Interagency collaboration to implement the International Health Regulations

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Interagency collaboration to implement the
International Health Regulations

• A Presentation for the
• 2009 USPHS Scientific Training Symposium
• LCDR Maria Benke, MPH, CHES
• 1 June 2009

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Presentation Overiew

• Provide an overview of the International Health
  Regulations (IHR)
• Describe US government (USG) efforts to develop
  an IHR implementation plan
• Describe the USG assessment and implementation
  process
• Describe the role of the HHS Secretarys
  Operation Center as the USG IHR National Focal
  Point

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International Health Regulations Overview

• Origins 1851 International Sanitary Conference,
  Paris.
• International law agreed upon by Member States of
  the World Health Organization (WHO).
• Revised in 2005 194 signatories.
• IHR (2005) Overarching Goals
• Prevent, protect against, control, and respond to
  the international spread of disease.
• Avoid unnecessary interference with international
  traffic and trade.
• Reduce the risk of disease spread at
  international airports, seaports, and ground
  crossings.

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Major Changes from IHR(1969) Overview
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IHR OverviewKey Actions for IHR Compliance

• Establish a National IHR Focal Point (NFP)
• Strengthen the following core capacities for
  public health events
• Disease surveillance and reporting
• Assessment and notification
• Response
• Assess and report potential public health
  emergencies of international concern (PHEIC)
• Provide routine inspection and control activities
  to prevent international disease spread at
  designated airports, ports and ground crossings
• Collaborate with other Member States and WHO
  concerning IHR implementation

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Public Health Emergency of International Concern
(PHEIC)

• An extraordinary public health event that is
  determined
• to constitute a public health risk to other
  States through the international spread of
  disease and
• to potentially require a coordinated
  international response.
• PHEIC decision criteria (IHR Annex 2)
• Is the public health impact of the event serious?
• Is the event unusual or unexpected ?
• Is there a significant risk of international
  disease spread?
• Is there a significant risk of international
  travel or trade restrictions?

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PHEIC Determination

• Always Notifiable
• Smallpox
• Poliomyelitis due to wild-type poliovirus
• Human influenza (new subtype)
• Severe acute respiratory syndrome (SARS)
• Use Algorithm (right)
• Cholera
• Pneumonic plague
• Yellow fever
• Viral hemorrhagic fevers
• West Nile fever
• Other diseases of special national/regional
  concern
• Dengue fever,
• Rift Valley fever
• Meningococcal disease
• Other Events of Potential International Public
  Health Concern

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IHR Assessment and Implementation Timeline

• Entry into force
• 191 WHO Member States June 15, 2007
• U.S. July 18, 2007
• India August 7, 2007
• Montenegro February 5, 2008
• Assessment Phase
• 20072009 Assess the ability of existing
  national structures and resources to meet the
  minimum requirements described in Annex 1.
• Implementation Phase
• 2009-2012 Develop, strengthen, and maintain the
  minimum requirements described in Annex 1.

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U.S. IHR Assessment and Implementation Overview

• Process
• Collaboratively focused 20 USG
  departments/agencies involved.
• Coordinated by the Department of Health and
  Human Services.
• ASPR Office of Medicine, Science and Public
  Health
• Oversight provided by the White House.
• Homeland Security Council and National Security
  Council
• Requirements
• Identify IHR requirements and specific actions.
• Ensure USG partners have identified roles and
  responsibilities.
• Identify relevant non-USG stakeholders
• Develop outreach and education strategies.
• Assess and build upon (when possible) existing
  systems, policies, and procedures.

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USG Departments and Agencies Involved in IHR
Implementation

• Partners in implementation

• Central Intelligence Agency
• Department of Agriculture
• Department of Commerce
• Department of Defense
• Department of Energy
• Department of Health and Human Services
• Department of Homeland Security
• Department of Justice
• Department of State
• Department of the Treasury

• Department of Transportation
• Department of Veterans Affairs
• Environmental Protection Agency
• Joint Chiefs of Staff
• Nuclear Regulatory Commission
• Office of Management and Budget
• Office of Science and Technology Policy
• U.S. Agency for International Development
• U.S. Trade Representative
• United States Postal Service

The federal agencies listed here worked with HHS
to develop and approve the IHR implementation
plan. ALL relevant federal agencies would be
expected to respond to an event in accordance
with the NRF.
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Interagency Assessment and Implementation Tool
The Matrix

• Table of all specific actions that address the
  requirements identified in the IHRs.
• Each action was assigned the following
• Measure of performance
• Completion timeframe
• Working group
• Lead and support departments or agencies
• Legal authorities
• 97 individual actions were identified to address
  66 Articles of the IHR.

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IHR Implementation Matrix
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IHR Work Groups

• National IHR Focal Point
• Lead Department Health Human Services
• Focus Messaging to/from WHO and the U.S.
  National IHR Focal Point regarding potential
  PHEICs.
• U.S. Points of Entry
• Lead Department Homeland Security
• Focus Surveillance and health measures for
  people at points of entry (airports, seaports,
  and land border crossings).
• Health Measures for Conveyances
• Lead Department Transportation
• Focus Surveillance and health measures for
  baggage, cargo, containers, goods, and parcels.
• Education and Outreach
• Lead Department Health Human Services
• Focus Creation of educational tools stakeholder
  awareness-raising.

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National IHR Focal PointWorking Group

• Active interagency participation.
• Established the HHS Secretarys Operations Center
  as the U.S. National IHR Focal Point.
• New policies, procedures, and programs
• National Focal Point Policy
• USG roles and responsibilities overall IHR
  message flow
• Interagency Communications Group Standard
  Operating Procedure
• International Health Regulations Program
• Established within ASPR/Office of Medicine,
  Science and Public Health
• 24/7 Action Officers to monitor, assess and
  report potential PHEICs
• PHEIC Report Form

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IHR Message Flow Role of the National Focal
Point
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USG PHEIC Report Form
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U.S. IHR Notifications toWHO of Potential PHEICs
International Health Regulations Program ? Office
of the Assistant Secretary for Preparedness and
Response ? Department of Health and Human Services
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Continued USG (Domestic) Collaboration

• Engagement of key federal partners
• Department of Agriculture
• Department of Defense
• Department of Homeland Security
• Department of Interior
• Department of Transportation
• Engagement of key state/territorial partners
• Public health (APHL, CSTE, PIHOA)
• Agriculture (NASDA)
• Emergency management/homeland security (NEMA)
• Engagement of key tribal partners
• Public health (NIHB)

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International Collaboration

• ASPR IHR Program
• Technical assistance on implementation to Canada,
  France, Japan, and Mexico.
• Shared U.S. implementation plan with 43 countries
  in all six WHO regions.
• ASPR
• Global Health Security Initiative (GHSI) project
  to develop a single, web-based platform for GHSI
  partners to receive early warnings of credible
  CBRN threats and avian influenza outbreaks.
• Security and Prosperity Partnership of North
  America (SPP) work to integrate U.S, Canadian,
  and Mexican epidemiological information systems,
  allowing simultaneous access.

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Points of Contact

• HHS Secretarys Operation Center (24/7)
• Phone (202)
• Email hhs.soc_at_hhs.gov
• IHRP Action Officer on-call (24/7)
• Phone [phone]
• Email hhs.ihrp_at_hhs.gov
• Dr. Jose Fernandez (IHR Program Manager)
• Phone [phone]
• Email Jose.Fernandez_at_hhs.gov
• LCDR Maria Benke
• Phone [phone]
• Email MariaLourdes.Benke_at_hhs.gov

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Thank you for your attention.