WORLD TRADE G/SPS/GEN/59
5March 1998
ORGANIZATION(98-0857)
Original: English Committee onSanitary andPhytosanitary Measures
THE REVISION OFTHE INTERNATIONAL HEALTH REGULATIONS (IHR)
Submission bytheWorld Health Organization
Division ofEmerging andOther Communicable Diseases Surveillance andControl
Background
1. Thecurrent International Health Regulations wereadopted bytheTwenty-second World Health
Assembly in1969, andwereamended in1973and1981. Theneedtoinspect andcontrol themovement
ofships andcargos toprevent thespread ofdisease dates fromasearly as1377, andtheInternational
SanitaryRegulations,adoptedbytheWorldHealthAssemblyin1951,wasthefirstomnibusinternational
legislation designed forthispurpose. TheIHRarebinding onallWHO Member States butone,and
theyareoften referenced innational public health andquarantine legislation. TheIHRdescribe the
obligations ofMember States regarding notifications fordisease outbreaks (currently limited tocholera,
yellow fever andplague); health organisation atfrontiers, andtherequired health documents forthe
international movement ofpersons, ships, aircraft andother conveyances.
2. TheIHRarebeing revised inaccordance withWHO resolution WHA 48.7, adopted in1995.
Thepurpose oftherevision istoadapt theRegulations tothepresent volume ofinternational traffic
andtrade andtakeaccount ofcurrent trends intheepidemiology ofcommunicable diseases, including
emerging andreemerging disease threats.
WHO Position
3. BoththeWorld Trade Organization Sanitary andPhytosanitary Measures Agreement (SPS)
andtheWorldHealthOrganizationInternationalHealthRegulations(IHR)arecommittedtotheprinciple
ofprotecting health while interfering aslittleaspossible withinternational trade. Potential strengthening
ofeachofthese documents through mutual acceptance andacknowledgement must beexplored.
4. Therevised draft oftheInternational Health Regulations specifically references the
SPSAgreement indraftArticle 48,(January 1998), which states: "Theprovisions oftheseRegulations
donotprejudice therights andobligations oftheparties bound bytheWorld Trade Organization
Agreement onSanitary andPhytosanitary Measures which came intoforce on1January 1995 orany
subsequent amendment tothatAgreement". TheSPSAgreement, however, doesnotreference the
International Health Regulations, nordoesitrecognize thecapacity oftheWorld Health Organization
toprovide dispute resolution forpublic health matters between Member States oftheWHO (draft IHR
Article 56). Therecognition ofthiscapacity asareference intheSPSAgreement would provide a
natural anduseful linkage between these documents andprovide acredible andconsistent focus for
health riskassessment forMember State disputes.
Progress ontheIHRRevision
5. Agroup ofinternational consultants metinDecember 1995andconsidered methods toimprove
theutility andeffectiveness oftheRegulations inviewofthepublic health andeconomic consequencesG/SPS/GEN/59
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ofrecentoutbreaksofinfectiousdiseasesofinternationalimportance.Theydeterminedthattheprinciples
upon which theRegulations arebased remain valid butthatsignificant revisions would berequired
tomeetcurrent andfuture challenges posed byinfectious disease threats. Theconsultation proposed
thattheRegulations should provide fortheimmediate reporting ofanumber ofdefined clinical
syndromes. Thiswould facilitate therapid recognition andreporting ofoutbreaks ofneworunusual
infectious diseases. Immediate notification ofsyndromes would normally befollowed laterbyareport
onthespecific disease involved afterconfirmation ofthediagnosis. Byexpediting thenotification
ofsyndromes, international awareness ofrapidly evolving infectious disease threats would beimproved.
AnothermajorrecommendationwasthattheRegulationsshouldberevisedtoincludeprovisionsdesigned
tolimitorprevent theintroduction ofinappropriate orunnecessary control measures thatcould affect
international trade andtransportation.
6. Thegovernments ofallMember States were invited todesignate anofficial focal point for
liaison withWHO ontheIHRrevision. Over 80Member States havenowdoneso.Allpotentially
interested IGOs andNGOs werealsoinvited todesignate focalpoints forthispurpose andseveral have
doneso.
7. Toassist theCommittee inpreparing therevised IHR, asmall working group wassetupto
advise ontheprovisions tobeincluded intherevised IHR,inthelightoftheprincipal recommendations
oftheconsultation inDecember 1995. Thecomposition oftheworking group wasbased ontheneed
forexpertise inpublic health andquarantine matters, disease surveillance, international cooperation
inpublic health, communicable diseases including foodborne diseases andvector control, aswellas
legalexpertise andexperience intheapplication andadministration oftheexisting IHR.
