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World Health Assembly Adopts New Disease-Reporting Rules

Regulations respond to possible cross-border movement of disease

The World Health Assembly, recognizing that disease can sweep across the continents more rapidly than ever before because of expanded international travel and trade, adopted new International Health Regulations (IHRs) May 23.

U.S. representatives were actively involved in the discussions and issued a statement of support upon passage of the regulations, which were updated for the first time since 1969. According to the statement, “The United States believes that the revised IHRs will provide an effective mechanism to respond to new global public health threats.”

The assembly comprises representatives of the 192 members of the World Health Organization (WHO).  Members voted to expand the circumstances under which national health authorities must report disease occurrence to international authorities.

The regulations in their earlier form monitored and controlled just six diseases – cholera, plague, yellow fever, smallpox, relapsing fever and typhus, according to a WHO press release. The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak and more recent experiences with the spread of avian flu provided the impetus to update the regulations to apply to a wider range of diseases.

William Steiger, with the Department of Health and Human Services, was one of the chief U.S. negotiators in the process. He said in a May 17 press briefing that the expanded list of diseases is an important change.

“Certainly one of the things we worked hardest on was the list of specific diseases that will require automatic reporting,” he said, “and [U.S. negotiators] worked with the technical experts here at the WHO and with others around the world to get a list of those, including new versions of influenza that are of most immediate priority and threat, to be automatically reportable on a mandatory basis to the WHO.”

Smallpox, polio and SARS are among the diseases that must be reported to the WHO under the new regulations.

The IHRs require countries not only to report certain disease outbreaks when they occur, but also to increase their capability to detect and respond to public health emergencies.

"The new regulations bring disease control into the 21st century," said Anarfi Asamoa-Baah, WHO assistant director-general in charge of communicable diseases. "With this framework, we can now support the work of countries in controlling outbreaks more effectively. The regulations provide WHO with new, clearly defined roles and responsibilities as we help countries to respond to disease outbreaks."

The U.S. statement also expresses several concerns about interpretations of provisions of the IHRs relating to releases of chemical, biological and radiological materials; the protection of national security; and federalism.

According to the statement, the United States will submit a later reservation to the IHRs to clarify that U.S. implementation will be consistent with the federalist system, which reserves many powers and responsibilities to state governments.

For additional information, see a May 23 WHO press release on the new International Health Regulations.

The text of the U.S. statement follows:

[The U.S. Mission to the United Nations]
[Geneva, Switzerland]
A 58/4

May 23, 2005

STATEMENT FOR THE RECORD BY THE
GOVERNMENT OF THE UNITED STATES OF AMERICA
CONCERNING THE WORLD HEALTH ORGANIZATION’S
REVISED INTERNATIONAL HEALTH REGULATIONS

The United States agrees with other Member States that the current International Health Regulations (IHRs) are insufficient in view of today’s rapid, high-volume international migration, emerging infections, and threats of terrorism. Accordingly, the United States has participated actively in the Intergovernmental Working Group (IGWG) and in sub-regional and regional meetings.  The United States believes that the revised IHRs will provide an effective mechanism to respond to new global public health threats in a manner that is consistent with the principles embodied in Article 3.  We attach particular importance to the universal application of the IHRs for the protection of all people of the world from the international spread of disease. The United States is pleased with the work of the IGWG and the cooperation and flexibility of negotiating partners and fully supports the adoption of the text of the revised IHRs that was approved by the Working Group on May 14. 

The United States, however, has several concerns regarding the final text of the revised IHRs.  Therefore, the United States makes this statement regarding the concerns set forth below and, at the appropriate time, will submit formal understandings and a reservation in relation to these concerns.

INTENTIONAL RELEASE/CHEMICAL, BIOLOGICAL, AND RADIOLOGICAL MATERIALS

Throughout the revision process of the IHRs, the United States has taken the position that the new IHRs must reflect the real threats to international public health in the 21st century.  Among the most serious of those threats is the accidental or deliberate release of biological, chemical and radiological materials. One of the reasons proposed by the WHO for revising the IHRs was to address these new threats to public health.

The United States is pleased that all States Parties to the revised IHRs will be obligated to notify events that involve the accidental or deliberate release of biological, chemical and radiological materials that may have the potential to cause Public Health Emergencies of International Concern and that the WHO Director-General may declare Public Health Emergencies of International Concern regardless of the source or origin of the event. We note that Article 7 of the revised IHRs specifically requires a State Party to provide to WHO any evidence it has of an “unexpected or unusual public health event within its territory irrespective of origin or source, which may constitute a Public Health Emergency of International Concern.” The deliberate or accidental release of biological, chemical and radiological materials within the territory of a State Party would certainly constitute an “unexpected or unusual event . . . irrespective of origin or source.”  Moreover, the World Health Assembly has explicitly acknowledged a role for WHO in this area, most notably in World Health Assembly Resolution 55.16 (“Global public health response to natural occurrence, accidental release or deliberate use of biological and chemical agents or radionculear material that affect health”), which was adopted by consensus in 2002. Thus the United States will apply the revised IHRs with the understanding that the regulations apply to all such health threats—chemical, biological, and radiological--and all causes and modes of events -- regardless of whether they are naturally occurring, accidental, or deliberate-- and we expect all other Member States of the WHO to do the same.  The United States expects to submit a formal understanding to that effect at the appropriate time.

NATIONAL SECURITY

The United States sought a provision within the IHRs that would have explicitly allowed States Parties, in rare cases, to take into account national security requirements as they apply the IHRs to their Armed Forces.  Although the IGWG did not adopt this explicit provision, the United States understands that the IHRs – a public health instrument – are not intended to compromise the national security of States Parties.   Therefore we will implement these IHRs as they apply to armed forces with that understanding.  The United States expects to submit a formal understanding to that effect at the appropriate time.

FEDERALISM

For the record, the United States sought a provision that would explicitly recognize the right of federal states to implement the IHRs in a manner that is consistent with the division of rights and responsibilities existing in their constitutionally mandated systems of government.  Unfortunately, the IGWG did not accept this straightforward request. 

Accordingly, the United States will submit a narrowly tailored reservation in accordance with Article 62 of the IHRs that will clarify that the United States will implement the IHRs in a manner consistent with our federal system of government.

The United States also states for the record of this meeting that with respect to the United States, the Federal government will implement the IHRs to the extent it exercises jurisdiction over the matters covered therein.  Otherwise, our state and local governments will implement them.  To the extent that state and local governments in the United States exercise jurisdiction over such matters, the Federal Government will take measures appropriate to our Federal system to facilitate the implementation of these Regulations.