Proposed new International Health RegulationsBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7487.321 (Published 10 February 2005) Cite this as: BMJ 2005;330:321
All rapid responses
The authors state: “The new regulations take a radical approach... WHO will officially be allowed to use information from informal sources such as the media. All countries will have to develop internal surveillance and response mechanisms that can detect issues within the country that threaten the global community.” Also: “Some countries have concerns over ... who will pay for the modernization and strengthening of surveillance ... systems.”
A global internet system giving early warning of outbreaks due to infectious diseases and toxins has been in operation for 10 years, and costs its participants nothing above their time and their existing investment in a computer and internet connection. Ministries and departments of health all over the world use it. Currently with over 30,000 participants in more than 185 countries, its name is ProMED-mail, with a website at www.promedmail.org and moderated e-mail lists in several languages. Reports come from the media and also direct from the hospital, clinician, laboratory, or government individual dealing with the outbreak.
The unique features of ProMED include its focus on emerging and re- emerging diseases, its speed of reporting (often days to weeks ahead of official acknowledgement of an outbreak), its extensive use of news media and other informal sources, and the comments by its moderators, an international panel of experts on infectious disease and toxins, veterinary medicine and plant pathology -- ProMED includes reports on outbreaks of emerging diseases of animals and crop plants because of their potential repercussions on human health.
ProMED is a program of the International Society for Infectious Diseases (ISID). Web services are provided as a public service by the Oracle Corporation, e-mail hosting is contracted to the Harvard School of Public Health. Funds to cover e-mailing and moderator costs come from ISID, foundation grants and individual donations; the program is therefore independent of government constraints. WHO acknowledges ProMED as a complementary, not a competing, system and uses its reports.
ProMED is assisting in the development of disease early warning networks in East Africa and the six Mekong Delta countries. But surprisingly, to date only two countries have taken up the model to complement their own routine disease monitoring – Brazil and South Korea. Brazil has expanded its monitoring to cover all adverse health events, including problems with medicines, vaccines, the blood supply, and medical devices (LISAS, www.lisas.org.br). Other countries should encourage similar low-budget initiatives.
Competing interests: Co-founder & Associate Editor, ProMED Coordinator, LISAS
Competing interests: No competing interests
Angus Nicoll and colleagues are right in addressing the important decision and commitment of the World Health Organization and global community to the long-waited revision of the IHR in coming weeks.
They are right to call that "equally neither can any country be confident that it will not be the source of a threat to the global community". This has been demonstrated in the previous global epidemics, like polio, HIV, and SARS. Again, it is also true for the global health community to recognize the mutual benefits of efficient and immediate reporting and surveillance, proactive assistances in verification of emerging diseases, and technical support at all time by all scientists of the globe. Unfortunately, SARS could have been better handled if the revision had been completed and sufficiently implemented before 2003. There had been significant delay in reporting SARS from its origins at the beginning, mixed with non-scientific or over-optimistic statements from the States of concern. These retarded WHO in gathering sufficient evidences and made best professional decisions before dispatching her staffs to areas in great needs.
On the other hand, some State Members are reluctant to consider in any way that WHO and global health community would "interfere" with States' health affairs. Today, there are many competent and responsible health authorities and organizations independently fulfill the requirements for effective health measures for their residents and the communities of concern. These health authorities and international organizations have been partners with WHO as well as global health communities in one way or another, and they will be indispensable partners of the WHO beyond the revision of the IHR. Without comprehensive participation of these partners, it will be even more difficult to see full implementation of the revised IHR by many developing countries.
Revision of the IHR will not guarantee successful public health measures against newly emerging health threats. Without establishment of systems to implement these regulations, the world and nations will be as vulnerable as periods during SARS epidemics. On the other hand, capacity building and enhanced cooperation between global partners will prevent failure of this long-thought IHR revision.
Competing interests: None declared
Competing interests: No competing interests