EXECUTIVE BOARD 132nd session Provisional agenda item 8.1
EB132/15 Add.1 14 December 2012
Implementation of the International Health Regulations (2005) Report by the Director-General
CRITERIA FOR EXTENSIONS IN 2014 1. The International Health Regulations (2005) set out a time frame within which States Parties are to “develop, strengthen and maintain” the national core capacities described in Annex 1 of the Regulations. For the great majority of States Parties the target date to achieve this was 15 June 2012. The Regulations also provide for extensions to the target date and more than 100 States Parties have requested two-year extensions. 2. Under the International Health Regulations (2005), an additional extension may be requested for a period not exceeding two years. It is anticipated that this will be sought by a significant number of countries after the expiry of the first two-year extension in 2014. According to the Regulations, this request is granted by the Director-General in exceptional circumstances and when the request is supported by a new implementation plan. In this connection, resolution WHA65.23 requests the Director-General “to develop and publish the criteria to be used in 2014 by the Director-General (…) when making decisions about the granting of any further extensions”. 3. The criteria proposed by the Secretariat are reported to the Executive Board in this Addendum in order that Member States have adequate foreknowledge of the criteria to be used when considering future extension requests and to provide an opportunity for Member States to obtain advice and direction. In proposing these criteria the Secretariat seeks to ensure that obstacles to any States’ full participation in the Regulations are not being created. At the same time, the aim is to provide a concrete incentive to ensure that the national capacities on which Global Health Security relies are indeed present throughout the world.
CRITERIA PROPOSED BY THE SECRETARIAT 4. Based on the requirements stated in the Regulations, the first criterion proposed by the Secretariat is that a State Party makes a formal request in writing to the Director-General at least four months in advance of the target date (which for most countries is 15 June 2014). This request must include a statement explaining the exceptional circumstances that have prevented the development and maintenance of the national International Health Regulations (2005) capacities.
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5. Secondly any such request must be accompanied by a new implementation plan that includes the following elements: (1) a clear and specific identification of those capacity elements that are missing or inadequate; (2) a description of the activities and progress made in establishing those capacities up until that date; (3) a set of proposed actions that will be undertaken and a specified time frame to ensure the capacities are present; and (4) an estimation of the technical support and financial resources required to implement these activities; the proportion of these resources that will be invested from national budgets; and the extent of any external support required. ACTION BY THE EXECUTIVE BOARD 6. The Executive Board is invited to take note of this report.
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EXECUTIVE BOARD 132nd session Provisional agenda item 8.1
EB132/15 21 December 2012
Implementation of the International Health Regulations (2005) Report by the Director-General 1. The primary focus of this report is to provide an update on progress made in taking forward the recommendations of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009,1 as requested in resolution WHA64.1. This report also takes into account information provided by States Parties on the implementation of the Regulations and describes the Secretariat’s related support activities, in line with the annual reporting mechanism established under resolution WHA61.2. In addition, it contains sections on the proposed monitoring of national core capacities and the development of criteria for future extensions, as requested in resolution WHA65.23.
RECOMMENDATIONS OF THE REVIEW COMMITTEE Recommendation 1 (Accelerate implementation of core capacities required by the IHR) 2. In order to take forward this country-led recommendation, the Secretariat, at all levels of the Organization and in line with existing, revised or adapted regional strategies and mechanisms, has intensified its support to States Parties and has been able to attract some donor interest and targeted funding for this purpose in a number of key fields related to the International Health Regulations (2005). 3. The Secretariat has continued its substantial efforts in support of States Parties, both in terms of technical cooperation and the provision of advice. In addition, a significant degree of support in relation to the International Health Regulations (2005) has been directed towards human resources development. This has been provided by means of training on implementation of the Regulations undertaken in several key areas, including the following: points of entry, laboratory strengthening, biosafety and biosecurity, field epidemiology, implementation in national legislation, together with the assessment, management and communication of risk. These training initiatives have been made possible as part of a concerted effort to develop extensive guidance materials in each of these key areas, including their translation into other official languages of the Organization. 4. With regard to implementation of the Regulations at points of entry, missions to assess country capacity have been conducted in the African, Eastern Mediterranean and Western Pacific regions. Consultations, training meetings and workshops have been held to further develop competencies and guidance. These efforts, which have included the provision of toolkits, have covered the inspection of ships, the issuance of ship sanitation certificates and the management of public health events occurring on ships and in air travel. 1
See document A64/10.
