No 24b - 2012

International Health Regulations

The International Health Regulations (IHR) are a body of binding international guidelines implemented with a view to limiting health threats that may spread quickly from one country to the next.

In 2005, IHR were amended and the new IHR came into force on 15 June 2007 with a view to complete implementation no later than 15 June 2012. The background for the amendments made was experienced learned, e.g. during the SARS epidemic, EPI-NEWS 11, 12 and 13/03, and during outbreaks with highly pathogenic avian influenza A (H5N1) virus, EPI-NEWS 6/04.

The above experiences pointed to a need for a greater degree of cooperation and openness concerning threats among countries, the introduction of an obligation to share data among countries, and a principle of proportionality ensuring that the control measures adopted by countries were proportionate to the impact and character of the threats.

The objective of IHR is to decrease the introduction and spread of infectious diseases, foodborne-associated diseases, zoonoses and disease caused by chemical, radiological and nuclear episodes.

Furthermore, the IHR shall ensure that the control measures introduced to not impose unreasonable limitations on trade and commerce. The IHR thus stipulate that countries monitor, control and report incidents to the WHO if these incidents might constitute a potential Public Health Emergency of International Concern (PHEIC).

Danish Health Authorities in IHR

Health preparedness is the jurisdiction of the Danish Ministry of Health. The Danish Health and Medicines Authority was appointed coordinator with a view to the implementation of the IHR, and the implementation was documented in the report: The International Health Regulations - Implemented Structures and Practices in Danish Preparedness (Det Internationale Sundhedsregulativ - gennemført i struktur og praktik i dansk beredskab), www.sst.dk (Danish language).

The Department of Infectious Disease Epidemiology, SSI, was appointed National IHR Point of Contact and is as such responsible for the reporting of any PHEIC episodes to WHO. The Danish Health and Medicines Authority, including the Medical Officers of Health, form a well-coordinated cooperation with Statens Serum Institut and report any occurrence of PHEIC to the Department of Infectious Disease Epidemiology.

IHR preparedness requirements

The IHR strides to ensure that countries have efficient preparedness measures to handle - i.e. detect, respond to and report - any unexpected public health-related episode. Health threats shall be monitored and assessed. Control measures shall be available for implementation and, furthermore, countries shall fulfil specific capacity requirements concerning specified harbours and airports to have the capacity to limit the spread of diseases and similar at points of entry.

In Denmark, a specific operative IHR preparedness plan is irrelevant as preparedness in Denmark for all authorities is based on the sector responsibility held by all authorities and on the principles of equality and subsidiarity. A National Danish preparedness plan based on an "all hazards approach" to planning has been prepared; it constitutes a framework that outlines the structure and organisation. Specific preparedness tasks are handled on the basis hereof and on the sector responsibility.

Monitoring and assessment

Denmark enjoys an adequate monitoring of any episodes that may constitute a public health risk of international concern. The authorities serving as main suppliers of these services have 24-7 monitoring in place ensuring that any episodes may be detected, described and confirmed rapidly; just as any measures to counter and control episodes may quickly be implemented. Furthermore, episodes may thus rapidly be communicated to WHO and other relevant bodies, nationally as well as internally, including the EU Early Warning Response System.

Public health measures

The Danish Health and Medicines Authority serves as sector responsible authority and thus has at its disposal 24-7 monitoring (via the Health Inspector On-call Service) and receives notifications and other reports around the clock. Whenever a notification is relevant to IHR, the Danish Health and Medicines Authority will immediately notify the national point of contact at the Department of Infectious Disease Epidemiology which is manned 24 hours a day.

From the Danish Health and Medicines Authority, any reports may also be communicated to other relevant central authorities either via current agreements to such effect or via the National Operative Staff (NOST). The NOST ensures rapid contact to all relevant central authorities and expert preparedness groups. A route of communication to such effect was specifically agreed on via the Danish Health and Medicines Authority. It may therefore quickly be decided which control measures should be implemented in the field of health-care as well as within the fields pertaining to other authorities.

Capacity requirements - specific harbours and airports

The present Danish healthcare system has the capacity to receive and assess individual persons as well as larger groups of persons with infectious diseases or suspicion hereof - or any other condition that may constitute a health-related threat.

The Regions in charge of preparedness measures associated with the prehospital period, ambulances and hospitals are capable of handling the reception of the ill/infected at regional points of entry in collaboration with the Medical Officers of Health and the Epidemic Commission of the Region. Other cases, including those of acute and possibly life-threatening disease can also be transported from airports and harbours to receive acute medical treatment. Provided the WHO recommends entry and exit controls in connection with a PHEIC episode, such controls can be implemented according to the needs observed in the specific situation. From the Danish side, it is believed that collecting information about each individual traveller is a priority including information on e.g. symptoms and/or stays in areas where infection may occur and any contact with ill persons.

IHR implementation in Denmark

In the report: The International Health Regulations - Implemented Structures and Practices in Danish Preparedness, the Danish Health and Medicines Authority documents that the IHR is fully implemented in Denmark as from 2012. In connection with the implementation, Danish conditions were taken into account and existing structures and organisations of the involved sectors and preparedness mechanisms were used.

(A. Troest, S. Jønson, Danish Health and Medicines Authority)

13 June 2012