Human Rights and the International Health Regulations (2005)

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Human Rights and the International Health
Regulations (2005)

• Jo Cooper
• Health Legislation Consultant

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What are IHR (2005)?

• International legal instrument
• In force 15 June 2007
• Replace IHR (1969) only included cholera,
  plague yellow fever
• World Health Assembly empowered to adopt binding
  regulations concerning sanitary and quarantine
  requirements and other procedures designed to
  prevent international spread of disease

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Problems with IHR (1969)

• Did not permit response to diseases other than
  those listed inflexibility revealed by SARS and
  avian influenza
• Did not permit risk-based and appropriate
  response
• Did not allow for emerging and re-emerging
  infectious diseases nor non-infectious disease
  agents

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As IHR (1969) no help .

• Responses to SARS and avian influenza resulted
  in
• Unwarranted/disproportionate trade and travel
  restrictions imposed
• Reluctance by some countries to promptly report
  disease outbreaks and other events

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Aims of IHR (2005)

• Rapid gathering of information
• Determination of when an event constitutes a
  Public Health Emergency of International Concern
• WHO, using extensive communications network, to
  assess information, recommend actions and provide
  technical assistance, tailored to events as they
  unfold
• Minimizing interference world travel and world
  trade

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Purpose and scope of IHR (2005)

• To provide a public health response to the
  international spread of disease in ways that are
• Commensurate with public health risk
• Restricted to public health risk
• Avoid unnecessary interference with international
  traffic and trade

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FIRST PRINCIPLE OF IHR (2005)

• The implementation of the Regulations if to be
• With full respect for the dignity, human rights
  and fundamental freedoms of persons
• Guided by the Charters of the
• United Nations WHO
• but recognises sovereign rights to legislate

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International Bill on Human Rights

• Universal Declaration of Human Rights (UDHR)
• International Covenant on Economic, Social
  Cultural Rights (ICESCR)
• International Covenant on Civil and Political
  Rights (ICCPR)
• NB Siracusa Principles

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Siracusa Principles on the Limitation and
Derogation of Provisions in ICCPR

• 25. Public health may be invoked as a ground for
  limiting certain rights in order to allow a state
  to take measures dealing with a serious threat to
  health of the population or individual members of
  the population. These measures must be
  specifically aimed at preventing disease or
  injury or providing care to the sick and injured.

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Siracusa Principles

• 26. Due regard shall be had to the international
  health regulations of the World Health
  Organization.

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Siracusa Principles

• Restrictions (of limited duration subject to
  review) can only be justified in very narrow
  circumstances
• Provided for carried out in accordance with law
• In interest of legitimate objective
• Strictly necessary to achieve objective
• No less intrusive restrictive means available
  to reach same objective
• Not drafted or imposed in unreasonable or
  discriminatory manner

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IHR and other international agreements

• Article 57
• IHR and other relevant international agreements
  should be interpreted so as to be compatible
• Provisions of IHR do not affect rights
  obligations of SPs deriving from other
  international agreements

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Broad definition of ill person

• An individual suffering from or affected with a
  physical ailment that may pose a public health
  risk
• Infection defined
• Infectious/communicable disease is not

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Core Capacities (found in Annex 1)

• For surveillance and response
• For designated airports, ports and ground
  crossings
• Core capacities to be developed, strengthened
  maintained by State Parties ASAP but not later
  than 15 June 2012 capacity assessment by 15
  June 2009

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Capacity for surveillance response

• Developed at 3 different levels
• 1. community/primary public health level
• 2. intermediate response level
• 3. national level
• The 3 different levels may mean different things
  to different SPs

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Capacity for Surveillance Response

• To
• Detect, assess notify events
• Report public health risks
• Respond to health risks and emergencies of
  international concern

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In event of Public Health Emergency of
International Concern

• WHO may recommend measures
• to be applied by States affected by the emergency
  
• to be applied by operators of international
  transportation

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Health measures can be applied to

• Persons
• Baggage
• Cargo
• Containers
• Ships
• Aircraft
• Road Vehicles
• Goods
• Postal Parcels

• There can be Standing Recommendations (i.e.
  measures that are in place at all times at all
  designated points of entry) and Temporary
  Recommendations