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5. In the area of laboratory strengthening, the Secretariat’s activities have included joint implementation, together with FAO and OIE, of the IDENTIFY project. This project strives to strengthen laboratory capacities for detecting pathogens that are a threat to human and animal health in regions where the risk of emerging human and/or animal diseases is highest, such as the Congo basin in central Africa and countries in southern and South-East Asia. Capacity building takes the form of direct support to individual institutions, support to governments to provide a suitable regulatory framework and support for the development and strengthening of laboratory networks within and across the public health and animal health sectors. In the context of the Pandemic Influenza Preparedness Framework, special attention has been given to building influenza surveillance and laboratory capacity in developing countries (see also Recommendations 11 and 14 below). In addition, support continues to be provided for the implementation of systems for laboratory biorisk management at the national level, including through training for trainers. Most recently, in the Eastern Mediterranean Region, two subregional meetings were held on laboratory capacities in line with the requirements of the International Health Regulations (2005). 6. In the specific area of implementation of the Regulations in national legislation, in the past 12 months the Secretariat has supported and conducted six subregional workshops involving the African Region, the Region of the Americas, European Region and the Eastern Mediterranean Region. The workshops were designed to provide countries with the necessary tools and guidance to assess and, where necessary, revise existing national legislation in order to further facilitate the full and efficient implementation of the Regulations. Support in this area has also been provided through country-specific missions and other means of communications, including teleconferences, IT-supported interactive sessions and individual exchanges with countries on specific legal issues. 7. Many of these training initiatives and workshops have involved the use of table top exercises. The public health scenarios that are explored in this way develop the relevant staff competencies for implementation of the Regulations, reinforce understanding of organizational roles and obligations, test plans and procedures and foster cooperation, coordination and information-sharing between sectors, administrative levels, organizations and agencies. These exercises have been conducted at the national and regional levels in a number of WHO regions. 8. In addition, the global training course on the International Health Regulations (2005) received a positive independent external evaluation in September 2012 and continued to generate a high level of interest among national public health professionals. The course is in the process of being adapted to the regional context, including through the translation of key course materials into the Russian language. 9. The Secretariat has continued to strengthen its ties and intensify collaboration with other international organizations and agencies (i) to accelerate the establishment of core capacities under the Regulations, and (ii) to enhance the response to public health events. This cooperation includes work with the following: ICAO, especially through the ICAO’s Cooperative Arrangement for the Prevention of Spread of Communicable disease through Air Travel; IAEA, in response to the continuing after-effects of the emergency at the Fukushima nuclear plant in Japan; and other joint initiatives, including one with UNICEF in the area of behavioural and social interventions. The Secretariat has continued to provide significant support to the strengthening, assessment and planning of national core capacities development under the Regulations. In support of this effort, which has involved States Parties in the African, South-East Asia, European and Eastern Mediterranean regions, the Secretariat has undertaken assessment missions and desk audits to identify gaps and facilitate countries’ work (i) to draw up action plans and (ii) to implement those plans over the next two years.
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10. Subregional cooperation initiatives, including surveillance networks and economic integration mechanisms, have continued to be important partners in tailoring approaches to meeting the core capacity requirements so that they match the context of specific groups of States Parties ‒ for example, those in the Pacific setting. 11. In order to provide new impetus for implementation activities, the Secretariat has been conducting regional meetings of stakeholders in the WHO regions. These meetings bring together participants from the subregional, regional and global levels ‒ stakeholders, partners and traditional and non-traditional donors ‒ in order to support implementation of the International Health Regulations (2005), providing a forum for sharing details of experiences and challenges. The meetings highlight the important work that has been done and the achievements recorded since the Regulations entered into force and the specific priority areas for strengthening national core capacities. The meetings also serve to reinforce the roles and responsibilities of national, regional and global partners in improving and maintaining core capacities, in providing technical and financial support and in fostering intersectoral collaboration within countries and collaboration between countries. During the meetings, gaps, vulnerabilities and priorities are mapped, as well as existing partner and network support. The meetings are an opportunity to advocate further for the strengthening of capacities under the Regulations and to generate technical, bilateral and funding support. With two exceptions, the stakeholders meetings are scheduled to have taken place before the end of 2012. The meeting for States Parties in the European Region is planned for early 2013 in order to coincide with a related meeting organized by the European Union. Such coordination will further foster cooperation between the European Union and WHO as well as provide efficiency savings for States Parties and the Organization.
Recommendation 2 (Enhance the WHO Event Information Site) 12. The Event Information Site for National IHR Focal Points began operating on 15 June 2007. In Recommendation 2, the Review Committee advised the Secretariat that it should enhance the Event Information Site to make it an authoritative resource for disseminating reliable, up-to-date and readily accessible international epidemic information. The Review Committee’s view was that States Parties should be able to rely on the Site as a primary source of information on epidemiological status, risk assessment, and response measures. Following the recommendations of the Review Committee and the results of the Event Information Site user survey, the Secretariat elaborated the criteria for the redesign of the Site with the aim of allowing for timely information-sharing of more comprehensive event-related information.1 Work to develop the Site is under way with the release date scheduled for the first quarter of 2013. The new Site will use upgraded underlying technology, allowing it to adapt more readily to future requirements. The new Site will be easier to use, will have more powerful search capabilities and will enable the Organization to expand the information available to users about ongoing public health events. The new technology will set the foundation for new features to be deployed rapidly in evolving situations. Following the launch, the Secretariat will seek regular feedback from users of the Site in order to guide future phases of improvement work. In parallel to the technology update, the Secretariat is working to increase the volume of event-related information communicated through the Site. The risk assessment process has been refined and standardized to ensure that the high quality of information products can be maintained over time and across all acute public health events.
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See document A65/17.
