International health regulations- What are they and India’s position?
Grant medical college, Mumbai
2009- Swine flu
A disease travelling worldwide, an atmosphere of fear, a sense of vulnerability, all wreaking havoc in societies all across the world. Yes, one such disease can create a havoc because death and distress is not the only thing it causes, it impacts people and resources all over the world leaving repercussions for years to come. These 6 are the most recent ones but such pandemics have been affecting us since a long time. The scariest aspect of these diseases is the fact that they jump across countries, across continents affecting and killing a large number of people before the healthcare systems even have the time to comprehend and control the situation. It was to tackle these issues, restrict and prevent the spread and assist all countries in doing so that the International health regulations were born.
Following the cholera epidemics in Europe in 1830 and 1847, the International sanitary regulations were adapted by the International Sanitary conference held in Paris in 1851. As the WHO came about in 1948, the ISR were revised and renamed as the International health regulations. They were amended in 1973. Following another amendment they finally entered into force on 15th June, 2007 and are binding on 196 countries including the 194 member states 0f WHO.
The functions of IHR could be divided into-
The most important aspect is that every member state has the duty to notify the WHO about every single event which constitutes a public health emergency of international concern (PHEIC). The IHR list 4 criteria to asses whether an event is notifiable to WHO;
The notification must be done within 24 hours of detecting and assessing such an event. The states are required to notify the regional WHO contact points through the National IHR focal points. These focal and contact points have to remain available 24 hours a day for seven days. Currently there are 193 focal points and 6 contact points.
In order for countries to be able to efficiently and effectively detect such events, they need to have adequate surveillance capacities and infrastructure. The IHR lays down the standards for such core capacities which every state is required to develop including legislations like national plans.
Upon notifying, the WHO and the state party jointly asses the event to understand the nature and extent of the risks. The director general, assisted by the Emergency committee of WHO, declares the event to be a PHEIC after a thorough review. The WHO also maintains an IHR information site to facilitate proper information sharing to all state parties which is accessible by the national IHR focal points. The WHO then gives recommendations and also develops appropriate response and containment strategies.
The most important part about containment is to prevent the international spread. This is especially relevant in today’s scenario as trade and travel form an important part of economic obligations of every country. Further, the world today is a small place, every region is accessible with multiple modes of transport. So, the IHR focuses at international airports, ports as well as ground crossings. States are required to designate these points of entry to develop certain core capacities. These include appropriate medical services with diagnostic capacities, services for transport of ill persons, maintenance of plan and facilities to apply emergency measures such as quarantine. This ensures that these points of entry are equipped to handle a variety of public health emergencies.
Let’s see how India is implementing the IHR to tackle the corona virus.
The covid19 after first being detected in china has now spread to over 90 countries with 101,923 cases and 3486 deaths. As of 08/03/20, the Indian health ministry has reported the total number of cases to be 34.
Screening is being done in India at 30 airports having international operations. A total of 7,26,122 passengers have been screened so far from 7,108 flights. All passengers are required to fill the self reporting form.
First, thermal screening is done at the airports ,ports and ground crossing. The individuals with fever are picked out by this and sent to the designated hospitals for further tests. The patients are isolated for 14-21 days till the test results are received. If positive, the patient is sent for treatment and all their contacts are traced,with whom the same procedure is followed.
The health ministry has provided all states with the Containment action plan and conducted a national level training workshop for all hospitals on the management of covid19. Officers have been designated for every state to review their preparedness.
52 laboratories are currently operational for testing for covid19 and have been provided by the necessary equipment and materials.
International spread is being restricted by suspending visas to nationals from Italy, South Korea and Japan and Indians citizens have been advised to avoid travelling to the same locations.
Apart from this, the general public is being educated about the preventive measures.
Times like these are when there is an atmosphere of panic everywhere, people don’t know what to do. There is much uncertainty even amongst the healthcare personnel especially in the developing countries with limited resources who themselves are at high risk of contracting the infection. The virus is new, the disease unknown and it’s like grappling with the killer in the dark. It is at such times that the IHR provide a beacon of light, unite all countries in tackling the issue with complete cooperation, harmony and efficiency.
Sources- WHO, The Hindu