Revised International Health Regulations Research Articles

The World Health Organization Legal Regimes and the Shaping of Nigeria’s Health Law and Policy

Global health governance concerns the collective responses needed within the public health community to effectively tackle the shared challenges arising in an increasingly connected world. It is a truism that promoting a robust health infrastructure is critical to the attainment of good health and wellbeing. Yet the legal infrastructure – the laws and policies that empower and obligate as well as limit government and private action concerning health, has been neglected in the mainstream literature. This is because health infrastructure has focused more on physical structures of public health agencies such as clinics, hospitals and the human resources that operate them. The purpose of the study was to explore the extent to which the World Health Organization legal regimes such as the Framework Convention on Tobacco Control (2003) and the Revised International Health Regulations, have impacted on health law and policy in Nigeria. It posits that the various conventions and regulations adopted, which were subsequently ratified and declared applicable to Nigeria, had been domesticated. However, the lack of respect for the rule of law has stymied the maximisation of the expected benefits from such legal regimes. It concludes that the World Health Organization should develop a programme for public health law capacity-building and policy surveillance to ensure continuous and organised efforts to assist member states including Nigeria to strengthen their legal infrastructure.

Exploring collective health security in a new age of pandemics. A review of Sara E. Davies’ Containing Contagion.

In Chapter Two, Davies walks the reader through the political context of Southeast Asia in relation to the management of infectious disease outbreaks In Chapter Five, Davies impressively surveys surveillance reports relating to the ASEAN states from 1996 to 2010, thereby tracking the changing performance in disease surveillance and response during this period In Chapter One, Davies provides a historical account of the negotiation and adoption in 2005 of the revised International Health Regulations (IHR), described as "a significant diplomatic coup for the WHO" (p 16) [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 )

Breaking State-Centric Shackles in the WHO: Taiwan as a Catalyst for a New Global Health Order

After World War II, states recognizing that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being” and “the health of all peoples is fundamental to the attainment of peace and security”, decided to establish the World Health Organization (WHO), with the aim of promoting and protecting health for all. Mindful of the fact that disease neither recognizes nor respects borders, the revised International Health Regulations (IHR) in 2005 reiterates the goal of the universal application “for the protection of all people of the world from the international spread of disease.” The WHO Framework Convention on Tobacco Control (FCTC), similarly, stands as an “evidence-based treaty that reaffirms the right of all people to the highest standard of health.” Such statements indicate an aspiration that the WHO’s normative work not just be about “a collection of nation states”, given the inherently global nature of public health affairs.Such aspiration embedded in global health governance introduces a paradox vis-à-vis the WHO’s state-centric institutional design, as evidenced and amplified by the COVID-19 crisis. The exclusion of Taiwan—which alerted the WHO of potential human-to-human transmission at the early stage and successfully guarded its people against the pandemic—is heatedly debated. Taiwan’s WHO participation presents a sharp contrast between its goal of health for all peoples, on one hand, and its outdated state-centric design and power politics, on the other. While scholars proposed the concept of “global health law” to reflect the erosion of sovereignty and encroachment of state powers due to globalization, the WHO continues to rest its institutional design on the assumption of states being the dominant actors of international (health) law, envisaging international health governance rather than global health governance. This state-centric view inevitably goes hand in hand with power struggles that undermine global health.Against this background, this paper aims to demonstrate how and why state-centric international health governance neither delivers its goal to “promote and protect the health of all peoples” nor accommodates the complexity of international politics, and to explore new venues allowing a pluralist membership structure that better serves the WHO’s promise. We proceed as follows. Part II analyzes challenges and constraints facing Taiwan’s participation in the WHO as a full member and as an observer under the existing institutional framework. Part III proposes an amendment to the WHO Constitution and maps a new contour of global health governance through the lens of the trans-governmental network. Part IV concludes.

Responding to COVID-19 pandemic: Why a strong health system is required.

Responding to COVID-19 pandemic: Why a strong health system is required.

Global Health Security Implementation: Expanding the Evidence Base.

Global Health Security Implementation: Expanding the Evidence Base.

