored in the theoretical frameworks of international law and international security. It seeks to understand how these frameworks intersect with Saudi Arabia's response to the pandemic.   Method: Utilizing secondary research data, the study adopts a qualitative approach to analyze the phenomenon. It focuses on examining existing literature and data sources to derive insights into Saudi Arabia's pandemic response and its international implications.   Results and Conclusions: The findings reveal that international human rights law and the World Health Organization’s (WHO) health regulations significantly shaped Saudi Arabia’s response to the pandemic. The nation adhered to WHO guidelines, contributed funds to the WHO and regional countries, and implemented strong national policies. Additionally, Saudi Arabia made notable efforts in international security by de-escalating conflict with Yemen, in line with the UN secretary-general's ceasefire call. Collectively, these actions have positioned Saudi Arabia as a responsible state in the international community.   Research Implications: This study contributes to the broader understanding of state responses to global crises, highlighting the role of national policies and international cooperation. It offers insights into how countries like Saudi Arabia navigate complex challenges like a pandemic while balancing international obligations and national interests.   Originality/Value: This research is unique in its comprehensive analysis of Saudi Arabia's multifaceted response to the COVID-19 pandemic, encompassing aspects of international law, health regulations, and security measures. It provides a nuanced understanding of how a key Middle Eastern country has managed a global health crisis while also navigating its own economic transformation and regional geopolitical challenges.

World Pandemic Control in International Law: Through a Transboundary Harm Perspective

The current pandemic response system under the International Health Regulations has been considered unsatisfactory in controlling world pandemic outbreaks. Opinions are voiced that a legal evolution incorporating other sources of international law is imperative to meet the system’s primary deficiency: the uneven degree of State compliance with the ‘core capacity’ requirements. Against this background, this paper aims to examine the potential application of transboundary harm rules in world pandemic prevention, where existing treaty obligations are insufficient or ineffective in addressing future obstacles. By comparing their conceptual characters and legal elements, this paper seeks to reveal the inherent link between the two domains, which may further demonstrate an existing manifestation of transboundary harm rules as emerging customary international law in current pandemic prevention practice. Based on the structure of transboundary harm rules, this paper aims to provide an innovative legal framework that justifies the differentiated standards among States with uneven capacity and underlines the obligation of cooperation. Such a framework is designed to improve the level of States’ prevention and response towards future global health emergencies raised by world pandemics. Moreover, it hopes to provide practical ideas for formulating the new international instrument on pandemic prevention, which is currently being drafted by the Member States of the World Health Organization.

A Historic Moment in Global Health—“Futureproofing” the World Against Pandemics

This JAMA Forum discusses the International Health Regulations of the World Health Organization, political declarations of the United Nations, and a pandemic agreement proposed by the World Health Assembly and suggests 5 reforms that could improve pandemic prevention, preparedness, and response.