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Recommendation 3 (Reinforce evidence-based decisions on international travel and trade) 13. In late 2009 and early 2010, WHO was involved in preparing and conducting a survey on public health measures taken at international borders during the early stages of pandemic (H1N1) 2009. The results, and an analysis thereof, were published in the WHO’s Weekly Epidemiological Record in May 2010.1 14. Following the extensive review of the current and historical evidence for areas at risk of yellow fever transmission, undertaken by a WHO-led informal working group, countries where the strength of existing evidence remains questionable have been encouraged and supported to design and implement new studies in order better to define the level of risk. The Secretariat has published guidelines for testing the efficacy of insecticide products used in aircraft,2 with the aim of harmonizing testing procedures to allow objective comparisons to be made between different products. 15. Building on experience acquired during pandemic (H1N1) 2009, the Secretariat has been monitoring reports of travel and trade measures applied during major public health events and emergencies, including the following: the nuclear emergency at Fukushima, the outbreak in Europe of Escherichia coli in 2011 and certain outbreaks of viral haemorrhagic fever in Africa in 2012. In a few instances, where reported measures could be perceived as excessive, national authorities have been contacted by the Secretariat to confirm the implementation of these measures and requested to reconsider, as appropriate. The Secretariat is currently preparing standard operating procedures for monitoring international travel and trade measures during public health events and emergencies. It is anticipated that a first draft of the procedures will be available by early 2013.
Recommendation 4 (Ensure necessary authority and resources for all National IHR Focal Points) 16. The Review Committee concluded in its report that some National IHR Focal Points lack the authority to communicate information related to public health emergencies to WHO in a timely manner; its recommendation to strengthen the role of the Focal Points was primarily directed to States Parties. The Secretariat is undertaking a number of activities to complement and support States in following up on this recommendation. In order to increase awareness and understanding of the critical role played by a country’s Focal Point, it is planned to produce a short video and brochure tailored to high-level officials and non-health sectors of government, explaining the National IHR Focal Point function and the Review Committee’s findings. On the basis of the findings of external studies of the process for assessment and notification of public health events by Focal Points, a web-based tutorial for notification assessment under the International Health Regulations (2005) is being developed. The tutorial will invite all Focal Points to work through the steps of the assessment process for a number of fictitious event scenarios. Focal Points will subsequently be provided with the responses proposed by an expert panel, as well as the relevant explanations, and will have opportunities for discussion. New scenarios will be published at regular intervals on a continuing basis. Finally, it is planned to hold a technical consultation on event notification, verification and exchange of event information under the Regulations with the aim of revising the WHO’s guidance to deal with the concerns raised in the Review Committee’s report.
1 Public health measures taken at international borders during early stages of pandemic influenza (H1N1) 2009: preliminary results. Weekly Epidemiological Record 2010; 85: 186–194. Available at http://www.who.int/wer/2010/ wer8521.pdf (accessed 27 November 2012). 2
Guidelines for testing the efficacy of insecticide products used in aircraft. Geneva, World Health Organization, 2012.
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Recommendation 5 (Strengthen WHO’s internal capacity for sustained response) 17. The Secretariat’s work to operationalize the Emergency Response Framework was given impetus by the Executive Board in January 2012 and the Health Assembly in May 2012.1 The Framework clarifies WHO’s roles and responsibilities in emergency response in order to provide a common approach for WHO’s work across all emergencies, including natural disasters, conflict, disease outbreaks, food contamination, chemical spills or radionuclear incidents. The Framework further provides an overarching organizational policy structure to take forward this recommendation.2 18. In December 2011, the Secretariat reorganized its structures in respect of the following key Regulations-related functions at headquarters: (1) alert and response operations; (2) technical support for the development of national core capacities for implementing the Regulations; and (3) the assessment and monitoring of progress in implementing and applying the Regulations. The technical teams responsible for carrying out these functions maintain headquarters’ capacity to detect the public health risks posed by epidemics and other threats, to assess those risks, to communicate information about them, and to mount an appropriate response. These teams continue to coordinate closely with technical programmes on specific health hazards, including infectious diseases, zoonoses and threats to food safety or environmental health. The Secretariat coordinates the response to such risks at all levels of the Organization. This effort takes the form of risk assessment, communications, operations, logistics and technical support; as necessary, it can also involve cooperation with technical partners from the Global Outbreak Alert and Response Network.
Recommendation 6 (Improve practices for appointment of an Emergency Committee) 19. The Secretariat’s conflict of interest policy for experts was significantly revised in July 2010, before the Review Committee had presented its findings. As experience is gained in the application of this revised policy, it will be reviewed for further improvement and refinement. With a view to further strengthening the procedures for appointing members of future Emergency Committees, a new personal information form was developed that requires experts being considered for placement on the International Health Regulations (2005) Roster of Experts to disclose information that allows the Secretariat to make an initial high-level assessment of conflict of interest. This requirement was applied to all candidates under consideration for appointment to the Roster, as well as to those already included on the Roster. All personal information forms are reviewed by the Secretariat and follow-up action is taken, as appropriate. Any information that might constitute evidence of the existence of a conflict of interest is included in the database for the Roster. It is important to underscore that prior to the appointment of an expert from the Roster to any Committee under the Regulations, a more detailed conflict of interest assessment is undertaken that takes into account the mandate of the relevant Committee. 20. The Roster has been revised in order to broaden the spectrum of expertise among future Emergency Committee members. Eleven new areas of expertise have been added and a number of existing categories have been subdivided to provide increased specificity. As a result, the total number of areas of expertise has been increased from 53 in 2009 to 76 in 2012. The details of the Secretariat’s technical focal points for the various categories of expertise have been updated and new nominations of experts for both existing and new areas of expertise are continuing. Geographical and gender balance are now systematically reviewed in respect of experts under each category, which has led to new nominations for some of the categories. As a result, some 200 new experts have been put forward since the Review Committee made its recommendations. 1 2
See resolutions EB130.R14 and WHA65.20. See also document EB132/42 Add.1, progress report H.
