International Health Regulations (IHR)

Dr.Sajjan Madappady

Dr. Dr.Sajjan Madappady

Preventive Medicine

MBBS, MD, MBA, PGDDM, Certified Medical Tourism Professional,

Article Views: 3091

Published On: Thursday May 5, 2016

Global Health Security: International Health Regulations (IHR)


  • The International Health Regulations (IHR) are an international legal instrument that is binding on 196 countries across the globe, including all the Member States of WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.IHR
  • The IHR, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO.
  • Building on the unique experience of WHO in global disease surveillance, alert and response, the IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security
  • With the signing of the revised International Health Regulations (IHR) in 2005, the international community agreed to improve the detection and reporting of potential public health emergencies worldwide.
  • The revised IHR better address today’s global health security concerns and are a critical part of protecting global health.
  • The regulations require that all countries have the ability to detect, assess, report and respond to public health events.


IHR Timeline

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1830s;;;New trade patterns allow cholera to spread from South Asia to Europe and North America, leaving hundreds of thousands dead;nn;

1851;;;France convenes the first International Sanitary Conference to explore agreement on harmonizing quarantine regulations for cholera, plague, and yellow fever;nn;

1892;;;Delegates to the seventh conference ratify die first International Sanitary Convention;nn;

1918-1920;;;-Spanish flu” pandemic kills 50-100 million people worldwide;nn;

1902-1935;;;States create intergovernmental institutions [Pan American Samary Bureau (1902). Office International d’Hygiene Publique (1907). Health Organization of the League of Nations (1920)] to coordinate international public health measures;nn;

1948;;;World Health Organization (and its governing body, the World Health Assembly. WHA) created;nn;

1951;;;WHA consolidates existing international sanitary conventions into the singular International Sanitary Regulations (covering plague, cholea. yellow fever, smallpox, typhus, relapsing fever);nn;

1959;;;The renamed International Health Regulations (1969) replace prior agreements: revisions eliminate but do not add diseases;nn;

1995;;;Ebola virus outbreak in Central Africa captures global attention: WHA calls upon WHO Director-General to overhaul the IHF.;nn;

2003;;;SARS spreads from China to 25 other countries via air travel;nn;

2005;;;WHA adopts the revised International Health Regulations (2005);nn;

2007;;;IHR (2005) enter into force in 194 countries, beginning 5-year assessment and capacity-building period;nn;

2009;;;Pandemic H1N1 influenza A tests IHR (2005);nn;



IHR basics

  • The IHR are a framework that will help countries minimize the impact and spread of public health threats.
  • As an international treaty, the IHR are legally binding; all countries must report events of international public health importance.
  • Countries are using the IHR framework to prevent and control global health threats while keeping international travel and trade as open as possible.
  • The IHR, which are coordinated by the World Health Organization (WHO), aims to keep the world informed about public health risks and events.

Did You Know?

U.S. government agencies have just 48 hours to assess the situation after learning about a public health emergency of international concern (PHEIC).

The IHR require that all countries have the ability to do the following:

  • Detect: Make sure surveillance systems and laboratories can detect potential threats
  • Assess: Work together with other countries to make decisions in public health emergencies
  • Report: Report specific diseases, plus any potential international public health emergencies, through participation in a network of National Focal Points
  • Respond: Respond to public health events
  • The IHR also include specific measures countries can take at ports, airports and ground crossings to limit the spread of health risks to neighboring countries, and to prevent unwarranted travel and trade restrictions.

IHR: Made for today’s health threats

  • In today’s interconnected society, it’s more important than ever to make sure all countries are able to respond to and contain public health threats.
  • In 2003, severe acute respiratory syndrome (SARS) threatened global health, showing us how easily an outbreak can spread.
  • Recently, the Ebola epidemic in West Africa and outbreaks of MERS CoV have shown that we are only as safe as the most fragile state.
  • All countries have a responsibility to one another to build healthcare systems that are strong and that work to identify and contain public health events before they spread.
  • While previous regulations required countries to report incidents of cholera, plague, and yellow fever, the revised IHR are more flexible and future-oriented, requiring countries to consider the possible impact of all hazards, whether they occur naturally, accidentally, or intentionally.
  • The IHR cover all events that might potentially become a public health emergency of international concern (PHEIC).
  • And global health security is not just a health issue; a crisis such as HIV or Ebola can devastate economies and keep countries from developing.
  • The World Bank Group estimates that Guinea, Liberia, and Sierra Leone together will lose at least $1.6 billion in forgone economic growth in 2015 as a result of the Ebola epidemic.
  • The impact of this kind of economic devastation reaches farther and wider than ever.

Protecting people

One of the most important aspects of IHR is the requirement that countries will detect and report events that may constitute a potential public health emergency of international concern (PHEIC).

Under IHR, a PHEIC is declared by the World Health Organization if the situation meets 2 of 4 criteria:

  • Is the public health impact of the event serious?
  • Is the event unusual or unexpected?
  • Is there a significant risk of international spread?
  • Is there a significant risk of international travel or trade restrictions?

Once a WHO member country identifies an event of concern, the country must assess the public health risks of the event within 48 hours. If the event is determined to be notifiable under the IHR, the country must report the information to WHO within 24 hours.

Some diseases always require reporting under the IHR, no matter when or where they occur, while others become notifiable when they represent an unusual risk or situation.


Always Notifiable :

  1. Smallpox
  2. Poliomyelitis due to wild-type poliovirus
  3. Human influenza caused by a new subtype
  4. Severe acute respiratory syndrome (SARS)

Other Potentially Notifiable Events:

  • May include cholera, pneumonic plague, yellow fever, viral hemorrhagic fever, and West Nile fever, as well as any others that meet the criteria laid out by the IHR.
  • Other biological, radiological, or chemical events that meet IHR criteria

Since the revised IHR were put into place, four PHEICs have been declared by WHO:

  1. H1N1 influenza (2009)
  2. Polio (2014)
  3. Ebola (2014)
  4. Zika virus (2016)

o     2014 and 2015 have been unprecedented years for potential PHEICs.

o   In the months from January 2014 to February 2015, 321 possible PHEICs were reported to WHO.

o   WHO posted more than 400 updates and announcements on their event information site for National IHR Focal Points, relating to 79 public health events and regional updates.

o     Most postings concerned the Middle East respiratory syndrome coronavirus (MERS-CoV) event, the influenza A (H7N9) virus event in China, and the outbreak of Ebola in West Africa.

o   When a PHEIC is declared, WHO helps coordinate an immediate response with the affected country and with other countries around the world.

The seven areas of work for IHR (2005) implementation:

  1. Foster global partnerships
  2. Strengthen national disease prevention, surveillance, control and response systems
  3. Strengthen public health security in travel and transport
  4. Strengthen WHO global alert and response systems
  5. Strengthen the management of specific risks
  6. Sustain rights, obligations and procedures
  7. Conduct studies and monitor progress



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