Unprepared: Global Health in a Time of Emergency by Andrew Lakoff

Reviewed by: Unprepared: Global Health in a Time of Emergency by Andrew Lakoff Limor Samimian-Darash Andrew Lakoff. Unprepared: Global Health in a Time of Emergency. Oakland: University of California Press, 2017. 240 pp. $29.95. (978–0–52029–576–6). This book joins the recent literature that examines future intervention technologies and identifies a new modality of securing against “future threats” that goes beyond Foucauldian biopolitical security apparatuses. Preparedness within this framework involves multiple techniques emerging in response to the problem of potential uncertainty.1 One of the first works to present this approach was Andrew Lakoff and Stephen Collier’s edited volume on Biosecurity Interventions.2 In their introduction, the editors argued that preparedness combines elements of national security and population security and is directed toward reducing potential damage rather than preventing specific threats. Subsequent studies have also identified related governmental forms, variously termed “preparedness,”3 “anticipation,”4 “precaution,”5 “preemption,”6 “prudence,”7 “the politics of possibilities,”8 and “resilience.”9 The present book shows how a global health security assemblage consisting of diverse elements, experts, and technologies has established “preparedness” as its central governmental modality. It traces both the roots of preparedness from the end of the Cold War to the present and the emergence of this [End Page 723] assemblage, analyzing how relevant authorities—public health officials, national security experts, and life scientists—conceptualize and act on an encroaching future of disease emergence. Significantly, the book focuses not only on the changing mode of governing—the emergence of preparedness—but also on the diverse governmental technologies applied within this approach. If the problem has shifted from knowledge-dependent possibilities (accidents, risks), manageable by means of risk technology, to potential threats, what types of intervention technologies become possible? The book seeks neither to provide a manifesto for the importance of preparedness nor to criticize its failures. Instead, drawing on the perspective of historical ontology, it tracks the emergence of an unstable consolidation of global health security, posing the question: “How did the norm of preparedness come to structure expert thought and action concerning the future of infectious disease?” (p. 12). Each chapter draws on a different case study to explore how uncertain global health threats can be addressed and made into an object of present intervention, according to different and sometimes competitive rationalities, such as probability, and imaginative enactment, risk assessment, and preparedness. Chapter 1 presents the case of Hurricane Katrina (2005), focusing on how “contemporary authorities seek to manage potential future dangers . . . whose probability cannot be statistically calculated and whose potential consequences outstrip the capacities of existing prevention and mitigation measures (p. 8).” It distinguishes between two forms of thinking about and intervening on the dangerous future and its potential threats: as a regularly occurring event that can be calculated via probabilities (based on known historical patterns) and managed through risk distribution, or as an unprecedented, potentially catastrophic event whose consequences are to be managed through methods of imaginative enactment (enabling planners to mitigate vulnerabilities). Chapter 2 discusses the 1976 swine flu outbreak and the 2005 avian influenza threat in the United States, examining how techniques of emergency management migrated to and were implemented within U.S. public health. This “involved the composition of a new object of knowledge and intervention for public health: no longer, or not only, the population but also the infrastructure that underpins response to health emergencies” (p. 9). Chapter 3 discusses the controversy surrounding Indonesia’s refusal to provide the WHO with samples of a new strain of the H5N1 influenza virus. It examines how, from the early 2000s, public health preparedness was extended as a global strategy in relation to the threat of emerging disease, focusing on the development of the 2005 revised International Health Regulations that form part of the WHO’s strategy of “global public health security.” Here, an analytic distinction is made between two regimes for governing global health problems: global health security and humanitarian biomedicine. Chapter 4 examines the controversy over the WHO’s decision to declare a Public Health Emergency of International Concern over the 2009 swine flu (A\ H1N1) outbreak. It shows how decision instruments for guiding emergency interventions at the early stages...

Public Health Emergencies of International Concern: Global, Regional, and Local Responses to Risk.

The declaration in 2009 that the H1N1 pandemic constituted a public health emergency of international concern (PHEIC) was the first such declaration under the revised International Health Regulations that were adopted in 2005. In the period since then PHEIC have been declared in relation to polio, Ebola, and Zika. This article evaluates initiatives that have been introduced globally, within the Asia-Pacific region, and within Australia, to strengthen preparedness for public health emergencies. Through analysis of evolving conceptualisations of risk, surveillance of zoonotic diseases, and development of public health capacities, the article argues that to date the global community has failed to make the necessary investments in health system strengthening, and that without these investments, global public health emergencies will continue to be an ongoing challenge.

Implementation of the International Health Regulations (2005) Through Cooperative Bioengagement.

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program, the State Department’s Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public health capacities. This article examines the extent to which cooperative bioengagement projects address public health capacity building under the revised International Health Regulations and alignment with the Global Health Security Agenda action packages.

Revising the International Health Regulations: call for a 2017 review conference.