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Recommendation 7 (Revise pandemic preparedness guidance) 21. The Secretariat is currently revising its pandemic influenza preparedness and response guidance. The new guidance will be based on a multisectoral, all-hazards risk-management approach and will include generic components essential to all public health emergencies, while also maintaining influenza specificity. A discussion paper on pandemic influenza phases has been produced in order to be shared with States Parties and other stakeholders. In addition, a further paper is now available to form the basis of a dialogue with stakeholders on the essential components of health emergency risk management. A multidisciplinary management team is in place to oversee the project and ensure that the guidance takes account of cross-cutting issues, that it maintains a “whole-of-society” approach, and that it genuinely reflects the requirements of non-health sectors.
Recommendation 8 (Develop and apply measures to assess severity) 22. Gauging the severity of an influenza pandemic ‒ a critical component of overall pandemic risk assessment ‒ is an important consideration for the Secretariat and its Member States in planning for and responding to the next pandemic. In rethinking an approach to pandemic severity, WHO has considered lessons learnt during the 2009 (H1N1) pandemic. WHO faced many challenges in assessing the severity of the pandemic at the global level. Four major difficulties were identified: (1) reliable data were not available in the first four to six weeks, even from countries with well-developed health infrastructures; (2) not all countries, and in particular those with fewer resources, have national systems for laboratory and disease surveillance of influenza; (3) factors not related to disease affected the calculation of indicator variables (e.g. hospitalization rates were strongly influenced by national protocols, making comparisons between countries difficult); and (4) communication about the severity of the pandemic was an overarching consideration as multiple audiences, including the general public, scientists and policy-makers, had to be accommodated. A new approach to assess pandemic severity in the future has been developed to provide the best description of the event using available information, often from disparate settings, and to provide information that will help hitherto unaffected countries respond to the pandemic when it occurs. The new severity framework, which includes a basket of indicators with an agreed list of data-sets, will be proposed for testing during seasonal influenza outbreaks in a variety of settings before its finalization.
Recommendation 9 (Streamline management of guidance documents) 23. WHO’s Guidelines Review Committee sets the standards for guidance documents, supports technical teams in their development, ensures consistency across the Organization, and oversees clearance. During the last two years the Committee’s membership has been expanded in order to be strengthened; this has included the direct participation of WHO regional offices. These changes have enabled the WHO Handbook for Guideline Development to be revised, updated and published.1 To strengthen the use of evidence in WHO guidance documents, the Cochrane Collaboration has been admitted into official relations with WHO.2 With regard to dissemination of information products in public health emergencies, in 2011 the Secretariat established a dedicated team, under the leadership of an experienced medical editorial manager, to facilitate the development of timely relevant information products from the relevant technical programmes. The team supports these programmes with the planning, editing and clearance of publications, and will be an integral element of the Secretariat’s involvement in public health emergencies. WHO handbook for guideline development. Geneva, World Health Organization, 2012. Available at http://www.who.int/kms/guidelines_review_committee/en/ (accessed on 28 November 2012). 2 1
Resolution EB128.R16.
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Recommendation 10 (Develop and implement a strategic, Organization-wide communications policy) 24. The global communications strategy, which is based on the results of the 2012 stakeholder perception survey, is currently being developed in consultation with regional communications offices. Regional communications strategies are also in various stages of development. These will be integrated into the global strategy before final review begins. As part of its development of standard operating procedures for emergency communications, the Secretariat has carried out a qualitative analysis, including more than 30 interviews with experts both inside the Organization and beyond, in order to identify lessons learnt and determine ways of improving communications in future emergencies. A first draft of the standard operating procedures has now been prepared. The Secretariat is working with technical teams to ensure they are in line with the Emergency Response Framework. In this connection, an Emergency Communications Network has been created to pre-train communications experts for all communications in emergencies, both within WHO offices and in the field, when needed. The development of brand standards to harmonize the content, form and style of communications across the Organization began with the 2012 perception survey and will be a priority project for the period 2013‒2014. With regard to web communications, the Organization has taken steps to modify its process to ensure a more systematic tracking of revisions to web pages. In a new feature, currently being introduced, web pages that are no longer being updated and that have been archived will be marked. Finally, a dedicated, proactive, social media team has been put in place by headquarters to serve as the front line for intelligence-gathering, dissemination of information and reputation management.
Recommendation 11 (Encourage advance agreements for vaccine distribution and delivery) 25. Resolution WHA64.5 requested the Director-General, inter alia, to implement the Pandemic Influenza Preparedness Framework1 and to report on progress on a biennial basis. The first such report is to be submitted to the Sixty-sixth World Health Assembly in 2013, through the Executive Board at its 132nd session.2 It includes information on advance agreements for vaccine distribution and delivery.
