New regulations aim to prevent international health emergencies

BMJ 2007; 334 doi: (Published 14 June 2007) Cite this as: BMJ 2007;334:1243
  1. Peter Moszynski
  1. London

    New regulations concerning public health emergencies came into force this week, revising the rules that have been in force since 1969.

    The regulations were agreed at the 2005 World Health Assembly and have a far wider scope than the previous ones, including procedures for dealing with new and re-emerging diseases and acute chemical or radiation events.

    The revision broadens the scope of notification to the World Health Organization—from cases of cholera, plague, and yellow fever to “all events which may constitute public health emergencies of international concern and the reporting of other serious international health risks, irrespective of origin or source.”

    The regulations were originally intended to help monitor and control six serious infectious diseases—cholera, plague, yellow fever, smallpox, relapsing fever, and typhus—but the last three were dropped in 1969. In the early 1990s the resurgence of epidemics such as cholera in parts of South America and plague in India, and the emergence of new infectious agents, such as Ebola haemorrhagic fever, resulted in a resolution at the 48th World Health Assembly in 1995 to revise the regulations.

    A statement from WHO said: “Recent decades have seen the emergence of new disease challenges for national and international public health. New and re-emerging epidemic risks have been compounded by concerns about potential dissemination of chemical or radioactive substances which also jeopardize international health security.”

    International travel and trade have grown, and communication technology has developed markedly, WHO says. “New challenges have arisen in the control of emerging and re-emerging infectious diseases. The world has entered an information age in which news spreads via a multitude of formal and informal channels.”

    The new regulations require automatic notification to WHO of smallpox, wild polio virus, severe acute respiratory syndrome, and new human subtypes of avian flu. They also define criteria to help countries decide whether other events are notifiable:

    • • Is the impact of the event on public health serious?

    • • Is the event unusual or unexpected?

    • • Is there a significant risk of international spread?

    • • Is there a significant risk of international restriction of travel and trade?

    The occurrence of a specific disease does not in itself provide enough information to allow assessment of the risk of international spread. “The geographical setting, time, size of outbreak, closeness to an international border or airport, speed of spread, and mode of transmission, amongst other factors, are all relevant in analysing whether the event is an international public health risk,” WHO says.

    The regulations came into force on 15 June, but because of the expanded criteria countries have two years to assess the ability of existing national structures and resources to meet the new surveillance and response requirements and to develop plans of action to ensure that such surveillance and response capacities are up and running. This initial period will be followed by a three year period to implement these plans.

    WHO says that the updated regulations are designed “to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks and which avoid unnecessary interference with international traffic and trade.”


    • The International Health Regulations are available at

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