The revised International Health Regulations (IHR)1 entered into force on June 15, 2007, obligating (now) 196 States Parties to detect, assess, report, and respond to potential public health emergencies of international concern (PHEIC) at all levels of government, and to report such events rapidly to the WHO to determine whether a coordinated, global response is required. In the 8 years since its entry into force, there have been three declared PHEIC, including pandemic influenza H1N1 in 2009, re-emerging wild-type poliovirus in April, 2014, Ebola virus disease in west Africa in August, 2014, and the emergence of new diseases such as Middle East respiratory syndrome coronavirus and influenza H7N9, with still uncertain risks to global population health.

Comparing timeliness, content, and disease severity of formal and informal source outbreak reporting.

BackgroundInfectious disease surveillance has recently seen many changes including rapid growth of informal surveillance, acting both as competitor and a facilitator to traditional surveillance, as well as the implementation of the revised International Health Regulations. The present study aims to compare outbreak reporting by formal and informal sources given such changes in the field.Methods111 outbreaks identified from June to December 2012 were studied using first formal source report and first informal source report collected by HealthMap, an automated and curated aggregator of data sources for infectious disease surveillance. The outbreak reports were compared for timeliness, reported content, and disease severity.ResultsFormal source reports lagged behind informal source reports by a median of 1.26 days (p = 0.002). In 61% of the outbreaks studied, the same information was reported in the initial formal and informal reports. Disease severity had no significant effect on timeliness of reporting.ConclusionThe findings suggest that recent changes in the field of surveillance improved formal source reporting, particularly in the dimension of timeliness. Still, informal sources were found to report slightly faster and with accurate information. This study emphasizes the importance of utilizing both formal and informal sources for timely and accurate infectious disease outbreak surveillance.

Leveraging the laboratory response network model for the global health security agenda.

Promoting global health security as an international priority is a challenge; the US Centers for Disease Control and Prevention (CDC) in its Global Health Security Agenda has articulated the importance of accelerating progress toward a world safe and secure from infectious disease threats. The goals are to (1) prevent and reduce the likelihood of outbreaks-natural, accidental, or intentional; (2) detect threats early to save lives; and (3) respond rapidly and effectively using multisectoral, international coordination and communication. Foundational to this agenda is the World Health Organization (WHO) Revised International Health Regulations (IHR) of 2005, which provide the legal framework for countries to strengthen their health systems in order to be able to respond to any public health emergency of international concern. This article proposes leveraging the distributed structure of the US-managed Laboratory Response Network for Biological Threats Preparedness (LRN-B) to develop the core capacity of laboratory testing and to fulfill the laboratory-strengthening component of the Global Health Security Agenda. The LRN model offers an effective mechanism to detect and respond to public health emergencies of international concern.

Global health security agenda and the international health regulations: moving forward.

The launch of the Global Health Security Agenda (GHSA) in February 2014 capped over a decade of global efforts to develop new approaches to emerging and reemerging infectious diseases-part of the growing recognition that disease events, whether natural, accidental, or intentional, threaten not just public health, but national, regional, and global security interests. In 2005, the United States, along with other Member States of the World Health Organization (WHO), adopted the revised International Health Regulations [IHR (2005)]. The IHR (2005) conferred new responsibilities on WHO and the global health community to coordinate resources for capacity building and emergency response, and on the now-196 States Parties to develop the core capacities required to detect, assess, report, and respond to potential public health emergencies of international concern. Both GHSA and the IHR aim to elevate political attention and encourage participation, coordination, and collaboration by multiple stakeholders, while leveraging previously existing commitments and multilateral efforts. GHSA and the IHR (2005) are platforms for action; how efforts under each will complement each other remains unclear. Mechanisms that measure progress under these 2 overlapping frameworks will aid in focusing resources and in sustaining political momentum for IHR implementation after 2016.

The global health security agenda in an age of biosecurity.

Historically, the Oval Office has been a leader in global health assistance. From the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI) under the Bush Administration, to the Global Health Initiative launched by President Obama in 2009. However, unlike PEPFAR and PMI, the Global Health Initiative met an untimely end with the launch of a bold new global health measure by the Obama Administration: the Global Health Security Agenda (GHS Agenda). The GHS Agenda aims to “accelerate progress toward a world safe and secure from infectious disease threats” through a US-led diplomatic collaboration with 30 countries, international organizations, nongovernmental organizations, and public/private entities. The intertwining of global health and security follows a line of international agreements, including the revised International Health Regulations (2005), aimed at improving surveillance and response to public health emergencies of international concern. By mid-2012 however, only 22% of WHO member states had implemented the required core competencies. The GHS Agenda aims to address these global deficiencies in infectious disease preparedness. In doing so, the United States faces formidable obstacles including America’s lack of legal legitimacy in setting global norms, as well as the same domestic coordination difficulties that resulted in the dissolution of the Global Health Initiative, and the potential impediment of passing the President’s budget through a hostile Congress. While the securitization of global health has its criticisms, it also has the potential to be transformative, succeeding where international organizations have not always been able to, building a safer and healthier world.