Recommendation 12 (Establish a more extensive global, public-health reserve workforce) 26. The Review Committee report recognized that the Global Outbreak Alert and Response Network serves as the primary mechanism for the Secretariat to support Member States during public health events, and that the Network is used to coordinate international response with technical institutions. The Review Committee further indicated that WHO’s capacity to prepare and respond in a sustained way to any public-health emergency is severely limited by chronic funding shortfalls. The Steering Committee of the Network considered the Review Committee’s recommendations, together with the findings of an independent evaluation of the Network’s performance. Working groups were set up to perform the following functions: strengthen capacity to coordinate and respond to large-scale events and emergencies; support regional leadership and capacity to respond to requests from Member States for support with outbreak preparedness and response; develop procedures for specific diseases and threats; and support preparedness and training in outbreak response. WHO has conducted regional meetings, training courses, and workshops to develop regional response capacities, and engage additional technical institutions and partners in the Global Outbreak Alert and Response Network. In order to ensure that appropriate experts are available for the assessment of, and response to, public health events, communications and coordination between the Network and technical networks have been strengthened. The networks concerned include, field epidemiology training programmes and 1 2
See also Recommendation 14. Document EB132/17.
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networks, the Global Infection Prevention and Control Network, the WHO Emerging and Dangerous Pathogens Laboratory Network, the ePORTUGUÊSe network, International Food Safety Authorities Network (INFOSAN), and the FAO/OIE Crisis Management Centre for Animal Health. WHO has coordinated the support and international deployment of partners in the Global Outbreak Alert and Response Network, together with experts in major outbreak responses and emergencies, including viral haemorrhagic fever outbreaks, and major cholera and dengue outbreaks.
Recommendation 13 (Create a contingency fund for public-health emergencies) 27. In response to this recommendation, the Secretariat has carried out an exercise to map existing contingency funds for public-health emergencies within WHO, and an analysis of lessons learnt in the area of funding. On the basis of this assessment, a proposal was presented to the Executive Board at its 130th session in January 2012.1 The proposal concerned the creation of a contingency fund to strengthen the Organization’s response to outbreaks and to ensure that response teams can be operational quickly. During the discussions, Board members were in general supportive of the concept of establishing a contingency fund, and suggested that consideration be given to establishing a reserve for outbreaks within future programme budgets, starting with the Programme budget 2014‒2015.2
Recommendation 14 (Reach agreement on sharing of viruses and access to vaccines and other benefits) 28. In May 2011, the Health Assembly adopted resolution WHA64.5, Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits. In the resolution the Health Assembly adopted the Pandemic Influenza Preparedness Framework.
Recommendation 15 (Pursue comprehensive influenza research and evaluation programme) 29. In November 2009, more than 90 researchers, donors, public health and policy officials from 35 countries joined forces with the Secretariat to develop a proposed research agenda in order that knowledge gained could improve public health decision-making for prevention and control of influenza. This research agenda is structured around the following five public health needs: (1) to reduce the risk of emergence of pandemic influenza; (2) to limit the spread of epidemic/pandemic influenza; (3) to minimize the impact of seasonal and pandemic influenza; (4) to optimize the treatment of patients with influenza; and (5) to promote the application of modern public health tools. In November 2011, a review of the progress was undertaken to: (i) collate the knowledge and progress attained since the launch of the agenda; (ii) interpret or apply the knowledge for improved influenza prevention and control; and (iii) highlight remaining gaps and revise recommendations, as required. Twenty academic groups performed literature reviews on a selection of key areas of research of the agenda. More than 4000 scientific papers have been published since 2009 and some of the research gaps identified at the early stage of the pandemic are about to be filled.
MONITORING IMPLEMENTATION OF THE REGULATIONS 30. In 2012, States Parties have continued to provide information on implementation of the Regulations, using both the format proposed by the Secretariat for the submission of the States Parties’ annual report and corresponding tools based on a monitoring framework developed by the Organization to address the national capacity requirements set out in Annex 1 of the Regulations. The annual reporting 1 2
See document EB130/5 Add.6. See summary records of the Executive Board at its 130th session, seventh and ninth meetings.
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process involves assessing the development of eight core capacities, as well as capacities at points of entry, and capacities to respond to four relevant types of hazard (zoonotic, food safety, chemical and radiological). The 2012 self-assessment questionnaire, sent to States Parties between March and November 2012, has so far elicited 99 responses, representing 51% of the 195 States Parties. It is to be anticipated that further responses will be received and will be included in the report provided to the Sixty-sixth World Health Assembly. The data showed States Parties making fair progress for a number of core capacities, notably those for surveillance (with a global average score of 81%), response (78%), and zoonotic events (81%). On the other hand, States Parties reported relatively low capacities for human resources (with a global average of 54%), chemical events (53%) and radiological events (53%). The Annex to the present document shows the capacity scores by WHO region of all States Parties that have submitted a completed questionnaire in 2012 prior to the finalization of this report. 31. As discussed below, the initial deadline for establishing national core capacities to ensure public health surveillance and response throughout their territory and public health capacity at designated Points of Entry was 15 June 2012 for most States Parties. Since then, 106 States Parties have obtained a two-year extension. In this context, pursuant to the relevant paragraphs of resolution WHA65.23, the Secretariat is drafting a document to propose different options for monitoring progress of work to develop core capacities under the Regulations and to satisfy related reporting requirements during the period 2013‒2014. This document takes into account the fact that reporting may vary depending on whether or not a State Party has obtained an extension. The document will be shared with National IHR Focal Points for information and implementation. The monitoring options and reporting requirements will take effect in 2013.