8. Theinformal working group ofexperts mettwice in1996and3times in1997andformulated
theconcepts onwhich therevised IHRwillbebased andonthestructure oftheIHRdocument. In
renewing theIHR, theoriginal fundamental principle -toensure maximum security against the
internationalspreadofdiseaseswithminimuminterferencewithworldtrafficandtrade-willberetained.
Furthermore, many ofthepublic health provisions ofthecurrent IHRwhich remain validatthepresent
time, willbeincluded intherevised IHR. However, important changes areproposed under therevised
IHR, involving anewapproach tomandatory notification aswellasamajor alteration inthestructure
oftheIHR, asfollows:
(a) Notification
Inaccordance withrecommendations from theconsultation inDecember 1995, the
revised IHRwillrequire immediate reporting ofanumber ofdefined clinical syndromes that
areofinternational importance. Thiswillfacilitate timely notification, which would normally
befollowed byspecific disease reporting oncethediagnosis hasbeenconfirmed. Itwillalso
provide forreporting ofdisease outbreaks ofunknown origin where apotential hazard to
international travel ortradeisobserved. Thesyndromes, which willbenotifiable onlywhere
aninternational public health threat isinvolved, include acute haemorrhagic fever, acute
respiratory, acute diarrhoeal, acute jaundice andacute neurological syndromes aswellasa
category covering other undefined syndromes ofpresumed infectious origin. Theprecise
definition ofthesyndromes, toensure appropriate levels ofsensitivity andspecificity for
reporting purposes, isthesubject ofinternational consultation atthepresent time.G/SPS/GEN/59
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(b) Structure oftherevised IHR
Theproposed structure fortherevised IHRwilltaketheform of:
- aframework document containing (i)general principles andobligations on
appropriate public health measures and(ii)legal provisions relating tothe
operation andamendment ofIHRandincorporating byreference thetechnical
annexes (seebelow); and
- aseries ofannexes describing technical provisions andspecific requirements,
which -because ofthereference intheframework parttotheannexes -will
form anintegral partofIHR.
9. Inaddition,therewillbeoperationalguidelinestoaccompanyIHRandassistintheirapplication.
Thus, theIHRframework willstipulate appropriate measures thatshould betaken, forexample, for
themanagement andcontrol ofsyndromes ordiseases subject totheRegulations; toeliminate orreduce
animal hosts orvectors ofdisease nearairports, ports andcontainer terminals; todisinsect aircraft
leaving anairport inanareawhere mosquito-borne disease occurs using internationally approved
procedures. Inallsuchinstances, thetechnical details ofthemeasures tobetaken willbedescribed
infullintheannexes. Theannexes willbesubject toregular review andwillbeupdated asnecessary.
Thisnewstructure fortheIHRwillprovide basic regulations ofageneric nature which should remain
valid formany years. Atthesame time, thespecific public health measures contained intheannexes
could bemodified rapidly according tochanging needs andnewknowledge. Theintention istoensure
longevity oftheIHRtogether withadaptability ofthespecific technical provisions. Itisenvisaged
that,iftheWorld Health Assembly agrees todelegate totheExecutive Board oftheWorld Health
Organization thenecessary authority, theannexes could berevised upon approval oftheExecutive
Board afterhaving beenconsidered bytheCommittee onInternational Surveillance ofCommunicable
Diseases orother appropriate expert committee.
10. Animportant parallel totherevised textwillbeamove toamore collaborative response to
significant outbreaks, where allkeypartners willbelinked toadecision andrecommendation process.
11. Theprovisional drafttextoftherevised IHRwasdistributed inFebruary 1998 toMember
States, other IGOs andNGOs andtothemembers oftheCommittee onInternational Surveillance of
Communicable Diseases. Thesyndromic approach tonotification isbeing evaluated inapilotstudy
inalimited number ofselected countries ineachWHO region. Information seminars were heldin
eachregion fortheparticipating countries inOctober-November 1997 andseveral country visits by
WHO staffwerealsoarranged. ThedraftIHRwillberevised inlightoftheexperience gained during
thepilotstudy. Information from thisstudy willbecomplemented byaretrospective evaluation of
outbreak reports received byWHO (EMC).
12. TheCommittee onInternational Surveillance ofCommunicable Diseases willbeconvened to
finalize thetextaftercompletion ofthepilotstudy andanynecessary revision ofthedraftIHR. A
meeting oftheCommittee isplanned totakeplace in1998anditsrecommendations submitted tothe
World Health Assembly in1999. Progress reports arepublished every sixmonths intheWeekly
Epidemiological Record .
13. Further information ontherevision oftheIHRcanbeobtained bywriting toWHO-EMC,
attention Dr.L.J.Martinez, Room 6022, Avenue Appia 20,Geneva 27,Switzerland, orby
E-mail: Martinezlj@who.ch.
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