China's position in negotiating the Framework Convention on Tobacco Control and the revised International Health Regulations

This paper examines China's position in the negotiations of the Framework Convention on Tobacco Control and the revised International Health Regulations. In particular, it explores three sets of factors shaping China's attitudes and actions in the negotiations: the aspiration to be a responsible power; concerns about sovereignty; and domestic political economy. In both cases, China demonstrated strong incentives to participate in the negotiation of legally binding international rules. Still, the sovereignty issue was a major, if not the biggest, concern for China when engaging in global health rule making. The two cases also reveal domestic political economy as an important factor in shaping China's position in international health negotiations.

IDSR as a Platform for Implementing IHR in African Countries

Of the 46 countries in the World Health Organization (WHO) African region (AFRO), 43 are implementing Integrated Disease Surveillance and Response (IDSR) guidelines to improve their abilities to detect, confirm, and respond to high-priority communicable and noncommunicable diseases. IDSR provides a framework for strengthening the surveillance, response, and laboratory core capacities required by the revised International Health Regulations [IHR (2005)]. In turn, IHR obligations can serve as a driving force to sustain national commitments to IDSR strategies. The ability to report potential public health events of international concern according to IHR (2005) relies on early warning systems founded in national surveillance capacities. Public health events reported through IDSR to the WHO Emergency Management System in Africa illustrate the growing capacities in African countries to detect, assess, and report infectious and noninfectious threats to public health. The IHR (2005) provide an opportunity to continue strengthening national IDSR systems so they can characterize outbreaks and respond to public health events in the region.

Between success and failure: Lee Jong-wook and the global health agenda

Between success and failure: Lee Jong-wook and the global health agenda

Building national public health capacity for managing chemical events: A case study of the development of health protection services in the United Kingdom

The revised International Health Regulations (2005) require that countries develop plans for chemical threats. In 2012, the World Health Assembly reported that most countries had not yet achieved ‘adequate capacity'. We review the evolution of chemical hazards services in the United Kingdom, the result of 15 years of grass-roots pressure and an accumulating weight of chemical incidents that eventually convinced the UK Department of Health of the need for a new national public health function, culminating, in 2003, in the creation of the Chemical Hazards Division of the new Health Protection Agency. Ten years later, public health services are again being radically reorganized with the creation of Public Health England, potentially destabilizing health protection arrangements and creating confusion among roles in managing chemical emergencies. Incorporating health protection into a broader public health organization, however, offers a new opportunity to broaden the scope of health protection services to embrace prevention of non-infectious environmental diseases.

Enhanced Surveillance for Detection and Management of Infectious Diseases: Regional Collaboration in the Middle East

Formed before international negotiations of the revised International Health Regulations (IHR), the Middle East Consortium for Infectious Disease Surveillance (MECIDS) is a regional collaboration aimed at facilitating implementation of the revised IHR and, more broadly, improving the detection and control of infectious disease outbreaks among neighboring countries in an area of continuous dispute. Initially focused on enhancing foodborne disease surveillance, MECIDS has expanded the scope of its work to also include avian and pandemic influenza and other emerging and re-emerging infectious diseases. Here, we describe the history and governance of MECIDS, highlighting key achievements over the consortium's seven-year history, and discuss the future of MECIDS.

Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

BackgroundEmerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness.MethodsAs components of its Suite for Automated Global bioSurveillance (SAGES) program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies.ResultsESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system.ConclusionsOpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations.

Costing Framework for International Health Regulations (2005)

The revised International Health Regulations (IHR [2005]) conferred new responsibilities on member states of the World Health Organization, requiring them to develop core capacities to detect, assess, report, and respond to public health emergencies. Many countries have not yet developed these capacities, and poor understanding of the associated costs have created a barrier to effectively marshaling assistance. To help national and international decision makers understand the inputs and associated costs of implementing the IHR (2005), we developed an IHR implementation strategy to serve as a framework for making preliminary estimates of fixed and operating costs associated with developing and sustaining IHR core capacities across an entire public health system. This tool lays the groundwork for modeling the costs of strengthening public health systems from the central to the peripheral level of an integrated health system, a key step in helping national health authorities define necessary actions and investments required for IHR compliance.