EXTENSION REQUESTS IN 2012 32. States Parties to the International Health Regulations (2005) have undertaken to develop, strengthen and maintain a number of functional capacities described in Annex 1 of the Regulations within five years of the entry into force of the Regulations, which for the majority of countries was on 15 June 2007. States Parties unable to fully complete this work by that time can avail themselves of an extension of the period for a further two years upon submitting a request to WHO accompanied by an implementation plan. In order to support countries requiring an extension, the Secretariat wrote to all States Parties in September 2011, reminding them of the June 2012 deadline and proposing procedures to facilitate decision-making on the submission of any subsequent request. Further reminders were sent in January and May 2012. As at 3 December 2012, a total of 107 States Parties had obtained extensions to the deadline and a further 12 States Parties had submitted requests but had not yet provided the necessary implementation plan. Of the 75 States Parties that had not requested an extension, 40 had positively indicated that they did not need an extension to the time period. The Secretariat is working with the remaining 35 States Parties to ensure that they do not miss the opportunity of obtaining an extension through oversight.
CRITERIA FOR EXTENSIONS IN 2014 33. Although the States Parties were the main actors and decision-makers in the extension process in 2012, the International Health Regulations (2005) give the Director-General very specific roles with respect to further extensions in 2014. These roles include taking decisions about granting extensions at that time and obtaining the advice of a Review Committee set up under the Regulations. Resolution WHA65.23 requests the Director-General, inter alia, “to develop and publish the criteria to be used in 2014 by the Director-General (…) when making decisions about the granting of any further extensions”, and it is clearly important for States Parties to know about and have the opportunity to discuss these criteria well in advance of their application in 2014.
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34. Before making proposals for relevant and useful criteria, it is necessary first to consider the objectives of the capacity obligations in the International Health Regulations (2005) and the timetable that accompanies them. The purpose of these provisions is to ensure a minimum capacity to prevent, detect and respond to a range of public health events in all countries and territories of the world. The aim is not only to achieve the widest possible population coverage, it is also to ensure that there are no significant gaps at national level, as these have the potential to threaten the health security of all countries in the world. This interdependency of the States Parties highlights the need both to keep all States Parties within the framework of the Regulations and to provide support and incentives for those countries not able to achieve the capacity requirements within the anticipated time frame. With this in mind, the criteria developed should not introduce hurdles that hinder States Parties’ ability to obtain extensions; rather, they should justify the continued efforts of all States Parties and international actors to focus support on those countries that face the greatest obstacles in meeting requirements under the Regulations in relation to core capacities. 35. The Secretariat is undertaking a process of internal consultation in order to identify appropriate criteria that can then be provided to the Executive Board for its consideration in an addendum to this report.1 These criteria will support the identification of factors that have impeded the establishment of the capacities up until 2014, but also the recognition of efforts to implement the Regulations made in good faith and of countries’ commitment to global and regional implementation activities. 36. The Secretariat intends to provide the final criteria to all States Parties in its report to the Sixty-sixth World Health Assembly. As part of this effort, the Secretariat would welcome any guidance the Executive Board can offer on the nature and content of the proposed criteria as well as on the procedures for their finalization and application.
CONCLUSION 37. The Review Committee’s report and recommendations have played an important role in shaping the Secretariat’s work, both in terms of the implementation of the International Health Regulations (2005) and the preparations for future influenza pandemics. While the value of the Regulations to countries and to the Secretariat continues to be demonstrated during the management of acute public health events, such as the recent identification of illness associated with a novel coronavirus, at the same time the extension procedures have kept international attention on the establishment of the national capacities. At a time of global economic crisis, when rapid progress is challenged by limitations in technical, human and financial resources, the Regulations remain a focus for commitment to maintain and improve global public health security.
ACTION BY THE EXECUTIVE BOARD 38. The Executive Board is invited to take note of this report.
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Document EB132/15 Add.1.
