In 2005 the World Health Organization adopted the IHR (International Health Regulations) that – among other things - requires countries to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO.
Although the agreement went into force in 2007, member states had until mid-2012 to meet core surveillance and response requirements. Most nations failed to meet that deadline, and since then we've seen multiple extensions to that timetable.
While supposedly binding for all 193 WHO member nations, the IHR is notoriously lacking in `teeth’. Nations agree to abide, but there is little recourse if they don’t follow through - a topic we looked at in depth in 2015 in Adding Accountability To The IHR.
While for some countries it has largely been a lack of money, or logistics ... sometimes it seems to simply boil down to policy. From Indonesia’s refusal to share H5N1 virus samples to the Saudi’s chronic foot dragging on MERS, we’ve seen examples where the spirit – and at times the actual letter – of the 2005 IHR has not been fully embraced or followed by member nations.
During the first two epidemic waves of H7N9, China earned high praise by reporting - fully and in real time - on their avian flu epidemic. That changed abruptly, and without explanation, during the middle of the 3rd wave, and since then reports have been delayed and noticeably lacking in detail.
Now with avian flu (H7N9, HPAI H5) making a big comeback this year on several continents, it is more important than ever that all nations fully, and immediately disclose any and all outbreaks in wild birds, poultry, and humans.
A point reiterated today by WHO Director-General Margaret Chan in a speech to the Executive Board at their 140th Session in Geneva. Some pertinent excerpts from a much longer speech.
The world is better prepared for the next influenza pandemic, but not at all well enough.
I am asking all countries to keep a close watch over outbreaks of avian influenza in birds and related human cases. Just since November of last year, nearly 40 countries have reported fresh outbreaks of highly pathogenic avian influenza in poultry or wild birds.
The rapidly expanding geographical distribution of these outbreaks and the number of virus strains currently co-circulating have put WHO on high alert. For example, the H5N6 virus causing severe outbreaks in Asia is a new strain created by gene-swapping among four different viruses.
Since 2013, China has reported seasonal epidemics of H7N9 infections in humans, now amounting to more than 1,000 cases, of which 38.5% were fatal.
The latest epidemic, which began in late September 2016 and since December has shown a sudden and steep increase in cases.
In two clusters, WHO could not rule out limited human-to-human transmission, though no sustained transmission has been detected to date.
(Continue . . . )
As required by the International Health Regulations, all countries must detect and report human cases promptly. We cannot afford to miss the early signals.
At the bottom of each risk assessment on avian flu published by the WHO, the following points are always stressed.
- Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health. Continued vigilance is needed within affected and neighbouring areas to detect infections in animals and humans. As the extent of virus circulation in animals is not clear, epidemiological and virological surveillance and the follow-up of suspected human cases should remain high.
- All human infections caused by a new influenza subtype are notifiable under the International Health Regulations (IHR, 2005).12 State Parties to the IHR (2005) are required to immediately notify WHO of any laboratory-confirmed case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic. Evidence of illness is not required for this report.
- It is critical that influenza viruses from animals and people are fully characterized in appropriate animal or human health influenza reference laboratories and reported according to international standards. Under WHO’s Pandemic Influenza Preparedness (PIP) Framework, Member States are expected to share their influenza viruses with pandemic potential on a regular and timely basis with the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of public health laboratories. The viruses are used by the public health laboratories to assess the risk of pandemic influenza and to develop candidate vaccine viruses.
Now, more than ever, these regulations need to be taken as more than just suggestions.