Leavitt announces U.S. accepts new IHR early

[sharon sanders]

UNITED STATES OFFICIALLY ACCEPTS NEW INTERNATIONAL HEALTH
REGULATIONS

Revised World Health Organization Rules Will Enhance Global
Disease-Control Efforts

HHS Secretary Mike Leavitt today announced the United States has formally accepted the revised International Health Regulations (IHR), and will begin the process of implementing these new international rules immediately instead of waiting for them to take effect in June 2007. Secretary Leavitt made the announcement during a week-long visit to the People's Republic of China.

The International Health Regulations are an international legal instrument that governs the roles of the World Health Organization (WHO) and its member countries in identifying and responding to and sharing information about public health emergencies of international concern. The updated rules are designed to prevent and protect against the international spread of diseases, while minimizing interference with world travel and trade. Many of the provisions in the new regulations are based on experiences gained and lessons learned by the global community over the past 30 years.

"As we have seen recently with SARS and H5N1 avian influenza, diseases respect no boundaries. In today's world, a threat anywhere means danger everywhere," Secretary Leavitt said. "The improved global cooperation that will come from implementing these new International Health Regulations represents a major step forward for global public health."


First adopted by WHO Member States in 1969, the current IHRs apply to only three diseases: cholera, yellow fever and plague. However, in recent decades, increases in international travel and trade, along with marked developments in communication technology, have led to new challenges in the control of emerging and re-emerging infectious diseases.

Under the revised regulations, countries that have accepted the IHRs have much broader responsibility to take preventive measures against, as well as to detect and respond to, public-health emergencies of international concern. The regulations give the WHO clearer authority to recommend to its Member States measures that will help contain the international spread of disease, including public-health actions to be taken at ports, airports, land borders and on means of transport that involve international travel.


The revised regulations include a list of four diseases -- smallpox, polio, Severe Acute Respiratory Syndrome (SARS) and new strains of human influenza -- whose occurrence Member States must immediately report to the WHO. In addition, the regulations provide an algorithm to determine whether other incidents, including those of a biological, chemical or radiological nature, constitute public-health events of international concern. The rules also provide specific procedures and timelines for announcing and responding to public health events of international concern.


Countries that intend to accept the IHRs may submit reservations and understandings regarding their implementation of the Regulations.

The United States has accepted the IHRs with the reservation that it will implement them in line with U.S. principles of federalism. In addition, the U.S. Government has also submitted three understandings, setting forth its views that (1) incidents that involve the natural, accidental or deliberate release of chemical, biological or radiological materials are notifiable under the IHRs; (2) countries that accept the IHRs are obligated to report potential public health emergencies that occur outside their borders to the extent possible; and (3) the IHRs do not create any separate private right to legal action against the federal government.

Following several years of work by the WHO and its Member States, the annual World Health Assembly approved the revised IHRs in May 2005, and agreed the revised regulations will officially take effect in June 2007.
More information about the International Health Regulations (2005) is available at http://www.who.int/csr/ihr/en/.

[Snicklefritz]

Re: Leavitt announces U.S. accepts new IHR early

Well, this certainly connects some dots for me. I was wondering why Leavitt kinda sneaked off the China under the radar.

While in China Leavitt formally accepted the new IHR rules adopted in May 2005. These new rules, which focus on international travel and trade among other things, are to go into effect in June 2007, but the US is beginning implementation immediately. Here's my take on why the US jumped in so early.

The rules require member states to report epidemics occuring within their borders to WHO.

WHO has the ability to impose international travel and trade restrictions on member states in the event of an epidemic with international public health implications. Now no member state would want that, so there is no motivation for a member state to do that unless they really needed WHO's help in fighting the epidemic.

There are no enforcement provision to make a member state report. However, the Director General (Dr. Margaret) can act unilaterally after consulting with a board of advisors. My guess is it will be the same board convened this fall to advise about pandemic phases until the rules take effect (remember that one?) But, what are the chances the DG will take unilateral action against a member state, say China?

So, let's say there is an outbreak of H5N1 in China. China is required to report this. But, there is nothing forcing China to do so. Chan isn't likely to do it. If China does not report the outbreak, WHO has no legal authority to do anything (i.e. travel and trade). So, China says 'What outbreak, there's no outbreak here.' WHO's hands are tied.