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Core capacities at points of entry

• Apply to
• Ports
• Airports
• Ground Crossings.
• SP designates the points of entry those that
  receive international traffic need to develop
  core capacity to implement health measures
  (Standing/Temporary)

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Core capacity requirements at points of entry

• Access to appropriate medical service including
  diagnostic facilities, trained staff, equipment
  premises (so basic medical service at point of
  entry, perhaps staffed only when international
  travellers are received)
• Access to equipment and personnel to transfer ill
  travellers to medical facility

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Core capacity requirements at points of entry
cont/d

• Availability of trained personnel to inspect
  conveyances
• Safe environment for travellers using points of
  entry facilities (potable water, public
  washrooms, clean eating establishments,
  appropriate solid liquid waste disposal
  services)

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For responding to events that may constitute a
PHEIC, points of entry to have

• Public health emergency contingency plan
• Capacity to assess and care for affected
  travellers can be arrangements with local
  facilities for isolation treatment
• Provision of appropriate space, separate from
  other travellers, to interview suspect or
  affected travellers
• Facilities for assessment/potential quarantine
  preferably in facilities away from points of entry

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Points of entry requirements cont/d

• Means to apply recommended measures (e.g. to
  disinsect/disinfect) to baggage, cargo,
  containers, conveyances, good or postal parcels
• Ability to apply entry or exit controls for
  arriving departing passengers
• Access to specially designated equipment and
  trained personnel with appropriate personal
  protection for transfer of passengers who may
  carry infection

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Permitted treatment of persons

• Obtaining of information re. travellers
  destination/past itinerary
• Review of any health documents if required under
  the regulations
• Non-invasive medical examination which is the
  least intrusive examination that would achieve
  the public health objective

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IHR defines public health risk as

• A likelihood of an event that may affect
  adversely the health of human populations, with
  an emphasis on one which may spread
  internationally or may present a serious and
  direct danger.

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If there is evidence of a public health risk
obtained

• Additional health measures may be applied
• on a case-by-case basis
• THE LEAST INTRUSIVE AND INVASIVE MEDICAL
  EXAMINATION THAT WOULD ACHIEVE THE PUBLIC HEALTH
  OBJECTIVE OF PREVENTING THE INTERNATIONAL SPREAD
  OF DISEASE.

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Express informed consent required for

• Medical examination
• Vaccination
• Prophylaxis
• Health measure
• MUST ALSO BE IN ACCORDANCE WITH LAW AND
  INTERNATIONAL OBLIGATIONS

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Failure to consent or provide information

• Permits SP to deny entry
• If imminent public health risk SP, to extent
  necessary to control risk, can compel/advise
  traveller to undergo
• LEAST INVASIVE INTRUSIVE medical examination,
  vaccination or other prophylaxis, or additional
  established health measures (includes isolation,
  quarantine or placing under public health
  observation) SUBJECT TO LAW/INTERNATIONAL
  OBLIGATIONS

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Health measures relating to entry

• Invasive medical examination, vaccination or
  other prophylaxis shall not required as a
  condition of entry - but allowed
• When necessary to determine whether a public
  health risk exists
• As condition of entry for travellers seeking
  temporary or permanent residence

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Health measures relating to entry..

• Additional health measures pursuant to Article
  43 or Annexes 6 or 7 (requirements for
  vaccination etc) as condition of entry

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Additional health measures under Article 43

• Determinations to implement measures must be
  based on
• Scientific principles
• Available scientific evidence of a risk to human
  health
• Available specific guidance or advice from WHO

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SP applying additional health measures

• If significantly interfere with international
  traffic provide WHO with public health
  rationale and relevant scientific information

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Significant interference when

• Refusal of entry,departure or delay for more
  than 24 hours of international travellers
• baggage
• cargo
• containers
• conveyances
• or goods

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Significant interference measures

• Report to WHO within 48 hours (unless they are
  covered by temporary or standing recommendation
  of WHO)
• SP must review within 3 months taking into
  account scientific principles and evidence
  advice of WHO

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Full text of IHR (2005)

• Found at
• http//www.who.int/csr/ihr/IHRWHA58_3-en.pdf

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