Role of the International Health Regulations and WHO during the Pandemics

I. Introduction

A pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on 31 December 2019³. This was the beginning of the greatest disease pandemic that this generation of human beings had ever seen. To say that this has impacted International relations in Himalayan Proportions is an understatement. This virus has soon spread to more than 200 countries with more than twenty lakh cases and close to one lakh eighty-thousand deaths⁴. It has in a sense overwhelmed the medical and public health infrastructure of even countries like the United States and Italy which could boast to having the some of the best hospitals and healthcare facilities in the world. This horrible pandemic has kicked into light an aspect of international that is not as fancy or glamorous as Trade or counter terrorism conventions. The International Health regulations or IHR 2005 as it is commonly known is an agreement between more than 196 countries most of whom are members of the World Health Organization to work towards global health security. The world health organisation which sits atop response to such pandemics had issued the IHR in the year 2005 to deal with such pandemics and the actions and regulations to be issued. This was built upon the International health regulation of 1969 with were considered incomplete in a sense for the 21^st century. WHO’s constitution lays out a detailed procedure that it has to follow in order to enact regulations-according to articles 21 and 22, WHO can enact or the World health assembly rather can enact regulations and enforce them without it being subject to ratification at the national level. The states however have an option to opt out subject to the wishes of their domestic government but this does not change the fact that the WHO has a position that is quite different than other world bodies. This shows enormous trust in technical rule-making fostered by experts, technocrats and diplomats. Consequently, it is all the more detrimental to its authority if the WHO is accused for acting, or failing to do so, due to reasons not strictly related to health⁵. Pursuant to this power granted to it, WHO has enacted the International Health regulations, the International sanitary regulations and the Nomenclature regulations. The IHR was, one could say updated after the outbreak of the SARS virus in 2002-03 after the world came to terms with the fact that the current regime would not suffice if they are to encounter similar pandemics in the future. In short, one can say that, The global community has a new legal framework to better manage its collective defences to detect disease events and to respond to public health risks and emergencies that can have devastating impacts on human health and economies. The successful implementation of the IHR (2005) by the countries that have agreed to be bound by them (States Parties) and WHO, will contribute significantly to enhancing national and global public health security. ⁶

II. International health regulations, 2005

The new International Health Regulations came into force in 2007 after its formulation in 2005. The importance of the IHR can’t be stressed enough as it is the sole binding legal instrument on a global level that is meant to the prevention and control of the international spread of disease. The most dramatic action under the IHR 2005 is the declaration by the WHO Director-General (DG), on the advice of an “emergency committee” composed of individual experts, of a “public health emergency of international concern” (PHEIC) and the consequential adoption of time-limited “temporary recommendations” of urgent measures to contain the outbreak domestically and control international spread.⁷ Countries around the world have an obligation to protect its citizens against enemies known and unknown. Growing scope of international conventions and covenants also fixes responsibility of member states to provide certain fundamental safeguards to guarantee a minimum standard of life and one can make the argument that protecting them against such pandemics also figures into it. This is where the IHR plays a crucial role. Such pandemics cause not only immediate loss of a home number of lives but its effects are felt for decades together in terms of changes in culture, social behaviour and the most important of all a country’s economy. Why this does is bring together countries both developing and developed onto a platform where they can effectively co-ordinate their response in need and defend by collaborating resources and necessary information. international fora have also recognised the importance of the IHR as a global framework, and have focused discussions among nations on IHR-related core capacities in meetings of the Biological and Toxin Weapons Convention, the Global Health Security Initiative, the North American Plan for Pandemic and Avian Influenza, the Convention on Biological Diversity, and United Nations Security Council Resolution 1540, in addition to debate at the World Health Assembly.⁸

III. Objectives and scope of ihr⁹:

1. State parties are required to notify to the World Health Organization a wide range of events based on certain predetermined criteria the event or events may cause a public health emergency of international concern

2. WHO is obliged to request verification of events that it detects through its surveillance equipment across states and the states are obliged to respond to those requests in a timely manner.

3. States are also obliged to raise concern or issue over significant evidence of an event that may be a public health emergency of international concern even if it is not within its territory.