However, when a member state accepts the new IHR rules they can do so with 'reservations'. If a member state has 'reservations' and 1/3 of other member states do not object within 6 months, the 'reservations' become a part of the rules for that member state.

One of the 'reservations' that the US has reserved for itself is the right to report on events outside its own borders. If less than 1/3 object within 6 months, the US will legally be able to report an outbreak event in China, thus empowering WHO to act.

So, it looks to me like Leavitt went to China, to have a little talk with the boys there, and they weren't listening. So, the US has painted China and Chan into a corner by accepting the rules now, with the 'outside the borders' reservation, just in time to take affect before the rules become effective in June 2007. Additionally, the US is saying they are accepting and implementing the rules, with reservations, immediately.

That's what I call 'in your face' diplomacy.

Now, I could be misreading the whole thing, so here's the link to WHO and IRH rules page:

http://www.who.int/csr/ihr/en/

[Allan]

Re: Leavitt announces U.S. accepts new IHR early

Fascinating analysis, thanks for your thoughts. This would seem to indicate that H5N1 has obtained the attention of the U.S. administration.

Best regards,

Allan Edie

[Mellie]

Re: Leavitt announces U.S. accepts new IHR early

Thanks for the insightful post, Snicklefritz.

[hawkeye]

Re: Leavitt announces U.S. accepts new IHR early

Snicklefritz. Most Excellent. Thank you.
I have a couple of follow-up question in regards to:

WHO has the ability to impose international travel and trade restrictions on member states in the event of an epidemic with international public health implications.

This doesn't limit the U.S. to impose it's own restrictions does it? Would getting the WHO involved just make the claim that more legitimate?

So now we have to wait 6 months to see if your theory is correct?

[e_armigeri]

Re: Leavitt announces U.S. accepts new IHR early

Opposition to IHR country reservations would need to get publicly, globally organized sooner than 6 months to reach a 1/3 signatory critical mass.
e_

[Snicklefritz]

Re: Leavitt announces U.S. accepts new IHR early

Thanks everone. Hawkeye, it is my understanding the a major focus of the IRH is to prevent countries from imposing these restrictions without cause. In other words, to prevent an overreaction that would hurt travel and trade to any one country. If I read that right then everyone should follow suit when action is taken, and no one should act unilaterally.

However, the US had another 'reservation' that said the US would act in accord the 'Federalism'. That may mean that the US will do what the President, the congress, etc decide is in their (our) own best interest.

[hawkeye]

Re: Leavitt announces U.S. accepts new IHR early

great. thank you!

[Treyfish]

Re: Leavitt announces U.S. accepts new IHR early

http://tinyurl.com/y4mmat
Here is what china says about the trip.<TABLE cellSpacing=0 cellPadding=0 width="80%" align=center border=0><TBODY><TR><TD vAlign=bottom align=middle height=35>Senior U.S. official calls for more Sino-American health cooperation</TD></TR><TR><TD align=middle bgColor=#5798dc height=1></TD></TR><TR><TD align=middle>2006/12/13 </TD></TR><TR><TD height=10></TD></TR><TR><TD vAlign=top>
CHENGDU, Dec. 10 (Xinhua) -- The United States and China can share more experience in medical and health service, said MichaelO. Leavitt, Secretary of U.S. Department of Health and Human Services, during his visit to southwest China's Sichuan Province.
Leavitt, who started his 10-day visit to China on Dec. 7 at the invitation of Chinese Ministry of Health, visited rural clinics, medical stations and hospitals in Sichuan during his three-day visit.
Sichuan health officials briefed him on local medical infrastructures and disease control.
In Tangjia township of Suining city, Leavitt visited an eight-year-old girl who recovered from the H5N1 strain of bird fluin May. He spoke highly of local hospitals' immediate response to and proper treatment of the disease.
Health cooperation between the two countries should start with people-to-people exchanges, he said.
During his meeting on Saturday with Jiang Jufeng, vice-governor of Sichuan, Leavitt said he hopes the United States can cooperate more with Sichuan as the province boasts great potential on pharmaceutical and chemical industry.
According to the Sichuan provincial department of health, the province has conducted a series of medical cooperation with the United States since 1993.
A MOU signed between Sichuan Province and the State of Utah this year has boosted large-scale cooperation on the research and development of traditional Chinese medicine (TCM), TCM treatment, and the TCM education and academic exchanges, the department said. Leavitt left Sichuan for Guangdong Province Sunday afternoon.
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