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ANNEX Table. International Health Regulations (2005): national capacity monitoring. Capacity scores for all reporting States Parties for 2012 African Region State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic communications resources of entry Food safety Chemical Radiological
Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Côte d’Ivoire Democratic Republic of the Congo Equatorial Guinea Eritrea Ethiopia 11 Gabon 100 83 85 58 100 25 56 100 77 70 100 26 75 63 60 100 53 60 58 30
Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 43 86 20 100 76 90 9 29 56 100 27 47 8 15 8 15 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 71 60 66 67 89 67 54 54 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available EB132/15 Data for 2012 not yet available 86 100 100 36 100 73 69 69 Data for 2012 not yet available
12 State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic communications resources of entry Food safety Chemical Radiological
EB132/15
Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone South Africa Swaziland 75 73 50 94 80 0 0 0 36 53 20 55 70 95 34 35 71 0 30 0 0 83 70 94 30 0 20 35 6 0 50 90 75 77 70 50 53 80 65 50
Data for 2012 not yet available 43 40 51 31 78 47 31 31 Data for 2012 not yet available Data for 2012 not yet available 57 40 65 55 89 80 46 46 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 0 43 0 100 35 91 3 85 100 33 13 20 46 8 46 8 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 14 0 0 100 0 0 40 40 22 66 86 90 12 39 40 33 56 22 78 100 27 40 53 60 0 31 46 92 0 31 46 92
Data for 2012 not yet available Annex Data for 2012 not yet available
Annex
State Party
Legislation Coordination Surveillance Response Preparedness
Risk Human Laboratory Points Zoonotic communications resources of entry
Food safety
Chemical Radiological
Togo Uganda United Republic of Tanzania Zambia Zimbabwe Total 38 57 73 63 49 0 83 95 94 100 25 70 75 58 60
Data for 2012 not yet available 71 40 86 0 67 53 8 8
Data for 2012 not yet available 71 49 80 47 96 73 24 33 100 76 93 50 77 38 77 36
Data for 2012 not yet available
Region of the Americas State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic communications resources of entry Food safety Chemical Radiological
Antigua and Barbuda Argentina Bahamas Barbados Belize Bolivia (Plurinational State of) Brazil Canada Chile Colombia Costa Rica 13
100 50 50 25
66 73 40 36
95 80 95 85
70 83 66 76
60 100 40 10
43 86 86 71
100 100 80 40
66 73 96 77
77 n/a 97 58
89 67 100 78
80 60 93 67
62 69 54 8
62 69 54 8
Data for 2012 not yet available
Data for 2012 not yet available Data for 2012 not yet available 100 100 83 73 100 70 100 65 100 50 100 86 100 80 100 90 94 97 100 33 100 80 100 62 100 EB132/15 62 Data for 2012 not yet available Data for 2012 not yet available
14 State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic communications resources of entry Food safety Chemical Radiological
EB132/15
Cuba Dominica Dominican Republic Ecuador El Salvador Grenada Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname 0 0 73 46 80 75 65 60 50 10 50 73 100 100 90 0 75 50 75 100 56 90 83 66 83 35 100 90 85 80 47 100 52 76 94 20 50 0 20 90
Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 43 71 57 86 71 20 100 0 100 80 35 100 41 91 100 45 97 64 38 50 56 67 100 89 100 60 73 67 47 67 38 46 23 62 62 38 46 23 62 62
Data for 2012 not yet available Data for 2012 not yet available 86 0 90 91 100 93 54 54 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 29 0 20 0 43 81 12 41 67 100 40 40 15 0 15 0
Data for 2012 not yet available Annex
Annex
State Party
Legislation Coordination Surveillance Response Preparedness
Risk Human Laboratory Points Zoonotic communications resources of entry
Food safety
Chemical Radiological
Trinidad and Tobago United States of America Uruguay Venezuela (Bolivarian Republic of) Total
50
56
80
76
50
71
0
77
74
89
87
46
46
Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 55 66 83 75 49 66 55 77 67 82 70 47 32
Argentina had submitted the report using the MERCOSUR tool, subsequently migrating data from the relevant sections to the format proposed by WHO as per the agreement with the UNASUR Technical Working Group for Surveillance and Response.
South-East Asia Region State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic communications resources of entry Food safety Chemical Radiological
Bangladesh Bhutan Democratic People’s Republic of Korea India Indonesia Maldives Myanmar Nepal 15 75 75 90 66 100 35 100 52 100 40 100 46 85 76 80 25 46 70 65 60
Data for 2012 not yet available Data for 2012 not yet available 71 40 65 21 78 60 15 15
Data for 2012 not yet available 100 100 29 80 100 20 96 70 60 77 91 65 100 100 44 87 100 60 85 38 0 85 38 0 Data for 2012 not yet available EB132/15
16 State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic communications resources of entry Food safety Chemical Radiological
EB132/15
Sri Lanka Thailand TimorLeste Total
100 100 50 75
63 90 46 64
100 85 50 75
83 94 58 75
50 90 20 63
86 71 57 73
80 80 40 63
71 100 37 71
88 74 58 68
100 89 67 83
87 93 93 83
23 31 0 27
23 31 0 39
European Region State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic Food Chemical Radiological communications resources of safety entry
Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland
75 75 75
30 90 90
65 85 95
37 94 100
40 100 100
100
80
65
72
50
Data for 2012 not yet available 14 0 86 80 100 80 Data for 2012 not yet available Data for 2012 not yet available 100 60 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available
