Geneva: The WHO Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 Response, in its interim report stated that the COVID-19 pandemic revealed “significant gaps in pandemic preparedness” in countries across the world, including in the areas of: surveillance, health systems, equipment and training, essential public health functions and the role of national IHR focal points, emergency legislation, risk communication and coordination.
According to the interim report, WHO requires flexibility and agility to rapidly inform the world on public health events with risk of international spread in recognition of the importance of timeliness in identifying, assessing and sharing information about an outbreak, as well as agreements and obligations under the Regulations.
“Any practices relating to the Regulations that led to delays, for example in the verification process, need to be addressed,” it stated while stressing that it is crucial to understand how the communication between States Parties (China) and the WHO Secretariat unfolded in the days and weeks following initial reports of atypical pneumonia.
According to the report, the IHR review committee examined practices relating to the regulations that may have led to delays. It stated that the Alert subgroup had explored how the communication between States Parties and the WHO Secretariat unfolded in the very early days of the pandemic.
According to its findings, initial alerts between China and WHO were based on several sources of information, including ProMED, part of the Epidemic Intelligence from Open Sources (EIOS) initiative, media reports, Chinese television and social media.
An announcement made by the Wuhan Health Commission of a cluster of pneumonia cases of unknown cause was identified by the Chinese Center for Disease Control and Prevention and the WHO country office through routine epidemic intelligence activities. WHO requested verification of these reports on 1 January 2020 and received a response from the China National IHR Focal Point on 3 January 2020.
“Such response timings do not seem to be any different in scope and duration from other similar delays (beyond the 24 hours required by the IHR) reported by WHO and some of the national IHR focal points interviewed by the Committee. The Committee considers that the timelines required by the Regulations for States Parties’ notification are not realistic given that the speed and ubiquitous presence of social media results in information reaching the public domain before countries have concluded a comprehensive risk assessment,” the interim report stated. According to it, the limited authority and status of the national IHR focal points often leads to delays in notification.
“Another consideration is that countries may be reluctant to report on events if they perceive consequences, mainly related to travel and trade, deriving from early notification,” it said, and emphasised on the need that the current IHR requirements for notification and verification, as well as information sharing by WHO, to be further examined.
The interim report stated that the Review Committee was also considering whether the international spread of COVID-19 was due to inconsistent implementation of health measures by States Parties or insufficient WHO recommendations in relation to international traffic.
“The Committee is reviewing aspects of WHO’s advice and recommendations on international travel and States Parties’ implementation of additional health measures, including: evidence on the effectiveness and timeliness of both WHO’s travel advice and the travel restrictions implemented by States Parties; compliance with States Parties’ and WHO’s reporting obligations under Article 43 on additional health measures; and the absence of an enforcement mechanism to hold States Parties to account for lack of compliance with their obligations under the International Health Regulations (2005),” it stated.
The interim report has been tabled at the ongoing 148th session of the Executive Board of the World Health Organisation which take place which started on January 18 and will continue till January 26, 2021.
The report stated that the global COVID-19 pandemic, which has impacted every corner of the world, “will continue to do so for the foreseeable future”. It called for meeting critical information requirements with timely, accurate guidance that must be sustained throughout the duration of the pandemic. “Mass media, social media, risk communication and community engagement have during the past decade become extremely relevant to a health emergency response, yet for obvious reasons are not reflected in the International Health Regulations (2005),” it noted.
According to the interim report, the Review Committee examined the extent to which the current tools and methods for assessing and monitoring International Health Regulations (IHR) core capacities covered all the necessary capacities, including those at subnational level and those related to whole-of-government and One Health approaches. The Committee also examined how the current tools for preparedness assessment and monitoring could be strengthened to better help countries implement a more effective response.
“A peer-review mechanism, based on the Universal Periodic Review used by the Human Rights Council, may be useful in improving preparedness and response, as well as compliance with States Parties’ legal obligations under the Regulations,” it recommended. For example, the Universal Periodic Review had been shown to foster inter-sectoral coordination and whole-of-government approaches, to encourage good practices, and to link implementation of its recommendations with the Sustainable Development Goals and other government agendas – all of which are vital to strengthening IHR core capacities.
The Committee reviewed the role of national IHR focal points. Previous Review Committees had noted that, while the Regulations required all countries to have a national IHR focal point as a “centre” accessible 24/7 for communication with WHO, not all countries had designated such a centre; in some countries the national IHR focal point is just one person.
The Committee, however, noted that effective implementation of the International Health Regulations (2005) required many functions that were not within the narrow mandate of the national IHR focal point, such as multi-sectoral coordination for preparedness and response and collaborative risk assessment.
“The absence of a dedicated national entity, with sufficient authority and a clear mandate to take ownership of and leadership on implementation, is considered a significant limitation to effective implementation of the Regulations at national and subnational levels. At country level, legislation establishing the national IHR focal point institution should formalise its inclusion in the national emergency plan as well as its participation in the national health committee or similar body,” it recommended.
With regard to preparedness for a pandemic or an “unexpected” event, the Committee noted that many countries had been using the Pandemic Influenza Preparedness (PIP) Framework as a foundation for their COVID-19 response. While some areas of IHR core capacities had improved under PIP, others had not. “Although the health ministry is the responsible authority, effective preparedness and response measures require a whole-of-government approach,” it stated. However, it noted that response measures were often led by non-health ministries, with little consultation.
The interim report further said that another challenge was that pandemic preparedness planning was generally not an integral part of public health system strengthening and primary health care. “Influenza pandemic preparedness can help broaden the approach for respiratory illnesses preparedness. Disease-specific plans and other relevant plans, however, are often not integrated with national action plans for health security as part of a single platform for all activities related to the International Health Regulations (2005) and health security in the country,” it pointed out.
In case of COVID-19, it further noted that high-level political support and resources for implementation of the Regulations were insufficient and irregular at both national and international levels, and referred to the lack of a robust compliance evaluation and accountability mechanism. It recommended that a robust system of compliance evaluation built into the IHR could be a potential approach to strengthening the overall framework of the Regulations and its credibility as a legal instrument.
Another area for improvement identified by the Committee is strengthening global efforts for outbreak alert and response, including through considering increased coordination and cooperation with Global Outbreak Alert and Response Network (GOARN). “At the Committee’s request, GOARN is conducting a survey to identify the challenges to and support required for more effective engagement in alert and risk assessment activities and in response operations.,” it stated. It may be mentioned that GOARN is a WHO network of over 250 technical institutions and networks globally that respond to acute public health events with the deployment of staff and resources to affected countries.
– global bihari bureau