4. Notifications and information are communicated by a National IHR Focal Point to a WHO IHR Contact Point which, together, establish a unique and effective communications network between countries and with WHO.

5. It is also necessary for state parties to ensure that their national health surveillance and response mechanisms meet certain functional criteria, the states also have a fixed time period to meet this condition.

6. Provisions with regard to routine public health measures for international traffic at points of entry (airports, ports and certain ground crossings) have been updated and certain minimum capacity requirements and are set out for international points of entry that have been designated by countries.

7. States Parties and WHO alike are required to report to the World Health Assembly on IHR implementation. To date, this requirement has been fulfilled through annual reporting by the WHO Secretariat to its governing bodies.

8. The IHR (2005) also set out procedures for certain rare but very serious events which are determined to constitute a public health emergency of international concern. Only the Director-General of WHO has the authority to make such a determination, but only after consultation with an Emergency Committee of external experts before issuing temporary recommendations for the application of appropriate health measures to prevent the international spread of disease and to avoid interference with international traffic.

IV. India

India is a signatory to the WHO’s International health regulations of 2005 and as per this regulation it is mandatory to have a dedicated Health Units present at International Airports. These health units should be available through the day and should have the capacity to undertake routine checks and specific measures during the period of public emergencies. India also strives to take up a leadership position because of its unique environment and geographical, which enables it neighbouring countries of South East Asian Region to develop core capacities in various controlling activities. Sone challenges India faces is The WHO recommends training in epidemiological skills for ‘compilation, analysis and interpretation of health data and initiation of timely and appropriate public health action’ which enables the correct application of the decision instrument for notification of PHIEC (core capacity 3 and 7). Since health is a state subject in India, the government of India has planned setting up of NCDC branches in the states through a decentralised process in order to enhance human resources for strengthening capacity for outbreak investigation, prevention and control of public health emergencies.¹⁰ There is a shortfall of trained epidemiologists in India, this could be equated by promoting inclusion of short field epidemiological training programs within course curriculum of MD Community Medicine programs. The Government should also promote vaccine development and research in order to reduce dependency on international partners in event of such pandemics. The IHR provides India with unique opportunities for improving the health status of its own population and contribute to betterment of global health but also posits challenges which must be overcome. India has very poor health indices with only 1 doctor per 1800 and just 1 hospital bed per 1000 population¹¹. The IHR thus provide India with an additional incentive for health system strengthening and capacity building efforts which also reduce the risk of over-stretching limited public health systems and permit their sustainable development. India should also consider commitment of resources to meet IHR requirements in its neighboring countries especially those with which it shares its borders wherever it is feasible by provision of technical expertise, training and material resources like medicines and bed nets. Strengthening of surveillance systems in India would help improve outputs related to several national health programs for control of HIV-AIDS, Vector borne diseases, etc.¹²

V. Conclusion

Even though the IHR implemented in 2007 was leaps and bounds ahead when compared to its earlier iteration in several areas like mechanisms to identify and respond, this does not translate into actual action on the ground. In 2012, only 42 nations (21%) reported that they had fully implemented the IHR and built appropriate core capacities to detect, assess, report, and respond to public health emergencies. With follow-up reporting in 2014, only 64 nations reported that they had fully implemented the IHR—an increase of only 10% over 2 years. The other 67% of nations either requested another 2-year extension (81) or reported nothing at all (48). This calls for introducing a stricter mechanism to ensure that member states implement the International Heath Regulations in letter and spirit and can secure the same wither by enacting UNGA resolutions, UNSC resolutions if the situation calls for it or international pressure exerted by certain other countries to secure due participation in preparedness as well as response infrastructure in case a pandemic were to break out. Failure of the global community to respond rapidly and effectively to the Ebola virus disease outbreak in west Africa demonstrates that there remains major implementation challenges, even beyond funding and political will¹³. It is time to consider whether or not aspects of the foundation for global health security embodied in the IHR are too vague, missing, or need to be strengthened in order for IHR to stay relevant and useful. It is imperative to ensure that these guidelines are understood properly and followed especially in countries developing countries as they would not have the same medical resources and infrastructure that could keep them on par with developed countries.