25 75 91
0 97 91
44 100 100
73 87 100
0 92 92
0 92 92
91
70
89
100
92
92
100
83
100
100
90
86
60
100
88
100
100
100
100
100
100
100
100
80
Data for 2012 not yet available Data for 2012 not yet available 100 80
Annex
96
97
100
100
100
100
Annex
State Party
Legislation Coordination Surveillance Response Preparedness
Risk Human Laboratory Points Zoonotic Food Chemical Radiological communications resources of safety entry
France Georgia Germany Greece Holy See Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Liechtenstein Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation
100 100 100
63 100 100
95 100 100
94 100 94
80 100 80
100 100
50 100
80 75
65 83
60 100
100 100 100 100 75 25 100 100
53 66 83 100 63 100 100 100
70 80 85 100 70 75 100 95
76 94 55 71 83 59 94 100
90 100 70 60 60 70 70 100
86 60 100 100 100 100 Data for 2012 not yet available Data for 2012 not yet available 71 60 71 20 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 43 100 Data for 2012 not yet available 71 20 Data for 2012 not yet available 100 20 Data for 2012 not yet available 57 0 71 20 57 20 86 0 100 40 Data for 2012 not yet available Data for 2012 not yet available 57 20
96 91 100
22 66 27
78 100 100
93 67 100
92 62 100
92 62 100
91 77
92 74
100 100
93 100
92 54
92 54
96 96 87 79 57 77 86 100
97 59 94 28 75 9 77 97
89 100 100 100 0 56 89 100
100 100 100 100 100 80 100 100
100 92 100 54 69 31 100 85
100 92 100 54 69 31 100 85
100
83
95
88
40
66
85
89
67
69
69 EB132/15
Data for 2012 not yet available Data for 2012 not yet available
17
18 State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic Food Chemical Radiological communications resources of safety entry
EB132/15
San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom of Great Britain and Northern Ireland Uzbekistan Total
100 100 100 100 100 100
100 30 83 100 100 90
100 85 95 95 90 95
89 55 94 100 100 83
90 40 100 100 100 90
Data for 2012 not yet available Data for 2012 not yet available 100 40 14 20 43 60 100 80 86 20 100 20 Data for 2012 not yet available
86 43 81 100 100 34
9 41 96 88 22 5
89 100 100 100 100 100
100 87 93 100 93 80
77 69 92 100 100 77
77 69 92 100 100 77
75
100
65
94
70
57 100 Data for 2012 not yet available Data for 2012 not yet available
100
62
89
80
69
69
Data provided in a format that could not be included in the analysis
93
83
87
84
79
Data for 2012 not yet available 76 47
82
62
89
92
80
85
Annex
Annex
Eastern Mediterranean Region State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic Food Chemical Radiological communications resources of safety entry
Afghanistan Bahrain Djibouti Egypt Iran (Islamic Republic of) Iraq Jordan Kuwait Lebanon Libya Morocco Oman Pakistan Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen Total 19
0 100 50 75 100
36 100 36 83 90
80 100 45 90 100
47 94 52 94 94
0 70 0 80 80
43 86 57 86 86
20 20 60 80 100
26 86 29 86 100
3 100 50 100 91
56 78 56 89 100
13 93 67 73 100
0 85 8 77 77
0 85 8 77 77
100
100
65
94
90
100
100
95
100
100
0 50 75
56 53 100
85 70 85
64 58 48
60 20 40
Data for 2012 not yet available Data for 2012 not yet available 100 60 Data for 2012 not yet available Data for 2012 not yet available 100 100 Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available Data for 2012 not yet available 14 40 29 43 60 80
100
89
100
80
0
0
86
83
100
100
38
38
49 96 49
18 42 60
100 67 89
7 87 73
15 46 31
15 46 31
Data for 2012 not yet available 65 75 82 74 54 Data for 2012 not yet available 64 62 EB132/15 71 64 84 69 38 51
20
EB132/15
Western Pacific Region State Party Legislation Coordination Surveillance Response Preparedness Risk Human Laboratory Points Zoonotic Food Chemical Radiological communications resources of safety entry
Australia Brunei Darussalam Cambodia China Cook Islands Fiji Japan Kiribati Lao People’s Democratic Republic Malaysia Marshall Islands Micronesia (Federated States of) Mongolia Nauru New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea
100 50 50 100 100 75 100 100 50 100 75 100 100 100 25 100 0 25 100
100 63 56 100 90 36 100 100 36 100 60 83 100 90 20 70 73 100 100
95 90 95 100 100 50 100 100 75 100 75 75 55 100 55 100 80 100 100
94 94 65 94 100 94 87 100 40 100 94 83 76 100 71 100 76 100 100
100 70 20 100 100 40 100 100 10 100 90 80 50 100 40 90 50 100 100
100 57 43 100 100 0 100 100 14 100 86 100
100 60 40 100 60 20 100 0 60 100 40 20
100 71 57 87 96 86 100 56 31 100 37 73 73 86 67 96 66 57 100
100 81 72 24 100 46 94 24 0 97 12 91 97 97 72 80 41 31 100
100 100 89 44 100 0 100 89 44 100 0 56 100 100 67 100 44 33 100
100 93 40 93 100 60 100 80 40 100 20 87 33 100 53 100 47 47 100
100 15 15 77 77 54 100 0 0 100 0 38 46 85 8 100 0 100 100
100 15 15 77 77 54 100 0 0 100 0 38 46 85 8 100 0 100 Annex 100
71 40 Data for 2012 not yet available 100 100 57 0 100 80 86 86 100 40 100 100
Annex
State Party
Legislation Coordination Surveillance Response Preparedness
Risk Human Laboratory Points Zoonotic Food Chemical Radiological communications resources of safety entry
Samoa Singapore Solomon Islands Tonga Tuvalu Vanuatu Viet Nam Total Global Total
75 100
90 100
70 100
70 100
80 100
86 100
40 100
56 100
60 97
67 100
53 100
0 100
0 100
Data for 2012 not yet available 100 100 0 50 75 70 100 100 0 46 77 72 65 100 30 60 83 81 77 100 37 94 86 78 10 100 0 70 72 64 71 100 0 14 75 68 80 60 0 60 60 54 25 100 49 56 73 75 18 100 0 84 65 60 100 78 0 100 72 81 40 100 27 87 72 74 8 85 0 46 50 53 8 85 0 46 46 53
= = = EB132/15 21